OB/GYN Flashcards
1
Q
First line test for gonorrhea/chlamydia
A
NAAT
2
Q
First line test for gonorrhea/chlamydia
A
NAAT
3
Q
Less than 25, frequency of STD testing
A
Q annual STD testing
4
Q
Do we screen for HPV in women under 30 years old?
A
No; in most women, this is transient
5
Q
Pap frequency: Women 21-30 years old
A
q3 years with cytology only
6
Q
Pap frequency: Women 30-65
A
q5 years w/ HPV
q3 years alone
7
Q
Do we screen for HPV in women under 30 years old?
A
No; in most women, this is transient
8
Q
Pap frequency: Women 21-30 years old
A
q3 years
9
Q
Pap frequency: Women 30-65
A
q5 years w/ HPV
q3 years alone
10
Q
Who doesn’t need a Pap?
A
Women > 65 years old; h/o hysterectomy
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
12
Q
Mammo screening recommendations
A
Mammo at 40 q yearly (or 1-2 years)
USPTF: 50-74 biannual
13
Q
RF cervical cancer
A
No screening (inadequate screening), immunosuppression, early coitarche
14
Q
HPV vaccine age guidelines for females
A
9-26
15
Q
DEXA begins at age
A
65 (less than 65 h/o fragility fx, positive family history, smoking, RA, EtOH)
16
Q
Low bone mass
A
Osteopenia
17
Q
First day of LMP to EDD is how long?
A
40 weeks (0-13, 14-27, 28-40)
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
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
20
Q
N/V in 1st trimester 2/2
A
Progresterone, beta-HCG
21
Q
Severe n/v in pgx
A
Hyperemesis gravidarum (related to high beta-HCG)
22
Q
T/F Female body needs more blood in pgx.
A
T
23
Q
Does CO increase in pgx?
A
Yes! Increased CO (30-50%),
- First half: SV; Second half: HR
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)
25
T/F O2 consumption increases in pgx.
T (Development of respiratory alkalosis 2/2 increased minute ventilation)
26
T/F Hypercoagulable state in pregnancy?
Yes: Increase fibrinogen, decreased protein C/S
27
Blood flow in fetus
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
28
Three shunts of fetal circulation
DV, FO, DA
29
Describe the placenta
Placenta has pools of maternal blood, fetus inserts trophoblastic cells/capillaries into pools; sites of intersection (simple diffusion)
30
T/F High A1C results in high fetal malformation rate
True! And a high miscarriage rate
| -CV, CNS, GI/GU, Skeletal
31
HTN agents contraindicated in pregnancy
Normal: 160/>90
| No ACEi
32
Anti-HTN agents in pgx
Methyldopa, labetalol
33
HTN in pgx a/w
Placental abruption, pre-eclampsia, FGR
34
Guidelines for folate in pregnancy, and for folate for women with a h/o baby with NTD
0.4 mg Folate
| 4 g qd if prior NTD
35
GDM is generally screened for at what week? What about obese women?
1 hour GTT 24-28 weeks; obese: first visit
36
Triple screen; quad screen consists of...
AFP, estriol, HCG, (Inhibin)
37
NST consists of...
Fetal HR, accelerations, 20 minutes (2 accels)
| - 5 movements 1 hour; 10 in 2 hours
38
Decreased AFI means
Decreased fetal shunting of blood to kidneys, more to the brain
39
Fetal lung maturity...
Amnio/ markers of lung maturity
40
Guidelines for weight gain in pregnancy by BMI
BMI 20: 11 lbs
41
Definition of labor
Painful uterine contractions, cervical dilation
42
No dilation with contractions is called
Braxton-Hicks
43
4 Most IMPORTANT questions to ask a laboring woman
1. LOF
2. Vaginal bleeding
3. Painful contractions q 5 minutes/hr
4. Decreased fetal movement
44
Define dilation, effacement, station
Dilation: internal os opening (10 cm)
Effacement: thinning out int-ext os (non = 4 cm)
Station: presenting part to ischial spines 0-->+5
45
The four stages of labor
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
An external tocometer is used to assess ...
Uterine activity
47
Signs of immenent placental delivery
-Gush blood, lengthening of cord
| Fundal massage, gentle cord traction, IV oxytocin
48
Heavy peripartum blood loss complicated by hypotension
Sheehan syndrome; post-partum pituitary infarction
49
Maternal and fetal risk factors for fetal macrosomia
Mat: Age, DM, obesity, multiparity
Fetal: AA/Hispanic, male, post-term
50
Waiter's tip posture
Erb-Duchenne palsy (C5-7)
51
Definition of pre-eclampsia
New onset hypertension (>140/90 at 20 weeks) plus proteinuria or end-organ damage (Severe: TBOpenia, Cr, transaminases, pulmonary edema, visual)
52
Patients with pre-eclampsia at risk for...
