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Year 3 > COMBANK OBGYN COMAT > Flashcards

COMBANK OBGYN COMAT Flashcards

1
Q

tx of uterine atony

A
  1. bimanual uterine massage asap
  2. if not resolved by 1, IV oxytocin infusion
  3. if still not resolved, admin another uterotonic agent (IM methylergonovine or rectal misoprostol)
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2
Q

pt with noncyclical pain, menorrhagia, and globular uterus … suspect _____

A

adenomyosis

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3
Q

difference between adenomyosis and endometriosis

A 
Endometrial tissue
- A = in myometrium
- E = outside repro tract
Pain
- A = non- cyclical
- E = cyclical
Age
- A  = 40s and up
- E = under 35
Fertility
- A = parity and uterine surgeries (ex/ C/S)
- E = difficulty conceiving
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4
Q

oxytocin effect on electrolytes

A

high dose has antiduretic and natriuretic effects

— can cause hyponatremia

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5
Q

oxytocin structurally similar to ______

A

vasopressin

beware high dose vasopressin admin can cause uterine contractions

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6
Q

most common vaginal cancers by age

A
  • premenopausal women = adenocarcinoma, endodermal sinus tumor, rhabdomyosarcoma
    • postmenopausal women = squamous cell carcinoma
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7
Q

vaginal cancer associated with DES exposure in utero

A

clear cell adenocarcinoma

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8
Q

most common cause of immediate pospartum fever (2-3days)

A

endometritis

Esp after C/S

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9
Q

most common abx regimen for PID

A

ceftriaxone (IM) + doxycycline (PO)

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10
Q

initial dx modality for postmenopausal bleeding

A

endometrial biopsy or Transvaginal US (not abd US)

– due to high suspicion for endometrial hyperplasia or carcinoma

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11
Q

rheumatologic disorder associated with hx of miscarriage

A

antiphospholipid antibody syndrome (in associateion with SLE)

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12
Q

how to dx SLE

A 
need 4 out of 11 criteria, including:
mucocutaneous manifestations
evidence of serositis and arthritis
renal failure
neuro manifestations
hematological and/or immunological markers
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13
Q

classic SLE sx

A

fever, malaise, joint pain, rash,

+/- glomerulonephritis, pericarditis, endocarditis

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14
Q

classic Sjogren’s syndrome sx

A
  • dry eyes, dry mouth, bilateral parotid gland enlargement

- can also have fever, malaise, fatigue, arthritis

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15
Q

what type of heme dz in lupus

A

hemolytic anemia with reticulocytosis, leukopenia, lyphopenia, thrombocytopenia

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16
Q

what type of mucocutaneous manifestations in SLE

A

oral ulcers, discoid lesions, malar rash, photosensitivity

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17
Q

what type of kidney dz in SLE

A

glomerulonephritis: subendothelial immune complex deposits with marked thickening of capillary walls

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18
Q

what is included in fetal biophysical profile

A

sonographic assessment of 4 discrete biophysical variables: fetal movement, tone, breathing, amniotic fluid volume,
and nonstress testing.
- each assigned 2 (normal) or 0 (abnormal)

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19
Q

what is included in modified fetal biophysical profile

A

NST as a measure of acute oxygenation and assessment of AFV as a measure of longer-term oxygenation

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20
Q

dx of IUGR

A

ultrasound screening + *umbilical artery Doppler velocimetry

— IUGR is associated with diminished blood flow to maternal and fetal vessels

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21
Q

most common causes for a delay in the latent phase of labor

A

unripe cervix and false labor

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22
Q

common causes of galactorrhea

A

pituitary adenoma/prolactinoma, pituitary stalk compression, side effect of medications, and physiologic conditions (e.g., pregnancy, breast stimulation)

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23
Q

medications that cause galactorrhea

A

antipsychotics (Ex/ chlorpromazine), opiates, methyldopa, and serotonin reuptake inhibitors
— dopamine inhibits prolactin secretion. So dopamine antagonists prevent inhibition of prolactin

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24
Q

What does the bishop score mean?

