Notes in Mehlman Ob Gyn

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Status	Last Update	Fields
Published	02/28/2024	32F + not breastfeeding + upper-outer quadrant warm, tender, red non-fluctuant mass +/- fever = {{c1::mastitis}}
Published	02/28/2024	32 F + recently stopped breastfeeding + temp 99.5* + tender, fluctuant mass on lateral breast (not warm and not erythematous) = {{c1::galactocele (mil…
Published	02/28/2024	31F + gave birth two days ago + exclusively bottle-feeding neonate + breasts are engorged and tender + fever 101* + sx of dysuria + suprapubic tendern…
Published	02/28/2024	24F + amenorrhea since D&C 13 months ago for postpartum hemorrhage + progestin withdrawal test shows no withdrawal bleeding = {{c1::Asherman syndr…
Published	02/28/2024	27F + spontaneous abortion at 10 weeks gestation complicated by postpartum endometritis + sharp D/C to remove infected material; pt is at increased ri…
Published	02/28/2024	Progestin withdrawal test:If progestin is given then withdrawn,bleeding should occur. If bleeding occurs, {{c1::estrogen}} is not deficient and t…
Published	02/28/2024	18F + no bleeding after progestin withdrawal test.If not Tx over ten years, the patient is at risk for {{c1::osteoporosis}}
Published	02/28/2024	Basal body temp increases ~0.5* F mid-cycle, and stays at this higher temp due to {{c1::progesterone (ovulation)}}
Published	02/28/2024	45F + she asks about best way to decrease risk of osteoporosis = {{c1::weight-bearing exercise}}
Published	02/28/2024	72F + already has osteoporosis. What is best way to decrease fracture risk = {{c1::going on long walks}}
Published	02/28/2024	69F + Caucasian + nulliparous + on beta-blocker + drinks daily + compression facture of vertebra.strongest predisposing risk factor = {{c1::white…
Published	02/28/2024	42F + 8-month Hx of severe pelvic pain and heavy bleeding during menses + regular periods + two kids + does not want more kids + husband to get vasect…
Published	02/28/2024	11F + Tanner stage 3 breast and pubic hair = {{c1::menarche is imminent}}
Published	02/28/2024	13 F + Tanner stage 2 + never had menstruation + brough in by mom concerned about lack of menstruation = {{c1::follow-up in 6 mo}}
Published	02/28/2024	14F + 4x6cm mass in left breast + slightly tender + vitals normal + aunt died of brast cancer; next best step = {{c1::follow-up in 6 months}}
Published	02/28/2024	23F + 10 weeks gestation + nausea and vomiting for 4 weeks + lost 1.8kg. most likely adverse effect on fetus = {{c1::no significant adverse effec…
Published	02/28/2024	How to dx hyperemesis gravidarum = {{c1::urinary ketones}}
Published	02/28/2024	When does hyperemesis gravidarum present + what is the mechanism = {{c1::8-10 weeks gestation; an effect of beta-hCG (levels highest at 8-10 weeks)}}
Published	02/28/2024	Biochemical disturbance in hyperemesis gravidarum = {{c1::hypokalemic, hypochloremic metabolikc alkalosis}}
Published	02/28/2024	Tx for hyperemesis gravidarum = {{c1::admit to hospital and give parenteral anti-emetic therapy}}
Published	02/28/2024	Important drug causing hyperprolactinemia apart from antipsychotics = {{c1::metoclopramide}} (mechanism = {{c1::D2 antagonist}})
