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OB/GYN Flashcards

1
Q

3 indications for getting a QUANTitative BhCG

A

dx and follow ectopic pregnancy
monitor trophoblastic disease
screen for fetal aneuploidy

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2
Q

Avg age of thelarche, adrenarche/pubarche and menarche

A 
thelarche = 8-9
adrenarche/pubarche = 9-10
menarche = 12-13
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3
Q

Ages for primary amenorrhea

A

14 w/o secondary sex characteristics

16 if secondary sex characteristics

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4
Q

2 Cell hypothesis

A

LH -> Thecal cells -> androgen precursors

FSH -> Granulosa cells -> convert androgens into estradiol (therefore requires BOTH fxnal cells)

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5
Q

Trigger for ovulation

A

E2 rises –> LH surge mid-cycle –> ovulation

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6
Q

Corpus luteum prodoces…

A

progesterone

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7
Q

role of progesterone

A

endometrial proliferation

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8
Q

3 clinical signs of heavy periods

A

changes tampon q1hr, mutliple nighttime changes, anemia

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9
Q

6 predisposing factors for vaginal candidiasis

A

Abx, steroids, immunodef, DM, OCPs, pregnancy

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10
Q

vaginal pH in candidiasis

A

normal (3.8-4.2)

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11
Q

Tx vaginal candidiasis? Recurrent?

A

Tx = topical antifungals (monistat) or oral (fluconazole)

recurrent Tx = antifungal monthly after menses OR oral med daily/weekly

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12
Q

highly infectious vaginal infxn

A

trichomoniasis

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13
Q

the pt c/o genial pruritus, frequency, dysuria, and dyspareunia. On PE you note erythema, yellow-green frothy discharge, and punctate cervical hemorrhages (“strawberry cervix”). What is the dx?

A

trichomoniasis

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14
Q

4 Dx test trichomonas

A

vaginal pH >4.5, pap, saline prep (motile flagellated organisms), cx

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15
Q

Tx trichomonas

A

DOC = metronidazole, 1x 2g dose, also tx partner

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16
Q

Positive amine test

A

bacterial vaginosis

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17
Q

Clue cells

A

bacterial vaginosis

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18
Q

6 complications of bacterial vaginosis

A

PID, endometritis, post-op infxn, PPROM, chorioamnionitis, preterm delivery

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19
Q

Tx bacterial vaginosis

A

oral metronidazole

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20
Q

palpable mass on labia majora, painful and swollen but not fever, no drainage. Dx? Tx?

A

bartholin’s gland cyst

Tx = drain and catheter, sitz bath and marsupialization (definitive)

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21
Q

palpable, fluctuant mass on labia majora. painful, swollen, erythematous with drainage. Dx, Tx?

A

bartholin’s gland abscess

Tx drainage, abx, catheter, sitz bath and marsupialization (definitive)

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22
Q

4 causes of bartholin’s gland abscess

A

gonorrhea, chlamydia&raquo_space;coliforms, anaerobes

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23
Q

palpable, firm, indurated mass on labia majora. No pain but is swollen. Dx, Tx?

A

bartholin’s gland tumor, dx = bx

Tx = excision

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24
Q

Abx for bartholin’s gland abscess (4)

A

doxy + metro
augmentin
azithromycin (chlamydia)
ceftriaxone (gonorrhea)

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25
Q

MC type of cervical cancer

A

SCCA

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26
Q

5 RF for cervical cancer

A

early 1st intercourse, multiple partners, High-risk HPV infxn, recurrent STDs, smoking

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27
Q

when can you switch from q2yr to q3yr pap smears?

A

30yo+ and 3 consecutive negative paps

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28
Q

2 indications for d/c pap smears

A

hysterectomy for a benign condition and no h/o high-grade cytologic abnormalities
OR
>65yo + 3 consec. neg. paps and normal for the past 10 yrs

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29
Q

management of ASC-US: low risk HPV

A

rescreen at 1yr

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30
Q

management of ASC-US: high risk HPV

A

colposcopy + bx

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31
Q

management of LSIL or HSIL

A

colposcopy and bx

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32
Q

Tx CIN I

A

close observation and repeat pap at 6 and 12mo AND/OR HPV DNA testing at 12mo. if negative, return to normal screening. Only applies if >21yo

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33
Q

Tx CIN II

A

ablation or ecision

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34
Q

f/u CIN 1-3 if negative margins

A

pap and/or HPV dna testing at 12mo

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35
Q

f/u if CIN 2-3 with positive margins

A

pap at 6mo +/- repeat endocervical curettage

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36
Q

what 4 strains of HPV does the quadrivalent vaccine (Gardasil) protect from?
is it effective?
what is the sequence of vaccination?
how long has it proven to last?

