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Clinical Medicine

Quiz yourself by thinking what should be in each of the black spaces below before clicking on it to display the answer.
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Question
Answer
Define Endometriosis   The presence of endometrial glands and stroma outside the uterus  
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Define Adenomyosis   The presence of endometrial glands and stroma that extends into uterine musculature  
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Bacterial Vaginosis Diagnosis   clue cells on wet prep*  
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Bacterial Vaginosis treatment   Flagyl (Metronidazole)  
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greenish/yellow, frothy vaginal discharge   Trichomonas vaginitis*  
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"strawberry cervix"   Trichomonas vaginitis*  
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"Cottage cheese" discharge   Yeast vaginitis*  
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Yeast vaginitis Diagnosis   clinically, hyphea/ pseudohyphea/ budding on KOH prep*  
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Yeast vaginitis Treatment   oral fluconazole  
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Neisseria Gonorrhoeae (Gonorrhea) is a gram   Gram-negative intracellular diplococci*  
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USPTF recommends screening yearly for Neisseria Gonorrhoeae (Gonorrhea)   from onset sexual activity-26yo  
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Most common STI   Chlamydiae Trachomatis (Chlamydia)*  
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Syphilis is caused by   Treponema pallidum (a spirochete)*  
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Syphilis treatment   PCN G 2.4 mill units IM x 1 dose  
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Average age in US for menopause   51.5 years  
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Define menopause   no menses >1 yr, or FSH >30mIU/ml  
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never give unopposed estrogen to a woman with a   uterus  
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Level of uterus at 12 weeks   pubic symphysis*  
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Normal Fetal heart rate   120-160bpm  
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Define Round ligament pain   Sharp, shooting, fleeting pain, unilateral- typically located in the groin  
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"Mask of pregnancy"   Chloasma  
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Maternal screening AFP screens for   open neural tube defects  
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Pregnancy implantation outside the uterine cavity   Ectopic Pregnancy  
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Treatment for ectopic pregnancy   surgery or methotrexate  
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bleeding, passing "grapelike tissue", partial may present like SAB   Gestational trophoblastic neoplasia (GTN or GTD)*  
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In Gestational trophoblastic neoplasia (GTN or GTD) HCG is over   >100,000mU/mL  
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Diagnosis criteria for Preeclampsia   (1)Hypertension, BP>140/90 (2)Proteinuria >300mg/24hrs (3)+/- Edema (often hands and face in addition to legs)  
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Diagnosis criteria for Eclampsia   (1) Hypertension, BP>140/90 (2) Proteinuria >300mg/24hrs (3) +/- Edema (often hands and face in addition to legs) (4) seizures  
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HA, visual changes, pulmonary edema, elevated LFTs, RUQ/epigastric pain   Preeclampsia  
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Define PROM   rupture of membranes prior to onset of labor at or after 37weeks  
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Define PPROM   rupture of membranes prior to onset of labor in patients less than 37 weeks gestation  
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Premature separation of the normally implanted placenta from the uterus after 20 weeks   Placental abruption*  
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Placenta partially or completely covers the cervical os   Placenta previa*  
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Bright red, painless, recurrent vaginal bleeding, no fetal distress (usually)   Placenta previa*  
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Placenta directly attached to the myometrium   Placenta accreta*  
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Placenta invades the myometrium   Placenta increta*  
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Placenta penetrates the myometrium   Placenta percreta*  
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Follicular/proliferative phase occurs during days   Days 1-14  
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Luteal/ secretory phase occurs during days   after ovulation (days after 14)  
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Short stature, web neck, lacks ovary or uterus   Turners syndrome*  
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'string of pearls' on ultrasound   Polycystic ovarian disease  
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Polycystic ovarian syndrome AKA   Stein levanthal syndrome*  
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MC organism of PID   GC*  
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PID etiology   GC, chlamydia, E. coli, mixed anaerobes and myco/ureaplasma  
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Most common STD   Chlamydia*  
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Treatment for chlamydia   Zithromax or doxycycline*  
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treatment for GC   Ceftriaxone, cefixime*  
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Primary syphilis presents with a   chancre*  
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Secondary syphilis presents with   Symmetric rash on palms and soles  
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Latent/ tertiary syphilis AKA   Neurosyphilis  
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Chancroid caused by   H. ducreyi  
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Painful genital ulcer with fluctuant inguinal adenitis   Chancroid  
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Painless genital ulcer   Granuloma Inguinale  
