Obgyn 301-400

Front 1

Dull, ill-defined pelvic ache worse prior to menstruation and relieved by menses; Hx of sexual problems

Back 1

Pelvic congestion syndrome

Front 2

5 aspects of a BPP

Back 2

NST, tone, movements, breathing, amniotic fluid volume

Front 3

BPP of 4 or less

Back 3

Delivery if fetus is >26wks

Front 4

pH of amniotic fluid

Back 4

7-7.5

Front 5

Definition of maternal leukocytosis

Back 5

>15,000

Front 6

Amenorrhea eval

Back 6

Uterus on pelvic U/S: if FSH increased --> karyotype; if FSH decreased --> cranial MRI

Uterus absent on U/S: if 46,XX/ nml testosterone, indicates abnormal Mullerian dev't; if 46,XY/male testosterone levels, indicates androgen insensitivity

Front 7

How does FSH aid in the diagnosis of amenorrhea

Back 7

If increased, is hypergonadotropic amenorrhea: peripheral problem

If decreased, is hypogonadotropic amenorrhea: central problem

Front 8

Cause of amenorrhea in female athlete's trial

Back 8

Decreased GnRH/LH --> estrogen deficiency

Front 9

Test to determine whether vaginal bleeding is from a fetal hemorrhage

Back 9

Apt test

Front 10

Rx for gonorrhea or chlamydia

Back 10

Ceftriaxone and azithro (or doxy)

Front 11

Most common cause of a nonreactive NST

Back 11

Sleeping baby: wake up with vibroacoustic stimulation

Front 12

Cause of vaginismus

Back 12

Involuntary contraction of perineal musculature (psychological)

Front 13

Rx for vaginismus

Back 13

Relaxation, Kegels, gradual dilation w/ dilators, fingers, etc.

Front 14

Rx for primary anorgasmia

Back 14

Self-stimulation

Front 15

After what point are breech presentations attempted to be converted?

Back 15

37wks (b/c most self-resolve by then)

Front 16

When are fetuses at highest risk from ionizing radiation exposure?

Back 16

8-15wks

Front 17

Effects of ionizing radiation

Back 17

Mental retardation, microcephaly, abnormal genitalia, growth restriction, microphthalmia, cataracts

Front 18

Test when suspect anovulation as cause of infertility

Back 18

Mid-luteal phase serum progesterone (should be increased to >10)

Front 19

Monomorphous pink papules, absence of comedones

Back 19

Steroid-induced folliculitis (steroid acne)

Front 20

Most preventable cause of fetal growth restriction in the US

Back 20

Smoking (causes 1 in 3 cases)

Front 21

Most common infection leading to IUGR

Back 21

CMV

Front 22

DES exposure in utero increases the risk for

Back 22

Adenocarcinoma of the vagina

Front 23

pH of vaginitis infections

Back 23

Normal (4-4.5) in yeast infections; elevated (5-6) in BV and trich

Front 24

How to distinguish BV and tric clinically?

Back 24

Pruritis and inflammation seen only in trichomonas

Front 25

Decreased long-term variability can be due to this benign condition

Back 25

Fetal sleep

Front 26

Yellow mucopurulent discharge from the cervix

Back 26

Most commonly chlamydia

Front 27

Dyspareunia, dysmenorrhea, dyschezia

Back 27

Endometriosis

Front 28

Rx for endometriosis

Back 28

OCPs; GnRH analogs; danazol

Front 29

Bilateral, multinodular, solid masses on both ovaries

Back 29

Pregnancy luteoma: benign condition, no Rx

Front 30

Things to rule out with hyperemesis in pregnancy

Back 30

Hyaditiform mole

Front 31

Enlarged uterus, hyperemesis, and greatly increased hCG

Back 31

Hyaditiform mole

Front 32

Vomiting, weight loss, ketonuria

Back 32

Hyperemesis gravidum (can have mild increases in ALT/AST, amylase/lipase)

Front 33

Definition of arrest of descent

Back 33

No change in descent of fetal presenting part after 2hrs in nullips, 1 in multips (add an hr with epidural in place)

Front 34

Definition of arrest of dilation

Back 34

Dilation does not change (once >4cm) >1cm/hr in nullips or 1.2cm/hr

Front 35

What is the Zavanelli maneuver?

