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PANCE > OB/GYN > Flashcards

OB/GYN Flashcards

1
Q

What is Nägele’ s rule?

A

Used to calculate EDC in pregnant woman: 1st day of LMP + 1 year + 7 days - 3 months

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2
Q

Common side effects of emergency contraception?

A

Nausea - Vomiting - Irregular bleeding - Headache - Breast tenderness - Fatigue

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3
Q

What medication is used in the emergency contraception pill?

A

Levonorgestrel

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4
Q

Name the 7 Cardinal stages of labor?

A

Engagement of the head - Descent - Flexion - Internal rotation - Extension - External rotation - Expulsion

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5
Q

Emergency contraception is available over the counter provided the patient is at least ______ years old?

A

17

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6
Q

Preferred treatment for gestational diabetes?

A

Insulin

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7
Q

What is the Dx? Abnormal vaginal bleeding elevated betaHCG absent fetal heart tones passage of grape like vesicles and hyperemesis gravidarum?

A

Molar pregnancy (AKA: Gestational trophoblastic disease)

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8
Q

Most common site of ectopic pregnancy

A

Fallopian tubes

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9
Q

What is the most likely Dx? Young female with no intrauterine pregnancy by US and elevated betaHCG.

A

Ectopic pregnancy

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10
Q

Medication often used to treat stable ectopic pregnancy?

A

Methotrexate

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11
Q

Define the type of abortion? 20 weeks gestation with vaginal bleeding and no cervical dilation.

A

Threatened abortion

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12
Q

Define the type of abortion? Less than 20 weeks gestation with vaginal bleeding some tissue in vagina tissue in the uterus and dilated cervix.

A

Incomplete abortion

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13
Q

Define the type of abortion? Less than 20 weeks pregnant with pregnancy tissue seen in vagina an empty uterus and dilated cervix?

A

Inevitable abortion

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14
Q

Define the type of abortion? No symptoms no cervical dilation in female less than 20 weeks gestation no heartbeat seen in gestational sac.

A

Missed abortion

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15
Q

What mother/father blood types may lead to Rh incompatibility?

A

Rh – (negative) mother with an Rh + (positive) father

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16
Q

Treatment for Rh incompatibility?

A

RhoGAM (Rh Immuno globulin) at 28 weeks gestation and postnatally in non-sensitized patient

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17
Q

Implantation of placenta over the cervical os is called?

A

Placenta Previa

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18
Q

Which placental disorder presents with painless vaginal bleeding?

A

Placenta Previa

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19
Q

Define Abruptio Placenta.

A

Premature separation of the placenta from the uterine wall

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20
Q

Which placental disorder presents with painful vaginal bleeding uterine contractions and fetal distress?

A

Abruptio placenta

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21
Q

Leakage of amniotic fluid prior to 37 weeks gestation?

A

Premature Rupture of membranes

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22
Q

What lab test is used to diagnose premature rupture of membranes?

A

Nitrazine strip test and/or fern test on slide

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23
Q

What 3 markers are screened in the triple screen test to look for potential birth defects?

A

Maternal AFP - Estriol - HCG

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24
Q

What 4 markers are screened in the pregnant female in the Quad screen?

A

Maternal AFP - Estriol - HCG - Inhibin A

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25
Q

What vaccines should always be avoided during pregnancy?

A

All live vaccines (e.g. MMR and Varicella)

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26
Q

What two factors define preeclampsia?

A

Hypertension and proteinuria

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27
Q

How do you cure a woman with preeclampsia?

A

Delivering the fetus will cure preeclampsia

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28
Q

What differentiates preeclampsia form eclampsia?

A

Eclampsia is preeclampsia with seizure (HTN - Proteinuria - Seizure)

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29
Q

Patients with severe eclampsia may develop HELLP syndrome. What does HELLP stand for?

A

Hemolysis - Elevated Liver enzymes - Low Platelets

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30
Q

What medication is used for seizure prophylaxis in preeclampsia and seizure treatment in eclampsia?

A

Magnesium

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31
Q

What are the 5 APGAR assessments in the newborn?

A

Activity (muscle tone) - Pulse - Grimace (reflex irritability) - Appearance (skin color) - Respirations

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32
Q

When is APGAR score assessed?

