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OB/GYN > Gyn+OB OME > Flashcards

Gyn+OB OME Flashcards

1
Q

Ultrasound and ca125 indicated to screen for cervical cancer when

Is increased surveillance adequate in these pts

A

When pt has BRCA1/2 mutation

No ppx hysterectomy oopherectomy mastectomy is superior to surveillance

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2
Q

BRCA1/2 mut predisposes to what cancers

A

breast ovarian uterine

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3
Q

Risk factor for vaginal and vulvar squamous cell carcinoma

A

HPV

Vag and vulv scc just like cervical csused by hpv

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4
Q

Endometrial cancer is driven by ______

A

Estrogen

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5
Q

64 F with maligmant ascites, which gym cancer to suspect

A

Ovarian cancer

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6
Q

Biggest risk factor for ovarian cancer

A

Ovulation

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7
Q

Teenage girl has huge obvious cystic teratoma by history and ultrasound, next step cystectomy or CT to better stage and characterize

A

cystectomy

age of patient and size of tumor make diagnosis clear (serous cystadenoma), no need for radiation exposure

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8
Q

why is TAH + BSO required for breast and uterine carcinomas?

total abdominal hysterectomy and bilateral salpingoopherectomy

A

estrogen responsive tumors
estrogen comes from ovaries
must take ovaries out in case mets

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9
Q

what % of women with infertility are found to have endometriosis

A

30%

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10
Q

define preterm labor

A

v37wks

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11
Q

tf

ovarian torsion often occurs seated not doing anything / at rest

A

T

often does

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12
Q

tf

treat 3cm simple ovarian cyst with oral contraceptives

A

f
oral contraceptives don’t affect ovarian cysts – used ot think so but not anymore

for 3cm, just repeat US in 3 mos to check but expecting spontaneous resolution

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13
Q

tubo-ovarian abscess is a complication of

A

pelvic inflammatory disease

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14
Q

1st and 2nd line tx of endometriosis

far down the line definitive therapy

A

nsaids
OCPs
laparoscopy

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15
Q

3cm smooth fluid-filled cyst in otherwise normal child-bearing age female, what is it likely, next step

A

Likely a functional follicular cyst (ovulating ovaries make them every month)… low risk (v10cm smooth thin-walled no septations)

Reassurance, typically regress weeks to months

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16
Q

rectocele causing constipation, surgery planned for next week, how to treat constipation till surgery

A

transvaginal digital reduction of rectocele - to restore normal alignment of colon and alow expulsion

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17
Q

how do kegel exercises treat vaginismus

A

contract the pelvic floor, relax the vaginal muscles so they can be gradually dilated

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18
Q

Mittleschmerz pain

A

Peritoneal pain from rupture / bleed from functional ovarian cyst or follicle

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19
Q

primary causative organism in bacterial vaginosis

A

gardnerella

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20
Q

choose between gonorrhea and chlamydia for cause of cervicitis on test

A

choose chlamydia

more prevalent

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21
Q

what kind of incontinence do neurogenic bladder and hypertonic bladder cause

A

neurogenic - overflow incontinence

hypertonic - spastic/urge incontinence

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22
Q

diabetes
ms
spinal lesion

are risk factors for what kind of urinary incontinence

A

neurogenic bladder - overflow incontincence

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23
Q

when to get ct scan for urothelial cancer

A

to stage – CT good at identifying mets, not primary urothelial cancer – get cystoscopy and biopsy for that

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24
Q

oxybutinin moa

use

A

urinary smooth muscle antispasmotic
also anticholinergic at urinary smooth muscle

tx overactive bladder (hyptertonic, spasmotic)

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25
Q

how does fibroid surgery lead to vesico vaginal surgery

A

trauma from surgery, or retained stitch, etc…. can lead to epithelialized tract between two epithelia…

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26
Q

when to get urodynamics

A

eval urinary incontinence when not sure stress vs urgency

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27
Q

overflow incontinence aka aka

A

hypotonic aka neurogenic bladder

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28
Q

when to use foley vs bethanecol or doxasosin for neurogenic bladder

A

foley for acute relief of hydronephrosis

bethanecol or doxasosin for long term treatment

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29
Q

When to perform external cephalic version of fetus

A

When baby is breech after 37 weeks (before 37 weeks the fetus is likely to spontaneously cephalize)

