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TrueLearn > TrueLearn/Walls > Flashcards

TrueLearn/Walls Flashcards

1
Q

Treatment for DCIS

A

surgical removal (mastectomy or lumpectomy) w or w/o radiation/tamoxifen

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2
Q

Risk of reoperation following a hyst/USO for persistent pelvic pain (endo)

A

30% (33%)

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3
Q

What is the most appropriate tx of genital warts in pregnancy?

A

Trichloroacetic acid (TCA)
-immune based tx (no systemic absorption)

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4
Q

What are the cryodestructive therapies for genital warts?

A

-Podophyllotoxin
-Podophyllum resin
-Flurouracil

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5
Q

in an HIV pos pt, above what viral load is a c/s indicated and at what gestational age?

A

> 1,000copies @ 38 weeks

*transmission rates 1-2% if viral load < 1000 copies/mL regardless of route of delivery

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6
Q

7 weeks with IUD in place:

A

Removal today (lowest risk of miscarriage)

*miscarriage rate is 50% if IUD left in place

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7
Q

When do fetal red blood cells start to appear

A

7-8 weeks GA

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8
Q

dz of thrombocytopenia, microangiopathic hemolytic anemia, renal abnl, fever, neuro sxs

A

TTP (thrombotic thrombocytopenic purpura (TTP)

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9
Q

Cause of TTP

A

deficiency or antibody of ADAMTS13 (cleaves vWF multimers)

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10
Q

Treatment of TTP

A

plasmapheresis to remove antibodies to ADAMTS-13 and replenish the depleted protease

*if severe, can add glucocorticoids, not gold standard. LDASA to prevent recurrence

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11
Q

What additional structure should be removed when a unilateral cyst returns as mucinous adenocarcinoma?

A

Vermiform appendix (most likely site of extra-mullerian origin)

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12
Q

What is the MC ovarian cancer diagnosed in pregnancy?

A

Dysgerminoma

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13
Q

What is the MC benign ovarian tumor in pregnancy?

A

Mature cystic teratomas (benign)

MC malignant = dysgerminoma

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14
Q

What is the MC epithelial ovarian carcinoma diagnosed in postmenopausal women?

A

Serous carcinoma

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15
Q

At what age do you offer ppx BSO for BRCA1?

A

35-40
Chrom 17
Ovarian risk of 40%

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16
Q

At what age do you offer ppx BSO for BRCA 2?

A

40-45
Chrom 13
Ovarian risk of 20% (10-27%)

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17
Q

What is the incidence of fetal postmaturity syndrome in postterm pregnancies?

A

1-5%
-dec subq fat
-lack of vernix
-lack of lanugo
-Meconium staining
-oligo

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18
Q

Timing of delivery for dichorionic twins

A

38 weeks

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19
Q

Timing of delivery for monochorionic diamniotic twins

A

34- 37w6d

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20
Q

Timing of delivery for monoamniontic twins

A

32 to 34 weeks

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21
Q

At what gestational age range does the fetal growth rate in twins slow, compared to the rate in singletons?

A

28 to 32 weeks

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22
Q

When should gonads be removed in a 18yo female with 46XY?

A

At completion of puberty
-malignancies rarely occurs before 20
-keep gonads until full breast development

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23
Q

what percentage of people have a pos HSV2 serology?

A

26%

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24
Q

monochorionic twin at 25 weeks pregnant. if 1 twin dies, what is the risk of the surviving twin having a neurologic abnl?

A

18%

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25
Q

Indications for thyroid function testing in pregnancy:

A
  1. personal h/o thyroid disease
  2. Family h/o thyroid disease
  3. T1DM
  4. Clinical suspicion of thyroid disease (goiter or nodules, not mild enlargement of the thyroid)
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26
Q

HbA1c level to diagnose diabetes in nonpregnant women w/o risks

A

> /= 6.5%

*fasting glucose 126 or higher
*2hr GTT > 200

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27
Q

Do white or black women have a higher risk of osteoporotic fracture?

A

White

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28
Q

Where does the vaginal artery branch from?

A

Uterine artery

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29
Q

What is the earliest age to consider herpes zoster in a healthy female patient?

A

50 yo
*2 doses, 2-6 months apart

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30
Q

What is the inheritance pattern of Fabry disease?

A

X-linked
-deficiency in alpha-galactosidase A

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31
Q

HbA1c that diagnosis dm?

A

6.5% or higher

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32
Q

Fasting plasma glucose level diagnostic of dm?

A

126 or higher

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33
Q

2 hr glucose tolerance test diagnostic of dm?

A

75g glucose load, level > 200 at one or 2 hour blood draw

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34
Q

What is the strongest risk factor for urinary incontinece?

A

obesity

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35
Q

Tx for heavy bleeding while on DMPA?

A

NSAIDs for 5-7 days or hormonal tx w 1.25 of conjugated estrogen for 10-20 days
*12% amenorrhea during first 3 months, 46% after 1 year

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36
Q

Where does the vaginal artery branch from?

A

The uterine artery

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37
Q

Anterior branches of the internal iliac?

A
  1. superior vesicle
  2. middle vesicle
  3. inf vesicle
  4. middle hemorrhoidal
  5. obturator
  6. Internal pudendal
  7. sciatic
  8. uterine
  9. vaginal artery
    *the vaginal artery can also branch from the uterine
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38
Q

Rec age to get recombinant zoster vaccine Shingrix?

A

50 years

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39
Q

Lysosomal storage disorder that is X-Linked?

A

Fabry disease
-def in alpha-galactosidase A > accumulation of glycosphingolipid in vasculature of brain, kidney, heart. Usually males

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40
Q

What vessel supplies the anterior abdominal wall?

A

sup/inf epigastric, musculophrenic, and deep circumflex iliac vessels

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41
Q

How is cervical cancer staged?

A

clinical: EUA, cysto, proctoscopy, CT, MRI, PET

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42
Q

Stage 0 cervical cancer:

A

Carcinoma in situ, abnl cells in innermost lining of cervix

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43
Q

Stage I cervical cancer:

A

invasive carcinoma that is strickly confined to the cervix

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44
Q

Stage II cervical cancer

A

Locoregional spread of the cancer beyond the uterus but not to the pelvic sidewall of lower 1/3 of the vagina

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45
Q

Stage III cervical cancer:

A

Cancerous spread to the pelvic sidewall or the lower third of the vagina, and/or hydronephrosis or a nonfunctioning kidney that is incident to invasion of the ureter

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46
Q

Stage IV cervical cancer:

A

Cancerous spread beyond the true pelvis or into the mucosa of the bladder or rectum

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47
Q

What procoagulatnt increases in pregnancy?

A

Fibrinogen
7, 8, 10
VW
PA1, PA2

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48
Q

What procoagulant decreases in pregnancy?

A

11, 13

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49
Q

What procoagulant stays the same in pregnancy?

A

2, 5, 9

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50
Q

What anticoagulant decreases in pregnancy?

A

Protein S (increases by trimester, but overall still decreases)

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51
Q

What anticoagulant stays the same in pregnancy?

A

Protein C, Antithrombin 3

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52
Q

Thyroid treatment by trimester

A

PTU - 1st (Hepatotoxic)
methimazole 2nd and 3rd T (aplasia cutis and esophageal/choanal atresia)

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53
Q

Side effects of PTU

A

liver toxicity, agranulocytosis (maternal)

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54
Q

Thyroid treatment in 2nd and 3rd trimester

A

Methimazole

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55
Q

Side effects of methimazole

A

Aplasia Cutis (if used before 2nd trimester)

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56
Q

peripartum management of women with APS WITH a history of thrombotic event vs NO history of thrombotic event:

A

h/o thrombotic event: ppx heparin in pregnancy + 6 weeks PP (ASA benefit unkn), transition to warfarin after deliv

NO h/o thrombotic event: ppx heparin and ASA while pregnant and for 6 weeks pp

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57
Q

What are CAPS (contraction associated proteins)?

A

expressed as a result of increase in myometrial activation/stimulation > initiation of labor:
-oxytocin receptors, connexin 43 (gap junctions), prostaglandin F2 alpha receptors, calcium channels

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58
Q

What is the role of NF - Kappa B’s role in labor stimulation

A

protein that results in stimulation of the CAPs but induces inflammatory genes > induces progesterone withdrawal > parturition

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59
Q

How long does it take for the postpartum uterus to completely involute to prepregnancy size?

A

4 weeks (becomes 100g or less)

-cell size decreases along with involution of connective tissue

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60
Q

Anatomic boundaries of inguinal triangle (Hesselbach’s triangle)

A

Rectus sheath, inguinal ligament, inferior epigastric vessels
*site of direct inguinal hernias

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61
Q

Where are indirect inguinal hernias located?

A

-at the internal inguinal ring (where round ligament exists the abdomen)
-lateral to inferior epigastric vessels
-MC type of hernias

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62
Q

This is a conservative tx option for SBO

A

Gastrografin: water soluble contrast, draws fluid into lumen of bowel > decreases edema and increases peristalsis
*dec hospital stay

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63
Q

Persistently elevated bHCG and bleeding after pregnancy…

A

GTN

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64
Q

GTN confined to the uterus

A

Stage I

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65
Q

GTN outside of uterus but limited to genital structures

A

Stage II

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66
Q

GTN that extends to lungs w or w/o known genital tract involvement

A

Stage III

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67
Q

GTN with mets past lung

A

Stage IV

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68
Q

Treatment of GTN for score 0 to 6:

A

single agent chemo

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69
Q

Treatment of GTN for socre of 7 or greater or stage IV

A

combination tx: EMACO (etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine/oncovin)

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70
Q

What is the only FDA approved treatment for acute abnormal uterine bleeding?

A

IV conjugated equine estrogen

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71
Q

How does IV estrogen work?

A

rapidly causing proliferation of the endometrium to prevent shedding
*works on most forms of dysfunctional bleeding

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72
Q

What is the prevalence o f obesity in the US among all individuals (BMI > 30)?

A

42.4%

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73
Q

What is the MC cause of neonatal thrombocytopenia?

A

Alloimmune thrombocytopenia
-caused from maternal alloimmunization to paternal inherited platelet antigens

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74
Q

Lifetime probability of UTIs in women?

A

60%
*11% of women report at least 1 physician dx UTI per year

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75
Q

What is the MC cause of pancreatitis during pregnancy?

A

Gallstones
outside of pregnancy: alcohol

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76
Q

Management of labial abscess in diabetic patient:

A

admission to Hospital, I&D, IV antibiotics

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77
Q

Drug of choice for anticoagulation in patients w a h/o heparin-induced-thrombocytopenia?

A

Fondaparinux
-binds to AT III and accelerates inhibition of factor Xa

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78
Q

Most common cause of secondary (delayed) postpartum hemorrhage?

A

retained POC (after 24 hours to 12 weeks PP)

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79
Q

What percentage of CO does the uterus receive at term?

A

17% (450 - 650ml/min)

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80
Q

What is the most common thrombophilia mutation?

A

Factor V Leiden

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81
Q

Management for singleton gestation w prior spontaneous preterm singleton birth

A

progesterone supplementation 16 - 24 weeks of gestation to reduce the risk of recurrent spontaneous preterm birth

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82
Q

Indication for history indicated cerclage:

A

-h/o 1 or more 2nd T preg loses 2/2 painless cervical dilation in absence of labor or placental abruption
-prior cerclage due to painless cervical dilation in 2 T

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83
Q

Exam indicated/rescue cerclage indication

A

painless cervical dilation in 2T

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84
Q

US indicated cerclage

A

-current singleton pregnancy, prior spontaneous preterm birth at < 34 weeks, short cervical length < 25mm before 24 weeks

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85
Q

What are the 2 mechanisms of the primary pathophys of PCOS?

A
  1. intrinsic functional hyperandrogenism > ovarian dysfnx > anovulation/oligomenorrhea, hirsutism. LH excess is seen
  2. 1/2 pts have insulin resistance > hyperinsulinism. Ovary is insulin sensitive despite liver/skeletal muscle resistance. + androgen production in ovary
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86
Q

Phase 1 of partuition

A

Quiescence:
- contractile unresponsiveness
-cervical softening

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87
Q

Phase 2 of parturition

A

Activation:
- Uterine preparedness for labor
- Cervical ripening

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88
Q

Phase 3 of parturition

A

Stimulation:
-uterine contraction
-cervical dilation
-fetal and placental expulsion

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89
Q

Phase 4 of parturition

A

Involution:
-Uterine involution
-cervical repair
-breastfeeding

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90
Q

Management of CIN2 in woman 21-24 years olf

A

repeat cytology and colpo at 6 month intervals for 1 year
-if both neg > cotesting 1 year
-if abnl/persistent dysplasia > repeat colpo/bx

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91
Q

Sxs of post-embolism syndrome:

A

Fever, nausea, pain, malaise
-self limited and resolve within 24 hours

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92
Q

Triad for AFE:

A

SUDDEN ONSET:
1. DIC
2. Hemodynamic compromise
3. Respiratory compromise

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93
Q

At what serum level of Mg would you most likely start to see respiratory depression?

A

12 mEq/L

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94
Q

Therapeutic range of Mag:

A

4 to 7 mEq/L

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95
Q

At what serum Mg level would you see loss of DTR?

A

8 mEq or greater

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96
Q

What is the antidote to MgSo4?

A

calcium gluconate
15 to 30 mL of a 10% solution slowly IV

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97
Q

What is the risk for development of GTN after a complete hydatidiform mole?

A

15%

*1-5% if partial mole!!

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98
Q

Type of Mole:
46 XX or 46 XY

A

Complete mole
**Complete set of chromosomes

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99
Q

Complete mole: absent or + fetal tissue:

A

Absent

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100
Q

Diffuse or focal swelling of chorionic villi in complete mole?

A

diffuse

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101
Q

p57 staining in complete mole?

A

negative

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102
Q

Risk of GTN in partial mole?

A

1-5%

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103
Q

Complete or partial mole:
69XXY, 69XYY, 69XXX

A

Partial

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104
Q

Fetal tissue absent or present in partial mole

A

Present

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105
Q

Focal or diffuse swelling of chorionic villi in partial mole?

A

Focal

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106
Q

p57 staining in partial mole:

A

positive

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107
Q

What percentage of FEV1 or Peak flow indicates adequate control of asthma during pregnancy?

A

80% or higher

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108
Q

Type of asthma and FEV1/Peak flow:
-sxs 2x/day or less per week
-nighttime awakening 2x or less per month:

A

Intermittent/well controlled
> 80%

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109
Q

Type of asthma and FEV1/Peak flow:
-sxs > 2x/day
-nighttime awakening > 2x/month

A

Mild persistent (not well controlled)
> 80%

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110
Q

Type of asthma and FEV1/Peak flow:
-sxs daily
-nighttime awakening > 1 per week

A

Moderate persistent (not well controlled)
60-80%

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111
Q

Type of asthma and FEV1/Peak flow:
-sxs throughout the day
-nighttime awakening 4 times or more per week

A

Severe persistent (poorly controlled)
< 60%

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112
Q

What is the percentage of neonates born between 23/0 and 23/6 who will survive WITHOUT disability to 18-22 months corrected age?

A

13%

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113
Q

Type 0 fibroids

A

pedunculated - intracavity

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114
Q

Type 1 fibroids

A

submucosal: < 50% intramural

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115
Q

Type 2 fibroids

A

Submucosal: > 50% intramural

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116
Q

Management of type 0 to type 1 fibroids

A

hysteroscopy

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117
Q

Management of type 2 - 7 fibroids:

A

Laparoscopic myomectomy

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118
Q

Equivocal scoring on BPP:

A

6/10:
-if < 37 weeks w normal AFI –> repeat testing in 24 hours w prolonged fetal monitoring

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119
Q

Location of the iliohypogastric nerve:

A

2cm medial and 1cm inferior to ASIS
-cant be injured during surgery

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120
Q

Result of injury to the iliohypogastric nerve?

A

Paresthesia of labia
numbess around pfannensteil incision
suprapubic numbess

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121
Q

Nerve injured with weakness in adduction of the thigh or numbness at medial/inner thigh

A

obturator nerve injury

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122
Q

Nerve injured with medial/anterior thigh paresthesias

A

femoral nerve injury

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123
Q

nerve injured with weakness of quad, inability to flex at hip or extend at the knee

A

femoral nerve injury

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124
Q

Vaccine schedule for HPV quadrivalent vaccine if given between 15 - 26 yo

A
  • 3 doses: 0, 2, 6 months
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125
Q

Vaccine schedule for HPV quadrivalent vaccine if given between 9 - 14 yo

A

-TWO DOSES only: 0, 6-12 months

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126
Q

Algorithm for IV labetalol for SR BP:

A

*20mg IV
-recheck in 10 mins
*40mg IV
-recheck in 10 mins
*80mg IV
-recheck in 10 mins
**10mg hydralazine

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127
Q

SNRI vs SSRI for tx of vasomotor sxs with patients on tamoxifen

A

-tx w SNRI (venlafaxine) bc SSRIs have a theoretical risk of decreasing efficacy (SSRI inhibit cytochrome p450 pathway)

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128
Q

HDL and Triglyceride levels that warrant early GTT screening:

A

HDL < 35, or TG < 250

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129
Q

plt requirement prior to epidural/spinal anesthesia

A

> 70,000

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130
Q

plt requirement prior to c/s or surgical procedure:

A

> 50,000

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131
Q

When do steroids start to increase plts for ITP

A

4-14 days

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132
Q

1st line tx for ITP:

A

glucocorticoids, IVIG if steroids contraindicated or not effective

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133
Q

2nd line tx for ITP:

A

rituximab, thrombopoietin receptor agonists, immunosuppressive tx, anti-D immunoglobin

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134
Q

Protective factors for ulcerative colitis:

A

-smoking
-appendectomy

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135
Q

This type of disease is limited to the mucosal layer of the bowel (not submucosal) and almost always involves the rectum, then proximally the rest of the colon:

A

Ulcerative colitis

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136
Q

This type of disease has skip lesions- transmural lesions are a hallmark. Affects all areas of the GI tract including the mouth

A

Crohn disease

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137
Q

effects of smoking and appendectomy on crohn’s disease

A

-smoking increases risk/rate of recurrence, appendectomy increases risk

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138
Q

Most common cause of pancreatitis in the US?

