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401 Cards in this Set
- Front
- Back
- 3rd side (hint)
At what week gestation does B-HCG peak?
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At 10 weeks - peaks at 100,000 mIU/mL
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At what week gestation does an embryo start being called a fetus?
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8 weeks gestation
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How early might you start seeing fetal heart beats on US?
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6 weeks
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At what week gestational age might you first see the gestational sac in the uterus?
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5 weeks
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What is the Chadwick sign?
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Bluish discoloration of the vagina and cervix indicating pregnancy
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What is the difference between "Gestational age" and "Developmental age?"
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Gestational age is the weeks since the LMP
Developmental age is the weeks since conception (usually two weeks less than GA) |
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At what week of gestation does the mother begin to be aware of fetal movements?
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16-20 weeks
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How much does plasma volume increase during pregnancy?
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By 50%.
RBC volume increases by 20-30%, so hematocrit decreases |
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Which hormone affects smooth muscle in pregnancy and is responsible for many of the physiologic changes seen?
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Progesterone causes smooth muscle relaxation
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How much does the daily caloric intake requirement increase during pregnancy?
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By 300kCal/day
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If a patient begins to gain an unusually large amount of weight late in pregnancy, what pathology should you consider?
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Pre-eclampsia - it could be a sign of fluid retention
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Which three chemicals are assayed in the standard triple test for Down syndrome?
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Alpha feto protein
B-HCG estriol |
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At what week is AFP usually screened to check for Down syndrome?
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15-18 weeks
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At what week of pregnancy are women screened for Group B Streptococcal infection?
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36 weeks
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What is the treatment for women who test positive for GBS late in pregnancy?
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IV penicillin
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Name the common, benign cause of lower abdominal pain that often occurs late in the second trimester of pregnancy?
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Round ligament pain - secondary to the rapid expansion of the uterus and stretching of the ligamentous attachments
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What are the five components of the Biophysical Profile?
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Amniotic fluid volume
Fetal tone Fetal activity Fetal breathing movements NST |
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Which chemical is seen in higher concentrations in the amniotic fluid when the lung matures?
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Lecithin increases as the lungs mature, while sphingomyelin decreases beyond about 32 weeks
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What is a heterotropic pregnancy?
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When there is an intrauterine and an extrauterine pregnancy simultaneously
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詫び
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/(n) apology/(P)/
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[わび]
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What is the treatment of choice for an unruptured ectopic pregnancy?
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Methotrexate
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What is the name for the death of an embryo or fetus before 20 weeks with complete retention of the POC?
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Missed abortion
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What is the most common cause of first trimester abortions?
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Fetal chromosomal abnormalities
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What are the most common causes (4) of second-trimester abortions?
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Uterine or cervical abnormalties
Trauma Systemic disease Infection |
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What is the definition of recurrent/habitual abortions?
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Three or more consecutive spontaneous abortions
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What additional analyte is sometimes added to the triple test to make the "quad screen?"
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Inhibin A
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How many days after fertilization does the blastocyst typically implant into the endometrium?
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7 days
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In which weeks of development does organogenesis take place?
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Weeks 3-8
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What level of sensitivity does the triple-test have?
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Only 60%
but 80% over the age of 35 |
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With a Down syndrome fetus, which of the analytes in the triple test are elevated and which are decreased?
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MSAFP - decreased
estriol - decreased BHCG - increased |
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What percentage of amniocenteses have complications?
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0.5%
Complications include ROM, premature labor, fetal injury |
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At which week gestation can CVS be performed?
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9 weeks (six weeks earlier than amniocentesis)
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What problems are associated with performing CVS before 9 weeks?
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Limb abnormalities
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What is fetal lie (what are the options/classifications)?
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Either longitudinal or transverse in the uterus
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What is fetal presentation (what are the options/classifications)?
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Either breech or cephalic
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What does the P in PROM stand for? What is the definition?
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Premature Rupture of Membranes
Rupture 18 hours before labor |
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What do the P and P in PPROM stand for? What is the clinical definition?
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Preterm Premature Rupture of Membranes
ROM before 37 weeks |
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How can leaks of amniotic fluid be differentiated from stress incontinence?
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Nitrazine or fern tests of the fluid
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How does the nitrazine test for amniotic fluid work?
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Tests the pH of the vaginal fluid
Amniotic fluid is alkaline, while normal vaginal secretions are usually acidic |
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What are the five aspects of the Bishop score?
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Cervical dilation
Cervical effacement Fetal station Cervical position Cervical consistency |
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What does a high Bishop score indicate?
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That the cervix is favorable for labor (either spontaneous or induced)
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How is the station of the fetal head assessed?
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The relation of the fetal head to the ischial spines. Positive is past the spines, negative is above the spines
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How does the cervical position change throughout labor?
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Advances its position from posterior to mid to anterior as labor progresses
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What is the definition of Prodromal Labor or "false labor?"
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Irregular contractions that vary in duration, intensity and intervals that yield little or no cervical change
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Name five common indications for inducing labor?
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Postterm pregnancy
Preeclampsia Premature ROM Nonreassuring fetal testing IUGR |
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What is the normal range for the fetal heart rate?
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110-160 bpm
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What conditions are considered if the fetus has tachycardia >160?
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Fetal distress secondary to
Infection Hypoxia Anemia |
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What is the definition of a formally reactive fetal heart tracing?
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20 minute monitor
At least 2 accelerations of at least 15 beats per minute over the baseline that last at least 15 seconds |
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What causes early decelerations on the tocometer?
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Increased vagal tone secondary to head compression during a contraction
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What causes variable decelerations?
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A result of umbilical cord compression
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What causes late decelerations on a tocometer?
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Uteroplacental insufficiency
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What are the most worrisome - early, late, or variable decelerations?
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Late decelerations - caused by uteroplacental insufficiency
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The pH of fetal blood is nonreassuring if it is below what level?
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<7.2
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If you put a pulse oximeter on a fetus, what is a normal reading?
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30%
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What are the five cardinal movements of labor?
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Engagement
Flexion Internal rotation Extension External rotation |
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What marks the beginning and end of the second stage of labor?
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Begins at full dilation of the cervix and ends at delivery of the infant
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How long does the first stage of labor last?
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10-12 hours in nulliparous woman
6-8 hours in a multiparous woman |
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What are signs of nonreassuring fetal status on a fetal heart monitor?
