OB/GYN COMAT/Shelf (Uworld & TruLearn)

PID

24 y/o c/o of abnormal vaginal bleeding. She has history of regular menses prior to IUD placement 2 years. After IUD she became amenorrheic. however for the last month, she has had light vaginal spotting with wiping, intermittent pelvic pain which is now constant and unrelieved with pain meds. On exam there is uterine and bilateral adnexal tenderness. the IUD strings are palpable and urine pregnancy is negative. what is your diagnosis?

salpingectomy

24 y/o patient presents w/left lower quadrant pain, dizziness, weakness and heavy vaginal bleeding. Beta hCG is 8698 h/o non intrauterine pregnancy. TV ultrasound reveals complex adnexal mass and hyperechoic ring surrounding the gestation sac (tubal sign). Given the patient is hemodynamically unstable what is the most appropriate treatment?

hidradenitis suppurativa

24 y/o woman comes to the office due to painful bums in her groin. she's had these b4, they typically resolve and sometimes drain on their own. Now the bumps occur more frequently and last longer making sitting painful. She has no chronic medical conditions or prior sx. BMI is 35.

No

25 Woman, gravida 2 para 1 at 8 w gestation blood type is O-negative blood type. The biological father's blood type is O positive. Her anti-D antibody titers are 1:32. Did she receive the correct dose of anti-D immune globulin (rhogam) after her first pregnancy to prevent alloimmunization?

perform anatomy scan (optimal time for a single US is at 18-22 weeks gestation)

25 y/o 21 weeks gestation presents to the office for routine prenatal care. there are no complications. she feels the baby move multiple times a day. the most appropriate next step is to?

ovarian cyst rupture

25 y/o comes to ED due to pelvic pain that started immediately after sex 3hr earlier. its is a sharp and stabbing pain that has intensified. she has no fever but feels slightly nauseas. the abdomen is soft and tender in RLQ. Beta-hCG is (-). Pelvic US shows an enlarged uterus w/ multiple fibroids and a 4x5 right cystic ovarian mass with moderate amount of free fluid in the pelvis. Doppler shows normal blood flow to the adnexa. What is the most likely cause to the patient's acute symptoms?

combo oral contraceptive (endometriosis)

26 y/o nullparous F w/ severe pain during sec especially with deep n pentagon. Lubrication doesn't not improve pain. Menses occur every 30 days, are painful, last 5d, w/moderate bleeding. Speculum exam is normal. What is the most appropriate treatment

placenta accreta

27 week gestation in active labor but with vaginal bleeding for the last hour. she endorses pelvic discomfort for the past week. Her last 3 deliveries were c-sections. after vaginal delivery, the patient suffers from a postpartum hemorrhage with concerns for placental retention. the most likely cause for her bleeding is?

MMR vaccine

27 y/o at 16 weeks gestation. she immigrated to US 6 years ago. she takes daily prenatal vitamins and no tobacco or drug use. rubella and varicella titers both show no immunity. all other routine labs are normal. what is the best recommendation postpartum?

hysterosalpino

27 y/o nulligravid is having trouble to conceive. Menses are normal and regular. In her late teens hse had a pelvic infection but no other medical/surgical hx. Patient's husband's semen analysis was noraml. PE and pelvic exam show no abnormalities. What is the next best step in management?

Hypogonadotropic hypogonadism

27 y/o nulligravid women has been trying to conceive for the past 12 months. her menses are irregular with frequent missed periods. she has frequent migraines and often takes triptan w/metoclopramide. PE and pelvic exam is unremarkable. Pelvic US is normal. Lab shows low FSH, LH, prolactin, and estradiol. What is most likely cause of her infertility?

Herpes, acyclovir

28 y/o F comes with painful ulcerative lesions over her labia majora. they are described as 5 circular, shallow vesicles, 2-3mm in size scattered. What is your diagnosis and treatment

endometritis

28 y/o G2P2 female develops a fever and abdominal pain 30hrs post-delivery. Vitals are 101.8F. PE reveals foul-smelling lochia, lower abdominal pain and uterine tenderness. the most likely diagnosis is?

uteroplacental insufficiency

28 y/o gravida 1 para 0 female with no past prenatal care at 32 weeks gestation presents to labor and delivery w/the complaints of contractions, headaches and blurry vision. Vital signs reveal a blood pressure of 150/92 and HR of 86/min. Labs reveal proteinuria. Fetal HR shows persistent late decelerations. the most likely cause of the findings on fetal hr tracing is?

corticosteroids

29 y/o pregnant female at 33 weeks gestation is having minor contractions and pelvic exam reveals the cervix to be dilated to 4cm and 100% effaced with bulging amniotic membranes. at 24 weeks she had received antenatal corticosteroids when briefly admitted for concerns for preterm labor. what is the most appropriate management at this time?