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30
Q

TF

Mom with PPROM and fever and tachy fhm needs betamethasone

A

F
Abx - broad spectrum pip/tazo or amp/gent/metro

And deliver asap… don’t wait to deliver with evidence of chorioamnionitis

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31
Q

TF

Abx for PROM even if no signs of infection yet

A

T

Not laboring yet, may take time, ppx against infectiom

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32
Q

When to use cerclage

A

First trimester presence or historynof cervical incompetence

aka way before labor, mist be removed before cervical changes in labor or else damage

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33
Q

TF

One sac, two placentas is possible

A 
F
These are possibe:
One sac one placenta
Two sacs two placentas
Two sacs one placenta
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34
Q

What kind of twinning risks cord entanglement

A

One sac one placenta

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35
Q

What kind of twinning risks twin-twin transfusion

A

Two sacs one placenta

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36
Q

What kind of twinning risks malpresentation and premature birh

A

Two sacs two placentas

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37
Q

Types of twinning according to time of separation

A

Earlier separation, less shared

Separate eggs - dizy dichor diamn
Day 0-3 - monozy dichor diamn
Day 4-8 - monozy monochor diamn
Day 9-12 - monozy monochor monoamn
Day 12+ -  conjoined mono mono mono
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38
Q

Each additional gestation pushes the EDD up about…

A

4 weeks (from mono edd 40 wks)

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39
Q

Quadruplets cooking in there, edd?

A

28 weeks

Each additional gestation pushes the EDD up about 4 weeks

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40
Q

Major cause of DIC in delivery

A

Placental embolization

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41
Q

How does amnionic fluid embolism present differently from placental embolism

A

Amnionic fluid PE w dyspnea amd hypoxia then maybe DIC

Pacental embolism DIC

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42
Q

Blood vessels to edge of delivered placenta implies…

And how to treat…

A

Retained parts of placenta

If PPH - D&C, then uterine artery ligation, then total abdominal hysterectomy ad needed

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43
Q

Retained placenta has long term complication of this cancer

A

Choriocarcinoma

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44
Q

How to follow up a DandC of a retained placenta

A

Serial bHCG’s for about a year to make sure no choriocarcinoma developes

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45
Q

Algorithm for workup of decreased fetal movement

A

Doppler for fetal heart tones (alive)
NST
NST w vibrioacoustic stim
BPP
CST or repeat BPP 24h if BPP 3-7 and preterm
Deliver if BPP 2 or less or CST abnorm or BPP 3-7 and term

Only go to next one if you get an abnormal… if normal.. can repeat at follow-up to acknowledge mom’s feelings

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46
Q

Act on BPP score

A

8-10 reassure and repeat weekly to check again

3-7 consider delivery if term, if preterm consider steroids and try to keep cooking a bit longer and do CST or repeat BPP IN 24hrs to help decide whether to deliver

0-2 deliver or else baby is going to die

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47
Q

In which does fetus decompensate faster, placenta previa or vasa previa?

A

Vasaprevia

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48
Q

What Rh antibody titer would cause you not to give rhogam because Mom already has anti-Rh abs

A

1:8 or greater

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49
Q

Painless genital ulcer
Think…
Dx by…

A

Painless genital ulcer
Think syphilis
Dx by dark field microscopy

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50
Q

Dx heamophilis ducrei in painful genital ulcer

A

Culture

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51
Q

Diffuse intracranial calcifications
Hydrocephalus
Chorioretinitis

Think what congenital infection

A

Toxoplasma

52
Q

Saddle nose
Saber shins
Snuffles/rhinitis

Think what congenital infection

A

Syphilis

53
Q

Periventricar calcifications
IUGR
Microcephaly

Think what congenital infection

A

CMV

54
Q

Labs typically obtained at first prenatal visit

A 
Type and screen
CBC
HIV
HBV HBsAg
Pap
Rubella
Syphillis
Gonorrhea/Chlamydia
Urine culture

2 blood stuffs, 4 virus stuffs, 3 bacterial stuffs

55
Q

Labs typically obtained at first prenatal visit

2 blood stuffs, 4 virus stuffs, 3 bacterial stuffs

A

Type and screen
CBC

HIV
HBV HBsAg
Pap
Rubella

Syphillis
Gonorrhea/Chlamydia
Urine culture

56
Q

TF
Routinely screen folate levels in preggys

TF
Routinely give folate supplementation to preggys

A

F - only screen if megaloblastoc anemia

T - always supplement regardless of level

57
Q

When to screen for gestational diabetes with ogtt

A

At or after 24 weeks

GDM gets a 2nd-3rd trimester screen

58
Q

When to stop pap screening if all prior paps have been normal

A

Age 65

59
Q 
Primary amenorrhea and anosmia think
Pathophys
Anatomy
Karyotype
Tx
A

Kallman syndrome
Pituitary GnRH deficiency
Normal anatomy (uterus, vagina, ovaries, etc)
46XX normal karyotype
Estrogen and Progesterone supplementation

