Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
USMLE 2 ogbyn 2
USMLE done
| Question | Answer |
|---|---|
| Green, bilateral discharge in a 22-year-old woman without other abnormal findings is highly suggestive of a physiological discharge. | physiological nipple discharge due to nipple stimulation, - common condition in women of reproductive age. |
| What is the most common cause of bloody nipple discharge? | Intraductal papilloma - unilateral bloody nipple discharge. -mass palpable close to nipple or may not be palpable - u/s finding of a dilated duct enclosing a well-defined solitary mass - core needle biopsy to confirm diagnosis, rule out malignancy |
| mobile mass in a 29-year-old woman without any mastalgia, changes in skin over the breast, or axillary lymphadenopathy | Fibroadenoma - A benign estrogen-dependent breast tumor - An ultrasound of the breast would likely show a well-defined mass with generally uniform hypoechogenicity. - monitor with u/s / mammogram - u/s guided biopsy if it enlarges |
| 45-year-old pt has rapidly growing 5-cm breast mass without any mastalgia, skin/nipple changes, or lymphadenopathy. mammogram shows polylobulated mass, and the biopsy shows papillary projection (leaf-like microarchitecture.) | Phyllodes tumor - ultrasonography and/or mammography, as well as core biopsy are indicated. - surgical excision with wide margins |
| A well-circumscribed, anechoic mass with posterior acoustic enhancement in a premenopausal woman suggests | simple cyst -, pts who are symptomatic, should undergo fine needle aspiration (diagnostic & therapeutic) - pt should be re-evaluated after 4–6 weeks for potential recurrence. |
| pt presents with a tender, firm, swollen, erythematous breast, pain during breastfeeding, fever, and malaise. These symptoms started 2–4 weeks after birth, which suggests | mastitis. Rx; dicloxacillin or cephalexin, which are also safe during breastfeeding. - continue breast feeding |
| presence of oil cysts on mammography is usually pathognomonic for | fat necrosis of the breast, - Ultrasonography would also show oil cysts. -a biopsy should be done to confirm the diagnosis -Biopsy findings of foam cells and multinucleated giant cells - reassure pt |
| Rh(D) negative mother who has previously given birth to an Rh(D) positive baby or who has otherwise been exposed to Rh(D) positive red blood cells is at risk for developing anti-D antibodies. | Rh(D) positive fetuses of these mothers are in turn at risk for developing hemolytic disease of the fetus and newborn (HDFN). Therefore, prophylactic measures must be taken to protect the fetus of this particular patient. |
| Rh(D) negative mother who has previously given birth to an Rh(D) positive baby or who has otherwise been exposed to Rh(D) positive red blood cells is at risk for developing anti-D antibodies. | If the first anti-D screen shows mother is unsensitized, repeat screening between 24 & 28 weeks' , unless the father of the baby is Rh(D) negative.. If the anti-D screen remains negative, anti-D immunoglobulin should be administered in the 28 week' |
| All pregnant women should receive a single dose of Tdap between the 27th and 36th week of pregnancy. | protects; - the mother from puerperal tetanus - the neonate from pertussis, diphtheria, and neonatal tetanus |
| pt in reproductive age, sexually active, uses oral contraceptive pills inconsistently. menstrual period is late by 2 weeks. acute onset of abdominal pain, right adnexal tenderness & signs of shock (diaphoresis, tachycardia, tachypnea, and hypotension) | a ruptured ectopic pregnancy, resulting in hemorrhagic shock. pt in hypovolemic from intraperitoneal hemorrhage Rx; stabilize with fluid resuscitation; normal saline/lactated Ringer's solution . prepare for surgery |
| maternal use of anticonvulsants, | Fetal hydantoin syndrome collection of congenital defects; -intrauterine growth restriction, -microcephaly, -craniofacial deformities, -nail hypoplasia, -mental retardation. |
| screening method has the highest detection rate for Down syndrome. | Cell-free DNA (cfDNA) testing - safe and can be done early -**chorionic villus sampling should be performed for a definitive diagnosis between 10–13 weeks of gestation. |
| quadruple marker test | performed at 15–18 weeks' gestation |
