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OBGyn Rotations > Case Files Notecards > Flashcards

Case Files Notecards Flashcards

1
Q

Incontinence due to bladder neck falling out of normal intra-abdominal position

A

Genuine stress incontinence

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2
Q

incontinence due to detrusor muscle overactivity

A

urge

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3
Q

“I have to go the bathroom and can’t make it there in time”

A

urge

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4
Q

what will cytometric exam show w/ urge incontinence

A

uninhibited contractions

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5
Q

Tx for stress incontinence

A

kegal exercises

urethropexy

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6
Q

Tx for urge incontinence

A

anticholinergic med

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7
Q

tx for neurogenic bladder

A

intermittent self cath

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8
Q

when can the HPV vaccine be given

A

ages 9-26

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9
Q

most common cause of an inverted uterus

A

undue traction on the cord when the placenta hasn’t separated

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10
Q

Signs of placental separation (4)

A

1- gush of blood
2- lengthening of the cord
3- globular shaped uterus
4- uterus rising to the anterior abdominal wall

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11
Q

most common complication of an inverted uterus

A

hemorrhage

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12
Q

ULN for the 3rd stage of labor

A

30 minutes

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13
Q

what should be done if the placenta doesn’t deliver spontaneously after 30 minutes

A

manual extraction of the placenta should be attempted

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14
Q

vasomotor change due to decreased estrogen levels associated with skin temp elevation and sweating lasting for 2-4 minutes

A

hot flash

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15
Q

changes in the vagina during perimenopause

A

lwo estrogen causes a decrease in the epithelial thickness leading to atrophy and dryness

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16
Q

what help confirm the diagnosis of menopause

A

elevated serum FSh and LH

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17
Q

Tx for hot flashes

A

estrogen replacement therapy w/ progestin

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18
Q

Why is it important to prescribe progestin in addition to estrogen replacement in a women who still has her uterus

A

helps prevent endometrial cancer

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19
Q

how long does perimenopause last?

A

2-4 years

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20
Q

the cessation of ovarian function due to atresia of follicles before age 40

A

premature ovarian failure

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21
Q

benefits of hormone replacement therapy

A

decreases osteoporosis and lower incidence of colon cancer

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22
Q

what is an alternative to estrogen therapy for vasomotor symptoms of menopause

A

clonidine

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23
Q

what is a drug that helpful in preventing bone loss but doesn’t alter hot flashes

A

SERm- raloxifene

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24
Q

what help maintains bone mass

A

weight bearign exercise
calcium
vitamin D
estrogen replacement

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25
Q

will FSH levels go down w/ estrogen replacement thearpy

A

No, FSH doesn’t respond to estrogen

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26
Q

when the anterior pituitary suffers from hemorrhagic necrosis associated with postpartum hemorrhage

A

Sheehan syndrome

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27
Q

most common location of an osteoporosis associated fracture

A

thoracic spine compression fracture

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28
Q

A mean arterial pressure of what is needed to perfuse vital organs?

A

65

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29
Q

How do you calculate mean arterial pressure?

A

[(2 × Diastolic blood pressure) + (1 × Systolic blood pressure)]/3

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30
Q

what is a red flag for necrotizing fasciitis?

A

gas in the muscle or fascia tussieu

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31
Q

Abx for Staph aureus infection

A

IV nafcillin or methicillin

if MRSA- vanco is used

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32
Q

during the active phase of labor in a nulliparous woman how many cm does the cervix dilate at?

A

1.2 cm/ hours

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33
Q

What phase of labor is where the cervix mainly efface (thins) rather than dilates

A

latent stage

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34
Q

what is the active phase of labor?

A

where dilation occurs more rapidly, usually when the cervix is >4 cm dilated

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35
Q

What is protraction of the active phase of labor?

A

<1.5 cm/hour in multiparous

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36
Q

what is no progress in the active phase of labor for 2 hours

A

arrest of active phase

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37
Q

what is the second stage of labor?

A

complete cervical dilation to delivery of infant

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38
Q

what is the third stage of labor?

A

delivery of the infant to delivery of the placenta

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39
Q

What are normal fetal heart rates

A

110-160

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40
Q

What are fetal heart rate episodic changes below the baseline

A

declerations

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41
Q

What type of decleration is a mirror image of the contraction?

A

early

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42
Q

what is a late decleration?

A

follow uterine contraction

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43
Q

what is an accleration?

A

episodes of fetal heart rate that increase above the baseline for at least 15 bpm and last for at least 15 seconds

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44
Q

how long does the latent phase (<4 cm dilated) typically alst in a nullpara women? a mulipara?q

A

n<14 hours

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45
Q

How long does the second stage of labor typically last in a nullpara women? a multipara?

A

n <2 w/ epidural

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46
Q

What is a clinically adequate uterine contraction

A

contraction every 2-3 minutes
firm on palpation
last 40-60 seconds

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47
Q

one main reason for fetal tachycardia

A

matrenal fever

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48
Q

what typically causes variable decelerations?

A

cord compression

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49
Q

are early decelerations concerning?

A

No, these are benign and are due to fetal head compression

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50
Q

What does late fetal contractions suggest?

A

fetal hypoxia

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51
Q

What are the 3 Ps?

