Flashcards in BC General OBGYN Deck (68):
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?
Dilatation and curettage
Oral contraceptive pill
NSAIDS is initial Tx but in this question OCP is best answer;
Oral Contraceptive Pill
(Approach to dysmennorhea)
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
-Fever, low BP and Rash is key point for Toxic Shock Syndrome.
-Organism; Staph Aureus, Exotoxin
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
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
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?
(approach to incontinence)
Metrorrhagia in a 14-year-old girl is most often associated with
- Ovulatory cycles
- anovulatory cycles.
- coagulaltion disorders.
- short follicular phase.
- luteal phase defect
15-year-old woman has experienced severe dysmenorrhea since menarche at age 13.
Which one of the following interventions should you recommend?
- diagnostic laparoscopy
- oral contraceptives
- narcotic analgesics
The most common complication of epidural anesthesia for obstetrics is
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
46 yo woman with right foot drop, post lithotomy position transvaginal Hysterectomy. Which nerve is most likely to have been injured during the procedure?
Common personeal nerve
(foot drop = weak dorsiflexion)
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.
-at or near the umbilicus.
-4 to 6 cm above the umbilicus.
At or near the umbilicus
Menopause maybe associated with each of the following EXCEPT
-vaginal mucosa atrophy
-urethral mucosa atrophy
most common retinal change associated with pregnancy-induced hypertension is
spasm of arterioles.
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.
Painful Vag Bleeding (abruptio)
Painful Vag Bleeding (previa's)
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
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)
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
Need to feel 6 mvmts in 2hrs after 26wk
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
60-year-old post menopausal presents with vaginal bleeding of one week duration. Which one of the following is the diagnostic method of choice?
- Pap smear
- Diagnostic laparoscopy
- endometrial biopsy
- dilatation and curretage
Most likely Cause; atrophic Vaginitis
Need to R/o; endometrial ca
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.
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
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
Most Common cause of secondary Dysmennorhea
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
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
-gonadotropin-releasing --hormone (GnRH) agonist.
-pelvic ultrasound examination
-reassessment in 1 month
Pelvic Ultrasound Exam
If it is a cyst and 6cm refer
If Cyst <6cm repeat in 6wk
Which of the following physiologic changes occurs during a normal pregnancy?
-40% increase in the glomerular filtration rate (GFR)
40% increase in the glomerular filtration rate (GFR)
- WBC can go up in 2nd trimester (usually not above 15)
Where does endometriosis implant outside of the pelvis?
Thorax; Pleura (causing pneumothorax, needs VAT)
When do you introduce suppressive therapy in HSV
Oligohydramnios is associated with which one of the following fetal conditions?
- talipes equinovarus (club foot)
- Down syndrome
- fetal erythroblastosis
- tracheo-esophageal fistula
Most common cause; Renal Agenesis
If <5cm AFI = oligohydramnios
If >25cm AFI = polyhydramnios
Single deep pocket <2cm = oligohydramnios
Single deep pocket >8cm = polyhydramnios
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.
-stress urinary incontinence.
Stress Urinary Incontinence
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.
- lupus anticoagulant.
- semen analysis.
- postcoital test.
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
N fetal HR 110 - 160
Vasa Previa; Vilamentous insertion of the cord
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
-acute respiratory distress syndrome
A 56-year-old patient is complaining of hot flushes, sweating, and sleep disturbance. Refuses HRT. Wants Herbal. Which one of the following natural products is most likely to help her symptoms?
-Evening primrose oil
Evening Primrose Oil
A 43-year-old woman with a family history of osteoporosis seeks counseling. Which statement is true regarding an increased risk of osteoporosis?
-women with regular physical exercise
-white women with a late menopause
-black women with a late menopause
-white women with larger bone mass
-women with history of cigarette smoking
Women with hx of cig smoking.
which one of the following nerve blocks is recommended for pain control in labor, for women who decline epidural?
-inferior gluteal nerve
-pelvic sympathetic nerve
-pelvic splanchnic nerve
Causes of female stress incontinence include all of the following EXCEPT
-trauma from repeated deliveries.
-weakness of the urethral supports.
Weakness of urethral support
27 year old nulligravid woman with epilepsy comes for pre-conceptional counselling. She is taking phenytoin and carbamazepine and has been five weeks seizure-free. What advice should you give her?
-The risk of anomalies exceeds that of untreated epilepsy if she continues her medication.
- The benefits of the drugs outweigh the risks, and pregnancy may be attempted.
- The fetal hydantoin syndrome is mostly familial
- There is no significant increased risk of anomalies.
- She needs anticonvulsants and should therefore not undertake pregnancy.
The benefits of the drugs outweigh the risks, and pregnancy may be attempted.
A 27-year-old woman gravida 2 presented at 6 weeks of pregnancy . She has a history of DVT and PE 6 years ago during her first pregnancy. She was treated with intravenous heparin followed by several months of oral warfarin and has had no recurrence since. Which of the following statements about her current condition is true?
