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11 y/o with mod changs. mom is concerned menstral periods will start soon.

mom
menarche = 14 y. pt is 75th for ht and 90th for wt. br and pubic hair development is
tanner stage 3. recent pubic hair deveoplment is most indicaAve of?

uterine prolapse

13 y/o 1 yt of irregular vaginal bleeeding every 2-8 w for 10-30 d. uterus is normal.
normal ovaries. most appropriate pharmacotherapy?

ACTH
oversecreAon
(CAH)

15 y/o with 1 week of sever abd pain. 10 episodes of cramps in past year lasAng 3-5d.
never had a period. sex acAve no contracepAon. 80th percent for ht and wt. mass in
suprapubic region at midline. bluish bulge obscures the upper vag. dx?

Get Beta HCG


before gePng
FSH

16 y/o w 6h of abdmonial cramps and intermiTent nausea. LMP 2 months ago.


admission and IV
menarche at 15. Inconsistent condom use. scant vaginal bleed, right adnexa mass. next
abtx
step?
17 y/o comes in with moderate severe pelvic pain with n/v during menses since
menarche. sx begin soon a[er onset of menses. nsaids help. never been sexually
acAve. normal PE. DX?

abtx therapy is
delivery hasnt
occured by 18
hours a[er
rupture of
membranes

17 y/o concern for never had menstrual period. no breast development, not sex actve, every 6 months if
no meds. BMI =31. br = tanner 1, nl thyroid, conAnuous murmur on midsternal borner, abnl, then every
normal pelvic exam. no masses. what do u measure nect?
1 yr
18 hr a[er c/s a 23 y/o g1 has a fever. her temp is 100.4. decr breath sounds are heard
cholesterol
bilaterally with no crackles or rhonchi. ijncision site is dry and intact. 2+ piPng
studies
bilaterally. Most likely dx?
18 nulligravid comes for health maintenence. pain in adnexal region that occurs during
days 13 and 14 of her cycle. its brief and shapr. menarche was at 13 nd she has regular ovarian torsion
cucles. never sexually acAve, and exam is normal next step in managemnt?
18 y/o G1P1 has pinkish vaginal discharge that has persisted for 6 w. uterus is fully
involuted and no adnexal masses. next step?

pelvic exam

18 y/o without menstrual period in last year. no withdrawal bleed a[er


medroxyprogesteron x 7d. BMI =20. breasts are tanner 2, pubic hair is tanner 5, PE
shows normal vag but prepubertal uterus.

androstenidione
to estrone

19 y/o primagravid at 31 w admiTed for intense uterine contracAons every 1-2 mins
for 2 hours. uterus rm and tender, fetal hr is 165. dark blood from vgina, cervix is
eaced and 7 cm dilated, fundal height at 30 . Most likely dx?

hysterosalpingog
ram

19 y/o primagravid at 8 w is brought to ED w light vaginal bleeding. no tenderness or


abnl bowel sounds. uterus is consiteten with 6w gestaAon. TVUS is IUP with fetal
heart beat. next step?

triphasic oral
contracepAves

20 prima at 40 w is admiTed in lobar. cervix is 4 cm dilate and 0 staAon. she gets 2 L of


cervical
LR. epidural cath is placed and test dose of lido and epi is injected. she immediately has
insuciency
Annutus and metaalic taste. pulse is now 110 what cuased it?
20 y/o with 3 yr of hirsuAsm wosrsening over last 2 years, cause of hair growth?

type 2 DM
(acanthosis
nigracans)

22 y/o comes in for 3d of pain with urinaAon, vaginal itching, watery discharge, no hx
of serious illness takes no meds. . sexually acAve w/o contracepAon. erythema of vulva vulvar carcinoma
and vagina, yellow gray frothy discharge. pH=5. wet mount nding?
22 y/o prima at 20 w comes for rouAne prenatal visit. uncomplicated, declined
mulAgestaAon,
aneuploidy screen , other labs normal. exam has normal uterus, abdominal organs seen
get an u/s
outside abd canvity without a covering membrane,cord is medial to defect. dx?
22 y/o prima with a tonic clonic seizre, HTn, and incr DTRs. dx

intraductal
papilloma

22 y/o woman 2 days of pain w urinaAon, vaginal itches, curd like disharge,
pseudohyphae. dx?