Published	02/28/2024	Amenorrhea in patient with anorexia; mechanism = decreased {{c1::GnRH pulsation (hypogonadotropic)}} -> {{c1::decreased LH + FSH = decreased FSH an…
Published	02/28/2024	28F + tight-fitting sports bra and/or breast trauma = {{c1::fat necrosis}}
Published	02/28/2024	36F + rubbery, mobile, painless mass in breast = {{c1::fibroadenoma}}
Published	02/28/2024	Mammogram guidelines = {{c1::start at age 50 + every two years until 75}}
Published	02/28/2024	44F + painless unilateral cyst in breast that drains brown serous fluid.Dx = {{c1::fibrocystic change}}
Published	02/28/2024	25F + sharp pain in outer quadrant of right breast + exam shows 2cm tender area in right breast but no mass found.Dx = {{c1::fibrocystic change }…
Published	02/28/2024	47F + breast lump self-palpated + breast USS shows 3cm complex cyst + FNA performed of the cyst revealing straw-colored fluid + mass still present aft…
Published	02/28/2024	45F + unilateral rusty nipple discharge. dx = {{c1::intraductal papilloma }}
Published	02/28/2024	45F + unilateral rusty nipple discharge + biopsy shows stellate morphology.dx = {{c1::invasive ductal carcinoma}}
Published	02/28/2024	45F + mammography shows cluster of microcalcifications in upper-outer quadrant; next best step = {{c1::needle-guided open biopsy}}
Published	02/28/2024	45F + inverted nipple + greenish discharge; dx = {{c1::mammary ductal ectasia}}
Published	02/28/2024	42F + recurrent miscarriage + SLE;dx = {{c1::antiphospholipid syndrome (lupis anticoagulant)}}tx with {{c1::aspirin or heparin}}
Published	02/28/2024	45F + SLE + commencing third course of corticosteroids during past 18 months.what should be given = {{c1::alendronate}}
Published	02/28/2024	Intrauterine growth restriction (IUGR) of fetus.what lifestyle factor is most contributory = {{c1::smoking}}
Published	02/28/2024	Which fetal parameter is most reflective of IUGR = {{c1::abdominal circumference}}
Published	02/28/2024	24F + 33 weeks gestation + Factor V Leiden mutation + intrauterine female demise. Which vessel is the thrombosis most likely to occur i…
Published	02/28/2024	Female at 24 weeks gestation + HTN + proteinuria.Most likely cause of findings = {{c1::uteroplacental insufficiency or placental dysfunction}}
Published	02/28/2024	Female at 16 weeks gestation + HTN + proteinuria + fundal height measured at the umbilicus Dx = {{c1::hydatidiform mole}}
Published	02/28/2024	Uteroplacental insufficiency can cause what issue on fetal heart tracing = {{c1::late decelerations (fetal hypoxia)}}
Published	02/28/2024	Early decelerations = {{c1::fetal head compression}}Variable decelerations = {{c1::cord compression}}Late decelerations = {{c1::fetal hypoxia}}
Published	02/28/2024	Fetus has HR at 120 bpm (NR 110-160), but there is no variability = {{c1::fetal sleep state}}
Published	02/28/2024	Fetus has HR 180 bpm with zero variability = {{c1::maternal fever }}
Published	02/28/2024	Accelerations indicated fetal well-being = rise of ~{{c1::20}}bpm lasting ~{{c1::20}} seconds; {{c1::2-3}} occurences every 20 min
Published	02/28/2024	{{c1::Biophysical profile}} assesses fetal wellbeing when non-stress test is non-ractive.