A

Gallstones

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139
Q

Most common type of uterine sarcoma:

A

Leiomyosarcoma

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140
Q

Tx for Chlamydia trachomatis (L1-L3)

A

Doxy 100mg PO BID x 21 days

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141
Q

tx for H. ducreyi

A

-aspiration of fluctuant buboes
-1g PO azithromycin x 1 OR
-250mg ceftiaxone IM x 1

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142
Q

Dx of persistent, painless, beefy red papules or ulcers w/o LAD. Dx by donovan bodies on wright stain or + Giemsa stain or bx of granulation tissue:

A

Calymmatobacterium (Klebsiella)

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143
Q

Tx of Calymmatobacterium (Klebsiella)

A

Azithromycin 1g PO Q weekly or 500mg PO QD

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144
Q

Timing of delivery for pregestational DM well controlled

A

Full term:
39/0 to 39/6

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145
Q

Timing of delivery for pregestational DM w/ vascular complications, poor glucose control, or prior stillbirth

A

late preterm/early term:
36/0 to 38/6

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146
Q

Delivery timing for GDM well controlled w diet/exercise

A

Full term:
39/0 to 40/6

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147
Q

Delivery timing for GDM well controlled on meds

A

Full term:
39/0 to 39/6

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148
Q

Delivery timing for GDM poorly controlled:

A

late preterm/early term
individualized

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149
Q

Hereditary cancer syndrome caused by defect in MLH1 and MSH2

A

Lynch syndrome

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150
Q

Lynch-related tumors:

A

-colorectal
-endometrial
-stomach
-ovarian
-pancreatic
-ureter/renal pelvis
-biliary tract
-brain (glioblastoma)
-sebaceous gland adenomas
-keratoacanthomas
-small bowel

**Not breast!

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151
Q

Recommendation for lipid profile assessment:

A

Start at age 20, repeat lipid assessment every 4 to 6 years

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152
Q

What is the most common congenital infection?

A

CMV

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153
Q

What does CMV avidity test

A

The maturity of the IgG antibody: low avidity = immature antibody or recent infection!

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154
Q

CMV: IgM pos, IgG pos w low avidity:

A

primary infection

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155
Q

CMV: IgM pos, IgG pos w high avidity

A

chronic infx

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156
Q

3 clinical features of suspected IAI:

A

Maternal leukocytosis
Fetal tachycardia
Purulent cervical discharge

**can lead to neonatal morbidity > increased risk of cerebral palsy

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157
Q

Best initial therapy for moderate to severe premenstrual syndrome

A

MODERATE TO SEVERE: SSRI or COC
if mild: stress reduction and exercise

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158
Q

Method of IOL for fetal demise at less than 28 weeks gestation w h/o previous uterine scar

A

-prostaglandins
< 24wks: prostaglandin
24-28 wks: may use prostaglandins, need more research
28 weeks or > : no prostaglandin

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159
Q

What percentage of infants will have long term sequelae following a neonatal central nervous system infection from HSV?

A

20%

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160
Q

What is the diagnostic and treatment modality for pelvic congestion syndrome

A

Pelvic venogram

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161
Q

inheritance that lacks gender bias w males and females equally affected and male to male transmission. 50% of siblings have it

A

Autosomal dominant

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162
Q

inheritance of Marfan, NF, and huntington’s

A

AD

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163
Q

Inheritance that is lack of gender bias, males and females equally affected. 25% of the siblings are affected

A

AR

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164
Q

Inheritance of Phenylketonuria

A

AR

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165
Q

Inheritance that affects males more than females, females can be affected. Transmission is only mother to sons no father to son transmission

A

X - Linked recessive

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166
Q

What is the preterm birth rate in the United States?

A

10.2%
(delivery on or after 20/0 to 37/0)

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167
Q

Risk of developing Type 2 DM after being diagnosed with GDM

A

70% chance

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168
Q

Max fluid deficit for 1.5% glycine for HSC

A

1000cc
*low viscosity, electrolye poor

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169
Q

Max fluid deficit for 3% sorbitol for HSC

A

1000cc
*low viscosity, electrolyte poor

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170
Q

Max fluid deficit for 5% mannitol for HSC

A

1000cc
*low viscosity, electrolyte poor

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171
Q

Max fluid deficit for NS for HSC

A

2500cc
*low vis, electrolytes!

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172
Q

Max fluid deficit for LR for HSC

A

2500cc
*low visc, electrolyte containing

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173
Q

5 year failure rate for postpartum partial salpingectomy

A

6.3 pregnancies per 1000 procedures

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174
Q

Is a previous full thickness myomectomy an absolute or relative contraindication to an ablation

A

Absolute - myometrium may be too thin and serious complications if perforation were to occur

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175
Q

Is bleeding or clotting disorder and relative or absolute contraindication to an endometrial ablation?

A

Absolute
- if causing AUB need to be worked up to control their bleeding medically

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176
Q

Algorithm for oral nifedipine for SR BP

A

10mg oral nifedipine
-repeat BP in 20 mins
20mg oral nifedipine
-repeat BP in 20 mins
20mg oral nifedipine
-repeat BP in 20 mins
20mg IV labetalol

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177
Q

Points for CARPREG

A

1 point:
-history of prior cardiac event/arrhythmia
-NYHA class > II or cyanosis
-left heart obstruction (AV < 1.5cm)
-left ventricular EF < 40%

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178
Q

What is the risk of cardiac complication for 1 point from the CARPREG risk score?

A

1 point: 27%
0 points: 5%

1 point:
-history of prior cardiac event/arrhythmia
-NYHA class > II or cyanosis
-left heart obstruction (AV < 1.5cm)
-left ventricular EF < 40%

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179
Q

Which component of the BPP is the LAST to disappear in fetal distress?

A

AFI

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180
Q

Order of how things are lost on a BPP

A

NST > Breathing > Gross movement > Fetal tone > AFI

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181
Q

What thrombophilia is the most thrombogenic of all the thrombophilias?

A

Antithrombin III deficiency
Thrombosis risk of 11 - 40% per preg
*start heparin in pregnancy

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182
Q

MOA of antithrombin III

A

*natural anticoagulant
-inactivates thrombin and IXa, Xa, XIa, XIIa

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183
Q

What is the MC thrombophilia?

A

Factor V Leiden

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184
Q

What is the mortality rate of primary pulmonary artery HTN in pregnancy?

A

9-28%
*mean arterial pressure > 25 mm Hg at rest
*contraindication to pregnancy

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185
Q

What is the most sensitive test to diagnose chorioamnionitis by amniocentesis?

A

IL-6 by amnio

*better indication of microbial invasion than gram stain, glucose concentration, or WBC
*most specific (reliable) is amniotic fluid culture)

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186
Q

After lifestyle modifications, what is the next BEST recommended intervention to induce ovulation in a woman with PCOS?

A

Letrozole
*superior to clomiphene citrate

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187
Q

MOA of letrozole

A

Aromatase inhibitor: blocks peripheral conversion of T and androstenedione to estradiol and estrone > lower estrogen levels > increase in FSH from ant pituitary

*1st line tx for ovulation induction (not yet approved by FDA)

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188
Q

MOA of clomiphene citrate:

A

SERM: completely inhibits estrogen receptors in hypothalamus > disrupts negative feedback from estrogen increased GnRH from hypothalamus > stimulates pituitary to secrete FSH > growth of ovarian follicles

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189
Q

What type of sterilization has the lowest failure rate after 5 and 10 years

A

Postpartum partial salpingectomy

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190
Q

Dx of pt w vaginal bleeding and pos UPT, with intermediate trophoblasts w few syncytial elements on D&C:

A

Placental site trophoblastic tumor: need Hysterectomy

*doesn’t respond to chemo

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191
Q

Risk o mortality in pregnant patient with congenital aortic stenosis

A

8%

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192
Q

What type of fibroid is a pedunculated intracavity fibroid?

A

Type 0

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193
Q

What type of ovarian tumor is likely to develop in a patient with androgen insensitivity after puberty?

A

Gonadoblastoma
-benign mixed tumors (mixed = dysgerminoma that THAT is malignant)

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194
Q

Tumor markers are dysgerminoma

A

bhcg and LDH

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195
Q

Which parenteral opioid analgesic used intrapartum is associate with the LEAST risk of resp depression in a newborn:
-Morphine
-Butorphanol (stadol)
-Meperidine (demerol)
-Remifentanil

A

Remifentanil

Meperidine: very bad, doesn’t reverse with Narcan

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196
Q

What is the origin of the DNA used to perform maternal cell free DNA testing aneuploidy?

A

Placental cells
*need 4% fetal fraction for a good test

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197
Q

The main arterial blood supply to the breast originates from which artery?
-Aorta
-lateral thoracic artery
-internal thoracic artery
-Axillary

A

Axillary artery (umbrella term)

Axillary > thoraco-acromial branches and lateral thoracic (2/3 blood supply)
Subclavian > internal thoracic (medial 1/3 blood supply)

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198
Q

The most common presenting symptoms of vaginal carcinoma is:

A
  • watery discharge and *painless vaginal bleeding (ans)
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199
Q

Treatment of hydrosalpinx seen at time of HSG

A

Doxy 100mg BID x 5 days
*treating possibility of worsening infx

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200
Q

Advantages of LMWH

A

-lowers risk of HIT
-Dec bone dens loss
-Predictable therapeutic range

*it has a long half life

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201
Q

MC cause of infertility:

A

Male factor (51%)

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202
Q

Which is not affected by estrogen in oral contraceptives?
-AT III
-Factor VII
-Factor X
-Fibrinogen

A

AT III

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203
Q

What procoagulants decrease in pregnancy?

A

13, 11

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204
Q

What anticoagulants decrease in pregnancy?

A

Protein S (but the test sucks in pregnancy - hard to follow)

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205
Q

What procoagulants stay the same in pregnancy?

A

2,5,9

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206
Q

What anticoagulants stay the same in pregnancy?

A

Protein C

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207
Q

What are the anticoagulants?

A

Protein C and S

*Letters!

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208
Q

Tx of scarring inflammatory disorder of the skin, oral mucosa, and vulvovaginal area. Erosive, friable patches, vaginal synechiae?

A

Lichen planus - treat with hydrocortisone acetate suppositories!!

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209
Q

Female with no secondary sex characteristics, streak gonads, and XY, no Testosterone

A

Swyer sydrome: XY but nonfunctioning Y

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210
Q

Most precise way to evaluate a pregnancy affected by alloimmunization is:

A

MCA dopplers

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211
Q

Next step after head entrapment after 28 weeks breech delivery

A

Duhrssen incisions: quick and will work

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212
Q

Quintero stages of TTTS:

A
  1. Oli/poly (DVP < 2/ > 2)
  2. Pee no more (donor)
  3. Dopplers abnl
  4. Ascites/hydrops
  5. Death
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213
Q

Stage III Quintero TTTS?

A

Abnl dopplers

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214
Q

Stage I of Quintero TTTS?

A
  1. Oli/poly
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215
Q

Stage II Quintero TTTS

A
  1. Pee no more (no bladder seen in donor)
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216
Q

Stage IV Quintero TTTS

A
  1. hydrops/ascites
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217
Q

Stage V Quintero TTTS

A

5: Death

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218
Q

Contraindication of Zolendronate

A

Renal failure
*IV bisphosphonate that is given 1 time per year if can’t tolerate PO 2/2 GERD

*pregnancy, hypocalcemia, paralysis

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219
Q

Layers of the skull that a subgaleal hematoma is between?

A

Skull and epicranial aponeurosis

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220
Q

Cranial hematoma between periosteum and aponeurosis

A

subgaleal hematoma

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221
Q

Cranial hematoma between skull and periosteum

A

cephalahematoma
*cannot cross suture lines

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222
Q

Cranial hematoma between skin and galea aponeurosis

A

caput succadaneum

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223
Q

Cranial hematoma between skull and dura mater

A

epidural hematoma (inside near brain!)

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224
Q

Most thrombogenic thrombophilia in pregnancy

A

AT III Deficiency (AD)

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225
Q

Most common thrombophiia in pregnancy:

A

Factor V Leiden (AD)

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226
Q

This thrombophilia has a decreased risk if heterozygote, but increased risk if double hetero (homo)

A

Prothrombin G20210A (AD)

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227
Q

When do you transfuse if Hgb < 10:

A

if Hgb < 10 + s/s neuro (syncope) or s/s hypoxia

**Transfuse

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228
Q

Bromley criteria for adenomyosis

A
  1. Heterogenous myometrium
  2. Globular uterus
  3. Cystic spaces (2mm or greater)
  4. Indistinct border

*highly suggestive of adeno

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229
Q

What is the gold standard for clinical dx of adeno

A

MRI

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230
Q

Which of the following is the most suggestive of adenomyosis on US?
-Myometrial cysts
-Myometrial calcifications
-Myometrial liquification
-Hyperechoic masses

A

Cysts!

  1. Heterogenous myometrium
  2. Globular uterus
  3. Cystic spaces (2mm or greater)
  4. Indistinct border
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231
Q

Side effects of Addyi (Flibanserin)

A

-Expensive
-2 Drink > blackouts

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232
Q

Tx of 23 yo w elevated 17 - OHP levels:

A

Corticosteroids
-Adult onset CAH (21 hydroxylase def) > no corticosteroids (STRESSFULL need steroids to manage stress)

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233
Q

Next step if injury to bladder is in trigone?

A

cystotomy
*need to remove the function of the bladder so it can heal

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234
Q

Function of tamoxifen:

A

SERM
-dec breast tissue
-INC uterine tissue (endometrium)

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235
Q

Raloxifene and ospemifene effect on the endometrium:

A

NONE

SERMS:
Raloxifene (+ bone)
Ospemifene (vaginal tx)

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236
Q

When does the plt count return to normal with gestational thrombocytopenia?

A

6 - 8 weeks

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237
Q

S/p TAH/BSO w LNBX > grade 2 adenocarcinoma w myometrial invasion of < 50% w negative LNs . Tx:

A

Vaginal brachytherapy*

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238
Q

Which poses no risks during antepartum period if positive or negative?
-rubella
-Hb/Hct
-Hepatitis
-Syphillis

A

Hepatitis: worry about this during delivery

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239
Q

Test that holds highest value in eval of a 38 week fetal demise:

A

Thrombophilia

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240
Q

Assoc w postmen women and prepubertal girls, can see labial adhesions, white plaques/papules and tx w steroids. Seen w sexual abuse

A

Lichen sclerosus

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241
Q

Teratogenic window for Warfain in pregnancy?

A

6-12 weeks GA

6% teratogenic effect. 3% if < 5 mg/day

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242
Q

This is a steroid androgen antagonist used to treat hirsutism. Must follow Cr:

A

SpiRonolactone
(inhibits 5-a reductase)
R = renal function

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243
Q

Nonsteroidal androgen antagonist to treat hirsutism. Must check LFTs

A

FLutamide
L = LFTs

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244
Q

This is a suicide inhibitor to ornithine decarboxylase used for hirsutism

A

Eflornithine (topical!)

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245
Q

MC causes of IAI:

A

polymicrobial: Staph/strep), GBS, Gardnerella

*listeria is separate cause

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246
Q

Vessel at risk during sacrospinous ligament suspension:

A

Inferior gluteal

*pudendal artery is behind ischial spine
*superior/inferior gluteal is behind SSL

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247
Q

Muscle that lays anterior to sacrospinous ligament:

A

coccygeous

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248
Q

Muscle that lays posterior to sacrospinous ligament:

A

Piriformis

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249
Q

This vessel feeds the gluteus minimus and can be injured during SSL fixation

A

inferior gluteal

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250
Q

MOA of mirabegron

A

B3 agonist (BEG)

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251
Q

Side effects of Mirabegron:

A

Tachycardia
HTN
HAs
Diarrhea/constipation

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252
Q

What does the metanephros usually form in the female?

A

Kidney

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253
Q

Average pCO2 in the umbilical cord artery at term>

A

50 mmHg

[20 - [30 - 40 ] 50]

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254
Q

Best way to identify a genetic abnormality in a stillborn fetus?