NTD

22 y/o woman comes because of second episode of painful vesicular genital lesions.
her partner has similar lesions on his penis. most likely clinical course?

asherman
syndrome

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 enlarged uterus with
scaTer hyperechoic material. next step in management?

low FSH and low


estrogen
(hypogonadotrop
ic hypogonadism)

23 y/o comes for follow up exam 3 weeks a[er being dx with UTI. tx with tmp-smx
foreign body in
relieved her sx. this is her 3rd uA in the last year. . she was married 3 m ago. her ua and
the vagina
vitals are unremarkable now. what is the bst tx for ppx of this?
23 y/o primagravid at 32 weeks admiTed for irregular uterine contracAon x 3 hr. temp
is 100.8, uterus is moderately tender and fetal hr is 170. cervix 80% eaced and 2 cm
dilated, -1 staAon. watery vaginal discharge that is + nitrazine. DX?

46 XY (androgen
inseniAvty)

23 y/o, acute onset of intense right sided lower abdominal pain becoming worse with
irregular mentrual intervals. 5 x 5 x 4 mass, no fever, + guarding and rebound. mass
grwoing with cysAc and solid components. Dx?

FTA ABS

24 y/o prima at 30 w admiTed for birght red vaginal bleedrst noted as spoPng 12 h
a[er sex, since then bleed has incr. otherwise uncomplicated. u/s at 20w has fundal
placenta. most likely cause of bleeding?

chest xray

25 y/o G2 P2 w 3 days of painful swelling in vaginal area, LMP was 2 m ago. acAve w
one parter and uses depoprovera. has exquisitely tender mass in le[ labium minor,
prevents inserAon of sepculum. dx?

H. ducreyi

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 irregularly and not
on HAART. uterus is slightly enlarge and adnexa normal dx?

wound infecAon

26 y/o G3 po 0, ab 3 sue to 3 consecuAve 1st trimester ab. hx of UTI since childhood.


IV pyelogram showed single le[ kidney. exam today shows palpable uterus and
palpable le[ ovary. most likely dx?

dichorionic (di di)

27 y/o G0 severe pain w menses causing missing work. cervix is pink, uterus normal
size. R ovary bigger than le[. most likely dx?

urge inconAned,
detrusor
instability . tx
with meds

27 y/o G2, P1 comes a[er an episode of bright red blood with no contracAons or
cramping. she has incr br size, morning sicknessand faAgue. LMP was 8 w ago. exam
shows uterus consistent w 6 w. TVUS shows normal fetal heart. Dx?

genuine stress
inconAnence,
sphincter
insucincy. tx
with pessary/
surgery

27 y/o G2P1 at 36w comes w 2 hr of intermiTent vag bleeding. no prenatal care and
overow
fundus at 35. fetal Hr =135. bleed is of uterine origin. she is O-.nst is reacAve and BPP inconAnecy
= 8. next step?
(neuro)
27 y/o comes in with ha, blurred vision abd RUQ pain for 12 hr. labs show HELLP. dx

maternal fever

27 y/o nulligravid unable to conceive for 12 m. had PID 4 y ago. nest step in dx?

follwed to zero

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 visited relaAves with a u like illness. uterus is consitent with 10 w NST
pregnancy. next step in management?
27 y/o prima at 33 w comes for prenatal visit. has SLE x 8y. remission. preg normal
besides lagging fundal ht 2 m ago. at 20 week things were normal on us. at 33w there
is oligo and 30 w fetus. what is cause of olgio?

parvovirus B19

27 y/o prima at 34 comes with 1 day of anxiety, sweaAng, rapid heart beat. some
disorientaAon. rapid pulse, low grade fever high b. diusely enlarged thyroid with 4+
clonus. along with a beta blocker what else should you give her?

