Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OB/GYN > UWorld 2 > Flashcards

UWorld 2 Flashcards

1
Q

28 yo G2P1 at 37 wks p/w hypotension and tachycardia

  • h/o C-sxn
  • PE: palpable, irregular protuberance in lower abdomen and moderate vaginal bleeding
  • FHT: late decels
A

Rupture uterus

  • increased risk given h/o C-sxn
  • palpable fetal part
  • late decels indicating uteroplacental insufficiency (b/c uterus is ruptured…)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Mechanism of acute postpartum urinary retention

A

Bladder atony 2/2 a decrease in detrusor tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Screening test for ovarian cancer

A

There is none…

-so if person wants to be screened (concerned b/c friend has it etc) there is no good option

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Best diagnostic test for primary syphilis

A

Dark field microscopy showing spirochetes

At the time of primary syphilis- often too early, antibodies aren’t made yet => RPR would give false negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Differentiate the etiologies of symmetric vs. asymmetric fetal growth restriction

A

Symmetric (both head and body affected): 2/2 fetal factors

  • chromosomal abnormalities
  • early maternal infection (causing congenital infxns)

Asymmetric (only body affected, head intact), 2/2 fetal adaptation to suboptimal maternal factors

  • ‘head sparing’ fetal growth restriction
  • maternal HTN, DM, preeclampsia, smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

78 yo w/ h/o Alzheimer’s p/w urinary incontinence x1 week

  • less active
  • afebrile

Next best step

A

UA and Cx-

UTI is a very common cause of acute urinary incontinence in the elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Clinical features of newborn clavicular fracture

A

Crepitus over the clavicle/palpable bony irregularity

-complication of macroscomia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

36 yo F p/w lump in right breast found on self exam

  • no other symptoms
  • 1 cm firm, round mass in UOQ of right breast w/ no palpable LN

Next step?

A

Palpable breast mass, next step depends on age
Over 30: mammogram is first step
Under 30: Ultrasound in first step

So first use mammorgam (pt is 36) to further locate/characterize lump

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

45 yo G5P5 p/w involuntary loss of urine x5mo while jogging

  • loses small amoung after coughing
  • normal UA and low post-risidual volume

(a) Dx
(b) Mechanism

A

(a) Stress incontinence

(b) Urethral hypermobility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Define tachysystole

A

Tachysystole = abnormally frequent contractions defined as more than 5 contractions in 10 minutes averaged over 30 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Main clinical feature of Sheehan syndrome

A

Sheehan syndrome = postpartum hypopituitarism 2/2 pituitary necrosis from hypovolemic shock/bloodloss after childbirth

Presents w/ lactation failure w/ hypotension and anorexia (2/2 adrenal insufficiency)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clinical presentation of placental abruption

A

Biggest one = sudden-onset vaginal bleeding

  • abdominal or back pain
  • high-frequency (really close together), low-intensity contractions
    ex: contractions q2 minutes
  • hypertonic, tender uterus

Diagnosed primarily by clinical presentation, then can use US to r/o placenta previa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Mechanism by which urinary incontinence risk increases in post-menopausal women

A

Estrogen deficiency

Hypoestrogenemia => atrophy of urethral mucosal epithelium and diminished urethral closure pressure => urinary frequency, urgency, UTI, incontinence

Tx = low-dose vaginal estrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

23 yo F presents for infertility, irregular periods for past 2 yrs

  • intense exerciser, lots of stress at work, BMI 18, negative pregnancy test
  • labs: low FSH/LH, normal prolactin/TSH

(a) Dx
(b) Tx

A

(a) Hypogonadotropic hypogonadism
- problem is at the level of the hypothalamus not secreting proper GnRH

(b) Tx = pulsatile GnRH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Purpose if fetal fibronectin screening

A

Screening test for preterm labor-
-Best for negative predictive value (sensitive not specific): good predictor of spontaneous preterm labor before cervical dilation

