Obstetrics and Gynecology: Diagnosis and Treatment of Common Conditions, Exams of Health sciences

Download Obstetrics and Gynecology: Diagnosis and Treatment of Common Conditions and more Exams Health sciences in PDF only on Docsity!

EOR Women's Health Final Exam questions

with 100% Correct Answers

what causes condylomata acuminate - Correct answer HPV

• soft, skin-colored, fleshy lesions caused by HPV subtypes 6, 11, 16, 18, 31, 33, and 35 most genital warts are caused by? - Correct answer HPV type 6, 11 (low risk)

90% of cervical cancer is associated with HPV types __________________________

• Correct answer 16, 18, 31, 33, and 35 Koilocytic squamous epithelial cells in clumps are found on a pap smear and are typical of ____________ - Correct answer cervical warts
• HPV Tx for genital warts (however they typically resolve on their own) Provider: Pt: Surgery: - Correct answer The provider may apply podophyllin or trichloroacetic acid (TCA) Topical imiquimod (Aldara) cream can be applied by the patient Surgery: cryotherapy with liquid nitrogen, surgical excision, electrocautery, laser, intralesional interferon what ages only require 2 doses of Gardasil - Correct answer 9-12yo Which medication can be started during the second trimester in high-risk patients to reduce the risk of developing preeclampsia? - Correct answer Low-dose aspirin. Pregnancy > 20 weeks gestation or postpartum Visual disturbances, severe headaches, or asymptomatic Evaluation will show new-onset hypertension (≥ 140/90 mm Hg) with either proteinuria (≥ 300 mg/24 hr or urine protein: creatinine ratio ≥ 0.3) OR significant end-organ dysfunction Treatment: delivery at 37 weeks (without severe features) and 34 weeks (with severe features) AND prevention of seizures with magnesium sulfate and prevention of permanent maternal organ damage New-onset hypertension < 20 weeks gestation: suspect molar pregnancy - Correct answer Preeclampsia associated with an increased risk of preterm birth, small for gestational age infants, and maternal and fetal morbidity and mortality. Long-term complications associated with

__________ include cardiovascular, kidney, and chronic hypertensive disease. - Correct answer preeclampsia Risk factors for preeclampsia include: - Correct answer nulliparity, previous preeclampsia, age > 40 years or < 18 years, diabetes mellitus, obesity, systemic lupus erythematosus, chronic hypertension, and chronic kidney disease. Preeclampsia is defined by ________ and ______ or ___________ after 20 weeks gestation in a previously normotensive woman. - Correct answer new-onset hypertension and proteinuria or evidence of end-organ dysfunction (still HTN but in the absence of proteinuria) The hypertension associated with preeclampsia is defined as a systolic blood pressure ______ mm Hg or a diastolic blood pressure ______ mm Hg on _____ separate measurements taken at least ________ apart. - Correct answer systolic blood pressure ≥ 140 mm Hg or a diastolic blood pressure ≥ 90 mm Hg on two separate measurements taken at least 4 hours apart. Proteinuria associated with preeclampsia is defined as ________ per 24-hour urine collection, urine protein to creatinine ratio___, or urine dipstick reading of ______ - Correct answer Proteinuria associated with preeclampsia is defined as ≥ 300 mg per 24-hour urine collection, urine protein to creatinine ratio > 0.3, or urine dipstick reading of ≥ 2+. End-organ dysfunction is characterized by the presence of new-onset cerebral or visual disturbance (e.g., photopia, stomata, severe headache, altered mental status), severe and persistent right upper quadrant or epigastric pain, platelet count < 100,000/mall, progressive kidney insufficiency indicated by a serum creatinine > 1.1 mg/dL or doubling of the serum creatinine, or pulmonary edema. - Correct answer Preeclampsia end- organ damage Antihypertensive therapy (e.g., labetalol, hydralazine, nifedipine) is indicated if the systolic blood pressure is _____ mm Hg or the diastolic blood pressure is _____ mm Hg to prevent stroke. The definitive treatment for preeclampsia is delivery, though the timing depends on the patient's condition. Immediate delivery is indicated in patients with preeclampsia and ______________, and patients who are _____ weeks gestation should be given antenatal ________ to promote fetal lung maturity. Expectant management with delivery at 37 weeks gestation is appropriate for patients ___________________. - Correct answer ≥ 160 ≥ 110 evidence of end-organ dysfunction < 34 glucocorticoids (e.g., betamethasone) without evidence of end-organ dysfunction

