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Step 2 > OB/GYN > Flashcards

OB/GYN Flashcards

1
Q

First line test for gonorrhea/chlamydia

A

NAAT

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2
Q

First line test for gonorrhea/chlamydia

A

NAAT

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3
Q

Less than 25, frequency of STD testing

A

Q annual STD testing

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4
Q

Do we screen for HPV in women under 30 years old?

A

No; in most women, this is transient

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5
Q

Pap frequency: Women 21-30 years old

A

q3 years with cytology only

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6
Q

Pap frequency: Women 30-65

A

q5 years w/ HPV

q3 years alone

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7
Q

Do we screen for HPV in women under 30 years old?

A

No; in most women, this is transient

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8
Q

Pap frequency: Women 21-30 years old

A

q3 years

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9
Q

Pap frequency: Women 30-65

A

q5 years w/ HPV

q3 years alone

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10
Q

Who doesn’t need a Pap?

A

Women > 65 years old; h/o hysterectomy

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11
Q

Most significant risk factor for BRCA

A

Age (FH, genetics, early (before 12, after 55), nulliparity, radiation exposure, first child after 30), dense breasts

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12
Q

Mammo screening recommendations

A

Mammo at 40 q yearly (or 1-2 years)

USPTF: 50-74 biannual

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13
Q

RF cervical cancer

A

No screening (inadequate screening), immunosuppression, early coitarche

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14
Q

HPV vaccine age guidelines for females

A

9-26

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15
Q

DEXA begins at age

A

65 (less than 65 h/o fragility fx, positive family history, smoking, RA, EtOH)

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16
Q

Low bone mass

A

Osteopenia

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17
Q

First day of LMP to EDD is how long?

A

40 weeks (0-13, 14-27, 28-40)

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18
Q

Why does T4 rise in early pregnancy?

A

Thyroid: beta-HCG peak at 10 weeks (stimulates maternal T4)
Estrogen: TBG increased, total T4, T3 up, but free is unchanged

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19
Q

CL secretes large volumes of…

Why GERD and gallstones in pregnancy?

A

Progesterone (placenta takes over)

- Relaxes smooth muscles, including LES and gb contractility, GI motility

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20
Q

N/V in 1st trimester 2/2

A

Progresterone, beta-HCG

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21
Q

Severe n/v in pgx

A

Hyperemesis gravidarum (related to high beta-HCG)

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22
Q

T/F Female body needs more blood in pgx.

A

T

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23
Q

Does CO increase in pgx?

A

Yes! Increased CO (30-50%),

- First half: SV; Second half: HR

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24
Q

Supine postural hypotension syndrome in pgx

A

Decreased BP 2/2 progesterone

- Don’t lay flat on back; sleep w/ left tilt (IVC obstruction)

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25
Q

T/F O2 consumption increases in pgx.

A

T (Development of respiratory alkalosis 2/2 increased minute ventilation)

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26
Q

T/F Hypercoagulable state in pregnancy?

A

Yes: Increase fibrinogen, decreased protein C/S

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27
Q

Blood flow in fetus

A

2 umbilical arteries, 1 umbilical vein (in)
- Portal –> liver/ductus venous –> IVC –> RA –> FO (RA–> LA) –> LV –> Aorta (RA–>RV–>Pulm arteries–>Ductus arteriosus)–> Aorta) Aorta –> Iliacs -> Internal –> Umbilical arteries

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28
Q

Three shunts of fetal circulation

A

DV, FO, DA

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29
Q

Describe the placenta

A

Placenta has pools of maternal blood, fetus inserts trophoblastic cells/capillaries into pools; sites of intersection (simple diffusion)

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30
Q

T/F High A1C results in high fetal malformation rate

A

True! And a high miscarriage rate

-CV, CNS, GI/GU, Skeletal

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31
Q

HTN agents contraindicated in pregnancy

A

Normal: 160/>90

No ACEi

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32
Q

Anti-HTN agents in pgx

A

Methyldopa, labetalol

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33
Q

HTN in pgx a/w

A

Placental abruption, pre-eclampsia, FGR

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34
Q

Guidelines for folate in pregnancy, and for folate for women with a h/o baby with NTD

A

0.4 mg Folate

4 g qd if prior NTD

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35
Q

GDM is generally screened for at what week? What about obese women?

