Ob/gyn: APGO, UWorld, PreTest +
Vignettes (Answered)
****
MGMT of abnormal Pap smear (low-grade) in a young healthy woman (21-24 yo)
-Repeat cytology in 12 months
-Repeat colposcopy in 12 months
-Refer to oncology
Management of abnormal Pap smear (High-grade) in a young healthy woman
-Repeat cytology or high-risk HPV
-Colposcopy
Cytology alone and 12 months
Colposcopy!!!
♻♻♻♻♻
All sexually active women <25 y/o get worked up for these two STI's
Chlamydia & gonorrhea
Screening recs for women b/t the ages of 30 to 65 regarding HPV and cytology
testing
HPV + cytology ("co-testing") every 5 years (preferred)
FYI: cytology alone every 3 years
*****
♻♻♻♻♻
Lower abd pain, Adnexal tenderness, fever, friable cervix, cervical motion
tenderness, mucopurulent vaginal discharge, n/v
Micro?
PID!
Micro - chlamydia & gonorrhea;
but also Bacteroides & E. coli
♻♻♻♻♻
Macular rash on trunk that extends to the palms and soles
Syphilis > Obtain a treponemal-specific test
yellow discharge - what to look for?
♻♻♻♻♻♻♻
tx?
Trichomoniasis - motile protozoa on saline wet mount
Tx - metronidazole PO both partners
Gold standard for dx herpes
,Cx
FYI: 10-20% false negative rate
*****
♻♻♻
21 y/o screening
♻♻♻
40 age group screenings
♻♻♻
50 age group screenings
♻♻♻
65
Cervical CA screen
MAMMOGRAM annually
COLONOSCOPY q10y
DEXA scan for osteoporosis
--> FYI: if fam hx (<60 yo), then screen at 40, or 10 years before the youngest relative
dx + repeat 15y
♻♻♻♻♻
Most effective methods of birth control?
2nd?
3rd?
Nexplanon (levonorgestrel dermal implant) 0.1%
Depot shot (medroxyprogesterone acetate) 0.3%
OCPs 0.5% (but need to account user error)
Vaccines C/I in pregnancy
MMR
FYI: but recommended immediately postpartum!
#1 proactive lifestyle change for pt. w/FamHx of heart disease
Exercise / physical activity
*****
Suspected PCOS (irregular menses, acanthosis nigricans, clit enlargement, deep
voice) mgmt
-DM screen
-Lipid profile
-Pelvic U/S
acanthosis nigricans = insulin resistance
hence, DIABEETUS
,(Insulin resistance + chronic anovulation are hallmarks of PCOS)
A vegetarian pt. who is wanting to get pregnant should be prescribed
FOLATE / folic acid suppl
♻♻♻
Strongest predictor of osteoporosis
-Female gender
-FamHx
Best PPx?
FamHx
Weight-bearing exercise 3-4x/wk
(wouldn't hurt: 1,000 mg Ca2+; 600IU Vit D daily if not in the sun 20 mins daily)
Pregnancy-related decr. Hg w/normal MCV
Relative hemodilution of pregnancy
♻♻♻
Pregnancy-related SOB + incr. WOB
Mgmt?
Physiologic dyspnea of pregnancy;
just normal prenatal care b/c this is normal
FYI: code for PE is tachycardia, tachypnea, hypoxia, chest pain, signs of DVT
FYI: code for MS is diastolic murmur, signs of HF
♻♻♻♻♻
MGMT of pulmonary edema (difficulty breathing, cough, frothy sputum; in
distress; bibasilar crackles) in pregnancy
BONUS: pulm edema is a complication of which condition?
Adm 20 mg Lasix IV
BONUS: pre-eclampsia
Pyelonephrosis (flank pain, leukocytosis) during pregnancy. MGMT?