60
Q

47XXX phenotype

A

Normal phenotype, may never be diagnosed

61
Q

47XXY
Syndrome
Phenotype

A

Klinefelter syndrome

Tall lanky male phenotype with small testes

62
Q

Leuprolide is a ___ analog

A

GnRH analogue

63
Q

TF

Oophorectomy for Kallman’s

A

F
Just supplement axis with E and P or maybe from the top woth GnRH
(Kallman’s is GnRH insufficiency in setting of normal everything else)

Leaving ovaries in is not a cancer risk like leaving undescended testes in

64
Q

When is gonadectomy performed for testicular feminization

A

After completion of puberty

(Testosterone that cannot be converted into active 5-DHT will be converted into estrogen instead and female secondary sex traits will develop – just amenorrhea because no upper vagine uterus or tubes because mullerian inhibiting factor killed those back as a fetus)

65
Q

How does testicular feminization commonly present

Pathophys

A

Amenorrhea

Testosterone that cannot be converted into active 5-DHT will be converted into estrogen instead and female secondary sex traits will develop – just amenorrhea because no upper vagine uterus or tubes because mullerian inhibiting factor killed those back as a fetus

66
Q

why tah+BSO for endometrial cancer in PMP woman

A

because endometrial carcinoma is an estrogen-responsive tumor and there may be mets even if remove uterus, so remove ovaries (a potential source of estrogen even though post-menopausal)

67
Q

what is the staging process for endometrial cancer in a postmenopausal woman

A

CT

completed via paraaortic lymph node dissection and peritoneal wash during TAH+BSO

68
Q

TF

radical hysterectomy includes resection of omentum

A

T

69
Q

stages of endometrial cancer and corresponding general tx guidelines

A

stage I: contained by myometrium - TAH+BSO

stage II: subserosal? TAH+BSO and radiation

stage III: local mets - TAH+BSO and chemo/radiation

stage IV: A - beyond uterus bowel bladder, B - distant – chemo +/- radiation/debulking

70
Q

which female hormone is protective against endometrial cancer

A

PROgesterone is Protective against endometrial cancer

71
Q

when do ovaries pathologically overproduce estrogen enough to increase risk of endometrial cancer

A

granulosa-theca tumor

POCS (anovulation so less progesterone, more estrogen)

72
Q

define menometorrhagia

A 
menorrhagia (heavy)
plus metrorrhagia (irregular)

prolonged or excessive uterine bleeding occurs irregularly and more frequently than normal. It is thus a combination of menorrhagia (heavy) and metrorrhagia (irregular)

73
Q

otherwise healthy woman with menometorrhagia and endometrial hyperplasia without atypia on biopsy, tx? hysterectomy? OCP?

A

cyclical progestin

reserve hysterectomy for atypia… too much risk to surgery for just hyperplasia

OCP prevents hyperplasia, but too late when hyperplasia already present

74
Q

indication for endometrial ablation

  • for endometrial hyperplasia?
  • for endometrial atypia?
A

only in women with uterine bleeding before menopause who are done having kids but in whom the biopsy ins normal

  • not for endometrial hyperplasia - can burn in developing cancer such that cancer is hidden on future biopsies
  • not for atypia for same reason and also just do hysterectomy for atypia (or cyclical progestin if premenopausal and wants more kids… I think…)
75
Q

TF

tamoxifen is a treatment for uterine cancer

A

F

it causes uterine cancer

76
Q

Irregular periods leading to amenorrhea and positive bleeding with progestin test think…

related pathophys

A

PCOS

Oligo-anovulation… no luteal/progesterone phase, just estrogen endometrium buildup without differentiation and scheduled sloughing so only sloughs less frequently when outgrows blood supply

77
Q

chemo regimen for endometrial cancer

A

pac splat dox

paclitaxel doxorubicin cisplatin

78
Q

cyclophosphamide doxorubicin 5-fu in setting of OBGYN treats…

A

breast cancer

79
Q

Adriamycin bleomycin vinblastine and dacarbazine a the chemo regimen for…

A

Hodgkin’s lymphoma

ABVD

80
Q

most common cause of postmenopausal bleeding

most concerning cause of postmenopausal bleeding

A

vaginal atrophy

endometrial carcinoma

81
Q

define hyperemesis gravidarum

BMP disturbance

1st 2 staps

A

severe nausea and vomiting leading to dehydration

hypokalemic hypochloremic metabolic acidosis

IVF and K
beta quant (quant beta hCG) to confirm cause (pregnancy, mole)
pelvic US

82
Q

most dangerous cause of hyperemesis gravidarum

A

gestational trophoblastic disease i.e. hydatidiform moleor choriocarcinoma

83
Q

How do you treat choriocarcinoma of the uterus?

