Women's Health Rosh Review Flashcards
What is the best test to evaluate for early onset of menopause?
FSH
In menopause, are FSH levels high or low?
High. as ovarian follicles are depleted, estrogen becomes low and FSH becomes high.
What is the median age for menopause?
51.4 years
Why would you order a test for anti-mullerian hormone?
Is can be used to estimate ovarian reserve as part of a workup when infertility is a concern.
What is the clomiphene citrate challenge test for?
It screens for ovarian reserve.
What are measurements of luteinizing hormone used for?
Used as a predictor for ovulation
Which study evaluates for patency of the fallopian tube system?
Hysterosalpingogram.
What is the recommended treatment for chlamydia in pregnancy?
1g azithromycin PO once.
What is the recommended treatment for gonorrhea in pregnancy?
azithromycin 1g PO once and ceftriaxone 500mg IM once.
When should repeat testing be done for gonorrhea and/or chlamydia in pregnancy?
Test for cure 3-4 weeks after treatment is completed and repeat testing for gonorrhea and chlamydia 3 months after the test of cure.
Which sexually transmitted infection is associated with the congenital abnormality known as Hutchinson teeth?
Syphilis
What is dysmenorrhea?
Painful menstruation
What is the difference between primary and secondary dysmenorrhea?
Primary is without a clear underlying cause.
Secondary is due to underlying pathology such as fibroids, adenomyosis, endometriosis, ovarian cysts, IBS, or inflammatory bowel disease.
Describe the classic pain associated with primary dysmenorrhea.
Crampy and midline
Name 2 non-pharmacologic treatments for primary dysmenorrhea.
Exercise and application of heat
What is the first line pharmacologic treatment for primary dysmenorrhea?
NSAIDs, hormonal contraceptives, or both
How long after menarche do ovulatory cycles typically start?
2–5 years.
What lifestyle modifications can be recommended to patients with breast pain from fibrocystic breast disease?
Decreasing dietary fat intake, decreasing caffeine intake, decreasing chocolate intake, and wearing well-fitting brassiere
What is the only FDA approved treatment for pain associated with fibrocystic breast disease?
Danazol
Which natural medication used to alleviate pain in fibrocystic disease is a form of gamolenic acid?
Evening primrose oil.
What is the first line treatment for PMS?
If the patient desires fertility, SSRIs such as fluoxetine or sertraline.
if the patient does not desire fertility, combined oral contraceptives.
What is the most common finding in vaginal candidiasis?
Vulvar pruritis
Describe the discharge present in vulvovaginal cadidiasis.
Thick, white, clumpy
T or F? KOH odor (whiff test) is positive in vulvovaginal candidiasis.
False
What is seen on a wet mount to confirm vulvovaginal cadidiasis?
Pseudohypae and spores
What is the treatment for uncomplicated vulvovaginal candidiasis?
Single dose of oral fluconazole
What is the treatment for complicated vulvovaginal candidiasis?
Two doses of oral fluconazole administered 3 days apart
What is the recommended treatment for vulvovaginal candidiasis in pregnant women?
Topical miconazole or clotrimazole applied vaginally for 7 days.
What is the biggest risk factor for postpartum endometritis?
Recent C section
What is the treatment for postpartum endometritis?
Broad spectrum abx, typically gentamicin and clindamycin
What sign typically differentiates postpartum endometritis from septic pelvic thrombophlebitis?
A palpable cord-like mass
How does the treatment of postpartum endometritis differ from the treatment of septic pelvic thrombophlebitis?
Anticoagulation is recommended along with gentamicin and clindamycin for septic pelvic thrombophlebitis.
Which bacteria most frequently causes toxic shock syndrome?
Staphylococcus aureus.
Which bacteria most frequently causes toxic shock syndrome?
Staphylococcus aureus.
What is the earliest gestation that gestational trophoblastic disease can be diagnosed?
8 weeks
What is the most common form of gestational trophoblastic disease?
Hydatidiform moles
What is the cause of hydatidiform moles?
abnormalities in fertilization
What are the 3 classifications of hydatidiform moles?
Complete, partial, or invasive.
What type of molar pregnancy is more likely to present with vaginal bleeding?
Complete molar pregnancy
A snowstorm appearance and absence of fetal parts is diagnostic of?
Complete molar pregnancy
An abnormally formed fetus with variable, focal, villous edema on US is consistent with what diagnosis?
Partial molar pregnancy
What is the definitive treatment for a molar pregnancy?
Prompt evacuation of uterine contents, most commonly by dilation and curettage.
What is considered an acceptable decrease in human chorionic gonadotropin levels after treatment for gestational trophoblastic disease?
A decrease > 10% demonstrated by four values taken weekly for 3 consecutive weeks.
What medication is commonly used for induction of labor?
Oxytocin
What is the most common side effect of oxytocin?
Tachysystole, which is defined as 5 or more contractions per 10 minutes for >30 mintues.
What is the treatment for tachysystole?
Reduce or discontinue oxytocin.
At which level of cervical dilation is a patient considered to be in active labor?
≥ 6 cm.
Where do most cervical carcinomas develop?
The transformation zone, which is located between squamous epithelium and collumnar epithelium and is an area of active squamous metaplasia.
What is the most common type of cervical carcinoma associated with HPV?
Squamous cell carcinoma
What are the high risk HPV types?
16, 18, 31, 33, 45, 52, 58
What is the definitive treatment for a cervical carcinoma?
Total hysterectomy
At what age should a sexually active woman begin screenings for cervical cancer?
21 years old
True or false: the survival rate for women with low-risk gestational trophoblastic neoplasia after treatment is 100%.
True.
When does cyclic breast pain occur in relation to menses?
The week before menstruation.
In which phase of the menstrual cycle does cyclic breast pain occur?
Luteal phase.
What is the treatment for urge incontinence (Detrusor over activity)?
Anticholinergics, such as oxybutynin
What is the treatment for stress incontinence?
Kegel exercises, topical estrogen in postmenopausal women, and pessary placement if indicated.
Which nerve plexus provides sympathetic innervation that relaxes the detrusor muscle, allowing urine to fill the bladder?
Inferior hypogastric plexus.
What is the most common site of early hematogenous metastases of a choriocarcinoma?
Lungs.
What is the appropriate follow up after treatment of a partial molar pregnancy?
hCG at 1 month and then discontinued if undetectable.
What is the first line choice for persistent nausea and vomiting in pregnancy?
Pyridoxine alone or in combination with doxylamine
What medications would you consider adding to a patient on pyridoxine and doxylamine for persistent nausea in pregnancy?
Diphenhydramine, meclizine, dimendydrinate, or ondansetron would be reasonable additions.
Your patient has failed first and second line treatments for persistent nausea and vomiting in pregnancy. What is the third line option?
Methylprednisolone or chlorpromazine.
What tool can be used to quantify the severity of nausea and vomiting in pregnancy?
Pregnancy Unique-Quantification of Emesis (PUQE) score.
What is routinely given to neonates at birth to prevent ophthalmia neonatorum in the US?
