Ob/Gyn

Patrick Joseph Wed Jun 27 10:05:02 PDT 2018

Pap smear
Diagnostic test for cervical cancer. Scraping of the cervix

For women 30-65, how often should they be tested for HPV and cytology?
Both HPV/cytology every 5 years, or cytology alone every 3 years

Difference between condyloma acuminata and condyloma lata

Condyloma acuminata is from HPV. They are pink/flesh colored macules. "Genital warts." Lata is secondary syphilis

Fetus is born with microcephaly, hypoplasia of the distal phalanges, excess hair, cleft palate.
Fetal hydrantoin syndrome (Phenytoin or Carbamazapine use)

Leiomyomata uteri
Aka fibroids. Smooth muscle tumors that arise from the myometrium, especially in AA women. Can present as a globular mass with
protuberances. Can lead to longer periods, dysmenorrhea (painful cramps during menses)

Signs of endometriosis
3 D's: dysmenorrhea, deep dyspareunia (pain with deep penetration), dyschezia (pain with defecation). Can have tenderness of
recto-vaginal area, tenderness with uterine movement, and thickening of the uterosacral ligaments. Best treatment is NSAIDs or
OCs. Failure of therapy -> laparoscopy

Difference between adenomyosis and endometriosis

Adenomyosis will have heavy bleeding, large tender mobile "boggy" "globular" uterus. Endometriosis will have a normal sized
immobile uterus and will not cause heavy bleeding.

Test for ovarian cancer

There isn't one. For a person without significant family history of ovarian cancer no specific screening is required

Patient has bilateral gray nonbloody nipple discharge. No lumps or masses

Physiologic galactorrhea. Can also be milky, yellow, brown, or green. Could be due to hyperprolactinemia. May want to check
prolactin and TSH

Quad screen values for Trisomy 18, 21 and Neural tube defects. Quad includes Maternal Serum AFP, betaHCG, unconjugated estriol
and inhibin A
Trisomy 18 and 21 both have low AFP and estriol. Trisomy 18 has low HCG and normal inhibin A. Trisomy 21 has high HCG and high
Inhibin A. Neural tube defect has high AFP and everything else is normal

Difference between adenomyosis, leiomyomata uteri (fibroids) and endometriosis

Adenomyosis: bulky tender uterus that is uniformly enlarged. Fibroids: proliferation of smooth muscle within myometrium. Causes
heavy bleeding, irregularly enlarged uterus. Endometriosis: cyclic bleeding of ectopic endometrial glands. Will have pelvic pain, but
won't have an enlarged uterus or excessive bleeding.

Placental abruption
Bleeding between the placenta and the underlying decidua that can lead to placental detachment and vaginal bleeding. Can have
lower abdominal pain. Complications include DIC and hypovolemic shock. Fetal complications include hypoxia and preterm delivery

What to do with a 37 week woman with no other complications but the baby is in incomplete breech
External cephalic version. Can be done if at 37 weeks. Contraindicated with prior c-section, extensive uterine myomectomy, placenta
previa.
One day after delivery, patient is experiencing sharp midline abdominal pain that radiates down her leg during ambulation
Pubic symphisis diastasis. Can be caused by a traumatic delivery, fetal macrosomia, multiparity. Presents with suprapubic pain that
can radiate down leg or to the back.

Tamoxifen; Raloxifene
Tamoxifen: estrogen antagonist at the breast. It is an estrogen agonist at the endometrium -> hyperplasia or cancer; Raloxifene has
antagonistic effects of bone -> bone resorption -> osteoporosis

Patient has vulvar itching and burning, pain with sex, thin/dry white plaque-like vulvar skin
Lichen sclerosus. Punch biopsy is recommended for diagnosis

Patient presents with intermittent bloody discharge from one breast. No masses. Mammography -
Intraductal papilloma. It is small so it is nonpalpable.

Patient presents with epigastric and RUQ pain, HTN, 2+ edema, 3+ urinary protein, low platelets, elevated LFTs, hemolysis, anemia
HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count). HTN and proteinuria are consistent with preeclampsia.