-done as vaginal swab (preferably before manipulation by vaginal exam)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

43 yo G6P5 at 39 wks w/ brief TC seizure

  • BP 80/40, HR 110/min, RR 30, O2 75% on facemask
  • PE: purpuric rash and bleeding from IV site

Dx
Mgmt

A

Respiratory failure 2/2 amniotic fluid embolism
-hypoxemia => seizures

Mgmt = intubation and mechanical ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Common causes of fetal tachycardia

A

Maternal fever (ex: chorio)
Maternal hyperthyroid
Medication use (ex: terbutaline- tocolytic)
Placental aburption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Pt w/ hyperemesis gravidarum has pelvic US: enlarged ovaries w/ multilocular cystic appearance

Dx

A

Molar pregnancy

  • b/l ovarian enlargement 2/2 hyperstimulation and ovarian cyst formation (theca lutein cysts)
  • even more elevated beta-hCG puts these pts at higher risk for hyperemesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When is external cephalic version performed

A

External cephalic version = convert breech into vertex for delivery

  • performed btwn 37 weeks and onset of labor
  • not before 37 wks: breech before can just move/convert to vertex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Thyroid hormone production during pregnancy

T4/T3/TSH

A

During pregnancy- total T4 is 1.5x greater than pre-pregnancy state, free T4 and T3 moderately increased
-slightly decreased TSH production b/c higher T3/T4 suppresses the TSH

beta-hCG stimulates thyroid hormone production, estrogen does increase TBG production but net effect is increase in T4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

39 yo G4P0030 at 35 wks p/w intense constant lower abdominal pain

  • h/o fibroids, s/p abdominal myomectomy where uterine cavity entered
  • cervical dilation of 4cm, contractions q2-3 min
  • FHR: persistent variable decels to the 90s

Next best step

A

Laparotomy and delivery
-aka C-section

Abdominal myomectomy- if uteirne cavity is entered then trial of labor is contraindicated 2/2 risk of uterine rupture
(if uterine cavity not entered you can do trial)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Cause of infertility:

37 yo w/ regular 28 day cycles, no other GU complaints

  • no h/o STIs
  • previous child w/ husband at age 31
  • aeorbics instructor, normal vital
A

Decreased ovarian reserve

-significant drop in oocytes in 4th decade, one in 5 women are infertile btwn 35-39

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is hyperemesis gravidarum?

A

Such excessive/severe nausea/vomiting in pregnancy that it results in wt loss and dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Causes of hypogonadotropic hypogonadism

A

Hypogonadotropic hypogonadism causes infertility 2/2 hypothalamic dysfunction: insufficient GnRH pulses from hypothalamus causes insufficient LH/FSH production

Causes: severe life stressors, eating d/o, excessive exercise

  • anorexia
  • marathon runners
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

2 maternal complications of abruptio placentae

A

2 maternal complications of placental abruption

  • DIC
  • hypovolemic shock

Increased risk w/ larger detachment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which is a worse risk factor for osteoporosis: obesity or excessive EtOH

A

Ok so adipose tissue actually is protective from osteoporosis- inherent increase in wt bearing and adipose tissue acts as endogenous source of excess estrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

2 hr old boy w/ minimal right arm movement after vacuum-assisted vaginal delivery at 37 wks gestation c/b shoulder dystocia

  • birth wt 9 lbs
  • RUE: adduction and internal rotation w/ elbow extended
  • absent moro and biceps reflexes

Next step

A

Reassurance about prognosis

2/2 Erb-Duchenne palsy (brachail plexus injury to C5-7) => ‘waiter’s tip posture’

  • up to 80% have spontaneous recovery
  • surgical intervention only if no improvement by 3-6 mo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Function of MgSO4 when not used for seizure ppx

A

Give MgSO4 in under 32 weeks gestation when anticipating preterm birth for fetal neuroprotection, specifically CP (cerebral palsy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