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Repetitive late decelerations
Bradycardia Loss of variability |
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What conditions are necessary for safe application of forceps during delivery?
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Full dilation of cervix
Ruptured membranes Head at at least +2 station Experienced operator |
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What is the normal interval between the delivery of the infant and the placenta?
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Usually 5-10 minutes
But up to 30 minutes is within normal limits |
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What is the current rate of cesarean delivery in the US (2007)?
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29%
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What is the risk of uterine rupture during TOLAC (trial of labor after cesarean)?
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0.5-1%
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In what percent of pregnancies does placenta previa occur?
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0.5%
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What are the associated sequelae of placenta previa?
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Antepartum hemorrhage
Preterm delivery PPROM IUGR Increased risk of puerperal hysterectomy |
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What is the classic presentation of placenta previa?
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Painless third trimester bleeding
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What is the most common factor associated with increased incidence of placental abruption?
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Hypertension
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What is the vascular volume of a term fetus?
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About 250mL
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What is the Apt test?
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Examination of materanal blood for nucleated (fetal) red blood cells
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What is a succenturiate placenta?
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An accessory lobe of the placenta
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What is the definition of low birth weight?
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<2500g
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What is the only medication approved by the FDA for tocolysis?
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Ritrodine - a beta mimetic agent
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How does good hydration decrease the number of contractions in preterm labor?
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It decreases ADH which cross reacts with oxytocin receptors
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What antibiotic(s) are used in the setting of PPROM?
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Ampicillin with or without erythromycin
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What is the "obstetric conjugate?"
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The distance between the sacral promontory and the midpoint of the symphysis pubis - the shortest anteroposterior diameter of the pelvic inlet
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What percentage of singleton deliveries present breech at delivery?
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3-4%
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How should a fetus with a shoulder presentation be managed?
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Cesarean section
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What is the antiseizure medication of choice in pregnancy?
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Magnesium sulfate
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What malignancies are LGA infants at a higher risk for?
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Leukemia, Wilms tumor, osteosarcoma
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Should obese patients be counselled to lose weight during pregnancy?
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They shouldn't lose weight during pregnancy - but should gain less weight than other women
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What is the normal maximum volume of amniotic fluid during pregnancy?
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800 mL at ~28 weeks
500 mL at term |
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What are the common causes of polyhydramnios?
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Maternal diabetes
Neural tube defects Obstruction of alimentary canal Hydrops |
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Which is a more ominous sign - polyhydramnios or oligohydramnios?
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Oligohydramnios - umbilical cord often gets compressed leading to fetal asphyxia
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What are the risks/complications for the fetus in a uterus with polyhydramnios?
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Risk for malpresentation
Risk of cord prolapse |
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At what times in pregnancy should an Rh negative mother recieve RhoGAM when she has an Rh positive fetus?
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At week 28 and postpartum
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What is a good non-invasive test for fetal anemia?
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Doppler measurement of blood flow in the middle cerebral artery
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What are the dangers for the fetus of postterm pregnancies?
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Increased risk of fetal demise
Macrosomia Meconium aspiration Oligohydramnios |
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What is the average gestational age for delivery of twins?
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36-37 weeks
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Which type of twins have the highest mortality rate?
-Monochorionic, diamniotic -Monochorionic, monoamniotic -Dichorionic, diamniotic |
Monochorionic, monoamniotic due to cord accidents from entanglements
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Which type of twins are at risk for Twin-to-twin transfusion syndrome?
-Monochorionic, diamniotic -Monochorionic, monoamniotic -Dichorionic, diamniotic |
Monochorionic, diamnionic twins
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What are the treatment options for Twin-to-twin transfusion syndrome?
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Serial amniocenteses
Laser coagulation of vascular connections between the fetuses |
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Blood pressure typically decreases during pregnancy until which point?
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About the middle of the second trimester
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Is preeclampsia more common in primiparous or multiparous women?
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Primiparous - 8x more common
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What does HELLP syndrome stand for?
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Hemolysis
Elevated Liver enzymes Low Platelets |
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What are the typical medical treatments indicated in severe preeclampsia?
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Magnesium sulfate for seizure prophylaxis
and Hydalazine for HTN |
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What is the recurrence rate for preeclamspia in subsequent pregnancies?
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25-33%
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What is the treatment for overdose with Magnesium sulfate during pregnancy?
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10mL of calcium chloride or calcium gluconate
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In eclamptic patients, do seizures typically occur before, during or after delivery?
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25% before
50% during labor 25% after |
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What percentage of patients with chronic hypertension will develop superimposed preeclampsia during pregnancy?
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33% or more
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In which trimester is the onset of carbohydrate metabolism abnormalities in gestational diabetes most common?
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Usually they do not occur until the third trimeseter
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What blood glucose level qualifies as a positive glucose challenge test?
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140mg/dL after 1 hour following a 50g dose of glucose
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What are the cutoff blood glucose levels during the glucose tolerance test at
1 hour? 2 hours? 3 hours? |
1 - 180mg/dL
2 - 155mg/dL 3 - 140mg/dL |
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What are the common signs of chorioamnionitis?
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Maternal fever and high WBC
Uterine tenderness Fetal tachycardia |
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How is chorioamnionitis treated?
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Antibiotics and DELIVERY
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Without treatment, what percentage of infants who are born to HIV infected mothers are born with infection?
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About 25%
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What is required to diagnose hyperemesis gravidarum in a pregnant woman?
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Vomiting that leads to dehydration and possibly electrolyte disturbances
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Does elevated estrogen increase or decrease the likelihood of developing seizures? What about progesterone?
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Estrogen - increases seizures
Progesterone - decreases seizures |
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What is the drug of choice to control seizures for epileptic patients who become pregnant?
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Phenytoin
Mg sulfate is good for seizures due to preeclampsia, but phenytoin is usually use for patients with known seizure disorder Single drug treatment is optimal |
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What is the characteristic morphologic change to the heart in a patient with Peripartum Cardiomyopathy (PPCM)?
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A dialated heart with an ejection fraction far below normal in the 20-40% range
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What is the presentation of superficial vein thrombosis in pregnancy?
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Painful, palpable venous cord with local erythema and edema
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When Anticoagulant therapy is given what activities should be avoided
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Shave With An Electric Razor instead of a disposable.
