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ob gyn blueprints

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At what week gestation does


B-HCG peak?

At 10 weeks - peaks at
100,000 mIU/mL

At what week gestation does


an embryo start being
called a fetus?

8 weeks gestation

How early might you start


seeing fetal heart beats on
US?

6 weeks

At what week gestational


age might you first see the
gestational sac in the
uterus?

5 weeks

What is the Chadwick sign?

Bluish discoloration of the


vagina and cervix indicating
pregnancy

What is the difference


between "Gestational age"
and "Developmental age?"

Gestational age is the weeks


since the
LMP\nDevelopmental age is
the weeks since conception
(usually two weeks less than
GA)

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At what week of gestation


does the mother begin to be
aware of fetal movements?

16-20 weeks

How much does plasma


volume increase during
pregnancy?

By 50%.\nRBC volume
increases by 20-30%, so
hematocrit decreases

Which hormone affects


smooth muscle in
pregnancy and is
responsible for many of the
physiologic changes seen?

Progesterone causes smooth


muscle relaxation

How much does the daily


caloric intake requirement
increase during
pregnancy?

By 300kCal/day

If a patient begins to gain


an unusually large amount
of weight late in pregnancy,
what pathology should you
consider?

Pre-eclampsia - it could be a
sign of fluid retention

Which three chemicals are


assayed in the standard
triple test for Down
syndrome?

Alpha feto protein\nBHCG\nestriol

At what week is AFP usually


screened to check for Down
syndrome?

15-18 weeks

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At what week of
pregnancy are women
screened for Group B
Streptococcal
infection?

36 weeks

What is the treatment


for women who test
positive for GBS late in
pregnancy?

IV penicillin

Name the common,


benign cause of lower
abdominal pain that
often occurs late in the
second trimester of
pregnancy?

Round ligament pain - secondary


to the rapid expansion of the
uterus and stretching of the
ligamentous attachments

What are the five


components of the
Biophysical Profile?

Amniotic fluid volume\nFetal


tone\nFetal activity\nFetal
breathing movements\nNST

Which chemical is
seen in higher
concentrations in the
amniotic fluid when
the lung matures?

Lecithin increases as the lungs


mature, while sphingomyelin
decreases beyond about 32 weeks

What is a heterotropic
pregnancy?

When there is an intrauterine and


an extrauterine pregnancy
simultaneously

/(n) apology/(P)/ []

What is the treatment


of choice for an
unruptured ectopic
pregnancy?

Methotrexate

What is the name for


the death of an embryo
or fetus before 20
weeks with complete
retention of the POC?

Missed abortion

What is the most


common cause of first
trimester abortions?

Fetal chromosomal abnormalities

What are the most


common causes (4) of
second-trimester
abortions?

Uterine or cervical
abnormalties\nTrauma\nSystemic
disease\nInfection

What is the definition


of recurrent/habitual
abortions?

Three or more consecutive


spontaneous abortions

What additional
analyte is sometimes
added to the triple test
to make the "quad
screen?"

Inhibin A

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How many days after


fertilization does the
blastocyst typically implant
into the endometrium?

7 days

In which weeks of
development does
organogenesis take place?

Weeks 3-8

What level of sensitivity


does the triple-test have?

Only 60%\nbut 80% over


the age of 35

With a Down syndrome


fetus, which of the analytes
in the triple test are elevated
and which are decreased?

MSAFP - decreased\nestriol
- decreased\nBHCG increased

45.

What percentage of
amniocenteses have
complications?

0.5%\nComplications
include ROM, premature
labor, fetal injury

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At which week gestation can


CVS be performed?

9 weeks (six weeks earlier


than amniocentesis)

What problems are


associated with performing
CVS before 9 weeks?

Limb abnormalities

What is fetal lie (what are


the
options/classifications)?

Either longitudinal or
transverse in the uterus

What is fetal presentation


(what are the
options/classifications)?

Either breech or cephalic

What does the P in PROM


stand for? What is the
definition?

Premature Rupture of
Membranes\nRupture 18
hours before labor

What do the P and P in


PPROM stand for? What is
the clinical definition?

Preterm Premature Rupture


of Membranes\nROM
before 37 weeks

How can leaks of amniotic


fluid be differentiated from
stress incontinence?

Nitrazine or fern tests of the


fluid

How does the nitrazine test


for amniotic fluid work?

Tests the pH of the vaginal


fluid\nAmniotic fluid is
alkaline, while normal
vaginal secretions are
usually acidic

What are the five aspects of


the Bishop score?

What does a high Bishop


score indicate?

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Cervical dilation\nCervical
effacement\nFetal
station\nCervical
position\nCervical
consistency
That the cervix is favorable
for labor (either
spontaneous or induced)

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How is the station


of the fetal head
assessed?

The relation of the fetal head to the


ischial spines. Positive is past the
spines, negative is above the spines

How does the


cervical position
change throughout
labor?

Advances its position from posterior to


mid to anterior as labor progresses

What is the
definition of
Prodromal Labor
or "false labor?"

Irregular contractions that vary in


duration, intensity and intervals that
yield little or no cervical change

Name five common


indications for
inducing labor?

Postterm
pregnancy\nPreeclampsia\nPremature
ROM\nNonreassuring fetal
testing\nIUGR

What is the normal


range for the fetal
heart rate?

110-160 bpm

What conditions
are considered if
the fetus has
tachycardia >160?

Fetal distress secondary


to\nInfection\nHypoxia\nAnemia

What is the
definition of a
formally reactive
fetal heart tracing?

20 minute monitor\nAt least 2


accelerations of at least 15 beats per
minute over the baseline that last at
least 15 seconds

What causes early


decelerations on
the tocometer?

Increased vagal tone secondary to head


compression during a contraction

What causes
variable
decelerations?

A result of umbilical cord compression

What causes late


decelerations on a
tocometer?

Uteroplacental insufficiency

What are the most


worrisome - early,
late, or variable
decelerations?

Late decelerations - caused by


uteroplacental insufficiency

The pH of fetal
blood is
nonreassuring if it
is below what level?

<7.2

If you put a pulse


oximeter on a
fetus, what is a
normal reading?

30%

What are the five


cardinal
movements of
labor?

Engagement\nFlexion\nInternal
rotation\nExtension\nExternal
rotation

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What marks the


beginning and end
of the second stage
of labor?

