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OBGYN > uworld > Flashcards

uworld Flashcards

1
Q

3 risk factors for SCC of the vagina

A

HPV 16 or 18, smoking, h/o cervical dysplasia/ca.

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2
Q

MC risk factor for abruptio placentae? 2 others?

A

HTN; maternal trauma and cocaine use

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3
Q

Unilateral bloody nipple discharge is the hallmark symptom of?

A

an intraductal papilloma (a benign breast condition)

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4
Q

abnormal results of a nonstress test?

A

recurrent variabilty, loate decels or nonreactive= less than 2 acceleration

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5
Q

a strong predictor of preterm delivery is a short cervix on TVUS, what is considered short?

A

2cm or less w/o a h/o preterm birth or 2.5cm or less with a h/o preterm birth

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6
Q

Preeclampsia puts fetus at risk for chronic uteroplacental insuff which can cause

A

oligohydramnios and IUGR/ small for gestational age infants

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7
Q

name 2 recommended antihypertensives to use during preg, 2 acceptable alternatives?

A

beta-blockers esp Labetalol, methyldopa;

Hydralazine, Ca channel blockers (nifedipine)

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8
Q

Tx of an ASx Bartholin cyst?

if symptomatic?

A

Observation;

I and D then placement of a Word catheter

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9
Q

Late-term and postterm preg complications to the fetus? (5)

A

Oligo, meconium aspiration, stillbirth, macrosomia, convulsions

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10
Q

Late-term and postterm preg complications to the mom?

A

C-section, infection, PPH, perineal trauma

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11
Q

criteria of oligo: single deepest vertical pocket of… OR an AFI of… in transabdominal U/S

A

less than or equal to 2cm;

less than or equal to 5cm

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12
Q

first line therapy for vulvar lichen sclerosis ?

A

high potency topical corticosteroids (ie Clobetasol)

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13
Q

types of miscarriages that present with vaginal bleeding and dilated cervical os

A

incomplete and inevitable

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14
Q

preg pt. Pap test showed HGSIL, best next step?

A

immediate colposcopy and Bx of cervical abnormalities d/t high risk of progression to cancer

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15
Q

endometrial Bx is indicated in all pts 45yo or more with AUB, and in pts less than 45 with?

A

AUB plus any of these: unopposed estrogen exposure (obesity, chronic anovulation ie oliomenorrhea), failed med management, or lynch Sy

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16
Q

PCOS pts levels of FSH, LH and testosterone?

A

FSH and LH are nml to increased, elevated testosterone

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17
Q

classic signs of mag toxicity

A

m. weakness, loss of DTRs, nausea, resp depression

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18
Q

TOC for eclampsia?

A

mag sulfate

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19
Q

past history of what conditions increases risk of preeclampsia

A

preeclampsia, cHTN, multifetal and molar pregnancy

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20
Q

Lewis Abs are not assoc w isoimmunization or hemolytic disease of the newborn bc?

A

they are IgM Abs thus do not cross the placenta

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21
Q

causes of elevated maternal serum AFP?

A

multiple gestation, neural tube defects, fetal abdominal wall defect, fetal death, cystic hygroma…

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22
Q

common presenting signs of an abruption

A

abdominal pain, bleeding, uterine hypertonus and fetal distress

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23
Q

assoc w painless cervical dilation and typically Dxed early in 2nd trimester

A

cervical incompetece

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24
Q

this tocolytic should not be used due to its side effects and lack of efficacy

A

terbutaline

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25
Q

This tocolytic agent is CI in pts w myasthenia gravis

A

Mag sulfate

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26
Q

a low AF glucose is an indication of

A

intra-amniotic infection

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27
Q

in placenta previa, the first bleeding episode occurs MC at what gestational age?

A

29-30wks

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28
Q

this Dx is usually confirmed by dark red, velvety rectal mucosa on the post. vaginal wall? MC cause?

A

rectovaginal fistula ;

obstetric injury

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29
Q

MC type of brachial plexus injury from birth ? grasp reflex should remain intact, what nerves are involved?

A

erb-duchenne palsy (waiter’s tip posture);

5th and 6th CNs

30
Q

Rare but potentially permanent complication of shoulder dystocia that results in hand paralysis/claw hand and ipsilateral Horner Sy? what nn are involved?

A

Klumpke palsy;

8th CN and 1st thoracic nerve

31
Q

4 complications of cervical conization which is indicated for CIN grades 2 and 3?

A

cervical stenosis, preterm birth, PPROM, cervical insuff (2nd trimester loss)

32
Q

2 causes of painful genital ulcers and a diff btwn them

A

HSV (small ulcers on red base, mild lymphadenopathy) and Haemophilus ducreyi (chancroid, larger deep ulcers w exudate, severe lymphadenopathy)

33
Q

2 causes of painless genital ulcers?

A

Treponema pallidum (chancre, primary syphilis) and Chlamydia serovars L1-3 (lymphogranuloma venerum, small shallow ulcers often missed, can progress to painful buboes)

34
Q

what quadruple screen results are assoc with Down Sy?

A

low MSAFP, low estriol, increased beta-hCG, and increased inhibin A

35
Q

pathogenesis of HELLP Sy involves?

A

hepatic and systemic inflamm, activation of coag cascade and platelet consumption

36
Q

intense itching, elevated bile acids and/or aminotransferases in pregnancy suggests?

A

Intrahepatic cholestasis of preg

37
Q

this should be suspected in postpartum women with an enlarged uterus, irregular vaginal bleeding, pulmonary Sxs, and multiple infiltrates on chest x-ray? Dx confirmed by?

