OB/GYN Flashcards
classic US and gross appearance of complete hydatiform mole
snowstorm on US and cluster of grapes appearance on gross exam
chromosomal pattern on complete mole
46 XX
molar pregnancy containing fetal tissue
partial mole
symptoms of placental abruption
continuous, painful vaginal bleeding
symptoms of placenta previa
self-limiting, painless vaginal bleeding
when should a vaginal exam be performed w/ suspected placenta previa
never
abx w/ teratogenic effects
tetracycline, fluoroquinolones, aminoglycosides, sulfonamides
meds given to accelerate fetal lung maturity
betamethasone or dexamethasone x 48 hrs
most common cause of postpartum hemorrhage
uterine atony
tx for postpartum hemorrhage
uterine massage; if that fails, oxytocin
typical abx for GBS prophylaxis
IV PCN or ampicillin
pt fails to lactate after an emergency c-section w/ marked blood loss
sheehan’s sydnrome (postpartum pituitary necrosis)
first test to perform when a woman presents w/ amenorrhea
b-hCG (the most common cause of amenorrhea is pregnancy)
cause of amenorrhea w/ normal prolactin, no response to estrogen-progesterone challenge, and hx of D&C
asherman’s syndrome
therapy for polycystic ovarian syndrome
weight loss and OCPs (consider metformin if insulin resistant)
meds used to induce ovulation
clomiphene citrate
diagnostic step required in a postmenopausal woman who presents w/ vaginal bleeding
endometrial biopsy
medical options for endometriosis
OCPs, danazol, GnRH agonists
laparoscopic findings in endometriosis
powder burns, “chocolate cysts”
most common location of ectopic prego
ampulla of the oviduct
most common cause of bloody nipple discharge
intraductal papilloma
contraceptive methods that protect against PID
OCPs and barrier methods
unopposed estrogen is contraindicated in which cancers
endometrial or estrogen receptor + breast cancer
pt w/ recent PID and RUQ pain
consider fitz-hugh-curtis syndrome
breast malignancy presenting as itching, burning, and erosion of the nipple
paget’s dz (underlying adenocarcinoma)
annual screening for women w/ strong family hx of ovarian cancer
CA-125 and transvaginal US
50 yo woman who leaks urine when laughing or coughing. Dx? Tx?
stress incontinence. kegel exercises, estrogen, pessaries, surgery
30 yo woman has unpredictable urine loss. Dx? Tx?
urge incontinence. tx w/ anticholinergics (oxybutynin) or beta-adrenergics (metaproterenol)
lab values suggestive of menopause
increased serum FSH
most common cause of female infertility
endometriosis
breast cancer type that increases the future risk of invasive carcinoma in both breasts
lobular carcinoma in situ
primary causes of third trimester bleeding
placental abruption and placenta previa
type of incontinence - loss of urine only w/ increased intra-abdominal pressure (ie coughing, laughing, exercise)
stress incontinence
type of incontinence - sudden urgency to go to the bathroom (key in the door sign)
urge incontinence
type of incontinence - constant dribbling +/- urgency, w/ inability to completely empty bladder
overflow incontinence
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
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
thick, cottage cheese discharge, vaginal inflammation/pruritus, pH normal (3.8-4.2), budding yeast and pseudohyphae. Dx? Tx?
candida vaginitis. tx w/ fluconazole
pt presents w/ crampy, lower-abdominal pain during menses and a normal PE. Dx? Tx?
primary dysmenorrhea. tx w/ NSAIDs and hormonal contraception
tx for UTI in prego?
nitrofurantoin, amoxicillin or amox-clavulanate, or fosfomycin (avoid fluroquinolones and TMP/SMX)
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
tamoxifen increases the risk of what cancer?
endometrial cancer
first line tx of PMS
SSRI
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)
type of abortion - bleeding/may only have spotting, pain ceased, POC expelled, closed os, US shows empty uterus
complete abortion
type of abortion - bleeding/mild cramping, some POC expelled, open os w/ visible tissue, US shows retained fetal tissue
incomplete abortion
type of abortion - uterine bleeding, +/- pain, no POC expelled, closed os, fetal cardiac motion on US
threatened abortion
type of abortion - uterine bleeding/cramps, no POC expelled, open os, +/- rupture of membranes
inevitable abortion
quad screening finding in trisomy 21
decreased MSAFP and estriol, and increased inhibin A and b-hCG
quad screening finding in trisomy 18
decreased MSAFP, estriol, inhibin A, and b-hCG
hyperglycemia in the first trimester suggests?
pre-existing DM and therefore should be managed as pregestational DM
classic triad of pre-eclampsia
HTN, proteinuria, and edema
HELLP syndrome?
hemolysis, elevated LFTs, and low platelets
triad of ectopic prego?
pain (abdominal), amenorrhea, vaginal bleeding
regular uterine contractions + concurrent cervical change at less than 36 weeks
preterm labor
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)
fever > 38 w/in 36 hrs of delivery + uterine tenderness + malodorous lochia
postpartum endometritis
OCPs decrease the risk of which cancers?
ovarian and endometrial cancers
DDx for acute pelvic pain in women
appendicitis, ruptured ovarian cysts, ovarian torsion/abcess, PID, and ectopic pregnancy
3 signs of placental separation
- gush of blood
- umbilical cord lengthening
- fundus of uterus rises and firms
name 2 labor-inducing agents and mechanism
- vaginal prostaglandins - ripening (softening) of the cervix
- IV pitocin - increases the strength and frequency of contractions
causes of post-partum hemorrhage - 4 T’s
- tissue = retained placenta
- trauma = instrumentation, lacerations, episiotomy
- tone = uterine atony (most common)
- thrombin = coagulation defects, DIC
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
maternal serum alpha-fetoprotein screening - what causes increased? decreased?
increased - open NTD, ventral wall defects, multiple gestations
decreased - aneuoploides (trisomies)
emergency contraception?
most effective is copper IUD (0-120 hrs after intercourse). alternative is progestin pills (0-72 hrs after intercourse)
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)
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
anovulation vs premature ovarian failure
FSH and LH are normal in anovulation vs FSH and LH are increased in premature ovarian failure
anti-psychotic that can cause amenorrhea and galactorrhea
risperidone (due to dopamine effects –> hyperprolactinemia)
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
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
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
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)