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PID treatment in pregnancy   Clindamycin with gentamycin  
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Most common metabolic disease in the U.S.   Osteoporosis*  
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Benign solid mass, typically painless in breast   Fibroadenoma*  
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Most common reason for fever after the immediate puerperium in nursing mothers   Mastitis*  
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Mastitis caused by   S. aureus*  
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Treatment for mastitis   dicloxacillin  
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Second most common cause of cancer death in women   Breast cancer  
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Most common type of breast cancer   Infiltrating intraductal carcinoma  
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Most common reason for spontaneous abortion   Chromosomal abnormalities*  
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Abruptio placentae   Painful vaginal bleeding*  
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Placenta praevia   Painless vaginal bleeding*  
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oligohydramnios   Decreased amniotic fluid levels  
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polyhydramnios   Excess amniotic fluid levels  
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Strawberry cervix   Trichomonas infection*  
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BRCA genes are associated with   Breast and ovarian cancer*  
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To delineate a solid vs. cystic breast mass, use a   Ultrasound  
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To evaluate for ovarian torsion, use a   Color Doppler  
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Clue cells for diagnosis of   Bacterial Vaginosis  
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UPSTF recommends mammograms every   2 yrs  
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inhibit ovulation, thicken cervical mucous and alter quality of endometrium   Oral contraceptives  
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Risk factors for oral contraception with female at 35 y/o   smoking  
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Yeast infection treatment   Diflucan  
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The USPSTF recommends biennial screening mammography for women aged   50 to 74 years  
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Most common cause of cancer death in women?   Lung cancer  
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Pap smear frequency   Every 3 years, may cease if all pap smears have been normal until 65; if never tested, stop after two negative smears  
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When do you do pap smear on a girl?   starting at age of 21 and doing every 3 years  
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USPSTF guideline for breast cancer screening in women   USPSTF recommends biennial screening mammography for women aged 50 to 74 years  
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Contraindications for Oral Contraceptives?   Thromboembolic (DVT past or present)  
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Hegar's Sign   softening of the lower uterine segment or uterine isthmus*  
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Chadwick's Sign   is bluish or purplish discoloration of vagina and cervix during pregnancy*  
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Goodell's sign   softening of the cervix*  
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Cervix becomes soft, blue and swollen when   pregnant  
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pt may need to be hospitalized. Excessive N/V, weight loss of 5% or greater from pre-pregnancy weight. Dehydration, ketones in urine   Hyperemesis Gravidum  
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20 WKS fundal height   AT UMBILICUS*  
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Patient unable to get pregnant, male sperm count ok, give   clomiphene citrate  
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Treatment for Mild Eclampsia   bedrest (BP 140/90, Protein +2,+3)  
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Consistent, Late decelerations are a sign of   uteroplacental deficiency  
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Corpus luteum produces   Progesterone  
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Choriocarcinoma is usually preceded by   PREGNANCY  
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Vaginal bleeding at 12 weeks can lead to   Threatened Abortion  
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lead to chocolate colored ovaries, raspberry colored nodules in the pelvic cavity but NOT cervical stenosis.   Endometriosis  
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contraindications of OCP (estrogen and progesterone)   active liver disease  
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The most common Gyn cancer is   endometrial cancer*  
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Cause Violin String adhesions between liver and abdominal wall (Perihepatitis:)   Fitz - Hugh - Curtis Syndrome*  
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are paraurethral glands that may be related to female ejaculation   Skene Glands  
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Nulliparity is a risk factors for   Ovarian Cancer*  
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is common cause of post partum hemorrhage   Uterine Atony*  
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Mastitis is treated with   dicloxacillin*  
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The rate Dizygotic or "fraternal" twins increases with   maternal age  
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Menopause or peri-menopause have this as first sign/symptom   HOT FLASHES  
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from excess Prostaglandin produced in endometrium   Primary Dysmenorrhea  
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C-section ALWAYS required with hx of previous C-section that had   CLASSICAL Incision (vertical incision)  
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adhesions in the uterine cavity   Asherman's syndrome  
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Fibroids, Fibroadenoma (common benign neoplasm), leiomyomas think   bleeding  
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most common medical abortions medications   Mifepristone and Misoprostol  