A
  • used to determine likelihood of vaginal delivery

- determines if cervix is “favorable” and thus mode of induction

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25
Q

how to interpret bishop score

A
  • score >8 indicates that there is a high likelihood of a spontaneous vaginal delivery.
  • A score of ≤ 6 indicates that the cervix is unfavorable and will need a cervical ripening agent
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26
Q

how to calculate bishop score

A

using the fetal station, plus four characteristics of the cervix: dilation, effacement, consistency, position

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27
Q

Fetal heart rate tracing category I

A

only reassuring components (baseline heart rate 110-160/min, moderate variability, no late or variable decelerations, early decelerations may be present or absent, accelerations may be present or absent)

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28
Q

Fetal heart rate tracing category II

A

those that cannot be classified as category I or category III

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29
Q

Fetal heart rate tracing category III

A

have concerning findings (absent variability and any of the following: , recurrent variable or late decelerations, bradycardia OR sinusoidal pattern).

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30
Q

how to detect fetal anuploidies as early as 9 weeks

A

serum PAP-A and B-HCG in combo with ultrasound (nuchal translucency)

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31
Q

when can you do amniocentesis

A

15-20w

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32
Q

when can you do chorionic villus sampling

A

10-12w

— more invasive, need US first

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33
Q

recc for IUD in place in pregnant woman

A
  • remove in first trimester (decreases miscarriage rate)

- if string not visible, do US guided. Or can do hysteroscopy

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34
Q

What does elevated DHEA-S mean?

A

dehydroepiandrosterone sulfate

  • produced by adrenal gland
  • = hyperandrogenism from adrenal source (rather than PCOS)
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35
Q

Skene’s glands are located on

A

anterior surface of the vagina, directly below the urethra

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36
Q

Nabothian cysts

A

mucus-filled cysts located on the surface of the cervix.

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37
Q

Gartner’s duct

A

embryological remnant of the mesonephric duct.

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38
Q

Hyperemesis gravidarum vs physiologic nausea and vomiting of pregnancy (morning sickness)

A

hyper:
intractable vomiting with dehydration, metabolic alkalosis, hypokalemia, hyponatremia, hypochloremia, elevated hematocrit, and weight loss.

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39
Q

Phyllodes tumors

A

rare breast masses characterized by their large, multilobular shape (rapidly expanding)

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40
Q

use of Vitamin B6 (pyridoxine) supplementation in preg

A

tx of nausea

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41
Q

What are Amsel’s criteria used for?

A

clinical criteria used for diagnosing BV

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42
Q

How to use Amsel’s criteria

A

3/4 to make dx of BV:

  1. Homogenous vaginal discharge
  2. Discharge has a pH greater than or equal to 4.5
  3. Positive whiff test: an amine like odor when discharge mixed with 10% KOH
  4. A wet mount demonstrating 20% more clue cells than vaginal epithelial cells
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43
Q

cause of GERD in pregnancy

A

increased progesterone causes smooth muscle relaxation, decreases LES tone and gastric motility -> increases the risk for GERD

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44
Q

chancroid characteristics

A

sx:

  • painful ulcer (papule -> pustule -> ulcer, gray base)
  • painful inguinal lymphadenopathy

notes:

  • common in sex workers in underdeveloped areas
  • age 15-19
  • G stain shows G neg rods.
  • Tx: azithromycin, ceftriaxone, ciprofloxacin, or erythromycin
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45
Q

common causes of cervicitis

A

chlamydia, gonorrhea

– chlamydia often otherwise asymptomatic

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46
Q

description of anogenital warts

A
  • cauliflower-like lesion on vagina, vulva, and labia
  • typically itchy
  • also: discrete papillary, exophytic lesion on thigh
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47
Q

risk factors for ectopic implantation

A
  • conditions that can damage and alter the structure of Fallopian tubes.
  • – ex/ chlamydia, trich
  • smoking
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48
Q

pilonidal cyst sx

A

Acute exacerbations cause sudden onset of pain with stretching of the skin in the intergluteal area. Intermittent swelling with purulent or bloody drainage can occur.
Chronic disease can result in recurrent drainage and pain.