A

Chromosomal microarray analysis

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255
Q

FHT of an anacephalic infant

A

Flat bc no parasympathetic/sympathetic sxs

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256
Q

Holoprosencephaly is associated with which chrom abnormality:

A

Trisomy 13 (close to 12 or WHOLE)
-Can live entire life - spectrum
*Patau syndrome

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257
Q

Most common skin condition in pregnancy:

A

PUPPS
periumbilical sparing
severe itching

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258
Q

Generalized itching in pregnancy, no rash

A

Pruritis gravidarium

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259
Q

Folliculitis or rash in pregnancy

A

Atopic eruption of pregnancy

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260
Q

Most important reason to treat preHTN or stage 1 HTN in pregnancy:

A

to reduce peripartum mortality

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261
Q

Thickened nuchal translucency with normal fetal karyotype is most likely due to what:

A

Structural defects (30% cardiac)

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262
Q

What type of hypersensitivity is SLE?

A

Immune complex (type III)

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263
Q

What is a Type I hypersensitivity?

A

IgE - mediated
*asthma, seasonal allergies, anaphylaxis

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264
Q

What is a Type II hypersensitivity?

A

2 things: IgG and IgM
*AB directed
-blood transfusions, erythroblastosis fetalis, autoimmune hemolytic anemia

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265
Q

What is a Type III sensitivity

A

III = C3b = Ag-AB complexes deposit in tissues > compliment activation > inflm by neutrophils
Type III = C3b = 3 diseases
1) SLE 2) Glomerulonephritis 3) RA

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266
Q

3 diseases seen with Type III hypersensitivity reactions?

A
  1. SLE
  2. GN
  3. RA
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267
Q

Deficit on superior anterior aspect of right thigh is what nerve injury?

A

Lateral femoral cutaneous

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268
Q

This is a mediation approved obesity in adolescents that are not responding to lifestyle modifications:

A

Orlistat or Tetrahydrolipostatin
*cuts fat into sizes that cannot be absorbed

*metformin is for T2DM

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269
Q

This space is entered in performing a SSLF

A

Pararectal fossa

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270
Q

What are the 5 pelvic spaces:

A
  1. vesicovaginal
  2. rectovaginal
  3. Paravesical
  4. Obturator
  5. Pararectal
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271
Q

A deep sulcal tear in the vagina can open up what pelvic space

A

Pararectal space (will see fat)

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272
Q

What are the boundaries of the pararectal space?

A

ant: uterine artery
lat: internal iliac
medial: ureter

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273
Q

What is the main goal of tx of precocious puberty:

A

Slow skeletal maturation

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274
Q

Tx of central precocious puberty:

A

Lupron (GnrH agonist)

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275
Q

Tx of peripheral precocious pubery:

A

Aromatase inhibitor

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276
Q

An increase in placental lacunae can be an indication of what:

A

Placenta accreta

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277
Q

Measles during pregnancy is assoc with which of the following:
-Ventriculomegaly
-Hepatosplenomegaly
-Nonimmue hydrops
-Fetal Demise

A

Fetal demise!

-PTD, low birth weight, fetal demise

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278
Q

What metabolite does MESNA block and what does it prevent:

A

Blocks Acrolein
*prevents hemorrhagic cystitis

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279
Q

What does isofoamide cause?

A

Acrolein > hemorrhagic cystitis
*mesna blocks acrolein

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280
Q

Which of the following does not cause ovarian failure?
-Chorambucil
-Isofamide
-Cisplatin
-Cyclophosphamide

A

*cisplatin

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281
Q

This nerve innervates the quads. L2, L3, L4. If injured, can’t climb stairs

A

Femoral
* +1/4 patellar reflexes

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282
Q

What are the 4 F’s of the Peroneal nerve:

A
  1. Foot drop
  2. Four roots: L3, 4, S1, 2)
  3. Fin (yellow fin)
  4. Fibular head
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283
Q

MC bug if a infant presents with red discharge:

A

Shigella

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284
Q

Which ventricle will be enlarged if there is a Pulm embolism:

A

RV

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285
Q

This nerve can be injured with TVT placement

A

ilioinguinal

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286
Q

Effective surgical tx for EIN:

A

Simple Hyst- FIRST LINE tx

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287
Q

Inheritance of Androgen insensitivity:

A

X-linked recessive (2/3) or spontaneous mutations (1/3)

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288
Q

Which is not associated with PP depression:
-Older maternal age
-Smoking
-physical/verbal abuse
-HEG

A

Older maternal age
-more relationships, more stability

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289
Q

Definition of PP blues

A

< 2 2wks

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290
Q

Definition of PP depression

A

> 2 weeks

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291
Q

Hormonal tx for transgender female:

A

Estrogen + spironolactone (gynecomastia side effect)

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292
Q

This mediation can reduce vertebra fractures in pts with BRCA mutations:
-Calcitonin
-Bisphosphonates
-Raloxifene
-Denosumab

A

Raloxifene (+ bone)

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293
Q

For the OA fetal head, appropriately applied forceps blades are placed:
1. Equidistant from the sagittal and lambdoidal sutures
2. Equidistant on the parietal bones
3. Symmetrical to the coronal suture
4. Symmetrical to the sagittal and coronal suture

A

1 - Equidistant from the sagittal and lamboidal sutures

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294
Q

Time between last dose of LMWH and spinal?

A

Can be as early as 2

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295
Q

74yo w 10cm mass, has PMB, w recent EMB showing EIN. What tumor markers will be positive?

A

Inhibin B
**Granulosa cell tumor: GRANNY!!
-*the Granny named Rosy (rosette) used to lose her inhibitions (inhibin B) bc she was a CALL girl (Call-exner bodies) and she had to drink a lot of coffee to get up (coffee bean nuclei/nuclear grooves)

**Microfollicular pattern w numerous small cavities that contain eosinophilic fluid

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296
Q

Which is assoc w Kallman Syn (X-linked mutation):
-cardiac defect
-Cleft lip/palate
-Scoliosis
-Cataracts

A

*Cleft lip/palate

*facial anl, anosmia, long extremities, qdec GnRH

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297
Q

Next step if pt at 12 week GA had cfDNA resulted as uninterpretable:

A

US and dx testing
*assuming everything was done correctly, need more diagnostic testing

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298
Q

Side effect of Anastrozole

A

NASTY to bones
*aromatase inhibitor, can be used for breast cancer treatment

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299
Q

Fish recommendation in pregnancy:

A

2-3 servings of 8-12 ounces

*ans was 3 servings, 12 oz

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300
Q

What type of vaginal repair is recommended if there is a 30% laceration of the external anal sphincter?

A

End to end - can’t do an overlapping because it is not a full thickness laceration

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301
Q

Meds used for HIV post exposure prophylaxis

A

Tenofovir, Emtricitabine, Raltegravir

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302
Q

What is ligated during vasectomy?

A

Ductus (vas) deferens

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303
Q

At what PCO2 should intubation be performed in pregnancy?

A

PcO2 > 42mmHG

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304
Q

Trick to remember is suture absorbable or not:

A

If D or G in word = DONE GONE
**absorbable

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305
Q

Type of suture: poliglecaprone 25

A

absorbable monofilament

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306
Q

Type of suture: polyglactin 910:

A

absorbable vicryl braided

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307
Q

At what creatinine should you give the loading dose of Mg followed by only 1gm/hr

A

Cr 1.0 - 1.5 OR oliguria ( UOP < 30ml for more than 4 hours)

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308
Q

Association of elevated AFP (3.5MoM)
-FGR
-Trisomy 18
-Fetal death < 24 weeks
-Fetal death > 24 weeks

A

Fetal death before 24 weeks

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309
Q

What makes AFP in fetus?

A

Liver and yolk sac

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310
Q

When does AFP peak in maternal circulation?

A

13 to 16 weeks

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311
Q

Most common complication in McCall’s culdoplasty:

A

Dyspareunia - extra sutures in vagina

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312
Q

4 C’s of cervical cancer:

A

-CLINICAL staging
-CAUSE is CERVICAL HPV
-CISPLATIN is tx
-CIGARETTES are high risk factor

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313
Q

Cervical cancer treatment for invasion < 3mm

A

CKC or simple hyst
*1A1

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314
Q

Treatment of cervical cancer that has invasion of 3 or more mm to < 5mm

A

Radical hyst
-1A2 to 1B3

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315
Q

What is 2A stage of cervical cancer & tx:

A

-Upper 2/3 vagina
-cisplatin + radiation

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316
Q

What is 3A stage of cervical cancer and tx:

A

lower 1/3 of vagina
-cisplatin and radiation

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317
Q

When will you use cisplastin and radiation for tx of cervical cancer:

A

Stages 2A to 4A
*upper 2/3 vagina to rectal/bladder mucosa
*combination increases survival by 30-50%

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318
Q

Treatment of 4B cervical cancer:

A

*further mets > palliative radiation chemo

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319
Q

What are the two types of carrier mediated transport systems?

A

Facilitated diffusion and active transport

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320
Q

How are the heavy minerals transported across the placenta?
-Iron, AAs, Calcium, phos, iodine

A

Active transport (carrier mediated)

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321
Q

How are the sugars transported across the placenta?
-Glucose, sucrose, fructose, lactate

A

Facilitated diffusion (carrier mediated)

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322
Q

Most necessary step after 30 wk gravid uterus comes to ED after gunshot wound to abdomen, VSS Wound in LUQ above the uterus. FHR Cat I with contractions:

A

Laparotomy

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323
Q

Where in the fetus is Hbg F produced?

A

Liver

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324
Q

Where in the fetus is Hb Gower 1, 2, and portland produced?

A

Yolk sac

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325
Q

Superficial epigastric artery is a branch of:

A

The femoral artery

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326
Q

What testing methodology detects trisomies?

A

Targeted single variant!

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327
Q

The fetal heart completes morphological development at what gestational age?

A

5- 8 weeks

5: tube
6-7: horseshoe
8: morph development complete

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328
Q

What type of breech presentation is most susceptible to cord prolapse?

A

Footling breech
-cor can be anywhere around there

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329
Q

Frank breech position is like what?

A

Foot frank face
*like pike

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330
Q

What is the most predictive ultrasound finding of a placenta accreta?

A

Placenta previa
*a previa is present in more than 80% of accretas

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331
Q

Minimal invasion of cervical cancer to recommend LN dissection:

A

3mm

IAI = < 3mm CKC/simple hyst
IA2 = 3-5 mm = radical hyst

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332
Q

When does bHCG normalize after the evacuation of a complete mole?

A

8 weeks (2 months)

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333
Q

What is the regular recommended dose of folic acid?

A

0.4mg or 400mcg

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334
Q

Type of pessary for SUI with small vaginal introitus:

A

Hodge (manually shapeable)
*has metal > no MRI

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335
Q

Need to avoid MRIs in what type of pessaries:

A

Hodge and Gehrung (waterslide shape)
*both have metal

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336
Q

Most cost effective test for dx of AIS vs MA:

A

Testosterone:
AIS: XY (M test level)
MA: XX (F test level)

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337
Q

What is the most common genetic cardiac disease?

A

Hypertrophic cardiomyopathy

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338
Q

What percentage of brow presentation will convert to face presentation?

A

30%
From BROW to FACE: 30%
From FACE to VTX 20%

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339
Q

Can you delivery mentum anterior or posterior vaginally?

A

Mentum anterior: MAMA - Men. Ant

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340
Q

Serous tubal and tubal intraepithelial lesions in transition are most frequently seen in which part of the tube?

A

FIMBRIA

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341
Q

most common way endometroid adenocarcinoma spreads?

A

Direct extension

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342
Q

This type of malpractice covers all incidents during a poly period regardless of when it was reported:

A

Occurrence: covers when it OCCURED. Doesn’t matter when reported

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343
Q

This type of malpractice covers the incidence depending on if it is reported when you had the insurance that covered it

A

Claims-made

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344
Q

Type of breast cancer if ductal cells in dermal lymphatics:

A

INFLM breast cancer

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345
Q

Blood flow to term uterus:

A

400-650ml/min

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346
Q

What phase of cell division are oocytes arrested between birth and ovualtion:

A

Prophase I
*PROs - get benched from birth to puberty

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347
Q

Cytogenetic karyotype is performed on chromosomes arrested in what phase of replication?

A

Metaphase

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348
Q

Next step after ASCUS pap in 28 yo:

A

HPV typing

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349
Q

Management of 35yo 28 wks pregnant w SCC on cone with 1mm stromal invasion?

A

Repeat colpo

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350
Q

Cause of late onset FGR:

A

placental insuff (HTN, etc)

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351
Q

Cause of early onset FGR:

A

-aneuploidy, infx, structural (heart) defect)

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352
Q

This FDA approved tx for osteoporosis increases osteoblasts and stimulates bone formation:

A

Recombinant parathyroid hormone (Teriparatide)
-daily SQ injection
-2 year duration
-can cause osteosarcoma if used longer

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353
Q

This medication for osteoporosis inhibits osteoclasts actions

A

Calcitonin

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354
Q

This drug for osteoporosis slows osteoclast formation

A

Zolendronate
-inhibits bone resorption

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355
Q

Which is most valuable in detecting a gas embolus intraop:
-Hypotension
-cardiac arrhythmia
-end tidal CO2
-pulse ox

A

*end tidal Co2
- there will be a fall in end-tidal CO2, increase in dead space, and worsening of ventilation-perfusion mismatching

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356
Q

Which of the following is most liekyl to result in bone resorption?
-Diuretics
-CCBs
-Digoxin
-Lithium

A

Lithium!! > osteoporosis

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357
Q

Which muscle contributes to the anal canal’s resting pressure and fecal continence:

A

Internal anal sphincter
*Internal = Involuntary

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358
Q

Specific marker seen with abnl or pathologically adherent placenta?

A

PaPP-A: pregnancy-associated plasma protein A

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359
Q

Inheritance of BRCA:

A

AD

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360
Q

Risk of ovarian cancer with BRCA 1?

A

40%

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361
Q

Risk of ovarian cancer with BRCA2?

A

20%

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362
Q

What medication should be avoided in pts receiving a full opioid agonist during labor?

A

Stadol or Butorphanol

*Can diminish the effect of the opioid agonist

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363
Q

4 findings that are diagnostic of early pregnancy loss:

A
  1. CRL 7mm or more with no HB
  2. Mean gest sac 25mm or more with no embryo
  3. no fetal HB AND no embryo 2 or more weeks post scan showing gestational sac and no yolk sac
  4. no fetal HB AND no embryo 11 days or more after a scan with a gestational sac and yolk sac
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364
Q

What percentage of early pregnancy loss is 2/2 fetal chromosomal abnormalities:

A

50%

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365
Q

Protein/Carb/Fat recs in pregnant diabetic:

A

P: 15-30%
C: 40-50%
F: 20-35%

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366
Q

Leading cause of blindness in 24 to 74 year olds:

A

Retinopathy - 2/2 DM

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367
Q

What are normal triglycerides:

A

< 150mg/dL

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368
Q

How long should exposed and asx male and females wait to have intercourse after Zika exposure?

A

Males: 12 weeks
Females: 8 weeks

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369
Q

Newborn is pale, poor cry, grimaces, some flexion, HR 160. APGAR at 1 min:

A

APGAR
-Appearance: pale: 0
-Pulse: > 100: 2
-Grimace: poor cry: 1
-Activity: some flexion: 1
-Respiration: poor cry: 1
5

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370
Q

Newborn is pale, poor cry, grimaces, some flexion, HR 160. APGAR at 1 min:

A

APGAR
-Appearance: pale: 0
-Pulse: > 100: 2
-Grimace: poor cry: 1
-Activity: some flexion: 1
-Respiration: poor cry: 1
5

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371
Q

Newborn is pale, poor cry, grimaces, some flexion, HR 160. APGAR at 1 min:

A

APGAR
-Appearance: pale: 0
-Pulse: > 100: 2
-Grimace: poor cry: 1
-Activity: some flexion: 1
-Respiration: poor cry: 1
5

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372
Q

What type of cancer is theoretically increased when using OCPs?

A

CERVICAL:
-inc sexual activty w dec condom use –> STIs (HPV)
*more exposure, ectropion is exposed, transformation zone is exposed –> inc risk of cervical cancer

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373
Q

Two or more cell populations w diff chromosomal complements present within the same embryo:

A

Mosaicism

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374
Q

Uniparental disomy:

A

both members of pair of chromosomes are from 1 parent
*molar = all father

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375
Q

Gamete specific gene silencing where only 1 allele from mother or father is expressed

A

Imprinting
*Prader-Willi
*Angelman

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376
Q

Tx for K. granulomatis:

A

Azithromycin 1gm/week or 500mg QD for 3 weeks
**Donovan bodies

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377
Q

What is the most practical marker of reproductive aging?

A

AMH
Nml: 1 to 4

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378
Q

Gestational threshold for lung hypoplasia:

A

24 weeks (if delivered at 24 weeks or less can have lung hypoplasia)

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379
Q

Most common aneuploidy associated with SAB:

A

45 XO (mc aneuploidy)

*trisomy 16 is MC trisomy associated with SAB

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380
Q

MOA of decreased uteroplacental blood flow if intraperitoneal insufflation > 15mmHg

A

*increase in placental vessel resistance
-decreased CO > hypotension > dec placental perfusion > increased resistance

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381
Q

Anesthesia induction agents:

A

Ketamine, propofol, etomidate

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382
Q

TOC vs retesting timing for CT in preg:

A

TOC: 4 weeks
Retesting: 12 weeks (do even if TOC was neg and sex partners treated)

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383
Q

Virchow’s triad:

A
  1. statis
  2. endothelial injury
  3. hyper-coagulopathy
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384
Q

Risk of renal disease in DM:

A

35%

*Higher than HTN, GN, polycystic kidney disease

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385
Q

Crohn’s or UC: perianal involvement:

A

Crohn’s

*Crohn’s has no home and SKIPS down the COBBLESTONE through ALL ZONES (transmural)

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386
Q

Sciatic nerve bundle:

A

L4- S3

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387
Q

Common fibular nerve bundle (peroneal):

A

L4 - S2

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388
Q

Tibial nerve bundle:

A

L4 to S3

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389
Q

Pudendal nerve bundle:

A

S2- S4

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390
Q

Cancer associated with Paget’s disease of the breast:

A

Ductal carcinoma

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391
Q

What is a best overall predictor of sperm function in a semen anaylsis

A

Morphology

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392
Q

Markers of osteoblastic activity:

A

-Osteocalcin
-Alk phos
-Procollagen peptide

393
Q

Markers of bone resorption

A

-Hydroxyproline
-Pyridinoline
-Deoxypyridoline
-N-telopeptide
-C-telopeptide

394
Q

What happens to UA resistnce in a normal pregnancy?

