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step3 > 2014-03-07 USMLE OB_Gyn - USMLE OB_Gyn > Flashcards

2014-03-07 USMLE OB_Gyn - USMLE OB_Gyn Flashcards

1
Q

When does standard HCG test for pregnancy become positive?

A

2 weeks after conception

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2
Q

What is Heagar’s sign

A

sofetening and compressivility of the lower uterine segment indicating pregnancy

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3
Q

What is Chadwick’s sign

A

dark discoloration of the vulva and vaginal walls

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4
Q

What is the significance of linea nigra in preganancy?

A

normal benign finding

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5
Q

What is melasma?

A

hyperpigmentation of sun exposed areas; often in pregnancy

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6
Q

When does quickening occur?

A

primigravida: 18-20 weeks
multi: 16-18 weeks

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7
Q

When during pregnancy do you need a pap smear?

A

at first visit unless done in last 6 months

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8
Q

When during pregnancy do you need a urinalysis?

A

at every visit

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9
Q

Urinalysis in pregnancy is used to screen for…

A
  • pre-eclamppsia
  • bacteriuria
  • diabetes
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10
Q

When during pregnancy do you need a CBC?

A

at first visit

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11
Q

When during pregnancy do you need a blood type/screen?

A

at first visit

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12
Q

When during pregnancy do you need a syphilis test?

A

at first visit, repeat later if high risk

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13
Q

When during pregnancy do you need a rubella titer?

A

first visit if vaccination history not known

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14
Q

When during pregnancy do you need diabetes screening?

A
  • betwen 24-28 weeks; at first visit if high risk factors
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15
Q

High risk factors for gestational diabetes

A
  • obese
  • family history
  • age over 30
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16
Q

When during pregnancy do you need a triple screen?

A

15-20 weeks for older/high risk women

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17
Q

Significance of low AFP on triple screen

A
  • Down syndrome
  • fetal demise
  • inaccurate dates
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18
Q

Significance of high AFP on triple screen

A
  • neural tube defects
  • ventral wall defects
  • multiple gestation
  • inaccurate dates
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19
Q

What do you do if triple screen is abnormal.

A
  • order an US to check dates and look for anomalies

- if US not helpful, order amnio for AFP level and cell culture for chromosomes

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20
Q

When during pregnancy do you need a Group b strep culture?

A

35-37 weeks

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21
Q

How do you treat group B strep in pregnant mom?

A

treat with amoxicillin during labor

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22
Q

When can fetal heart tones be heard?

A
  • doppler: 10-12 weeks

- stethascope: 16-20 weeks

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23
Q

What is significant for size/date discrepency

A

uterine size difference of 2-3 cm to dates; get US

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24
Q

What do HCG levels do in the first trimester of pregnancy?

A

double every 2 days

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25
Q

Ongoing increase in HCG or increase after delivery indicates

A
  • hydatiform mole

- choriocarcionma

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26
Q

HCG level at 5 weeks

A

> 2000

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27
Q

Transvaginal US can detect intrauterine pregnancy at

A

5 weeks

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28
Q

Average weight gain of pregnancy

A

28 pounds

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29
Q

With extra weight gain in pregnancy think

A

diabetes

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30
Q

With poor weight gain during pregnancy think

A
  • hyperemesis gravidum
  • psych disorder
  • major systemic disease
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31
Q

ESR in pregnancy

A

very elevated

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32
Q

Thyroid tests in pregnancy

A
  • free T4 same

- overall total T4 and thyroid binding globulin increase

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33
Q

Hematocrit in pregancy

A
  • decreased (increased red cells but fluid increases more)
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34
Q

BUN and Cr in pregnancy

A

decrease (GFR increases)

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35
Q

Alkaline phosphatase in pregnancy

A

very increased

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36
Q

Mild proteinuiria in pregnancy

A

normal

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37
Q

Mild glucosuria in pregnancy

A

normal

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38
Q

Electrolyte in pregnancy

A

unchanged

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39
Q

Liver function tests in pregnancy

A

unchanged

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40
Q

BP changes in pregnancy

A

decreases slightly

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41
Q

HR changes in pregnancy

A

increased 10-20 beats per minute

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42
Q

Stroke volume and cardiac output in pregnancy

A

increase, often by 50%

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43
Q

Minute ventillation in pregnancy

A

increases (increased tidal volume, rate about the same)

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44
Q

Residual lung volume in pregnancy

A

decreased

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45
Q

Respiratory alkalosis in pregnancy is

A

normal

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46
Q

Definition of IUGR

A

below 10th percentile for age

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47
Q

3 classes of causes of IUGR

A
  • maternal
  • fetal
  • placental
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48
Q

US parameters to look for IUGR

A
  • biparietal diameter
  • head circumference
  • abdominal circumference
  • femur length
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49
Q

Components of biophysical profile (BPP)

A
  • heart rate tracing
  • US for:
  • amniotic fluid ndex
  • fetal breathing movements
  • fetal body movements
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50
Q

If you are concerned about a fetus, but non-emergent, what is the series of investigations?

A
  • BPP, if abnormal then contractile stress test. If decels, usually go to c-section
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51
Q

What is the contraction stress test

A
  • looks for uretroplacental dysfunction.

