Ob Gyn Flashcards
1
Q
when do you get a Quantitative Beta hCG?
A
- diagnose and follow ectopic pregnancy
- to monitor trophoblastic disease
- to screen for fetal aneuploidy
2
Q
When is the gestational sack visible by ultrasound?
A
Five weeks gestational age
3
Q
What defines an embryo?
A
0 to 8 weeks
4
Q
What defines a fetus?
A
8 weeks to delivery
5
Q
What as an infant?
A
Delivery to one year
6
Q
What is the term pregnancy?
A
37 weeks or later
7
Q
What is a preterm pregnancy
A
20 to 36 weeks
8
Q
What renal change occurs during pregnancy
A
Increased GFR ~50%, increased renal flow
9
Q
How does blood pressure change during pregnancy
A
Decreases 10% by 34 weeks then normalizes
10
Q
How does heart rate change during pregnancy
A
Gradually increases twenty percent
11
Q
How does cardiac output change during pregnancy
A
Increases
12
Q
How’s peripheral vascular resistance changing pregnancy
A
Decreases
13
Q
How does peripheral venous distention change during pregnancy?
A
Progressively increasing
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
15
Q
How does fibrinogen change during pregnancy?
A
Increases
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
17
Q
Rh negative when do you give Rhogam?
A
Week 28 and postpartum if the fetus is Rh positive
18
Q
What drug: fetal renal tubular dysplasia and neonatal renal failure, oligohydramnios, IU GR, lack of cranial ossification
A
ACEis
19
Q
What drugs: growth restriction before and after birth, mental retardation, mid facial hypoplasia, renal and cardiac defects
A
alcohol
20
Q
What drug: virilization of female, advanced genital development in males
A
Androgens
21
Q
What drugs: note to defects, fingernail hypoplasia, microcephaly, developmental delay, IUGR
A
Carbamazepine
22
Q
What drugs: bowel atresia, congenital malformations of the heart, face and GU tract, microcephaly, IUGR, cerebral instructions
A
Cocaine
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
24
Q
What drug: increase spontaneous abortion rate, stillbirths
A
Lead
25
What drug: congenital heart disease
Lithium
26
What drugs: increased spontaneous abortion rate
Methotrexate
27
What drugs: cerebral atrophy, microcephaly, mental retardation, spasticity, Seizures, or blindness
Organic Mercury
28
What drugs: IUGR, mental retardation, microcephaly, dysmorphic craniofacial features, cardiac defects, fingernail hyperplasia
Phenytoin
29
What drugs: microcephaly, mental retardation
Radiation
30
What drug: hearing loss cranial nerve eight damage
streptomycin and kanamycin
31
What drug: permanent teeth discoloration, hypoplasia of tooth enamel
Tetracycline
32
What drug: neural tube defects, minor craniofacial defects
valproic acid
33
What drugs: increased SAB rate, thymic agenesis, cardiovascular defects, craniofacial dysmorphism, micropthalmia, cleft lip or palate, mental retardation
Vitamin A
34
Nasal hypoplasia and stippled bone epiphyses, developmental delay, IUGR, ophthalmologic abnormalities
Warfarin
35
Mgmt of fetus with anomaly incompatible with life
allow labor to procede
36
First stage arrest definition
no cervical change for >4 hours with adequate contractions or no cervical change for >6 hours with INadequate contractions
37
When screen for GDM?
first visit in pts with a history of diabetes, otherwise 24-28 weeks with OGTT
38
when check AFP?
15-20 weeks
39
when check for GBS?
35-37 weeks
40
when hear fetal heart tones
10 to 12 wks on US
41
when order US to evaluate fetus?
- size date discrepancy >2-3cm
- suspect fetal death or demise
- RF for pregnancy related problems ex. SLE, DM, HTN, renal disease
42
should ASA be avoided in pregnancy?
yes, unless pts have Anti phospholipid syndrome
43
what are rare disorders associated with prolonged gestation?
anencephaly and placental sulfatase deficiency
44
what can a low AFP indicate?