Treatment for candida vaginitis

Oral fluconazole or intravaginal nystatin

Patient presents with fever, RUQ pain with pain upon inspiration, diffuse lower abdominal tenderness, increased menstrual irregularity
and 3 months of spotting
PID. Treat with ceftriaxone + azithro or doxy

Biophysical profile
Categories are nonstress test, amniotic fluid volume, fetal movements, fetal tone, and fetal breathing movements. All are scored from
0 to 2. Total less than 4 suggests risk of imminent fetal demise. This can be a sign of hypoxemia due to uteroplacental insufficiency

Late decelerations
Sign of uteroplacental insufficiency (chronic fetal hypoxemia)

Lung complication in preeclampsia/eclampsia

Pulmonary edema due to systemic hypertension -> increased afterload -> increased pulmonary cap pressure.

Patient had prolonged delivery, c-section, developed fever on post-partum day 2 along with abdominal pain and uterine pain.
Diagnosis and treatment?
Postpartum endometritis. Most common infection following birth, especially with uterine pain. Best treated with clindamycin and
gentamicin (polymicrobial infection)

Disorders of the active phase of labor (stage 1)

Either protraction (cervical changes slower than expected or inadequate contractions) or arrest (no cervical change in 4 hrs w/
adequate contractions OR no changes in 6 hours with inadequate contractions). Protraction is treated with oxytocin, arrest is treated
with C-section.

Primary cause of postpartum hemorrhage

Uterine atony

65 year old woman with postmenopausal bleeding, right adnexal mass, endometrial hyperplasia
Granulosa cell tumor (sex cord-stromal tumor). Produces estrogen -> endometrial hyperplasia and bleeding. Would want to biopsy
endometrium to make sure there's no cancer there as well. Will see Call-Exner bodies.

74 year old obese patient with Class III heart failure and HTN has cervical prolapse causing difficulty in defecation. Best treatment?
If asymptomatic would not require treatment. Since she is symptomatic, she could either have a pessary installed or begin pelvic floor
exercises. Since she has complete herniation of the uterus the exercises would not be very useful.

Patient at 10 weeks gestation presents with vaginal bleeding, intense abdominal cramps, open cervical os, non-viable fetus, BP 90/65
and HR 110. What is the next step?
This is an inevitable abortion. Would perform suction curettage. Would not give misoprostol since she is hemodynamically unstable
and that medication would take too long. Wouldn't give oxytocin since there aren't many receptors in the 1st and 2nd trimesters.

60 year old presents with ascites, SOB, FH of BRCA mutation, mass in left adnexa, positive US findings. What is the next step in
treatment?
Exploratory laparotomy. She has Epithelial Ovarian Cancer (EOC) which is often present in postmenopausal women with BRCA
history. It is presenting with signs of metastasis (ascites, SOB).

Patient delivered 6 weeks ago. Now presents with 1 week history of left breast pain and swelling. Has patch of erythema and 3 cm
area of fluctuance. What is the best treatment?
Most likely has a breast abscess from untreated mastitis. Can be due to incomplete emptying or alternating BF and bottle-feeding.
Will have typical signs of mastitis (localized erythema/pain malaise, fever) with a fluctuant tender mass. Needle aspiration and ABX
are required for abscesses. Regular mastitis can be treated with warm compresses.

40 year old woman at 10 weeks gestation has cousin with Down syndrome. Exam is normal. What is the next step in management?
Plasma cell-free fetal DNA test ( cffDNA). Appropriate for women >35, has 99% specificity for Trisomy 21. Can be performed in first
trimester. Quad screen can be done in the second trimester and has 80% specificity for DS.

Exercise in pregnancy
Can have 20-30 minutes of moderate-intensity exercise on most or all days of the week. Can be contraindicated in patients with
severe CV disease or preeclampsia. Avoid contact sports, gymnastics, skiing.

Patient recently had an elective abortion. Now has fever, persistent heavy vaginal bleeding, lower abdominal pain, foul-smelling
purulent discharge, boggy/tender uterus. What is the best treatment?
This is a septic abortion. Medical emergency treated with antibiotics and D&C

Patient has thin malodorous vaginal discharge and erythema of the vulvar and vaginal mucosa. Wet mount shows motile, pear-
shaped organisms. What is the disease and the treatment?
Trichomoniasis. Treat with metronidazole (both for the patient and the partner)

Nonreactive nonstress test in 35 week fetus that is otherwise normal

Fetal sleep cycle

Risk factors for developing breast cancer

First degree relative w/ cancer or genetic mutation, white race, increasing age, early menarche or late menopause, nulliparity