| HIV post-exposure prophylaxis in newborn | Zidovudine with either lamivudine and nevirapine, or nevirapine if the maternal viral load is > 1,000 copies/mL near time of deliver |
| HIV post-exposure prophylaxis in newborn with mother's viral load is ≥ 50 copies/mL, | (zidovudine and nevirapine) or (zidovudine, lamivudine, and nevirapine or raltegravir) |
| HIV post-exposure prophylaxis in newborn with mothers with a viral load < 50 copies/mL | Zidovudine |
| During pregnancy, | progesterone indirectly > minute ventilation -- slightly higher pO2 & slightly lower pCO2 -- renal acidification. > plasma volume -- cardiac output -- > glomerular filtration rate -- < urea, creatinine |
| To screen for gestational diabetes mellitus, | 50-g, 1-hour oral glucose challenge test - for every pregnant woman at 24–28 weeks' gestation - earlier in obese women - ≥ 140 mg/dL is +ve +ve screening test should be followed by a diagnostic 100-g, 3-hr oral glucose tolerance test. |
| a screening test for GBS should be performed | in all pregnant women between; 36 0/7 and 37 6/7 weeks of gestation |
| After positive β-hCG testing, the location of the fertilized egg should be confirmed via vaginal ultrasound | serum β-hCG must be > 1,500–2,000 mlU/mL to reliably determine an intrauterine pregnancy via this method |
| second-trimester screening test (quadruple test), the combination of ↑ human chorionic gonadotropin (hCG), ↑ inhibin A, ↓ unconjugated estriol, and ↓ alpha-fetoprotein (AFP) indicates that the fetus may have Down syndrome. | Amniocentesis to confirm diagnosis -performed from 15 weeks' of gestation onward |
| Valproic acid intake is known to inhibit folate absorption in the mother. | increased risk of neural tube defects such as spina bifida , which may require lower spinal surgery after birth. |
| . Valproic acid AVR | cognitive impairment, facial, cardiovascular (e.g., ASD), and skeletal abnormalities (e.g., polydactyly), |
| lithium AVR | Ebstein anomaly |
| Common peroneal nerve injury | “Obstetric nerve injuries - high-stepping gait, weakness of foot eversion and dorsiflexion, - decreased sensation in the anterolateral aspect of the leg and dorsum of the foot |
| Decelerations occurring in ≥ 50 % of uterine contractions in a 20-minute time period are known as recurrent variable decelerations and are indicative of ? | umbilical cord compression |
| umbilical cord compression management | - Initial management consists of maternal repositioning to ease compression of the umbilical cord - administration of oxygen and IV fluids to improve blood flow to the fetus. -, amnioinfusion is indicated if initial resuscitative measures fail |
| If uterine tachysystole (> 5 contractions in a period of 10 minutes) is present in umbilical cord compression | terbutaline (a tocolytic) should also be considered. |
| True labor is marked by the onset of regular contractions that > in frequency, duration, & intensity. with progressive cervical dilation & descent of the fetal presenting part. | True labor is also commonly preceded by bloody show. |
| Arborization or ferning is indicative of the presence of amniotic fluid, confirming premature rupture of membranes (PROM). | risk factors; - ascending infection and cigarette smoking. Complications; - chorioamnionitis - placental abruption, - umbilical cord prolapse. |
| After rupture of membranes, > 4 hours of adequate uterine contractions and failure of the cervix to dilate past 7 cm indicates? | - arrest of labor in the first stage. - Cesarean delivery is indicated |
| pt is in preterm labor. One of the measures that has to be taken now is prophylaxis against cerebral palsy. | Magnesium sulfate - tocolytic agent given to pts < 32 wks -can be administered in combination with another tocolytic agent (terbutaline) - delay preterm labor for up to 48 hours - also has a fetal neuroprotective effect |
| pt with preterm premature rupture of membranes (PPROM), is diagnosed by detection of clear fluid in the cervix and vagina on sterile speculum examination. A positive nitrazine test confirms the presence of amniotic fluid. | - antibiotic prophylaxis with ampicillin and azithromycin is administered to prevent bacterial infections - betamethasone is given before 34 weeks |