Published	02/28/2024	21F + 41 weeks' gestation + 4cm dilated + variable decels; next best step = {{c1::amnioinfusion}}
Published	02/28/2024	What is external cephalic version = transabdominal manipulation of breech fetus into cephalic engagement; only performed after {{c1::36 weeks}}
Published	02/28/2024	Internal podalic version = {{c1::reorienting fetus wn womb during a breech delivery}}
Published	02/28/2024	2-day-old neonate + purplish fluctuant mound on scalp + crosses suture lines = {{c1::caput succedaneum}}
Published	02/28/2024	{{c1::cephalohematoma}} = well-defined, localized, fluctuant swelling; caused by subperiosteal hemorrhage; does not cross suture lines; may be associa…
Published	02/28/2024	31F + G1P0 + third trimester + itchy hives- like eruptions within abdominal striae; Dx = {{c1::pruritic urticarial papules and plaques of pregnan…
Published	02/28/2024	25F + G1P0 + third trimester + itchy palms + soles;Dx = {{c1::intrahepatic cholestasis of pregnancy (ICP)}}Tx = {{c1::ursodeoxycholic acid (ursodiol)}…
Published	02/28/2024	32F + 30 weeks gestation + 10-day Hx of nausea and generalized itching + bilirubin 2.1 mg/dL + ALT/AST/ALP all normalDx = {{c1::intrahepatic cholestas…
Published	02/28/2024	36F + G1P0 + 36 weeks gestation + nausea/vomiting + jaundice + high bilirubin + high ALT and AST Dx = {{c1::acute fatty liver of pregnancy}}cause…
Published	02/28/2024	29F + G1P0 + 2nd or 3rd trimester + intensily itchy eruption around umbilicus that spreads outward;Dx = {{c1::herpes gestationis (gestational pemphigo…
Published	02/28/2024	13F + never had a menstrual period + morning nausea/vomiting + suprapubic fullness;next best step = {{c1::beta-hCG}}
Published	02/28/2024	Tx for preeclampsia = {{c1::hypertensive medications (labetalol, methyldopa, etc); definitive Tx is delivery}}
Published	02/28/2024	Tx for eclampsia = {{c1::Mg for seizures; definitive is delivery}}
Published	02/28/2024	Tx for Htn emergencies in pregnancy = {{c1::hydralazine is an option}}
Published	02/28/2024	Female at 8 weeks gestation + cysts visualized bilaterally on pelvic USSDx = {{c1::theca-lutein cysts}}
Published	02/28/2024	{{c1::Complete mole}} = karyotype of 46; empty egg fertilized by a sperm that duplicates; bunches of grapes / snowstorm appearance on USS; chance of p…
Published	02/28/2024	Anovulation + hirsutism + BMI 27; Dx = {{c1::PCOS}}
Published	02/28/2024	Anovulation; mechanism USMLE wants = {{c1::insulin resistance}} -> causes abnormal {{c2::GnRH pulsation}} -> high LH/FSH -> LH high enou…
Published	02/28/2024	Hirsutism in anovulation due to higher relative {{c1::LH}}
Published	02/28/2024	{{c1::LH}} stimulates theca interna cells (females) and Leydig cells (males) to make androgens{{c1::FSH}} stimulates granulosa cells (females) and Ser…
Published	02/28/2024	Best Tx for PCOS:if high BMI = {{c1::weight lost first}}next step = {{c1::OCPs}} (if not wanting pregnancy), {{c1::clomiphene}} (if wanting pregnancy)
Published	02/28/2024	PCOS increases risk of {{c1::endometrial cancer}} (due to unopposed estrogen)
Published	02/28/2024	32F + unable to conceive for 3 years + BMI 30 + acanthosis nigricansDx = {{c1::T2DM}}
Published	02/28/2024	40F + vasomotor Sx; which hormone to confirm Dx = {{c1::high FSH for premature ovarian failure}}
Published	02/28/2024	28F + Hashimoto thyroiditis + hot flashes for 6 mo + high FSH. Dx = {{c1::autoimmune ovarian failure}}
Published	02/28/2024	Thyroid levels in pregnancy: TSH {{c1::normal}}, free T3 {{c1::normal}}, free T4 {{c1::normal}}, total T4 {{c1::elevated}}, total T4 {{c1::elevat…
Published	02/28/2024	What to order to evaluate thyroid function in pregnancy = {{c1::free T4}}
