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
uterine prolapse
there is a pale mass in the lower vagina, the pt develop
hypovolemic shock and uterus cant be palpated. dx?
What is the most likely cause of a 46 XX baby born
ACTH oversecretion (CAH)
with scrotum and phallius?
What is the fisrt step in mangement of a 47 y/o with
Get Beta HCG before getting
questionable menopause with 4 months without a
FSH
mentsrual period, with an enlarged uterus?
What is the most apporopriate management of a 15 y/o
admission and IV abtx
pt with PID and 103.5 fever?
What is the appropriate step for preventing group B abtx therapy is delivery
strep sepsis in the newborn with 12 hrs of ruptured hasnt occured by 18 hours
membranes? after rupture of membranes
every 6 months if abnl, then
When should HIV + women have pap smears?
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 cholesterol studies
and a 36 y/o brother with T2DM and a smoking 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, + ovarian torsion
guarding and rebound. mass grwoing with cystic and
solid components. Dx?
fisrt step in management with ROM at term with
pelvic exam
sudden decrease in fetal HR?
What is converted peripherally in PCOS? androstenidione to estrone
Best evaluation tool for soncern for PID infertility? hysterosalpingogram
What type of contraceptive is contraI in a 37 y/o
triphasic oral contraceptives
smoker of 2 ppd?
LEEP is a RF for what in future pregnancy? cervical insufficiency
A patient with a velvety pigmented skin over the axilla type 2 DM (acanthosis
is at risk for? nigracans)
painless ulcerated lesion in 60 y/o lady with puritis.
vulvar carcinoma
dx?
What might be seen in a uterus large for dates in an
multigestation, get an u/s
IVF pt?
What is the most common cause of 4 months of
serosanguinous breast discharge with a normal intraductal papilloma
mammogram?
Most common birht defect of valproate? NTD
What is the most likely cause of a lady not having a
menstrual period after her last child required a d and asherman syndrome
C?
low FSH and low estrogen
What is seen in amenorrhea from running (FSH and
(hypogonadotropic
estrogen)?
hypogonadism)
What is the most likely cause of a 5 y/o without
genital truma with persistant green vaginal discharge foreign body in the vagina
and burning and itching?
what is the most likely karyotype of a pat with
progressive facial hair, axillary hair, without breast 46 XY (androgen
devlopment. a blind vagina, clitoromegaly and insenitivty)
posterior 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
chest xray
with HIV and a PPD of 9mm?
An exquisitely tender ulcer at the introitus is most
H. ducreyi
likely caused by what in an 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, detrusor
Urge, enuresis, with large volume is?
instability . tx with meds
 genuine stress incontinence,
triggers with coughing of small volume of urine is? sphincter insufficincy. tx
with pessary/surgery
small amount of urine, enuresis, frequently is? overflow incontinecy (neuro)
What causes persistant fetal tachycardia? maternal fever
What should be done with BHCG levels in an INC
follwed to zero
Ab?
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 46
What is no breast, no uterus? XY 2. enzyme deficiency in
testosterone synthesis
gonadal failure of 46 XX 2.
What is no breat, yes uterus?
disruption of hyp-pit axis
1. testicular feminization 2.
What is yes breast, no uterus?
mullerian agensis
- hypothalamic, puituitary or
What is yes breat, yes uterus, amenorrhea? ovarian failure 2. congenital
anomalies
Main cause of premature deteriorating AGPARS? pulmonary hypoplasia
A 22 y/o with multiple raised, crusty papule and an
condyloma acuminatum
abnl pap. dx?
Dx of cjoice for endometriosis? laparoscopy
How do you evaluate green forthy discharge, vaginal wet mount (look for mobile
erythema? protozoa)
MCC big uterus with correct dates? polyhydramnios
Chronic HTn can have what effect on fetal/placenta? uteroplacental insufficiency
A baby with macrosomnia incr chances for what in
GDM
future pregnacies?
Tx for transverse lie, full dilation and effacement? casarean delivery
Does dilution of Hb in pregnancy cause changes in
NO
MCV?
what is best tx for irregular periods in a smoker? cyclci progestins
A prolapse after a hysterectomy relived by lying
enterocele (even without BM
down, bulging posterior mass high in the vaginal vault
issues)
is?
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
Staph aureus, toxic shock
adnexal tenderness. uses tampons during periods.
syndrome
Causal organism?
pregnant woman, suddent onset of sever left sided uterolithiasis ( doesnt require
flank pain radiating to labia. no gross hematuria, gross hematuria, could be
afebrile, n/v, only comfortable when ambulating. dx? microscopic)
new breastfeeder with eryhtematous, nonfluctuant,
tender area in upper outer quandrant. engorded breast mastitis
bilaterally. fever and tachycardia. Dx?
