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STEP 2 > Ob Gyn > Flashcards

Ob Gyn Flashcards

1
Q

when do you get a Quantitative Beta hCG?

A
  1. diagnose and follow ectopic pregnancy
  2. to monitor trophoblastic disease
  3. to screen for fetal aneuploidy
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2
Q

When is the gestational sack visible by ultrasound?

A

Five weeks gestational age

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3
Q

What defines an embryo?

A

0 to 8 weeks

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4
Q

What defines a fetus?

A

8 weeks to delivery

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5
Q

What as an infant?

A

Delivery to one year

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6
Q

What is the term pregnancy?

A

37 weeks or later

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7
Q

What is a preterm pregnancy

A

20 to 36 weeks

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8
Q

What renal change occurs during pregnancy

A

Increased GFR ~50%, increased renal flow

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9
Q

How does blood pressure change during pregnancy

A

Decreases 10% by 34 weeks then normalizes

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10
Q

How does heart rate change during pregnancy

A

Gradually increases twenty percent

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11
Q

How does cardiac output change during pregnancy

A

Increases

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12
Q

How’s peripheral vascular resistance changing pregnancy

A

Decreases

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13
Q

How does peripheral venous distention change during pregnancy?

A

Progressively increasing

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14
Q

What is the effect of an increase title volume during pregnancy?

A

Create an increased CO2 gradient for the fetus for gas exchange

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15
Q

How does fibrinogen change during pregnancy?

A

Increases

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16
Q

What is the recommended folic acid supplementation during pregnancy

A

0.4 mg a day 4 mg a day if h/o neural tube defects in prior pregnancies

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17
Q

Rh negative when do you give Rhogam?

A

Week 28 and postpartum if the fetus is Rh positive

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18
Q

What drug: fetal renal tubular dysplasia and neonatal renal failure, oligohydramnios, IU GR, lack of cranial ossification

A

ACEis

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19
Q

What drugs: growth restriction before and after birth, mental retardation, mid facial hypoplasia, renal and cardiac defects

A

alcohol

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20
Q

What drug: virilization of female, advanced genital development in males

A

Androgens

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21
Q

What drugs: note to defects, fingernail hypoplasia, microcephaly, developmental delay, IUGR

A

Carbamazepine

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22
Q

What drugs: bowel atresia, congenital malformations of the heart, face and GU tract, microcephaly, IUGR, cerebral instructions

A

Cocaine

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23
Q

What drugs: clear cell adenocarcinoma of the vagina or cervix, vaginal adenosis, Amber melodies of the cervix and uterus or testes possible infertility

A

DES

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24
Q

What drug: increase spontaneous abortion rate, stillbirths

A

Lead

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25
Q

What drug: congenital heart disease

A

Lithium

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26
Q

What drugs: increased spontaneous abortion rate

A

Methotrexate

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27
Q

What drugs: cerebral atrophy, microcephaly, mental retardation, spasticity, Seizures, or blindness

A

Organic Mercury

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28
Q

What drugs: IUGR, mental retardation, microcephaly, dysmorphic craniofacial features, cardiac defects, fingernail hyperplasia

A

Phenytoin

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29
Q

What drugs: microcephaly, mental retardation

A

Radiation

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30
Q

What drug: hearing loss cranial nerve eight damage

A

streptomycin and kanamycin

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31
Q

What drug: permanent teeth discoloration, hypoplasia of tooth enamel

A

Tetracycline

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32
Q

What drug: neural tube defects, minor craniofacial defects

A

valproic acid

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33
Q

What drugs: increased SAB rate, thymic agenesis, cardiovascular defects, craniofacial dysmorphism, micropthalmia, cleft lip or palate, mental retardation

A

Vitamin A

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34
Q

Nasal hypoplasia and stippled bone epiphyses, developmental delay, IUGR, ophthalmologic abnormalities

A

Warfarin

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35
Q

Mgmt of fetus with anomaly incompatible with life

A

allow labor to procede

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36
Q

First stage arrest definition

A

no cervical change for >4 hours with adequate contractions or no cervical change for >6 hours with INadequate contractions

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37
Q

When screen for GDM?

A

first visit in pts with a history of diabetes, otherwise 24-28 weeks with OGTT

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38
Q

when check AFP?

A

15-20 weeks

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39
Q

when check for GBS?