Erythromycin ophthalmic ointment
When is ophthalmia neonatorum most likely to appear in a newborn?
About 2–5 days after birth.
What pathogen is responsible for ophthalmia neonatorum?
Gonorrhea
When is an infant considered full term?
39 weeks.
What is the surgical repair of a cystocele called?
Anterior vaginal colporrhaphy.
What condition should a patient be evaluated for when presenting with postcoital bleeding?
Cervical cancer.
What are some common causes of postmenopausal bleeding?
endometrial atrophy, proliferation, or hyperplasia.
Endometrial or cervical cancer
Endometrial thickness > ___ should be evaluated with an endometrial biopsy for hyperplasia or cancer.
4mm
What is PPROM?
Preterm Prelabor Rupture or Membranes
PPROM occurs before ___ weeks gestation
37
What is oligohydramnois?
Less amniotic fluid than expected for gestational age
How is fluid tested to see if it is amniotic fluid?
Nitrazine test resulting in pH >7 and microscopic examination of fluid revealing a ferning pattern is consistent with amniotic fluid.
What is the most common risk factor for PPROM?
Gardnerella vaginalis infection (BV)
What is the recommended route, dosage, and duration of metronidazole prescribed for pregnant patients with bacterial vaginosis?
Metronidazole 500 mg PO bid for 7 days.
In a patient with PID, elevated white count, and elevated inflammatory markers, what diagnosis must you consider?
Tubo-ovarian abscess
What is the best imaging modality to assess for tubo-ovarian abscess?
Pelvic US and pelvic CT
What findings lead you to think that a patient with a tubo-ovarian abscess can be treated with antibiotics without surgical intervention?
Hemodynamic stability, abscess <7cm, no evidence of rupture.
What are the inpatient empiric antibiotic regimen options for tubo-ovarian abscess?
Cefotetan + doxycycline
Cefoxitin + doxycycline
Ceftriaxone + doxycycline + metronidazole
Clindamycin +gentamicin
What is the most common type of uterine tumor?
Fibroid tumors
What is the most common type of vulvar cancer?
Squamous cell carcinoma
What rare disease should be included in your differential for postmenopausal women with vulvar pruritis and erythema?
Paget disease of the vulva (which is a type of adenocarinoma or apocrine or eccrine glands)
What are the common causes for acetowhite changes seen with colposcopy?
Inflammation, subclinical papillomavirus infection, cervical intraepithelial neoplasia, and metaplasia
How does the composition of colostrum differ from breast milk?
Colostrum has higher concentrations of protein, immunoglobulins, calcium, phosphorus, and sodium when compared to breast milk.
Describe the discharge associated with trichomoniasis.
Thin, frothy, yellow-green, malodorous, discharge.
What is strawberry cervix?
What is it found in?
Punctate macular hemorrhages on the cervix, which are found in trichomoniasis.
What should be seen on a wet mount in trichomoniasis?
Flagellated protozoa moving in corkscrew patterns.
What is the treatment for trichomoniais?
Metronidazole 500mg BID x 7 days
What side effect of metronidazole is it important to warn patients about?
The disulfiram like reaction that occurs if the patient drinks alcohol while on the medication.
How long does the Trichomonas vaginalis protozoa remain motile after a sample is collected?
10–20 minutes.
Which complication of loop electrosurgical excision procedure is characterized by recurrent second-trimester miscarriage?
Cervical insufficiency.
Where does the first stage of labor start and end?
Onset is when the the patient is having regular contraction every 3-5 minutes for 1 hour.
It ends when the cervix is fully dilated to 10cm.
Where does the second stage of labor start and end?
Time from complete cervical dilation to fetal expulsion.
When does the third stage of labor start and end?
Time between fetal expulsion and placental expulsion.
What anatomic landmark is used to measure fetal station?
Ischial spine.
What anatomic landmark is used to measure fetal station?
Ischial spine.
What are the 5 classifications of ovarian masses?
Benign Malignant Cystic Complex cystic Solid
What is an endometrioma?
Adnexal masses that consist of ectopic endometrial tissue in patients with endometriosis
Describe the appearance of an endometrioma on ultrasound.
Smooth-walled with homogenous internal echoes that have the appearance of ground glass
Why are endometriomas often referred to as chocolate cysts?
The fluid inside is old blood, and appears chocolate-colored on biopsy.
What type of cysts contain materials such as teeth and hair?
Dermoid cyst AKA mature teratoma
What cell line do dermoid cysts arise from?
Germ cells
What cell line do dermoid cysts arise from?
Germ cells
What is a theca lutein cyst?
An ovarian cyst that results from overstimulation by beta-human chorionic gonadotropin, such as occurs during molar pregnancy, multiple gestation, or clomiphene therapy.
What is the treatment for trichomoniasis in a non-pregnant patient?
Metronidazole 2g PO once
What is the treatment for bacterial vaginosis in a non-pregnant patient?
Metronidazole 500mg BID x 7 days
What bacteria causes bacterial vaginosis?
Gerdnerella vaginallis
What autosomal recessive syndrome characterized by intellectual disability and accelerated pathologic aging is an absolute contraindication to the use of metronidazole?
Cockayne syndrome.
In what stage of labor can a patient receive neuraxial analgesia?
Any stage of labor
Name 3 relative contraindications to neuraxial analgesia?
Coagulopathy, infection at the site of neuraxial analgesia puncture, and increased intracranial pressure.
What medications typically make up neuraxial analgesia?
A dilute local anesthetic such as bupivacaine or ropivacaine, and an opioid such as fentanyl or sufentanil.
What is total spinal anesthesia?
It is when local anesthesia intended for an epidural is inadvertently injected into the subarachnoid space, which can lead to bradycardia, hypotension, dyspnea, and cardiac arrest.
What is the treatment for a postdural puncture headache?
An epidural blood patch
What is the most common gestational age for ectopic pregnancy to present?
6-8 weeks
A hCG above _____ should have a gestational sac visible on transvaginal US.
2,000
What percentage of patients with ectopic pregnancy initially present with tubal rupture?
50%
What are the classic symptoms of ectopic pregnancy?
Lower abdominal pain and heavy vaginal bleeding.
What signs or symptoms in ectopic pregnancy make you concerned for tubal rupture?
Hypotension, syncope, lightheadedness, orthostasis, and tachycardia. (Although, blood can be irritating to the peritoneum, causing a vagal response and reflex bradycardia)
What is the treatment for an ectopic pregnany?
Methotrexate and/or surgical intervention
What is a heterotopic pregnancy?
Pregnancy with one intrauterine gestational sac and one ectopic gestational sac.
What is the first-line pharmacologic therapy for gestational diabetes?
Insulin
What is the most common complication for the baby resulting from gestational diabetes?
Macrosomia and large for gestational age
When are pregnant women screened for gestational diabtetes?
At their first prenatal visit if they have a prior history of diabetes.
All women should be tested between 24 and 28 weeks gestation.
Why shouldn’t oral antihyperglycemics be used in pregnancy?