A

It progressively decreases throughout pregnancy

395
Q

CST result of intermittent late decels or significant variable decels:

A

Equivocal-suspicious

*CST must have 3 ctx in 10 minutes, lasting at least 40 sec

396
Q

CST result of FHR decels that occur in the presence of contractions more frequency than every 2 minutes or lasting longer than 90 sec:

A

Equivocal

397
Q

CST result of late decels after 50% or more of contractions (even if ctx freq is less than 3 in 10)

A

Positive

398
Q

Tx of multifocal VAIN III:

A

Co2 laser
I and II: lower 1/3 and 2/3 of epithelium
III: more than 2/3 epithelium

399
Q

Tx of VAINIII that is not multifocal, cannot be fully visualized, poss disease in vaginal vault and lateral fornices, and invasive disease has not been excluded:

A

surgical excision
-wide local excision, partial vaginectomy

400
Q

Treatment of Stage II endometrial adenocarcinoma with less than 50% invasion and less than 2cm?

A

TAH/BSO w LN sampling**

401
Q

Which HPV strain has the highest carcinogenic potential?

A

16

402
Q

What generation is Ancef?

A

1st gen cephalosporin
*Cefazolin

403
Q

When to redose ancef/cefazolin?

A

1) time: 3.6hrs (2 x 1/2 life which is 1.8)
2) EBL 1500 or greater

404
Q

Management of positive margins on a LEEP or cone:

A

repeat testing (cytology/ECC and colpo in 4-6 months) > if persistenly CIN2/3 = repeat dx or tx

405
Q

What is the most common post-op complication seen with SSLF

A

Anterior vaginal wall prolapse
+ dyspareunia

406
Q

What is Ristocetin cofactor activity test used for?

A

vWF - bleeding disorder, NOT thrombotic workup!

407
Q

Tx of Type I and Type II VWD

A

DDVAP (Desmopressin)

-Type I : Quantitative (AD)
-Type II: Qualitative (have vwf but not functioning, AD or AR)

408
Q

Tx of type III vWD:

A

vwf!

This is a profound deficiency or complete absence of vWF (AR)

409
Q

what is a low urethral closing pressure indicate:

A

*intrinsic urethral issue. Pressure < 60mmHg
Tx: sling or bulking agent bc failing!

410
Q

Leading cause of septic shock in pregnancy:

A

Pyelonephritis

411
Q

1) % of untreated UTI that get pyelo _
2) % of pyelo that get septic _

A
  1. 40%
  2. 20%

*devastating complication of sepsis in pregnancy > ARDS

412
Q

MC intraop complication assoc w abdominal sacral colpopexy:

A

Hemorrhage!
*bleeding retracts in the sacral plexus and hard to control
**thumbtack

413
Q

Most common gyn malignancy in preadolescent females?

A

Germ cell (epithelial tumors)

414
Q

Most common gyn malignancy found in adolescent/reproductive females?

A

Serous tumor

415
Q

Back up method if progesterone implant inserted within 5 days of bleeding

A

None needed

416
Q

Backup method if progesterone implant inserted > 5 days since menstrual bleeding?

A

additional backup for 7 days

417
Q

most likely cause of a chronic cough:
-PNA
-bronchitis
-GERD
-PUD

A

GERD!

-chronic cough
-sore throat
-chronic laryngitis
-sleep apnea
-non cardiac chest pain

418
Q

Which is a physical exam finding in pt with AIS
-clitoromegaly
-small uterus
-blind vaginal pouch
-tanner stage 1 breasts

A

-bling vaginal pouch

419
Q

Which is not a germ cell tumor:
-dysgerminoma
-endodermal cell
-choriocarcinoma
-granulosa cell tumor

A

Granulosa cell tumor
*all others are

420
Q

What are the germ cell tumors?

A
  1. Benign cystic teratomas
  2. Dysgerminomas
  3. Choriocarcinoma
  4. Endodermal sinus tumor
  5. Embryonal
  6. Polyembryoma (rare)
  7. Gonadoblastoma
421
Q

Dysgerminoma markers (Germ cell tumor)

A

bhcg, LDH

*distant germans (dysgerminoma) Betta (b-hcg) have long distance (LDH)

422
Q

biomarkers in Yolk sac/endodermal tumor (Germ cell tumor)

A

AFP
Schiller Duvall bodies

*Egg yolks (yolk sac) can only be Awesome Fresh Picks (AFP) if you leave them in the Chiller (SD bodies)

423
Q

Biomarkers for immature teratoma (germ cell tumor)

A

AFP, Ca 125

Immature ladies Are From Pasadena (AFP) California (Ca 125)

424
Q

Biomarkers for embryonal carcinoma (germ cell tumor)

A

b-hcg, AFP

*embryo are Betta (bhcg) As Fresh Picks (AFP)

425
Q

What Which germ cell tumor can be bilateral?

A

Mature cystic teratomWhat a (12-15% can be bilateral)
*bilateral and benign

*most germ cell tumors are unilateral

426
Q

How many weeks after fertilization does the neural tube form?

A

3 - 4 weeks

427
Q

Top 3 most common causes of morbidity with a shoulder dystocia:

A
  1. Brachial plexus injury (65%)
  2. Clavicle fracture (38%)
  3. Fracture of the humerus (17%)
428
Q

At what point in pregnancy was the infection if a pt has limb hypoplasia and skin scarring?

A

2nd trimester
*Congenital Varicella

429
Q

if unsure of stage of tx, and retreating a pt for syphillis, how long will it take for a decrease of titer to know the tx was successful?

A

6 months
-retreat with Benzathine PCN x 3 doses
-will take 6 months to decrease titer to 1:4 which is proven successful tx

430
Q

This is an absolute contraindication for methylene blue use during an eval of ureteral patency?

A

G6PD def

431
Q

Which does not cause hemolytic disease of the newborn?
-Kidd Jka
-Rh C
-Kidd Jkb
-Diffy Fya

A

Kidd Jk B

*A = awful
*B = better

*Kidd, Kell (kills) Duffy A
E, D, C table

432
Q

This cancer is most diagnosed in pregnancy and this cancer is the one that pregnant women are most likely to have:

A
  1. Cervical (getting paps)
  2. Breast
433
Q

Reasons to bx a bartholin gland cyst:

A

-solid components
-cyst/abscess wall fixed to surrounding tissue
-mass is persistent
-pt is postmenopausal (can also do if > 40 yo)

434
Q

When do bhcg levels plateau at 100,000 in a normal pregnancy?

A

10 weeks

435
Q

Does delayed cord clamping decrease the incidence of sepsis?

A

NO!
-improves blood count
-decreases need for transfusion
-lowers rates of intraventricular hemorrhage

436
Q

Management of pregnant woman w Listeria exposure but no s/s

A

Observe

437
Q

Management of pregnancy woman with Listeria exposure and + s/s (no fever)

A

Test and monitor (can start augmentin)

438
Q

Management of pregnant woman w Listeria exposure, + s/s, + fever:

A

test & treat
-blood cultures, Hospitalize for IV Amp 2g q 4 hours

439
Q

Correct chest compressions to breaths per minute in resuscitation of term neonate?

A

90 compressions to 30 breaths (3:1 ratio)

440
Q

Resuscitation of neonate if HR < 100:

A

Ventilation measures (MR SOPA)
-Mask
-Reposition
-Suction
-O2 increase
-Pressure
-Airway

441
Q

Resuscitation of neonate if HR < 60:

A

-Consider ETT/Mask
-Chest compressions
-Airway
-Epi

442
Q

What type of anemia is thalassemia?
(microcytic or macrocytic)

A

Microcytic

443
Q

Megaloblastic vs nonmegaloblastic anemia:

A

Megaloblastic: B12 or folate
**due to a nuclear maturation issue
Non-megaloblastic are other types (MDS)

**all macrocytic

444
Q

Which of the following actors in best in determining the prognosis of breast cancer?
-# of lymph nodes
-Presence of estrogen/progesterone receptors
-Histologic grade
-Stage of disease

A

*Stage
**need stage to know prognosis

445
Q

Which tumor marker does not change in pregnancy

A

LDH!

AFP: inc in abnl/nml pregnancies
CEA: colon cancer/bad sens/spec in preg
CA125: trash

446
Q

Does inhibin A or B peak in the midluteal phase only?

A

Inhibin A

A= peaks After ovulation
B = peaks before

447
Q

What are the 2 types of vulvar cancer:

A

Differentiated and ususal

Diff:
-age dep (> 70)
-h/o dermatosis
-Lichen

Usual:
-HPV, STI, cig smoking, younger age, high risk behavior

448
Q

Tx option for stage IBI squamous cell carcinoma:

A

Radical hyst

449
Q

Does pulm HTN or Aortic stenosis have a worse maternal prognosis?

A

Pulm HTN: 50% mortality rate
AS: 15% mortality rate

450
Q

What to do if imiquimod tx is not helping with genital warts:

A

Add IL-10

451
Q

Treatment of stage II invasive carcinoma of the vagina:

A

Radiation therapy

452
Q

MOA of RhoGAM:

A

Blocking D antigenic determinants on the erythrocyte membranes

453
Q

Treatment of pediculosis pubis:

A

(pubic lice)
**Permethrin 5% cream or

Tx: topical permethrin or topical pyrethrins w piperonyl butoxide

454
Q

Incidence and carrier frequency of:
-CF
-FXS
-SMA

A

Incidence/CF

CF: 1/2500 > 1/25
FXS 1/4000 > 1/250
SMA: 1/10,000 > 1/40

455
Q

Definition of perinatal period:

A

20 weeks GA to 28 days PP

*neonatal is 1 day to 28 days

456
Q

LDL goal:

A

< 100mgdl

457
Q

Fecundity vs Fecundability:

A

Fecundity: fertility
Fecundability: Achieving a pregnancy

458
Q

When does Fecundity decline?

A

steep decline at age 32

459
Q

What is the parameters that need to be met regarding discordance for the safe extraction of a second breech twin, assuming presenting twin is smaller?

A

Discordance 22%, 2nd twin 1550g
- 28 weeks
- 2nd nonvertex twin > 1500g
- if presenting twin smaller, discordance < 20-25%

460
Q

First step in intraop cautery injury to middle third of ureter at IP ligament during TLH/BSO

A

Pass stent w contrast

461
Q

Fluid cutoff for HSC using monopolar sxs:

A

1000ml
-glycine, sorbitol, mannitol!
*if fluid overload > cerebral edema

462
Q

Effects of fluid overload in electrolyte rich fluids during HSC?

A

pulm edema –> start CPR!

*max def 2000 to 2500ml

463
Q

Location of Nexplanon insert device:

A

8-10cm from medial epicondyle, 3-5cm from sulcus

464
Q

% of neurologic complication assoc w death of a monochorionic twin in 2T

A

Mono: % neuro complication: 18%
Mono: % death of 2nd twin: 15%

465
Q

% of neurologic complication assoc w death of dichorionic twin in 2T?

A

Di: % neuro complication: 1%
Di: % death of 2nd twin: 3%

466
Q

Placenta site trophoblastic tumors MC present following what:

A

A TERM gestation

Dx: endometrial bx

467
Q

Treatment of placenta site trophoblastic tumor w NO mets vs Mets:

A

No mets: Hyst
Mets: chemo/radiation

468
Q

Days in cycle that implantation occurs?

A

Day 20 to 24
*Day 14 = ovulation
need some days to meet and travel > 20-24 is implantation

469
Q

Contraindications of bremelanotide:

A

UNCONTROLLED HTN
(can use if controlled)
— or —
known CVD

*this is Vylessi - melanocortin receptor agonist, used for tx of HSDD in premenopausal women, injection given 45 mins prior to intercourse

*not approved for postmenopausal women

470
Q

Mass suspicious for teratoma during term CS. Management:

A

Cystectomy

*if simple cyst: leave
*if poss path: cystectomy

471
Q

Management of exposed gyn mesh (< 1cm and 1cm or greater):

A

< 1cm: estrogen and re-eval
1cm or greater: excision and estrogen

472
Q

Most common early post op complication of LN dissection in groin:

A

Lymphocyst formation: 40% of cases
Lymphedema is a late complication

473
Q

MOA of Trichloroacetic acid:

A

Coagulation of tissue proteins
*safe during pregnancy

474
Q

MOA of 5-fluroauricil for warts

A

interferes w DNA synthesis

475
Q

MOA of imiquimod for vaginal warts

A

stimulates local cytokine production

476
Q

MOA of podofilox for vaginal warts

A

breakdown of intercellular junctions

477
Q

Is Antithrombin III a procoagulant or anticoagulant?

A

Anticoagulant

*so decreasing its level (tamoxifen) is procoagulant!

478
Q

Anatomic support to vagina:
Anatomic support to uterus:

A

Vagina: Uterosacral
Uterus: Cardinal ligament

479
Q

Risk of neonatal death with uterine rupture:

A

5%

480
Q

tx for hyperkalemia?

A

IV calcium gluconate

*peaked T waves

481
Q

Major criteria for TSS:

A
  1. fever
  2. rash
  3. hypotension (* watch out for orthostatic hypotension on Qs)

Minor Criteria:
-GI sxs
-myalgias
-erythema of mucus membranes

482
Q

MC complication following TOT sling vs TVT:

A

TOT: pain
TVT: vesicle/vessel injury

483
Q

inheritance of dz associated with fused labioscrotal folds seen at delivery of neonate:

A

AR!!!

*CAH!

484
Q

Age that max bone density is achieved in women:

A

19 yo

485
Q

% of pts that have cHTN that develop preE:

A

25%

*cHTN –25%–PreE
*gen pop – 3% –PreE

486
Q

DEXA and FRAX score used to treat patients w pharmacotherapy:

A

if T score </= - 2.5 alone then can treat

If Tscore -1.0 to -2.5 AND
Frax hip: 3.0 or more or major fracture 20% or more 10 year risk

487
Q

What is the Gail model 5 year cut off for chemo prevention

A

1.67%
*if higher> use chemo

488
Q

What hormone in pregnancy causes increased insulin sensitivity?

A

Estriol

489
Q

What hormone in pregnancy causes increased insulin resistance?

A

HPL, TNFa, prolactin, progesterone

490
Q

Which is not assoc with chorioangioma > 5cm
-nml preg
-AV shunting
-fetal anemia
-thrombosis

A

*thrombosis

491
Q

Disruption of pubourethral ligament =

A

hypermobile urethra

492
Q

Disruption of pubocervical fascia from the acrus tendinous fascia pelvis:

A

Paravaginal defect - a lateral anterior vaginal wall defect

493
Q

Detachment of endocervical facia from the pubocervical ring:

A

Cystocele

494
Q

Med used for tx of hyperthyroidism in pt w molar pregnancy to prevent pulm edema?

A

B-adrenergic blocker
**BLOCK hormone peripherally and dec HR to prevent pulm edema

495
Q

What nerves are involved in Erb’s palsy:

A

C5-C6
*waiter tip (hire a waiter, higher lesion than Klumpke)

496
Q

What nerves are involved in Klumpke’s?

A

C8-T1
*K(c)law hand

497
Q

Effect of placenta previa on fetal lie:

A

Increased risk of transverse lie

498
Q

What is the MC type of breast cancer?

A

Infiltrating DUCTAL carcinoma
80%

*lobular is the 2nd MC

499
Q

This type of study answers questions about risk factors and disease and prognosis:

A

Prospective cohort study

500
Q

BMI associated with FGR:

A

> 50

501
Q

Antiepileptics to avoid in pregnancy:

A

Phenobarbital, valproic acid, phenytoin, carbamazepine

*keep keppra, leave lamotrigine, don’t ox oxcarbazepine

502
Q

Treatment of thyroid storm:

A

PID!
-PTU
-Iodine
-Dexamethasone

503
Q

Tx for ex lap in 19 year w frozen path showing Schiller-Duval bodies:

A

Right adnexectomy and chemo

*Endodermal tumor
19 year old!

504
Q

Which is not an extraintestinal manifestation of crohn’s disease?
-Glaucoma
-VTE
-renal calculi
-B12 def

A

Glaucoma!

-VTE
-Renal calic
-B12
-Pulm sclerosing cholangitis
-osteoporosis
-pulm involvement
-amylodosis

505
Q

By how long does epidural anesthesia prolong the 2nd stage of labor?

