QG SB4 (F) Flashcards
W4 QG blocks (58,61,64,67) Deck is full
1
Q
post-menopausal bleeding is ___ until proven otherwise?
A
cancer
2
Q
what is the greatest risk factor for SCC of the vagina?
A
smoking
3
Q
what are the risk factors for vaginal cancer?
A
- smoking (prevents viral clearing
- age > 60 yo
- HPV (strains 16, 18, 31, 33)
- DES exposure in utero (clear cell only)
4
Q
what are the two main strains of HPV that cause cancer?
A
16 and 18
5
Q
how does endometriosis present?
A
- pelvic pain
- abn bleeding
- 3Ds = dysmenorrhea, dyschezia, dyspareunia
6
Q
what is genito-pelvic pain/penetration (vaginismus)?
A
- psych condition in which pt can’t tolerate penetration
- involuntarily CTX of pelvic floor muscles –> pain during attempted penetration
7
Q
can you do a spec exam w/ vaginisumus?
A
NO (causes severe pain)
8
Q
painful menses + heavy bleeding. ddx = ?
A
- uterine leiomyomas
- adenomyosis
9
Q
how do you tell uterine leiomyomas apart from adenomyosis on p/e?
A
fibroids = irreg enlarged uterus adenomyosis = symmetrically enlarged uterus
10
Q
uterus is boggy. what is your differential dx?
A
- uterine atony
- adenomyosis
11
Q
pt presents w/ vaginal pain but there is no external pain on p/e. what do you r/o?
A
vulvodynia
12
Q
how does pudendal neuralgia present?
A
superficial pain @ vulva, perineum and rectum (pudendal n. distribution)
13
Q
all women w/in child-bearing age and presenting w/ lower abd pain get test 1st?
A
preg test
14
Q
you suspect a pt has PMS. how do you dx?
A
s/s diary documenting >= 2mos symp
15
Q
how does PMS present?
A
dysmenorrhea s/s (w/ alt timeline) + irritability/mood symp
16
Q
what is the timeline for PMS s/s presentation?
A
onset s/s = 2 wks prior to menses (luteal phase)
resolution = start of menses or w/in few days of start (follicular phase)
17
Q
how do you tx PMS?
A
- SSRI
2. OCP
18
Q
pt presents w/ heavy bleeding + uterus that is irregularly enlarged on p/e. what is the dx?
A
fibroids
19
Q
how does chancroid present?
A
- suppurative lymphadenopathy
- deep ulcer w/ grey exudate
- PAINFUL
20
Q
question state that the pt uses condoms consistently. what is not the dx?
A
STI
21
Q
question states that there is no inflammation on pelvic exam. what is not the dx?
A
STI
22
Q
when should you suspect a vesiculovaginal fistula?
A
- h/o trauma or protracted labor
- no s/s infx
- continuous leakage of clear fluid w/ pH > 4.5 +/- odor (from necrotic tissue)
23
Q
what is aromatase def?
A
inability to convert androgens to estrogens
leads to high T and low estrogen/estrodiol
24
Q
what is high in PCOS?
A
androgens (T)
25
what causes 1* dysmenorrhea?
incr prostaglandin production
26
pain, n/v/d w/in the 1st few days of menses = what?
1* dysmenorrhea
27
how do you tx 1* dysmenorrhea?
1. NSAIDs
| 2. OCPs
28
how do you tx period type pain/symptoms?
pre-mentrual = PMS - tx w/ SSRI
| w/ menses = dysmenorrhea - tx w/ NSAIDs
29
pt presents w/ pre-eclampsia + severe features but is at gestation < 20wks. dx = ?
hiatidiform mole
30
how do you tx hyatidiform mole?
- D&C
| - serial B-hCG measurements
31
young female presents to your office. what is on the diff dx?
AI condition
32
young female presesnts w/ h/o repeated miscarraiges. dx = ?
antiphospholipid synd
33
can you give pregnant women warfarin?
