1/13/2018 Study Stack - OBGYN SHelf SR Table Review

OBGYN SHelf SR
Question Answer
32 y/o G3 P2 delivers a 9 lb baby following a 2hr second stgae of labor.
follwoing placental deliveyr there is a pale mass in the lower vagina, the pt uterine prolapse
develop hypovolemic shock and uterus cant be palpated. dx?
What is the most likely cause of a 46 XX baby born with scrotum and phallius? ACTH(CAH)
oversecretion

What is the srt step in mangement of a 47 y/o with questionable menopause Get Beta HCG before
with 4 months without a mentsrual period, with an enlarged uterus? getting FSH
What is the most apporopriate management of a 15 y/o pt with PID and 103.5 admission and IV abtx
fever?
abtx therapy is delivery
What is the appropriate step for preventing group B strep sepsis in the hasnt occured by 18
newborn with 12 hrs of ruptured membranes? hours after rupture of
membranes
When should HIV + women have pap smears? every 6 months if abnl,
then every 1 yr
What is the best screening test for a 30 y/o woman with br cancer in a 58 y/o
relative, a MI in father at39 and a 36 y/o brother with T2DM and a smoking cholesterol studies
hx?
23 y/o, acute onset of intense right sided lower abdominal pain becoming
worse with irregular mentrual intervals. 5 x 5 x 4 mass, no fever, + guarding ovarian torsion
and rebound. mass grwoing with cystic and solid components. Dx?
srt step in management with ROM at term with sudden decrease in fetal HR? pelvic exam
androstenidione to
What is converted peripherally in PCOS? estrone
Best evaluation tool for soncern for PID infertility? hysterosalpingogram
triphasic oral
What type of contraceptive is contraI in a 37 y/o smoker of 2 ppd? contraceptives
LEEP is a RF for what in future pregnancy? cervical insuf ciency
type 2 DM (acanthosis
A patient with a velvety pigmented skin over the axilla is at risk for? nigracans)
painless ulcerated lesion in 60 y/o lady with puritis. dx? vulvar carcinoma
What might be seen in a uterus large for dates in an IVF pt? multigestation, get an
u/s
What is the most common cause of 4 months of serosanguinous breast intraductal papilloma
discharge with a normal mammogram?
Most common birht defect of valproate? NTD
What is the most likely cause of a lady not having a menstrual period after her asherman syndrome
last child required a d and C?
low FSH and low
What is seen in amenorrhea from running (FSH and estrogen)? estrogen
(hypogonadotropic
hypogonadism)
What is the most likely cause of a 5 y/o without genital truma with persistant foreign body in the
green vaginal discharge and burning and itching? vagina
what is the most likely karyotype of a pat with progressive facial hair, axillary
hair, without breast devlopment. a blind vagina, clitoromegaly and posterior 46 XY (androgen
insenitivty)
labioscrotal fusion?
What do you follow a + RPR VDRL with? FTA ABS
What should you order for an 18 y/o pt at 10 weekd with HIV and a PPD of
9mm? chest xray

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An exquisitely tender ulcer at the introitus is most likely caused by what in an H. ducreyi
immigrant?
A fever with wonund induration and erythema is? wound infection
A twin gestation with a thick dividing membrane is? dichorionic (di -di)
urge incontined,
Urge, enuresis, with large volume is? detrusor instability . tx
with meds
genuine stress
incontinence, sphincter
triggers with coughing of small volume of urine is? insuf cincy. tx with
pessary/surgery
small amount of urine, enuresis, frequently is? over ow incontinecy
(neuro)
What causes persistant fetal tachycardia? maternal fever
What should be done with BHCG levels in an INC Ab? follwed to zero
First step in a smoker with no pre atal care? NST
MCC of hydrops fetalis in a day care worker? parvovirus B19
1. gonadal agensis of a
What is no breast, no uterus? 46 XY 2. enzyme
de ciency in
testosterone synthesis
gonadal failure of 46
What is no breat, yes uterus? XX 2. disruption of hyp-
pit axis
1. testicular
What is yes breast, no uterus? feminization 2.