Labs would be significant for elevated testosterone and increased LH:FSH ratio greater than or equal to 3:1. Focal heterogeneous mass would be noted on a pelvic ultrasound if the patient were to have - Correct answer uterine fibroids, also known as a leiomyoma Which of the following hormones is responsible for breast milk production following delivery? - Correct answer Prolactin

• Oxytocin = milk EJECTION
• prolactin = milk PRODUCTION
• Estrogen and progesterone stimulate growth of ductal tissue and maturation of the alveolar glands Estrogen and other sex hormones are antagonistic in lacto genesis, and thus production of milk is delayed until these steroid levels fall after delivery. When do prolactin levels return to normal in a mother who is not nursing? - Correct answer 2 to 3 weeks following delivery. A 35-year-old woman with a 15 pack-year history presents with postcoital bleeding and dyspareunia. On exam, you note a white, sharply demarcated lesion of the cervix after acetic acid is applied. You suspect cervical intraepithelial neoplasia. Which of the following types of human papillomavirus is the most likely type to be present in this patient? - Correct answer 16
• Although HPV type 18 (C) is associated with cervical cancer, it causes only about 20% of cases high risk HPV types - Correct answer 16, 18, 31, 33 other name for genital warts - Correct answer condyloma acuminate CIN I (involving one-third of the epithelium), CIN II (involving two-thirds of the epithelium), CIN III (involving more than two-thirds of epithelium), and carcinoma in situ (involving the entire thickness of the epithelium). - Correct answer According to USPSTF, women between the ages of 21 and 29 years should undergo screening for cervical cancer every 3 years with cervical cytology alone. In women ages 30 and 65 years, screening should be done every 3 years with cervical cytology alone, every 5 years with high-risk HPV testing alone, or every 5 years with high-risk HPV testing in combination with cytology (contesting). A 35-year-old woman presents for a follow-up with her gynecologist. She had a Pap smear completed 2 weeks ago, and the results were positive for human papillomavirus with low-grade squamous intraepithelial lesions. Which of the following is the most appropriate next step in management? - Correct answer Colposcopy