A

Power
passenger
pelvis

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52
Q

What type pelvis predisposes to persistent fetal occiput posterior position?

A

anthropoid pelvis

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53
Q

what is an anthropoid pelvis?

A

pelvis with an AP diameter greater than the transverse diametere w/ prominent ischial spines and narrow anterior segment.

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54
Q

What is 0 station?

A

the presenting part of the baby is right at the plane of the ischial spines

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55
Q

What is a C-section usually reserved for?

A

Cephalopelvic disproportion and arrest of active phase w/ adequate uterine contractions

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56
Q

Risk factor for ectopic pregnancy

A

hx of STDs

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57
Q

what is the hCG level whereby transvaginal sonography shoudl reveal an intrauterine pregnancy?

A

1500-2000

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58
Q

After 48 hours how much should hCG levels rise?

A

at least 66%

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59
Q

What are the best tools for evaluating a possible ectopic pregnancy?

A

hCG levels and a transvaginal US

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60
Q

what is HCG?

A

human chorionic gonadotropin

glycoprotein secreted by the chorionic villi of a pregnancy

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61
Q

If an intrauterine pregnancy isn’t seen on sonography and the hCG level is >1500-2000 then what is likely?

A

ectopic pregnancy

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62
Q

When the hCG level is below the threshold for sono- graphic visualization of an intrauterine gestational sac and an ectopic pregnancy is suspected what should be done?

A

repeat hCG levels in 48 hours

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63
Q

What progesterone level almost always indicates a normal intrauterine gestation?

A

greater than 25 ng/mL

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64
Q

what progesterone levels typically correlates w/ a nonviable gestation?

A

<5 ng/mL

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65
Q

If a nonviable pregnancy is diagnosed what is typically done?

A

Uterine curettage to assess whether the patient has had a miscarriage (histologic confirmation of chorionic villi)

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66
Q

What can be done w/ asymptomatic, small (<3.5 cm) ectopic pregnacies?

A

intramuscular methotrexate

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67
Q

what is another medical option for a nonviable pregnancy?

A

vaginal misoprostol

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68
Q

If hCG level is above the threshold and there is non sonographic evidence of intrauterine pregnancy what is done?

A

laparoscopy

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69
Q

If the patient presents w/ severe abdominal/ pelvic pain, HPOTN, volume depletion and ectopic is suspected what shoudl be done?

A

laparoscopy

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70
Q

what should Rh negative women w/ threatened abortions, spontaneous abortions or ectopic pregnancies recieve?

A

Rhogam

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71
Q

what increases the risks of placenta accreta?

A 
previous uterine incisions 
low-lying placentation
placenta previa
previous uterine curettage
prior myomectomy 
fetal down syndrome
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72
Q

tx for placental accreta?

A

hysterectomy

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73
Q

what causes placenta acreta?

A

abnormality of the decidua basalis layer of the uterus leading to abnormal adherence of the placenta to the uterine wall

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74
Q

term for when the abnormally implanted placenta penetrates into the myometrium

A

placenta increta

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75
Q

where the abnormally implanted placenta penetrates entirely through the myometrium to the serosa. often invasion into the bladder is noted

A

placenta percreta

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76
Q

Gram-negative intracellular diplococci are highly suggestive of what?

A

Neisseria gonorrhoeae.

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77
Q

Tx for gonorrhoeae

A

Intramuscular ceftriaxone 125 to 250 mg for gonorrhea, and oral
azithromycin (or doxycycline) for chlamydial infection.

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78
Q

what is Yellow exudative discharge arising from the endocervix with 10 or more polymorphonucleocytes per high-power field on microscopy.

A

mucopurulent cervicitis

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79
Q

If the Gram stain of the cervical discharge is negative, then what condition is is probably?

A

Chlamydia

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80
Q

what can gonococcal cervicitis often cause?

A

salpingitis

arthritis, usually involving the large joints, and classically is migratory.

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81
Q

what skin condition can gonorrheae cause

A

eruptions of painful pustules with an erythematous base on the skin.

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82
Q

wht can cause conjunctivitis and blindness in a newborn?

A

chlamydia and gonorrhea

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83
Q

when do gonococcal infections usually present in a newborn?

A

2-5 days of life

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84
Q

when do chlamydial infections usually present in a newborn?

A

5-14 day of life

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85
Q

what other condition can chlamydia trachomatis cause in newborns

A

infantile pneumonia- between 1-3 months of age

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86
Q

what signifies a completed spontaneous aboration

A

intense cramping, passage of tissue, closed cervical os

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87
Q

after a completed spontaneous abortion what should be done?

A

follow serum hCG levels to 0

should halve every 48-72 hours

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88
Q

if HCG levels plateau instead of fall after a sponataneous abortion what has happened?

A

residual pregnancy tissue (incomplete abortion or ectopic pregnancy)

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89
Q

most common cause of a sponataneous abortion

A

chromosomal abnormality of the embryo

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90
Q

A pregnancy less than 20 weeks’ gestation asso- ciated with vaginal bleeding, generally without cervical dilation.

A

threatened abortion

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91
Q

pregnancy less than 20 weeks’ gestation asso- ciated with cramping, bleeding, and cervical dilation; there is no passage of tissue.