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luteal phase corresponds with what phase   secretory phase  
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women with fibroids have an increased risk of   endometrial cancer  
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Most common position for the baby in utero   Vertex (head first)  
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the embryo or fetus dies in utero, but products of conception are retained   Missed abortion*  
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deliberate termination of pregnancy   Induced abortion  
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Any uterine cramping or bleeding in the presence of a closed cervix during the first 20 weeks   Threatened abortion*  
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Involves uterine bleeding or pain when the cervix is beginning to efface or dilate   Inevitable abortion  
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Passage of part of the POC through the cervix, cervix is dilated, bleeding is present   Incomplete abortion  
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Passage of all of the POC, with subsequent closure of the cervix and return of the uterus to normal size   Complete abortion  
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Death of a fetus and its retention in utero for 4 weeks or longer   Missed abortion  
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Infection of the uterine contents before, during, or after an abortion   Septic abortion  
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Fever, chills with painful erythema and induration of the breast. due to staph aureus   Mastitis*  
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Normal apgar score   At least 7 at one minute and 9 at five minutes  
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Follicular phase AKA   Proliferative phase  
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Do not give this medication during pregnancy (cat. D)   doxycycline  
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"abnormal bleeding in the absence of an anatomical lesion"   Dysfunctional uterine bleeding (DUB)  
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Bleeding for greater than 35 day intervals   oligomenorrhea  
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Bleeding for less than 21 day intervals   polymenorrhea  
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heavy menses (more than 80 mL)   menorrhagia  
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irr/ heavy bleeding   menometrorrhagia  
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clue cells on wet prep, fishy odor   Bacterial vaginosis*  
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"strawberry cervix"   Trichomonas vaginitis*  
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"Cottage cheese" discharge   Yeast vaginitis*  
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Nagele's rule:   EDD= LMP+7days- 3mon  
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Recurrent AB   3 SABs, or 2 SABs in a row  
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HELLP Syndrome   Hemolysis, elevated liver enzymes, low platelets  
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Detachment of a normally implanted placenta can cause severe hemorrhage   Abruptio placenta  
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Implantation of the placenta occurs over or near the cervical os   Placenta previa  
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Causes Fitz - Hugh - Curtis Syndrome   Neisseria gonorrhoeae  
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Shoulder Dystocia is common with a fetus of   4,500 grams and up  
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This becomes soft, blue and swollen when pregnant   Cervix  
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Severe Eclampsia treatment   Mag sulfate, antihypertensives (hydralazine, labetalol)  
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continues to produce ESTROGEN in uterus   follicle cyst*  
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produces Progesterone in uterus   Corpus luteum*  
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Endometriosis does not lead to   cervical stenosis  
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Decent of the bladder into the upper anterior vaginal wall   cystocele*  
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Bulging of the urethra into the lower anterior vaginal wall without urethral dilation   urethrocele  
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Involves prolapse of the rectum into the lower posterior vaginal wall   rectocele  
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Prolapse of a loop of intestine into the upper posterior vaginal wall   enterocele  
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Enteroceles are almost always due to   Herniation of the pouch of Douglas  
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Occurs when sudden increases in intraabdominal pressure such as coughing, sneezing or exercise cause leakage of small amount of urine   Stress incontinence  
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Detrusor instability; involves the loss of large amounts of urine immediately after the urge to void   Urge incontinence  
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Leiomyoma or fibroids are also known as   Uterine myoma  
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Most common benign breast tumors   Fibroadenoma  
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Obstruction of skin lymphatics causing lymphedema and skin thickening on the breast   Peau d orange  
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Intraductal carcinoma that involves the main excretory ducts of the breast   Paget's Disease  
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excess body hair in a male hair pattern often accompanied by acne and oily skin   Hirsutism  
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First stage of labor   Onset of labor to complete dilatation of the cervix  
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Second stage of labor   From cervical dilatation until the birth of the infant  
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Third stage of labor   Birth of infant until the delivery of the placenta  
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Signs of separation of the placenta   Sudden gush of blood from vagina, lengthening of the umbilical cord, and firming of the uterine fundus.  