- mom is given oxytocin and HR is monitored. If decels, then usually to c-section

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52
Q

Define oligohydramnios

A

<300-500 ml

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53
Q

4 major causes of oligohydramnios

A
  • IUGR
  • premature rupture of membranes
  • postmaturity
  • renal agenesis (Potter disease)
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54
Q

4 complications of oligohydraminios

A
  • pulmonary hypoplasia
  • cutaneous problems (compression)
  • skeletal problems (compression)
  • hypoxia (cord compression)
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55
Q

Define polyhydramnios

A

> 1700-2000ml

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56
Q

5 major causes of polyhydramnios

A
  • maternal diabetes
  • multiple gestation
  • neural tube defects
  • GI anomolies
  • hydrops fetalis
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57
Q

Maternal complications of polyhydramnios

A
  • uterine atony

- dyspnea from large uterus

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58
Q

At term normal fetal heart rate is

A

110 to 160 bpm

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59
Q

Discuss early decelerations

A
  • low point of fetal HR and high point of uterine contraction coincide
  • from head compression
  • normal
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60
Q

Discuss varible decelerations

A
  • most common
  • variable occurance with contractions
  • signifies cord compression
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61
Q

Treatment of variable decelerations

A
  • mom in lateral decub
  • give O2 by facemask
  • stop oxytocin
  • if brady (t resolve measure fetal O2
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62
Q

Discuss late decelerations

A
  • fetal HR nadir occurs after contraction
  • uteroplacental insufficiency
  • worrisome
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63
Q

Treatment in late decelerations

A
  • lateral decub, O2, stop oxytocin
  • give tocolytic
  • give IVF if BP not optimal
  • if persist, measure fetal O2
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64
Q

Examples of tocolytic agents

A
  • ritodrine

- magnesium sulfate

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65
Q

Discuss the loss of fetal variability if heart rate in labor

A
  • check fetal scalp pH

- if associated with variable or late decels, likely need to deliver

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66
Q

In labor, what are the scalp pH parameters that indicate need for delivery?

A
  • fetal scalp pH < 7.2 or abnormal O2
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67
Q

How can you distinguish true labor

A
  • regular contraction (every 3 minutes)

- associated with cervical changes

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68
Q

Describe “false labor”

A

aka Braxton-Hicks contraction

  • irregular
  • no cervical changes
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69
Q

Desribe the stages of labor

A

1st- true labor to full dilation
2nd- full dilation to dirth
3rd- delivery of baby
4th- placenta to stabilization

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70
Q

1st stage of labor lasts how long?

A
  • nuligravida: < 20 hours

- multigravida: < 14 hours

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71
Q

In the active phase of 1st stage of labor, how fast does the cervix dilate?

A
  • nuligravida: >1cm/hr

- multigravida: >1.2 cm/hr

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72
Q

Time from full cervical dilation to start delivery of baby

A
  • nuligravida: 30min - 3 hrs

- multigravida: 5-30 min

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73
Q

Time to delivery baby

A

0-30 minutes

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74
Q

Time to delivery placenta and maternal stabilization

A

up to 48 hours

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75
Q

What is protraction disorder

A

Labor takes long than expected

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76
Q

What is labor arrest disorder?

A

No change in cervical dilation occurs over 2 hours and no change in fetal descent after 1 hour

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77
Q

Treatment of arrest disorder

A
  • check fetal lie
  • check for cephalopelvic disproportion
  • augment labor
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78
Q

Name 3 ways to augment labor

A
  • oxytocin
  • prostaglandin gel
  • amniotomy
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79
Q

Most common cause of “failure to progress” in labor

A

cephalopelic disporoprtion (labor augmentation contraindicated)

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80
Q

Half life of oxytocin

A

less than 10 minutes

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81
Q

Side effects of oxytocin

A
  • uterine hyperstimulation
  • uterine rupture
  • fetal heart deccelerations
  • hyponatremia
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82
Q

Side effects of PGE2 used for ripening cervix

A

uterine hyperstimulation

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83
Q

Decision of vaginal delivery with HSV based on…

A

if active lesions during labor, opt for c-section

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84
Q

Orientation of “classic” c- section incision

A

vertical

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85
Q

Signs of placental separation

A
  • fresh blood from vagina
  • umbilical cord lengthens
  • fundus rises and becomes firm and globular
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86
Q

What is the first step during delivery with shoulder dystocia

A
  • McRobert maneuver: mother sharpely flexes thighs against abdomen
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87
Q

List the order of labor positions

A
  • descent
  • flexion
  • internal rotation
  • extension
  • external rotation
  • expulsion
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88
Q

Postpartum discharge

A
  • red the first few days, usually white by day 10
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89
Q

Foul smelling lochia is concerning for

A

endometritis

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90
Q

What is the underlying likely cause when new mom develops PE

A

PE from amniotic fluid

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91
Q

Definition of post-partum hemorrhage

A

> 500 cc with vaginal

>1000cc with c-section

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92
Q

Most common cause of post-partum hemorrhage

A

uterine atony

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93
Q

Complication of severe post-partum hemorrhage

A

Sheeham sydrome

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94
Q

Risk factors for retained placenta after delivery

A
  • previous uterine surgery

- previous c- section

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95
Q

Risk factors for uterine atony

A
  • overdistended
  • prolonged labor
  • oxytocin
  • more than 5 deliveries
  • precipitous labor (<3h)
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96
Q

Treatment of uterine atony

A
  1. uterine massage with low dose oxytocin
  2. ergot drug or PGF2-alpha
  3. hysterectomy
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97
Q

Treatment of retained products of conception

A
  • remove placenta manually to stop bleeding
  • curettage in OR
  • if placental accreta, likely to need hysterectomy
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98
Q

Most common cause of uterine inversion

A

iatrogenic; pulling too hard on the cord

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99
Q

Treatment of uterine inversion

A
  • manually replace uterus may need anesthesia)

- IVF, oxytocin

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100
Q

Definition of post-partum fever

A

fever for 2 days

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101
Q

5 most common causes of post-partum fever

A
  • breast engorgement
  • UTI
  • endometritis
  • endomyometritis
  • puerperal sepsis
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102
Q

Risk factors for endometritis

A
  • C-section
  • PROM
  • prolonged labor
  • frequent vaginal exams
  • manual removal of placenta
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103
Q

Treatment of endometritis

A
  • obtain cultures of endometrium, vagina, blood and urine

- treat with broad spectrum antibiotics

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104
Q

If endometritis doesn’t resolve, what’s likely going on?