A

inevitable abortion

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92
Q

A pregnancy less than 20 weeks’ gestation asso- ciated with cramping, vaginal bleeding, an open cervical os, and some passage of tissue per vagina, but also some retained tissue in utero. The cervix remains open due to the continued uterine contractions; the uterus continues to con- tract in an effort to expel the retained tissue.

A

incomplete abortion

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93
Q

A pregnancy less than 20 weeks’ gestation in which all the products of conception have passed; the cervix is generally closed. Because all the tissue has passed, the uterus no longer contracts, and the cervix closes.

A

completed abortion

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94
Q

A pregnancy less than 20 weeks’ gestation with embryonic or fetal demise but no symptoms such as bleeding or cramping.

A

missed abortion

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95
Q

women present with painless cervical dilation.

A

incompetent cervix

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96
Q

tx for incompetent cervix

A

ligature at the level of the internal cervical os (cerclage)

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97
Q

aginal spotting, absence of fetal heart tones, size greater than dates, and markedly elevated HCG levels.

A

molar pregnancy

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98
Q

diagnosis of molar pregnancy

A

US- “snow storm” pattern in uterus

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99
Q

tx for molar pregnancy

A

uterine suction curettage and follow w/ weekly hCG levels

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100
Q

2 most common causes of antepartum bleeding

A

placenta previa

placental abruption

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101
Q

What is McRoberts maneuver?

A

hyperflexion of the maternal hips onto the maternal abdomen and/or suprapubic pressure

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102
Q

what maternal issues contribute to difficultly delivering the baby’s shoulders (shoulder dytocia)?

A

gestational DM
multiparous
obesity
post-term

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103
Q

what is a sign of shoulder dystocia?

A

fetal head retracted back toward the maternal introitus “turtle sign”

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104
Q

A brachial plexus injury involving the C5-C6 nerve roots, which may result from the downward traction of the anterior shoulder; the baby usually has weakness of the deltoid and infraspinatus muscles as well as the flexor muscles of the forearm. The arm often hangs limply by the side and is internally rotated.

A

Erb palsy

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105
Q

what is wood’s corkscrew manuver

A

progressively rotating the posterior shoulder in 180° in a corkscrew fashion), delivery of the posterior arm,

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106
Q

what is cephalic replacement with immediate cesarean section

A

Zavanelli maneuver

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107
Q

best test to determine ureteral injury post hysterectomy

A

intravenous pyelogram (IVP)

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108
Q

how does a ureteral injury post hysterectomy often present?

A

similar to pyelonephritis

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109
Q

what attaches the uterine cervix to the pelvic side walls (where the uterine arteries transverse)

A

cardinal ligament

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110
Q

Dilation of the renal collecting system, which gives evidence of urinary obstruction.

A

hydronephrosis

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111
Q

Placement of a stent into the renal pelvis through the skin under radiologic guidance to relieve a urinary obstruction.

A

percutaneous nephrostomy

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112
Q

if an IVP shows possible obstruction post hysterectomy what is the next step?

A

antibiotic administration and cystoscopy to attempt retrograde stent passage.

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113
Q

Risk factors for endometrial cancer

A 
Obesity
DM
HTN
prior irregular menses
late menopause
nulliparity  
unopposed estrogen replacement
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114
Q

initial test of choice for endometrial cancer

A

endometrial sampling or aspiration in office- place a thin, flexible catheter through the cervix

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115
Q

A growth of endometrial glands and stroma, which projects into the uterine cavity, usually on a stalk; it can cause postmenopausal bleeding.

A

endometrial polyp

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116
Q

what is the most common cause of postmenopausal bleeding?

A

friable tissue of the endometrium or vagina due to low estrogen levels

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117
Q

Transvaginal sonographic assessment of the endome- trial thickness; a thickness greater than 5 mm is abnormal in a postmenopausal woman.

A

endometrial stripe

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118
Q

what is the most common female genital tract malignancy

A

endometrial carcinoma

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119
Q

staging procedure for endometrial cancer

A

TAH B/L salpingo-oophorectomy
omentectomy
lymph node sampling
peritoneal washings

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120
Q

what may atypical glandular cells on pap smear indicate?

A

endocervical or endometrial cancer

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121
Q

next step after finding atypical glandular cells on pap smear?

A

colposcopic exam of the cervix
curettage of the endocervix
endometrial sampling

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122
Q

most common cause of painless vaginal bleeding after 20 weeks

A

placenta previa

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123
Q

management of placenta previa

A

C-section at 36-37 weeks

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124
Q

bleeding after 20 weeks associated w/ painful uterine contractions or excess uterine tone

A

placental abruption

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125
Q

Should vaginal manipulation be done w/ suspected placenta previa

A

no- it can induce bleeding

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126
Q

The edge of the placenta is within 2 to 3 cm of the internal cervical os.

A

low-lying placenta

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127
Q

Umbilical cord vessels that insert into the membranes with the vessels overlying the internal cervical os, thus being vulnerable to fetal exsanguination upon rupture of membranes.

A

vasa previa

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128
Q

risk factors for placenta previa

A 
grand multiparity
prior C-section
prior uterine curettage
previous placenta previa
multiple gestation
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129
Q

risk factors for placental abruption

A 
cocaine abuse 
HTN
short umbilical cord
trauma
cigarette smoking
PPROM
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130
Q

Bleeding into the myometrium of the uterus giving a discolored appearance to the uterine surface.

