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OBGYN shelf > Case files > Flashcards

Case files Flashcards

1
Q

MC cause of PPH:

MC cause of PPH in a firm, well-contracted uterus:

A

MC cause of PPH: uterine atony

MC cause of PPH in a well-contracted uterus: genital tract laceration

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2
Q

32yo woman has severe PPH that does not respond to medical therapy. she desires future childbearing.

which artery is ligated to achieve therapeutic goals?

A

hypogastric artery

-decreases pulse pressure to the uterus

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3
Q

MC cause of late PPH (after first 24 hours):

A

subinvolution of the uterus

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4
Q

contraindication for ergot alkaloids:

contraindication for PGF2a:

A

contraindication for ergot alkaloids: hypertension

contraindication for PGF2a: asthma

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5
Q

MC cause of abnormal serum screening:

A

wrong dates

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6
Q
  • U/S at 20 weeks reveals hydramnios with AFI of 30 cm
  • fetal abdomen reveals cystic masses in both R and L abdominal regions

most likely associated condition?

A

“double bubble” sign of duodenal atresia

associated with Down syndrome

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7
Q

pregnancies with elevated AFP, which after evaluation are unexplained, are at increased risk for: (4)

A
  • increased risk for stillbirth
  • growth restriction
  • preeclampsia
  • placental abruption
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8
Q

next step in the evaluation of abnormal triple screening:

A

basic ultrasound

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9
Q

up to 95% of neural tube defects are detectable by:

A

targeted sonography

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10
Q
  • 32yo G1P0 pregnant with triplets
  • arrives at L&D at 30 weeks with preeclampsia
  • complains of dyspnea, 82% on room air

tx?

A

IV furosemide

  • pt likely has pulmonary edema due to the preeclampsia as well as the increased plasma volume due to the multiple gestations
  • pt should be placed on IV furosemide to decrease intravascular volume, magnesium sulfate for seizure prophylaxis, and plans made for delivery
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11
Q

causes rapid fetal demise after rupture of membranes

A

vasa previa

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12
Q

prenatal diagnosis of vasa previa is best made by:

mgmt: planned cesarean (before/after) rupture of membranes

A

U/S with color Doppler

mgmt: planned cesarean BEFORE rupture of membranes

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13
Q

rationale for oral acyclovir therapy at the primary outbreak:

A

decrease viral shedding and the duration of infection

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14
Q

postcoital spotting is a common complaint in a pt with placenta ______

A

postcoital spotting is a common complaint in a pt with placenta PREVIA

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15
Q

the best plan for placenta previa at term is:

A

cesarean delivery

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16
Q

diagnostic test of choice in assessing placenta previa, and should be performed before speculum or digital exam:

A

U/S

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17
Q

placenta previa, in the face of prior cesarean deliveries, increases the risk for placenta _______

A

placenta previa, in the face of prior cesarean deliveries, increases the risk for placenta ACCRETA

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18
Q

T/F
when placenta previa is dx’d at an early gestation, such as the 2nd trimester, repeat sonography is warranted since many times the placenta will move away from the cervix (transmigration)

A

TRUE

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19
Q

major risk factors for placental abruption: (3)

A

HTN (MC)
trauma
cocaine use

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20
Q

MC cause of antepartum bleeding with coagulopathy:

A

placental abruption

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21
Q
  • abnormal adherence of placenta to uterine wall due to an abnormality of the decidua basalis layer of the uterus
  • the placental villi are attached to the myometrium
A

placenta accreta

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22
Q

abnormally implanted placenta invades into myometrium

A

placenta increta

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23
Q
  • abnormally implanted placenta penetrates entirely through the myometrium to the serosa
  • often invades into bladder
A

placenta percreta

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24
Q

risk factors for placenta accreta: (6)

A
  • low-lying placentation or placenta previa
  • prior cesarean scar
  • uterine curettage
  • fetal Down syndrome
  • age ≥35 y
  • markedly increased risk if multiple cesareans with placenta previa
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25
Q

T/F

placenta accreta is more common with increasing number of cesareans and placenta previa

A

TRUE

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26
Q

T/F
In general, myomectomy incisions on the serosal (outside) surface of the uterus do not predispose to accreta because the endometrium is not distrubed.