19 y/o primagravid at 31 w admitted for intense
uterine contractions every 1-2 mins for 2 hours. uterus
firm and tender, fetal hr is 165. dark blood from vgina, abruptio placenta
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. + home preg test. afebrile,
normal vitals, BHCG= 554,367. TVUS has an suction and curretage ( mole)
enlarged uterus with scatter hyperechoic material. next
step in management?
87 y/o with urinary incontince for 6 years, she avoids
genuine stress incontinence
house for fear of public ridicule.incontinence with
= decr external urethral
sneezing, coughing, exertion. hysterectomy 30 y ago.
sphincter tone
BMI = 31. Most likely cause?
Purulent cervical discharge, cervical motion
N. Gonorrhoeae
tenderness, G+ diplococci in slide. dx?
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 menarche is imminent
development is tanner stage 3. recent pubic hair
deveoplment is most indicative of?
22 y/o woman comes because of second episode of
increasign symtpoms for 3
painful vesicular genital lesions. her partner has
weeks then a gradual
similar lesions on his penis. most likely clinical
decrease
course?
18 nulligravid comes for health maintenence. pain in
adnexal region that occurs during days 13 and 14 of
leuprolide ( GnRH agonist,
her cycle. its brief and shapr. menarche was at 13 nd
for endometriosis)
she has regular cucles. never sexually active, and
exam is normal next step in managemnt?
26 y/o G3 po 0, ab 3 sue to 3 consecutive 1st trimester
congenital uterin anomailies
ab. hx of UTI since childhood. IV pyelogram showed
( urinary tract anomalies
single left kidney. exam today shows palpable uterus
follow with uterine)
and palpable left ovary. most likely dx?
Prior to discharge, a 30 y/o woman wants to resume
combo oral contraceptives prior to pregnancy. but decreased protein content in
wants to breast feed. what problem do you counsel her breast milk
about?
22 y/o prima at 20 w comes for routine prenatal visit.
uncomplicated, declined aneuploidy screen , other labs
gastrochisis (omhalocele
normal. exam has normal uterus, abdominal organs
would be within cord)
seen outside abd canvity without a covering
membrane,cord is medial to defect. dx?
32 y/o G3 P2 at 20 w comes in for routine prenatal. u/s
shows skeletal dysplasia consistent with autoD
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 contraception. flagellated protozoa
erythema of vulva and vagina, yellow gray frothy
discharge. pH=5. wet mount finding?
57 yo for routine health maintenence. HTN, t2 DM,
hormone therpay
generalized anxiety. she has been getting conj
estrogen and medroxyprogesterone after menoapuse.
also HCTZ, metformin,herbal meds. What is her
greatest risk for Br Ca.
18 y/o without menstrual period in last year. no
oseoporosis, no withdrawal
withdrawal bleed after medroxyprogesteron x 7d. BMI
bleed suggests ovarian
=20. breasts are tanner 2, pubic hair is tanner 5, PE
failure
shows normal vag but prepubertal uterus.
27 y/o G2, P1 comes after an episode of bright red
blood with no contractions or cramping. she has incr
normal pregnancy, painless
br size, morning sicknessand fatigue. LMP was 8 w
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 adnexal with tenderness. BHCG is
normal cysts, OCP and f/u in
neg. pelvic u/s has 5 cm simple cyst. she is anxious
6 weeks to see if it regrsses
about tx as her insurance expires in 2 weeks. next
step?
what causes variable decelerations? umbilical cord compression
4 weeks after c/s. with feeling of pulling on right side
of incision. exacerbated by movement. she was d/c on normal post op course, this is
pod 3. in last 2 weeks she started exercising and sex. where the knot in the sitches
bmi 29. abd is tender on right of incision. most likely is
explanation?
67 y/o with moderate vulvar itching for 2 years.
otherwise healthy, takes no meds. normal vitals. exam punch biopsy of affeted
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. first 2 kids
were SVD. cervix is 2 cm dilated on admission with
cephelopelvic disproportion
fundal ht of 42. 4 hurs later, cervix complete, vertex is
(DM)
OA, -1.1 hr later, contractions are every 2 mins and
station and cervix unchanged. cuase?
67 yo with 9mvulvar itching. unresolved with zinc, vit
E, steroids, or metrantifungals. has type 2 DM and
hyper colesterolemia. BMI =53. eryhtmatous swollen type 2 DM
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 sex actve, no meds. BMI =31.