A

16,18 (cervical cancer)
6,11 (genital warts)

YES! > 90% efficacy
0 mos, 2 mos, 6 mos
2.5-3.5 years

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37
Q

Screening rec for any woman with prior tx for LSIL, HSIL or invasive cervical cancer? how long is she at risk for persistent/recurrent disease?

A

screen ANNUALLY, at increased risk for 20yrs

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38
Q

the pt presents with sudden onset of severe pain localized to one lower quadrant and is associated with nausea, vomiting, tachycardia, and sometimes fever. On PE the pt has direct tenderness in the lower quadrant, rebound tenderness (+psoas sign, +heel percussion sign) and an adnexal mass. 6 diff dx

A 
adnexal torsion
ectopic pregnancy
appendicitis
ruptured ovarian cyst
tubo-ovarian absess (assoc with PID)
rapidly growing neoplasm
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39
Q

what 5 tests would you want to do to evaluate for adnexal torsion and why?

A

HCG- to r/o ectopic pregnancy
pelvic ultrasound: assess ectopic pregnancy and adnexal mass
CBC: Hct (bleeding) and WBC (infxn)
CT scan: r/o appendicitis and adnexal mass
PCR: screen for G and C (TOA)

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40
Q

3 (proposed) etiologies of endometriosis

A

tubal regurgitation
metaplasia of mesothelium
hematogenous dissemination

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41
Q

dysmenorrhea + dyspareunia + chronic pelvic pain + infertility

A

classic tetrad for endometriosis

42
Q

3 dx tests for endometriosis

A

bx (laparotomy) > laparoscopic visualization > US

43
Q

laparascopic feature suggesting endometriosis

A

“powder burns”

44
Q

5 tx for endometriosis

A

OCP, depo-provera, GnRH agonist, laparascopic sgy, laparotomy

45
Q

MC gyn cancer

A

endometrial CA

46
Q

MC type endometrial CA

A

adenocarcinoma

47
Q

9 RF for endometrial CA

A

age, FHx, early menarche/late menopause, low parity, PCOS / unopposed E2, HRT, HTN, DM, obesity

48
Q

The pt c/o abnormal uterine bleeding (menorrhagia, menometrorragia and increasing abdominal girth. on exam you find ascites, hepatomegaly, pulmonary changes, and an enlarged uterus. what is your diagnosis?

A

Endometrial CA UPO

49
Q

Tx Endometrial CA

A

child-bearing age = high-dose progrestin??
post-menopausal = TAH/BSO +/- radiation
advanced d/s = TAH/BSO +/- adjuvant chemo

50
Q

MCC PID

A

Chlamydia, gonorrhea, mixed flora

51
Q

outpatient tx for PID

A

ofloxacin/levofloxacin + metronidazole 14D
OR
ceftriaxone + probenecid + doxy +/- metro 14d

52
Q

2 inpatient tx for PID

A

cefotetan + doxy
OR
clinda + gent

53
Q

3 major sequelae of PID

A

chronic pelvic pain, infertility, ectopic pregnancy

54
Q

MCC infertility in women

A

irregular ovulation

55
Q

7 tests to w/u PCOS and why

A

LH; elevated
testosterone: ovary overproduction = PCOS
I:G ratio: hyperinsulinemia

FSH: r/o premature menopause
DHEA-sulfate: adrenal overprodction of androgen
prolactin: causes amenorrhea
TSH: hypothyroidism causes amenorrhea

56
Q

3 possible sequelae of PCOS

A

infertility, endometrial hyperplasia, endometrial CA

57
Q

Tx PCOS (desire pregnancy or not)

A

desire pregnancy = clomiphene citrate +/- metformin

no desire = OCP, progestin, metformin

58
Q

MC ovarian neoplasm in older women

A

serous (epithelial tumor)

59
Q

MC ovarian neoplasm in teen/young adult

A

germ cell tumor

60
Q

hormonally active ovarian mass

A

stromal cell tumors

61
Q

MC ovarian mass in women of reproductive age

A

functional cyst

62
Q

MC type of ovarian CA overall

A

epithelial tumors

63
Q

5 tests for w/u of ovarian neoplasm

A

US, CA-125 level, exlap for bx

mammogram +/- colonoscopy for mets

64
Q

MC ovarian neoplasm in women of reproductive age

A

cystic teratoma?

65
Q

5 major causes of non-anatomical secondary amenorrhea

A

pregnancy, hypothyroidism, PCOS, hyperprolactinemia (prolactinoma), premature ovarian failure

66
Q

Dx premature ovarian failure

A

sx + elevated FSH

67
Q

Progesterone withdrawal test, hows it work?

A

progesterone+medroxyprogesterone x 5d, should withdrawal within 7-14d

68
Q

withdrawal bleeding after progesterone withdrawal test, dx? Tx?

A

PCOS

Tx OCP+progestin+metformin vs. clomiphene + metformin

69
Q

Negative progesterone withdrawal test and LOW FSH, dx tx?

