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ObGynShelf > Casefiles > Flashcards

Casefiles Flashcards

1
Q

indications for c/s

A

fetal/maternal distress
cephalopelvic disproportion
arrest of active phase despite active contractions (>200MU by IUPC OR q2-3min x 40-60sec by toco)

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2
Q

nl fetal heart rate

A

110-160

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3
Q

microcytic anemia (<10.5)

A

Fe deficiency -> trial Fe x3wks

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4
Q

elevated A2 hemoglobin

elevated F hemoglobin

A

beta-thal -> no intervention unless major, then transfusions

alpha thal

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5
Q

megaloblastic anemia

A

folate def

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6
Q

reddish mass bulging @ the introitus post partum -> dx? complication?

A

inverted uterus. Hemorrhage 2/2 uterine atony

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7
Q

4 signs of placental seapration

A
  1. gush of blood
  2. cord lengthening
  3. globular shaped uterus
  4. uterus rising to anterior abd wall
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8
Q

No placenta after 30 min

A

manual extraction -> abx

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9
Q

shoulder dystocia -> do not use what?

A

fundal pressure

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10
Q

workup for fetal bradycardia

A
  1. distinguish from maternal pulse

2. push cord back -> emergency c/s

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11
Q

RF for cord prolapse

A

presentation

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12
Q

most common finding w/ uterine rupture -> tx?

A

fetal heart rate abnormalities (deep variable decels or bradycardia) -> immediate c/s

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13
Q

MCC of postpartum hemorrhage after 24hrs

A

subinvolution of uterus

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14
Q

postpartum hemorrhage -> mgmt?

A

ABCs -> address source

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15
Q 
targeted US id's ?% of NTD
triple screen (2nd semester) id's ?% of Down
A

95

60

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16
Q

teratogen ?

teratogen between 15-60?

A

all or nothing

organogenesis problems

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17
Q

monozygotic twins

A

more anomalies and maternal complications

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18
Q

no dividing membrain -> complications?

A

stillbirth 2/2 cord entanglement

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19
Q

dx and tx of vasa previa?

A

US w/ Doppler + stat c/s

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20
Q

give acyclovir during pregnancy to HSV patient?

A

Yes -> decreases duration and viral shedding -> decreases transmission

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21
Q

mgmt of stable placenta previa

A

US (do NOT examine) -> expectant and plan for c/s @ 34wks

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22
Q

placental previa is a risk for?

A

placental accreta

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23
Q

placental previa in early trimester?

A

repeat US for migration

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24
Q

complications of abruption

A

hemorrhage w/ coagulopathy, fetal-maternal hemorrhage, PTL

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25
Q

RFs for abruption

A

HTN, trauma, cocaine

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26
Q

tx for accreta

A

hysterectomy

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27
Q

RFs for accreta

A

previa, C/S, defect in decidua basalis layer

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28
Q

location of appendix during pregnancy

A

out and up

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29
Q

character of ovarian torsion pain

A

colicky

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30
Q

what can mimic ecopic

A

ruptured corpus luteum cyst (more commonly in patients w/ bleeding tendencies)

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31
Q

if corpus luteum is excised in pregnancy mgmt?

A

progesterone supplementation

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32
Q

MCC of generalized pruritus in pregnancy w/o skin lesions

A

cholestasis -> adverse fetal outcomes (premature, fetal distress/loss)

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33
Q

lesion beginning on abd -> thighs and buttocks and arms

A

PUPP -> no adverse fetal outcomes

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34
Q

mgmt for AFLP

A

immediate delivery

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35
Q

MCC of maternal mortality

A

emoblism (thrombo or amniotic)

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36
Q

location for DVT in gyn

A

lower extremities and pelvic veins

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37
Q

O2 limit in pregnancy

A

80mmHg

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38
Q

hemo instability in pre-eclampsia patient post delivery

A

hepatic rupture -> stat ex lap + blood replacement

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39
Q

Tx of PET @ term

A

Mg and delivery

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40
Q

Mgmt of PET @ preterm

A

observe until severe/term

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41
Q

dyspnea in PTL w/ tocolysis

A

pulmonary edema

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42
Q

MCC of neonatal morbidity in preterm infant

A

RDS

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43
Q

mgmt of women w/ h/o PTL

A

progesterone @ 16 through 36 wks

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44
Q

PPROM

A

> 34wks -> IOL

expectant

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45
Q

earliest sign of chorio -> do not give?