• Endocervical curettage (B) with biopsies should only be performed with colposcopy after initial visualization of the lesions with acetic acid. Follow-up in 1 year for a repeat Pap smear and HPV testing (C) is a recommended plan for patients with ASC-US and a negative HPV test. A positive HPV test and an abnormal Pap smear require colposcopy. A loop electrosurgical excision procedure (D) would be performed after colposcopy or for patients with HSIL. A patient with a history of LSIL and a negative HPV test that has negative cytology and negative HPV at one year should have repeat contesting at what time? - Correct answer 3 years later. Women with ASC-US and a negative HPV screening should follow-up in 1 year with repeat Pap smear and HPV testing. Colposcopy should be performed on patients with a positive HPV test with ASC-US, HSIL, LSIL, or atypical glandular cells. - Correct answer The loop electrosurgical excision procedure (LEEP) is used for HSIL lesions and those lesions that are completely visible without magnification. Conization surgically removes the entire transformation zone and endocervical canal. It is reserved for severe dysplasia or carcinoma in situ, especially with endocervical extension. tx for urge incontinence (not stress incontinence) - Correct answer oxybutynin tx for stress incontinence (not urge) - Correct answer pessary Treatments good for stress and urge incontinence - Correct answer kegel exercises (more stress), topical estrogen (more stress) Which nerve plexus provides sympathetic innervation that relaxes the detrusor muscle, allowing urine to fill the bladder? - Correct answer Inferior hypogastria plexus. Urge incontinence, also known as overactive bladder, is caused by spasms of the detrusor muscle and is characterized by a sudden urge to urinate, often resulting in the loss of a large amount of urine before the patient is able to make it to the bathroom. A urodynamic study is the diagnostic test of choice. Scheduled toileting, weight loss, and Kegel exercises are recommended for management of urge incontinence. First-line pharmacologic treatments include antimuscarinics (e.g., oxybutynin) and beta- adrenergic (e.g., mirabegron). - Correct answer Stress incontinence is caused by pelvic floor weakness, resulting in involuntary leakage of urine with increased intra- abdominal pressure (e.g., coughing, sneezing, laughing, exercise). Urethral hypermobility and intrinsic sphincter deficiency can result in stress incontinence. A bladder stress test is useful for confirming stress incontinence. The cotton swab test may be performed to evaluate for urethral hypermobility. Weight loss has been associated with improvement in symptoms. Patients should perform Kegel exercises to strengthen the pelvic floor muscles. Topical vaginal estrogen may be used in postmenopausal women with urge or stress incontinence. Duloxetine has been used as an off-label treatment for patients with stress incontinence and concomitant depression. Surgical options for stress incontinence include a midurethral sling or a pessary.

what is the marker for ovarian cancer - Correct answer CA-

• a result > 35 U/mL is considered elevated
• Surgical exploration is also recommended for postmenopausal women with a mass greater than 10 cm in diameter
• Risk factors for malignancy include BRCA1 or 2 gene mutation, Lynch syndrome, and endometriosis. RF for ovarian cancer - Correct answer Nulliparity Infertility Endometriosis Inherited mutations BRCA, HNPCC Advancing age (postmenopausal) Family history Late menopause Protective factors for ovarian cancer - Correct answer OCPs, tubal ligation, hysterectomy According to the U.S. Preventive Services Task Force, at what age is it recommended to start screening for breast cancer for those at average risk? - Correct answer 50 years. Most commonly caused by a complication of pelvic inflammatory disease Sx: lower abdominal pain, fever, vaginal discharge PE: unilateral adnexal tenderness Dx: pelvic ultrasound Tx: intravenous antibiotics, surgical drainage, or both - Correct answer Tuba-Ovarian Abscess
• The classic presentation of TOA includes acute lower abdominal pain, vaginal discharge, and systemic symptoms, such as fever and chills. This presentation is similar to moderate to severe cases of PID. A TOA is said to have ruptured when it is leaking contents into the abdominal cavity. Most patients with a ruptured TOA present with an acute abdomen and sepsis, which requires immediate surgical exploration.
• Patients diagnosed with a TOA should be admitted for intravenous antibiotics A 26-year-old woman presents to the emergency department with complaints of lower abdominal pain and vaginal discharge for the past 5 days. She also reports chills and malaise. Vital signs are T of 100.3°F, HR of 105 bpm, BP of 145/94 mm Hg, and RR of 20/min. On physical exam, she has tenderness to palpation in the left lower quadrant without guarding or rebound. Pelvic exam reveals purulent discharge from the cervical os, cervical motion tenderness, and left-sided adnexal tenderness. Transvaginal ultrasound shows an inflammatory multilocular mass in the left adnexal area. Which of the following is the most likely diagnosis? A Acute diverticulitis B Ruptured ovarian cyst

C Ruptured tubo-ovarian abscess D Tubo-ovarian abscess without rupture - Correct answer D!!!

