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Flashcards in BC General OBGYN Deck (68)
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1

An 18 year old university student presents to your office suffering from severe dysmenorrhea. Menarche occurred at age 14. she has had incapacitating pain during the first 2 days of her period for the last 4 years. She describes the pain as crampy, radiating to her back. Pelvic examination is normal. Which one of the following is the best choice for treatment of this condition?


Danazol
Dilatation and curettage
Oral contraceptive pill
Doxycycline
Medroxyprogesterone (Depo-Provera)


NSAIDS is initial Tx but in this question OCP is best answer;
Oral Contraceptive Pill
(Approach to dysmennorhea)

2

A 21-year-old female presented with high fever, rash, vomiting and diarrhea. Her pulse is rapid and threaded, and her blood pressure 70/50 mmHg. A diffuse generalized macular rash is noted. which of the following culture specimens will most likely lead to the correct diagnosis?
 
  - cerebrospinal fluid
-cervicovaginal secretions
-stool
  -sputum
-urine

- Cervicovaginal Secretions

-Fever, low BP and Rash is key point for Toxic Shock Syndrome.

-Organism; Staph Aureus, Exotoxin

-Cloxacillin tx

3

9 weeks pregnant with a copper-containing intrauterine device. The string is visible on exam. Which one of the following would be the most appropriate management.
 
 -Remove IUD immediately.
-laparoscopy to rule out ectopic pregnancy.
-Cut the string in the endocervix, allowing IUD to retract as pregnancy develops.
- Remove the device if signs of infection develop
- Leave device alone as there is no risk to the fetus/mother

- Remove IUD in first trimester

4

A full term baby, delivered by vaginal delivery, is noted to have a large cephalohematoma.  His birth weight is 4800 g. Which one of the following maternal factors is most likely to have contributed to the baby's clinical condition?
 

A - diabetes mellitus
B - Maternal substance use
C - Maternal age and obesity
D- Graves disease
E - Preeclampsia

- Diabetes Mellitus

5

70-year-old woman has a protrusion into her anterior vagina. She has a long history of urinary stress incontinence. Which one of the following is the most likely diagnosis?
 
  Cystocele
enterocele
  urethral diverticulum
  uterine myoma
  rectocele

Cystocele

(approach to incontinence)

6

Metrorrhagia in a 14-year-old girl is most often associated with
 
  - Ovulatory cycles
  - anovulatory cycles.
  - coagulaltion disorders.
  - short follicular phase.
- luteal phase defect

Anovulatory Bleed

7

 
15-year-old woman has experienced severe dysmenorrhea since menarche at age 13.
Which one of the following interventions should you recommend?
 
 
 
  - reassurance
  - NSAIDS
- diagnostic laparoscopy
- oral contraceptives
- narcotic analgesics

NSAIDs

8

The most common complication of epidural anesthesia for obstetrics is
 
  hemorrhage.
  hypoventilation.
  hypotension.
  hyperventilation
  infection

Hypotension

9

A 30-year-old woman presents with a 10-month history of amenorrhea and hot flushes. She denies any symptoms of pregnancy and the uterus is of normal size. The most appropriate diagnostic test to support a diagnosis of premature ovarian failure is
 
  - Alpha fetoprotein and chromosome analysis
  - serum LH and FSH
  - medroxyprogesterone withdrawal test.
  - diagnostic laparoscopy.
  - serum estradiol

Serum LH and FSH

Age <40 consider premature ovarian failure

Causes; Autoimmune, radiation of ovaries

Choose FSH over LH

10

 
46 yo woman with right foot drop, post lithotomy position transvaginal Hysterectomy. Which nerve is most likely to have been injured during the procedure?
 
  -peroneal
  -sural
  -tibial
  -saphenous
  -femoral

Common personeal nerve

(foot drop = weak dorsiflexion)

11

At 20 weeks' gestation in a normal, singleton pregnancy, the fundus is usually
 
  -between the symphysis pubis and the umbilicus.
  -just above the symphysis pubis.
  -not palpable.
  -at or near the umbilicus.
  -4 to 6 cm above the umbilicus.

