UWorld: Step 2 CK - "Obstetrics & Gynecology" Flashcards
1
Q
In what age groups is the HPV vaccine indicated?
A
- Women: 11 - 26
* Men: 11 - 21 (26 if they are MSM)
2
Q
How should an asymptomatic Bartholin cyst be treated?
A
Observation (many times they resolve on their own)
If they are infected (abscesses), then incision and drainage can be curative.
3
Q
What should you do in the case of a Pap test showing high-grade dysplasia?
A
Immediate colposcopy
4
Q
In addition to PID, N. gonorrhoeae can cause ____________.
A
pharyngitis (look for cervical lymphadenopathy)
5
Q
Both tamoxifen and raloxifene can cause what side effects?
A
Hot flashes and clots
6
Q
The first-line choice for evaluating the endometrium is _______________.
A
endometrial biopsy
7
Q
True or false: endometriosis can present with dyspareunia.
A
True
8
Q
How can you use the timing of pain to distinguish between primary dysmenorrhea and endometriosis?
A
Endometriosis pain peaks before bleeding while dysmenorrhea peaks during bleeding.
9
Q
Uterine fibroids are also called _______________.
A
leiomyomata uteri or leiomyoma
10
Q
What patient characteristic can help you distinguish leiomyoma from leiomyosarcoma?
A
Age
Fibroids are more common in younger women.
11
Q
What neoplasm can cause bloody discharge?
A
Intraductal papilloma
12
Q
True or false: biopsies are needed to evaluate ovarian masses.
A
False
If they are malignant, then the cancer could seed the abdomen during a biopsy.
13
Q
Ovarian torsion shows __________ on doppler flow.
A
absence of movement
14
Q
After an ultrasound has shown the absence of flow on a suspected case of ovarian torsion, the next step is to ______________.
A
do urgent laparoscopy
15
Q
One of the most common complications of cervical conization is _____________.
A
cervical stenosis (impeded menstrual flow and dysmenorrhea)
16
Q
Lichen sclerosis is diagnosed by ______________.
A
vulvar punch biopsy
17
Q
_______________ occurs more frequently in those with lichen sclerosis.
A
Squamous cell carcinoma
18
Q
True or false: topical estrogen is used to treat lichen sclerosis.
A
False.
Corticosteroids are treatment.
19
Q
Lichen sclerosis typically spares _________.
A
the vagina itself (it surrounds the labia majora)
20
Q
HELLP is a ______________________ syndrome.
A
systemic inflammatory disorder with platelet consumption
The consumption of platelets causes congestion of the liver with swelling and hepatocellular destruction.
21
Q
Cystic teratomas can show ______________ on ultrasound.
A
calcifications and hyperechoic nodules
22
Q
Teratomas are also called ___________.
A
dermoid cysts
23
Q
What is dyschezia?
A
Pain with defecation (in the context of OB/GYN, suggestive of endometriosis)
24
Q
In a menstrual cycle, “day 1” is the day that ____________.
A
bleeding starts
25
The most effective form of emergency contraception is _____________.
copper IUDs
26
What are some indications for endometrial biopsy by age?
* Older than 45: postmenopausal bleeding or AUB
| * Younger than 45: AUB with either excess estrogen exposure, anovulation, or failed medical management
27
What is ACOG's recommendation for alcohol intake for women?
Less than 7 drinks per week
More than this increases risk of breast cancer.
28
Which women should get genetic testing?
Those who have had breast cancer before age 50, have a first-degree relative who had breast cancer before age 50, or ovarian cancer at any age.
29
When should you do laparoscopy in a patient with endometriosis?
* When NSAIDs and OCPs have failed
* Infertility with a desire to have children
* Concern for concomitant malignancy
30
How can you further evaluate a woman with suspected infertility due to past PID?
Hysterosalpingogram
31
All sexually active women younger than 25 should be tested for ________________.
chlamydia and gonorrhea; many cases are asymptomatic, so testing can catch underlying infections
32
True or false: combined OCPs increase risk of endometrial cancer.
False. They actually lower the risk because the progesterone promotes differentiation and stabilization rather than uncontrolled growth.
33
The most common symptoms of vaginal cancer are _______________.
vaginal bleeding and malodorous discharge
34
What are the two diagnostic tests done to evaluated ovarian masses?
TVU and CA-125
If the US does not show suspicious features and the CA-125 is normal, then the patient can be managed with observation. If either test is abnormal, however, laparoscopy is indicated.
35
Atrophic vaginitis can present with what kind of incontinence?
Mixed
36
Normal breast milk is what color?
Brownish-gray
37
How should genital HSV in a pregnant woman be managed?
* Administer acyclovir or valacyclovir to women with a history of HSV beginning at 36 weeks gestation.
* If a woman is in labor and has active genital lesions, then a c-section is indicated.
38
Explain the two phases of gestational diabetes treatment.
* First, recommend dietary changes, specifically no more than three small meals and 2 snacks per day.
