Term
What is the differential diagnosis for a 29 y/o with gradually worsening severe dysmenorrhea for 3 years? |
|
Definition
The differential diagnosis may include: endometriosis, adenomyosis, or overproduction of prostaglandins. |
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Term
| Cramping periods with nausea and loose stool usually represents an overproduction of what hormone? |
|
Definition
|
|
Term
Dysmenorrhea that begins in the late teens and gradually worsens is most likely due to what condition? |
|
Definition
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|
Term
| Increasingly severe menorrhagia for the last 7 years in a 40 y/o patient may be associated with what medical conditions? |
|
Definition
The differential diagnosis may include: fibroids, adenomyosis, or endometrial polyps. |
|
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Term
| Intermenstrual bleeding in a 35 y/o patient on oral contraceptives is associated with what conditions? |
|
Definition
The differential diagnosis may include: high progestin content of the BCPs, cervicitis, vaginitis, polyps, or fibroids. |
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Term
Name the cervical lesion seen on colposcopy. [image] |
|
Definition
Cervical cancer. Note the abnormal vascular pattern: the varying vessel caliber and unusual vessel shapes. Such a lesion must always be biopsied. |
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Term
What is the differential diagnosis for vulvar pruritits in a 65 y/o patient? |
|
Definition
The differential diagnosis may include: candidiasis, atrophic changes, vulvar cancer, or allergic dermatitis. |
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Term
A 23 y/o has the acute onset of abdominal pain. Her last menstrual period occurred 6 weeks ago. Her quantitative beta HCG is 5,200 mIU/mL . What test do you order next? |
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Definition
You order an ultrasound of the pelvis. Ectopic pregnancy is high on the differential diagnosis, and an UTS will help by demonstrating either an intrauterine pregnancy, ectopic pregnancy, ovarian cyst, or free peritoneal fluid. |
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Term
| A 22 y/o presents with protracted nausea and vomiting at 10 weeks gestational age. There is associated midepigastric abdominal pain. The differential diagnosis should include what conditions? |
|
Definition
The differential diagnosis may include: hyperemesis gravidarum, gastroenteritis, gallbladder disease, pancreatitis, or hepatitis. |
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Term
An 18 y/o is 2 weeks late on her period. Review the longitudinal view of the patient's uterus on pelvic sonogram below. What is your diagnosis? [image] |
|
Definition
| This is an early intrauterine pregnancy. A gestational sac with yolk sac is demonstrated. |
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Term
| A 44 y/o woman complains of a six-month history of galactorrhea. The fluid is grey in color. She is on multiple medications for bipolar disorder, hypertension, and diabetes. The differential diagnosis should include what conditions? |
|
Definition
The differential diagnosis may include: breast cancer, secondary to medications, idiopathic, or excessive stimulation. |
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Term
| A pap smear result returns on a 30 y/o woman as "high grade intraepithelial lesion." What is the next step? |
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Definition
Colposcopy should be performed. A clearly abnormal pap smear demands an investigation for a cervical lesion. |
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Term
| An 18 y/o patient asks for contraceptive advice. She has no major medical issues except dysmenorrhea. Birth control pills would be a reasonable choice due to what mechanism of action to help the menstrual cramps? |
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Definition
| BCPs reduce the amount of endometrium, which, in turn, reduces the amount of prostaglandin produced. In general, the lighter the menses, the less cramping. With time, most women on BCPs note lighter menses. |
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Term
| The following adnexal mass is found on ultrasound in a 44 y/o women with the acute onset of left lower quadrant abdominal pain. The differential diagnosis should include what conditions?[image] |
|
Definition
The UTS shows a unilocular cyst most likely of ovarian origin. The diffferential diagnosis may include: ovarian torsion, cyst rupture, or hemorrhagic cyst. |
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Term
| A 22 y/o G1 at 30 weeks gestational age has lower abdominal cramping. Her cervix is closed, uneffaced, and the presenting part is high. The fetal fibronectin is negative and the cervical length by UTS is 3.4 cm and normal. What is the likely diagnosis? |
|
Definition
False labor: no cervical change and the lack of the adhesive protein fibronectin makes the possibility of preterm labor quite low (but never say never). |
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Term
| A 27 y/o woman has attempted pregnancy for two years. She has a history of chlamydia, periods every five weeks, a male partner who has fathered two children, mild dysmenorrhea, a family history of diabetes and hypothyroidism, menstrual migraines, and a BMI of 30. What is the most likely cause of her infertility? |
|
Definition
| Her cycles are in the normal range, mild dysmenorrhea is common and not necessarily endometriosis, her partner sounds fertile, the other info is not very revealing . . . leading one to suspect tubal damage from her prior chlamydia. A test of tubal function is in order. |
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Term
| You palpate a 16 week size abdomino-pelvic mass in a 38 y/o that is suggestive of a fibroid. What symptoms should you ask about, if she may have this condition? |
|
Definition
Ask about pressure-related symptoms (pelvic, bladder, or rectal), menorrhagia, increasing abdominal girth, lightheadedness, and fatigue due to anemia. |
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Term
| A 33 y/o woman is admitted to the internal medicine service for an evaluation of anemia. She has an iron deficiency anemia and history significant for heavy menstrual periods. The differential diagnosis should include what conditions? |
|
Definition
Your differential diagnosis may include: fibroids, adenomyosis, endometrial polyps, anovulatory bleeding, or Von Wildebrand's disease. |
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Term
A large abdomino-pelvic mass is removed surgically. The histology is shown below. It most likely represents what condition? [image] [image] |
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Definition
| This is a benign leiomyoma. Notice the orderly spindle-shaped cells with little-to-no mitotic activity. |
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Term
Vulvar pruritis may be a presenting symptom for what conditions in a 26 y/o woman? |
|
Definition
The differential diagnosis may include: allergic dermatitis, candidiasis, or condyloma accuminata. |
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Term
| The differential diagnosis of a 6 cm solid, left adnexal mass should include what conditions? |
|
Definition
The differential diagnosis may include: ovarian neoplasm, pedunculated fibroid, cancer metastatic to the ovary, colon/rectal cancer, or lymphoma. |
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|
Term
| What is the most common vaginal infection associated with bleeding (usually light spotting)? |
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Definition
|
|
Term
|
Definition
| The absence of menstrual cycles for twelve months. This can be verified with an FSH level. |
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Term
|
Definition
| Endometrial glands and stroma lying deep within the myometrium. Adenomyosis may be associated with dysmenorrhea and abnormal uterine bleeding. |
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Term
Define post cesarean febrile morbidity. |
|
Definition