Down syndrome, fetal demise, inaccurate dates
45
what can a high AFP represent?
neural tube defects, ventral wall defects, multiple gestation or inaccurate dates
46
what do if AFP elevated?
repeat it if remains elevated--> US to look for anatomical abnormality
US uncertain--> amnio
47
rec for Downs syndrome screening
offer to all women prior to 20 weeks
48
best test when suspect intrauterine fetal demise
real-time ultrasound
49
what is the best diagnostic test for endometriosis?
laparoscopy
50
how confirm a true PCN allergy
skin testing
51
MCC elevated AFP
neural tube defects and abdominal wall defects , also multiple gestations
52
first line testing for thalassemia
CBC
53
pt with positive pregnancy test, but no evidence of ectopic pregnancy on imaging, next step?
repeat B hCG in 48 hours
54
what meds can be used as emergency contraception ootions
ulipristal pill (antiprogestin) delays ovulation
levonorgenstrel pill (progestin, delays ovulation)
OCPs ""
**not mifepristone and misoprostol
55
MCC of a nonreactive non stress test?
fetal sleep cycleuse vibroacoustic stimluation to awaken fetus
56
patient with dyspareunia, dysmenorrhea and dyschezia: dx and tx
EndometriosisOCPs + NSAIDS
| if no improvement the laparoscopy
57
tx for chlamydia if asymptomatic
single dose azithro or 7 day course of doxy
58
what is the association between hypothyroidism and hyperprolactinemia?
TRH stimulates prolactin production
59
34 yo trying to get pregnant, 3 months of amenorrhea, next step?
IVF!
60
mgmt of threatened abortion
1. ascertain fetus is present and alive
| 2. reassurance and performance of US one week later-bed rest
61
Downs Syndrome testing for woman at 10 wks gestation?
cell free fetal DNA
62
mgmt of a pregnant woman with severe nausea and vomiting
US to rule out trophoblastic dz or multifetal gestation
63
Tamoxifen increases risk of what?
endometrial cancer
64
tx preeclampsia
hydral or labetalol to decrease BP
| mag sulfate to prevent or tx eclamptic seizures
65
suppression of lactation
tight fitting bra and ice packs and analgesics
66
depressed DTRs indicate what? mgmt?
Mag sulfate toxstop mag sulfate and start Ca gluconate
67
#1 RF for clear cell adenocarcinoma?
in utero exposure to DES
68
sudden vaginal bleeding an a hypertonic, tender uterus: dx? mgmt?
placental abruptionemergency C section
69
Dx: painless hemorrhage coinciding with rapid fetal deterioration and preceded by ROM
torn fetal vessel
vasa previa
see tachycardia followed by bradycardia and a sinusoidal pattern
dx: antenatal and trasvag doppler US
70
MCC heavy or prolonged menses in a young woman who recently started menstruating
anovulation
71
decreased aFP, bHCG, estriol and normal inhibin A
trisomy 18
72
increased AFP, nml bHCG, estriol adn inhibin A
neural tube or abdominal wall defect
73
mgmt of septic abortion
suction curreage
74
most accurate way to determine estimated gestational age?
US dating in the FIRST TRIMESTER
75
patients with complete androgen insensitivity with cryptorchid gonads: when intervene?
gonadectomy after puberty
76
mucopurulent discharge and erythematous, friable cervix: ddx
Cervicitis, either chlamydia or gonorrhea
77
cause of schistocytes and platelet consumption seen in HELLP
MAHA
overall cause of HELLP is abnormal placentation, but the specific cause of plt/RBC damage is due to systemic inflammation and platelet consumption
78
Does a woman with HELLP have to have a C section?
NO!She needs to DELIVER
| vaginal delivery is preferred in women in labor or with ROM and a vertex presentation, can induce!
79
which pregnant women should be vaccinated against the flu?
ALL of them
80
what is alloimmunity?
immune response to antigens from members of the same species
81
patient with orthostatic changes and cervical motion tenderness, dx?
ectopic pregnancy
82
what are common tocolytic drugs?
beta agonists
CCBs
NSAIDs
83
Bilateral breast discharge, brown, serous or milky or unilateral: next step in mgmt?
mammo +/- US surgical eval
84
bilateral breast discharge that is not milky, serous or bloody: next step in mgmt
likely physiologic
- pregnancy test
- serum TSH and prolactin
- consider pituitary MRI
85
fetal heart rate monitoring mneumonic?