• A ruptured tubo-ovarian abscess (C) is actually a misnomer since the pathologic process is more consistent with a leak than a rupture. Ruptured TOAs present with signs of an acute abdomen (involuntary guarding and rebound tenderness), and some patients have hemodynamic instability. The patient in the vignette did not have signs of an acute abdomen. Treatment abx for TOA - Correct answer cefotetan + doxy cefoxitin + doxy ceftriaxone + doxy + metronidazole clindamycin + gentamicin ampicillin-sulbactam + doxy Patient presents with fever, malaise, painful breast lump PE will show fluctuant, tender, palpable mass Most commonly caused by Staph aureus Usually a complication of mastitis - Correct answer Breast Abscess
• abx: dicloxacillin, cephalexin
• if MRSA: Bactrim, clindamycin Patient will be a breastfeeding mother Breast erythema, tenderness, fever Most commonly caused by Staph. aureus Management includes cool compresses and analgesics between feedings Antibiotics: dicloxacillin, cephalexin, TMP-SMX (MRSA), clindamycin (PCN allergy) Continue breast feeding to avoid progression to abscess - Correct answer Mastitis Alpha-fetoprotein (AFP) measures for - Correct answer neural tube defects
• amniotic fluid or maternal bloodstream
• can also look for NTD with an ultrasound screening What class of medications is associated with neural tube defects? - Correct answer Antiepileptic medications, such as carbamazepine and valproic acid when is AFP measured - Correct answer 12-20 weeks
• normal is <
• An elevated AFP level is associated with many fetal anomalies, including but not limited to anencephaly, spine bifida, conjoined twins, Turner syndrome, oligohydramnios, polycystic kidneys, urinary tract obstruction, and fetal death. What is considered an acceptable decrease in human chorionic gonadotropin levels after treatment for gestational trophoblastic disease? - Correct answer A decrease > 10% demonstrated by four values taken weekly for 3 consecutive weeks.

Which hormone dominates the luteal phase of the menstrual cycle? - Correct answer Progesterone. PMS starts at _________ and ends at _______ - Correct answer at the end of the luteal phase the beginning of the follicular phase what phase does PMS happen during - Correct answer luteal phase (second half)

• 5 days prior to menses to 3 days after menses starts First and second line tx for PMS - Correct answer SSRI

2. OCPs preferred type of episiotomy to minimize the risk of anal sphincter laceration? - Correct answer Mediolateral episiotomy

• the mediolateral episiotomy is associated with a lower risk of anal sphincter injury but increased blood loss compared with the median episiotomy
• Absorbable synthetic suture is preferred for repair. A single dose of a broad-spectrum antibiotic (e.g., cefotetan, cefoxitin, clindamycin) is not necessary for first- or second- degree lacerations but is recommended for third- or fourth-degree lacerations Treatment of premenstrual dysphoric disorder includes lifestyle modifications (e.g., exercise, stress reduction), cognitive behavioral therapy, and pharmacotherapy. Pharmacologic therapy includes increasing serotonergic transmission with selective serotonin reuptake inhibitors (SSRIs) and suppressing the hypothalamic-pituitary- ovarian axis to decrease cyclic change in gonadal steroids with combined oral contraceptives or gonadotropin-releasing hormone (GnRH) agonists. SSRIs such as sertraline, citalopram, or fluoxetine are considered first-line treatment. SSRI therapy may be given continuously, as a luteal phase-only regimen, or as a symptom-onset regimen. Patients with severe physical symptoms or low-level symptoms during the follicular phase should receive continuous therapy. Patients with predictable symptoms for more than a week prior to the onset of menses may use a luteal phase-only regimen. Patients with predi - Correct answer 1. SSRI

2. OCP containing drospirenone, continuous OCP containing any progestin, GnRH agonists (leuprolide) A 30-year-old nulliparous woman presents with cyclical pelvic pain that has progressively worsened over the last 10 months. She also reports dysmenorrhea, hematuria, and pain with sexual intercourse. She has been trying to get pregnant but has not been successful. Which of the following physical findings is most suggestive of the suspected diagnosis? A Adnexal masses B Atrophic vulvar changes C Cervical motion tenderness