A
  • pelvic abscess
    OR
  • Pelvic thrombophlebitis
    (get a CT)
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105
Q

Treatment of post-partum pelvic thrombphlebitis

A

heparin

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106
Q

3 major things to think of with postpartum shock and no evident bleeding

A
  • amniotic fluid embolus
  • uterine inversion
  • concealed hemorrhage
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107
Q

If a woman doesn’t want to breastfeed, what would you prescribe

A
  • tight bra
  • ice
  • analgesia
  • bromocriptin
  • birth control pills
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108
Q

Mastidis after delivery usually occurs

A

within 2 months

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109
Q

Usual organism of mastidis

A

staph aureus

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110
Q

Treatment of mastidis

A
  • keep breast feeding
  • analgesia
  • warm compresses
  • antibiotics if more than mild (cephalexin, dicloxacillin)
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111
Q

Contraindications to breast feeding

A
  • maternal HIV
  • illicit drug use
  • sedatives
  • stimulants
  • lithium
  • chemotherapy
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112
Q

Define abortion

A

termination of pregnancy before 20 weeks or fetus less than 500 grams

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113
Q

Define threatened abortion

A

uterine bleeding without cervical dilation and no expulsion of tissue

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114
Q

Treatment of threatened abortion

A

pelvic rest

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115
Q

What percentage of pregnancies with threatened abortion go on to be normal?

A

50%

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116
Q

Define inevitable abortion

A

uterine bleeding with cervical dilation, crampy pain and no tissue

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117
Q

Treatment of inevitable abortion

A

follow, D&C of uterine cavity

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118
Q

Define incomplete abortion

A

passage of some products of conception through cervix

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119
Q

Treatmetn of incomplete abortion

A

observation, often need D&C

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120
Q

Define complete abortion

A

expulsion of all products of conception from the uterus

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121
Q

Treatment of complete abortion

A

Serial HCGs to be sure returns to zero. D&C if pain or opeen cervical os

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122
Q

Define missed abortion

A

fetal death without expulsion of fetus

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123
Q

Treatment of missed abortion

A

most women go on to have spontaneous miscarriage but D&C often performed

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124
Q

Define induced abortion

A

intentional temination prior to 20 weeks (elective or therapeutic)

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125
Q

Define recurrent abortion

A

two or three successive unplanned abortions

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126
Q

4 infectious causes of recurrent abortion

A
  • syphilis
  • Listeria
  • Mycoplasma
  • Toxoplasma
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127
Q

3 environmental causes of recurrent abortion

A
  • alcohol
  • tobacco
  • drugs
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128
Q

2 metabolic causes of recurrent abortion

A
  • hypothyroidism

- diabetes

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129
Q

3 autoimmune causes of recurrent abortion

A
  • lupus
  • anitphospholipid antibodies
  • lupus anticoagulant
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130
Q

3 anatomic causes of recurrent abortion

A
  • cervical incompience
  • congenital female tract abnormalities
  • fibroids
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131
Q

Classic cause of painless recurrent abortions in the second trimester

A

cervical incompetence

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132
Q

Treatment of cervical incompetence

A

cerclage at 14-16 weeks

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133
Q

Typical time when ectopic pregnancy presents

A

4-10 weeks.

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134
Q

Definitive diagnosis and treatment of ectopic pregnancy in unstable patient

A

laparoscopy

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135
Q

Major risk factors for ectopic pregancy

A
    • history of PID
  • previous ectopic
  • history of tubal ligation
  • pregnancy with IUD in place
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136
Q

In 3rd trimester bleeding always do a ______ before a ______

A

always do an US before a pelvic exam

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137
Q

Ddx of 3rd trimester bleeding

A
  • placenta previa
  • abruptio placentae
  • uterine rupture
  • fetal bleeding
  • cervical/vaginal lesions
  • cervical/vaginal trauma
  • bleeding disorder
  • cervical cancer
  • “bloody show”
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138
Q

In all patients with 3rd trimester bleeding, what do you do?

A
  • IV
  • blood if needed
  • O2
  • order CBC, coags
  • do US
  • setup maternal and fetal monitoring
  • tox screen if suspected
  • give Rh immune globuline if mother Rh negative
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139
Q

Risk factors for placenta previa

A
  • multiparity
  • older age
  • multiple gestation
  • prior previa
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140
Q

Why do you do an US before a pelvic exam in 3rd trimester bleeding

A

because of placenta previa.

