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OB-Gyn EOR > EOR pearls > Flashcards

EOR pearls Flashcards

1
Q

most common cause of consumptive coagulopathy (DIC) in pregnancy

A

placental abruption

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2
Q

When does an average woman with 3-4 day menses and a 28-day cycle ovulate? What about a 30-day cycle?

A

28 days- day 14

30 days- day 16

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3
Q

Uncomplicated mastitis- 1st line

A

dicloxicillin 500mg q6h for 10 days

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4
Q

according to our exam-making overlords, what does cervical motion tenderness mean?

A

PID (not just cervicitis)

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5
Q

risk factors for metritis

A
  1. prolonged induction of labor
  2. c-section
  3. fever >39
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6
Q

Why shouldn’t a newly delivered baby be held below the introitus?

A

increase in passage of hemoglobin/RBCs from mother can cause hyperbilirubinemia.

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7
Q

Should you give rhogam after a miscarriage? When?

A

Yes (if mom is Rh negative), it should be given immediately after the miscarriage because of slight chance of maternal sensitization.

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8
Q

Birth control while breastfeeding?

A

LARC or progestin-only pill. Estrogen reduces milk production.

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9
Q

When to screen for diabetes in pregnancy?

A

24-28 weeks

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10
Q

What can you use for pain management during labor?

A

Stadol (butorphanol) can be administered if delivery is not anticipated within 4 hours. Otherwise an epidural must be used.

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11
Q

What is the most common cause of rectocoele?

A

Pelvic floor injury (usually childbirth).

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12
Q

What is the only thing that increases risk of multi-gestation?

A

Use of fertility drugs, like clomifine.

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13
Q

How to treat Graves’ in pregnancy:

A

PTU only. It is associated with lower placental penetration and less penetration into breast milk than methimazole, the other choice for Tx. Absolutely NO radio-iodide ablation in pregnancy.

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14
Q

Aside from multiple gestation, what risk does use of a fertility drug like clomifene pose?

A

risk of ovarian cysts.

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15
Q

Why do most ectopic pregnancies implant in the fallopian tube?

A

FT lacks a submucosal layer allows easy wall access and implantation

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16
Q

What is the safest reversible form of contraception for women who smoke or are over 35 (or have other cardio risk factors)?

A

Copper IUD.

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17
Q

What is the most common cause of scarring in the fallopian tubes?

A

occult PID caused by Chlamydia.

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18
Q

Primary and secondary syphilis: presenting sx

A

Primary: painless chancre at site of inoculation. That’s it.
Secondary (1-2 months after primary): Generalized maculopapular rash, lymphadenopathy, fever, HA, sore throat

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19
Q

When must quad-screen or AFP be drawn?

A

at 15-20 weeks GA. If done outside this window the result will be invalid.

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20
Q

Tx for cystocoele with urinary incontinence:

A

Pessary

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21
Q

What is the causative agent in bacterial vaginosis? How to Dx?

A

Gardnerella overgrowth. KOH “whiff” test. Yeast, viruses will not cause positive whiff test.

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22
Q

What medicine can cause hypothyroidism?

A

Amiodarone

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23
Q

What is the most common breast lesion in premenopausal women? What about women of child-bearing age? How to distinguish?

A

Fibroadenoma- discrete mobile mass. More common in pregnant women than fibrocystic changes.

In women of childbearing age, fibrocystic changes are very common, but the lesion is irregular and worse around menses. Pregnant women don’t usually get this.

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24
Q

Adenexal pain after exertion - EXTREMELY painful, with vomiting.

A

Ovarian torsion.

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25
Q

What is the most common cause of post-partum hemorrhage?

A

Uterine atony

26
Q

Most ovarian cancer is what type?

A

from epithelium (carcinoma)- Serous tumors.

27
Q

Definitive diagnosis of endometriosis:

A

Laparoscopy

28
Q

At what gestational age should a normal pregnancy (inc macrosomia without GDM) be induced?

A

41.5 weeks or earlier. After this, inc risk of still birth

29
Q

Cause of proteinuria in GDM?

A

Glomeruloendotheliosis - leaky endothelial dysfunction

30
Q

Why do very thin women have fertility problems and amenorrhea?

A

Hypothalamic axis suppression due to low weight/low fat

31
Q

At what endometrial thickness are you concerned about endometrial cancer?

A

5mm or greater in post-menopausal

32
Q

At what fasting blood glucose level should a pt be switched to medical management for GDM?

A

> = 95

33
Q

How to treat primary amenorrhea in young woman with hirsuitism?

A

Oral progesterone will slow GnRH pulses, improving follicle maturation.