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)
86
hemodynamically stable pt with an incomplete abortion: mgmt?
expectant, prostaglandins or surgical eval
87
what abx for mastitis
diclox or cephalexin
88
risk factors for vaginal squamous cell cancer
smoking
| HPV
89
MC symptoms of vaginal cancer?
vaginal bleeding
| malodorous vaginal discharge
90
what 3 criteria do you need for PID?
One: abdominal pain
two: adnexal tenderness three: cervical motion tenderness
91
tx chlamydia pt for gonorrhea?
No...
92
tx gonorrhea pt for chlamydia
yes! unless testing is negative
93
tx for chlamydia in pregnant pt
erythromycin
94
What is the first test to order any women of reproductive age without uterine bleeding?
Pregnancy test
95
Why is dilation and curettage done in women older than age 35 with dysfunctional uterine bleeding?
To rule out endometrial cancer also get H&H
96
Fertility evaluation after semen evaluation
Documentation of ovulation: basal bike temperature, luteal phase progesterone, and or a endometrial biopsy
97
What is the medical therapy to restore female fertility?
Clomiphene citrate to induce ovulation if the woman is hypo estrogenic, use human menopausal gonadotropin which is a combination LH and FSH
98
At what age can primary amenorrhea be diagnosed? What is the first step in diagnosis?
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
What is the average age of menopause
51
100
Bilateral, multiple, cystic breast lesion are tender to the touch especially around ovulation
fibrocystic disease
101
step 2 mgmt of woman >35 with a breast mass
Bx and mammo
102
what are the major problems with IUDs?
increase risk of PID esp with actinomyces and ectopic pregnancies
103
classic cause of ambiguous genitalia?
adrenogenital syndrome aka CAH
| tx: steroids and IV fluids immediately
104
do you know the gender of a child with ambiguous genitalia?
NO, need to karyotype
105
bunch of grapes protruding from pediatric vagina?
sarcoma botryoides, malignant tumor, type of embryonal rhabdomyosarcoma
106
benefits of estrogen tx?
decreased osteoporosis and fractures
reduced hot flashes
decreased risk of colorectal cancer
107
risks of estrogen tx
```
Endometrial cancer
Coronary heart dz
VTE
breast cancer if estrogen and progesterone
stroke
gallbaldder dz
```
108
absolute contraindications to estrogen therapy
```
unexplained vaginal bleeding
active liver dzhistory of thromboembolism
CAD
history of endometrial or breast cancer
pregnancy
```
109
what do before starting estrogen therapy
endometrial bx
| US or D+C to rule out endometrial hyperplasia or cancer
110
when stop OCPs in relation to surgery
1 month prior
| start 1 month after
111
what drugs can interfere with OCP metabolism and make them less effective
rifampin and antiepileptics
112
OCPs relation to ovarian and endometrial cancer?
decrease incidence of ovarian cancer by 50%, reduce endometrial cancer
113
when give RhoGAM for Rh - women
28-30 weeks after antibody screen
114
why do D+E for intrauterine fetal demise
to prevent DIC at gestational age > 16 weeks
115
normal non-stress test
external HR monitoring for 20-40 minutes
| 15 x 15 (bpm x seconds) is normal
116
treatment for incompetent cervix prior to 24 weeks
betamethasone and strict bed rest
117
stage 1 of labor
onset to complete cervical dilation (10cm)
118
stage 2 of labor
dilation to delivery
119
Amniotic fluid index #s for oligo and poly hydramnios
oligo 20
120
MCC oligohydramnios
ROM
121
oligohydramnios and meconium in amniotic fluid
amnioinfusion
122
mgmt intrauterine fetal demis
delivery within 3 weeks and f/u autopsy to search for a cause
123
GDM pathophys
increased human placental lactogen, estrogen, progesterone that causes insulin antagonism
124
what if GBS is seen on urine cx on woman dx with UTI during pregnancy?
give PCN during labor
125
tx for CMV during pregnancy
postpartum GCV
126
how ddx lupus flare vs. pre-E
complement decreased in lupus
127
what counts as the postpartum period
6 weeks after delivery
128
contraindications to breast feeding
HIV and active HBV infection
129
OCPs during breastfeeding?