Hydronephrosis (b/l renal enlargement w/dilated renal pelvices + proximal
ureters)
Inc. progesterone affects SM (relaxation), which contributes to dilation of renal collecting
system & as uterus rises out of pelvis, it rests on the ureters, compressing + dilating
them
Inpatient IV abx
Hydronephrosis has same etiology (incr. progesterone) + is physiologic during
pregnancy, requiring no additional mgmt
Labs used to dx sickle cells?
, Hg electrophoresis AND CBC
(not sickle cell prep)
Most common disease among Caucasians
Cystic fibrosis
*****
Teratogenic effects of valproate
neural tube defects (due to inhibition of maternal folate absorption)
Uncontrolled DM (+HTN) in pregnancy can cause ___________
Bonus: Labs/tests to monitor the infant for? (2)
Cardiac anomalies + fetal growth restriction;
HYPOglycemia (due to hyperinsulinemia)
//polycythemia, hyperbili, hypocalcemia, NRDS
Doppler (DM is a vascular disease and can cause chronic prenatal vasoconstriction +
ischemia w/resultant ♻uteroplacental insufficiency♻)
Most common form in inherited intellectual disability
Fragile X
preconception counseling for pt on lamotrigine
Folate suppl
After establishing gestational age using LMP, what is done to confirm gestational
age?
U/S!
FYI: An u/s performed b/t 14 and 15 6/7 weeks gestation should be used to revise the
due date if there is greater than a 7-day discrepancy
♻♻♻
Most effective screening for Down Synd?
Cell-free DNA screen
*****
♻♻♻♻♻♻♻
Next step in mgmt after elevated AFP
U/S
(rationale: can detect multiple gestations, determine accurate gestational age +
visualize fetal CNS structures)
*****
♻♻♻♻♻
Next step in mgmt after nuchal translucency
Amniocentesis
♻♻♻
Anticoag during pregnancy
LMWH, not warfarin
How is GBS screened + treated?
Screen by collecting rectovaginal cx @ 36-38 wks (i.e. near anticipated delivery), unless
empirically high risk like prior neonatal sepsis
Treat w/abx DURING labor
Vignettes (Answered)
****
MGMT of abnormal Pap smear (low-grade) in a young healthy woman (21-24 yo)
-Repeat cytology in 12 months
-Repeat colposcopy in 12 months
-Refer to oncology
Management of abnormal Pap smear (High-grade) in a young healthy woman
-Repeat cytology or high-risk HPV
-Colposcopy
Cytology alone and 12 months
Colposcopy!!!
♻♻♻♻♻
All sexually active women <25 y/o get worked up for these two STI's
Chlamydia & gonorrhea
Screening recs for women b/t the ages of 30 to 65 regarding HPV and cytology
testing
HPV + cytology ("co-testing") every 5 years (preferred)
FYI: cytology alone every 3 years
*****
♻♻♻♻♻
Lower abd pain, Adnexal tenderness, fever, friable cervix, cervical motion
tenderness, mucopurulent vaginal discharge, n/v
Micro?
PID!
Micro - chlamydia & gonorrhea;
but also Bacteroides & E. coli
♻♻♻♻♻
Macular rash on trunk that extends to the palms and soles
Syphilis > Obtain a treponemal-specific test
yellow discharge - what to look for?
♻♻♻♻♻♻♻
tx?
Trichomoniasis - motile protozoa on saline wet mount
Tx - metronidazole PO both partners
Gold standard for dx herpes
,Cx
FYI: 10-20% false negative rate
*****
♻♻♻
21 y/o screening
♻♻♻
40 age group screenings
♻♻♻
50 age group screenings
♻♻♻
65
Cervical CA screen
MAMMOGRAM annually
COLONOSCOPY q10y
DEXA scan for osteoporosis
--> FYI: if fam hx (<60 yo), then screen at 40, or 10 years before the youngest relative
dx + repeat 15y
♻♻♻♻♻
Most effective methods of birth control?
2nd?
3rd?