Use a Toothbrush With Soft Bristles Any activities that could cause injuries |
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What is the treatment for DVT during pregnancy?
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Heparin
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Do SLE symptoms tend to get better or worse in pregnancy?
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One-third rule:
1/3 get better 1/3 get worse 1/3 stay the same |
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What lab test helps to differentiate a lupus flare-up from preeclampsia?
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There will be reduced C3 and C4 levels in a lupus flare-up
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What is the treatment for alcohol withdrawal during pregnancy?
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Barbituates, because benzodiazepines have a potential teratogenic effect
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What are the major risk factors for the fetus if the mother smokes during pregnancy?
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Spontaneous abortion
Preterm birth Abruption Decreased birth weight SIDS Respiratory illness in childhood |
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What is the definition of the puerperium?
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The first six weeks after delivery
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What are the top causes of postpartum bleeding?
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Uterine atony (#1)
Retained POCs Placenta accreta Cervical/vaginal lacerations |
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What puts a woman at higher risk for uterine atony after birth?
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Multiple gestations
Chorioamnionitis Mg sulfate Multiparity Macrosomia |
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At what point in pregnancy is endomyometritis most likely to occur?
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5-10 days after delivery
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What treatment is commonly given for mastitis?
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Dicloxacillin
Breast feeding can continue |
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How do you diagnose congenital adrenal hyperplasia?
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Elevated 17-a-hydroxyprogesterone or urine 17-ketosteroid with decreased serum cortisol
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How is imperforate hymen commonly diagnosed?
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It is often diagnosed at puberty with primary amenorrhea in the setting of cyclic pelvic pain.
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What is a synonym for testicular feminization?
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Androgen insensitivity syndrome
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What vaginal pathology presents in postmenopausal women with thin, white atrophic epithelium and labial fusion?
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Lichen sclerosis
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Where (on a clock face) on the vagina are Bartholin cysts and abscesses found?
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4 o'clock and 8 o'clock
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What is the surgical procedure used as treatment for Bartholin cysts and abscesses?
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Marsupialization - the entire abscess or cyst is incised and the resulting space is sewn open. Epithelialization can then occur.
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What is the name for cysts found on the cervix that are caused by blockage of an endocervical glands?
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Nabothian cysts (or retention cysts)
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How do fibroids behave during pregnancy?
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They can grow quickly and to huge proportions due to estrogen sensitivity.
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Is smoking a risk factor for fibroids?
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No, smoking is protective.
Smoking suppresses estrogen and fibroids grow in response to estrogens. |
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Do fibroids appear darker or lighter than myometrium on US?
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Fibroids are areas of hypoechogenicity - lighter than myometrium
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What is the best medication to treat endometrial hyperplasia?
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Progestin therapy
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What abnormal lab value accompanies ovarian theca lutein cysts?
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Beta HCG
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What are the two most common sites for endometriosis?
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Ovary and pelvic peritoneum
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What percentage of women with infertility have endometriosis?
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40%
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What are medical treatment options for endometriosis?
|
NSAIDs
Oral contraceptives Danazol GnRH agonists |
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What are the common side effects of danazol?
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Androgenic side effects -
Acne Oily skin Weight gain Hirsutism |
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Where in the uterus is adenomyosis most commonly found?
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Fundus and posterior wall
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How is adenomyosis diagnosed?
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It's a clinical diagnosis - menorrhagia and/or dysmenorrhea in parous women
Imaging studies are not useful/cost effective |
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What is the treatment of adenomyosis?
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NSAIDs
OCPs Progestins |
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What is the lifetime incidence of adenomyosis? (and in what age group does it most commonly occur)
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15% of women
Usually in late 30's early 40's in parous women |
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What is the cause of malaise, fever, pharyngitis and/or rash after treatment for syphilis?
|
Jarisch-Herzheimer reaction
Caused by an immune reaction to the dead spirochetes |
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What is the initial test for syphilis?
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RPR or VDRL nonspecific antibody testing. Darkfield microscopy can be used to investigate the primary genital lesions
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Should patients with Herpes be treated medically?
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Yes, treating with acyclovir reduces the length of primary infection and can suppress recurrances (but doesn't cure)
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How is chancroid diagnosed?
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Painful genital lesions with ragged/purulent edges are identified and herpes and syphilis chancre are ruled out with lab tests
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What is the treatment for chancroid?
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Single dose of PO azithromycin or IM ceftriaxone
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What is the other name for genital warts?
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Condyloma acuminata
Caused by HPV |
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What is the usual treatment for genital warts?
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Cryotherapy or topical medications (trichloroacetic acid, podophyllin or 5-FU cream)
Large lesions can be treated with a CO2 laser |
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What is mostly responsible for the acidic pH of the vagina?
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Lactobacillus sp. generally maintain the vaginal pH below 4
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What is the most common complaint of bacterial vaginosis?
|
Amine odor
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How is bacterial vaginosis diagnosed?
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Adding KOH to a vaginal prep (whiff test)
or Clue cells |
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What are the predisposing factors for C. albicans overgrowth?
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Use of broad-spectrum antibiotics
Diabetes mellitus Decreased cellular immunity Intercourse Late luteal phase of the menstrual cycle |
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What percentage of patients suffering with genital candidiasis display the characteristic white plaques or cottage cheese-like discharge?
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Only 20%
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What is the recommended treatment for Neisseria gonorrhea?
|
Ceftriaxone 250mg IM once
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Is incidence of gonorrhea increasing or decreasing in the US? What about chlamydia?
|
Gonorrhea decreasing
Chlamydia increasing (probably due to increased diagnosis) |
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When does endometritis or endomyometritis usually present?
|
Most commonly after C. section, vaginal deliveries, D&C or IUD placement
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What patients should be hospitalized for treatment for PID?
|
Teenagers
Pregnant women Noncompliant patients Patients who can't tolerate oral treatment |
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How many cases of Toxic shock syndrome are generally seen each year in the US?
|
Fewer than 300 cases per year
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What is the treatment for Toxic shock syndrome?
|
Hospitalization is always indicated
Treat hypotension with fluids and pressors |
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What percentage of AIDS patients in the US are women?
in the world? |
US - 18%
World - 50% |
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How should HIV positive women be treated to reduce the risk of vertical transmission?
|
AZT treatment after the first trimester, during labor, and treating the neonate as well.