34
Q

First line for infertility associated with PCOS?

A

Clomiphene citrate

35
Q

Ddx for nipple discharge in a woman without pregnancy?

A

Intraductal papilloma (serous or sanguinous) vs pituitary adenoma (milk)

36
Q

If mom has MRSA mastitis, where did she get it?

A

Baby…who prob got it from hospital staff

37
Q

How should an ovarian mass be investigated?

A

If high risk (premenopausal, family hx, large mass), then surgery. If low risk, repeat imaging in 1 yr.

38
Q

How fast does a cervix dilate during the active stage of labor?

A

1.2 cm/hr in primigravida, faster in multip

39
Q

What is tested in a triple screen? What values do you expect?

A

alphafetoprotein (AFP), human chorionic gonadotropin (hCG), and unconjugated estriol (uE3). If all 3 are low, it suggests trisomy 18. If all are low except hCG (high), then down’s.

40
Q

pH of amniotic fluid? Measured value suggesting rupture?

A

7-7.5 is normal for amniotic fluid. A pH of greater than 4.5 in vaginal fluid suggests ROM.

41
Q

Most likely cause of menorrhagia, bleeding between cycles in perimenopausal woman?

A

Anovulatory bleeding due to unopposed estrogen.

42
Q

What procedures are CI in labor of an HIV-positive pt?

A

Fetal scalp testing or electrodes increase likelihood of vertical transmission. Prolonged ROM also does, but AROM is not CI.

43
Q

When to add metronidazole to PID treatment?

A

When tubo-ovarian abscess is suspected.

44
Q

Early management of suspected infertility- what’s the early work up?

A

First look at mom. If no Hx of abdominal surgery, then test for ovulation. If she is ovulating, then investigate FOB.

45
Q

Clinical pres of trichomoniasis:

A

Profuse, frothy yellow-green discharge, foul smelling, pruritis.
Vaginal pH >5.0, vagina and cervix erythema, cervical petechiae

46
Q

If hCG continues to rise after d&c for hydratiform mole, what are you thinking?

A

Choriocarcinoma

47
Q

For whom is a progestin-only OCP a good choice?

A

In general, combined OCPs are more effective. Progestin-only type are good for smokers >35 yo who are at an increased risk of MI from combined OCPs.

48
Q

Shoulder dystocia- definition and early management:

A

a type of obstructed labor where, after delivery of head, anterior shoulder cannot pass below pubic symphysis.

[ALARMER]
Ask for help
Leg hyperflexion (McRoberts')
Anterior shoulder disimpaction (pressure)
Rubin maneuver
Manual delivery of posterior arm
Episiotomy
Roll over on all fours.
49
Q

Pap smear screening guidelines

A

Women

50
Q

ASCUS- now what?

A

2 options:

1- repeat pap @ 6&12 mo (ideal for pt

51
Q

LSIL, now what?

A

If 21-24, repeat pap in 12 mo;
If 25-29, colposcopy
If 30+ and HPV negative, repeat pap in 12 mo
If 30+ and HPV positive, colposcopy

52
Q

ASC-H or HSIL, now what?

A

ASC-H- colposcopy, all ages

HSIL- Colposcopy for women

53
Q

PCOS, infertility failed clomiphene, now what?

A

Metformin for underlying insulin resistance.

54
Q

PMS Tx

A

NSAIDs. If those fail, then Fluoxetine on cycle days 21-7

55
Q

Mammogram screening recs:

A

Women 40+ - Annual

Women 19+ -clinical breast exam annually

56
Q

Oligomenorrhea with headaches, fatigue, breast discharge…likely dx

A

pituitary adenoma (most secrete prolactin). Evaluate with serum prolactin level.

57
Q

least common reason for infertility…

A

pituitary disease.

58
Q

What is considered “prolonged labor” in each stage?

A

latent (stage 1) - >20h for null; >14 hours for multip
Second stage- Null >2h; multip >1h. (epidural adds 1 hour)
Third stage- >30 mins

59
Q

In a woman presenting in labor with vaginal bleeding who is at term, 8 cm dilated with cephalic presentation and going to deliver vaginally, what will reduce her time to labor and bleeding?

A

AROM

60
Q

pathophysiologic cause of post-partum stress incontinence:

A

widening of levator gap

61
Q

who is at higher risk of clots from combined oral contraceptives?

A

women with factor V Leiden. Broadly, we use alternatives for any woman with clotting hx or hypercoagulable state.

62
Q

Leopolds determine what:

A

fetal lie (longitudinal or transverse) and position (ROP, LOP, ROA, LOA)

OB-Gyn EOR (1 decks)

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