A

7.6 mins

506
Q

By how much does a ppx BSO reduce the risk of breast cancer in pt with BRCA2/BRCA1:

A

BRCA2: 46%
BRCA 1: 57%

*all > 50%

507
Q

Origin of the obturator artery:

A

Internal iliac

508
Q

Contraindication to Palmer’s point entry:

A

h/o splenectomy

509
Q

Is a dopamine agonist or antagonist a first line tx for a prolactin excreting microadenoma?

A

Dopamine AGONIST

(carbergoline or bromocriptine)

510
Q

This medication is associated with increased intracranial pressure and cerebral edema in women:

A

sodium nitroprusside

*use only for emergencies and for shortest time 2/2 increased cyanide and thiocyanate toxicty to women and fetuses

511
Q

First line tx for premenstrual syn:

A

SSRIs

512
Q

How many additional calories are recommended in the 1st, 2nd, 3rd trimesters of pregnancy?

A

1st: 0
2nd: 350
3rd: 450

513
Q

Biggest risk factor for breech presentation:

A

Preterm gestation

514
Q

Serum analyte levels on Quad screen for down syndrome:

A

DOWN low unless they are HI
(hcg and inhibin A are high – AFP, estradiol are low)

515
Q

Intrapartum management of AS and MS:

A

Aortic stenosis - WET
Mitral stenosis - DRY

WAS = wet

516
Q

Delivery for cHTN , uncomplicated, no meds:

A

38/0 to 39 6/7

517
Q

Delivery for cHTN, uncomplicated, controlled ON meds:

A

37/0 to 39 6/7

518
Q

Delivery for cTHN, difficult to control, w freq medication adjustments:

A

36 0 to 37 6/7

519
Q

Delivery of gHTN without SR BP or PreE without SF

A

37/0 or at dx if later

520
Q

Delivery of gHTN w SR BP or preE with SF (stable maternal/fetal conditions)

A

34/0 or at time of dx

521
Q

Delivery of preE with SF, unstable or complicated, after fetal viability (SIPE and HELLP), AND preE with SF, before viability

A

Soon after maternal stabilization

522
Q

Testing of HSV lesion in pregnancy:

A

Viral test (PCR* vs Culture) and type specific serologic testing

523
Q

Cancer seen with exposure to DES:

A

Clear cell adenocarcinoma

524
Q

Do neonates with NAS have seizures?

A

NO! Shake but no seizures!!!

*tremors, hyper-reflexive, fevers, poor feeding, etc.

525
Q

NAS syndrome lengths in methadone vs buprenorphoine/heroin:

A

occurs earlier (24 hours) and lasts longer
-dose dependent

526
Q

Lowest cut off for umbilical artery pH that confers neonatal encephalopathy was NOT related to intrapartum hypoxia:

A

7.2

*if cord pH is at least 7.2, and there is hypoxia, then it was probably due to something else!

527
Q

Most states require that physicians who take a leave of absence greater than how many months need to participate in physician re-entry program?

A

24 months!

528
Q

1st line med for tx of post op PE in a healthy woman:

A

LMWH or fondaparinux
-*monitor only if obesity, low BMI, renal insuff, preg

*LMWH = lower mortality, fewer thromboembolic events, less major bleeding than UFH

529
Q

MC cause of death following a UAE

A

Septicemia

530
Q

This is the only modality to decrease mortality or the best tx for pulmonary arterial hypertension caused by chronic obstructive disease?

A

Oxygen therapy

531
Q

Max dose of lidocaine WITH epi:

A

7mg/kg

532
Q

Max dose of lidocaine W/O epi:

A

4mg/kg

533
Q

Earliest sign of lidocaine toxicity:

A

circumoral numbness and tongue paresthesia

534
Q

Which is assoc with nec fas: alcoholism or smoking?

A

alcoholism

*smoking is NOT!!!

535
Q

Risk factors associated w nec fasc that are specifically seen in women:

A

Pregnancy, childbirth, preg loss, gyn procedures

536
Q

What medications are seen with nec fasc?

A

Sodium-glucose cotransporter 2 inhibitors:
-flozins

537
Q

What is the MC gyn cancer worldwide?

A

Cervical cancer!!!
4th mc cancer in women

MC gyn cancer in the US: Type I Endometrial cancer (developed countries)

538
Q

What are the 4 most common cancers in women worldwide?

A
  1. Breast
  2. Lung
  3. Colorectal
    4.Cervical
539
Q

Equation of Fetomaterna hemorrhage to determine vials needed for Rhogam:

A

Vials = (dec perc of fetal cells on KB x mat blood vol) / 30 ml
OR
(fetal cells in maternal circulation) / (fetal blood covered by RhoGAM)

540
Q

tracing of a false positive NST and percentage of false positive NSTs:

A

false pos = nonreactive
**think of it like screening
rate: 55-90%

541
Q

What is the false negative rate of an NST and what is the tracing?

A

Tracing: reactive
rate: 0.2 to 0.65
*this would mean there is a reactive tracing but stillbirth within 7 days

542
Q

timing of delayed PP hemorrhage:

A

> 24 hours UP TO 12 WEEKS!!!!

543
Q

Options for tx if pt preg and corpus luteum removed prior to 10 weeks GA?

A
  1. Weekly 17 OHP through 10 weeks
  2. Oral micronized prog @ 200-300mg through 10 weeks
  3. 8% prog vaginal gel PLUS 100-200 micron progesterone orally
544
Q

How should pts with weak D blood type be treated?

A

As Rh neg!

*don’t recommend genotyping

545
Q

When to start PEP for HIV after a sexual assault

A

ASAP but no later than 72 hours after exposure

546
Q

Risk of accreta in pt with known previa and 3 prior c/s:

A

61%

4 prior: 67%
5 prior: 67%

547
Q

Risk of accreta in pt with known previa and # c/s:

A

Primary: 3.3%
2nd: 11%
3rd: 40%
4th: 61%
5th: 67%
6th: 67%

548
Q

Diagnostic criteria for HEG

A
  1. dehydration
  2. electrolyte abnl
  3. intractable vomiting
  4. wt loss > 5% of prepregnancy weight
549
Q

What is the most common complication of urinary Botox injections?

A

UTIs!!! - 33% have UTI

only 5% have urinary retention

550
Q

This US finding most reliably defines an intrauterine pregnancy:

A

Yolk sac

*double decidual sign is not as reliable - can be a pseudogestational sac

551
Q

What is the lifetime incidence of depression for women in the US?

A

17%

552
Q

This triad is pathognomonic for tubal carcinoma

A
  1. abdominal pain
  2. vaginal bleeding
  3. vaginal discharge (hydrops tubae - serous/yellow/copious)

*vag bleeding and d/c are the MC sxs

553
Q

Latzko technique:

A

-repair for simple vesicovaginal fistulas
-use small probe to bring fistula to introitus, incise vaginal epithelium, vaginal flaps are raised and removed and then closed in 2 layers
*wait 6-12 weeks after surgery to repair to dec granulation tissue
**Highest chance of closure at 80-90%

554
Q

What endometrial strip measurement on TVUS for a postmenopausal woman should prompt a workup to rule out malignancy?

A

> 4mm SO 5mm NOT 4mm

less than or EQUAL to 4mm is OKAY

555
Q

thought on 2nd line chemo for ovarian cancer:

A

NOT CURATIVE

**purely palliative

556
Q

Tests used to stage cervica cancer:

A

-EUA
-cysto
-proctoscopy
-CT
-MRI
-PET

557
Q

These emergency contraception options are effective up to 5 days after intercourse:

A

-Copper IUD
-Levonorgestrel 52mg
-Ulipristal 30mg

558
Q

Rec for vax if pt received Pneumovax23 prior to age 65 and is immunocompetent?

A

Give another dose at age 65 or older, at least 5 years from last dose

559
Q

Ideal laparoscopic entry in pt in 1st trimester:

A

Intraumbilical entry

*prior to completion of 1st trimester

560
Q

initial management of cervical ectopic pregnancy when future fertility is desired:

A

Methotrexate

561
Q

Hemoglobinopathy associated with fetal hydrops?

A

hb Barts or alpha globin gene deletion!

Genotype: –/– results in severe microcytic anemia, hydrops, feta demise in utero

562
Q

Failure rate of copper IUD:

A

0.8%

*never need backup contraception
*avoid placement in PID/septic abortion
*screen for STIs at time of placement but don’t wait for results. if pos just treat while in place
*most effective type of emergency contraception

563
Q

What type of contraception has a failure rate of 0.05%?

A

Nexplanon

564
Q

Management of acute PE:

A

LMWH wt based BID or IV heparin
*eventually transition to warfarin for 3 moths for DVT and 6 months for PE

565
Q

absolute contraindications to aspirin use in pregnancy:

A
  1. hypersensitivity to salicylates or NSAIDs
  2. Nasal polyps
  3. Asthma with aspirin induced bronchospasm
566
Q

Most commonly injured nerve during abdominal hysts:

A

Femoral nerve
**during retractors placed on psoas muscles

567
Q

Treatment of gonorrhea when Chlamydia has been exlcuded:

A

IM ceftriaxone:
< 150kg: 500mg IM
> 150kg: 1000mg IM

568
Q

Management of dopamine agonist (bromocriptine and cabergoline) for prolactinoma once patients are found to be pregnant:

A

d/c when pt found to be pregnant
*regularly screen pts for visual changes to monitor tumor growth

*do not monitor prolactin levels during pregnancy

569
Q

Why irrigate after rupture of a dermoid cyst?

A

To avoid acute and chronic pain

570
Q

How long after the LH surge on a home OPK kit occur?

A

14 - 26 hours

*Peak fertility days are the day the LH surge is detected and the following 2 days

571
Q

Criteria to diagnose metabolic syndrome:

A

3 out of 5:
1. waist circumference > 88cm
2. Triglycerides >/= 150
3. HDL </= 50
4: BP 130/80 or higher
5. elevated FBG >/= 100

572
Q

What is the most common mode of transmission of Hep C:

A

IV drug use

573
Q

Fetal monitoring after blunt abdominal trauma:

A

Min 4 hours
If ctx > 24 hours!

574
Q

Dx testing at 10-14 weeks vs 14-20 weeks after an elevated nuchal translucency testing:

A

10-14 weeks: CVS
14- 20: Amniocentesis

*Abnormal nuchal translucency is > 3mm

575
Q

Percentage of women who are carrier of GBS:

A

20% (10-30%)

576
Q

What is the anti-inflm MOA of NSAIDS:

A

inhibition of Cox 2

*most inhibit both COX1 and COX2

577
Q

This is a first line drug for tx hirsutism:

A

COCs
*none are FDA approved
*increases SHBG binds to testosterone

578
Q

New 2018 FIGO cervical cancer staging criteria that can be used:

A

CT scan or ANY imaging modality
-remember 4 C’s:
Clinical, Cause is cervical HPV, Cisplatin, Cigarettes

579
Q

Best next step if hemodynamically unstable pt w suspected ruptured ectopic pregnancy:

A

Immediate surgery and salpingectomy
*Laparotomy vs laparoscopy based on surgeon preference

580
Q

Placenta of stillbirth foul-smelling with multiple abscess. Mom s/p flu like sxs:

A

Listeria
**ABSCESSES
*hematogenous spread to placenta

581
Q

Percentage of pregnancies with a nuchal cord:

A

20-34%

582
Q

Med likely associated with external ear malformations, cleft palate, micrognathia, conotruncal heart defects, brain abnl:

A

Isotretinoin for acne

**Cat X - use 2 forms of contraception

583
Q

Anomaly associate w apical displacement of the tricuspid valve:

A

Ebstein anomaly = Lithium use

584
Q

Anomaly assoc w fingernail hypoplasia, craniofacial abnormalities, cardiac defects, and developmental delay:

A

Fetal hydantoin syndrome: seen w exposure to seizure meds (phenytoin)

585
Q

Longest lasting of the absorbable sutures:

A

Polydioxanone (PDS)

*50% tensile strength at 4 weeks

586
Q

This pelvic shape is the least common and most associated w transverse lie:

A

Platypelloid
**platypus has a flat, long tail (transverse)

587
Q

This is the classic female shape and the MC

A

Gynecoid!!

588
Q

This is the pelvic shape that is least favorable for a vaginal delivery and associated with CPD:

A

Android
(heart: I heart phones - LOP or ROP usually)

589
Q

This pelvic shape is associated with OP position:

A

Anthropoid
(anthropods walked, tall skinny pelvis, direct OP)

590
Q

Percentage of mature teratomas that will develop into squamous cell cancers:

A

0.2 to 2%
**originates from the ectoderm layer

Risks of malignant transformation:
-over 45 yo
-tumor size > 10 cm
-rapid growth

591
Q

Trisomy vs Triploidy:

A

Trisomy: Extra copy of one chromosome
Triploidy: Extra set of chromosomes (moles, etc)

592
Q

Screening for colon cancer in pt with a h/o Lynch syndrome or HNPCC:

A

-colonoscopy every 1-2 years starting at age 20-25
OR
-every 2-5 years before the earliest cancer dx in the family
**AD

593
Q

Lynch syn genes:

A

AD:
MLH1, MSH2, MSH6, PMS2, EPCAM

594
Q

Leading cause of chronic liver disease in US:

A

Hep C

595
Q

At what gestational age is a VAVD contraindicated?

A

prior to 34 weeks

596
Q

Best method for operative delivery if fetus is 33 weeks:

A

Forceps
*preferred for vaginal deliv if < 34 weeks

597
Q

Contents of cryo:

A

Factor VIII, Factor XIII
vWD, fibrinogen

598
Q

T score for Osteoporosis:

A

< - 2.5

  • -1 to -2.5 is low bone mass
599
Q

Does pregnancy change the course of HIV?

A

No
*no increase or decrease of HIV-related illnesses

600
Q

What factor can be tested for screening of vWD?

A

Factor VIII (it would be low if VWD present)

*vWF binds to Factor VIII and presents its degradation so def = degradation

601
Q

When prevalence changes, what else changes in a test:

A

*Pos and negative predictive values
*specificity and sensitivity do not change

602
Q

What is a short cervical length:

A

< 2.5cm

603
Q

What most value approximates the sensitivity of maternal serum AFP for the detection of an open neural tube defect:

A

open NTD: 65-80%
for anencephaly > 95%

*when it is elevated to 2.5 MoM or greater

604
Q

Risk of developing endometriosis if pt has a family history of endo:

A

if 1st degree relative> 7 to 10 x increased risk of developing endo!

605
Q

RFs for endo:

A

-early menarche before age 11
-shorter menstrual cycles
-heavy prolonged periods

606
Q

Incidence of endo in reproductive age

A

6-10%

607
Q

Management of cystotomy that is < 1cm vs > 1cm:

A

*< 1cm: conservative management/closure, 1-3 days of bladder decompression

  • > 1cm: Intraop closure of injury followed by bladder decompression for 7 to 10 days
608
Q

What suture has the strongest INITIAL tensile strength:

A

Absorbable synthetic suture
*highest required knot pull tensile strength at ANY size

609
Q

MC stage at diagnosis of endometrial cancer:

A

Stage I
*MC gyn malignancy and is dx at stage I in 73% of patients

610
Q

Stage of endometrial cancer that is < 50% myometrial invasion:

A

Stage IA

611
Q

Stage of endometrial cancer that is > 50% myometrial invasion:

A

Stage IB

612
Q

Stage of endometrial cancer that invades the cervix:

A

Stage 2

613
Q

Stage of endometrial cancer that invades the ovary and uterine serosa

A

Stage 3A

614
Q

Stage of endometrial cancer that invades the vaginal parametrium:

A

Stage 3B

615
Q

Stage of endometrial cancer that invades the para-aortic LNs:

A

Stage 3C2

(2 words: para-aortic = C2)

616
Q

Stage of endometrial cancer that invades the pelvic LNs:

A

Stage 3C1

(1 word = pelvic = C1)

617
Q

Dx of chronic pelvic pain, assoc w dysuria w negative urine cultures:

A

Interstitial cystitis or painful bladder syndrome (PBS)

*Hunner’s ulcers are pathognomonic

618
Q

Tx of interstitial cystitis:

A

dietary changes (avoid acidic, alcohol, soda, spicy foods, artificial sweeteners) and pentosan polysulfate sodium (Elmiron)

*Elmiron is the only FDA approved oral drug for IC

619
Q

This is universal finding on MRI in a pt with eclampsia:

A

Parietal and occipital lobe edema (PRES)

*hallmark: Hyperintense T2 lesions representing edema in the subcortical and cortical regions of the parietal and occipital lobes (edema in the white and gray matter junction)
*reversible findings!

620
Q

10 year CVE risk and who should start a statin?

A

risk < 5%: occasionally
Risk 5 to 7.5: often should be
Risk > 7.5%: DEFINITELY!!!

*CVE takes into account, age, sex, BP, smoker, total cholesterol, HDL, LDL, h/o DM, HTN meds

621
Q

Isotonic liquid medias:

A

NS, Mannitol, LR

622
Q

Hypotonic fluid that can be used with monopolar energy:

A

Glycine, glucose, dextrose

623
Q

What are the two fluid medias that have electrolytes and cannot be used with monopolar energy?

A

Normal saline and LR
*isotonic and + electrolytes

624
Q

Contraindications to breastfeeding in US:

A
  1. Infant galactosemia
  2. HIV (even if VL 0, also NOT CI in developing countries)
  3. Human Tcell lymphoblastic virus I and II
  4. Current illegal drug use or alc use
  5. active untreated TB (airborne transmission w close contact w infant)
  6. methotrexate

*hep B and C are NOT contraindications!