Raloxifene
Often used as an estrogen agonist for postmenopausal osteoporosis. Contraindicated in patients with history of DVT

Lab finding in preeclampsia/eclampsia

Proteinuria

DDx for urinary incontinence

Stress: caused by decreased sphincter tone/urethral hypermobility. Leakage with coughing/sneezing. Treat with eplvic floor
exercises. Urge: detrusor hyperactivity. Sudden overwhelming urge to urinate. Overflow: impaired detrusor contractility/bladder
outlet obstruction Incomplete emptying and persistent dribbling.

What can cause fever in the days following delivery?

Most common is endometritis. Treat with antibiotics. If those are not effective, then you can consider septic pelvic thrombophlebitis
(SPT), which is a diagnosis of exclusion. Treat with anticoagulation and broad spectrum ABX

How to tell the difference between vasa previa and placenta previa
Both will have painless antepartum vaginal bleeding. Placenta previa will have a normal fetal heart tracing whereas vasa previa will
have decreased functioning

Patient immigrated from another country. Rubella and varicella titers show no immunity. What should we do?
Should plan on giving MMR and varicella vaccines immediately postpartum. Both are contraindicated during pregnancy (as well as
HPV and live attenuated influenza)

Patient has hypothyroidism being treated with levothyroxin. What changes to her regimen needed to be made when she becomes
pregnant?
The dose needs to be increased

Management of shoulder dystocia

Anterior shoulder can't be delivered. BE CALM: Breathe/don't push, Elevate legs/flex hips against abdomen (McRoberts maneuver),
Call for help, Apply suprapubic pressure, EnLarge vaginal opening with episiotomy. Follow these steps in order.

Missed abortion characteristics

No bleeding, closed cervical os, no fetal cardiac activity or empty sac. Could have decreased pregnancy symptoms (nausea, breast
tenderness). Could see empty gestational sac with no fetal pole (aka no embryo). Also beta HCG levels could fall during this period
(normally continually rise in first trimester)

Woman at 10 weeks gestation has vaginal bleeding, dilated cervix and visible products of conception. Suction currettage is
performed. Mother is AB- and Anti-Rh ab titer was negative. What is the next step?
Administer Anti-D immune globulin. This is indicated soon after a spontaneous abortion, delivery of an Rh+ infant, at 28-32 weeks
gestation, during ectopic pregnancy or hydatidiform mole, trauma, 2nd or 3rd trimester bleeding

Patient is sexually active, not using contraception. Has yellow cervical discharge. Cervix is friable and bleeds easily
She has cervicitis which is often caused by Chlamydia or Neisseria. Gold standard test is NAAT. Would not visualize any organisms
on microscopic examination

Difference between CAH and aromatase deficiency

Both will have ambiguous genitalia and normal internal organs. Aromatase will have undetectable estrogen levels, delayed puberty,
polycystic ovaries. CAH will have electrolyte abnormalities

Patient is 10 weeks pregnant. No urinary symptoms. Clean catch reveals >100,000 colonies of E coli. What is the next step
Treat with Amox-Clav (or nitro or cephalexin)

Patient has intense vulvar pruritus, green frothy vaginal discharge, pH 5.5
Trichomoniasis. Will see flagellated mobile organisms on microscopic exam. Remember that BV and candida are both white. BV is
fishy. Candida has a normal pH

Risk factors for shoulder dystocia

Fetal macrosomia, maternal obesity, excessive pregnancy weight gain, gestational diabetes, post-term pregnancy

Medications given to women when they are in labor <32 weeks gestation
Betamethasone, tocolytics (indomethacin or nifedipine), magnesium sulfate

Pseudocyesis
Form of somatization. Maybe an older woman who has been trying to get pregnant for several years. Presents with abdominal
distension, morning sickness, breast fullness. Negative office urine pregnancy test. Patient will not be psychotic

Effect of too much oxytocin

Hyponatremia, hypotension, tachysystole (>5 contractions in 10 minutes)

Bartholin duct cyst

Located at the 4 and 8 o'clock positions near the base of the labia majora. Can be asymptomatic, soft, mobile and nontender. If
asymptomatic no treatment is needed. If symptomatic undergo incision and drainage

