Obstetrics and Gynecology

Question 1

• 4 T’s:
• Tone – uterine atony most common
• Tissue – retained placental tissue
• Trauma – cervical, perineal, or vaginal; uterine rupture
• Thrombin – coagulopathy (hemophilia A, ITP, vWD, DIC)

Answer 1

Postpartum hemorrhage (etiologies)

Question 2

• Blood pressure > 140/>90 mmHg after 20 weeks’ gestation
• Elevated BP + proteinuria (> 5 grams/24 hours) + pitting edema = preeclampsia
• Preeclampsia + seizures = eclampsia

Answer 2

Forms and complications of maternal hypertension

Question 3

• Breast masses that increase and decrease with menstrual hormonal changes
• Often worse during menstruation
• Multiple, nodular, mobile, smooth round or ovoid lumps in both breasts

Answer 3

Fibrocystic breast changes

Question 4

• Breast mass without changes during menstrual hormonal changes
• Firm, nontender, solitary, smooth, well-circumscribed, freely mobile, rubbery lump in the involved breast

Answer 4

Fibroadenoma

Question 5

• Cervical petechiae (“strawberry cervix”)
• Copious frothy yellow-green discharge
• Mobile protozoan trophozoites on microscopy

Answer 5

Trichomoniasis

Question 6

Chronic eczematous itchy scaly rash on nipples and areola

Answer 6

Paget disease of the breast

Question 7

• Cyclic premenstrual pelvic pain
• Dysmenorrhea
• Dyspareunia
• Dyschezia (painful defecation)

Answer 7

Endometriosis

Question 8

• Lower abdominal pain
• Cervical motion tenderness (chandelier sign)
• Adnexal tenderness
• Fever
• Purulent cervical discharge

Answer 8

Pelvic inflammatory disease

(AKA: salpingitis)

Question 9

• Malodorous vaginal discharge
• Copious thin, homogenous grayish-white vaginal discharge
• Vaginal pH > 4.5
• Positive amine-whiff test (“fishy odor” when KOH added)
• Clue cells on saline wet mount (epithelial cells covered by bacteria)

Answer 9

Bacterial vaginosis

Question 10

• Painful vaginal bleeding in third trimester
• Severe abdominal pain (uterine contractions)
• Hx of maternal hypertension is common

Answer 10

Placental abruption

Question 11

• Painless vaginal bleeding in third trimester
• Absence of abdominal pain or uterine tenderness

Answer 11

Placenta previa

Question 12

• “Snowstorm” or “cluster of grapes” on ultrasound
• Markedly elevated HCG

Answer 12

Hydatidiform (molar) pregnancy

Question 13

• “String of pearls” on pelvic ultrasound
• Menstrual dysfunction + androgen excess + insulin resistance
• Hirsutism

Answer 13

Polycystic ovarian syndrome

Question 14

• Sudden onset of severe, prolonged fetal bradycardia or variable decelerations
• Palpable cord on vaginal examination

Answer 14

Prolapsed umbilical cord

Question 15

• Tampon use
• High fever
• Erythroderma: diffuse erythematous macular rash (like sunburn, including to palms and soles)
• Hypotension

Answer 15

Toxic shock syndrome

Question 16

• Unilateral pelvic or abdominal pain + vaginal bleeding + amenorrhea (pregnancy)
• Adnexal mass with cervical motion tenderness
• Hx of pelvic inflammatory disease

Answer 16

Ectopic pregnancy