OBGYN

At how many weeks of pregnancy can chorionic villus sampling be done?

10-13 weeks

At approximately how many weeks pregnant is the uterus at the level of the pubic symphysis?

12 weeks

What is the normal range of fetal heart rate?

120-160

At how many weeks of pregnancy can an amniocentesis be done?

15-20 weeks

At approximately how many weeks pregnant is the uterus at the level of the umbilicus?

20 weeks

About how much weight should a woman gain during pregnancy?

20-35 lbs

At what point during pregnancy is RhoGAM given if it is needed?

28 weeks 72 hours postpartum

What is the karyotype for a patient with Turner's syndrome?

45, XO

Early on in pregnancy serial beta-HCG should double over what time period?

48-72 hours

What is the average age of menopause?

51

What is the mean age for ovarian cancer?

63, you will need to think of this in an older patient with vague abdominal symptoms.

What is the most common endometrial cancer?

75% are adenocarcinomas

How many days after conception is a serum beta-hCG positive?

8 days

What age range is the HPV vaccination recommended for?

9-45

Under what size does a simple ovarian cyst in a premenopausal female require no follow up?

<5mm

What heart rate reflects a score of 2 on APGAR?

>100

An adnexal mass of greater than what size is at highest risk for torsion?

>5cm

What is a normal APGAR score?

>7

What is a cystocele?

A herniation of the bladder into the vagina.

What are the five components of the biophysical profile as part of antepartum testing?

A non-stress test, fetal breathing, two gross body movements, fetal tone, amniotic fluid index

An elevated 17-hydroxyprogesterone plus symptoms of PCOS should make you think of what diagnosis?

Adrenal hyperplasia

What ethnic background is at an increased risk of fibroids?

African Americans are 5x more likely to have fibroids as compared to caucasians

At what age is primary amenorrhea diagnosed?

Age 14 if no secondary sex characteristics. Age 16 if some secondary development.

Name three risk factors for placenta previa.

Anything that causes uterine scarring: multiparity, prior c-section, fibroids, any uterine surgery, older maternal age and smoking

List four risk factors for breast cancer.

BRCA1 or BRCA2 positive, unopposed estrogen, nulliparity, early menarche, late menopause

List 2 risk factors for ovarian cancer.

BRCA1, family history, nulliparity, late menopause, Caucasian, Asian

Is male breast cancer associated with BRCA1 or BRCA2 gene mutations?

BRCA2

Clue cells should make you think of what diagnosis?

BV

What three labs should you order if you are considering secondary amenorrhea?

Beta-HCG, TSH, Prolactin

During what portion of the menstrual cycle does PMS occur?

By definition it is in the second half and menstruation should relieve the symptoms.

What is the most common TORCH infection in pregnancy?

CMV

What are two medications used to induce labor?

Cervidil (Prostoglandin gel applied to the cervix) which encourages cervical ripening and oxytocin which encourages uterine contractions.

A patient believes she is pregnant. You notice that her cervix appears a little blue. What is the name of this sign?

Chadwick sign

If the pap report comes back on a 29 YO woman as ASCUS, what is the recommendation for follow up?

Check HPV- If ASC-US positive and HPV positive, proceed to colposcopy- If ASC-US positive and HPV negative: repeat in 3 years

If the pap report/cytology comes back on a 29 YO woman as LSIL, what is the recommendation for follow up?

Check HPV- If LSIL positive and HPV positive, proceed to colposcopy- If LSIL positive and HPV negative: repeat in 1 year

A patient presents with mucopurulent discharge and cervical motion tenderness. What diagnosis and organism should you be considering?

Chlamydia - cervicitis

List 4 risk factors for endometrial cancer.

Chronic unopposed estrogen, nulliparity, early menarche, late menopause, tamoxifen, DM, obesity, HTN, breast CA, ovarian CA

Give the definition for preterm labor.

Contractions that open the cervix before 37 weeks.

What is the treatment for Turner's syndrome?

Cyclical estrogen and progesterone

Define full term.

Delivery at 37-42 weeks

Define premature birth.

Delivery before 37 weeks.

Define the third stage of labor.

Delivery of baby to delivery of placenta

Define abortion.

Delivery of uterine contents before 20 weeks

What is the first line treatment for mastitis?

Dicloxacillin Cephalexin

Give two symptoms of magnesium toxicity?