Begins at full dilation of the cervix and


ends at delivery of the infant

How long does the


first stage of labor
last?

10-12 hours in nulliparous


woman\n6-8 hours in a multiparous
woman

What are signs of


nonreassuring fetal
status on a fetal
heart monitor?

Repetitive late
decelerations\nBradycardia\nLoss of
variability

What conditions
are necessary for
safe application of
forceps during
delivery?

Full dilation of cervix\nRuptured


membranes\nHead at at least +2
station\nExperienced operator

What is the normal


interval between
the delivery of the
infant and the
placenta?

Usually 5-10 minutes\nBut up to 30


minutes is within normal limits

What is the current


rate of cesarean
delivery in the US
(2007)?

29%

What is the risk of


uterine rupture
during TOLAC
(trial of labor after
cesarean)?

0.5-1%

In what percent of
pregnancies does
placenta previa
occur?

0.5%

What are the


associated sequelae
of placenta previa?

Antepartum hemorrhage\nPreterm
delivery\nPPROM\nIUGR\nIncreased
risk of puerperal hysterectomy

What is the classic


presentation of
placenta previa?

Painless third trimester bleeding

What is the most


common factor
associated with
increased
incidence of
placental
abruption?

Hypertension

What is the
vascular volume of
a term fetus?

About 250mL

What is the Apt


test?

Examination of materanal blood for


nucleated (fetal) red blood cells

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What is a
succenturiate
placenta?

An accessory lobe of the placenta

What is the
definition of low
birth weight?

<2500g

What is the only


medication
approved by the FDA
for tocolysis?

Ritrodine - a beta mimetic agent

How does good


hydration decrease
the number of
contractions in
preterm labor?

It decreases ADH which cross reacts


with oxytocin receptors

What antibiotic(s)
are used in the
setting of PPROM?

Ampicillin with or without


erythromycin

What is the
"obstetric
conjugate?"

The distance between the sacral


promontory and the midpoint of the
symphysis pubis - the shortest
anteroposterior diameter of the
pelvic inlet

What percentage of
singleton deliveries
present breech at
delivery?

3-4%

How should a fetus


with a shoulder
presentation be
managed?

Cesarean section

What is the
antiseizure
medication of choice
in pregnancy?

Magnesium sulfate

What malignancies
are LGA infants at a
higher risk for?

Leukemia, Wilms tumor,


osteosarcoma

Should obese
patients be
counselled to lose
weight during
pregnancy?

They shouldn't lose weight during


pregnancy - but should gain less
weight than other women

What is the normal


maximum volume of
amniotic fluid
during pregnancy?

800 mL at ~28 weeks\n500 mL at


term

What are the


common causes of
polyhydramnios?

Maternal diabetes\nNeural tube


defects\nObstruction of alimentary
canal\nHydrops

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Which is a more
ominous sign polyhydramnios or
oligohydramnios?

Oligohydramnios - umbilical cord


often gets compressed leading to
fetal asphyxia

What are the


risks/complications
for the fetus in a
uterus with
polyhydramnios?

Risk for malpresentation\nRisk of


cord prolapse

At what times in
pregnancy should an
Rh negative mother
recieve RhoGAM when
she has an Rh positive
fetus?

At week 28 and postpartum

What is a good noninvasive test for fetal


anemia?

Doppler measurement of blood


flow in the middle cerebral artery

What are the dangers


for the fetus of
postterm
pregnancies?

Increased risk of fetal


demise\nMacrosomia\nMeconium
aspiration\nOligohydramnios

What is the average


gestational age for
delivery of twins?

36-37 weeks

Which type of twins


have the highest
mortality rate?\nMonochorionic,
diamniotic\nMonochorionic,
monoamniotic\nDichorionic,
diamniotic

Monochorionic, monoamniotic
due to cord accidents from
entanglements

Which type of twins


are at risk for Twin-totwin transfusion
syndrome?\nMonochorionic,
diamniotic\nMonochorionic,
monoamniotic\nDichorionic,
diamniotic

Monochorionic, diamnionic twins

What are the


treatment options for
Twin-to-twin
transfusion
syndrome?

Serial amniocenteses\nLaser
coagulation of vascular
connections between the fetuses

Blood pressure
typically decreases
during pregnancy
until which point?

About the middle of the second


trimester

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Is preeclampsia more common in


primiparous or multiparous
women?

Primiparous - 8x
more common

What does HELLP syndrome


stand for?

Hemolysis\nElevated
Liver enzymes\nLow
Platelets

What are the typical medical


treatments indicated in severe
preeclampsia?

Magnesium sulfate
for seizure
prophylaxis\nand
Hydalazine for HTN

What is the recurrence rate for


preeclamspia in subsequent
pregnancies?

25-33%

What is the treatment for


overdose with Magnesium sulfate
during pregnancy?

10mL of calcium
chloride or calcium
gluconate

In eclamptic patients, do seizures


typically occur before, during or
after delivery?

25% before\n50%
during labor\n25%
after

What percentage of patients with


chronic hypertension will develop
superimposed preeclampsia
during pregnancy?

33% or more

In which trimester is the onset of


carbohydrate metabolism
abnormalities in gestational
diabetes most common?

Usually they do not


occur until the third
trimeseter

What blood glucose level qualifies


as a positive glucose challenge
test?

140mg/dL after 1
hour following a 50g
dose of glucose

What are the cutoff blood glucose


levels during the glucose
tolerance test at\n1 hour?\n2
hours?\n3 hours?

1 - 180mg/dL\n2 155mg/dL\n3 140mg/dL

What are the common signs of


chorioamnionitis?

Maternal fever and


high WBC\nUterine
tenderness\nFetal
tachycardia

How is chorioamnionitis treated?

Antibiotics and
DELIVERY

Without treatment, what


percentage of infants who are
born to HIV infected mothers are
born with infection?

About 25%

What is required to diagnose


hyperemesis gravidarum in a
pregnant woman?

Vomiting that leads


to dehydration and
possibly electrolyte
disturbances

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Does elevated estrogen


increase or decrease
the likelihood of
developing seizures?
What about
progesterone?

Estrogen - increases
seizures\nProgesterone decreases seizures

What is the drug of


choice to control
seizures for epileptic
patients who become
pregnant?