HSV

29 y/o women comes due to painful sores on her labia. she first noticed them 3 days ago. for the past 5 days since shes had headaches and intermittent fever. patient recently became sexually active and doesn't use condoms. PE reveals several clusters of multiple, small, vesicular lesions on the right labium minora and tender inguinal lymphadenopathy on right side. What is your diagnosis?

cervical biopsy (most likely cervical CA)

37 y/o presents for abnormal vaginal discharge. she noticed increased, clear, watery vaginal discharge 4 months ago and now has intermenstrual bleeding. on pelvic exam, a raised, ulcerative lesion is noted on the cervix, and clear discharge is present. the vaginal mucosa, uterus and adnexa are all unremarkable on exam. What is the next best step in diagnosis?

uterine atony

39 y/o woman 38 weeks gestation with history of HTN on nifedipine and asthma. after prolonged labor, the patient delivers 9lb boy via forceps-assisted vaginal delivery. during delivery of placenta it avulses and the placenta is manually extracted. 60min later the patients perineal pad becomes soaked with blood . o bimanual uterine exam, 1,000 mL o clotted blood is expressed from the lower uterine segment. the uterus is soft and 4cm above the umbilicus after expression of clots. what is most likely the cause of her postpartum bleeding?

Antiphospholipid antibody syndrome

Young woman with history of 3 consecutive spontaneous abortions and a transient ischemic attack is concerning for what hypercoagulable syndrome?

Sertoli-Leydig cell tumor

a previously healthy 30 y/o F presents with a 2mo hx of abdominal cramping and that her voice has deepened. she also notes amenorrhea for the past 3 months when she was regular prior. PE reveals coarse hair over the upper lip and bitemporal hair thinning. abdominal exam reveals a large, nontender, right-sided pelvic mass that extends into the right lower quadrant. Hb concentrtaion is 17.5 g/dl. what is the most probable diagnosis?

hydronephrosis (from ureteral injury)

49 y/o is being evaluated for back pain. she underwent total abdominal hysterectomy and b/l salpingo-oophorectomy 1 week ago. she was discharged on postoperative day 4. she noted some back pain after surgery but it improved with pain meds. however, the pain has become progressively worse. it doe not radiate and is associated with nausea and vomiting. the abdominal incision is clean and dry. there is mild right CVA; left side nontender. serum creatinine is 0.8. catheterized urinalysis is normal. what is your diagnosis?

vesicovaginal fistula

49 y/o woman, G5P5 comes to office due to urine leakage over the last 2 monhs. she has no dysuria, urgency, or vulvar pruritis. 2 years ago she received brachytherapy and external-beam pelvic radiation for cervical cancer. Pelvic exam shows no urethral leakage with Valsalva. there are postradiation changes and a pool of clear fluid in the vagina. postvoid residual is 20ml. what is most likely the cause of her symtpoms?

D

All of the following medications are indicated for asymptomatic UTI in pregnancy, BUT which of the medication listed should be avoided in the first and third trimester? A. Cefpodoxime B. Fosfomycin C. Amoxicillin-clavulanate D. Nitrofurantoin

duodenal atresia

An ultrasound reveals polyhydramnios. Evaluation of the fetus reveals dilation of the stomach and proximal duodenum. what is the abnormality present?

ultrasound of abdomen and pelvis

Female 6 y/o child shows signs of precocious puberty. bone age is 10 yrs. leuprolide stimulation test reveals a negative LH response. the most appropriate next step in diagnosis is?

B

Female athletes with new onset secondary amenorrhea most likely has functional hypothalamic amenorrhea. These patients are at greatest risk for which of the following? A. Vasomotor symptoms B. Decreased bone mineral density C. endometrial hyperplasia D. epithelial ovarian cancer

ureteral laceration

Female presents with abdominal pain, nausea and vomiting. A week ago she underwent hysterectomy of severe endometriosis and she went home the next morning. for the past two days shes had increasing diffuse abdominal pain and bloating, and she now has nausea and vomiting. she has also noticed increased vaginal discharge. Temp is 100.4F. the abdomen is moderately distended but soft and nontender. the laparoscopic incisions are intact and w/o palpable masses or defects. on PE there is watery vaginal discharge. Urinalysis is normal. abdominal ultrasound reveals a large amount of intraabdominal fluid w/no internal echoes. what is your diagnosis?

empiric treatment for STIs

Following sexual assault all patients should be provided?

incomplete abortion

Identify the type of Abortion: - cramping or vaginal bleeding present -partial expulsion of products of conception - dilated cervical os

inevitable abortion

Identify the type of Abortion: - vaginal bleeding - lower abdominal pain - dilated cervical os - no expulsion of products of conception - ultrasound shows nonviable gestation at or above the cervical os

threatened abortion

Identify the type of Abortion: - vaginal bleeding or spotting present -intrauterine pregnancy(products of conception) w/fetal heartbeat -closed cervical os

missed abortion

Identify the type of Abortion: -possible bleeding or cramping but usually mild or asymptomatic - intrauterine pregnancy, no fetal heartbeat - closed cervical os

complete

Identify the type of Abortion: -resolution of cramping or vaginal bleeding - no intrauterine pregnancy visualized - open or closed cervical os

septic abortion

Identify the type of Abortion: -vaginal bleeding, cramping purulent discharge, fever may be present -+/- retained products of conception or intrauterine pregnancy - open or closed cervical os

nitroglycerin

In delivery with unsuccessful placental removal via cord traction and persistent uterine/cervical contraction, the most appropriate next step in management is to induce uterine relaxation. what is the first line treatment for this?

