Ob/Gyn

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A young female with LLQ pain s/t simple cyst. What's the treatment?: Repeat US in 6-8 weeks
Enlarged, globular uterus w/ cystic areas in myometrium: Adenomyosis
RFs for pseudomonal UTI: Metabolic & anatomic abnormalities
MC manifestations of Trichomoniasis: Vaginitis & urethritis
MC etiologic agent of UTI in otherwise healthy 25 yof: E. coli
38 yof 8 days s/p C/s w/ red, painful, fluctuant mass at lateral margin of incision. Afebrile. What treatment?: I & D
Complication of untreated wound abscess: Spread to fascia, bacteremia, sepsis
27 yof w/ + RPR. What test is required as follow-up?: MHA-TP or FTA-ABS
Perinatal mortality rate of fetus infected by syphilis: Up to 50%
Sequelae of congenital syphilis: Hydrops, macerated skin, hepatosplenomegaly
Treatment of congenital syphilis: Penicillin (+/- prior desensitization)
MMR & pregnancy?: Contraindicated
For a rubella-nonimmune pregnant patient, when should MMR be administered?: Postpartum
Indications for RhoGAM in Rh- pregnant patient: 28 weeks' gestation or with bleeding during pregnancy
23 yobf w/ normal Hb electrophoresis, no complaints, w/ Hb 11.2, WBC 11, Plt 154, nl MCV, nl ferritin. What type of anemia?: Dilutional
When is Hb diluting the most during pregnancy?: 2nd trimester
Anemia assoc w/ b-thal?: Hypochromic, microcytic
2nd trimester pt w/ foul-smelling discharge & + chlamydia. What antibiotic?: Azithromycin
Complications of maternal chlamydia infection: PPROM, premature labor
Complication of congenital chlamydia infection: Conjunctivitis
Besides azithromycin, what else can be used to treat pregnant patient w/ chlamydia?: Erythromycin or amoxicillin
Why is doxycycline contraindicated in pregnancy?: Effects on fetal teeth & bone
Why are fluoroquinolones contraindicated in pregnancy?: Arthropathies
Why is streptomycin contraindicated in pregnancy?: CN VIII damage
30-wks gestation, no contractions, no bleeding, fundal height 27 cm x 4 weeks. Dx = ?: IUGR
IUGR is associated with what fetal weight in percentile?: < 10
When is US dating of a pregnancy most accurate?: Early
Complications of hypothyroidism in pregnant patient?: Preeclampsia, placental abruption, cretinism
Two major RFs for uncomplicated UTI: Sex & hypoestrogenism
67 yof not sexually active w/ genital atrophy & UTI: Hypoestrogenism
Sequelae of vertically-transmitted GBS: Sepsis, meningitis, PNA
Indications for treating GBS in pregnant patient: h/o GBS-infected neonate, + urine/BCx,
Why should asymptomatic bacteriuria in the pregnant woman be treated?: Risk of PTD/low birth weight
3 meds used for treatment of asymptomatic bacteriuria in pregnant woman?: TMP-SMX, nitrofurantoinm, cephalexin
Most common reason for condom failure?: Improper or inconsistent use
Established consequences of hypothyroidism in pregnancy?: LBW or still-born infant
Besides LBW & still-births, what other consequences are associated with hypothyroidism in pregnancy?: Preeclampsia, placental abruption, heart failure
Is there any known association between taking the OCP during the first trimester & birth defects?: No.
Consequences of taking tetracycline during pregnancy: Fetal teeth & bone malformations.
G2P2 presents w/ depression, but denies S/H ideations. What's the appropriate action?: Psych referral
What are the three types of psychological illness in the postpartum period?: Blues, depression, & psychosis
Which ovarian neoplasm is associated with the carcinoid tumor?: Struma ovarii
What are the four most common mets to the ovary?: Colon, breast, stomach, & pancreas.
What is the advantage of vacuum extraction over the forceps in expediting delivery?: Vacuum does not occupy space next to fetal head.
Which type of presentation is a classic indication for forceps delivery?: Face w/ mentum anterior
What is the advantage of the vacuum providing more safe area around the head?: Less damage to maternal tissues.