Phenytoin\nMg sulfate is good


for seizures due to preeclampsia,
but phenytoin is usually use for
patients with known seizure
disorder\nSingle drug treatment
is optimal

What is the
characteristic
morphologic change to
the heart in a patient
with Peripartum
Cardiomyopathy
(PPCM)?

A dialated heart with an ejection


fraction far below normal in the
20-40% range

What is the
presentation of
superficial vein
thrombosis in
pregnancy?

Painful, palpable venous cord


with local erythema and edema

When Anticoagulant
therapy is given what
activities should be
avoided

Shave With An Electric Razor


instead of a disposable. \n\nUse
a Toothbrush With Soft Bristles
\n\nAny activities that could
cause injuries

What is the treatment


for DVT during
pregnancy?

Heparin

Do SLE symptoms tend


to get better or worse in
pregnancy?

One-third rule:\n1/3 get


better\n1/3 get worse\n1/3 stay
the same

What lab test helps to


differentiate a lupus
flare-up from
preeclampsia?

There will be reduced C3 and C4


levels in a lupus flare-up

What is the treatment


for alcohol withdrawal
during pregnancy?

Barbituates, because
benzodiazepines have a potential
teratogenic effect

What are the major


risk factors for the
fetus if the mother
smokes during
pregnancy?

Spontaneous abortion\nPreterm
birth\nAbruption\nDecreased
birth
weight\nSIDS\nRespiratory
illness in childhood

What is the definition


of the puerperium?

The first six weeks after delivery

What are the top


causes of postpartum
bleeding?

Uterine atony (#1)\nRetained


POCs\nPlacenta
accreta\nCervical/vaginal
lacerations

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What puts a woman


at higher risk for
uterine atony after
birth?

Multiple
gestations\nChorioamnionitis\nMg
sulfate\nMultiparity\nMacrosomia

At what point in
pregnancy is
endomyometritis
most likely to occur?

5-10 days after delivery

What treatment is
commonly given for
mastitis?

Dicloxacillin\nBreast feeding can


continue

How do you
diagnose congenital
adrenal
hyperplasia?

Elevated 17-a-hydroxyprogesterone
or urine 17-ketosteroid with
decreased serum cortisol

How is imperforate
hymen commonly
diagnosed?

It is often diagnosed at puberty with


primary amenorrhea in the setting
of cyclic pelvic pain.

What is a synonym
for testicular
feminization?

Androgen insensitivity syndrome

What vaginal
pathology presents
in postmenopausal
women with thin,
white atrophic
epithelium and
labial fusion?

Lichen sclerosis

Where (on a clock


face) on the vagina
are Bartholin cysts
and abscesses
found?

4 o'clock and 8 o'clock

What is the surgical


procedure used as
treatment for
Bartholin cysts and
abscesses?

Marsupialization - the entire


abscess or cyst is incised and the
resulting space is sewn open.
Epithelialization can then occur.

What is the name for


cysts found on the
cervix that are
caused by blockage
of an endocervical
glands?

Nabothian cysts (or retention cysts)

How do fibroids
behave during
pregnancy?

They can grow quickly and to huge


proportions due to estrogen
sensitivity.

Is smoking a risk
factor for fibroids?

No, smoking is
protective.\nSmoking suppresses
estrogen and fibroids grow in
response to estrogens.

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Do fibroids appear
darker or lighter than
myometrium on US?

Fibroids are areas of


hypoechogenicity - lighter than
myometrium

What is the best


medication to treat
endometrial
hyperplasia?

Progestin therapy

What abnormal lab


value accompanies
ovarian theca lutein
cysts?

Beta HCG

What are the two most


common sites for
endometriosis?

Ovary and pelvic peritoneum

What percentage of
women with infertility
have endometriosis?

40%

What are medical


treatment options for
endometriosis?

NSAIDs\nOral
contraceptives\nDanazol\nGnRH
agonists

149.

What are the common


side effects of
danazol?

Androgenic side effects \nAcne\nOily skin\nWeight


gain\nHirsutism

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Where in the uterus is


adenomyosis most
commonly found?

Fundus and posterior wall

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How is adenomyosis
diagnosed?

It's a clinical diagnosis menorrhagia and/or


dysmenorrhea in parous
women\nImaging studies are not
useful/cost effective

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What is the treatment


of adenomyosis?

NSAIDs\nOCPs\nProgestins

What is the lifetime


incidence of
adenomyosis? (and in
what age group does it
most commonly occur)

15% of women\nUsually in late


30's early 40's in parous women

What is the cause of


malaise, fever,
pharyngitis and/or
rash after treatment
for syphilis?

Jarisch-Herzheimer
reaction\nCaused by an immune
reaction to the dead spirochetes

What is the initial test


for syphilis?

RPR or VDRL nonspecific


antibody testing. Darkfield
microscopy can be used to
investigate the primary genital
lesions

Should patients with


Herpes be treated
medically?

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Yes, treating with acyclovir


reduces the length of primary
infection and can suppress
recurrances (but doesn't cure)

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How is chancroid
diagnosed?

Painful genital lesions with


ragged/purulent edges are
identified and herpes and
syphilis chancre are ruled out
with lab tests

What is the treatment for


chancroid?

Single dose of PO
azithromycin or IM
ceftriaxone

What is the other name


for genital warts?

Condyloma
acuminata\nCaused by HPV

What is the usual


treatment for genital
warts?

Cryotherapy or topical
medications (trichloroacetic
acid, podophyllin or 5-FU
cream)\nLarge lesions can be
treated with a CO2 laser

What is mostly
responsible for the acidic
pH of the vagina?

Lactobacillus sp. generally


maintain the vaginal pH
below 4

What is the most common


complaint of bacterial
vaginosis?

Amine odor

How is bacterial vaginosis


diagnosed?

Adding KOH to a vaginal prep


(whiff test)\nor Clue cells

What are the


predisposing factors for
C. albicans overgrowth?

Use of broad-spectrum
antibiotics\nDiabetes
mellitus\nDecreased cellular
immunity\nIntercourse\nLate
luteal phase of the menstrual
cycle

What percentage of
patients suffering with
genital candidiasis
display the characteristic
white plaques or cottage
cheese-like discharge?

Only 20%

What is the recommended


treatment for Neisseria
gonorrhea?

Ceftriaxone 250mg IM once

Is incidence of gonorrhea
increasing or decreasing
in the US? What about
chlamydia?