49
Q

Bartholin duct cyst sx

A
  • unilateral, soft and painless mass medial to the labia minora.
  • patients are typically asymptomatic but may sense the presence of the cyst when ambulating or bending. Larger cysts may cause discomfort during sexual intercourse, sitting or ambulating.
50
Q

Gartner’s duct cysts

A
  • Wolffian (Müllerian) remnants
  • usually found on the lateral or posterior vaginal walls
  • may present in adolescence with difficulty inserting a tampon or dyspareunia
51
Q

trichilemmal or pilar cyst

A
  • mobile mass that contains fibrous tissue and fluid
  • scalp, face, upper arms and back are usually affected.
  • hairy areas are susceptible b/c cysts form at root sheath of follicle
52
Q

antidote for Mg Sulfate

A

calcium gluconate

53
Q

sx of magnesium sulfate toxicity

A

bradycardia, hypotension, decreased patellar reflexes and flaccid paralysis

54
Q

Definitive management for an ectopic pregnancy

A

removal of the Fallopian tube.

55
Q

when can use Methotrexate as alternative to surgical treatment of an ectopic pregnancy.

A
  • pt not bleeding, hemodynamically stable
  • β-HCG level < 5000 miU/mL.
  • gestational size less than 4 cm,
56
Q

Colpocleisis

A

surgical closing of the vaginal canal designed to treat vaginal prolapse in elderly females who are no longer sexually active.

  • – thought to prevent uterine prolapse too
  • – not used much anymore
57
Q

Primary dysmenorrhea

A

pain associated with menses

  • no actual pelvic pathology.
  • starts shortly after menarche
58
Q

Secondary dysmenorrhea

A
  • pain associated with menses:
  • – pain associated with endometriosis, pelvic inflammatory disease, uterine fibroids, etc.
  • see in the 20s and 30s after previous normal menstruation
59
Q

Risk factors for primary dysmenorrhea

A

menarche before the age of 12, nulliparity, smoking, family history, and obesity.

60
Q

Risk factors for pre-eclampsia and eclampsia

A 
multiple gestations, 
age at either extreme of reproduction, 
African-American or Hispanic race, 
hydatidiform mole, and 
extrauterine pregnancy

(NOT hx Sz or hx HTN)

61
Q

Risk factors associated with an increased risk for maternal mortality include

A

advanced maternal age,
African-American or Hispanic race,
obesity, and
multifetal gestation.

62
Q

Incomplete spontaneous abortions are managed with

A
  • tissue extraction by forceps if POCs can be visualized at the cervical os.
  • – Dilation and curettage may be performed if bleeding continues
  • Misoprostol may be used instead of dilation and curettage for patients at less than 12 weeks gestation who are hemodynamically stable and do not desire surgical management.
63
Q

Osteoporosis T score

A

bone density that falls 2.5 standard deviations (SD) below the mean for a young normal individual (a T-score of less than -2.5).

64
Q

Osteopenia T score

A

between -1 and -2.5

65
Q

dx severe osteoporosis

A

T-score less than -2.5

+ history of one or more fragility fractures

66
Q

cervical insufficiency is defined as

A

recurrent painless cervical dilation in the absence of uterine contractions, infection, placental abruption or uterine anomaly.
(dx of exclusion)

67
Q

Risk factors for cervical insufficiency

A

prior cervical laceration,
history of cervical conization (or CIN b/c they prbly had procedure),
multiple terminations with mechanical cervical dilation,
congenital cervical anomaly, and
collagen abnormalities.

68
Q

contraindication to carboprost as uterotonic agent

A

hx asthma

— b/c prostaglandin analog. side effects include nausea, vomiting, and bronchoconstriction.