mullerian agensis
- hypothalamic,
puituitary or ovarian
What is yes breat, yes uterus, amenorrhea? failure 2. congenital
anomalies
Main cause of premature deteriorating AGPARS? pulmonary hypoplasia
condyloma
A 22 y/o with multiple raised, crusty papule and an abnl pap. dx? acuminatum
Dx of cjoice for endometriosis? laparoscopy
How do you evaluate green forthy discharge, vaginal erythema? wet mount (look for
mobile protozoa)
MCC big uterus with correct dates? polyhydramnios
uteroplacental
Chronic HTn can have what effect on fetal/placenta? insuf ciency
A baby with macrosomnia incr chances for what in future pregnacies? GDM
Tx for transverse lie, full dilation and effacement? casarean delivery
Does dilution of Hb in pregnancy cause changes in MCV? NO
what is best tx for irregular periods in a smoker? cyclci progestins
A prolapse after a hysterectomy relived by lying down, bulging posterior mass enterocele (even
high in the vaginal vault is? without BM issues)
squamos cell cA of the
8 cm growth of cervix into parametrium is?
cervix
Pt with 1 day hx of fever, n/v, perineal rash, bilateral adnexal tenderness. uses Staph aureus, toxic
tampons during periods. Causal organism? shock syndrome
uterolithiasis ( doesnt
pregnant woman, suddent onset of sever left sided ank pain radiating to require gross
labia. no gross hematuria, afebrile, n/v, only comfortable when ambulating. dx? hematuria, could be
microscopic)
new breastfeeder with eryhtematous, non uctuant, tender area in upper
mastitis
outer quandrant. engorded breast bilaterally. fever and tachycardia. Dx?
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19 y/o primagravid at 31 w admitted for intense uterine contractions every 1- abruptio placenta
2 mins for 2 hours. uterus rm and tender, fetal hr is 165. dark blood from
vgina, cervix is effaced and 7 cm dilated, fundal height at 30 . Most likely dx?
23 y/o primagravid at 32 weeks admitted for irregular uterine contraction x 3
hr. temp is 100.8, uterus is moderately tender and fetal hr is 170. cervix 80% chorio amionitis
effaced and 2 cm dilated, -1 station. watery vaginal discharge that is +
nitrazine. DX?
22 y/o woman in ED with vagianl bleeding the last 2 days, lmp was 8 w ago. +
suction and curretage (
home preg test. afebrile, normal vitals, BHCG= 554,367. TVUS has an mole)
enlarged uterus with scatter hyperechoic material. next step in management?
genuine stress
87 y/o with urinary incontince for 6 years, she avoids house for fear of public incontinence = decr
ridicule.incontinence with sneezing, coughing, exertion. hysterectomy 30 y
ago. BMI = 31. Most likely cause? external urethral
sphincter tone
Purulent cervical discharge, cervical motion tenderness, G+ diplococci in
slide. dx? N. Gonorrhoeae
11 y/o with mod changs. mom is concerned menstral periods will start soon.
mom menarche = 14 y. pt is 75th for ht and 90th for wt. br and pubic hair
development is tanner stage 3. recent pubic hair deveoplment is most menarche is imminent
indicative of?