Gonorrhea
decreasing\nChlamydia
increasing (probably due to
increased diagnosis)

When does endometritis


or endomyometritis
usually present?

Most commonly after C.


section, vaginal deliveries,
D&C or IUD placement

What patients should be


hospitalized for treatment
for PID?

Teenagers\nPregnant
women\nNoncompliant
patients\nPatients who can't
tolerate oral treatment

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How many cases


of Toxic shock
syndrome are
generally seen
each year in the
US?

Fewer than 300 cases per year

What is the
treatment for
Toxic shock
syndrome?

Hospitalization is always
indicated\nTreat hypotension with
fluids and pressors

What percentage
of AIDS patients
in the US are
women?\nin the
world?

US - 18%\nWorld - 50%

How should HIV


positive women
be treated to
reduce the risk of
vertical
transmission?

AZT treatment after the first trimester,


during labor, and treating the neonate
as well.\nCesarean section.

What are the risk


factors for Pelvic
Organ Prolapse
(POP)?

Chronic
cough\nStraining\nAscites\nTraumatic
delivery\nAging and menopause

What are
common
presenting
symptoms of
pelvic organ
prolapse?

Pelvic pressure/heaviness\nVaginal
bulge\nUrinary incontinence,
frequency, urgency, or retention

How is first
degree pelvic
organ prolapse
defined?

The herniated structure is confined to


the upper 2/3 of the vagina

How is second
degree pelvic
organ prolapse
defined?

The herniated structure decends to the


level of the introitus

How is third
degree pelvic
organ prolapse
defined?

The herniated structure protrudes


through the introitus

What medical
treatment might
improve
symptoms of
pelvic organ
prolapse in postmenopausal
women?

Estrogen replacement can improve


tissue tone and facilitate reversal of
atrophic changes

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What is the usual


anatomic cause of
stress incontinence?

Pelvic relaxation and


displacement of the
urethrovesical junction

What is total
incontinence (what is
the cause)?

Continuous leakage of urine due


to urinary fistula resulting from
pelvic surgery or radiation

What are the four


primary types of
incontinence?

Urge\nStress\nTotal\nOverflow

For which type of


incontinence are
pessaries a therapeutic
option?

Stress incontinence

What are medical


therapeutic options for
stress incontinence?

Alpha adrenergic
agonists\nEstrogen

What are some


conditions known to
cause detrusor
instability (urge
incontinence)?

UTIs\nBladder stones and


cancer\nForeign bodies\nMost
are idiopathic

What is the most


frequently used and
effective medical
treatment for urge
incontinence?

Anticholinergics

What are common


causes of overflow
incontinence?

Medications anticholinergics\nLower motor


neuron disease\nSpinal cord
injuries\nDiabetes mellitus

How is overflow
incontinence treated?

Cholinergic agents
(bethanachol)\nSelfcatheterization

What is the average


length of time between
thelarche and
menstruation?

2.5 years

List the following in


order of normal
appearance in
puberty:\n1. Growth
spurt (peak
velocity)\n2.
Menarche\n3.
Pubarche\n4. Thelarche

1. Thelarche\n2. Pubarche\n3.
Growth spurt\n4. Menarche

What is the role of the


granulosa cells and
theca cells in the
production of estrogen?

Theca cells produce


androstenedione\nGranulosa
cells convert this to estradiol

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What is the physiologic


role of B-HCG in the
pregnant woman?

It is secreted by the trophoblast


and maintains the corpus luteum
so it can continue to support the
endometrium with estrogen and
progesterone production

What change in
hormones is directly
responsible for
endometrium
sloughing in the
menstrual cycle?

Withdrawal of progesterone

How is the diagnosis of


menopause
confirmed?

Testing FSH levels - they should


be elevated in menopause

What are the two


major body systems
that have an increased
risk of disease in post
menopausal women?

Cardiovascular - increased risk of


coronary artery disease\nBones bone resorption accelerates
leading to osteoporosis

What are the two main


indications for HRT?

Short-term treatment of
postmenopausal
symptoms\nPrevention of bone
loss

What are the


contraindications for
HRT (5)?

191.

192.

193.

194.

195.

Chronic liver
disease\nPregnancy\nKnown
estrogen-dependent
neoplasm\nHistory of
thromboembolic
disease\nUndiagnosed vaginal
bleeding

196.

What is MayerRokitansky-KusterHauser syndrome?

Mullerian agenesis or dysgenesis

197.

What is Savage
syndrome?

Failure of the ovaries to respond


to FSH and LH due to a receptor
defect - primary ovarian failure

What is the
pathophysiology of
testicular
femininization?

Dysfunction or absence of
testosterone receptors

What is Kallman
syndrome?

Congenital absence of
GnRH\nAlso associated with
anosmia

What is the most


common cause of
cervical stenosis?

Scarring of the cervical os due to


surgical or obstetric trauma

What chemical
inhibits prolactin
secretion and which 2
chemicals stimulate its
secretion?

Dopamine inhibits\nSerotonin
and TRH stimulate

198.

199.

200.

201.

What are the first


three chemicals
that should be
analyzed when
investigating
secondary
amenorrhea?

B-HCG for pregnancy\nTSH\nProlactin

What medical
treatment might
cause tumor
regression in
patients with
pituitary micro
or
macroadenomas?

Bromocriptine

What type of drug


is bromocriptime
(mechanism)?

Dopamine agonist

What is primary
vs. secondary
dymenorrhea?

Primary - idiopathic\nSecondary - due to a known


underlying pathology

What are
common causes
of secondary
dysmenorrhea
(5)?

Endometriosis\nFibroids\nAdenomyosis\nPID\nCervical
Stenosis

What is the firstline and secondline treatment for


dysmenorrhea?

First - NSAIDs\nSecond - OCPs\nMost patients who take


OCPs for a year have reduced symptoms even after they are
discontinued

What is
laminaria?

A device made from seaweed that is placed in the cervix


and absorbs water and dialates the cervical os. Its a
treatment for cervical stenosis

Where in the
menstrual cycle
do PMS
symptoms
usually occur?

In the second half of the cycle

What is the
normal amount
of blood lost
during
menstruation?

30-50 mL

What are the


most common
causes of
menorrhagia (6)?

Uterine fibroids\nAdenomyosis\nEndometrial
hyperplasia\nEndometrial polyps\nEndometrial/cervical
cancer\nDUB

What is the
definition of
oligomenorrhea?