69
Q

contraindication to methylergonovine as uterotonic agent

A

HTN or preeclampsia

– b/c ergot derivative that causes vascular smooth muscle contraction (also why IM only, not IV)

70
Q

thresholds to treat asymptomatic bacteriuria in pregnancy

A
  • clean-catch urine culture with >100,000 colonies/mL
    or
  • catheterized urine culture with >100 colonies/mL
71
Q

difference between chronic HTN and gestational HTN

A

chronic is before 20w

gestational is at or after 20w

72
Q

s/sx of uterine rupture

A

fetal bradycardia, abdominal pain, loss of fetal station, maternal hypotension, uterine tenderness

73
Q

risk factors for uterine rupture

A

previous C-section, myomectomy, ectopic pregnancy

74
Q

how to dx chorioamnionitis

A

clinical and requires maternal fever of 38.0° C (100.4° F) that is not attributable to any other cause plus any one of the following:

  • maternal or fetal tachycardia,
  • uterine tenderness,
  • foul-smelling amniotic fluid,
  • purulent discharge, and
  • leukocytosis
75
Q

fetal “Engagement”

A

descent of the biparietal diameter of the fetal head below the plane of the pelvic inlet
— has occurred if at station 0

76
Q

fetal “external rotation”

A

the fetus resumes its face-forward position, with the occiput and spine lying in the same plane.

77
Q

fetal “internal rotation”

A

fetal occiput rotates from its original position (usually transverse) toward the symphysis pubis (occiput anterior) or, less commonly, toward the hollow of the sacrum (occiput posterior)

78
Q

Menorrhagia

A

irregularly prolonged or heavy menstrual period that maintains a normal menstrual cycle (between 21-35 days)
— causes include coagulopathy (ITP, hemophilia, von Willebrand’s), Endometriosis, Leiomyoma, or Neoplasms

79
Q

Metrorrhagia

A

uterine bleeding at irregular intervals, typically occurring between menstrual periods
— causes: contraceptive medications, called “breakthrough bleeding”, or underlying disorders such as leiomyomas, endometriosis, or genitourinary neoplasms

80
Q

Menometrorrhagia

A
  • menstruation cycle is heavy or prolonged AND occurs at irregularly intervals
  • – combination of metrorrhagia and menorrhagia
81
Q

Intermenstrual bleeding vs Metrorrhagia

A
  • both involve bleeding in between cycles

- Metrorrhagia is separated by re-occurring at irregular intervals

82
Q

Polymenorrhea

A

regular menstruation cycles occurring at irregularly shortened intermenstruation intervals, defined as 21 days or fewer

83
Q

GBS Tx if penicillin allergy

A
  • if NO hx anaphylaxis, urticaria, angioedema, or respiratory distress: Cefazolin
  • if any of the above: vancomycin or clindamycin
84
Q

Full anatomic screen should take place when?

A

between weeks 18-20

85
Q

One-hour glucose challenge test is used to screen for gestational diabetes mellitus when?

A

between weeks 24-28.

86
Q

when to do Testing for HIV in pregnancy?

A

initial prenatal appointment

87
Q

Group B streptococcus culture is typically collected when? (preg)

A

between weeks 32-36.

88
Q

when to do Cystic fibrosis (CF) screening in preg?

A
  • indicated if there was a family history of CF on either side of the family.
  • Discussion of genetic screening should take place at initial prenatal appointments.
89
Q

Maternal benefits of breast feeding

A 
early maternal/infant bonding, 
more rapid rate of uterine involution, 
decreased postpartum blood loss, 
lower cost compared to formula and 
decreased risk of ovarian cancer and premenopausal breast cancer
90
Q

breastfeeding and cancer risk

A

breastfeeding for greater than 12 months decreases the risk of epithelial ovarian cancer.
— This is thought to be secondary to decreased ovulation during breastfeeding.

  • also decreased risk of premenopausal breast cancer
91
Q

side effect of ritodrine and terbutaline

A

both are B-2 agonists

- can cause hyperglycemia in diabetic mothers

92
Q

first-line for treatment of cessation of premature labor

A
  • Indomethacin if less than 32w

- – can’t use if hx PUD or renal/hepatic disease/bleeding disorder

93
Q

Why can’t use ACE inhibitors in preg?

A

1st tri: increased risk fetal cardiac and CNS malformation

2nd-3rd tri: renal hemodynamics -> decreased GFR

94
Q

when to start MMG screening

A

begin at age 40 or 10 years before the earliest diagnosed breast cancer in a relative.