Fitz-Hugh-Curtis syndrome

In patients with PID ascent of the infection into the upper reproductive tract leads to fever and lower abdominal pain. Subsequent spread into the peritoneal cavity can cause perihepatitis with RUQ and vomiting. this is called?

nifedipine

Indomethacin is the first line therapy for tocolysis which enables prolongation of pregnancy. however it is contraindicated in patients with a history of peptic ulcer disease. what can be given instead?

lichen sclerosus

Inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women. women will complain of intense pruritus and PE will describe coalescing white plaques with surrounding excoriations that can extend from the superior vulva to the perianal region.

A

Patient develops postpartum hemorrhage secondary to uterine atony. management includes treatment with uterotonic meds. which of the following would be a contraindication if the patient is asthmatic? A. carboprost tromethamine B. methylergonovine maleate C. oxytocin D. terbutaline

48-72 hrs

Patient has an undetermined intrauterine pregnancy and a Beta-HCG below discriminatory zone but elevated. when would you repeat her Beta-HCG?

C (check ovulation/ovulatory function)

Patient is seeing you for infertility evaluation after removal of IUD 13 months ago. Her partners semen analysis came back normal and her hysterosalpingogram was unremarkable. What is the next best step in management? A. diagnostic laparoscopy B. karyotype analysis C. midluteal phase progesterone level D. Reassurance that this is normal after IUD removal

B

Patient presents for routine prenatal visit. only abnormality is placenta previa caught on ultrasound. what is the most appropriate next step in management? A. admit the patient to the hospital B. continue routine obstetric care C. perform cervical cerclage D. recommend complete bed rest

B

Patient presents in premature labor w/ultrasound demonstrating fetal demise. what is the most appropriate next step in management? A. administer prophylactic antibiotics, steroids, and oxytocin B. attempt spontaneous vaginal delivery C. perform C-section D. perform dilation and extraction

uterine adenomyosis

Patient presents to office to c/o of abdominal vaginal bleeding, constipation and pelvic pressure. Her periods have become heavier and longer. Pelvic exam shows a uterus that is mobile, diffusely (globular) enlarged and soft (boggy). What is the most likely diagnosis?

uterine leiomyoma

Patient presents to office to c/o of abdominal vaginal bleeding, constipation and pelvic pressure. Her periods have become heavier and longer. She has also been unable to conceive and she has been trying for 2 yrs. Pelvic exam reveals an enlarged uterus with and irregular contour. the most likely diagnosis is?

B

Patient with CIN grade 3, recommended treatment is cervical excisional procedure such as cold knife conization. Which of the following is the most likely complication of this treatment? A. Asherman syndrome B. cervical stenosis C. sexual dysfunction D. thromboembolism

Estrogen only patch

Patients dealing with severe vasomotor symptoms during menopause and that dont have a uterus can receive what type of medication?

inflammatory breast carcinoma

Perimenopausal women with unilateral, diffusely enlarged breast that is pruritic. there is a rash and breast erythema along with edema and axillary lymphadenopathy. patient's presentation is most concerning for what disease?

biopsy (most likely condylomata acuminata but because of age vulvar cancer must be ruled out)

Physical exam reveals three verrucous papules less than 5 mm in size over the inner face of the labia minora. this patient is a 65 y/o sexually active and doe snot use condoms. what is the most appropriate next step in management?

pyogenic granuloma

Polypoid capillary hemangioma that can ulcerate and bleed. Associated with trauma and pregnancy.

Toxoplasma gondii

Pregnant woman at 27 weeks gestation had a fever, diffuse, nonpruritic maculopapular rash several weeks ago that lasted for 2 days and resolved w/o intervention. Fetal ultrasound reveals bilateral ventriculomegaly and multiple calcifications w/in the basal ganglia and at the gray-white matter junction. Fetal ascites and hepatosplenomegaly are noted. This is most likely due to what fetal infection?

fetal ultrasound (rule out neural tube defect)

Prenatal lab test for a 16 w gestation pregnant women reveals the patient's serum alpha-fetoprotein concentration is 3.8 multiples of the median. what is the next best step in management?

lichen planus

Pruritic, purple, polygonal planar papules and plaques (6 P's)

Intrahepatic cholestasis of pregnancy, ursodeoxycholic acid

Sx: Intractable nocturnal pruritus on palms and soles of feet without skin changes in the 3rd trimester. Dx: 10-100x increase in serum bile acids with mildly elevated liver transaminases Diagnosis and treatment?

fibroma

benign ovarian tumor that has the common triad of ascites, pleural effusion and pulling sensation in the groin?

Thecoma

benign ovarian tumor that is most common in postmenopausal women. can present with abnormal uterine bleeding

struma ovarii

benign, mature cystic teratoma composed of thyroid tissue that present with features of hyperthyroidism.

