OB/GYN

Question 1

Tx for ovarian torsion

Answer 1

diagnostic laparascopy

Question 2

What causes a tender, globular uterus and heavy menstrual bleeding with dull midline pelvic pain?

Answer 2

Adenomyosis

Question 3

What presents with nausea/vomiting, acute onset unilateral pelvic pain (LLQ), adnexal tenderness?

Answer 3

Ovarian torsion

Question 4

Bilateral nipple discharge workup vs. unilateral nipple discharge workup

Answer 4

Bilateral: pregnancy vs. galactorrhea eval
Unilateral: over 30= US + mammography, under 30= US plus/minus mammography

Question 5

When should a pregnant woman with hyperemesis gravidarum be admitted to the hospital?

Answer 5

If she has ketonuria (ketones in urine due to prolonged hypoglycemia 2/2 inadequate oral intake) –> admit for IV antiemetics, rehydration, electrolyte repletion

**as a result, make sure to get UA for ketones on patient with HG b/c it will guide management

Question 6

Carboprost (hemabate) is contraidicated in

Answer 6

Asthma

Question 7

Methergine is contraindicated in

Answer 7

HTN

Question 8

What do you give before methergine/hemabate for hemorrhage?

Answer 8

Uterine massage, oxytocin/misoprostol, tranexamic acid

Question 9

Complications of PPROM?

Answer 9

preterm labor, placental abruption (decreased amniotic fluid–> uterine decompression–> placental vessels shear and separate), umbilical cord prolapse, intraamniotic infection

Question 10

Workup of Atypical glandular cells on pap

Answer 10

Could be do to cervical or endometrial cancer so–>

colposcopy, endocervical curettage, endometrial biopsy

Question 11

Normal progression for:

Latent phase of labor (0-6 cm)
Active phase labor (over 6-10 cm)

Answer 11

Latent phase- no defined rate of expected cervical change

Active phase- normal progression of greater than or equal to 1 cm every 2 hours

Question 12

Active phase labor arrest is defined as:

Answer 12

no cervical change for 4 hours or more with adequate contractions and 6 hours or more with inadequate contractions (less than 200 mvu)–> C-section

Question 13

When to administer anti-D immune globulin?

Answer 13

28-32 weeks and again within 72 hours of delivery if baby is RhD positive

Question 14

60 year old patient with post-menopausal bleeding, breast tenderness, 11 cm ovarian mass, thickened endometrial stripe indicative of endometrial hyperplasia, and endometrial biopsy with hyperplasia without atypic- what is the diagnosis?

Answer 14

Granulosa cell tumor
- secretes estradiol/inhibin–> chronic, unopposed estrogen exposure–> endometrial hyperplasia/postmenopausal bleeding

**breast tenderness, endometrial hyperplasia from estrogen exposure

**call-exner bodies (rosette pattern)

Question 15

Predisposing factors to hepatic adenoma

Answer 15

Young woman on oral contraception

• complications: malignant transformation in 10% and rupture/hemorrhagic shock
• resect if over 5 cm or symptomatic

Question 16

Work-up/tx of lichen sclerosis

Answer 16

Vulvar punch biopsy to confirm dx and r/o vulvar cancer

-tx w/ superpotent corticosteroid cream (clobetasol)

Question 17

24-28 week prenatal stuff

Answer 17

Hgb/Hct, Antibody screen if Rh-D negative, 1-hr 50-g GCT

Question 18

36-38 weeks

Answer 18

Group B strep rectovaginal culture

Question 19

Presentation of amniotic fluid embolism

Answer 19

Shock, hypoxemic respiratory failure, DIC, coma/seizures

Tx= respiratory/hemodynamic support, +/- transfusion
intubation with ventilation for hypoxemia, vasopressors for BP, and massive transfusions to correct DIC

Question 20

pH ddx of vaginitis

• BV
• Trichomonas
• Candidiasis

Answer 20

• BV/Trichomonas= >4.5

Candidiasis= 3.8-4.5 (normal pH)