Difficulty breathing, slow deep tendon reflexes

Postmenopausal bleeding is immediately believed to be what diagnosis?

Endometrial cancer until proven otherwise.

How do you definitively diagnose endometriosis?

Exploratory laparoscopy

What is the most common site of an ectopic pregnancy?

Fallopian tube

What is the formula for calculating estimated date of confinement or due date?

First day of last menstrual period + 7 days - 3 months

How do you treat vaginal candida?

Fluconazole po 1 dose or azole cream x 1 week

Define the second stage of labor.

Fully dilated to delivery

What is the most common type of ovarian cyst?

Functional cyst - no treatment necessary.

A woman presents to the ER concerned she is in preterm labor. What treatment should you begin before even getting any imaging or lab results?

Give IV fluids (most often the patient is suffering from dehydration).

When is it recommended to begin pap smears?

Guidelines suggest beginning at age 21 regardless of sexual history.

Which four human papillomaviruses are linked to cervical cancer?

HPV 16, 18, 31, 33

Name two vaccinations that are contraindicated in pregnancy.

HPV, MMR, live flu, varicella

List three risk factors for placental abruption.

HTN, smoking, AMA, cocaine use, PROM

What are the components of HELLP syndrome?

Hemolysis Elevated LFTs Low Platelets

A snowstorm appearance on U/S of the uterus should make you think of what diagnosis?

Hydatidiform mole

A patient with primary amenorrhea and a low FSH should make you think of what diagnosis?

Hypothalamic pituitary insufficiency

How much time needs to pass before diagnosing secondary amenorrhea?

If cycles have been normal 3 months. If cycles have been irregular 6 months.

How long does menstruation need to be absent before secondary amenorrhea can be diagnosed?

If cycles have been previously normal: 3 months. If cycles have been previously irregular: 6 months.

What is the most common uterine tumor?

Leiomyoma, also known as fibroids

Why is folic acid given as prenatal vitamin?

Low folic acid can lead to neural tube defects.

Define menorrhagia.

Menstrual bleeding that is very heavy or that lasts longer than 7 days

List two medications commonly used for hypertension in pregnancy.

Methyldopa, labetalol, hydralazine

How do you treat a Trichomonas infection?

Metronidazole

What is the most common medication used to treat preterm labor?

Mg sulfate

What are two tocolytic medications you should be aware of?

Mg sulfate and CCB

When is an APGAR assessment performed?

Minute 1 and minute 5 after birth

What Rh combination for mom and dad might cause the mother to create antibodies against the baby's red blood cells?

Mom Rh-negative and dad Rh-positive

List two risk factors for cervical cancer.

Multiple sexual partners, smoking

What lab test is the gold standard for chlamydia?

NAAT

Define missed abortion.

No vaginal bleeding, cervix is closed, products of conception are still inside.

Is trace glycosuria concerning for pathology in a pregnant woman?

No, trace glycosuria is a result of an increase in circulating volume and increase in GFR, and is a normal finding in many pregnancies.

Is a nulliparous or multiparous woman more likely to get preeclampsia?

Nulliparity is a risk factor for preeclampsia.

When does quickening occur?

Nulliparous 18-20 weeks, multiparous 14-16 weeks

Define the first stage of labor.

Onset of contractions to full dilation of the cervix.

A patient presents with irregular menses, hirsutism and infertility. What diagnosis should you be considering?

PCOS

What is the more popular term for Stein-Leventhal syndrome?

PCOS

What is the leading cause of infertility and ectopic pregnancy?

PID

What characteristic of pelvic inflammatory disease will help to differentiate it in a question stem from ectopic pregnancy, appendicitis, ovarian torsion and ovarian cyst?

PID will be bilateral pain. Most common abdominal complaints have unilateral pain.

How do you treat bacterial vaginosis?

PO Metronidazole x 7 days

What is a major difference in the presenting symptoms of placenta previa vs placental abruption?

Placenta previa presents with PAINLESS vaginal bleeding while placental abruption presents with PAINFUL vaginal bleeding.

A 36 week pregnant mom presents to the ED following an MVA. You observe blood on her inner thighs, but she states she has not been hurt. What diagnosis should you be considering?

Placental abruption. Aside from known risk factors, these also can be caused by acute traumatic events such as deceleration injuries.

Gestational diabetes puts mom and baby at increased risk of for what three things?