progestin only
130
risk of tamoxifen
endometrial cancer
131
definition of first stage arrest
no cervical change in 4 hrs despite adequate contractions or 6 hours with inadequate contractions
132
definition of first stage arrest
no cervical change in 4 hrs despite adequate contractions or 6 hours with inadequate contractions
133
cause of uterine abnormalities
problems in fusion of paramesonephric ducts
134
tx chancroid
azithro or ctx
135
painful chancre + inguinal LAD
chancroid
136
tx toxic shock
nafcillin IV
137
tx toxic shock
nafcillin IV
138
FSH over what level indicates ovarian failure
40
139
when can you do a medical abortion?
140
#1 risk factor for vaginal squamous neoplasia
multiple sexual partners
141
persistent abnormal pap but normal cervical bx, dx?
vulvar intra epithelial neoplasia
colpo directed bx--> local excision, laser ablation or topical 5-FU
142
pap results, what is mgmt if anything other than ASC-US?
colpo + cervical bx
143
pap results: ASC-US, mgmt?
HPV DNA testing
if HPV negative, repeat pap in 1 year
if HPV positive, colpo + cervical bx
144
when do a cone bx
Microinvasion
145
CIN stages relate to what?
how far into epithelium
146
mgmt CIN I
repeat pap Q 6 months x 2 or HPV testing in 12 months
* 65% regress
* LEEP if persistent for 2 years
147
mgmt CIN II or III
LEEP
148
what is the #1 cancer killer of women in 3rd world countries
cervical SCC
149
tx cervical SCC
hysterectomy (stage 0, in situ)
| up to chemo (cisplatin, internal and external radiation for stage IV)
150
how dx endometrial CA in a premenopausal woman?
endometrial bx
151
how dx endometrial CA in a postmenopausal woman?
U/S, endometrial stripe > 5mm --> bx
152
Tx for endometrial CA
TAHBSO
+/-
pelvic/paraaortic LN-ectomy
radiation (if high risk)
153
#1 prognostic factor for endometrial cancer?
grade
154
type 2 endometrial cancer, what etiology?
clear cell
| pap serous
155
#1 RF for ovarian cancer
family history
156
protective factors for ovarian cancer
OCPs
multip
breastfeeding
chronic anovulation
**all decrease ovulation
157
mgmt of ovarian CA?
Dx pelvic U/S --> stage --> tx
158
tx for epithelial ovarian CA
surgery (TAHBSO, omentectomy, pelvic/paraaortic lymph node ectomy) +carboplatin/paclitaxel
159
tx for germ cell ovarian CA?
USO + BEP (bleomycin, etoposide, cisplatin)
160
tx for sex-cord stromal CA?
USO
161
what is Meigs syndrome?
2/2 ovarian cancer: fibroma, ascites and right sided hydrothroax
162
MC ovarian epithelial tumor
serous cystadenocarcinoma
163
psammoma bodies indicate what kind of cancer?
papillary
164
what kind of ovarian cancer: pt with appendiceal carcinoma "jelly belly"
mucinous cystadenocarcinoma
165
tumor with elevated LDH associated with Turner syndrome
dysgerminoma
166
elevated AFP and schiller-duval bodies, dx?
yolk sac tumor
schiller duval bodies look like glomeruli
167
choriocarcinoma has elevated what lab?
b-hcg
168
elevated AFP and bHCG: dx?
teratoma
169
Call-Exner bodies = what kind of tumor?
granulosa cell
170
how dx complete mole?
very elevated bhcg >100k
pelvic US showing snowstorm appearance
Tx: D+C and oxytocin
follow bHCG for a few months
171
#1 RF for breast cancer
Family history
172
rapidly growing breast mass in a teenager: dx and tx
Dx: giant juvenile fibroadenoma
tx: removal to avoid breast deformity (not CA)
173
Phyllodes mgmt
core or incisional bx since FNA is insufficienct, tx: excision with negative margins
174
papilloma mgmt
galactogram/ductogram guided excision due to small risk of carcinoma
175
how dx. fibroadenoma
US or FNA
176
breast mass in 20yo that becomes very large
Phyllodes tumor
does have malignant potential to become a SARCOMA: cannot do FNA, need to do are core bx
177
does a history of trauma rule out breast cancer?