22 y/o woman comes because of second episode of painful vesicular genital increasign symtpoms
for 3 weeks then a
lesions. her partner has similar lesions on his penis. most likely clinical course? gradual decrease
18 nulligravid comes for health maintenence. pain in adnexal region that
leuprolide ( GnRH
occurs during days 13 and 14 of her cycle. its brief and shapr. menarche was at agonist, for
13 nd she has regular cucles. never sexually active, and exam is normal next
step in managemnt? endometriosis)
congenital uterin
26 y/o G3 po 0, ab 3 sue to 3 consecutive 1st trimester ab. hx of UTI since
childhood. IV pyelogram showed single left kidney. exam today shows anomailies ( urinary
tract anomalies follow
palpable uterus and palpable left ovary. most likely dx? with uterine)
Prior to discharge, a 30 y/o woman wants to resume combo oral decreased protein
contraceptives prior to pregnancy. but wants to breast feed. what problem do
you counsel her about? content in breast milk
22 y/o prima at 20 w comes for routine prenatal visit. uncomplicated, declined
gastrochisis
aneuploidy screen , other labs normal. exam has normal uterus, abdominal (omhalocele would be
organs seen outside abd canvity without a covering membrane,cord is medial
within cord)
to defect. dx?
32 y/o G3 P2 at 20 w comes in for routine prenatal. u/s shows skeletal
autoD
dysplasia consistent with achondroplasia. what is the inheritance pattern?
22 y/o comes in for 3d of pain with urination, vaginal itching, watery
discharge, no hx of serious illness takes no meds. . sexually active w/o
agellated protozoa
contraception. erythema of vulva and vagina, yellow gray frothy discharge.
pH=5. wet mount nding?
57 yo for routine health maintenence. HTN, t2 DM, generalized anxiety. she
has been getting conj estrogen and medroxyprogesterone after menoapuse. hormone therpay
also HCTZ, metformin,herbal meds. What is her greatest risk for Br Ca.
18 y/o without menstrual period in last year. no withdrawal bleed after oseoporosis, no
medroxyprogesteron x 7d. BMI =20. breasts are tanner 2, pubic hair is tanner withdrawal bleed
5, PE shows normal vag but prepubertal uterus. suggests ovarian failure
27 y/o G2, P1 comes after an episode of bright red blood with no contractions
or cramping. she has incr br size, morning sicknessand fatigue. LMP was 8 w normal pregnancy,
painless blood
ago. exam shows uterus consistent w 6 w. TVUS shows normal fetal heart. Dx?
32 y/o 2 months adnexal dull pain. worst with menses, exams shows full normal cysts, OCP and
adnexal with tenderness. BHCG is neg. pelvic u/s has 5 cm simple cyst. she is f/u in 6 weeks to see if it
anxious about tx as her insurance expires in 2 weeks. next step? regrsses
umbilical cord
what causes variable decelerations?
compression
4 weeks after c/s. with feeling of pulling on right side of incision. exacerbated normal post op course,
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by movement. she was d/c on pod 3. in last 2 weeks she started exercising and this is where the knot in
sex. bmi 29. abd is tender on right of incision. most likely explanation? the sitches is
67 y/o with moderate vulvar itching for 2 years. otherwise healthy, takes no
punch biopsy of affeted
meds. normal vitals. exam shows white epithelium over lever labia majus. no
areas
inguinal adenopathy or discharge. next step?
32 y/o G3P2 type 2 dm admitted at 38 w. rst 2 kids were SVD. cervix is 2 cm
dilated on admission with fundal ht of 42. 4 hurs later, cervix complete, vertex cephelopelvic
is OA, -1.1 hr later, contractions are every 2 mins and station and cervix disproportion (DM)
unchanged. cuase?
67 yo with 9mvulvar itching. unresolved with zinc, vit E, steroids, or
metrantifungals. has type 2 DM and hyper colesterolemia. BMI =53.
type 2 DM
eryhtmatous swollen vulva, pauples and pustulesthights. KOH shows
pseudophyphae. why not respond to previous therapy?
17 y/o concern for never had menstrual period. no breast development, not
FSH (turners she is 4 ft
sex actve, no meds. BMI =31. br = tanner 1, nl thyroid, continuous murmur on
tall, coartation)
midsternal borner, normal pelvic exam. no masses. what do u measure nect?