Cesarean section. |
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What are the risk factors for Pelvic Organ Prolapse (POP)?
|
Chronic cough
Straining Ascites Traumatic delivery Aging and menopause |
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What are common presenting symptoms of pelvic organ prolapse?
|
Pelvic pressure/heaviness
Vaginal bulge Urinary incontinence, frequency, urgency, or retention |
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How is first degree pelvic organ prolapse defined?
|
The herniated structure is confined to the upper 2/3 of the vagina
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How is second degree pelvic organ prolapse defined?
|
The herniated structure decends to the level of the introitus
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How is third degree pelvic organ prolapse defined?
|
The herniated structure protrudes through the introitus
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What medical treatment might improve symptoms of pelvic organ prolapse in post-menopausal women?
|
Estrogen replacement can improve tissue tone and facilitate reversal of atrophic changes
|
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What is the usual anatomic cause of stress incontinence?
|
Pelvic relaxation and displacement of the urethrovesical junction
|
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What is total incontinence (what is the cause)?
|
Continuous leakage of urine due to urinary fistula resulting from pelvic surgery or radiation
|
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What are the four primary types of incontinence?
|
Urge
Stress Total Overflow |
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For which type of incontinence are pessaries a therapeutic option?
|
Stress incontinence
|
|
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What are medical therapeutic options for stress incontinence?
|
Alpha adrenergic agonists
Estrogen |
|
|
What are some conditions known to cause detrusor instability (urge incontinence)?
|
UTIs
Bladder stones and cancer Foreign bodies Most are idiopathic |
|
|
What is the most frequently used and effective medical treatment for urge incontinence?
|
Anticholinergics
|
|
|
What are common causes of overflow incontinence?
|
Medications - anticholinergics
Lower motor neuron disease Spinal cord injuries Diabetes mellitus |
|
|
How is overflow incontinence treated?
|
Cholinergic agents (bethanachol)
Self-catheterization |
|
|
What is the average length of time between thelarche and menstruation?
|
2.5 years
|
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|
List the following in order of normal appearance in puberty:
1. Growth spurt (peak velocity) 2. Menarche 3. Pubarche 4. Thelarche |
1. Thelarche
2. Pubarche 3. Growth spurt 4. Menarche |
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What is the role of the granulosa cells and theca cells in the production of estrogen?
|
Theca cells produce androstenedione
Granulosa cells convert this to estradiol |
|
|
What is the physiologic role of B-HCG in the pregnant woman?
|
It is secreted by the trophoblast and maintains the corpus luteum so it can continue to support the endometrium with estrogen and progesterone production
|
|
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What change in hormones is directly responsible for endometrium sloughing in the menstrual cycle?
|
Withdrawal of progesterone
|
|
|
How is the diagnosis of menopause confirmed?
|
Testing FSH levels - they should be elevated in menopause
|
|
|
What are the two major body systems that have an increased risk of disease in post menopausal women?
|
Cardiovascular - increased risk of coronary artery disease
Bones - bone resorption accelerates leading to osteoporosis |
|
|
What are the two main indications for HRT?
|
Short-term treatment of postmenopausal symptoms
Prevention of bone loss |
|
|
What are the contraindications for HRT (5)?
|
Chronic liver disease
Pregnancy Known estrogen-dependent neoplasm History of thromboembolic disease Undiagnosed vaginal bleeding |
|
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What is Mayer-Rokitansky-Kuster-Hauser syndrome?
|
Mullerian agenesis or dysgenesis
|
|
|
What is Savage syndrome?
|
Failure of the ovaries to respond to FSH and LH due to a receptor defect - primary ovarian failure
|
|
|
What is the pathophysiology of testicular femininization?
|
Dysfunction or absence of testosterone receptors
|
|
|
What is Kallman syndrome?
|
Congenital absence of GnRH
Also associated with anosmia |
|
|
What is the most common cause of cervical stenosis?
|
Scarring of the cervical os due to surgical or obstetric trauma
|
|
|
What chemical inhibits prolactin secretion and which 2 chemicals stimulate its secretion?
|
Dopamine inhibits
Serotonin and TRH stimulate |
|
|
What are the first three chemicals that should be analyzed when investigating secondary amenorrhea?
|
B-HCG for pregnancy
TSH Prolactin |
|
|
What medical treatment might cause tumor regression in patients with pituitary micro or macroadenomas?
|
Bromocriptine
|
|
|
What type of drug is bromocriptime (mechanism)?
|
Dopamine agonist
|
|
|
What is primary vs. secondary dymenorrhea?
|
Primary - idiopathic
Secondary - due to a known underlying pathology |
|
|
What are common causes of secondary dysmenorrhea (5)?
|
Endometriosis
Fibroids Adenomyosis PID Cervical Stenosis |
|
|
What is the first-line and second-line treatment for dysmenorrhea?
|
First - NSAIDs
Second - OCPs Most patients who take OCPs for a year have reduced symptoms even after they are discontinued |
|
|
What is laminaria?
|
A device made from seaweed that is placed in the cervix and absorbs water and dialates the cervical os. Its a treatment for cervical stenosis
|
|
|
Where in the menstrual cycle do PMS symptoms usually occur?
|
In the second half of the cycle
|
|
|
What is the normal amount of blood lost during menstruation?
|
30-50 mL
|
|
|
What are the most common causes of menorrhagia (6)?
|
Uterine fibroids
Adenomyosis Endometrial hyperplasia Endometrial polyps Endometrial/cervical cancer DUB |
|
|
What is the definition of oligomenorrhea?
|
Periods greater than 35 days apart
|
|
|
What are the most common causes of oligomenorrhea (3)?
|
PCOS
Chronic anovulation Pregnancy |
|
|
How is a diagnosis of Dysfunctional Uterine Bleeding made?
|
A diagnosis of exclusion when no pathologic cause of abnormal uterine bleeding is identified
|
|
|
What medical treatment may be helpful if patients with DUB experience acute hemorrhage?
|
IV estrogens and high dose oral estrogens
|
|
|
What are the four most common causes of post menopausal bleeding?
|
Vaginal/endometrial atrophy (30%)
Exogenous estrogens (30%) Endometrial cancer (15%) Endometrial polyps (10%) |
|
|
If a female patient has elevated androgens, what are the two possible sources?
|
Ovaries
Adrenal glands |
|
|
How is Cushing syndrome diagnosed?