| A temperature of >/= 100.4 degrees F on two separate occasions six hours apart after the first 24 hours post operative. |
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Term
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Definition
| The number of stillbirths per 1,000 live births. |
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|
Term
|
Definition
| A fetus born dead after the 20th week gestation or >/= 300 grams. |
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Term
|
Definition
| Babies that die in the first month of life. |
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Term
Define perinatal mortality rate. |
|
Definition
| The sum of the stillbirth rate and the neonatal death rate. |
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Term
Define fetal presentation. |
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Definition
| The part of the fetus that is presenting to the pelvic inlet. Some presentations include: vertex, face, brow, breech, shoulder, or umbilical cord. |
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Term
Define funic presentation. |
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Definition
| Funic refers to the umbilical cord. Therefore, a funic presentation implies that the cord presents below the fetus. Once diagnosed, this usually necessitates cesarean section. |
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Term
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Definition
| Lie refers to the orientation of the fetal long axis with reference to the maternal long axis. If oriented in a vertical fashion, it would be a longitudinal lie. Other options include transverse and oblique lie. |
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Term
Define position of the vertex presentation. |
|
Definition
| Position refers to the orientation of the fetal cranium within the maternal pelvis. The occitput of the fetal cranium is the reference point. The various orientations include: occiput anterior, R or L occiput anterior, occiput posterior, R or L occiput posterior, or R or L occiput transverse. |
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Term
Define position of the breech presentation. |
|
Definition
| Position refers to the orientation of the fetal pelvis within the maternal pelvis. The sacrum of the fetal pelvis is the reference point. The various orientations include: sacrum anterior, R or L sacrum anterior, sacrum posterior, R or L sacrum posterior, or R or L sacrum transverse. |
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Term
|
Definition
| Heavy menstrual bleeding (> 80cc per cycle). |
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|
Term
|
Definition
| Irregularly irregular bleeding. |
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|
Term
| A 29 y/o woman has not had a period for 3 months. Previously, her menses were regular (every 28 days). Name the most likely cause. |
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Definition
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Term
| A 39 y/o woman has not had a period for 3 months. Previously, her menses were regular (every 28 days). She had a tubal ligation one year ago. Name the most likely cause. |
|
Definition
Anovulation. A search for potential causes, including thyroid disease, hyperprolactinemia, or PCOS, would be in order. Pregnancy is possible, and an HCG should be obtained, but this is less likely. |
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Term
A 64 y/o woman has a hysterectomy for post menopausal bleeding. The uterine specimen is opened in the operating room, and may be seen below. What is the most likely diagnosis? [image] |
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Definition
| The fungating endometrial mass is most likely an adenocarcinoma. A leiomyosarcoma would also be possible. |
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Term
A 34 y/o G2P2 has a hysterectomy for severe dysmenorrhea. The histology of the myometrium is shown. What is the diagnosis? [image] |
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Definition
| The section demonstrates both glands and stroma deep within the myometrium, making the diagnosis adenomyosis. |
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Term
| A 44 y/o G1P1 complains of abdominal bloating and pelvic pressure for three months. She has lost 10# and has not been dieting. What is the most likely gynecologic malignancy to cause these symptoms? |
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Definition
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Term
| What is the most common cause of postmenopausal bleeding in the United States? |
|
Definition
| Exogenous estrogen administration. |
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Term
Which of the following is most likely to cause thrombocytopenia: (a) systemic lupus erythematosus, (b) post partum hemorrhage, (c) preeclampsia, or (d) abruptio placentae. |
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Definition
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Term
A patient is 7 weeks pregnant with a known LMP. She has light bleeding and the following UTS demonstrates a fetal pole with a heart beat. What is the diagnosis? [image] |
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Definition
| Threatened abortion, since a viable intrauterine pregnancy is present and vaginal bleeding is occurring. |
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Term
| A 26 y/o G1 has been dilated six centimeters for four hours. What is her stage of labor? |
|
Definition
| She is in the first stage of labor (from the onset of cervical dilatation to complete dilatation). |
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Term
| A 26 y/o G1 has been dilated six centimeters for four hours, and the contractions are deemed adequate to 70 mm Hg. What is your diagnosis? |
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Definition
| Arrest of dilatation. No cervical change over two hours in the active phase of labor establishes the diagnosis of an arrest of dilatation. |
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Term
What is the first diagnostic test to evaluate postmenopausal bleeding? |
|
Definition
| Endometrial biopsy. A tissue sample is needed to rule-out endometrial neoplasia. |
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Term
A patient presents at term with brisk vaginal bleeding and a soft uterus that is not tender to palpation. What is the placental location on this UTS? (The arrow marks the internal cervical os.) [image] |
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Definition
| The placenta overlies the internal cervical os (placenta previa). |
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Term
| A gestational sac can been identified transvaginally or transabdominally at what quantitative serum beta HCG values, respectively? |
|
Definition
| 1,500 mIU/mL or 5,000 mIU/mL, respectively. |
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Term
From the time of fertilization until 8 weeks conceptional age or 10 weeks menstrual (gestational) age, the conceptus is referred to as a(n)? |
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Definition
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|
Term
| From 10 weeks gestational age until delivery, the conceptus is referred to as a? |
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Definition
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Term
| Fetal viability is said to begin at what gestational age and/or fetal weight? |
|
Definition
24 weeks gestational age or 500 grams. |
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Term
| G1 P2-3-4-5. Please define the numbers 1 through 5, referring to gravidity and parity. |
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Definition
| 1 refers to the current pregnancy, or number of times a woman has been pregnant; 2 refers to the number of full term deliveries (> 37 weeks); 3 refers to the number of pre term delivieries (20 - 36-6/7 weeks); 4 refers to the number of abortions (< 20 weeks; spontaneous or elective); 5 refers to the number of living children. |
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Term