They cross the placental barrier
What is the most common complication of macrosomia/LGA?
Shoulder dystocia
Which hormones secreted by the placenta lead to postprandial hyperglycemia, permitting more nutrients to flow to the fetus?
Growth hormone, corticotropin-releasing hormone, human placental lactogen, and progesterone.
What is the most common type of breech presentation?
Frank breech
Describe the fetal positioning of a frank breech fetus.
Hips flexed and knees extended.
Feet adjacent to head.
Describe the fetal positioning of a complete breech fetus.
Both hips flexed
Both knees flexed.
Describe the fetal positioning of an incomplete breech fetus.
One or both hips not completely flexed.
Presenting parts may be buttocks or one or both feet.
Describe the fetal positioning of a nonfrank breech fetus.
One or both feet present between the buttocks and the birth canal
What is the maximum fetal weight recommended for low-risk women who elect a planned vaginal breech birth?
3,800 g.
What type of contraceptives are contraindicated during the postpartum period?
Combined oral contraceptives due to the increased risk of VTE
True or false: the copper intrauterine device is contraindicated during breastfeeding.
False.
Which hormone is responsible for uterine ripening to allow proper implantation of a fertilized ovum?
Progesterone
What hormones released from the anterior pituitary affect the menstrual cycle?
LH and FSH
What hormones are released by the ovaries are part of the menstrual cycle?
Estradiol and progesterone
What hormone stimulates the proliferation of the endometrial lining?
Estrogen
What hormone stimulates granulosa cells in the ovaries to produce estrogen?
FSH
What hormone stimulates ovarian theca cells to produce progesterone?
Luteinizing hormone
What is the function of prolactin in the female breast?
To stimulate milk production.
What are the two diagnostic criteria for preeclampsia?
Blood pressure > 140/>90 on two occasions 4 hours apart after 20 weeks gestation in a woman with previously normal blood pressure (or >160/>110 on two occasions minutes apart)
and
Proteinuria >300mg per 24 hour urine collection or Urine dipstick 2+ proteinuria or protein to creatinine ratio >0.3
Can preeclampsia be diagnosed in the absence of proteinuria?
yes, if they have new onset HTN and platelet count <100k, creatinine >1.1 in the absence of renal disease, elevated transaminases at 2x ULN, pulmonary edema, or cerebral or visual symptoms.
What must happen for a patient to be diagnosed with eclampsia?
A woman with preeclampsia who has a grad mal seizure
What is HELLP syndrome?
hemolysis, elevated liver enzymes, low platlets.
What is the definitive treatment for preeclampsia?
Delivery
What is the treatment for HTN in preeclampsia?
Mag sulfate (?) isnt this primarily for prevention of seizures? Mag sulfate decreases BP because it is a smooth muscle relaxer, but I’ve also heard first line treatment is labetalol so idk.
What is the typical fetal response to maternal seizures in eclampsia?
Bradycardia during and immediately after the seizure.
Patients with PCOS are at increased risk of developing what type of cancer?
Endometrial cancer
Why are patients with PCOS at increased risk for endometrial cancer?
PCOS causes anovulatory cycles, where only estrogen is released. Estrogen causes proliferation of the endometrium, so unopposed estrogen release causes increased risk of endometrial cancer.
The inappropriate release of GnRH and testosterone by the ovaries occurs in what?
PCOS
What is the treatment for PCOS?
oral contraceptives and spironolactone for androgen antagonism
What role does metformin play in the treatment of polycystic ovary syndrome?
Metformin is recommended in the treatment of insulin resistance and diabetes mellitus but is not recommended solely for the treatment of anovulation or hirsutism in patients with polycystic ovary syndrome.
What is the most common cause of infertility?
PCOS
Excessive intake of which micronutrient during pregnancy is associated with fetal goiter?
Iodine.
The ductus arteriosus connects which two fetal structures?
The pulmonary artery and the descending aorta.
what is the outpatient treatment for PID?
Ceftriaxone 500mg IM (1g to those over 150kg) + doxycycline 100mg PO BID + metronidazole 500mg PO BID X 14 days
Describe the stages of uterine prolapse.
Stage 1: prolapse of the uterus into the upper half of the vagina
Stage 2: prolapse of the uterus into the lower half of the vagina but >1cm above the hymen
Stage 3: prolapse of the uterus >1cm past the hymen without complete uterine prolapse
Stage 4: The uterus is completely out of the vagina
Which ligaments support the uterus and attach the cervix to the posterior surface of the pubic symphysis?
Pubocervical ligaments.
What is the first line maneuver to perform in the case of shoulder dystocia?
How is it preformed?
McRoberts maneuver.
Preformed by hyper flexing the legs to the abdomen and applying suprapubic pressure.
What is the presenting part of the fetal head in a position of asynclitism?
The parietal bone.
What is the most appropriate initial diagnostic test for postmenopausal women with abnormal vaginal bleeding?
Transvaginal US
What is the most common cause of anovulatory abnormal uterine bleeding in a premenopausal woman?
Polycystic ovary syndrome.
A well-defined, mobile, firm, rubber, nontender, breast mass best describes what type of tumor.
Is it benign or malignant?
A fibroadenoma
It is the most common benign tumor of the breast
Which quadrant of the breast is the most frequent site of breast cancer?
Upper outer quadrant.
What is the term for hemolytic disease of the newborn when the infant is still in utero?
Erythroblastosis fetalis.
According to USPSTF guidelines, at what age should breast cancer screening mammograms start?
50
How often should screening mammograms be done in average risk patients?
Every 2 years
Define menorrhagia.
Menses >7 days or 60 mL blood loss occurring < every 21 days
Define metrorrhagia?
Bleeding at irregular times
What is menometrorrhagia?
Heavy, irregular vaginal bleeding
What is defined as abnormal uterine bleeding?
Abnormal vaginal bleeding due to anovulation
What is postcoital bleeding?
Vaginal bleeding after intercourse suggesting cervical pathology
Define postmenopausal bleeding
Any bleeding that occurs >6 months after cessation of menses.
What is secondary amenorrhea?
It is the absence of a menstrual cycle for more than 3 months in women with regular menses or 6 months in those with irregular menses.
What maneuver is used to determine the fetal lie, presentation, and position?
The Leopold maneuvers
Which step of the Leopold maneuvers is the Pawlick grip associated with?
The third step.
True or false: the volume of milk production by mothers of twins is consistently twice that of mothers of singletons.
True.
What is placenta accreta?
Invasion of the placenta into the myometrium.
What is the triad of symptoms of placental abruption?
Severe abdominal pain, fetal distress, and third trimester bleeding.
What complication of placental abruption can cause extravaginal bleeding, thrombosis, and organ failure?
DIsseminated intravascular coagulation
What medications are indicated for women with placental abruption that are < 34 weeks gestation?
IV steroids to promote fetal lung maturity and tocolytics to prevent labor.
What additional medications should be given to women < 32 weeks gestation with placental abruption?
In addition to IV steroids and tocolytics, mag sulfate and fetal neuroprotectin should be given.