A

35-37 weeks

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40
Q

when hear fetal heart tones

A

10 to 12 wks on US

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41
Q

when order US to evaluate fetus?

A
  • size date discrepancy >2-3cm
  • suspect fetal death or demise
  • RF for pregnancy related problems ex. SLE, DM, HTN, renal disease
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42
Q

should ASA be avoided in pregnancy?

A

yes, unless pts have Anti phospholipid syndrome

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43
Q

what are rare disorders associated with prolonged gestation?

A

anencephaly and placental sulfatase deficiency

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44
Q

what can a low AFP indicate?

A

Down syndrome, fetal demise, inaccurate dates

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45
Q

what can a high AFP represent?

A

neural tube defects, ventral wall defects, multiple gestation or inaccurate dates

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46
Q

what do if AFP elevated?

A

repeat it if remains elevated–> US to look for anatomical abnormality
US uncertain–> amnio

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47
Q

rec for Downs syndrome screening

A

offer to all women prior to 20 weeks

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48
Q

best test when suspect intrauterine fetal demise

A

real-time ultrasound

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49
Q

what is the best diagnostic test for endometriosis?

A

laparoscopy

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50
Q

how confirm a true PCN allergy

A

skin testing

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51
Q

MCC elevated AFP

A

neural tube defects and abdominal wall defects , also multiple gestations

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52
Q

first line testing for thalassemia

A

CBC

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53
Q

pt with positive pregnancy test, but no evidence of ectopic pregnancy on imaging, next step?

A

repeat B hCG in 48 hours

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54
Q

what meds can be used as emergency contraception ootions

A

ulipristal pill (antiprogestin) delays ovulation
levonorgenstrel pill (progestin, delays ovulation)
OCPs “”
**not mifepristone and misoprostol

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55
Q

MCC of a nonreactive non stress test?

A

fetal sleep cycleuse vibroacoustic stimluation to awaken fetus

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56
Q

patient with dyspareunia, dysmenorrhea and dyschezia: dx and tx

A

EndometriosisOCPs + NSAIDS

if no improvement the laparoscopy

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57
Q

tx for chlamydia if asymptomatic

A

single dose azithro or 7 day course of doxy

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58
Q

what is the association between hypothyroidism and hyperprolactinemia?

A

TRH stimulates prolactin production

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59
Q

34 yo trying to get pregnant, 3 months of amenorrhea, next step?

A

IVF!

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60
Q

mgmt of threatened abortion

A
  1. ascertain fetus is present and alive

2. reassurance and performance of US one week later-bed rest

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61
Q

Downs Syndrome testing for woman at 10 wks gestation?

A

cell free fetal DNA

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62
Q

mgmt of a pregnant woman with severe nausea and vomiting

A

US to rule out trophoblastic dz or multifetal gestation

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63
Q

Tamoxifen increases risk of what?

A

endometrial cancer

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64
Q

tx preeclampsia

A

hydral or labetalol to decrease BP

mag sulfate to prevent or tx eclamptic seizures

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65
Q

suppression of lactation

A

tight fitting bra and ice packs and analgesics

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66
Q

depressed DTRs indicate what? mgmt?

A

Mag sulfate toxstop mag sulfate and start Ca gluconate

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67
Q

1 RF for clear cell adenocarcinoma?

A

in utero exposure to DES

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68
Q

sudden vaginal bleeding an a hypertonic, tender uterus: dx? mgmt?

A

placental abruptionemergency C section

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69
Q

Dx: painless hemorrhage coinciding with rapid fetal deterioration and preceded by ROM

A

torn fetal vessel
vasa previa
see tachycardia followed by bradycardia and a sinusoidal pattern
dx: antenatal and trasvag doppler US

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70
Q

MCC heavy or prolonged menses in a young woman who recently started menstruating

A

anovulation

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71
Q

decreased aFP, bHCG, estriol and normal inhibin A

A

trisomy 18

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72
Q

increased AFP, nml bHCG, estriol adn inhibin A

A

neural tube or abdominal wall defect

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73
Q

mgmt of septic abortion

A

suction curreage

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74
Q

most accurate way to determine estimated gestational age?

A

US dating in the FIRST TRIMESTER

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75
Q

patients with complete androgen insensitivity with cryptorchid gonads: when intervene?