Preeclampsia, macrosomia (traumatic birth), slowing in fetal lung development

Interference with work or school is part of which diagnosis, premenstrual syndrome or premenstrual dysphoric syndrome?

Premenstrual dysphoric syndrome

List three risk factors for an ectopic pregnancy.

Previous ectopic, scarred tubes (hx of PID or salpingitis), IUD

How is cervical insufficiency in pregnancy diagnosed?

TVUS

How is cervical insufficiency in pregnancy defined?

The cervix is < 25 mm long prior to 24 weeks gestation

Why is ovarian cancer so hard to diagnose?

There are no good markers and the symptoms are very vague.

As part of the antepartum testing a baby has a positive stress test. What does that mean?

They have had two heart rate accelerations in a 20 minute period of 15 beats above baseline for at least 15 seconds. That's a good thing.

What are the four T's of postpartum hemorrhage?

Tone (uterine atony), tissue (retained placenta), trauma (genital laceration), thrombin (clotting issue)

What is the first step treatment for endometrial cancer?

Total hysterectomy and bilateral salpingo- oophorectomy

What is the treatment for ovarian cancer?

Total hysterectomy and bilateral salpingo-oophorectomy. Chemo + radiation.

What is the hallmark physical exam finding for placenta previa?

Trick question - NEVER do a physical exam on someone with presumed placenta previa.

Does mastitis tend to be unilateral or bilateral?

Unilateral and only one quadrant

What are three causes for postpartum hemorrhage?

Uterine atony, genital laceration, retained placenta

Define procidentia.

Uterine prolapse beyond the introitus

Grade 3 vaginal lacerations due to vaginal delivery involve what part of the body?

Vagina → SQ → sphincter → mucosa (rectal)

Define inevitable abortion.

Vaginal bleeding, cervix is open, products of conception are still inside

Define incomplete abortion.

Vaginal bleeding, cervix is open, products of conception partially passed

Define complete abortion.

Vaginal bleeding, cervix open, products of conception have passed

Define threatened abortion.

Vaginal bleeding, closed cervix, products of conception are still inside

What is placenta previa?

When the placenta implants over or near the internal os of the cervix

What is the most common cause of abnormal uterine bleeding in premenopausal women?

anovulation

What medication is used to increase surfactant levels and help with lung maturity if you are worried about preterm labor?

betamethasone

Are fibrocystic breast masses usually bilateral or unilateral?

bilateral

A breast mass in a female >50 should be considered what until proven otherwise?

breast cancer

What medication is used to reverse the effects of magnesium toxicity?

calcium gluconate

What is the treatment for an incompetent cervix?

cerclage

What organism is the most commonly sexually transmitted bacteria?

chlamydia

What medication(s) are used to treat postpartum metritis?

clindamycin + gentamicin

If the pap smear results come back anything other than negative or ASCUS what is your next step?

colonoscopy and biopsy

What is Amsel's criteria used for?

diagnose BV

What is the most common cause of abnormal uterine bleeding in an older but still premenopausal, obese woman?

endometrial hyperplasia

If you see the term chocolate cyst, it should make you think of what diagnosis?

endometrioma

A physical exam revealing a retroverted uterus or uterosacral ligament nodularity should make you think of what diagnosis?

endometriosis

The follicular phase of menstruation is dominated by what hormone?

estrogen

What are three ways you can check for ruptured membranes?

ferrying pattern

A unilateral, single, mobile, firm, nontender solid breast mass should make you think of what diagnosis?

fibroadenoma

A rope-like breast mass should make you think of what diagnosis?

fibrocystic breast disease

What is the most common benign breast finding?

fibrocystic disease

How is the first day of the menstrual cycle defined?

first day of menstrual bleeding is first day of cycle

Dizygotic, dichorionic, diamniotic (di-di-di) twins are more commonly known as what type of twins?

fraternal- have separate placenta and amniotic sac

What is the #1 cause of septic arthritis in sexually active young adults?

gonorrhea

What is the drug of choice for anticoagulation during pregnancy?

heparin

Is FSH high or low in Turner's syndrome?

high

Grape-like vesicles or a sack of grapes on ultrasound should make you think of what diagnosis?

hydatidiform mole

What is the classic triad of preeclampsia?

hypertension, edema, proteinuria

What endocrine issue is associated with PCOS?