Back 35

Last resort for a shoulder dystocia: pushing baby back into uterine cavity followed by C-section

Front 36

Mechanism of hypotension post-epidural

Back 36

Sympathetic block --> vasodilation of lower extremity vessels --> blood redistribution and venous pooling in lower extremities

Front 37

Relationship btwn hypothyroidism and hyperprolactinemia

Back 37

TRH stimulates prolactin production

Front 38

When is a contraction stress test indicated?

Back 38

When the BPP score is 6

Front 39

Best Abx for UTIs in pregnancy

Back 39

Amox, nitrofurantoin, cephalexin

Front 40

Why is the risk of UTI increased in pregnancy?

Back 40

Progesterone causes smooth muscle relaxation --> ureteral dilation --> facilitates bacterial colonization and ascension

Front 41

Post-delivery, woman with respiratory failure, cardiogenic shock, and DIC

Back 41

Amniotic fluid embolism (can also occur post-amniocentesis)

Front 42

Rx for AFE

Back 42

Respiratory support first; then IVF

Front 43

How to differentiate btwn central and peripheral precocious puberty?

Back 43

Central: high basal LH that increases with GnRH stimulation

Peripheral: low LH with no response to GnRH

Front 44

Rx for central precocious puberty and reasoning

Back 44

GnRH agonist; prevention of premature epiphyseal plate fusion

Front 45

How to distinguish mastitis from breast engorgement

Back 45

Mastitis is usually unilateral

Front 46

What lecithin/sphingomyelin ratio indicates lung maturity?

Back 46

> 2.0

Front 47

Management of decreased fetal movements with no fetal heart tones heard on Doppler

Back 47

Ultrasonography to confirm IUFD

Front 48

When is serial fibrinogen monitoring necessary after IUFD?

Back 48

Only if monitored expectantly to look for DIC (e.g. not if fetus is evacuated)

Front 49

What is the cause of primary dysmenorrhea

Back 49

Increased prostaglandins

Front 50

Rx for women with refractory PMS

Back 50

Low-dose SSRIs; if unsuccessful, alprazolam

Front 51

Precocious puberty is defined as before what age

Back 51

8yo in girls

Front 52

Cause of central precocious puberty

Back 52

Early activation of the HPO axis

Front 53

Cause of peripheral precocious puberty

Back 53

Gonadal or adrenal release of excess sex hormones

Front 54

Rx for HELLP syndrome

Back 54

Immediate delivery if >34wks; otherwise steroids, monitoring, etc.

Front 55

What is pseudocyesis

Back 55

Woman who desperately wants to be pregnant presents with all the signs and symptoms, but has a normal endometrial stripe and negative hCG

Front 56

Best measurement on U/S for estimation of fetal size

Back 56

Abdominal circumference (b/c affected in both symmetric and asymmetric fetal growth restriction)

Front 57

At what antibody titer level is the mother already sensitized (i.e. RhoGAM not helpful), and at what level is the fetus at risk for hemolytic disease

Back 57

1:6

1:16

Front 58

Role of beta-hCG and what secretes it

Back 58

Syncytiotrophoblast: to maintain corpus luteum (for its progesterone production until placenta takes over)

Front 59

Definition of missed abortion

Back 59

IUFD <20wks w/ complete retained products of conception and a closed cervix

Front 60

Sx of missed abortion

Back 60

Brown vaginal discharge and loss of pregnancy symptoms

Front 61

Medical Rx for spontaneous vs. elective abortion

Back 61

Misoprostol/mifepristone can eliminate products of conception from uterus

Methotrexate is an abortifacient (useful for ectopic as well)

Front 62

FSH and LH levels in Turner's

Back 62

High (due to poor estrogen function: lack of negative feedback)

Front 63

Inhibin levels in Turner's

Back 63

Low (b/c is a marker of ovarian function)

Front 64

When do you not need to treat for both chlamydia and gonorrhea?

Back 64

When the other infection has been ruled out with a highly sensitive test, e.g. NAAT

Front 65

Management of pt with antepartum hemorrhage

Back 65

Resuscitation first! IVF, etc.; then ultrasound, then emergency C-section if needed

Front 66

Cause of neonatal thyroidtoxicosis if mother has just had thyroidectomy due to Graves?

Back 66

Thyroid stimulating Ig levels remain high for several months after thyroidectomy and can cross placenta

Front 67

Increased osteoporosis/fracture risk in pts who drink more than ___ drinks/day

Back 67

2

Front 68

Why is asymptomatic bacteriuria treated in pregnant women?