NO
34
antiphospholipid synd problem = ?
abn clotting
35
antiphospholipid synd tx = ?
anti-coag (LMWH)
36
what is oxytocin used for?
-labor augmentation (stim CTX)
37
oxytocin leads to fetal descent and dilation. what else might you see?
late decels (if uterus squeezes baby too much)
38
what are the possible causes of hyperemesis gravidarum?
- molar preg
| - mult gestation
39
when does labor enter the active stage?
>= 6cm cervical dilation
40
how strong are adequate CTX?
> 200 MVU
41
what is the expected rate of cervical change in a primigravida in active labor w/ adequate CTX?
1 cm/hr
42
what is the expected rate of cervical change in a primigravida woman in active labor w/o adequate CTX?
1 cm/hr
43
how long do you let a primigravida woman in active labor w/ adequate CTX labor w/o seeing cervical change?
```
4 hours
(if don't see >= 1cm dilation w/in 4 hrs, you go to c-sec)
```
44
how long do you let a primigravida woman in active labor w/o adequate CTX labor w/o seeing cervical change?
```
6 hours
(if don't see >= 1 cm dilation w/in 6 hrs, you go to c-sec)
```
45
active labor + adeq. CTX but no cervical change for 4hr. what do you do?
c-sec
46
active labor + inadeq. CTX and no cervical change for 6hrs. what do you do?
c-sec
47
if baby doesn't turn on its own, when do you turn baby (from breech or transverse position to vertex)?
> 37 wks
48
why do you wait until > 37 wks to turn baby?
ext. cephalic version can cause 1. PROM and 2. placental abruption
49
how will molar pregancy present?
- incr vomiting
| - diff/symmetrical uterine swelling
50
what do you check at 24-26wks gestation?
- Rh-D
- HgB
- DM
51
how long is a GBS test result good for?
5 wks (check @ wk 35)
52
what can anesthesia cause in a preg woman?
urinary retention
53
h/o trauma --> injury of ___ leads to ___.
- pudendal n.
| - loss of urge to urinate (can't sense bladder fullness)
54
how does post-partum urinary retention present?
inability to void after 6 hrs post-delivery
55
how do you tx post-partum urinary retention?
-catheterize and wait
56
you do a D&C for molar pregnancy. what must you do next?
- serial B-hCG checks to ensure return to nL (no Ca)
| - contraception for AT LEAST 6 mos (if get preg can't tell if rise in BhCG is due to pregancy or developing cancer)
57
how does parvovirus B-19 lead to anemia?
destroys RBC precursors
58
what are the potential fetal complications of HELLP?
- IUGR (placental insuff --> decr nutrients --> decr growth)
| - oligohydramnios
59
what 2 things cause decr fetal movement?
- sleeping
| - baby is acidotic (decr O2)
60
if baby is acidotic, how does the body react?
- blood is redirected to the brain to preserve it
| - this is done at the expense of the arms
61
what are considered positive NST results?
>= 2 accels (> 15bpm incr lasting 15 sec) w/in 20 min period
62
how do determine type of miscarraige?
1. look at cervix (Is are open)
2. look at contents (complete = no contents)
3. look at HR (threatened has FHT; missed does not)
63
what Ca can you see s/p molar preg?
gestational trophoblastic neoplasia
64
when do placental acreta, increta, percreta and previa occur?
1st trimester
65
PPROM incr the risk of what?
- abruption
- preterm labor
- infx (after 18hr s/p ROM)
- cord prolapse
66
dark rash w/ sun exposure that presents during pregnancy is called what?
melasma
67
what does melasma w/u include?
nothing. will resolve after delivery
68
where do you see the discolorations in Addison's dz?
all over
69
cushing's discoloration will also present w/ what?
hump
70
how is the hemachromatosis discoloration classically described?
bronze
71
severe dehydration --> vascular collapse (shrinkage) --> hard sticks/failed gain of access. what do you do?
intraosseous cannulation
72
when is the one time sickle cell pts will present w/ decr retic count?
aplastic crisis
73
what is a common cause of aplastic crisis in sickle cell pts?
parvovirus B19 infx
74
how does congenital dermal melanocytosis present?