625
Q

When should colorectal screening start (USPSTF)

A

45 year old

626
Q

Branches of the posterior division of the internal illiac artery:

A

I Love Sex
-iliolumbar
-lateral sacral
-superior gluteal

627
Q

Branches of the anterior portion of the internal iliac artery:

A

8
1. Superior vesicle (obliterated umbilical)
2. obturator
3. inferior vesicle
4. middle rectal
5. internal pudendal
6. inferior gluteal
7. uterine > vaginal

SO IM [IP] IGU(V)
[ ] lesser foramen

628
Q

What artery goes through the lesser sciatic foramen

A

*internal pudendal

629
Q

What arteries go through the greater foramen?

A

Superior gluteal (post division)
inferior gluteal (ant division)
internal pudendal (ant division)

630
Q

Lyphmatic drainage of the upper 1/3 of the vagina:

A

Iliac

631
Q

Lymphatic drainage of the middle 1/3 of the vagina:

A

Hypogastric/internal iliac

632
Q

Lymphatic drainage of the lower 1/3 of the vagina:

A

Inguinal LN

633
Q

What is the vaginal arterial supply

A

Upper: cervical branch of uterine (cuff bleeding)
Middle: inf. vesicle
Lower: internal pudendal and middle hemorrhoidal

634
Q

What nerves are associated with perineal pain?

A

S2, S3, S4

635
Q

Where does the herpes virus reside and in what phase?

A

LATENT phase in the DORSAL ROOT GANGLIA of S2 - 4

636
Q

Tx of chlamydia:

A

Doxycycline 100mg BID x 7 days

637
Q

Tx of Lymphogranuloma Venereum

A

Doxycycline 100mg BID x 21 days

*CT L1, L2, and L3 serotypes

638
Q

Dx for Lymphogranuloma venerum:

A
  1. culture (of drainage)
  2. complement fixation ab titer (MC method). if titers > 1:64 then active infection

**DON’t DO FREI SKIN TEST (low sens)

639
Q

Tx of Chancroid (H. Ducreyi)

A

Erythromycin base x 7 days

640
Q

How long into a maternal code is a c/s indicated?

A

4-5 minutes of arrest

641
Q

Next step for 21yo w ASCUS:

A

either reflex HPV or repeat cytology ONLY in 12 months

642
Q

1st line tx for complicated UTI

A

Floroquinolone

*macrobid doesn’t achieve high levels outside of bladder

643
Q

Tx of HSIL pap if > 25 yo

A

colpo or excisional procedure

*if under 25 –> Colpo

644
Q

What induration is pos for a TB skin test if immunocompromised?

A

5 or more mm induration

645
Q

What induration is considered pos on a TB skin test for IV drug users, moved/working/living in HR area, < 4 yo

A

10 or more mm

646
Q

What induration is considered pos for a TB skin test if there are no known risk factors?

A

15 mm or more

647
Q

How is the dx of inflm breast cancer mainly made?

A

Clinically!

648
Q

What happens to angiotensinogen during pregnancy?

A

Elevated estrogen > elevated angiotensinogen > maintains BP (esp during 1st trimester)

649
Q

Explain the Renin-Angiotensin casade:

A

Kidney and liver release angiotensinogen. ACE converts angiotensinogen I to II which increases aldosterone secretion by the adrenal cortex > stimulates Na and H2O absorption by the nephrons

650
Q

At what gestational age does iodizing radiation have an all or nothing effect on a fetus?

A

before implantation: 0-2 weeks after conception or 2-4 weeks GA

651
Q

What is the best next step in a pregnant pt with HAs and a macroadenoma?

A

Visual field testing – do this to determine if imaging needed
-HAs are common!

652
Q

Risk of PID in pt with IUD in place?

A

< 1%

*same as if no IUD in place
-tx infection withOUT removing IUD

653
Q

Tx of maternal varicella at term?

A

Oral acyclovir within 24 hours
-Don’t need to deliver ASAP

654
Q

What type of suture is Mersilene (for cerclage)

A

uncoated polyester

*low inflm response

655
Q

MC cause of vaginal bleeding in patients with tamoxifen

A

polyps
-do SIS

656
Q

What is the most reliable characteristic of the placenta detaching in the 3rd stage of labor?

A

umbilical cord lengthening

657
Q

When should twin to twin transfusion syndrome screening start in monochorionic twins?

A

16 weeks and recur every 2 weeks

658
Q

Tx for heterozygous factor V Leiden in pregnancy?

A

No tx
only tx if personal h/o VTE

659
Q

Daily intake of vit D in pregnancy?

A

600 IU

660
Q

prevalence of uterine sarcoma during a surgery for a presumed leiomyoma:

A

0.05 to 0.28%

*rare but relevant risk

661
Q

Effect on fetal thyroid if mom exposed to radioiodine < 12 weeks GA?

A

Probably nothing bc fetus doesn’t make thyroid hormone until 12 weeks

*if after 12 weeks: fetal thyroid would concentrate the iodine and destroy the gland > hypothyroidism

662
Q

Dx if negative low dose dexamethasone test and pos high dose dexamethasone test for pt with Cushing’s d/o?

A

*pituitary tumor

-the high dose DOES stop the pituitary from making cortisol so the hormone is being made at the level of the pituitary gland

663
Q

After delivery, when is the uterus no longer palpable on exam?

A

no longer palpable at 2 weeks

*at pre-pregnancy wt/size at 4 weeks (100g)

664
Q

Fetal and maternal complications associated with inadequately treated hypothyroidism in pregnancy:

A

–spontaneous abortion
-low birth weight/preterm delivery
-neurodevelopmental delays
-placental abruption/fetal demise
-PreE/gHTN

665
Q

Fetal association seen with Graves disease:

A

Fetal thyrotoxicosis

666
Q

What is the MC complication following gyn laparoscopic surgery?

A

Bleeding complications

667
Q

The plt inhibition function of NSAIDs is mediated by what?

A

COX1

*COX2 is inflammation

*also reversible inhibition. ASA is IRREVERSIBLE

668
Q

What are the strongest predictors of bone fracture?

A
  • age
    -h/o prev low impact bone fracture
    -bone mineral density
669
Q

Relative contraindications to methotrexate use for ectopic?

A

-cardiac activity
-high bHCG
-ectopic > 4cm
-refusal of blood transfusion

*all relative contraindications

670
Q

Baseline prevalence of NTD in the US:

A

5 in 10,000 live births, stillbirths, terminations

*1 in every 2,250 “ “

671
Q

Next best step when intrauterine adhesions are suspected?

A

HSG

672
Q

Cut off value for Ca125 in postmenopausal women?

A

35

673
Q

Action of hormone activin (HPO axis)

A

increases FSH

674
Q

action of hormone follistatin (HPO axis):

A

inhibits FSH production
(STAT - inhibits)

675
Q

Action of hormone inhibin:

A

inhibits FSH

676
Q

Action of hormone leptin?

A

Regulated eating behavior - often asked!!!
this will be LOW in anorexia

677
Q

Action of hormone ghrelin?

A

Stimulates growth hormone (GHrelin = GH = growth hormone)

678
Q

What is Fontan circulation?

A

univentricular heart
*fontan operation performed in infants born w univentricular circulation. Prolongs life, reduces risk of PAH, can still be at increased risk for PAH compared to general population

679
Q

Definition of pulmonary HTN (PAH):

A

Mean pulm arterial pressure > 25mmHg at rest
-high risk of maternal morbidity/mortality if pregnancy occurs

680
Q

Absolute contraindications to UAE:

A

Pregnancy
Asymptomatic fibroids
Uterine malignancy
PID

*relative c/i: postmenopausal, desire for future pregnancy, c/i to radiologic contrasts, subserosal or submucosal fibroid w a thin stalk, large vol fibroids

681
Q

Rome criteria dx for IBS:

A

recurrent abdominal pain on at least 1 day per week on avg for 3 months w 2 or more:
-improvement w defecation
-assoc w a change in stool freq
-associ w change in stool form

682
Q

Definition of immediate postpartum IUD placement:

A

Insertion within 10 minutes of delivery of the placenta

*Early is > 10 minutes and < 1 week PP
*Delayed is 1 week to 6-8 weeks
*interval is not related to timing of delivery

683
Q

Rare of postplacental expulsion of levonorgestrel IUDs vs copper IUDs

A

Levonorgestrel IUDs have 2 fold increased expulsion rate

684
Q

What is a normal pCO2 on umbical artery values?

A

49 +/- 8 (41-57)

**if High > respiratory acidosis

685
Q

When do you add ampicillin for endometritis tx?

A

If known GBS colonization or if initial tx failure w gent/clinda and no improvement in 48 to 72 hours

686
Q

Diagnostic gold standard or PE, regardless of pregnancy?

A

Spiral CT

687
Q

Top 3 vaginal infections associated with preterm birth:

A
  1. Bacterial vaginosis (stronger if detected early in preg, before 16 weeks)
  2. Neisseria gonorrhoeae
  3. Asymptomatic bacteriuria
688
Q

Tx of primary syphillis:

A

Benzathine PCN G 2.4 million units IM x 1

*only desensitization if rxn: urticaria, angioedema, anaphylaxis, bronchospasm, hypotension and pos skin test testing

*maculopapular rash is not a reason to have desensitization

689
Q

What is the most common etiology of nonimmune hydrops?

A

Cardiovascular abnormalities
(structural, arrhythmias, cardiomyopathies, cardiac tumors, vascular abnormalities)

*infectious is NOT the mc cause

690
Q

What is the upper limit of vit D that is safe to take in pregnancy?

A

up to 4,000 IU

*vegetarian dose: 1000-2000IU
*rec daily intake in preg: 600 IU

691
Q

At what gestational age is nuchal translucency measurement most sensitive in screening for aneuploidy?

A

13 weeks

692
Q

BMI of class I obesity:

A

30 - 34.9 kg/m2

693
Q

BMI of class II obesity?

A

35 - 39.9 kg/m2

694
Q

BMI of class III obesity?

A

40 kg or higher

695
Q

BMI of overweight:

A

25 to 29.9 kg/m2

696
Q

What is the most common karyotype of a partial mole?

A

69 XXX
**girls girls girls rule the world!!!
*can be 69XXX, 69XXY, or rarely 69XYY

697
Q

how much does a personal history of a VTE increase the risk of VTE in pregnancy?

A

3-4 fold

(3.5 times)
Other risks: obesity, HTN, DM, smoking, hypercholesteremia

698
Q

most common cause of mild to moderate poly and most common cause of severe poly?

A

mild to moderate: idiopathic (MVP 8-15.9, AFI 24 to 34.9)
severe: fetal anomalies (MVP > 16, AFI 35 or greater)

699
Q

Management of pts taking ACE-I prior to surgery:

A

hold for 24 hours before surgery to reduce the risk of periop hypotension
-if d/c have a lower risk of all-cause mortality, MI, or stroke when compared to those who continue it

700
Q

Rec for cleaning vaginal probes between pts:

A

-wipe gel, rinse w soap/water, soak FOR 2 MINUTES IN 500 PPM CHLORINE, rinse again, air dry

701
Q

Does functional residual capacity increase or decrease in pregnancy?

A

decrease!

*the amount of air remaining after a normal exhalation

702
Q

Does inspiratory capacity increase or decrease in pregnancy:

A

increase!

*the max amount of air that can be inhaled

703
Q

Which pulm function parameters in pregnancy stay the same?

A

-Forced expiratory volume in 1 sec (FEV1)
-Forced vitals capacity (FVC)
-FEV1/FVC ratio
-Peak expiratory flow rate

704
Q

MC cause of post op fever occurring 3-5 days after surgery?

A

UTI

Causes of post op fever:
*wind (1-2 d) , water (2-5 d), wound (5-7 d) walking (5 + day), wonder drugs (anytime)

705
Q

Average risk of GTN following uterine evacuation?

A

15%

(after tx of a complete mole)

can be 35% if high ris w any of these: HCG > 100,000, theca lutein cysts > 6cm, enlarged uterus

706
Q

MC way to contract toxoplasmosis:

A

undercooked pork and lamb products

707
Q

Antibiotics requirements in ob D&C or D&E?

A

Doxycycline 200mg

708
Q

Contraindications for COCs:

A
  • > 35 yo and smoke
  • high BP or h/o stroke
  • h/o heart attack
  • h/o DVT
  • h/o migraines w aura
  • breast cancer or h/o breast cancer
709
Q

1st line tx for complicated cystitis:

A

Fluoroquinolones (complicated cystitis: dm, renal anomalies)

Doses: cipro 500 mg BID, levo 750mg PO QD, Cipro XL 1000mg PO 7 - 12 days

710
Q

Most common drug associated with acute pancreatitis?

A

Thiazides!
-acetaminophen, metronidazole, fibrates, statins, clomiphene, premarin, ACE-I, omeprazole

711
Q

Rec to prevent postop VTE in a moderate risk pt:

A

Anticoag:
-low dose UFH: 500-u q 12
-LMWH: 2500 u dalteparin or 40mg lovenox OD
-compression stockings

712
Q

Initia

A
713
Q

Initial management of a patient with eclampsia:

A

-left lateral decubitus position
-administer supplemental O2 via nonrebreather
-raising padded bed rails
-monitor vital signs

714
Q

MC location of endometrial implants after a TLH with BSO:

A

large and small bowel

*recurrent rate of 15%

715
Q

How long should oxytocin be administered after membrane rupture before a pt is diagnosed with a failed IOL after ROM?

A

12 - 18 hours

Criteria for failed IOL:
1. up to 24 hours of longer of attempts to induce labor
2. amniotic membranes ruptured
3. 12 - 18 hours of oxytocin administration after membranes ruptured

716
Q

Definition of active phase arrest:

A

6 or more cm dilated and ROM w no cervical change:
1. after 4 hours of adequate ctx (MVU > 200) OR
2. after 6 hours of inadequate ctx

717
Q

Maternal consequences of inadequately treated hyperthyroidism:

A

preE and heart failure

Neonatal:
-low birth wt
-iatrogenic PTB
-IUFD

718
Q

Best timing of menstrual cycle to have a dx hysteroscopy?

A

Early follicular phase

-avoid menses/bleeding
-secretory/luteal phase will be confusing 2/2 thick lining

719
Q

HPV is associated with what percentage of cervical cancers?

A

91%

**ALMOST ALL OF THEM!!!

720
Q

Exercise recommendation for postpartum patients?

A

moderate intensity aerobic exercise for 150 minutes weekly

721
Q

What type of cancer does hormone replacement therapy actually decrease?

A

Colorectal cancer

722
Q

Risk of VTE in pregnancy or postpartum state if heterozygote for FVL and personal h/o VTE:

A

10%
*FVL is the MC inherited thrombophilia
*if no personal h/o of VTE then 0.5 to 1.2% risk of VTE

723
Q

Most common side effect of lisinopril use in 1st and 2nd trimester:

A

Renal impairment!

**Anuria and oligohydramnios can be present in 50% of cases > pulm hypoplasia, resp disease

724
Q

How is vaginal cancer staged?

A

Clinically!
(cysto, proctoscopy, IV pyelo)

*PET can be useful in planning tx but not for staging

725
Q

Carrier frequency of FVL in White patients:

A

5.27%

726
Q

Positive predictive value for fetal fibronectin for pts 24 to 34 weeks gestational age with ctx:

A

30%

*low positive predictive value, high negative predictive value (99%)

727
Q

This can predict ovulation prospectively:

A

Urine LH tests (pos 36 hours before the oocyte is released)

*Basal body temp, prog level: all pos after ovulation

728
Q

Percentage of patients that have xerostomia while taking oxybutynin for urge incontinence:

A

30%

(dry mouth)

729
Q

Optimal interpregnancy interval:

A

18 months

730
Q

Pruritic, purple papules, painful vaginal mucosal erosions with white lacy wickham striae. + extragenital lesions, + vaginal involvement:

A

Lichen planus

    • risk of squamous cell carcinoma
731
Q

Porcelain-white papules or plaques, thin/crinkling cigarette paper skin, fusion of labia minora. Rare extragenital lesions, no vaginal involvement:

A

Lichen sclerosus

*+ risk of SCC

732
Q

Thick, leathery skin, pruritic plaques and excoriations, + extragenital lesions, no vaginal involvement

A

Lichen Simplex Chronicus

  • no risk of SCC
733
Q

US findings of congenital varicella:

A

-fetal hydrops
-hyperechogenic foci in liver/bowel
-cardiac malformations
-limb deformitis
-microcephaly
-FGR

734
Q

What virus is congenital hearing loss associated with?

A

CMV

735
Q

What virus is associated with periventricular calcifications and placentomegaly:

A

Toxoplasmosis

736
Q

Tx of gonorrhea if cephalosporin allergy

A

240mg IM gentamicin + 2g oral azithromycin once

737
Q

systemic steroids and vulvar psoriasis:

A

Systemic steroids may cause a REBOUND flare-up

-vulvar psoriasis does not involve the vagina, and ppl do have lesions elsewhere

738
Q

MOA of ulipristal acetate:

A

inhibits follicular rupture

*levonorgestrel pills DELAY follicular development (not rupture)

739
Q

MOA of COCs as emergency contraception:

A

inhibiting ovulation

740
Q

MOA of copper IUD for emergency contraception:

A

affects sperm viability

741
Q

What is the risk of concurrent high risk uterine carcinoma in women w a biopsy of EIN:

A

10%

742
Q

How much of the endometrium is sampled during EMB?

