Uworld Women's Health EOR Latest Update 2023

How to differentiate cervical insufficiency - ANSWER There is cramping but not pain with cervical insufficiency First step for patients with unexplained post menopausal bleeding - ANSWER Transvaginal ultrasound What endometrial thickness in a post menopausal women necessitates biopsy? - ANSWER 4 mm or greater First line treatment for acute heavy bleeding due to anovulation in a stable female - ANSWER HIgh dose estrogen combined contraceptives or IV conjugated estrogen to stabilize endometrial lining How do fibroadenoma symptoms and size change with menses? - ANSWER Both decrease after menses What size breast fibroadenoma may be reduced with surgery? - ANSWER 5 cm Major cuase of secondary dysmenorrhea? What is a major indication? - ANSWER Endometriosis Major indication: Non midline pain (Also onset after 25, lack of systemic symptoms) Patient with primary amenorrhea And no secondary sex characteristics: First step? - ANSWER Pelvic ultrasound to look for uterus Patient with primary amenorrhea, no secondary sex characteristics, and HAS a uterus: Next step? - ANSWER FSH to evaluate for pathological causes How does FSH help differentiate between central vs peripheral causes of amenorrhea - ANSWER Low/normal FSH= central High FSH= peripheral Patient with primary amenorrhea, no secondary sex characteristics, and DOES NOT have a uterus: Next step? - ANSWER Karyotype What ligament is involved in ovarian torsion? - ANSWER Infundibulopelvic ligament or suspensory ligament of the ovary Treatment for septic abortion with retention of products of conception - ANSWER Suction curettage with broad spectrum IV ABX like cefoxitin and doxycycline When is urinalysis obtained for pregnant woman? - ANSWER First prenatal visit When is glucose tolerance test done? - ANSWER 24-28 weeks Most common GDM screening - ANSWER 1 hour 50 g glucose tolerance followed by confirmation with a 100 g glucose 3 hour tolerance test. Woman gave birth 2 months ago and is breast feeding and has trichomoniasis. What next? - ANSWER 2 g Metronidazole once, discard breast milk for 24 hours then restart breastfeeding Q tip test - ANSWER test urethral hypermobility -insert cotton swab into urethral orifice -angle 30 deg on increased intraabdominal pressure What is active phase protraction - ANSWER Patients cervix is 6 cm dilated (Active phase) but has remained unchanged for 2 hours and is progressing less than 1 cm per every 2 hours meaning it is protracted. Most common cause of action phase protraction? - ANSWER Inadequate contraction What is the ideal contraction frequency for delivery? - ANSWER Contractions every 2-3 minutes Next step in management of action phase protraction - ANSWER Oxytocin administration Dilation range in active phase of labor? - ANSWER 6-10 cm 3 general characteristics of benign or normal fetal heart rate tracing - ANSWER Moderate variability +/- Early accelerations +/- Decelerations Woman in active labor with 4 hours of adequate contractions without cervical change is what? Next step? - ANSWER She is in phase arrest. Next step is C section Normal/predictable rate of cervical dilation in active phase of labor? - ANSWER 1 cm every 2 hours How can menarche cause heavy abnormal bleeding for the first few cycles? - ANSWER Immaturity of the hypothalamic ovarian pituitary axis fails to produce enough GnRH to produce adequate amounts of FSH and LH to induce ovulation. They result in anovulatory heavy, painless, irregular cycles. Treatment for heavy bleeding from anovulatory cycles - ANSWER Combined OCPs or progestin only How long must membranes be ruptured for patient to qualify for prophylactic ABX? - ANSWER 18 hours When is GBS swab done? - ANSWER 36-38 weeks Intrapartum prophylaxis for group B strep - ANSWER IV Penicillin How is post partum depression screened? - ANSWER With edinburgh postnatal depression score (EPDS) What size adenexal mass is a contraindication to methotrexate for ectopic pregnancy? - ANSWER 3.5 cm What B hcg level is a contraindication to methotrexate? - ANSWER 5000 How does uterus shape/appearance differ between uterine fibroids leiomyoma vs uterine adenomyosis - ANSWER Leiomyoma (Fibroids) make uterus irregularly enlarged Adenomyosis makes uterus diffusely enlarged. What is the greatest risk factor for PID reoccurrence? - ANSWER Multiple sexual partners Why do HIV positive patients need increased cervical cancer screening? - ANSWER Can allow cervical dysplasia to rapidly progress to cancer