Lipid panel (during third trimester of pregnancy triglycerides levels rise which can cause pancreatitis

patient at 30 weeks gestation has severe epigastric pain and elevated lipase. RUQ ultrasound reveals no biliary sludge or dilation of biliary tree. You suspect acute pancreatitis. what is your next best step in management to confirm your diagnosis?

uterine atony

patient experienced a relatively uncomplicated labor and birth of twins followed by sudden-onset vagina hemorrhage. on physical examination uterus will typically have been boggy and nontender. What is most likely the cause of her hemorrhage?

Tranexamic Acid (TXA)

patient is experiencing postpartum uterine atony. Uterine massage and high-dose oxytocin do not resolve the bleeding. What is the next best step in management?

Gardnerella vaginalis

patient present with complaint of foul smelling, white vaginal discharge. she mention that she has recently become sexually active. microscope reveals epithelial cells that appear granular with ragged borders and a vaginal pH of 5. KOH reveals a strong fishy order. most likely organism present

Bartholin abscess, incision and drainage

patient presents with dyspareunia and painful, unilateral swelling and erythema lateral to the vaginal orifice at the 8'oclock position. what is your diagnosis and next appropriate step in management?

direct Coombs (acute hemolytic transfusion reaction)

patient who developed flank pain, pink urine, fever and hypotension immediately after receiving a blood transfusion should have what test to confirm the underlying cause?

pelvic muscle exercises

patient with urinary urgency that has led to some incontinence. she denies any association of these episodes with sneezing, coughing or laughing. urinalysis reveals no indication of UTI. what is the initial treatment plan?

left on right sacral torsion

patients structural findings of a shallow left sulcus, anterior right ILA, positive left seated flexion test, and positive lumbosacral spring test are consistent with?

D

patients who are pregnant from IVF have an increased risk of what pregnancy complication? A. placental abruption B. placenta accreta C. placenta previa D. vasa previa

pseudcyesis

persistent nondelusional belief of being pregnant

Mittelschmerz

physiological unilateral abdominal pain that occurs midway between the menstrual cycle at ovulation. Transvaginal ultrasound will reveal a cyst/free fluid around the ovary.

B

pregnant women with vaginal bleeding, contractions, abdominal pain and retroplacental hematoma most likely has a placental abruption. where would tissue texture changes most likely be present? A. T10-T11 B. T10-L2 C. T12 D. T12-L2

abruptio placentae

premature separation of the placenta from the uterine wall. patient will present with acute abdominal pain, vaginal bleeding and a rigid, diffusely tender uterus.

ex utero intrapartum treatment (EXIT)

refers to a special technique where the baby is delivered through an incision in the uterus and a functioning airway via intubation is established before separation from the placenta. uteroplacental blood flow and gas exchange continues and maintained by using inhalation agents to provide uterine relaxation and amnio fusion to avoid uterine collapse

acute respiratory distress syndrome (ARDS)

respiratory insufficiency marked by progressive hypoxia

local anesthetic systemic toxicity

sudden onset of tinnitus, metallic taste, tachycardia, hypertension and general tonic seizure right after an epidural injection.

clue cells (Gardnerella vaginalis)

thin, off-white/grayish discharge with fishy order, no vaginal inflammation, pH >4.5 and a positive whiff test. what will you see on wet prep?

fetal head compressions

this is most commonly caused by?

Trichomoniasis

vaginitis with thin, yellow-green, malodorous, frothy discharge, vaginal inflammation and pH >4.5 is most likely?

II, VII, IX, X

warfarin is a vitamin K antagonist which leads to depletion of what 4 coagulation factors?

HPV MMR Live attenuated flu Varicella

what 4 vaccines are contraindicated during pregnancy?

D2 receptor antagonists

what drugs are the most common cause of physiological nipple discharge?

high dose oral contraceptives

what is the first line treatment in patients with acute uterine bleeding outside of menses, that are hemodynamically stable (Hb >7.0 g/dL) ?

diagnostic laparoscopy with lesion biopsy

what is the gold standard for diagnosis of persistent pelvic pain that is nonresponsive to medical management.

epithelial tumors

what is the most common ovarian tumor that is associated with BRCA mutations. Example: serous carcinoma

B

Which of the following is the greatest risk factor for patient with vaginal squamous cell carcinoma? A. Obesity B. Chronic tobacco use C. Diethylstilbestrol exposure in utero D. History of infertility

Letrozole (Femara)

Which of the following is the most appropriate therapy for infertility in a patient with PCOS

D

Which of the following medications is safe treatment option for a women is bipolar 1 that would like to get pregnant? A. bupropion B. Haloperidol C. Sertraline D. Lamotrigine

D

Which of the listed is the best medication for asymptomatic UTI in pregnancy? A. ciprofloxacin B. doxycycline C. Bactrim D. Fosfomycin

B

Which test is diagnostic for gestational diabetes? A. 1 hr glucose tolerance test B. 3 hr glucose tolerance test C.HbA1c D. HbA1c & 2 hr glucose tolerance test