A

At 1 min and 5 min after birth (Normal score is 7-10 - Score of < 7 needs to be evaluated further)

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33
Q

What is McRobert’s Maneuver?

A

Used to manage shoulder dystocia during delivery of the infant. Maternal legs are removed from stirrups and sharply flexed upon the abdomen.

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34
Q

Risk factors for Shoulder dystocia?

A

Fetal Macrosomia - Diabetic mother - Maternal obesity - Postdate pregnancy

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35
Q

Most common causes of post partum hemorrhage?

A

Uterine atony (laceration is the second most common cause)

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36
Q

Treatment for Incompetent cervix?

A

Cervical cerclage

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37
Q

Which hormone is dominant in the follicular phase of menstruation?

A

Estrogen

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38
Q

Which hormone is dominant in the luteal phase of menstruation?

A

Progesterone

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39
Q

Premature ovarian failure is defined as the onset of menopause less than ? years old.

A

< 40 years old

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40
Q

List the “3D’s” of endometriosis symptoms.

A

Dyspareunia - Dyschezia - Dysmenorrhea

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41
Q

What is the recommended treatment for syphilis in a penicillin allergic non pregnant patient?

A

Oral doxycycline or azithromycin

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42
Q

What is the recommended treatment for syphilis in a penicillin allergic pregnant patient?

A

Desensitize and treat with PCN

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43
Q

What does the term procidentia of the uterus refer to?

A

Complete prolapse of the uterus

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44
Q

List the 4 antihypertensive drugs used in pregnancy.

A

Alpha-methyldopa - Hydralazine - beta blockers - Calcium channel blockers

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45
Q

What do a lecithin to sphingomyelin ratio > 2:1 and presence of the pulmonary surfactant phosphatidylglycerol represent?

A

Fetal lung maturity

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46
Q

What is the most likely disorder in a bleeding pregnant patient with a suboptimal rise in betaHCG?

A

Abortion

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47
Q

What is the most likely disorder in a bleeding pregnant patient with an extremely elevated betaHCG?

A

Gestational Trophoblastic Disease

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48
Q

What does a snow storm pattern on US likely represent?

A

Gestational Trophoblastic Disease

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49
Q

Name the emergency contraception which is available over the counter?

A

Plan B

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50
Q

How often is Depo Provera injection required for contraception maintenance?

A

Every 12 weeks

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51
Q

Screening test for high risk women for breast cancer?

A

Mammogram and MRI

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52
Q

Treatment of Fibrocystic breast disease?

A

NSAIDs - Heat or ice - Supportive bra - Decrease caffeine/chocolate

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53
Q

Painful swollen lumpy breast bilaterally usually before menses?

A

Fibrocystic breast disease (or fibrocystic changes)

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54
Q

Painless firm solitary/mobile well defined breast lump in young women?

A

Fibroadenoma

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55
Q

Treatment for breast abscess?

A

I & D and antibiotics (e.g. cephalexin)

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56
Q

Preferred treatment for atrophic vaginitis?

A

Topical estrogen cream

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57
Q

Most common organism in bacterial vaginosis?

A

Gardnerella vaginalis

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58
Q

Greenish/yellow vaginal discharge associated with fishy odor and clue cells on a wet prep?

A

Bacterial vaginosis

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59
Q

What underlying disorders must be considered in a patient with recurrent candida vaginitis?

A

Diabetes - HIV - Immunocompromise

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60
Q

Clumpy cheesy thick white vaginal discharge associated with vaginal itching burning erythema?

A

Candida vaginitis

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61
Q

Which types of HPV virus are most highly associated with cervical cancer?

A

HPV types 16 & 18

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62
Q

Which types of HPV virus frequently cause Condyloma acuminata?

A

HPV types 6 & 11

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63
Q

Treatment for genital herpes?

A

Acyclovir valacyclovir or famciclovir

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64
Q

What causes genital herpes?

A

Herpes simplex virus (HSV) type 1 or 2

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65
Q

Treatment of Syphilis in early stages (< 1 year)?

A

Penicillin G 2.4 million units X 1

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66
Q

Single painless chancre of the genitalia?

A

Primary Syphilis

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67
Q

Treatment for chancroid?

A

Azithromycin ceftriaxone or ciprofloxacin

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68
Q

Painful ulcerated lesion on vulva or perineal area?