insulin insensitivity

A woman who is 35 weeks pregnant and complains of diffuse pruritus on the palms and soles of her feet, that is worse at night should make you think of what diagnosis?

intrahepatic cholestaisis of pregnancy MC in 3rd trimester

What is the most common type of malignant breast cancer?

invasive ductal

Since a genetic cause is the number one reason for primary amenorrhea what is one very important test?

karyotype

What organism causes us to warn pregnant patients to stay away from deli meats and soft cheeses?

listeria

A surge in what hormone leads to ovulation?

luteinizing hormone (LH)

What is the first line screening test for suspicious breast complaints in a woman > 30?

mammography + ultrasound

You have a patient with PCOS who would like to get pregnant. What are two medications you may start her on?

metformin and clomiphene

What is the medical treatment for an early ectopic pregnancy?

methotrexate

What is the most common infection following a C-section?

metritis

With a hydatidiform mole pregnancy will the uterus be larger or smaller than expected for the gestational age?

much larger

What is the most common side effect of progestin pills (emergency contraception)?

n/v

A sexually active female presents with dysuria and mucopurulent cervical discharge. Gram stain shows gram-negative intracellular diplococci. What diagnosis should you be considering?

neisseria gonorrhea

Purulent cervical discharge should make you think of what diagnosis?

neisseria gonorrhea

Should a breastfeeding mother stop breastfeeding if she develops mastitis?

no

What location within the pelvis is endometriosis most commonly found?

on ovary

A 66 year old female patient presents with bouts of nausea, weight loss, and vague abdominal pain. What diagnosis should you be considering?

ovarian cancer

Which reproductive cancer carries the highest rates of death in women?

ovarian cancer

What medication can be used to control bleeding due to uterine atony?

oxytocin / Pitocin

Painless vaginal bleeding after 20 weeks gestation should make you think of what diagnosis?

placenta previa

What is the term for when the placenta has implanted directly over the cervical os?

placenta previa

Which is associated with painful third trimester bleeding placental abruption or placenta previa?

placental abruption

The baby was delivered several minutes ago. Suddenly there is an increase in blood flow from the vagina and the cord noticeably lengthens. What is the most likely cause of these signs?

placental seperation

What is the #1 cause of maternal death?

postpartum hemorrhage

What is the most common cause of secondary amenorrhea?

pregnancy

The secretory phase of the menstrual cycle (days 14-28) is dominated by what hormone?

progesterone

A woman presents with bilateral hemianopsia, headache, amenorrhea, and bilateral milky nipple discharge. What is the most likely diagnosis?

prolactinoma

What would you expect to see on a KOH prep if the patient had vaginal candidiasis?

pseudohyphae

If the pap report comes back on a 23 YO woman as ASCUS or LSIL, what is the recommendation for follow up?

repeat cytology in 1 year

The pap smear results on a 23 year old patient comes back as atypical squamous cell uncertain significance (ASCUS). What is your next step?

repeat pap in 12 months

"Turtle sign" should make you think of what diagnosis?

shoulder dystocia

A pelvic U/S on a 35 YO woman shows a 4.1 cm, thin- walled mass with anechoic fluid. What is the most likely diagnosis?

simple ovarian cyst

What is the most common type of cervical cancer?

squamous cell

What is the most common organism that causes mastitis?

staph aureus

What are two important things you need to tell your patients before putting them on metronidazole?

stay out of sun and avoid alcohol

What is the treatment for a hydatidiform mole?

suction curettage

An ovarian cyst that contains hair and teeth should make you think of what diagnosis?

teratoma

What medium do you need to grow out Neisseria gonorrhoeae?

thayer-martin

A strawberry cervix with copious yellow/green discharge should make you think of what diagnosis?

trichomonas vaginalis

Thin, sticky, malodorous vaginal discharge should make you think of what diagnosis?

trichomonas vaginalis

A description of a young girl with a web neck or wide shield chest should make you think of what diagnosis?

turner

What is the first line screening test for suspicious breast complaints in a woman <30?

ultrasound

What is the most common cause of postpartum hemorrhage?

uterine atony

Cottage cheese discharge should make you think of what diagnosis?

vaginal candidiasis

What is the ideal position of the occiput for delivery of a fetus?

vertex presentation with anterior occiput

What happens to beta-hCG in the presence of a hydatidiform mole?

very high