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OB Gyn Shelf > OB Gyn > Flashcards

OB Gyn Flashcards

1
Q
A

small bowel obstruction

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2
Q

adjustment disorder is diagnosed when

A

symptoms occur within 3 months of stressor

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3
Q

Asherman syndrome

A

intrauterine adhesions
symtoms: amenorrhea, infertility
light period due to decreased amount of functioning endometrium

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4
Q

azoospermia

A

no sperm in ejaculate

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5
Q

Baby who has Horner’s Syndrome and klumpke palsy most likely has injury to ?

A

C8 and T1 nerves

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6
Q

Bactrim use in pregnancy

A

avoided in 3rd trimester cus of risk of kernicterus

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7
Q

Beneficence vs nonmaleficence

A

beneficence: addition of benefits
nonmaleficience: avoidance of a harm

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8
Q

causes of second stage arrest of labor?
Definition of arrest of labor?

A
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9
Q

complete procidentia

A

severe form of pelvic organ prolapse

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10
Q

contraindications to exercise for pregnant women

A
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11
Q

critical valueof of anti-D immuneglobulin titer

A

1:32

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12
Q

cystic fibrosis gene

A

delta f508 mutation

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13
Q

Delivery method recommendation for pregnant patient who has received a classical c-section

A

c-section at 37 weeks

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14
Q

dichorionic diamniotic pregnancy has ___ placentas

whereas a monochorionic diamniotic has ____

A

Dichorionic - 2 placentas
monochorionic- 1 placenta

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15
Q

during labor, a protruding vaginal mass, min signs of vaginal bleeding, but with hypovolemic shock is probably

A

vaginal hematoma

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16
Q

ectopic pregnancy: when to treat with MTX and when not ?

A

Hemodynamically stable, pt reliable for followup
IUP ruled out
size <3.5 cm
no fetal cardiac activity
BHcg less than or equal to 5000

When not to use:
BHCG greater than or equal to 15000
size >3.5cm or ruptured
Thrombocytopenia: PLT < 100,000
Renal or Hepatic Disease
active peptic ulcer disease
IUP, breastfeedimg

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17
Q

Female Puberty Stages

A

Thalarche ( Breast Development) 9.5 yrs
Adrenarche
Growth Spurt
Menustration

TAG M

Menstruation within 1-2 yrs after thelarche

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18
Q

gestational trophoblastic disease

A

haas chorionic villi and bHCG> 500k

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19
Q

hormone produced during menustratio, that causes increase in body temperature

A

progesterone

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20
Q

how long is the corpus luteum the primary source of progesterone for pregnancy?

A

8-10 weeks getation

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21
Q

how would hyperemesis gravidarum affect the developing fetus?

A
  • no impact if treated
  • if it isn’t treated appropriately then premature birth
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22
Q

Hydrosalpinx

A

accumulation of fluid of in Fallopian tube due to chronic inflammation

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23
Q

Hysterosalpingogram (HSG) is? useful for?

A
  • contrast is injected through the cervix to outline the uterine cavity and Fallopian tubes
  • detecting abnormalities in those areas— ie bicornate uterus, hydrosalpinx, salpingitis isthmica nodosum
  • doesn’t detect things outside ie endometriosis, ovarian tumor
  • fallopian tube patrency and uterine lining
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24
Q

immune thrombocytopenia purpura

A

autoantibodies aginst platelet surface antigens, causing thrombocytopenia and increaed bleeding

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25
Q

In a pregnant patient with HIV when do you start antivirals?

A

combinations antiretroviral as soon as possible

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26
Q

inadequate contractions

A

< 200 Montevideo units over 10. minutes

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27
Q

Inevitable abortion

A

< 20 weeks, vaginal bleeding, pelvic pain, dilated cervix

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28
Q

Infertility diagosis

A

<35yo - no concepiton after 12 months of trying’ >35 yo 6 months of trying

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29
Q

intra-amniotic infection/ chorioamnioitis signs:
* common with

A

signs: N&V, uterine fundal tenderness, abnormal uterine muscle contractility

diagnosis: maternal fever + 1 of following
- fetal tachycardia (>160) for at least 10 min, maternal leukocytosis, maternal tachycardia, purulent amniotic fluid

  • premature rupture of membranes
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30
Q

intrammniotic fluid infection (IAI) treatment

A
  • broad spectrum antibiotics
  • immediate delivery with augmentation
  • pt with PPROM + IAI –> always deliver not expectant management
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31
Q

vulvar lichen planus

A

2 types
1) Erosive variant
associated with oral ulcers, erosive glazed lesions with white border

2) papulosquamous variant
small pruritic papules with purple hue

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32
Q

McCune Allbirght Syndrome 3 P’s

A
  1. precocious puberty
  2. polyostotic fibrous dysplasia (normal tissue is replaced. by fibrous tissue causing x-ray changes)
  3. pigmentation Café-au-lait spots
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33
Q

Mittelschmerz

A
  • Enlargement and rupture of the follicular cyst and contraction of Fallopian tubes during midcycle ovulation lead to transient peritoneal irritation from follicular fluid.
  • Physical examination: lower abdominal pain on palpation, enlarged adnexa
  • Diagnostics: Pelvic ultrasound shows simple follicular cyst and small amount of intraperitoneal fluid
  • Management: reassurance and symptomatic treatment with NSAIDs prn
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34
Q

MSAFP is low for

A

aneuploidies, trisomy

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35
Q

myelomeningocele

A

neural crest arch fails to fully form posteriorly - dura and spinal cord protrude posteriorly out of the spinal cord

  • can be due to folate metabolism abnormality or lack of adequate folic acid concentrations
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36
Q

neuraxial anesthesia lengthens which stage of labor?