A

5-15%

743
Q

What is the definition of pelvic engagement?

A

Passage of the widest presenting part in vertex position, when the BPD passes through the pelvic inlet

744
Q

At what plt count should medical treatment for ITP be started if pt is asymptomatic and approaching scheduled repeat c/s

A

less than 50,000

745
Q

When to treat ITP?

A

-symp (epistaxis or bruising) - regardless of plt count
-plt count < 30,000 even if asymptomatic
-prior to epidural or spinal anesthesia (plt > 70,000)
-prior to c/s (plt > 50,000K)

746
Q

What is treatment if ITP (Immune thrombocytopenic purpura)

A

First line:
-Glucocorticoids, IVIG (if steroids are contraindicated)

2nd line: rituximab, Thrombopoietin receptor agonists, immunosuppressive therapy, anti-D immunoglobulin

Refractory: Splenectomy

Emergency: plts transfusion

747
Q

The risk of fetal structural congenital anomalies increase among obese women with the exception of what:

A

Gastroschisis - this is actually reduced!
(**Just think there is more fat on the baby or something!)

748
Q

What is the effect of cell free DNA results on obesity?

A

MC to have test failures of “no-call” results

749
Q

most likely HSC fluids to cause hyponatremia?

A

3% sorbitol and 1.5% glycine
-both hypoosmolar

*need preop, intraop and 4 hour post op serum sodium levels if these are used!

750
Q

When does a DEXA scan need to be ordered:

A

AGE 65!!!

751
Q

percentage of frank virilization with Sertoli-Leydig tumors?

A

30-35%

*this is a sex cord stromal tumor that originates from the ovarian matrix
-avg age is 25 yo
-unilateral, 50% of pts have abdominal pain or palp mass, 1/3 have virilization, additonal 10% have signs of androgen excess

752
Q

Tx of a sertoli-leydig tumor:

A

-removal for definitive tx
15-20% are malignancy

**3-7cm solid tumor, multilocular tumors w mixed areas, purely solid areas, and tightly packed small cyst locules

753
Q

This neurotransmitter binds to M3 muscarinic receptor for bladder contraction:

A

Acetylcholine

Ach binds to M3 receptors > bladder ctx/increased pressure on urethra

*inhibitory input to urethral smooth muscle by NO for bladder relaxation

754
Q

Most common histological cell type of endometrial cancer

A

Endometrioid adenocarcinoma

755
Q

When to restart ppx anticoagulation after a c/s vs vaginal delivery:

A

C/S: 6-12 (if neuraxial/spinal: 24 hours)
Vaginal delivery: 4 to 6

756
Q

This Mullerian anomaly has the greatest risk of miscarriage and is the most common:

A

Septate uterus

*miscarriage rate > 60%, accounts for over 80% of anomalies among pts w RPL

757
Q

What hormone inhibits alpha-lactalbumin (main stimulator of lactose synthase)

A

Progesterone
(also inhibits prolactin)

*when progesterone decreases after delivery > these hormones inc milk production

758
Q

Management of exposure to rubella in pregnancy if unvaccinated:

A

-watched carefully
-if sxs develop> maternal serum testing and amnio

**80% of women w rubella infx in first 12 weeks of pregnancy have an affected fetus, 25% if end of 2nd trimester

759
Q

Most common cause of respiratory distress in a patient with pyelo?

A

ARDS

*endotoxin related injury (completely reversible)

760
Q

Prevalence of T2DM if women over the age of 30 with PCOS?

A

12%

*glucose intolerance is 40% if > 30 w PCOS

761
Q

Next best step in treating a patient with suspected septic abortion after a recent elective termination, after ensuring hemodynamic stability:

A

IV clindamycin900mg and gentamicin 5mg/kg IV

(or cefoxitin 2g IV q 6 hrs or cefotetan 2g IV q 12 hours + doxy 100mg PO/IV q 12)

*tx with broad spectrum abx while bringing patient to OR for suction D&C

762
Q

Percentage of shoulder dystocia in all vaginal deliveries?

A

0.2 to 3%

763
Q

This fetal finding is pathognomonic for CMV:

A

Petechiae

764
Q

Heat intolerance, excessive sweating, palpitations, diarrhea: hypo or hyperthyroid:

A

Hyperthyroid!!!

765
Q

Most likely to be a risk factor for developing endometritis:
-AMA
-GBS
-Precip labor
-Immediate spon. ROM
-C/S

A

C/S!!!
-complicates 5-35% of c/s deliveries

Others
-prolonged ROM
-GBS pos
-young age
-prolonged labor
-multiple vaginal exams
-low SES
-BV infections

766
Q

35 weeks in labor with GBS unk status. Management:

A

GBS ppx AND steroids
-Give for late preterm 34 to 36/6 to decrease resp morbidity. Don’t give tocolytics
*don’t give if DM or multi-fetal gestation

767
Q

This is multiple blisters that burst on gentle palpation:

A

Pemphigus vulgaris

*AutoAbs to desmogleins that are part of the desmosomes that hold cells together

Skin AND mucous membranes (Different than bullous pemphigoid(

Tx: oral/topical steroids

768
Q

Lesions due to auto-ab against hemidesmosomes that hold interstellar junctions to the basement membranes. Do not rupture w gentle palpation:

A

Bullous pemphigoid (BELOW the surface - not on the skin)
-do NOT rupture w gentle palpation

Tx: high-potency steroids

769
Q

When should HAART be given for postexposure ppx and for how long:

A

-more effective if given within 72 hours of exposure
-28 day course

770
Q

Electrolyte abnormality seen with massive transfusions:

A

Hyperkalemia!!!

-can also have hypocalcemia

*from packed RBCs and citrate

-hyperkalemia (tissue damage/hemolysis)
-hypocalcemia due to citrate toxicity
-metabolic acidosis 2/2 LA and dec removal of citrate
-hypothermia
-TRALI

771
Q

What is the most commonly reported sentinel event?

A

Falls

Not delay in tx

772
Q

1st line medical tx for osteoporosis

A

bisphosphonates (after lifestyle modifications)

options: alendronate, risedronate, ibandronate, zoledronate

773
Q

What is considered successful tx of an ectopic pregnancy using the single dose protocol?

A

15% or more decline on days 4 to 7

then: follow weekly, and as along as 15% decline, surveillance can be continued
-if < 15%, repeat dose
*tx day is day 1

*the bhcg levels actually RISE during day 1 to 4 due to rupture in ectopic syncytiophoblasts

774
Q

What kind of vaccine in the HPV vaccine?

A

Viral capsid protein

775
Q

What is the percentage of endometriosis in couples with infertility?

A

40%

776
Q

Surgical staging for ovarian and fallopian tube cancers:

A

TAH, BSO, pelvic washings, peritoneal biopsies, paraaortic and pelvic LN dissection, partial/total omentectomy

*overall prognosis is improved if immediate surgical staging/debulking is performed by gyn onc

777
Q

Prevalence of DM in the US:

A

10.5%

778
Q

Stage II pelvic organ prolapse:

A

Leading point is -1cm to 1cm of the hymen!!!!

Stage 1: < -1cm
Stage III: > +1cm but not within TVL - 2
Stage IV: >/= TVL - 2

779
Q

Green nipple discharge:

A

Ductal ectasia (noncancerous)

780
Q

Bloody nipple discharge:

A

intraductal papilloma (noncancerous)

781
Q

What is used in the Gail Breast Risk model:

A

-age
-# breast bx done and presence of atypical hyperplasia
-# primary relatives w BC when age they had first child

Does NOT take into account: other cancers, 2nd degree + relatives, BC in paternal relatives

782
Q

Who has the highest RR of breast cancer using the gail breast risk model?

A

having 2 more more relatives with breast cancer who had their children young (20s)
Risk 6.88

783
Q

WHI showed that estrogen/progesterone increased what:

A

risk of breast cancer, clots/strokes, and heart attack

784
Q

WHI showed that estrogen/progesterone decreased risk of what:

A

colorectal cancer and risk of fractures

785
Q

What are the absolute contraindications for HRT?

A

-h/o breast cancer
-h/o endometrial cancer
-severe active liver disease
-hypertriglyceridemia
-thromboembolic disorders
-undiagnosed vaginal bleeding

786
Q

What is the Amsel criteria:

A

3 out of the 4 for dx of BV:
1. gray/white d/c
2. Vaginal pH > 4.5
3. Positive whiff test
4. at least 20% epithelial clue cells

787
Q

What is normal vaginal pH:

A

3.3 to 4.5

788
Q

Which type of yeast can be treated by any of the formulations?

A

C. albicans
*and MC

789
Q

What type of yeast is resistant to terconazole:

A

C. Parapsilosis

*terrified of parasailing

790
Q

What type of yeast is resistant to Nystatin?

A

C. Krusei

*tx w miconazole or clotrimazole

**don;t take Krusei at Nyght

791
Q

most common cause of death for 13 to 18 yo:

A

Accidents
#2 in 19 to 39

792
Q

Patient with what medical conditions should receive the pneumococcal vaccine between the ages of 19 and 64?

A

-alcoholism
-chronic lung/liver/heart disease
-DM
-SCD or other hemoglobinopathies
-Smokers
*also inc risk of meningitis, cochlear implants OR immunocompromised pts

793
Q

What is the hgb goal and HbS percentage goal for a pregnant patient with SCD?

A

Hgb 10 and HbS of 40%
*reduced incidence of sickle cell crisis

794
Q

Best option for a IOL of a stillbirth at 24 to 28 weeks GA with previous hysterotomy?

A

Mifepristone followed by vaginal misoprostol
*can use high dose oxy or misoprostol alone

795
Q

Treatment of pos TB skin test and neg CXR during pregnancy:

A

delay treatment to 2-3 months postpartum (if low risk)
isoniazid for 9 months

*if high risk (HIV, immunosuppressed, recent exposure, can tx during preg)

*this is latent TB

796
Q

Tx of active TB in pregnancy:

A

Isoniazid w B6 and rifampin for 9 months, +/- ethambutol

*pos skin test and pos CXR

797
Q

What is the most common stage at which endometrial cancer is diagnosed at?

A

IB
> 50% of the myometrium

73% of pts are diagnosed in stage I

798
Q

outpatient tx for PID

A

-ceftriaxone 500/1000mg IM x 1 dose (</> 150kg)
-Doxycycline 100mg BID x 14 days
-Flagyl 500mg BID x 14 days

799
Q

inpatient tx for PID:

A

cefoxitin 2g IV q 6 hours (or ceftriaxone or cefotetan) +
Doxycycline 100mg BID

until clinical improvement for 24 hours then transition to PO

800
Q

Who needs to be inpatient for PID tx:

A

-pregnancy
-severe clinical illness
-lack of response to oral abs
-TOA
-persistent N/V
-inability to adhere to therapy
-possible need for surgical intervention

801
Q

Most common presenting sxs of rhabdomyosarcoma?

A

vaginal bleeding!!

*mass at introitus is occasionally seen
Tx w VAC chemo (vincristine, actino-D, cyclophosphamide)

802
Q

Endpoints of septoplasty procedure:

A

-level line between tubal ostia
-bleeding
-increased vascularity
-serosal transillumination

803
Q

This is uncontrolled muscle clenching of the vaginal and perineum, interfering with sexual and vaginal penetration

A

Vaginismus

804
Q

This mullerian anomaly has the highest rate of 1st and 2nd trimester miscarriage of all the anomalies:

A

Uterine septum

805
Q

complication of banana-like uterine cavity w noncommunicating mass containing thick stripe similar to an endometrial lining?

A

This is a Class II Mullerian anomaly (unicornuate uterus) and risk of rupture of accessory horn at less than 20 weeks

*if pregnancy in the access horn

806
Q

Difference between complete vs LeFort Colpocleisis:

A

Lefort: retains some vaginal mucosa leaving lateral canals for drainage

Complete: Entirely removes vaginal mucosa tissue with NO canals

*increased likelihood of SUI following procedures

807
Q

Efficacy of OCP, depot leuprolide, and danazol for endometriosis

A

Lupron and Danazol have similar efficacy (gnrh agonist and antiestrogenic MOA)
-Better efficacy than OCPs

808
Q

discomfort arising in some individuals from the incongruence between gender identity and their external sexual anatomy at birth:

A

Gender dysphoria or gender identity disorder

809
Q

This medication inhibits aldehyde dehydrogenase:

A

Disulfiram

-pts feel fatigue, nausea, HA if relapse w alcohol

810
Q

1st line tx for alcohol dependence:

A

naltrexone and acamprosate

  1. opioid receptor antagonist
  2. modulates glutamate neurotransmission at M5G receptors
811
Q

most sensitive and specific US findings of ovarian torsion:

A

ovarian edema and relative enlargement of the ipsilateral ovary

812
Q

outcome of operative laparoscopy on livebirth rate or ongoing pregnancy rate compared w dx lap for endometriosis:

A

doubles the live birth rate

813
Q

Is bleeding into a vulvar hematoma usually arterial or venous?

A

Venous

814
Q

Management of a vulvar hematoma:

A

if stable: foley cath, ice pain, pain management

815
Q

Risk of placenta accreta w 3 prior c/s if no previa:

A

2%

No previa:
primary c/s: 0.24
1 prior: 0.31
2 prior: 0.57
3 prior: 2.13
4 prior: 2.33
5 or more: 6.74

816
Q

Tx for curative intent for central recurrence of cervical cancer in pts who previously had radiation therapy:

A

Pelvic exenteration

817
Q

Earliest age to give the meningococcal vaccine?

A

11-12 yo

818
Q

Management of a serosal bowel injury:

A

Single layer closure

819
Q

This is a repair of a ureter injury that is for a middle 1/3 injury, close to the pelvic brin. It encompasses the ureteral repair:

A

Boari flap

820
Q

This is a repair for the upper or middle 1/3 ureter and is end to end:

A

Uretero-uretostomy: end to end or spatulating (tension repair)

821
Q

This ureter repair is for an injury that is within the pelvic brim, 6cm or less from the bladder implantation:

A

ureteroneocystotomy

822
Q

This ureter repair mobilizes the bladder to the psoas muscle to reduce tension on the repair:

A

Psoas hitch

823
Q

Most common blood type:

A

O+

824
Q

Least common blood type:

A

ABneg

825
Q

Universal donor blood type:

A

O neg

826
Q

Universal recipient blood type:

A

AB pos

827
Q

Make up of whole blood:

A

55% plasma
1% WBC/plts
45% RBCs

828
Q

Factors that trigger extrinsic pathway:

A

damage to a vessel

829
Q

Tx for a pt presenting to the ED > 72 hours after a sexual assault:

A

-ceftriaxone, doxycycline, metronidazole
-emergency contraception
*no HIV ppx since > 72 hours
*hep B vaccine if not immune

830
Q

Components of functional status (capacity for surgery)

A

-nutritional status, eating, feeding
-continence
-transferring
-dressing
-bathing

831
Q

What is the most effective method used to prepare a stenotic cervix for HSC?

A

laminaria (more effective than misoprostol)

832
Q

This is an action done in the best interested of the patient:

A

Beneficence: providing the best tx for a pt regardless of ability to pay

833
Q

This is the right of a pt to make their own decisions without interference from other health care staff or family

A

Autonomy (ensuring they have a translator available if needed so they fully understand)

834
Q

Woman with POI 2/2 mutation in the FMR1 gene. What is the most likely # of CGG repeats she has?

A

55 to 200**

Fragile X premutation can present with premature ovarian insuff

*can transmit a full mutation to the next generation

835
Q

Does lisinopril increase urinary incontience?

A

Yes - dry cough > increases incontience

836
Q

Effect of haloperidol on incontinence:

A

dopamine receptor blockade weakens internal urethral sphincter

837
Q

MC cause of NON-mechanical small bowel obstruction:

A

small bowel adynamic ileus

838
Q

What is the total iron requirement for normal pregnancy?

A

1000mg

300 is what the fetus requires

839
Q

Risk of NTD if 1 parent with NTD:

A

4.5%

840
Q

Risk of NTD if 1 parent and 1 sibling affected?

A

12%

841
Q

Risk of NTD if 2 parents with NTD and no siblings:

A

30%

842
Q

Risk of NTD if 2 parents with NTD and 1 affected sibling:

A

33%

843
Q

This side of the coagulation cascade is the result of a disruption within the lumen of the vessel

A

intrinsic pathway

844
Q

What coagulation factor combines both the intrinsic and extrinsic pathway?

A

10

perfect 10

845
Q

MOA of heparin:

A

heprIN - thrombIN»

*direct thrombIN INhibitor

*effect on INdirect coagulation pathway

*binds factor Xa with AT3 inactivating the factor. The chain length is not long enough to bind thrombin

846
Q

What is monitoring for heprin?

A

PTT

TT and can make H (Heparin)

847
Q

What is the antidote for heparin:

A

Protamine sulfate

848
Q

Autoantibodies that are directed against endogenous plt factor 4 in complex with heparin > arterial and venous thrombosis

A

Heparin induced thrombocytopenia

849
Q

half life of heparin:

A

90 mins

850
Q

half life of LMWH

A

3-7 hours

851
Q

What lab is done to monitor LMWH

A

Anti-Factor Xa

852
Q

Where do flouroquinolones act at the cell level:

A

DNA gyrase

853
Q

Where in the cell does nitrofurantoin act:

A

DNA

854
Q

Where in the cell does rifampin act?