Published	02/28/2024	Levothyroxine dose in pregnancy for those with Hashimoto = {{c1::may need to be increased up to 50%}}
Published	02/28/2024	Thionamides in pregnancy = {{c1::methimaxole}} is teratogenic in first trimesters (causes aplasia cutis congenita); give {{c1::PTU}} in first tri…
Published	02/28/2024	27F + 34 weeks gestation + thyroid storm; Tx = {{c1::PTU}}
Published	02/28/2024	27F + gave birth to healthy boy 6 months ago following uncomplicated labor + no weight change or mood disturbances + not on meds + vitals WNL + dry sk…
Published	02/28/2024	Neonate born with cretinism; what could have prevented this = {{c1::routine newborn screening}}
Published	02/28/2024	16F + anterior vaginal wall pain and dysuria for 6 months + u/s normal + vitals normal;Dx = {{c1::chronic interstitial cystitis}}Tx = {{c1::supportive…
Published	02/28/2024	In ectopic pregnancy, beta-hCG can be {{c1::low with a slow rate of increase}}
Published	02/28/2024	32F + presentation similar to stroke + beta-hCG hundreds of thousands;Dx = {{c1::choriocarcinoma (brain mets)}}
Published	02/28/2024	24F + pregnancy visualized in corneum of uterus;Dx = {{c1::ectopic pregnancy}}
Published	02/28/2024	27F + pregnancy visualized in parametrium of uterus; Dx = {{c1::ectopic pregnancy}}
Published	02/28/2024	Most common location for ectopic = {{c1::ampulla of fallopian tubes}}
Published	02/28/2024	Most common etiology for ectopic = {{c1::Hx of PID -> scarring of fallopian tubes}}
Published	02/28/2024	Tx for ectopic pregnancy = {{c1::laparoscopic removal (salpingostomy/salpingectomy)}}
Published	02/28/2024	When to give methotrexate to Tx ectopic (5):{{c1::beta-hCG <6,000}}{{c1::<3 cm in size}}{{c1::fetal HR not detectable}}{{c1::no evidence of flui…
Published	02/28/2024	Organisms causing PID + Tx:chlamydia and/or gonorrhea; Tx = {{c1::IM ceftriaxone, plus either oral azithromycin or oral doxycycline}}If patient is sep…
Published	02/28/2024	PID + fever does not improve after several days on ABx; next best step = {{c1::adnexal USS to look for tubo-ovarian abscess}}
Published	02/28/2024	Abortions: Bleeding + open cervix = {{c1::inevitable}}Tx = {{c1::vacuum aspiration}}bleeding + closed cervix = {{c1::threatened}}Tx = {{c1::bed r…
Published	02/28/2024	32F + 9 weeks gestation + bleeding and passage of clots per vaginum + intrauterine pregnancy seen on USS; Dx = {{c1::incomplete abortion }}
Published	02/28/2024	35F + vaginal bleeding at 6 weeks and beta-hCG 450 mIU/mL + USS shows thickened endometrial stripe and no fetal pole + one week later beta-hCG is 90 m…
Published	02/28/2024	43F + bleeding per vaginum + uterus is large and smooth. which type of fibroid = {{c1::submucosal leiomyomata}}
Published	02/28/2024	43F + no bleeding per vaginum + uterus is globular.which type of fibroid = {{c1::subserosal}}
Published	02/28/2024	43F + beefy red mass protruding from vagina;Dx = {{c1::pedunculated submucosal leiomyomata uteri}}
Published	02/28/2024	42F + comes in for routine exam + no complaints + large uterus on exam + USS shows various leiomyomata; next best step = {{c1::observation}} (asymptom…
Published	02/28/2024	44F + dysmenorrhea + menorrhagia + USS shows large, smooth uterus with no overt masses; Dx = {{c1::adenomyosis}}Tx = {{c1::NSAIDs, OCPs; leuproli…
Published	02/28/2024	27F + 30 weeks gestation + weakness of thumb abduction bilaterally;Dx = {{c1::carpal tunnel syndrome}}
Published	02/28/2024	23F + unintended pregnancy + fever of 104F + vaginal discharge + abdo pain + laceration visualized on cervix;Dx = {{c1::septic abortion}}
Published	02/28/2024	32F + rupture of membranes (ROM)>18 hours + abdo pain + fever;Dx = {{c1::chorioamnionitis}}Tx = {{c1::ampicillin + gentamicin + clindamycin}}