1. gonadal
agensis of a 46
XY 2. enzyme
deciency in
testosterone
synthesis

gonadal failure of
27 y/o primagravid at 14 w comes for 24 hrs of n/v, right sided abd pain, loss of
46 XX 2.
appeAte x 2 d.no n/v. afebrile. RLQ tenderness without rigidity or rebound. WBC 16.5,
disrupAon of
leukocytosis in urine. Dx?
hyp-pit axis
3 d a[er 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 are tense
and tender. uterus rm20w size. she has no elevated WBC and hb and UA norm.Dx?

1. tesAcular
feminizaAon 2.
mullerian agensis

30 y/o G2P1 at 26w. uterine size greater than expected for dates. fetus has hydrops.
next step in dx?

- hypothalamic,
puituitary or
ovarian failure 2.
congenital
anomalies

32 y/o 2 months adnexal dull pain. worst with menses, exams shows full adnexal with
tenderness. BHCG is neg. pelvic u/s has 5 cm simple cyst. she is anxious about tx as
her insurance expires in 2 weeks. next step?

pulmonary
hypoplasia

32 y/o G3 P2 at 20 w comes in for rouAne prenatal. u/s shows skeletal dysplasia


consistent with achondroplasia. what is the inheritance paTern?

condyloma
acuminatum

uterine
32 y/o G3 P2 delivers a 9 lb baby following a 2hr second stgae of labor. follwoing
replacement + IV
placental deliveyr there is a pale mass in the lower vagina, the pt develop hypovolemic
oxytocin
shock and uterus cant be palpated. dx?
(inverted uterus)

32 y/o G3P2 type 2 dm admiTed at 38 w. rst 2 kids were SVD. cervix is 2 cm dilated
on admission with fundal ht of 42. 4 hurs later, cervix complete, vertex is OA, -1.1 hr
later, contracAons are every 2 mins and staAon and cervix unchanged. cuase?

wet mount (look


for mobile
protozoa)

32 y/o G5P4 at 21w bright red vag bleed for 4 hr.no prenatal care. speculum has bright
polyhydramnios
red blood in post fornix. no other abn in cervix. next step?
32 y/o nulligravid with 6 w of fould smelling frothy discharge with aggellated
organisms on wet mount. Dx?

uteroplacental
insuciency

32 y/o nulligravid with no mentstural period since soTped taking OCP 6m ago. menses
were regular before. also has incr libido, facial hair and acne. BMI=33. has
GDM
clitoromegaly. 2 cm mass in right ovary. what hormone is likely abnormal?
32 y/o prima at 10 w for 5 d of n/v decr appeAte. cant keep food down. labs show
some hypovolemia, large ketones, some electrolytes disturbances. what should you do casarean delivery
for her?
32 y/o with 6m of increasing frequent pelvic cramps, pain with urinaAon, urgency
relived with urinaAon. regular menses. suprapubic tendenress. tender to palpaAon dx?

NO

39 y/o woman wets e 2-3x daily, feels need to void but does not make it in Ame. dx
and tx?

cyclci progesAns

4 weeks a[er c/s. with feeling of pulling on right side of incision. exacerbated by
movement. she was d/c on pod 3. in last 2 weeks she started exercising and sex. bmi
29. abd is tender on right of incision. most likely explanaAon?

enterocele (even
without BM
issues)

42 y/o G2P@ with loss of urine when cough, sneeze. uncomplicated SVDs, urine loss
with valsalva. dx?

squamos cell cA
of the cervix

42 y/o G3P3 amenorhea or 2m, some spoPng 3 w ago. slightly enlarged uterus. next
step?

