OB/GYN Flashcards
1
Q
classic US and gross appearance of complete hydatiform mole
A
snowstorm on US and cluster of grapes appearance on gross exam
2
Q
chromosomal pattern on complete mole
A
46 XX
3
Q
molar pregnancy containing fetal tissue
A
partial mole
4
Q
symptoms of placental abruption
A
continuous, painful vaginal bleeding
5
Q
symptoms of placenta previa
A
self-limiting, painless vaginal bleeding
6
Q
when should a vaginal exam be performed w/ suspected placenta previa
A
never
7
Q
abx w/ teratogenic effects
A
tetracycline, fluoroquinolones, aminoglycosides, sulfonamides
8
Q
meds given to accelerate fetal lung maturity
A
betamethasone or dexamethasone x 48 hrs
9
Q
most common cause of postpartum hemorrhage
A
uterine atony
10
Q
tx for postpartum hemorrhage
A
uterine massage; if that fails, oxytocin
11
Q
typical abx for GBS prophylaxis
A
IV PCN or ampicillin
12
Q
pt fails to lactate after an emergency c-section w/ marked blood loss
A
sheehan’s sydnrome (postpartum pituitary necrosis)
13
Q
first test to perform when a woman presents w/ amenorrhea
A
b-hCG (the most common cause of amenorrhea is pregnancy)
14
Q
cause of amenorrhea w/ normal prolactin, no response to estrogen-progesterone challenge, and hx of D&C
A
asherman’s syndrome
15
Q
therapy for polycystic ovarian syndrome
A
weight loss and OCPs (consider metformin if insulin resistant)
16
Q
meds used to induce ovulation
A
clomiphene citrate
17
Q
diagnostic step required in a postmenopausal woman who presents w/ vaginal bleeding
A
endometrial biopsy
18
Q
medical options for endometriosis
A
OCPs, danazol, GnRH agonists
19
Q
laparoscopic findings in endometriosis
A
powder burns, “chocolate cysts”
20
Q
most common location of ectopic prego
A
ampulla of the oviduct
21
Q
most common cause of bloody nipple discharge
A
intraductal papilloma
22
Q
contraceptive methods that protect against PID
A
OCPs and barrier methods
23
Q
unopposed estrogen is contraindicated in which cancers
A
endometrial or estrogen receptor + breast cancer
24
Q
pt w/ recent PID and RUQ pain
A
consider fitz-hugh-curtis syndrome
25
breast malignancy presenting as itching, burning, and erosion of the nipple
paget's dz (underlying adenocarcinoma)
26
annual screening for women w/ strong family hx of ovarian cancer
CA-125 and transvaginal US
27
50 yo woman who leaks urine when laughing or coughing. Dx? Tx?
stress incontinence. kegel exercises, estrogen, pessaries, surgery
28
30 yo woman has unpredictable urine loss. Dx? Tx?
urge incontinence. tx w/ anticholinergics (oxybutynin) or beta-adrenergics (metaproterenol)
29
lab values suggestive of menopause
increased serum FSH
30
most common cause of female infertility
endometriosis
31
breast cancer type that increases the future risk of invasive carcinoma in both breasts
lobular carcinoma in situ
32
primary causes of third trimester bleeding
placental abruption and placenta previa
33
type of incontinence - loss of urine only w/ increased intra-abdominal pressure (ie coughing, laughing, exercise)
stress incontinence
34
type of incontinence - sudden urgency to go to the bathroom (key in the door sign)
urge incontinence
35
type of incontinence - constant dribbling +/- urgency, w/ inability to completely empty bladder
overflow incontinence
36
thin, off-white discharge w/ fishy odor, no inflammation, pH >4.5, clue cells (epithelial cells w/ bacteria attached to surface), positive whiff test (amine odor w/ KOH). Dx? Tx?
bacterial vaginosis (gardnella). tx w/ metronidazole
37
thin, yellow-green, malodorous, frothy discharge, vaginal inflammation/pruritus, pH > 4.5, motile, flaagellated protozoa. Dx? Tx?
trichomoniasis. tx w/ metronidazole. tx partner as well
38
thick, cottage cheese discharge, vaginal inflammation/pruritus, pH normal (3.8-4.2), budding yeast and pseudohyphae. Dx? Tx?
candida vaginitis. tx w/ fluconazole
39
pt presents w/ crampy, lower-abdominal pain during menses and a normal PE. Dx? Tx?
primary dysmenorrhea. tx w/ NSAIDs and hormonal contraception
40
tx for UTI in prego?
nitrofurantoin, amoxicillin or amox-clavulanate, or fosfomycin (avoid fluroquinolones and TMP/SMX)
41
pt presents w/ rapid onset of respiratory failure, severe hypotension, and DIC during or immediately following labor. Dx? Tx?
amniotic fluid emobolism. tx is supportive w/ poor prognosis
42
tamoxifen increases the risk of what cancer?