A

the second stage

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37
Q

normal post partum bleeding. lochia lasts

A

6-8 weeks

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38
Q

normal semen analysis: sperm count, motility, morphology, volume

A

sperm count >15 million/mL; motility (>40%); morphology >4%; >1.5mL

39
Q

Ovarian torsion vs appendicitis

A

Ovarian torsion, sudden onset; appendicitis occurs over days with leukocytosis and fever

40
Q

Intrauterine Fetal Demise Causes

A

death after 20 weeks gestation, while still in utero

41
Q

persistent mullerian duct syndrome
karyotype and sx?

A

46, xy
mullerian structures include uterus, Fallopian tube, cervix, part of vagina

deficiency of mullerian inhibiting
factor in males causes persistence of these structures

-will see normal male genitalia with female structures internally
- infertile

42
Q

Placental abruption can cause, risk factors?

A
43
Q

postpartum fever

A

Temp > 38 degree or 100.4 F

44
Q

precocious puberty age and treatment

A

girls <8yo
boys <9 yo

Treatment
GnRh agonist (leuprolide),
will initially see increased GnRh and in sex steroids week 1-2 of treatment, d/c at age of puberty

45
Q

Preeclampsia with severe features

When do you deliver?

A

Deliver if > 34 weeks
LirN, PT
Liver abnormality ( RUQ pain, AST/ALT > 2ULN)
Renal abnormality Scr >1.1, 2x increase
Neural defects ( Scotomata AMAS)

Pulmonary edema
Thrombocytopenia < 100K

46
Q

primary amenorrhea diagnosis and evaluation

A

13yo or older : no menses or sex characteristics
15yo or older: no menses with sex characteristics

Evaluation TSH and pelvic ultrasound

47
Q

Primary amenorrhea, breast present, but uterus absent

A
  1. mullerian agenesis ( 46,xx) mullerian structures just don’t form, normal testosterone 2. Androgen insensitivity syndrome (46, xy) male but no androgen receptor so will see no pubic hair
48
Q

primary amenorrhea: no breasts, no uterus

A

17 alpha hydroxylase deficiency

46,XY female external genitalia but internal male genitalia, infertile

49
Q

primary amenorrhea: no breasts, uterus present

A
  1. no ovarian follicle top produce sex steroid, estrogen ( FSH high) GT17 Gonadal Dysgenesis, Turner Syndrome 17alpha-Hydroxylase deficiency 46(,XX) 2. HPA Axis disorder, low (FSH from lack of GnRh secretion) Kallman Syndrome, lesion in brain
50
Q

Primary dysmmenorrhea signs and ysmtoms

A

sx: pains 2-3 days of menses, n&V, diarrhea, normal pelvic exam

51
Q

in pregnancy, progesterone therapy is indicated for

A

patients with a prior spontaneous preterm delivery

52
Q

Pt with recent surgery, no flatus, bowel moment, mildly distended abdomen/ decreased bowel sounds. How should they be ,=managed?

A

post op ileus self resolves
- antiemetics, bowel rest, and serial examinations
- avoid opioids and rectal enema will worsen issue

53
Q

risk factors for intrauterine adhesions includes

A

infection, intrauterine surgery (d&C)

54
Q

routine pregnancy test for first visit

A
55
Q

sarcoma botyroides

A

rhabdosarcoma of the vagina
- soft nodules at the vaginal entrance that has the appearance of a cluster of grapes ( no bleeding or discomfort)

56
Q

should a woman with blood type O who gives birth to an infant with blood type a or b be concerned? why or why not?

A

No because, A and B antigens will be present on fetal tissue ( in addition to RBC) neutralizing the hemolytic antibody response

  • newborns will only have milder form of disease that can be managed with phototherapy, oral rehydration, exchange transfusion for severe cases
57
Q

Shoulder dystocia Management

A

BE CALM
- Breath
- Elevate hip, flex hips, thighs against abdomen and apply pressure to surpapubic area (mc roberts)
-Call for Help
- enLarge vaginal opening with episiotomy ( laceration to vagina)
-Maneuvers
- deliver posterior arm
-Woods ScrewL rotate posterior shoulder
-Rubin: Adduct posterior shoulder
-Gaskin: mother on all fours
- Zavanelli: replace fetal head into pelvis for c-section

58
Q

Signs of cephalopelvic disproportion and caused by?