D Tender introit mass - Correct answer A!!! Endometriosis

• triad of dysmenorrhea, dyspareunia, and dysphasia. They may also present with cyclical pelvic pain and urinary symptoms such as dysuria, hematuria, urgency, or frequency. Physical exam findings suggestive of endometriosis include tenderness on vaginal exam, nodules in the posterior fornix, adnexal masses, and immobility or lateral displacement of the cervix or uterus. Treatment of mild to moderate endometriosis consists of the use of no steroidal anti- inflammatory drugs and oral contraceptives. Leuprolide with oral contraceptives, laparoscopy, and hysterectomy with bilateral sapling-oophorectomy (definitive treatment) are reserved for severe endometriosis. - Correct answer endometriosis tx Sx: dysmenorrhea, dyspareunia, dysphasia (painful bowel movement) PE may show uterosacral nodularity or a fixed or retroverted uterus or adnexal mass Definitive diagnosis is made by laparoscopy and histology Most common site is ovaries Tx: NSAIDs, COCs, depot medroxyprogesterone acetate, GnRH agonists, surgery - Correct answer Endometriosis Spontaneous abortion is the most common cause of persistent first-trimester vaginal bleeding and is defined as loss of a fetus before 20 weeks of gestation. The most common cause of spontaneous abortion is fetal chromosomal abnormalities. - Correct answer A missed abortion occurs when there is no fetal heart-tone activity with retained products of conception in utero, the cervical os is closed, and there is no history of vaginal bleeding.
• in utero death of embryo or fetus prior to 20 weeks of gestation with retention of pregnancy, closed os, no passage of tissue when should you do test of cure in a pregnant pt w chlamydia - Correct answer 3- weeks, then repeat test for both 3 months after test of cure
• Screening for chlamydia and gonorrhea with nucleic acid amplification testing is recommended in all pregnant women < 25 years of age and pregnant women ≥ 25 years of age at increased risk for sexually transmitted infections.
• Because cure rates are lower in pregnant women compared to nonpregnant women, a test of cure is indicated in all pregnant women 3-4 weeks after treatment is completed. Furthermore, due to high rates of reinfection, repeat testing for chlamydia and gonorrhea is recommended 3 months after the test of cure. gonorrhea and chlamydia tx for pregnant people - Correct answer If nucleic acid amplification testing is positive for gonorrhea only or both chlamydia and gonorrhea, the recommended treatment is azithromycin 1 g PO in a single dose and ceftriaxone 500 mg IM in a single dose. Which of the following tests will give a quantitative measurement of fetal red blood cells in the maternal blood? (for Rh testing purposes) - Correct answer Kleihauer-Betke test

You notice the fetal heart rate gradually decreases at the start of the uterine contraction, reaches a nadir at the peak of the contraction, and returns to baseline as the contraction ends. Which of the following is the most likely cause of this change in the fetal heart rate? - Correct answer Compression of the fetal head

• early deceleration
• gradual deceleration in the fetal heart that starts at the same time as the uterine contraction begins. The nadir of the fetal heart rate deceleration matches the peak of the uterine contraction, and the deceleration returns to baseline as the uterine contraction ends. Early fetal decelerations are a normal and benign finding during labor, and they do not indicate an interruption in fetal oxygenation.
• usually during second stage of labor what causes: variable decelerations accelerations late decelerations - Correct answer compression of the umbilical cord fetal movement uteroplacental insufficiency Risk factors for pelvic organ prolapse - Correct answer increased parity vaginal delivery advancing age obesity menopausal status chronic constipation connective tissue disorders chronic cough
• hysterectomy plays an unclear role Membrane rupture prior to labor Preterm PROM (PPROM): PROM occurring at < 37 weeks Fluid ferning + blue nitrazine paper = amniotic fluid Admission, OB consultation - Correct answer Predator Rupture of Membranes (PROM) Risk factors for PROM are infection and inflammation, pathologic uterine distention, placental abruption, vaginal bleeding, low socioeconomic status, smoking, activation of the hypothalamic-pituitary-adrenal (HPA) axis through stress, and pathologic cervical changes. Corticotrophin-releasing hormone and estrogen both play a role in normal labor and delivery and can both be activated prematurely by the HPA axis in the presence of excessive stress. Oxidative stress caused by smoking has also been shown to increase the risk for PROM. Thus, smoking cessation should be strongly encouraged in all pregnant women, especially those with a history of PROM. A 24-year-old woman who gave birth to a premature baby girl at 30 weeks gestation presents to your office for a follow-up visit after being diagnosed with mastitis three days ago. You had prescribed her amoxicillin, but after taking it as directed, she has not had

