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Obgyn > 1 > Flashcards

1 Flashcards

1
Q

Ddx for 1st trimester bleeding

A

SAB
Postcoital bleeding
Ectopic pregnancy
Vaginal or cervical lesions or lacerations
Extrusion of molar pregnancy
Non pregnancy cause of bleeding

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2
Q

What are the 3 classes of leiomyomas (fibroids)?

A

Submucosal
Intramural
Subserosal

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3
Q

What is the most common type of leiomyoma?

A

Intramural

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4
Q

What type of leiomyoma is most commonly associated with heavy or prolonged bleeding?

A

Submucosal

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5
Q

Risk factors for leiomyomas

A

AA heritage
Nonsmoking
Increased estrogen exposure (Early menarche, Nulliparity, Perimenopause)
Increased EtOH use
HTN

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6
Q

What is the most common sx of leiomyomas?

A

Abnormal uterine bleeding (AUB)

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7
Q

Biannual exam for leiomyomas can often reveal…

A

A nontnder irregularly enlarged uterus

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8
Q

Do fibroids shrink with hormonal tx?

A

GnRH is the only hormone to decrease size. However, once any tx is stopped the fibroid will continue growing.

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9
Q

Endometrial hyperplasia can occur through what pathogenesis?

A

Unopposed estrogen

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10
Q

Endometrial hyperplasia is the abnormal proliferation of what elements of the endometrium?

A

Glandular and stromal elements

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11
Q

What causes the increased risk for endometrial hyperplasia?

A

Unopposed estrogen exposure

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12
Q

Tx for simple and complex hyperplasia with out atypia is …

A

Progestin therapy

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13
Q

Tx for endometrial hyperplasia with atypia

A

Hysterectomy

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14
Q

Most common sites of endometriosis

A

Ovary and pelvic peritoneum

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15
Q

What are 4 theories about the etiology of endometriosis

A

Lymphatic system
Metaplastic transformation
Retrograde menstruation
Altered immune system

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16
Q

Risk factors for endometriosis

A

Increased estrogen exposure (Nulliparity, Early menarche, Prolonged menses)
Mullerian anomalies
First degree relatives
Autoimmune disorders

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17
Q

Sx of endometriosis

A

Cyclic pelvic pain
Dysmenorrhea
Dyspareunia
AUB
Bowel and bladder sx
Subfertility

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18
Q

DDX of endometriosis

A

Chronic processes that result in recurring pelvic pain
Infection
PID
Interstitial cystitis
Masses
Ovarian mass
Final ovarian cysts
Adenomyosis
IBS
Pelvic adhesions
Ectopic
Ovarian neoplasms

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19
Q

Tx for endometriosis

A

NSAIDs
Estrogen-progestin contraceptives
Progestin
GnRH agonists
Aromatase inhibitors
Surgery if fertility is not wanted

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20
Q

Adenomyosis

A

Extension of endometrial tissue into the uterine myometrium

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21
Q

Tx of Adenomyosis

A

Progestin containing IUD and hysterectomy

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22
Q

Adenomyoma

A

Well-circumscribed non-encapsulated collection of endometrial tissue with the uterine wall

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23
Q

Difference in Adenomyosis and leiomyoma

A

Adenomyosis - endometrial tissue into the myometrium

Leiomyoma - proliferation of smooth muscle cells within the myometrium

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24
Q

Why does adenomyosis not respond to hormone tx?

A

Does not contain glandular and stromal endometrial tissue. Extends from the basal is layer.

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25
Q

Adenomyoma

A

Well-circumscribed non-encapsulated smooth muscle cells and endometrial glands and stroma.

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26
Q

Most effective temporary management of adenomyosis

A

Levonorgestrel-containing IUD

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27
Q

Risk factors for endometritis

A

Retained products
STIs
Intrauterine foreign bodies/instrumentation

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28
Q

Risk factors for PID

A

Age 15-25
Non-white and non-Asian
Multiple partners
Recent douching
PID
Smoking
IUD with chlamydial/gonorrhea

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29
Q

What 2 organisms are suspected to cause 40% of PID?

A

N. Gonorrhoeae and C. Trachomatis

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30
Q

What three components can an ovarian tumor be associated with?

A

Surface epithelium
Ovarian germ cells
Ovarian stroma

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31
Q

What is the most common type of ovarian tumor?

A

Epithelial tumors

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32
Q

What are the most common lymph nodes to be involved in ovarian cancer spread?

A

Retroperitoneal pelvic lymph nodes
Para-aortic lymph nodes

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33
Q

What is the thought behind the cause of ovarian cancer?

A

Chronic uninterrupted ovulation
- early menarche, infertility, nulliparity, delayed childbearing

34
Q

Stage 1 broken in to what phases and distinguished by what?

A

Latent phase - 0-5 dilation
Active phase - 6-10 dilation

35
Q

What is the expected change in active phase?

A

1cm every hr

36
Q

What two factors help determine the estimated time it takes to deliver?

A

Parity
Epidural

37
Q

What are the expected times to deliver in stage two based on different women and their factors?

A

Multip w/o epidural - 1 hr
Multip w/ epidural - 3 hrs
Nullip w/o epidural - 3 hrs
Nullip w/ epidural 4 hrs

38
Q

How long can the placenta take to deliver?

