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Ob Gyn > Case Files Notes > Flashcards

Case Files Notes Flashcards

1
Q

Hormone changes in menopause

A

Inhibin decreases
Leads to increased FSH and LH

Lastly estradiol levels fall

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2
Q

Sides effects of decreased estradiol (after menopause)

A

Vaginal atrophy
Bone loss
Vasomotor symptoms (hot flashes)

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3
Q

What should be added to post menopause estrogen therapy and why?

A

Progestin (if still has uterus)

To prevent endometrial cancer

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4
Q

Premature ovarian failure, define

A

Cessation of ovarian function due to atresia of follicles prior to age 40 yrs

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5
Q

Effect of oxytocin on labor

A

Enhances contraction strength and/or frequency

Does not affect cervical dilation

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6
Q

Protracted active phase of labor, define

A

Def: during active phase, some progress in cervical dilations, but less than expected. Abnormally slow dilation or fetal head descent

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7
Q

Arrest of active phase of labor

A

No progress at all in cervical dilation during active phase

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8
Q

Threatened abortion

A

Pregnancy with vaginal spotting during first half of pregnancy

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9
Q

Discriminatory level hCG for transvaginal US to detect intrauterine pregnancy

A

1500-2000 mIU/mL

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10
Q

HCG level for ectopic pregnancy.

What other exam finding indicates ectopic?

A

HCG in or above discriminatory zone but…

Finding: no intrauterine pregnancy on ultrasound

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11
Q

Indications for laparoscopy or laparotomy early in pregnancy

A
  • hypotension or volume depleted

- severe abdominal/ pelvic pain or adnexal mass

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12
Q

Myomectomy

A

Surgical removal of fibroids from the uterus. Leaving the uterus intact, treatment for women who want to become pregnant and have fibroids

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13
Q

Treatment for placenta accreta

A

Most often results in total abdominal hysterectomy

Often leave placenta in place to prevent massive hemorrhage

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14
Q

Accreta:
Increta:
Precreta:

A

Accreta: issue with decidua basalis layer, placenta attached to myometrium
Increta: into myometrium
Precreta: thru myometrium, sometimes into bladder

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15
Q

Risks for placenta accreta

A

Multiple uterine surgeries (including c-sections)

  • placenta in low lying or anterior position
  • placenta previa
  • implantation over lower uterine segment
  • uterine cutterage
  • fetal down syndrome
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16
Q

What causes conjunctivitis or blindness in a fetus?

A

Gonorrhea or chlamydia

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17
Q

Treatment for gonorrhea and chlamydia

A

Ceftriaxone (gonorrhea)

Doxycycline (chlamydia)

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18
Q

Most common cause or first trimester spontaneous abortion

A

Chromosomal abnormality

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19
Q

Distinguish btw incompetent cervix and inevitable abortion

A

Incompetent cervix= painless dilation of cervix with absence of uterine contractions (tx with ligature at level of internal os, called cerclage)

Inevitable abortion = open cervix with presence of contractions

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20
Q

Bleeding

A

Think of a type of spontaneous abortion

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21
Q

Antepartum bleeding time frame

A

Bleeding that happens > 20 wks gestation

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22
Q

Frothy yellow-green discharge,
Strawberry cervicitis
Motile ovoid protozoa with flagella

A

Trichomoniasis

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23
Q

Cervical motion tenderness

A

Peritoneal sign

Classical assoc with PID or ectopic preg

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24
Q

Medical management of ectopic pregnancy

A

Methotrexate

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25
Q

of days to follow B-hCG levels s/p methotrexate to tx ectopic pregnancy

How far should it fall?

A

Day 3 and 7 s/p methotrexate

Should see 15% decrease in bHCG

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26
Q

Timing to repeat bHCG for concern of ectopic pregnancy

A

48 hrs and look for 66% increase

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27
Q

Most common cause of sepsis in pregnancy?

A

Acute pyelonephritis

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28
Q

Triad of congenital toxoplasmosis

A

Chorioretinitis, hydrocephalus, intracranial calcifications

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29
Q

Why should we not give nifedipine and magnesium sulfate together?

A

Both block calcium channels (nifedipine = CCB, Mag = membrane stabilizer/competotive inhibition of calcium), therefore risk of HYPOTENSION

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30
Q

amniotic fluid index

and cut-off calues

A

estimate of amount of amniotic fluid and index for fetal well being
normal AFI = 8-18
oligohydramnios = 20-24

Low AFI can mean ROM, placenta problems, birth defects, or maternal complications

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31
Q

PROM

A

premature ROM

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32
Q

PPROM

A

preterm premature ROM

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33
Q

prolonged ROM

A

ROM >18 hrs before onset of labor

34
Q

Things associated with breech presentation

A

Prematurity, multiple gestation, genetic disorders, polyhydramnios, hydrocephaly, anencephaly, placenta previa, uterine anomalies and uterine fibroids

35
Q

Asthma worsens during pregnancy for 40% of women, what do you use to treat them?

A

corticosteroids or cromolyn sodium

36
Q

treatment of syphilis during pregnancy?

A

Penicillin G

-if allergic, make sure to desensitize pt to PCN first

37
Q

Bacterial vaginosis

  • diagnosis
  • treatment
A

+ whiff test
clue cells

-Tx: metronidazole

38
Q

which ureter is most likely to be compressed by uterus during pregnancy? right or left? why?

A

Right ureter (and right ovarian vein)

  • left is cushioned by the sigmoid colon
39
Q

what metabolic derrangement to women get in pregnancy? and why?

A

respiratory alkalosis, due to increased minute ventilation (leads to hypoventilation)

40
Q

how does plasma osmolality change in pregnancy? what does this make ladies more susceptible to?

