Gynecology Flashcards
1
Q
1) Conception, Implantation, Placentation
- Where does fertilization occur?
- What is 16 cell stage called?
- What happens during placentation?
A
-Fallopian tube
-Morula
- Trophoblasts create placental disc and chorionic membranes
2
Q
2) Gyn evaluation
- Goal of colpopscopy?
- Pap smear?
- Why more white with acetic acid?
A
- Distinguish normal from abnormal appearing tissue
- Look for changes in the cells that show cancerous or precancerous lesions
- Higher nuclear density (biopsy)
3
Q
2) Bimanual examination:
A
- Size, nature of uterus, adnexal masses
- Mobility and tenderness
4
Q
2) Obstetric evaluation
- First visit?
- and then?
- Naegele´s rule?
A
- Bw week 6 and 8
- Until w28: every 4th
- Until w35: every 2nd
- Until birth: weekly
- To calculate due date:
First day of last mens - 3 months + 7 days (add 1 year)
5
Q
2) Obstetric evaluation
- Gravidity (G)?
- Parity?
- Low levels HCG?
- High levels HCG?
- Which 3 tests is important to perform?
A
- Total number of pregnancies
- TPAL
T: term delivered
P: premature delivered
A: abortions #
L: Living children - Ectopic pregnancy, abortion, inaccurate dates
- Multiple gestation, molar pregnancy, trisomy 21, inaccurate dates
- Urinalysis, urine culture and dental examination
6
Q
3) Endocrinology
- List hormones
A
- hCG
- Estrogen
- Progesterone
- hPL
- Prolactin
- Oxytocin
- Relaxin
- Cortisol
- Thyroid - TSH, T4
7
Q
6) Changes in pregnancy
- Which three physiological changes are seen in the circulatory system?
A
- Increased metabolic demands
- Expansion of vascular channels
- Increase in steroid hormones
8
Q
6) Changes in pregnancy
- Which three factors are involved when there are changes seen in the respiratory system?
A
- The mechanical effect of the enlarging uterus
- The increased total body O2 consumption
- The respiratory stimulant effects of progesterone
9
Q
8) HTN
- Diagnosis og HTN
- How do we classify it?
A
- 140/90 mmHg
- Preexisting or gestational
10
Q
8) HTN
- What is transient HTN?
- What is essential HTN?
A
- Transient: >140/90 occurring before 20 weeks of gestation, non-sustained with no symptoms
- Essential: >140/90 occurring before 20 weeks of gestation, and persisting 7 weeks postpartum
11
Q
8) HTN
- Essential HTN can lead to?
- Treatment of essential HTN?
A
- Gestational HTN, abruptio placenta, IUGR, intrauterine fetal demise
- alpha-methyldopa, beta-blockers or Ca-channel blockers
12
Q
8) HTN
- What is gestational HTN?
- What is preeclampsia?
A
- Gestational: >140/90 developing after 20 weeks of gestation and return to normal after 12 weeks postpartum
(tx. same as essential)
- Preeclampsia: developing after 20 weeks.
Mild: >140/90 mmHg + proteinuria (300mg/day)
Severe: >140/90 mmHg + proteinuria >5g/day
13
Q
8) HTN
What is eclampsia?
A
Unexplained general seizures in a woman with preeclampsia
14
Q
8) HTN
Risk factors for preeclampsia?
A
- Nulliparity
- Multifetal pregnancy
- Family history
- First conception with a new partner
- <18 or >35
- DM
- Obesity
15
Q
8) HTN
- Triad of preeclampsia?
- Other symptoms?
A
1) New onset HTN
2) Proteinuria
3) Edema (non-dependent)
- Headache
- Petechiae and other signs of coagulopathy
- Nausea, vomiting
Vasospasm: - Visual disturbance
- RUQ pain (due to liver)
- Oliguria w/ proteinuria
16
Q
8) HTN
- Tx other than delivery?
A
- g. age >37 weeks: Magnesium sulfate and deliver
- g. age <37 weeks: risk/benefit. If premature but can be delivered give CS, magnesium and b-blocker/ca-ch. bl.
17
Q
8) HTN
- What is HELLP syndrome?
- Stand for?
- Most common presenting sign?
A
- A variant of severe preeclampsia w/ high mortality
(HTN may be absent) - Hemolysis, elevated Liver enzymes, Low Platelets
- Epigatric/RUQ pain
18
Q
8) HTN
Symptoms of HELLP
A
- Blurry vision
- Chest pain
- Headache, fatigue
- Nausea
- Quiet weight gain and swelling
19
Q
8) HTN
What is the Mississippi classification?