Periods greater than 35 days apart

202.

203.

204.

205.

206.

207.

208.

209.

210.

211.

212.

213.

214.

What are the most common


causes of oligomenorrhea
(3)?

PCOS\nChronic
anovulation\nPregnancy

How is a diagnosis of
Dysfunctional Uterine
Bleeding made?

A diagnosis of exclusion
when no pathologic cause of
abnormal uterine bleeding is
identified

What medical treatment


may be helpful if patients
with DUB experience acute
hemorrhage?

IV estrogens and high dose


oral estrogens

What are the four most


common causes of post
menopausal bleeding?

Vaginal/endometrial
atrophy (30%)\nExogenous
estrogens
(30%)\nEndometrial cancer
(15%)\nEndometrial polyps
(10%)

If a female patient has


elevated androgens, what
are the two possible
sources?

Ovaries\nAdrenal glands

How is Cushing syndrome


diagnosed?

Overnight dexamethasone
suppression test

In the overnight
dexamethasone
suppression test, if a
patient has Cushing
syndrome, what results do
you suspect?

A cortisol level above


10ug/dL

What molecule is
overproduced and builds
up if a patient has 21alpha-hydroxylase
deficiency?

17-a-hydroxyprogesterone
which is shunted to the
androgen pathway

Name 5 primary causes of


hirsutism and virilization-

PCOS\nOvarian
tumors\nAdrenal
tumors\nCAH\nCushing
syndrome

What percentage of
pregnancies in the US are
unintended?

55%

What is the average


effectiveness of periodic
abstinence (the rhythm
method) as a form of
contraception?

55-80%

How long after pregnancy


should breast feeding be
relied on as an effective
form of contraception?

Maximum of 6 months

What is the only form of


contraception that offers
protection against HIV?

Male Latex Condoms

215.

216.

217.

218.

219.

220.

221.

222.

223.

224.

225.

226.

What are
nonoxynol-9 and
octoxynol-9?

Spermicides

How do
spermacide
agents work
(biologic
mechanism)?

They disrupt the cell membranes of


spermatazoa

What is believed
to be the
mechanism of
IUDs?

Act primarily by killing sperm through a


sterile inflammatory response

How long can the


ParaGard IUD be
left in place as a
contraceptive?
The Mirena IUD?

ParaGard - 10 years\nMirena - 5 years

Who is the ideal


population for
IUDs?

Monogamous multiparous women

Name 5
complications
associated with
OCPs-

DVT\nPE\nCVA\nMI\nHTN

What is the
mechanism of
the progestroneonly pill as a
contraceptive?

Thickening of cervical
mucosa\nThinning of endometrium

What is the
active drug in
Depo-Provera?

Medroxyprogesterone acetate (DMPA)

What is the
advantage of the
Depo-Provera
birth control
method?

It lasts for 3 months and is 99.7%


effective over the year.

What are the


Side Effects of
the DepoProvera birth
control method?

Irregular menstrual bleeding\nBone


demineralization\nSignificant delay in
return of fertility after discontinuation

Describe the
Essure
procedure for
sterilization-

Soft polyester fibers are introduced into


the uterine portions of the fallopian
tubes. Over ~12 weeks, sterilization is
accomplished as in-growth of tissue
around the coils results in a barrier in
the tubes

What are the


side effects of
vasectomies?

Bascially, none

227.

228.

229.

230.

231.

232.

233.

234.

What is the
mechanism of
Mifepristone
(RU-486)?

A synthetic progesterone receptor


antagonist that binds to progesterone
receptors and blocks the stimulatory
effects on endometrial growth

How long after


the LMP can
mifepristone be
used as an
abortifactant?

49 days past the LMP\nTypically given


with a prostaglandin analogue

What is the
success rate of
abortions with
mifepristone
(RU 486) in
early
pregnancy?

65-85% when used alone\nUp to 98%


effective when combined with a
prostaglandin analogue (misoprostol)

What
medications
are used for
induction of
labor as a
method of
terminating
secondtrimester
pregnancies?

Cervical ripening
agents\nAmniotomy\nIV Oxytocin

What is the
fecundity rate
per month for a
couple with
normal
fertility?

20-25%

With modern
technologies,
what percent of
infertile
couples can
have the cause
of infertility
identified?

About 90%

What
endocrine
factors can be a
cause of male
infertility?

Kallman (hypothalamic
dysfunction)\nPituitary
failure\nHyperprolactinemia\nExogenous
androgens\nThyroid disease\nAdrenal
hyperplasia

What is the
treatment for a
couple who is
infertile due to
low semen
volume?

Intrauterine insemination with washed


sperm

235.

236.

237.

238.

239.

240.

241.

242.

243.

244.

If a couple is
infertile due to
endometriosis in
the female, what
is the treatment
of choice?

Surgical removal of pelvic adhesions. There is no


place for medical management.\nIVF is another
option

What are three


effective
management
options for
infertile women
with PCOS?

Weight loss\nClomiphene\nMetformin

What is the
mechanism of
clomiphene
citrate (how does
it promote
ovulation)?

It binds to estrogen receptors in the hypothalamus


stimulating pulsatile release of GnRH causing FSH
and LH release from the pituitary

What are the two


major options
for medical
ovulation
induction?

Clomiphene citrate\nHuman menopausal


gonadotropins

What are the


symptoms of
ovarian
hyperstimulation
syndrome?

Edema\nAscites\nPleural
effusion\nHemoconcentration\nHypercoagulability

What are the two


major
complications of
ovulation
induction?

Ovarian hyperstimulation syndrome\nMultiple


gestation pregnancy

When should
pruritic lesions
of the vulva be
biopsied?

When they do not respond to antifungal creams especially in post menopausal women

What does VIN


and VAIN stand
for?

Vulvar Intraepithelial Neoplasia\nVaginal


Intraepithelial Neoplasia

What is the cause


of 80-90% of
Vulvar
Intraepithelial
Neoplasia?

HPV infection\nOther risk factors include cigarette


smoking and an immunocompromised state

What percentage
of women with
Vulvar
Intraepithelial
Neoplasia have
symptoms?

Only 50%\nVulvar pruritis or irritation are the


common symptoms

245.

246.

247.

248.

249.

250.

251.

252.

253.

What are the three most


common types of vulvar
neoplasms?

