OB/GYN Flashcards
The secretory phase of the menstrual cycle (day 14-28) is dominated by what hormone?
Progesterone
Who is more likely to acquire pre-eclampsia nulliparous or multiparous
Nulliparity
Purulent cervical discharge is consistent with what diagnosis?
Neisseria gonorrhoeae
A description of a young girl with a web neck or wide shield chest should make you think of what diagnosis?
Turner’s Syndrome
Cervical biopsy comes back as CIN1. What would you do next?
Repeat pap smear in 6 months and repeat colposcopy in 12 months
What is the most common cause of secondary amenorrhea?
Pregnancy
What three labs should you order if you are considering secondary amenorrhea?
beta HCG, TSH, Prolactin
Define premature birth
Delivery of uterine contents between 20-36 weeks
A unilateral, single, mobile, firm, nontender solid breast mass should make you think of what diagnosis?
Fibroadenoma
Define metrorrhagia
Bleeding between menstrual cycles
Postmenopausal bleeding is immediately believed to be what diagnosis?
Endometrial cancer until proven otherwise
During what portion of the menstrual cycle does PMS occur?
The 2nd half, and menstruation should relieve the symptoms
Treatment for bacterial vaginosis
Metronidazole x 7 days
What location within the pelvis is endometriosis most commonly found?
On an ovary
What is the gold standard lab test for chlamydia?
Nucleic acid amplification test
Are fibrocystic breast masses usually bilateral or unilateral?
Bilateral
How do you definitively diagnose endometriosis?
Exploratory laparoscopy
What is the most common uterine tumor?
Leiomyoma, also known as fibroids.
What ethnic background is at an increased risk of fibroids?
African American
How do you treat vaginal candida?
Fluconazole po 1 dose or azole cream x 1 week
What is the first step of treatment for endometrial cancer?
Total hysterectomy and bilateral salpingo-oophorectomy
If you see the term chocolate cyst it should make you think of what diagnosis?
Endometrioma
A surge in what hormone leads to ovulation
Luteinizing hormone
A patient presents with irregular menses, hirsutism and infertility. What is the most likely diagnosis?
Polycystic ovarian syndrome
What endocrine issue is associated with PCOS?
Insulin insensitivity
You have a patient with PCOS who would like to
get pregnant. What are two medications you may
start her on?
Metformin and Clomid
What is the medical treatment for an early ectopic
pregnancy?
Methotrexate
An ovarian cyst that contains hair and teeth should
make you think of what diagnosis?
Teratoma
What is the mean age for ovarian cancer?
63, Older patient with vague abdominal symptoms
Define the second stage of labor.
Fully dilated to delivery
A 66 year old female patient presents with bouts
of nausea, weight loss and vague abdominal pain.
What is the most likely diagnosis?
Ovarian cancer
When is it recommended to begin pap smears?
When a woman becomes sexually active or when she is 21 years old
Cervical biopsy comes back as CIN2 or CIN3. What
is your next step?
Excision (LEEP, Cold knife, Cryotherapy)
List two risk factors for cervical cancer.
Multiple sexual partners, smoking
How much time needs to pass before diagnosing
secondary amenorrhea?
Normal cycling = 3 months; Irregular cycling = 6 months
What is a cystocele?
A herniation of the bladder into the vagina.
What is the treatment for Turner’s Syndrome?
Cyclical estrogen and progesterone
What are three treatment for uterine prolapse?
Pessary, Kegel’s maneuvers, surgical repair
What is the most common organism that causes
mastitis?
Staph aureus
At approximately how many weeks pregnant is the
uterus at the level of the umbilicus?
20 weeks
What is the most common cause of postpartum
hemorrhage?
Uterine atony
Define missed abortion.
No vaginal bleeding, cervix is closed, products of conception are retained
At what age is primary amenorrhea diagnosed?
Age 14 if no secondary sex characteristics. Age 16 if some secondary development.
What is the first line treatment for mastitis?
Dicloxacillin = 1st line; Cephalexin or erthromycin = 2nd line
Should a breast feeding mother stop breast feeding
if she develops mastitis?
Mastitis is not a reason to stop breast feeding, but an abscess is.
A physical exam revealing a retroverted uterus or
uterosacral ligament nodularity should make you
think of what diagnosis?
