Ob Gyn Blueprints

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)/ []

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

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

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

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.

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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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

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
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
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

presenting symptom with
endometrial cancer?
Post menopausal bleeding \nirregular bleeding occurs in

90% of patients

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

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.

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

of severe fetal anemia?
Intrauterine transfusion is
<34 weeks\nDelivery if >34
days

risk factor for PROM?
Ascending infection from the

lower genital tract

plan of a patient 24-35
weeks pregnant with
PROM?
Bed rest\nIM
betamethasone\nProphylactic
antibiotics

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

postpartum day 3-4?
Endometritis
What is the most

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

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.

(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

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