Squamous cell carcinoma (8590%)\nMalignant melanoma


(5-10%)\nBasal cell
carcinoma (2%)

What is the most


important prognostic
factor in vulvar cancer?

Number of positive inguinal


lymph nodes

What is the most


common presentation of
Vaginal Intraepithelial
Neoplasia?

Almost always
asymptomatic\nBut repeatedly
positive Pap smears with
negative cervical biopsies

Where in the vagina are


most vaginal cancers
located?

In the apex near the cervix

What are the common


therapeutic options for
vaginal cancer?

Local excision\nLaser
vaporization\nTopical 5-FU

Which is the number one


cancer killer of women in
the developing world?

Cervical cancer

Besides HPV infection,


which other risk factors
predispose to cervical
cancer?

Smoking\nLong term OCP


use\nDepressed immune
status\nDES exposure

What is "reflex HPV


testing"?

The principle that an ASC-US


result should be immediately
tested for HPV

Is HPV testing
recommended for an
LSIL or HSIL result from
a Pap smear?

No, because nearly all will be


positive

254.

255.

256.

257.

258.

259.

260.

261.

What are the


four classic
presentations
of dysplasia
on
colposcopy?

Acetowhite
changes\nMosaicism\nPunctations\nAtypical
vessels

What is the
management
of CIN I? CIN
II?

CIN I is followed with repeat Pap smears,


because most will regress. CIN II (and III) is
treated with LEEP

Which 4
strains of
HPV are
considered
high risk
types
associated
with cervical
cancer?

16, 18, 31, 45

What is the
most
common
presenting
symptom of
cervical
cancer?

Post coital bleeding\nalso-- any other


abnormal vaginal bleeding, watery discharge,
pelvic pain or pressure, and rectal or urinary
tract symptoms

What is the
treatment for
preinvasive
(stage 0-1a)
cervical
cancer?

CKC biopsy or simple hysterectomy

What is the
treatment for
advanced
cervical
cancer
(stages IIbIV)

Chemoradiation (cisplatin based therapy)

What are the


top four most
common
cancers in
women
(including
nongynecologic)?

Breast\nLung\nBowel\nEndometrial

What is the
average age of
diagnosis for
endometrial
cancer?

61

262.

263.

264.

265.

266.

267.

268.

269.

270.

271.

What risk factor for


endometrial cancer
carries the highest relative
risk?

Obesity >50lbs overweight


carries a relative risk of 10

What is the most common


presenting symptom with
endometrial cancer?

Post menopausal bleeding \nirregular bleeding occurs in


90% of patients

What is the treatment for


most stages of
endometrial cancer?

TAHBSO with radiation


therapy (especially for the
higher stages)

What percentage of
ovarian tumors are
benign?

80%

What is the 5-year


survival rate of ovarian
carcinoma?

25-30%

What are the three


distinct components of the
ovary from which tumors
can arise?

Epithelial
cells\nStroma\nGerm cells

What is the other name


for HNPCC syndrome?

Lynch syndrome - also


predisposes to ovarian cancer

Are OCPs a risk factor for


ovarian cancer, or
protective?

Protective

What is the name for


ovarian cancer
metastasizing to the
umbilicus?

Sister Mary Joseph nodule

What tumor marker to


dysgerminomas produce?

LDH

Why do germ cell tumors


have better survival rates
than epithelial tumors of
the ovary?

They grow faster and produce


symptoms like hemorrhage
and pelvic pain. So they get
diagnosed earlier.

Which ovarian tumors are


especially sensitive to
radiation therapy?

Dysgerminomas

What tumor marker do


choriocarcinomas
produce?

HCG

What is the name of an


ovarian tumor with
accompanying ascites and
right hydrothorax?

Meig's syndrome

Which tumor type


accounts for 70% of sex
cord-stromal ovarian
tumors?

Granulosa cell tumors

277.

278.

279.

280.

281.

282.

283.

284.

285.
272.

273.

286.

287.
274.

275.

276.

288.

289.

Which has a higher


malignancy rate complete or
incomplete moles?

Complete moles

What is the common


karyotype of
complete moles?

46XX

What is the common


karyotype of
incomplete moles?

69XXY

What gynecologic
pathology is
associated with
bilateral theca lutein
cysts seen on US?

Complete moles

What are common


symptoms
associated with
molar pregnancy?

Vaginal bleeding (97%)\nPassage


of molar vessicles (80%)\nTheca
lutein cysts (15-50%)\nSymptoms
related to BHCG - hyperemesis (1025%)

Biologically, how is a
complete mole
formed?

Fertilization of an empty egg

Biologically, how is
an incomplete mole
formed?

When a normal egg is fertilized by


two sperms

What is seen on
ultrasound in
incomplete mole?

May reveal a fetus with regular


cardiac activity, congenital
malformations and growth
restrictions.\n"Snowstorm"
appearance is only in complete mole

How are invasive


moles diagnosed?

Serial follow-up of HCG shows


plateauing or elevated levels after
removal of the mole.

What is the
treatment of
invasive mole?

Methotrexate or actinomycin single


agent therapy, or multi-agent
chemotherapy if metastases are
present

What fraction of
women will have
breast cancer in
their lifetime?

1 in 8 (12.5%)

What two arteries


supply the breast?

Internal mammary artery\nLateral


thoracic artery

What nerve, if
damaged in breast
surgery, can caused
"winged scapula"?

Long thoracic nerve

290.

291.

292.

293.

294.

295.

296.

When during the


menstrual cycle is the
best time for breast selfexamination?

5 days after menses when the


breast is least engorged and
tender

What qualities typify


malignant breast lesions
on palpation?

Firm, nontender, poorly


circumscribed and immobile

Which breast tumors are


associated with bloody
nipple discharge?

Intraductal
papilloma\nInvasive papillary
cancer

What breast pathology is


typified by painful breast
masses that are often
multiple and vary
throughout the menstrual
cycle?

Fibrocystic breast change - not


associated with cancer risk

What is the prognosis for


Phyllodes tumors of the
breast?

Clinical course is
unpredictable. 10% contain
malignant cells and there is a
high rate of recurrence after
simple excision. Wide
excision is recommended

In which quadrant do
50% of malignant breast
lesions occur?

Upper Outer Quadrant

What breast tumor


accounts for 70% of all
malignant breast
disease?