In which situation will attempted vacuum delivery fail due to loss of suction?: True CPD
Which types of situations are best suited for forceps or vacuum delivery?: < +2
Contraindication to vacuum delivery: Facial presentation, intact membranes
contraindication to forceps delivery: Intact membranes
G2P2 has received 7 days of MTX for ectopic. LLQ pain & BhCG persist. No decrease in size of ectopic, but w/ increased fluid in pelvis. Treatment?: Laparoscopy.
What is the definitive surgical treatment of a ruptured ectopic?: Salpingostomy or salpingectomy.
Grayish vaginal discharge in pregnant patient which produces a strong amine odor with addition of KOH. Diagnosis?: Bacterial vaginosis.
Treatment of bacterial vaginosis =: Metronidazole po
Microbiology of bacterial vaginosis: Decrease in lactobacilli & increase in anaerobic organisms.
Grayish malodorous vaginal discharge: Bacterial vaginosis
Clue cells go with which clinical test?: Whiff test
Sequela of bacterial vaginosis: PTD
Treatment of syphilis in pregnancy: IM penicillin
Treatment of GBS during labor: IV penicillin
First trimester bleeding: Threatened ab
Treatment of incomplete abortion: D & C
Definition of missed abortion: Retention of a failed IUP for > 2 menstrual cycles
Signs of PTL?: 20-37 wks, contractions, dilation
What is the treatment of PTL?: Tocolytics, corticosteroids (wks 24-34), & penicillin
How to prophylax against vertically-transmitted GBS in pen-allergic patient?: Clinda or erythromycin
How is placenta previa diagnosed?: Sono
What's the pH of the discharge produced in PPROM?: Strongly basic
Signs of uterine rupture in pregnancy: Abdominal pain, vaginal bleeding, & abnormal FHR
Signs of PID: Diffuse abdominal pain, no guarding, no rebound
What's another name for Fitz-Hugh-Curtis syndrome?: Perihepatitis
What's the pathogenesis of Fitz-Hugh-Curtis syndrome?: Inflammation & scarring of anterior surface of liver & surrounding peritoneum.
First test of choice for PID: Bimanual pelvic
How much glucose is used in the GCT vs the GTT?: 50 vs 100
What's the Kleihauer-Betke test used for?: Determining correct amount of RhoGAM to administer.
Four situations where an unimmunized Rh- patients should receive RhoGAM: 28 wks gestation, w/in 72 hrs after birth of Rh+ infant, after spontaneous Ab, or after amniocentesis
What's the main difference between the OCP & HRT?: Dosage
An excellent test to rule out TOA or appy: US
"Cottage cheese" vaginal discharge: Candidiasis
Clue cells: Bacterial vaginosis
Treatment for newly resolved herpes in 36 wk patient: Prophylactic acyclovir
Initial drug of choice for PMDD?: Fluoxetine
Consequence of excessive Vitamin B6?: Peripheral neuropathy
"Bad flu" plus labial rash: Genital herpes
Prodrome of herpes genitalis: Tingling, itching, burning.
Sequelae of gonorrhea in the pregnant patient: PTD & chorioamnionitis
How is ceftriaxone given to the pregnant patient w/ GC?: One-time IM injection
When can Flagyl be used on the pregnant patient?: 2nd or 3rd trimester
Maternal serum markers suggesting Down's Syndrome?: Low AFP, low estriol, relatively high HCG
Window for chorionic villus sampling: 9 to 12 wks
Another name for cordocentesis: PUBS
In a patient with h/o incompetent cervix who declines cerclage placement, when should vaginal exams begin?: 16 wks
When does cervical incompetence cause miscarriages?: 2nd trimester
RFs for cervical incompetence: Trauma, Mullerian anomalies, DES
Where might a cerclage be placed?: At internal os after bladder dissection or as high up on cervix as possible
When's a cerclage place?: Between wks 12 & 16
When's a cerclage removed?: 37 wks
Treatment of uterine hyperstimulation d/t oxytocin?: Discontinue oxytocin
How much dilation is required for forceps- or vacuum-assisted delivery?: Full
Role of antibiotics in pregnant pt w/ mitral valve prolapse desiring C-section?: Not needed
Woman w/ no risk factors for breast CA or family history who asks for BRCA screening?: No benefit
31 yo woman at 9 wks gestation w/ resolved profuse bleeding, closed os, & no products of conception seen on US. What treatment?: Counseling
DDx of first-trimester bleeding: Ectopic, incomplete abortion, missed abortion, inevitable abortion, threatened abortion, and complete abortion.