| How is Nagele's rule used to calculate the estimated date of confinement (EDC) or estimated date of delivery (EDD)? |
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Definition
| Add 7 days to and subtract 3 months from the first day of the last menstrual period (LMP). |
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Term
| Do the following increase or decrease during pregnancy: cardiac output; systemic vascular resistance; tidal lung volume; residual lung volume; total lung capacity. |
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Definition
| Cardiac output increases; systemic vascular resistance decreases; tidal lung volume increases; residual lung volume decreases; total lung capacity decreases. |
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Term
| Do the following increase or decrease during pregnancy: glomerular filtration rate (GFR); plasma volume; red blood cell volume; hematocrit? |
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Definition
| Glomerular filtration rate (GFR) increases; plasma volume increases; red blood cell volume increases; hematocrit decreases (because the increase in plasma volume is greater than that in red blood cell volume). |
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Term
| What is the additional nutritional support in the form of calories required by a healthy pregnant mother? |
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Definition
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Term
Name the following conditions: trisomy 13, 18, & 21. |
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Definition
| Patau's syndrome, Edward's syndrome, & Down's syndrome. |
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Term
| All mothers who will be 35 years of age or older at the time of delivery are considered of "advanced maternal age" and routinely should be offered what diagnostic test? |
|
Definition
| Genetic amniocentesis (fetal karyotyping). |
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Term
| At what gestational age should an anatomy scan (sonogram) be performed? |
|
Definition
| 18 - 20 weeks gestational age. |
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Term
| What components comprise a biophysical profile (BPP)? |
|
Definition
| Gross fetal movement; fine motor movement (tone); amniotic fluid; fetal breathing; non-stress testing. |
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Term
| You are called to evaluate a patient in the emergency department with a blood pressure of 80/50, pulse of 120, positive urine HCG, minimal vaginal spotting, and left lower quadrant pain. What is your working diagnosis? |
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Definition
Ruptured ectopic pregnancy. |
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Term
| A visually dilated cervix with bleeding, but no expulsion of products of conception. |
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Definition
|
|
Term
| A visually closed cervix with bleeding, and no |
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Definition
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Term
| What tests would you order for a stable patient with first trimester vaginal bleeding? |
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Definition
| CBC, blood type & antibody screen, quantitative serum beta HCG, and ultrasound. |
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Term
A patient with vaginal bleeding in her second trimester has an ultrasound that identifies a placenta previa. Her vital signs are stable, and the bleeding has ceased. Her blood type is A -. What intervention is indicated? |
|
Definition
| RhoGAM to prevent Rh isoimmunization of the mother. |
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Term
| A 24-y/o G2P0101 @ 8 weeks enters your office for her first prenatal visit. She reports a history of preterm delivery, although she cannot recall the exact gestational age. You perform a speculum examination and find her cervix to be dilated 3 cm by visualization. She denies cramping or contractions. What is your assessment and plan? |
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Definition
| Assessment: cervical incompetence or insufficiency. Plan: cervical cerclage. |
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|
Term
Three or more CONSECUTIVE spontaneous abortions. |
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Definition
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|
Term
| How would you confirm rupture of membranes (list three tests)? |
|
Definition
Rupture of membranes can be confirmed with a test for pooling (of amniotic fluid within the vaginal vault), nitrazine (pH paper will turn blue, as amniotic fluid is basic), and ferning (estrogen within amniotic fluid causes arborization when swabbed on a glass slide and allowed to dry). |
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Term
| What three key fetal landmarks are used to determine fetal position. |
|
Definition
| The anterior & posterior fontanelles and the sagittal suture. |
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Term
| List, in order, the cardinal movements of labor. |
|
Definition
| The cardinal movements of labor include: engagement, flexion, descent, internal rotation, extension, and external rotation. |
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Term
| What value of pressure in mmHg, as measured only by an intrauterine pressure catheter, is indicative of "adequate" strength of contractions? |
|
Definition
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|
Term
| List three resuscitative measures used at times of fetal distress. |
|
Definition
| Resuscitative measures include O2 via non-rebreather, IV fluid boluses, and repositioning the patient into the left lateral decubitus. |
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Term
| What are three signs of placental detachment from the uterus after delivery? |
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Definition
| With placental detachment, one will see the uterus rise up within the abdomen, a lengthening of the umbilical cord, and a gush of blood from the vagina. |
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Term
| What is often the initial maneuver performed for shoulder dystocia? |
|
Definition
| McRobert's maneuver--the maternal thighs are flexed onto the chest at the hips such that the pelvic inlet and outlet are aligned in a more favorable angle. |
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Term
What might this procedure be associated with in a subsequent pregnancy? [image] |
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Definition
| This is a laser ablation of the cervix and it may be associated with cervical insufficiency in subsequent pregnancies. |
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Term
Under certain circumstances, in a hemodynamically stable patient, what is an alternative medical treatment to the following surgical treatment? [image] |
|
Definition
These images represent laparoscopic treatment of a tubal ectopic pregnancy. Under certain circumstances, methotrexate is an alternative treatment. |
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Term
How would you describe the location of this leiomyoma? [image] |
|
Definition
| This is a submucosal leiomyoma. |
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|
Term
How would you describe the location of this leiomyoma? [image] |
|
Definition
| This is a subserosal leiomyoma. |
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Term
For what diagnosis is this procedure indicated? [image] |
|
Definition
| This represents a transvaginal tape (TVT) procedure as performed for stress urinary incontinence. |
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Term
Your elderly patient complains of new-onset back pain. You order the following film, and decide to begin treatment for what medical condition? [image] |
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Definition
| Your patient has compression fractures related osteoporosis. Your treatment for her osteoporosis is likely to include calcium and bisphosphonates. |
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Term