| Preterm premature rupture of membrane | A rupture of membranes that occurs before the onset of uterine contractions and before 37 weeks' gestation. |
| Normal duration of the second stage of labor is | <3 hours in a primiparous <2 hours in a multiparous -Oxytocin for prolonged 2nd stage of labor when descent is minimal & maternal uterine contractions are inadequate (occurring > 2–3 minutes and/or with pressures < 200 units |
| second stage of labor | - regular uterine contractions increasing in frequency and intensity - appearance of the fetus' head at the vaginal opening as contractions progress. |
| External cephalic version | is one option for non-laboring woman who are ≥ 36 weeks and not in labor. majority of breech presentations will resolve before 37 weeks' gestation |
| pt has manifestations of acute respiratory failure (dyspnea, tachypnea, hypoxia), cardiovascular collapse (tachycardia, hypotension), altered consciousness (agitation and confusion) in the peripartum period. These findings are highly concerning for | Amniotic fluid embolism Amniotic fluid enters mothers circulation during or shortly after delivery - hypotension, arrhythmias, dyspnea, tachypnea, and cyanosis. |
| pt has fatigue, proximal muscle weakness, and decreased deep tendon reflexes. | hypokalemia adverse effect of terbutaline, a beta-2 adrenergic receptor agonist. |
| An itchy maculopapular rash that started at the face and spread to the rest of the body but spares the palms and soles, in combination with postauricular lymphadenopathy and polyarthritis, is suggestive of? | - rubella. this disease does not pose a risk for the fetus after 16 weeks. |
| neonatal rubella infection - 1st trimester intrauterine transmission | - triad of defects; sensorineural hearing loss, cataracts, cardiac defects (patent ductus arteriosus) **low birth weight, purpura/petechiae, a blueberry muffin rash, hepatosplenomegaly, osteitis, microcephaly, ocular manifestation |
| 29 weeks primigravida has Perianal itching .,abdominal pain, vomiting, tape test to perianal region shows the presence of ova (eggs of a worm) confirms? | pinworm infestation (i.e., enterobiasis) Enterobius vermicularis causes an allergic reaction and thus itching - supportive management in mild cases |
| Rx of severe pinworm infestation in pregnant women | Pyrantel pamoate . ** Bendazoles (e.g., albendazole, mebendazole) are another drug class ** Rx safer after 1st trimester. |
| In a patient with HIV, | hepatitis A infection may occur even after vaccination. - seroconversion after HAV vaccination does not occur in approximately 30% of HIV-infected patients. |
| Transmission of varicella zoster virus late in pregnancy may result in neonatal varicella infection. pt who has been exposed is also at risk for severe varicella infection and requires treatment to prevent complications. | VZIG VZV immune globulin Rx of severe infection in Pregnant women and newborns : Acyclovir. |
| combination of maternal fever, tachycardia, uterine tenderness, malodorous and purulent amniotic fluid, vaginal discharge, and fetal tachycardia indicates chorioamnionitis. | A major risk factor for chorioamnionitis is (PROM), Rx; if birth is vaginal ( IV ampicillin plus gentamicin) or cesarean ( IV ampicillin and gentamicin, plus clindamycin/metro). |
| newborn's ill appearance, fever, tachycardia, tachypnea, and elevated leukocyte count are concerning for neonatal sepsis. | - group B strep (GBS)) is most common pathogen of early-onset neonatal sepsis (i.e., < 7 days after delivery). - Routine screening is performed by rectal or vaginal swab cultures in 35–37 weeks' |
| Rx of GBS neonatal sepsis includes | parenteral ampicillin and gentamycin. |
| pt, at 36 wks', recently had a UTI. now has diffuse abdominal tenderness, nausea, vomiting, fever, tachycardia, tachypnea, leukocytosis. has malodorous amniotic fluid, There are no signs of fetal tachycardia. | chorioamnionitis with (PPROM - Antibiotic therapy and prompt induction of labor |
| concomitant neurological signs and symptoms (paresthesias, loss of vibratory sensation and proprioception, positive Romberg test) is most likely | deficiency of vitamin B12 |
| Infants of mothers with diabetes are at risk for ? | - transient neonatal hypoglycemia due to hyperinsulinemia - polycythemia - most infants are asymptomatic, - symptomatic infants; prolonged QTc, poor feeding, and seizures. |