28 yo G1P0 at 35 wks p/w N/V/epigastric and RUQ pain

  • gestation HTN, BP 160/94, 2+ edema, 3+ protein on UA
  • elevated AST/ALT, PT/PTT

(a) Dx
(b) Pathophys

A

(a) HELLP = hemolysis and elevated liver enzymes w/ low platelets
- complication/subtype of severe preclampsia

(b) Systemic inflammation and platelet consumption
- platets rapidly consumed and microangiopathic hemolytic anemia causes hepatocellular necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Tx for urinary incontinence

(a) stress
(b) Urge
(c) Overflow

A

Treatment for urinary incontinence

(a) stress: kegels and urethral sling surgery
(b) Urge (sudden overwhelming need to empty bladder) tx w/ antimuscarinic
(c) tx overflow w/ cholinergic agents
- last line catheterization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What risk does tachysystole pose to the baby?

A

Tachysystole: insufficient time between contractions for uterus to relax => causes placental spiral artery constriction

Can => fetal hypoxia/acidemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Risk of a complete molar pregnancy

A

Molar pregnancy = abnormal trophoblastic proliferation following abnormal fertilization, complete molar pregnancies have a 2.5% risk of developing into choriocarcinoma (malignant trophoblastic cancer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

First step in workup for palpable breast mass

A

First step depends on pt’s age

Under 30: do ultrasound +/- mammogram
30 or over: do mammogram +/- ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Differentiate the patterns of symmetric vs. asymmetric fetal growth restriction

A

Symmetric: growth lag begins at 1st-2nd trimester (before 28 wks)
-both head and body are affected

Asymmetric: head grows appropriately, fetus redistributes blood flow to vital organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Clinical presentation of CAH

A

Oligo-ovulation (abnormal menses), hyperandrogenism (hirsuitism, acne), elevated 17-OH progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How is a molar pregnancy created?

A

Complete molar pregnancy = either one or two sperms fertilize an egg lacking genetic material

Partial = haploid egg fertilized by one or two sperm which reduplicated causing too many chromosomes (ex: 69 XXY)

-basically abnormally fertilized egg allows for abnormal trophoblastic proliferation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Acid base disturbance seen in physiologic pregnancy

A

Direct effect of progesterone that stimulates the central respiratory center => relative hyperventilation => primary respiratory alkalosis due to hypocapnia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Typical inpatient abx regimens for PID

A
  • Cefoxitin or cefotetan + doxy

- clindamycin + gentamycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

19 yo p/w sudden onset intensifying lower abdominal pain + vomiting

  • diffuse tenderness, left greater than right, w/o guarding/rebound
  • pelvic US: complex left adnexal mass w/o Dopller flow w/ small free fluid

(a) Dx
(b) Next step

A

(a) Ovarian torsion: sudden onset unilateral pelvic pain, N/V
- classic US finding = adnexal mass w/ absent doppler flow to ovary

(b) Laparoscopy
- laparoscopic cystectomy and detorsion w/ goal of saving ovary from irreversible necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Workup for hyperemesis gravidarum

A

Ultrasound- r/o multifetal gestation and molar pregnancy (since both have increased placental mass => increased risk of HG)

-after do US, can turn to supportive tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

37 yo p/w severe abdominal pain x5 hrs, TTP w/ mild guarding, normal VS and labs

Next steps

A
  1. pregnancy test
  2. pelvic ultrasound to determine location of pregnancy test

-wouldn’t go straight to pelvic US before pregnancy test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is Mittleschmerz?