Question 21

Presentation of Hydatidiform mole

Answer 21

Can present with 1st trimester bleeding, early preeclampsia, uterine size greater than expected

• hyperemesis gravidarum
• Ultrasound of pelvis will show bilateral multilocular ovarian cysts (theca-lutein cysts) and abnormal echogenicity in uterus (mole) - treat with dilation and curettage/suction

Question 22

Complications of maternal gestational diabetes on infant

Answer 22

• neonatal hypoglycemia
• neonatal respiratory distress
• macrosomia
• polycythemia
• hypocalcemia (jitteriness), hypomagnesemia

Question 23

1st line tx for infertility in PCOS

Answer 23

weight loss (then letrozole if ineffective)

Question 24

Breast cancer screening

Answer 24

50-74 every 2 years

Question 25

Urinary incontinence type and tx Stress - leaking with vasalva, coughing, sneezing, laugh Urgency (bladder overactivity)- sudden overwhelming or frequent need to void Mixed - stress + urgency Overflow - constant dribbling and incomplete emptying

Answer 25

Stress - lifestyle mod, pelvic floor exercise, pessary, surgery Urgency - bladder training, antimuscarinic drugs, beta adrenergic agonists -- oxybutynin Overflow - cholinergic agonists (carbachol, bethenechol), terazosin (alpha adrenergic antagonist) for outflow obstruction 2/2 BPH

Question 26

Imaging modalities to confirm suspected placenta previa

Answer 26

Transabdominal US followed by transvaginal US (still safe)

Question 27

Tocolytic used at <32 weeks

Answer 27

Indomethacin

Question 28

Tocolytic used at 32-34 weeks

Answer 28

Nifedipine (side effects nausea, flushing, HA, tachycardia)

Question 29

Tocolytic for uterine tachysystole during term delivery

Answer 29

Terbutaline (b-agonist)

Question 30

Benefits/risks of OCPs

Answer 30

Benefits: reduced risk ovarian/endometrial cancer, Risk: increased risk cervical/breast cancer, hepatic adenoma, stroke, venous thromboembolism

Question 31

Normal physiologic changes of pregnancy

Answer 31

- Systolic murmur - Ankle edema - Avg. 25 lb weight gain - Increased uterine weight (estrogen mediated hypertrophy) - Increase renal flow, increase GFR early then plateaus - enlarged cardiac silhouette - Increased HR, increased cardiac output - GERD, constipation due to progesterone relaxation - Physiologic anemia of pregnancy (plasma increases more than RBC) - hyperventilation, dyspnea, increased tidal volume * *respiratory alkalosis: decreased PaCO2 with slightly increased O2 (i.e. 29 and 109) - Thrombocytopenia of pregnancy (100,000-150,000= benign finding)

Question 32

Thrombocytopenia in pregnancy Thrombocytopenia of pregnancy (isolated) HELLP Immune-mediated TTP DIC

Answer 32

-- Mild- 100,000-150,000 - less than 100,000 - less than 100,000 - less than 30,000 - less than 100,000 with decreased fibrinogen and increased PT and aPTT

Question 33

Mullerian agenesis results in:

Answer 33

46XX female with blind pouch (normal external genitalia/anterior 2/3 vagina) - check with renal ultrasound for renal abnormalities upon diagnosis

Question 34

Vaginal cancer risk factors - vaginal bleeding, malodorous discharge, vaginal lesion - could have constipation as bulk sxs

Answer 34

Tobacco, HPV, age over 60 | - in utero DES exposure only for clear cell adenocarcinoma NOT squamous cell carcinoma

Question 35

Risk factors for ovarian cancer

Answer 35

Anything that results in a higher number of ovulatory cycles - early menarche, late menopause, nulliparity, decreased fertility, late childbearing, family hx, genetic mutation

Question 36

Protective factors for ovarian cancer

Answer 36

OCPs for over 5 years, lactation, bilateral salpingo-oophorecomy, multiple childbearing