A

low risk: methotrexate

high risk: EMA/CO (etoposide, methotrexate, and dactinomycin, cyclophosphamide and vincristine (Oncovin))

84
Q

what distinguishes hyperemesis gravidarum from normal morning sickness

and what causes them

A

degree of metabolic and vital sign derangement

vomiting likely caused by elevated b-HCG

85
Q

snowstorm on US and no fetal parts suggests what kind of molar pregnancy

A

complete mole

86
Q

when to perform suction curettage vs dilation and curettage for mole/abortion

A

suction curettage for early gestation moles and abortions

dilation and curettage for second trimester

87
Q

what is the role of CT scan in molar pregnancy

A

staging CHORIOCARCINOMA to inform surgical decision / therapy if this cancer arises AFTER the molar pregnancy is removed

88
Q

what is the role of MTX in molar pregnancy

A

a treatment for CHORIOCARCINOMA if it arises AFTER the molar pregnancy is removed

89
Q

incomplete mole is caused by how many sperm and how many eggs

A

2 sperm
1 egg

(Dispermy)

90
Q

what type of molar pregnancy is caused by dispermy

A

incomplete mole

2 sperm, 1 egg

91
Q

TF

karyotype of molar pregnancy is necessary to guide management

A

F

not necessary, but often obtained

92
Q

how does dispermy occur

A

rarely, when two sperm enter egg at exactly the same time

93
Q

how do incomplete moles present vs complete moles

A

just the same for the most part
-B-HCG too elevated for dates +/- hyperemesis gravidarum, size/date discrepancy, US shows snowstorm

but some fetal parts in snowstorm in incomplete mole

94
Q

what is the cause of a complete mole

how many sperm, how many eggs

A

dyfunctional oocyte

1 sperm meets 1 dysfunctional egg (absent nucleus), sperm doubles own genetic content, can grow but non-viable

95
Q

absence of barr bories is associated mostly with

A

Turner syndrome 46XO

96
Q

maternal nondisjunction is associated mostly with

A

downs trisomy 21

97
Q

high b-HCG with molar pregnancy makes high risk for ___ after removal

A

high risk of choriocarcinoma

98
Q 
molar pregnancy with bHCG 150,000 now 3,600 8weeks s/p suciton curettage
lost to follow-up in interim
no symptoms
no period
not compliant with OCPs

what is the risk to worry about
next step
next next step
management if risk becomes reality

A

risk for choriocarcinoma s/p gestational trophoblastic disease

repeat bHCG in a week, it has downtrended, make sure of this with 1 week repeat bHCG

repeat US if 1 week not downtrending

CT, suction curettage vs ex-lap, chemo

99
Q

choriocarcinoma diagnosed, manage

A

CT, suction curettage vs ex-lap, chemo

100
Q

choriocarcinoma with mets but no mass effect after normal pregnancy spontaneously aborted, treat

A

methotrexate, actinomycin D (standard)

+ cyclophosphamide (after pregnancy, elevated bHCG, or brain mets)

101
Q

standard chemo for choriocarcinoma

additional agent and indications

A

standard methotrexate and actinomycin D

add cyclophosphamide if follows a normal pregnancy, bHCG elevated, or brain mets

102
Q

indications for cyclophosphamide in chemo for choriocarcinoma

A

if follows a normal pregnancy, bHCG elevated, or brain mets

103
Q

what is a positive GnRH stimulation test and what does it tell you in the setting of precocious puberty, e.g. tanner stage II axillary hair pubic hair and breast development with bone age 2 years ahead of stated age. Next step after positive GnRH stim test in this patient, differential, treatment, why treat

A

positive if exogenous GnRH elevates LH

tells you its a central issue

get MRI

  • pituitary adenoma - resect
  • “constitutional” if negative – aka idiopathic but maybe caused by diet or urban environement factor that stimulates axis early – continuous leuprolide (GnRH agonist) to stifle axis

treat to stave off early menarche which will compromise growth spurt

104
Q

cause of “constitutional” precocious puberty

A

idiopathic but maybe caused by diet or urban environement factora that stimulates hormonal axis early