15 y/o with 1 week of sever abd pain. 10 episodes of cramps in past year
lasting 3-5d. never had a period. sex active no contraception. 80th percent for hematocolpos
ht and wt. mass in suprapubic region at midline. bluish bulge obscures the (imperforate hymen)
upper vag. dx?
32 y/o G5P4 at 21w bright red vag bleed for 4 hr.no prenatal care. speculum fetal u/s
has bright red blood in post fornix. no other abn in cervix. next step?
hyperemesis
32 y/o prima at 10 w for 5 d of n/v decr appetite. cant keep food down. labs gravidarum, inpatient
show some hypovolemia, large ketones, some electrolytes disturbances. what
admission for iv uids
should you do for her?
and antiemetics
27 y/o prima at 33 w comes for prenatal visit. has SLE x 8y. remission. preg uteroplacental
normal besides lagging fundal ht 2 m ago. at 20 week things were normal on insuf ciency ( SLE can
us. at 33w there is oligo and 30 w fetus. what is cause of olgio? mimic GHTN)
32 y/o with 6m of increasing frequent pelvic cramps, pain with urination,
urgency relived with urination. regular menses. suprapubic tendenress. interstital cystitis
tender to palpation dx?
20 y/o with 3 yr of hirsutism wosrsening over last 2 years, cause of hair
increased testosterone
growth?
27 y/o primagravid at 14 w comes for 24 hrs of n/v, right sided abd pain, loss of appendicitis (might be
appetite x 2 d.no n/v. afebrile. RLQ tenderness without rigidity or rebound. pyelo) but i think the
WBC 16.5, leukocytosis in urine. Dx? loss of appetitie
32 y/o nulligravid with no mentstural period since sottped taking OCP 6m ago.
testosterone ( DHEAS
menses were regular before. also has incr libido, facial hair and acne. BMI=33.
is from adrenals)
has clitoromegaly. 2 cm mass in right ovary. what hormone is likely abnormal?
previously healthy 42 y/o comes with 6m of increasingly heavy periods and 2
months of prolonged ow. she has an irregular and smooth uterus. ABUS submucosal
shows leimyoma uteri.Which is the most likely type of leiomyoma in this case?
20 prima at 40 w is admitted in lobar. cervix is 4 cm dilate and 0 station. she
IV injection of the
gets 2 L of LR. epidural cath is placed and test dose of lido and epi is injected. anastetic (epidural
she immediately has tinnutus and metaalic taste. pulse is now 110 what
woundt cause these sx)
cuased it?
18 hr after c/s a 23 y/o g1 has a fever. her temp is 100.4. decr breath sounds
are heard bilaterally with no crackles or rhonchi. ijncision site is dry and intact. atelectasis
2+ pitting bilaterally. Most likely dx?
27 y/o prima at 34 comes with 1 day of anxiety, sweating, rapid heart beat. levothyroxine.
some disorientation. rapid pulse, low grade fever high b. diffusely enlarged propythiuracil can
thyroid with 4+ clonus. along with a beta blocker what else should you give concentrate in the fetal
her? thyroid
a 32 y/o G5P4 at 18w comes for routine prenatal. Rh -. previos pregnancies
reuqired c/s at33-35 for breech, She got rhogam for both pregnancies. her preterm labor
mother has T2DM. vitals normal. TVUS shows breech and bicornate uterus. (bicronate uterus)
What is she at incr risk for?
42 y/o G3P3routine exam. iregular period varying length for the last yr. last annovulation
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period was 6 w ago. she has t2dm tx w metformin. BMI=32she has an irregular
enlarged uterus. endometrial biops shows atypical complex hyperplasia.
predisposing factor?
27 y/o G2P1 at 36w comes w 2 hr of intermittent vag bleeding. no prenatal
care and fundus at 35. fetal Hr =135. bleed is of uterine origin. she is O-.nst is give rhogam for any
bleed in Rh-
reactive and BPP = 8. next step?