You identified these vessels coursing freely (unprotected by the placenta) on ultrasound. You then informed the patient that this condition (a) DOES or (b) DOES NOT dictate the mode of delivery. [image] |
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Definition
| This is a vasa previa, and it DOES dictate a cesarean delivery. This is often preceded by prolonged inpatient fetal monitoring. Rupture of the membranes could lead to life-threatening fetal hemorrhage. |
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Term
Your patient has had difficulty becoming pregnant since her last pregnancy, which was associated with post-partum hemorrhage and D&C. Part of your work-up included this imaging study. What is your diagnosis? [image] |
|
Definition
| Your patient has Asherman's syndrome--these synechiae or intrauterine adhesions are likely related to an overly aggressive post-partum D&C. Notice the intrauterine filling defect. |
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|
Term
This measurement in the first trimester helps to determine one's risk for what condition? [image] |
|
Definition
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|
Term
In addition to the following, what three parameters are used to generate an estimated fetal weight? [image] |
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Definition
| Sonographic measurements of femur length, head circumference, biparietal diameter, and abdominal circumference are used to generate an estimated fetal weight. |
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|
Term
| What is a woman's lifetime risk of breast cancer? |
|
Definition
| One in 8 women (12.5%) will develop breast cancer. |
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|
Term
| Most breast masses are located in which quadrant? |
|
Definition
| The upper outer quadrant contains most breast masses. Note that this quadrant contains the majority of breast tissue. |
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Term
Which lymph nodes receive the most drainage from the breast? |
|
Definition
| The ipsilateral lymph nodes receive the most drainage from the breast. This is the basis for sentinel lymph node mapping. |
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Term
| Which benign condition of the breast is present in half of premenopausal women? |
|
Definition
| Fibrocystic change is present in half of premenopausal women. |
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Term
| You evaluate a frantic 23 y/o G0 who recently discovered a firm, rubbery, freely mobile, solid 2 X 1 cm mass in the upper outer quadrant of her left breast. There are no palpable lymph nodes. What is the most likely diagnosis? |
|
Definition
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|
Term
| True or False: Screening mammography reduces breast cancer-related mortality? |
|
Definition
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|
Term
Ectopic pregnancy, chronic pelvic pain, and infertility are associated with what entity? |
|
Definition
| Pelvic inflammatory disease is associated with ectopic pregnancy, chronic pelvic pain, and infertility. |
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Term
| True or False: The increased risk of pelvic inflammatory disease associated with an intrauterine device is present only during the first three weeks after insertion. |
|
Definition
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|
Term
| According to the CDC, empiric treatment for pelvic inflammatory disease should be initiated when what three symptoms are present (with no other obvious source of infection)? |
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Definition
| Treatment for pelvic inflammatory disease should be initiated when the combination of abdominal, adnexal, and cervical motion tenderness is present. One's threshold for treatment should be low, as the complications of pelvic inflammatory disease (e.g., ectopic pregnancy, chronic pelvic pain, and infertility) are serious. |
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Term
| Your 18 y/o G0 patient is sexually active, and has arrived for her first well-woman exam. She has no complaints. On your speculum exam, you observe a round, red ulcer on the cervix. It is indurated with raised edges and painless. She has nontender regional adenopathy. What is the recommended treatment? |
|
Definition
| Benzathine penicillin G is the recommended treatment for syphilis. |
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Term
| Your patient complains of vaginal itching, discharge, and a "fishy" odor. You perform a wet mount of her vaginal discharge and notice an abundance of "clue cells." What do you expect the pH of her vaginal discharge to be, given that normal pH is approximately 4. |
|
Definition
| This patient has bacterial vaginosis, which is characteristically associated with a thin, homogenous, gray discharge that is adherent to the vaginal sidewalls. The pH is generally greater than 5 and the whiff test is positive (the addition of KOH releases amines that are associated with a "fishy" odor). |
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Term
AIDS is associated with a CD4 count less than or equal to what value? |
|
Definition
| A CD4 count less than or equal to 200 cells per milliliter is diagnostic of AIDS. |
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Term
Your patient has been unsuccessfully treated for recurrent urinary tract infection. She routinely presents with dysuria, urgency, and frequency. You perform a cystoscopy with hydrodistention of the bladder and observe and inflammed bladder wall with petechial hemorrhages. What is your diagnosis? |
|
Definition
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|
Term
| List three key steps prior to application of a vacuum or forceps. |
|
Definition
| Identify fetal position and station, empty the maternal bladder, and ensure adequate anesthesia. |
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|
Term
| True or False: Oral contraceptives are protective against ovarian cancer. |
|
Definition
|
|
Term
| True or False: Betamethasone has been proven to decrease neonatal mortality. |
|
Definition
|
|
Term
| Magnesium sulfate, a common tocolytic, is metabolized and excreted by what organ? |
|
Definition
| Magnesium sulfate is metabolized and excreted by the kidney, such that the dose may need to be adjusted in patients with abnormal renal function. |
|
|
Term
| Describe the difference in therapy between an A1 and A2 gestational diabetic. |
|
Definition
| A1 represents diet control, while A2 represents medication control with regards to gestational diabetes. |
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Term
| What critical value of proteinuria in a 24 hour collection of urine is used to diagnose pre-eclampsia? |
|
Definition
| >/= 300 mg/dL of protein in a 24 hour collection of urine is used to diagnose pre-eclampsia. |
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|
Term
| What critical value of proteinuria in a 24 hour collection of urine is used to diagnose SEVERE pre-eclampsia? |
|
Definition
| >/= 5,000 mg/dL of protein in a 24 hour collection of urine is used to diagnose pre-eclampsia. |
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|
Term
| What are the components of a thrombophilia work-up in pregnancy? |
|
Definition
| To rule out thrombophilia, order: lupus anticoagulant, anticardiolipin antibody, factor five leiden mutation (activated protein C resistance), prothrombin G20210A mutation, antithrombin three activity, proteins S and C activity, and methylene tetrahydrofolate reductase mutation +/- fasting homocysteine level. |
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|
Term
| True or False: Perinatal transmission of HIV can be reduced from ~25% to ~2% by use of highly active antiretroviral therapy. |
|
Definition
|
|
Term
List causes of a false-positive nitrazine test. |
|
Definition
| Some causes of a false-positive nitrazine test include: blood, semen, alkaline antiseptics, and bacterial vaginosis. |
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Term
| Septic pelvic thrombophlebitis is often diagnosed in retrospect after satisfactory response to what medication? |
|
Definition