Endometriosis
At how many weeks of pregnancy can an
amniocentesis be done?
15-20 weeks
List four risk factors for breast cancer?
BRCA1 or 2 positive, unopposed estrogen, nulliparity, early menarche, late menopause
What is the average age of menopause?
51
Cottage cheese discharge should make you think of what diagnosis?
Vaginal candidiasis
The follicular phase of menstruation is dominated by what hormone?
Estrogen
About how much weight should a woman gain
during pregnancy?
20-35 lbs.
Thin, sticky, malodorous vaginal discharge should
make you think of what diagnosis?
Bacterial vaginosis
Vaginal infection with motile flagellated protozoa
should make you think of what diagnosis?
Trichomonas
List two medications commonly used for
hypertension in pregnancy.
Methyldopa and labetalol
What is the classic triad of pre-eclampsia?
HTN, edema, and proteinuria
Why is ovarian cancer so hard to diagnose?
There are no good markers and the symptoms are very vague
What are two important things you need to tell you
patients before putting them on metronidazole?
Stay out of the sun and avoid alcohol
Define inevitable abortion
Vaginal bleeding, cervix is open, products of conception are retained
How is the first day of the menstrual cycle defined?
The first day of menstrual bleeding
What is the karyotype for patient with Turner’s
syndrome?
(45,X) They are missing one sex chromosome
Give the time frame for preterm labor.
20-37 weeks
A patient presents with mucopurulent discharge
and cervical motion tenderness. What is the most
likely diagnosis?
Chlamydia - cervicitis
Which four human papillomaviruses are linked to
cervical cancer?
HPV 16.18.31, and 33
Clue cells should make you think of what
diagnosis?
Bacterial vaginosis
What is the hallmark physical exam finding for
placenta previa?
Trick Question! NEVER do a physical exam on someone with presumed placenta previa
What medium do you need to grow out Neisseria
gonorrhoeae?
Thayer martin
What age range is the HPV vaccination
recommended for?
9-26 years old
A patient with primary amenorrhea and a low FSH
should make you think of what diagnosis?
Hypothalamic pituitary insufficiency
What characteristic of pelvic inflammatory disease
will help to differentiate it in a question stem from
ectopic pregnancy, appendicitis, ovarian torsion and
ovarian cyst?
It will be bilateral pain, but most other common abdominal complaints have unilateral pain.
List 2 factors for ovarian cancer.
BRCA 1, Family history, nulliparity, late menopause, Caucasian, Asian.
Define abortion.
Delivery of uterine contents before 20 weeks.
Does mastitis tend to be unilateral or bilateral?
Unilateral and only one quadrant
Define full term.
Delivery at 37-42 weeks
When does quickening occur?
Nulliparous 18-20 weeks, multiparous 14-20 weeks
List three risk factors for placental abruption.
HTN, smoking, AMA, cocaine use, PROM
What is the treatment for ovarian cancer?
Total hysterectomy and bilateral salpingo-oophorectomy. Chemo + radiation.
A patient believes she is pregnant. You notice that
her cervix appears a little blue. What is the name
of this sign?
Chadwick’s sign
At approximately how many weeks pregnant is the
uterus at the level of the symphysis pubis?
12 weeks
A snowstorm appearance on ultrasound should
make you think of what diagnosis?
Hydatidiform mole
What medication can be used to control bleeding
due to uterine atony?
Oxytocin (pitocin)
What is the term for when the placenta has
implanted directly over the cervical os?
Placenta previa
At how many weeks of pregnancy can chorionic
villus sampling be done?
10-13 weeks
Why is folic acid given as a prenatal vitamin?
To prevent neural tube defects
What is the most common endometrial cancer?
75% are adenocarcinomas
A strawberry cervix with copious yellow/green
discharge should make you think of what
diagnosis?
Trichomonas
What organism causes us to warn pregnant
patients to stay away from deli meats and soft
cheeses?
Listeria
The baby was delivered several minutes ago.
Suddenly there is a increase in blood flow from the
vagina and the cord noticeably lengthens. What is
the most likely cause of these signs?
Placental separation
What are two medications used to induce labor?
Cervidil (prostoglandin gel applied to the cervix) which encourages cervical ripening and oxytocin which encourages uterine contractions.