What is the puerperium?
The 6-8 week period after delivery during which the body returns to the nonpregnant state.
What is lochia?
Menses like bleeding followed by other forms of vaginal discharge after delivery
Describe the 3 types of lochia and the order which they are discharged from the vagina.
Lochia rubra - red or brown discharge that lasts for a few days following pregnancy
Lochia serosa - pinkish brown discharge that lasts for 2-3 weeks
Lochia alba - yellow-white serous exudate that continues up to 8 weeks after pregnancy
When does ovulation resume after childbirth on average?
After 45 days in nonlactating women and 189 days in lactating women.
What is the best imaging study to assess for ovarian torsion?
pelvic ultrasound
What is the recommended outpatient antibiotic treatment regimen for pelvic inflammatory disease?
Ceftriaxone intramuscular injection and prescription of doxycycline.
What is the most common bacterial STD?
Chlamydia trachomatis
Which syndrome is characterized by inflammation of the liver capsule and normal liver enzymes in a patient with a pelvic inflammatory disease?
Fitz-Hugh-Curtis syndrome.
What are the 3 D’s of entometriosis?
Dysmenorrhea, dyschezia, and dyspareunia
Define dyschezia.
Difficulty deffecating
What is dyspareunia?
Difficult or painful sexual intercourse.
What is the mechanism of action of leuprolide?
It is a gonadotropin-releasing hormone analogue. It acts to cause suppression of FSH and LH.
How is definitive diagnosis of endometriosis made?
Laparoscopy with biopsy
What is a monochorionic diamniotic gestation? What sign would you expect to find on ultrasound?
Means there is one placenta and two amniotic sacs.
Expect to see a T sign on ultrasound.
What type of multifetal gestation would you expect if you see a twin peak or lambda sign on ultrasound?
It means two separate placentas in a dichorionic placenta fused into one large placenta.
It is still classified as a dichorionic diamniotic pregnancy
What type of twins occurs with division of a fertilized egg 13 days or later after fertilization?
Conjoined twins.
What is a category 1 pattern on fetal heart rate monitoring?
A normal pattern, with fetal heart rate between 110-160, a moderate heart rate variability, and no late or variable decelerations.
What is a category 3 fetal heart rate monitoring pattern?
An abnormal pattern with at least one of the following:
Variability with recurrent or late variable decelerations.
Variability with recurrent bradycardia
A sinusoidal pattern
What is a category 2 fetal heart rate monitoring pattern?
Anything that does not fall into category 1 or 3 and needs further investigation.
What is the most common age group to develop a tubo-ovarian abscess?
15–25 years of age.
By what age should a patient have her first period?
15 years
What should be included in the initial evaluation of a 16 year old girl who had not undergone menarche?
FSH, LH, prolactin, testosterone, TSH, free T4, and pregnancy test.
Pelvic ultrasound is also recommended.
True or false: patients with amenorrhea should always have a pregnancy test.
True.
What is the genus and species name of group B Streptococcus?
Streptococcus agalactiae.
What is the treatment for group B strep in pregnancy?
ampicillin or penicillin
What are the 1st and 2nd antibiotic treatments for mastitis/breast abscess?
Dicloxacillin
Cephalexin
How is a breast abscess differentiated from mastitis?
Breast abscess has fluctuance
What antibiotic medication can be used to treat breast abscesses in the absence of risk factors for methicillin-resistant Staphylococcus aureus (MRSA) in patients who are allergic to beta-lactams and cephalosporins?
Clindamycin.
What is the most common site effected by endometriosis?
The ovaries
Which class of nonsteroidal anti-inflammatory drugs should be avoided in patients with endometriosis who desire conception?
Cyclooxygenase-2 inhibitors (e.g., celecoxib, rofexocix, valdecoxib).
Painless ulceration with raised and indurated margins is the classic finding in what STD?
Syphilis patients presenting with a chancre.
True or false: pregnant women with a history of genital herpes and prodromal symptoms but no active lesions at the time of labor should deliver vaginally.
False. Prodromal symptoms are an indication for cesarean delivery.
What is the most common cause of primary amenorrhea?
Gonadal dysgenesis
What electrolyte abnormality is associated with hyperemesis gravidarum?
Hypokalemia
What is the causative pathogen of chancroid?
Haemophilus ducreyi
Name 3 appropriate antibiotic regimens for chancroid.
Azithromycin 1g PO once
Ceftriaxone 250mg IM once
Ciprofloxacin 500mg PO BID x 3 days
Which organism causes lymphogranuloma venereum?
Chlamydia trachomatis.
Does chancroid cause painful or painless genital ulcers?
Painful
Infants born later than ___ weeks gestation are considered postterm infants.
42
Macrosomia is defined as infant weight > ______
4500 grams
What are the five components of the biophysical profile?
Fetal breathing, fetal movement, fetal tone, amniotic fluid volume, and nonstress test to measure fetal heart rate.
What is ptyalism gravidarum?
Excessive salivation during pregnancy.
How long should women wait to have sexual activity following an uncomplicated vaginal delivery?
As soon as they feel ready after a minimum of 2 weeks.
When should women with hypertensive disorders follow-up for a clinic visit following delivery?
Within 7 days.
What is the cause of condylomata acuminata
HPV type 6 and 11
What is the treatment for condylomata acuminata for home treatment?
Imiquimod, podophyllotoxin, sinecatechins are home treatments.
What are office-based therapies for condylomata acuminata?
Trichloroacetic acid, cryotherapy, or surgical removal
Are condylomata acuminata lesions painful?
No, but they are often itchy.
What is the gold standard test for gestational diabetes?
3-hour 100g oral glucose tolerance test
How many weeks gestation should testing for gestational diabetes be done?
24-28 weeks
What are the 7 cardinal movements of fetal descent during labor?
Engagement Descent Flexion Internal rotation Extension External rotation Expulsion
(Every Dick Fucks, In Reality, Especially Extra for Real 1s, Eyyyyy)
What is the name of the medical maneuver used to resolve shoulder dystocia, where the maternal thighs are flexed against the maternal abdomen to reduce the sacral-spinal angle?
McRoberts technique.
What is the appropriate treatment for endometritis post C-section?
Clindamycin and gentamycin
What is the appropriate treatment for endometritis post vaginal delivery?
Ampicillin and gentamicin
What is the appropriate prophylactic treatment before a C-section?
A first generation cephalosporin
What is the only risk factor found to be significantly associated with breast abscess recurrence?
Tobacco use
What type of breast cancer is associated with breast abscess?
Inflammatory breast cancer.
What type of breast cancer is associated with breast abscess?
Inflammatory breast cancer.
What is the antibiotic treatment of choice for chorioamnionitis?
Ampicillin and gentamicin
What is fetal station?
The number of centimeters above or below the level of the ischial spines the fetus’ presenting part is at.
What positon marks a fetal station of 0?
If the baby’s head was at the level of the ischial spines.
What does doppler volocimetry of the middle cerebral artery of the fetus measure?