Most common significant sequela of complete previa: Placenta accreta
Major RFs for previa: Maternal age, minority, previous C-section
What's the placenta attached to in placenta accreta?: Myometrium
Radical treatment of previa + accreta?: Post-delivery hysterectomy
Relationship between previa & IUFD: None demonstrated
4 days s/p C-section w/ fever & incision that is discolored, cyanotic, & numb: Necrotizing fasciitis
Common cause of necrotizing fasciitis in ob setting?: C-section
What's lochia?: Period-like vaginal discharge following delivery
Signs of endometritis: Abd pain, foul-smelling lochia, fever, malaise, uterine tenderness
An absolute contraindication to IUD?: Multiple partners and h/o recent STD
Symptoms of adenomyosis?: Heavy or abnormal uterine bleeding & dysmenorrhea
How does one diagnose adenomyosis?: Histologically
Hallmark finding of leiomyosarcoma?: Rapidly expanding solitary uterine mass
Which drugs can be used in the treatment of typical UTI in the pregnant patient?: TMP-SMX, nitrofurantoin, cephalexin
Most significant cause of morbidity w/ a dermoid cyst?: Torsion
Hematologic sequela of mature cystic teratoma: Hemolytic anemia
Urinary frequency + incontinence associated with coughing, laughing, or weight lifting = ?: Stress incontinence
Pelvic floor exercises used to treat stress incontinence: Kegel maneuvers
What are three causes of functional incontinence?: Psycologic unwillingness or pathology, immobility, & physical barriers.
Causes of overflow incontinence: Detrusor sphincter dyssynergy or anatomic abnormalities
Treatment of overflow incontinence: Surgery and/or cath
What's the cause of urge incontinence?: Neurologic
Treatment of sexual preference issues: Refer to psychological counseling
Complications of tamoxifen therapy: DVT, menopausal sx, endometrial CA
When should evaluation of late menarche be done?: 15
The best candidates for a LEEP procedure: HGSIL
Does a LEEP require hospitalization?: No
Infectious complications of LEEP: Cervicitis, parametritis, salpingitis, pelvic abscess
Long-term complications of a LEEP?: Cervical incompetence or stenosis
Why is uterine perforation more common in postmenopausal women?: Uterus is more anteflexed or atrophied
Definition of inevitable abortion?: Rupture of membranes or cervical dilation in first half of pregnancy
Retention of failed IUP for more than 2 cycles: Missed ab
When should a pregnant woman get a HepB test?: First visit
When should a pregnant woman get a Pap smear?: First visit
Medical treatment of postpartum endometritis?: Clinda-gent
Mechanism of infection in postpartum endometritis?: Ascending
First step in suspected rupture of ectopic?: Laparoscopy
What's the advantage of progestasert?: Decreased menorrhagia
What's the advantage of Mirena?: Decreased bleeding & cramping
Initial treatment of TOA: IV abx
PID affects which cells primarily?: Epithelial cells of fallopian tube
Causes of ovarian hyperstimulation syndrome: Gonadotropins of clomiphene citrate
Si/Sx of severe OHSS?: Ascites, hydrothorax, oliguria, hemoconcentration.
Treatment options for severe OHSS?: Paracentesis, thoracentesis, or surgery.