A

Ovulation/midcycle pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Tx of lichen sclerosus

A

High potency vaginal steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

When do you do endometrial biopsy in women under 45

A

Persistent AUB or risk factors for endometrial cancer: obesity, diabetes, unopposed estrogen exposure, PCOS, early menarche/late menarche

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Management of second pregnancy in mother w/ h/o preterm delivery

A

Can manage pts w/ h/o spontaneous preterm delivery w/ progesterone supplementation and serial cervical length measurements

46
Q

60 yo G3P3 p/w SOB x6 mo

  • sister w/ breast cancer, BRCA+
  • distended abdomen w/ decreased bowel sounds, clear lungs
  • firm, non-mobile mass palpated in the left adenexa

(a) Dx
(b) Next step

A

(a) Epithelial ovarian carcinoma
- give away if pelvic mass + ascites

(b) Next step = exploratory laparotomy

47
Q

Objectively most accurate way of assessing gestational age

A

First trimester ultrasound

More accurate than date of LMP b/c LMP assumes normal 28 day cycles w/ ovulation on day 14 (that’s the average but not always the exact case)

48
Q

Risk factors for placental abruption (besides previous C-section)

A

Maternal HTN, smoking, cocaine use, abdominal trauma

49
Q

Name some meds that common cause urinary incontinence

A
  • Alpha-adrenergic 2/2 urethral relaxation
  • Anticholinergics, opiates, CCB 2/2 urinary retention and overflow
  • Diuretics 2/2 excess urine production
50
Q

Clinical presentation of degenerating fibroids

A

Fibroids degenerate in pregnancy when they outgrow their blood supply

  • presents w/ intense constant abdominal pain
  • no bleeding
51
Q

Contraindications to external cephalic version

A
  • placental abnormalities: previa or abruption
  • oligohydramnios
  • multiple gestations

Can cause fetal distress => so needs to be performed when arrangements have been made for back-up emergency C-section

52
Q

16 yo runner p/w excessive facial hair

  • irregular menses since age 12
  • normal external genitalia
  • elevated LH/FSH, testosterone, DHEA-S

Dx

A

Congenital adrenal hyperplasia- would expect elevated 17-hydroxyprogesterone

53
Q

Lactation mastitis

(a) Most common bug
(b) Mechanism of infection

A

Lactation mastitis

(a) staph aureus- skin flora enters ducts thru nipple and multiples in stagnant milk
(b) stagnant milk 2/2 inadequate milk duct draining
- increased risk if miss nursing sessions

54
Q

Clinical features differentiating endometriosis and adenomyosis

A

Both have dysmenorrhea, pelvic pain

Endometriosis associated w/ infertility
Adenomyosis: bulky, globular, tender uterus

55
Q

Complications of the following during pregnancy

(a) Valproate
(b) Lithium

A

(a) Valproate => neural tube defects

(b) Lithium = cardiac defects: setpal defects and Ebstein’s anomaly
- specifically Ebstein’s anomaly: ASD, atrialized RV w/ malformed tricuspid valve

56
Q

Indication for raloxifene

A

Raloxifene = SERM (selective estrogen receptor modulator)

-for prevention and tx of osteoporosis in postmenopausal F

57
Q

17 yo sexually active F on OCPs p/w normal external genitalia w/o erythema or edema + copious, white, mucoid vaginal discharge w/ no odor
-microscopic: squamous cells w/ rare PMNs

(a) Dx
(b) Mgmt

A

(a) Physiologic leukorrhea = amount of normal vaginal discharge varies greatly. white/yellow, nonmalodorous, w/o symptoms or finding on exam = physiologic
(b) Mgmt = reassurance, no tx required

58
Q

Management of uterine inversion

A

Manual replacement of the uterus

Then after uterus is replaced: remove placenta (if still in) and give uterotonic drugs
-don’t give uterotonics before replacing uterus

59
Q

Birth plan for placenta previa

A

Planned C section at 36-37 weeks

60
Q

FHT: moderate variability, recurrent variables

Next step?

