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OB/GYN Flashcards

1
Q

Mean age of menarche in the US?

A

13

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2
Q

Definition of precocious puberty?

A

puberty

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3
Q

Lab findings distinguish true precocious puberty from pseudoprecocious puberty?

A

True: incr LH/FSH, GnRH increases LH/FSH

Pseudo: decr LH/FSH, no response with GnRH

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4
Q

Some causes of psuedoprecocious puberty?

A

Exogenous hormones, androgen/adrenal tumor, CAH

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5
Q

Treatment for central precocious puberty?

A

continuous GnRH agonist

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6
Q

Which phase of the menstrual cycle is fixed at 14 days, regardless of cycle length?

A

luteal

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7
Q

FSH triggers the release of which hormone from the follicle?

A

estradiol

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8
Q

Premature menopause is defined as menopause before what age?

A

40

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9
Q

WHat is required for a diagnosis of menopause?

A

woman > 45 with 1 year of amenorrhea

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10
Q

As periods become less frequent during perimenopause, what hormonal changes are occurring?

A

incr FSH/LH, fluctuating estrogen and decr response to FSH/LH

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11
Q

Side effects of estrogen? Side effects of progesterone?

A

Estrogen - weight gain, nausea, breast tenderness, HA, endometrial proliferation

progesterone - acne, depression, HTN`

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12
Q

Four different options for emergency contraception?

A

Combo OCP
levonorgestrel
copper IUD
mifepristone

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13
Q

Mechanisms of action of OCPs?

A

inhibit follicle/ovulation, incr cervical mucous, decr chance of implantation

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14
Q

OCP use decreases the incidence of what types of cancer?

A

endometrial CA

ovarian CA

colon CA

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15
Q

Woman present with primary amenorrhea, absent secondary sexual characteristics, and anosmia. What is the diagnosis?

A

Kallmann syndrome

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16
Q

What is the definition of premature ovarian failure?

A

1 year

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17
Q

What is the most common cause of secondary amenorrhea?

A

pregnancy

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18
Q

What is the initial step in the management of a woman presenting with secondary amenorrhea and new galactorrhea when the beta hcg is negative?

A

PRL level

TSH

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19
Q

Basic components of a work up for secondary amenorrhea?

A 
beta hcg
PRL
TSH/FSH
DHEAS/testosterone
progesterone; prog/estrogen challenge
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20
Q

Treatment of choice for primary dysmenorrhea?

A

NSAIDS

OCP

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21
Q

Medications effective in treatment of PMS and PMDD?

A

NSAIDS, OCP, exercise, vit B6, progesterone, SSRI, benzo

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22
Q

first line tx for endometriosus?

A

NSAIDs/OCPS

laparoscopy

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23
Q

Most common cause of female infertility?

A

Endometriosis

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24
Q

3 D’s of endometriosis

A

dysmenorrhea
deep dyspareunia
dyschezia

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25
Q

What is the most common cause of irregular, heavy uterine bleeding?

A

ovulatory dysfunction

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26
Q

When is endometrial biopsy necessary part of work up for abnormal uterine bleeding?

A

> 45 year old

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27
Q

What is the most common clotting disorder that can cause menorrhagia? What lab values are abnormal?

A

von Willebrand disease

incr bleeding time, increase PTT

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28
Q

most common cause of hirsutism in US? What lab finding is used to make the diagnosis?

A

PCOS

incr LH, LH:FSH ratio, incr andorgens, pos progestin challenge

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29
Q

which type of cancer are women with PCOS at increased risk and why?

A

endometrial CA, unopposed estrogen

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30
Q

medications used in the treatment of PCOS?

A

OCP, progesterone, metformin, spironolactone, statin, clomiphene, abx cream

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31
Q

What can lactational amenorrhea be relied upon as an effective method of contraception?

A

if patient only breast feeds every 3-4 hours, and under 6 months from delivery

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32
Q

Distinguishing features of bacterial vaginosis, candida vaginitis, and trichomonas?

A

bact vag - PH > 4.5, clue cells on wet mount

candida - budding hyphae on wet mount

tricho - flagellated organisms on wet mount

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33
Q

treatment of gonorrhea?

A

ceftriaxone

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34
Q

treatment of chlamydia?

A

azithro, doxy

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35
Q

Sexually active woman presents with classic symptoms of cystitis. UA shows no organisms. What organism do you suspect is the cause of this patient’s symptoms?