| in the later stages of pregnancy, the gravid uterus often puts pressure on the inferior vena cava and the iliac veins | pitting edema of lower extremities in pregnancy |
| Painless, bright red bleeding in the third trimester suggests a placenta previa. What would be the next best step in a patient with active bleeding and maternal hypotension? | > maternal age and grand multiparity are risk factors for placenta previa - A C-section is preferred if the mother is hemodynamically unstable and/or if there is evidence fetal distress. |
| Gestational hypertension is the onset of elevated blood pressure (> 140/90 mm Hg) after 20 weeks' of gestation. | Antihypertensive indicated in pregnant women: - gestational hypertension (systolic BP ≥ 160 mm Hg or a diastolic BP ≥ 110 mm Hg). - hydralazine, labetalol, methyldopa, and nifedipine |
| Vasa previa | - presence of fetal vessels directly over the internal cervical os - below the presenting part of the fetus. - These vessels are typically unprotected by placental tissue |
| Ruptured vasa previa causes fetal exsanguination, | - results in fetal distress (e.g., fetal bradycardia) without evidence of maternal blood loss. - emergency C-section should be performed if fetal distress is present. |
| Vaginal bleeding and abdominal pain before the 20th week of gestation with a closed cervical os and ultrasonography showing a viable fetus is diagnostic of | threatened abortion. - follow up u/s every week. - pts should abstain from strenuous exercise and sexual intercourse during this time |
| 37 weeks primigravida pt with hypertension & proteinuria. In the absence of further symptoms, this is consistent with the diagnosis of preeclampsia without severe features. what is next step? | labor should be induced at ≥ 37 weeks of gestation in order to minimize adverse maternal outcomes without worsening neonatal outcome |
| 32 weeks pregnant pt has severe hypertension (systolic blood pressure > 160 mm Hg) and thrombocytopenia (platelet count < 100,000/mm3),next step of management is? | preeclampsia with severe features. gestational age is < 34 weeks & both mother & fetus are stable, conservative expectant management; magnesium sulfate for prophylaxis of eclampsia, antihypertensives (labetalol). Dexamethasone |
| In patients with preeclampsia with severe features at ≥ 34 weeks' gestation, | immediate delivery after initial stabilization is indicated. |
| magnesium sulfate toxicity | - depressed or absent deep tendon reflexes - can progress to respiratory depression , cardiac arrest. ** < dose of infusion. absence of deep tendon reflexes indicates a more severe toxicity - stop infusion and administer calcium gluconate. |
| Intrahepatic cholestasis of pregnancy | - elevated direct bilirubin - elevated bile acid - presence of pruritus (due to elevated bile salts Rx; Ursodeoxycholic acid, Ursodiol |
| presence of generalized pruritus with excoriations, jaundice, elevated liver tests (bile acids, direct bilirubin, transaminases), and normal liver ultrasonography suggests | intrahepatic cholestasis of pregnancy. |
| A history of recent-onset abdominal pain or discomfort in a pregnant woman, especially in the third trimester, with hypertension should arouse the suspicion of | HELLP syndrome - hemolysis (H), elevated liver (EL) enzymes, and low platelet (LP) count. |
| Painless vaginal bleeding in late pregnancy should always raise suspicion for placenta previa, especially in Pt with multiple risk factors such as increased maternal age (> 35 years), multiparity, and previous cesarean sections. | transvaginal and transabdominal sonography can be performed for assessing placental position |
| pt with generalized tonic-clonic seizures hours after birth of her child. has hyperreflexia and clonus. These findings together with a history of headache, blurry vision, and abdominal pain are severe warning signs for | postpartum eclampsia. -magnesium sulfate - lorazepam indicated if no improvement |
| Vaginal bleeding, an open cervical os, and no fetal cardiac activity on ultrasonography are diagnostic of an inevitable abortion | Dilation and curettage (D&C) is indicated in all cases of early pregnancy loss with heavy bleeding or intrauterine sepsis. |