It is a measure of hemoglobin in the fetus. Increased velocity correlates with decreased hemoglobin.
When should doppler velocimetry be preformed?
If maternal anti-D titers are at a critical titer level (usually 1:16 or 1:32)
Which placental complication has the greatest risk for postpartum hemorrhage due to the depth of invasion into the uterine myometrium?
Placenta percreta
What is the leading cause of maternal morbidity and mortality worldwide?
Postpartum hemorrhage
How much blood loss is needed to diagnose postpartum hemorrhage?
> 1000mL
What is the most common cause of postpartum hemorrhage?
Atony
Placental invasion into the uterine myometrium is categorized in 3 categories based upon depth of invasion. Name the 3 categories from least invasive to most invasive.
Placenta accreta - invasion past the the decidua basalis to the myometrium
Placenta increta - invasion deeper into the myometrium
Placenta percreta - growth through the uterine wall even into surrounding structures (I.e. bladder)
What are the four Ts (mnemonic) for causes of postpartum hemorrhage?
Tone, trauma, tissue, and thrombin.
How is endometrial stripe thickness used to risk stratify endometrial cancer?
4mm or less indicates low likelihood of hyperplasia or endometrial cancer in postmenopausal women
> 4mm or if certain areas of the endometrium appear heterogeneous, an endometrial sample should be obtained.
What is the treatment for endometrial cancer?
Total hysterectomy and bilateral salpingo-oophorectomy +/- chemo/radiation post surgically
What factors other than endometrial cancer may cause a thickened endometrial stripe?
Presence of endometrial polyps, obesity, diabetes, and current tamoxifen therapy.
What is the criteria for diagnosing cervical insufficiency?
Two consecutive second-trimester pregnancy losses or early premature births (<28 weeks gestation)
what genetic syndrome predisposes women to cervical insufficiency?
Ehlers-Danlos syndrome
At which gestational age in the pregnancy are cervical cerclages typically removed?
36–37 weeks gestation or with the onset of preterm labor.
What is a cervical cerclage?
A cervical suture or synthetic tape to reinforce the cervix to prevent premature birth or abortion.
What is the most likely diagnosis of an ultrasound revealing an ovarian cyst with surrounding fluid in the pelvis?
Ruptured ovarian cyst
What is the treatment for a ruptured ovarian cyst without signs of hemodynamic instability?
Pain medication such as an NSAID
True or false: the absence of an ovarian cyst on ultrasound rules out ovarian cyst rupture.
False, ovarian cysts may collapse following cyst rupture. However, the absence of an ovarian cyst makes the diagnosis less likely.
What vitamin, if taken in excess, is teratogenic in the first trimester?
Vitamin A
Deficiency of which essential trace element is associated with impaired taste and smell, night blindness, decreased spermatogenesis, dermatitis, delayed wound healing, and alopecia?
Zinc.
What is more commonly used to diagnose gestational diabetes in the US? The one-step oral glucose tolerance test or two step oral glucose tolerance test?
Two-step OGTT
What are the two steps of the two step OGTT?
A 50-gram OGTT without regard to fasting. IF serum glucose >130 after 1 hour, proceed to step 2.
Step two is a 100-gram OGTT administered after at least 8 hours of fasting. If 2 out of the following criteria are met, it is diagnostic for gestational diabetes: Serum glucose >95 fasting, >180 at 1 hour, >155 at 2 hours, or >140 at 3 hours
When should women be routinely screened for group B Streptococcus during pregnancy?
Between weeks 36–41 of gestation.
What is the first sign of hypermagnesemia in patients being treated with magnesium sulfate to prevent seizures?
Loss of the patellar reflex.
What is the most common reason a vaginal culture is performed when vulvovaginal candidiasis is suspected?
If the patient’s symptoms are resistant to azole therapy and Candida glabrata is suspected.
What is the name for the type of prolapse that involves the herniation of the anterior, posterior, and apical compartments simultaneously?
Procidentia.
What is the MOST important risk factor for breast cancer?
Age
What is interval breast cancer?
Breast cancer that presents during the period between normal mammogram screenings.
What gland is located in the posterior left and right vaginal introitus and secretes mucus?
Bartholin gland.
What genital ulcer disease caused by select serotypes of chlamydia trachomatis is more common in tropical and subtropical areas?
Lymphogranuloma venereum
What is the treatment for lymphogranuloma venerum?
Doxycycline 100mg bid x 21 days
What lab is a cancer marker for ovarian cancer?
Cancer antigen 125
What lab is a cancer marker for breast cancer?
Cancer antigen 15-3
According to the U.S. Preventive Services Task Force, at what age is it recommended to start screening for breast cancer for those at average risk?
50 years.
Which organisms most often cause bacteremia secondary to intra-amniotic infection?
Escherichia coli and group B Streptococcus.
Which screening tests for fetal anomalies are included in the quadruple test?
Alpha-fetoprotein, unconjugated estriol, human chorionic gonadotropin, and inhibin A.
What is the treatment for pyelonephritis in pregnancy?
Admission and IV ampicillin/gentamicin or third generation cephalosporin (ceftriaxone) x 14 days
What is the recommended prophylactic antibiotic in pregnant women with a history of extended-spectrum beta-lactamase-producing Enterobacteriaceae?
Meropenem.
What is the term used when the endometrial lining breaks through the myometrium?
Adenomyosis.
What types of HPV cause condyloma acuminata?
HPV 6 and 11
What disorder is associated with preeclampsia that presents prior to 20 weeks of gestation?
A molar pregnancy.
What is a bubo and what STI is it associated with?
It is a tender unilateral or bilateral inguinal or femoral lymphadenopathy seen in lymphogranuloma venereum
What is a gumma and what STI is it seen in?
A gumma is a soft noncancerous growth typically seen in patients with tertiary syphilis. It is seen in tertiary syphilis
What is the causative pathogen of syphilis?
Treponema pallidum
Along with a macoulopapular rash affecting the trunk, extremities, and palms and soles, what other finding is seen in secondary syphilis?
Condyloma latum - wart like lesions on the genitals
What is the gold standard for diagnosis of syphilis?
Dark field microscopy.
What is the preferred agent for the treatment of syphilis?
Benzathine penicillin G
What is an alternative antibiotic medication that can be used to treat syphilis in the setting of penicillin hypersensitivity?
Tetracycline or doxycycline.
What is Mayer-Rokitansky-Hauser syndrome?
It is the failure of the uterus and vagina to develop in women who have normal functioning ovaries and normal external genitalia
What is the recommended treatment for hyperandrogenic symptoms?
combined oral contraceptive pill
What is the name of the criteria used to diagnose polycystic ovary syndrome?
Rotterdam criteria.
True or false: brachial plexus injuries from shoulder dystocia are usually permanent.
False, most result in no long-term deficits.
In the first 30 days of pregnancy, the hCG should double every ______.
2 days
Slowly rising hCG levels in the first 30 days of pregnancy is suggestive of _______ or ___________.
ectopic pregnancy or early embryonic death
Which human chorionic gonadotropin level is used as the discriminatory zone for when a gestational sac should be visualized on transvaginal ultrasound?