Staph aureus,
toxic shock
syndrome

uterolithiasis
42 y/o G3P3rouAne exam. iregular period varying length for the last yr. last period was ( doesnt require
6 w ago. she has t2dm tx w mepormin. BMI=32she has an irregular enlarged uterus.
gross hematuria,
endometrial biops shows atypical complex hyperplasia. predisposing factor?
could be
microscopic)
42 y/o woman with DM with constant dribbling of small amounts? dx and tx?

masAAs

47 y/o comes to physicisn 2w a[er lump in le[ br. she started estrogen replacement 3
m ago and has had br engorgement since that Ame. L br shows 2 cm tense, mobile,
abrupAo placenta
cyst like structure. mammography 3 m later is normal. next step in mamangement?
55 y/o woman with constant wetness from vagina following hysterectomy. no dysuria
or urgency. like dx and what next step?

chorio amioniAs

57 y/o 1 week a[er mass in le[ breast. no family hx of br cancer. 2 cm palpable


nontender mobile mass, no discharge. nothing in R breast. next steo?

sucAon and
curretage ( mole)

genuine stress
57 y/o complains of small blood stains on underwear x 6m. menopause occured 5 y
inconAnence =
ago and has not recieved hormone therapy. reports dysparunia but no GI or urinary sx. decr external
there is atrophy in vagina. most likely cause?
urethral
sphincter tone

57 y/o vegan, doesnt want meds, has evidence of low none density on DEXA. what
vitamin do you recommend supplemenAng?

N. Gonorrhoeae

57 yo for rouAne health maintenence. HTN, t2 DM, generalized anxiety. she has been
gePng conj estrogen and medroxyprogesterone a[er menoapuse. also HCTZ,
mepormin,herbal meds. What is her greatest risk for Br Ca.

menarche is
imminent

67 y/o with moderate vulvar itching for 2 years. otherwise healthy, takes no meds.
normal vitals. exam shows white epithelium over lever labia majus. no inguinal
adenopathy or discharge. next step?

increasign
symtpoms for 3
weeks then a
gradual decrease

67 yo with 9mvulvar itching. unresolved with zinc, vit E, steroids, or metranAfungals.


has type 2 DM and hyper colesterolemia. BMI =53. eryhtmatous swollen vulva,
pauples and pustulesthights. KOH shows pseudophyphae. why not respond to
previous therapy?

leuprolide
( GnRH agonist,
for
endometriosis)

8 cm growth of cervix into parametrium is?

congenital uterin
anomailies
( urinary tract
anomalies follow
with uterine)

87 y/o with urinary inconAnce for 6 years, she avoids house for fear of public
decreased
ridicule.inconAnence with sneezing, coughing, exerAon. hysterectomy 30 y ago. BMI = protein content
31. Most likely cause?
in breast milk
A 22 y/o with mulAple raised, crusty papule and an abnl pap. dx?

gastrochisis
(omhalocele
would be within
cord)

A baby is post with spina bida, what during pregnancy could have been given?

autoD

A baby with macrosomnia incr chances for what in future pregnacies?

agellated
protozoa

A fever with wonund induraAon and erythema is?

hormone therpay

A paAent with a velvety pigmented skin over the axilla is at risk for?

oseoporosis, no
withdrawal bleed
suggests ovarian
failure

A prolapse a[er a hysterectomy relived by lying down, bulging posterior mass high in
the vaginal vault is?

normal
pregnancy,
painless blood

A twin gestaAon with a thick dividing membrane is?

normal cysts,
OCP and f/u in 6
weeks to see if it
regrsses

An exquisitely tender ulcer at the introitus is most likely caused by what in an


immigrant?

umbilical cord
compression

Asx 24 G1 at 36w has grade 2/6 systolic murmur at upper le[ sternal border. dx?

normal post op
course, this is
where the knot
in the sitches is

At what Ame should manual placental extracAon be aTemtped?

punch biopsy of
aeted areas

Best evaluaAon tool for soncern for PID inferAlity?

cephelopelvic
disproporAon
(DM)

Chronic HTn can have what eect on fetal/placenta?

type 2 DM

Does diluAon of Hb in pregnancy cause changes in MCV?

