Ob/Gyn Flashcards
increased menstrual bleeding, pelvic pain, increased inhibin
granulosa cell tumor
tocolytic contraindications
maternal hemorrhage
chorioamnionitis
Poor fetal testing
closed cervix, empty uterus
complete abortion
MC complication w / forceps
perineal laceration
management of CIN 1
do nothing until 1) still there after 2 years or 2) gets worse.
1) → ablation (cryo or laser)
advantage of laser VS. cryo ablation
maintain squamocolumnar jxn → Can do colps in future
cardinal mvmts of labor
engagement descent flexion int. rotation extension ext. rotation expulsion
Cardinal mvmt @ 0 station
engagement
cardinal mvmt @ ischial spine
int. rotation
deceleration starts after contraction and ends after contraction
late decelerations
deceleration starts with contraction and ends with contraction
early decelerations
rapid decelerations that resolve quickly
variable decelerations
hysterosalpingography contraindication
active pelvic infection
management of prolapsed cord
C-section!
Trendebnburg
fill bladder (500-700 mL)
elevate fetal presentation
post-op fever – when is it ok?
first 48 hours
weeks to do chorionic villus sampling
10-13
weeks to do amniocentesis
14-18
order of puberty/growing things (girls)
thelarche
pubarche
growth spurt
menarche
enlarged, tender, erythematous, firm breasts
inflammatory breast cancer
ddx: cellulitis, mastitis, neglected breast CA
dx: inflammatory breast cancer
mammography
when do you do a Kleihauer-Betke test?
determine how much Rh Ig to give
dx placenta abruption (kinda)
when do you use the Apt test?
dx vasa previa (but not really so much)
tx: postpartum endometritis
clindamycin + gentamicin
pip-tazo if not
ASCUS next steps
HPV testing
negative –> observe
positive –> colp
preg physio: SVR
decreases
preg physio: CO
increases (HR and SV both increase)
preg physio: BP
decrease (SVR down (MAP down), CO up)
preg physio: creatinine
decreases (clearance up)
preg physio: insulin resistance
increases
feedings: 1 wk old
8 - 12/day
type of abortion by weeks gestation
medical: up to 7 (internet says 10)
7 - 14 wks: suction D&C
14+: D&E
tx: pregestational DM, now gestational
insulin (or metformin + insulin)
possible GDM tx
metformin
glyburide
insulin
(not tolbutamide)
FSH level = low ovarian reserve
> 30
tx for low risk of rupture ectopic preg
methotrexate (+ check bHCG @ day 4 and 7 – must go down by 15% or give a second dose/laproscopy)
why would someone be considered low risk ectopic preg
hemodynamically stable
beta-HCG < 5000
gestational sac < 4 mm
no fetal heart tones
pain in endometriosis
right before menses to end of menses
dyspareunia
dyschezia
uterosacral ligaments
dx: solid breast mass
core needle biopsy (even w/ negative mammography)
amniotic fluid pH
~ 7 (turns nitrazine paper blue)
when to test for GBS
35 - 37 wks
only thing continuous cardiotocography has been shown to improve
neonatal seizures (which lack long term effects)
causes of abnormal uterine bleeding
PALM E. COIN polyps adenomyosis leiomyomas (fibroids) malignancy endometrial coagulopathy ovulatory dysfxn (menopause, PCOS, weight, thyroid) iatrogenic not yet classified
enlarged globular uterus + abnormal bleeding
adenomyosis
when to give anti-Rh (D)
~ 28 wks
w/ vaginal bleeding
dx: endometriosis
pain, dysmenorrhea, menorrhagia refratory to tx w/ nsaids + OCPs
after U/S –> laparoscopy
first line tx for depression in preg
psychotherapy then 1) sertraline (not paroxetine) 2) venlafaxine/bupropion 3) nortriptyline
why dyschezia in endometriosis
implanted tissue on rectal serosa –> dyschezia, constipation or cyclic heamtochezia
postpartum: fever, uterine tenderness, purulent lochia
postpartum endometritis
prophylactic ABx for cesarean section
cefazolin (or cefoxitin)
tx for Turners @ puberty
conjugated estrogens
tx for hyperprolactinemia
bromocriptine (or cabergoline)
tx for PCOS wanting kids
clomiphene citrate
w/ or w/o metformin
tx for precocious puberty
leuprolide
goserelin
how much folic acid for someone w/ previous spina bifida
4000 micrograms/day
tx for CIN 2+
LEEP
laser conization
cold-knife conization
MC complication after cesarean
postoperative ileus
preggo w/ hep B tx
tenofovir
telbivudine
hormone levels in PCOS
increased DHEA/T
LH:FSH = 3:1
tx PCOS
OCPs, metformin
amenorrhea + anosmia
Kallman’s (problem in hypothalamus)
when to c section HSV pts
lesions present or prodromal sx (burning/tingling)
ABx for PROM
ampicillin + gentamicin
use clinda w/ penicillin allergy
tx for lichen sclerosis
topical steroid (clobetasol) biopsy first, apparently
dx endometriosis
laparoscopy (not EMB)
f/u after granulosa cell tumors
uterine sampling for endo hyperplasia/cancer
mgmt: visible cervical lesion
biopsy
body measurement that shows IUGR
abdominal circumference
fluid for hypovolemic shock (hemorrhage)
packed RBCs, FFP, platelets (1:1:1)
if none –> lactated ringers or normal saline
changes to surgical protocol w/ shellfish allergies?
no iodine prep –> use alternative (chloroprep)
fetal acceleration =
up 15 bpm for 15 s
fetal deceleration =
drop 15 bpm for 15 s
warfarin in pregnancy
nope
switch to heparin
(if have antiphospholipid ab synd give ASA too)
risk of anemic preggo
PTL
how anemic can preggo be?