A

Which test is the universal screening for gestational diabetes? A. 1 hr glucose tolerance test B. 3 hr glucose tolerance test C.HbA1c D. HbA1c & 2 hr glucose tolerance test

vancomycin, cefepime, clindamycin

how do you treat staph toxic shock syndrome?

granulosa cell tumor

malignant ovarian tumor that is most common in women's 50s. symptoms include abnormal uterine bleeding and breast tenderness due to uncontrolled release of estrogen. the tumor marker is INHIBIN.

primary metabolic alkalosis with secondary respiratory acidossis

pH 7.49 PaCO2 54 Bicarb 44 What is the acid-base distrubance

ovarian torsion, diagnostic laparoscopy

15 y/o girl is brought to ED w/intermittent lower abdominal pain. She woke up today w/ intermittent, sharp pain in the LLQ that radiates to the back. She denies nausea, vomiting, urinary symptoms, vaginal bleeding, or discharge. Her last menses was 2w ago and she is not sexually active. BP is 130/84mmHg. On PE she appears comfortable, there is mild tenderness to palpation in the LLQ. Pelvic ultrasound shows a 5cm left ovarian mass w/normal ovarian blood flow. After the US, the patient has another episode of severe pain w/nausea when walking back from the restroom. On reevaluation she is in acute distress and has severe, constant tenderness to palpation of LLQ. What is your diagnosis and next best step to confirm this?

imperforate hymen

15 y/o girl present with lower abdominal pain. for the past few years, the patient has had recurrent, self-limited episodes of aching lower abdominal pain lasting 2-3 days and occurring nearly every month. The patients breast and external genitalia are tanner stage IV. Pelvic exam reveals a firm mass protruding between the labia majora. which of the following is the most likely diagnosis?

ectopic pregnancy

16 y/o comes to ED due to nausea and cramping, stabbing lower abdominal pain. The pain began yesterday but has become more severe over the past 12 hrs. She has urinary frequency but no dysuria or hematuria. She vomited twice this morning. She describes a strong urge to defecate even after passing normal bowel. Menarche occurred at age 13, and the patient is unsure of her last menstrual period as they are irregular. Vitals normal, PE shows tenderness to palpation in the left lower quadrant of the abdomen. What is the most probable diagnosis?

physiological leukorrhea

17 y/o F that is sexually active presents for water thin white discharge. Discharge's pH is 4.5, the amine test is negative and wet mount is remarkable for squamous epithelial cells, rare PMLs and Lactobacilli. what is your diagnosis?

PID, IM ceftriaxone, and oral doxycycline and metronidazole

18 y/o F presents to the office w/low grade fever and mucopurulent vaginal discharge. She is sexually active, doesn't use condoms. there is lower abdominal tenderness w/o guarding. PE confirms discharge and a positive chandelier sign. Urine pregnancy test is negative. Pelvic US reveals mil thickening of the fallopian tube w/o abscess formation. What is your diagnosis and the most appropriate pharmacologic treatment?

measure tissue transglutaminase (Turner syndrome patients are at increased risk for autoimmune conditions such as celiac and thyroiditis)

18 y/o women was diagnosed with Turner at age 8. Labs reveal: Hb: 9.4 g/dl MCV: 68 Platelets: 440,000/mm 25-Hydroxycholecalciferol: 8 ng/ml (normal 15-80) Stool is negative for occult blood. what is the next step in management?

HSV

24 y/o F comes to office due to vulvar pain and dysuria that started 2 days ago. no new urinary symptoms or flank pain. shes had intermittent fever and malaise for the past week. she's had 3 new mail partners over 6 months. PE shows grouped, shallow ulcers w/surrounding erythema on the left labia minora. The left inguinal lymph nodes tender to palpation. What pathogen is most likely the cause of the patient's presentation?

VSD (or ASD)

20-40% of infants with duodenal atresia will have down syndrome and approximately 50% will have what cardiac abnormality?

B

21 y/o F presents because she had unprotected sexual intercourse 4 days ago and is worried she might become pregnant. urine pregnancy test is negative. the most appropriate next step in management is? A. single or two dose regimen of oral levonorgestrel B. single dose of oral ulipristal acetate C. progestin-releasing subdermal implant D. multiple combo OC

skin testing and penicillin desensitization

22 y/o primigravid woman at 8 weeks gestation comes for initial prenatal visits. She test positive for syphilis. She has a history of an allergic reaction to penicillin; she developed a generalized rash with pruritus' which responded to antihistamine. What is the best next step in management of this patient?

immediate delivery

22 y/o primigravida 32 weeks gestation Patient presents with epigastric and RUQ pain, jaundice, leukocytosis , thrombocytopenia, nausea and vomiting and signs of liver failure associated with elevated liver enzymes and hypoglycemia. this is consistent with acute fatty liver. what is the most next appropriate step?

obtain maternal rubella antibody titers

23 y/o G1P0 female at 22 weeks gestation presents for prenatal examination. Rubella immune status is unknown and she had contact with someone who had rubella. what is the most appropriate management?

chorioamnionitis, broad spectrum antibiotics and immediate delivery

23 y/o G2P1 female at 34 weeks gestation presents to the hospital with a 24 hr history worsening abdominal pain, clear vaginal discharge and vaginal spotting. Vital reveal fever of 103F and HR of 108/min. Clear fluid w/in the posterior fornix is nitrazine positive. Fetal HR is 170/min w/mod variability. What is your diagnosis and appropriate management?

