OBGYN

Question 1

What is normal vaginal pH?

Answer 1

3.8/4.0-4.5

Question 2

Is an obligate intracellular bacterium and the most common cause of sexually transmitted bacterial disease worldwide.

Answer 2

Chlamydia caused by Chlamydia trachomatis

Question 3

Vaginal and cervical erythema with punctate hemorrhages along with foul-smelling, frothy, yellow-green vaginal discharge with an elevated pH value is consistent with _______.

Answer 3

Vaginal and cervical erythema with punctate hemorrhages along with foul-smelling, frothy, yellow-green vaginal discharge with an elevated pH value is consistent with trichomoniasis.

Question 4

Vaginal and cervical erythema with punctate hemorrhages is called what?

Answer 4

strawberry cervix

Question 5

What are the characteristics of the causative agent of trichomoniasis?

Answer 5

• anaerobic
• protozoan
• has flagella (motile)

Question 6

Gram-negative diplococci that has purlent creamy vaginal/penile discharge with intermenstrual bleeding indicates an infection with what?

Answer 6

Gonorrhea caused by Neisseria gonorrhoeae

gonorrhea latin roots are gono-: seed; -rrhea: flow/discharge. “A flow of seeds”
The creamy/white discharge from the tip of the penis always showed this bacteria and it looked like semen leakage.

Question 7

Most common vaginal infection. Often asymptomatic but can produce gray or milky vaginal discharge ( pH > 4.5) with a fishy odor.

Answer 7

Bacterial vaginosis (BV) caused by Gardnerella vaginalis

Question 8

Vaginal epithelial cells with a stippled appearance and fuzzy borders due to bacteria adhering to the cell surface;

on kOH mount

Answer 8

Clue cells in bacterial vaginosis (BV)

on Gramm-Stain

Question 9

Associated with odorless, white, crumbly, and sticky vaginal discharge (pH is normal) that may resemble cottage cheese.

Answer 9

vulvovaginal candidiasis

Question 10

Are loosely filamentous forms of fungi assumed by many yeasts

Answer 10

pseudohyphae

Aspergillus species form a 90 degree true hyphae

Question 11

What are 3 predisposing factors to vulvovaginal candidiasis?

Answer 11

• pregnancy
• antibiotic use
• immunosuppression

Question 12

What is treatment for trichomonas vaginalis?

Answer 12

• oral metronidazole or
• tinidazole

antibiotic that is effective against protozoa and anaerobic bacteria

Question 13

Prolonged labor in lithotomy position can compress what nerve?

Answer 13

common peroneal/fibular

Question 14

What are 4 features of preeclamspia with severe features?

Answer 14

• SBP ≥ 160 and DBP ≥ 110
• severe headaches and/or blurry vision
• reduced fetal movement
• epigastric pain

Question 15

After the 20 week mark, how do you differentiate between gestational hypertension and preeclampsia

Answer 15

preeclampsia has proteinuria

Question 16

What is a positive 50-g, one-hour oral glucose challenge test result

Answer 16

≥ 135 mg/dL

Question 17

If your 50-g, one-hour oral glucose challenge test is positive what is next step management?

Answer 17

• 100-g, three-hour oral glucose tolerance test and
• 24-hour urine protein excretion test

Question 18

In an otherwise healthy woman of reproductive age, the combination of sudden-onset abdominal pain during sexual intercourse and free fluid on pelvic ultrasonography suggests

Answer 18

• ruptured ovarian cyst

Question 19

A bacterial infection that spreads beyond the cervix to any part of the upper female reproductive tract.

Answer 19

pelvic inflammatory disease (PID)

Question 20

Antibiotic therapy indicated in patients with pelvic inflammatory disease (PID)

Answer 20

• ceftriaxone
• doxycycline
• metronidazole

Question 21

Transvaginal ultrasound shows a structure with a hypoechoic center in the ovary

Answer 21

ovarian cyst

free fluid in peritoneal cavity (usually rectouterine pouch) it is ruptured

Question 22

Transvaginal ultrasound shows a structure with sebaceous material

Answer 22

teratoma

if sebaceous material in peritoneal cavity it is ruptured

Question 23

Transvaginal ultrasound shows a structure with irregular septa

Answer 23

malignancy

Question 24

What are 5 contraindications for IUD insertion?

Answer 24

• pregnancy
• active infections
• distorted uterine cavity (e.g. submucosal fibroids)
• thrombocytopenia secondary to SLE (copper only)
• Wilson’s disease (copper only)

Question 25

What is the most effective emergency contraception option?

Answer 25

IUD placement

Question 26

Ulipristal acetate is primarily used for what two things?

Answer 26

* emergency contraception * uterine fibroids (leiomyomas)

Question 27

A progesterone antagonist that disrupts the effects of progesterone during pregnancy. Used in combination with a prostaglandin analog/PGE1 analog during medication abortions.

Answer 27

mifepristone ## Footnote misoprostol alone can be used

Question 28

Is widely used for long-term progestin-only contraception administered once every three months.

Answer 28

Depot medroxyprogesterone acetate (DMPA)

Question 29

Genetic anomaly in which the individual inherits two of the same chromosomes from one parent and none from the other.

Answer 29

maternal/paternal disomy

Question 30

Sample from the placenta is taken to test for chromosomal abnormalities, rather than direct fetal tissue.

Answer 30

Chorionic Villus Sampling (CVS)

Question 31

What is initial anticoagulation treatment for DVT

Answer 31

* LMWH (enoxaparin) * unfractioned heparin * fondaparinux

Question 32

What is the preferred anticoagulation therapy in pregnancy?

Answer 32

LMWH (enoxaparin)

Question 33

What should be done in the instance of placenta previa?

Answer 33

* low lying can be vaginal if both mother and child are hemodynamically stable * ~37 weeks perform elective C-section for the other degrees of previa

Question 34

Is the prophylactic medication of choice for pregnant individuals traveling to areas where P. falciparum is endemic and resistance to chloroquine is likely

Answer 34

Mefloquine

Question 35

Is a prophylactic medication effective against Plasmodium vivax and Plasmodium ovale

Answer 35

primaquine

Question 36

What antihypertensives are used in patients with preeclampsia with severe features?

Answer 36

* IV **h**ydralazine or **l**abetalol * oral **n**ifedipine ## Footnote **L**owers **N**eonatal **H**ypertension

Question 37

What is seizure prophylaxis in preeclampsia and has neuroprotective effects on the fetus associated with a significantly reduced incidence of cerebral palsy?

Answer 37

Magnesium sulfate

Question 38

Can be initiated after 12 weeks' gestation to reduce the risk of preeclampsia in patients with certain high-risk features,

Answer 38

low-dose (81 mg) aspirin

Question 39

Failure of the uterus to effectively contract after delivery, which can lead to severe bleeding from the myometrial vessels and is the most common cause of postpartum hemorrhage.

Answer 39

uterine atony

Question 40

Is a rare cause of postpartum hemorrhage and usually occurs in vaginal delivery involving an attached placenta. On vaginal examination, the endometrium is visible as a red bulging mass.

Answer 40

Uterine inversion

Question 41

A rare disorder in which the placenta is directly adherent to the myometrium (without penetrating) instead of the decidua basalis.

Answer 41

placenta accreta

Question 42

The chorionic villi invade or penetrate into the myometrium

Answer 42

placenta increta

Question 43

The chorionic villi penetrate the myometrium, penetrate the serosa, and, in some cases, adjacent organs/structures

Answer 43

placenta percreta

Question 44

What two vaccines should be given in pregnancy?

Answer 44

* Tdap between 27-36 weeks * Influenza by end of October ## Footnote no live/attentuated vaccines! can do hepatitis B in unvaccinated mothers or those with high risk

Question 45

Following the first serum β-hCG measurement. Repeated measurement of β-hCG is also indicated to confirm an appropriate rise in concentration (i.e., doubling of β-hCG approx. every ________ within the first 4 weeks of pregnancy).

Answer 45

Following the first serum β-hCG measurement. Repeated measurement of β-hCG is also indicated to confirm an appropriate rise in concentration (i.e., doubling of β-hCG approx. every **2.5 days** within the first 4 weeks of pregnancy).

Question 46

Abdominal ultrasound can only detect a gestational sac when serum β-hCG is approx. > ________ mlU/mL

Answer 46

Abdominal ultrasound can only detect a gestational sac when serum β-hCG is approx. >**1500–2000** mlU/mL

Question 47

What is the diagnosis?

Answer 47

complete androgen insensitivity syndrome ## Footnote XY karyotype, but presents XX. Absent ovaries/present testes, female secondary sex characteristics, and high percentile height

Question 48

A short stature, webbed neck, widely spaced nipples, and low hairline would suggest this diagnosis

Answer 48

Turner Syndrome (45, X0)

Question 49

Bilateral ovarian masses that contain signet ring cells (round, mucin-filled cells with a flat, peripheral nucleus), which indicates a diagnosis of

Answer 49

Krukenberg tumor ## Footnote bilaterality indicates it likely metastasized from a primary site, most commonly the stomach

Question 50

Dark blue peritoneal spots known as powder-burn or gunshot lesions are seen in what?

Answer 50

endometriosis

Question 51

Pleural effusion, in the setting of ascites with an ovarian mass, raises concern for what?

Answer 51

Meigs syndrome ## Footnote The triad of ascites, pleural effusion, and an ovarian mass is referred to as Meigs syndrome.

Question 52

Decreased TSH levels in association with an ovarian mass, weight loss, and pelvic pain are seen in patients with what?

Answer 52

Struma ovarii

Question 53

Elevated β-hCG levels and histopathology would show hyperplasia of the theca interna cells are implicated in the development of what?

Answer 53

theca lutein cyst

Question 54

What are the three biggest risk factors for developing sudden infant death syndrome (SIDS)?

Answer 54

* maternal age < 20 * maternal cigarette use * late or no prenatal care

Question 55

What are 3 risks factors for neonatal sepsis?

Answer 55

* maternal infection * premature rupture of membranes * preterm labor

Question 56

Primary ovarian insufficiency manifests with ________ estrogen levels as well as ________ FSH and LH levels

Answer 56

Primary ovarian insufficiency manifests with **decreased** estrogen levels as well as **elevated** FSH and LH levels ## Footnote think menopause in < 40 years of age

Question 57

What can cause someone to present with primary ovarian insufficiency (POI)?

Answer 57

* radiation/chemotherapy * Turner syndrome * fragile X syndrome

Question 58

A rare genetic condition characterized by anosmia (an inability to smell) and decreased production of GnRH from the hypothalamus, leading to delayed or absent puberty.

Answer 58

Kallmann syndrome

Question 59

A condition of decreased gonadal function due to a disease that primarily affects the pituitary gland and/or hypothalamus. Characterized by low concentrations of pituitary gonadotropins (FSH and LH) and low concentrations of sex hormones (e.g., estrogen, testosterone).

Answer 59

hypogonadotropic hypogonadism

Question 60

What are 4 acquired causes of hypogonadotropic hypogonadism?

Answer 60

* excessive exercise (e.g. eating disorder) * reduced caloric intake (e.g. eating disorder) * stress * pituitary lesions

Question 61

Condition of vaginal bleeding, cervical dilation without expulsion of products of conception (POC) and a FHR may or may not be present before 20 weeks' gestation.

Answer 61

inevitable abortion

Question 62

Presence of fetal vessels directly over the internal cervical os and below the presenting part of the fetus. These vessels are typically unprotected by placental tissue or the umbilical cord and may bleed following rupture of membranes, resulting in fetal exsanguination

Answer 62

vasa previa

Question 63

The death of a fetus before 20 weeks' gestation without expulsion of any products of conception. Typically asymptomatic or manifests with cramping. The cervical os is closed, and ultrasonography shows a gestational sac with products of conception and absent fetal cardiac activity.

Answer 63

missed abortion

Question 64

Painless cervical dilation, in the absence of uterine contractions and/or labor, in the second trimester of pregnancy. Can lead to second-trimester pregnancy loss and preterm birth. Presents with feelings of fullness in the lower pelvis, a funneled lower uterine segment, and possible protrusion of fetal membranes (e.g. a foot).

Answer 64

cervical insufficiency ## Footnote cervical procedures like abortions, conization, LEEP are risk factors

Question 65

bA life-threatening obstetric condition for the mother and the baby that usually arises during labor and manifests with a sudden pause in contractions, an abnormal fetal heart rate (usually bradycardia), severe abdominal pain, vaginal bleeding, loss of fetal station, and hemodynamic instability. Previous c-section predisposes

Answer 65

uterine rupture

Question 66

A condition characterized by the destruction of fetal red blood cells (RBC) and anemia. Most frequently caused by Rhesus (more severe) or ABO incompatibility (milder) between the mother and fetus, leading to immune-mediated hemolysis in the fetus/neonate

Answer 66

hemolytic disease of the newborn / erythroblastosis fetalis

Question 67

A nontender, well-defined mobile mass with a rubbery consistency in a 29-year-old woman with no mastalgia, no changes in the skin over the breast, nor axillary lymphadenopathy indicates

Answer 67

fibroadenoma

Question 68

The most common benign lesions of the breast and typically manifest with premenstrual breast pain that may be recurring or constant and unilateral or *bilateral*. On exam, areas of suspected growth tend to be diffuse

Answer 68

fibrocystic breast changes

Question 69

Manifest with unilateral bloody nipple discharge and are typically located in the central area of the breast

Answer 69

intraductal papilloma

Question 70

A ductal carcinoma (either in situ or invasive) of the secretory ducts with early infiltration of the nipple and areola. Patients present with a scaly erythematous rash of the nipple and areola.

Answer 70

Paget disease of the breast ## Footnote need tissue biopsy to confirm

Question 71

Characterized by skin changes, specifically breast erythema, dimpling, and diffuse swelling that is similar in appearance to the peel of an orange (often termed “peau d'orange”)

Answer 71

Inflammatory Breast Cancer

Question 72

Commonly report a history of breast trauma, this condition typically manifests as a firm, periareolar mass with irregular borders that may have an overlying area of skin thickening or retraction

Answer 72

fat necrosis

Question 73

This condition, which typically presents as painless vaginal bleeding in the third trimester. cardiotocography shows normal/reactive fetal heart tones with no decelerations and no uterine contractions

Answer 73

placenta previa

Question 74

A combination of maternal fever, tachycardia, uterine tenderness, malodorous and purulent amniotic fluid, vaginal discharge, and fetal tachycardia indicates

Answer 74

chorioamnionitis

Question 75

In blunt dissection of the infundibulopelvic (suspensory) ligament what structure must be closely monitored for?

Answer 75

ureter

Question 76

Release of ________ by granulosa lutein cells (corpus luteum) results in an increase in the basal body temperature (BBT) by approximately 0.2–0.5°C. This occurs 1–2 days after the ________ that induces ovulation and marks the transition from the follicular to the luteal phase of the menstrual cycle.

Answer 76

Release of **progesterone** by granulosa lutein cells (corpus luteum) results in an increase in the basal body temperature (BBT) by approximately 0.2–0.5°C. This occurs 1–2 days after the **luteinizing hormone surge** that induces ovulation and marks the transition from the follicular to the luteal phase of the menstrual cycle.

Question 77

For patients < 30-35 years of age, subareolar ________ is the preferred imaging modality; because breast tissue density is higher in this age group

Answer 77

For patients < 30-35 years of age, subareolar **breast ultrasound** is the preferred imaging modality; because breast tissue density is higher in this age group

Question 78

For patients > 30 years of age, ________ is the preferred imaging modality; because breast tissue density is lower and more fatty in this age group

Answer 78

For patients > 30 years of age, **mammography** is the preferred imaging modality; because breast tissue density is lower and more fatty in this age group

Question 79

In pregnant women ________ caused by ________ can cause complications (e.g., fever, chorioamnionitis, PPROM) and result in preterm birth or spontaneous abortion.

Answer 79

In pregnant women **listeria** caused by ***Listeria monocytogenes*** can cause complications (e.g., fever, chorioamnionitis, PPROM) and result in preterm birth or spontaneous abortion.

Question 80

Usually benign tumors that can occur during pregnancy and manifest with features of virilization (e.g., deepening of the voice and clitoromegaly)

Answer 80

Sertoli-Leydig cell tumors

Question 81

Can develop during pregnancy due to excessive amounts of circulating gonadotropins, such as β-hCG, and can manifest with features of hyperandrogenism, including virilization (e.g., voice deepening, clitoromegaly). Appear as cystic lesions on ultrasound.

Answer 81

theca lutein cyst

Question 82

Rare, benign tumors that develop from androgen-producing lutein cells in response to elevated levels of β-hCG during pregnancy. Although the majority of patients are asymptomatic, these tumors can manifest with features of virilization, such as deepening of the voice and clitoromegaly. Ultrasound typically shows unilateral or bilateral *solid adnexal masses* with a diameter of ≥ 4 cm and significant venous or arterial flow.

Answer 82

luteomas

Question 83

Common in pregnancy but typically regress at the beginning of the second trimester. Produce progestone and on ultrasound are thick-walled cystic lesions.

Answer 83

corpus luteum cysts

Question 84

Manifest with hirsutism, acne, and hyperpigmentation. Does not show virilization, but has acanthosis nigricans and cystic lesions on ultrasound

Answer 84

polycystic ovarian syndrome (PCOS)

Question 85

Constellation of increased testosterone and dihydrotestosterone levels with decreased levels of dehydroepiandrosterone, dehydroepiandrosterone sulfate, and androstenedione is seen in ________

Answer 85

Constellation of increased testosterone and dihydrotestosterone levels with decreased levels of dehydroepiandrosterone, dehydroepiandrosterone sulfate, and androstenedione is seen in **exogenous androgen administration**

Question 86

Constellation of decreased levels of testosterone, dehydroepiandrosterone, dehydroepiandrosterone sulfate, androstenedione, and dihydrotestosterone is typically seen in ________

Answer 86

Constellation of decreased levels of testosterone, dehydroepiandrosterone, dehydroepiandrosterone sulfate, androstenedione, and dihydrotestosterone is typically seen in **17-alpha-hydroxylase deficiency**

Question 87

The combination of elevated levels of testosterone, dehydroepiandrosterone, dehydroepiandrosterone sulfate, and androstenedione with decreased levels of dihydrotestosterone is seen in ________

Answer 87

The combination of elevated levels of testosterone, dehydroepiandrosterone, dehydroepiandrosterone sulfate, and androstenedione with decreased levels of dihydrotestosterone is seen in **5-alpha-reductase deficiency**

Question 88

Constellation of elevated levels of testosterone, dehydroepiandrosterone, dehydroepiandrosterone sulfate (DHEA-S), androstenedione, and dihydrotestosterone is typically seen in ________

Answer 88

Constellation of elevated levels of testosterone, dehydroepiandrosterone, dehydroepiandrosterone sulfate (DHEA-S), androstenedione, and dihydrotestosterone is typically seen in **excess adrenal androgen secretion**

Question 89

The combination of elevated levels of dehydroepiandrosterone and dehydroepiandrosterone sulfate with decreased levels of testosterone, androstenedione, and dihydrotestosterone is seen in ________

Answer 89

The combination of elevated levels of dehydroepiandrosterone and dehydroepiandrosterone sulfate with decreased levels of testosterone, androstenedione, and dihydrotestosterone is seen in **3-beta-hydroxysteroid dehydrogenase deficiency**

Question 90

Results from failure of the embryonic prosencephalon to separate into two cerebral hemispheres, leading to brain malformation of varying severity as well as midline craniofacial defects.

Answer 90

holoprosencephaly

Question 91

Results from failure of neuronal cell migration, thereby inhibiting development of the gyri and sulci. This malformation is typically genetic but may also be caused by viral infections or insufficient intrauterine perfusion in early pregnancy.

Answer 91

lissencephaly

Question 92

Results from failure of the caudal neuropore to close. Is a closed NTD because neural tissue is not exposed to external environment

Answer 92

spina bifida occulta ## Footnote look for sacral tuft of hair

Question 93

Results from failure of the caudal neuropore to close. Is an open NTD because neural tissue is exposured to external environment. Shows elevated AFP and acetylcholinesterase activity

Answer 93

myelomeningocele

Question 94

How do you differentiate anencephaly from myelomeningocele because both show elevated AFP and acetylcholinesterase

Answer 94

* anencephaly shows polyhydramniois because baby can't swallow amniotic fluid and lower levels. * myelomeningocele does not show polyhydramnios because swallowing can still occur in he amniotic sac.

Question 95

A history of ________ is the strongest predisposing factor for preterm birth

Answer 95

A history of **spontaneous preterm birth (PTB)** is the strongest predisposing factor for preterm birth

Question 96

An elective cesarean section may be performed after ________ weeks if IUGR is accompanied by oligohydramnios.

Answer 96

An elective cesarean section may be performed after **34** weeks if IUGR is accompanied by oligohydramnios.

Question 97

Is a benign disorder characterized by irregular, patchy hyperpigmentation of the skin that is most commonly seen in women of reproductive age. Can be triggered and/or exacerbated by exposure to sunlight

Answer 97

melasma

Question 98

Is velvety hyperpigmentation of skin folds (e.g., axilla, nape of the neck) and does not involve the face.

Answer 98

acanthosis nigricans

Question 99

Results from the fertilization of an “empty” oocyte (i.e., one that does not carry any chromosomes) by a sperm. The haploid set of chromosomes from the sperm then doubles (paternal disomy) to yield a karyotype of either 46,XX (∼ 90% of cases) or 46,XY (∼ 10% of cases)

Answer 99

complete hydatidiform mole ## Footnote "complete" absence of maternal genetic contribution so only moles, unlike partial moles which have some fetal parts.

Question 100

A type of gestational trophoblastic disease (GTD) that is caused by aberrant fertilization in an embryo and has the potential to invade the uterus and metastasize. Are triploid and usually result from fertilization of an egg with 2 sperm or a diploid sperm

Answer 100

partial hydatidiform mole ## Footnote "partial" absence of maternal genetic contribution, so they have some fetal parts.

Question 101

Systemic autoimmune disease characterized by thrombotic (e.g., DVT, stroke) and/or obstetrical complications (e.g., recurrent early miscarriages, severe preeclampsia). Other clinical manifestations include livedo reticularis, thrombocytopenia, and valvular heart disease.

Answer 101

antiphospholipid syndrome (APS)

Question 102

A group of antibodies against phospholipids found in cell membranes. In vitro, they prevent blood clotting and prolong aPTT, but have a procoagulatory effect in vivo. The antibodies induce a hypercoagulable state and thrombosis formation.

Answer 102

lupus anticoagulant

Question 103

Combined oral contraceptive pills (COCPs) can decrease the risk of ________, possibly through reduced cell proliferation

Answer 103

Combined oral contraceptive pills (COCPs) can decrease the risk of **ovarian and endometrial cancer**, possibly through reduced cell proliferation ## Footnote O and E are a vowel and protects against the vowel cancers, but increases risk of breast cancer

Question 104

Long-term combined oral contraceptive use (≥ 5 years) is associated with an increased risk of ________.

Answer 104

Long-term combined oral contraceptive use (≥ 5 years) is associated with an increased risk of **cervical cancer**.

Question 105

Is used in the treatment of nausea and vomiting of pregnancy. However, is only indicated if other treatment options have been unsuccessful or if patients have refractory symptoms despite initial combination therapy.

Answer 105

metoclopramide

Question 106

A condition of severe, persistent nausea and vomiting during pregnancy that is associated with > 5% loss of pre-pregnancy weight and severe dehydration. More common among young, primigravid women and women with multifetal gestation or molar pregnancy.

Answer 106

hyperemesis gravidarum

Question 107

What is first and second-line treatment of morning sickness?

Answer 107

* vitamin B6 (pyridoxine) * doxylamine (1st gen antihistamine)

Question 108

Granulomatous inflammation of the thyroid gland and pain with symptoms of hyperthyroidism, increased ESR, and decreased blood flow on thyroid ultrasound.

Answer 108

DeQuervain thyroiditis

Question 109

A highly malignant gestational trophoblastic neoplasia (GTN) characterized by invasive, highly vascular, and anaplastic trophoblastic tissue without villi. It is rare but can arise from any type of trophoblastic tissue. increased levels of human chorionic gonadotropin (hCG)

Answer 109

choriocarcinoma

Question 110

Thyrotropin receptor antibodies (TRAbs) are most commonly seen in ________

Answer 110

Thyrotropin receptor antibodies (TRAbs) are most commonly seen in **Graves disease**

Question 111

An activating somatic mutation of the thyrotropin receptor is seen in ________

Answer 111

An activating somatic mutation of the thyrotropin receptor is seen in **toxic multinodular goiter (TMNG)**

Question 112

Is the first-line pharmacotherapy for patients with polycystic ovarian syndrome (PCOS) who currently do not wish to conceive

Answer 112

combination oral contraceptive pill (COCP)

Question 113

What is the MoA of leuprolide?

Answer 113

gonadotropin-releasing hormone (GNRH) agonists

Question 114

Is a first-line treatment for women with PCOS who wish to conceive

Answer 114

letrozole

Question 115

What is the MoA of letrozole?

Answer 115

aromatase inhibitor ## Footnote aromatase converts testosterone to estrogen

Question 116

Used in patients with endometriosis or fibrocystic breast disease because of its antigonadotropic (decreasing luteinizing hormone levels and follicle-stimulating hormone levels) and antiestrogenic effects.

Answer 116

Danazol

Question 117

What is the MoA of danazol?

Answer 117

androgen agonist

Question 118

Uterine atony is the most common cause of postpartum hemorrhage (PPH) and can be managed with ________ massage in conjunction with prompt administration of the uterine stimulant, ________, followed by an increased dose, then additional uterotonic agents (e.g., IM ________, sublingual/intracavitary ________, or deep IM ________ ) and ________.

Answer 118

Uterine atony is the most common cause of postpartum hemorrhage (PPH) and can be managed with **bimanual uterine** massage in conjunction with prompt administration of the uterine stimulant, **oxytocin**, followed by an increased dose, then additional uterotonic agents (e.g., IM **methylergonovine**, sublingual/intracavitary **misoprostol**, or deep IM **carboprost**) and **tranexamic acid (TXA)**.

Question 119

Are performed in patients with postpartum hemorrhage (PPH) caused by retained products of conception (RPOC), such as placental fragments or fetal membranes if manual removal has been unsuccessful

Answer 119

dilation and curettage (D&C)

Question 120

Synthetic prostaglandin E1 analog that is used in the termination of intrauterine pregnancies, to induce cervical ripening or labor, to treat incomplete or missed abortions, and in the prevention of NSAID-induced gastric ulcers.

Answer 120

misoprostol

Question 121

A prostaglandin PGF-2a analog that is used in refractory postpartum hemorrhage due to uterine atony and pregnancy termination between 13–20 weeks' gestation. Should be used with caution in those with asthma.

Answer 121

carboprost tromethamine

Question 122

Combined oral contraceptive pills (COCPs) significantly reduce the risk of developing what cancer and why?

Answer 122

* type 1 endometrial cancer because the progestin contained in COCs opposes estrogen-driven endometrial hyperplasia * ovarian cancer ## Footnote should be used with caution in patients with high risk for breast cancer development

Question 123

Long-term combined oral contraceptives (COCs) use (≥ 5 years) is associated with an increased risk of developing ________ cancer.

Answer 123

Long-term combined oral contraceptives (COCs) use (≥ 5 years) is associated with an increased risk of developing **cervical** cancer.

Question 124

Patients with Turner syndrome have reduced fertility due to: ________

Answer 124

Patients with Turner syndrome have reduced fertility due to: **ovarian dysgenesis (streak ovary)**

Question 125

What is ovarian dysgenesis (streak ovary)?

Answer 125

a lack of hormone production from defective ovaries leading to estrogen and progesterone deficiency

Question 126

What is the expected FSH and LH levels in Turner syndrome?

Answer 126

elevated FSH and LH due to the lack of estrogen and progesterone production in the defective ovaries.

Question 127

Infertility due to impaired fallopian tube ciliary function is seen in: ________

Answer 127

Infertility due to impaired fallopian tube ciliary function is seen in: **primary ciliary dyskinesia**

Question 128

Functional gametes in the absence of a uterus with pubic and axillary hair present characterize ________

Answer 128

Functional gametes in the absence of a uterus with pubic and axillary hair present characterize **Müllerian agenesis** ## Footnote surrogacy is necessary due to lack of a uterus

Question 129

What is the pathogenesis in preeclampsia?

Answer 129

Abnormal remodeling of the spiral arteries creates narrow vessels instead of large, high-capacity vessels, which leads to placental hypoperfusion so placenta releases vasoactive substances to get more blood to fetus

Question 130

Increase in circulating plasma volume can lead to what in pregnancy?

Answer 130

anemia

Question 131

Lack of ________ indicates that preeclampsia has not yet progressed to eclampsia.

Answer 131

Lack of **seizures** indicates that preeclampsia has not yet progressed to eclampsia.

Question 132

Overactivation of the coagulation cascade is the primary component in the pathogenesis of ________

Answer 132

Overactivation of the coagulation cascade is the primary component in the pathogenesis of **HELLP syndrome**

Question 133

HELLP syndrome is characterized by evidence ________

Answer 133

HELLP syndrome is characterized by evidence of **hemolysis**, **elevated LFTs**, and **thrombocytopenia** ## Footnote hemolysis (H), elevated liver (EL) enzymes, and low platelet (LP) count

Question 134

Regular, heavy menstrual bleeding and dysmenorrhea in a multiparous woman with a uniformly enlarged and tender uterus suggest a diagnosis of

Answer 134

adenomyosis

Question 135

A disease of unknown etiology characterized by growth of nonmalignant endometrial tissue within the myometrium

Answer 135

adenomyosis

Question 136

Benign smooth muscle tumors within the uterine wall (myometrium) are characteristic of

Answer 136

uterine fibroids (leiomyomas)

Question 137

Stalk-like endometrial overgrowths that can cause heavy menstrual bleeding if they are highly vascularized

Answer 137

uterine polyp (pedunculated)

Question 138

Malignant proliferation of trophoblasts is seen in

Answer 138

choriocarcinoma

Question 139

What are the two major risk factors for choriocarcinoma?

Answer 139

* hydatidiform mole * pregnancy

Question 140

Can cause abnormal uterine bleeding but is not associated with an enlarged uterus. Presents with fever, constant lower abdominal pain and tenderness, abnormal discharge, and a history of sexually transmitted infections.

Answer 140

endometritis

Question 141

Endometriotic cell implants in the ovaries, fallopian tubes, and/or cervix.

Answer 141

endometriosis

Question 142

What is the treatment for community-acquired pneumonia (CAP) in pregnant women?

Answer 142

* ampicillin-sulbactam (Unasyn) * azithromycin ## Footnote the same as that for the general adult population, excluding potentially teratogenic medications.

Question 143

Monotherapy is the treatment of choice for terminating an uncomplicated ectopic pregnancy

Answer 143

IM/IV methotrexate (MTX) ## Footnote you CANNOT use oral methotrexate

Question 144

In patients with suspected umbilical cord compression, intrauterine resuscitation measures should be initiated as soon as possible. ________ is a reasonable first step that can relieve cord compression by shifting the baby's position or alleviating pressure from the uterus on the umbilical cord.

Answer 144

In patients with suspected umbilical cord compression, intrauterine resuscitation measures should be initiated as soon as possible. **Repositioning the birthing parent** (e.g., turning to the left or right lateral position or knee-chest position) is a reasonable first step that can relieve cord compression by shifting the baby's position or alleviating pressure from the uterus on the umbilical cord.

Question 145

Decelerations occurring in ≥ 50% of uterine contractions in a 20-minute period are known as recurrent variable decelerations and suggest:

Answer 145

Decelerations occurring in ≥ 50% of uterine contractions in a 20-minute period are known as recurrent variable decelerations and suggest: **umbilical cord compression**

Question 146

Second-line treatment option in patients with persistent variable decelerations (e.g., due to umbilical cord compression) despite intrauterine resuscitation

Answer 146

amnioinfusion ## Footnote If this doesn't work emergency C-section is indicated

Question 147

Sharing a common placenta can lead to ________ syndrome

Answer 147

Sharing a common placenta can lead to **twin-to-twin transfusion** syndrome

Question 148

What amnionicity and chorionicity cannot lead to vascular anomalies?

Answer 148

* dichorionic-diamniotic monozygotic * dichorionic-diamniotic dizygotic ## Footnote each fetus has its own placenta and circulation, it is not possible for vascular anastomoses and anomalies to develop

Question 149

All dizygotic twin pregnancies are ________chorionic-________amniotic

Answer 149

All dizygotic twin pregnancies are **di**chorionic-**di**amniotic

Question 150

Conjoined twin pregancies are associated with what change in amniotic fluid?

Answer 150

polyhydramnios

Question 151

Twin-to-twin transfusion syndrome pregancies are associated with what change in amniotic fluid?

Answer 151

oligohydramnios

Question 152

Can result in mild dyspareunia and a palpable, tender mass on pelvic examination located at the posterior vaginal introitus

Answer 152

Bartholin gland cyst ## Footnote usually bacterial origin (e.g. *Escherichia coli* from posterior vaginas proximity to the anus.

Question 153

Can cause dysuria, dyspareunia, and urinary incontinence. They typically result in overflow incontinence and masses located just lateral to the external urethral meatus

Answer 153

paraurethral (Skene) gland cyst

Question 154

Classically manifests with the triad of urinary incontinence (postvoid dripping), dysuria, and dyspareunia. Can sometimes be identified on pelvic examination as a tender anterior vaginal wall mass.

Answer 154

urethral diverticulum

Question 155

These two conditions are associated with prior pelvic surgery. This condition typically results in continuous leakage of urine into the vagina, however, the patient usually doesn't know the leakage is there.

Answer 155

* vesicovaginal fistula or * urethrovaginal fistula

Question 156

Patient has an itchy, erythematous, scaly rash on the areola. What diagnosis is at the top of your differential?

Answer 156

Paget disease of the breast (PDB) ## Footnote punch biopsy showing Paget cells on microscopy confirms diagnosis

Question 157

Is indicated in patients with a prolonged active phase of labor to augment the frequency and strength of contractions, which may help progress cervical dilation and fetal descent

Answer 157

oxytocin infusion

Question 158

Montevideo units are a measurement of uterine contraction during labor. The net pressure of all individual contractions over the course of 10 minutes is summed. ________ MVUs is considered adequate uterine contractions during the active phase of labor.

Answer 158

Montevideo units are a measurement of uterine contraction during labor. The net pressure of all individual contractions over the course of 10 minutes is summed. **200-250** MVUs is considered adequate uterine contractions during the active phase of labor. ## Footnote anything below is considered uterine hypocontractility

Question 159

Characterized by systemic consumption of both procoagulant and anticoagulant clotting factors, usually resulting in abnormal bleeding

Answer 159

Disseminated Intravascular Coagulation (DIC)

Question 160

Additional laboratory findings that may be seen in DIC include ________ (condition), ________ PT and PTT, ________ bleeding time, ________ D-dimer, and ________ factor V concentrations.

Answer 160

Additional laboratory findings that may be seen in DIC include **thrombocytopenia**, **increased** PT and PTT, **increased** bleeding time, **increased** D-dimer, and **decreased** factor V concentrations.

Question 161

What two strains of HPV are most highly associated with vaginal carcinoma?

Answer 161

HPV 16 and 18 ## Footnote 31 and 33 are also highly causative

Question 162

What strains of HPV are associated with genital warts (condylomata acuminata)?

Answer 162

HPV 6 and 11

Question 163

Is a chronic, noninfectious cause of cystitis with an unknown etiology. Patients often present with suprapubic pain, dyspareunia, and increased urgency/frequency for longer than 6 weeks. The painful sensation is often due to bladder filling and relieved with urination. It is a diagnosis of exclusion and other causes of cystitis

Answer 163

interstitial cystitis

Question 164

Urine-specific gravity tends to be ________ in patients with diabetes insipidus.

Answer 164

Urine-specific gravity tends to be **very low (< 1.003)** in patients with diabetes insipidus.

Question 165

Chronic urinary retention usually manifests with ________ residual volume

Answer 165

Chronic urinary retention usually manifests with **> 300 mL** residual volume

Question 166

Is indicated in nonpregnant women with a high immediate risk of CIN III+ risk (e.g., patients with high-grade cervical lesions and positive HPV testing (risk ))

Answer 166

loop electrosurgical excision procedure (LEEP)

Question 167

In pregnant women with high-grade precancerous lesions (i.e., CIN2 or CIN3), this is the preferred treatment method.

Answer 167

* colposcopic surveillance with HPV-based testing every 12-24 weeks * deferring colposcopy until ≥ 4 weeks after delivery is also acceptable.

Question 168

A method to perform cervical conization in which a scalpel is used to remove a cone-shaped portion of cervical tissue. Typically requires general or regional anesthesia. Used for diagnosis and/or treatment of cervical cancer.

Answer 168

cold-knife conization

Question 169

Usually performed in women with high-grade squamous intraepithelial lesion (HSIL) to allow sampling of the endocervical canal

Answer 169

endocervical curettage (ECC)

Question 170

The most important mechanism of action of combined oral contraceptives in preventing ovulation is ________

Answer 170

The most important mechanism of action of combined oral contraceptives in preventing ovulation is **the inhibition of the LH surge**.

Question 171

OCPs are contraindicated in women who have:

Answer 171

* migraines * cigarettes above age 35 * hx of stroke or thromboembolism

Question 172

The USPSTF recommends HPV/Pap cotesting every ________ years for individuals with a cervix who are 30–65 years of age and a solitary Pap smear every ________ years for those between 21–29 years of age.

Answer 172

The USPSTF recommends HPV/Pap cotesting every **5** years for individuals with a cervix who are 30–65 years of age and a solitary Pap smear every **3** years for those between 21–29 years of age.

Question 173

All guidelines recommend a solitary Pap smear every ________ years if HPV testing is unavailable.

Answer 173

All guidelines recommend a solitary Pap smear every **3** years if HPV testing is unavailable.

Question 174

According to the USPSTF, breast cancer screening with mammography should be performed every ________ years between 40–74 years of age.

Answer 174

According to the USPSTF, breast cancer screening with mammography should be performed every **2** years between 40–74 years of age.

Question 175

A congenital defect in which the hymen does not have an opening. Caused by failure of the central cells of the Müllerian eminence to disintegrate. Causes cryptomenorrhea (backup of menstrual blood) at puberty. Typically manifests as primary amenorrhea with periodic lower abdominal pain.

Answer 175

imperforate hymen

Question 176

When a pelvic exam shows a bulging bluish membrane under the labia and rectal exam shows an anterior mass. Typically manifests as primary amenorrhea with periodic lower abdominal pain. What is the diagnosis and next step management?

Answer 176

imperforate hymen and hymenotomy

Question 177

Intrapartum administration of ________ is used for the prophylaxis of neonatal GBS infection.

Answer 177

Intrapartum administration of **IV penicillin G** is used for the prophylaxis of neonatal GBS infection.

Question 178

Is the strongest risk factor for pelvic organ prolapse (POP) and is estimated to account for ∼ 75% of cases.

Answer 178

multiparity

Question 179

A chronic inflammatory dermatosis characterized by pruritic white plaques with epidermal atrophy and scarring. Most commonly affects the anogenital area but may also affect extragenital areas

Answer 179

lichen sclerosus (LS)

Question 180

Although lichen sclerosus is a benign condition, genital lesions are associated with an increased risk of ________.

Answer 180

Although lichen sclerosus is a benign condition, genital lesions are associated with an increased risk of **squamous cell carcinoma**.

Question 181

A prolonged second stage of labor in a nulliparous woman (i.e., > ________ hours of pushing in women without epidural anesthesia; > ________ hours with epidural anesthesia)

Answer 181

A prolonged second stage of labor in a nulliparous woman (i.e., > **3** hours of pushing in women without epidural anesthesia; > **4** hours with epidural anesthesia) ## Footnote subtract 1 hour from these values if a woman has given birth before

Question 182

What is the difference between an unengaged and engaged fetal head?

Answer 182

* unengaged fetal head means the station is < 0 * engaged fetal head means the station is ≥ 0 ## Footnote if the fetal head is unengaged that makes it contraindicated to do either a vacuum-assisted or forceps-assisted delivery

Question 183

In women with a prolonged second stage of labor and an unengaged fetal head, ________ should be performed.

Answer 183

cesarean delivery

Question 184

In women with a prolonged second stage of labor and an engaged fetal head, ________ can be considered to be performed.

Answer 184

In women with a prolonged second stage of labor and an engaged fetal head, **vacuum-assisted delivery** can be considered to be performed.

Question 185

A protein that is secreted by epithelial cells and elevated in the majority of individuals with epithelial ovarian or fallopian tube cancer.

Answer 185

carcinoma antigen (CA) 125

Question 186

A hereditary cancer syndrome caused by a mutation in mismatch repair genes. Individuals have a significantly higher risk of developing colorectal, gastric, ovarian, and endometrial cancer.

Answer 186

hereditary nonpolyposis colorectal cancer (HNPCC) / Lynch Syndrome

Question 187

Some preexisting or obstetric medical conditions, such as hemodynamically significant heart disease, restrictive lung disease, severe anemia, and cervical insufficiency, constitute ________ contradictions to exercise during pregnancy. ________ contraindications include chronic bronchitis, poorly controlled diabetes mellitus type 1, and intrauterine growth restriction.

Answer 187

Some preexisting or obstetric medical conditions, such as hemodynamically significant heart disease, restrictive lung disease, severe anemia, and cervical insufficiency, constitute **absolute** contradictions to exercise during pregnancy. **Relative** contraindications include chronic bronchitis, poorly controlled diabetes mellitus type 1, and intrauterine growth restriction.

Question 188

Histology of an ________ would show glandular cells and stroma resembling the endometrium. Contains chocolate-colored bloody fluid. May be a true cyst or formed by invagination.

Answer 188

Histology of an **endometrioma** would show glandular cells and stroma resembling the endometrium. ontains chocolate-colored bloody fluid. May be a true cyst or formed by invagination.

Question 189

Benign epithelial tumors and the most common type of ovarian neoplasm. Histology from a ________ would show psammoma bodies

Answer 189

Benign epithelial tumors and the most common type of ovarian neoplasm. Histology from a **serous cystadenoma** would show psammoma bodies

Question 190

Is a type of benign sex cord-stromal tumor. Typically causes abnormal uterine bleeding as the estrogen produced stimulates hyperplasia of the endometrium.

Answer 190

Ovarian thecoma ## Footnote the theca cells produce estrogen

Question 191

Are the most common type of all germ cell tumors. They are usually benign and appear as hypoechoic and hyperechoic areas on ultrasonography. Histology would likely show multiple cell types derived from one or more of the three germ layers.

Answer 191

Dermoid cysts (mature teratomas)

Question 192

A type of benign sex cord-stromal tumor. Biopsy typically shows spindle-shaped cells which correspond to fibroblasts.

Answer 192

Ovarian fibroma ## Footnote fibroma is a leiomyoma and spindle cells are a feature of smooth muscle

Question 193

Between 24 and 36 weeks' gestation, the fundal height (in cm) should roughly equal the gestational age (in weeks). A fundal height of at least 3 cm less than the gestational age, as seen here, should raise concern for ________.

Answer 193

Between 24 and 36 weeks' gestation, the fundal height (in cm) should roughly equal the gestational age (in weeks). A fundal height of at least 3 cm less than the gestational age, as seen here, should raise concern for **intrauterine growth restriction (IUGR)**.

Question 194

When should a glucose challenge/tollerance test (GTT) be performed in pregnancy?

Answer 194

between 24-28 weeks

Question 195

A history of seizures, intellectual disability, and nonprogressive spastic paresis is consistent with

Answer 195

cerebral palsy (CP)

Question 196

What is damaged in cerebral palsy (CP) that results in upper motor neuron (UMN) paresis in one or more limbs?

Answer 196

pyramidal tracts

Question 197

What two conditions are encompassed in spina bifida cystica?

Answer 197

* meningocele * myelomeningocele

Question 198

Why is diabetes mellitus (DM) a predisposing factor to vaginal yeast infections (vulvovaginal candidiasis / vaginal thrush)

Answer 198

* high blood glucose provides needed nutrients for overgrowth and infection * immunodeficiecy in DM is associated with an increased risk of fungal infections

Question 199

What is reflex triage testing for cervical cancer?

Answer 199

* do pap smear (cytology) if HPV testing is positive * do HPV testing if pap smear (cytology) is positive

Question 200

What are spoon-shaped nails called?

Answer 200

koilonychia

Question 201

What is koilonychia a sign of?

Answer 201

iron deficiency anemia (IDA)

Question 202

Craving ice along with angular cheilitis is a sign of what?

Answer 202

iron deficiency anemia (IDA)

Question 203

What is the main cause of atrophic vaginitis?

Answer 203

decreased estrogen levels ## Footnote menopause and pharmacotherapy are most common cause

Question 204

What medication(s) cause decreased estrogen?

Answer 204

aromatase inhibitors (e.g. exemestane, anastrozole, and letrozole)

Question 205

What is the MoA of leuprolide

Answer 205

GnRH agonist

Question 206

What three conditions does leuprolide primarily treat?

Answer 206

* endometriosis * leiomyomas (fibroids) * precocious puberty

Question 207

What is the MoA of tamoxifen and raloxifene?

Answer 207

Selective estrogen receptor modulators (SERM)

Question 208

What does tamoxifen do to bone density in pre and postmenopausal individuals respectively?

Answer 208

premenopausal - too much estrogen shuts off estrogen production and results in **decreased** bone density postmenopausal - estrogen agonist and **increased** bone density

Question 209

First-line treatment for triple-negative breast cancer and ovarian cancer

Answer 209

Paclitaxel ## Footnote adverse effect is peripheral neuropathy

Question 210

A humanized antibody that is used in ERBB2-positive breast cancer

Answer 210

Trastuzumab

Question 211

A condition of incomplete formation of the skull bones. It is a birth defect associated with maternal ACE inhibitor use.

Answer 211

hypocalvaria

Question 212

Use during pregnancy is associated with the inhibition of bone growth and discoloration of the primary teeth

Answer 212

tetracycline

Question 213

Intake during pregnancy can cause maternal folate deficiency

Answer 213

carbamazepine ## Footnote neural tube defects (NTD)

Question 214

Intake during the second and third trimester is associated with premature closure of the ductus arteriosus, persistent pulmonary hypertension, and inhibition of uterine contractility.

Answer 214

NSAIDs (e.g. ibuprofen, diclofenac, indomethacin)

Question 215

Intake during pregnancy is highly associated with congenital malformations, such as cardiac abnormalities and facial cleft.

Answer 215

isotretinoin (accutane) ## Footnote many pregnancy tests are needed before starting and during use because of how higly teratogenic it is

Question 216

Intake during pregnancy is associated with intrauterine growth restriction, bone deformities (e.g., nasal hypoplasia), ophthalmic abnormalities, and cerebral hemorrhage

Answer 216

warfarin

Question 217

Symptoms initially include mild febrile illness followed by a rash with macules and papules that occurs several days later on the cheeks before spreading to the trunk and extremities (does NOT spare palms and soles). Can also cause a self-limited, symmetrical, nondestructive polyarthritis, which is more commonly seen in infected adults.

Answer 217

erythema infectiosum (fifth disease) caused by Parvovirus B19

Question 218

The absence of fetal periventricular calcifications on ultrasound rules out this diagnosis.

Answer 218

cytomegalovirus (CMV)

Question 219

The absence of intracranial calcifications and hydrocephalus on antenatal ultrasound make this diagnosis unlikely. ## Footnote hydrocephalus on ultrasound are born with macrocephaly

Answer 219

toxoplasmosis caused by *Toxoplasma gondii*

Question 220

Annual lung cancer screening is recommended for individuals aged 50–80 years who have a smoking history of ≥ ________ pack-year

Answer 220

Annual lung cancer screening is recommended for individuals aged 50–80 years who have a smoking history of ≥ **20** pack-year

Question 221

Small cuboidal cells aranged in clusters surrounding a central cavity with eosinophilic secretions. inhibin positive, not CA-125 positive

Answer 221

Call-Exner body ## Footnote seen in granulosa cell tumor

Question 222

The two most common identifiable causes of polyhydramnios are

Answer 222

* fetal anomalies/abnormalities * gestational diabetes mellitus (GDM)

Question 223

Presentation of the umbilical cord ahead of the presenting body part of the fetus with prolapse into the cervix or vagina.

Answer 223

umbilical cord prolapse ## Footnote associated with breech presentation, long umbilical cord, PROM, and others

Question 224

What is first-line treatment for vulvovaginal candidiasis in non pregnant individuals?

Answer 224

* topical azole (miconazole) or * single dose oral azole (fluconazole)

Question 225

What is first-line treatment for vulvovaginal candidiasis in pregnant individuals?

Answer 225

* 7-day course of a topical/intravaginal imidazole (miconazole and clotrimazole)

Question 226

What is second-line treatment for vulvovaginal candidiasis in both pregnant and non pregnant individuals?

Answer 226

nystatin

Question 227

Is usually caused by a polymicrobial infection originating from normal vaginal flora that entered the uterine cavity during delivery.

Answer 227

postpartum endometritis

Question 228

What is the first-line treatment of postpartum endometritis?

Answer 228

* IV gentamicin and clindamycin

Question 229

What are the six largest risk factors for endometrial cancer?

Answer 229

* chronic anovulation * obesity * nulliparous * early menarche * late menopause * Black ethnicity ## Footnote first 5 - unopposed estrogen secretion and causes of it!

Question 230

Yellow mucopurulent discharge, bleeding after sexual activity, and a friable cervix on pelvic examination are all suggestive of

Answer 230

bacterial cervicitis

Question 231

Can be used in the diagnosis of viral infections such as herpes simplex virus and varicella-zoster virus infection. Scrapings from the base of a herpetic lesion typically show multinucleated giant cells

Answer 231

Tzanck smear ## Footnote multinucleated giant cells are Tzanck cells

Question 232

Method of choice to confirm fetal aneuploidy in patients at ≥ 15 weeks' gestation

Answer 232

amniocentesis

Question 233

Transcervical or transabdominal removal of tissue under sonographic guidance for diagnosing potential genetic abnormalities in early pregnancy. Performed for definitive testing between 10–13 weeks of gestation.

Answer 233

chorionic villus sampling (CVS)

Question 234

Recommended as the first-line therapy for women with hirsutism due to their ability to reduce androgen levels

Answer 234

combined oral contraceptive pills (COCPs)

Question 235

Are a preferred treatment option for dyspepsia in pregnant women. ## Footnote presents most commonly with epigastric pain

Answer 235

proton pump inhibitors (PPIs)

Question 236

The first-step in the diagnostic approach of a patient with primary amenorrhea

Answer 236

pregnancy test

Question 237

________ testing in pediatrics is most commonly performed in the diagnostics for precocious or delayed puberty.

Answer 237

**Gonadotropin-releasing hormone stimulation** testing in pediatrics is most commonly performed in the diagnostics for precocious or delayed puberty.

Question 238

________ is indicated for the definitive diagnosis of endometriosis in patients with a presumptive clinical diagnosis but inconclusive imaging findings

Answer 238

**Laparoscopy** is indicated for the definitive diagnosis of endometriosis in patients with a presumptive clinical diagnosis but inconclusive imaging findings

Question 239

________ is used to diagnose and treat submucosal uterine fibroids, uterine polyps, and intrauterine adhesions.

Answer 239

**Hysteroscopy** is used to diagnose and treat submucosal uterine fibroids, uterine polyps, and intrauterine adhesions.

Question 240

No fetal pole in a true gestational sac ≥ 25 mm in size

Answer 240

anembryonic pregnancy

Question 241

Where are the two most common locations choriocarcinoma metastasizes to?

Answer 241

* brain * lungs

Question 242

Tamoxifen use is associated with what cancer?

Answer 242

uterine leiomyosarcoma

Question 243

Typically discrete, pearly, dome-shaped, and smooth, with central umbilication

Answer 243

molluscum contagiosum (MC) caused by molluscum contagiosum virus

Question 244

Are painful, erythematous papules and fluid-filled vesicles that ulcerate located in the anogenital region.

Answer 244

genital herpes caused by HSV-2 ## Footnote sometimes HSV-1.

Question 245

A rare, premalignant, focal epidermal dysplasia caused by human papillomavirus (HPV) infection (most commonly HPV type 16). This condition typically manifests as multiple, flat, red-brown pigmented papules on the external genitals

Answer 245

Bowenoid papulosis

Question 246

Are painless skin lesions in the anogenital region that occur in secondary syphilis. Typically broad-based, smooth, papular erosions

Answer 246

condylomata lata

Question 247

Is a chronic inflammatory disease of unknown origin that classically manifests with pruritic, planar (flat-topped), polygonal, purple papules, and plaques in individuals 30–60 years of age

Answer 247

lichen planus

Question 248

A quad screening result of A indicates?

Answer 248

Down syndrome (DS)

Question 249

A quad screening result of B indicates?

Answer 249

* normal or * Patau syndrome (trisomy 13)

Question 250

A quad screening result of C indicates?

Answer 250

Turner syndrome and * infrequently Edwards syndrome (trisomy 18)

Question 251

A quad screening result of D indicates?

Answer 251

Edwards syndrome (trisomy 18)

Question 252

A quad screening result of E indicates?

Answer 252

neural tube defect (NTD)

Question 253

An erythematous, fluctuant breast mass associated with fever, chills, and local skin involvement is consistent with a

Answer 253

breast abscess caused by S*taphylococcus aureus* most commonly ## Footnote cephalosporin is a good first-line (e.g. cephalexin), if resistant/MRSA is shown clindamycin is second-line.

Question 254

Is the recommended treatment for breast abscesses with intact overlying skin.

Answer 254

Ultrasound-guided needle aspiration

Question 255

Is the recommended treatment for breast abscesses complicated by overlying skin necrosis or failure to respond to less invasive treatments

Answer 255

surgical incision and drainage (I&D)

Question 256

Is the most common ovarian tumor in patients < 30 years of age.

Answer 256

dermoid cyst

Question 257

The second most common benign ovarian tumor and are often asymptomatic. Shows a large multilocular cystic mass with thin septations without solid components. The peak incidence is 30–50 years of age.

Answer 257

mucinous cystadenoma

Question 258

The most common malignant ovarian tumors and can manifest as a complex mass on pelvic ultrasound. Patients are most often older women who present with symptoms such as abdominal pain or abnormal vaginal bleeding. Histology would show Psammoma bodies.

Answer 258

Serous Cystadenocarcinoma

Question 259

Manifests as a simple ovarian cyst with diffusely thick walls that have increased vascularity (“ring of fire” sign) and sometimes intracystic hemorrhage

Answer 259

corpus luteum cyst

Question 260

Individuals with lichen sclerosus have an increased risk of developing vulvar ________.

Answer 260

Individuals with lichen sclerosus have an increased risk of developing vulvar **squamous cell carcinoma**.

Question 261

What is the treatment for lichen sclerosus in adults?

Answer 261

* punch biopsy * biopsy negative a glucocorticoid (clobetasol)

Question 262

An abnormally located insertion of the umbilical cord in the chorioamniotic membranes. The fetal blood vessels travel without the protective Wharton jelly from the insertion of the umbilical cord to their entry site in the placenta.

Answer 262

velamentous cord insertion

Question 263

Are the most common fetal cause for spontaneous abortions, particularly in the 1st and first week of 2nd trimester.

Answer 263

chromosomal anomalies

Question 264

A double decidual sac sign in the uterine fundus with the absence of fetal cardiac activity and a closed cervical os is most likely a diagnosis of this?

Answer 264

missed abortion

Question 265

Have a positive pregnancy test, a gravid uterus with closed cervical os, and ultrasonographic evidence of intrauterine pregnancy (double decidual sac sign). Is associated with preserved fetal cardiac activity and serum β-hCG appropriate to gestational age

Answer 265

threatened abortion

Question 266

Are the two recommended methods of birth control post partum

Answer 266

* IUD (if no contraindications like endometritis, positive cytology, PUD, etc.) * progestin-only contraceptive pills

Question 267

Is the treatment of choice for spontaneous abortion complicated by heavy vaginal bleeding

Answer 267

dilation and curretage

Question 268

A condition of vaginal bleeding and cervical dilation without expulsion of products of conception (POC) before 20 weeks' gestation. FHR may or may not be present. Typically followed by partial or complete passage of POC.

Answer 268

inevitable abortion

Question 269

Is prescribed for patients with large and/or multiple uterine leiomyomas 2–3 months prior to surgery

Answer 269

GnRH agonist (e.g. leuprolide) ## Footnote GnRH agonists can reduce the size of leiomyomas by inducing hypoestrogenism and hypoprogesteronism

Question 270

The first-line therapy for symptomatic labial fusion

Answer 270

topical estrogen

Question 271

The ERBB2 receptor can be directly targeted by what pharmacotherapy?

Answer 271

trastuzumab

Question 272

Invasive ductal carcinoma usually shows overexpression of what gene?

Answer 272

ERBB2

Question 273

What change in hormones levels are associated with menopause?

Answer 273

* decreased estrogen * increased GnRH, FSH, and LH

Question 274

Is a first-line antibiotic agent for asymptomatic bacteriuria during pregnancy.

Answer 274

amoyxcillin and clavulanate (augmentin)

Question 275

Is the first-line drug for uncomplicated cystitis in nonpregnant women and a second-line antibiotic for the treatment of urinary tract infections in pregnant women in the 2nd and 3rd trimesters (except in the last month of pregnancy).

Answer 275

trimethoprim/sulfamethoxazole (Bactrim)

Question 276

Most cases of menorrhagia within the first two years after menarche are due to

Answer 276

hypothalamic-pituitary-ovarian axis immature with decreased GnRH

Question 277

Karyotypically female (46 XX) patients are born with ambiguous external genitalia and female internal reproductive organs. At puberty, affected individuals typically present with absent secondary sexual characteristics, amenorrhea (due to absent estrogen activity and the development of ovarian cysts, which impair ovulation), and features of virilization (due to increased testosterone levels). In addition, both men and women have a tall stature due to a delayed fusion of the epiphyseal growth plates, and signs of osteoporosis

Answer 277

aromatase deficiency

Question 278

A common cause of female pseudohermaphroditism and may manifest with virilization and menstrual irregularities. Female individuals usually have precocious puberty with the early development of female secondary sexual characteristics (due to synthesis of estrogens from excess androgens). In addition, they typically present earlier in childhood with salt-wasting.

Answer 278

congenital adrenal hyperplasia (CAH)

Question 279

Firm ulcer with indurated borders and inguinal lymphadenopathy. Arise as a single painless ulcer.

Answer 279

chancre (primary syphilis)

Question 280

Is a sexually transmitted infection that can manifest with multiple anogenital ulcers 1-2 cm in diamater and inguinal lymphadenopathy. They are usually covered in gray-yellow exudates.

Answer 280

chancroid

Question 281

What is the causative agent of a chancroid?

Answer 281

*Haemophilus ducreyi*

Question 282

The uterine artery and vein runs in what structure?

Answer 282

transverse cervical (cardinal) ligament

Question 283

What is the relation of the ureter to the cardinal ligament?

Answer 283

ureter courses inferior to the cardinal ligament ## Footnote water (urine) under the bridge

Question 284

What artery is contained in the round ligament?

Answer 284

Sampson artery ## Footnote A small, insignificant vessel that anastomoses with the uterine and ovarian arteries

Question 285

What artery is contained in the ovarian ligament?

Answer 285

ovarian branch of the uterine artery

Question 286

A sexually transmitted disease caused by L1–3 serovars of Chlamydia trachomatis. Patients initially develop a small, painless papule in the genital region that may ulcerate but will heal and disappear within one week. 2–4 weeks after the initial lesion, patients present with painful, suppurative, bilateral inguinal lymphadenopathy, and systemic symptoms such as fever, malaise, chills, and/or myalgia. Giemsa-stained smear of the ulcer may show intracytoplasmic bodies (reticulate bodies)

Answer 286

lymphogranuloma venereum

Question 287

Is a synthetic estrogen that was introduced in the 1940s as it was believed to prevent miscarriage in pregnant women. In 1971, it was discontinued because studies found that it is a potent transplacental carcinogen. It significantly increases the lifetime risk of vaginal clear cell adenocarcinoma, a rare form of vaginal cancer, in daughters of the women who received it.

Answer 287

Diethylstilbestrol (DES)

Question 288

What is first-line treatment for diastasis recti?

Answer 288

abdominal exercise to strengthen the rectus abdominis muscles and reduce the abnormal extension of the linea alba.

Question 289

What is the criteria for laparoscopy to treat an ectopic pregnancy compared to IM/IV methotrexate?

Answer 289

* β-hCG concentration > 5000 mIU/mL and * mass size > 3.5 cm ## Footnote If less than these values methotrexate is indicated

Question 290

What is the safest way to deliver a stillborn baby?

Answer 290

vaginal delivery, but some women may prefer C-section to avoid the experience of labor with a stillborn baby

Question 291

A condition characterized by the development of intense pruritus, usually of the palms and soles, during the second and/or third trimesters of pregnancy.

Answer 291

intrahepatic cholestasis of pregnancy (ICP)

Question 292

A pelvic organ prolapse characterized by protrusion of the bladder behind the anterior vaginal wall and into the vaginal introitus. Typically causes urinary hesitancy and a sensation of vaginal fullness.

Answer 292

cystocele

Question 293

Is a malignant type of vaginal cancer that most commonly affects girls < 8 years of age; Its classic appearance is a polypoid mass that resembles a bunch of grapes protruding through the vagina,

Answer 293

vaginal rhabdomyosarcoma

Question 294

A herniation (bulging) of the anterior wall of the rectum into the posterior wall of the vagina. Patients may be asymptomatic or can present with difficult bowel movements, a sensation of fullness in the vagina, and/or pain during sex. Diagnosis is typically made with vaginal examination (i.e., speculum and bimanual examination) and with digital rectal examination as the patient performs a Valsalva maneuver.

Answer 294

rectocele

Question 295

A third- or fourth-degree laceration that occurs during childbirth. These lacerations involve the anal sphincter and, in severe cases, the anal mucosa. Short-term complications include hemorrhage and infection. Long-term complications include urinary and/or fecal incontinence, chronic perineal pain, and dyspareunia.

Answer 295

obstetric anal sphincter injury (OASI)

Question 296

A type of small fiber neuropathy that affects autonomic nerves. Common in individuals with poorly controlled diabetes. May result in constipation, urinary retention, gastroparesis, erectile dysfunction, postural hypotension, and/or arrhythmias.

Answer 296

autonomic neuropathy

Question 297

What is a common hepatic sign (not enzyme levels) of HELLP syndrome?

Answer 297

Stretching of Glisson capsule

Question 298

The US Preventive Services Task Force recommends screening women ≥ ________ years of age for osteoporosis with bone measurement testing (e.g., dual-energy x-ray absorptiometry) every two years.

Answer 298

The US Preventive Services Task Force recommends screening women ≥ **65** years of age for osteoporosis with bone measurement testing (e.g., dual-energy x-ray absorptiometry) every two years.

Question 299

Is the best initial test to confirm the diagnosis of uterine leiomyomas.

Answer 299

pelvic ultrasound (US)

Question 300

Is the most common gynecological complaint among adolescent females. The condition is most likely caused by an increased production of endometrial prostaglandin (PG) F2

Answer 300

primary dysmenorrhea

Question 301

Hemolysis (e.g., anemia, mixed hyperbilirubinemia), acute hepatic failure (e.g., elevated liver function tests, prolonged PT, hypoalbuminemia), and acute renal insufficiency (e.g., elevated creatinine) in a pregnant woman at 32 weeks' gestation (third trimester) indicate what condition?

Answer 301

acute fatty liver of pregnancy (AFLP)

Question 302

What is first-line treatment for acute fatty liver of pregnancy (AFLP)

Answer 302

delivery of baby

Question 303

What is first-line treatment for intrahepatic cholestasis of pregnancy (ICP)

Answer 303

Ursodeoxycholic acid / ursodiol (UDCA)

Question 304

First-line treatment for patients with thrombotic thrombocytopenic purpura (TTP)

Answer 304

plasma exchange therapy

Question 305

Post exposure prophylaxis (PEP) for infants born to mothers with HIV and a viral load < 50 copies/mL

Answer 305

zidovudine

Question 306

Post exposure prophylaxis (PEP) for infants born to mothers with HIV and a viral load ≥ 50 copies/mL

Answer 306

* zidovudine * lamivudine * nevirapine

Question 307

Tender, fluctuant mass surrounded by edema and erythema on the inner posterior labium and causes pain with intercourse (dyspareunia)

Answer 307

Bartholin gland abscess ## Footnote > 3 cm drainage followed antibiotics < 3 cm monitoring/sitz bath

Question 308

Patients with an ovarian mass that has a high probability of malignancy should undergo

Answer 308

surgical exploration and oophorectomy

Question 309

Is the most common and second most common cause of abnormal maternal serum AFP (MSAFP) levels

Answer 309

* incorrect estimate of gestational age (older than expected) * neural tube defects * abdominal wall defects (gastroschisis and omphalocele) ## Footnote usually combined with fetal ultrasound to account of any errors in gestational age

Question 310

What should be done if placenta previa is detected at the 16-20 week transvaginal ultrasound (TVUS)?

Answer 310

Repeat ultrasonography at 32 weeks' gestation and if still covering the os schedule a c-section for 36 to 37 weeks.

Question 311

Are the primary lymphatic draining site for the ovaries.

Answer 311

para-aortic lymph nodes

Question 312

Are the primary lymphatic draining site for the distal vagina, vulva, and penis.

Answer 312

superficial inguinal lymph nodes

Question 313

Are the primary lymphatic draining site for the colon starting from the splenic flexure to the upper rectum.

Answer 313

inferior mesenteric lymph nodes

Question 314

Are the primary lymphatic draining site for the body of the uterus as well as the superior bladder.

Answer 314

external iliac lymph nodes

Question 315

Are the primary lymphatic draining site for the middle third of the vagina as well as the cervix

Answer 315

internal iliac lymph nodes

Question 316

Is recommended for breastfeeding patients with nipple injury in the absence of infection.

Answer 316

Continued breastfeeding and management of injury including latch education and supportive care

Question 317

What enzyme is most commonly deficient in congenital adrenal hyperplasia (CAH) and what substrate is elevated?

Answer 317

* enzyme - 21-hydroxlase * substrate - 17-hydroxy-progesterone

Question 318

Ovarian fibrosis and multiple cystic follicles are characteristic of

Answer 318

polycystic ovarian syndrome (PCOS)

Question 319

Can Zika virus be transmitted sexually and how do you prevent its transmission?

Answer 319

Zika virus can be sexually transmitted. Patients should use contraception or abstain (2 months women and 3 months men). In the case of pregnancy, both partners should use contraception or abstain from sex for the entire pregnancy.

Question 320

The strongest predisposing factors for HPV infection are ________ and ________.

Answer 320

The strongest predisposing factors for HPV infection are **early onset of sexual activity** and **multiple sexual partners**.

Question 321

Individuals with a genetic predisposition to breast cancer (e.g., BRCA mutation) should begin screening from 25–29 years of age. For those aged ≤ 29 years, ________ are recommended. For those aged ≥ 30 years, ________ is recommended.

Answer 321

Individuals with a genetic predisposition to breast cancer (e.g., BRCA mutation) should begin screening from 25–29 years of age. For those aged ≤ 29 years, **breast examination every 6–12 months and annual breast MRI** are recommended. For those aged ≥ 30 years, **annual MRI plus mammography** is recommended.

Question 322

Typically manifests with features of heart failure at the end of pregnancy or the early postpartum period. Diagnosis is based on a LVEF of < 0.45 on echocardiography and the exclusion of other potential causes of heart failure.

Answer 322

Peripartum cardiomyopathy (PPCM)

Question 323

Common sources of *Listeria monocytogenes*?

Answer 323

* soft cheese * deli meat * unpasteurized milk

Question 324

How does treatment of lichen sclerosus differ in pediatric versus adult patients with a new diagnosis?

Answer 324

* pediatric - start topical corticosteroids * perform a punch biopsy first to rule out malignancy then start topical corticosteroids ## Footnote lichen sclerosus has an increased risk of squamous cell carcinoma (SCC).

Question 325

Is indicated in all Rh-negative women after spontaneous abortion

Answer 325

Administration of anti-D immunoglobulin (RhoGAM)

Question 326

A rare but life-threatening condition in the peripartum period caused by the entry of fetal cells and debris from the amniotic fluid into maternal circulation. These cells and debris are thromboplastin-rich and trigger disseminated intravascular coagulation. Risk factors include placental abruption, uterine rupture, grand multiparity, age > 35 years, and certain procedures such as amniocentesis.

Answer 326

amniotic fluid embolism (AFE)

Question 327

Is the second most common cause of PPH

Answer 327

GU injury

Question 328

A life-threatening obstetric condition for the mother and the baby that usually arises during labor and manifests with a sudden pause in contractions, an abnormal fetal heart rate (usually bradycardia), severe abdominal pain, vaginal bleeding, loss of fetal station, and hemodynamic instability. Previous c-section and macrosomia predisposes to it.

Answer 328

uterine rupture ## Footnote treated with emergent laparotomy

Question 329

Causes for genital tract lacerations include:

Answer 329

* fetal macrosomia * fetal malpresentation * iatrogenic (operative vaginal delivery and episiotomy)

Question 330

Inhaled ________ are indicated in patients with mild persistent asthma to reduce exacerbations and can be combined with ________

Answer 330

Inhaled **corticosteroids (e.g., budesonide)** are indicated in patients with mild persistent asthma to reduce exacerbations and can be combined with **short-acting beta-2 agonists (e.g., albuterol)**

Question 331

Painless cervical dilation, in the absence of uterine contractions and/or labor, in the second trimester of pregnancy. Can lead to second-trimester pregnancy loss and preterm birth.

Answer 331

cervical incompetence/insufficiency

Question 332

A procedure in which the cervix is temporarily sutured shut.

Answer 332

cervical cerclage

Question 333

The most common causative organism overall, causing ∼ 80% of cases of urinary tract infections (UTI).

Answer 333

*Escherichia coli*

Question 334

A lower urinary tract infection that occurs in women after recent sexual activity, which can cause irritation of the urethral meatus and facilitate bacterial entry into the urethra (e.g., from the genital and/or anal region).

Answer 334

honeymoon cystitis

Question 335

Is the first-line treatment in patients with endometriosis who do not want to conceive and have mild to moderate pelvic pain without complications.

Answer 335

* NSAIDs * estrogen-progestin or progestogen-only contraceptives

Question 336

Is used to remove the products of conception following first-trimester pregnancy loss

Answer 336

dilation and curretage (D&C)

Question 337

A decline in the number of functioning oocytes (either as a normal consequence of age or due to an underlying disorder such as endometriosis) that manifests as a reduced response to ovarian stimulation in individuals who can become pregnant and who have regular menstruation.

Answer 337

diminished ovarian response (DOR)

Question 338

Is the most common causative pathogen of infectious puerperal mastitis.

Answer 338

*Staphylococcus aureus*

Question 339

Multiple, painless, indurated genital ulcers with a vascular beefy-red base and elevated, rolled margins along with the absence of inguinal lymphadenopathy. Obligate intracellular coccobacillus that multiplies in mononuclear cells (e.g., macrophages) and forms bipolar intracytoplasmic inclusions called Donovan bodies.

Answer 339

granuloma inguinale

Question 340

What 2 antibodies are seen in antiphospholipid syndrome (APS)

Answer 340

* anti-β2-glycoprotein 1 antibodies * lupus anticoagulant

Question 341

What antibodies are seen in systemic lupus erythematosus (SLE)

Answer 341

* anti-nuclear antibodies (non-specific) * anti-smith antibodies

Question 342

What antibody is seen in mixed connective tissue disease (MCTD)

Answer 342

anti-ribonucleoprotein antibodies

Question 343

What antibody is seen in rheumatoid arthritis?

Answer 343

anti-cyclical citrullinated peptide (CCP) antibodies

Question 344

What antibody is seen in diffuse systemic sclerosis (SSc)?

Answer 344

Anti-DNA topoisomerase I antibodies

Question 345

What antibody is seen in dermatomyositis and polymyositis?

Answer 345

Anti-synthetase antibodies

Question 346

Aggressive, invasive breast tumor that arises from ductal epithelium. The most common type of breast cancer (80% of cases). Usually affects women between the ages of 35 and 60. Most often discovered incidentally as a breast lump during routine examination but may present with bloody or serous nipple discharge, and/or skin changes. Poorly circumscribed mass with microcalcifications.

Answer 346

invasive ductal carcinoma

Question 347

What is a the most common side effect of magnesium sulfate ## Footnote eclampsia prophylaxis

Answer 347

depressed or absent DTRs ## Footnote if depressed taper dose and if absent stop and switch to calcium gluconate

Question 348

Oxytocin stimulates the ________ cells in the breast parenchyma to contract and aids in milk secretion

Answer 348

Oxytocin stimulates the **myoepithelial** cells in the breast parenchyma to contract and aids in milk secretion

Question 349

Test used for diagnosing premature rupture of membranes. Vaginal fluid is placed on a pH indicator strip. The strip turns blue (indicating pH >6.0) when the vaginal fluid is composed of amniotic fluid;

Answer 349

nitrazine test

Question 350

A test used to diagnose ruptured membranes in pregnant patients. Vaginal fluid is placed on a glass slide and allowed to dry. Amniotic fluid creates a characteristic pattern under microscopy.

Answer 350

Fern test

Question 351

Indicated in patients with PPROM who are at < 34 weeks' gestation and patients with PPROM at ≥ 34 weeks' gestation, respectively

Answer 351

i* < 34 weeks - ampicillin, azithromycin (macrolide), and betamethasone (lung maturity) * ≥ 34 weeks - Sterile speculum examination and bethamethasone

Question 352

What antibody is seen in autoimmune hepatitis (AIH)?

Answer 352

Anti-smooth muscle antibodies (ASMA)

Question 353

What antibodies are seen in Sjögren's Syndrome

Answer 353

* Anti-Ro (SSA) and * Anti-La (SSB) antibodies

Question 354

The first/second/third-line treatment for hirsutism

Answer 354

* first - combined oral contraceptives (COCs) for 6 months * spironolactone * flutamide (considered)

Question 355

The treatment of choice for neurosyphilis

Answer 355

IV penicillin G

Question 356

The treatment of choice for primary, secondary, and early latent syphilis

Answer 356

IM penicillin G

Question 357

Is the most common causes of cervicitis

Answer 357

an STI like chlamydia and/or gonorrhea

Question 358

The treatment for chlamydia in a pregnant and non-pregnant patient?

Answer 358

* pregnant - oral azithromycin (1 oral dose) * non-pregnant - oral doxycyclin (oral bid 7 days)

Question 359

The treatment for gonorrhea in a pregnant and non-pregnant patient?

Answer 359

both - IM ceftriaxone

Question 360

Course of action in pregnant women with exposure to parvovirus B19 (erythema infectiosum/Fifth disease)?

Answer 360

* before 20 weeks' - viral assays (IgG/IgM) and risk of fetal loss counseling * after 20 weeks' - serial fetal ultrasounds for hydrops fetalis ## Footnote hydrops fetalis is a RBC lysis problem causing anemia compared to placental abruption which casues fetal hypoxemia

Question 361

PCOS is commonly associated with metabolic syndrome, which can manifest with ________, ________ and ________.

Answer 361

PCOS is commonly associated with metabolic syndrome, which can manifest with **dyslipidemia**, **obesity**, and **insulin resistance**.

Question 362

What is treatment for chorioamnionitis

Answer 362

* IV ampicillin and gentamicin, and labor induction * post labor one dose of ampicillin or gentamicin plus clindamycin

Question 363

What is the most common adverse effect of raloxifene?

Answer 363

thromboembolitic events

Question 364

An umbilical hernia, erosive scalp lesions, and aplasia cutis in a neonate would be most consistent with

Answer 364

methimazole use

Question 365

Bradycardia (due to heart block) and annular rash are features seen in neonatal

Answer 365

systemic lupus erythematosus (SLE)

Question 366

A mechanical holosystolic murmur and tetany in a neonate would be consistent with

Answer 366

DiGeorge syndrome

Question 367

Poor weight gain and stridor are serious neonatal manifestations that may be seen in

Answer 367

neonatal Graves disease

Question 368

Trastuzumab, anthracyclines, and taxanes are ________toxic

Answer 368

Trastuzumab, anthracyclines, and taxanes are **cardio**toxic ## Footnote perform echocardiogram

Question 369

May cause eye dryness, irritation, cataracts, and retinopathy (e.g., deposits in the retina and macula resulting in edema)

Answer 369

tamoxifen ## Footnote perform fundoscopy

Question 370

A complication of long-term therapy with aromatase inhibitors (e.g., anastrozole)

Answer 370

osteoporosis

Question 371

If a pregnant woman is exposed to a patient with rubella, ________ within 5 days of exposure can prevent maternal rubella infection.

Answer 371

If a pregnant woman is exposed to a patient with rubella, **passive immunization with intravenous immunoglobulins (IVIG)** within 5 days of exposure can prevent maternal rubella infection.

Question 372

Placentation defects are associated mostly with drugs that manipulate blood flow and induce vasospasm, such as

Answer 372

* cocaine and * nicotine

Question 373

Can be used in the management of women who are not in labor and are at ≥ 36 weeks' gestation with a breech singleton fetus. Should only be performed in patients who are near-term or full-term as there are significant risks (e.g., preterm labor, rupture of membranes, antepartum hemorrhage), which might necessitate emergency delivery.

Answer 373

external cephalic version (ECV)

Question 374

Is the best initial step for managing patients with mildly symptomatic pelvic organ prolapse (POP) in the absence of urinary or defecatory dysfunction

Answer 374

* pelvic floor muscle training (e.g., Kegel exercises) * vaginal pessary (silicone supportive insert) ## Footnote conservative management for absence of urinary/fecal incontinence

Question 375

Is the best initial step for managing patients with symptomatic pelvic organ prolapse (POP) with urinary or defecatory dysfunction

Answer 375

surgical correction

Question 376

In primary amenorrhea for AFAB individuals >13 years old what is the steps for care?

Answer 376

* first - pregnancy test and then pelvic exam to check for uterus * second - measure serum FSH levels

Question 377

The first-line surgical procedure for stress incontinence if conservative therapy, consisting of pelvic floor muscle exercises (Kegel exercises), lifestyle changes (e.g., weight loss, alcohol cessation), and use of continence pessaries have failed.

Answer 377

urethral sling

Question 378

typically begin in the abdominal striae with periumbilical sparing. They can subsequently spread to the chest, back, and extremities, that usually spare the face, palms, and soles.

Answer 378

polymorphic eruption of pregnancy (PEP)/pruritic urticarial papules and plaques of pregnancy (PUPPP)

Question 379

How do you treat polymorphic eruption of pregnancy (PEP)

Answer 379

* topical corticosteroids and * antihistamines for symptoms ## Footnote usually resolve spontaneously

Question 380

is the first-line agent for the treatment of severe enterobiasis in pregnancy

Answer 380

Pyrantel pamoate

Question 381

Medication is effective against Schistosoma spp. and tapeworms such as Taenia spp. (e.g., intestinal taeniasis and neurocysticercosis) and Diphyllobothrium latum (fish tapeworm),

Answer 381

praziquantel

Question 382

Is the drug of choice for the treatment of infection with Strongyloides spp. or Onchocerca volvulus

Answer 382

ivermectin

Question 383

ID the chorionicity and amnionicity

Answer 383

dichorionicity and diamnionicity (di/di) ## Footnote lambda-sign

Question 384

ID the chorionicity and amnionicity

Answer 384

monochorionicity/diamnionicity (mono/di) ## Footnote T-sign

Question 385

For a pregnant woman with Graves disease, ________ is the therapy of choice during the first trimester. ________ is the preferred antithyroid drug during the second and third trimesters

Answer 385

For a pregnant woman with Graves disease, **propylthiouracil (PTU)** is the therapy of choice during the first trimester. **Methimazole** is the preferred antithyroid drug during the second and third trimesters

Question 386

The risk of intimate partner violence (IPV) increases during what two periods

Answer 386

* pregnancy * postpartum period

Question 387

Is the most sensitive test for detecting early pregnancy.

Answer 387

Serum β-hCG testing ## Footnote as early as 6–9 days after fertilization

Question 388

The common adverse effect of a beta-2 adrenergic receptor agonist ## Footnote Terbutaline and the -terol drugs

Answer 388

hypokalemia ## Footnote Can cause hypokalemia by stimulating the Na+/K+-ATPase, which leads to an intracellular K+ shift.

Question 389

Patients with PID should be treated with what empiric antibiotic therapy ## Footnote Outpatient treatment

Answer 389

* ceftriaxone (gonorrhea) * doxycycline (chlamydia) * metronidazole (anaerobes and protozoa)

Question 390

Is the single most accurate method of estimating the gestational age in the first trimester

Answer 390

crown rump length (CRL)

Question 391

Is the most accurate method of estimating the gestational age in the second trimester

Answer 391

* head circumference * femur length ## Footnote crown rump length (CRL) is most accurate in 1st trimester and overall most accurate

Question 392

calcifications of the placenta indicate what?

Answer 392

placental insufficiency

Question 393

A collection of congenital defects including intrauterine growth restriction, microcephaly, craniofacial deformities, nail hypoplasia, and intellectual disability. Usually caused by maternal use of phenytoin or, less commonly, carbamazepine.

Answer 393

fetal hydantoin syndrome

Question 394

is the antidote for heparin overdose

Answer 394

protamine sulfate

Question 395

What are the five F's of gallstones

Answer 395

* Female * Fat * Forty * Fair Skin * Fertile

Question 396

progesterone supplementation is essential in patients who undergo removal of the corpus luteum (via oophorectomy) before ________ weeks' gestation.

Answer 396

progesterone supplementation is essential in patients who undergo removal of the corpus luteum (via oophorectomy) before **10** weeks' gestation.

Question 397

Isolated mild thrombocytopenia (________) in an asymptomatic pregnant patient should raise concern for gestational thrombocytopenia (GT).

Answer 397

Isolated mild thrombocytopenia (**≤ 100,000/mm3**) in an asymptomatic pregnant patient should raise concern for gestational thrombocytopenia (GT). ## Footnote reassurance if asymptomatic

Question 398

Provide mechanical support to the uterus by connecting the cervix to the sacrum and lateral pelvis. These ligaments play a vital role in the prevention of uterine prolapse. The ligaments also provide mechanical support to the pelvic floor as a whole and so play a role in the pathogenesis of the broader group of disorders comprised by pelvic organ prolapse.

Answer 398

Uterosacral ligaments

Question 399

Benign breast condition most commonly caused by trauma to the breast. Patients may present with examination and radiological findings that mimic malignancy (e.g., irregular borders, skin retraction), and biopsy is typically performed to confirm the diagnosis with foam cells and multinucleated giant cells

Answer 399

fat necrosis of the breast ## Footnote reassure patient

Question 400

Is indicated for phyllodes tumors because of their high rate of recurrence and potential for malignancy.

Answer 400

wide resection

Question 401

Indicated for patients with biopsy-proven breast cancer without spread to the axillary lymph nodes,

Answer 401

simple mastectomy

Question 402

Indicated for patients with biopsy-proven breast cancer that has spread to the axillary lymph nodes

Answer 402

modified radical mastectomy

Question 403

Is the most appropriate next step in the diagnostic evaluation of the female partner if she has risk factors for tubal obstruction, such as endometriosis, pelvic inflammatory disease, or a previous ectopic pregnancy.

Answer 403

hysteroscopy

Question 404

Colposcopy with endocervical sampling is appropriate for all nonpregnant patients with atypical glandular cells (AGCs) to rule out cervical cancer, regardless of HPV test results. In addition, ________ should be performed in nonpregnant patients with atypical glandular cells (AGCs) who are ≥ 35 years of age and in nonpregnant patients aged < 35 years with atypical glandular cells (AGCs) and abnormal uterine bleeding

Answer 404

Colposcopy with endocervical sampling is appropriate for all nonpregnant patients with atypical glandular cells (AGCs) to rule out cervical cancer, regardless of HPV test results. In addition, **endometrial sampling** should be performed in nonpregnant patients with atypical glandular cells (AGCs) who are ≥ 35 years of age and in nonpregnant patients aged < 35 years with atypical glandular cells (AGCs) and abnormal uterine bleeding

Question 405

is indicated in patients with HELLP syndrome at ≥ 34 weeks' gestation

Answer 405

delivery ## Footnote any gestational age if the maternal or fetal status deteriorates

Question 406

What are maternal complications of HELLP syndrome?

Answer 406

* PE * abruptio placentae (placental abruption) * DIC * stroke ## Footnote PADS HELLP

Question 407

is indicated in all patients with HELLP syndrome for seizure prophylaxis

Answer 407

magnesium sulfate

Question 408

Postterm pregnancy increases the risk for

Answer 408

* meconium-stained amniotic fluid and meconium aspiration syndrome (MAS) * placental insufficiency * oligohydramnios * macrosomia

Question 409

A substance that promotes blood coagulation. Includes factors:

Answer 409

V, VII, VIII, IX, and X ## Footnote protein S and C are anticoagulants

Question 410

What is the general treatment for mastitis in breastfeeding mothers?

Answer 410

Continue breastfeeding with the affected breast and initiate dicloxacillin or cephalexin (*Staphylococcus aureus* and GAS, *Haemophilus influenzae*, and *E. coli* sensitive meds safe in breast feeding, respectively).

Question 411

What is a complication of mastitis?

Answer 411

breast abscess

Question 412

Regardless of the CIN grade before a procedure or the patient's previous HPV status, an ________ (i.e., primary HPV testing or cotesting with a Pap smear and HPV test) in 6 months is the most appropriate next step for follow-up in patients ≥ 25 years and a ________ in 6 months for follow-up in patients < 25

Answer 412

Regardless of the CIN grade before a procedure or the patient's previous HPV status, an **HPV-based test** (i.e., primary HPV testing or cotesting with a Pap smear and HPV test) in 6 months is the most appropriate next step for follow-up in patients ≥ 25 years and a **solitary pap** in 6 months for follow-up in patients < 25

Question 413

Obese postmenopausal women with early menarche, late menopause, and nulliparity, are at an increased risk of developing ________.

Answer 413

Obese postmenopausal women with early menarche, late menopause, and nulliparity, are at an increased risk of developing **endometrial hyperplasia/cancer**.

Question 414

What is treatment for endometrial hyperplasia without atypia

Answer 414

progestin therapy ## Footnote Progestin opposes the stimulating effect of estrogen on the endometrium, thereby preventing hyperplasia

Question 415

A condition characterized by adhesions and/or fibrosis of the endometrium that can cause amenorrhea and infertility. Associated with intrauterine instrumentation (e.g., dilation and curettage), postpartum hemorrhage, or intrauterine infections.

Answer 415

Asherman syndrome (intrauterine adhesions)

Question 416

A test used to measure the level of a protein that attaches the fetal amniotic sac to the uterus. Is used to determine whether a patient is in true or false labor and can determine the likelihood of delivery within 7 to 10 days of testing when present in cervicovaginal fluid

Answer 416

fetal fibronectin test

Question 417

Used to assess for placental insufficiency in pregnant individuals with fetal growth restriction. Reduced or reversed end-diastolic flow indicates placental insufficiency.

Answer 417

doppler velocimetry of the umbilical artery

Question 418

What is the primary treatment for granuloma inguinale (sexually transmitted infection caused by *Klebsiella granulomatis*)?

Answer 418

oral azithromycin ## Footnote Klebsiella species are resistant to carbapenems

Question 419

What should be done for preeclampsia without severe features after 37 weeks?

Answer 419

induction of labor

Question 420

In regards to endometrial hyperplasia, what SERMS increase and decrease the risk?

Answer 420

increase - tamoxifen decrease - raloxifene ## Footnote tam(pon)oxifene - tampons are for flow and endometrial hyperplasia increases flow, so tamoxifene increases risk for endometrial hyperplasia

Question 421

Indicated for pregnant individuals with cervical insufficiency who are at < 24 weeks' gestation to help prevent pregnancy loss and preterm birth

Answer 421

Transvaginal cervical cerclage placement

Question 422

A cervical length of < 25 mm that is measured via transvaginal ultrasound either at or before 24 weeks' gestation.

Answer 422

short cervix length

Question 423

What is the treatment of short cervical length without cervical dilation (insufficiency) present?

Answer 423

vaginal progesterone supplementation

Question 424

The treatment of choice in hemodynamically stable women with acute AUB,

Answer 424

conjugated estrogen therapy

Question 425

The initial step to decrease severe bleeding in a hemodynamically unstable woman with acute AUB

Answer 425

intrauterine tamponade

Question 426

Is the onset of hypertension (defined as sBP ≥ 140 mm Hg or dBP ≥ 90 mm Hg) prior to pregnancy, before 20 weeks' gestation, or > 12 weeks after giving birth.

Answer 426

chronic hypertension in pregnancy ## Footnote NOT gestational hypertension because that has to be after 20 weeks

Question 427

When systolic blood pressure is ≥ 140 mm Hg or diastolic pressure is ≥ 90 mm Hg at ≥ 20 weeks' gestation.

Answer 427

gestational hypertension

Question 428

Is characterized by the new onset of proteinuria and/or evidence of end-organ damage (transaminitis, renal insufficiency, thrombocytopenia, pulmonary edema, abdominal pain, visual disturbances, treatment-refractory headache) in a patient with chronic hypertension.

Answer 428

superimposed preeclampsia

Question 429

What ovarian condition is associated with molar pregnancies?

Answer 429

theca lutein cysts

Question 430

A well-circumscribed anechoic mass with posterior acoustic enhancement in a premenopausal woman suggests a:

Answer 430

simple breast cyst

Question 431

What is monitoring/treatment of an asymptomatic versus symptomatic breast cyst?

Answer 431

asymptomatic - ultrasound to confirm; if cancer concern FNA symptomatic - ultrasound can confirm; followed by FNA

Question 432

Is an invasive (or internal) form of intrapartum fetal heart rate (FHR) monitoring that is typically used in patients whose external FHR monitoring poses technical difficulties from an anterior placenta, too much body fat, or other conditions that limit obtaining a measurement.

Answer 432

fetal scalp electrode monitoring

Question 433

Is the best initial step in the management of hemodynamically unstable patients with hypovolemic shock (tachycardia, hypotension, and cool, clammy extremities), regardless of the etiology, to prevent ischemic injury and multiorgan failure.

Answer 433

administer IV fluids (IVF tx)

Question 434

strong risk factor for developing hyperemesis gravidarum

Answer 434

* multiple gestation (twins) * molar pregnancies (complete > partial) ## Footnote due to the elevated levels of hCG and progesterone

Question 435

Inadequately treated hyperemesis gravidarum may cause ________ vitamin deficiency and consequent ________

Answer 435

Inadequately treated hyperemesis gravidarum may cause **thiamine** deficiency and consequent **Wernicke encephalopathy**.

Question 436

Manifests as firm, nontender masses in the subareolar region that are commonly seen in women who are lactating.

Answer 436

galactocele

Question 437

When do you administer RhoGAM shots?

Answer 437

* First shot - beginning of third trimester ~28 weeks * Second shot - within 72 hours after birth if the baby is Rh+ * After any invasive procedure in an Rh- mother (e.g. amniocentesis, etc.) * Any fetomaternal bleeding event

Question 438

What is treatment of an uncomplicated ectopic pregnancy?

Answer 438

* IM/IV methotrexate and RhoGAM (if Rh- blood type)

Question 439

Forms when a Graafian follicle fails to ovulate and continues to grow instead. Are thin-walled, fluid-filled unilocular without solid components in the ovary

Answer 439

follicular (Graafian) cyst

Question 440

What is the triad of Down Syndrome (DS) in first trimester pregnancy screening tests?

Answer 440

* increased nuchal translucency * elevated hCG * decreased pregnancy-associated plasma protein A (PAPP-A)

Question 441

The status of ________ in patients with breast cancer is considered one of the most important prognostic factors for disease outcome.

Answer 441

The status of **axillary lymph nodes** in patients with breast cancer is considered one of the most important prognostic factors for disease outcome.

Question 442

What arthritis is associated with *Neisseria gonorrheae*?

Answer 442

purulent arthritis

Question 443

What arthritis is associated with *Chlamydia trachomatis*?

Answer 443

reactive arthritis

Question 444

Prophylactic ________ in the second and third trimesters is indicated in all pregnant women with a high risk of developing preeclampsia

Answer 444

Prophylactic **low-dose aspirin** in the second and third trimesters is indicated in all pregnant women with a high risk of developing preeclampsia

Question 445

What is the Rotterdam criteria?

Answer 445

* oligoovulation or anovulation * hyperadrogenism (hirsutism, facial hair, acne) * enlarged ovaries

Question 446

What are complications of PCOS?

Answer 446

* pregnancy loss * endometrial cancer * T2DM * cardiovascular disease

Question 447

What is the mechanism of peau d'orange (skin resembling an orange peel), which supports the diagnosis of inflammatory breast cancer?

Answer 447

obstruction of the lymphatic channels

Question 448

A serious complication of ovulation induction or ovarian stimulation characterized by ovarian enlargement, ascites, and hypovolemia. Caused by extravasation of fluid into the interstitial space due to increased capillary permeability. Most commonly occurs following hCG administration.

Answer 448

ovarian hyperstimulation syndrome (OHSS)

Question 449

What is the mechanism of ovarian hyperstimulation syndrome (OHSS)

Answer 449

granulosa cell luteinization

Question 450

An amniotic fluid index ≤ ________ is consistent with oligohydramnios

Answer 450

An amniotic fluid index ≤ **5** is consistent with oligohydramnios

Question 451

What is the confirmatory test for thalassemia?

Answer 451

hemoglobin electrophoresis

Question 452

Until proven otherwise, the cause of postmenopausal vaginal bleeding should be considered ________.

Answer 452

Until proven otherwise, the cause of postmenopausal vaginal bleeding should be considered **malignant**.

Question 453

The beginning and end of FHR decelerations correspond with the progression of a contraction, resulting in early decelerations on CTG. Early decelerations are a benign finding and not a sign of fetal distress. They can be caused by what?

Answer 453

fetal head compression

Question 454

An accumulation of serous fluid in the fallopian tubes that results from distal blockage of the tubes. Distended fallopian tube with incomplete septations on imaging.

Answer 454

hydrosalpinx

Question 455

Is the most appropriate next step in the management of a patient with a palpable breast lump and imaging findings suggestive of breast cancer.

Answer 455

core needle biopsy

Question 456

Who is most at risk of osteoporosis?

Answer 456

post-menopausal caucasian women who smoke ## Footnote female, caucasian race, smoking, skinny, corticosteroid use, adrenal/thyroid conditions, and menopause status (late menarche and early menopause).

Question 457

Compare and contrast hormone status in osteoporosis and endometrial cancer

Answer 457

osteoporosis - late menarche and early menopause (decrease estrogen exposure) endometrial cancer - early menarche and late menopause (increased estrogen exposure)

Question 458

What blood pressure medication is a protective factor for osteoporosis?

Answer 458

beta-blockers

Question 459

Can be used to determine whether a fetus at risk for hemolytic disease of the newborn / erythroblastosis fetalis is in distress?

Answer 459

bilirubin concentration in amniotic fluid

Question 460

antibodies that may be acquired during a blood transfusion or from blood products

Answer 460

Kell antibody ## Footnote can result in HDN just like in Rh - mothers with Rh + baby

Question 461

What are 5 causes of fetal tachycardia?

Answer 461

* maternal fever * maternal medications * fetal anemia * fetal hypoxia * intra-amniotic/uterine infections

Question 462

Occiput posterior position can cause protraction or arrest of labor but more common presents with molding of the fetal head and what?

Answer 462

caput succedaneum ## Footnote **c**aput **s**uccedaneum - **c**rosses **s**utures (compared to cephalohematoma which doesn't)

Question 463

The most common cause of chorioamnionitis

Answer 463

prolonged rupture of membranes ( > 18 hours prior to delivery)

Question 464

Aortocaval compression is caused by what and treated how in delivery?

Answer 464

gravid uterus compression aorta and treated with maternal supine position during labor

Question 465

methylergonovine is contraindicated in patients with a history of what?

Answer 465

hypertension and coronary/cerebral artery disease

Question 466

Treatment of pelvic infections such as endometritis and tubo-ovarian abscess (TOA)

Answer 466

* oral clindamycin * oral gentamicin ## Footnote or IV

Question 467

Treatment of choice for bacterial vaginosis

Answer 467

* oral metronidazole * vaginal clindamycin * vaginal metronidazole

Question 468

patient presents with vulvar and vaginal itching.

Answer 468

vulvovaginal candidiasis

Question 469

First and second-line treatment for condylomata acuminata?

Answer 469

* Podophyllum resin therapy * Interferon therapy

Question 470

In post menopausal woman what happens to the ovaries?

Answer 470

They decrease in volume ## Footnote A palpable ovary in a post menopausal patient is concerning for malignancy. (30% are)

Question 471

Can be used as a treatment for leiomyomas with abnormal uterine bleeding.

Answer 471

uterine artery embolization

Question 472

Is recommended for patients with secondary amenorrhea who are not pregnant and have normal levels of hypothalamic-pituitary hormones (i.e., prolactin, FSH, and TSH)

Answer 472

progesterone withdrawal test

Question 473

is caused by a subacute autoimmune inflammation of the thyroid gland that results in lymphocytic infiltration, destruction of the ________ cells, and subsequent release of preformed thyroid hormones after giving birth: ________

Answer 473

is caused by a subacute autoimmune inflammation of the thyroid gland that results in lymphocytic infiltration, destruction of the **follicular** cells, and subsequent release of preformed thyroid hormones after giving birth: **Postpartum thyroiditis (PPT)**

Question 474

What is the triad of congenital rubella?

Answer 474

* cataracts * PDA * sensorineural deafness ## Footnote CPS should be called on antivax mothers who don't get the MMR vaccine in themselves or their babies

Question 475

When is a pregnancy at risk for congenital rubella?

Answer 475

first trimester (up to 12 weeks)

Question 476

antepartum test frequently performed for at-risk pregnancies. measures FHR and response to fetal movements.

Answer 476

fetal nonstress test

Question 477

Test to quantify the amount of fetal blood to which the maternal circulation has been exposed in order to determine adequacy of Rh(D) immune globulin dosing

Answer 477

Kleihauer-Betke (acid elution) test

Question 478

What would you expect to see with FSH levels in diminished ovarian response (DOR)?

Answer 478

Increased FSH - more hormone is needed to stimulate remaining follicles

Question 479

What is the progestin challenge test for?

Answer 479

amenorrhea evaluation - observed for uterine bleeding after the withdrawal of progesterone. If uterine bleeding occurs that means they have adequate estrogen to create a lining

Question 480

ID

Answer 480

Question 481

ID

Answer 481

Question 482

ID

Answer 482

Question 483

A patient presents with suspicion of fibrocystic changes of the breast during menses. What should your next step be?

Answer 483

Re-examine the patient on day 9 of their next cycle. ## Footnote IF fibrocystic size would be decreases as there is a hormone level drop around this time of the next cycle

Question 484

A drug used for fertility that stimulates ovulation

Answer 484

clomiphene

Question 485

What is the MoA of clomiphene?

Answer 485

estrogen receptor antagonist in the hypothalamus (stops GnRH negative feedback) thus multiple ovulations

Question 486

What occurrences increase chance of multiple gestations?

Answer 486

* ovulation induction * intrauterine insemination * IVF ## Footnote reproductive technologies. Twins skip a generation in families a lot of times (grandparent and grandchild)

Question 487

more than five uterine contractions in a 10-minute period, averaged over a 30-minute window

Answer 487

uterine tachysystole ## Footnote Excessively frequent contractions can reduce blood flow to the fetus, potentially causing distress

Question 488

What is treatment for uterine tachysystole?

Answer 488

terbutaline

Question 489

What is the most common cause of both acute and chronic endometritis?

Answer 489

* acute - infections like GC/CT (e.g. PID) * chronic - inflammatory or idiopathic

Question 490

What is seen on biospy in chronic endometritis?

Answer 490

plasma cells

Question 491

What artery is involved/injured in vulvar hematomas?

Answer 491

pudendal

Question 492

What artery is involved/injured in retroperitoneal or vaginal hematomas?

Answer 492

uterine and hypogastric arteries

Question 493

What is first and second-line treatment for vulvar and vaginal hematomas?

Answer 493

first - ice packs / OTC analgesics (supportive) second - incision and drainage

Question 494

What is treatment for retroperitoneal hematomas?

Answer 494

surgical drainage

Question 495

vaginal discharge following delivery is called?

Answer 495

lochia alba ## Footnote can be as long 6 weeks post partum. first week is red, then pale for 2-3 weeks, followed by white to yellow the remaining 2-3 weeks.

Question 496

What 3 antibiotics are primarily used for uncomplicated cystitis?

Answer 496

* trimethoprim/sulfamethoxazole (Bactrim) * fosfomycin * nitrofurantoin

Question 497

What antibiotics are used primarily for complicated cystitis?

Answer 497

* Outpatient - fluoroquinolones * Inpatient - piperacillin/tazobactam (zosyn), ceftriaxone, and carbapenems

Question 498

Excluding BRCA1/2, what is the biggest risk factor for breast cancer?

Answer 498

age

Question 499

Dysuria without any identifiable infectious or inflammatory causes of urethral pain.

Answer 499

acute urethral syndrome / urethral pain syndrome (UPS)

Question 500

Incontinence that is due to detrusor instability where you feel the urge to urinate immediately

Answer 500

urge incontinence ## Footnote treatment is oxybutynin, pelvic floor exercises, and reducing caffeine/alcohol intake

Question 501

Incontinence that is due to pressure and urine passing through the urinary system due to some kind of instability due to the pressure. Can result from coughing, sneezing, or lifting objects. ## Footnote instability (e.g. increased urethral mobility, pelvic muscle relaxation, poor intrinsic sphincter function)

Answer 501

stress incontinence

Question 502

Incontinence due to detrussor muscle hypotonia likely a sensory neuropathy is

Answer 502

neurogenic bladder ## Footnote diabetic nephropathy is a common underlying sensory neuropathy in this condition

Question 503

Hyperglycemia in pregnancy increases the risk of what 4 conditions the most?

Answer 503

* cardiac anomalies (transposition and VSD) * neural tube defects * renal anomalies * craniofacial defects (cleft lip and palate) ## Footnote hyperglycemia disrupts organogenesis in weeks 2-8. If it develops after this time other risks are higher like macrosomia, neonatal jaundice, and pre-eclampsia.

Question 504

Is a pregnancy in which there exists dual gestation of both an intrauterine and ectopic pregnancy. risk factor includes reproductive technologies like clomiphene, IVF, IUI, and embryo transfer as well as a PID history.

Answer 504

heterotopic pregnancy

Question 505

What antihypertensive agents are safe in pregnancy?

Answer 505

* **n**ifedipine * **m**ethyldopa * **h**ydralazine * **l**abetalol ## Footnote **n**ew **m**oms **h**ate **l**abor

Question 506

A heart rate pattern is an associated sign suggestive of fetomaternal hemorrhage

Answer 506

sinusoidal

Question 507

How does erythema infectiosum (fifth disease) cause hydrops fetalis?

Answer 507

infects fetal erythroid progenitor cells, causing myelosupression and severe anemia

Question 508

Dyspareunia particularly caused by entry is most likely a diagnosis of what?

Answer 508

vestibulitis