2,000 mIU/mL.
Bitemporal vision loss is a sign suggesting what etiology of abnormal uterine bleeding?
Prolactinoma.
What is associated more closely with cervical cancer? HPV type 16 or 18?
16
Serosanguinous nipple discharge is a common presentation for what type of breast cancer?
Papillary breast cancer
What is the most common type of breast cancer found in younger women with a BRCA mutation?
Medullary breast cancer
Peai d’orange and blistering are physical exam findings common in what type of breast cancer?
Inflammatory breast cancer
What is the recommended age at which screening mammography becomes appropriate for average risk women?
50 years of age.
What is a normal Apgar score?
7-10
What does APGAR stand for?
Appearance (skin color) Pulse Grimace (Reflex irritability) Activity (Muscle tone) Respiration
When are apgar scores measured?
At 1 and 5 minutes
T/F? Placenta previa is an indication for cesarean delivery.
True
What gestational age should a cesarean be preformed in a mother with placenta previa?
36-38 weeks
At what gestational age should Rho(D) administration be done?
26-28 weeks
At what gestational age should an anatomy survey ultrasound be done?
18-22 weeks gestation.
At what gestational age should group B strep screening be done?
35-37 weeks
True or false: the annual influenza vaccine is contraindicated in pregnancy.
False. It is highly recommended because pregnant women can have more severe symptoms of influenza.
How long must a patient have symptoms to be diagnosed with premenstrual dysphoric disorder?
1 year
What is the name of the physical exam finding common in neurosyphilis where small pupils will accommodate near objects but do not react to bright light?
Argyll Robertson pupil.
What are physical exam findings consistent with androgen excess?
Hirsutism, acne, and male pattern baldness.
Which diagnostic tests are recommended immediately prior to inserting an intrauterine device?
Pregnancy testing and gonorrhea and chlamydia testing.
What vaginal pH is associated with vaginal atrophy?
≥ 5.
What is the first line treatment for atrophic vaginitis?
Estradiol 0.01% vaginal cream
Which fetal malformation is Zika virus classically associated with during pregnancy?
Congenital microcephaly.
What type of cancer does administration of estrogen-only therapy in a perimenopausal woman with an intact uterus increase the risk of?
Endometrial cancer.
Name two absolute contraindications to oral contraceptives?
History of stroke and migraine with aura due to increased risk for CVA
What is the first line treatment for HTN in pregnancy?
Labetalol
What is the first line treatment for HTN in a pregnant patient with uncontrolled asthma?
Extended release nifedipine
What type of fetal abnormalities are associated with an elevated alpha-fetoprotein level?
Neural tube defects.
What class of medications is associated with neural tube defects?
Antiepileptic medications, such as carbamazepine and valproic acid.
What phase of the menstrual cycle do symptoms of premenstrual disorders occur during?
The luteal phase (second half)
At what age should routine screening for osteoporosis begin for women according to the United States Preventive Services Task Force?
65 years of age
What are common risk factors for developing placental previa?
Multiparity, increased age, and tobacco use.
True or false: the gestational sac is able to be visualized before the yolk sac on transvaginal ultrasound.
True.
True or false: topical estrogen therapy helps prevent uterine prolapse.
False.
What organism is most responsible for toxic shock syndrome?
Staphylococcus aureus.
What defines a reactive nonstress test?
At least two accelerations in a 20 minute period.
What is the cause of early decelerations with uterine contractions?
Compression of the fetal head by the contraction causes a vagal reaction leading to an early deceleration.
At what gestational age is the yolk sack typically visible on transvaginal ultrasound?
5 weeks
Which medication can be started during the second trimester in high-risk patients to reduce the risk of developing preeclampsia?
Low-dose aspirin.
True or false: cigarette smoking increases the risk of preeclampsia.
False. Cigarette smoking is associated with a lower risk of preeclampsia.
Antihypertensive therapy should be started in patients with preeclampsia with a blood pressure greater than ______.
> /= 160 SBP or >/= 110 DBP
When should delivery be planned for patients with preeclampsia without severe features?
37 weeks
What is the most common type of vulvar cancer?
Squamous cell carcinoma
Which human papillomavirus subtypes are most associated with causing gynecologic squamous cell carcinoma?
Types 16 and 18.
What side is ovarian torsion more common on?
Right side
What is the first line pharmacologic treatment for fibrocystic breast disease?
Tamoxifen
What is the second line pharmacologic treatment for fibrocystic breast disease?
Danazol
Why is tamoxifen preferred over danazol for treatment of fibrocystic breast disease?
danazol has more androgenic side effects.
What form of cervical cancer is linked closely to diethylstilbestrol exposure?
Clear cell adenocarcinoma.
What is diethylstilbestrol?
A synthetic estrogen that was prescribed between 1940-1971
How does the normal vaginal pH compare to the vaginal pH in postmenopausal women?
Postmenopausal pH is more basic. The normal pH in reproductive-aged women is 3.5–5.0, and the pH in postmenopausal women is often 5.5–6.8.
Does lymphogranuloma venerum cause painless or painful genital ulcers?
Painless
What is the recommended treatment for lymphogranuloma venereum for patients who cannot take doxycycline?
Azithromycin once weekly for 3 weeks.
What part of the world is lymphogranuloma venereum more commonly seen in?
The tropics
What is the diagnostic criteria for preterm labor?
Regular and painful uterine contractions approx. 5 minutes apart for one hour accompanied by cervical dilation >3 cm or cervical length >20cm prior to 37 weeks of gestational age.
Patient in preterm labor should be treated with tocolytic therapy if they are less than ____ weeks gestation.
34
What other treatments should women in preterm labor receive if they are less than 34 weeks gestation?
Antibiotics for group B strep prophylaxis and antenatal corticosteroids for 48 hours.
Why should indomethacin not be used for more than 48 hours in women who are in preterm labor?
Use for more than 48 hours can cause premature closure of the ductus arteriosus.
What tests make up the quadruple screen?
AFP
Unconjugated estriol
hCG
Inhibin A
What results of a quadruple screen indicate down syndrome?
Low AFP and unconjugated estriol
High hCG and inhibin A
What gestational age should the quadruple screen be preformed?
15-18 weeks
Is HIV a contraindication to breast feeding?
Yes
What medication should be given to patients with PROM >37 weeks gestation?
Oxytocin to induce contrations
What are some commonly used tocolytic drugs?
Magnesium sulfate, indomethacin, terbutaline, and nifedipine.
True or false: continued breastfeeding from the affected breast should be encouraged for both lactational mastitis and breast abscess.
True.
What is the most commonly encountered form of pelvic organ prolapse?
Cystocele.
Describe the qualities of a fibroadenoma.
Smooth, well-circumscribed, non-tender and mobile.
What is the most common symptom of menopause?
Hot flashes
Menopause is defined by a women going more than ______ without a peroid.
12 months
What follicle-stimulating hormone level is suggestive of a woman being in the later part of the menopausal transition?