C-section

23 y/o female at 38 w gestation comes to L&D for spontaneous rupture of membranes and painful contractions. Cervical exam shows the cervix to be 8 cm dilated and 90% effaced w/the fetal vertex at 0 station. Epidural is administered. Intrauterine pressure catheter shows contractions every 2-3 minutes, and the sum of contraction strength is 240 Montevideo over 10 mins. this pattern continues and 4 hours later the cervix remains unchanged. fetal heart rate tracing is category 1. what is the next best step?

epidural anesthesia

23 y/o female is being evaluated nausea, vomiting and severe headache which she developed last night after getting out of bed and walking. does not improve w/ NSAID and only lying down makes her better. No dizziness, changes in vision or loss of consciousness. She had a normal vaginal delivery 2 days ago after an induction and received epidural anesthesia. the patient has neck stiffness and is unable to sit up due to severe nausea. No papilledema, PEERL. B/l LE pitting edema. Depp tendon reflexes are 2+. What is the most probable cause of her symptoms?

endoanal ultrasound

30 y/o F present for new onset fecal incontinence two weeks after giving birth. on PE there is weak anal sphincter tone and asymmetric contraction. what is the nest best step in management?

cervical cancer

30 y/o F present to the office with a 3 month history of postcoital bleeding. she typically has regular 28 day menstrual cycles w/ 3-4 days of light bleeding. the patient was diagnosed with HIV infection 2 years ago and is noncompliant with antiviral therapy. the right inguinal lymph nodes are enlarged and nontender. speculum examination reveals a solitary ulcerative lesion on the aspect of the cervix that bleeds with light contact. there is not discharge. the most likely diagnosis?

uterine rupture (key points: loss of fetal station + abdominal pain+ abnormal FHR)

32 y/o F , gravida 3 para 2, t 38 weeks gestation comes for contractions. prenatal course uncomplicated. She had a c-section prior for breech. FHR is normal on admission and cervix is 6cm dilated and 60% effaced with fetal vertex at 0 station. After 2 hours, the patient is suddenly restless and has intense lower abdominal pain. FHR monitoring now shows late decelerations. On pelvic exam there is moderate vaginal bleeding. cervix and effacement havnt changed but station is now -3. What is the most probably diagnosis?

Asherman syndrome

32 y/o comes to office for evaluation of absent menses. She ahd a vaginal delivery 4 months ago and has not had a period since. Her postpartum course was complicated by retained placenta and postpartum hemorrhage that required blood transfusion and emergency suction and sharp curettage. prior to this pregnancy, she had regular monthly menstrual cycles w/ 3-4 days of moderate bleeding. the patient has had no headaches, galactorrhea, or hot flashes. Pelvic exam is normal. FSH, TSH ar e normal. pregnancy test is neg. what is the most likely cause of her absent menses?

leiomyomas, hysteroscopic myomectomy

32 y/o nulliparous women comes for heavier menstrual bleeding. for the past few years. she has a period every month in which she often bleeds through her clothes. Pelvic exam shows an enlarged, 10 week-sized uterus. Urine pregnancy test is neg. Transvaginal ultrasound reveals an anteverted uterus w/multiples submucosal fibroids. The endometrium is thickened and has multiple areas impinged by fibroids. What is your diagnosis and the next best step?

vaginal candidiasis

32 y/o women has several days of vaginal itching and discharge. She also has pain w/sex. Denies any other symptoms. Has had 2 new male sexual partners in the past year. She takes OC and uses condoms. non chronic medical conditions. Last menses was 3 weeks ago. Pelvic exam shows vulvar and vaginal erythema and a small amount of white ordorless vaginal discharge w/pH of 4. What is your diagnosis

HPV testing

33 y/o Female speculum exam reveals a normal-appearing, non-friable cervix. A pap smear reveals atypical squamous cells of undetermined significance. Which of the following is the most appropriate next step in diagnosis?

placenta accreta, postpartum hemorrhage

34 y/o 18 weeks gestation comes to office for routine prenatal visit. prior pregnancies ended in 2 dilation and curettage procedures for spontaneous abortions. amniotic fluid index and fetal anatomy are within normal limits. the placenta is anterior and low-lying with numerous lacunae and myometrial thinning. What is her diagnosis and what pregnancy-related complication is she at greatest risk for?

staph toxic shock syndrome

34 y/o present to ED with 2 days of fever, rash and focal perineal pain. she was discharged 10 days ago after an uncomplicated spontaneous vaginal delivery at 38 weeks gestation. she had second degree perineal laceration that was repaired w/suture. temp is 104 F, P 86/54. pulse is 132/min. Pulmonary exam reveals bilateral crackles. there is a diffuse macular rash over the trunk. ther perineal laceration is tender but no redness or swelling. leukocyte count is 20,400/mm w/95% neutrophils. what is your diagnosis?