105
Q

when to get abdominal ultrasound in workup of precocious puberty

what have your ruled out already
what are you looking for now

A

after negative GnRH stim test rules out central lesion (pituitary mass vs “constitutional” issue)

looking for peripheral lesion – ovarian or adrenal gland tumors

106
Q 
CAH with female masculinization
what will be elevated in urine
what is functional hormone is overproduced
what hormone is upregulated in blood
how to treat and reasoning
A

17-OH-progesterone elevated in urine
androgens overproduced
ACTH upregulated to try to get cortisol going
give prednisone (adrenalcorticoid) to suppress ACTH which is driving androgen production

107
Q

T/F

prednisone and fludrocortisone for CAH with female masculinization or precocious puberty, why

A

F
prednisone only - suppress ACTH which is driving androgen production

prednisone + fludrocortisone for renal failure (AI, TB, Neisseria) with hypotension and electrolyte abnormalities, to support sugar and salt… not for precocious puberty

108
Q

TF

bilateral adrenalectomy for CAH

A

F
would force hormone dependence when can be treated by prednisone to suppress the upregulated ACTH driving androgen production

109
Q

why is ACTH elevated in CAH

A

no cortiosol negatively inhibitin

all the 17-OH-progesterone shunted into androgen production by 21-hydrozylase deficiency

110
Q

risk factors, lab abnorms, radiologic findings in dysfunctional uterine bleeding

1st line treatment
2nd line addition

A

none – no risk factors, lab abnorms, radiologic findings in dysfunctional uterine bleeding, diagnosis of exclusion

OCPs
NSAIDS - vague prostaglandin effect on uterus reduces bleeding

111
Q

TF

get coags for irregular periods that do not provoke anemia

A

F
not likely to be a bleeding/clotting disorder, those look more like menorrhagia (heavy but regular), not metorrhagia (irregular)

-give OCPs and add NSAID if necessary

112
Q

when to get coags for uterine bleeding

A

if bleeding and can’t stop it

if menorrhagia suspicious of acquired bleeding disorder

113
Q

how to NSAIDS treat uterine bleeding

A

a mysterious prostaglandin effect

114
Q

when to give leuprolide for fibroids

routine?

A

to shrink Large fibroids prior to myomectomy

not routine, not necessary if fibroids small

115
Q

how is endometriosis most commonly definitively diagnosed

A

ex-lap

typically clinically suspected but not usually evident on imaging and unconfirmed till ex-lap

116
Q

classic physical exam finding in adenomyosis

next step

A

smooth, symmetric, enlarged uterus with soft consistency on bimanual exam

rule out cancer with a biopsy, though exam reassuring

117
Q

leiomyosarcoma

common presentation and diagnosis

A

presents like fibroids and commonly diagnosed surgically while treating fibroids or if MRI distinguishes irregular invading borders on a fibroid-like mass

118
Q

painful irregular heavy periods in 14yo, otherwise healthy normal doing well, most likely cause, pathogenesis

next step
if hemodynamically stable
if anemic

ddx if persists, next steps

A

anovulaiton - just common at extremes of menarche / menopause, FSH and LH getting their levels figured out (but no need to draw levels)

reassurance with follow-up if hemodynamically stable
coags if symptomatic anemia looking for von willebrand and hemophilia

consider endometrial pathology eg fibroids or cancer if persists – imaging, endometrial biopsy

119
Q

DES exposure increases risk of

A

endometrial cancer

120
Q

chemical risk factor

2 common presentations of endometrial cancer

A

DES exposure
obese woman with heavy periods
post-menopausal bleeding

121
Q

fibroids are ___-responsive and get better with ____ ____ and ____

A

estrogen-responsive

better with OCPs, pregnancy, menopause

122
Q

how to check if advanced maternal age mom has ovarian reserve to ovulate

A

check inhibin-B level – decreases with age

123
Q

38yo w enlarged uterus that has a prominent smooth posterior mass on bimanual exam

likely dx?
next step(s)?
A

likely fibroids
(smooth… not symmetric)

pelvic ultrasound to decrease supsicion of cancer, followed by biopsy if ultrasound equivocal or if pt age ^45

124
Q

when to get endometrial biopsy for large uterus with assymetric smooth mass on bimanual exam

A

after ultrasound if ultrasound equivocal for fibroid vs cancer

or in any woman ^45yo… cancer risk high

125
Q

bimanual exam in endometriosis

A

normal typically

126
Q

TF
CT with IV contrast is good for GYN pathology

general use indications

A

F
not usually for GYN - uterus bladder ovaries etc small and tight down there in pelvis, and radiation to these organs not great for young patients

maybe used for staging cancer once found

much better for abdominal pathology

OB/GYN (5 decks)

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