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141
Q

Accuracy of US in dx placenta previa

A

95-100%

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142
Q

Characteristics of bleeding in placenta previa

A
  • *painless

- may be profuse

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143
Q

Treatment of placenta previa

A
  • if premature, can try rest and tocolysis if stable

* **otherwise needs c-section

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144
Q

Risk factors for abruptio placentae

A
  • HTN
  • cocaine
  • trauma
  • polyhydramnios with rapid decompression with membrane rupture
  • tobacco
    preterm PROM
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145
Q

3rd trimester bleeding where blood may not be visible

A

abruptio placentae

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146
Q

Woman in 3rd trimester with uterine pain/tenderness and hyperactive contraction pattern and fetal distress is concerning for

A

abruptio placentae

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147
Q

Use of US in diagnosing abruptio placentae

A

may be falsely normal

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148
Q

Complication of abruptio placentae

A

maternal DIC if fetal products enter blood stream

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149
Q

Treatment of abruptio placentae

A

rapid delivery (vaginal preferred)

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150
Q

Risk factors for uterine rupture

A
  • previous uterine surgery
  • trauma
  • oxytocin
  • grand multiparity
  • excessive uterine distention
  • abnormal fetal lie
  • CPD
  • shoulder dystocia
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151
Q

Sudden onset of abdominal pain in 3rd trimester with sudden materal hypotension most concerning for

A

uterine rupture

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152
Q

Changes in maternal abdomen that occur with uterine rupture

A
  • fetal parts palpable in abdomen

- abdominal contour may change

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153
Q

Treatment of uterine rupture

A
  • laparotomy for delivery

- usually requires hysterectomy

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154
Q

2 major causes of 3rd trimester fetal bleeding

A
  • vasa previa

- velamentous insertion of the cord

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155
Q

Major risk factor for 3rd trimester fetal bleeding

A

multiple gestation (higher # of fetuses = higher risk)

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156
Q

3rd trimester bleeding with painless bleeding, stable mom and fetal distress

A

from fetal bleeding

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157
Q

How do you differentiate maternal from fetal blood (such as in 3rd trimester bleeding?)

A

The Apt test

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158
Q

Treatment of fetal bleeding in 3rd trimester

A

c-section

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159
Q

Cervical/vaginal lesions commonly causing 3rd trimester bleeding

A
  • herpes
  • gonorrhea
  • chlamydia
  • candida
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160
Q

How can you decide on the dose of rhogam needed in a pregnant mom with 3rd trimester bleeding?

A

Use the Kleihauer-Betke test to quantify fetal blood in maternal circulation and use this to calculate dose

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161
Q

Define preterm labor

A

labor between 20-37 weeks

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162
Q

1st line treatment of preterm labor

A
  • lateral decub position
  • fluids
  • bed/pelvic rest
  • O2
  • tocolytics
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163
Q

Can a patient in preterm labor on tocolytics be discharged home?

A

yes, on oral tocolytics

164
Q

List the more common contraindications to tocolysis in preterm labor

A
  • herat disease
  • HTN
  • DM
  • hemorrhage
  • pre-eclampsia
  • chorioamnionitis
  • IUGR
  • ruptured membranes
  • cervical dilation >4cm
  • fetal demise
  • fetal abnormalities incompatible with survival
165
Q

Describe the use of fetal fibronectin

A
  • useful in preterm labor between 22-34 weeks

- if negative in vaginal secretions, very low chance of delivery in next 2 weeks

166
Q

What action for the fetus must be taken in a stable patient with possible pre-term labor and positive fetal fibronectin?

A

measures for lung maturity

167
Q

Amniocentesis results that indicate immature lungs

A
  • lecithin : sphingomyelin (L:S) ration less than 2:1
    OR
  • phosphatidylglycerol negative
168
Q

At what age in premature labor do you give steroids to hasten lung maturity

A

between 26 and 34 weeks

169
Q

Define premature rupture of membrance

A
  • ruputre of amniotic sac prior to onset of labor
170
Q

3 critera for premature rupture of membranes

A
  • pooling of amniotic fluid
  • ferning pattern
  • positive nitrazine test
171
Q

What test should be done in confirmed premature rupture of membranes

A

US

172
Q

How long do you give a mom at full term with PROM before inducing labor?

A

6-8 hours

173
Q

Mom with PROM, fever and tender uterus likely has

A

chorioamnionitis

174
Q

Classic cause of chorioamnionitis

A

premature rupture of membranes

175
Q

Complications of chorioamnionitis in mom and fetus

A
  • neonatal sepsis
  • maternal sepsis
  • maternal endomyometritis
176
Q

Empiric treatment of chorioamnionitis

A

ampicillin

177
Q

Define preterm PROM

A

premature rupture of membranes before 36-37 weeks

178
Q

What do you need to test for with preterm PROM

A

culture fluid for group B step and treat mom with ampicillin if positive culture

179
Q

2 major clues that twins are dizygotic

A
  • different sexes

- different blood types

180
Q

If placenta is monochorionic then twins are

A

monozygotic

181
Q

What can you do to further investigate if twins are mono or dizygotic?

A

HLA typing

182
Q

4 major maternal complications of multiple gestations

A
  • anemia
  • HTN/pre-eclampsia
  • postpartum uterine atony
  • postpartum hemorrhage
183
Q

9 major fetal complications of multiple gestations

A
  • polyhydramnios
  • malpresentation
  • placenta previa
  • abruptio placentae
  • velamentous cord/vasa previa
  • umbilical cord prolapse
  • IUGR
  • congenital anomalies
  • increased morbidity/mortality
184
Q

When can you try to delivery twins vaginally?

A

When they are BOTH vertex; any other combo, do c-section

185
Q

Define post-term pregnancy

A

after 42 weeks

186
Q

If dates for pregnancy are known and reach 42 weeks, what do you do?

A

induce labor

187
Q

If dates for pregnancy are unknown and reach 42 weeks, what do you do?