A

chlamydia

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36
Q

What medications can be used in the treatment of syphilis?

A

PCN G

doxy/tetra

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37
Q

Indications for an endometrial biopsy?

A

woman > 35 with abnormal uterine bleeding

age

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38
Q

What is the next step in the management of a CIN 2 cervical lesion identified on biopsy in a woman who has completed fertility?

A

excision: LEEP, conization, laser

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39
Q

What is the next step in the management of an ASCUS pap smear with positive HPV test?

A

colposcopy

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40
Q

What is the next step in the management of an AGUS pap smear?

A

coloposcopy, endometrial sampling

endo biopsy if > 35

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41
Q

What are the symptoms of ovarian cancer?

A

asymptomatic, abd pain, ascites, wt loss, change in bowel habits, change in menstruation, fatigue, adnexal mass

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42
Q

What are the risk factors for ovarian cancer?

A

fam hx (BRCA 1/2), nulliparity, early menarche, late menopause, infertility

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43
Q

Serum marker may be elevated in cases of ovarian cancer?

A

CA 125

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44
Q

Ultrasound findings consistent with benign ovarian tumors? With malignant ovarian tumors?

A

simple cysts, smooth edges, few septae

complex cysts, irreg, nodularity, many septae, spreading

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45
Q

Type of ovarian tumor is associated with psammomma bodies? Estrogen excess? Andorgen secretion?

A

serous cystadenoma

granulosa/theca cell

sertoli/ leydig cell

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46
Q

complication of gonorrhea or chlamydia that infects the capsule of liver?

A

Fitz Hugh Curtis

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47
Q

Breast disease described as most common tumor in teen and young women

A

fibroadenoma

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48
Q

Breast disease described as most common mass in patients 35-50

A

fibrocystic changes

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49
Q

Breast disease described as often presents with serous or bloody nipple discharge

A

intraductal papilloma

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50
Q

Drugs notable for causing gynecomastia?

A

STACKED

spironolactone
THC
alcohol
cimetidine
ketoconazole
estrogen
dig
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51
Q

most common breast cancer? most common site for breast cancer?

A

invasive ductal CA

upper outer quadrant

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52
Q

Findings suspicious on a mammogram?

A

hyperdense regions, microcalcifications

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53
Q

Treatment for ductal carcinoma in situ of the breast?

A

lumpectomy + radiation

mastectomy

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54
Q

Once you have ruled out invasive cancer, what is the management of LCIS? Why is drug therapy so effective?

A

observe, SERMs, excisional biopsy

LCIS always ER (+), PR (+)

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55
Q

What term describes heavy bleeding during and between menstrual periods?

A

menometrorrhagia

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56
Q

SIgn of early pregnancy matching hyperpigmentation of sun exposed areas of the face

A

chloasma

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57
Q

SIgn of early pregnancy matching hyperpigmentation of midline of lower abdomen

A

linea nigra

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58
Q

SIgn of early pregnancy matching dark bluish red discoloration of the vaginal mucosa

A

chadwick sign

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59
Q

SIgn of early pregnancy matching softening of the cervix

A

Goodall

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60
Q

presence of what hormone is used to confirm pregnancy?

61
Q

LMP February 8, 2015. What is her expected date of delivery?

A

November 15, 2015

62
Q

What does G6P3214 mean?

A

6 pregnancies, 3 term births, 2 preterm, 1 abortion, 4 living children

63
Q

How does Cardiac output change in pregnancy?

64
Q

how does plasma volume change in pregnancy?

65
Q

how does blood pressure change in pregnancy?

66
Q

how does creatinine change in pregnancy

67
Q

What vitamin should be supplemented during pregnancy? Why?

A

folic acid - prevent NTD

68
Q

24 year old woman at 6 weeks gestation comes to the physician for her first prenatal visit. BMI is 28, WHat is the recommended weight gain for this patient during this pregnancy?

69
Q

during pregnancy when should you screen for syphilis

A

first trimester, 3rd trimester

70
Q

during pregnancy when should you screen for quadruple screen

A

15-20 weeks

71
Q

during pregnancy when should you screen for gestational diabetes

72
Q

during pregnancy when should you screen for administration of anti D immunoglobulin

73
Q

during pregnancy when should you screen for GBS

74
Q

40 year old G3P2 woman at 11 weeks gestation comes to the physician for a prenatal visit. Given her age she is concerned about the risk of down syndrome and would like a definitive test immediately. What test should you recommend?