A

Turn mother on side (decompress IVC), give fluid bolus, potentially amnioinfusion
-all to reduce cord compression

Don’t need to resort to C-sxn yet b/c moderate variability shows fetus is not acidemic

61
Q

32 yo F w/ abdominal pain and nausea x2 days

  • several blood clots vaginally
  • BP 90/55, HR 120, guarding w/ decreased BS, + pregnancy test
  • TVUS: gestational sac at upper left uterine cornu w/ free fluid in posterior col-de-sac

Next step

A

So this is totally an ruptured ectopic in a bicornate uterus

Next step = surgical exploration
-HDUS, hemoperitoneum

-Can’t use MTX here b/c pt is not HDS
Cornual ectopic pregnancy = gestation sac in the upper outer corner of bicornate uterine fundus

62
Q

Tx of lactation mastitis

A

Dicloxacillin or cephalexin

  • encourage breast feeding! even increased breast feeding since infxn is commonly 2/2 inadequate milk duct draining
  • analgesia
63
Q

25 yo G1P0 at 36 wks p/w sudden onset excruciating abdominal pain and vaginal bleeding x3h

  • BP 160/110, HR 18
  • PE: firm, distended and tender uterus
  • FHT: 108 baseline w/ no variability

Dx

A

Dx = abruptio placentae = premature placental separation

-painful vaginal bleeding causing both fetal and maternal distress

Not vasa previa b/c that wouldn’t cause the hypertonic and tender uterus (it would be painless vaginal bleeding), and wouldn’t cause maternal HTN b/c blood loss is all fetal

64
Q

Etiologies of premature ovarian failure

A

Multifactorial

  • autoimmune component
  • heritable factors
  • exogenous factors: radiation
65
Q

Distinguish visual manifestations of primary syphilis vs. chancroid

A

Syphilis- painless, non-exudative base, raised indurated margin

Chancroid- painful, lymphadenopathy, ulcer w/ deep purulent base

Basically painless (syphilis) vs. painful (chancroid)

66
Q

36 yo G2P1 at 35 wks p/w vaginal bleeding and back pain

  • h/o HTN controlled w/ HCTZ
  • smooth, firm, distended uterus w/ fundal height of 38 cm
  • cervix closed
  • NST: minimal variability w/ 3 late decels

Dx

A

Dx = placental abruption
-painless vaginal bleeding

NOT placental previa = painLESS bleeding

67
Q

Describe the change in management of hypothyroidism during pregnancy

A

Increase levothyroxine dose

Elevated estrogen stimulates TBG production => need more thyroid hormone

68
Q

Criteria for diagnosis of chorioamnionitis

A

Maternal fever + 1:

  • uterine tenderness
  • maternal or fetal tachy
  • malodorous amniotic fluid
  • purulent vaginal discharge
69
Q

Risk factors for hyperemesis gravidarum

A

Increased placental mass => higher beta-hCG

  • multiple gestations
  • molar pregnancy
70
Q

Common clinical presentation of submucous fibroids

A

Heavy and prolonged menstrual bleeding 2/2 endometrial distortion

71
Q

Pelvic mass + ascites

A

Buzzword for epithelial ovarian carcinoma

72
Q

23 yo F w/ regular menses and no PMH, normal external genetalia w/ 27 yo husband present for infertility work up

First step…

A

Semen analysis- simple, noninvasive test

-male factor alone accounts for 35% of infertility

73
Q

Tx of endometriosis

A

First things first is observation- you don’t need to tx unless pt is symptomatic

If symptomatic- then things to atrophy endometrial tissue: OCPs (first line), progestin only options, NSAIDs

74
Q

Name 3 complications of using too high of a dose of uterotonic agents (ex: oxytocin overdose)

A
  1. Tachysystole
  2. Hyponatremia
    - b/c oxytocin is similar in structure to ADH => causes water retention and hyponatremia
  3. Hypotension
75
Q

23 yo G1P0 at 39 wks p/w 1-day of abdominal pain and persistent wetness of underwear

  • T 100.7, diffuse uterine tenderness, cervix 2cm dilated w/ positive nitrazine and ferning tests
  • Hb 10.2, WBC 18k, plt 198k

Dx

A

Intraamniotic infection = chorioamnionitis

RF = prolonged rupture of membranes
-positive nitrazine/ferning = amniotic fluid

76
Q

Step to take before starting trastuzumab therapy

A

Trastuzumab = Herceptin for HER2 positive breast cancer

Do echo before starting trastuzumab b/c of risk of cardiotoxicity, particularly if have low baseline EF

77
Q

What is fetal fibronectin?