-Doppler ultrasonography is not a useful to evaluate her for deep venous thrombosis in pregnancy.
- Her risk of thromboembolism is not greater than normal
- she should be placed on low-dose heparin therapy throughout her pregnancy and postpartum period
- She is at highest risk for recurrent thromboembolism during the second trimester of pregnancy.
- Impedance plethysmography is not useful to evaluate her for deep venous thrombosis in pregnancy.
She should be placed on low-dose heparin therapy throughout her pregnancy and postpartum period
39-year-old mother of five who is currently 5 weeks pregnant and has had one previous abortion and one previous twin gestation. Which one of the following is her gravidity and parity?
gravida 6, para 4
gravida 4, para 4
gravida 5, para 4
gravida 5, para 3
gravida 6, para 3
Gravida 6 Para 4
What is the biggest RF for infertility?
multiple sexual partners (PID)
Which one of the following hormones is responsible for the proliferation of the milk ducts during pregnancy?
-human placental lactogen
-human chorionic gonadotropin
32-year-old physician presents with a long standing history of irregular menstrual periods associated with severe pelvic pain and menorrhagia. She has also been experiencing dyspareunia and pain during defecation. Which one of the following is most likely to assist you in diagnosing this patient's condition?
-Culdocentesis during menses
Most common cause of secondary dysmennorhia; endometriosis
A 39 year old at 18 weeks gestation is diagnosed as having an intrauterine fetal demise. She returns to your office 5 weeks later and has not had a miscarriage, although she has had some occasional spotting. This patient is at increased risk for which of the following?
-Consumptive coagulopathy with hypofibrinogenemia
Consumptive coagulopathy with hypofibringenemia
The ovarian lesion most likely to undergo torsion is
- an endometrial cyst.
- a dermoid cyst.
- a papillary serous cystadenocarcinoma.
- an inflammatory cyst.
- a papillary pseudomucinous cystadenoma.
A 25 year old woman is diagnosed with endometriosis. Which one of the following is the commonest site of this disease outside of the pelvis?
- Gastrointestinal tract
You have a 57 year old patient who is complaining a vasomotor and vulvovaginal symptoms associated with menopause. There is a family history of both dementia and cardiovascular disease. Which one of the following will hormone replacement therapy prevent?
-Vulvovaginal and Vasomotor symptoms
Vulvovaginal and Vasomotor Sx
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 2 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?
Dilatation and curettage
Oral contraceptive pill
A 17 year old female presents with pain and swelling of her right knee and no other symptoms. X ray shows joint effusion. She has been sexually active since she was 15 and is seeing a gynecologist for follow up of cervical dysplasia. Rheumatoid factor was negative. Which one of the following is the most likely diagnosis?
Systemic lupus erythematosus
if pustular lesions still pick gonococcal.
A 17 year old woman with twin pregnancy is referred to your practice at 18 weeks of gestation. Which one of the following complications is most likely to occur in this patient?
Deep venous thrombosis
(both previa and PIH are more common in twin pregnancies)
29 year old woman presents with cauliflower like lesions of the external genitalia, vagina and cervix. They are between 1 and 5 mm in diameter, discrete and nontender. The lesions are most likely caused by which one of the following?
(HPV 18 causes cervical cancer more than 16)
A 25 year old woman has tried unsuccessfully for 5 months to become pregnant. which one of the following would you recommend at this time?
Counselling and reassurance
33 year primigravida presents at 34 weeks gestational age with blood pressure of 160/90 mmHg, headache, epigastric pain, visual abnormalities and 3 proteinuria. Biophysical profile of the fetus is 8/8. Which one of the following is the best course of action?
-Induced labour and attempt vaginal delivery
-Give betaclomethasone to induce fetal lung maturity
-Perform an emergency C-section
-Perform an amniocentesis to assess fetal lung maturity
-Start magnesium sulfate intravenously.
Emergency C/S is BEST
Mag sulf is initial
-HA, blurry vision, epigastric pain, HELLP
Low to normal FSH are found in patients with
-Pure gonadal dysgenesis
-Premature ovarian failure
-Resistant ovary syndrome
-Previous pelvic radiotherapy for Hodgkin's lymphoma
Hypothalamic amenorrhea will give you a low FSH. Causes of hypothalamic amenorrhea; stress, anorexia
27 year old Caucasian female, gravida 3 para 3, had a tubal cautery via laparoscopy. 36 hr later surgery she complains of abdominal pain and nausea, has a temperature 38.6 C, and has a somewhat distended abdomen. Which of the following is the most probable diagnosis?
-Hemorrhage from the tube
29 year old woman is currently 8 weeks pregnant. She is HBsAg positive and is concerned about the risk of transmission to the baby. Which one of the following is the most appropriate course to follow?
-C section at term
-Immediate termination of pregnancy
-Administer Hepatitis B vaccine to the baby at birth
-Administer passive immunization to the baby followed by Hep B vaccine at birth.