A

couvelaire uterus

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131
Q

does a normal US r/o a placental abruption

A

No

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132
Q

usual management of placental abruption

A

delivery

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133
Q

who is the HPV vaccine approved for

A

female aged 9-26

males 11-26

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134
Q

where do most cervical dysplasias arise

A

near the squamocolumnar junction of the cervix

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135
Q

when does cervical cytology begin?

A

3 years after onset of sexual activity of by age 21

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136
Q

what are signs of advanced cervical cancer?

A

flank tenderness or leg swelling

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137
Q

when does cervical cytology no longer need to be performed

A

after age 65-70, after total hysterectomy for benign reasons w/ no hx of cervical dysplasia

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138
Q

anterior pituitary hemorrhagic necrosis caused by hypertrophy of prolactin-secreting cells in conjunction w/ a hypotensive episode usually in setting of postpartum hemorrhage

A

sheehan syndrome

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139
Q

what is postpartum hemorrhage

A

bleeding >500 mL for vaginal and >1000 mL for C-section

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140
Q

characterized by obesity, hirutism, glucose intolerance and estrogen excess w/o progesterone, oligomenorrhea

A

PCOS

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141
Q

treatment of sheehan syndrome

A

replacement of hormones governed by the anterior pituitary gland

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142
Q

what is fetal bradycardia

A

fetal heart rate <110 for greater than 10 minutes

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143
Q

how to confirm fetal bradychardia

A

internal fetal scalp electrode

US (to distinguish from maternal pulse)

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144
Q

initial steps to improve cardiac output to uterus

A

place mom on her side to move the uterus from teh great vessels
IV bolus if possibly volume depelted
100% oxygen by face mask
stop oxytocin if it is being given

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145
Q

what drug often helps relax uterine musculature

A

terbutaline (beta agonist)

146
Q

what is the most common finding in a uterine rupture

A

fetal heart rate abnormality (fetal bradycardia) deep variable decelerations, late decelerations

147
Q

Tx for suspected uterine rupture

A

C-section

148
Q

what is a cervical ripening agent that can be placed in the vaginal

A

misoprostol

149
Q

prolonged fetal declerations associated with misoprostol cervical ripening are typically associated w/ what?

A

uterine hyperstimulation

150
Q

a fetal scalp pH can only be done if what?

A

cervicx is at least 4 cm dilated

151
Q

is atropine indicated for fetal bradycardia?

A

No

152
Q

causes of galactorrhea

A 
pituitary adenoma
pregnancy
breast stimulation
chest wall traum
ahypothyroidism
153
Q

TRH acts as what what?

A

prolactin releasing hormone

154
Q

Nonpuerperal watery or milky breast secretion that con- tains neither pus nor blood. The secretion can be manifested spontaneously or obtained only by breast examination.

A

galactorrhea

155
Q

A tumor in the pituitary gland that produces prolactin; symptoms include galactorrhea, headache, and peripheral vision defect (bitemporal hemianopsia).

A

pituitary secreting adenoma

156
Q

to determine if brast dx is truly galactorrhea what can you do?

A

smear under microscope- reveal multiple fat droplets

157
Q

a pregnant patient with a symptomatic microadenoma can be treated w/ what?

A

bromocriptine

158
Q

This 24-year-old woman, who is at 28 weeks’ gestational age, complains of gen- eralized pruritus. what is the most likely caused?

A

Cholestasis of pregnancy.

159
Q

a condition causing intense itching but associated with erythematous blisters on the abdomen and extremities

A

herpes gestationis

160
Q

when does cholestasis of pregnancy usually begin?

A

3rd trimester

161
Q

a common skin condition of unknown etiology unique to preg- nancy characterized by intense pruritus and erythematous papules on the abdomen and extremities.

A

Pruritic urticarial papules and plaques of pregnancy (PUPPP)

162
Q

what confirms the diagnosis of cholestasis of pregnancy

A

incrased levels of circulating bile acids

163
Q

cholestasis of pregnancy + jaundice is associated with what?

A

increased incidence of prematurity, fetal distress and fetal loss

164
Q

first line tx for cholestasis of pregnancy

A

antihistamines, cornstarch baths
vile salt binder (cholestyramine- associated w/ Vitamin K deficiency)
ursodeoxyholic acid- decreases puritis, better tolerated

165
Q

when does herpes gestationis usually begin?

A

2nd trimester of pregnancy

etiology is autoimmune

166
Q

tx of herpes gestationis

A

oral corticosteroids

167
Q

tx for PUPPP

A

topical steroids and anithistamines

168
Q

usual location of PUPPP

A

abdomen
thighs
buttocks and arms

169
Q

long term complications that can occur w/ PID

A

infertility or ectopic pregnancy

170
Q

Extreme tenderness when the uterine cervix is manipulated digitally, which suggests salpingitis.

A

cervical motion tenderness

171
Q

Collection of purulent material around the distal tube and ovary, which unlike the typical abscess is often treatable by antibiotic therapy rather than requiring surgical drainage.