A
LDH > 600 U/L +
ASAT and/or ALAT > 40 U/L +
Class I: platelets < 50.000
Class II: 50.000-100.000
Class III: 100.000-150.000
20
Q
9) Pregnancy sy
Which 3 categories do we divide into?
A
1) Presumptive
2) Probable
3) Definite
21
Q
9)
What are presumtive signs associated with primarily?
What presumptive signs do we have?
A
- Primarily those associated with skin and mucous membrane changes
- Discoloration and cyanosis of the vulva, vagina and cervix
- Pigmentation of the skin and abodmen
- Nausea, vomiting
22
Q
What is chadwick´s sign?
A
Bluish discoloration of the cervix and the vagina due to pelvic engorgement (6th week)
23
Q
What are probable signs of pregnancy?
A
- Uterine enlargement
- Breast engorgement
- Piscacek sign
- Goodell´s sign
- Hegar´s sign
- Positive home urine pregnancy test
24
Q
What is Piscacek sign?
A
Soft prominence over the site of implantation
25
What is Goodell´s sign?
Softening of the cervix (4-6 weeks)
26
What is Hegar´s sign?
Softening of the cervical isthmus (6-8 weeks)
27
What are definite signs of pregnancy?
Detection of fetal heart beat
Detection of movement
28
Late signs and symptoms in pregnancy?
Difficulty sleeping
IVC sy.
Galactorrhea
Edema
Fetal movement
Constipation
Weight gain
Tachypnea
29
When can you usually feel fetal movement?
After 18-20 weeks
30
What is normal weight gain?
9-14 kg
31
How do you determine gestational age with US?
Measure crown-rump length between 6-11th week
32
Triple marker screen test:
Down syndrome
afp: low
Estriol: low
hCG: high
33
Triple marker screen test:
Edwards sy.
afp: low
Estriol: low
hCG: low
34
Triple marker screen test:
NT defect
afp: high
Estriol: N/A
hCG: N/A
35
What does Nuchal tranlucency test measure?
Thickness of nuchal fold
36
Gestational diabetes screening?
GBS screening?
24-28 weeks
35-37 weeks
37
Which classification is used for GDM?
White classification
38
When is the GDM screening?
24-28 weeks
39
What is step 1 in GDM testing?
What is abnormal?
- 50 g, 1hr oral glucose challenge test OGCT
- > 7.2-7.8 mmol/L
if higher than 11.1 mmol/L, OGTT not necessary
40
What is step 2 in GDM testing?
Measure fasting first, then:
3h, 100g oral glucose tolerance test (OGTT)
41
When is the patient diagnosed w GDM?
>= 2 abnormal values:
Fasting >= 5.3 mmol/L
1h >= 10 mmol/L
2h >= 8.6 mmol/L
3h >= 7.8 mmol/L
42
Poorly controlled preexisting diabetes during organogenesis may lead to?
Poorly controlled diabetes later in pregnancy may lead to?
- congenital malformations, spontaneous abortion
- fetal macrosomia, preeclampsia, spontaneous abortion, shoulder dystocia, arrested labor
43
After kidney transplant which condittions must be present?
1) Kidney has been in place for two years
2) Normal renal function
3) No episodes of rejection
4) Normal BP
44
What risks are related to UTI or asymptomatic bacteriuria?
Increases risk of preterm labor
Premature rupture of membranes
45
Tx for asymptomatic baceriuria?
Oral nitrofurantoin
46
Tx UTI pregnancy?
Cephalexin
Nitrofurantoin
TMP/SMX (avoid: 1st trim/3rd trim)
47
What is hyperemesis gravidarum?
persisten nausea and vomiting in pregnancy associated w/ ketosis and loss of >5% pre-pregnancy body weight
48
Gastrointestinal disorders in pregnancy?
- Hyperemesis gravidarum
- GERD
- Mendelson syndrome
- IBD
- Acute fatty liver of pregnancy
49
Definition of anemia in pregnancy
Hb <10 g/dl and Hct <30%
50
What does folate deficiency lead to?
NT defect
51
What is Virchows triad?
Stasis
Endothelial injury
Hypercoagulability
52
Etiologies of spontaneous abortion
Chromosomal abnormalities
Immunological rejection
Infections - TORCH
DM, HT, Renal, hypothyr., SLE
Lifestyle
Uterine abnormalities e.g adhesions, fibroids
...