B

34 y/o woman is evaluated in postpartum unit for vaginal bleeding. 2hrs ago she underwent uncomplicated vaginal delivery with blood loss of 250mL. Bleeding was initially minimal, but there is now profuse vaginal bleeding. The patient has chronic hypertension that has been managed throughout this pregnancy w/labetalol. On pelvic exam the uterine fundus is soft, and the lower uterine segment is distended with blood clots. Which of the following medications is contraindicated in this patient? A. carboprost tromethamine B. methylergonovine C. misoprostol D. oxytocin E. tranexamic acid

uterine inversion

34 y/o women, gravida 3 para 2 has precipitous spontaneous delivery of a 4.2 9lb boy at 39 wks gestation. After 15 min of gentle umbilical cord traction and fundal message the placenta is not delivered. the umbilical cord abruptly avulses during traction and she suddenly develops abdominal pain. She becomes hypotensive and bradycardic. On exam the uterine fundus is not palpable at the umbilicus. There is copious vaginal bleeding w/bright red blood and large clots. Removal of the clots reveals a firm, rounded mas that is protruding from the vagina. What is most likely the cause of this patients symptoms?

vasa previa

36 y/o 35 weeks gestation presents with painless vaginal bleeding. the bleeding began immediately after her "water broke" including clots. patient is currently hemodynamically stable and there is no bleeding from the cervix. fetal HR is 85/min. what is the most probable diagnosis?

alpha-thalassemia major

36 y/o at 22 weeks gestation comes for initial prenatal visit. She immigrate to the states and has not received prenatal care but reports no illness or concerns during pregnancy. Routine labs are unremarkable. Ultrasound reveals a male fetus with an edematous scalp and nuchal fold. the fetal abdomen contains a large amount of echolucent fluid. the dingle deepest pocket of amniotic fluid is 12cm, and the placenta is thickened to 6cm. Fetal HR is 170/min. Which of the following is the most likely cause of this fetal presentation?

transvaginal ultrasound (ectopic pregnancy)

36 y/o has vaginal spotting for past 4 days after having been amenorrhoeic for past 2 yrs from progestin IUD placement. PE shows right adnexal tenderness. Urine pregnancy test is positive. transabdominal US shows a a small uterus w/ tine endometrium and IUD. What is the next best step to confirm the most probable diagnosis?

50%, tuberous sclerosis (autosomal dominant)

36 y/o nulligravid women comes for preconception counseling. she has epilepsy but is controlled with meds. Exam shows yellow-brown plaque w/irregular borders measuring about 6cm in diameter along the lower back. There are also periungual fibroma on hands and feet. Assuming she is heterozygous for her underlying disorder and they will give birth to a boy what is the likelihood their baby will have the disorder? what is the disorder?

parvovirus B19

37 gravida 2 para 1 comes to ED due to painful contractions and leakage of fluid. She has not received prenatal care and is at 24 week. She has not chronic medical conditions. She precipitously delivers a male fetus w/no cardiac activity. The fetus is edematous, peeling skin. The scalp is edematous but no dysmorphic palate of facial features. the abdomen is fluid filled. the placenta appears thickened and edematous. Indirect Coombs test and HIV-1 ab is negative. What is the most likely etiology of the baby's death?

induction of labor

37 week gestation Patient presents with increased welling, elevated blood pressure and 2+ protein on urine dipstick. what is the recommended management?

Acute ischemic stroke (preeclampsia)

37 y/o gravida 1 para 0 with severe epigastric pain that started yesterday. Blood pressure is 168/94, BMI 29. The uterus is nontender. Urinalysis shows 3+ protein. US of RUQ is normal. She has increase risk for developing?

D (uncomplicated preterm prelabor rupture of membranes at <34 weeks)

40 y/o 33 weeks gestation has had intermittent leakage of clear vaginal fluid for the past few hours but no vaginal bleeding. Speculum shows a closed cervix and clear fluid in the posterior fornix of the vagina; ferning is noted on microscopy. fetus is in vertex presentation surrounded by minimal amniotic fluid. What is the best next step? A. Amnioinfusion B. Mg sulfate C. nifedipine tocolysis D. prophylactic latency antibiotics

Missed abortion

40 y/o gravida 3 para 2 female at 10 weeks gestation presents to the office for follow-up. She had significant nausea and vomiting early in pregnancy but has since resolved. Evaluation today shows a closed cervix w/o vaginal bleeding, declined serum Beta-hCG concentrations. ultrasound at reveals intrauterine gestation with a yolk sac but no fetal pole or cardiac activity which was the same as her 8 week visit.. the most likely diagnosis is?

antiphospholipid syndrome, warfarin

42 y/o G8P1162 w/history of migraines present w/SOB. Imaging reveals acute PE. What is her diagnosis and what lifelong anticoagulation will she require?

endometrial biopsy

42 y/o with normal pap tests in the past comes for routine health exam. pelvic exam shows normal cervix, a small anteverted uterus, and no adnexal mass. Pap test demonstrates atypical glandular cells. What is the next best step in management?