Choriocarcinoma
Malignancy that arises from placental trophoblastic tissue and secretes beta-HCG. Presents <6 months after pregnancy. Can cause
irregular bleeding, enlarge uterus, can cause chest pain and dyspnea if metastatic

How to treat pregnant woman with HIV

3 drug therapy (ART). Should include zidovudine or tenofovir. Zidovudine should be administered to infant for >6 weeks

Most common side effect of tamoxifen therapy

Hot flashes. Can also cause endometrial hyperplasia/cancer

Most common type of breast cancer

Adenocarcinoma

Patient has pruritic eczematous rash on left nipple and areola. LMP was 2 years ago.
Mammary Paget disease. Often caused by an underlying cancer (most commonly adenocarcinoma)

Breast cancer risk factors

HRT, nulliparity, alcohol consumption, genetic mutation, increasing age, white race, early menarche or late menopause

Recommendations for patients with placenta previa in their first and second trimesters
Pelvic rest and avoid coitus

Role of hCG
Preserves the corpus luteum

Patient in labor presents with loss of fetal station (from 0 to -3) and sudden intense abdominal pain with moderate vaginal bleeding,
fetal tachycardia and variable decelerations
Uterine rupture

Fetal position during birth

Occiput anterior is the best position. Occiput transverse or posterior are considered malposition and can cause arrest of the second
stage of labor. Presentation refers to the part of the fetus that is lowest. Vertex = occiput is lowest

What does variable deceleration represent

Cord compression, cord prolapse, oligohydramnios

What do early and late decelerations mean?

Early: either fetal head compression or normal. Late: uteroplacental insufficiency

Fetal scalp stimulation

Designed to induce accelerations when they are absent. Does not help with decelerations

ABO incompatibility
Will produce mild hemolytic effects on the fetus. Can be asymptomatic or cause mild anemia. Baby might develop jaundice within the
first 24 hours

How to treat uterine inversion

Manually replace the uterus into its previous position. Can administer uterine relaxing agents if the first few attempts are
unsuccessful. Once back into place, administer uterotonic agents to help stabilize the uterus so the placenta can be removed.

How to assess for PID

Hysterosalpingogram

Symptoms of zika
Microcephaly, intracranial calcifications, thin cerebral cortices, closed anterior fontanelle

Patient was breastfeeding her child until 2 months ago. Had mastitis 1 month ago and was given ABX. BMI 46. Breast is warm and
erythematous and has dimpling
Inflammatory breast carcinoma (peau d'orange). May also have axillary LA. Should get mammogram and US. Tissue bx is necessary
for dx
Homogeneous cystic ovarian mass with chronic pelvic pain and infertility
Endometrioma due to endometriosis

Treating chlamydia and gonorrhea

If you do an NAAT, you can be confident about the result. If chlamydia alone give azithromycin. If gonorrhea alone or if both are
present give azithromycin and ceftriaxone

Clomiphene citrate
SERM that blocks estrogen receptors at the hypothalamus and thereby increases GnRH production -> ovulation. Helpful for PCOS
patients if weight loss doesn't work. Would also give OCs

Difference between anovulation and primary ovarian insufficiency (premature ovarian failure)
POI will have increased FSH and LH. Anovulation will have normal levels. Often seen in morbidly obese women.

40 yo patient with history of irregular periods had last period 8 weeks ago. Has had n/v for the past 2 days. Has 12 week size uterus
and bilateral adnexal mass Multiple small cysts are seen in uterus. Ovaries have a multilocular cystic appearance. UPT is +. What's
going on with the ovary?
Patient has a complete hydratidiform mole due to the UPT+ and bilateral adnexal mass enlargement. The ovarian cysts are called
theca lutein cysts

Pros and cons for medroxyprogesterone and levonorgestrel containing IUD

IUD: thickens mucus and impairs implantation. Lasts up to 5 years. Common side effect is amenorrhea (improves anemia and AUB).
Medroxy (Depo) is injected every 3 months. Weight gain is a major side effect

Primary dysmenorrhea
Seen in patients with normal exam, painful menses in the absence of dyspareunia or GI symptoms. Treat with NSAIDs and OCs