A

30 min

39
Q

Types of lacerations

A

1st degree - mucosa or skin
2nd degree - extend to perineal body
3rd - into or completely through anal sphincter
4th - through the anal mucosa

40
Q

3 types of variability

A

Minimal < 5 bpm
Moderate 5-25 bpm
Marked >25 bpm

41
Q

What is considered a reactive NST ?

A

2 15 bpm within 20 minutes

42
Q

3 types of decelerations

A

Early - begin and end with contraction
Variable - occur at any time
Late - begin at the peak of a contraction

43
Q

Cause of the 3 types of decelerations

A

Early - head compression
Variable - cord compression
Late - placental insufficiency

44
Q

Category I fetal heart rate

A

Normal fetal heart tracing with normal baseline (110-160), moderate variability, and no variables or late decelerations

45
Q

Category III

A

Abnormal FHR tracing. Absent fetal heart variability and recurrent late or variable decelerations or bradycardia.

46
Q

Cardinal movements of labor

A

Engagement
Descent
Flexion
Internal rotation
Extend
External rotation

47
Q

When is gonorrhea and chlamydia testing recommended?

A

Sexually active women under 25 yo

48
Q

When does Pap screening test start?

A

21 yo

49
Q

Is HPV testing recommend at 21 yo? Why or why not

A

No.
Due to high prevalence of HPV infection in the age group. Most HPV infections will clear without treatment over two years?

50
Q

What is the guideline for prevention and early detection of cervical cancer in women 30-65 years?

A

Screening with cytology and high-risk HPV co-testing q5yrs, high-risk HPV testing alone q5yrs or cytology alone q3yrs

51
Q

What is the most appropriate next step for a HSIL cytology result?

A

Colposcopy, regardless of high-risk HPV

52
Q

Lower abdominal pain, adnexal tenderness, fever, cervical motion tenderness and vaginal discharge suggestive of what?

A

PID

53
Q

Multiple painful genital ulcerations, fever and dysuria are suggestive of what dx?

A

Herpes. Test with herpes cx.

54
Q

Frothy, yellow-green vaginal discharge with erythematous patches on the cervix are characteristic of what?

A

Trichomoniasis
Protozoan STI

55
Q

Clue cells are seen in?

A

Bacterial vaginosis

56
Q

Fishy order from a KOH prep is suggestive of?

A

Bacterial vaginosis

57
Q

Multinucleate giant cells and inflammation are microscopic findings of?

A

Herpes

58
Q

What test is done to confirm genital herpes?

A

Nucleic acid amplification test (NAAT) or culture

59
Q

Osteoporosis RF

A

Female gender
Caucasian ethnicity
Chronic inflammatory dz
Use of corticosteroids
Adrenal, thyroid or parathyroid dz
Sedentary lifestyle
Low estrogen states

60
Q

When should Rho(D) immune globin be administered to a Rh-negative mother?

A

28 wks of gestation
After delivery of an Rh(D)-positive fetus
After any invasive procedure
And after any episodes of fetomaternal hemorrhage

61
Q

Causes of fetal tachycardia (>160bpm)

A

Maternal fever
Hypoxia
Fetal anemia
Intra-amniotic infection
Maternal medications

62
Q

Causes of fetal bradycardia (<110bpm)

A

Congenital heart malformations
Hypoxia
Fetal distress
Maternal hypotension

63
Q

When is glucose tolerance testing typically done?

A

24-28 weeks

64
Q

What age do mammograms start?

A

40 q1yr

65
Q

What contraceptive methods have the lowest pregnancy rate?

A

Depo, LARC, Sterilization

66
Q

What is the most likely cause of anemia in pregnancy?

A

Hemodiluation

67
Q

What is the most likely cause of respiratory alkalosis in pregnancy?

A

Progesterone is a respiratory stimulant

68
Q

What contributes to pyleonephritis in pregnancy?

A

dextrorotation of the uterus. Compresses ureters at the pelvic brim.

69
Q

In the first trimester is an US or LMP more accurate?

A

US (within about 5 days)

70
Q

Which test has the highest sensitivity for down syndrome?

A

amniocentesis (especially in women with increased BMI)

71
Q

Flattened nasal bridge, small size and small rotated, cup shaped ears, sandal gap toes, hypotonia are associated with…

A

Down syndrome

72
Q

What are the benefits to delayed cord clamping?

A

Increase Hgb levels, improve iron stores in the first several months

73
Q

Ddx of postpartum fever

A

Endometritis, UTI, lower genital tract infection, wound infections, pulmonary infections, thrombophlebitis, mastitis

74
Q

Prolactin is responsible for (lactation)

A

Milk production

75
Q

Oxytocin is responsible for (lactation)

A

Milk ejection

76
Q

AE of magnesium sulfate

A

respiratory depression, muscle weakness, loss of deep tendon reflexes, nausea

77
Q

Benefits of low dose aspirin

A

Decrease risk of recurrent preeclampsia ( given before 16 wks)
Reduce likelihood of fetal growth restriction

78
Q

Increased risks when smoking

A

Placenta previa
Placental abruption
Fetal growth restriction
Infection

79
Q

What is the post common cause of postpartum hemorrhage?

A

uterine atony

80
Q

What uterotonic is contraindicated in asthmatics?

A

Prostaglandin F2 alpha (carboprost)

81
Q

90% of vulvar cancers are..

A

squamous cell carcinoma

Obgyn (1 decks)

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