Reproduction

Question 1

What is the first test that should be ordered in the evaluation of amenorrhea?

Answer 1

Pregnancy test. ALWAYS. Even if the patient denies the possibility; the first test is always a pregnancy test.

Question 2

Dopamine antagonists will do what to prolactin?

Answer 2

Dopamine antagonists will INCREASE prolactin levels.

Question 3

Normally medications won’t elevate prolactin levels past what value?

Answer 3

Medications rarely increase prolactin levels >100. If a prolactin level >100 is seen, others causes should be ruled out.

Question 4

What hematologic etiology is a common cause of DUB?


Answer 4

Coagulation disorders such as Von-Willebrand (prolonged PTT). Screen with PT/PTT


Question 5

Next best step when evaluating post menopausal bleeding?

Answer 5

Every patient requires endometrial biopsy to rule out endometrial cancer.

Question 6

A post menopausal endometrial stripe over what value is suspicious for endometrial cancer?

Answer 6

> 5mm is suspicious for endometrial cancer. The next step should be biopsy.

Question 7

What is the most accurate test to diagnose endometriosis?

Answer 7

Laparoscopy

Question 8

What hormones are responsible for the growth of fibroids?

Answer 8

Progesterone and estrogen. This is the reason most will shrink after menopause.

Question 9

When is drawing a serum CA-125 useful?

Answer 9

This is most useful in post menopausal women. There are many etiologies that can give false positives in pre menopausal women.

Question 10

When should a simple cyst be explored surgically?

Answer 10

Any cyst >10cm should be surgically explored.

Question 11

At what age should women start to have cervical cancer screening?

Answer 11

Pap smear screening starts at 21 years of age, regardless of pregnancy or sexually activity before 21 years of age.

Question 12

What is the treatment of choice for chlamydia and gonorrhea?

Answer 12

1. Chlamydia is treated with azithromycin or doxycycline


2. Gonorrhea is treated with ceftriaxone

Question 13

What is the treatment of choice for chlamydia during pregnancy?

Answer 13

These patients should not receive doxycycline. First line treatment here is azithromycin.

Question 14

What cervical length increases the risk of second trimester loss due to an incom- petent cervix?

Answer 14

Patients with a cervical length

Question 15

What is the definition of menopause?

Answer 15

Menopause occurs after menses has stopped for >1 year.

Question 16

Why is progesterone given with estrogen during HRT?

Answer 16

Patients with an intact uterus are given progesterone to protect against endometrial cancer.

Question 17

What two genes increase the risk of breast cancer?

Answer 17

Those with BRCA 1 and BRCA 2 have an increased risk of developing breast cancer.

Question 18

At what age should mammogram screening be started?

Answer 18

A yearly mammogram should be started at 40 years of age.

Question 19

What is Fitz-Hugh Curtis syndrome?

Answer 19

This is seen in PID. Inflammation of the liver capsule will lead to RUQ pain.

Question 20

When is it appropriate to begin a workup for infertility in those trying to conceive?

Answer 20

Patients who are 35 should have a workup done after 6 months of trying.

Question 21

What is Naegles rule?

Answer 21

This is used to calculate the estimated date of delivery: (First day of LMP - 3 months) + 7 days = Due date

Question 22

What are pap smear guidelines during pregnancy?

Answer 22

Identical to those in non pregnant women. If pregnant and

Question 23

What are the genetic screening guidelines during pregnancy?

Answer 23

Patients should be screened with an NT and a first trimester serum testing at 11-13.6 weeks. Second trimester quadruple screening is done at 15-20 weeks gestation.

Question 24

When should Rhogam be administered?

Answer 24

Rhogam is administered to RH negative mothers at 28 weeks gestation.

Question 25

A patient is deemed to have a failed pregnancy. Products of conception are seen on ultrasound. The pelvic exam shows a closed cervical os. What type of abortion is this?

Answer 25

This is consistent with missed abortion.

Question 26

Painful third trimester bleeding is most likely what diagnosis?

Answer 26

Placental abruption

Question 27

Painless second and third trimester bleeding is what until proven otherwise?

Answer 27

Placenta previa. These patients should not have a pelvic exam or transvaginal ultrasound due to an increased risk of hemorrhage.

Question 28

What are three risk factors for ectopic pregnancy?

Answer 28

1. Prior ectopic
 | 2. Pregnancy with IUD
 3. History of PID

Question 29

After what HCG level should a gestational sac be visible on ultrasound?

Answer 29

A gestation sac should be seen after an HCG quant of 2,000 ml/ml is reached.

Question 30

What are the indications for methotrexate use in ectopic pregnancy?

Answer 30

1. Stable
 | 2. HCG quant

Question 31

How are patients screened for gestational diabetes?

Answer 31

1. First trimester screening is done with HA1c. 2. Second trimester screening (24-28 weeks) is done with a 2 hour OGTT. Alternatively can be done with 1 hour OGTT, and if abnormal, perform a 3 hour OGTT.

Question 32

A 40 year old patient is coming in for a first prenatal visit. She is complaining of vaginal bleeding with pelvic pain. Ultrasound demonstrates a snow storm pattern. What is the most likely diagnosis?

Answer 32

This is classic for gestational trophoblastic disease. These patients will usually have an HCG quant >100,000 and will be rapidly rising.

Question 33

What is the definition of chronic hypertension?

Answer 33

Hypertension diagnosed before 20 weeks gestation is termed chronic hypertension.

Question 34

Preeclampisa before 20 weeks should clue you in to what diagnosis?

Answer 34

A molar pregnancy should be suspected if this occurs.


Question 35

How is preeclampsia diagnosed?

Answer 35

Hypertension with proteinuria and/or end organ damage >20 weeks gestation. Edema is no longer part of the diagnostic criteria since most women will have edema during pregnancy.

Question 36

What is HEELP syndrome?

Answer 36

1. Hemolysis
 2. Elevated liver enzymes
 3. Low platelets

Question 37

What is the treatment for preeclampsia, eclampsia, and HEELP syndrome?

Answer 37

Definitive treatment for all the above is induction.

Question 38

Why is magnesium given to patients with severe preeclampsia?

Answer 38

This is given for seizure prophylaxis.

Question 39

What are first line medications for the treatment of gestational hypertension?

Answer 39

Labetolol and methyldopa are first line medications.

Question 40

What is the most common cause of post partum hemorrhage?

Answer 40

Uterine atopy is the most common cause. This occurs when the uterus does not con- tract after delivery.