27 y/o philipino at 10 w comes for prenatal. 15 y hx of anemia. Hct at 28 for 7 hemoglobin
yr desite iron. 5 days ago she visited relatives with a u like illness. uterus is electrophoresis
consitent with 10 w pregnancy. next step in management? (thalassemia)
3 d after c/s at term for failure to progress 27 y/o has 101.8 fever and mild
dysuria without frequency or urgency. incision site is intact. lungs are clear.
breast engrogement
breast are tense and tender. uterus rm20w size. she has no elevated WBC
and hb and UA norm.Dx?
25 y/o HIV + comes due to thin, clear vaginal discharge and increased urinary
freq x 2w. last menses 6w ago. normally has 28 d intervals. uses cndoms pregancy
irregularly and not on HAART. uterus is slightly enlarge and adnexa normal
dx?
24 y/o prima at 30 w admitted for birght red vaginal bleed rst noted as
spotting 12 h after sex, since then bleed has incr. otherwise uncomplicated. cervical trauma (sex)
u/s at 20w has fundal placenta. most likely cause of bleeding?
17 y/o comes in with moderate severe pelvic pain with n/v during menses primary dysmenorrhea
since menarche. sx begin soon after onset of menses. nsaids help. never been (endometriosis tends to
sexually active. normal PE. DX? be midcycle pain)
57 y/o complains of small blood stains on underwear x 6m. menopause
hypoestrogenic state
occured 5 y ago and has not recieved hormone therapy. reports dysparunia
(menopause)
but no GI or urinary sx. there is atrophy in vagina. most likely cause?
23 y/o comes for follow up exam 3 weeks after being dx with UTI. tx with tmp-
smx relieved her sx. this is her 3rd uti in the last year. . she was married 3 m tmp-smx
ago. her ua and vitals are unremarkable now. what is the bst tx for ppx of this?
27 y/o comes in with ha, blurred vision abd RUQ pain for 12 hr. labs show
severe Pre-E
HELLP. dx
47 y/o comes to physicisn 2w after lump in left br. she started estrogen
replacement 3 m ago and has had br engorgement since that time. L br shows ne needle aspiration
2 cm tense, mobile, cyst like structure. mammography 3 m later is normal. next biopsy of the cyst.
step in mamangement?
likely vesicovaginal
stula from
55 y/o woman with constant wetness from vagina following hysterectomy. no
hysterectomy. get dye
dysuria or urgency. like dx and what next step?
installation into
bladder
neurogenic bladder, do
42 y/o woman with DM with constant dribbling of small amounts? dx and tx?
intermittent self cath
39 y/o woman wets e 2-3x daily, feels need to void but does not make it in urger incontinence,
time. dx and tx? oxybutynin
pessary or burch
stress incontinece, tx?
urethropexy
what type of vaccine is VZV? live attenuated, no
effect on hsv
after 30 mins of
At what time should manual placental extraction be attemtped? retained placenta
anathesia (halothane)
what is the best inital therapy for non reducible uuterus?
(relax cervix)
which is more effective for reducing vertical transmission of HIV c/s or
zidovudine > c/s
zidovudine?
steroid induced
girld with lupus with acne w/o comedones is? comedones not
teenage acne
what might be seen in a woman with galactorrhea due to a prolactinoma? abnormal DEXA scan as
low estrogen can cause
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osteoprosis (decr
GnRH release)
What is the pathophys of hypotension in septic shock? vasodilation
what is upper limit of normal for the latent phase? 14 hours
antrhopoid (AP > TV
what type of pelvis predisposes to occiput posterior?
diameter)
what is expected progress in the active phase? 1.5 cm / hr
anterior placenta,
what implantation site is most likely to have placenta accreta? defect in endometrium
blue tissue densely adherent between uterus and bladder is? placenta percreta
what is the greatest concern for a retained placenta acreta not removed with
coagulopathy, infection
hysterectomy?