endometrial cancer
43
first line tx of PMS
SSRI
44
ddx of placental abruption, vs placenta previa, vs uterine rupture
placental abruption = sudden-onset vaginal bleeding, abdominal pain, hypertonic/tender uterus, no loss of fetal station
placenta previa = painless vaginal bleeding, low-lying placenta, no loss of fetal station
uterine rupture = sudden-onset vaginal bleeding, constant abdominal pain, cessation of uterine contractions, palpable fetal parts, fetal deterioration, loss of fetal station
(uterine rupture is differentiated from placental abruption by loss of fetal station vaginally or palpable fetal parts through the site of rupture abdominally)
45
type of abortion - bleeding/may only have spotting, pain ceased, POC expelled, closed os, US shows empty uterus
complete abortion
46
type of abortion - bleeding/mild cramping, some POC expelled, open os w/ visible tissue, US shows retained fetal tissue
incomplete abortion
47
type of abortion - uterine bleeding, +/- pain, no POC expelled, closed os, fetal cardiac motion on US
threatened abortion
48
type of abortion - uterine bleeding/cramps, no POC expelled, open os, +/- rupture of membranes
inevitable abortion
49
quad screening finding in trisomy 21
decreased MSAFP and estriol, and increased inhibin A and b-hCG
50
quad screening finding in trisomy 18
decreased MSAFP, estriol, inhibin A, and b-hCG
51
hyperglycemia in the first trimester suggests?
pre-existing DM and therefore should be managed as pregestational DM
52
classic triad of pre-eclampsia
HTN, proteinuria, and edema
53
HELLP syndrome?
hemolysis, elevated LFTs, and low platelets
54
triad of ectopic prego?
pain (abdominal), amenorrhea, vaginal bleeding
55
regular uterine contractions + concurrent cervical change at less than 36 weeks
preterm labor
56
indications for c-section
maternal factors = prior classical c-section; prior transverse c-section (relative indication); active gential herpes; cervical carcinoma; HIV infection
maternal and child factors = cephalopelvic disproportion; placenta previa/abruption; failed operative vaginal delivery; post-term prego
fetal factors = metal malposition; fetal distress; cord compression/prolapse; erythroblastosis fetalis (Rh incompatibility)
57
fever > 38 w/in 36 hrs of delivery + uterine tenderness + malodorous lochia
postpartum endometritis
58
OCPs decrease the risk of which cancers?
ovarian and endometrial cancers
59
DDx for acute pelvic pain in women
appendicitis, ruptured ovarian cysts, ovarian torsion/abcess, PID, and ectopic pregnancy
60
3 signs of placental separation
1. gush of blood
2. umbilical cord lengthening
3. fundus of uterus rises and firms
61
name 2 labor-inducing agents and mechanism
1. vaginal prostaglandins - ripening (softening) of the cervix
2. IV pitocin - increases the strength and frequency of contractions
62
causes of post-partum hemorrhage - 4 T's
1. tissue = retained placenta
2. trauma = instrumentation, lacerations, episiotomy
3. tone = uterine atony (most common)
4. thrombin = coagulation defects, DIC
63
women w/ abnormal uterine bleeding should undergo ________. tx based on two findings?
endometrial biopsy. two findings include hyperplasia vs cancer. tx hyperplasia w/ progestin therapy. tx cancer w/ hysterectomy
64
maternal serum alpha-fetoprotein screening - what causes increased? decreased?
increased - open NTD, ventral wall defects, multiple gestations
decreased - aneuoploides (trisomies)
65
emergency contraception?
most effective is copper IUD (0-120 hrs after intercourse). alternative is progestin pills (0-72 hrs after intercourse)
66
VEAL - CHOP
decels. ..
1. variable decels - cord compression (bad)
2. early decels - head compression (ok)
3. accelerations - oxygenation (ok)
4. late decels - placental insufficiency (bad)
67
workup for asymptomatic women w/ pelvic mass...
initial workup by transvaginal US and then cancer antigen (CA-125). any elevation in CA-125 in a post-menopausal woman raises suspicion for ovarian cancer. if the US suggests a simple cyst and the CA-125 is not elevated, masses under 10 cm can be watched
68
anovulation vs premature ovarian failure
FSH and LH are normal in anovulation vs FSH and LH are increased in premature ovarian failure
69
anti-psychotic that can cause amenorrhea and galactorrhea
risperidone (due to dopamine effects --> hyperprolactinemia)
70
systemic and topical steroid effects on skin
acneiform eruption characterized by monomorphus, erythematous follicular papules distributed on the face, trunk, and extremities that lack comedones
71
characteristics of uterine atony? tx of uterine atony?
characteristics include soft, boggy, poorly contracted uterus
tx includes bimanual uterine massage, IVF, uterotonic agents (oxytocin, methylergonovine, carboprost), and blood transfusion
72
postpartum pt w/ fever, uterine tenderness and foul-smelling lochia. dx? cause? tx?
postpartum endometritis. cause is polymicrobial infection composed of gram + and gram - organisms, aerobes, and anerobes. tx includes clindamycin and gentamicin
73
woman w/ new onset hirsutism, menstrual dysfunction, negative US, normal uterus/ovaries on US, and adrenal mass noted on US. dx? specifc lab for condition?
androgen-producing adrenal tumor - DHEA-S is specific
(explanation --> androgens produced by women include androstenedione (AS), dehydroepiandrosterone (DHEA), testosterone (T), and DHEA-sulfate (DHEA-S) --> DHEA and T are produced by the ovaries and adrenals, whereas DHEA-S is predominantly produced by the adrenal glands only; since DHEA and DHEA-S are not true androgens (no receptor), they are converted to testosterone, therefore overproduction of these hormones can lead to clinical features of androgen excess)