A

Tubo-ovarian abscess (TOA)

172
Q

diagnosis of acute salpingitis

A

abdominal tenderness
cervical motion tenderness
adnexal tenderness

173
Q

Criteria for outpatient treatment of acute salpingitis

A

low grade fever
can take meds PO
absence of peritoneal signs

174
Q

outpatient tx of acute salpingitis

A

IM ceftriaxone
oral doxycycline BID for 10-14 days
evaluated in 48 hours for improvement

175
Q

gold standard for diagnosing salpingitis

A

laparoscopy

176
Q

Risks for PID

A

IUD use

nulliparity

177
Q

sulfur granules are classic for what?

A

actinomyces (gram positive anaerobe)

178
Q

treatment of actinomyces

A

penicillin

179
Q

Diagnostic test of choice for PE in pregnancy

A

spinal CT or MR angiography

V?Q scan exposes fetus to more radiation

180
Q

why does pregnancy cause venous stasis?

A

mechanical effect of teh uterus on the vena cava and high estrogen levels induces a hypercoagulable state

181
Q

normal ABG levels in pregnancy

A

pH 7.45
Po2 95-100
PCo2- 28
HCO3- 19

182
Q

TX for PE in pregnancy

A

anticoagulation with LWMH

183
Q

most common cause for maternal morality

A

thromboembolism

184
Q

most common presenting symptom of PE

A

dyspnea

185
Q

What can herpes simplex virus cause in neonates?

A

Neonatal encephalitis

186
Q

what are prodromal symptoms of an HSV outbreak

A

burning, itching, tingling

187
Q

when do you recommend a C-section with HSV?

A

genital lesions suspicious for HSV or prodromal syndromes

188
Q

STD caused by the gram- negative bacterium Haemophilus ducreyi, and causes painful genital lesions

A

Chancroid

189
Q

what is the most common reason for hysterectomy in the US?

A

Uterine fibroids

190
Q

what is the most common symptoms of a uterine leiomyomata?

A

Menorrhagia

191
Q

how does leiomyomata present on PE?

A

enlarged midline mass that is irregular and contiguous with the cervix

192
Q

When is the maximum shrinkage of fibroids seen after introducing a GnRH agonist?

A

3 months and fibroids will regrow if it is stopped

193
Q

Malignant, smooth muscle tumor, with numerous mitoses in the uterus

A

Leiomyosarcoma

194
Q

Changes of the leiomyomata due to rapid growth; the center of the fibroid becomes red, causing pain. This is synony- mous with red degeneration.

A

Carneous degeneration

195
Q

what is a sign of a potential leiomyosarcoma?

A

Rapid growth- increase of more than 6 weeks’ gestational size in 1 year

196
Q

initial treatment for fibroids

A

NSAIDs, progestin

197
Q

What is a GnRH agonist typically used for w/ uterine fibroids?

A

correct anemia and shrink the fibroid before surgery

198
Q

Tx for a symptomatic uterine leiomyomata in women who desire pregnancy

A

myomectomy

199
Q

Risk factors for preeclampsia

A 
primigravida 
African american
family hx
chronic HTN
chronic renal dz
antiphospholipid syndrome
DM
multifetal gestation
200
Q

Hypertension with proteinuria (> 300 mg over 24 hour) at a gestational age greater than 20 weeks, caused by vasospasm.

A

preeclampsia

201
Q

Development of preeclampsia in a patient with chronic hypertension.

A

Superimposed preeclampsia

202
Q

what is chronic HTN?

A

HTN before the pregnancy or that develops before 20 weeks

203
Q

what is needed for the dx of preeclampsia

A

2 BP readings 6 horus apart of >140 or >90

proteinuria >300 mg in 24 hours

204
Q

what is the underlying pathophys of preeclampsia

A

vasosparsm and “leaky vessels”

205
Q

Cure for preeclampsia

A

delivery

206
Q

complications of preeclampsia

A 
placenta abruption
eclampsia (w/ possible intracerebral hemorrhage)
coagulopathies
renal failure
hepatic subcapsular hematoma
hepatic rupture
uteroplacental insufficiency
207
Q

when is the risk of eclampsia the greatest?

A

just prior to delivery, intrapartum, w/i the first 24 hours postpartum

208
Q

During labor what should the preeclamptic patient be started on

A 
magnesium sulfate (must monitor urine output, respirtaory depression, hyporeflexia) 
this is used to prevent surgeries
209
Q

Tx for severe HTN w/ preeclampsia

A

hydralazine

labetalol

210
Q

when should a patient w/ preeclampsia be seen postpartum

A

1-2 weeks to check BP and for proteinuria

211
Q

what is the most common cause of maternal death due to eclampsia

A

intracerebral hemorrhage

212
Q

what is the first sign of magnesium toxicity

A

loss of deep tendon reflexes

213
Q

Do fibroadenomas change with the menstrual cycle?

A

No

214
Q

multiple, irregular, “lumpiness of the breast”

most common benign breast condition

A

fibrocystic changes

215
Q

Tx for fibrocystic breast changes

A

NSAIds
decrease caffeine
tight fitting bras
OCPs or oral progestin

216
Q

With severe cases of fibrocystic breast changes what can be done

A

danazol (weak antiestrogen and androgenic compound)

mastectomy

217
Q

Most common of a breast mass in an adolescent or in 20s

A

fibroadenoma

218
Q

how are fibroadenomas described

A

firm, rubbery, mobile, and solid

219
Q

what should be done for a fibroadenoma

A

biopsy

220
Q

what will a fibroadenoma look like on histology

A

mature smooth muscle cells

221
Q

what are the five basic factors of infertility?