A

1 hour GTT 24-28 weeks; obese: first visit

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36
Q

Triple screen; quad screen consists of…

A

AFP, estriol, HCG, (Inhibin)

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37
Q

NST consists of…

A

Fetal HR, accelerations, 20 minutes (2 accels)

- 5 movements 1 hour; 10 in 2 hours

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38
Q

Decreased AFI means

A

Decreased fetal shunting of blood to kidneys, more to the brain

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39
Q

Fetal lung maturity…

A

Amnio/ markers of lung maturity

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40
Q

Guidelines for weight gain in pregnancy by BMI

A

BMI 20: 11 lbs

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41
Q

Definition of labor

A

Painful uterine contractions, cervical dilation

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42
Q

No dilation with contractions is called

A

Braxton-Hicks

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43
Q

4 Most IMPORTANT questions to ask a laboring woman

A
  1. LOF
  2. Vaginal bleeding
  3. Painful contractions q 5 minutes/hr
  4. Decreased fetal movement
44
Q

Define dilation, effacement, station

A

Dilation: internal os opening (10 cm)
Effacement: thinning out int-ext os (non = 4 cm)
Station: presenting part to ischial spines 0–>+5

45
Q

The four stages of labor

A

Stage 1: Latent (dilation to 4 cm–days), Active (4 cm, more rapid 1.2-1.5 cm/hr)
Stage 2: complete dilation –> infant
Stage 3: infant –> placenta
Stage 4: 2 hours post-partum

46
Q

An external tocometer is used to assess …

A

Uterine activity

47
Q

Signs of immenent placental delivery

A

-Gush blood, lengthening of cord

Fundal massage, gentle cord traction, IV oxytocin

48
Q

Heavy peripartum blood loss complicated by hypotension

A

Sheehan syndrome; post-partum pituitary infarction

49
Q

Maternal and fetal risk factors for fetal macrosomia

A

Mat: Age, DM, obesity, multiparity
Fetal: AA/Hispanic, male, post-term

50
Q

Waiter’s tip posture

A

Erb-Duchenne palsy (C5-7)

51
Q

Definition of pre-eclampsia

A

New onset hypertension (>140/90 at 20 weeks) plus proteinuria or end-organ damage (Severe: TBOpenia, Cr, transaminases, pulmonary edema, visual)

52
Q

Patients with pre-eclampsia at risk for…

A

Seizures, abruption, hepatic rupture, DIC

53
Q

Drugs for HTN treatment in preeclampsia

A

Hydralazine, Labetalol, Nifedipine

54
Q

T/F MS can present in pregnancy as CHF/AF-RVR

A

True (PPCM usually >36 weeks without AF/RVR)

55
Q

Immediate management of hemorrhage from placental abruption

A

IVF resuscitation, uterine displacement (LL deQ)

56
Q

Role of corpus luteum

A

Maintain and preserve the corpus luteum during early pregnancy

57
Q

Thin, off white discharge with fishy odor, pH > 4.5; clue cells

A

BV; Flagyl/Clinda

58
Q

Thin, yellow-green frothy discharge with vaginal inflammation with motile pear-shaped

A

Trichomonas (Flagyl, treat partner)

59
Q

Low pH vaginosis

A

Candida

60
Q

Universal screening for GBS infection includes…

A

Rectovaginal culture at 35-37 weeks gestation

61
Q

Indications for PCN in a pregnant patient with unknown GBS status

A

18 hours rupture

62
Q

Excessive fundal pressure and traction on the umbilical cord before placental separation can lead to…

A

Uterine inversion (“A smooth round mass protruding through the cervix/vagina)

63
Q

Severe antenatal pain, loss of station, plpable fetal parts

A

Uterine rupture

64
Q

Management of Eclampsia

A

Administer Mg, administer anti-HTN, deliver the fetus

65
Q

Shoulder dislocation: posterior or anterior. More common?