A

Biological glue that binds the fetal sac to the uterine lining
-produced by fetal cells, lies at the interface between the chorion and amnion

-swab used as screening test for preterm labor

78
Q

20 yo G2P2 evlauted 8 hrs after vaginal delivery for bloody vaginal discharge and rigors/chills x30 mins during placental delivery

  • T 100.2F, BP 120/80, HR 76
  • uterine NT and firm

Next step

A

Reassurance and routine postpartum care

-transient rigors/chills, peripheral edema, lochia rubra, breast engorgement, uterine contraction and involuation are all normal findings in the postpartum period

79
Q

What determines the first step in work up of nipple discharge?

A

Color of the discharge

Bloody or serous => do breast ultrasound/mammogram

If milky, nonbloody => serum prolactin, TSH, beta-hCG

80
Q

31 yo F at 28 wks gestation p/w painful contractions

  • no ROM/VB
  • 3cm/90%, vertex w/ bulging bag
  • BP 125/60 w/ contractions q5min

How to manage her?

A
  1. betamethasone
  2. MgSO4- used in under 32 wks for fetal neuroprotection
  3. indomethacin as tocolytic (not first line nifedipine b/c nifedipine + MgSO4 associated w/ respiratory depression)
81
Q

45 yo p/w night sweats and insomnia
-irregular periods x6 mo

Mgmt

A

Can’t just chalk this up to estrogen withdrawal w/o ruling out hyperthyroidism first….

  1. Measure TSH and FSH
  2. Tx hyperthyroidism or tx menopause
82
Q

Test for urethral hypermobility

A

Q-tip test: cotton swab in urethral orifice, if it moves more than a 30 degree angle w/ increased intrabdominal pressure (ex: coughing) that is diagnostic for urethral hypermobility

Urethral hypermobility => stress incontinence

83
Q

Mechanism of polycythemia in fetal hyperglycemia

A

Fetal hyperglycemia (due to uncontrolled maternal diabetes) => fetal hyperinsulinemia => increased metabolic demand => fetal hypoxemia => increased erythropoiesis => polycythemia

84
Q

Difference btwn raloxifene and tamoxifen

A

Tamoxifen has estrogen inhibitory effects on breast, but stimulates endometrial lining.

Raloxifene doesn’t have the effect on the endometrium => safe to give to postmenopausal women w/o increased risk of endometrial hyperplasia/cancer

85
Q

Acid base disturbance seen in hyperemesis gravidarum

A

Excessive vomiting = loss of gastric acid => metabolic alkalosis

86
Q

28 yo G3P2 at 30 wks gestation p/w vaginal bleeding after MVA

  • BP 95/65, HR 116, RR 22
  • minimally active bleeding from cervix
  • O+
  • contractions q5 min, no accel or decels

Dx
Mgmt

A

Placental abruption w/ hemorrhagic shock => need to give aggressive fluid resuscitation

So first step would be to stabilize mother (not assess fetus w/ BPP or anything) b/c baby complications would mainly be 2/2 insults to maternal circulation

87
Q

Recommendations for reduction of ovarian cancer rate in BRCA-1 carrier

A

Premenopausal prophylactic b/l salpingo-oophorectomy (BSO) for mutation carriers once childbearing is complete

88
Q

42 yo p/w left breast swelling and pain worsening x1 mo

  • finished breastfeeding 2 mo ago, s/p abx for mastitis 1 mo ago
  • VS normal
  • left breast: diffusely warm and erythematous w/ some dimpling

Fx

A

Inflammatory breast cancer
-rapid-onset peau d’orange (superficial dimpling, fine pitting)

Less likely to be breast abscess given no fever and lack of improvement w/ abx

89
Q

Clinical presentation of acute fatty liver of pregnancy

(a) Lab findings

A

Acute hepatic failure in the 3rd trimester or early postpartum

(a) prolonged PT/PTT, hypoglycemia, encephalopathy

90
Q

What is contraindicated in placenta previa?