|
Overnight dexamethasone suppression test
|
|
|
In the overnight dexamethasone suppression test, if a patient has Cushing syndrome, what results do you suspect?
|
A cortisol level above 10ug/dL
|
|
|
What molecule is overproduced and builds up if a patient has 21-alpha-hydroxylase deficiency?
|
17-a-hydroxyprogesterone which is shunted to the androgen pathway
|
|
|
Name 5 primary causes of hirsutism and virilization-
|
PCOS
Ovarian tumors Adrenal tumors CAH Cushing syndrome |
|
|
What percentage of pregnancies in the US are unintended?
|
55%
|
|
|
What is the average effectiveness of periodic abstinence (the rhythm method) as a form of contraception?
|
55-80%
|
|
|
How long after pregnancy should breast feeding be relied on as an effective form of contraception?
|
Maximum of 6 months
|
|
|
What is the only form of contraception that offers protection against HIV?
|
Male Latex Condoms
|
|
|
What are nonoxynol-9 and octoxynol-9?
|
Spermicides
|
|
|
How do spermacide agents work (biologic mechanism)?
|
They disrupt the cell membranes of spermatazoa
|
|
|
What is believed to be the mechanism of IUDs?
|
Act primarily by killing sperm through a sterile inflammatory response
|
|
|
How long can the ParaGard IUD be left in place as a contraceptive? The Mirena IUD?
|
ParaGard - 10 years
Mirena - 5 years |
|
|
Who is the ideal population for IUDs?
|
Monogamous multiparous women
|
|
|
Name 5 complications associated with OCPs-
|
DVT
PE CVA MI HTN |
|
|
What is the mechanism of the progestrone-only pill as a contraceptive?
|
Thickening of cervical mucosa
Thinning of endometrium |
|
|
What is the active drug in Depo-Provera?
|
Medroxyprogesterone acetate (DMPA)
|
|
|
What is the advantage of the Depo-Provera birth control method?
|
It lasts for 3 months and is 99.7% effective over the year.
|
|
|
What are the Side Effects of the Depo-Provera birth control method?
|
Irregular menstrual bleeding
Bone demineralization Significant delay in return of fertility after discontinuation |
|
|
Describe the Essure procedure for sterilization-
|
Soft polyester fibers are introduced into the uterine portions of the fallopian tubes. Over ~12 weeks, sterilization is accomplished as in-growth of tissue around the coils results in a barrier in the tubes
|
|
|
What are the side effects of vasectomies?
|
Bascially, none
|
|
|
What is the mechanism of Mifepristone (RU-486)?
|
A synthetic progesterone receptor antagonist that binds to progesterone receptors and blocks the stimulatory effects on endometrial growth
|
|
|
How long after the LMP can mifepristone be used as an abortifactant?
|
49 days past the LMP
Typically given with a prostaglandin analogue |
|
|
What is the success rate of abortions with mifepristone (RU 486) in early pregnancy?
|
65-85% when used alone
Up to 98% effective when combined with a prostaglandin analogue (misoprostol) |
|
|
What medications are used for induction of labor as a method of terminating second-trimester pregnancies?
|
Cervical ripening agents
Amniotomy IV Oxytocin |
|
|
What is the fecundity rate per month for a couple with normal fertility?
|
20-25%
|
|
|
With modern technologies, what percent of infertile couples can have the cause of infertility identified?
|
About 90%
|
|
|
What endocrine factors can be a cause of male infertility?
|
Kallman (hypothalamic dysfunction)
Pituitary failure Hyperprolactinemia Exogenous androgens Thyroid disease Adrenal hyperplasia |
|
|
What is the treatment for a couple who is infertile due to low semen volume?
|
Intrauterine insemination with washed sperm
|
|
|
If a couple is infertile due to endometriosis in the female, what is the treatment of choice?
|
Surgical removal of pelvic adhesions. There is no place for medical management.
IVF is another option |
|
|
What are three effective management options for infertile women with PCOS?
|
Weight loss
Clomiphene Metformin |
|
|
What is the mechanism of clomiphene citrate (how does it promote ovulation)?
|
It binds to estrogen receptors in the hypothalamus stimulating pulsatile release of GnRH causing FSH and LH release from the pituitary
|
|
|
What are the two major options for medical ovulation induction?
|
Clomiphene citrate
Human menopausal gonadotropins |
|
|
What are the symptoms of ovarian hyperstimulation syndrome?
|
Edema
Ascites Pleural effusion Hemoconcentration Hypercoagulability |
|
|
What are the two major complications of ovulation induction?
|
Ovarian hyperstimulation syndrome
Multiple gestation pregnancy |
|
|
When should pruritic lesions of the vulva be biopsied?
|
When they do not respond to antifungal creams - especially in post menopausal women
|
|
|
What does VIN and VAIN stand for?
|
Vulvar Intraepithelial Neoplasia
Vaginal Intraepithelial Neoplasia |
|
|
What is the cause of 80-90% of Vulvar Intraepithelial Neoplasia?
|
HPV infection
Other risk factors include cigarette smoking and an immunocompromised state |
|
|
What percentage of women with Vulvar Intraepithelial Neoplasia have symptoms?
|
Only 50%
Vulvar pruritis or irritation are the common symptoms |
|
|
What are the three most common types of vulvar neoplasms?
|
Squamous cell carcinoma (85-90%)
Malignant melanoma (5-10%) Basal cell carcinoma (2%) |
|
|
What is the most important prognostic factor in vulvar cancer?
|
Number of positive inguinal lymph nodes
|
|
|
What is the most common presentation of Vaginal Intraepithelial Neoplasia?
|
Almost always asymptomatic
But repeatedly positive Pap smears with negative cervical biopsies |
|
|
Where in the vagina are most vaginal cancers located?
|
In the apex near the cervix
|
|
|
What are the common therapeutic options for vaginal cancer?
|
Local excision
Laser vaporization Topical 5-FU |
|
|
Which is the number one cancer killer of women in the developing world?
|
Cervical cancer
|
|
|
Besides HPV infection, which other risk factors predispose to cervical cancer?
|
Smoking
Long term OCP use Depressed immune status DES exposure |
|
|
What is "reflex HPV testing"?
|
The principle that an ASC-US result should be immediately tested for HPV
|
|
|
Is HPV testing recommended for an LSIL or HSIL result from a Pap smear?