* Second, administer insulin, glyburide, or metformin if labs fail to correct with diet.
39
What should the following be during pregnancy?
• Fasting glucose
• 1-hour postprandial
• 2-hour postprandial
* Fasting glucose: less than 95
* 1-hour: less than 140
* 2-hour: 120
40
Explain the protocol for handling shoulder dystocia.
```
Remember the mnemonic BE CALM:
• Breath, do not push
• Elevate the legs to the chest (i.e., flex the hips)
• Call for help
• Apply suprapubic pressure
• enLarge the vagina with an episiotomy
• Maneuvers:
- deliver the posterior arm
- rotate 180º
- collapse the anterior shoulder
- put the fetus back in the uterus to prepare for c-section
```
41
RUQ pain in a young, sexually active female not using condoms?
Fitz-Hugh-Curtis
42
What organism causes chancroids?
H. ducreyi
43
One of the things that can help you diagnose granuloma inguinale is ____________.
that it is primarily present in Asia
44
If you suspect syphilis but an RPR was negative, then ______________.
get an FTA and treat with penicillin G; the false-negative rate of RPR tests are high (up to 30%), so these tests cannot rule out syphilis
45
A "smooth, firm, round mass seen through the cervical os" could be _____________.
leiomyomata uteri
46
Clear cervical mucus coming from the os occurs during ______________.
ovulation
47
_______________ cancer can present with thick septations.
Epithelial ovarian cancer
48
What is hydrosalpinx?
Fluid accumulation in the fallopian tube due to blockage (from adhesions secondary to PID or surgery, usually)
49
Describe the clinical features of aromatase deficiency.
* Excess testosterone due to inability to convert it to estradiol leads to acne, clitoromegaly, and normal pubic hair.
* Lack of estrogen leads to the absence of breasts and cystic ovaries.
For bonus points, remember that aromatase deficiency causes transient masculinization in the mother during pregnancy.
50
The false positive rate for urine dipstick protein detection is high. What is done to reach a conclusive diagnosis of proteinuria in women with potential preeclampsia?
* Gold standard: 24-hour urine collection demonstrating greater than 300 mg of protein
* Second best: urinalysis with protein/creatinine ratio greater than 0.3
51
The best test to confirm a diagnosis of fibroids is _____________.
pelvic ultrasound
52
Per UWorld, if the ß-hCG is less than ________ in a case of suspected ectopic pregnancy not seen on US, then you need to wait two days and test it again.
1,500 IU/L
53
If the question says that a patient has dry eyes and dental caries, they're trying to tell you that ___________.
the patient has Sjögren's
In a gynecologic setting, these symptoms might accompany dyspareunia.
54
Foamy histiocytes in a breast biopsy indicate __________.
fat necrosis
55
What kind of cancer (SCC or adenocarcinoma) is Paget's disease of the breast?
Adenocarcinoma
56
_________________ is the most accurate method for determing gestational age.
First-trimester ultrasound measuring crown-rump length
57
___________ are described as "multiple papular lesions around the vulva."
Condyloma acuminata
58
After a simple breast cyst is drained, it's recommended to _______________.
have the patient follow up in 2-4 months to evaluate for fluid return in the cyst
59
What does bleeding after progesterone withdrawal demonstrate?
That there is adequate estrogen in the body and that there is no uterine outlet obstruction
If a woman has insufficient estrogen, then there will be no bleeding after withdrawal.
60
You're working in the NICU. A 1-day-old baby boy has tachycardia and warm, flushed skin. The attending orders a beta blocker and says this syndrome will resolve shortly. What happened?
Maternal TSH-antibodies from a hyperthyroid mother passed through the placenta and into the baby, leading to transient thyrotoxicosis. This can be treated with methimazole and beta blockers and resolves when the antibodies break down.
61
All pregnant women with HIV should receive ______________.
triple antiretroviral therapy
62
If the ______________ in an HIV-positive pregnant woman, then you should do a caesarean section. Otherwise, vaginal delivery is standard.
viral load is greater than 1,000 copies/mL
63
How should lactational mastitis be treated?
Administer oxacillin/nafcillin and instruct the mother to continue breastfeeding
64
What is the standard regimen for RhoGAM treatment?
* 300 µg at 28 weeks gestation
* 300 µg within 72 hours of delivery
Important: women who have a labor complication – such as placental abruption or vaginal tears – may need a higher postpartum dose. In this case, there is a lab test on maternal RBCs that can tell you if a woman needs more RhoGAM.
65
How does ABO incompatibility in a pregnancy present?
Although the AB antigens elicit only an IgM response, some antibodies can affect the baby. This can lead to a mild anemia in some cases.
66
Although HBV and HAV are not routinely given to pregnant women, they should be given to _____________.
those with underlying hepatic disease; if a woman with chronic HCV, for example, gets HAV, then that could precipitate devastating hepatitis
67
How do thyroid labs change during pregnancy?
Total T4, total T3, and TSH all increase
68
Why does TSH decrease in pregnancy?