vulvar cancer

52 y/o postmenopausal women comes to the office for vulvar irritation. PMH includes previous abnormal pap, hysterectomy, and chronic smoker. Vital signs are normal. Pelvic exam shows multiple vulvar excoriations with surrounding erythema. There is unifocal, erythematous, highly friable plaque on the left labium majus. On speculum, vagina has no lesions or discharge. what is the most probable diagnosis?

epithelial ovarian carcinoma

53 y/o G2P2 comes to office due to right sided pelvic pain that has worsened over the past 3 months. Pelvic ultrasound shows a 7-cm right ovarian mass w/solid component, thick septations, and a moderate amount of peritoneal fluid. Your attending tells you the most common cause is abnormal proliferation of tubal or ovarian epithelium. What is your diagnosis?

granulosa cell tumor

59 y/o postmenopausal woman comes for concern of breast tenderness for 4 months. ther is no masses or nipple discharge. The patient has also noticed increase in her weight particularly around the abdomen. Mammogram history is normal including one performed earlier this year. Breast exam shows bilateral, diffuse fibrocystic changes. Abdomen is distended a large RLQ mass is palpable. Pelvic ultrasound reveals 12-cm complex R-ovarian mass w/solid components and multiple septations, slightly enlarged uterus, and a 9mm endometrial stripe. Tumor marker Estradiol is elevated.

serum CA-125 level

62 y/o nulligravid woman come sto office for follow-up right adnexal mass found during pelvic/pap exam. pap is normal and she denies postmenopausal spotting. ultrasound reveals a 5-cm right ovarian cyst. what is the next best step in management?

HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets)

A variant of gestational hypertension where hematologic conditions coexist with severe preeclampsia and hepatic dysfunction.

True

True or False hydronephrosis in a pregnant woman without symptoms does not need immediate management

Savage's (ovarian resistance) syndrome

Type of ovarian dysfunction that presents early in life with amenorrhea, delayed breast development, elevated GnRH and LH/FSH levels, low estrogen and normal karyotype.

HIV Hep B Syphilis

What are the 3 STI screenings that are required at the initial prenatal visit?

A

What are the current guideline recommendations for all pregnant women with HIV regardless of HIV RNA viral load or CD4 count? A. combination antiretroviral therapy started immediately B. combo antiretroviral therapy starting the third trimester C. maternal zidovudine monotherapy at delivery only

Progesterone

What hormone is responsible for increased risk of GERD during pregnancy?

E

What is the best contraceptive option for a 25 y/o who is looking for a reliable contraception ASAP and has a history of heavy menstrual bleeding? A. Oral contraceptives B copper IUD C. diaphragm and condoms D. progetsin only oral contraceptives E. subdermal progestin-releasing implant

Metronidazole

What is the drug of choice for a patient with malodorous vaginal discharge that is thin, gray in color and on saline wet mount reveal numerous epithelial cells coated w/bacteria

maternal repositioning

What is the first line management option for variable decelerations?

Adenosine

What is the first line medication for acute management of tachyarrhythmias in pregnant women?

Methotrexate

What is the medical therapy for ectopic pregnancies in patients with hemodynamic stability and a Beta-hCG leve <5000

amoxicillin, 10 days (ampicillin, nitrofurantoin are also choices)

What is the most appropriate medication and course for a pregnant women with asymptomatic bacteriuria (defined as >100,00 units of a single bacteria (eg. E.coli ))

ceftriaxone (only)

What is the most appropriate medication course for a patient who test positive for N. gonorrhoeae ONLY

squamous cell carcinoma

What is the most common vaginal cancer in postmenopausal women?

Inpatient IV antibiotics

What is the next step in management in a pregnant patient with acute pyelonephritis?

opiods (morphine)

What medication can cause transient absent/minimal FHR variability due to fetal CNS depression

antiviral suppression at 36 weeks gestation

What should be done with a pregnant patient that has history of genital herpes but was treated appropriately at the time and has not had any subsequent genital lesions since then.

E (actually is an indication as long as the none of the other are present)

Which of the following is NOT a contraindication for external cephalic version for vaginal delivery? A. </= 36 weeks gestation B. prior classical c-section C. prior extensive uterine myomectomy D. placenta previa E. breech presentation

E

Which of the following is a contraindication for taking raloxifene, a SERM medication? A. endometrial hyperplasia B. history of breast cancer on her mom's side C. history of cervical cancer on her mom's side D. hyperlipidemia E. prior PE

A

Which of the following is consistent w/ diagnosis of preeclampsia with severe features? A. new-onset visual disturbances B. platelet count of 160,000/microliter C. proteinuria of 8 g/day D. systolic blood pressure of 150 mmHg

oxytocin

after bimanual massage of of the uterus in a patient experiencing uterine atony, what is the next best step in management?

RUQ, or right flank

during pregnancy the appendix undergoes displacement by the gravid uterus. therefore appendicitis may have an atypical presentation of pain and present in what two possible locations?