Administer passive immunization (immunoglobulin) to the baby followed by Hep B vaccine at birth. (and Hep B and 1/6 months)
HbsAg = positive person
When baby is born give immunoglobulin and vaccine at delivery and vaccine at 1 month and 6 months
Fetal ultrasonography at 13 weeks gestation reveals a cystic hygroma of the neck. Which one the following karyotypes is most likely?
Turners Syndrome = XO
Cystic Hydroma = Turners syndrome
27 year old woman in her first trimester of pregnancy is diagnosed as having deep venous thrombosis in her left lower extremity. Which one of the following is the most appropriate therapy?
Cannot use NOACs in pregnancy
A 29 year old woman presents in labor at 40 weeks of gestation. Upon artificial membrane rupture. There are a several milliters of blood in addition to the amniotic fluid. Within minutes, fetal tachycardia develops. There is no change in the contraction pattern or in maternal discomfort. Which one of the following is the most likely diagnosis?
-Marginal sinus bleeding
-Rupture of cervical varix
Painless bleeding >20wk (previa's)
Which one of the following is the most common cause of asymptomatic vaginal ulceration or erosion?
-Toxic epidermal necrolysis
Tampons vs BV
22 year old woman in her first trimester of the pregnancy develops a urinary tract infection. Which one of the following antibiotics would be best to prescribe in this situation?
A 27 year old woman who is 15 weeks pregnant with her first child presents to the office with exquisitely painful, blister-like lesions on her labia. She had similar episodes before pregnancy. Her temperature is normal. Which one of following statements about her pregnancy is TRUE?
Transplacental transmission to her fetus is a significant concern
She should undergo cesarean section to protect her infant from infection
Her fetus has an increased risk of congenital malformations
Breast-feeding of her infant is probably unsafe.
Decisions regarding route of delivery are best made at onset of labour.
Decisions regarding route of delivery are best made at onset of labour.
Suppression at 36wk or C/S if lesions present
CONCEPT; Approach to genital ulcer
- HPV (cauliflower Lesion)
(trep Pallidum; chancre, dark field microscropy; spirochetes, single lesion), incubation period for primary syphillis is 45 weeks, secondary syphillis incub period
Chancroid (haemophylis ducryei)
In screening for cervical neoplasia, which one of the following statements about the papnicolau test is correct?
-It is not necessary following hysterectomy
-It has a low false negative rate
-It should always include an endocervical component
-It should not cause cervical bleeding
-It is best done in the premenstrual phase of the cycle.
It is best done in the premenstrual phase of the cycle.
Which factor brings the most increased risk for ectopic pregnancy?
Intrauterine device (IUD) in place
Tubal ligation in the last two years
Stage 1 endometriosis proven by laparoscopy
History of pelvic inflammatory disease (PID)
History of diethylstillbestrol (DES) exposure in utero
History of pelvic inflammatory disease (PID) (40 - 50%)
Which one of the following is the most important risk factor for maternal death?
Advanced maternal age
Age at first pregnancy
Previous caesarean section
Advanced Maternal Age
27 year old woman complains of light vaginal spotting for 6 days. Although her menstrual cycles occur normally every 28 days, she states that her last menstrual period was 7 weeks ago, she has noted breast tenderness, nausea and some left lower quadrant abdominal discomfort. On pelvic examination, the uterus is noted to be soft, slightly enlarged and the adnexae are palpably normal. Serum human chorionic gonadotropin is 6,800 units. Vaginal ultrasound reveals no intrauterine gestational sac. The most diagnosis is
-Implantation bleeding and inaccurate pregnancy dating.
Implantation bleeding and inaccurate pregnancy dating.
BHcg Level for Intrauterine Preg is:
- Transvag US 1500
- Transabdo US 6500
A 22 year old woman presents with 7.5 hour history of right lower quadrant pain of sudden onset. The pain is continuous in character. At the time of being seen, she also has pain in the right shoulder. From this history alone, which one of the following is the most likely diagnosis?
-Rupture ovarian cyst
-Rupture ectopic pregnancy
Kehr Sign; Shoulder pain/ belly pain (irritated diaphragm)
38 year old woman at 38 weeks gestation reports that her fetus has not moved for almost 22 hours. Which of the following would be the most appropriate action at this time?
-Immediate caesarean delivery
-Oxytocin stress test
-Immediate induction of labour with oxytocin
- Reassurance, with instructions to return the next day
A 25-year-old G 2, A1 at 14 weeks' gestation is Rh negative and, anti-D antibodies are identified. What is the appropriate next step?
-Initial serial obstetric ultrasound assessments
-Asses the antibody titer
-Reassess her is 4 weeks
-Refer her for serial aminiocentesis
-Give her 300 units of Rh immune globulin intramuscularly
Assess Antibody Titre
Test to see if maternal fetal hemorrhage
The best plan of management of a pregnant woman with a past history of herpes simplex genital infection is
-Cervical culture at 2 wks interval from week 22
-Observe for lesions at the time of labor
-Elective caesarean section
-Prophylactic topical acyclovir
Observe for lesions at time of labour