any improvement of symptoms. The patient now has a fever of 103℉ with increased pain to the left breast. Physical exam shows a severely tender fluctuant mass in the breast that is red and warm to touch. What is the most appropriate next step for treatment of this patient? A Admit her to the hospital immediately and start a course of IV antibiotics B Recommend that patient stop breastfeeding altogether, change the antibiotic to oral cephalexin and send her home C Refer patient to a surgeon for incision and drainage D Refer to oncologist to rule out inflammatory carcinoma - Correct answer C!!! Admit patient to the hospital and start a course of intravenous antibiotics (A) is not appropriate because abscesses cannot be treated with antibiotics alone without the removal of pus. Stopping breastfeeding altogether is not advised (B) since stopping suddenly will cause increased milk build-up and therefore cause the condition to worsen. However, if this is not possible, using a breast pump on the affected side could help to prevent build-up and breastfeeding can be continued on the unaffected side until the affected breast is treated. Also, cephalexin will not be effective against methicillin- resistant Staphylococcus aureus. Refer to oncologist to rule out inflammatory carcinoma (D) would be appropriate if the patient was not actively breastfeeding and had no signs and symptoms of active infection. What disease should be suspected in a non-lactating patient who develops a breast abscess? - Correct answer Diabetes mellitus. However, in certain cases where mother or child spend extended time in the hospital setting, more virulent strains can be contracted, such as methicillin-resistant Staphylococcus aureus. The patient in the above scenario likely had a more virulent bacterial infection because her infant might have spent extended periods of time in the neonatal intensive care unit and probably had poor feeding and suckling due to being premature at birth. Patients with breast abscesses present with symptoms similar to mastitis including fever, malaise, painful lumps to one or both breasts, redness, edema, and warmth. However, a breast abscess should be suspected if the patient continues to have worsening pressure or pain despite antibiotic treatment. Diagnosis is usually made clinically, but can be confirmed by culture. Surgical referral for incision and drainage or ultrasound guided aspiration is needed for treatment of abscesses - Correct answer FYI on breast abscesses The risk of which types of cancer can be reduced by combination oral contraceptives? - Correct answer Epithelial ovarian cancer and endometrial carcinoma. Oral pill, patch, ring Inhibit ovulation Alleviate menorrhagia, AUB, dysmenorrhea ↓ risk of ovarian, endometrial, colorectal cancers