A

fetal tachy -> steroids

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46
Q

mech of hydrops fetalis w/ parvovirus

A

parvo inhibits erythropoeisis -> anemia

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47
Q

earliest manifestation of hydrops

A

polyhydramnios

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48
Q

parvovirus in adult vs. child

A

myalgias + reticular rash vs. slapped cheek

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49
Q

ddx for hydramnios

A

GDM, isoimmunization, syphilis, cardiac arrhythmias, intestinal atresias

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50
Q

chlamydia tx in pregnancy

A

erythromycin/azithromycin or amoxicillin (avoid doxycycline; ophtho helps gonnorrhea but not CT)

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51
Q

mgmt of thyroid storm in pregnancy

A

propranolol, steroids, PTU (fx = agranulocytosis, rash, hepatotoxciity) (no methimazole b/c teratogen)

52
Q

Grave’s disease -> ? fetal hyperthyroidism?

A

yes 2/2 IgG crossing placenta

53
Q

Pregnancy effects on thyroid labs

A

up total T3/4 but unchanged free T3/4 b/c up TBG -> TSH unchanged

54
Q

antimicrosomal antibodies in hyperthyroidism 1-4 months post partum

A

postpartum thyroiditis -> hypothyroidism in several months

55
Q

symmetric IUGR vs. asymmetric

A

chromosomal/infections vs. vascular

56
Q

When to deliver IUGR?

A

when oligo, reverse doppler, HTN, absence of growth over 2-4 wks, non-reassuring testing

57
Q

dreaded complication of pyelonephritis

A

ARDS (dyspnea) 2/2 endotoxin release upon abx

58
Q

MCC of septic shock in pregnancy

A

pyelonephritis

59
Q

ddx for unresponsive pyelonephritis (72 hrs)

A

resistance, stone, abscess

60
Q

mgmt of septic shock

A

aggressive fluids (+/- pressor dopamine), debridement, abx

61
Q

desquamation in septic shock -> organism? mgmt?

A

s. aureus -> IV nafcillin/methicillin unless MRSA then vanc

62
Q

endometritis mgmt

A

genta + clinda

63
Q

MCC of fever s/p c/s

A

endomyometritis abx + heparin

64
Q

mgmt of mastitis

A

drain any abscess -> dicloxacillin -> continue breast feeding

65
Q

mastitis vs. breast engorgement

A

high fevers >24hrs

66
Q

how to confirm DKA w/ labs?

A

ABG, BS, electrolytes w/ AG and serum ketons

67
Q

Maternal monitoring during preg if diabetic

A

retinopathy, nephropathy

68
Q

50% of diabetic mothers will develop

A

preeclampsia

69
Q

HgA1C 7% vs. 11%

A

general population risk vs. elevated risk

70
Q

MCC anomalies associated w/ pre-GDM

A

cardiac and NTD

71
Q

What’s screened for at each prenatal visit?

A

HTN and proteinuria

72
Q

most common location of osteoporosis fracture

A

thoracic spine compression

73
Q

sequence of biochemical markers

A

AMH falls 1st -> inhibin B -> estradiol

74
Q

mgmt of POP

A

pessary or surgical fixation

75
Q

mgmt of stress incontinence

A

colporrhaphy / urethral sling

76
Q

mgmt of enteroceles

A

resection of hernia sac + fixation of the vagina to secure ligaments

77
Q

mgmt of rectoceles

A

colporrhaphy

78
Q

mgmt of lacteral defects

A

reattachment of levator ani to its tendinous insertion

79
Q

copious serosanguineous fluid post op -> concerning for?

A

fascial disruption -> stat surgical closure + abx

80
Q

MC time for fascial disruption or evisceration?

A

5-14 postop

81
Q

superficial wound separation mgmt? 2/2

A

2/2 infection or hematoma -> open the wound and dress

82
Q

initial mgmt of stress incontinence

A

kegel + timed voiding -> slings & TVT & urethropexy

83
Q

ddx for mucopurulent discharge

A

GC/CT, trichomonads, foreign body, irritation, allergic reaction

84
Q

urine test of GC/CT

A

NAAT (nucleic acid amplification)

85
Q

organisms of salpingitis

A

polymicrobial

86
Q

PID triad

A

abd pain, CMT, adnexal tenderness

87
Q

mgmt of ToA

A

IV abx (clinda, metro)

88
Q

what diseases are associated w/ BV?