ß-hCG has a shared subunit with TSH and stimulates the TSH receptors.
69
Rapid cessation of breastfeeding can cause engorgement. What are the symptoms and how do you treat it?
* Sx: bilateral breast enlargement; no erythema; absence of fever
* Tx: NSAIDs, ice packs, loose bras (to avoid nipples stimulation)
70
If they tell you that a woman has insomnia, difficulty concentrating, and weight gain, you say _________________.
"get a ß-hCG cause she's probably pregnant!"
71
Per UWorld, the discharge associated with trichomoniasis is what color?
Green
Yellow = gonorrhea/chlamydia
Grayish white = bacterial vaginosis
Thick and white = candidiasis
72
If a woman has a breast mass, the next step you should do is ______________.
a mammogram
If the mammogram shows a simple cyst, then no further workup is indicated. If it shows a complex cyst, then you need to get a core biopsy.
73
A postmenopausal woman presents with an ovarian mass and a thickened endometrial stripe. What is this likely and how should you approach treatment?
* Granulosa cell tumor (secreting estrogen)
| * Get an endometrial biopsy for rule out of endometrial cancer
74
What are the three steps you should follow in evaluating secondary amenorrhea?
* First, order a ß-hCG. If this is positive, it's pregnancy of some kind.
* Second, if the ß-hCG is negative, then you should measure TSH, FSH, and prolactin. If any of these are abnormal, treat accordingly.
* If those are negative – or if the woman has a history of PID or pelvic surgery – then get a hysteroscopy.
75
What lab sign is suggestive of oxytocin toxicity?
Hyponatremia
Oxytocin mimics ADH.
76
When should external cephalic version be done in breech pregnancies?
37 weeks and later
77
Go through the schematic for diagnosing and treating preterm labor.
First, ask if the patient has had preterm labor before:
• If yes, give progesterone and do a TVUS.
- If the TVUS reveals a short cervix, place a cerclage at 24 weeks.
- If the TVUS reveals a normal cervix, monitor with serial TVUS.
• If no, do a TVUS.
- If the TVUS reveals a short cervix, give vaginal progesterone.
- If the TVUS reveals a normal cervix, maintain normal prenatal care.
78
Don't forget that ____________ can also appear as multiloculated adnexal masses.
tubo-ovarian abscesses
79
_____________ often presents with intolerable pruritus.
Intrahepatic cholestasis of pregnancy (ICP)
Lab signs show elevated total bile, elevated alkaline phosphatase, and aminotransferases.
80
When the fetal head "delivers and then retracts into the perineum," it could be a sign of ____________.
shoulder dystocia
81
What is the first step you should try in the management of uterine inversion?
Replacement of the uterus
If the first attempt fails, then administer tocolytics to aid in the process.
82
________ palsy, a complication of shoulder dystocia, can present with ipsilateral Horner syndrome.
Klumpke
83
Low scores on the biophysical profile usually suggest ________________.
fetal hypoxia (itself from placental dysfunction)
84
What counts as "severe features" for preeclampsia?
* BP greater than 160/110
* Headache
* Visual changes
* Transaminitis
* Elevated creatinine
85
When physical exam finding or vital sign would make you choose hydralazine over labetalol?
Bradycardia!
As a beta blocker, labetalol will lower heart rate and should not be given to those with HRs less than 60. Nifedipine is oral, so if you need an antihypertensive in a pregnant, bradycardic women who is vomiting then go to hydralazine.
86
Vulvar/vaginal swelling can cause __________, which may necessitate urethral catheterization.
postpartum urinary retention
87
What are the official diagnostic criteria for chorioamnionitis?
```
• Maternal fever
• One of the following:
- Fetal tachycardia
- Maternal tachycardia
- Uterine tenderness
- Malodorous vaginal discharge
```
88
How should you treat chorioamnionitis?
* If the fetus has no decelerations and only moderate tachycardia, then administer antibiotics and induce labor via oxytocin.
* If the fetus has decelerations and bradycardia or tachycardia, then c-section.
89
Atrial fibrillation can result from _______________.
mitral stenosis
90
Peripartum cardiomyopathy happens after week _________.
36
91
True or false: variable decelerations are benign and do ot require intervention.
False. If variable decelerations recur with more than 50% of contractions then you should try to reposition the mother as these can lead to fetal acidosis.
92
True or false: placental abruption causes maternal pain.
False.
93
How can you differentiate placenta previa and vasa previa by physical exam/fetal monitoring?
Placenta previa is bleeding from the mother, so the fetal heart rate is typically normal. Vasa previa is fetal placenta vessels, so bleeding causes fetal distress.
94
When is suction curretage the correct choice for abortion management?
When the woman is hemodynamically unstable.
If the woman is stable, then misoprostol can be used as it avoids the complications of surgical treatment.
95
True or false: oxytocin cannot be used to manage first trimester abortions.
True
96
Bilateral pitting edema in pregnancy can be ___________.
benign