What is the correct action if an HIV-positive woman w/ no h/o mental illness decides to deliver vaginally?: Respect decision
What is the most common physical symptom associated w/ PMDD?: Abdominal bloating
49 yo previously healthy f w/ irritability, fatigue, and new variability in menstrual cycles. What's the diagnosis?: Perimenopause
What is the location of Bartholin's glands in relation to the vagina?: Near posterior fourchette
Where on a clock would Bartholin's glands be located?: 5 and 7
What type of catheter is used in the treatment of a Bartholin's abscess?: Word
When is marsupialization of a Bartholin's abscess appropriate?: When Word catheter fails
What's another name for granuloma inguinale?: Donovanosis
Cause of Donovanosis?: Calymmatobacterium granulomatis
What are the signs of granuloma inguinale?: Papules progressing to ulcers
Common cause of hematocolpos?: Imperforate hymen
Treatment of arrest of dilation?: IV oxytocin
Treatment of torsed benign cystic teratoma: Laparoscopy
When is an oophorectomy warranted in the treatment of a torsed benign cystic teratoma?: When the detorsed ovary looks non-viable & necrotic
Young pt with menorrhagia and elevated aPTT?: vW dz
An example of an absolute contraindication to CS?: A classic uterine scar
Compared to amniocentesis, CVS places the fetus at greater risk for what?: Limb defects
When can CVS be performed?: 10 to 12 wks
When is amniocentesis done?: 2nd trimester
34 yo F with dyschezia, dyspareunia, and dysmenorrhea. She is guiac negative. Diagnosis established via what?: Laparoscopy
What's another word for endometrioma?: Chocolate cyst
What is visualized when a sonographer detects an endometrioma?: Adnexal enlargement
Some RFs for an infection characterized by thick white vaginal discharge w/ pruritus?: Systemic steroids, abx, DM, OCP
Precipitants of genital herpes recurrences: Sex, stress, intercurrent disease
What is mupirocin used for?: 2nd line for S. aureus skin infections
How can terbinafine be anti-Candidal?: Systemic administration
What's the window period for meperidine administration leading to respiratory depression in the newborn?: 2 to 3 hours
Indications for administering penicillin in labor: Either h/o GBS-infected neonate or h/o GBS in urine
What is the most common side effect of giving corticosteroids to a 30 wk pregnant patient?: Increased maternal insulin requirement
Greenish-gray vaginal discharge plus petechial cervical lesions: Trichomoniasis
Strawberry cervix: Trichomoniasis
How is vaginal fluid treated in order to diagnose candidiasis?: KOH, saline, or Gram Stain
Sequelae of trichomoniasis in pregnancy: PTD, low BW, PPROM
A pregnant patient's BP hovers around 140/90 - 144/92 since before her pregnancy. What do you do?: Follow BPs.
Sequelae of chronic hypertension in a pregnant patient?: Preeclampsia, abruption, fetal growth restriction, PTD
When should antihypertensive therapy begin for a pregnant patient?: Persistent diastolic > 100
Sequelae of beta blockers during pregnancy?: IUGR, PTD
Sequelae of ACE inhibitors during pregnancy?: Fetal anomalies & death
Common side effect of raloxifene?: Hot flashes
Raloxifene & osteoporosis?: Preventive
Bilateral malar rashes on face in pregnant woman?: Normal/chloasma/melasma
Treatment for pregnant pt w/ mitral valve prolapse & regurge going into labor?: No abx
Definition of compound presentation?: Prolapse of an extremity w/ presenting part
Treatment for compound presentation?: Expectant management
Complications of vitamin A excess during pregnancy?: Cranial neural crest malformations
Fluctuant mass at margin of incision in postop patient?: Wound abscess
Proper treatment of abdominal wound abscess?: IND
Consequences of inadequate treatment of chancroid?: Draining sinuses
Something used to soften an unfavorable cervix: PGE2 gel
Major side effect of PGE2 gel?: Uterine hyperstimulation
19 yo F w/ normal appearing breasts but blind-ended vaginal pouch & scant pubic hair: Androgen insensitivity syndrome
Treatment of androgen insensitivity syndrome?: b/l orchiectomies
Four cardinal features of Kallman's syndrome?: Amenorrhea, color-blindedness, anosmia, facial deformities
Treatment for condyloma accuminata?: Cryotherapy, laser therapy, tricholoracetic acid, or imiquimod
Predisposing factors for transmission of GBS from infected patient to fetus?: PTD, PPROM, & T > 38 C
Drugs that can be used for GBS Px in pen-allergic pt?: Clinda, Erythro, (cefazolin), vanco
Treatment of pyelo w/ possible sepsis?: IV TMP/SMX

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