Back 68

Progresses to pyelo in 30-40%, which may cause septicemia, preterm labor, and low birth weight

Front 69

Management of placental abruption if pt and fetus are stable

Back 69

IOL

Front 70

What two lab values raise concern for DIC after IUFD?

Back 70

Low fibrinogen and low platelets

Front 71

How do granulosa cell tumors present in postmenopausal women?

Back 71

Breast enlargement, lack of menopausal symptoms

Front 72

4 methods of treating vaginal warts

Back 72

Trichloroacetic acid, podophyllin, excision, fulguration (electric current)

Front 73

Condyloma acuminata vs. condyloma lata?

Back 73

Former is HPV (pink, clustered, teardrop lesions); latter is secondary syphilis (flat, velvety lesions)

Front 74

Which common STD is always tested for, even if asymptomatic, in pregnancy?

Back 74

Chlamydia (not gonorrhea)

Front 75

Indications for inpatient Rx for PID

Back 75

High fever, unresponsive to orals, inability to take orals b/c of N/V, pregnancy, non-compliance

Front 76

Unexpected potential Abx regimen for PID

Back 76

Clinda + gent

Front 77

FSH and LH in premature ovarian failure

Back 77

Both increased due to lack of negative feedback from estrogen; FSH/LH >1 b/c FSH is cleared slower

Front 78

Flank pain and hematuria in pregnancy

Back 78

Nephrolithiasis (which may lead to hydronephrosis beyond the physiologic amt in pregnancy)

Front 79

BUN and Cr levels in pregnancy

Back 79

Both decrease due to increased GFR and renal plasma flow

Front 80

Uterine tenderness, hyperactivity, and increased uterine tone

Back 80

May be placental abruption, even without bleeding: can have concealed hemorrhage

Front 81

Besides HTN and cocaine use, risk factors for abruption include

Back 81

Short umbilical cord
Tobacco use
Folate deficiency

Front 82

Cause of stress incontinence

Back 82

Weak pelvic floor muscles --> urethral hypermobility with increased intraabdominal pressure --> ineffective sphincter closure

Front 83

Rx for stress incontinence

Back 83

Kegels and urethropexy

Front 84

Cause of urge incontinence

Back 84

Detrusor hyperactivity

Front 85

Rx for urge incontinence

Back 85

Oxybutynin

Front 86

Rx for overflow incontinence

Back 86

Bethanechol and alpha blockers

Front 87

Dysmenorrhea and dyspareunia

Back 87

Endometriosis

Front 88

Management of ovarian cyst seen on US in a postmenopausal pt

Back 88

Exploratory surgery

Front 89

2 first line options for endometriosis

Back 89

NSAIDs and OCPs

Front 90

Management of suspected hemorrhagic cyst

Back 90

Repeat US in 2mo

Front 91

Pathophys of interstitial cystitis

Back 91

Disruption of glycosaminoglycan layer in bladder mucosa

Front 92

Rx for interstitial cystitis

Back 92

Dimethyl sulfoxide (DMSO), pentosan polysulfate, or anti-inflammatory and analgesics

Front 93

How to aid fertility in women with endometriosis

Back 93

Clomiphene citrate (+ IUI if needed)

Front 94

Management of chronic pelvic pain if NSAIDs and OCPs have failed?

Back 94

Diagnostic laparoscopy to look for endometriosis (can't use GnRH agonist until diagnosis confirmed)

Front 95

2 non-gyne conditions associated with chronic pelvic pain

Back 95

Interstitial cystitis
IBS

Front 96

How do GnRH agonists work vs. danazol

Back 96

GnRH agonists down-regulate HPA axis, decrease FSH/LH/estrogen

Danozol suppresses the mid-cycle surge in FSH/LH

Front 97

50% of women with chronic pelvic pain have a history of

Back 97

Physical or sexual abuse

Front 98

Imaging study of choice for potential ovarian cancer

Back 98

Transvaginal US

Front 99

Surgical management of chronic pelvic pain due to past unilateral PID in pt hoping for future fertility

Back 99

Laparoscopic unilateral salpingectomy (leave both ovaries if can)

Front 100

Which 2 nerves are at risk of entrapment after LTCS

Back 100

Iliohypogastric
Ilioinguinal