Published	02/28/2024	32F + C-section 12 hours ago + abdo pain + fever;Dx = {{c1::postpartum endometritis}}Tx = {{c1::ampicillin + gentamicin + clindamycin}}
Published	02/28/2024	Organisms causing chorioamnionitis + endometritis = {{c1::polymicrobial}}
Published	02/28/2024	25F + postpartum endometritis + low BP;Dx = {{c1::puerperal sepsis}}
Published	02/28/2024	Lump seen at 4 or 8 o'clock position on vulva;Dx = {{c1::Bartholin gland cyst/abscess}}Tx = {{c1::warm compress for cyst; train if abscess}}
Published	02/28/2024	Organism (s) causing Bartholin gland abscess = {{c1::polymicrobial}}
Published	02/28/2024	37F + Bartholin gland abscess + "what is serious complication of this condition" = {{c1::necrotizing fasciitis}}
Published	02/28/2024	Grey/whitish patchy/rough area on vulva or perineum;Dx = {{c1::lichen sclerosis}}Tx = {{c1::do punch biopsy to r/o SCC; if confirmed LS, do topical st…
Published	02/28/2024	SCC of perineum in diabetic patient; biggest risk factor = {{c1::HPV}}
Published	02/28/2024	24F + sharp adnexal pain + no adnexal mass mentioned in vignette + 10-15 mL of serosanguinous fluid aspirated from cul de sac;Dx = {{c1::ruptured cyst…
Published	02/28/2024	24F + Hx of ovarian cyst + colicky pelvic pain past few weeks + pain has become constant past couple days + 6x8cm palpable adnexal mass;Dx = {{c1::ova…
Published	02/28/2024	24F + Hx of oavarian cyst + intermittent pelvic pain for four hours that has become constant past two hours + 8x10cm palpable adnexal mass;Dx = {{c1::…
Published	02/28/2024	24F + increasingly severe pelvic pain the past couple days + 6x8 cm mass palpable in adnexa;Dx = {{c1::torsion}}
Published	02/28/2024	25F  with normal periods, LMP 20 days ago and a 5cm mobile mass in right adnexa on examination that is slightly tender to palpation; Dx = {{…
Published	02/28/2024	18F + tampon use + diffuse rash + BP 90/60;Dx = {{c1::toxic shock syndrome (S. aureus)}}
Published	02/28/2024	24F + 30 weeks gestation + spotting on underwear 12 hours after sexual intercourse + bleeding gradually increasing since + USS normal;Dxx = {{c1::cerv…
Published	02/28/2024	36F + 26 weeks gestation + severe flank pain + feels faint when attempting to urinate; Dx = {{c1::urolithiasis}}
Published	02/28/2024	Mechanism for increasing cholesterol gallstones in pregnancy = {{c1::progesterone slows biliary peristalsis + estrogen increased activity of HMG-…
Published	02/28/2024	26F + three first-trimester miscarriages + has single kidney;what is most likely reason for recurrent miscarriage = {{c1::congenital uterine abnormali…
Published	02/28/2024	Tx for torsion = {{c1::laparoscopic detorsion}}
Published	02/28/2024	32F + dull right-sided pelvic pain + beta-hCG negative + USS shows simple 5cm cyst;Tx = {{c1::"oral contraceptive therapy and a second pelvic exam in …
Published	02/28/2024	23F + extremely painful periods + needs to miss grad school classes sometimes because of pain + exam shows no abnormalities;Dx = {{c1::primary dysmeno…
Published	02/28/2024	23F + extremely painful periods + needs to miss grad school classes sometimes because of the pain + exam shows nodularity of uterosacral ligaments;Dx …
Published	02/28/2024	How to Dx endometriosis = {{c1::diagnostic laparoscopy}}
Published	02/28/2024	26F + dull pelvic pain + USS shows cystic mass with calcification;Dx = {{c1::dermoid cyst (mature ctystic teratoma)}}
Published	02/28/2024	65F + multiple masses "caked" on omentum;Dx = {{c1::ovarian cancer}}
Published	02/28/2024	31F with epilepsy + 10 weeks gestation + has seizure + phenytoin serum level below therapeutic range; next best step = {{c1::increase dose of phenytoi…
Published	02/28/2024	31 F on valproic acid wanting to get pregnant; what do we do? {{c1::stop valproic acid }}