A

twice weekly BPP

188
Q

Post post-maturity for fetus increase risk of morbidity and mortality?

A

yes

189
Q

Prolonged gestation is classically associated with what congenital anomaly?

A

anencephaly

190
Q

Fetus with “frog-like” appearance on US likely has

A

anancephaly

191
Q

Risk factors for hyperemesis gravidarum

A
  • younger
  • first pregnancy
  • underlying stressors
192
Q

Hyperemesis gravidarum presents in which trimester?

A

1st

193
Q

With all high risk pregnancies, consider weekly _____ during the third trimester

A

biophysical profiles

194
Q

Can chorionic villi sampling detect neural tube defects?

A

no

195
Q

When can chorionic villi sampling be done?

A

at 9-12 weeks (earlier than amniocentesis)

196
Q

chorionic villi sampling is generally reserved for

A

testing of genetic diseases

197
Q

What is the miscarriage rate of chorionic villi sampling compared to amniocentesis

A

higher with chorio

198
Q

How do you know if a woman has pre-eclampsia if she already had HTN?

A

Increased greater than 30/15

199
Q

What does HELLP syndrome stand for?

A

H- hemolysis
EL-elevated liver enzymes
LP-low platelets

200
Q

S/s for pre-eclampsia

A
  • HTN
  • 2+ proteinuria
  • oliguria
  • facial/hand edema
  • headache
  • visual changes
  • HELLP syndrome
201
Q

Pain in what location often does with HELLP syndrome?

A

RUQ or epigastric pain

202
Q

When does pre-eclampsia usually occur?

A

3rd trimester

203
Q

Main risk factors for pre-eclampsia

A
  • chronic renal disease
  • HTN
  • family history
  • multiple gestation
  • nulliparity
  • extremes of reproductive age
  • DM
  • black race
204
Q

Treatment of pre-eclampsia

A
  • stabilization

- if at term, delivery the baby

205
Q

Treatment for pre-eclampsia if fetus is not full term

A
  • hydralazine or labetalol
  • magnesium sulfate (seziure prophylaxis)
  • bedrest
  • hospital observation
206
Q

Indications in pre-eclampsia to delivery baby regardless of gestational age

A
  • oliguria
  • mental status change
  • headache
  • blurred vision
  • pulmonary edema
  • cyanosis
  • HELLP
  • BP > 160/110
  • ecclampsia (seizures)
207
Q

Is severe ankle edema normal in pregnancy?

A

No, look for pre-ecclampsia

208
Q

HTN + proteinuria in pregnancy = ______ until proven otherwise

A

pre-eclampsia

209
Q

Complications of pre-eclampsia and eclampsia

A
  • uretoplacental insufficiency
  • IUGR
  • fetal demise
  • increased maternal morbidity and mortality
210
Q

Does pre-eclampsia during pregnancy mean higher risk for HTN later in life?

A

No, not generally

211
Q

Pre-eclampsia prior to the third trimester is likely

A

molar pregnancy

212
Q

Best way to prevent eclampsia?

A

routine prenatal care

213
Q

Initial treatment of choice for eclamptic seizures?

A
  • Magnesium sulfate wthich also lowers blood pressure
214
Q

Toxic effects of magnesium sulfate

A
  • hyporeflexia (1st sign)
  • respiratory depression
  • CNS depression
  • coma
  • death
215
Q

3 maternal complications of gestational diabetes

A
  • polyhydramnios
  • pre-eclampsia
  • complications of DM
216
Q

2 difference is fetus for gestational DM vs. pre-existing DM

A
  • gestational: macrosomia

- pre-existing: IUGR

217
Q

6 fetal complications of gestational DM

A
  • respiratory distress syndrome
  • cardiovascular defects
  • colon defects
  • craniofacial defects
  • neural tube defects
  • caudal regression syndrome
218
Q

What is caudal regression syndrome?

A

lower half of body incompletely formed (risk with gestational DM)

219
Q

Use of oral hypoglycemics in pregnancy

A

contraindicated (use insulin)

220
Q

Infants born to DM mothers are classically at risk for what right after birth?

A

postdelivery hypoglycemia

221
Q

Why do babies of DM mother’s get hypoglycemic after delivery?

A

fetal islet cell hypertrophy

222
Q

Only maternal antibody category to cross the placenta

A

IgG

223
Q

Meaning of elevated neonatal IgM concentration?

A

never normal

224
Q

Meaning of elevated neonatal IgG concentration

A

often represents maternal antibodies

225
Q

When does Rh incompatilbity occur

A

mom Rh negative

baby Rh positive

226
Q

At what time do you give Rh immune globulin

A
  • 28 weeks
  • within 72 hours of delivery
  • after any procedures which may cause transplacental hemorrhage (amnio)
227
Q

What type of prevention is Rh immune globulin?

A

primary

228
Q

IS Rh immune globulin effective if maternal Rh antibodies are strongly postiive?

A

no

229
Q

What is hydrop fetalis

A

edema, ascites, pleural/pericardial effusions

230
Q

Undetected Rh incompatability can lead to

A
  • hemolytic disease of newborn

- hydrops fetalis

231
Q

Who do you test the severity of fetal hemolysis

A

Amniotic fluid spectrophotometry

232
Q

Treatment of hemolytic disease of the fetus

A
  • delivery if mature
  • intrauterine blood transfusion
  • phenobarbital (helps fetal liver break down bilirubin)
233
Q

Mother with type O blood and baby with any other type, baby at risk for

A

hemolytic disease of the newborn

234
Q

Snow storm pattern on US =

A

hydatiform mole

235
Q

“grape like vesicles” with 1st or 2nd trimester bleeding

A

hydatiform mole

236
Q

uterine size/dates discrepancy brings concerns for

A

hydatiform mole

237
Q

Karyotype of complete moles

A

46XX or 46 XY (all from father)

238
Q

Do complete moles contain fetal tissue?