FSH (turners she


is 4 [ tall,
coartaAon)

Dx of cjoice for endometriosis?

hematocolpos
(imperforate
hymen)

First step in a smoker with no pre atal care?

fetal u/s

How do you evaluate green forthy discharge, vaginal erythema?

hyperemesis
gravidarum,
inpaAent
admission for iv
uids and
anAemeAcs

LEEP is a RF for what in future pregnancy?

uteroplacental
insuciency
( SLE can mimic
GHTN)

MC mass in breast of adolescents or 20s?

intersAtal cysAAs

MCC big uterus with correct dates?

increased
testosterone

MCC of hydrops fetalis in a day care worker?

appendiciAs
(might be pyelo)
but i think the
loss of appeAAe

MCC postpartum hemorrhage?

testosterone
( DHEAS is from
adrenals)

Main cause of premature deterioraAng AGPARS?

submucosal

Mc ureteral injury in hysterectomy?

IV injecAon of
the anasteAc
(epidural woundt
cause these sx)

Most common birht defect of valproate?

atelectasis

Prior to discharge, a 30 y/o woman wants to resume combo oral contracepAves prior
to pregnancy. but wants to breast feed. what problem do you counsel her about?

levothyroxine.
propythiuracil
can concentrate
in the fetal
thyroid

Pt with 1 day hx of fever, n/v, perineal rash, bilateral adnexal tenderness. uses tampons preterm labor
during periods. Causal organism?
(bicronate uterus)
Purulent cervical discharge, cervical moAon tenderness, G+ diplococci in slide. dx?

annovulaAon

Tx for transverse lie, full dilaAon and eacement?

give rhogam for


any bleed in Rh-

Urge, enuresis, with large volume is?

hemoglobin
electrophoresis
(thalassemia)

What causes persistant fetal tachycardia?

breast
engrogement

What do you follow a + RPR VDRL with?

pregancy

What is converted peripherally in PCOS?

cervical trauma
(sex)

What is no breast, no uterus?

primary
dysmenorrhea
(endometriosis
tends to be
midcycle pain)

What is no breat, yes uterus?

hypoestrogenic
state
(menopause)

What is seen in amenorrhea from running (FSH and estrogen)?

tmp-smx

What is the appropriate step for prevenAng group B strep sepsis in the newborn with
12 hrs of ruptured membranes?

severe Pre-E

What is the best screening test for a 30 y/o woman with br cancer in a 58 y/o relaAve,
a MI in father at39 and a 36 y/o brother with T2DM and a smoking hx?

ne needle
aspiraAon biopsy
of the cyst.

What is the srt step in mangement of a 47 y/o with quesAonable menopause with 4
months without a mentsrual period, with an enlarged uterus?

likely
vesicovaginal
stula from
hysterectomy.
get dye
installaAon into
bladder

What is the mech of Asherman syndrome?

neurogenic
bladder, do
intermiTent self
cath

What is the most apporopriate management of a 15 y/o pt with PID and 103.5 fever?

urger
inconAnence,
oxybutynin

What is the most common cause of 4 months of serosanguinous breast discharge with pessary or burch
a normal mammogram?
urethropexy
What is the most likely cause of a 46 XX baby born with scrotum and phallius?

live aTenuated,
no eect on hsv

What is the most likely cause of a 5 y/o without genital truma with persistant green
vaginal discharge and burning and itching?

a[er 30 mins of
retained placenta

What is the most likely cause of a lady not having a menstrual period a[er her last
child required a d and C?

anathesia
(halothane) (relax
cervix)

What is the pathophys of hypotension in sepAc shock?

zidovudine > c/s

What is the uAlity of the McRoberts maneurver?

steroid induced
comedones not
teenage acne

What is yes breast, no uterus?

abnormal DEXA
scan as low
estrogen can
cause
osteoprosis (decr
GnRH release)

What is yes breat, yes uterus, amenorrhea?

vasodilaAon

What might be seen in a uterus large for dates in an IVF pt?