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Serum B-HCG increases by how much every 4 hrs   doubles  
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If serum B HCG does not double in 4 hrs. think   Ectopic pregnancy  
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Ectopic triad   Abdominal pain, missed period, vaginal bleeding  
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This accounts for most abortions   Chromosomal abnormalities*  
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Snowstorm pattern   Gestational Trophoblastic Disease (Molar Pregnancy)  
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Vaginal bleeding, enlarged uterus, pelvic pain, increased B-HCG, sever hyperemesis   Molar pregnancy (surgical evacuation)  
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Common cause of dysfunctional uterine bleeding or abnormal bleeding.   Anovulation  
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Most specific sign for a functional ovarian cyst   Menstrual irregularity  
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Most common benign breast tumor   Fibroadenoma*  
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During a colposcopy, a vinegar solution is used to turn abnormal tissue what color?   White*  
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47, XXY   Klinefelters  
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45 X   Turner Syndrome  
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Pregnant patient at term who presents with outbreak of genital herpes, treat with   C-section*  
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What is the most likely site of an ectopic pregnancy within the tube   Ampulla*  
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heterotopic pregnancy   is a multiple pregnancy with one normal implantation in the uterus and one ectopic pregnancy  
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MOA of Methotrexate   folic acid antagonist  
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Postmenopausal bleeding should essentially be considered   endometrial cancer  
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An obese patient with persistent abnormal bleeding unresponsive to medical therapy requires   endometrial biopsy to evaluate for endometrial cancer.  
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Most common GYN malignancy in U.S.   Endometrial cancer*  
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No breast development & elevated FSH   Gonadal dysgenesis*  
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Uterus absent & FSH normal   Mullerian agenesis*  
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Prolactin > 200   CT of Sella pituitary microadenoma  
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Prolactin < 200   psychotropics  
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Dysmenorrhea is   Painful periods  
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MCC of secondary dysmenorrhea   Endometriosis*  
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Dyspareunia is   Pain with sexual intercourse  
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Endometriosis presents with   Dysmenorrhea, dyspareunia, infertility & pelvic pain  
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Diagnosis of endometriosis is with   Laparoscopy with laser ablation (therapeutic & diagnostic)*  
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Treatment of endometriosis   Laser ablation, excision, electrocautery, hysterectomy  
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Medical treatment for endometriosis   NSAIDs, OCPs, Lupron & Danocrine  
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GnRH agonists used in endometriosis include   Lupron & Danocrine  
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Treatment for most dysplasias in an abnormal PAP   LEEP*  
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Treatment reserved for carcinoma in situ (CIN III)   Cold cone (conization)*  
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Cold cone (conization) is   Surgical removal of the entire transformation zone & the Endocervical canal  
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This GYN procedure may create an incompetent cervix   Conization  
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Failure of the fluid in an incompletely developed follicle to be reabsorbed   Follicle cysts  
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Chocolate cysts   Endometriomas*  
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Benign germ cell tumor   Dermoid  
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Remove dermoid to avoid   Torsion or bleeding  
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PCOS presents with   Hyperandrogenism, Insulin resistance, & anovulation  
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Cancer of vagina & vulva are due to   HPV*  
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Normal pH of vagina   < 4.5  
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Normal vaginal flora   Lactobacillus  
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Amsel's criteria for BV   pH > 4.5, clue cells, (+) whiff test, & malodorous, grey frothy discharge  
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If recurrent candidal vaginitis screen for   Diabetes*  
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Cervical motion tenderness/ adnexal tenderness   PID*  
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Outpatient PID treatment   Ceftriaxone, doxycycline, or metronidazole*  
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Inpatient PID treatment   Cefoxitin or cefotetan with doxycycline OR clindamycin with gentamycin*  
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PCOS is associated with   Insulin resistance*  
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Intrauterine devices include   Paragard (copper) & Mirena  
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Best users for IUD are   Monogamous & have children*  
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ADR of mirena   Light irregular bleeding  
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ADR of paragard   Irregular heavy bleeding & dysmenorrhea  
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Progesterone only methods include   Mini pill, Depo-Provera & Implanon  
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OCP for breast feeding women   Mini Pill*  
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Contraindications for mini pill   DVT, dysfunctional uterine bleeding, liver disease & breast cancer  
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Fertility is possibly delayed 18 months after discontinuation of this OCP   Depo-Provera*  
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fertility is delayed with Depo-Provera for   18 months*  
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OCP that is an IM injection   Depo-Provera (Medroxyprogesterone acetate)  
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OCP that is a single thin flexible rod   Implanon  
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Insertion of paragard in emergency contraception is done   Within 5 days of intercourse*  