75
Q

Condition suggested by quad screen with incr AFP

A

NTD, abd wall defect, multiple gest, incorrect dating

76
Q

Condition suggested by quad screen with decr AFP, decr estriol, incr hCG, incr inhibin

77
Q

Condition suggested by quad screen with decr AFP, decr estriol, decr hcg

78
Q

hyperemesis gravidarum distinguished from nausea and vomiting of pregnancy?

A

wt loss > 5% pre pregnancy weight, dehydration, ketosis, abnormal labs

79
Q

Treatment for nausea and vomiting of pregnancy?

A

lifestyle
vit B6, doxylamine
diphenhydramine, prometh, ondansetron

80
Q

infants of mothers with pregestational diabetes are at increased risk for what complications?

A

macrosomia, hypoglycemia, spontaneous abortion, cong anomalies (cardiac defects, caudal regression), stillbirth

81
Q

21 year old at 26 weeks gestation comes to the hospital because of fever and back pain. Her temp is 100.9, pulse is 110, resp 22. Physical exam shows left flank tenderness. WHat test confirms diagnosis?

A

UA and culture

82
Q

next step in management of woman with uncomplicated cystitis?

A

nitrofurantoin, TMP-SMX, fospho

83
Q

Condition described as patient with PMH of HTN becomes pregnant

A

chronic HTN

84
Q

Condition described as new onset HTN during pregnancy with no proteinuria

85
Q

Condition described as new onset HTN during pregnancy + proteinuria or end organ dysfunction

A

preeclampsia

86
Q

Condition described as patient with preeclampsia has a seizure

87
Q

Condition described as patient with preeclampsia has anemia, thrombocytopenia, thrombocytopenia, and high AST

88
Q

antihypertensives commonly used during pregnancy?

A

hydralazine, methyldopa, labetalol, nifedipine

89
Q

diagnostic criteria for preeclampsia

A

HTN > 20 weeks 140/90

proteinuria > 300 mg/24 hour or end organ damage

90
Q

definitive treatment for preeclampsia?

91
Q

Which anticoagulant should be avoided during pregnancy?

92
Q

33 year old woman at 39 weeks gestation is admitted to the labor and delivery unit in active labor. During second stage of labor she complains of SOB and then suddenly becomes unresponsive. Pulse cannot be detected. Most likely diagnosis?

A

amniotic fluid embolism

pulmonary embolism

93
Q

Teratogen associated with ebstein anomaly

94
Q

Teratogen associated with yellow-brown discoloration of teeth

A

tetracycline

95
Q

Teratogen associated with phocomelia

A

thalidomide

96
Q

Teratogen associated with short palpebral fissures, smooth philtrum

97
Q

Teratogen associated with clear cell adenocarcinoma of the vagina

98
Q

Teratogen associated with nasal hypoplasia, epiphyseal stippling

99
Q

Teratogen associated with neural tube defects

A

antiepileptic

100
Q

Why should ACEI be avoided during pregnancy?

A

renal/CVS malformations, ossification of skull

101
Q

19 year old G1P0 woman at 32 weeks gestation is brought to the hospital after the sudden onset of vaginal bleeding, abdominal pain, and contractions. She admits to recreational drug use. What drug most likely contributed to this patient’s condition?

102
Q

Preferred medication for treatment of headache

A

acetaminophen

103
Q

Preferred medication for treatment of hypertension

A

hydralazine, methyldopa, labetalol

104
Q

Preferred medication for treatment of diabetes

105
Q

Preferred medication for treatment of DVT

A

heparin, LMWH

106
Q

Congenital infection associated with chorioretinitis + hydrocephalus + intracranial calcifications

107
Q

Congenital infection associated with hydrops fetalis

A

parvovirus B19

108
Q

Congenital infection associated with PDA + cataracts + deafness

109
Q

Congenital infection associated with saddle nose, snuffles, hutchinson teeth, saber shints

110
Q

Abx used for prophylaxis against GBS? Which patient should receive prophylaxis?

A

PCN G

pos GBS, unknown status + 1/3 (intrapartum fever, prolonged ROM, preterm labor)

111
Q

risk factors for ectopic pregnancy?

A

previous ectopic, PID, tubal surgery, smoking, infertility, IUD

112
Q

Patient has vaginal bleeding, LMP 8 weeks ago. beta hcg is 1000. Transvaginal US is unremarkable. Next step in diagnostic evaluation of this patient?