> 25 IU/L
What is the greatest risk factor for postpartum endometritis?
A cesarean section delivery.
Which two organs is the anterior cul-de-sac between?
The bladder and uterus.
What finding on thoracentesis of a patient with a pleural effusion suggests a diagnosis of epithelial ovarian cancer?
Malignant müllerian cells.
What test is a quantitative measurement of fetal red blood cells in the maternal blood?
Kleihauer-Betke test
What is the initial test used to evaluate for fetal red blood cells in maternal blood?
Rosette screening
When is it safe to not administer Rh IgG in an Rh-negative mother?
When the father is also Rh-negative.
Women with the BRCA1 gene mutation are more likely to be diagnosed with what form of breast cancer?
Medullary carcinoma.
What hormone is responsible for breast milk production following delivery?
Prolactin
When do prolactin levels return to normal in a mother who is not nursing?
2 to 3 weeks following delivery.
True or false: in the GTPAL system, abortion includes both medically induced abortions and miscarriages.
True.
Which bacterium is the leading cause of endometritis-associated infertility in endemic countries?
Mycobacterium tuberculosis.
What type of vaccines should be avoided in pregnancy?
Live vaccines including MMR, varicella, yellow fever, smallpox, Bacilus Calmette-Gueerin, live attenuated influenza, and live zoster vaccine.
True or false: the hepatitis B surface antigen test will always be negative if the patient has no history of hepatitis B, even if the patient has received the entire course of the hepatitis B vaccine.
True.
How many doses of the HPV vaccine are required?
2 for patients 9-14 years, 3 doses for anyone >14 years
Which human papillomavirus types most frequently cause genital warts?
6 and 11.
What is the medical term for the probability of achieving a pregnancy within one menstrual cycle?
Fecundability.
What are the four basic female pelvic types?
Gynecoid
Anthropoid
Android
Platypelloid
Which muscles comprise the levator ani muscle complex that provides primary support to the pelvic organs?
Pubococcygeus, puborectalis, and iliococcygeus muscles.
What condition is characterized by recurrent episodes of meningitis caused by herpes simplex virus type 2 (HSV-2)?
Mollaret meningitis.
What does a negative fetal fibronectin test tell you?
Negative predictive value of 98% for labor occurring within the next 7-14 days
What is the first-line tocolytic for women between 32-34 weeks gestation?
Nifedipine
What is the first line tocolytic for patients 24-32 weeks gestation?
Indomethacin
A fundal height just above the pubic bone corresponds to what gestational age?
12 weeks
A fundal height at the umbilicus corresponds to what gestational age?
20 weeks
A fundal height at the xiphoid process corresponds to what gestational age?
36 weeks
What is the most common symptom of uterine fibroids (leiomyomas)?
Heavy menses
What are the adverse effects of gonadotropin-releasing hormone agonists?
Hot flashes and decreased bone mineral density.
What hormone is associated with hypercoagulability?
Estrogen
True or false: the risk of venous thromboembolism is higher in women on combined hormonal contraception compared to pregnant women.
False.
What are the diagnostic criteria for oligohydramnois?
Amniotic fluid index < 5 cm or single deepest pocket that is <2 cm.
What are risk factors for oligohydramnios?
Absence of fetal urine production(causes include fetal urinary tract blockage, renal agenesis, polycystic kidneys, or obstructive lesions), preeclampsia and chronic hypertension due to placental insufficiency
True or false: oligohydramnios is more common than polyhydramnios.
True.
What skin change is associated with lymphatic obstruction of the breast?
Peau d’orange, which is associated with progressive breast cancer.
What is the definitive treatment for umbilical cord prolapse?
C section
What can be done for an umbilical cord prolapse if there is any delay in c section?
Place patient in trendelenburg position or knee-chest position.
Bladder filling and elevation of presenting fetal part can remove some compression of the cord.
What is the average length of an umbilical cord?
50 cm.
What is the appearance of gonorrhea on a gram stain?
Gram negative diplococci
What are the most common pathogens associated with pelvic inflammatory disease?
Chlamydia trachomatis and Neisseria gonorrhoeae.
Which artery does the uterine artery originate from?
The anterior division of the internal iliac artery.
What is the first line treatment for menorrhagia from adenomyosis?
Levonorgestrel-releasing intrauterine device
What is the appearance of staph aureus on gram stain?
Gram-positive cocci in clusters
Gestational diabetes increases risks of what complications for the fetus?
Polyhydramnios and large for gestational age(macrosomia).
What is the diagnostic criteria for polyhydramnios?
Amniotic fluid index > 25cm
Single deepest pocket >8 cm
What is the treatment for noninfective mastitis?
Ibuprofen
What is the medical term for a painless, asymptomatic, cystic collection of milky fluid caused by an obstructed milk duct?
A galactocele (a milk retention cyst).
True or false: cigarette smoking is associated with an increased risk of squamous cell carcinoma of the cervix but not of adenocarcinoma.
True.
What is the most common location for a cervical squamous cell carcinoma to arise?
The squamocolumnar junction
An inherited mutation in which genes is the most common cause of hereditary breast cancer?
BRCA1 and BRCA2.
Which skin surgical incisions is the preferred approach for most cesarean section deliveries?
Pfannenstiel
Describe the location of a Pfannenstiel skin incision.
A curved incision 2-3 cm above the symphisis pubis.
What c section surgical incision may be useful in patients who warrant urgent or emergent delivery?
A vertical midline incision
What is the most common type of incision used to enter the uterine cavity?
A Munro Kerr (low transverse uterine incision).
What is a VBAC?
Vaginal Birth After Cesarean
What patients qualify for a VBAC?
If someone knows please answer. I’m in prison and do not have my notes to look at and I don’t trust the internet
I think it’s no more than two prior c sections
What is the initial treatment for a pelvic organ prolapse?
Pessary, weight loss if obese, and kegel exercises.
What are the risk factors for pelvic organ prolapse?
Increased parity, advancing age, obesity, and increased intra-abdominal pressure.
What is the treatment for endometrial hyperplasia without atypia in patients who wish to preserve fertility?
Megestrol acetate and depot medroxyprogesterone acetate. (Progestin therapies)
What is the treatment for endometrial hyperplasia without atypia in patients who do not wish to preserve fertility?
Hysterectomy
What condition is FDA approved for treatment with anastrozole?
Breast cancer.
Vaginal agenesis is also known by what other names?
Mullerian agenesis and Mayer-Rokitansky-Kuster-Hauser syndrome
Are secondary sexual characteristics normal or underdeveloped in vaginal agenesis?
Normal
Are patients with vaginal agenesis able to carry a pregnancy?
No
Which autosomal dominant condition is characterized by short stature, pulmonary stenosis, hypertelorism, downslanting palpebral fissures with highly arched eyebrows, strikingly blue irises, and a webbed neck?
Noonan syndrome.
What is the appropriate dose of folic acid supplementation to reduce the risk of neural tube defects?