when should u start to screen DEXA? 65
When should you screen colonoscopy? 50
When should you start mamomograms? 40
When should you start pap smears? 21
decreases the fetal
what is the utility of delivery of the posterior fetal arm in shoulder dystocia? bony diameter from
shoulder to axila
anteriorly roates the
What is the utility of the McRoberts maneurver?
symphysis pubis
Mc ureteral injury in hysterectomy? ureteral ligation
what is the DOC for sydfuction uterine bleeding with active bleed? high dose estrogen
Compression by the
what is the mech of urinary system dilation in late pregnancy? uterus and right
ovarian vein
anterior hemorrhagic
what part of pituitary is acffected in sheehans?
necrosis, decr prolactin
disruption of large
What is the mech of Asherman syndrome? segments of the
endometrium
prolonged fetal decels associated with misoprostol is? uterine
hyperstimulation
amenorrhea due to
what is the mech of amenorrhea due to pituitary ademona? inhibiton of GnRH
pulsations
how you you tx a pituitary adenoma growing in size in pregnancy? bromocriptine
what is the most common underlying cause of maternal mortality? hypercoagulable state
breast pain, rubbery mass changing with menses is? brocystic change
MC mass in breast of adolescents or 20s? broadenoma
57 y/o 1 week after mass in left breast. no family hx of br cancer. 2 cm palpable
mammogram
nontender mobile mass, no discharge. nothing in R breast. next steo?
27 y/o G0 severe pain w menses causing missing work. cervix is pink, uterus
endometriosis
normal size. R ovary bigger than left. most likely dx?
22 y/o woman 2 days of pain w urination, vaginal itches, curd like disharge,
cadidiasis
pseudohyphae. dx?
27 y/o nulligravid unable to conceive for 12 m. had PID 4 y ago. nest step in
hysterosalpingogram
dx?
30 y/o G2P1 at 26w. uterine size greater than expected for dates. fetus has maternal Rh status with
hydrops. next step in dx? antibody screening
42 y/o G2P@ with loss of urine when cough, sneeze. uncomplicated SVDs,
stress incontinence
urine loss with valsalva. dx?
18 y/o G1P1 has pinkish vaginal discharge that has persisted for 6 w. uterus is reassurance that this is
fully involuted and no adnexal masses. next step? normal
32 y/o nulligravid with 6 w of fould smelling frothy discharge with aggellated trichomonas vaginalis
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organisms on wet mount. Dx?

Asx 24 G1 at 36w has grade 2/6 systolic murmur at upper left sternal border.
ow murmur
dx?
42 y/o G3P3 amenorhea or 2m, some spotting 3 w ago. slightly enlarged BHCG, must check
uterus. next step? pregnancy
57 y/o vegan, doesnt want meds, has evidence of low none density on DEXA.
Vit D
what vitamin do you recommend supplementing?
A baby is post with spina bi da, what during pregnancy could have been
folate
given?
MCC postpartum hemorrhage? uterine atony
19 y/o primagravid at 8 w is brought to ED w light vaginal bleeding. no
send home, threatened
tenderness or abnl bowel sounds. uterus is consiteten with 6w gestation.
abortion
TVUS is IUP with fetal heart beat. next step?
16 y/o w 6h of abdmonial cramps and intermittent nausea. LMP 2 months ago.
menarche at 15. Inconsistent condom use. scant vaginal bleed, right adnexa Beta HCG,
mass. next step?
13 y/o 1 yt of irregular vaginal bleeeding every 2-8 w for 10-30 d. uterus is
oral contraceptives
normal. normal ovaries. most appropriate pharmacotherapy?
25 y/o G2 P2 w 3 days of painful swelling in vaginal area, LMP was 2 m ago.
active w one parter and uses depoprovera. has exquisitely tender mass in left bartholin gland abscess
labium minor, prevents insertion of sepculum. dx?
22 y/o prima with a tonic clonic seizre, HTn, and incr DTRs. dx eclampsia

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