A

TRUE

However, the risk of accreta is not decreased due to the myomectomy either..

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27
Q

the usual mgmt of placenta accreta is:

A

hysterectomy

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28
Q

placenta accreta is assoc with a defect in the _______ _______ layer

A

placenta accreta is assoc with a defect in the DECIDUA BASALIS layer

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29
Q

T/F
Low-lying or marginal placenta previa diagnosed in the 2nd trimester will often resolve later in pregnancy, so repeat sonography is prudent.

A

TRUE

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30
Q

T/F

Ovarian torsion is the most frequent and serious complication of a benign ovarian cyst.

A

TRUE

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31
Q

tx of ovarian torsion:

if reperfusion cannot be restored:

A

tx of ovarian torsion: untwisting adnexa (reperfusion restored!) –> ovarian cystectomy

if reperfusion cannot be restored: oophorectomy

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32
Q

leading cause of maternal mortality in the first and second trimesters:

A

ectopic pregnancy

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33
Q

T/F

Typically, the pain of a degenerating fibroid is localized over the leiomyoma.

A

TRUE

Fibroids of the uterus can be assoc. with red or carneous degeneration during pregnancy due to the estrogen levels leading to rapid growth of the fibroid. The fibroid outgrows is blood supply leading to ischemia and pain.

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34
Q

Which of the following is the earliest indicator of hypovolemia?

A. Tachycardia
B. Hypotension
C. Positive tilt
D. Lethargy and confusion
E. Decreased urine output
A

E. Decreased urine output

  • Renal blood flow is decreased with early hypovolemia as reflected by decreased urine output
  • Compensatory mechanism to make blood volume available to the body
  • (+) tilt test is typically noted before tachycardia or hypotension
  • By the time hypotension is noted at rest in a young, healthy pt, 30% of blood volume is lost
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35
Q

when the corpus luteum is excised in a pregnancy of less than 10 to 12 weeks gestation, what should be supplemented?

A

progesterone

Placenta does not take full responsibility till at least 10 weeks gestation.

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36
Q

T/F
Intrahepatic cholestasis in pregnancy may be assoc. with increased perinatal morbidity, especially when accompanied by jaundice.

A

TRUE

Aside: Women with ICP may have slightly elevated liver enzymes, but almost never in the thousands.

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37
Q

T/F

PUPPP is not thought to be assoc. with adverse pregnancy outcomes.

A

TRUE

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38
Q

T/F
Neonatal lesions are sometimes seen with herpes gestationis caused by IgG Abs crossing the placenta, and these lesions will resolve.

A

TRUE

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39
Q

Which of the following is most consistent with acute fatty liver of pregnancy?

A. elevated serum bile acid levels
B. Hypoglycemia requiring multiple D50 injections
C. Proteinuria of 500 mg over 24 hours
D. Oligohydramnios

A

B. Hypoglycemia requiring multiple D50 injections

Because of the liver insufficiency, glycogen storage is compromised leading to low serum glucose levels, which often require multiple doses of dextrose.

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40
Q

MC cause of maternal mortality:

A

thromboembolism

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41
Q

most important method of preventing DVT after cesarean:

A

early ambulation

42
Q

MC side effect of long-term heparin use in pregnancy:

A

osteoporosis

43
Q

accurate method to diagnose DVT:

A

venous duplex Doppler sonography

44
Q

which tocolytic is assoc with decreased amniotic fluid and oligohydramnios? –> cord compression –> repetitive variable decels

A

indomethacin

45
Q

SEs of ß-agonist tocolysis: (4)

A
  • tachycardia
  • widened pulse pressure
  • hyperglycemia
  • hypokalemia
46
Q

the earliest sign of chorioamnionitis is usually:

A

fetal tachycardia

47
Q

T/F

Labor is the most common complication assoc with PROM.

A

TRUE

48
Q

T/F

Listeria may induce chorioamnionitis without rupture of membranes.