14 hours

What should be done with BHCG levels in an INC Ab?

antrhopoid (AP >


TV diameter)

What should you order for an 18 y/o pt at 10 weekd with HIV and a PPD of 9mm?

1.5 cm / hr

What type of contracepAve is contraI in a 37 y/o smoker of 2 ppd?

anterior placenta,
defect in
endometrium

When should HIV + women have pap smears?

placenta percreta

When should you screen colonoscopy?

coagulopathy,
infecAon

When should you start mamomograms?

65

When should you start pap smears?

50

a 32 y/o G5P4 at 18w comes for rouAne prenatal. Rh -. previos pregnancies reuqired c/
s at33-35 for breech, She got rhogam for both pregnancies. her mother has T2DM.
vitals normal. TVUS shows breech and bicornate uterus. What is she at incr risk for?

40

blue Assue densely adherent between uterus and bladder is?

21

breast pain, rubbery mass changing with menses is?

decreases the
fetal bony
diameter from
shoulder to axila

srt step in management with ROM at term with sudden decrease in fetal HR?

anteriorly roates
the symphysis
pubis

girld with lupus with acne w/o comedones is?

ureteral ligaAon

how you you tx a pituitary adenoma growing in size in pregnancy?

high dose
estrogen

new breaspeeder with eryhtematous, nonuctuant, tender area in upper outer


quandrant. engorded breast bilaterally. fever and tachycardia. Dx?

Compression by
the uterus and
right ovarian vein

painless ulcerated lesion in 60 y/o lady with puriAs. dx?

anterior
hemorrhagic
necrosis, decr
prolacAn

pregnant woman, suddent onset of sever le[ sided ank pain radiaAng to labia. no
gross hematuria, afebrile, n/v, only comfortable when ambulaAng. dx?

disrupAon of
large segments of
the endometrium

previously healthy 42 y/o comes with 6m of increasingly heavy periods and 2 months
of prolonged ow. she has an irregular and smooth uterus. ABUS shows leimyoma
uteri.Which is the most likely type of leiomyoma in this case?

uterine
hypersAmulaAon

prolonged fetal decels associated with misoprostol is?

amenorrhea due
to inhibiton of
GnRH pulsaAons

small amount of urine, enuresis, frequently is?

bromocripAne

stress inconAnece, tx?

hypercoagulable
state

triggers with coughing of small volume of urine is?

brocysAc
change

what causes variable deceleraAons?

broadenoma

what implantaAon site is most likely to have placenta accreta?

mammogram

what is best tx for irregular periods in a smoker?

endometriosis

what is expected progress in the acAve phase?

cadidiasis

what is the DOC for sydfucAon uterine bleeding with acAve bleed?

hysterosalpingog
ram

what is the best inital therapy for non reducible uuterus?

maternal Rh
status with
anAbody
screening

what is the greatest concern for a retained placenta acreta not removed with
hysterectomy?

stress
inconAnence

what is the mech of amenorrhea due to pituitary ademona?

reassurance that
this is normal

what is the mech of urinary system dilaAon in late pregnancy?

trichomonas
vaginalis

what is the most common underlying cause of maternal mortality?

ow murmur

what is the most likely karyotype of a pat with progressive facial hair, axillary hair,
without breast devlopment. a blind vagina, clitoromegaly and posterior labioscrotal
fusion?

BHCG, must
check pregnancy

what is the uAlity of delivery of the posterior fetal arm in shoulder dystocia?

Vit D

what is upper limit of normal for the latent phase?

folate

what might be seen in a woman with galactorrhea due to a prolacAnoma?

uterine atony

what part of pituitary is acected in sheehans?

send home,
threatened
aborAon

what type of pelvis predisposes to occiput posterior?

Beta HCG,

what type of vaccine is VZV?

oral
contracepAves

when should u start to screen DEXA?

bartholin gland
abscess

which is more eecAve for reducing verAcal transmission of HIV c/s or zidovudine?

eclampsia