-flat grey spots
-common in darker ethnicities
(=mongolian spot)
75
what are congenital melanocytic nevi?
benign, isolated, hyperpigmented, hairy patches that present w/in the first few months of life
76
cafe au lait spots are seen in what 2 conditions?
- mcune albright synd
| - NF
77
how does mccune albright synd present?
precocious puberty + cafe au lait spots
78
meningitis can lead to what?
neural sequella
79
what are the MC sequella of bacterial meningitis in kids?
- hearing loss
| - cerebral palsy
80
which n. is affected leading to hearing loss 2/2 meningitis?
CN 8
81
what is the underlying problem in chronic granulomatous dz?
recurrent pulm and cutaneous infx w/ catalase-positive oganisms 2/2 failed oxidative burst
82
which 4 bugs are chronic granulomatous dz pts susceptable to?
- staph
- serratia
- aspergillous
- burkholderia
83
pt presents w/ odynophagia + high F + new neck pain + muffled voice (i.e. swelling). dx = ?
retropharyngeal abscess
84
pt presents w/ NO stridor. what is not causing their resp s/s?
problem w/ the esophagus
85
pt presents w/ a "widened prevertebral space" on xray. what is the dx?
retropharygeal abscess
86
what is seen in diptheria?
grey pseudomembrane
87
pt presents w/ hoarseness. what nerve is likely affected?
recurrent laryngeal n.
88
pt presents w/ a monotone voice. what nerve has been compromised?
CN 10 (external branch)
89
what happens to the uvula if the tonsils are messed up?
deviates from midline
90
what burn pattern suggests abuse?
spared creases
91
the sphincter of odi is affected by what?
opioids
92
criglar najar synd leads to what type of hyperbilirubinemia?
unconj
93
what is the problem in criglar najar synd?
don't have the enzyme needed to conj bilirubin
94
gilbert synd leads to what kind of hyperbilirubinemia?
unconj
95
which two liver dz lead to unconj hyperbilirubinemia?
- crigler najar
| - gilbert synd
96
which liver diseases present w/ conj. hyperbilirubinemia?
- dubin johnson synd
| - rotor synd
97
how do you tx criglar najar?
type 1 (incr = severe) --> tx = plasmapharesis, phototherapy
type 2 --> phenobarbitol
98
phenobarbitol can precipitate what?
acute intermittent porphyria
99
why are stools pale?
bilirubin isn't being excreted into the bowel
100
what do the stools look like in biliary atresia?
pale stools
101
which nephrotic synd is assoc w/ active HepB infx?
membranous nephropathy
102
what will be elevated in an active(infectious) hepB infx?
HBeAg
103
what is the MC complication of all nephrotic synd?
renal vein thrombosis 2/2 decr antithrombin 3 (hypercoag state)
104
in which congenital cyanotic heart condition will squating make the murmur worse but decr the cyanosis?
ToF
105
a kid presents w/ MSK abnormalities. the baby has been mostly breastfed w/ occassional homegrown food supplementation. what MSK abnormality does the kid have and why?
- rickets 2/2 severe vit D def
| - kid isn't getting any vit D supplementation (no OTC source or enriched foods)
106
how do plt problems present?
- mucosal bleeding
| - skin changes (petichiae)
107
in fibrinogen dysf(x) (factor 1), what coag study results do you expect?
incr PT and incr PTT
108
which clotting factor is fibrinogen?
factor 1
109
how does von willebrand dz present?