A

gonadectomy after puberty

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76
Q

mucopurulent discharge and erythematous, friable cervix: ddx

A

Cervicitis, either chlamydia or gonorrhea

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77
Q

cause of schistocytes and platelet consumption seen in HELLP

A

MAHA
overall cause of HELLP is abnormal placentation, but the specific cause of plt/RBC damage is due to systemic inflammation and platelet consumption

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78
Q

Does a woman with HELLP have to have a C section?

A

NO!She needs to DELIVER

vaginal delivery is preferred in women in labor or with ROM and a vertex presentation, can induce!

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79
Q

which pregnant women should be vaccinated against the flu?

A

ALL of them

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80
Q

what is alloimmunity?

A

immune response to antigens from members of the same species

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81
Q

patient with orthostatic changes and cervical motion tenderness, dx?

A

ectopic pregnancy

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82
Q

what are common tocolytic drugs?

A

beta agonists
CCBs
NSAIDs

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83
Q

Bilateral breast discharge, brown, serous or milky or unilateral: next step in mgmt?

A

mammo +/- US surgical eval

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84
Q

bilateral breast discharge that is not milky, serous or bloody: next step in mgmt

A

likely physiologic

  • pregnancy test
  • serum TSH and prolactin
  • consider pituitary MRI
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85
Q

fetal heart rate monitoring mneumonic?

A

VEAL CHOP

Variables: cord compression. (V and C)
Early decelerations: head compression. This is generally a benign event. (E and H)
Accelerations : oxygenation – which explains why they’re generally a good prognostic factor. (A and O)
Late accelerations : placental insufficiency. (L and P)

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86
Q

hemodynamically stable pt with an incomplete abortion: mgmt?

A

expectant, prostaglandins or surgical eval

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87
Q

what abx for mastitis

A

diclox or cephalexin

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88
Q

risk factors for vaginal squamous cell cancer

A

smoking

HPV

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89
Q

MC symptoms of vaginal cancer?

A

vaginal bleeding

malodorous vaginal discharge

90
Q

what 3 criteria do you need for PID?

A

One: abdominal pain
two: adnexal tenderness three: cervical motion tenderness

91
Q

tx chlamydia pt for gonorrhea?

A

No…

92
Q

tx gonorrhea pt for chlamydia

A

yes! unless testing is negative

93
Q

tx for chlamydia in pregnant pt

A

erythromycin

94
Q

What is the first test to order any women of reproductive age without uterine bleeding?

A

Pregnancy test

95
Q

Why is dilation and curettage done in women older than age 35 with dysfunctional uterine bleeding?

A

To rule out endometrial cancer also get H&H

96
Q

Fertility evaluation after semen evaluation

A

Documentation of ovulation: basal bike temperature, luteal phase progesterone, and or a endometrial biopsy

97
Q

What is the medical therapy to restore female fertility?

A

Clomiphene citrate to induce ovulation if the woman is hypo estrogenic, use human menopausal gonadotropin which is a combination LH and FSH

98
Q

At what age can primary amenorrhea be diagnosed? What is the first step in diagnosis?

A

The diagnosis of primary amenorrhea is made when a girl has not menstruated by the age 16 years. patient should also be evaluated in the absence of secondary sexual characteristics by age 14 years, or in the absence menstruation within two years of developing secondary sex characteristics such as breast development, axillary and pubic hair. The first step is to rule out pregnancy

99
Q

What is the average age of menopause

A

51

100
Q

Bilateral, multiple, cystic breast lesion are tender to the touch especially around ovulation

A

fibrocystic disease

101
Q

step 2 mgmt of woman >35 with a breast mass

A

Bx and mammo

102
Q

what are the major problems with IUDs?

A

increase risk of PID esp with actinomyces and ectopic pregnancies

103
Q

classic cause of ambiguous genitalia?

A

adrenogenital syndrome aka CAH

tx: steroids and IV fluids immediately

104
Q

do you know the gender of a child with ambiguous genitalia?

A

NO, need to karyotype

105
Q

bunch of grapes protruding from pediatric vagina?

A

sarcoma botryoides, malignant tumor, type of embryonal rhabdomyosarcoma

106
Q

benefits of estrogen tx?