A

hypothalamic-pituitary FAILURE –> HRT or gonadotropins

70
Q

Negative progesterone withdrawal test and HIGH FSH, dx tx?

A

Primary ovarian failure

Tx = HRT, donor eggs

71
Q

5 major causes of anatomic-related secondary amenorrhea

A

uterine leiomyoma, uterine malformation, endometrial polyp, endometriosis, IUD

72
Q

menorrhagia vs. menometrorrhagia

A

excessive menstrual bleeding vs. excessive inter and itnra-menstrual bleeding

73
Q

Tx anovulatory bleeding

A

progestin, OCPs

74
Q

3 phases of menstrual cycle and timing

A
  1. follicular phase: first day of menses to the day of LH surge (14 days)
  2. Ovulation: occurs within 30-36 hrs of the LH surge
    3: luteal phase: day of LH surge to the onset of menses (14 days)
75
Q

principal hormone secreted/elevated in E2 deficient state

A

FSH b/c stimulates granulosa cells to convert androgens into estrodiol

76
Q

Eggs are arrested in what cell cycle phase?

A

prophase of meiosis I

77
Q

when are E2, progesterone and LH the lowest?

A

end of luteal phase (FSH already begins rising again during luteal phase to recruit new cohort of follicles!)

78
Q

E2 vs. progesterone relationship to FSH and LH

A

E2 =negative feedback on FSH, positive feedback on LH

Progesterone = decreases BOTH

79
Q

what induces endoervical secretion of watery mucus during follicular phase?

80
Q

What induces breast / temp changes during pregnancy

A

progesterone

81
Q

What US abnormality are you looking for in postmenopausal woman NOT on HRT? next step?

A

endometrial stripe thickness, if 5mm+ then get bx

82
Q

US technique used to look for polyps AND submucosal leiomyomas

A

sonohysterography saline infusion

83
Q

utility of cervical conization

A

definitive dx of abnormal pap smear if colposcopy is inadequate/equivocal. Also possible tx for CIN

84
Q

Tx Chlamydia

A

DOC = azithromycin 1x PO dose
OR
erythromycin, doxycycline

85
Q

obilgate intracellular parasite that can only be grown in tissue culture

A

chlamydia trachomatis

86
Q

STD symptoms plus pharyngitis, chlamydia or gonorrhea?

87
Q

Tx gonorrhea

A

DOC ceftriaxone IM x1

88
Q

Tx syphilis in pregnant woman

A

ONLY penicillin (even if have to desensitize) bc only drug effective in preventing fetal infection too

89
Q

MoA OCPs

A

inhibit ovulation, alter cervical mucus, alter endometrium

90
Q

what are 8 absolute contraindications for combination oral contraceptives?

A 
Smoking and age >35
Hyperlipidemia (congenital)
Ischemic heart disease
Pregnancy
Bleeding from genitl tract (undiagnosed)
Liver disease
Estrogen-dependent tumor (breast ca)
DVT/PE in history
91
Q

what is the ingredient in Plan B?
when should it be taken?
what is an alternative to it?

A

levonorgestrel (progestin only)
within 72 hrs of unprotected intercourse
copper IUD within 5 days

92
Q

SEs of depo-provera

A

breakthrough bleeding, wt gain, depression, bone loss

93
Q

w/u of suspected menopause

A

pregnancy test, FSH!, TSH, bone mineral density

94
Q

Menopause, increased LH or FSH?

95
Q

what is the difference btw T score and Z score in BMD tests?

A

T score compares BMD to young population-important value when determining risk for vertebral or hip fx in postmenopausal women
Z score compared BMD to age matched population- important to use in young athletic women (ballerinas, gymnasts, marathon runners)

96
Q

what is the T score for osteopenia? osteoporosis? normal?

A

normal: at or above -1 SD
osteopenia: -1 to -2.5 SD
osteoporosis: below -2.5 SD

97
Q

3 antidepressants for post-menopausal women

A

SSRIs, venlafaxine, buproprion

98
Q

5 PROVEN benefits of HRT

A

decrease: hot flashes, vaginal dryness, risk of fractures, colorectal cancer
improve sleep

99
Q

4 adverse effects of HRT

A

increased risk of CAD, CVA, DVT/PE, Breast CA

100
Q

Naegel’s rule

A

LMP -3mo + 7d

101
Q

11 teratogens and assoc. problems

A

ACE inbit- renal injury
ARBs- renal injury
antineoplastic agents: varied defects
anticoagulant (oral): facial deformity, intracerebral bleeding
Beta blockers: growth restriction
Carbamazepine: spina bifida, facial abnormalities
valproic acid: spinda bifida
lithium: cardiac malformations
tetracycline; stains teeth
quinolones: cartilage injury
isotretinoin: brain, face, thymus, heart defects

102
Q

tests during FIRST prenatal visit

A

CBC, blood type, rubella, VDRL, STD screen?? recheck

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