Type of contraceptives that decrease risk for ovarian cancer

OCs

What causes increased AFP and decreased AFP

Increased AFP: open neural tube defects (anencephaly, spina bifida), ventral wall defects (gastroschisis, omphalocele), multiple
gestation. Decreased AFP: aneuploidies (Trisomy 18 and 21). Think Down AFP = Down Syndrome

Antiphospholipid syndrome
Autoimmune, sometimes associated with lupus. Can lead to pregnancy complications (first trimester losses) or venous/arterial
thromboembolism. Need to give anticoagulant

Mechanism of the HPO axis immaturity in young people

Decreased GnRH production -> less FSH and LH -> anovulation

How to treat PPROM with prelabor

Basically all will receive antibiotics and corticosteroids (beta or dex).

Patient has leakage of urine with valvalva (coughing, sneezing). How do you treat
Pelvic floor exercises, pessary, urethral sling surgery.

How to treat urgency incontinence (sudden overwhelming urge to void)

Antimuscarinic drugs

How to treat overflow incontinence

constant involuntary dribbling of urine/incomplete emptying. Correct underling cause, prescribe cholinergic agonists

When to test for chlamydia and gonorrhea

All sexually active women <25 should be screened annually in addition to routine pap smears.
False labor
Mild, irregular contractions that cause no cervical change (aka Braxton Hicks).

Differences between lichen sclerosus, lichen planus and lichen simplex chronicus
Lichen sclerosus is associated with AI diseases (alopecea areata) with thin, wrinkled skin resulting in hypopigmented skin and
intense pruritus. Will also have perianal involvement in a figure-8 pattern. Lichen planus is AI that causes purple plaques with
Wickham striae. LSC is thickened leathery skin in response to frequent scratching.

48 yo patient has "copper-colored" discharge from her right breast. She has been on antipsychotics for 20 years. Paternal aunt died
from metastatic breast cancer at age 50. No masses or lymphadenopathy are present.
Intraductal papilloma. Hallmark is unilateral bloody nipple discharge. Benign = no masses or LA. US would reveal single dilated
breast duct.

STDs that have painful lesions

Chancroid and herpes

How to differentiate between the STDs that DON'T cause painful lesions
Granuloma inguinale: extensive ulcers without LA. Syphilis: single papule that develops into a indurated well-circumscribed ulcer.
Can have LA. L ymphogranuloma venereum (aka Chlamydia): small and shallow ulcers, large painful coalesced LNs (buboes)

Testing for syphilis

Start with RPR or VDRL. Can have false negative in early stage of infection. Still give penicillin if infection signs are obvious. More
advanced testing is FTA-ABS and TP-EIA

Differences between androgen insensitivity syndrome and Mullerian agenesis (MRKH)

AIS: Minimal axillary/pubic hair, normal external development, absent uterus/cervix/upper 2/3 vagina, increased testosterone. MRKH:
internal organs absent, but normal testosterone levels and normal hair development

When you get a GBS swab

35-37 weeks.

Acute cervicitis
Cervix bleeds, has thick yellow mucopurulent discharge that can have a bad odor. Often caused by chlamydia or neisseria

How to differentiate normal n/v from hyperemesis gravidarum

Ketones on UA.

Complication of treatment for CIN3

Cervical stenosis, cervical incompetence, preterm delivery

Maternal thyroid changes in pregnancy

Decreased TSH, increased total T4

First step in evaluating an adnexal mass in a middle aged woman

Start with pelvic US

What to do with a woman at 34 weeks with prior classical C-section whose current pregnancy is breech.
Schedule for C-section at 37 weeks. ECV at 37 would lead to increased risk of uterine rupture because of the previous classical
approach. Vaginal delivery would also be too risky.

Most effective emergency contraceptive

Copper IUD. Can be inserted up to 5 days after intercourse. Ulipristal and levonorgestrel pills delay ovulation but are less effective.
OCPs can also be used. They delay ovulation too but are the least effective

Fetal complication of pre-E

Chronic uteroplacental insufficiency -> fetal growth restriction/low birth weight
Patient receives spinal analgesia and then develops dizziness, hypotension, and tachycardia. What happened?
Venous pooling and vasodilation

Vesicovaginal fistula
Communication between bladder and vagina that allows for continuous leakage of fluid into vagina. Can happen after surgery or
childbirth. Painless.