Infiltrating ductal carcinoma

What percent of breast


cancer is related to
genetic predisposition?

Only 5-10%

What is the rate of Down


Syndrome in a 40 year old
mother?

1 in 110

How long after


conception does it take
for the embryo to reach
the uterus?

Day 3

Where is anti-mullerian
hormone secreted in
males?

Sertoli cells in testicle

What birth defect is


Lithium associated with?

Ebstein's anomaly

302.

303.

304.

305.

306.

307.
297.

298.

299.

300.

301.

308.

309.

310.

What birth
defects are
associated
with
Warfarin?

Chondrodysplasia\nMicrocephaly\nMental
retardation\nOptic atrophy

How many
days after
fertilization
does B-HCG
appear in the
maternal
serum?

10 days after fertilization

What is the
differential
diagnosis of
elevated hCG
in early
pregnancy?

Twin pregnancy\nHydatidiform
mole\nChoriocarcinoma\nEmbryonal
carcinoma

What are the


two sites of
progesterone
production
during
pregnancy?

Corpus luteum for the first 6-7


weeks\nPlacenta after 7 weeks

What is the
function of
progesterone
during
pregnancy?

Early - Keeps endometrium favorable\nLate


- Induces immune tolerance for pregnancy
and prevents myometrial contractions

What is
chloasma?

Blotchy pigmentation of the nose and face a soft sign of pregnancy

What is the
mean value of
WBCs in the
third
trimester?

16,000

How do
thyroid
markers
change during
pregnancy?

TBG increases\nT3 and T4 increases\nbut


unbound T3 T4 is unchanged

At what week
of pregnancy
does the
mother first
report fetal
quickening?

Multipara - 16-18 weeks\nPrimagravida 18-20 weeks

311.

312.

313.

314.

315.

316.

317.

318.

319.

320.

321.

322.

323.

What four
measurements are used
to estimate fetal age on
2nd and 3rd trimester
ultrasounds?

Biparietal diameter\nHead
circumference\nAbdominal
circumference\nFemur length

What is the difference


between the birth rate
and the fertility rate of a
population?

Birth rate is number of live


births per 1000 total
population\nFertility rate is
number of live births per 1000
women ages 15-45 yo

What is Bloody Show?

Vaginal passage of bloody


endocervical mucus resulting
from cervical dilation before
labor

What is the differential


diagnosis in a pregnant
woman with elevated
AFP?

Open neural tube


defects\nGastroschisis\nTwin
pregnancy\nPlacental
bleeding\nFetal renal disease

Which weeks are the


window for triple
testing?

15-20 weeks

What percent of women


with an abnormal OGCT
will be found to have
gestational diabetes on
OGTT?

Only 15%

What is the normal


range for Amniotic Fluid
Index (AFI)?

9-25cm

What is included in a
modified BPP?

Only the NST and amniotic


fluid volume. Its predictive
value is almost as high as a
complete BPP

In which fetuses is an
elevated S/D ratio
predictive of poor
perinatal outcome?

Only in IUGR fetuses

What is the management


of active genital HSV
lesions during
pregnancy?

Acyclovir and cesarean section

Are vaginal deliveries


recommended in women
with syphilis?

Yes, vaginal delivery is


appropriate

Are vaginal deliveries


recommended in women
with HepB?

Yes, vaginal delivery is


appropriate

What is the classic triad


of vasa previa?

Painless vaginal
bleeding\nRupture of
membranes\nFetal
bradycardia

324.

325.

326.

327.

328.

329.

330.

331.

332.

333.

334.

335.

336.

What is the management


of vasa previa?

Immediate cesarean delivery

What is the relative risk of


uterine rupture with a
vertical fundal cesarean
section vs. a low
transverse?

20x more common

What determines the


chorionicity and
amnionicity of
monozygotic twins?

They vary according to the


duration of time from
fertilization to cleavage.\nUp
to 72 hrs - Di Di\nBetween 912 days - Mo Mo

What is the management


of severe fetal anemia?

Intrauterine transfusion is
<34 weeks\nDelivery if >34
days

What is the most common


risk factor for PROM?

Ascending infection from the


lower genital tract

What is the management


plan of a patient 24-35
weeks pregnant with
PROM?

Bed rest\nIM
betamethasone\nProphylactic
antibiotics

What is the management


plan of a patient >35
weeks of pregnancy with
PROM?

Prompt delivery

Name four classes of


drugs that act as tocolytic
agents-

Magnesium sulfate\nBeta
agonists\nCa channel
blockers\nProstaglandin
synthase inhibitors
(indomethacin)

What is the definition of


gestational hypertension?

BP>140/90 after 20 weeks of


pregnancy without
proteinuria

Name four classes of


drugs that act as tocolytic
agents-

Magnesium sulfate\nBeta
agonists\nCa channel
blockers\nProstaglandin
syndthase inhibitors
(indomethacin)

Any sustained blood


pressure reading over
what value would classify
a pregnant woman as
severe preeclampsia?

160/110

After what gestational age


is prompt delivery
recommended for a
woman with severe
preeclampsia?

Any gestational age if there is


evidence of maternal or fetal
jeopardy

What is the incidence of


gestational diabetes in
pregnancy?

2-3%

337.

338.

339.

340.

341.

342.

343.

344.

What is Class A1 and


A2 gestational
diabetes?

A1 - GDM with normal fasting


blood sugar not requiring
insulin\nA2 - GDM with elevated
FBS requiring insulin

What is Class C
gestational diabetes?

Overt DM onset age 10-19 years or


duration 10-19 years

What are the most


common fetal
anomalies in pregnant
women with diabetes?

Neural tube defects\nCongenital


Heart Disease

What are the four


bones of the pelvis?

Ileum\nIschium\nPubis\nSacrum

What is the most


common position of
the fetus at delivery?

Occiput anterior

What is the
management of
prolapsed umbilical
cord?

Immediate cesarean
delivery.\nPut the patient in kneechest position and avoid palpating
the cord

What maneuvers help


deliver shoulder
dystocia?

Suprapubic pressure\nMaternal
thigh flexion\nInternal rotation
of the fetal shoulders\nDelivery of
the posterior arm

353.

354.

355.

356.

What are Piper


forceps used for?

Used for the after-coming head of


a vaginal breech baby

What is the most


common indication
for forceps delivery?