Seizures, abruption, hepatic rupture, DIC
53
Drugs for HTN treatment in preeclampsia
Hydralazine, Labetalol, Nifedipine
54
T/F MS can present in pregnancy as CHF/AF-RVR
True (PPCM usually >36 weeks without AF/RVR)
55
Immediate management of hemorrhage from placental abruption
IVF resuscitation, uterine displacement (LL deQ)
56
Role of corpus luteum
Maintain and preserve the corpus luteum during early pregnancy
57
Thin, off white discharge with fishy odor, pH > 4.5; clue cells
BV; Flagyl/Clinda
58
Thin, yellow-green frothy discharge with vaginal inflammation with motile pear-shaped
Trichomonas (Flagyl, treat partner)
59
Low pH vaginosis
Candida
60
Universal screening for GBS infection includes...
Rectovaginal culture at 35-37 weeks gestation
61
Indications for PCN in a pregnant patient with unknown GBS status
18 hours rupture
62
Excessive fundal pressure and traction on the umbilical cord before placental separation can lead to...
Uterine inversion ("A smooth round mass protruding through the cervix/vagina)
63
Severe antenatal pain, loss of station, plpable fetal parts
Uterine rupture
64
Management of Eclampsia
Administer Mg, administer anti-HTN, deliver the fetus
65
Shoulder dislocation: posterior or anterior. More common?
Anterior: blow/fall outstretched arm; abducted, externally rotated
Posterior: adducted, internally rotated
66
Risk factor for clear cell vaginal cancer
In utero exposure to DES
67
Vaginal cancer histologic subtypes posterior vs. anterior
Posterior: SCC
Anterior: Clear cell
68
Most common cause of post-partum hemorrhage; a soft and boggy uterus
Atony
69
Treatment of uterine atony
Bumanual uterine massage, IVF/O2, Oxytocin/Methylergonovine, carboprost, misoprostol
70
What is common about Tetracyclines, FQ, and Bactrim in pregnancy?
Contraindicated
71
Unilateral bloody nipple discharge with no associated mass or LAD
Intraductal papilloma
72
First line treatment for atrophic vaginiits
Vaginal moisturizer/lubricant
| Second line: Topical vaginal estrogen
73
Subareolar, mobile, well-circumscribed, nontender mass
Galactocele
74
T/F Mastitis p/w a fever
True
75
Tumor marker for ovarian ca
CA-125
76
Evaluation of secondary amenorrhea with blood tests includes...
Prolactin (brain), TSH (hypothyroid), FSH (premature ovarian failure)
77
When is an external cephalic version performed?
37 weeks to gestation
78
OCP use can decrease risk of which cancers?
Ovarian and endometrial
79
What is the well-known AE of Lithium in pregnancy?
Ebstein anomaly: atrialization of RV
80
AE of OCP's
VTE, HTN, hepatic adenoma
81
Does Klumpke palsy result in Horner syndrome?
Yes
82
Maternal/Asymmetric factors IUGR/FGR; Symmetric/fetal
Vascular disease, Lupus AC, AI, substance abuse
| Genetics, congenital heart, infections
83
Painless third trimester bleeding
Placenta previa
84
Hypoxemic respiratory failure immediately following delivery leading to cardiogenic shock, DIC
AF embolism
85
Treatment for sudden, overwhelming, or frequent need to empty the bladder
Urge; Anti-muscarinic (oxybutinin_
86
Treatment for constant involuntary dribbling of urine and incomplete emptying
Overflow; Cholinergic agonists (intermittent cath)
87
Test for urtheral hypermobility
Q-tip test; angle of >=30 degrees signals hypermobility with coughing
88
Management of BRBPV at 36-37 weeks 2/2 placenta previa
C-section
89
AIS vs. Mullerian agenesis karyotype
AIS: 46 XY (functioning testes secrete anti-Mullerian)
Mullerian: 46 XX
90
Boggy, tender, globular, freely mobile uterus
Adenomyosis
91
When is doppler sonography of the umbilical artery used?
Evaluation of umbilical artery flow in fetal IUGR
92
A noreactive NST requires further evaluation with...
A biophysical profile or contraction stress test
93
Contraindications to contraction stress test
Placenta previa, prior myomectomy
94
Excess LH in PCOS?
Yes
95
Pathophysiology of PCOS
Abnormal GnRH results in too much LH, not enough FSH, androgen excess
96
Most common organism in lactational mastitis
Staph
97
Maternal thyroid hormone requirement goes up or down during pregnancy
Goes up: increased beta-HCG increases T3/4, increased TBG
98
When is a TOL contraindicated?
Myomectomy with entry into uertus, classical C-section (vertical incision)
99
Trisomy 21 vs. 18 on quad screen
21: increased beta-hcg and inhibin
18: nl inhibin
100
Indications for C-section
Fetal distress, breech, multiple prior C-sections
101
Should HAV/HBV vaccines be given in pregnancy?
Yes
102
Lactational amenorrhea is 2/2
High levels of prolactin
103
HTN in pgx is a/w oligo or poly-hydramnios
Oligo
104
Paget disease is a/w what type of BRCA?
Adenoca
105
Complication of late-term delivery
Oligo
106
AE Herceptin (Trastuzumab)
Cardiac; must get pre-treatment echo