Hb < 6 increases risk of PTL
infertility tx: low motility sperm
intrauterine insemination (1st) in vitro insemination (2nd)
LSIL in 21 - 24 yo
Pap next year
LSIL in > 25
colposcopy
if >30 and HPV is neg, you can wait a year
what is EMB for?
endometrial hyperplasia/cancer
urge incontinence path
detrusor muscle instability
urge incontinence tx
muscarinic antagonists (anticholinergics) 2nd: TCAs but not great
IUD relative contraindications
STI in past 3 months
weird uterus
hx of ectopic preg
toxic shock syndrome organisms
group A strep
staph aureus
clostridium sordellii
postpartum, high fever, hTN, diffuse desquamating rash, 2 organ systems involved
toxic shock syndrome (endometritis)
tx for hot flashes
- HRT (E+P) if they have a uterus
- E (w/o uterus)
- SSRI (w/ hx of thromboembolic events)
tx for PMS/PMDD
SSRI
metrorrhagia/menorrhagia in 40 - 50
endometrial polyps
trisomy 13
Patau: facial cleft, rockerbottom feet, digital malforms, holoprosencephaly , cystic hygroma
trisomy 18
Edward: overlapping digits, NTDs, rockerbottom feet, diaphragmatic hernia, choroid plexus cysts
breast lump > 30
usually fibroadenoma
causes of postabortal hemorrhage
common: uterine atony, cervical lac
rare: uterine perf, retained tissue, infection, coagulopathy
trisomy 21 quad
AFP down
Estriol down
hCG up
inhibin up
trisomy 18 quad
AFP down
Estriol down
hCG down
mgmt: PROM
after 34 wks –> induce labor
before 34 wks, not in labor –> expectant management
before 34 wks, in labor –> tocolytics, antenatal corticosteroids
what can you see on hysteroscopy
endo polyps adhesions foreign bodies endocervical lesions uterine septum
risks of IUGR
cerebral palsy
HA, fever and flushing after syphilis tx
Jarisch-Herxheimer rxn
tx w/ acetaminophen + IV fluids
cervical insufficiency vs PTL
in CS, dilation is painless
in PTL there are painful contractions
recurrent preg loss definition
3+ spontaneous abortions w/ same partner
mgmt of recurrent preg loss
maternal anatomu exam immuno workup (anticardiolipin abs and lupus anticoag) mat/pat karyotype analysis
cervical ripening agents
misoprostol
dinoprostol
(contraindicated w/ hx c section)
mgmt: postmenopausal bleeding
EMB > TVUS
tx asrhma during preg
albuterol PRN
add daily budesonide if needed
wtf is the Kleihauer-Betke test
tests for fetomaternal hemorrhage (detects/measures fetal blood cells in maternal circulation)
stillbirth postmortem testing
CBC UDS RPR (or past) blood Ab screen glucose/glycosylated glucose (or past GTT) Kleihauer-Betke/flow cytometry
HIV viral load that –> c-section
> 1000 copies/mL
ABx for GBS (+) mom
penicillin G @ onset of labor
vaccines for HIV (+) preggers
pneumococcal
flu (inactivated)
TDaP
Hep A/B
other name for human placental lactogen (HPL)
chorionic somatomammotropin
monozygotic twins: chorio/amnio/split time
MC: monochorionic, diamniotic, split btwn 4 - 8 days
recommended weight gain for under/normal/over/obese preggers
28 - 40 lbs (under)
25 - 35 lbs (normal)
15 - 25 (over)
11 - 20 (obese)
CA a/w DES exposure
clear cell adenocarcinoma of vagina/cervix
cheapest birth control
IUD (if use for at least 2 yrs)
mgmt: postpartum hemorrhage, boggy uterus
bimanual uterine massage
oxytocin
uterotonics:
1. misoprostol (PGE1 analogue)
2. carboprost (PGF2-alpha analogue) – not w/ asthma
3. methylergonovine (ergot) – not w/ HTN
if all else fails –> surgery, even TAH if encessary
Rh alloimmunization test
indirect Coombs
cause of bleeding 2 weeks post spontaneous abortion
no infection clues –> retained products of conception
infection –> septic abortion, endometritis
imaging for bulging vagina/cyclic pain w/o bleeding
pelvic MRI > TVUS
measurement limiting head engagement
obstetrical conjugate - shortest AP diameter in females – shortest distance from sacral promontory to pubic symphysis
intrapartum varicella infection consequences
scarring rash (cicatricial)
limb hypoplasia
chorioretinitis
normal post-void value
50 mL
>200 –> retention
mgmt: postmenopausal w/ terrible hot flashes
combination E+P (if have uterus)
E only if uterus-less