A

decreased osteoporosis and fractures
reduced hot flashes
decreased risk of colorectal cancer

107
Q

risks of estrogen tx

A 
Endometrial cancer
Coronary heart dz
VTE
breast cancer if estrogen and progesterone
stroke
gallbaldder dz
108
Q

absolute contraindications to estrogen therapy

A 
unexplained vaginal bleeding
active liver dzhistory of thromboembolism
CAD
history of endometrial or breast cancer
pregnancy
109
Q

what do before starting estrogen therapy

A

endometrial bx

US or D+C to rule out endometrial hyperplasia or cancer

110
Q

when stop OCPs in relation to surgery

A

1 month prior

start 1 month after

111
Q

what drugs can interfere with OCP metabolism and make them less effective

A

rifampin and antiepileptics

112
Q

OCPs relation to ovarian and endometrial cancer?

A

decrease incidence of ovarian cancer by 50%, reduce endometrial cancer

113
Q

when give RhoGAM for Rh - women

A

28-30 weeks after antibody screen

114
Q

why do D+E for intrauterine fetal demise

A

to prevent DIC at gestational age > 16 weeks

115
Q

normal non-stress test

A

external HR monitoring for 20-40 minutes

15 x 15 (bpm x seconds) is normal

116
Q

treatment for incompetent cervix prior to 24 weeks

A

betamethasone and strict bed rest

117
Q

stage 1 of labor

A

onset to complete cervical dilation (10cm)

118
Q

stage 2 of labor

A

dilation to delivery

119
Q

Amniotic fluid index #s for oligo and poly hydramnios

A

oligo 20

120
Q

MCC oligohydramnios

A

ROM

121
Q

oligohydramnios and meconium in amniotic fluid

A

amnioinfusion

122
Q

mgmt intrauterine fetal demis

A

delivery within 3 weeks and f/u autopsy to search for a cause

123
Q

GDM pathophys

A

increased human placental lactogen, estrogen, progesterone that causes insulin antagonism

124
Q

what if GBS is seen on urine cx on woman dx with UTI during pregnancy?

A

give PCN during labor

125
Q

tx for CMV during pregnancy

A

postpartum GCV

126
Q

how ddx lupus flare vs. pre-E

A

complement decreased in lupus

127
Q

what counts as the postpartum period

A

6 weeks after delivery

128
Q

contraindications to breast feeding

A

HIV and active HBV infection

129
Q

OCPs during breastfeeding?

A

progestin only

130
Q

risk of tamoxifen

A

endometrial cancer

131
Q

definition of first stage arrest

A

no cervical change in 4 hrs despite adequate contractions or 6 hours with inadequate contractions

132
Q

definition of first stage arrest

A

no cervical change in 4 hrs despite adequate contractions or 6 hours with inadequate contractions

133
Q

cause of uterine abnormalities

A

problems in fusion of paramesonephric ducts

134
Q

tx chancroid

A

azithro or ctx

135
Q

painful chancre + inguinal LAD

A

chancroid

136
Q

tx toxic shock

A

nafcillin IV

137
Q

tx toxic shock

A

nafcillin IV

138
Q

FSH over what level indicates ovarian failure

A

40

139
Q

when can you do a medical abortion?

A
140
Q

1 risk factor for vaginal squamous neoplasia

A

multiple sexual partners

141
Q

persistent abnormal pap but normal cervical bx, dx?

A

vulvar intra epithelial neoplasia

colpo directed bx–> local excision, laser ablation or topical 5-FU

142
Q

pap results, what is mgmt if anything other than ASC-US?

A

colpo + cervical bx

143
Q

pap results: ASC-US, mgmt?

A

HPV DNA testing
if HPV negative, repeat pap in 1 year
if HPV positive, colpo + cervical bx

144
Q

when do a cone bx

A

Microinvasion

145
Q

CIN stages relate to what?

A

how far into epithelium

146
Q

mgmt CIN I

A

repeat pap Q 6 months x 2 or HPV testing in 12 months

  • 65% regress
  • LEEP if persistent for 2 years
147
Q

mgmt CIN II or III

A

LEEP

148
Q

what is the #1 cancer killer of women in 3rd world countries

A

cervical SCC

149
Q

tx cervical SCC

A

hysterectomy (stage 0, in situ)

up to chemo (cisplatin, internal and external radiation for stage IV)

150
Q

how dx endometrial CA in a premenopausal woman?