A

Intercourse, digital cervical exam, vaginal delivery all contraindicated

-recommend strict pelvic rest

91
Q

Complications of untreated PID

A
  • tubo-ovarian abscess
  • abscess rupture
  • pelvic peritonitis
  • sepsis
92
Q

Describe a complication of fibroids growing during pregnancy

A

Fibroids often grow during pregnancy 2/2 hormonal growth stimulation
-grow so much that they outgrow their blood supply, then undergo degeneration causing severe abdominal pain

93
Q

Differentiate use of the following for workup of palpable breast mass:

FNA vs. core biopsy vs. excision biopsy

A

FNA for suspected cystic or small masses

Core biopsy for complex cyst or solid mass
-acellular (like stromal) masses

Excisional biopsy for large or suspicious masses

94
Q

46 yo G3P3 p/w 2-yr heavy, dysmenorrhea and pelvic pain btwn periods
-PE: symmetrically enlarged uterus, boggy tender globular and freely mobile

Dx

A

Adenomyosis

Not endometriosis- usually has normal-sized, nontender uterus that is immobile (fixed)

95
Q

54 yo G2P2 w/ involuntary urine loss whenever she “laughs, coughs, or sneezes”

(a) Dx
(b) Mechanism
(b) Tx

A

(a) Dx = stress incontinence
(b) Urethral hypermobility
(c) Tx
first line = Kegels (pelvic floor muscle exercises)
second line = uretethral sling surgery

96
Q

What is lichen sclerosus? Clinical features

A

Lichen sclerosus = autoimmune skin disease causing intense pruritis and white atrophic plaques of the vulva, and sometimes perianal skin (but not the vagina)

97
Q

Most common bugs that cause PID

A

Neisseria gonorrhea, chlamydia trachomatis, genital mycoplasmas

98
Q

32 presents 2 days after her menstrual period ended w/ severe pelvic pain and what “feels like labor contractions”

  • irregularly enlarged uterus
  • h/o regular but heavy mentrual cycles
  • 5cm dilated cervix w/ spherical mass visible thru the external os

Dx

A

Protruding leiomyoma uteri = aborting submucousal fibroid

  • intramural fibroids can prolapse thru cervical os while hanging from a pedicle attached to the myometrium
  • labor-like pain caused by expulsion of the fibroid

Further confirmed b/c fibroids can distort the endometrium causing heavy menses

99
Q

Tx for gestational diabetes not responsive to dietary change

A

Insulin

-oral agents including metformin and glyburide

100
Q

Why do we treat asymptomatic bactiuria in pregnant F?

A

B/c of the risk of pyelo…

Untreated asymptomatic bacteriuria can progress to pyelo in 20-40% of cases
Then pyelo => septicemia, preterm labor, low birth weight

101
Q

34 yo 6 wks s/p vaginal delivery c/b severe postpartum hemorrhage requiring 5U pRBC p/w low energy, no milk production

  • wt loss below pre-pregnancy wt
  • BP 90/69

Dx

A

Dx = Sheehan syndrome = postpartum hypopituitarism from pituitary gland 2/2 blood loss and hypovolemic shock after childbirth

Infarcted pituitary => low prolactin release
-low ACTH => hypocortisolism => hypotension, wt loss, lethargy, loss of sexual hair

102
Q

What is pseudocyesis?