A

no

239
Q

Karyotype of incomplete moles

A

69 XXY

240
Q

Do incomplete moles contain fetal tissue?

A

yes

241
Q

Treatment of moles

A

D&C, follow HCG levels to zero

242
Q

What happens if patient treated for hydatiform mole and HCG doesn’t return to zero

A

invasive mole or choriocarcinoma and patient needs chemo

243
Q

Chemo options for invasive mole or choriocarcinoma

A
  • methotrexate

- actinomycin D

244
Q

Source of choriocarcinoma

A
  • denove

- complete mole

245
Q

Can choriocarcinoma develop from incomplete mole?

A

no

246
Q

Prevention of aborption in when with antiphsophlipid antibodies and previous pregnancy problems

A

Low dose ASA and heparin

247
Q

How do you treat TB in a pregnant patient

A

same treatment

248
Q

Drug to avoid if need to treat pregnant patient for TB

A

streptomycin

249
Q

Streptomycin given during preganancy risks causing ____ and ____ in the fetus

A
  • deafness

- nephrotoxicity

250
Q

Fetal defect caused by thalidomide

A

phocomelia

251
Q

Fetal defect caused by tetracycline

A

yellow/brown teeth

252
Q

Fetal defect caused by aminoglycoside

A

deafness

253
Q

Fetal defect caused by valproic acid

A
  • spina bifida

- hypospadias

254
Q

Fetal defect caused by progestersone

A

masculinization of females

255
Q

Fetal defect caused by cigarettes

A
  • IUGR
  • low birth weight
  • prematurity
256
Q

Fetal defect caused by birth control pills

A

VACTRERL syndrome:

  • veterbral
  • anal
  • cardiac
  • tracheal
  • esophageal
  • renal and
  • limb malformations
257
Q

Fetal defect caused by llithium

A

Ebstein anomalies (atrialization of right ventricle)

258
Q

Fetal defect caused by aminopterin

A
  • IUGR
  • CNS defects
  • cleft lip/palate
259
Q

Fetal defect caused by radiation

A
  • IUGR
  • CNS/face defects
  • leukemia
260
Q

Fetal defect caused by phenytoine (diphenyhydantoin)

A
  • craniofacial defects
  • limb defects
  • mental retardation
  • cardiac defects
261
Q

Fetal defect caused by trimethadione

A
  • craniofacial defects
  • cardiovascular defects
  • mental retardation
262
Q

Fetal defect caused by warfarin

A
  • craniofacial defects
  • CNS defects
  • IUGR
  • stillbirth
263
Q

Fetal defect caused by carbamazepine

A
  • fingernail hypoplasia

- craniofacial defets

264
Q

Fetal defect caused by isotretinoin

A
  • CNS defects
  • craniofacial/ear defects
  • cardiovascular defects
265
Q

Fetal abnormalities caused by iodine

A
  • goiter

- cretinism

266
Q

Fetal abnormalities caused by cocaine

A
  • cerebral infarcts

- mental retardation

267
Q

Fetal abnormalities caused by diazepam

A
  • clef lip/palate
268
Q

Fetal abnormalities caused by diethylstilbestrol

A
  • clear cell vaginal cancer
  • adenosis
  • cervical incompetence
269
Q

Is acetaminophen safe in preganancy?

A

Yes

270
Q

Is penicillin safe in preganancy?

A

Yes

271
Q

Is cepahlosporins safe in preganancy?

A

Yes

272
Q

Is erythromycin safe in preganancy?

A

Yes

273
Q

Is nitrofurantoin safe in preganancy?

A

Yes

274
Q

Is H2-blocker safe in preganancy?

A

Yes

275
Q

Is antacid safe in preganancy?

A

Yes

276
Q

Is heparin safe in preganancy?

A

Yes

277
Q

Is hydralazine safe in preganancy?

A

Yes

278
Q

Is methyldopa safe in preganancy?

A

Yes

279
Q

Is labetalol safe in preganancy?

A

Yes

280
Q

Is insulin safe in pregnancy?

A

yes

281
Q

Is docusate safe in pregnancy?

A

yes

282
Q

3 important features of PID

A
  • abdominal pain
  • adnexal tenderness
  • cervical motion tenderness
283
Q

4 supporting features of PID

A
  • elevated ESR
  • leukocytosis
  • fever
  • purulent cervical discharge
284
Q

3 biggest organisms in PID

A
  • Neiseria gonorrhoeae
  • Chlamydia
  • e coli
285
Q

Organism causing PID in patient with IUD

A

actinomyces israeli

286
Q

Most common preventable cause of infertility

A

PID

287
Q

Likely cause of infertility in woman under 30 with regular menstrual cycles

A

PID

288
Q

Treatment of PID

A
  • more than 1 abx
  • oupt: ceftriaxone/doxycycline
  • Inpt: clinda/gent
289
Q