| Heparin is used to treat septic pelvic thrombophlebitis. |
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|
Term
| When does the American College of Obstetricians and Gynecologists recommend initiating Papanicolaou smears? |
|
Definition
| The American College of Obstetricians and Gynecologists recommends initiating Papanicolaou smears by three years after the onset of vaginal intercourse or age 21, whichever is first. |
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|
Term
| Which type of episiotomy (midline or mediolateral) is reportedly more painful? |
|
Definition
| The mediolateral episiotomy is reportedly more painful. |
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|
Term
| Which type of episiotomy (midline or mediolateral) is more likely to lead to a third or fourth-degree extention? |
|
Definition
| The midline episiotomy is more likely to lead to a third- or fourth-degree extension. |
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|
Term
| What is the normal time allotted for stage three of labor? |
|
Definition
Placental delivery within thirty minutes of the fetus is considered within normal limits. |
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|
Term
| At what station is the fetal head considered "engaged?" |
|
Definition
| The fetal head generally is considered engaged at zero station, indicating that the widest fetal diameter has successfully maneuvered the pelvic inlet. |
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Term
| When facilitating delivery of the placenta, why is suprapubic pressure is applied in addition to gentle downward traction on the umbilical cord? |
|
Definition
| Suprapubic pressure is applied during delivery of placenta in order to prevent uterine inversion or prolapse. |
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|
Term
| What degree of laceration involves the perineal body and all or part of the rectal sphincter but no rectal mucosa? |
|
Definition
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|
Term
| What degree of laceration involves the perineal body, rectal sphincter, and rectal mucosa? |
|
Definition
| Fourth-degree laceration. |
|
|
Term
| What degree of laceration involves the mucosa or skin only? |
|
Definition
|
|
Term
| What degree of laceration involves the mucosa and subcutaneous tissue but not the anal sphincter or rectal mucosa? |
|
Definition
| Second-degree laceration. |
|
|
Term
| You are counselling your patient regarding trial of labor after cesarean section (TOLAC). She has a documented low transverse scar from her previous section for breech presentation. What is the chance (in percent) that her scar will rupture during a TOLAC? |
|
Definition
For a history of low transverse cesarean section, the chance that her scar will rupture during a TOLAC is < 1%. |
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|
Term
| True or False: Many second trimester marginal and low-lying placentas resolve as the lower uterine segment develops. |
|
Definition
|
|
Term
| What is the term used to describe a placenta that abnormally superficially invades the myometrium? |
|
Definition
|
|
Term
| What is the term used to describe a placenta that abnormally deeply invades the myometrium? |
|
Definition
|
|
Term
| What is the term used to describe a placenta that abnormally invades through the myometrium and (in)to the serosa? |
|
Definition
|
|
Term
| What drug of abuse is associated with placental abruption? |
|
Definition
| Cocaine use may result in placental abruption. |
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|
Term
| True or False: Placental aburption is always associated with vaginal bleeding. |
|
Definition
| False. Placental abruption may be associated with a concealed hemorrhage, where the blood accumulates within the uterine cavity. |
|
|
Term
| What is the most common maternal medical condition that predisposes to placental abruption? |
|
Definition
| The most common maternal medical condition that predisposes to placental abruption is hypertension. |
|
|
Term
| What type of fetal heart rate pattern is indicative of fetal anemia? |
|
Definition
| A sinusoidal fetal heart rate pattern is indicative of fetal anemia. |
|
|
Term
| Define low birth weight in grams. |
|
Definition
| Birth weight less than or equal to 2,500 grams. |
|
|
Term
| Define intrauterine growth restriction. |
|
Definition
| Growth that is less than or equal to the tenth percentile for gestational age. |
|
|
Term
| List three complications of prematurity. |
|
Definition
| Three complications of prematurity include: respiratory distress syndrome, necrotizing enterocolitis, and intraventricular hemorrhage. Other complications, such as retinopathy of prematurity, do exist. |
|
|
Term
| Dehydration results in the release of what hormone that may cross-react with oxytocin receptors, thereby resulting in contractions. |
|
Definition
| Dehydration results in the release of vasopression (antidiuretic hormone, ADH), which may cross-react with oxytocin receptors, thereby resulting in contractions. |
|
|
Term
| Match the tocolytic agent to its class. Agents: (a) terbutaline, (b) nifedipine, and (c) indomethacin. Classes: (1) calcium channel blocker, (2) beta agonist, and (3) prostaglandin inhibitor. |
|
Definition
| (a) terbutaline is a (2) beta agonist. (b) nifedipine is a (1) calcium channel blocker. (c) indomethacin is a (3) prostaglandin inhibitor. |
|
|
Term
| Why is the use of prostaglandin inhibitors (e.g., indomethacin) restricted beyond a gestational age of ~ 32 weeks? |
|
Definition
| Prostaglandin inhibitors may result in closure of the ductus arteriosus with pulmonary hypertension and oligohydramnios. |
|
|
Term
| What is the agent of choice recommended by the American College of Obstetricians and Gynecologists for group beta streptococcus prophylaxis in labor? |
|
Definition
| Penicillin is the agent of choice recommended by the American College of Obstetricians and Gynecologists for group beta streptococcus prophylaxis in labor. |
|
|
Term
| Which type of maternal pelvis is associated with a narrow subpubic arch? |
|
Definition
| The android pelvis is associated with a narrow subpubic arch. |
|
|
Term
| Define frank breech in terms of flexion or extension of the hips and knees. |
|
Definition
| An infant with flexed hips and extended knees is in the frank breech presentation. |
|
|
Term
| Define complete breech in terms of flexion or extension of the hips and knees. |
|
Definition
| An infant with flexed hips and one or both knee(s) flexed is in the complete breech presentation. |
|
|
Term
| Define incomplete (footling) breech in terms of flexion or extension of the hips. |
|
Definition
| An infant with one or both hips extended. One or both foot (feet) and/or knee(s) presents beneath the breech. |
|
|
Term
| When labor does not proceed as anticipated, what are the three P's that must be considered? |
|
Definition
| The powers (strength of uterine contractions), passenger (fetal features), and pelvis (maternal features) must all be considered when labor does not proceed as anticipated. |
|
|
Term
| Which is not a risk factor for shoulder dystocia: hypertension, diabetes, fetal macrosomia, maternal obesity, post-dates pregnancy, previous shoulder dystocia, and prolonged second stage of labor. |
|
Definition
| Hypertension is not a risk factor for shoulder dystocia. |
|
|
Term
| What condition corresponds to the chromosome complement 45 X0? |
|
Definition
|
|
Term
| Define large for gestational age. |
|
Definition
| Growth that is greater than or equal to the ninetieth percentile for gestational age. |
|
|
Term
| Define macrosomia in grams. |
|
Definition
| Birth weight greater than or equal to 4,000 grams. |
|
|
Term
| During the patient's initial fetal sonogram, you identify oligohydramnios. You then make the diagnosis of Potter Syndrome. What vital organ is involved in this condition? What is the prognosis? |
|
Definition
| Potter Syndrome refers to a lethal condition of renal agenesis with oligohydramnios. |
|
|
Term
| During the patient's initial fetal sonogram, you identify oligohydramnios. What is the most common cause of oligohydramnios? |
|
Definition