- low plt
| - mucosal bleeding and petechiae
110
1/4 of hemophilia pts have refractory incr aPTT. why?
inhibitor developement
111
what is a varicocele?
deformed/dilated papiniform plexus w/in L scrotal sac
112
when a pt lays supine, what happens to his varicocele?
it disappears
113
pt presents w/ R sided testicular mass that looks like a varicocele but doesn't disappear when the pt lays supine. what do you suspect?
cancer
114
what is another name for wilm's tumor?
nephroblastoma?
115
pheochromocytoma is seen in adults. what is the equivalent in kids?
neuroblastoma
116
other than providing supportive care, how do you treat measles?
give vitamin A
117
child presents w/ h/o hoarding and abuse. what dx do you suspect?
reactive attachment disorder
118
who do children belong to?
the state
119
if parent says no to life saving tx for their child, what do you do?
provide lifesaving tx anyway
120
what diseases cause rashes on the palms and soles?
Kawasaki
- coxsackie A
- RMSF
- sypilis
- SSSS (kids)
- scarlet fever
- streptobacillus
- TSS (adults)
121
how does Reye synd present?
- vomiting
- encephalopathy
- liver dysf(x)
- abn behavior
- seizures
- lethargy
- H/O ASA use in kid
122
why is breast feeding better?
human milk protein absorbs better and improves gastric emptying
123
what is the age cutoff for ADHD?
dx before age 12
124
pt presents w/ cough that leads to vomiting + incr WBC (lymphocyte predom). dx = ?
pertussis
125
why does pertussis present w/ a lymphocyte predom incr WBC when it is caused by a bacteria?
intracellular bacteria triggers lymphoctyte response instead of PMNs
126
pt presents w/ bleeding + petechiae. what is your ddx?
1. von willebrand
| 2. plt problem
127
what is the problem w/ von willebrand dz?
plt adhesion problem (von Willebrand = sticky man)
128
what is pathoneumonic for autism spectrum disorder?
NO eye contact
129
what is speech sound disorder?
articulation disorder
130
what is language disorder?
persistent difficulty comprehending and producing spoken and written language
131
what is childhood onset fluency disorder?
stuttering
132
what is herpangina?
mouth blisters seen w/ coxsackie A infx
133
vit C def presents how?
-gingivitis
-hemorrahage
-corkscrew hair
(SCURVY)
134
how does vit B2 (riboflavin) def present?
angular chelotis, stomatitis and glossitis
+normocytic anemia
+seborheic dermatitis (w/ eyelash crusties)
135
other than vit B2 (riboflavin), what other vit B def leads to chelotis, stomatitis and glossitis?
vit B6 (pyridoxine)
136
how does osteoid osteoma present?
- bone pain at night
- pain resolves w/ NSAIDS
- benign round radiolucency on xray
137
how does ewing sarcoma present?
- moth-eaten appearance on xray
- onion skinning (cortical layers) on xray
- pain @ night
- no response to NSAIDS
- located in diaphysis
138
how does osteosarcoma present on xray?
- sunburst
| - codmans triangle
139
how does giant cell tumor present on xray?
soap bubble tumor
140
if DM before 20 wk gestation, what happens to baby?
-organ malformations (including pancreas)
141
what 2 bugs cause impetigo?
1. s aurues
| 2. s pyogenes
142
how do you tx impetigo?
mupirocin
143
what is a possible complication of impetigo caused by s pyogenes?
PSGN
144
how does s aureus spread?
hematogenously
145
what 2 organisms do you suspect if pt presents w/ a bine infx?
1. s aureus
| 2. salmonella
146
how does BM look in ALL?
hypercellular w/ >25% blasts
147
CAH-21 hydroxyprogesterone def can affect M and F. what is the karyotype if pt presents w/ virualization?
46 XX
148
CAH-21 hydroxyprogesterone def can affect M and F. what is the karyotype if pt presents w/ precocious puberty?
46 XY
149
what is selective mutism?
-an anxiety disorder wherein the pt refuses to speak in specific social settings (i.e. school)
150
pt presents w/ F + rash (salmon patch) + arthritis. dx = ?
systemic juvenile idiopathic arthritis