A

Chancroid

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69
Q

Name the syndrome in which a patient with pelvic inflammatory disease develops RUQ pain pleuritic chest pain and a tender liver.

A

Fitz-Hugh-Curtis syndrome

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70
Q

What are the recommended treatment options for chlamydia?

A

Azithromycin or doxycycline

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71
Q

What are the potential complications of gonorrhea infection?

A

Pelvic inflammatory disease - Septic arthritis - Perihepatitis - Infertility

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72
Q

What is the preferred treatment for Gonorrhea?

A

Ceftriaxone

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73
Q

Name the common causes of cervicitis.

A

Chlamydia - Gonorrhea - Trichomonas - Herpes - HPV

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74
Q

Pap smear comes back with ASCUS. What’s next step?

A

HPV testing

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75
Q

Most common type of cervical cancer?

A

Squamous cell

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76
Q

Virus associated with cervical cancer?

A

Human papillomavirus (HPV)

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77
Q

High risk types of HPV virus?

A

HPV types 16 & 18

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78
Q

What must be considered in female patient complaining of feeling a bulge in the vagina and pelvic pressure?

A

Uterine prolapse - Cystocele

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79
Q

Most common surgical treatment for symptomatic leiomyoma?

A

Hysterectomy

80
Q

Symptoms seen in patients with Leiomyoma?

A

Range from asymptomatic to irregular/abnormal-heavy uterine bleeding pelvic pressure/pain back pain urinary symptoms

81
Q

Most common solid benign pelvic tumor in women?

A

Leiomyoma (Uterine fibroids)

82
Q

Treatment options for endometriosis?

A

NSAIDs - Oral contraceptives - Danazol - GnRH agonists (e.g. leuprolide)

83
Q

List the more common endometriosis symptoms

A

Abnormal vaginal bleeding - Pelvic pain - Dyspareunia - Infertility - Pain with BM or urination

84
Q

Growth of endometrial tissue/stroma outside of the uterus in aberrant locations?

A

Endometriosis

85
Q

How do you diagnose endometrial cancer?

A

Endometrial biopsy

86
Q

Most common type of endometrial cancer?

A

Adenocarcinoma

87
Q

Vaginal bleeding in a post-menopausal women is _______ until proven otherwise?

A

Endometrial cancer

88
Q

List the treatment options for premenstrual syndrome?

A

NSAIDs - Selective serotonin reuptake inhibitors - Oral contraceptives - Calcium - Exercise

89
Q

What do the following define? Weight gain edema mood changes breast tenderness 1-2 weeks before menstruation?

A

Premenstrual Syndrome

90
Q

Name 2 preferred treatments for dysmenorrhea.

A

NSAIDs - Oral contraceptives

91
Q

Define primary amenorrhea.

A

Absence of menstruation by age 16

92
Q

When is the luteal phase of the menstrual cycle?

A

Days 15-28

93
Q

When is the follicular phase of the menstrual cycle?

A

Days 1-14

94
Q

How many weeks gestation does a fundal height at the level of the umbilicus represent?

A

20 weeks gestation

95
Q

Medication used to induce ovulation?

A

Clomiphene

96
Q

When should a pregnant women have screening for gestational diabetes?

A

28 weeks gestation

97
Q

What is likely in a non-pregnant female with galactorrhea and visual field loss?

A

Pituitary adenoma

98
Q

Organism that causes Chancroid?

A

Haemophilus ducreyi

99
Q

List the two available HPV vaccines.

A

Gardasil and Cervarix

100
Q

What is the most common organism that causes mastitis?

A

Staph aureus

101
Q

What organism causes syphilis?

A

Treponema Pallidum

102
Q

Treatment for Trichomonas vaginitis?

A

Metronidazole vaginal or oral

103
Q

What is the Dx? Foul vaginal discharge with motile flagella on a wet prep?

A

Trichomonas

104
Q

Lifetime risk for women for developing breast cancer?

A

1 in 8 (12%)

105
Q

Second leading cause of cancer death in women?

A

Breast cancer

106
Q

Most common type of Gyn malignancy?

A

Endometrial cancer

107
Q

Will estrogen levels in a patient in menopause be elevated or decreased?

A

Decreased

108
Q

How do you diagnose menopause?

A

Lack of menses x 12 months - FSH >30 - Low estradiol levels

109
Q

Most common organism seen with toxic shock syndrome?