A 
1-ovulatory
2-uterine
3-tubal
4-male factor
5- peritoneal factor (endo)
222
Q

what are the 3 Ds of endometriosis

A

dysmenorrhea
dyspareunia
dyschezia

223
Q

what is infertility?

A

inability to conceive after 1 year of unprotected intercourse

224
Q

what is the easiest and cheapest way of detecting ovulation?

A

basal body temperature

225
Q

when shoudl BBT temp be taken?

A

before patient arises out of bed, eats or drinks. should be taken orally

226
Q

why does body temp rise 0.5 F after ovulation?

A

release of progesterone by the ovary

227
Q

when does ovulation occur?

A

36 hours after the onset of the LH surge

228
Q

when should a hysterosalpingogram be performed?

A

between days 6-10 of the cycle

229
Q

gold standard for diagnosing tubal and peritoneal disease?

A

hysteroslapingogram

230
Q

what is a treatment for anovulation

A

clompiphene citrate

231
Q

when is ovarian torsion most common?

A

14 weeks gestation (when uterus rises above the pelvic brim) or immediately postpartum

232
Q

what is the most serious and frequent complication of a benign ovarian cyst?

A

ovarian torsion

233
Q

with what hCG level should an intrauterine gestational sac be seen on TVUS?

A

1500-2000 mIU/ML

234
Q

A progesterone level greater than what refelects a normal IUP

A

25

235
Q

2 most common causes of microcytic anemia

A

iron def and thalassemia

236
Q

An X-linked condition whereby the red blood cells may have a decreased capacity for anaerobic glucose metabolism. Certain oxidizing agents, such as nitrofuran- toin, can lead to hemolysis.

A

Glucose-6-phosphate dehydrogenase deficiency

237
Q

what Hb is consistant w/ anemia?

A

<10.6

238
Q

an elevation in what type of hemoglobin is suggestive of Beta thalassemia?

A

A2 hemoglobin

239
Q

an elevated what hemoglobin level is suggestive of alpha thalassemia?

A

hemoglobin F

240
Q

what can trigger glucose-6-phosphate dehydrogenase deficiency?

A

sulfonamides, nitrofurantoin, antimalarial agents

241
Q

in a nulliparous women, a dilation of what and effacement of what indicate preterm labor?

A

2 cm and 80% effacement

242
Q

What can you swab the posterior vaginal fornix for to indicate possible preterm birth

A

fetal fibronectin (ffn)

243
Q

A negative fetal fibronectin is strongly associated with what?

A

No delivery within 1 week

244
Q

what should be given to a women who is in labor before 34 weeks

A

Intramuscular antenatal steroids (for fetal pulmonary maturity)

245
Q

Preterm labor is before how many weeks?

A

37 weeks

246
Q

most common tocolystics

A

indomethacin
nifedipine
terbutaline
ritodrine

247
Q

what are names of antenatal steroids?

A

bethamethasone, dexamethasone

248
Q

a basement membrane protein that helps bind placental membranes to the decidua of the uterus. Vaginal swab is used to detect its presence

A

fetal fibronectin assay

249
Q

A cervical length less than what is an increased risk of preterm delivery?

A

25 mm

250
Q

weekly shots of what from 20-36 weeks have been shown to help prevent preterm labor

A

17 α-hydroxyprogesterone caproate

251
Q

what infection is most stonrgly associated w/ pre-term labor

A

gonococcal cervicitis

252
Q

what is a contraindication for tocolysis?

A

suspected uterine abruption

253
Q

what is indomethacin associated with?

A

associated with decreased amni- otic fluid and oligohydramnios,

254
Q

organism that most often causes a UTI

A

e coli

255
Q

abx for e. coli

A

sulfa agents
cephalosporins
quinolones
nitrofurantoin

256
Q

what organism typically cuases urethritis

A

C trachomatis

257
Q

most common symptoms of cystitis

A

dysuria
urgency
urinary frequency

258
Q

gross hematuria raises the suspicion of what?

A

nephrolithiasis

259
Q

what should be suspected in a woman with typical symptoms of UTI yet with sterile culture and no response to the standard antibiotics.

A

urethritis

260
Q

next step w/ urethritis

A

cultures of the urethra for gonococcus and chlamydia

261
Q

contraindications to an IUD

A

STDs
behavior that increases risk for STD
abnormal size/ shape of uterus

262
Q

what can depot medroxyprogesterone acetate cause?

A

decrease in bone density

263
Q

common side effects of Yuzpe regimen for EC

A

N/V (due to increased estrogen)

264
Q

most common cause of septic shock in pregnancy

A

pyelonephritis

265
Q

when dyspnea occurs in a pregnant women being treated for pyelo what should be considered

A

ARDS

266
Q

preferred anticoag in pregnancy

A

heparin

267
Q

what does heparin block?

