Women's Health Questions

Question 1

Goodell’s Sign

Answer 1

cervical softening due to increased vascularization 4-5 wks

Question 2

Chadwick’s sign

Answer 2

bluish discoloration of the cervix and vulva around 10-12 wks

Question 3

Pelvic US detects fetus around:

Answer 3

5-6 wks

Question 4

Fetal Movement in Pregnancy:

Answer 4

16-20 wks (quickening)

Question 5

Fetal heart tones develop? normal HR?

Answer 5

10-12 wks

• -> end of first trimester
• ->120-160 BPM

Question 6

ladin’s sign

Answer 6

uterine softening after 6 wks

Question 7

hegar’s sign

Answer 7

uterine isthmus softening after 6-8 wks gestation

Question 8

piskacek’s sign

Answer 8

palpable lateral bulge or softening of the uterine corpus around 7-8 wks

Question 9

Prenatal Care: 2nd Trimester (5)

Answer 9

1- Triple Screening: 15-20 wks (AFP, B-hcg, estradiol)
2- Inhibin-A: high levels may indicate chromosomal abnormalities
3- UA: check amniotic fluid levels, fetal growth for GA, and viability
4- Amniocentesis 15-18 wks
5- Gestational Diabetes Screening 24-28 wks

Question 10

Prenatal Care: 1st Trimester (3)

Answer 10

1- Maternal Blood Screening Tests:
–Down syndrome (3 tests)
–Uterine Size and Gestation (abnormal –> CVS or Amniocentesis)
2- US (fetal heart sounds around 5-6 wks/doppler around 10-12 wks)
3- Chorionic Villi Samping (around 10-13 wks)
–> SaB

Question 11

Prenatal Care: Routine Tests During First Visit (14)

Answer 11

1-

2-

Question 12

Markers for Down Syndrome Screening in the 1st Trimester:

Answer 12

1- free beta-hcg (extremes high/low is abnormal)
2- PAPP-A (low is abnormal)
3- nuchal translucency (thickness=abnormal)

Question 13

Amniocentesis/CVS indications: (6)

Answer 13

sfkjdk

Question 14

Amniocentesis/CVS indications: (6)

Answer 14

1- chromosomal abnormality in previous child
2- abnormal maternal screen 1st trimester
3- abnormal maternal screen 2nd trimester
4- abnormal US
5- mom > 35 yo
6- previous pregnancy loss

Question 15

Indications for Colposcopy: (4)

Answer 15

1- ASCUS with HPV +
2- LSIL
3- HSIL
4- Persistent ASCUS

Question 16

Indications for Hysteroscopy: (4)

Answer 16

1- myoma bx or excision
2- PM bleeding
3- endometrial ablation
4- retained products of conception

Question 17

Indications for Laparoscopy: (3)

Answer 17

• essure/tubal ligation
• ectopic pregnancy, ruptured and unstable
• endometrium evaluation

Question 18

Mifepristone drug MOA

Answer 18

Progestin antagonist

Question 19

Misoprostol drug MOA

Answer 19

Prostaglandin analog—> stimulates uterine contractions

Question 20

Methotrexate drug MOA

Answer 20

Folic acid antagonist

Question 21

Cryptomenorrhea

Answer 21

Light flow or spotting

Question 22

Polymenorrhagia

Answer 22

Frequent cycle interval (<21 days)

Question 23

Oligomenorrhea

Answer 23

Infrequent menstruation (prolonged cycle length >35 days but <6 months)

Question 24

Acute severe dysfunctional bleeding TX:

Answer 24

IV high dose estrogens/high dose OCPs

—> if IV estrogens fail, then DnC

Question 25

How to dx DUB?

Answer 25

Negative pelvic exam and r/o organic causes; DX of exclusion

Question 26

Hypothalamus Dysfx TX: (2)

Answer 26

1-clomiphene | 2-menotropin (pergonal)

Question 27

MC cause of infertility:

Answer 27

PCOS

Question 28

If estrogen is contraindicated in a postmenopausal woman, which alternative medication can be used to treat significant hot flashes, especially if there is concurrent sleep disturbance?

Answer 28

Gabapentin

Question 29

If estrogen is contraindicated in a postmenopausal woman, which alternative medication can be used to treat significant hot flashes, especially if there is concurrent sleep disturbance?

Answer 29

reassurance (gynecomastia is common in males during early pubertal changes)

Question 30

Etiologies of gynecomastia:

Answer 30

``` 1- physiologic (early pubertal changes) 2- ethanol abuse 3- Klinefelter syndrome 4- Kidney failure, liver disease, etc. 5- Tumors (testicular and adrenal) 6- Medications --cimetidine --ketoconazole --spironolactone --steroids --risperidone --finasteride ```

Question 31

Premature Menopause is defined as:

Answer 31

Menopause before 40 y.o.

Question 32

RF for premature menopause: (4)

Answer 32

- DM - Smoker - malnourished pts - vegetarians

Question 33

Risks associated with combo OCP: (2)

Answer 33

- increased risk for breast cancer (controversial) | - Venous thromboembolism

Question 34

Predominant estrogen after menopause:

Answer 34

estrone (ester-ALONE)

Question 35

DX for menopause:

Answer 35

- elevated FSH: most sensitive initial test (>30) | - also, elevated LH

Question 36

Menopause hot flashes TX:

Answer 36

- estrogen - progesterone - clonidine - gabapentin - SSRI

Question 37

Menopause Osteoporosis prevention:

Answer 37

- Calcium (500-1000 mg/day for total of 1200mg/d) and Vitamin D (800 IU/d) - weight bearing exercise - bisphosphonates** - calcitonin - estrogen - SERM**--> raloxifene, tamoxifen

Question 38

MC benign gynecologic lesion

Answer 38

leiomyoma (uterine fibroid)

Question 39

MC leiomyoma SXS?

Answer 39

MC ASXS; but if SXS, then heavy periods

Question 40

RF for endometriosis: (3)

Answer 40

- nulliparity** - Fam hx - early menarche

Question 41

Onset for endometriosis occurs before age:

Answer 41

35

Question 42

MC gyn cancer in US

Answer 42

endometrial CA

Question 43

endometrial CA is ___ MC in US overall cancers

Answer 43

4th | 1- breast, 2- lung, 3- colorectal

Question 44

Prophylaxis for endometritis in a C-section:

Answer 44

1st gen cephalosporin x 1 dose during surgery (Cephalexin/Cefazolin)

Question 45

3 signs of placental separation:

Answer 45

1- gush of blood 2- lengthening of the umbilical cord 3- anterior-cephalad movement of the uterine fundus (becomes globular & firmer)