A

Staph aureus

110
Q

Name common causes of secondary amenorrhea.

A

Pregnancy - Thyroid disease - PCOS - Medication/drugs

111
Q

What is the number 1 cause of secondary amenorrhea?

A

Pregnancy

112
Q

If uterine massage fails to stop postpartum hemorrhage, what medications may be used?

A

Oxytocin - Methylergonovine - Carboprost tromethamine

113
Q

What is the most common cause of postpartum hemorrhage?

A

Uterine atony

114
Q

Which placental disorders can be differentiated by the presence or absence of pain with vaginal bleeding?

A

Abruptio placentae has painful vaginal bleeding - Placenta previa has painless vaginal bleeding

115
Q

What is the mode of delivery for a complete placenta previa?

A

C-section

116
Q

A patient at 39 weeks gestation has abdominal pain and vaginal bleeding. Fetal monitoring shows a heart rate of 70. What is the most likely diagnosis?

A

Abruptio placentae

117
Q

What is most likey with absent fetal heart tones, vaginal bleeding and a betaHCG level lower than expected for gestation?

A

Spontaneous abortion

118
Q

A 31 year old had her LMP 6 weeks ago and has a betaHCG level of 100,000. Ultrasound shows a “snowstorm pattern”. What is the most likely condition?

A

Gestational Trophoblastic Disease

119
Q

What medication may be used for ectopic pregnancy if surgical management is not appropriate?

A

Methotrexate

120
Q

What condition should patients who have recurrent 2nd trimester miscarriages be evaluated for?

A

Incompetent cervix

121
Q

A 28 year old pregnant patient presents concerned about “leaking” fluid. The fluid has a positive Fern test. What is the most likely diagnosis?

A

Premature rupture of membranes

122
Q

A pregnant patient has a 2 hour blood glucose of 104 on her glucose tolerance test at 28 weeks. What is the most appropriate next diagnostic test to order?

A

3 hour glucose tolerance test

123
Q

What electrolyte should be given to a patient who has eclampsia?

A

Magnesium sulfate

124
Q

A 28 year old female presents with hypertension and edema and now has seizures. What diagnosis may be confirmed?

A

Eclampsia (Preeclampsia is HTN and edema without seizures)

125
Q

What is the most likely condition in a patient who has a fundal height and an alpha-fetoprotein which are greater than expected for her due date?

A

Multiple Gestation

126
Q

An expectant mother has a blood type of B positive. How should you manage her case in regards to Rh incompatibility?

A

No concern (Rh positive mothers will not have Rh incompatibility)

127
Q

A 29 year old female is O negative. The father has AB positive blood type. What complication of pregnancy is she at risk for?

A

Rh incompatibility

128
Q

What is a normal fetal heart rate?

A

Normal fetal heart rate is 120-160 - < 120 for > 10 minute = bradycardic - > 160 for > 10 minutes = tachycardic

129
Q

A newborn is pink, has a heart rate of 110, good respiratory effort, some flexion and grimaces when suctioned. What is the APGAR score?

A

8

130
Q

What is a turtle sign during delivery and what does it indicate?

A

Shoulder dystocia (Turtle sign-retraction of the delivered head against the maternal perineum)

131
Q

What are some risk factors which would increase the chance for shoulder dystocia?

A

Fetal macrosomia - Diabetes - Maternal obesity - Postdate pregnancy - Prolonged second stage of labor

132
Q

A 26 year old pregnant female at 39 weeks with regular contractions is 5 centimeters dilated and 50% effaced. What phase of Stage 1 labor is she in?

A

Active Phase

133
Q

Which stage of labor consists of complete dilation of the cervix to delivery of the fetus?

A

Second stage

134
Q

A 23 year old pregnant female presents for her prenatal visit. What should be checked at every prenatal visit?

A

Fetal movement - Blood pressure - Fundal height - Fetal heart tones - Urinalysis

135
Q

Is the cause of infertility more likely to be a female factor or a male factor?

A

65% of infertility is due to a female factor

136
Q

What specific preconception counseling should be given regarding folic acid?

A

Folic acid should be supplemented at a minimum of 400 mcg

137
Q

A 27 year old woman presents concerned she is infertile. What is the period of time she must actively attempt to get pregnant before she can be considered for infertility testing?