A

conversion of fibringoen to fibrin

268
Q

reason for a hypercoaguable state in pregnancy

A

venous stasis due to uterus compressing the vena cava

269
Q

what type transmission does the BRCA gene have?

A

autosomal dominant

270
Q

what is the most common cause of unilateral serosanguineous nipple discharge from a single duct?

A

intraductal papilloma

271
Q

most common histological type of breast cancer

A

infiltrating intraductal carcinoma

272
Q

most common ovarian tumor in women under 30

A

benign cystic teratomas (dermoid cysts)

273
Q

why can dermoid cysts cause hyperthyroidism

A

they may contain thyroid tissue

274
Q

most common ovarian tumor in women over 30

A

epithelial origin, serous subtype and often B/L

275
Q

any adenxal mass greater than what size is likely to be a tumor

A

8 cm

276
Q

any adnexal mass less than __ cm suggests a functional cyst

A

5

277
Q

rotrusion of bowel or omentum through the incision, which connotes complete separation of all layers of the wound

A

Evisceration

278
Q

what type of SSI should be immediately repaired?

A

one with fascial disruption or evisceration

279
Q

A physiologic ovarian cyst formed from mature graafian follicles following ovulation, which secretes progesterone.

A

corpus luteum

280
Q

what is the earliest indicator of hypovolemia

A

decreased urine output

281
Q

allows for direct visualization of the uterine cavity and is considered the “gold standard” for the establishment of the diagnosis and extent of the IUA.

A

hysteroscopy

282
Q

2 most common causes of primary amenorrhea when there is normal breast development

A

mullerian agenesis

androgen insensitivity

283
Q

a significant number of individuals with Mullerian agenesis will also ahve what?

A

a urinary tract abnormality

284
Q

with androgen insensitivity what will be lacking

A

axillary and pubic hair

285
Q

how to confirm the diagnosis of androgen insensitivity

A

serum testosterone (will be elevated)

286
Q

what is missing with mullerian agensis

A

absence of uterus, cervix and fallopian tubes

287
Q

what karyotype are people w/ androgen insensitivity

A

46 XY

288
Q

why is there no formation of male internal or external genitalia with androgen insensitivity

A

no androgen receptor synthesis or action

289
Q

what must be done w/ androgen insensitivity

A

gonadectomy after puberty (around 16-18)

290
Q

hypogonadotropic hypogonadism, or hypothalamic hypogonadism, disorder caused by a deficiency in the gonadotropin-releasing hormone (GnRH) secreted by the hypothalamus (and therefore, decreased LH and FSH produc- tion). Also don’t have the ability to smell

A

Kallmann syndrome

291
Q

treatment for a septic abortion

A

abx and uterine curettage

292
Q

abx for spetic abortion

A

gentamicin and clindamycin

293
Q

what is an early sign of septic shock

A

oliguria

294
Q

what bacteria can be acquired through unpasturized milk products?

A

Listeria (gram positive rod)

295
Q

tx for listeria

A

IV ampicillin

296
Q

Tx for uterine atony

A

uterine massage, dilute IV oxytocin then prostaglandin F2 alpha or rectal misoprostol

297
Q

what is uterine atony

A

myometrium hasn’t contracted to cut off the uterine spiral arteries that are supplying the placental bed

298
Q

If the uterus is palpated and foudn to be firm, yet there is vaginal bleeding still what should be suspected?

A

a laceration to the genital tract

299
Q

Risk factors for uterine atony

A 
preeclampsia
magnesium sulfate
oxytocin use udring labor
rapid labor and/or delivery
overdistention of uterus (macrosomia, multifetal preg, hydramnios)
chorioamniotitis
prolonged labor
high parity
300
Q

What is an ergot alkyloid agent that induces myometrial contraction as a treatment of uterine atony, contraindicated in HTN

A

methylergonovine maleate (methergine)

301
Q

who is prostagladin F2-alpha contraindicated in?

A

asthmatic patients

302
Q

what are the 4 stages of puberty

A

therlarche
pubarche/ adrenarche
growth spurt
menarche

303
Q

what is the first sign of puberty

A

thelarche (around 10)

304
Q

What is the most commonc ause of delayed puberty that has high FSH and low estrogen

A

gonadal deficiency (Turner syndrome)

305
Q

karyotype w/ turner syndrome

A

45X

306
Q

what do women w/ turner syndroem lack?

A

ovaries and ovarian estrogen so they don’t have seoncary sexual characteristics

307
Q

most common etiology in postpartum mastitis?

A

staph aureus

308
Q

when does mastitis usually present

A

3rd or 4th week postpartum

309
Q

babies who are exclusively breast fed need supplementation of what at 2 months of age

A

vitamin D

310
Q

best tx for postpartum mastittis

A

oral antistphylococcal abx (dicloxacillin) and continue to breast feed/ pump

311
Q

best tx for a cracked nipple

A

air-drying and avoidance of using a harsh soap

312
Q

most commonly used medication for hyperthyroidism in pregnancy

A

PTU

313
Q

tx for thyroid storm in pregnancy

A

Beta blockers
corticosteroids
additionall PTU

314
Q

Extreme thyrotoxicosis leading to central nervous system dysfunction (coma or delirium) and autonomic instability (hyperthermia, hypertension, or hypotension).