Bipolar drug that can be safely used in pregnancy

Lamotrigine

27 yo primigravid female had fetus with appropriate growth until recently. Now fundal height is 30 at 33 weeks. There is also
oligohydramnios. What is the cause of the oligo?
Uteroplacental insufficiency

Best ABX for UTI prophylaxis

TMP-SMX. Patient had received it twice before and it worked

Patient is an IV drug abuser. Diagnosed with HIV 2 years ago. Has plaques with rolled edges, brown macular rash on palms and
soles. What is her diagnosis?
Syphilis

Patient has yellow frothy discharge and erythematous patches on the ectocervix
Trichomoniasis. Strawberry cervix

Patient with confirmed GBS during previous pregnancy. When should testing and ABX be given?
Testing is not necessary since she had previous pregnancy with GBS. Give ABX during labor

Patient is in active labor. Cervical prolapse is noted. What is the next step?
Elevate the fetal head with a vaginal hand and perform a C-section

Risk factors for the development of postpartum endometritis

Prolonged labor, prolonged ROM, manual removal of placenta, low SES

How to differentiate between postpartum blues and postpartum depression

Depression lasts longer than 2 weeks and could involve ambivalence toward the newborn.

Patient has had 4 previous C-sections. What complication is she most at risk for?
Placenta accreta. Since there is so much scarring, the placenta will preferentially grow into the myometrium. There's also an
increased risk for uterine rupture (5%)

Somewhat unusual benefit of giving beta to a premature newborn during labor

Will decrease incidence of intracerebral hemorrhage and NEC

Hormone that decreases postpartum and allows for better milk production
Progesterone

Breastfeeding woman complains of sore nipples and burning pain in the breasts. Nipples are pink and shiny and peeling at the
periphery. Causative organism?
Candida

Signs that baby is getting enough breastmilk

3-4 stools in 24 hours, 6 wet diapers in 24 hours, weight gain, signs of swallowing

Beta-hCG and ectopic pregnancy

Some definitive findings would be inappropriate bhCG increase (less than 50% increase in 48 hours) or an empty uterus with bhCG
levels >2000

What is cervical motion tenderness indicative of?

PID and ectopic pregnancy

Frequent cause of cord compression

Lack of amniotic fluid (can be due to rupture of membranes).

Antibiotics given to patients in PPROM but are not actively in labor

Amp and gent. Has been shown to prolong the latency period by 5-7 days

Medicine that has been shown to reduce the risk of preterm labor
17alpha-hydroxyprogesterone

Uterotonic agent that is contraindicated in patient with HTN/pre-E

Methylergonovine

Diabetic screening for patients with one or more risk factors (BMI>30, hx of GDM)
Glucose can be checked at the first visit. Start with 50 g glucose challenge followed by 100 OGTT if the it fails

Diseases that are at increased risk in babies born with IUGR

Cardiovascular disease, chronic HTN, stroke, COPD, Type 2 DM and obesity

Ovarian mass with ground glass appearance

Endometrioma

Treatment for patient with intrinsic sphincteric dysfunction aka "Drain pipe" urethra
Urethral bulking

Asherman's syndrome
Adhesions form inside the uterus and/or cervix. Can be caused by multiple D&C's, C-section, infections. Can cause abnormal
bleeding, infertility.

Test to order if concerned about PID causing infertility

Hysterosalpingogram. Will evaluate the patency of the fallopian tubes

What are AMH levels good for?

Low levels could be seen with decreased ovarian reserve. Seen in older women

Medications used to treat PMS/PMDD

OCPs, Fluoxetine (SSRI)

Risk factors for PMS

Positive family history or Vit B6/calciu

Type of leiomyoma that is most likely to cause miscarriages

Submucosal

Most important source of lubrication during intercourse

vaginal transudate

Management for ASCUS

HPV testing. If negative, repeat pap in 3 years. If positive -> colpo. If 21-24 with HPV+, repeat Pap in 1 year.

Advice for 18 yo patient who wants to lower her risk for developing ovarian cancer
Take OCPs while she doesn't want kids.

Type of ovarian tumor that is the most common in women <30 yo

Germ cell tumor. Epithelial tumors are the most common in patients >30 yo

28 yo has Pap smear revealing ASCUS. HPV confirmed for high-risk type. What is the next step?
Colpo. Necessary for any abnormal pap when HPV+. If HPV-, repeat cytology and HPV in 3 years

What would a baby from a moderately controlled Type 1 diabetic look like?
Small and probably hypoglycemic. Large babies are found in gestational diabetic mothers.