As part of the antepartum testing a baby has a
positive stress test. What does that mean?
They have had two heart rate accelerations in 20 minute period of 15 beats above baseline for at least 15 seconds. This is a good thing
Is FSH high or low in Turner’s syndrome?
High, there are no ovaries to respond to FSH and so there is no negative feedback.
What is the most common type of ovarian cyst?
Functional cyst - no treatment necessary.
Define threatened abortion.
Vaginal bleeding, closed cervix, products of are conception retained
List 4 risk factors for endometrial cancer.
Chronic unopposed estrogen,
nulliparity, early menarche, late
menopause, Tamoxifen, DM, obesity,
HTN, breast CA, ovarian CA
What would you expect to see on a KOH prep if the
patient had vaginal candidiasis?
Pseudohyphae
What is the #1 cause of septic arthritis in sexully
active young adults?
Neisseria gonorrhoeae
How many days after conception is a serum beta
HCG positive?
8
If the pap smear results come back anything other
than negative or ASCUS what is your next step?
Colposcopy and biopsy
List three risk factors for an ectopic pregnancy.
Previous ectopic, scarred tubes
(hx of PID or salpingitis), IUD.
Grape like vesicles or a sack of grapes on
ultrasound should make you think of what
diagnosis?
Hydatidiform mole
What medication is used to increase surfactant
levels and help with lung maturity if you are
worried about preterm labor?
Betamethasone
What are two tocolytic medications you should be
aware of?
Magnesium sulfate and calcium channel blockers
A woman presents to the ED concerned she is in
preterm labor. What treatment should you begin
before even getting any imaging or lab results?
Give IV fluids
A pap smear comes back as atypical squamous
uncertain significance (ASCUS). What is your next
step?
Repeat pap smear in 4-6 months.
What are three ways you can check for ruptured
membranes?
Ferning pattern on a slide, visualized leakage from the cervix, pooling in the vagina.
What is the normal range of fetal heart rate?
120-160 bpm
Define menorrhagia.
Heavy prolonged menstraul flow.
What Rh combination for mom and dad might
cause the mother to create antiboides against the
babies red blood cells?
Mom Rh negative and dad Rh
positive.
At what point during pregnancy is Rhogam given if
it is needed?
28 weeks
Define complete abortion.
Vaginal bleeding, cervix open, products of conception have passed.
Gestational diabetes puts mom and baby at
increased risk of for what three things?
Pre-eclampsia, macrosomia, slowing in fetal lung development
Which is associated with painful third trimester bleeding placental abruption or placenta previa?
Placental abruption
What are three causes for postpartum hemorrhage?
Uterine atony, genital laceration, retained placenta
Define the third stage of labor.
Delivery of baby to delivery of placenta.
What medication(s) are used to treat a postpartum metritis?
Clindamycin and gentamicin together.
What organism is the most common sexually transmitted infection?
Chlamydia
Interference with work or school is part of which
diagnosis premenstrual syndrome or premenstrual
dysphoric disorder?
Premenstrual dysphoric disorder
Which reproductive cancer carries the highest rates
of death in women?
Ovarian cancer
What is the most common infection following a
C-section?
Metritis
How do you treat a Trichomonas infection?
Metronidazole
Define incomplete abortion
Vaginal bleeding, cervix is open, products of conception partially passed.
What is the most common site of an ectopic pregnancy?
Within the fallopian tube
Early on in pregnancy serial beta HCG should double over what time period?
Every 48-72 hours
Define procidentia.
Uterine prolapse beyond the the
introitus.
What is the more popular term for Stein-Leventhal
syndrome?
Polycystic ovarian syndrome
What is the formula for calculating estimated date
of confinement or due date?
First day of last menstrual period + 7 days - 3 months.
What are the five components of the biophysical
profile as part of antepartum testing?
A non stress test, fetal breathing,
two gross body movements, fetal
tone, amniotic fluid index.
Define the first stage of labor.
Onset of contractions to full dilation
of the cervix.
Rope like breast mass should make you think of
what diagnosis?
Fibrocystic breast mass
What is the causative organism of syphilis?
Treponema pallium
What is primary syphilis characterized by?
Chancre
How long of treatment is usually needed for a UTI?
3 days