A

thyroid storms

315
Q

women in the postpartum period w/ hyperthyroidism are liekly to have what?

A

destructive lymphocytic thyroiditis due to high corticosteroid levels in pregnancy

316
Q

what can chlamydia cause in a neonate

A

conjunctivitis or pneumonia

317
Q

why should doxycycline not be taken by pregnant women

A

can lead to staining of the fetal teeth

318
Q

is eye prophylaxis w/ erythromycin effective against chalmydial conjunctivitis?

A

no, only gonococcal

319
Q

why is ciprofloxacin C/I in pregnancy

A

can lead to neontal MSK problems

320
Q

best treatments for chlamydial cervicitis in pregnancy

A

erythromycin
azithromycin
amoxicillin

321
Q

what does parovirus in pregnancy cause

A

hydramnios from fetal anemia which inhibits bone marrow erythrocyte production

322
Q

how does parovirus B19 present in children?

A

red cheeks and high fever

323
Q

How does parovirus B19 present in adults?

A

malaise, arthralgias, maylgias and lacy int rash

324
Q

Illness caused by a single-stranded DNA virus, parvovirus B19, also known as erythema infectiosum.

A

fifth disease

325
Q

A fetal heart rate pattern that resembles a sine wave with cycles of 3 to 5 per minute, indicative of severe fetal anemia or fetal asphyxia.

A

sinusoidal heart rate pattern

326
Q

most common cause of fever for a woman who has undergone C-section

A

endomyometritis

327
Q

what is the mechanism of endomyometritis?

A

Ascending infection of polymicrobial vaginal organisms

328
Q

Ddx for a women who has had C-section

A

mastitis
wound infection
pyelonephritis

329
Q

abx tx for endomyometritis

A

IV gentamicin and cindamycin

330
Q

are bacterial infection affecting thrombosed pelvic veins, usually the ovarian vessels.

A

septic pelvic thrombophlebitis (SPT)

331
Q

most commonly isolated organism in endomyometritis

A

anaerobic bacteria (most common species is bacteroides)

332
Q

Tx for spetic pelvic thrombophlebitis

A

antibiotic therapy and heparin

333
Q

if RPR or VDRL tests are negative and syphilis is suspected still what is the next diagnostic

A

scraping of lesion for darkfield microscopy

334
Q

best dx test for herpes

A

viral culture `

335
Q

what causes syphilis

A

T pallidum

336
Q

typical incubation of syphilis

A

10-90 days

337
Q

tx for syphilis

A

Pen G

338
Q

what physical sign indicates secondary syphillis

A

conyloma lata

339
Q

with penicillin allergy what can be used to tx syphili

A

erythromycin or doxycycline

340
Q

how long must a nontreponemal test be followed w/ syphillis

A

every three months for at least a year

341
Q

what type of organism is t. pallidum

A

spirochete

342
Q

what should pregnant women w/ syphillis be given

A

Pen G (desnesnitize them is they are allergic)

343
Q

Rupture of membranes prior to the onset of labor.

A

PROM

344
Q

Rupture of mem- branes in a gestation less than 37 weeks, prior to onset of labor.

A

PPROM

345
Q

what is an early sign of chorioamniotitis

A

maternal fever

346
Q

what can induce chioramnionitis w/o rupture of membranes

A

listeria

347
Q

c/i to corticosteroid use

A

clinical infection

348
Q

cell tumor of the ovary is a solid stromal type of tumor, the androgen counterpart of granulosa-theca cell tumor. These tumors are usually of low malignant potential and slow growing, but nevertheless may metastasize and often recur. Hence, surgical staging is the treatment of choice.

A

Sertoli-Leydig cell tumor

349
Q

Androgen effect other than hair pattern, such as cliteromegaly,
male balding, deepening of the voice, and acne.

A

virilism

350
Q

Excessive male pattern hair in a female.

A

hirsutism

351
Q

screen is used in pregnant women between 15 and 21 weeks’ gestation to identify those pregnancies that may be complicated by neural tube defects, Down syndrome, or trisomy 18.

A

triple screen

352
Q

what is used in the triple screen

A

alpha feto protein (AFP)
human chorionic gonadotropic (hCG)
unconjugated estriol

353
Q

what level os AFP are suspicious for neural tube defects?

A

> 2.0-2.5

354
Q

what does an elevated AFP raise suspicion for?

A

neural tube defects

355
Q

what does a low maternal serum of AFP raise suspicions for?

A

Down syndrome

356
Q

if unconjugated estriol elevated or decreased w/ trisomy 21

A

decrease

357
Q

what leve lis elevated in trisomy 21?

A

HCG

358
Q

how are the markers w/ trisomy 18?

A

all are low

359
Q

what does first trimester trisomy 21 screening use?

A

PAPP-A (pregnancy associated plama protein)
free beta hCG
sonographic measurement of nuchal translucency
(will have decreases PAPP-A and free beta-hcg with thickened nuchal translucency)

360
Q

most common cause of an abnormal triple screen?

A

wrong dates

361
Q

primary management of PCOS

A

combined oral contraceptives

362
Q

for PCOS patients desiring pregnancy what can be given

A

clomiphene citrate

OBGyn Rotations (2 decks)

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