A

molding and caput, can be caused by malposition of fetus

Caput: swelling on baby scalp due to pressure from squeezing through pelvis in difficult delivery

Molding: changing of shape of head from squeezing through a small birth canal

59
Q

signs of DIC, associated labs

A
  • increased fibrinolysis causes:

—-lower fibrinogen (protein that helps form clots, low means you can’t form clots) and increased d-dimer

  • low platelets
  • prolonged bleeding time
  • bleeding from all sites
60
Q

signs of infected perineal laceration and treatment

A

fever, wound breakdown, purulent drainage

tx: suture removal, antibiotic, surgical debridement

61
Q

signs of liver failure

A

hypoglycemia, thrombocytopenia, not seen with cholecystitis

62
Q

single lab to assess ovarian reserve

A

anti-mullerian hormone

63
Q

sinusoidal fetal heart tracing is a sign of

A

fetal anemia

64
Q

Surgical management of ectopic pregnancy

A

laparoscopy unless patient is hemodynamically unstable or large intraperitoneal bleed (laparotomy preferred for more emergent cases)

salpingectomy: removes fallopian tube, good if pregnancy is ruptured or tube is severely damaged

salpingostomy: unruptured distal tubal ectopic pregnancy, spares the tubes

65
Q

Symmetric fetal growth restriction(FGR) that occures during the first trimester is likely due to “________ “vs asymmetric FGR where is head is larger, 2nd 3rd trimester onset , due to “________”

A

chromosomal abnormality, congenitial infection
uteroplacental insufficiency / maternal malnutrition

66
Q

Symptoms of Sheehan syndrome

A
67
Q

Tanner Stage 2

A
68
Q

Tanner Stage 4

A
69
Q

Tanner Stage 3

A
70
Q

Tanner Stage 5

A
71
Q

Tanner Stage 4

A
72
Q

these birth defects are a result of

A

alcohol use

73
Q

these birth defects are a result of

A

hydantoin or phenytoin use

74
Q

To assess ovulation, what hormone level, when, cutoff?

A

day 21 (mid luteal phase) progesterone >3ng/mL means pt is ovulatory

75
Q

transfuse RBC when

A

Hct<21 of Hg < 7

76
Q

treatment of retroperitoneal hematoma

A

surgical intervention

77
Q

treatment of vulvar and vaginal hematoma

A

ice pack, potentially incision and drainage

78
Q

fever, diffuse lower abdominal pain

US: multicystic adnexal mass with thickened walls

A

tubovarianabscess symptoms

79
Q

urethritis is and is caused by?

A

urinary urgency, frequency, and dysuria

cause: chlamydia, gonnorrhea

80
Q

uterine leiomyoma vs endometrial polyp vs adenomyosis

A

endometrial polyp: light menstrual bleeding, lesions are inside uterus so uterus is small

uterine leiomyoma: fibroid, heavy prolonged menses and enlarged bulky uterus, pain with menses

-adenomyosis: uniformly enlarged, boggy uterus

81
Q

uterine rupture is characterized by
- management?

A
  • pain, signs of fetal distress, loss of fetal station, light to moderate vaginal bleeding
  • Management: emergent laparotomy with c-sections within 30 minutes
82
Q

uterine septum resection would fix

A

recurrent pregnancy loss

83
Q

varicoceles are?
effect on semen analysis

A

dilatation of the pampiniform plexus of spermatic vein and scrotum

decrease in spermatozoa, motility and increased abnormal forms

84
Q

virilization

A

female developing characteristics associated with male hormones

85
Q

vulvar hematoma is caused by
vagina hematoma
retroperitoneal hematoma

A

injury to pudendal artery
uterine artery
hypogastric artery

86
Q

What is this ? Treatment?

A

Erb’s palsy c-5-6 brachial plexus injury
- observe for 3 months ad if it doesn’t resolve, consider nerve repair surgery

87
Q

when do you deliver a baby with pre-ecclamsia with severe features?

A

> 34 weeks

88
Q

When do you place a cerclage?

A

more than 2 painless, 2nd trimester losses

89
Q

When do you put in an iupc

A

Takes longer s that 1cm/2hrs for patient to dilate in active phase of labor, want to put in the Cather to see if contractions are adequate and augment with oxytocin if < 200 montevideos per 10 min

90
Q

When should hysterosalpingogram be performed and why?

A

day 6-11 of cycle to avoid contrast injection when patient is pregnant

91
Q

When to deliver a baby with gestation hypertension

A

> 37 weeks

92
Q

Gonadal dysgenesis

A

ovaries are replaced by tissue called gonadal streak, no produciton of ovarian steroids ie estrogen, so no breasts, but internal and extern al gentialia are phenotypically female FSH LH elevted due to lack of negative feedback,

93
Q

maternal serum alpha-fetoprotein (MSAFP) is elevated for

A
  • fetal abdominal wall defects, open neural tube, and mutiple gestation

**major protein produced by fetal yolk sac, liver, and GI tract, measured at 15-20 wks
** when elevated need US to evaluate fetal anatomy

OB Gyn Shelf (15 decks)

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