A

endometrial bx

151
Q

how dx endometrial CA in a postmenopausal woman?

A

U/S, endometrial stripe > 5mm –> bx

152
Q

Tx for endometrial CA

A

TAHBSO
+/-
pelvic/paraaortic LN-ectomy
radiation (if high risk)

153
Q

1 prognostic factor for endometrial cancer?

A

grade

154
Q

type 2 endometrial cancer, what etiology?

A

clear cell

pap serous

155
Q

1 RF for ovarian cancer

A

family history

156
Q

protective factors for ovarian cancer

A

OCPs
multip
breastfeeding
chronic anovulation

**all decrease ovulation

157
Q

mgmt of ovarian CA?

A

Dx pelvic U/S –> stage –> tx

158
Q

tx for epithelial ovarian CA

A

surgery (TAHBSO, omentectomy, pelvic/paraaortic lymph node ectomy) +carboplatin/paclitaxel

159
Q

tx for germ cell ovarian CA?

A

USO + BEP (bleomycin, etoposide, cisplatin)

160
Q

tx for sex-cord stromal CA?

A

USO

161
Q

what is Meigs syndrome?

A

2/2 ovarian cancer: fibroma, ascites and right sided hydrothroax

162
Q

MC ovarian epithelial tumor

A

serous cystadenocarcinoma

163
Q

psammoma bodies indicate what kind of cancer?

A

papillary

164
Q

what kind of ovarian cancer: pt with appendiceal carcinoma “jelly belly”

A

mucinous cystadenocarcinoma

165
Q

tumor with elevated LDH associated with Turner syndrome

A

dysgerminoma

166
Q

elevated AFP and schiller-duval bodies, dx?

A

yolk sac tumor

schiller duval bodies look like glomeruli

167
Q

choriocarcinoma has elevated what lab?

A

b-hcg

168
Q

elevated AFP and bHCG: dx?

A

teratoma

169
Q

Call-Exner bodies = what kind of tumor?

A

granulosa cell

170
Q

how dx complete mole?

A

very elevated bhcg >100k
pelvic US showing snowstorm appearance
Tx: D+C and oxytocin
follow bHCG for a few months

171
Q

1 RF for breast cancer

A

Family history

172
Q

rapidly growing breast mass in a teenager: dx and tx

A

Dx: giant juvenile fibroadenoma

tx: removal to avoid breast deformity (not CA)

173
Q

Phyllodes mgmt

A

core or incisional bx since FNA is insufficienct, tx: excision with negative margins

174
Q

papilloma mgmt

A

galactogram/ductogram guided excision due to small risk of carcinoma

175
Q

how dx. fibroadenoma

A

US or FNA

176
Q

breast mass in 20yo that becomes very large

A

Phyllodes tumor

does have malignant potential to become a SARCOMA: cannot do FNA, need to do are core bx

177
Q

does a history of trauma rule out breast cancer?

A

NO

178
Q

how does breast cancer tx change during pregnancy?

A

no chemo during first trimester

no radioTHERAPY during pregnancy

179
Q

treatment of a resectable breast tumor?

A

lumpectomy + axillary sampling + post-op radiation (only if small, in a large breast and away from nipple and areola)
OR
modified radical mastectomy with axillary sampling

180
Q

inflammatory cancer mgmt?

A

needs pre-op chemotherapy

181
Q

DCIS mgmt

A

doesn’t metastasize but has high incidence of local recurrance so need total simple mastectomy if lesions are scattered + SLNB or if clumped together lumpectomy + radiation

182
Q

what meds do women get for ER/PR positive tumors if pre or post menopausal

A

pre: Tamoxifen

Post: anastrozole

183
Q

how follow up abnormal cell free fetal DNA testing

A

fetal karyotyping via CVS in first trimester or

amnio in second trimester

184
Q

initial workup of an adnexal mass in a POSTmenopausal woman

A

TVUS

CA-125 level (if high, suspicious for malignancy in a post menopausal woman)

185
Q

what are US features suspicious for an adnexal malignancy on US

A

size > 10cm
nodular or fixed
ascites
evidence of metastasis

–> Gyn Onc

186
Q

when recommend starting pap smears

A

age 21 REGARDLESS of sexual activity

187
Q

how does amenorrhea occur in female athletes

A

caloric deficiency that leads to decreased LH and GnRH which causes an estrogen deficiency

188
Q

tx of acute AUB

A

high dose estrogen, high dose OCPs, high dose progestin, tanexamic acid if prog/est both contraindicated

189
Q

mgmt of 15 yo with primary amenorrhea who has no breast develop and a uterus?