A

Choriocarcinoma;

elevated beta-hCG

38
Q

arrest of the 2nd stage of labor is when there is no fetal descent after pushing for how many hrs in nulli-/multi-parous women?
MC cause of 2nd stage arrest?

A 
3hrs in nulli, 2hrs in multi;
fetal malposition (ie not occiput ant.)
39
Q

routine prenatal lab tests for initial prenatal visit

A 
Rh(D) type, Ab screen
Hg/Hct, MCV
HIV, VDRL/RPR, HBsAg
Rubella and varicella immunity
Pap test if needed 
chlamydia PCR
Urine culture/urine protein
40
Q

testing that should be done at 24-28wks

A

Hg/Hct
Ab screen if Rh (D) negative
50g 1hr glucose challenge test

41
Q

management of preterm labor from 34wks to 36.6 weeks ?

A

PCN if GBS positive or unknown, can give betamethesone

42
Q

management of preterm labor from 32 wks to 33.6 wks

A

betamethasone, tocolytics, PCN if GBS positive or unknown

43
Q

management of preterm labor at less than 32 weeks ?

A

Betamethasone, tocolytics, PCN is GBS positive or unknown, Mag sulfate

44
Q

typically presents w fever more than 24hrs postpartum, purulent lochia and uterine tenderness ? TOC?

A

Postpartum endometritis ;

Clindamycin plus gentamicin

45
Q

3 first line ABXs used for ASx Bacteriuria in preg

A

Cephalexin, Amoxicillin-Clavulanate, Nitrofurantoin

46
Q

2 MC SERMs?

A

Tamoxifen and Raloxifene

47
Q

frequently used for osteoporosis management in postmenopausal women who cannot tolerate bisphosphonates or are at higher risk of invasive breast ca.

A

Raloxifene (a SERM)

48
Q

Arrest of active labor occurs at a cervical dilation of…… when there is no cervical change for….

A

6cm or more;

4hrs or more w adequate contractions (atleast 200 MVUs) OR 6hrs or more w inadequate contractions

49
Q

If arrest of active phase of labor occurs the next step in management should be ?

A

Cesarean delivery

50
Q

Infants born to women w Graves disease are at risk for? affected infants have what Sxs?
Tx?

A

thyrotoxicosis;
irritable, tachycardic, gain weight poorly;
Methimazole and beta-blocker until it resolves over a few wks-months

51
Q

mech of anovulation and amenorrhea in exclusively breastfeeding women?

A

elevated prolactin inhibits GnRH thereby suppressing LH and FSH

52
Q

Pts w placenta previa should undergo cesarean delivery when?

A

36-37wks

53
Q

inherited bleeding disorder that causes easy bruising, heavy menses, nosebleeds and excessive bleeding after surgery or delivery

A

Von Willebrand disease

54
Q

In a young pt w recent menarche and an irregular cycle, heavy bleeding is likely due to?

A

anovulatory cycles

55
Q

Adverse effects of Tamoxifen?

A

Hot flashes, Venous thromboembolism, endometrial hyperplasia and carcinoma

56
Q

when should women w unknown GBS status be treated in labor?

A

if they are preterm,
develop an intrapartum fever, or
have rupture of membranes for 18hrs or more

57
Q

3 adverse effects of Oxytocin

A

Hyponatremia, Hypotension, Tachysystole

58
Q

Severe features of pre-eclampsia (6)

A 
SBP 160 0r more, oe DBP 110 or more,
thrombocytopenia,
incr Cr,
incr transaminases,
pulm edema
visual or cerebral Sxs
59
Q

3 Tx options for PCOS

A

weight loss, OCPs for menstrual reg, Clomiphene citrate for ovulation induction

60
Q

diffuse breast erythema, warmth, pain and edema w a peau d’orange(dimpling) appearance are hallmark features of

A

inflammatory breast carcinoma

61
Q

the one type of fibroid that is not assoc w recurrent preg loss?

A

subserosal (located outside the uterine cavity)

62
Q

this syndrome c/b midfacial hypoplasia, microcephaly, cleft lip/palate, digital hypoplasia, hirsutism, devel delay??
caused by?

A

Fetal hydantoin syndrome;

exposure to anticonvulsants during devel, MC- Phenytoin and carbamazepine

63
Q

what is a nml post voidal residual volume in women?

A

LESS than 150mL

64
Q

Greatest risk factor for epithelial ovarian ca.? others?

A

FH (even w/o BRCA mutations),

early menarche, late menopause, nulliparity, over 50yo, endometriosis

65
Q

the nml hyperventilation of preg is c/b?

A

incr TV, ince minute ventilation, chronic resp alkalosis w metabolic compensation

66
Q

what should initial evaluation be for a pt. with bilateral, guaiac-neg discharge w/o signs of malignancy (ie mass, lymphadenopathy, nipple changes)

A

serum prolactin, TSH, and preg test

then MRI in pts w elevated prolactin and/or Sxs of a pituitary mass

67
Q

3 complications of PPROM ?

A

infection (chorioamnionitis/ endometritis), cord prolapse, abruptio placentae

68
Q

postmenopausal bleeding w a thickened endometrium and a large ovarian mass is concerning for?

A

endometrial hyperplasia/cancer in the setting of a granulosa cell ovarian tumor (which secretes estrogen)

69
Q

fetal fibronectin test use?

A

normally should be very low in vaginal secretions from 22-35 weeks, if detected it can help predict preterm delivery

70
Q

majority of pts w pagets disease have an underlying breast ca., MC is?

A

adenocarcinoma (starts in glandular tissue)

OBGYN (9 decks)

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