Published	02/28/2024	Hx of many pregnancies + downward movement of vesicourethral junction -> stress incontinence -> {{c1::"decreased external urethral tone"}}
Published	02/28/2024	Tx of stress incontinence -> {{c1::pelvic floor exercises (Kegel)}}; if insufficient -> {{c1::mid-urethral sling}}
Published	02/28/2024	Hyperactive detrusor or detrusor instability = {{c1::urge incontinence}}
Published	02/28/2024	Needs to run to the bathroom when sticking key in door = {{c1::urge incontinence}}
Published	02/28/2024	Incontinence in multiple sclerosis patient or perimenopausal = {{c1::urge incontinence}}
Published	02/28/2024	52F + hot flashes + urge incontinence; what is mechanism = {{c1::"estrogen deficiency"}}
Published	02/28/2024	Tx of urge incontinence = {{c1::oxybutynin (muscarinic cholinergic antagonist)}} or {{c1::mirabegron (beta-3 agonist)}}
Published	02/28/2024	Incontinence + high post-void volume (usually 3-400 in question; normal is <50 mL) = {{c1::overflow incontinence}}
Published	02/28/2024	incontinence in diabetes = {{c1::overflow incontinence due to neurogenic bladder}}
Published	02/28/2024	Rx for overflow incontinence in diabetes = {{c1::bethanechol (muscarinic cholinergic agonist)}}
Published	02/28/2024	Incontinence in BPH = overflow incontinence due to outlet obstruction = {{c1::eventual neurogenic bladder}}
Published	02/28/2024	What is the only approved indication for medication for hormone replacement therapy (HRT) = {{c1::severe vasomotor symptoms (hot flushes, urge inconti…
Published	02/28/2024	57F + blood stains on underwear for 6 mo + painful sexual intercourse + atrophic, friable vaginal mucosa on exam + cervical bimanual exams norma;&nbsp…
Published	02/28/2024	25F + currently breastfeeding + menstruation not yet resumed + dyspareunia + erythematous vagina with no discharge; next best step in Mx = {{c1::"reco…
Published	02/28/2024	HRT increases the risk of what kind of cancer = {{c1::breast}}
Published	02/28/2024	53F + taking HRT past six months + stopped taking progesterone component because she didn't like how it affected her moods + vaginal bleeding; next be…
Published	02/28/2024	53F + started HRT three months ago + normal mammogram when started HRT + now has cyst seen on ultrasound after self-palpation; next best step = {{c1::…
Published	02/28/2024	How do combined oral contraceptive pills affect cancer risk?{{c1::very decreased}} ovarian (50%), {{c1::decresed}} endometrial, {{c1::normal}} breast,…
Published	02/28/2024	16F + aunt die of ovarian cancer + asks GP how to screen for ovarian cancer = {{c1::no screening}}
Published	02/28/2024	25F + BRCA mutation confirmed + three first-degree family members with gynecologic cancers; next best step = {{c1::total abdominal hysterectomy and bi…
Published	02/28/2024	47F + total abdominal hysterectomy and bilateral salpingo-oophorectomy performed for leiomyomata uteri;Q asks what we do re Pap smears; answer = {{c1:…
Published	02/28/2024	22F + T1DM + 33 weeks gestation + fundal heigh 38 cm; Dx = {{c1::polyhydramnios}}
Published	02/28/2024	Neonatal girl with karyotype 46XX + has phallus and scrotum; Q asks mechanism = {{c1::ACTH hypersecretion}}
Published	02/28/2024	33F + prenatal USS shows two fetuses with thick dividing membrane; what kind of twin pregnancy? = {{c1::dichorionic diamniotic}}
Published	02/28/2024	33F + prenatal USS shows one fetus much larger than the other; what kind of twin pregnancy is this? {{c1::monochorionic monoamnionic}}
Published	02/28/2024	43F + receiving beta-hCG as part of IVF protocol + develops severe abdo pain + ascites; Dx = {{c1::ovarian hyperstimulation syndrome}}
Published	02/28/2024	21F + requests OCPs + Pap smear is normal; what else needs to be done?{{c1::check for chlamydia}}