In the setting of twin-twin transfusion syndrome, what will happen to the larger twin?
Will develop polycythemia

Lab abnormalities seen in a baby born to gestational diabetic mom

Hypoglycemia, polycythemia, hyperbilirubinemia, hypocalcemia and respiratory distress

Can a mom with HIV breastfeed?

Not recommended

Race that is at increased risk for molar pregnancy

Asian

Difference between partial and complete mole

Partial: 69 xxy, fetal parts, less chance of developing GTD. Lower levels of beta hCG. Complete: 46 xx, no fetal parts, higher chance
of developing GTD.

Finding often seen in complete molar pregnancies

Bilateral ovarian cysts due to increased beta-hCG that acts like TSH/LH and causes theca lutein cysts to grow

Patient has a history of lichen sclerosus of the vulva that was dx 15 years ago. Has pruritus. Genitalia has firm, elevated,
erythematous ulcerated lesion. What is the dx?
Squamous cell carcinoma

Patient has vulvar rash, intermittent pruritus. Vulva has fiery red mottled background with whitish hyperkeratotic areas
Paget's disease of the vulva

Patient is 2 days post-op D&C for incomplete abortion. Now has increasing lower abdominal pain, nausea, scant bleeding, fever.
Uterus is soft and slightly tender. Cause?
Uterine perforation

Most likely reason for spontaneous abortion in woman with T1DM, cHTN, hx of previous elective abortion
T1DM

Asian woman has hirsutism, regular testosterone, elevated DHEAS, BMI 25, irregular menses
Adrenal tumor

Patient has obesity, purple striae, hirsutism. Best test to order?

Dex suppression test or 24 hour urine cortisol. Looking for Cushing's syndrome.

Hyperthecosis
More severe form of PCOS. Can cause external genitalia virilization, deepening of the voice, acanthosis nigricans, acne, hirsutism

Medications that can be used to treat hirsutism

OCPs and Spironolactone
How to test for fetal anemia in setting of Rh-antibody positive mom
middle cerebral artery peak systolic velocity

Risk posed by atypical blood antibodies

Lewis lives, duffy dies, kelli kills

Measurement of what in the amniotic fluid is the best indication of the severity of Rh hemolytic disease
Bilirubin

How to reduce the risk of preterm delivery for twins

Early adequate weight gain

Type of twins where TTS is most likely

Monoamniotic dichorionic

Division for conjoined twins

One sperm fertilizes one egg and there is partial separation after day 12

Weeks of gestation where the risk of developing microcephaly and severe mental retardation due to radiation exposure
8-15 weeks

39 yo patient at 36 weeks presents to L&D. No FHT heard. Baby has NTD, weight >90th percentile, polyhydramnios. Cause?
Uncontrolled diabetes.

Can you be on SSRIs while breastfeeding?

Yes. Use during pregnancy can lead to extrapyramidal signs and withdrawal symptoms including agitation, abnormally increased or
decreased muscle tone, tremor, sleepiness, difficulty feeding. Sometimes these symptoms go away within days

During D&C following missed abortion, fatty appearing tissue begins to come through the curette. What do you do next?
Could be portion of the omentum that is attached to bowel. Remove tissue from curette -> laparoscopy to evaluate

Which can be performed earlier in a pregnancy: Chorionic villus sampling or amniocentesis

CVS at 10-12, amnio at 15

Risk factors for breech presentation

Prematurity, multiple gestation, genetic disorders, uterine fibroids, polyhydramnios, anencephaly/hydrocephaly

What to do when patient has arrest of active labor (no cervical change in 4 hours)
Amniotomy. If that doesn't help, give oxytocin.

Risk factor for cord prolapse

Abnormal fetal presentation (transverse), polyhydramnios

Signs of sertoli-leydig tumor

Increase in testosterone (baldness, hirsutism), virilization, lack of estrogen (vaginal dryness)

Drugs used to treat overflow and urge incontinence

Urge: Antimuscarinic (alice in wonderland sketch with the water tap open) Overflow: cholinergic agonists (fire hose filling truck and
overflowing)