| The most common cause of oligohydramnios is rupture of membranes. This finding is often an indication for examination to rule out rupture of membranes. |
|
|
Term
| Your patient with polyhydramnios is in labor, but the fetal vertex is not yet well-applied. What are two of your significant concerns? |
|
Definition
| Given polyhydramnios and a presenting part that is not yet well-applied, you are concerned regarding the possibility of malpresentation and cord prolapse. |
|
|
Term
| You performed an amniocentesis to determine fetal lung maturity in a poorly controlled diabetic patient. Why is it important to know her blood type? |
|
Definition
| It is important to know the maternal blood type when an amniocentesis is performed (for any indication) so that RhoGAM may be given if she is rh negative. |
|
|
Term
| Your patient's blood type is A negative. On sonogram, you identify a thickened placenta, fetal pleural and pericardial effusions, and fetal ascites. You suspect the maternal antibody screen is (a) positive or (b) negative. What is your diagnosis? |
|
Definition
| The antibody screen is positive, demonstrating antibodies against the Rh factor. Your diagnosis is hydrops fetalis. |
|
|
Term
Define post-term pregnancy. |
|
Definition
| A post-term pregnancy is that which has reached the gestational age of 42 complete weeks. |
|
|
Term
| If a fertilized ovum separates immediately, what type of placenta develops? |
|
Definition
| If a fertilized ovum separates immediately, monozygotic twins with a dichorionic diamnionic placenta develops. |
|
|
Term
| If a fertilized ovum separates after day 8, what type of placenta develops? |
|
Definition
| If a fertilized ovum separates after day 8, monozygotic twins with a monochorionic monoamnionic placenta develops. |
|
|
Term
| If a fertilized ovum separates after day 13, what type of placenta develops? |
|
Definition
| If a fertilized ovum separates after day 13, conjoined twins with a monochorionic monoamnionic placenta develops. |
|
|
Term
| True or False: A genetic predisposition to twinning is associated with monozygotic twins. |
|
Definition
|
|
Term
| True or False: A genetic predisposition to twinning is associated with dizygotic twins. |
|
Definition
|
|
Term
A 17 y/o G1 @ 41 weeks gestational age presents with persistently elevated blood pressures (> 180/90), visual disturbances, and 3+ proteinuria. Why do you immediately order IV magnesium sulfate? |
|
Definition
| You order IV magnesium sulfate to prevent seizures in this pre-eclamptic patient. Magnesium sulfate has been proven to decrease the risk of seizures (at least in patients with severe hypertension). |
|
|
Term
| A patient presents in her second trimester with markedly elevated blood pressures (> 180/90s), a uterine size greater than dates, and vaginal bleeding. What is your diagnosis? What do you expect to see on sonogram? |
|
Definition
| All these features are compatible with hydatidiform mole, which gives a snowstorm appearance on sonogram. |
|
|
Term
| You suspect the diagnosis of HELLP. What on the patient's peripheral smear would support this diagnosis? |
|
Definition
| On the peripheral smear of a patient with HELLP, one would expect to see schistocytes (due to red cell hemolysis). |
|
|
Term
| After a rapid load of 6 grams of IV magnesium sulfate, your patient complains of shortness of breath and lethargy. Her deep tendon reflexes are absent. Her breath sounds are distant and crackles can be heard. After ordering a stat magnesium level and turning off the IV medication, what antidote do you administer? |
|
Definition
| You administer 10cc of IV 10% calcium gluconate, an antidote to magnesium sulfate. Always remember to check renal function prior to beginning magnesium sulfate in order to determine if dosage must be adjusted (this drug is metabolized and excreted renally). |
|
|
Term
| True or False: Diabetes is not a risk factor for pre-eclampsia or eclampsia. |
|
Definition
|
|
Term
| Your patient just completed her glucose challenge test, with a result of 162mg/dL. What is your plan of action? |
|
Definition
| Next you will administer a fasting 3 hour oral glucose tolerance test with a 100 gram glucose load. |
|
|
Term
True or False: Insulin crosses the placenta. |
|
Definition
|
|
Term
| An asymptomatic pregnant patient has an e. coli colony count of 10^3 in a clean-catch urine specimen. Do you treat this finding? |
|
Definition
| Yes. Asymptomatic bacteriuria is aggressively treated in pregnancy, as ~25% of these cases will develop frank infection (e.g., cystitis/UTI or pyelonephritis). |
|
|
Term
| What treatment, if any, do you recommend for an infant you delivered yesterday whose mother now has signs and symptoms of chicken pox? |
|
Definition
| Varicella zoster immune globulin (VZIG) should be given to infants born to mothers with a diagnosis of chicken pox within 5 days before or 2-3 days after delivery. |
|
|
Term
| An infant you delivered has cataracts and a ventricular septal defect. The infant is deaf. What congenital condition does the infant have, and what trimester was it most likely to have been acquired? |
|
Definition
| The infant has congenital rubella syndrome, which is most likely to result from infection transmitted during the first trimester. |
|
|
Term
| A neonate has been diagnosed with encephalitis predominantly of the temporal lobes. IV therapy is being administered. Vertical transmission is suspected. Was transmission most likely to occur during a primary or secondary outbreak? |
|
Definition
| This neonate has herpes encephalitis and is being treated with IV acyclovir. Transmission is more likely to occur during a primary outbreak due to the lack of protective maternal IgG antibodies. |
|
|
Term
| What two agents are administered to the neonate of a mother with hepatitis B? |
|
Definition
| Both hepatitis B immune globulin (HBIG) and hepatitis B vaccine are given to the neonate of a mother with hepatitis B. |
|
|
Term
| A child with Hutchinson's teeth, saber shins, and a saddle nose has been identified by his pediatrician. Describe his mother's initial lesion. |
|
Definition
| This child has congenital syphilis. The lesion associated with primary infection is a painless, erythematous, indurated chancre. |
|
|
Term
| Just as in nutritionally deficient alcoholics, patients with severe hyperemesis gravidarum should have what key vitamin replaced prior to glucose? |
|
Definition
| Thiamine should be replaced (prior to glucose) in order to prevent precipitation of Wernicke's encephalopathy. |
|
|
Term
| What component (estrogen or progesterone) of oral contraceptive agents is more likely to decrease breast milk production? |
|
Definition
| Estrogen is more likely to decrease breast milk production in the post-partum period, such that agents with estrogen are often avoided. |
|
|
Term
| What recommendations do you make to your bottle-feeding patient when she complains of breast pain? |
|
Definition
| If, after history and physical examination, the pain is determined to be related to breast engorgement, then a tight-fitting bra, analgesics, and ice packs can be recommended. Encourage the patient to avoid all stimulation of the breasts. |
|
|
Term
| Define post-partum hemorrhage in vaginal and cesarean deliveries in cc of blood loss. |
|
Definition
| Post-partum hemorrhage is associated with > 500cc and > 1,000cc of blood loss in vaginal and cesarean deliveries, respectively. |
|
|
Term
| Your patient had a massive post-partum hemorrhage (~3,000 cc) at the time of vaginal delivery with a prolonged episode of hypotension. She was eventually successfully resuscitated. Unfortunately, she was unsuccessful at her attempts to breastfeed. Now, six months post-partum, she is still amenorrheic. Her urine HCG is negative. What is your diagnosis? |
|
Definition
|
|
Term
| What is the most common cause of post-partum hemorrhage? |
|
Definition
|
|
Term
| Your asthmatic patient is experiencing a post-partum hemorrhage. While you perform bimanual massage, you call for a uterotonic agent. What class of agents should you avoid? |
|
Definition
| Prostaglandins, such as carboprost (Hemabate, PGF-2 alpha), should be avoided in patients with asthma. |
|
|
Term
| Your hypertensive patient is experiencing a post-partum hemorrhage. While you perform bimanual massage, you call for a uterotonic agent. What common uterotonic agent should you avoid? |