A

12 months

138
Q

Can a 16 year old patient buy emergency contraception at the pharmacy without a prescription?

A

No (17 and older may purchase without a prescription)

139
Q

When prescribing a contraceptive method, what four parameters must be considered?

A

Effectiveness - Safety - Reversibility - Acceptability

140
Q

A 26 year old female presents concerned about white milky bilateral nipple discharge. What are the initial indicated laboratory tests? (3)

A

Prolactin - TSH - betaHCG

141
Q

What is considered to be the gold standard for screening patients for breast cancer?

A

Mammogram

142
Q

How does a patient’s history regarding pregnancy, menarche and menopause affect her chances of developing breast cancer?

A

Nulliparity, early menarche and late menopause all increase breast cancer risk

143
Q

What is the most common type of breast cancer?

A

Ductal carcinoma is seen in 85% of cases

144
Q

A 30 year old female presents complaining of bilateral swollen painful breasts prior and during menses. What is the most likely diagnosis?

A

Fibrocystic breast disease

145
Q

A 24 year old female has a painless, firm, rubbery unilateral breast mass. Ultrasound shows a solid lesion, Bx is negative. What is the most likely diagnosis?

A

Fibroadenoma

146
Q

What is the most common causative agent in a patient with a breast abscess?

A

Staphylococcus aureus

147
Q

What antibiotics may be considered in a patient with mastitis and concern for MRSA?

A

Clindamycin or trimethoprim-sulfamethoxazole

148
Q

A 68 year old female is diagnosed with a rectocele. What conservative treatment would you recommend?

A

Kegel exercises - Pelvic floor retraining - Behavioral changes - Bowel regimen

149
Q

A 74 year old female presents with bulging of the anterior wall of the vagina on exam and voiding dysfunction. What is the most likely diagnosis?

A

Cystocele

150
Q

A 50 year old female has a descended uterus with the cervix positioned beyond the hymen. What grade is her uterine prolapse?

A

Grade 3

151
Q

What type of vulvar neoplasm is associated with lichen sclerosis, vulvitis, Paget’s and psoriasis?

A

Differentiated vulvar intraepithelial neoplasm

152
Q

What is the presence of clue cells on a wet prep associated with?

A

Bacterial vaginosis

153
Q

How does vaginal pH affect a woman’s chance of getting bacterial vaginosis?

A

Increased pH (>4.5) increases the chance of getting bacterial vaginosis

154
Q

How does vaginal pH affect a woman’s chance of getting vaginal candidiasis?

A

Lower pH (<4.5) increases the chance of vaginal candidiasis

155
Q

Which types of human papillomavirus cause 70% of cervical cancer?

A

16 and 18 cause 70% of cervical cancer

156
Q

Which types of human papillomavirus cause 90% of genital warts?

A

6 and 11 cause 90% of genital warts

157
Q

A 28 year old female presents with finds small flesh colored “cauliflower-like” painless lesions. What is the most likely causative agent?

A

Human Papillomavirus (HPV)

158
Q

Name two oral treatments given for vaginal herpes?

A

Acyclovir and valacyclovir

159
Q

A 22 year old female presents with clear genital blisters which open to form multiple coalescing shallow ulcers. The ulcerated areas are painful. What is the most likely diagnosis?

A

Genital Herpes

160
Q

What type of bacteria causes syphilis?

A

Syphilis is caused by a spirochete bacteria

161
Q

What is the name of the causative organism of syphilis?

A

Treponema pallidum

162
Q

What treatment is recommended for a pregnant patient who has syphilis but is allergic to penicillin?

A

In pregnant patients allergic to penicillin, it is recommended to desensitize and treat with penicillin

163
Q

What three antibiotics may be used to treat chancroid?

A

Azithromycin (or erythromycin) - Ceftriaxone - Ciprofloxacin

164
Q

A 28 year old female presents with two painful ulcerated genital lesions and inguinal lymphadenopathy. What is the most likely causative agent?

A

Haemophilus ducreyi (Chancroid)

165
Q

Pelvic inflammatory disease is often polymicrobial. What are the three most common organisms associated with pelvic inflammatory disease?

A

Neisseria gonorrhea - Chlamydia trachomatis - Mycoplasma spp.

166
Q

What is the name of the syndrome in which a patient with pelvic inflammatory disease has right upper quadrant pain, pleuritic chest pain and a tender liver?