A

Anterior: blow/fall outstretched arm; abducted, externally rotated
Posterior: adducted, internally rotated

66
Q

Risk factor for clear cell vaginal cancer

A

In utero exposure to DES

67
Q

Vaginal cancer histologic subtypes posterior vs. anterior

A

Posterior: SCC
Anterior: Clear cell

68
Q

Most common cause of post-partum hemorrhage; a soft and boggy uterus

A

Atony

69
Q

Treatment of uterine atony

A

Bumanual uterine massage, IVF/O2, Oxytocin/Methylergonovine, carboprost, misoprostol

70
Q

What is common about Tetracyclines, FQ, and Bactrim in pregnancy?

A

Contraindicated

71
Q

Unilateral bloody nipple discharge with no associated mass or LAD

A

Intraductal papilloma

72
Q

First line treatment for atrophic vaginiits

A

Vaginal moisturizer/lubricant

Second line: Topical vaginal estrogen

73
Q

Subareolar, mobile, well-circumscribed, nontender mass

A

Galactocele

74
Q

T/F Mastitis p/w a fever

A

True

75
Q

Tumor marker for ovarian ca

A

CA-125

76
Q

Evaluation of secondary amenorrhea with blood tests includes…

A

Prolactin (brain), TSH (hypothyroid), FSH (premature ovarian failure)

77
Q

When is an external cephalic version performed?

A

37 weeks to gestation

78
Q

OCP use can decrease risk of which cancers?

A

Ovarian and endometrial

79
Q

What is the well-known AE of Lithium in pregnancy?

A

Ebstein anomaly: atrialization of RV

80
Q

AE of OCP’s

A

VTE, HTN, hepatic adenoma

81
Q

Does Klumpke palsy result in Horner syndrome?

A

Yes

82
Q

Maternal/Asymmetric factors IUGR/FGR; Symmetric/fetal

A

Vascular disease, Lupus AC, AI, substance abuse

Genetics, congenital heart, infections

83
Q

Painless third trimester bleeding

A

Placenta previa

84
Q

Hypoxemic respiratory failure immediately following delivery leading to cardiogenic shock, DIC

A

AF embolism

85
Q

Treatment for sudden, overwhelming, or frequent need to empty the bladder

A

Urge; Anti-muscarinic (oxybutinin_

86
Q

Treatment for constant involuntary dribbling of urine and incomplete emptying

A

Overflow; Cholinergic agonists (intermittent cath)

87
Q

Test for urtheral hypermobility

A

Q-tip test; angle of >=30 degrees signals hypermobility with coughing

88
Q

Management of BRBPV at 36-37 weeks 2/2 placenta previa

A

C-section

89
Q

AIS vs. Mullerian agenesis karyotype

A

AIS: 46 XY (functioning testes secrete anti-Mullerian)
Mullerian: 46 XX

90
Q

Boggy, tender, globular, freely mobile uterus

A

Adenomyosis

91
Q

When is doppler sonography of the umbilical artery used?

A

Evaluation of umbilical artery flow in fetal IUGR

92
Q

A noreactive NST requires further evaluation with…

A

A biophysical profile or contraction stress test

93
Q

Contraindications to contraction stress test

A

Placenta previa, prior myomectomy

94
Q

Excess LH in PCOS?

A

Yes

95
Q

Pathophysiology of PCOS

A

Abnormal GnRH results in too much LH, not enough FSH, androgen excess

96
Q

Most common organism in lactational mastitis

A

Staph

97
Q

Maternal thyroid hormone requirement goes up or down during pregnancy

A

Goes up: increased beta-HCG increases T3/4, increased TBG

98
Q

When is a TOL contraindicated?

A

Myomectomy with entry into uertus, classical C-section (vertical incision)

99
Q

Trisomy 21 vs. 18 on quad screen

A

21: increased beta-hcg and inhibin
18: nl inhibin

100
Q

Indications for C-section

A

Fetal distress, breech, multiple prior C-sections

101
Q

Should HAV/HBV vaccines be given in pregnancy?

A

Yes

102
Q

Lactational amenorrhea is 2/2

A

High levels of prolactin

103
Q

HTN in pgx is a/w oligo or poly-hydramnios

A

Oligo

104
Q

Paget disease is a/w what type of BRCA?

A

Adenoca

105
Q

Complication of late-term delivery

A

Oligo

106
Q

AE Herceptin (Trastuzumab)

A

Cardiac; must get pre-treatment echo

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