|
No, because nearly all will be positive
|
|
|
What are the four classic presentations of dysplasia on colposcopy?
|
Acetowhite changes
Mosaicism Punctations Atypical vessels |
|
|
What is the management of CIN I? CIN II?
|
CIN I is followed with repeat Pap smears, because most will regress. CIN II (and III) is treated with LEEP
|
|
|
Which 4 strains of HPV are considered high risk types associated with cervical cancer?
|
16, 18, 31, 45
|
|
|
What is the most common presenting symptom of cervical cancer?
|
Post coital bleeding
also-- any other abnormal vaginal bleeding, watery discharge, pelvic pain or pressure, and rectal or urinary tract symptoms |
|
|
What is the treatment for preinvasive (stage 0-1a) cervical cancer?
|
CKC biopsy or simple hysterectomy
|
|
|
What is the treatment for advanced cervical cancer (stages IIb-IV)
|
Chemoradiation (cisplatin based therapy)
|
|
|
What are the top four most common cancers in women (including non-gynecologic)?
|
Breast
Lung Bowel Endometrial |
|
|
What is the average age of diagnosis for endometrial cancer?
|
61
|
|
|
What risk factor for endometrial cancer carries the highest relative risk?
|
Obesity >50lbs overweight carries a relative risk of 10
|
|
|
What is the most common presenting symptom with endometrial cancer?
|
Post menopausal bleeding -
irregular bleeding occurs in 90% of patients |
|
|
What is the treatment for most stages of endometrial cancer?
|
TAHBSO with radiation therapy (especially for the higher stages)
|
|
|
What percentage of ovarian tumors are benign?
|
80%
|
|
|
What is the 5-year survival rate of ovarian carcinoma?
|
25-30%
|
|
|
What are the three distinct components of the ovary from which tumors can arise?
|
Epithelial cells
Stroma Germ cells |
|
|
What is the other name for HNPCC syndrome?
|
Lynch syndrome - also predisposes to ovarian cancer
|
|
|
Are OCPs a risk factor for ovarian cancer, or protective?
|
Protective
|
|
|
What is the name for ovarian cancer metastasizing to the umbilicus?
|
Sister Mary Joseph nodule
|
|
|
What tumor marker to dysgerminomas produce?
|
LDH
|
|
|
Why do germ cell tumors have better survival rates than epithelial tumors of the ovary?
|
They grow faster and produce symptoms like hemorrhage and pelvic pain. So they get diagnosed earlier.
|
|
|
Which ovarian tumors are especially sensitive to radiation therapy?
|
Dysgerminomas
|
|
|
What tumor marker do choriocarcinomas produce?
|
HCG
|
|
|
What is the name of an ovarian tumor with accompanying ascites and right hydrothorax?
|
Meig's syndrome
|
|
|
Which tumor type accounts for 70% of sex cord-stromal ovarian tumors?
|
Granulosa cell tumors
|
|
|
Which has a higher malignancy rate - complete or incomplete moles?
|
Complete moles
|
|
|
What is the common karyotype of complete moles?
|
46XX
|
|
|
What is the common karyotype of incomplete moles?
|
69XXY
|
|
|
What gynecologic pathology is associated with bilateral theca lutein cysts seen on US?
|
Complete moles
|
|
|
What are common symptoms associated with molar pregnancy?
|
Vaginal bleeding (97%)
Passage of molar vessicles (80%) Theca lutein cysts (15-50%) Symptoms related to BHCG - hyperemesis (10-25%) |
|
|
Biologically, how is a complete mole formed?
|
Fertilization of an empty egg
|
|
|
Biologically, how is an incomplete mole formed?
|
When a normal egg is fertilized by two sperms
|
|
|
What is seen on ultrasound in incomplete mole?
|
May reveal a fetus with regular cardiac activity, congenital malformations and growth restrictions.
"Snowstorm" appearance is only in complete mole |
|
|
How are invasive moles diagnosed?
|
Serial follow-up of HCG shows plateauing or elevated levels after removal of the mole.
|
|
|
What is the treatment of invasive mole?
|
Methotrexate or actinomycin single agent therapy, or multi-agent chemotherapy if metastases are present
|
|
|
What fraction of women will have breast cancer in their lifetime?
|
1 in 8 (12.5%)
|
|
|
What two arteries supply the breast?
|
Internal mammary artery
Lateral thoracic artery |
|
|
What nerve, if damaged in breast surgery, can caused "winged scapula"?
|
Long thoracic nerve
|
|
|
When during the menstrual cycle is the best time for breast self-examination?
|
5 days after menses when the breast is least engorged and tender
|
|
|
What qualities typify malignant breast lesions on palpation?
|
Firm, nontender, poorly circumscribed and immobile
|
|
|
Which breast tumors are associated with bloody nipple discharge?
|
Intraductal papilloma
Invasive papillary cancer |
|
|
What breast pathology is typified by painful breast masses that are often multiple and vary throughout the menstrual cycle?
|
Fibrocystic breast change - not associated with cancer risk
|
|
|
What is the prognosis for Phyllodes tumors of the breast?
|
Clinical course is unpredictable. 10% contain malignant cells and there is a high rate of recurrence after simple excision. Wide excision is recommended
|
|
|
In which quadrant do 50% of malignant breast lesions occur?
|
Upper Outer Quadrant
|
|
|
What breast tumor accounts for 70% of all malignant breast disease?
|
Infiltrating ductal carcinoma
|
|
|
What percent of breast cancer is related to genetic predisposition?
|
Only 5-10%
|
|
|
What is the rate of Down Syndrome in a 40 year old mother?
|
1 in 110
|
|
|
How long after conception does it take for the embryo to reach the uterus?
|
Day 3
|
|
|
Where is anti-mullerian hormone secreted in males?
|
Sertoli cells in testicle
|
|
|
What birth defect is Lithium associated with?
|
Ebstein's anomaly
|
|
|
What birth defects are associated with Warfarin?
|
Chondrodysplasia
Microcephaly Mental retardation Optic atrophy |
|
|
How many days after fertilization does B-HCG appear in the maternal serum?
|
10 days after fertilization
|
|
|
What is the differential diagnosis of elevated hCG in early pregnancy?
|
Twin pregnancy
Hydatidiform mole Choriocarcinoma Embryonal carcinoma |
|
|
What are the two sites of progesterone production during pregnancy?