FSH (turners she is 4 ft tall,
br = tanner 1, nl thyroid, continuous murmur on
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.
hematocolpos (imperforate
sex active no contraception. 80th percent for ht and
hymen)
wt. mass in suprapubic region at midline. bluish bulge
obscures the upper vag. dx?
32 y/o G5P4 at 21w bright red vag bleed for 4 hr.no
prenatal care. speculum has bright red blood in post fetal u/s
fornix. no other abn in cervix. next step?
32 y/o prima at 10 w for 5 d of n/v decr appetite. cant
hyperemesis gravidarum,
keep food down. labs show some hypovolemia, large
inpatient admission for iv
ketones, some electrolytes disturbances. what should
fluids and antiemetics
you do for her?
27 y/o prima at 33 w comes for prenatal visit. has SLE
x 8y. remission. preg normal besides lagging fundal ht uteroplacental insufficiency (
2 m ago. at 20 week things were normal on us. at 33w SLE can mimic GHTN)
there is oligo and 30 w fetus. what is cause of olgio?
32 y/o with 6m of increasing frequent pelvic cramps,
pain with urination, urgency relived with urination.
interstital cystitis
regular menses. suprapubic tendenress. tender to
palpation dx?
20 y/o with 3 yr of hirsutism wosrsening over last 2
increased testosterone
years, cause of hair growth?
27 y/o primagravid at 14 w comes for 24 hrs of n/v,
appendicitis (might be
right sided abd pain, loss of appetite x 2 d.no n/v.
pyelo) but i think the loss of
afebrile. RLQ tenderness without rigidity or rebound.
appetitie
WBC 16.5, leukocytosis in urine. Dx?
32 y/o nulligravid with no mentstural period since
sottped taking OCP 6m ago. menses were regular
testosterone ( DHEAS is
before. also has incr libido, facial hair and acne.
from adrenals)
BMI=33. 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
flow. 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 gets 2 L of LR. epidural cath IV injection of the anastetic
is placed and test dose of lido and epi is injected. she (epidural woundt cause these
immediately has tinnutus and metaalic taste. pulse is sx)
now 110 what 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
atelectasis
crackles or rhonchi. ijncision site is dry and intact. 2+
pitting bilaterally. Most likely dx?
27 y/o prima at 34 comes with 1 day of anxiety,
sweating, rapid heart beat. some disorientation. rapid levothyroxine. propythiuracil
pulse, low grade fever high b. diffusely enlarged can concentrate in the fetal
thyroid with 4+ clonus. along with a beta blocker what thyroid
else should you give her?
a 32 y/o G5P4 at 18w comes for routine prenatal. Rh -.
previos pregnancies reuqired c/s at33-35 for breech,
preterm labor (bicronate
She got rhogam for both pregnancies. her mother has
uterus)
T2DM. vitals normal. TVUS shows breech and
bicornate uterus. What is she at incr risk for?
42 y/o G3P3routine exam. iregular period varying
length for the last yr. last period was 6 w ago. she has
t2dm tx w metformin. BMI=32she has an irregular annovulation
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 give rhogam for any bleed in
=135. bleed is of uterine origin. she is O-.nst is 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 yr desite iron. 5 days ago she
hemoglobin electrophoresis
visited relatives with a flu like illness. uterus is
(thalassemia)
consitent with 10 w pregnancy. next step in
management?
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 breast engrogement
are tense and tender. uterus firm20w 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
bleedfirst noted as spotting 12 h after sex, since then
cervical trauma (sex)
bleed has incr. otherwise uncomplicated. u/s at 20w
has fundal placenta. most likely cause of bleeding?
17 y/o comes in with moderate severe pelvic pain with
primary dysmenorrhea
n/v during menses since menarche. sx begin soon after
(endometriosis tends to be
onset of menses. nsaids help. never been sexually
midcycle pain)
active. normal PE. DX?
57 y/o complains of small blood stains on underwear x
6m. menopause occured 5 y ago and has not recieved
hypoestrogenic state
hormone therapy. reports dysparunia but no GI or
(menopause)
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 ago. tmp-smx
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
severe Pre-E
for 12 hr. labs show 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
fine needle aspiration biopsy
engorgement since that time. L br shows 2 cm tense,
of the cyst.
mobile, cyst like structure. mammography 3 m later is
normal. next step in mamangement?
