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CREOG > Rosh (1/10) exam > Flashcards

Rosh (1/10) exam Flashcards

1
Q

Postpartum fever causes by day

A 
0 atelectasis "wind"
1-2 UTI "water"
2-3 endometritis "womb"
4-5 "wound"
5-6 septic pelvic thrombophlebitis "walking"
other: c. diff, drug fever
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2
Q

Ovarian vein more likely affected by thrombosis

A

right (drains to IVC)

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3
Q

Stages of alcohol withdrawal

A

0-12 hrs tremors
12-48 hrs hallucinations, then seizures
>48 hrs DTs

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4
Q

Oxybutynin mechanism and a contraindication

A

Antimuscarinic (blocks acetylcholine)

Closed angle glaucoma

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5
Q

Oligo and polyhydramnios definitions

A

<5 cm AFI or <2 cm DVP

>23 cm AFI or <8 cm DVP

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6
Q

Traveler’s diarrhea ppx

A

Rifaximin

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7
Q

Gestational ago for VAVD

A

34 wga

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8
Q

Caput succadeneum

A

Bleeding in scalp at point of vacuum application, resolves in 48-72 hrs

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9
Q

Cepalohematoma

A

Bleeding between skull and periosteum, does not cross suture lines, firm them fluctuant, resolved in 2-3 wks

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10
Q

Subgaleal hemorrhage

A

Between scalp and periosteum

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11
Q

Effect of pregnancy on CKD

A

Worsens kidney function

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12
Q

Screening in BRCA carriers, age 25-29

A

Clinical breast exam q6-12mos + yearly MRI, annual pelvic exam

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13
Q

Screening in BRCA carriers, age >29

A

Alternate mammogram and breast MRI q6mos, annual pelvic exam, TVUS, and CA-125

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14
Q

Inheritance of BRCA

A

Autosomal dominant

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15
Q

qSOFA

A

AMS, RR >22, SBP <100

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16
Q

Changes to cardiac output during pregnancy

A

Increased (increased SV and HR)

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17
Q

Changes to cardiac output 1 hour postpartum

A

Increased 50% (increased SV 70% and decreased HR)

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18
Q

Berlin criteria for ARDS

A
  1. Begins within one week of a known insult
  2. CT / CXR with bilateral infiltrates not explained by another etiology
  3. Moderate to severe hypoxemia
  4. Respiratory failure cannot be explained by cardiac failure or fluid overload
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19
Q

Best position for fitting a pessary

A

Lithotomy

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20
Q

First-line pessary types

A

Ring and Gellhorn

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21
Q

PID treatment with PCN allergy

A

Gent + clinda

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22
Q

Varicella treatment

A

Supportive under age 12 y/o

Acyclovir > age 12 y/o and/or pregnant

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23
Q

Varicella causes for hospitalization

A

Pneumonitis in adults
Super-imposed bacterial skin infections in kids
Encephalitis

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24
Q

Associations with hypoplastic umbilical artery

A

Maternal DM, polyhydramnios, IUGR, congenital anomalies, abnormal insertion of umbilical cord, placental abnormalities

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25
Q

Why no OCPs with anti-epileptics or rifampin?

A

Increased hepatic clearances makes them less effective

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26
Q

Mechanism of heparin and LMWH

A

Enhance action of antithrombin III –> inhibits thrombin and factor Xa

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27
Q

Mechanism of coumadin

A

Inhibits synthesis of vitamin K - dependent clotting factors

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28
Q

Mechanism of debigatran

A

Direct thrombin inhibitor

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29
Q

Mechanism of rivaroxaban

A

Direct factor Xa inhibitor

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30
Q

MCA Doppler measurement that means anemia

A

1.5 MoM

measures peak systolic velocity

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31
Q

How is hcg related to thyroid?

A

Alpha and beta subunits are similar to TSH so can induce hyperthyroidism

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32
Q

Symptoms of hyperthyroidism from a mole are due to…

A

Hcg activation of TSH receptor (and symptoms will not include exophthalmos because in Graves, the anti-TSH receptor antibodies cause inflammation)

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33
Q

Treatment of septic pelvic thrombophlebitis

A

Gent + clinda and anticoagulation

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34
Q

Age to start DEXA screening

A

65 y/o

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35
Q

Risk factors that warrant early DEXA screen

A

Personal history of fragility fracture, weight <127 lbs, chronic glucocorticoid use, parental history of hip fracture, smoking, alcoholism, RA

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36
Q

Why increased risk of pyelonephritis in pregnancy

A

Progesterone causes dilation of ureters and renal pelvises, leading to stasis

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37
Q

Most common bacteria of pyelonephritis (4)