A

PTL, postpartum endometritis, PID

89
Q

nontender ulcer w/ indurated edges

A

syphillis

90
Q

dysuria + urgency + freq w/o fever / CVA / masses + normal pelvic exam

A

cystitis

91
Q

uncomplicated vs. complicated cystitis

A

3 days vs. longer

92
Q

cystitis picture but neg urine cx

A

urethritis from GC/CT

93
Q

asymptomatic bacteriuria has a high incidence in?

A

women w/ sickle cell trait

94
Q

outcomes of threatened abortion (vaginal spotting in the 1st half of pregnancy -> no implications for viability)

A

viable IUP, ectopic, SAB

95
Q

mgmt of complete abortion

A

follow hCG to 0

96
Q

painless cervical dilation during pregnancy

A

cerclage

97
Q

molar pregnancy

A

size>date, snow storm on US, no fetal heart tones, vaginal spotting

98
Q

mgmt of septic abortion

A

maintain perfusion and oxygenation, abx and evacuate

99
Q

best initial imaging modality for younger patient w/ breast pathology

A

US

100
Q

red inflamed breast in non-lactating woman

A

?inflammatory breast cancer

101
Q

suspect familial breast cancer when?

A

2 1st degree relatives

102
Q

35yo+ w/ family hx -> mammography guidelines?

A

35yo+ w/ family hx -> annual

103
Q

MC histological type of breast cancer

A

infiltrating ductal carcinoma

104
Q

breast mass that persists after aspiration

A

biopsy

105
Q

suspiscious breast mass =? tx?

A

small cluster of calcifications w/ irregular bordered mass -> core needle or surgical bx

106
Q

how to confirm dx of Asherman

A

HSG or SIS or hysterscopy

107
Q

Galactorrhea 1st step in workup

A

pregnancy test -> PRL and TSH

108
Q

galactorrhea + nml menses and nml PRL

A

observe

109
Q

complication of hyper-PRL (pituitary adenoma <- MRI)

A

osteoporosis

110
Q

Sheehan associates

A

anterior pituitary insufficiency -> replace thyroid and adrenocoroticoids

111
Q

2 most common causes of secondary amenorrhea

A

Sheehan and intrauterine adhesions

112
Q

secondary amenorrhea + monophasic basal body temp and hypothyroidism

A

Sheehan

113
Q

PCOS: complications? dx? plan?

A

complications: DM, endometrial cancer, hyperlipidemia, metabolic syndrome, CV
dx: TSH/PRL, testosterone/DHEA, 17-OH, PUS
plan: OCP, metformin, diet and exercise; endometrial biopsy if long term

114
Q

1st step of tumor management

A

surgical staging

115
Q

MCC of infantile primary amenorrhea

MCC of primary amenorrhea w/ secondary sex characteristics

A

gonadal dysgenesis -> test FSH

Mullerian agenesis and androgen insensitivity -> testosterone and karyotype

116
Q

tx for idiopathic precocious puberty

A

GnRH agonist

117
Q

mulerian abnormalities are associated w/

A

renal anomalies

118
Q

infertility in asymptomatic woman

A

endometriosis

119
Q

how is endometrial cancer mg’d?

A

surgical staging and surgery

120
Q

persistent postmenopausal bleeding after endometrial sampling -> mgmt?

A

hysteroscopy

121
Q

flank tenderness or leg swelling can be a sign of what type of gyn cancer?

A

cervical

122
Q

MCC ovarian tumor in young woman

A

dermoid -> cystectomy

123
Q

When is CA-125 useful

A

epithelial tumor in post-menopausal women

124
Q

mgmt after debulking of epithelial cancer?

A

combination chemo

125
Q

tx for lichen sclerosis

A

corticosteroids

126
Q

which derm condition can become squamous cell carcinoma of the vulva

A

lichen slcerosis

127
Q

how to stage vulvar cancer

A

surgical including ipsilateral inguinal LN

ObGynShelf (20 decks)

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