55 y/o woman with constant wetness from vagina likely vesicovaginal fistula
following hysterectomy. no dysuria or urgency. like from hysterectomy. get dye
dx and what next step? installation into bladder
42 y/o woman with DM with constant dribbling of neurogenic bladder, do
small amounts? dx and tx? intermittent self cath
39 y/o woman wets efl 2-3x daily, feels need to void urger incontinence,
but does not make it in time. dx and tx? oxybutynin
stress incontinece, tx? pessary or burch urethropexy
live attenuated, no effect on
what type of vaccine is VZV?
hsv
At what time should manual placental extraction be after 30 mins of retained
attemtped? placenta
what is the best inital therapy for non reducible anathesia (halothane) (relax
uuterus? cervix)
which is more effective for reducing vertical
zidovudine > c/s
transmission of HIV c/s or zidovudine?
steroid induced comedones
girld with lupus with acne w/o comedones is?
not teenage acne
abnormal DEXA scan as low
what might be seen in a woman with galactorrhea due estrogen can cause
to a prolactinoma? 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
what implantation site is most likely to have placenta anterior placenta, defect in
accreta? endometrium
blue tissue densely adherent between uterus and
placenta percreta
bladder is?
what is the greatest concern for a retained placenta
coagulopathy, infection
acreta not removed with 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 bony
what is the utility of delivery of the posterior fetal arm
diameter from shoulder to
in shoulder dystocia?
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
high dose estrogen
active bleed?
what is the mech of urinary system dilation in late Compression by the uterus
pregnancy? and right ovarian vein
anterior hemorrhagic
what part of pituitary is acffected in sheehans?
necrosis, decr prolactin
disruption of large segments
What is the mech of Asherman syndrome?
of the endometrium
prolonged fetal decels associated with misoprostol is? uterine hyperstimulation
what is the mech of amenorrhea due to pituitary amenorrhea due to inhibiton
ademona? of GnRH pulsations
how you you tx a pituitary adenoma growing in size in
bromocriptine
pregnancy?
what is the most common underlying cause of
hypercoagulable state
maternal mortality?
breast pain, rubbery mass changing with menses is? fibrocystic change
MC mass in breast of adolescents or 20s? fibroadenoma
57 y/o 1 week after mass in left breast. no family hx of
br cancer. 2 cm palpable nontender mobile mass, no mammogram
discharge. nothing in R breast. next steo?
27 y/o G0 severe pain w menses causing missing
work. cervix is pink, uterus normal size. R ovary endometriosis
bigger than left. most likely dx?
22 y/o woman 2 days of pain w urination, vaginal
cadidiasis
itches, curd like disharge, pseudohyphae. dx?
27 y/o nulligravid unable to conceive for 12 m. had
hysterosalpingogram
PID 4 y ago. nest step in dx?
30 y/o G2P1 at 26w. uterine size greater than expected maternal Rh status with
for dates. fetus has hydrops. next step in dx? antibody screening
42 y/o G2P@ with loss of urine when cough, sneeze.
stress incontinence
uncomplicated SVDs, urine loss with valsalva. dx?
18 y/o G1P1 has pinkish vaginal discharge that has
reassurance that this is
persisted for 6 w. uterus is fully involuted and no
normal
adnexal masses. next step?
32 y/o nulligravid with 6 w of fould smelling frothy
discharge with flaggellated organisms on wet mount. trichomonas vaginalis
Dx?
Asx 24 G1 at 36w has grade 2/6 systolic murmur at
flow murmur
upper left sternal border. dx?
42 y/o G3P3 amenorhea or 2m, some spotting 3 w BHCG, must check
ago. slightly enlarged uterus. next step? pregnancy
57 y/o vegan, doesnt want meds, has evidence of low
none density on DEXA. what vitamin do you Vit D
recommend supplementing?
A baby is post with spina bifida, what during
folate
pregnancy could have been given?
MCC postpartum hemorrhage? uterine atony
19 y/o primagravid at 8 w is brought to ED w light
vaginal bleeding. no tenderness or abnl bowel sounds. send home, threatened
uterus is consiteten with 6w gestation. TVUS is IUP abortion
with fetal heart beat. next step?
16 y/o w 6h of abdmonial cramps and intermittent
nausea. LMP 2 months ago. menarche at 15.
Beta HCG,
Inconsistent condom use. scant vaginal bleed, right
adnexa mass. next step?
13 y/o 1 yt of irregular vaginal bleeeding every 2-8 w
for 10-30 d. uterus is normal. normal ovaries. most oral contraceptives
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
bartholin gland abscess
depoprovera. has exquisitely tender mass in left
labium minor, prevents insertion of sepculum. dx?
22 y/o prima with a tonic clonic seizre, HTn, and incr
eclampsia
DTRs. dx