Unusual feature of tubo-ovarian abscess

A

may resolve with antibiotics alone

290
Q

Vaginal discharge like cottage chees

A

candida

291
Q

Vaginal discharge with pseudohypahe on KOH

A

candida

292
Q

Vaginal discharge with history of diabetes

A

candida

293
Q

Vaginal discharge with history of antibiotic treatment

A

candida

294
Q

Vaginal discharge with during pregancy

A

candida

295
Q

Treatment of candidal vaginitis

A

oral or topical antifungal

296
Q

Vaginal discharge with organisms seen swimming under microscope

A

trichomonas

297
Q

Vaginal discharge that is pale green, frothy, watery

A

trichomonas

298
Q

Vaginal discharge with strawberry cervix

A

trichomonas

299
Q

Treatment of trichomonas

A

metronidazole

300
Q

Vaginal discharge with fishy smell on KOH prep

A

Gardnerella

301
Q

Vaginal discharge with clue cells

A

Gardnerella

302
Q

Vaginal discharge that is malodorous

A

Gardnerella

303
Q

Treatment of Gardnerella

A

Metronidazole

304
Q

Venereal warts are caused by

A

human papillomavirus

305
Q

Koilocytosis on pap smear =

A

human papillomavirus venereal warts

306
Q

Multiple shallow painful vaginal ulcers =

A

herpes

307
Q

Treatment of vaginal herpes

A

acyclovir, valacyclovir

308
Q

Most common sexually transmitted disease

A

Chlamydia

309
Q

STD that often causes dysuria

A

Chlamydia

310
Q

Treatment of chlamydia

A
  • doxycycline

- azithromycin

311
Q

One time oral treamtment option for chlamydia

A
  • 1 gram of azithromycin
312
Q

Treatment of chlamydia in pregnant patient

A

erythromycin or amoxicillin

313
Q

STD for mucopurulent cervicitis

A

Neisseria gonorhoeae

314
Q

Gram negative STD

A

Neisseria gonorhoeae

315
Q

Treatment of Neisseria gonorhoeae

A
  • ceftriaxone

- cipro

316
Q

STD with intracellular inclusions

A

molluscum

317
Q

Treatment of pediculosis

A

(crabs)

- permethrin cream

318
Q

If a patient has gonorrhea, what should you also treat for?

A

chlamydia

319
Q

Typical treatment for fonorrhea

A

ceftraizone and doxycycline (assume also chlaymdia infection)

320
Q

STDs where the partner does NOT need to be treated

A

candida, Gardnerella

321
Q

Test to do in primary amenorrhea

A
  • if basic overview normal, administer progesterone; if no bleeding, likely no estrogen or anatomic abnormality
322
Q

If patient with primary amenorrhea bleeds with progesterone test, this means

A
  • estrogen is present

- normal uterus

323
Q

If patient with primary amenorrhea has normal breasts but no pubic/axillary hair, likely

A

androgen insensitvity syndrome

324
Q

Features of androgen insensitivity syndrome

A
  • phenotypically female
  • no uterus
  • genetically XY
325
Q

Secondary amenorrhea with + progesterine challenge and HIGH leutinizing hormone

A

polycystic ovarian syndrome

326
Q

In polycystic ovarian sydrome, LH is

A

high

327
Q

Ddx for secondary amenorrhea with + progesterine challenge and LOW leutinizing hormone

A
  • pituitary adenoma
  • hypothyroidism
  • low gonadotropin hormone
328
Q

Causes of low gonadotropin hormone

A
  • drugs
  • stress
  • exercise
  • anorexia nervosa
329
Q

Test to check is patient has secondary amenorrhea that you think is from pituitary adenoma

A

prolactin

330
Q

Patient with secondary amenorrhea with normal prolactin, normal TSH and low gonadotropin likely has

A

anorexia nervosa

331
Q

A patient with secondary amenorrhea with + progesterone bleeding test can likey become pregnant by using which drug?

A

clomiphene

332
Q

Secondary amenorrhea with no bleeding on progesterine challenge has (generally)

A

insuffecient estrogen

333
Q

Secondary amenorrhea with no bleeding on progesterine challenge with elevated FSH has

A

premature ovarian failure/menopause

334
Q

FSH is _____ in premature ovarian failure

A

elevated

335
Q

Secondary amenorrhea with no bleeding on progesterine challenge with low/normal FSH may have

A

neoplasm of hypothalamus (get MRI of brain)

336
Q

First test to order in amenorrhea

A

pregnancy test

337
Q

Nulliparous 35 yr woman with dyspareunia and dyschezia

A

endometriosis

338
Q

Most common site for endometriosis

A
  • ovaries
339
Q

Tender adnexa WITHOUT evidence of PID =

A

endometriosis

340
Q

Endometriosis may be associated with this uterine position

A

retroverted

341
Q

Gold standard for diagnosis of endometriosis

A

laparoscopy with visualization

342
Q

Mulberry spots

A

endometriosis

343
Q

flat brown colored powder burns

A

endometriosis

344
Q

chocolate cysts

A

endometriosis

345
Q

Most likely cause of infertility in menstruating woman over 30

A

endometreosis

346
Q

Treatment of endometriosis

A

1st: birth control pills

2nd/3rd: danzol, GnRH agonists

347
Q

Effect of surgery for endometriosis on fertility

A

often improves it

348
Q

Define adenomyosis

A

ectopic endometrial glands within uterine musculature

349
Q

Typical characteristics of adenomyosis

A
  • over 40
  • dysmenorrhea
  • large boggy uterus
350
Q

Woman over 40 with large boggy uterus and dymenorrhea

A

adeomyosis

351
Q

Treatment of adenomyosis

A
  • D&C to r/u endometrial cancer
  • consider hysterectomy
  • may try GnRH agonists
352
Q

Define dysfunctional uterine bleeding

A

abnormal uterine bleeding not associated with tumor inflammation or pregnancy

353
Q

70% of dysfunctional uterine bleeding is associated with

A

anovulatory cycles

354
Q

When is dysfunction uterine bleeding common and physiologic?