Prolonged second stage of delivery

What is the mean


blood loss during a
cesarean section?

1000 mL - twice that of normal


vaginal delivery

What is the optimum


time for external
cephalic version of a
fetus?

37 weeks gestation

Are oral contraceptive


pills OK to use after
pregnancy during
lactation?

Combination pills should not be


used because estrogen diminishes
milk production\nProgestin only
pills are OK

What is the most


common cause of fever
postpartum day 1-2?

UTI

What is the most


common cause of fever
postpartum day 3-4?

Endometritis

What is the most


common cause of fever
postpartum day 4-5?

Wound infection

What is the most


common cause of
postpartum fever?

Endometritis

357.

358.

359.
345.

346.

360.

361.
347.

348.

349.

350.

351.

352.

362.

How is a Pap smear


technically performed?

Two specimens are obtained


- an ectocervical sample
scraping the T-zone, and an
endocervical sample
obtained with a cytobrush

What must be visualized in


order to declare a
"satisfactory colposcopy?"

The entire transitional zone


must be visualized with no
lesions disappearing into the
endocervical canal

What percentage of ASCUS Pap smears can


represent a significant
premalignant lesion?

10-15%

How thick is the


endometrium normally in
postmenopausal women
on US examination?

Usually 2-3mm\nOver 5mm


is suspicious

What is the presumptive


diagnosis of a woman with
post-menopausal bleeding
and a negative endometrial
biopsy?

Atrophy of the
endometrium\nCan be
treated with HRT

At what week of gestation


does the uterus reach the
umbilicus?

20 weeks

At what week in pregnancy


does the pregnant uterus
reach the symphysis
pubis?

12 weeks

What is a good medication


for shrinking leiomyomas?

GnRH analogs like


leuprolide

What is the management


of a simple ovarian cyst
diagnosed on US?

It is probably benign - follow


up exam in 6-8 weeks should
show resolution

What are the three most


common sites from which
metastases to the ovaries
are sent?

Endometrium\nGI
tract\nBreast

363.

364.

365.

366.

367.

368.

369.

370.

Name 5
classifications
of Epithelial
ovarian
tumors-

Serous\nMucinous\nBrenner\nEndometroid\nClear
371. What are
cell tumors
medical
therapies for
endometriosis?

What is the
most common
cause of death
in women with
advanced
ovarian
carcinoma?

Bowel obstruction

What is the
treatment for
lichen
sclerosis?

Testosterone cream

What is the
most common
site of distant
metastasis
from a
gestational
trophoblastic
tumor?

Lungs

Why should
patients with
gestational
trophoblastic
disease be
given effective
contraception
for 6-12 months
following
treatment of
their disease?
What three
muscles make
up the levator
ani?
What does
stimulation of
alpha and beta
adrenergic
receptors in
the bladder
cause?
What are the
two most
common sites
of
endometriosis?

372.

373.

374.

What is the
differential
diagnosis of
first trimester
bleeding -

Threatened abortion\nIncomplete
abortion\nEctopic
pregnancy\nHydatidiform mole

What is the
criteria for
methotrexate
use for an
ectopic
pregnancy?

Pregnancy mass <3.5cm\nNo fetal heart


motion\nB-hCG level <6000

What is the
medical
treatment for
Tubo-ovarian
abscess?

Inpatient IV clindamycin and


gentamycin\nDrainage may be required if
there is no response

What is the
most common
complaint in
women with
So that B-hCG can be followed accurately to ensurebacterial
there is no residual tumor
vaginosis?
375.

376.

377.

Puborectalis\nPubococcygeus\nIleococcygeus

Increases HDL\nLowers LDL

What
protective
effects are
offered by
taking OCPs
besides
contraception?

Endometrial and Ovarian cancer\nPID,


ectopic pregnancy\nBenign breast
disease\nAnemia\nDysmenorrhea

What causes
the decrease in
Alpha - Contraction of urethra\nBeta - Inhibition of
progesterone
fundal contraction
and estradiol
by day 23 of the
normal
menstrual
cycle?
379.

Fishy odor

What is the
effect of OCPs
on lipid
profile?

378.

1 - Ovary\n2 - Cul de sac

Medroxyprogesterone\nOCPs\nLeuprolide

What is the
differential
diagnosis of
premenarchal
vaginal
bleeding?

Involution of the corpus luteum

Foreign body (most common)\nIngesting


estrogen medication\nCancer of vagina or
cervix\nTumor of pituitary, adrenal gland
or ovary\nSexual abuse\nIdiopathic
precocious puberty

380.

381.

382.

383.

384.

385.

386.

387.

388.

389.

390.

391.

What is the definition


(age) of precocious
puberty in males and
females?

Secondary sexual
characteristics\nBefore age 8
in girls\nBefore age 9 in boys

What percentage of
precocious puberty in
girls gets classified as
constitutional or
idiopathic?

80%

What is the DD of
precocious puberty in
girls?

Constitutional\nCNS
pathology\nMcCune
Albright\nGranulosa cell
tumor

What is McCune Albright


syndrome?

Autonomous stimulation of
aromatase enzyme production
of estrogen by the
ovaries\nManaged with
aromatase inhibitors

What is the DD of
primary amenorrhea if
the uterus and breasts
are present?

Constitutional
delay\nImperforate
hymen\nVaginal
septum\nAnorexia\nExcessive
exercise\nPregnancy before
first menses

Which two conditions


should be considered if
there is primary
amenorrhea in a patient
with breasts but no
uterus?

Mullerian agenesis\nComplete
androgen insensitivity

Is the LH to FSH ratio


elevated or decreased in
PCOS?

Elevated to 3:1\nNormal is
1.5:1

What is the normal


sperm count in a mL of
semen?

20 million / mL

When in the menstural


cycle is clomiphene
citrate administered for
ovulation induction?

Administered orally for 5 days


beginning on day 5 of the
menstrual cycle

What is the next step


when investigating
infertility if semen
analysis is normal and
ovulation is confirmed?

Assessment of fallopian tube


abnormalities by HSG or
laparoscopy

What is the mean age of


menopause?

51

What is the most


common anatomic site of
injury due to
osteoporosis?

Vertebral body crush fractures,


kyphosis and loss of
height\n\nHip and wrist
fractures are the next most
common.

392.

What is the first line of treatment of


postmenopausal osteoporosis?

Bisphosphonates
and SERMs