Published	02/28/2024	33F + regular periods + Hx of multiple partners + unable to conceive with husband for 3 years + husband has normal semen sample; next best step?{{c1::…
Published	02/28/2024	35F + hysterosalpingogram shows spillage of dye into peritoneal cavity;Dx = {{c1::normal finding}}
Published	02/28/2024	What is uterine didelphys?{{c1::uterus develops as paired organ (double uterus) + double cervix +/- double vagina}}
Published	02/28/2024	52F + presents for routine screening for first time in 4 years; Q asks "in addition to cholesterol screening, Pap smear, and mammography, what else do…
Published	02/28/2024	How often are Pap smears indicated, and when are they started and stopped?commenced at age {{c1::21}}, then every {{c1::3}} years; starting age {{c1::…
Published	02/28/2024	Mx of Pap smear result = atypical squamous cells of undetermined significance (ASC-US): {{c1::repeat cytology in a year}}, OR {{c1::test for HPV;…
Published	02/28/2024	Mx of LSIL on Pap smear = if negative HPV testing, {{c1::repeat co-testing in oue year}}; if (+) HPV testing or no testing, {{c1::do colposcopy + biop…
Published	02/28/2024	Mx of high-grade squamous intraepithelial neoplasia (HSIL) on Pap smear? {{c1::regardless of HPV status: immediate loop electrosurgical excision …
Published	02/28/2024	Mx of cervical intraepithelial neoplasia (CIN) I seen on biopsy = {{c1::immediate LEEP, OR colposcopy + cytology every 6 months}}
Published	02/28/2024	Mx of CIN II/III seen on biopsy = {{c1::immediate LEEP demonstrating clear margins, then do Pap + HPV cotesting 1 and 2 years postoperatively}}
Published	02/28/2024	57F + vaginal hysterectomy performed for CIN III; next best step = {{c1::Pap smear annually}}
Published	02/28/2024	32F + colposcopy is performed for LSIL + entire squamocolumnar junction cannot be visualized; next best step = {{c1::cone biopsy}}
Published	02/28/2024	47F + Pap smear shows atypical glandular cells + colposcopy normal + endocervical curettage shows benign cells; next best step = {{c1::endometrial bio…
Published	02/28/2024	35F + two min after separation of placenta has shortness of breath + tachycardia + bleeding from venipuncture sites; Dx = {{c1::amniotic fluid em…
Published	02/28/2024	35F + two days after C-section + gets up to go to the bathroom + SoB + tachycardia; Dx = {{c1::pulmonary embolism }}Tx = {{c1::heparin follo…
Published	02/28/2024	39F + pregnant + Sx of pulmonary embolism + V/Q scan performed showing segmental defects; next step in Dx = {{c1::spiral CT}}
Published	02/28/2024	27F + two days after C-section + temp 100.8F + breath sounds decreased at both lung bases + urinary catheter specimen is negative + remainder of exam …
Published	02/28/2024	27F + triad of third-trimester painless bleeding + ROM + fetal bradycardia; Dx = {{c1::vasa previa (fetal vessels overlying internal cervical os)…
Published	02/28/2024	22F + uncomplicated delivery of newborn + heavy vaginal bleeding + placenta shows large, non-tapering vessels extending to margin of membranes;Dx = {{…
Published	02/28/2024	35F + c-section 6 weeks ago + required 3 units of transfused RBCs + 9 kg weight loss + has cold intolerance + could not breastfeed;Dx = {{c1::Sheehan …
Published	02/28/2024	15F + never had menstrual period + one-wk Hx of constant, severe pelvic pain + 10-month Hx of intermittent pelvic pain + BP of 90/50 + bluish bulge in…
Published	02/28/2024	15F + never had menstrual period + one-wk Hx of constant, severe pelvic pain + 10-month Hx of intermittent pelvic pain + BP normal + bluish bulge in u…
Published	02/28/2024	27F + delivered newborn 5 days ago + pain in calf with dorsiflexion of foot; next best step in Dx = {{c1::duplex ultrasonography of calf}}