A

TRUE

49
Q

When fetal lung maturity is demonstrated on vaginal amniotic fluid by the presence of phosphatidyl glycerol (PG), what is the next best step when there is leakage of fluid?

A

delivery (induction of labor)

50
Q

T/F
MC finding with PPROM is variable decels.

and why?

A

TRUE

variable decels likely due to oligohydramnios from the rupture of membranes

  • insufficient fluid to “buffer the cord” from compression
  • often alleviated by changing pt’s position
51
Q

pregnancies complicated by PPROM and chorioamnionitis should be tx with:

A

broad-spectrum abx and delivery

like ampicillin and gentamicin

52
Q

T/F

Clinical infection is a contraindication fro corticosteroid use.

A

TRUE

53
Q

One of the earliest signs of fetal hydrops is:

A

hydramnios, or excess amniotic fluid

  • uterine size may be greater than dates
  • fetal parts difficult to palpate
54
Q

sinusoidal heart pattern assoc with:

A

severe fetal anemia or asphyxia

55
Q

T/F

Rh isoimmunization can lead to significant fetal anemia is the baby is Rh(+).

A

TRUE

56
Q

T/F

hydramnios is assoc with problems with fetal swallowing or intestinal atresias, or assoc with hydrops.

A

TRUE

57
Q

MC method to diagnose acute fifth dz (Parvovirus infection):

A

IgM and IgG serology

58
Q

MC cause of conjunctivitis in the first month of life:

A

chlamydial conjunctivitis

59
Q

T/F
Chlamydia has a propensity for columnar and transitional epithelium, and it is a leading cause of preventable blindness worldwide.

T/F
Chlamydia is an obligate intracellular organism assoc with late postpartum endometritis and has a long replication cycle.

A

TRUE x2

60
Q

tx for preventing gonococcal eye infection vs. chlamydial infection:

A

gonococcal eye infection: erythromycin eyedrops

chlamydial infection: systemic erythromycin

61
Q

best tx of chlamydial cervicitis in pregnancy: (3 options)

A

erythromycin
azithromycin
amoxicillin

62
Q

the postpartum pt is unique in that the cause of hyperthyroidism is usually:

A

lymphocytic thyroiditis, NOT Graves dz

-therefore, antimicrosomal and antiperoxidase Abs are present

63
Q

MC cause of septic shock in pregnancy is:

A

pyelonephritis

64
Q

when dyspnea occurs in a pregnant woman who is being treated for pyelonephritis, ____ should be considered

A

when dyspnea occurs in a pregnant woman who is being treated for pyelonephritis, ARDS should be considered

65
Q

cause of ARDS assoc with pyelonephritis:

A

endotoxin release from gram(–) bacteria (eg, E. coli)

66
Q

next diagnostic test performed on cesarean pt whose fever persists despite triple abx therapy:

A

CT - looking for septic pelvic thrombophlebitis (SPT)

67
Q

tx for SPT:

A

antibiotic therapy + heparin

68
Q

the presence of fluctuance in a red, tender, indurated breast suggests:

tx?

A

abscess

tx: surgical drainage

69
Q

T/F

Breast engorgement rarely causes high fever persisting more than 24 hours.

A

TRUE

70
Q

all women with gestational DM should have a screening test at 6 weeks postpartum.. what is the optimal test?

A

2-hour 75-g GTT

71
Q

first line therapy for GDM:

gold standard tx for those who fail dietary tx:

A

first line therapy for GDM: diet!

gold standard tx for those who fail dietary tx: insulin

72
Q

reasonable approach to avoid repeat abruption:

A

induction at 37-38 weeks

73
Q

T/F

The thyroid gland is not affected by hyperprolactinemia; rather, hypothyroidism can lead to hyperprolactinemia.

A

TRUE

74
Q

tx for uncomplicated cystitis:

A

TMP/SMX (3-day course)

75
Q

T/F

Asymptomatic bacteriuria has a high incidence in women with sickle cell trait.