• Tumor marker: CA 125 Rule out germ cell tumors in patients < 30 years old with tumor markers such as hCG and AFP Routine screening not recommended (lack of benefit) Prevention:
• COCs ↓ risk by 30-50%
• Bilateral salpingectomy ↓ risk by 65% - Correct answer Ovarian Cancer Primarily seen in men who have sex with men History of recent travel to tropical and subtropical areas of the world Small, shallow painless genital ulcer PE will show tender inguinal or femoral lymphadenopathy (groove sign: adenopathy above and below Pauper leg) Most commonly caused by Chlamydia trachomatis Treatment is doxycycline - Correct answer Lymphogranuloma Venereum Patients with this condition may also present with rectal ulcerations and symptoms of prostates. Lymphogranuloma venereum occurs in three stages. The first stage involves a rapidly healing, painless genital papule or ulcer. The second stage involves painful inguinal lymphadenopathy (appearance of "grooves sign" or large bubo) that usually occurs two to six weeks after the primary lesion. Constitutional symptoms may include fever, chills, myalgia’s, and malaise. This stage is when most men are diagnosed. The third stage is characterized by proctocolitis and symptoms include bloody purulent discharge, rectal pain, and tenses. This stage may occur many years after the original infection. Women are more likely to be diagnosed in the third stage because they usually lack symptoms in the first or second stage. treatment for lymphogranuloma venereum - Correct answer Doxycycline
• erythromycin for pregnant or lactating women (second-line)
• azithromycin or doxy for partners who were exposed what organism causes lymphogranuloma venereum - Correct answer Chlamydia trachomatis
• usually anal related? What lifestyle modification is the first-line treatment for infertility in a patient with polycystic ovarian syndrome? - Correct answer Weight modulation. Patient body mass index should fall between 17 and 27 kg/m2 for improvement or restoration of ovulation. A 23-year-old woman with a diagnosis of polycystic ovarian syndrome and a history of infertility presents to her primary care provider with a positive pregnancy test. She began treatment for her diabetes mellitus type 2 a few months ago. What medication to treat her diabetes may have helped her to achieve pregnancy? - Correct answer Metformin
• While the addition of metformin can assist in weight loss and enhance ovulation, it is not as effective as clomiphene, a selective estrogen receptor modulator, in aiding in

pregnancy. Clomiphene is the drug of choice for treating infertility. Other second-line medications include tamoxifen, a selective estrogen receptor modulator, and aromatase inhibitors such as letrozole which is preferred over metformin. Bromocriptine may be useful in women with hyperprolactinemic anovulation. Should pharmacotherapy fail, more invasive procedures are available such as laparoscopic surgery, tubal catheterization, or in vitro fertilization. For the diagnosis of preeclampsia to be made, blood pressure must be elevated on two occasions at least 4 hours apart in combination with proteinuria or in the absence of proteinuria with signs or symptoms of significant end-organ dysfunction, which could include creatinine > 1.1mg/dL or a doubling of baseline, platelet count < 100,000/mall, or a doubling of liver transaminases. Additional severe features include pulmonary edema and cerebral or visual symptoms. Magnesium sulfate should be initiated to prevent seizures in patients with severe features. - Correct answer Preeclampsia dx fyi risk factors for preeclampsia - Correct answer nulliparity, preeclampsia in previous pregnancy, extremes of maternal age (> 40 or < 18 years), preexisting hypertension, presentational diabetes, multifocal gestation, chronic kidney disease, antiphospholipid syndrome, lupus, and high prepregnancy body mass index Imaging

• Age < 30: breast U/S
• Age ≥ 30: diagnostic mammogram with or without U/S Suspicious imaging or clinical findings → tissue biopsy - Correct answer Breast Mass Which is the most common breast malignancy? - Correct answer Infiltrating ductal carcinoma. TRUE: Breast magnetic resonance imaging is more sensitive than mammogram and ultrasound
• Breast magnetic resonance imaging is typically not performed in the diagnosis or preoperative management of breast cancer because it has not been shown to improve survival or recurrence outcomes. However, breast magnetic resonance imaging is more sensitive than mammogram and ultrasound and is also used as a screening method in young women with hereditary breast cancer syndromes who have dense breasts. - Correct answer FALSE: Breast magnetic resonance imaging highlights invasive cancer using contrast dye, but it also highlights benign breast disorders, such as fibroadenoma. Therefore, it would be incorrect to state that breast magnetic resonance imaging can easily distinguish between invasive disease and benign breast disease (A). It is also incorrect to assert that breast magnetic resonance imaging will expedite the time to surgery by eliminating the need for future biopsies (C) because the opposite has been found to be true. Breast magnetic resonance imaging often highlights both malignant and benign breast disease, requiring additional biopsies, and thus a delay in treatment time.