95
Q

meds for uterine relaxation

– ex/ to aide with retained placenta or uterine inversion or during EXIT procedure

A

volatile anesthesia (invasive, risky)
or
IV or sublingual nitroglycerin (first line)

96
Q

1h GTT values

A

50g oral glucose given
Done at 24-28w
positive if > 130 at 1hr

97
Q

first line tx for preeclampsia

A
  • Labetalol

- delivery = only cure

98
Q

contraindication to Labetalol

A

asthma pt

99
Q

Viscero-somatic reflex for bladder and lower ureters

A

Sympathetic: T12-L2

100
Q

Kallmann syndrome

A
  • failure of olfactory and GnRH neuronal migration from the olfactory placode.
  • causes primary amenorrhea, absent breast development, anosmia and color blindness
101
Q

Klinefelter syndrome

A
  • primary hypogonadism in males
  • extra X chromosome
  • small testes, low sperm count and infertility, decreased virilization, increased length of the long bones of the legs, and mild developmental abnormalities.
102
Q

Swyer syndrome

A
  • male karyotype, female phenotpye

- normal appearig woman who presents with delayed puberty

103
Q

Turner’s syndrome info

A
  • missing an X chromosome (all or part)
  • premature ovarian failure, primary amenorrhea, and infertility
  • – primordial follicles undergo accelerated atresia -> oocyte depletion before puberty
  • lack of gonadal estrogen production
  • – failure of breast development
104
Q

Turner’s syndrome classic findings

A

webbed neck
shield chest
short stature
sexual infantilism

105
Q

adenomyosis vs leiomyomas

A

Size
- Unlike leiomyomas, adenomyosis causes homogenous enlargement of the uterus that may be detectable on ultrasound

Pain

  • adenomyosis pain non-cylical
  • leiomyomas cyclical (hormonally responsive)
106
Q

What to do next if you have abnormal AFP on second tri screen

A

first step = fetal ultrasound to rule out inaccurate gestational age or multiple gestations

107
Q

medications that cause galactorrhea

A

those that cause lactotroph stimulation or inhibit dopamine: antipsychotics, TCAs, SSRIs, some antiemetics (metoclopramide, prochlorperazine), and some antihypertensives (verapamil, methyldopa).

108
Q

when to suspect physiologic nipple discharge

A

in women who are not pregnant, have normal serum prolactin levels, and are not on psychiatric medications.

109
Q

most reliable sign for dx of uterine rupturre

A

non-reassuring FHR patterns

110
Q

sx of placental abruption

A

vaginal bleeding with acute, severe, and constant abdominal pain late in pregnancy
— emergency!

111
Q

Risk factors for placental abruption

A

maternal hypertension, advanced maternal age, multiparity, cocaine use, tobacco use, chorioamnionitis and trauma

112
Q

viscerosomatic reflex for the uterus

A

T9-L2 bilaterally

113
Q

viscerosomatic reflex for the Fallopian tubes

A

T10-L2 ipsilaterally

114
Q

Progestin only pills main mechanism of action

A

thickening of cervical mucus to inhibit sperm penetration

115
Q

acceptable abx for asymptomatic bacteriuria in pregnancy

A

amoxicillin, ampicillin, nitrofurantoin, and first gen cephalosporins

116
Q

Features of severe preeclampsia

A

BP ≥ 160/110 mmHg on two occasions at least four hours apart,
thrombocytopenia,
impaired liver function,
progressive renal insufficiency,
pulmonary edema,
new-onset cerebral or visual disturbances

NOTE: Massive proteinuria (>5g) was an old feature. Doesn’t count anymore

117
Q

Ovarian resistance syndrome

A
  • rare cause of hypergonadotropic hypogonadism
  • dx: characterized by increased GnRH and LH/FSH levels accompanied by decreased estrogen and progesterone levels
  • sx: women present early in life with amenorrhea, delayed breast development, elevated gonadotropins, low estrogen, and normal karyotype
118
Q

first-line medication for acute management of tachyarrhythmias

A

adenosine

    • this is in everyone, including pregnant women
  • — second line agents include digoxin, CCBs, B-blockers

Year 3 (15 decks)

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