At or near the umbilicus

12

Menopause maybe associated with each of the following EXCEPT

  -vasomotor symptoms.
  -vaginal mucosa atrophy
  -urethral mucosa atrophy
- osteoporosis
-increase appetite

Increase Appetite

13

most common retinal change associated with pregnancy-induced hypertension is
 
  detachment.
  hemorrhage.
  exudates.
  spasm of arterioles.
  papilledema.

arteriole spasms

14

A 25-year-old multiparous woman is admitted to the delivery room at 31 weeks' gestation with a 1-hour history of vaginal bleeding. She has painful uterine contractions, with poor uterine relaxation. The most probable diagnosis is
 
  - blood-stained show.
  - vasa previa.
  - placenta previa.
  - abruptio placentae.
  - uterine rupture.

Abruptio Placenta

Painful Vag Bleeding (abruptio)

Painful Vag Bleeding (previa's)

15

35 year old recent immigrant to Canada presented in labor. She has had no prenatal care. You decide to give her anti-Rh Ig (RhoGam) to prevent which one of the following in subsequent pregnancies.
 
- T cell immune deficiency syndrome
 - neonatal lupus
 - hemolytic disease of the newborn
-  hypogammaglobulinemia
- immunodeficiency

Hemolytic Disease of the Newborn

Give rhogam if Rh- (i.e. O-)

if Rh -ve and Ab +ve then likely will have had rhogam already (get antibody titres to see what is actually happening)

16

27-year-old, 32 weeks pregnant comes to the office because she is concerned about feeling no fetal movements for the past two days. Which one of the following is the method of choice in assessing fetal death?
 
 persistent absence of fetal movements
 amniocentesis for examination of amniotic fluid
 real-time ultrasound assessment for cardiac motion
 change in positive serum pregnancy test to negative
abdominal x-ray examination of the fetus

'ANSWER: Ultrasound for cardiac Motion

Concepts;
Need to feel 6 mvmts in 2hrs after 26wk

17

28-year-old woman who is 38 weeks pregnant with her third child is having regular uterine contractions every two to five minutes. Which one of the following is the best criterion for assessing if she has entered the active phase of labour?
 
The contraction duration is over 30 seconds.
The presenting part is low in the pelvis.
The membranes are ruptured.
The cervix is effaced over 90%.
The cervical dilation is at least 4 cm.

ANSWER; Cervical Dilation is at least 4cm

Concepts; Stages of Labour
First Stage of labour (latent/active)
Latent; to 4cm
Active from 4cm to 10cm
Second Stage
delivery

18

60-year-old post menopausal presents with vaginal bleeding of one week duration. Which one of the following is the diagnostic method of choice?

- colposcopy  
- Pap smear
- Diagnostic laparoscopy
- endometrial biopsy
- dilatation and curretage

Endometrial Bx

Most likely Cause; atrophic Vaginitis

Need to R/o; endometrial ca

19

 35-year-old woman presents to the Emergency Department with a 6-hour history of intermittent severe crampy right lower quadrant pain. The patient is vomiting and is afebrile. There is a right adnexal tender mass on pelvic examination. The white blood cell count is 16 x 109/L per high power field; urinalysis is within normal limits; and the beta human chorionic gonadotropin (ß-HCG) is negative. The most probable diagnosis is
 
- right ovarian endometrioma.
- acute appendicitis.
- acute salpingitis.
- torsion of a right ovarian cyst.
- right pyelonephritis.

Torsion of R ovarian cyst.


Approach to Pelvic Masses


After 6h can lose ovary, pain out of proportion to physical findings.