A

E. coli, proteus mirabilis, klebsiella pneumoniae, staph saprophyticus

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38
Q

What to do if LDL >190

A

Evaluate for familial hypercholesterolemia, start on high-intensity statin – either atorvastatin or rosuvastatin

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39
Q

Rokitansky-Kuster-Hauser Syndrome

A

Normal ovaries and secondary sexual characteristics but no vagina, cervix, uterus

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40
Q

Transposition of the great arteries appearance on ultrasound

A

Normal 4-chamber view with parallel outflow tracts like normal

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41
Q

Truncus arteriosus appearance on ultrasound

A

Normal 4-chamber view with single outflow tract

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42
Q

Osteoporosis definition

A

T score

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43
Q

Erb palsy injury

A

Brachial plexus at C5-6

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44
Q

Categories of medications for osteoporosis

A

Bisphosphonates, calcitonin, SERM (raloxifene), monoclonal antibody (denosumab), parathyroid hormone (teriparatide)

45
Q

Monitoring for treatment of osteoporosis

A

DEXA about q2yrs

46
Q

Mechanism of bisphosphonate

A

Inhibit osteoclasts

47
Q

Prolonged latent phase

A

> 14 hrs in multipara

>20 hrs in nullipara

48
Q

Empiric treatment of UTI

A

TMP-SMX, cipro, or levofloxacin x 3 days OR nitrofurantoin x 7 days

49
Q

Timing of pre-eclampsia

A

At least 20 wga

50
Q

SERM used to treat dyspareunia associated with GU syndrome of menopause

A

Ospemifene

51
Q

How to decrease infection rate in medical abortion

A

Buccal misoprostol (abx only for surgical abortion)

52
Q

Most common bacteria in necrotizing fasciitis

A

Polymicrobial

Group A strep

53
Q

Most common medication error

A

Dosing error

54
Q

When to do sentinel lymph nodes in breast cancer

A

If surgery will distort anatomy, ie. planned complete mastectomy or tumor >5 cm

55
Q

What to do if a lymph node is detected on physical exam for breast cancer

A

Complete axillary node dissection (instead of sentinel nodes only)

56
Q

First and second line treatment for dysmenorrhea

A

NSAIDs, OCPs

57
Q

Normal breast development, abnormal pubic hair growth, absent uterus

A

Androgen insensitivity syndrome (46, XY); X-linked recessive

58
Q

When to evaluate primary amenorrhea

A

13 y/o without secondary sex characteristics

15 y/o with secondary sex characteristics

59
Q

Definition of secondary amenorrhea

A

No menses for 3 months with regular cycles

OR for 6 months with irregular cycles

60
Q

Work-up for amenorrhea

A

FSH, LH, prolactin, TFTs, testosterone, hcg

61
Q

Changes in geriatric physiology that impact anesthesia

A

Increased adipose tissue, worsened renal clearance, decreased albumin (less binding), decreased hepatic function

62
Q

Timeframe for Rhogam administration

A

Within 72 hours of delivery or other event

63
Q

First step in care for Rh alloimmunization after titers

A

Determine fetal status, ie. paternity, amniocentesis, or cffDNA

64
Q

Critical titer for alloimmunization

A

1:16 or 1:32

65
Q

BPP criteria

A

In 30 minutes: fetal breathing >30 seconds, at least 3 gross movements, at least 1 flexion/extension, vertical pocket of at least 2 cm amniotic fluid

66
Q

Positive CST

A

Late decelerations following at least 50% of contractions, even if less than 3 in 10 minutes (ideally at least 3 ctx lasting 40 sec in 10 min for a CST)

67
Q

Mode of hysterectomy with most to least ureteral injury

A
  1. Laparoscopic and robotic
  2. Open
  3. Vaginal
68
Q

Most common vascular injury in laparoscopy and what to do about it

A

Inferior epigastric, place a Foley catheter for tamponade and consult vascular surgery

69
Q

Which nerves can be injured with transverse abdominal incisions?

