Obstetrics and Gynecology Flashcards
A 30-year-old woman presents with right breast pain. She is 3 weeks postpartum and has been exclusively breastfeeding her child. Her vital signs are within normal limits. On exam, the patient has an area of erythema surrounding her nipple that is tender and warm. No fluctuance is appreciated. An ultrasound confirms the diagnosis. Which of the following is the best treatment for this patient?
A) Ceftriaxone
B) Dicloxacillin
C) Doxycycline
D) Trimethoprim-sulfamethoxazole
Dicloxacilin
A 36-year-old woman who is 35 weeks pregnant presents to the ED with sudden onset lower abdominal pain and vaginal bleeding. She reports constant lower abdominal pain and vaginal bleeding for the last 4 hours. On examination, her cervix is closed and she has dark blood coming from the cervical os. Her uterus is firm to the touch. Which of the following is the most likely risk factor that will be found in this patient based on her most likely diagnosis?
A) Advanced maternal age
B) Cocaine use
C) Hypertension
D) Tobacco use
Hypertension
The most common risk factor for the development of placental abruption is hypertension.
A 39-year-old woman presents to the ED with vaginal bleeding. She reports a history of heavy menstrual periods and has been going through multiple pads an hour for the past day. Physical exam reveals heavy bleeding with large clots. She has a BP of 92/59 mm Hg and HR of 125 bpm. Her pregnancy test is negative, and her hemoglobin is 7.2 g/dL. Which of the following medications is most appropriate to stop the bleeding?
A) Intravenous estrogen
B) Misoprostol
C) NSAID
D) Progestin-only contraception
What is the first line imaging modality for abnormal uterine bleeding?
Intravenous estrogen
Transvaginal ultrasound
Nonpregnant patients with acute hemorrhage due to AUB may be given intravenous estrogen to stabilize the endometrium and slow the bleeding.
What is the most common site of ectopic pregnancy?
What is the primary risk factor for ectopic pregnancy?
Fallopian Tube (ampulla)
History of pelvic inflammatory disease (PID)
What is the hallmark triad of symptoms in ectopic pregnancy?
- Abdominal pain
- Vaginal bleeding
- Amenorrhea
What is the diagnostic imaging modality of choice for ectopic pregnancy?
What serum marker is crucial for diagnosing ectopic pregnancy?
Transvaginal ultrasound
Beta-human chorionic gonadotropin (β-hCG)
What β-hCG level typically correlates with a visible intrauterine pregnancy on transvaginal ultrasound?
≥1500–2000 mIU/mL (discriminatory zone)
What medication is used to manage stable, unruptured ectopic pregnancies?
What is the surgical management option for ruptured ectopic pregnancy?
Methotrexate
Salpingectomy or salpingostomy
What is a contraindication for methotrexate therapy in ectopic pregnancy?
Evidence of rupture or unstable hemodynamics
A 24-year-old woman presents with severe right lower quadrant pain, dizziness, and syncope. She is tachycardic and hypotensive. Her β-hCG is 1800 mIU/mL, and transvaginal ultrasound reveals free fluid in the pelvis. What is the next step in management?
A. Administer methotrexate
B. Immediate laparoscopy
C. Repeat β-hCG in 48 hours
D. Perform dilation and curettage
Immediate laparoscopy
Hemodynamic instability and free fluid in the pelvis are consistent with ruptured ectopic pregnancy, requiring emergency surgical intervention.
A 34-year-old woman presents with vaginal bleeding and mild abdominal pain. Her β-hCG is 1200 mIU/mL, and transvaginal ultrasound shows a small intrauterine sac without a fetal pole. What is the most likely diagnosis?
A. Ectopic pregnancy
B. Molar pregnancy
C. Early intrauterine pregnancy
D. Missed abortion
Early intrauterine pregnancy
A small intrauterine sac without a fetal pole in the setting of a low β-hCG is likely an early pregnancy rather than ectopic. Follow-up imaging and β-hCG testing are required
A 25-year-old woman with a history of infertility and pelvic inflammatory disease is found to have an ectopic pregnancy. Which of the following is a risk factor for ectopic pregnancy?
A. Use of oral contraceptives
B. Previous pelvic surgery
C. Multiparity
D. Hypothyroidism
Previous pelvic surgery
Prior pelvic surgery, infertility, and PID are significant risk factors for ectopic pregnancy
What is the most common risk factor for postpartum endometritis?
What antibiotics are used to treat endometritis?
Cesarean section delivery
Clindamycin plus gentamicin
What is the imaging test of choice to diagnose ovarian torsion?
What is classically seen on imaging?
Ultrasound
Ovarian enlargement due to venous and lymphatic engorgement
Does the finding of arterial flow eliminate the possibility of torsion?
No, complete arterial obstruction is unlikely due to the dual blood supply to the ovary from the uterine and ovarian arteries. Therefore in high clinical suspicion this does not rule out torsion.
What laboratory test is essential in patients presenting with symptoms concerning for ovarian torsion?
Beta HcG
What are the most common sites of metastasis for gestational trophoblastic neoplasms?
Vagina and lungs