53
Definitions:
Abortion
Fetal demise
Preterm delivery
- death of fetus before week 24
- death of fetus after week 24
- passage of live fetus bw 24-37 weeks
54
Types of abortion
Threatened
Inevitable
Complete
Incomplete
Missed
55
Fetal complications from preterm birth?
Low birth weight
IRDS
Necrotizing enterocolitis
intraventricular hemorrhage
sepsis
56
Definition of IUGR?
When the birth weight of a newborn is <10th percentile for a given gestational age, due to a pathological process
57
What types of IUGR?
Symmetrical and asymmetrical
58
Typical appearance in IUGR?
-Big head, long nails, scaphoid abdomen
- Thin thighs, decreased fold thickness
- Wide skull sutures, big fontanelles, shortened crown-heel lenght
- Brain and heart large in proprtion to weight
59
Which parameter is especially important in IUGR?
Abdominal circumference
60
What is 1st stage of labor?
From onset of delivery to full dilation of cervix (10 cm)
contractions get progressively more intense and closer together
Latent phase: irregular. Every 5-30´, 60-90 sec, cervix becomes 4 cm
Active phase: Regular. Every 2-3´, 45 sec
50 mmHg
61
What is 2nd stage of labor?
Three P´s?
"pushing stage"
Every 3´, 45 sec, 75 mmHg
Influencing factors:
Power
Passenger
Passage
62
Cardinal movements of labor?
Descent
Engagement
Flexion
Internal rotation
Extension
Restitution
Expulsion
63
What is stage 3 of labor? Duration?
Stage 4?
Delivery of placenta, 5-30´
Adaption to blood loss
Start of uterine involution
64
What are active phase disorders?
1) Protraction disorders
2) Arrest disorders
65
What is active phase arrest? And why?
No dilation for 2hrs
Due to inadequate uterine contractions
66
What are second stage disorders?
Disproportion fetus-pelvis
Reduced pushing efforts
67
Causes of uterine dysfunction?
Epidural
Chorioamnionitis
Primigravida
Myomas
Nervousness
68
What is hypotonic uterine dysfunction?
Tx?
Contraction pressure is insufficient
Amniotomy
Oxytocin
Assisted vaginal delivery
C-section
69
Hypertonic contractions types?
Treatment?
1) colicky uterus w/ uncoordinated contractions
2) Hyperactive lower segment
Analgesics
Nifedipine (tocolytic)
Mobilize patient
70
What is normal fetal position?
longitudinal cephalic, vertex, occipitoanterior
71
Shoulder dystocia maneuvers?
McRoberts
Rubin
Wood screw
Gunn-Zavanellie
72
Definition of labor
Progressive cervical effacement and dilation, resulting from regular uterine contractions that occur at least every 3 minutes and last 30-60 second
73
When is the highest chance for thromboembolism?
After 6 weeks
74
Regional anesthesia?
Lumbar epidural
Spinal injection
75
Local anesthesia?
Pudendal block
Paracervical block
76
3 types of breech?
Frank breech
Incomplete breech/footling
Complete breech
77
What is malpresentation of the fetus?
Breech, face, and brow presentation
78
Diagnostic tests for PROM?
Nitrazine paper test
Fern test
AmniSure test
79
What is placenta accreta/ increta, and percreta?
Abnormal attachement of the placenta through the uterine myometrium
accreta - superficial
increta - extend into myometrium
percreta - extend through uterine serosa
80
Abnormalities of twinning process
- Interplacental vascular anastomosis
- Twin-twin transfusion syndrome
- Fetal malformations
- Umbilical cord abnormalities
- Retained dead fetus syndrome
81
Most common risk for placental abruption?
Maternal HTN
82
Most common cause of DIC in pregnancy?
Placental abruption
83
Functions of amniotic fluid:
1) space for movement
2) permits fetal swallowing
3) Guards against cord compression
4) Trauma protection
84
Polyhydramnios etiologies
Fetal malformation (especially those w swallow dysfunction)
Maternal DM
Multiple gestation
Fetal disorders
Idiopathic
85
Oligohydramnios etiologies
Uteroplacental deficiency
Drugs
Post-term preg
PROM
Fetal malformations (especially those w decreased urine output)
Fetal groth restriction
Idiopathic
86
Causes of PPH
Uterine atony
Laceration
Retained placenta
DIC
(4T´s: tone, trauma, tissue, thrombin)
87
TORCHeS?