A

RNA polymerase

855
Q

Where in the cell does PCN, Vanc, Bacitracin, cephalosporins, carbapenems act?

A

Cell wall

856
Q

Where in the cell does chloramphenicol, macrolides, clinda, and linezolid act?

A

Ribosome 50s

857
Q

Where in the cell does aminoglycosides and tetracyclines act?

A

Ribosome 30s

858
Q

MOA of trimethoprim-sulfamethoxazole

A

Trimethoprim: inhibits reduction of DHFA to THFA
Sulfamethoxazole: competes w PABA to inhibit synthesis of DHFA

859
Q

These medications act at the level of the cell membrane:

A

antifungals
(polymixin, amp B, ketoconazole, triazoles, fluconazole, clotirmazole, terbinafine, 5-FU)

860
Q

Abx for vaginal sling placement:

A

Cefazolin

861
Q

This wound class is surgically sterile w/o exposure to GI/GU or foreign nonsterile debris:

A

Class I

*no antibiotics

862
Q

This wound class is clean contaminated (intentional controlled entry to GI/GU):

A

Class 2

*hysterectomy
*yes abx!

863
Q

This wound class is contaminated (acute inlm, nonsterile debrisin field)

A

Class 3 (clean contaminated)

*enterotomy
*yes abx

864
Q

This would class is dirty, infection (abscess management)

A

Class 4

*ruptured TOA
*yes abx!

865
Q

Type of shock: low PCWP, low CO, high SV:

A

Hypovolemic shock

866
Q

Type of shock: low SVR:

A

septic**
things are 3rd spacing

867
Q

Type of shock: low CO, high PCWP:

A

Cardiogenic

868
Q

This is the only point on the POP-Q that is not measured after a total hyst:

A

D!

869
Q

This measurement of popQ is measured in rest at supine position:

A

TVL

870
Q

This POP-Q has the least variability in measurement between providers:

A

gH

871
Q

Nerve injured with sxs: numbness of anteromedial thigh, weak external rotation, weak adduction:

A

Obturator, L2-L4
sensory & motor

freq: 20-30%

872
Q

Nerve injury w sxs: numbness to anteromedial thigh, weak leg extension, wea flexion of hip, absent knee jerk:

A

Femoral, L2-4
*sensory and motor

Freq: 11-30%

873
Q

Nurve injury: numbness/burning pain upper labia and thigh:

A

Genitofemoral, L1-L2
Sensory only

Freq: 17%

874
Q

Nerve injury: numbness foot/leg, foot drop, buttock pain, post/lateral leg pain:

A

lumbosacral/sciatic, L4- S3
*sensory and motor

Freq: 10%

875
Q

Nerve injury: sharp, cutting pain, usually delayed pain lower ab:

A

ilioinguinal/iliohypogastric, T12-L1
*sensory

Freq: 7%

876
Q

Nerve injury sxs: numbess, lateral thigh or hyperesthesia:

A

Lateral femoral cutaneous, L2-L3
Sensory

Freq: 6%

877
Q

What is the goal of BP reduction in the first 2 hours after HTN emergency?

A

-10-15% over 30-60 mins
and continued reduction over next 23 hours

if pt starts at 200, goal = 170-180

*a bigger decrease will cause hypoperfusion

878
Q

Treatment of transfusion related citrate toxicity:

A

Calcium chloride OR calcium gluconate

*citrate causes hypocalcemia

879
Q

Management of subclinical hypothyroidism (nml T4, elevated TSH):

A

repeat tests in 1-3 months

*if TSH > 15, repeat in 1-2 weeks

Tx controversial/considered if repeat testing is the same (can tx if preg)

880
Q

1st line tx of uncomplicated UTIs:

A

Nitrofurantoin or TMP-SMX

*complicated will be fluoroquinolones

881
Q

What is the hepatitis screening test performed in all pregnant patients?

A

Hep B surface antigen
*pos in acute and chronically infected pts

882
Q

What hepatitis B lab will be positive if a pt is immune due to vaccination?

A

Anti-Hep B surface

883
Q

What is the most common symptom of coronary artery disease in women?

A

Chest pain

884
Q

What is the most serious long term complication associated with VAVD:

A

intracranial hemorrhage

**most serious –bleeding into the brain may lead to permanent death or damage

885
Q

What is the best imaging modality for a suspected urethral diverticulum?

A

MRI

886
Q

most common food borne pathogen causing nonbloody diarrhea?

A

S. Aureus

887
Q

Definition of midforceps:

A

fetal station above +2

888
Q

Management of pt at 18 weeks gestation withOUT a h/o preterm birth and an incidentally found shortened cervix:

A

Nightly vaginal progesterone

*if h/o PTB, US indicated cerclage

889
Q

5 year failure rate of pp tubal and levonorgestrel IUD:

A

PP tubal: 6.3 per 1000
L-IUD: 5-11 per 1000

890
Q

What is the limiting dimension of the pelvis?

A

Interspinous diameter
*distance between ischial spines (smallest dimension of the female pelvis)

891
Q

Risk of uterine rupture in patients with a single low transverse c/s:

A

0.5%

1-2% if h/o 2 prior c/s deliveries

892
Q

What is the best diagnostic modality for identifying the location of a fistulous tract between the bladder and vagina?

A

Cystourethroscopy

-directly visualizes the abnormality and assesses the bladder
*dye test can confirm its presence

893
Q

Most important risk factor for development of epithelial ovarian cancer in the general population:

A

Age

894
Q

Definition of pregnancy that is 41/0 to 41 6/7:

A

Late term

**postterm is at 42/0 and beyond

895
Q

What comorbidities is a pt with PCOS at risk for?

A

T2DM
OSA!!!
HLD
metabolic syndrome
NAFLD

896
Q

Treatment of fever, pain at incision 7 days post hyst:

A

Vanc (likely cellulitis)

897
Q

What are the ONLY two indications for testing for thrombophilia:

A

personal h/o and 1st degree relative w inherited thrombophilia

898
Q

Management of HELLP

A

Proceed w immed

899
Q

Management of HELLP:

A

Proceed w immediate delivery
-don’t wait for steroids

900
Q

Affect of neuraxial analgesia on herpes:

A

Can reactivate oral herpes

*maybe due to irritation of trigeminal nerve from facial scratching due to neuraxial opioid-induced pruritus

901
Q

What is dull/dense white epithelium a finding consistent with on colpo using acetic acid?

A

high grade dysplastic lesions

-also SHARP/Straight (not feathery)
-coarse, dilated, nonuniform vessels

902
Q

What is the rate of PTB in twins?

A

60%

903
Q

Most common site of metastatic GTN:

A

lung - 80%

904
Q

What is the gold standard for screening for Cushing syndrome?

A

24 hour free cortisol

905
Q

Intrapartum management of pulm hypertension?

A

avoid hypotension, vol depletion, hypoxemia (cont pulse ox >90%)

906
Q

How long can conservative management w no improvement for a SBO ocur before surgical management is recommended?

A

5 days!

907
Q

Pt > 26 yo w pos ECC showing high grade dysplasia:

A

Excisional procedure

908
Q

Who is able to get a physical exam indicated cerclage?

A

no prior PTB: if digital/speculum exam reveals cervical dilation (1-4cm_ < 24 weels

Prior PTB if digital/speculum reveals cervical dilation < 24 weeks

*Dilation is 1-4 cm

909
Q

Who is a candidate for a US based cerclage?

A

no prior PTB: CL < 10mm before 24 weeks

Prior PTB: CL < 25mm before 24 weeks

910
Q

Prevalence of IPV in pregnancy:

A

5 to 20%

911
Q

Closure of a active wound infection:

A

secondary closure

912
Q

What increases the risk of sudden cardiopulmonary arrest in a pregnant pt with Eisenmenger syndrome?

A

Hypotension

*anything that causes a reduction in preload
*pt have a 50% risk of dying during their pregnancy

913
Q

1 year failure rate of Mirena:

A

0.2%

914
Q

Describe the normal physiologic events during the menstrual cycle that are responsible for the development of fibrocystic change in the breast:

A

Theca externa producing large amounts of progesterone to stimulate glandular growth

915
Q

This gives rise to the bladder (except trigone), the bulbourethral glands, the urethra, and the lower 2/3’s of the vagina

A

Urogenital sinus

916
Q

This gives rise to the oviducts, uterus, and upper 1/3 of the vagina:

A

Paramesonephric ducts

917
Q

Best next step in a newborn born with enlarged clitoris:

A

Electrolyte testing!!!

-ddx: CAH

*would have an elevated 17-hydroxyprogesterone but that is not the next best step!

918
Q

Unique complication of presacral neurectomy:

A

Urinary retention and constipation

*Temporary -urinary retention resolves in 1to 2 weeks, constipation in 6 wks
**NOT life threatening hemorrhage

919
Q

Does multiparity increase or decrease the risk of cervical cancer?

A

INCREASE
(early age at first birth, increased parity > increased exposure to HPV)

920
Q

Incidence of twin gestation in the US

A

33 in 1,000 births

921
Q

Should you do manual extraction of retained POC of a septic abortion in the ED?

A

No- high risk for hemorrhage, stabilize, start antibiotics, and take to OR

922
Q

This is the pregnancy rate following excision of an endometrioma:

A

56-65%

Excision: 60%, drainage/ablation = 23%

923
Q

Tx of gonorrhea and chlamydia if pregnant:

A

Ceftriaxone and azithromycin (not doxy)

924
Q

What branches are the most commonly injured in a vulvar hematoma:

A

branches of pudendal artery
-inferior rectal
-transverse perineal
-posterior labial

925
Q

Diagnostic step in diagnosing premenstural syndrome:

A

symptom diary
-should have sxs 5 or more days prior to onset of menses and resolve within 4 days after onset of menses

926
Q

Treatment of breast abscess in the setting of mastitis:

A

I&D - treat the ABSCESS!!!

*also suspect if tissue is fluctuant or if pt’s sxs do not improve after 2-3 days of tx

*can tx w Vanc of Trimethoprim-sulfamethoxazole (dicloxacillin when no abscess)

927
Q

Risk of breast cancer if mother/sister with breast cancer?

A

Increased relative risk of 2.6%

928
Q

GA and cervical dx to define preterm labor:

A

regular uterine ctx w cervical change (effacement or dilation) or regular ctx w cervical dilation of at least 2cm on initial presentation at 20/0 to 36 6/7

929
Q

Failure rate of ParaGard for typical use vs perfect use in 1st year:

A

Typical use: 0.8
Perfect use: 0.6

930
Q

Failure rate of Levonorgesterol IUD for typical use vs perfect use in 1st year:

A

Typical use: 0.2
Perfect use: 0.2

931
Q

Failure rate of Implant for typical use vs perfect use in 1st year:

A

Typical use: 0.05
Perfect use: 0.05

932
Q

MC type of epithelial ovarian cancer:

A

Serous!!!
Serous cystadenocarcinoma is the MC type of ovarian cancer

933
Q

When to start OCPs after delivery:

A

4-6 weeks (due to effect on milk supply and increased risk of VTE)

934
Q

Hormone involved in hyperandrogenism in PCOS:

A

LH!!

inc peripheral estrogen > decreased FSH, inc LH

935
Q

Treatment of asymptomatic bacteria vaginosis in pregnancy:

A

NO TREATMENT in pts without a h/o preterm birth

*asymp women should NOT be screened for BV and tx is NOT recommended

936
Q

Max intraabdominal pressure allowed in order to ensure central venous return and diaphragmatic excursion during laparoscopic surgery:

A

20-24mmHg

standard is 12mmHg

937
Q

if a pt with a known BRCA2 mutation undergoes a ppx BSO, how much is her risk of epithelial ovarian cancer reduced by?

A

80% for ovarian cancer

40-100% for breast cancer
70% for all cause mortality

*all BRCA carriers

938
Q

What stage are most epithelial ovarian tumors diagnosed in?

A

Stage III

939
Q

What is the safest entry point in a pt with numerous pelvic and abdominal surgeries?

A

Palmer’s point

940
Q

What is the percentage of DM among adults in the US?

A

14.8%

941
Q

What strain of HPV is most commonly associated with cervical adenocarcinoma?

A

18!

16 is more common w squamous

942
Q

What ethnicities are MOST likely to have a Rhesus negative blood type?

A

White! ME!

943
Q

Risk of uterine rupture during labor in a pt w a h/o prior classical hysterotomy scar?

A

1-12 %

944
Q

Most common presenting sxs of fallopian tube cancer?

A

Hydrops tubae profluens (copious serosanginous vaginal discharge)

945
Q

Tx of CIN I if > 24 yo and not pregnant:

A

1 year f/u

946
Q

Tx of CIN II if > 24 yo and not pregnant:

A

excisional procedure

947
Q

tx for CIN II if > 24 yo and concern for pregnancy:

A

colpo and HPV based testing at 6 adn 12 months

948
Q

Tx of CIN III if > 24 yo and not pregnant:

A

Excisional procedure

949
Q

Thermal spread of monopolar vs bipolar energy:

A

monopolar 3.5mm
bipolar 2mm

950
Q

Malignant features on the IOTA US rules for adnexal masses:

A

-Irregular solid tumor
-ascites
-4 or more papillary structures
-irregular multilocular solid tumor w greatest diameter of 10 or more cm
-very high color content on Doppler

951
Q

MOA of methimazole:

A

inhibits thyroid peroxidase

952
Q

Use of OCPs in pts with SLE:

A

Don’t do it!!!

SLE pts have an increased risk of heart disease, stroke, VTE

*don’t give if APA pos or unknown status. Need to test for antiphospholipid antibodies before starting hormonal contraception

953
Q

Tx of acute/early/mild hidradenitis suppurativa:

A

Topical clindamycin (1st line)
-oral tetracyclines
-warm compresses
-intralesional corticosteroids
-surgically unroofing lesions

954
Q

Tx of chronic hidradenitis suppurativa:

A

(scarring w fistulous tracks) > Wide operative excision

955
Q

wt gain in pregnancy if underweight (BMI < 20)

A

28 to 40 lbs

956
Q

wt gain in pregnancy if normal BMI (20-25)

A

25 to 35 lbs

957
Q

Wt gain in pregnancy if overweight (BMI 25-30)

A

15-25 lbs

958
Q

Wt gain in pregnancy if obese (BMI > 30):

A

11- 20 lbs

959
Q

Novasure (radiofrequency) can be used if there is a submucosal fibroid of what size?

A

3cm or less

*must sound to at least 6cm, no more than 10cm (Ut length 4cm)
*uterine width 2.5cm or greater

960
Q

What muscles make up the perineal body?

A

superficial transverse perineal muscles
bulboCAVERnousos
external anal sphincter

961
Q

When does a fever occur during alcohol withdrawal?

A

48-96 hours after last drink

962
Q

When do the decidua parietalis and decidua capsularis fuse?

A

At 3 to 4 months gestation

*the decidua capsularis (covers the blastocyte) and the rest of it is the parietalis
*the blastocyst implants into the decidua basalis, covered by the capsularis. The rest is the parietalis

963
Q

most common side effect of copper IUD?

A

Dysmenorrhea and heavy menstrual bleeding

964
Q

risk of rupture of endometriomas and OCPs

A

They can cause an increased risk of rupture in large endometriomas

*overall decrease sxs in 80% of pts

965
Q

What is the most common presenting sign or sxs of CAD in women younge than 45yo?

A

Myocardia infarction

966
Q

Definition of macrosomia EFW:

A

4,000 to 4500g

*4500g rec c/s if DM
*5000g rec c/s if no DM

967
Q

MOA and contraindications to Mirabegron:

A

MOA: B3 adrenergic receptor agonist (detrusor muscle of bladder) - relaxes detrusor muscle, increases bladder capacity

C/I: uncontrolled HTN, ESRD, significant liver impairment

968
Q

Risk of shoulder dystocia if EFW > 4500g and maternal diabetes:

A

20-50%

*if > 4500g w/o DM then 10-25%

969
Q

Smoking decreases the risk of this type of cancer:

A

Endometrial cancer

*smoking and OCPs

970
Q

Definition for SAB:

A

< 20 weeks and less than 500g

971
Q

Risk of stillbirth in a fetus with EFW < 10% for GA?

A

1.5%

if EFW < 5% = 2.5%

972
Q

Risk of newborns developing GBS disease if mom GBS + and untreated:

A

1-2%
*First 7 days

973
Q

What percentage of women with pregestational DM also have cHTN?

A

5 - 10%

974
Q

What is the most common way for ovarian cancer to spread?

A

Exfoliation or Transcoelomic —through the peritoneal cavity

*the carcinoma exfoliates malignant cells into the peritoneal cavity

975
Q

What factors are most consistent w HPV-independent vulvar cancers?

A

*older women so not HPV related
-vulvar dystrophy
-lichen sclerosus

*not associated w smoking

976
Q

What stage is given to a pt wh is stage IA but the ovarian capsule ruptures during removal?

A

IC now

-now high risk of recurrence

977
Q

Treatment for placental site trophoblastic tumor:

A

Hyst!! MAINSTAY

978
Q

Reasons to get an MRI for breast cancer screening:

A

-BRCA carrier
-Strong family h/o (1st degree relative)
-h/o chest radiation

*anything that increases risk >20-25%

979
Q

Relative risk of developing breast cancer with a diagnosis of atypical ductal hyperplasia?

A

5.0

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