A

Right are menarche and before menopause

355
Q

If dysfunctional uterine bleeding that doesn’t appear simple, think

A

polycystic ovarian syndrome

356
Q

What needs to be done in woman over 35 with dysfunctional uterine bleeding?

A

D&C to r/o endometrial cancer

357
Q

Why should you get a CBC in patient with polycystic ovarian syndrome?

A

excess blood loss

358
Q

4 uncommon causes of dysfunctional uterine bleeding

A
  • infections
  • endocrine disorders
  • coagulation defects
  • estrogen producing neoplasms
359
Q

First line treatment for idiopathic dysfunctional uterine bleeding

A

NSAIDs or OCPs

360
Q

First line treatment for dysmenorrhea

A

NSAIDs

361
Q

Treatment of severe bleeding with dysfunctional uterine bleeding

A

progesterone

362
Q

Overweight woman with infertility and amenorrhea

A

polycystic ovarian syndrome

363
Q

Most common cause of infertility in woman under 30 with ABnormal menstruation

A

polycystic ovarian syndrome

364
Q

LH:FSH in polycystic ovarian syndrome

A

greater than 2:1

365
Q

Cancer risk in polycystic ovarian syndome

A

unopposed estrogen causes increased risk for endometrial hyperplasia and enodmetrial carcinoma

366
Q

Treatment of polycystic ovarian syndrome

A
  • OPCs
  • cyclic progesterone
  • if wants pregnancy, use clomiphene
367
Q

Treatment of premenstrual dysphoric disorder

A

NSAIDs; antidepressants

368
Q

Average age of menopause

A

50

369
Q

Increase parabasal cells on vaginal cytology indicates

A

menopause

370
Q

Fibroids aka

A

leimyoma

371
Q

Are leiomyomas malignant or benign?

A

benign

372
Q

Most common indication for hysterectomy

A

leiomyoma

373
Q

Rate of malignant transformation of leimyoma

A

<1%

374
Q

When do leiomyomas often grow rapidly?

A

During pregnancy or high estrogen (OCPs)

375
Q

Anemia with fibroids is an indication for

A

hysterectomy

376
Q

Test that should be done in woman over 40 with leiomyoma

A

D&C to r/o endometrial cancer

377
Q

Polyp protruding through cervix is likely

A

leiomyoma

378
Q

4 non-cancerous causes of breast discharge

A
  • birth control pills
  • hormone therapies
  • antipsychotic medications
  • hypothyroidism
379
Q

If a patient has bilateral non-bloody breast discharge, what are the chances that it’s cancer?

A

very low

380
Q

Unilateral breast discharge is concerning for

A

cancer

381
Q

Most common breast disorder

A

fibrocystic disease

382
Q

Treatment of fibrocystic breast disease if under 35

A

if symptoms are very severe can do progesterone or danazol for a week at the end of each month

383
Q

Features of fibrocystic breast disease

A
  • under 35
  • bilateral
  • multiple cystic lesions
  • tender
384
Q

A painless, shaprly circumscribed, rubbery, mobile breast mass is likely

A

fibroadenoma

385
Q

Most common benign tumor of the female breast

A

fibroadenoma

386
Q

Age when you become more concerned about breast cancer

A

35

387
Q

Treatment of fibroadenoma of the breast

A

excision is curative but often not needed

388
Q

Fibroadenoma of the breast often growns quickly in the setting of

A

OCPs or pregnancy (estrogen)

389
Q

Is mammogram useful under the age of 35?

A

No. Breast tissue too dense. Proceed directly to biopsy

390
Q

Approach to fibrocystic breast disease in woman over 35

A
  • aspirate fluid
  • baseline mammogram
  • if fluid is bloody or cyst recurrs, do biopsy
391
Q

This potentially malignant tumor often masquerades as a rapidly growing fibroadenoma of the breast

A

phylloides tumor

392
Q

Treatment of fibroadenoma of the breast if over 35

A
  • baseline mammogram

- can observe if very low risk, but low threshold for biopsy

393
Q

In a woman over 35 with a breast mass, when in doubt…

A

get a biopsy

394
Q

A new breast mass in a postmenopausal woman…

A

is breast cancer until proven otherwise

395
Q

Pelvic heaviness that is worse with standing and improves with lying down may be

A

vaginal prolapse

396
Q

A bulge into the upper vaginal wall is likely

A

a cystocele

397
Q

Symptoms of cystocele

A

urianry urgency, frequency and incontinence

398
Q

A bulge into the lower posterior vaginal wall is likely

A

a rectocele

399
Q

Symptoms of rectocele

A

difficultly defecating

400
Q

What is an enterocele

A

bulding of loops of bowel into upper posterior vaginal wall

401
Q

Treatment of -celes (cystocele, etc)

A
  • pelvic strengthening
  • pessary
  • surgery
402
Q

Male/female ratio for “problem source” in infertility

A
  • male 1/3

- female 2/3

403
Q

1st step in eval of infertility (after based H&P)

A

semen anlysis

404
Q

Risk factor for uterine synechiae

A

D&C

405
Q

What radiographic test do you order to look for uterine structural abnormalities?

A

hysterosalpingogram

406
Q

Clomiphene can be used to stimulate ovulation in what setting

A

need adequate estrogen

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