Tx

A

False/phantom pregnancy- pt presents w/ actual clinical signs and symptoms of pregnancy (ex: morning sickness, amenorrhea, self-reported positive pregnancy test…) w/ negative in-office test

Form of conversion d/o => requires psych eval

103
Q

What is internal podalic version?

A

When you literally reach into the uterus and grab the baby by its feet for vaginal delivery
-done for breech extraction of a malpresenting second twin

104
Q

Fetal complications of maternal hyperglycemia

A

Fetal hyperglycemia => fetal hyperinsulinemia =>

  • Polycythemia
  • organomegaly
  • shoulder dystocia => birth injuries
  • neonatal hypoglycemia
105
Q

29 yo w/ UC p/w syncope and right-sided abdominal pain w/ rebound tenderness and voluntary guarding

  • vaginal bleeding
  • LMP 8 wks ago
  • cervical motion tenderness, right-sided adnexal tenderness, no palpable masses

Dx

A

Rupture ectopic: abdominal pain, vaginal bleeding, hypovolemic shock
-cervical motion, adnexal, abdominal tenderness, amenorrhea

106
Q

25 yo F at 28 weeks presents in active labor
-US shows AFI of 4 and b/l renal agenesis

Mgmt

A

Mgmt = allow spontaneous vaginal delivery
-don’t administer corticostoierds/amniotransfusion/tocolysis b/c fetal anomaly of b/l renal agenesis is incompatible w/ life

107
Q

34 yo w/ quad screen showing low MSAFP/estriol w/ elevated hCG/inhibin A

Next step?

A

Ultrasound- do US before amnio to evaluate fetal anatomy and measure growth (anomalies associated w/ trisomy 21)

108
Q

FSH/LH levels seen in premature ovarian failure

A

Both FSH and LH are elevated (b/c hypoestrogen => loss of negative feedback)

FSH/LH > 1 (greater increase in FSH elevation) b/c of slower clearance of FSH from circulation

109
Q

67 yo F p/w severe vulvar itching/burning x6mo

  • dysparanuria
  • h/o DM1
  • thin, dry, white plaque-like vulvar skin w/ loss of labia minora, clitoral hood retraction, vulvar excoriation b/l

Dx
Mgmt

A

(a) Dx = lichen sclerosis
- autoimmune in etiology (associated w/ others like DM1)
- causes intense pruritis, dysparanuria, dysuria
- affects vulva and perianal region, not vagina

(b) Vulvar punch biopsy to r/o vulvar squamous cell carcinoma
- lichen sclerosis is considered a premalignancy of the vulva

110
Q

25 yo G2P1 at 32 wks p/w acute-onset severe abdominal pain and diffuse vaginal bleeding

  • h/o C-sxn for first pregnancy w/ vertical incision 2/2 anterior fibroids
  • BP 160/95, HR 100
  • firm, tender uterus
  • FHT: baseline 150/min w/ no decels
  • contractions q1-2m

Dx

A

Abruptio placentae = painful vaginal bleeding

  • hypertonic/tender uterus
  • tachysystole (frequent uterine contractions)

RF: h/o C-section w/ vertical incision

111
Q

19 yo 3 days s/p D&C for abortion p/w 2 days of fever, foul-smelling yellowish discharge from cervical os

Dx
Mgmt

A

Dx = septic abortion
-infection of retained products of conception

Mgmt = suction curettage

112
Q

Erbs vs. Klumpke’s palsy

(a) Nerves affected
(b) Clinical presentation

A

Erbs: C5/C5
-waiter’s tip: extended elbow, pronated forearm, flexed wrist and fingers

Klumpkes: C8/T1

  • claw hand: extended wrist, flexed IP joints
      • Horner’s = ipsilateral miosis and ptosis

So if baby has slight ptosis and anisocoria + arm abnormalities = Klumpke’s
-use the Horner’s stuff to easily differentiate

OB/GYN (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions