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OBGYN SHelf SR
| Question | Answer |
|---|---|
| 32 y/o G3 P2 delivers a 9 lb baby following a 2hr second stgae of labor. follwoing placental deliveyr there is a pale mass in the lower vagina, the pt develop hypovolemic shock and uterus cant be palpated. dx? | uterine prolapse |
| What is the most likely cause of a 46 XX baby born with scrotum and phallius? | ACTH oversecretion (CAH) |
| What is the fisrt step in mangement of a 47 y/o with questionable menopause with 4 months without a mentsrual period, with an enlarged uterus? | Get Beta HCG before getting FSH |
| What is the most apporopriate management of a 15 y/o pt with PID and 103.5 fever? | admission and IV abtx |
| What is the appropriate step for preventing group B strep sepsis in the newborn with 12 hrs of ruptured membranes? | abtx therapy is delivery hasnt occured by 18 hours after rupture of membranes |
| When should HIV + women have pap smears? | every 6 months if abnl, then every 1 yr |
| What is the best screening test for a 30 y/o woman with br cancer in a 58 y/o relative, a MI in father at39 and a 36 y/o brother with T2DM and a smoking hx? | cholesterol studies |
| 23 y/o, acute onset of intense right sided lower abdominal pain becoming worse with irregular mentrual intervals. 5 x 5 x 4 mass, no fever, + guarding and rebound. mass grwoing with cystic and solid components. Dx? | ovarian torsion |
| fisrt step in management with ROM at term with sudden decrease in fetal HR? | pelvic exam |
| What is converted peripherally in PCOS? | androstenidione to estrone |
| Best evaluation tool for soncern for PID infertility? | hysterosalpingogram |
| What type of contraceptive is contraI in a 37 y/o smoker of 2 ppd? | triphasic oral contraceptives |
| LEEP is a RF for what in future pregnancy? | cervical insufficiency |
| A patient with a velvety pigmented skin over the axilla is at risk for? | type 2 DM (acanthosis nigracans) |
| painless ulcerated lesion in 60 y/o lady with puritis. dx? | vulvar carcinoma |
| What might be seen in a uterus large for dates in an IVF pt? | multigestation, get an u/s |
| What is the most common cause of 4 months of serosanguinous breast discharge with a normal mammogram? | intraductal papilloma |
| Most common birht defect of valproate? | NTD |
| What is the most likely cause of a lady not having a menstrual period after her last child required a d and C? | asherman syndrome |
| What is seen in amenorrhea from running (FSH and estrogen)? | low FSH and low estrogen (hypogonadotropic hypogonadism) |
| What is the most likely cause of a 5 y/o without genital truma with persistant green vaginal discharge and burning and itching? | foreign body in the vagina |
| what is the most likely karyotype of a pat with progressive facial hair, axillary hair, without breast devlopment. a blind vagina, clitoromegaly and posterior labioscrotal fusion? | 46 XY (androgen insenitivty) |
| What do you follow a + RPR VDRL with? | FTA ABS |
| What should you order for an 18 y/o pt at 10 weekd with HIV and a PPD of 9mm? | chest xray |
| An exquisitely tender ulcer at the introitus is most likely caused by what in an immigrant? | H. ducreyi |
| A fever with wonund induration and erythema is? | wound infection |
| A twin gestation with a thick dividing membrane is? | dichorionic (di -di) |
| Urge, enuresis, with large volume is? | urge incontined, detrusor instability . tx with meds |
| triggers with coughing of small volume of urine is? | genuine stress incontinence, sphincter insufficincy. tx with pessary/surgery |
| small amount of urine, enuresis, frequently is? | overflow incontinecy (neuro) |
| What causes persistant fetal tachycardia? | maternal fever |
| What should be done with BHCG levels in an INC Ab? | follwed to zero |
| First step in a smoker with no pre atal care? | NST |
| MCC of hydrops fetalis in a day care worker? | parvovirus B19 |
| What is no breast, no uterus? | 1. gonadal agensis of a 46 XY 2. enzyme deficiency in testosterone synthesis |
| What is no breat, yes uterus? | gonadal failure of 46 XX 2. disruption of hyp-pit axis |
| What is yes breast, no uterus? | 1. testicular feminization 2. mullerian agensis |
| What is yes breat, yes uterus, amenorrhea? | - hypothalamic, puituitary or ovarian failure 2. congenital anomalies |
| Main cause of premature deteriorating AGPARS? | pulmonary hypoplasia |
| A 22 y/o with multiple raised, crusty papule and an abnl pap. dx? | condyloma acuminatum |
| Dx of cjoice for endometriosis? | laparoscopy |
| How do you evaluate green forthy discharge, vaginal erythema? | wet mount (look for mobile protozoa) |
| MCC big uterus with correct dates? | polyhydramnios |
| Chronic HTn can have what effect on fetal/placenta? | uteroplacental insufficiency |
| A baby with macrosomnia incr chances for what in future pregnacies? | GDM |
| Tx for transverse lie, full dilation and effacement? | casarean delivery |
| Does dilution of Hb in pregnancy cause changes in MCV? | NO |
| what is best tx for irregular periods in a smoker? | cyclci progestins |
| A prolapse after a hysterectomy relived by lying down, bulging posterior mass high in the vaginal vault is? | enterocele (even without BM issues) |
| 8 cm growth of cervix into parametrium is? | squamos cell cA of the cervix |
| Pt with 1 day hx of fever, n/v, perineal rash, bilateral adnexal tenderness. uses tampons during periods. Causal organism? | Staph aureus, toxic shock syndrome |
| pregnant woman, suddent onset of sever left sided flank pain radiating to labia. no gross hematuria, afebrile, n/v, only comfortable when ambulating. dx? | uterolithiasis ( doesnt require gross hematuria, could be microscopic) |
| new breastfeeder with eryhtematous, nonfluctuant, tender area in upper outer quandrant. engorded breast bilaterally. fever and tachycardia. Dx? | mastitis |
| 19 y/o primagravid at 31 w admitted for intense uterine contractions every 1-2 mins for 2 hours. uterus firm and tender, fetal hr is 165. dark blood from vgina, cervix is effaced and 7 cm dilated, fundal height at 30 . Most likely dx? | abruptio placenta |
| 23 y/o primagravid at 32 weeks admitted for irregular uterine contraction x 3 hr. temp is 100.8, uterus is moderately tender and fetal hr is 170. cervix 80% effaced and 2 cm dilated, -1 station. watery vaginal discharge that is + nitrazine. DX? | chorio amionitis |
| 22 y/o woman in ED with vagianl bleeding the last 2 days, lmp was 8 w ago. + home preg test. afebrile, normal vitals, BHCG= 554,367. TVUS has an enlarged uterus with scatter hyperechoic material. next step in management? | suction and curretage ( mole) |
| 87 y/o with urinary incontince for 6 years, she avoids house for fear of public ridicule.incontinence with sneezing, coughing, exertion. hysterectomy 30 y ago. BMI = 31. Most likely cause? | genuine stress incontinence = decr external urethral sphincter tone |
| Purulent cervical discharge, cervical motion tenderness, G+ diplococci in slide. dx? | N. Gonorrhoeae |
| 11 y/o with mod changs. mom is concerned menstral periods will start soon. mom menarche = 14 y. pt is 75th for ht and 90th for wt. br and pubic hair development is tanner stage 3. recent pubic hair deveoplment is most indicative of? | menarche is imminent |
| 22 y/o woman comes because of second episode of painful vesicular genital lesions. her partner has similar lesions on his penis. most likely clinical course? | increasign symtpoms for 3 weeks then a gradual decrease |
| 18 nulligravid comes for health maintenence. pain in adnexal region that occurs during days 13 and 14 of her cycle. its brief and shapr. menarche was at 13 nd she has regular cucles. never sexually active, and exam is normal next step in managemnt? | leuprolide ( GnRH agonist, for endometriosis) |
| 26 y/o G3 po 0, ab 3 sue to 3 consecutive 1st trimester ab. hx of UTI since childhood. IV pyelogram showed single left kidney. exam today shows palpable uterus and palpable left ovary. most likely dx? | congenital uterin anomailies ( urinary tract anomalies follow with uterine) |
| Prior to discharge, a 30 y/o woman wants to resume combo oral contraceptives prior to pregnancy. but wants to breast feed. what problem do you counsel her about? | decreased protein content in breast milk |
| 22 y/o prima at 20 w comes for routine prenatal visit. uncomplicated, declined aneuploidy screen , other labs normal. exam has normal uterus, abdominal organs seen outside abd canvity without a covering membrane,cord is medial to defect. dx? | gastrochisis (omhalocele would be within cord) |
| 32 y/o G3 P2 at 20 w comes in for routine prenatal. u/s shows skeletal dysplasia consistent with achondroplasia. what is the inheritance pattern? | autoD |
| 22 y/o comes in for 3d of pain with urination, vaginal itching, watery discharge, no hx of serious illness takes no meds. . sexually active w/o contraception. erythema of vulva and vagina, yellow gray frothy discharge. pH=5. wet mount finding? | flagellated protozoa |
| 57 yo for routine health maintenence. HTN, t2 DM, generalized anxiety. she has been getting conj estrogen and medroxyprogesterone after menoapuse. also HCTZ, metformin,herbal meds. What is her greatest risk for Br Ca. | hormone therpay |
| 18 y/o without menstrual period in last year. no withdrawal bleed after medroxyprogesteron x 7d. BMI =20. breasts are tanner 2, pubic hair is tanner 5, PE shows normal vag but prepubertal uterus. | oseoporosis, no withdrawal bleed suggests ovarian failure |
| 27 y/o G2, P1 comes after an episode of bright red blood with no contractions or cramping. she has incr br size, morning sicknessand fatigue. LMP was 8 w ago. exam shows uterus consistent w 6 w. TVUS shows normal fetal heart. Dx? | normal pregnancy, painless blood |
| 32 y/o 2 months adnexal dull pain. worst with menses, exams shows full adnexal with tenderness. BHCG is neg. pelvic u/s has 5 cm simple cyst. she is anxious about tx as her insurance expires in 2 weeks. next step? | normal cysts, OCP and f/u in 6 weeks to see if it regrsses |
| what causes variable decelerations? | umbilical cord compression |
| 4 weeks after c/s. with feeling of pulling on right side of incision. exacerbated by movement. she was d/c on pod 3. in last 2 weeks she started exercising and sex. bmi 29. abd is tender on right of incision. most likely explanation? | normal post op course, this is where the knot in the sitches is |
| 67 y/o with moderate vulvar itching for 2 years. otherwise healthy, takes no meds. normal vitals. exam shows white epithelium over lever labia majus. no inguinal adenopathy or discharge. next step? | punch biopsy of affeted areas |
| 32 y/o G3P2 type 2 dm admitted at 38 w. first 2 kids were SVD. cervix is 2 cm dilated on admission with fundal ht of 42. 4 hurs later, cervix complete, vertex is OA, -1.1 hr later, contractions are every 2 mins and station and cervix unchanged. cuase? | cephelopelvic disproportion (DM) |
| 67 yo with 9mvulvar itching. unresolved with zinc, vit E, steroids, or metrantifungals. has type 2 DM and hyper colesterolemia. BMI =53. eryhtmatous swollen vulva, pauples and pustulesthights. KOH shows pseudophyphae. why not respond to previous therapy? | type 2 DM |
| 17 y/o concern for never had menstrual period. no breast development, not sex actve, no meds. BMI =31. br = tanner 1, nl thyroid, continuous murmur on midsternal borner, normal pelvic exam. no masses. what do u measure nect? | FSH (turners she is 4 ft tall, coartation) |
| 15 y/o with 1 week of sever abd pain. 10 episodes of cramps in past year lasting 3-5d. never had a period. sex active no contraception. 80th percent for ht and wt. mass in suprapubic region at midline. bluish bulge obscures the upper vag. dx? | hematocolpos (imperforate hymen) |
| 32 y/o G5P4 at 21w bright red vag bleed for 4 hr.no prenatal care. speculum has bright red blood in post fornix. no other abn in cervix. next step? | fetal u/s |
| 32 y/o prima at 10 w for 5 d of n/v decr appetite. cant keep food down. labs show some hypovolemia, large ketones, some electrolytes disturbances. what should you do for her? | hyperemesis gravidarum, inpatient admission for iv fluids and antiemetics |
| 27 y/o prima at 33 w comes for prenatal visit. has SLE x 8y. remission. preg normal besides lagging fundal ht 2 m ago. at 20 week things were normal on us. at 33w there is oligo and 30 w fetus. what is cause of olgio? | uteroplacental insufficiency ( SLE can mimic GHTN) |
| 32 y/o with 6m of increasing frequent pelvic cramps, pain with urination, urgency relived with urination. regular menses. suprapubic tendenress. tender to palpation dx? | interstital cystitis |
| 20 y/o with 3 yr of hirsutism wosrsening over last 2 years, cause of hair growth? | increased testosterone |
| 27 y/o primagravid at 14 w comes for 24 hrs of n/v, right sided abd pain, loss of appetite x 2 d.no n/v. afebrile. RLQ tenderness without rigidity or rebound. WBC 16.5, leukocytosis in urine. Dx? | appendicitis (might be pyelo) but i think the loss of appetitie |
| 32 y/o nulligravid with no mentstural period since sottped taking OCP 6m ago. menses were regular before. also has incr libido, facial hair and acne. BMI=33. has clitoromegaly. 2 cm mass in right ovary. what hormone is likely abnormal? | testosterone ( DHEAS is from adrenals) |
| previously healthy 42 y/o comes with 6m of increasingly heavy periods and 2 months of prolonged flow. she has an irregular and smooth uterus. ABUS shows leimyoma uteri.Which is the most likely type of leiomyoma in this case? | submucosal |
| 20 prima at 40 w is admitted in lobar. cervix is 4 cm dilate and 0 station. she gets 2 L of LR. epidural cath is placed and test dose of lido and epi is injected. she immediately has tinnutus and metaalic taste. pulse is now 110 what cuased it? | IV injection of the anastetic (epidural woundt cause these sx) |
| 18 hr after c/s a 23 y/o g1 has a fever. her temp is 100.4. decr breath sounds are heard bilaterally with no crackles or rhonchi. ijncision site is dry and intact. 2+ pitting bilaterally. Most likely dx? | atelectasis |
| 27 y/o prima at 34 comes with 1 day of anxiety, sweating, rapid heart beat. some disorientation. rapid pulse, low grade fever high b. diffusely enlarged thyroid with 4+ clonus. along with a beta blocker what else should you give her? | levothyroxine. propythiuracil can concentrate in the fetal thyroid |
| a 32 y/o G5P4 at 18w comes for routine prenatal. Rh -. previos pregnancies reuqired c/s at33-35 for breech, She got rhogam for both pregnancies. her mother has T2DM. vitals normal. TVUS shows breech and bicornate uterus. What is she at incr risk for? | preterm labor (bicronate uterus) |
| 42 y/o G3P3routine exam. iregular period varying length for the last yr. last period was 6 w ago. she has t2dm tx w metformin. BMI=32she has an irregular enlarged uterus. endometrial biops shows atypical complex hyperplasia. predisposing factor? | annovulation |
| 27 y/o G2P1 at 36w comes w 2 hr of intermittent vag bleeding. no prenatal care and fundus at 35. fetal Hr =135. bleed is of uterine origin. she is O-.nst is reactive and BPP = 8. next step? | give rhogam for any bleed in Rh- |
| 27 y/o philipino at 10 w comes for prenatal. 15 y hx of anemia. Hct at 28 for 7 yr desite iron. 5 days ago she visited relatives with a flu like illness. uterus is consitent with 10 w pregnancy. next step in management? | hemoglobin electrophoresis (thalassemia) |
| 3 d after c/s at term for failure to progress 27 y/o has 101.8 fever and mild dysuria without frequency or urgency. incision site is intact. lungs are clear. breast are tense and tender. uterus firm20w size. she has no elevated WBC and hb and UA norm.Dx? | breast engrogement |
| 25 y/o HIV + comes due to thin, clear vaginal discharge and increased urinary freq x 2w. last menses 6w ago. normally has 28 d intervals. uses cndoms irregularly and not on HAART. uterus is slightly enlarge and adnexa normal dx? | pregancy |
| 24 y/o prima at 30 w admitted for birght red vaginal bleedfirst noted as spotting 12 h after sex, since then bleed has incr. otherwise uncomplicated. u/s at 20w has fundal placenta. most likely cause of bleeding? | cervical trauma (sex) |
| 17 y/o comes in with moderate severe pelvic pain with n/v during menses since menarche. sx begin soon after onset of menses. nsaids help. never been sexually active. normal PE. DX? | primary dysmenorrhea (endometriosis tends to be midcycle pain) |
| 57 y/o complains of small blood stains on underwear x 6m. menopause occured 5 y ago and has not recieved hormone therapy. reports dysparunia but no GI or urinary sx. there is atrophy in vagina. most likely cause? | hypoestrogenic state (menopause) |
| 23 y/o comes for follow up exam 3 weeks after being dx with UTI. tx with tmp-smx relieved her sx. this is her 3rd uti in the last year. . she was married 3 m ago. her ua and vitals are unremarkable now. what is the bst tx for ppx of this? | tmp-smx |
| 27 y/o comes in with ha, blurred vision abd RUQ pain for 12 hr. labs show HELLP. dx | severe Pre-E |
| 47 y/o comes to physicisn 2w after lump in left br. she started estrogen replacement 3 m ago and has had br engorgement since that time. L br shows 2 cm tense, mobile, cyst like structure. mammography 3 m later is normal. next step in mamangement? | fine needle aspiration biopsy of the cyst. |
| 55 y/o woman with constant wetness from vagina following hysterectomy. no dysuria or urgency. like dx and what next step? | likely vesicovaginal fistula from hysterectomy. get dye installation into bladder |
| 42 y/o woman with DM with constant dribbling of small amounts? dx and tx? | neurogenic bladder, do intermittent self cath |
| 39 y/o woman wets efl 2-3x daily, feels need to void but does not make it in time. dx and tx? | urger incontinence, oxybutynin |
| stress incontinece, tx? | pessary or burch urethropexy |
| what type of vaccine is VZV? | live attenuated, no effect on hsv |
| At what time should manual placental extraction be attemtped? | after 30 mins of retained placenta |
| what is the best inital therapy for non reducible uuterus? | anathesia (halothane) (relax cervix) |
| which is more effective for reducing vertical transmission of HIV c/s or zidovudine? | zidovudine > c/s |
| girld with lupus with acne w/o comedones is? | steroid induced comedones not teenage acne |
| what might be seen in a woman with galactorrhea due to a prolactinoma? | abnormal DEXA scan as low estrogen can cause osteoprosis (decr GnRH release) |
| What is the pathophys of hypotension in septic shock? | vasodilation |
| what is upper limit of normal for the latent phase? | 14 hours |
| what type of pelvis predisposes to occiput posterior? | antrhopoid (AP > TV diameter) |
| what is expected progress in the active phase? | 1.5 cm / hr |
| what implantation site is most likely to have placenta accreta? | anterior placenta, defect in endometrium |
| blue tissue densely adherent between uterus and bladder is? | placenta percreta |
| what is the greatest concern for a retained placenta acreta not removed with hysterectomy? | coagulopathy, infection |
| when should u start to screen DEXA? | 65 |
| When should you screen colonoscopy? | 50 |
| When should you start mamomograms? | 40 |
| When should you start pap smears? | 21 |
| what is the utility of delivery of the posterior fetal arm in shoulder dystocia? | decreases the fetal bony diameter from shoulder to axila |
| What is the utility of the McRoberts maneurver? | anteriorly roates the symphysis pubis |
| Mc ureteral injury in hysterectomy? | ureteral ligation |
| what is the DOC for sydfuction uterine bleeding with active bleed? | high dose estrogen |
| what is the mech of urinary system dilation in late pregnancy? | Compression by the uterus and right ovarian vein |
| what part of pituitary is acffected in sheehans? | anterior hemorrhagic necrosis, decr prolactin |
| What is the mech of Asherman syndrome? | disruption of large segments of the endometrium |
| prolonged fetal decels associated with misoprostol is? | uterine hyperstimulation |
| what is the mech of amenorrhea due to pituitary ademona? | amenorrhea due to inhibiton of GnRH pulsations |
| how you you tx a pituitary adenoma growing in size in pregnancy? | bromocriptine |
| what is the most common underlying cause of maternal mortality? | hypercoagulable state |
| breast pain, rubbery mass changing with menses is? | fibrocystic change |
| MC mass in breast of adolescents or 20s? | fibroadenoma |
| 57 y/o 1 week after mass in left breast. no family hx of br cancer. 2 cm palpable nontender mobile mass, no discharge. nothing in R breast. next steo? | mammogram |
| 27 y/o G0 severe pain w menses causing missing work. cervix is pink, uterus normal size. R ovary bigger than left. most likely dx? | endometriosis |
| 22 y/o woman 2 days of pain w urination, vaginal itches, curd like disharge, pseudohyphae. dx? | cadidiasis |
| 27 y/o nulligravid unable to conceive for 12 m. had PID 4 y ago. nest step in dx? | hysterosalpingogram |
| 30 y/o G2P1 at 26w. uterine size greater than expected for dates. fetus has hydrops. next step in dx? | maternal Rh status with antibody screening |
| 42 y/o G2P@ with loss of urine when cough, sneeze. uncomplicated SVDs, urine loss with valsalva. dx? | stress incontinence |
| 18 y/o G1P1 has pinkish vaginal discharge that has persisted for 6 w. uterus is fully involuted and no adnexal masses. next step? | reassurance that this is normal |
| 32 y/o nulligravid with 6 w of fould smelling frothy discharge with flaggellated organisms on wet mount. Dx? | trichomonas vaginalis |
| Asx 24 G1 at 36w has grade 2/6 systolic murmur at upper left sternal border. dx? | flow murmur |
| 42 y/o G3P3 amenorhea or 2m, some spotting 3 w ago. slightly enlarged uterus. next step? | BHCG, must check pregnancy |
| 57 y/o vegan, doesnt want meds, has evidence of low none density on DEXA. what vitamin do you recommend supplementing? | Vit D |
| A baby is post with spina bifida, what during pregnancy could have been given? | folate |
| MCC postpartum hemorrhage? | uterine atony |
| 19 y/o primagravid at 8 w is brought to ED w light vaginal bleeding. no tenderness or abnl bowel sounds. uterus is consiteten with 6w gestation. TVUS is IUP with fetal heart beat. next step? | send home, threatened abortion |
| 16 y/o w 6h of abdmonial cramps and intermittent nausea. LMP 2 months ago. menarche at 15. Inconsistent condom use. scant vaginal bleed, right adnexa mass. next step? | Beta HCG, |
| 13 y/o 1 yt of irregular vaginal bleeeding every 2-8 w for 10-30 d. uterus is normal. normal ovaries. most appropriate pharmacotherapy? | oral contraceptives |
| 25 y/o G2 P2 w 3 days of painful swelling in vaginal area, LMP was 2 m ago. active w one parter and uses depoprovera. has exquisitely tender mass in left labium minor, prevents insertion of sepculum. dx? | bartholin gland abscess |
| 22 y/o prima with a tonic clonic seizre, HTn, and incr DTRs. dx | eclampsia |
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