NO
178
how does breast cancer tx change during pregnancy?
no chemo during first trimester
| no radioTHERAPY during pregnancy
179
treatment of a resectable breast tumor?
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
inflammatory cancer mgmt?
needs pre-op chemotherapy
181
DCIS mgmt
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
what meds do women get for ER/PR positive tumors if pre or post menopausal
pre: Tamoxifen
Post: anastrozole
183
how follow up abnormal cell free fetal DNA testing
fetal karyotyping via CVS in first trimester or
| amnio in second trimester
184
initial workup of an adnexal mass in a POSTmenopausal woman
TVUS
| CA-125 level (if high, suspicious for malignancy in a post menopausal woman)
185
what are US features suspicious for an adnexal malignancy on US
size > 10cm
nodular or fixed
ascites
evidence of metastasis
--> Gyn Onc
186
when recommend starting pap smears
age 21 REGARDLESS of sexual activity
187
how does amenorrhea occur in female athletes
caloric deficiency that leads to decreased LH and GnRH which causes an estrogen deficiency
188
tx of acute AUB
high dose estrogen, high dose OCPs, high dose progestin, tanexamic acid if prog/est both contraindicated
189
mgmt of 15 yo with primary amenorrhea who has no breast develop and a uterus?
serum FSH
if low --> MRI
if elevated --> karyotyping
190
tx of recurrent variable decels after oxygen, repositioning?
amnioinfusion: artificial ROM and infusion of saline into the amniotic cavity
191
pt with IUFD with any changes in coagulation
immediate delivery
192
hyperemesis gravidarum: what other test?
US to look for multigestation or molar pregnancy
193
what is the most reliable way to date fetus
crown rump length on first trimester US
194
best way to delay labor in PPROM?
antibiotics
PCN or amp
195
how does GDM effect fetus calcium
HYPOcalcemia due to increased insulin!
196
woman with h/o PID, next best test in workup of infertility?
hysterosalpingogram
197
what is normally seen in woman with pre-existing DM but not women with GDM
IUGR
198
best test to detect severe fetal anemia?
MCA peak systolic velocity
199
what does a negative fetal fibronectin test indicate?
if negative, mom is unlikely to deliver in the next 14 days
200
signs newborn is well hydrated
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
what is the most effective birth control method after abstinence?
depo provera
202
prolonged rupture of membranes
>18hrs before onset of labor
203
ddx IUGR vs. decreased growth potential
decreased growth potential: stays small
| IUGR: falls off growth curve
204
weight cut off where C section is indicated?
4500 g
205
what should you consider if a woman has pre-eclampsia before the 3rd trimester?
trophoblastic dz
206
mgmt and treatment of Chorioamnionitis
* Mgmt: Dx amnioscentesis and cx amniotic fluid
| * Tx: broad spectrum Abx (amp, gent, clinda) and delivery (can be vaginal!)
207
are pre-E and eclampsia RFs for future HTN?
no
208
major causes of pregnancy associated mortality associated with childbirth?
PE
pregnancy induced HTN
hemorrhage
209
causes of oligohydramnios
IUGR, PROM, postmaturity, renal agenesis
210
causes of polyhydramnios
maternal diabetes, multiple gestation, neural tube defects, GI anomalies, hydrops fetalis
211
foul smelling lochia indicates what? tx?
endometritis
clinda and gent since polymicrobial
212
who gets progesterone supplementation during pregnancy?
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
what do you give to patients in preterm labor?
tocolytics
corticosteroids for fetal lung maturity
MgSO4 for neuro protection
214
abnormal non stress text, next step?
BPP
215
GDM target insulin levels
fasting
216
DX premature ovarian failure
FSH in menopausal range for 3 months--> IVF
also have decreased estrogen
217
how dx incompetent cervix?
TVUS
218
mgmt of patient with prolonged PROM?
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
mom with quad screen showing increased risk of Downs Syndrome, next step?
US during 18-20 weeks
220
placenta previa mgmt:
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
how do GFR and BUN change during pregnancy
decrease! 2/2 increase in renal plasma flow and GFR
222
treatment for a threatened abortion
reassurance and outpatient follow up