|
Definition
| Methylergonovine (Methergine) should be avoided in patients with hypertension. |
|
|
Term
| What type of antibiotic should be selected to treat mastitis? |
|
Definition
| A penicillinase-producing antibiotic should be selected to treat mastitis. |
|
|
Term
| Ambiguous genitalia with salt-wasting is associated with what condition and what inheritance pattern? |
|
Definition
| Congenital adrenal hyperplasia (21-hydroxylase deficiency) is inherited in an autosomal recessive pattern. |
|
|
Term
| Your patient has recurrent Bartholin's gland cysts and abscesses. She has failed conservative treatment, including sitz baths, incision and drainage, and Word catheter. What procedure do you plan in the operating room? |
|
Definition
| You plan marsupialization, in which the entire cyst/abscess is removed and the remaining pouch sewn open to re-epithelialize. |
|
|
Term
| True or False: Leiomyomas often regress after menopause. |
|
Definition
|
|
Term
| The fallopian tubes, uterus, cervix, and upper vagina arise from what embryologic structures? |
|
Definition
| The paramesonephric ducts give rise to the aforementioned structures. |
|
|
Term
| Anomalies of the reproductive tract may be associated with anomalies of what other organ system? |
|
Definition
| Anomalies of the reproductive tract may be associated with anomalies of the urinary system? |
|
|
Term
| True or False: Most leiomyomas are asymptomatic. |
|
Definition
|
|
Term
| What agent constitutes medical treatment for endometrial hyperplasia? |
|
Definition
|
|
Term
| What is not a risk factor for endometrial hyperplasia: obesity, multiparity, anovulation, and tamoxifen? |
|
Definition
|
|
Term
| True or False: The hormones in oral contraceptives stimulate production of ovarian cysts. |
|
Definition
|
|
Term
| You order a triple screen on a G1 @ 18 weeks gestational age. Alpha feto-protein, beta human chorionic gonadotropin, and estriol are all low. Does this pattern correspond with an increased risk of Down Syndrome or trisomy 18? |
|
Definition
| This pattern corresponds with trisomy 18 or 13. |
|
|
Term
| A quad screen is performed on a G1 @ 18 weeks gestational age. The fetus is determined to be at increased risk for Down Syndrome. Please identify if the following components are decreased or elevated: alpha feto-protein, beta human chorionic gonadotropin, estriol, and inhibin. |
|
Definition
Down Syndrome is associated with decreased alpha feto-protein, elevated beta human chorionic gonadotropin, decreased estriol, and elevated inhibin. |
|
|
Term
| You evaluate an amenorrheic 16 y/o girl with a negative urine HCG. She has well-developed breasts but an absent uterus. If karyotyping reveals a 46 XX complement, what is your diagnosis? If karyotyping reveals a 46 XY complement, what is your diagnosis? |
|
Definition
| If karyotyping reveals a 46 XX complement, your diagnosis is mullerian agenesis. If karyotyping reveals a 46 XY complement, your diagnosis is androgen insensitivity. |
|
|
Term
| What biochemical marker may be used to confirm menopause? |
|
Definition
| FSH is elevated after menopause. |
|
|
Term
An endodermal sinus tumor is associated with an elevation in what tumor marker? |
|
Definition
|
|
Term
An embryonal cell tumor is associated with an elevation in what two tumor markers? |
|
Definition
| Alpha feto-protein and beta human chorionic gonadotropin. |
|
|
Term
A dysgerminoma is associated with an elevation in what tumor marker? |
|
Definition
|
|
Term
| What condition corresponds to the chromosome complement 47 XXY? |
|
Definition
|
|
Term
| What syndrome is associated with anosmia and an absence of GnRH? What is the consequence of an absence of GnRH? |
|
Definition
| Patients with Kallmann Syndrome do not develop secondary sexual characteristics. |
|
|
Term
| Match the condition with its inheritance pattern: (a) neurofibromatosis, (b) galactosemia, and (c) placental sulfatase deficiency; (1) sex linked, (2) autosomal dominant, and (3) autosomal recessive. |
|
Definition
| (a) neurofibromatosis is (2) autosomal dominant; (b) galactosemia is (3) autosomal recessive; (c) placental sulfatase deficiency is sex linked. |
|
|
Term
| List three popular theories regarding the etiology of endometriosis. |
|
Definition
| Three popular theories regarding the etiology of endometriosis include: lymphatic spread; metaplastic transformation; retrograde menstruation. |
|
|
Term
| Your 36 y/o G0 complains of increasingly painful periods and difficulty becoming pregnant. Her periods are heavy. On bimanual examination, you detect uterosacral nodularity and a fixed, retroverted uterus. What is your diagnosis? |
|
Definition
|
|
Term
| Your 36 y/o G3P3 complains of increasingly painful, heavy periods. On bimanual examination, you detect a soft, globular uterus. What is your diagnosis? |
|
Definition
|
|
Term
| Condyloma lata are associated with infection by what organism? |
|
Definition
| Treponema pallidum (syphilis). |
|
|
Term
| Which HPV serotypes are associated with genital warts and which are associated with cervical cancer: 6, 11, 16, 18, 31, and 33? |
|
Definition
| HPV serotypes 6 and 11 are associated with genital warts, whereas types 16, 18, 31, and 33 are associated with cervical cancer. |
|
|
Term
| You evaluate a 16 y/o G1 with intense pruritis in the webs of her fingers and toes, wrists, elbows, and knees. What treatment do you prescribe? |
|
Definition
| Permethrin cream, rather than lindane, should be used in pregnant/lactating women with scabies. |
|
|
Term
| With regards to innervation of the bladder and urethra, the parasympathetic control originates from which nerve roots? From which nerve roots does sympathetic control originate? |
|
Definition
| Parasympathetic control of the bladder and urethra originates from the nerve roots S2-4. Sympathetic control originates from the nerve roots T10-L2. |
|
|
Term
| The external urethral sphincter is controlled by what somatic nerve? |
|
Definition
|
|
Term
| You perform the "cotton swab test" on your patient due to her complaints. With your patient straining, the change in the angle of the cotton swab is approximately 45 degrees. What is your diagnosis, and what do you suspect her complaints are? |
|
Definition
| Your diagnosis is hypermobility of the bladder neck with genuine stress incontinence. Her complaints are likely to include urinary incontinence with coughing, sneezing, and laughing (activities associated with increased intraabdominal pressure). |
|
|
Term
| Your 68 y/o G5P5 complains of spontaneous urges to void with incontinence of urine. What category of medication do you plan to prescribe? |
|
Definition
| You prescribe anticholinergics for detrusor instability (urge incontinence). |
|
|
Term
| Your 58 y/o G5P5 poorly-controlled diabetic patient complains of constant dribbling and poor urinary stream. What class of medication will not be included in her treatment regimen: alpha adrenergic antagonists, anticholinergics, and striated muscle relaxants. |
|
Definition
| Anticholinergic agents are a cause of overflow incontinence, rather than a treatment. |
|
|
Term
| What is the most common cause for irregular menses in the months following menarche? |
|
Definition
|
|
Term
| What hormone surge during the middle of the menstrual cycle stimulates ovulation? |
|
Definition
Luteinizing hormone (LH). |
|
|
Term
| The corpus luteum is responsible for production of what hormone? |
|
Definition
|
|
Term
| Development of a primary ovarian follicle is due to the secretion of what hormone? |
|
Definition
| Follicle stimulating hormone (FSH). |
|
|
Term
| The decline in what hormone is the primary stimulus for menstruation? |
|
Definition
|
|
Term
| The follicular phase of the ovary corresponds to what phase of the endometrium? |
|
Definition
|
|
Term
| The luteal phase of the ovary corresponds to what phase of the endometrium? |
|
Definition
|
|
Term
| Before what age is menopause considered premature? |
|
Definition
| Forty. The average age of menopause is ~fifty-one. |
|
|
Term
| Your 48 y/o G2P2 has had irregular menses for five months. She recently noticed brief episodes of excessive sweating and irritability. What change in levels of estrogen and FSH may be found in this patient? |
