UWorld 3

Question 1

Complications of post-term pregnancies

Answer 1

• meconium aspiration
• stillbirth
• macrosomia
• oligohydramnios: aging placenta => decreased fetal perfusion => decreased urine output

Question 2

Clinical presentation of Kallmann’s syndrome

Answer 2

Amenorrhea or delayed puberty w/ low or absent LH and FSH (2/2 no GnRH)

Kallmann’s = hypogonadotropic hypogonadism + anosmia

Question 3

Signs of congenital adrenal hyperplasia

Answer 3

Verilization (b/c of high androgens) and salt wasting (b/c high aldo)

Question 4

Differentiate cervical secretions during

(a) Pre-ovaulatory / early follciular
(b) Ovulatory
(c) Post-ovulatory . late follicular

Answer 4

Vaginal mucus secretions

Pre and post-ovulatory: mucus is scant, opaque, thick, acidic
-incompatible w/ penetration by spermatozoa

During ovulatory phase: clear cervical secretion that extends in a long thread (6 cm) when lifted vertically, pH of 6.5 (more basic)

Question 5

SSRI safety during pregnancy

Answer 5

SSRIs except Paxil (paroxetine) are ok during pregnancy

Question 6

Define menorrhagia

Answer 6

Technically: period lasting longer than 7 days or greater than 80 mls

Question 7

How does hypothyroidism affect prolactin secretion

Answer 7

Hypothyroidism => hyperprolactinemia

b/c TRH (high when no negative feedback from low thyroid hormone) stimulates prolactin production
-explains how hypothyroidism can => amenorrhea and galactorrhea

Question 8

When to suspect McCune Albright syndrome

Answer 8

Early puberty w/ some bony abnormalities and cafe au lait spots

Question 9

17 yo G1P0 at 37 wks p/w HA

Answer 9

Preeclampsia (after 20 wks) w/ severe features

Question 10

14 yo p/w excessive menstrual bleeding
-menarche at 13

Cause of the excessive bleeding?

Answer 10

Anovulation

-W/ recent menarche, menorrhagia (longer than 7 days or greater than 80 ml) is 2/2 anovulatory cycles due to an immature/irregular HPA axis

Question 11

First step if F of reproductive age presents w/ amenorrhea and negative beta-hCG

Answer 11

Depends on if she’s had a prior uterine procedure or infection

No prior procedure/infection => check prolactin, TSH, FSH
Prior uterine procedure or infection => hysteroscopy (camera up vagina to look inside uterus)

Question 12

Genitalia of fetus w/ congenital aromase deficiency

Answer 12

Normal internal w/ ambiguous external genitalia

-virilization

Question 13

G2P1 at 29 wks w/ fetus in transverse lie and low lying placenta at 3cm away from the cervical os

Next step?

Answer 13

Reassure and wait

-don’t have to do C-sex: transverse lie is typically transient and will spontaneously convert to cephalic

Question 14

How to differentiate intraductal papilloma and infiltrating ductal carcinoma on physical exam

Answer 14

Both can present w/ pathologic nipple discharge (unilateral bloody discharge)

Intraductal papilloma = benign

Infiltrating ductal carcinoma as accompanying breast mass and lymphadenopathy

Question 15

What is Kallmann’s syndrome?

Answer 15

Hypogonadotropic hypogonadism (failure of hypothalamus to release GnRH) + anosmia (no sense of smell)
=> delayed puberty w/ low or absent LH/FSH

Mechanism = failure of GnRH secreting hypothalamic neurons to migrate to the correct place during embryonic development

Question 16

Most common side effect of Tamoxifen

Answer 16

Hot flashes

-Tamoxifen blocks estrogen from its receptor => similar to estrogen withdrawal in menopause

Question 17

Tamoxifen increases risk of which 2 dangerous conditions

Answer 17

• endometrial hyperplasia

- VTE

Question 18

Traid of McCune-Albright syndrome

Answer 18

1. hyperfunctioning endocrine disease => gonadotropin-independent precocious puberty
2. progressive fibrous dysplasia => polyostic (bony abnormalities)
3. cafe au lait macules (coast of Maine appearance)

Question 19

Imaging finding on intraductal papilloma

Answer 19

Normal on imaging, potentially a single dilated breast duct

Question 20

Unilteral bloody nipple discharge

Answer 20

Hallmark finding of intraductal papilloma (tis benign)

Question 21

Lab findings: pseudohyphae

Dx

Answer 21

Dx = candida

-normal pH of secretions (3.8-4.5), not over 4.5 like BV and trich

Question 22

Is oligo or poly hydramnios more assocaited w/ post-term pregnancies?

Answer 22

Oligo b/c aging/calcified placenta => decreased perfusion => decreased fetal urine output

Question 23

Post-term induced neonates are at higher risk for which two fetal complications?

Answer 23

SGA and oligohydramnios
Placenta ages/calcifies => chronic uteroplacental insufficiency
-SGA b/c lack of nutrients in last bit
-oligo b/c decreased fetal perfusion => decreased fetal urine output

Question 24

24 yo obese F w/ hirsuitism, acne, and menstrual irregularity

-greatest risk of which gynecologic malignancy?

Answer 24

Endometrial carcinoma 2/2 unbalanced estrogen secretion

-insufficiency estrogen + peripheral conversion of estrogen

Unopposed estrogen secretion => endometrial hyperplasia

Question 25

Mode of inheritance of hemophilia

(a) A
(b) B

Answer 25

Both hemophilia A and B are X-linked recessive

Question 26

Name features that count to make preeclampsia classified as severe

Answer 26

• > 160 or >110
• thrombocytopenia (plt under 100)
• Cr over 1.1
• AST/ALT over 2x ULN
• pulmonary edema
• new onset visual or cerebral symptoms