A

serum FSH
if low –> MRI
if elevated –> karyotyping

190
Q

tx of recurrent variable decels after oxygen, repositioning?

A

amnioinfusion: artificial ROM and infusion of saline into the amniotic cavity

191
Q

pt with IUFD with any changes in coagulation

A

immediate delivery

192
Q

hyperemesis gravidarum: what other test?

A

US to look for multigestation or molar pregnancy

193
Q

what is the most reliable way to date fetus

A

crown rump length on first trimester US

194
Q

best way to delay labor in PPROM?

A

antibiotics

PCN or amp

195
Q

how does GDM effect fetus calcium

A

HYPOcalcemia due to increased insulin!

196
Q

woman with h/o PID, next best test in workup of infertility?

A

hysterosalpingogram

197
Q

what is normally seen in woman with pre-existing DM but not women with GDM

A

IUGR

198
Q

best test to detect severe fetal anemia?

A

MCA peak systolic velocity

199
Q

what does a negative fetal fibronectin test indicate?

A

if negative, mom is unlikely to deliver in the next 14 days

200
Q

signs newborn is well hydrated

A

Signs that a baby is getting sufficient milk include 3-4 stools in 24 hours, six wet diapers in 24 hours, weight gain and sounds of swallowing.

201
Q

what is the most effective birth control method after abstinence?

A

depo provera

202
Q

prolonged rupture of membranes

A

> 18hrs before onset of labor

203
Q

ddx IUGR vs. decreased growth potential

A

decreased growth potential: stays small

IUGR: falls off growth curve

204
Q

weight cut off where C section is indicated?

A

4500 g

205
Q

what should you consider if a woman has pre-eclampsia before the 3rd trimester?

A

trophoblastic dz

206
Q

mgmt and treatment of Chorioamnionitis

A
  • Mgmt: Dx amnioscentesis and cx amniotic fluid

* Tx: broad spectrum Abx (amp, gent, clinda) and delivery (can be vaginal!)

207
Q

are pre-E and eclampsia RFs for future HTN?

A

no

208
Q

major causes of pregnancy associated mortality associated with childbirth?

A

PE
pregnancy induced HTN
hemorrhage

209
Q

causes of oligohydramnios

A

IUGR, PROM, postmaturity, renal agenesis

210
Q

causes of polyhydramnios

A

maternal diabetes, multiple gestation, neural tube defects, GI anomalies, hydrops fetalis

211
Q

foul smelling lochia indicates what? tx?

A

endometritis

clinda and gent since polymicrobial

212
Q

who gets progesterone supplementation during pregnancy?

A

women 16-36 weeks with a singleton pregnancy and a history of preterm birth

progesterone can reduce the risk of preterm birth in patients with a short cervical length on vaginal US at

213
Q

what do you give to patients in preterm labor?

A

tocolytics
corticosteroids for fetal lung maturity
MgSO4 for neuro protection

214
Q

abnormal non stress text, next step?

A

BPP

215
Q

GDM target insulin levels

A

fasting

216
Q

DX premature ovarian failure

A

FSH in menopausal range for 3 months–> IVF

also have decreased estrogen

217
Q

how dx incompetent cervix?

A

TVUS

218
Q

mgmt of patient with prolonged PROM?

A

broad spectrum Abx (Amp, Gent, Clinda) and delivery: oxytocin if in labor, C section only if there is an obstetric indication

can also give mom anitpyretics which can help fetal tachycardia

219
Q

mom with quad screen showing increased risk of Downs Syndrome, next step?

A

US during 18-20 weeks

220
Q

placenta previa mgmt:

A

fluid resuscitate if bleeding

> 37 weeks –> scheduled C section
close monitoring of hct, expectant mgmt, amnio at 36 weeks to eval fetal lung maturity

221
Q

how do GFR and BUN change during pregnancy

A

decrease! 2/2 increase in renal plasma flow and GFR

222
Q

treatment for a threatened abortion

A

reassurance and outpatient follow up

STEP 2 (8 decks)

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