UWORLD OBGYN

Question 1

Sxs:

Thin, off white vaginal discharge
fishy odor
no inflammation

Answer 1

Bacterial vaginosis (Gardnerella vaginalis)

Tx: metro or clinda

Question 2

Vaginitis sxs Micro:

pH >4.5
clue cells
positive whiff test (amine odor with KOH)

Answer 2

Bacterial Vaginosis
(garnerella vaginalis)

Tx: metro or clinda

Question 3

Vaginitis sxs:

Thin yellow-green frothy discharge
Vaginal inflamatin

Answer 3

Trichomoniasis
(trichomonas Vaginalis)

TX: Metro and treat sexual partner

Question 4

Vaginits sxs :

Thick, cottage cheese discharge
vaginal inflammation

Answer 4

Candida vaginitis

Tx: fluconazole

Question 5

Vaginitis sxs micro:

pH >4.5
Motile trichomonadas

Answer 5

Trichomoniasis
(trichomonas Vaginalis)

TX: Oral Metro and treat sexual partner

Question 6

vaginits sx micro:

normal pH (3.8-4.5)
Pseudohyphae

Answer 6

Candida Vaginitis

Tx: Fluconazole

Question 7

vaginal metronidazole for trichomoniasis

Answer 7

vaginal metro fails to eradicate T.vaginals from all reservoirs of infection (eg concomitant urethral and periurethral gland infections.

Not recommended tx

Question 8

classical Lobular Carcinoma in situ (LCIS)

Answer 8

Incidental finding on breast biopsy for other reason. Arises in the terminal ducts and lobules of the breast.

No pleomorphic changes, non invasive lesion, observed with survailance

Question 9

non classical LCIS

Answer 9

Arises in terminal ducts and lobules.

Has nuclear pleomorphism, distorted cellular adherence, and areas of necrosis.

Increases risk of invasive lobular or ductal carcinoma. Require excisional biopsy.

Question 10

Step up treatment of n&v in pregnancy

Answer 10

1. Dietary changes (small frequent meals)
2. Vit b6 &H1 antihistamine
3. Oral dopamine &seretonin antagonist
4. IV fluids & IV antiemetics
5. Corticosteroids
6. TPN or tube feeding (refactory)

Question 11

Tx of PMDD

Answer 11

SSRi are first line treatment.

Fluoxetine is nor studied and relieves both affective and somatic sxs.

However, if it doesnt work trial different SSRI. If not switch to combined OCP (progestin not effective)

Question 12

pathophys of preeclampsia

Answer 12

abnormal cytotrophoblast invasion –>
underdeveloped maternal spiral arteries with high resistance –>
chronic placental ischemia –>
^ release of antiangiogenic factors–>
Decreased proangiogenic factors (VEGF and placental growth factor)

Question 13

Effect of decreased proangiogenic factors

Answer 13

inhibited angiogenesis and widespread maternal endothelial cell dysfunction

dysregulated vascular tone
abnormally increased vascular permeability
Decreased end organ perfusion

Question 14

Endothilin and thromboxane A2 in preeclampsia

Answer 14

Endothelin adn TXA2 are potent vasoconstrictors.

Typically increased due to increased production in dysfunctional endothelial cells

Question 15

risks for cervical cancer

Answer 15

infection with high- risk HPV (eg. 16, 18)
Hx of STI
Early onset sexual activity
multiple or high-risk partners
immunosuppresion
OCP use
low socioeconomic status
tobacco use

Question 16

Presenting features of invasive cervical cancer

Answer 16

Most common:
irregular vagginal bleeding
friable exophytic cervical mass

other:
postcoital bleeding
watery mucoid vaginal discharge
ulcerative cervical lessions

Question 17

Best next step in managment for suspected cervical cancer?

Answer 17

Cervical biopsy

Question 18

Turner Syndrome and Pregnancy

Answer 18

Greatest risk is aortic dissection. Very high risk in pregnancy because of hormone-induced aortic wall weakening and the hyperdynamic state of pregnancy can precipitate dissection.

Question 19

Factor the increase risk of aortic dissection in Turners

Answer 19

Pregnancy
coarctation of the aorta
bicuspid aortic valve
hypertension

Question 20

Additional screening for mom with turner syndrome in pregnancy

Answer 20

Periodic repeat imaging of the aorta

Question 21

SLE and pregnancy

Answer 21

test for antiphospholipid syndrome (APS)

APS causes recurrent miscarriages, placental insufficiency, preeclampsia, fetal thrombosis and preterm delivery

Question 22

Comorbidities in Turner Syndrome

Answer 22

CV: congenital heart defect, aortic dilation/dissection, metabolic syndrome

Renal: horseshoe

MSK: osteo

ENT: strabismus, myopia, otits media, hearing loss

rhem: celiacs, hypothyroid

Question 23

Vulvular cancer presenation

Answer 23

Vulular pruritus
abnormal bleeding
dyspareunia

Single raised plaque or ulcer covering labia majora. (raised pigmented fungating)

Question 24

Cause of valvular cancer

Answer 24

persistent HPV
chronic inflammation (typically due to lichen sclerosis)

Question 25

Risk factors vulcular cancer

Answer 25

tobacco use
vulvar lichen sclerosis
immunodeficiency
prior cervical cancer
vulvar/cervical intraepithelial neoplasia

Question 26

management of Lichen Sclerosus

Answer 26

An autoimmune inflammatory dermatologic condition.

routine examination and topical corticosteroids. biopsy with atypical lesions or refractory

Question 27

Tx vulvar cancer

Answer 27

surgical excision and possible chemoradiation

Question 28

Physiologic nipple discharge features

Answer 28

bilateral
multiductal
nonbloody
only with expression or manipulation

Question 29

physiologic nipple discharge etiolofy

Answer 29

endocrine abnormalities
medications
stress
exs breast/nipple stimulation

Question 30

pathologic nipple discharge features

Answer 30

unilateral
bloody
spontaneous

Question 31

management of physiologic nipple discharge

Answer 31

lab workup for galactorrhea (pregnancy test, prolactin, TSH)
mammogram

all normal: reassurance and observation.
Persistence or bothersome: duct excision