A

Ilioinguinal and iliohypogastric

70
Q

Likelihood dermoid is bilateral

71
Q

Cell lines in a dermoid

A

Endoderm (lungs, GI)
Mesoderm (muscle, urinary)
Ectoderm (skin, hair, sebaceous glands)

72
Q

Risk factors for multiple-drug resistant gram negative bacteria in pyelonephritis

A

Inpatient stay, isolated bacteria, travel to endemic areas, or prior treatment

73
Q

How to treat possible multi-drug resistance gram negative bacteria

A

Imipenem, meropenem, doripenem

74
Q

Timeline of sex differentiation in a fetus

A

3 weeks, no differentiation
6 weeks, no Sertoli cells in females
9 weeks, gonad differentiation has occurred
12 weeks, full phenotype has developed
13.5 weeks, ovarian primordial follicles start forming if female

75
Q

Cause of male differentiation

A

SRY gene, which causes testes to develop and give off AMH, testosterone, and dihydrotestosterone

76
Q

When to deliver ICP

A

36.0 to 36.6 wga

77
Q

Active thyroid hormone

A

T3 (converted from T4)

78
Q

Treatment for thyroid storm

A
  1. Beta blocker (propanolol)
  2. PTU
  3. Iodine
  4. Glucocorticoid
  5. Bile acid sequestrant (cholestyramine)
79
Q

What PTU does

A

Block synthesis of new thyroid hormone (like methimazole) AND blocks peripheral conversion of T4 to T3

80
Q

Chemotherapy associated with premature ovarian insufficiency

A

Alkylating agents - cyclophosphamide and ifosphamide

81
Q

Prevention of hemorrhagic cystitis

A

Mesna (given with alkylating agents)

82
Q

Factors that could cause earlier menopause

A

Night shift work, smoking

83
Q

Air-fluid levels

A

SBO, but not ileus

84
Q

How to use peak flow during asthma exacerbation

A

80-100% of personal best is okay
50-80% of personal best is obstructive
<50% of personal best is severe

85
Q

Anocutaneous reflex nerves

A

S2, 3, or 4

86
Q

Rash, pharyngitis, soft tissue necrosis, sepsis a few days postpartum

A

Group A strep sepsis or TSSS

87
Q

Elagolix mechanism

A

GnRH antagonist

88
Q

What to do for bone density loss in leupron administration

A

Norethindrone “add-back”

89
Q

Changes to renal excretion during pregnancy

A

Increased protein, amnio acids, and glucose in urine due to decreased reuptake

90
Q

When to test for thrombophilias

A

At least 6 wks from acute event, not pregnant, not on anticoagulation

91
Q

Thrombophilias to evaluate for…

A
  1. Factor V Leiden
  2. Prothrombin mutation
  3. Protein C deficiency
  4. Protein S deficiency
  5. Antithrombin deficiency
92
Q

Thrombophilia testing not reliable in pregnancy

A

Protein S functional assay

93
Q

How to test for Factor V Leiden

A

Activated protein C assay, then DNA analysis if abnormal

94
Q

Induction method for IUFD

A

Misoprostol until 28 wga, then routine methods for IOL

95
Q

Mole more likely to be malignant

96
Q

Gestational age safe for indomethacin

A

<32 wks (otherwise associated with premature closure of the ductus arteriosus)

97
Q

Contraindication to magnesium sulfate

A

Myasthenia gravis

98
Q

Alternative therapy in case of HIT

A

Direct Xa (thrombin) inhibitor like fondaparinux (safe in pregnancy)

99
Q

HIT type 1 vs type 2

A

type 2: plts <100,000, likely to cause thrombosis, day 4-14 post-exposure (instead of immediate)

100
Q

Hyperthyroidism treatment in pregnancy

A

PTU in first trimester (choanal atresia with MMI)

Methimazole later in pregnancy (hepatoxicity with PTU)

101
Q

Timing for ECV

102
Q

Ultrasound finding c/w malignant transformation of a dermoid cyst

A

Low-resistance Doppler flow inside the tumor

103
Q

Treatment for…
A) Pre-malignant vulvar dysplasia
B) Cancer <2 cm diameter, >2cm from midline, no palpable lymph nodes
C) Cancer anything but above

A

A) Simple vulvectomy
B) Partial radical vulvectomy and unilateral lymph node dissection
C) Radical vulvectomy with bilateral lymph node dissection

104
Q

Treatment of gonorrhea

A

Ceftriaxone alone

105
Q

CMV vs toxo calcifications

A

Periventricular in CMV and intracranial in toxo

106
Q

Postpartum depression diagnosis

A

At least 2 consecutive weeks with 5 or more depression symptoms, sometime within one year of delivery

107
Q

Salpingitis isthmica nodosum

A

Acquired condition in which mucosal glands penetrate the myosalpinx with resultate hyperplasia and hypertrophy; cannot be fixed surgically; unknown etiology

108
Q

Indication for lymph node dissection in surgery for endometrial cancer

A

Clear cell type, high-grade histology, myometrial invasion >50%, and tumors >2cm diameter or filling endometrial cavity

CREOG (8 decks)

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