Nexplanon (levonorgestrel dermal implant) 0.1%
Depot shot (medroxyprogesterone acetate) 0.3%
OCPs 0.5% (but need to account user error)
Vaccines C/I in pregnancy
MMR
FYI: but recommended immediately postpartum!
#1 proactive lifestyle change for pt. w/FamHx of heart disease
Exercise / physical activity
*****
Suspected PCOS (irregular menses, acanthosis nigricans, clit enlargement, deep
voice) mgmt
-DM screen
-Lipid profile
-Pelvic U/S
acanthosis nigricans = insulin resistance
hence, DIABEETUS
,(Insulin resistance + chronic anovulation are hallmarks of PCOS)
A vegetarian pt. who is wanting to get pregnant should be prescribed
FOLATE / folic acid suppl
♻♻♻
Strongest predictor of osteoporosis
-Female gender
-FamHx
Best PPx?
FamHx
Weight-bearing exercise 3-4x/wk
(wouldn't hurt: 1,000 mg Ca2+; 600IU Vit D daily if not in the sun 20 mins daily)
Pregnancy-related decr. Hg w/normal MCV
Relative hemodilution of pregnancy
♻♻♻
Pregnancy-related SOB + incr. WOB
Mgmt?
Physiologic dyspnea of pregnancy;
just normal prenatal care b/c this is normal
FYI: code for PE is tachycardia, tachypnea, hypoxia, chest pain, signs of DVT
FYI: code for MS is diastolic murmur, signs of HF
♻♻♻♻♻
MGMT of pulmonary edema (difficulty breathing, cough, frothy sputum; in
distress; bibasilar crackles) in pregnancy
BONUS: pulm edema is a complication of which condition?
Adm 20 mg Lasix IV
BONUS: pre-eclampsia
Pyelonephrosis (flank pain, leukocytosis) during pregnancy. MGMT?
Hydronephrosis (b/l renal enlargement w/dilated renal pelvices + proximal
ureters)
Inc. progesterone affects SM (relaxation), which contributes to dilation of renal collecting
system & as uterus rises out of pelvis, it rests on the ureters, compressing + dilating
them
Inpatient IV abx
Hydronephrosis has same etiology (incr. progesterone) + is physiologic during
pregnancy, requiring no additional mgmt
Labs used to dx sickle cells?
, Hg electrophoresis AND CBC
(not sickle cell prep)
Most common disease among Caucasians
Cystic fibrosis
*****
Teratogenic effects of valproate
neural tube defects (due to inhibition of maternal folate absorption)
Uncontrolled DM (+HTN) in pregnancy can cause ___________
Bonus: Labs/tests to monitor the infant for? (2)
Cardiac anomalies + fetal growth restriction;
HYPOglycemia (due to hyperinsulinemia)
//polycythemia, hyperbili, hypocalcemia, NRDS
Doppler (DM is a vascular disease and can cause chronic prenatal vasoconstriction +
ischemia w/resultant ♻uteroplacental insufficiency♻)
Most common form in inherited intellectual disability
Fragile X
preconception counseling for pt on lamotrigine
Folate suppl
After establishing gestational age using LMP, what is done to confirm gestational
age?
U/S!
FYI: An u/s performed b/t 14 and 15 6/7 weeks gestation should be used to revise the
due date if there is greater than a 7-day discrepancy
♻♻♻
Most effective screening for Down Synd?
Cell-free DNA screen
*****
♻♻♻♻♻♻♻
Next step in mgmt after elevated AFP
U/S
(rationale: can detect multiple gestations, determine accurate gestational age +
visualize fetal CNS structures)
*****
♻♻♻♻♻
Next step in mgmt after nuchal translucency
Amniocentesis
♻♻♻
Anticoag during pregnancy
LMWH, not warfarin
How is GBS screened + treated?
Screen by collecting rectovaginal cx @ 36-38 wks (i.e. near anticipated delivery), unless
empirically high risk like prior neonatal sepsis
Treat w/abx DURING labor