|
Corpus luteum for the first 6-7 weeks
Placenta after 7 weeks |
|
|
What is the function of progesterone during pregnancy?
|
Early - Keeps endometrium favorable
Late - Induces immune tolerance for pregnancy and prevents myometrial contractions |
|
|
What is chloasma?
|
Blotchy pigmentation of the nose and face - a soft sign of pregnancy
|
|
|
What is the mean value of WBCs in the third trimester?
|
16,000
|
|
|
How do thyroid markers change during pregnancy?
|
TBG increases
T3 and T4 increases but unbound T3 T4 is unchanged |
|
|
At what week of pregnancy does the mother first report fetal quickening?
|
Multipara - 16-18 weeks
Primagravida - 18-20 weeks |
|
|
What four measurements are used to estimate fetal age on 2nd and 3rd trimester ultrasounds?
|
Biparietal diameter
Head circumference Abdominal circumference Femur length |
|
|
What is the difference between the birth rate and the fertility rate of a population?
|
Birth rate is number of live births per 1000 total population
Fertility rate is number of live births per 1000 women ages 15-45 yo |
|
|
What is Bloody Show?
|
Vaginal passage of bloody endocervical mucus resulting from cervical dilation before labor
|
|
|
What is the differential diagnosis in a pregnant woman with elevated AFP?
|
Open neural tube defects
Gastroschisis Twin pregnancy Placental bleeding Fetal renal disease |
|
|
Which weeks are the window for triple testing?
|
15-20 weeks
|
|
|
What percent of women with an abnormal OGCT will be found to have gestational diabetes on OGTT?
|
Only 15%
|
|
|
What is the normal range for Amniotic Fluid Index (AFI)?
|
9-25cm
|
|
|
What is included in a modified BPP?
|
Only the NST and amniotic fluid volume. Its predictive value is almost as high as a complete BPP
|
|
|
In which fetuses is an elevated S/D ratio predictive of poor perinatal outcome?
|
Only in IUGR fetuses
|
|
|
What is the management of active genital HSV lesions during pregnancy?
|
Acyclovir and cesarean section
|
|
|
Are vaginal deliveries recommended in women with syphilis?
|
Yes, vaginal delivery is appropriate
|
|
|
Are vaginal deliveries recommended in women with HepB?
|
Yes, vaginal delivery is appropriate
|
|
|
What is the classic triad of vasa previa?
|
Painless vaginal bleeding
Rupture of membranes Fetal bradycardia |
|
|
What is the management of vasa previa?
|
Immediate cesarean delivery
|
|
|
What is the relative risk of uterine rupture with a vertical fundal cesarean section vs. a low transverse?
|
20x more common
|
|
|
What determines the chorionicity and amnionicity of monozygotic twins?
|
They vary according to the duration of time from fertilization to cleavage.
Up to 72 hrs - Di Di Between 9-12 days - Mo Mo |
|
|
What is the management of severe fetal anemia?
|
Intrauterine transfusion is <34 weeks
Delivery if >34 days |
|
|
What is the most common risk factor for PROM?
|
Ascending infection from the lower genital tract
|
|
|
What is the management plan of a patient 24-35 weeks pregnant with PROM?
|
Bed rest
IM betamethasone Prophylactic antibiotics |
|
|
What is the management plan of a patient >35 weeks of pregnancy with PROM?
|
Prompt delivery
|
|
|
What is the most common risk factor for PROM?
|
Ascending infection from the lower genital tract
|
|
|
Name four classes of drugs that act as tocolytic agents-
|
Magnesium sulfate
Beta agonists Ca channel blockers Prostaglandin synthase inhibitors (indomethacin) |
|
|
What is the management plan of a patient 24-35 weeks pregnant with PROM?
|
Bed rest
IM betamethasone Prophylactic antibiotics |
|
|
What is the definition of gestational hypertension?
|
BP>140/90 after 20 weeks of pregnancy without proteinuria
|
|
|
What is the management plan of a patient >35 weeks of pregnancy with PROM?
|
Prompt delivery
|
|
|
Name four classes of drugs that act as tocolytic agents-
|
Magnesium sulfate
Beta agonists Ca channel blockers Prostaglandin syndthase inhibitors (indomethacin) |
|
|
What is the definition of gestational hypertension?
|
BP>140/90 after 20 weeks of pregnancy without proteinuria
|
|
|
What is the most common risk factor for PROM?
|
Ascending infection from the lower genital tract
|
|
|
What is the management plan of a patient 24-35 weeks pregnant with PROM?
|
Bed rest
IM betamethasone Prophylactic antibiotics |
|
|
What is the management plan of a patient >35 weeks of pregnancy with PROM?
|
Prompt delivery
|
|
|
Name four classes of drugs that act as tocolytic agents-
|
Magnesium sulfate
Beta agonists Ca channel blockers Prostaglandin syndthase inhibitors (indomethacin) |
|
|
What is the definition of gestational hypertension?
|
BP>140/90 after 20 weeks of pregnancy without proteinuria
|
|
|
Any sustained blood pressure reading over what value would classify a pregnant woman as severe preeclampsia?
|
160/110
|
|
|
After what gestational age is prompt delivery recommended for a woman with severe preeclampsia?
|
Any gestational age if there is evidence of maternal or fetal jeopardy
|
|
|
What is the incidence of gestational diabetes in pregnancy?
|
2-3%
|
|
|
What is Class A1 and A2 gestational diabetes?
|
A1 - GDM with normal fasting blood sugar not requiring insulin
A2 - GDM with elevated FBS requiring insulin |
|
|
What is Class C gestational diabetes?
|
Overt DM onset age 10-19 years or duration 10-19 years
|
|
|
What are the most common fetal anomalies in pregnant women with diabetes?
|
Neural tube defects
Congenital Heart Disease |
|
|
What are the four bones of the pelvis?
|
Ileum
Ischium Pubis Sacrum |
|
|
What is the most common position of the fetus at delivery?
|
Occiput anterior
|
|
|
What is the management of prolapsed umbilical cord?
|
Immediate cesarean delivery.