A

Fitz-Hugh-Curtis

167
Q

An 18 year old female with a history of recent unprotected sex has purulent vaginal discharge and dysuria. What is the appropriate treatment?

A

Ceftriaxone and azithromycin to cover both gonorrhea and chlamydia

168
Q

A 23 year old female presents with frothy grey-white malodorous discharge. Wet prep finds flagellated protozoa. What treatment is indicated?

A

Metronidazole or tinidazole for patient with trichomonas

169
Q

When should a woman have her first Pap smear?

A

At age 21 as of the 2012 guideline update

170
Q

Which types of human papillomavirus are responsible for 70% of cervical cancers?

A

16 and 18

171
Q

What sexually-transmitted virus increases a woman’s chance of getting cervical cancer?

A

Human papillomavirus

172
Q

A 22 year old female has a history of an ASC-US PAP and HPV positive test. Which cancer does she have an increased risk for developing?

A

Cervical Cancer

173
Q

A 25 year old female has an ASC-US PAP and HPV positive test. What is the most appropriate next step?

A

Colposcopy

174
Q

A 27 year old female has Atypical Squamous Cells of Undetermined Significance (ASC-US) on her PAP. What test should be ordered next?

A

HPV by hybrid 2 capture

175
Q

The mother of a 12 year old female patient is inquiring about HPV vaccine? Is her daughter eligible for the vaccine?

A

Yes. Ages 9-26 are eligible for vaccine

176
Q

What type of ovarian neoplasm will have Micro-Schiller-Duval bodies seen on histology?

A

Yolk sac/Endodermal Sinus Tumor

177
Q

What type of ovarian cyst will have hemosiderin laden macrophages on histology?

A

Chocolate cyst (endometrioma)

178
Q

What type of ovarian cyst can cause carcinoid syndrome?

A

Teratoma

179
Q

What is the chromosomal makeup of the benign cystic teratoma?

A

46XX

180
Q

A 23 year old female has oligomenorrhea and hirsutism. Pelvic US shows enlarged ovaries with a “string of pearls” appearance. What is the likely diagnosis?

A

Polycystic Ovarian Syndrome

181
Q

What is the most likely cause of excessive uterine bleeding with no demonstrable organic cause?

A

Anovulation or endocrine abnormality

182
Q

What must always be ruled out in postmenopausal women with vaginal bleeding?

A

Endometrial Cancer

183
Q

How does a woman’s endometrial cancer risk change in respect to her history of pregnancy, her age of menarche and her age of menopause?

A

Nulliparity - Early menarche - Late menopause all increase endometrial cancer risk

184
Q

What are the three D’s of endometriosis which describe symptoms?

A

Dyspareunia - Dyschezia -Dysmenorrhea

185
Q

Almost all uterine fibroids are benign. What type of cancer occurs in the case of a malignant fibroid?

A

Leiomyosarcoma

186
Q

What bone disorder must be screened for all postmenopausal women?

A

Osteoporosis

187
Q

What hormone would be most definitive in diagnosing menopause in a 54 year old female with amenorrhea?

A

FSH levels > 30

188
Q

What are the two most likely causes of her secondary amenorrhea?

A

Asherman’s Syndrome or Polycystic Ovarian Syndrome

189
Q

What is the most common cause of secondary amenorrhea?

A

Pregnancy

190
Q

What physical exam findings are most important in determining the cause of primary amenorrhea?

A

Development of sexual characteristics

191
Q

Primary amenorrhea is defined as the absence of menses by what age?

A

Primary amenorrhea is defined as absence of menstruation by age 16

192
Q

What two pathogens are most commonly associated with toxic shock syndrome?

A

What two pathogens are most commonly associated with toxic shock syndrome?

193
Q

What is the first line antibiotic for a septic patient with toxic shock syndrome from a retained tampon?

A

IV clindamycin

194
Q

Which type of dysmenorrhea usually occurs shortly after menarche?

A

Primary dysmenorrhea

195
Q

Which type of dysmenorrhea occurs mostly later in life?

A

Secondary dysmenorrhea

196
Q

A 26 year old female has painful periods after she had recovered from a pelvic infection. Is her dysmenorrhea considered to be primary or secondary?

A

Secondary

PANCE (9 decks)

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