| Placental abruption | - hypovolemic shock (maternal tachycardia, hypotension, and cool, clammy extremities) - fetal distress (fetal bradycardia, in this case), and a rigid/woody, tender uterus on palpation. ** no vaginal bleeding in concealed placental abruption |
| Intrauterine growth restriction | fetal weight below the 10th percentile. seen in; - placental insufficiency, - fetal genetic abnormalities, - maternal hypertension, - maternal substance abuse. - maternal malnutrition |
| pt in 3rd trimester with hemolysis (anemia, mixed hyperbilirubinemia), acute hepatic failure ( right upper quadrant pain, elevated liver function tests, prolonged PT, asterixis), & acute renal insufficiency (e.g., elevated creatinine). | Acute fatty liver of pregnancy **Pt is at increased risk of developing disseminated intravascular coagulation (DIC). |
| Copper-containing intrauterine devices | - by far the most effective option for emergency contraception, rate of 99.9%. - IUDs provide contraception for up to 10 years, - good for women who do not iwish to become pregnant in the near future. |
| Intrauterine adhesions (Asherman syndrome) | - endometrial adhesions or fibrosis - bleeding does not occur following progestin withdrawal given block of the outflow tract |
| Rx for preventing thrombosis and pregnancy-related complications in pregnant women with antiphospholipid syndrome | low-dose aspirin and low molecular weight heparin (e.g., such as enoxaparin |
| Fibrocystic changes of the breast | typically presents with - premenstrual breast pain that may be recurring or constant and unilateral or bilateral. - diffuse versus focal on examination |
| fat necrosis | - an ill-defined, firm breast mass - overlying area of skin thickening or retraction - oil cysts on mammography u/s then mammography then biopsy to confirm Biopsy findings of foam cells and multinucleated giant cells confirms the diagnosis |
| presence of a solid, painless, mobile mass in a 29-year-old woman without any mastalgia, changes in skin over the breast, or axillary lymphadenopathy indicates | fibroadenoma |
| Phyllodes tumor | benign rapidly growing and painless breast lump leaf like architecture (papillary projections) no myalgia, no lymphadenopathy no skin changes surgical excision with wide margins is required. **25% are malignant |
| A well-circumscribed, anechoic mass with posterior acoustic enhancement in a premenopausal woman suggests a simple cyst. | pts who are symptomatic should undergo fine needle aspiration |
| Rx for Mastitis | dicloxacillin or cephalexin, |
| Premature rupture of membranes | rupture of amniotic membranes before the onset of uterine contractions |
| Umbilical cord compression | Compression of the umbilical cord between the presenting part of the fetus (usually the head) and the pelvis. Typically causes recurrent variable decelerations on CTG |
| Premature rupture of membranes | risk factors include; - ascending infection and cigarette smoking - previous PROM - multiple pregnancies, Complications include; - chorioamnionitis, - placental abruption - umbilical cord prolapse. |
| Preterm Premature rupture of membranes management in 32 weeks gestation in a stable mother and fetus | - antibiotic prophylaxis with ampicillin & azithromycin - betamethasone to induce fetal lung maturation. - delay labor for 48 hours with tocolytics (e.g., NSAIDs, beta-adrenergic agonists, calcium-channel blockers) **fetal lungs mature @ 34 weeks |
| second stage of labor | period of time between complete cervical dilation to delivery of the infant. Normal duration <3 hours in a primiparous woman <2 hours in a multiparous woman appearance of fetal head regular and itensified contraction |
| A prolonged second stage of labor management | pt with adequate uterine contractions & engaged fetal head; operative vaginal delivery Pt with weak uterine contractions, labor augmentation (e.g., with oxytocin) if neither, preparation for cesarean delivery |
| HELLP syndrome | hemolysis elevated liver enzyme low platelet severe htn may see abdominal pain, nausea |
| Acute fatty liver of pregnancy | jaundice, RUQ pain, nausea, and vomiting. hypertension hemolytic anemia thrombocytopenia hyperbilirubinemia transaminitis. |
Created by:
beccao
Popular USMLE sets