Published	02/28/2024	Down syndrome testing:First trimester screen (11-13 weeks): {{c1::decreased}} pregnancy-associated plasma protein A (PAPPA), {{c1::increased}} beta-hC…
Published	02/28/2024	Most common cause of abnormal AFP measurement = {{c1::dating error}}
Published	02/28/2024	32F + AFP measurement comes back 2.6X upper limit of normal; next best step = {{c1::re-ultrasound}}
Published	02/28/2024	"celes"cystocele = {{c1::anterior superior vaginal wall}}urethrocele = {{c1::anterior inferior vaginal wall}}enterocele = {{c1::posterior superior vag…
Published	02/28/2024	32F + protrusion of distal urethral through urethral meatus; Dx = {{c1::urethral prolapse}}
Published	02/28/2024	22F + 24 weeks gestation + fundal heigh 20cm + no cervix palpated + examination shows fetus in breech position in vagina; Dx = {{c1::cervical inc…
Published	02/28/2024	30F + 37 weeks gestation + fetus in breech position; during labor, risk of which complication is greatest = {{c1::cord prolapse}}
Published	02/28/2024	32F + 14 weeks gestation + Hx of two LEEP + cervix flush against upper vagina and measures 2cm in diameter + pelvic USS shows funneled lower uterine s…
Published	02/28/2024	87F + partial prolapse of uterine cervix through the introitus + uterus can easily be pushed back into the uterus; next best step? {{c1::vaginal …
Published	02/28/2024	Stages of labor:Stage 1 latent: {{c1::0-6cm cervical dilation}}Stage 1 active: {{c1::6-10cm (complete) cervical dilation}}Stage 2: {{c1::10cm (complet…
Published	02/28/2024	32F has 5cm dilation for past 4 hours = {{c1::arrest of active phase}}
Published	02/28/2024	Definition of protracted latent phase = {{c1::dilating <1-2 cm per hour}}
Published	02/28/2024	What does "arrest of active phase" mean? {{c1::no cervical change in >4 hours despite adequate contractions }}
Published	02/28/2024	28F + 38 weeks gestation + cervix completely dilated + strong contractions + fetal station remains unchanged over next hour; Dx = {{c1::cephalope…
Published	02/28/2024	5F + foul-smelling yellow vaginal discharge + blood spotting on underpants + no dysuria + mild vulvar erythema seen on exam;Dx = {{c1::vaginal foreign…
Published	02/28/2024	82F + Alzheimers + brought in by daughter for blood on underwear + 3cm vaginal laceration + erythematous, edematous perineal body;Dx = {{c1::sexual as…
Published	02/28/2024	23F + dysuria + bacteriuria + pyuria; how to decrease future episodes? = {{c1::voiding immediately after coitus}}
Published	02/28/2024	23F + three UTIs over past year + Hx of UTIs being Tx successfully with TMP-SMX; most appropriate med for daily UTI prophylaxis = {{c1::TMP-SMX}}
Published	02/28/2024	37F + dysuria + urinalysis shows 20-50 WBCs/hpf + one week of TMP-SMX does not improve Sx; Next best step = {{c1::urethral culture for chlamydia}…
Published	02/28/2024	20F + 40 weeks gestation + epidural catheter placed + lidocaine and epinephrine injected + develops metallic taste in mouth; Dx = {{c1::intravasc…
Published	02/28/2024	25F + 5 weeks post-delivery + insomnia + irritability + finds baby's cry annoying and leaves him in crib crying for long periods of time;next best ste…
Published	02/28/2024	25F + 42 weeks gestation + oligohydramnios + cervix long, closed, and posterior;next best step = {{c1::administer a prostaglandin}}
Published	02/28/2024	34F + pregnany + low serum iron and ferrin + microcytic anemia + proceeds to take iron for three weeks + three weeks later, iron and ferritin are norm…
Published	02/28/2024	28F + 7 weeks gestation + started taking prenatal vitamin 3 weeks ago + microcytic anemia; next best step = {{c1::hemoglobin electrophoresis}}
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