A

beta hcg in 48-72 hours

113
Q

management options for intrauterine fetal demise

A

expectant

D&E

misoprostol, mifepristone, oxytocin

114
Q

Potter sequence?

A 
pulmonary hypoplasia
oligo
twisted skin
twisted face
extremitities
renal agenesis
115
Q

Causes of poly?

A 
esophageal/ duodenal atresia
cong infection
multiple gestation
anencephaly
maternal DM
RH alloimmunization
116
Q

recipient of twin twin transfusion is at risk for what complications?

A

polycythemia
vol overload
heart failure
polyhydramnios

117
Q

Term described by implantation of the placenta over the cervical os

A

placenta previa

118
Q

Term described by fetal blood vessels overlie the cervical os

A

vasa previa

119
Q

Term described by abnormal adherence of the placenta to the myometrium

A

placenta accreta

120
Q

Term described by invasion of the placenta into the myometrium

A

placenta increta

121
Q

Term described by invasion of the placenta through the myometrium

A

placenta percreta

122
Q

Term described by premature separation of the placenta from the uterus before delivery

A

placental abruption

123
Q

presentation of placental abruption differ from that of placenta previa

A

painful vs painless vag bleeding

124
Q

medication used to promote fetal lung maturity

A

corticosteroids

125
Q

what agents are used for tocolysis?

A

mg sulfate, indomethacin, nifedipine, terbutaline

126
Q

What hormone is elevated in gestational trophoblastic disease?

127
Q

Type of hydatidiform mole associated with an increased risk of choriocarcinoma?

128
Q

What is the treatment for choriocarcinoma?

A

chemo (MTX)
surgery
no pregnancy for 1 year

129
Q

What is Rhogam administered?

A

28 weeks, delivery, any risk of fetomaternal hemorrhage

130
Q

antibiotics avoided during pregnancy due to potential teratogenic effects?

A 
fluoroquinolones
tetracycline
chloramphenicol
aminoglycoside
sulfonamide
131
Q

laparoscopic findings can be seen in endometriosis?

A

choc cysts, powder burn lesions

132
Q

Normal reactive nonstress test?

A

2 accelerations > 15 bpm lasting 15 seconds

133
Q

Components of biophysical profile? What is considered a reassuring biophysical profile?

A 
nonstress
AFI
fetal breathing
fetal movement
fetal tone

8-10

134
Q

Medication is used to produce contractions in a contraction stress test?

135
Q

Fetal heart rate of variable deceleration indicates?

A

cord compression

136
Q

Fetal heart rate of sinusoidal pattern indicates?

A

severe anemia

137
Q

Fetal heart rate of early deceleration indicates?

A

head compression

138
Q

Fetal heart rate of late deceleration indicates?

A

uteroplacental insufficiency

139
Q

Stages of labor?

A

1st stage: latent - 0-6cm
active - 6 cm - 10 cm
2nd stage: fully dilated to delivery infant
3rd stage: delivery infant to placenta delivery

140
Q

Signs of placental separation?

A

gush of fluid
umb cord lengthening
uterus changes shape

141
Q

Agents used to induce labor?

A

prostaglandin, oxytocin, amniotomy

142
Q

Clinical features of chorioamnionitis?

A

maternal fever
maternal and fever tachy
uterine tenderness
purulent fluid

143
Q

treatment for chorioamnionitis?

A

broad spectrum antibiotics

delivery

144
Q

Signs of uterine rupture? Management?

A 
fetal brady
abd pain
loss of fetal station
change in uterus shape
maternal tachy and hypotension

treatment: c section, hysterectomy, surgical repair

145
Q

Medications used in management of uterine atony?

A

oxytocin
methylgervonivine
carboprost
misoprostol

146
Q

Male newborn with pulse 110, respirations regular, moves arms and legs spontaneously, gives a strong cry. Pink with bluish hands and feet. Apgar score?

147
Q

Antibiotics used in treatment of postpartum endometritis?

A

gentamicin and clinda

148
Q

What organism is most commonly implicated in postpartum mastitis? what is the treatment?

A

s aureus

dicloxacillin or clinda, TMP-SMX, vanco

149
Q

Cardinal movements of labor?

A 
engaged
descent
flexion
internal rotation
extension
external rotation
expulsion

Step 2 CK (16 decks)

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