A

plasma osmolality decreases

  • inc susceptibility to pulm edema
41
Q

Most effective screening test for down syndrome

A

Cell free DNA

42
Q

dosage of Folic acid for women w/ h/o pregnancy w/ neural tube defect

A

4mg

regular proph dose is 0.6mg

43
Q

most common reason for elevated MSAFP?

A

under-estimation of gestational age

44
Q

late decels =

A

uteroplacental insufficiency

45
Q

early decels =

A

head compression

46
Q

variable decels =

A

cord compression

47
Q

Mothers with gestational DMhave infants at increased risk for…

A

hypoglycemia, polycythemia, hyperbilirubinemia, hypocalcemia and respiratory distress

48
Q

Which ones have small babies, DM1 or DM2?

What type of glycemia do babies of DM1 and DM2 have?

A

Small babies = DM1
Large babies = DM2

Both have hypoglycemia

49
Q

what characteristics do infants with chorio have at birth?

A

Lethargic, pale with high temperature.

50
Q

Mastitis tx

A

Antibiotics
(to cover strep flora from infants mouth and staph from mom’s skin)
- want to prevent abscess formation

51
Q

PP endometritis

  • causative organism type?
  • initial treatment?
A
  • Infxn with normal vaginal floral, both anaerobes and aerobic bact = polymicrobial
  • Tx: gent and clinda (covers both aerobes and anaerobes)
  • gent + amp can also be used, but covers mostly aerobes only
52
Q

best way to suppress lactation in a PP patient

A

Breast-binding, ice packs, analgesia

53
Q

Mastitis tx

A

Antibiotics

to cover strep flora from infants mouth and staph from mom’s skin

54
Q

hormone for milk let down

A

oxytocin

-stimulated by baby suckling the nipple

55
Q

hormone for milk production

A

prolactin

56
Q

MSAFP levels in pregnancy

  • increase =?
  • decrease =?
A

Increased MSAFP = neural tube defects, ventral wall defects, multiple gestations (will also have larger uterus)

Decreased MSAFP= aneuplodies (trisomies)

57
Q

Method for diagnosing cervical incompetence

A

TVUS

- assess for funneling of cervix or shortening

58
Q

Tx: septic abortion

A

D&C (uterine evacuation) and antibiotics

59
Q

First line treatment for Endometriosis

A

NSAIDs, OCP’s

*definitive treatment is Diagnostic Laparotomy.

60
Q

Contraindication to OCP’s

A

> 35 yo and a smoker

61
Q

Interstitial cystitis.

  • def
  • signs/symptoms
A

Suprapubic pain, urinary frequency, painful coitus, waking up from sleep to urinate

62
Q

Postmenopausal bleeding… Think this until proven otherwise

A

In women taking hormonal replacement therapy, think endometrial cancer until proven otherwise

63
Q

Painless vaginal bleeding in late pregnancy

A

Placenta previa

Often first sign is postcoital spotting

64
Q

Painful vaginal bleeding in late pregnancy

A

Placental abruption

Complication= coagulopathy

65
Q

Post partum amenorrhea in the setting of PP hemorrhage

A

Sheehan syndrome (anterior pituitary hemorrhagic necrosis)

66
Q

Hormone ratio in PCOS

A

LH:FSH 2:1

Estrogen excess (from adipose tissue) without progesterone

67
Q

Pseudocyesis

A

Disorder where women have signs of pregnancy and believe they are pregnant, but really are not pregnant. It is a form of conversion disorder

68
Q

What is HCG hormonal action?

A

Maintain corpus luteum

69
Q

What are the hormonal actions of progesterone early in pregnancy?

A

Inhibit uterine contractions

Prepare endometrium for implantation of fertilized egg

70
Q

Ruptured ovarian cyst

A

Severe pelvic pain after sex or strenuous activity

Ultrasound shows free fluid around ovary

71
Q

Associations with DES (diethylstilbestrol)

A

Clear cell adenocarcinoma
Structural anomalies of reproductive tract
Infertility
Birth anomalies

72
Q

during pregnancy/labor intense abdominal pain with vaginal bleeding, loss of fetal station; h/o cesarean section

A

uterine rupture

73
Q

most common indication for hysterectomy in USA

A

symptomatic leiomyomas (fibroids)

74
Q

irregular midline, firm, nontender mass that moves contiguously with the cervix; indicates what?

A

uterine leiomyoma

75
Q

Fibroadenoma definition

A

benign, smooth muscle tumor of the breast, usually in young women

76
Q

What type of breast disease?:

34 yo F complains of unilateral serosanguineous nipple discharge from breast, expressed form 1 duct. no mass palpated

A

Intraductal papilloma (small benign tumors that grow in lactation ducts)

77
Q

What type of breast disease?

27 yo F comlpains of breast pain, which increases with menses. Breast has lumpy-bumpy sensation.

A

Fibrocystic changes (premenopausal, cyclic, painful, engorged breast, more pronounced during menstruation)

78
Q

What type of breast disease?

47 yo F has 1.5 cm right breast mass with nipple retraction and skin dimpling over the mass.

A

Breast Cancer

79
Q

What type of breast disease?

18 yo F has asymptomatic, 1 cm, non-tender, mobile right breast mass

A

Fibroadenoma (most common cause of dominant breast mass in adolescents = firm, rubbery, mobile, and solid bump)

-US to image since tissue is dense in young women

80
Q

5 etiologies of infertility

A
  1. ovulatory
  2. uterine
  3. tubal
  4. male factor
  5. endometriosis
81
Q

Oral contraceptives decrease risk of ______ cancer and increase risk of ________ cancer.

A
  • Decrease risk of ovarian and endometrial cancers

- Increase risk of breast cancer

Ob Gyn (2 decks)

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