4mg
Which micronutrient deficiency can lead to maternal and fetal or neonatal hypothyroidism?
Iodine
What vitamin is teratogenic in excessive doses?
Vitamin A
What is more useful in diagnosing fibrocystic breast disease? Mammography or ultrasonography?
Ultrasonography
What does the term triple-negative breast cancer indicate?
It describes a tumor that does not express the estrogen receptor, progesterone receptor, or human epidermal growth factor receptor 2 receptor.
Is the prognosis for triple negative breast cancer better or worse than single or double negative breast cancer?
Worse. It is more aggressive with faster growth, higher risk of metastasis and recurrence, and less treatment options.
True or false: anterior placenta previa is less likely to resolve prior to delivery than posterior placenta previa.
False. It is more likely to resolve.
What is the first-line treatment of bladder fistula?
Surgical management.
Atrophic vaginitis is caused by decreased levels of what hormone?
Estrogen
When a woman presents with dysuria and frequency, what is the most appropriate diagnostic test?
Urinalysis.
The risk of acute disseminated intravascular coagulation is increased with placental abruption >___
50%
What is the classic ultrasound finding of placental abruption?
Retroplacental hematoma
Which condition in pregnancy is characterized by an accumulation of blood between the uterine wall and the chorionic membrane?
Subchorionic hematoma.
What result of nitrazine testing confirms PROM?
Color change to blue
What other readily available test can confirm PROM?
Microscopy - A positive result is ferning, which is a pattern of dried vaginal secretions that occurs with amniotic fluid
What is the medical term used to describe a lower volume of amniotic fluid than expected for gestational age?
Oligohydramnios.
What is the treatment for stress incontinence in women?
Topical vaginal estrogen
Pathology finding of sheets of trophoblastic tissue consisting of syncytiotrophoblasts and cytotrophoblasts without villi from biopsy sites in the lungs or GI tract is the characteristic finding in _______________.
Choriocarcinoma
T/F? Choriocarcinoma may occur following a molar pregnancy, miscarriage or abortion, or following a preterm or term intrauterine pregnancy.
True
How do choriocarcinomas metastasize?
Hematogenously
Why do hyperthyroidism and theca lutein cysts occur during gestational trophoblastic disease?
The alpha subunit of human chorionic gonadotropin closely mimics thyroid-stimulating hormone and luteinizing hormone.
What is the most common cause of cervicitis?
Chlamydia
True or false: an individual who has had one preterm birth is at increased risk for preterm labor in subsequent pregnancies.
True.
What is the preferred initial biopsy procedure for evaluating suspicious breast masses?
Core-needle biopsy
What are bad prognostic factors of breast masses?
Immoveable, irregular borders, spiculations, microcalcifications, and hypoechogenicity.
What physical exam finding can be used to monitor for mag sulfate toxicity?
Patellar tendon reflexes. Loss of DTRs occurs at 12mg/dL.
What is the therapeutic window for mag sulfate for seizure prevention in preeclampsia?
4.8-9.6mg/dL or 4-8 mEq/L
What is the treatment for magnesium toxicity?
Calcium gluconate
When can magnesium sulfate be discontinued in preeclampsia with severe features?
At least 24 hours after delivery.
Which condition refers to a fallopian tube that is blocked with fluid?
Hydrosalpinx.
What diuretic can be used to treat symptoms of bloating, fluid retention, and breast tenderness in premenstural syndrome?
Spironolactone
What is a more severe form of premenstrual syndrome?
Premenstrual dysphoric disorder.
What is fetal quickening?
The perceived fetal motion by the mother
When is fetal quickening often first detected in primiparous women?
18-20 weeks
When can fetal quickening be expected in multiparous women?
As early as 14 weeks due to their better ability to differentiate fetal movements than primiparous women
What is the Chadwick sign?
Bluish hue on the cervix, which is a common sign of pregnancy.
Which class of medications do leuprolide acetate and goserelin acetate belong to?
Gonadotropin-releasing hormone agonists.
What are the causes of fetal tachycardia?
Fetal movement, maternal factors (anemia, hyperthyroidism, hypoxia, dehydration, fever or sepsis, and anxiety), fetal factors (dysrhythmias), and placental abruption.
What diagnostic studies are most appropriate for a couple who are having difficulties conceiving?
Hysteroscopy and semen analysis
What is the medical term for a low sperm count?
Oligospermia.
What is the greatest risk factor for placental abruption?
Previous placental abruption
What are the greatest risk factors for developing placenta previa?
Multiparity, smoking, and increasing maternal age.
What is the definition of a shortened cervix?
Less than 25 mm before 24 weeks gestation.
What pharmacologic treatment can be used to increase fecundability in patients with PCOS?
Clomiphene citrate
What class of medications does clomiphene citrate belong in?
Selective estrogen receptor modulator
What is the major reason for in vitro fertilization to be used?
Lack of implantation
What are common adverse effects of clomiphene citrate?
Hot flashes, abdominal distention and pain, nausea and vomiting, and breast discomfort.
True or false: all inflammatory breast cancer tumors should undergo testing for hormone receptors and human epidermal growth factor receptor 2.
True.
What is the preferred type of episiotomy incision?
Mediolateral incision
What is the first line treatment for uterine atony with less than 1000mL of cumulative blood loss?
Uterine massage
What medications can be used to decrease blood loss associated with uterine atony?
Uterotonic agents such as oxytocin, methylergonovine, misoprostol, dinoprostone, and 15-methyl prostaglandin F2-alpha.
What interventions are indicated in uterine atony with signs of hemodynamic instability?
B-lynch compression sutures, uterine balloon tamponade, hysterectomy,
What rare cause of postpartum hemorrhage impacts the secretion of one or more pituitary gland hormones?
Sheehan syndrome aka postpartum hypopituitarism
What are the halmark features of Sheehan syndrome?
Failure to lactate after delivery and amenorrhea or oligomenorrhea.
What is the physiologic cause of Sheehan syndrome?
The pituitary gland is enlarged during pregnancy making it particularly prone to infarction from hypovolemia. Postpartum hemorrhage can lead to hypovolemic shock, and ischemia of the pituitary gland can impact the secretion of pituitary gland hormones.
What medication would be used as treatment for a hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer?
Endocrine therapy such as tamoxifen, raloxifene, or letrozole.
What is the black box warning for tamoxifen?
Endometrial hyperplasia and uterine malignancy
What medication should be used for human epidermal growth factor 2 (HER2) positive breast cancer?
trastuzumab or similar biologics.
What is the leading cause of cancer-related deaths in women?
Lung cancer.
What sign associated with pregnancy is characterized by softening of the cervix?
Goodell sign
What is Piskacek sign in pregnancy?
Asymmetrical enlargement of the uterus due to lateral implantation.
What physiological role does follicle-stimulating hormone play in the human body?
Follicle-stimulating hormone is a gonadotropin that stimulates the growth of ovarian follicles in women and helps the maturation of sperm in men
Name 3 appropriate choices for cystitis in pregnancy.
Fosfomycin
Augmentin
Cefpodoxime