|
Definition
| This patient is approaching menopause, and depressed levels of estrogen with elevated levels of FSH may be expected.. |
|
|
Term
| You are asked to evaluate a 16 y/o G0 with primary amenorrhea. She reports cyclic pelvic pain and a newly distended abdomen. On physical examination, you identify a bulging membrane at the introitus. Her urine HCG is negative and all reproductive organs are present on sonogram. What is your diagnosis? |
|
Definition
| Outflow tract obstruction (e.g., imperforate hymen or transverse vaginal septum or vaginal agenesis/atresia). |
|
|
Term
| The presence of what substance prevents Mullerian structures from developing in patients with testicular feminization (androgen insensitivity)? |
|
Definition
| Mullerian inhibiting factor (MIF). |
|
|
Term
| Your patient's infertility has been attributed to an ovarian receptor defect, rendering the tissue insensitive to FSH & LH. What is the name for this disorder? |
|
Definition
|
|
Term
| Your patient complains of bilateral breast discharge, and is found to have an elevated prolactin level. In addition to galactorrhea, what abnormality in her menses do you expect? |
|
Definition
| Hyperprolactinemia is associated with amenorrhea. |
|
|
Term
| A progesterone challenge is used to determine the presence and adequacy of what hormone? |
|
Definition
|
|
Term
| What treatment would you offer a 22 y/o G0 with amenorrhea, galactorrhea, and a pituitary microadenoma who is attempting pregnancy? |
|
Definition
| A dopamine agonist (e.g., bromocriptine). |
|
|
Term
| You are performing three month post-operative testing on a patient who received a transvaginal tubal occlusion procedure. Which technique would be most helpful and efficient: laparoscopy with chromopertubation, hysteroscopy, sonohysterogram, or hysterosalpingogram? |
|
Definition
| Hysterosalpinogram (HSG). |
|
|
Term
| Prior to an endometrial ablation, the presence of neoplastic cells must be ruled-out by what test? |
|
Definition
| Endometrial biopsy (EMB). |
|
|
Term
| What enzyme is responsible for the conversion of testosterone to dihydrotestosterone? |
|
Definition
|
|
Term
| Which hormone is a marker of adrenal androgen production? |
|
Definition
| Dehydroepiandrosterone sulfate (DHEAS). |
|
|
Term
| Which of the following is not associated with polycystic ovarian syndrome (PCOS): hirsutism, decreased estrogen production, anovulation, obesity, and diabetes. |
|
Definition
| Decreased estrogen production. |
|
|
Term
| Theca lutein cysts are responsible for the production of what class of hormones? What effects may be associated with such cysts? |
|
Definition
| Theca cells respond to LH with the production of androgens, including androstenedione and testosterone. Therefore, theca lutein cysts may be associated with effects such as hirsutism. |
|
|
Term
True or False: Many women ovulate despite the presence of an intrauterine device. |
|
Definition
|
|
Term
| List reasonable contraceptive options in patients with a personal history of DVT. |
|
Definition
| Contraceptive agents with an estrogen component should be avoided in patients with a history of DVT. Therefore, reasonable contraceptive options include: abstinence, natural family planning (e.g., rhythm method), condom, diaphragm or cervical cap, IUD, depot medroxyprogesterone acetate, implantable progestins, or (male or female) sterilization. |
|
|
Term
| You evaluate a new patient who recently had an IUD placed post-partum. She complains of crampy abdominal pain and amenorrhea. On physical examination, the IUD strings are not visible. What is your concern? |
|
Definition
| The post-partum period is associated with an increased likelihood of uterine perforation during/after IUD placement. An evaluation (sonogram or abdominal x-ray) and urine HCG should be performed to verify the location of the IUD and to rule-out pregnancy. |
|
|
Term
| Your patient is diagnosed with an intrauterine pregnancy @ ~7 weeks gestational age. You personally placed her IUD eight months ago. Should you schedule an appointment to remove the IUD? |
|
Definition
| Yes. If the strings are readily visible, the IUD should be removed. |
|
|
Term
| True or False: Vasectomy is safer and less expensive than tubal ligation. |
|
Definition
|
|
Term
| Describe the mechanism of action for mifepristone. |
|
Definition
| Mifepristone functions as an anti-progesterone: it binds to progesterone receptors within the endometrium without generating the normal effect of progestone. It is an abortifacient. |
|
|
Term
| True or False: When a second trimester termination must be performed, induction of labor is safer than dilatation and evacuation. |
|
Definition
| False. Dilatation and evacuation is safer than induction of labor for the management of a second trimester termination. |
|
|
Term
|
Definition
| The inability to conceive after twelve months of unprotected coitus. |
|
|
Term
| Your 26 y/o G0 has been attempting pregnancy. She is obese and hirsuit. You suspect that she is anovulatory. What is your first recommendation? |
|
Definition
| Weight loss should be your first recommendation, as loss of even a small amount has been associated with resumption of ovulation in patients with polycystic ovarian syndrome (PCOS, anovulatory patients). |
|
|
Term
| Describe the mechanism of action for clomiphene citrate. |
|
Definition
| Clomiphene citrate functions as an anti-estrogen: it binds to estrogen receptors within the hypothalamus, stimulating pulsatile GnRH release. |
|
|
Term
| Paget's disease of the vulva is associated with (a) squamous cell carcinoma or (b) adenocarcinoma. |
|
Definition
| Paget's disease of the vulva is associated with adenocarcinoma in ~20% of cases. |
|
|
Term
According to Schiller's test, abnormal (precancerous) cells (a) do or (b) do not stain dark brown due to decreased glycogen content. |
|
Definition
| Lugol's solution (iodine and potassium iodide) is used to perform Schiller's test. Glycogen-containing squamous cells stain dark brown. Nonglycogenated cells (including columnar or glandular cells and precancerous cells) remain pale. |
|
|
Term
| Acetic acid (a) does or (b) does not stain abnormal (precancerous) cells white. |
|
Definition
| Acetic acid does stain abnormal (precancerous) cells white. |
|
|
Term
| What is the most common cause of postmenopausal bleeding? |
|
Definition
|
|
Term
| What is the most important cause of postmenopausal bleeding to exclude? |
|
Definition
|
|
Term
| Which characteristic of adnexal masses is not commonly associated with malignancy: size > 8 cm, solid, bilateral, and unilocular. |
|
Definition
| Unilocular adnexal masses are generally benign. |
|
|
Term
| True or False: Complete moles are associated with fetal tissue. |
|
Definition
| False. Only incomplete moles are associated with fetal tissue. |
|
|
Term
A 46 y/o G2P2 is taking tamoxifen for breast cancer chemotherapy. After three years of treatment, she complains of intermenstrual bleeding. What is your concern, and what may have contributed to this irregular bleeding? |
|
Definition
| Tamoxifen is a selective estrogen receptor modulator that has been associated with endometrial hyperplasia, which, itself, may give rise to endometrial cancer. Both of these conditions must be ruled-out. |
|
|
Term
| What vitamin will enhance the absorption of iron? |
|
Definition
|
|
Term
| What vitamin will enhance the absorption of calcium? |
|
Definition
|
|
Term
| Which type of molar pregnancy (complete or incomplete) has greater malignant potential? |
|
Definition
| Complete molar pregnancy. |
|
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Term
| You perform an external cephalic version on a 22 y/o G1 @ 37 weeks gestational age. Fifteen minutes later she reports scant vaginal bleeding. Fetal heart tones demonstrate minimal variability with new-onset late decelerations. What is your diagnosis of concern? |
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Definition
| The external cephalic version may have caused a small placental abruption. This may necessitate cesarean section if the decelerations do not resolve with conservative measures. |
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