20

40-year-old woman, gravida 2, para 2, complains of progressive secondary dysmenorrhea and menorrhagia.  Pelvic examination demonstrates a firm, diffuse symmetrically enlarged uterus  The most likely diagnosis
 
-Endometritis
-Adenomyosis
-Leiomyoma
-Endometriosis
-Uterine Sarcoma

Adenomyosis (glands and stroma implant in myometrium and cause symmetrical bulky uterus)

Leiomyoma; not symmetrically bulky
Endometriosis; not usually bulky and no increased bleeding. (implants to thorax; lungs)


Most common cause of primary dysmenorrhea
-Ovulatory

Most Common cause of secondary Dysmennorhea
- Endometriosis

21

 The current best management of a pregnant woman with a past history of herpes simplex genital infection on the inner labia minora?
 
-Cesarean section if lesions are present at time of labor.
-Cesarean section only if herpes culture positive.
-Elective cesarean section at 38 weeks in all cases.
-Daily application of topical acyclovir to site of previous lesions.
-CVaginal delivery in all cases.

CS if lesions present.


introduce suppression at 36wk

22

A 21-year-old asymptomatic woman is seen for routine examination.  You are able to palpate a 4-cm diameter right-sided cystic adnexal mass.  The appropriate management is
 
-trans-vaginal aspiration.
-gonadotropin-releasing --hormone (GnRH) agonist.
-laparoscopy.
-pelvic ultrasound examination
-reassessment in 1 month

Pelvic Ultrasound Exam


If it is a cyst and 6cm refer
If Cyst <6cm repeat in 6wk

23

Which of the following physiologic changes occurs during a normal pregnancy?

-hypertension
-metabolic alkalosis
-Hyperuricemia
-40% increase in the glomerular filtration rate (GFR)
-proteinuria

40% increase in the glomerular filtration rate (GFR)

OTHER;
- WBC can go up in 2nd trimester (usually not above 15)
-

24

Where does endometriosis implant outside of the pelvis?

Thorax; Pleura (causing pneumothorax, needs VAT)

25

When do you introduce suppressive therapy in HSV

36wk gestation

26

Oligohydramnios is associated with which one of the following fetal conditions?
 
- talipes equinovarus (club foot)
- Down syndrome
- fetal erythroblastosis
- tracheo-esophageal fistula
- anencephaly

Club Foot

Most common cause; Renal Agenesis


If <5cm AFI = oligohydramnios
If >25cm AFI = polyhydramnios

Single deep pocket <2cm = oligohydramnios
Single deep pocket >8cm = polyhydramnios

27

 
A 72-year-old woman complains of a lump protruding through the vagina with local pressure symptoms.  On examination, there is a visible uterine prolapse.  All of the following may be etiologic factors, EXCEPT

-history of large babies.
-postmenopausal status.
-stress urinary incontinence.
-chronic smoking.
-multiparity.

Stress Urinary Incontinence

Other;

28

30-year-old woman with regular menses presents with a 18 months history of primary infertility. Her husband has fathered two children from a previous marriage. A history of possible pelvic inflammatory disease. Temperature graphs are compatible with ovulatory cycles. Pelvic examination N. The most important further investigation would be

- endometrial biopsy.
- hysterosalpingogram.
- lupus anticoagulant.
- semen analysis.
- postcoital test.

Hysterosalpingogram

29

38-year-old woman gravida 3, with 2 healthy twins presented 30 week to the obstetric unit with onset of painless vaginal bleeding two hours ago, accompanied by passage of significant blood and clots. Fetal heart rate is regular at 150 beats/minute. She is having no uterine contractions. Which one of the following is the most likely diagnosis?

- vasa previa
- disseminated intravascular coagulation
- abruptio placentae
- placenta previa
- bloody show

Placenta Previa

CONCEPT
>37wk Term
<37wk Preterm
N fetal HR 110 - 160

Vasa Previa; Vilamentous insertion of the cord

30

 A 32-year-old pregnant woman develops sudden onset of dyspnea and tachycardia.  Which one of the following is the most likely explanation?

-acute mitral valve regurgitation
-myocardial infarction
-lobar pneumonia
-pulmonary embolism
-acute respiratory distress syndrome

PE