Put the patient in knee-chest position and avoid palpating the cord |
|
|
What maneuvers help deliver shoulder dystocia?
|
Suprapubic pressure
Maternal thigh flexion Internal rotation of the fetal shoulders Delivery of the posterior arm |
|
|
What are Piper forceps used for?
|
Used for the after-coming head of a vaginal breech baby
|
|
|
What is the most common indication for forceps delivery?
|
Prolonged second stage of delivery
|
|
|
What is the mean blood loss during a cesarean section?
|
1000 mL - twice that of normal vaginal delivery
|
|
|
What is the optimum time for external cephalic version of a fetus?
|
37 weeks gestation
|
|
|
Are oral contraceptive pills OK to use after pregnancy during lactation?
|
Combination pills should not be used because estrogen diminishes milk production
Progestin only pills are OK |
|
|
What is the most common cause of fever postpartum day 1-2?
|
UTI
|
|
|
What is the most common cause of fever postpartum day 3-4?
|
Endometritis
|
|
|
What is the most common cause of fever postpartum day 4-5?
|
Wound infection
|
|
|
What is the most common cause of postpartum fever?
|
Endometritis
|
|
|
How is a Pap smear technically performed?
|
Two specimens are obtained - an ectocervical sample scraping the T-zone, and an endocervical sample obtained with a cytobrush
|
|
|
What must be visualized in order to declare a "satisfactory colposcopy?"
|
The entire transitional zone must be visualized with no lesions disappearing into the endocervical canal
|
|
|
What percentage of ASC-US Pap smears can represent a significant premalignant lesion?
|
10-15%
|
|
|
How thick is the endometrium normally in postmenopausal women on US examination?
|
Usually 2-3mm
Over 5mm is suspicious |
|
|
What is the presumptive diagnosis of a woman with post-menopausal bleeding and a negative endometrial biopsy?
|
Atrophy of the endometrium
Can be treated with HRT |
|
|
At what week of gestation does the uterus reach the umbilicus?
|
20 weeks
|
|
|
At what week in pregnancy does the pregnant uterus reach the symphysis pubis?
|
12 weeks
|
|
|
What is a good medication for shrinking leiomyomas?
|
GnRH analogs like leuprolide
|
|
|
What is the management of a simple ovarian cyst diagnosed on US?
|
It is probably benign - follow up exam in 6-8 weeks should show resolution
|
|
|
What are the three most common sites from which metastases to the ovaries are sent?
|
Endometrium
GI tract Breast |
|
|
Name 5 classifications of Epithelial ovarian tumors-
|
Serous
Mucinous Brenner Endometroid Clear cell tumors |
|
|
What is the most common cause of death in women with advanced ovarian carcinoma?
|
Bowel obstruction
|
|
|
What is the treatment for lichen sclerosis?
|
Testosterone cream
|
|
|
What is the most common site of distant metastasis from a gestational trophoblastic tumor?
|
Lungs
|
|
|
Why should patients with gestational trophoblastic disease be given effective contraception for 6-12 months following treatment of their disease?
|
So that B-hCG can be followed accurately to ensure there is no residual tumor
|
|
|
What three muscles make up the levator ani?
|
Puborectalis
Pubococcygeus Ileococcygeus |
|
|
What does stimulation of alpha and beta adrenergic receptors in the bladder cause?
|
Alpha - Contraction of urethra
Beta - Inhibition of fundal contraction |
|
|
What are the two most common sites of endometriosis?
|
1 - Ovary
2 - Cul de sac |
|
|
What are medical therapies for endometriosis?
|
Medroxyprogesterone
OCPs Leuprolide |
|
|
What is the differential diagnosis of first trimester bleeding -
|
Threatened abortion
Incomplete abortion Ectopic pregnancy Hydatidiform mole |
|
|
What is the criteria for methotrexate use for an ectopic pregnancy?
|
Pregnancy mass <3.5cm
No fetal heart motion B-hCG level <6000 |
|
|
What is the medical treatment for Tubo-ovarian abscess?
|
Inpatient IV clindamycin and gentamycin
Drainage may be required if there is no response |
|
|
What is the most common complaint in women with bacterial vaginosis?
|
Fishy odor
|
|
|
What is the effect of OCPs on lipid profile?
|
Increases HDL
Lowers LDL |
|
|
What protective effects are offered by taking OCPs besides contraception?
|
Endometrial and Ovarian cancer
PID, ectopic pregnancy Benign breast disease Anemia Dysmenorrhea |
|
|
What causes the decrease in progesterone and estradiol by day 23 of the normal menstrual cycle?
|
Involution of the corpus luteum
|
|
|
What is the differential diagnosis of premenarchal vaginal bleeding?
|
Foreign body (most common)
Ingesting estrogen medication Cancer of vagina or cervix Tumor of pituitary, adrenal gland or ovary Sexual abuse Idiopathic precocious puberty |
|
|
What is the definition (age) of precocious puberty in males and females?
|
Secondary sexual characteristics
Before age 8 in girls Before age 9 in boys |
|
|
What percentage of precocious puberty in girls gets classified as constitutional or idiopathic?
|
80%
|
|
|
What is the DD of precocious puberty in girls?
|
Constitutional
CNS pathology McCune Albright Granulosa cell tumor |
|
|
What is McCune Albright syndrome?
|
Autonomous stimulation of aromatase enzyme production of estrogen by the ovaries
Managed with aromatase inhibitors |
|
|
What is the DD of primary amenorrhea if the uterus and breasts are present?
|
Constitutional delay
Imperforate hymen Vaginal septum Anorexia Excessive exercise Pregnancy before first menses |
|
|
Which two conditions should be considered if there is primary amenorrhea in a patient with breasts but no uterus?
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Mullerian agenesis
Complete androgen insensitivity |
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Is the LH to FSH ratio elevated or decreased in PCOS?
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Elevated to 3:1
Normal is 1.5:1 |
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What is the normal sperm count in a mL of semen?
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20 million / mL
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When in the menstural cycle is clomiphene citrate administered for ovulation induction?
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Administered orally for 5 days beginning on day 5 of the menstrual cycle
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What is the next step when investigating infertility if semen analysis is normal and ovulation is confirmed?
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Assessment of fallopian tube abnormalities by HSG or laparoscopy
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What is the mean age of menopause?
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51
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What is the most common anatomic site of injury due to osteoporosis?
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Vertebral body crush fractures, kyphosis and loss of height
Hip and wrist fractures are the next most common. |
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What is the first line of treatment of postmenopausal osteoporosis?
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Bisphosphonates and SERMs
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