A

TRUE

76
Q

tx of choice for women with symptomatic uterine leiomyomata who DESIRE pregnancy:

A

myomectomy

77
Q

tx for women with symptomatic uterine fibroids when future pregnancy is UNDESIRED:

A

hysterectomy

78
Q

rapid growth of leiomyoma or h/o prior pelvic radiation should raise the index of suspicion for:

A

leiomyosarcoma

79
Q

a progesterone level greater than __ reflects a normal IUP

A

a progesterone level greater than 25 reflects a normal IUP

80
Q

best contraception for pt who is breast-feeding:

A

progestin-only pill

minipill

81
Q

best contraception for pt with sickle cell dz or epilepsy:

A

injectables

eg, depot medroxyprogesterone acetate

82
Q

OCPs decrease the risk of _______ and ___________ cancer

A

OCPs decrease the risk of OVARIAN and ENDOMETRIAL cancer

83
Q

T/F

The contraceptive patch may be assoc with a greater risk of DVT.

A

TRUE

84
Q

most important risk factor for breast cancer:

A

age

85
Q

when the fluid from a breast cyst is straw-colored or clear and the mass disappears, what’s the next step?

when the fluid is a different color (eg, bloody):
or mass persists:

A

straw-colored or clear and mass disappears: no further therapy is needed

different color (eg, bloody):  send fluid for cytology
mass persists:  biopsy
86
Q

MC cause of unilateral serosanguineous nipple discharge from a single duct:

A

intraductal papilloma

87
Q

accepted methods of assessing suspicious mammographic nonpalpable masses:

A

stereotactic core biopsy

needle-localization excisional biopsy

88
Q

definitive diagnosis of IUA can be made with: (2)

gold standard for the establishment of the diagnosis and extent of intrauterine adhesions (Asherman syndrome):

ideal tx for Ashermans:

A

definitive dx: saline infusion sonohysterogram (SIS) or hysterosalpingogram

gold standard: hysteroscopy

ideal tx: operative hysteroscopy (resection)

89
Q

T/F

Primary hypothyroidism can lead to hyperprolactinemia.

A

TRUE

tx with thyroxine

90
Q

elevated prolactin levels (stimulate/inhibit) GnRH pulsations from the hypothalamus –> ?

A

elevated prolactin levels INHIBIT GnRH pulsations from the hypothalamus –> decreased release of FSH and LH –> no estrogen or progesterone released from ovaries –> amenorrhea

91
Q

most sensitive imaging test to assess pituitary adenomas:

A

MRI

92
Q

MC causes of secondary amenorrhea after postpartum hemorrhage:

A 
Sheehan syndrome
intrauterine adhesions (Asherman syndrome)
93
Q

primary mgmt for irregular cycles (and also help to decrease androgen levels):

A

combined OCPs

94
Q

what diagnostic test should be considered in pts with long-standing anovulation and unopposed estrogen?

A

endometrial biopsy

95
Q

tx for infertility assoc with PCOS:

A

clomiphene citrate

96
Q

which hormone would be elevated in a female with gonadal dysgenesis (Turner syndrome)?

why?

A

FSH

streaked ovaries –> no estrogen production (causes elevated FSH)

97
Q

tx for idiopathic precocious puberty:

A

GnRH agonist therapy

98
Q

most important initial test for any female with primary or secondary amenorrhea:

A

pregnancy test

99
Q

next step in diagnosis for mullerian agenesis:

A

serum testosterone, or karyotype

100
Q
  • normal breast development
  • normal axillary and pubic hair
  • absent uterus and blind vagina
  • normal testosterone level
  • 46,XX
  • renal anomalies

Dx?

A

mullerian agenesis

101
Q
  • normal breast development
  • scant or absent axillary or pubic hair
  • absent uterus and blind vagina
  • high testosterone levels (male range)
  • 46,XY
  • need gonadectomy
A

androgen insensitivity syndrome

testicular feminization

102
Q

MC causes of primary amenorrhea in a woman with normal breast development:

A 
androgen insensitivity (scant axillary and pubic hair)
mullerian agenesis (assoc with renal anomalies)

OBGYN shelf (2 decks)

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