Toxoplasmosis
Others (Listeria, HBV, Coxackie, VZV, HIV, Parvo)
Rubella
CMV
HSV
Syphilis
88
Congenital rubella syndrome
IUGR
Microcephaly
Meningoencephalitis
Cataracts
Cardiac defects
Hearing loss
Retinopathy
Bone radiolucency
89
CMV symptoms neonate
IUGR
Petechial rash
Periventricular calcification
Sensorineural hearing loss
...
90
Viral infections
Rubella
CMV
VZV
HSV
HBV
HIV
Zika
91
What does cardiotocography do?
Monitor fetal wellbeing and allow early detection of fetal distress
92
Non invasive testing in prenatal genetic counsling
US
MRI
Non-invasive prenatal testing (NIPT)
Triple/quad biochemical screening
93
Invasive testing in prenatal genetic counsling
Amniocentesis
Chorionic villous sampling
Percutaneous umbilical blood sampling
Fetal tissue sampling
94
4 questions in genetic counsling?
What is the disease in question?
How severe is it?
How is it inherited?
How can it be prevented?
95
How to confirm an intrauterine pregnancy?
Presence of a yolk sac
96
Pathological puerperium
-> psychological
Postpartum blues
Postpartum depression
Postpartum psychosis
97
Pathological puerperium
-> GI/urinary
Diastasis recti
Pelvic atrophy
Hemorrhoids
Urinary retention
98
What is the most common puerperal infection and what are the pathogens?
Endometritis
E. Coli, Proteus, Klebsiella
99
Puerpural sepsis tx.?
Clindamycin and piperacillin i.v
100
Baby at birth:
Weight
Length
HC
AC
2500-4290 g
44-54 cm
32-38 cm
17-24 cm
101
APGAR score + what gives top score?
Appearance - Pink
Pulse >100 bpm
Grimace - Cries and pulls away
Activity - Active movement
Respiration - Strong cry
102
Reasons for 2ndary amenorrhea?
Pregnancy
Hypothyrodism
Antidopamine meds
Prolactinoma
...
Hypothalamus: anorexia, stress, severe chronic disease...
103
PCOS
mild obesity
chronic anovulation
signs of androgen excess
104
Barrier and chemical contraceptives
Spermacides
Condoms
Diaphragm
Vasectomy
Tubal ligation
105
Inflammatory disorders of vulva and vagina
Bacterial vaginosis
Trichomoniasis
Vulvovaginal candidiasis
106
syphilis stage 2
Maculopapular rash
Condyloma lata
107
Lichen planus P´s
Pruritic
Purple
Polygonal planar papules and plaques
+ Wickham striae
108
Benign lesions of vulva
Vitiligo
Lichen planus
Lichen simplex
Vuvlovaginal atrophy
Seborrheic dermatitis
Psoriasis
Pigmented lesions - dd melanoma
Acanthosis nigricans
Ulcerations and fissures
Epidermal cyst
Vulvar vestibular papillomatosis
Fordyce spots
Fox-fordyce disease
109
Benign lesions of the vagina
Epithelial changes
ulcerations and fistulas
Cystic masses
- Gartner duct cysts
- Bartholin cyst
110
Vulvar precanc. conditions
Vulvar intraepithelial neoplasia
Pagets disease
111
Vulvar cancer staging
FIGO
0: in situ
Ia: <2cm
Ib: >2cm
II: Extend to adjacent perineum i.e urethra, vagina, anus
III: LN involvement inguinal + femoral
IVa: Rectum/bladder
IVb: Distant mets incl. Pelvic LN
112
Malignant transformation of vagina
Vaginal intraepithelial neoplasia
Vaginal cancer
113
Benign disease of the uterus
Uterine fibroids - leiomyomas
Endometrial polyps
Cervical polyps
Nabothian cysts
114
Ovarian tumors of epithelial origin
Serous
Mucinous
Endometroid
Clear cell
115
Ovarian tumors of germ cell origin
Dysgerminomas
Immature teratomas
116
Ovarian tumors of gonadostromal origin
Granulosa cell tumors
Thecomas
Sertoli-Leydig cell tumors
117
Common sites for endometriotic implants?
Ovaries (most common)
Douglas pouch
Fallopian tube
Bladder
Cervix
Peritoneum
Extrapelvic organs
118