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Demineralization of osteoporosis occurs in   Trabecular bone  
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Normal Dexa score is   T score of (+) 1.0 to (-)1.0  
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T score of (-) 1 to (-) 2.5   Osteopenia  
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T score of < (-) 2.5   Osteoporosis  
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Osteoporosis treatment   Calcium, Vit D, weight bearing exercise, estrogen & Bisphosphonates  
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Bisphosphonates include   Alendronate, Risedronate, Ibandronate, calcitonin, forteo*  
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Selective estrogen receptor modulator (SERMC) is   Raloxifene (Evista)*  
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Drug that increases bone density and decreases risk for breast cancer   Raloxifene (Evista)*  
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MCC of fever after the immediate puerperium in nursing mothers   Mastitis*  
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Mastitis presentation   Flu-like with HAs & myalgias, unilateral pink area on breast  
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Treatment for mastitis   Antibiotics, keep breastfeeding*  
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If mastitis in non-lactating woman think   Cancer  
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Causes of Galactorrhea   Psychotropics, cimetidine, TCAs, OCPs, Depo Provera, hypothyroidism & pituitary Microadenoma  
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MCC of bloody nipple discharge   Papilloma*  
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This is indicated in bloody nipple discharge regardless of cause   Excision of bloody duct system  
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Differential of a breast mass   Fibrocystic disease of the breast, fibroadenoma, carcinoma  
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Treatment of fibrocystic breast disease   Wear supportive bra, NSAIDs, acetaminophen, OCPs, Danocrine/ Lupron  
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MCC of breast lump   Fibroadenoma*  
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Definitive diagnosis of solid breast tumor with   Excisional biopsy*  
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MC site of Mets in breast cancer   Lymph nodes*  
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Sites of metastases of breast cancer   Lymph nodes, lung, pleura, liver, bone, brain  
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MC type of breast cancer   Infiltrating ductal carcinoma*  
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Most lethal type of breast cancer   Inflammatory*  
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Peau d' orange   Inflammatory breast cancer*  
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Infiltrating intraductal carcinoma in the nipple & ducts of nipple   Paget's disease of the breast  
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First symptom of Paget's disease   Itching or burning of the nipple*  
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Herpes zoster vaccine given after 60 is   Zostavax  
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Screening at 16 - 20 weeks   Fundal heights, QS-AFP, US  
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Screening at 24 - 28 weeks   1 Hour GTT, H&H  
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Screening at 34 - 36 weeks   Group B strep screen  
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Prenatal vitamins   800 mcg folic acid  
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Foods that contain folic acid   Green leafy vegetables, orange, cantaloupe, banana, milk, grains & organ meats*  
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Anembryonic pregnancy   Blighted ovum, embryonic sac with no tissue  
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Risk factors for ectopic pregnancy   Previous ectopic or PID, BTL, hx of pelvic surgery, current IUD, infertility & assisted reproductive technology  
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Presentation of ectopic pregnancy   Unilateral pelvic pain, spotting, (+) HCG, US  
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Management of ectopic   Check Rh & type, surgery, methotrexate  
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RhoGam is given at   28 weeks or after complications  
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Heterotopic pregnancy is   Co-existence of intrauterine pregnancy with an ectopic pregnancy  
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Pre-eclampsia in first or second trimester is pathognomic for   Molar pregnancy*  
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Complications of molar (hydatidiform) pregnancy   Metastasize to the lungs, choriocarcinoma*  
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After a molar pregnancy, unable to get pregnant for   1 year (follow sHCG weekly to zero)*  
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Gestational HTN   BP > 140/90 at or after 20 weeks gestation  
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Treat gestational HTN with   Labetalol/ methyldopa*  
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This signals magnesium toxicity   Absence of DTRs*  
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If loss of DTRs   Delivery  
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Treatment of HELLP   Delivery  
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Treatment of premature rupture of membranes   Antibiotics, corticosteroids, tocolysis, delivery  
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Contraction stress test is looking for   Presence or absence of late fetal heart rate decelerations in response to uterine contractions  
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Variable decelerations are due to   Cord compression, oligohydramnios  
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Components of the biophysical profile include   Non-stress test, fetal breathing movements, fetal movements, fetal tone & amniotic fluid index  
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Risk factors of shoulder dystocia   Fetal macrosomia (>4500g), maternal diabetes*  
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Maternal complications of shoulder dystocia   Post-partum hemorrhage, 4 degree laceration  
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Fetal complications of shoulder dystocia   Brachial plexus palsies, clavicle fractures, fetal death*  
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Meds associated with reduced risk of post-menopausal osteoporosis   Diuretics*  
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Meds that decrease risk of ovarian cysts   OCPs*  
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Drug to cause uterine relaxation in order to turn the fetus from outside   Terbutaline (Brethine)  
🗑


   

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