If BP elevation persists > 12 wks postpartum: chronic hypertension If BP returns to normal by 12 wks postpartum: transient hypertension of pregnancy - Correct answer Gestational Hypertension tx for acute HTN in pregnancy tx for chronic HTN in pregnancy - Correct answer acute: hydralazine (or labetalol, nifedipine) chronic: methyldopa (or clonidine)

• While thiazide diuretics, beta blockers, and calcium channel blockers can be used in pregnancy, they are not proven to be as safe. 3 meds for gestational HTN - Correct answer hydralazine, labetalol, nifedipine
• NOT ACE or ARB, nitroprusside, spironolactone Five or more symptoms (e.g., mood swings, irritability, change in appetite or sleep, breast tenderness, bloating, weight gain) present during the week prior to menses, resolving within a few days after menses starts Symptoms present for most of the preceding year Patients who require treatment have symptoms associated with significant distress and interference with work, school, and relationships Management includes lifestyle modifications and pharmacologic options (SSRIs are first line) Key point between premenstrual syndrome and premenstrual dysphoric disorder is PMDD symptoms usually hinder personal or professional life (unlike premenstrual disorder) - Correct answer Premenstrual Dysphoric Disorder (PMDD) Which of the following factors is more indicative of premenstrual dysphoric disorder than premenstrual syndrome? A Missing work and school B Presence of symptoms for most of the preceding year C Symptom onset during the week before menses D Symptom onset in early 20s - Correct answer B!!! Missing work and school (A), can be seen in both PMS and PMDD. In PMS, patients may miss a day of work or school but do not lose their job or fail their classes. In PMDD the absence will cause more significant outcomes such as losing a job or failing a class. Symptom onset the week before menses (C), and symptom onset in a woman's early 20s (D) are characteristic of both premenstrual syndrome and premenstrual dysphoric disorder. first and second line tx for PMDD - Correct answer 1: relaxation techniques, SSRI 2: OCPs, gonadotropin-releasing hormone agonists How is the definitive diagnosis of endometriosis made? - Correct answer Biopsy is the only way to give a definitive diagnosis of endometriosis. factors associated with a(n) _______ risk of endometriosis:

multiple births extended intervals of lactation late menarche increased consumption of long-chain omega-3 fatty acids regular exercise - Correct answer DECREASED risk factors associated with a(n) _______ risk of endometriosis: Nulliparity Prolonged exposure to endogenous estrogen (early menarche or late menopause) shorter menstrual cycles Heavy menstrual bleeding obstruction of menstrual outflow (Mullerian anomalies) exposure to diethylstilbestrol in utero height greater than 68 inches lower BMI high consumption of trans unsaturated fat - Correct answer INCREASED risk Which of the following is associated with a decreased risk for endometriosis? A Avoiding oral contraceptives B Extended intervals of lactation C Increasing consumption of trans unsaturated fat D Maintaining a low body mass index - Correct answer B!!! Avoiding oral contraceptives (A) would not decrease the risk of endometriosis. Oral contraceptives can be used to treat the condition. Increasing consumption of trans unsaturated fats (C) will increase the risk of endometriosis. Maintaining a low body mass index (D) is also a risk factor for endometriosis. Painless vaginal bleeding

• Most often during the third trimester Diagnosis is made by ultrasound (transvaginal > transabdominal) Do not do a digital vaginal exam Delivery: cesarean section at 36 0/7-37 6/7 gestation - Correct answer Placenta Previa
• Women should avoid vaginal intercourse and strenuous exercise. Cesarean delivery is indicated in women with placenta previa to prevent severe hemorrhage. what sex is more associated with placenta previa - Correct answer male fetus risk factors for placenta previa - Correct answer prior c-section (previous uterine procedures), multiple gestations, multiple induced abortions, advanced maternal age previous placenta previa maternal smoking, cocaine use male fetus A 25-year-old G1P0 at 39 weeks' gestation has been admitted to the labor and delivery department. On admission, a digital cervical examination was performed. Which of the