OB/GYN Flashcards
What is Nägele’ s rule?
Used to calculate EDC in pregnant woman: 1st day of LMP + 1 year + 7 days - 3 months
Common side effects of emergency contraception?
Nausea - Vomiting - Irregular bleeding - Headache - Breast tenderness - Fatigue
What medication is used in the emergency contraception pill?
Levonorgestrel
Name the 7 Cardinal stages of labor?
Engagement of the head - Descent - Flexion - Internal rotation - Extension - External rotation - Expulsion
Emergency contraception is available over the counter provided the patient is at least ______ years old?
17
Preferred treatment for gestational diabetes?
Insulin
What is the Dx? Abnormal vaginal bleeding elevated betaHCG absent fetal heart tones passage of grape like vesicles and hyperemesis gravidarum?
Molar pregnancy (AKA: Gestational trophoblastic disease)
Most common site of ectopic pregnancy
Fallopian tubes
What is the most likely Dx? Young female with no intrauterine pregnancy by US and elevated betaHCG.
Ectopic pregnancy
Medication often used to treat stable ectopic pregnancy?
Methotrexate
Define the type of abortion? 20 weeks gestation with vaginal bleeding and no cervical dilation.
Threatened abortion
Define the type of abortion? Less than 20 weeks gestation with vaginal bleeding some tissue in vagina tissue in the uterus and dilated cervix.
Incomplete abortion
Define the type of abortion? Less than 20 weeks pregnant with pregnancy tissue seen in vagina an empty uterus and dilated cervix?
Inevitable abortion
Define the type of abortion? No symptoms no cervical dilation in female less than 20 weeks gestation no heartbeat seen in gestational sac.
Missed abortion
What mother/father blood types may lead to Rh incompatibility?
Rh – (negative) mother with an Rh + (positive) father
Treatment for Rh incompatibility?
RhoGAM (Rh Immuno globulin) at 28 weeks gestation and postnatally in non-sensitized patient
Implantation of placenta over the cervical os is called?
Placenta Previa
Which placental disorder presents with painless vaginal bleeding?
Placenta Previa
Define Abruptio Placenta.
Premature separation of the placenta from the uterine wall
Which placental disorder presents with painful vaginal bleeding uterine contractions and fetal distress?
Abruptio placenta
Leakage of amniotic fluid prior to 37 weeks gestation?
Premature Rupture of membranes
What lab test is used to diagnose premature rupture of membranes?
Nitrazine strip test and/or fern test on slide
What 3 markers are screened in the triple screen test to look for potential birth defects?
Maternal AFP - Estriol - HCG
What 4 markers are screened in the pregnant female in the Quad screen?
Maternal AFP - Estriol - HCG - Inhibin A
What vaccines should always be avoided during pregnancy?
All live vaccines (e.g. MMR and Varicella)
What two factors define preeclampsia?
Hypertension and proteinuria
How do you cure a woman with preeclampsia?
Delivering the fetus will cure preeclampsia
What differentiates preeclampsia form eclampsia?
Eclampsia is preeclampsia with seizure (HTN - Proteinuria - Seizure)
Patients with severe eclampsia may develop HELLP syndrome. What does HELLP stand for?
Hemolysis - Elevated Liver enzymes - Low Platelets
What medication is used for seizure prophylaxis in preeclampsia and seizure treatment in eclampsia?
Magnesium
What are the 5 APGAR assessments in the newborn?
Activity (muscle tone) - Pulse - Grimace (reflex irritability) - Appearance (skin color) - Respirations
When is APGAR score assessed?
At 1 min and 5 min after birth (Normal score is 7-10 - Score of < 7 needs to be evaluated further)
What is McRobert’s Maneuver?
Used to manage shoulder dystocia during delivery of the infant. Maternal legs are removed from stirrups and sharply flexed upon the abdomen.
Risk factors for Shoulder dystocia?
Fetal Macrosomia - Diabetic mother - Maternal obesity - Postdate pregnancy
Most common causes of post partum hemorrhage?
Uterine atony (laceration is the second most common cause)
Treatment for Incompetent cervix?
Cervical cerclage
Which hormone is dominant in the follicular phase of menstruation?
Estrogen
Which hormone is dominant in the luteal phase of menstruation?
Progesterone
Premature ovarian failure is defined as the onset of menopause less than ? years old.
< 40 years old
List the “3D’s” of endometriosis symptoms.
Dyspareunia - Dyschezia - Dysmenorrhea
What is the recommended treatment for syphilis in a penicillin allergic non pregnant patient?
Oral doxycycline or azithromycin
What is the recommended treatment for syphilis in a penicillin allergic pregnant patient?
Desensitize and treat with PCN
What does the term procidentia of the uterus refer to?
Complete prolapse of the uterus
List the 4 antihypertensive drugs used in pregnancy.
Alpha-methyldopa - Hydralazine - beta blockers - Calcium channel blockers
What do a lecithin to sphingomyelin ratio > 2:1 and presence of the pulmonary surfactant phosphatidylglycerol represent?
Fetal lung maturity
What is the most likely disorder in a bleeding pregnant patient with a suboptimal rise in betaHCG?
Abortion
What is the most likely disorder in a bleeding pregnant patient with an extremely elevated betaHCG?
Gestational Trophoblastic Disease
What does a snow storm pattern on US likely represent?
Gestational Trophoblastic Disease
Name the emergency contraception which is available over the counter?
Plan B
How often is Depo Provera injection required for contraception maintenance?
Every 12 weeks
Screening test for high risk women for breast cancer?
Mammogram and MRI
Treatment of Fibrocystic breast disease?
NSAIDs - Heat or ice - Supportive bra - Decrease caffeine/chocolate
Painful swollen lumpy breast bilaterally usually before menses?
Fibrocystic breast disease (or fibrocystic changes)
Painless firm solitary/mobile well defined breast lump in young women?
Fibroadenoma
Treatment for breast abscess?
I & D and antibiotics (e.g. cephalexin)
Preferred treatment for atrophic vaginitis?
Topical estrogen cream
Most common organism in bacterial vaginosis?
Gardnerella vaginalis
Greenish/yellow vaginal discharge associated with fishy odor and clue cells on a wet prep?
Bacterial vaginosis
What underlying disorders must be considered in a patient with recurrent candida vaginitis?
Diabetes - HIV - Immunocompromise
Clumpy cheesy thick white vaginal discharge associated with vaginal itching burning erythema?
Candida vaginitis
Which types of HPV virus are most highly associated with cervical cancer?
HPV types 16 & 18
Which types of HPV virus frequently cause Condyloma acuminata?
HPV types 6 & 11
Treatment for genital herpes?
Acyclovir valacyclovir or famciclovir
What causes genital herpes?
Herpes simplex virus (HSV) type 1 or 2
Treatment of Syphilis in early stages (< 1 year)?
Penicillin G 2.4 million units X 1
Single painless chancre of the genitalia?
Primary Syphilis
Treatment for chancroid?
Azithromycin ceftriaxone or ciprofloxacin
Painful ulcerated lesion on vulva or perineal area?
Chancroid
Name the syndrome in which a patient with pelvic inflammatory disease develops RUQ pain pleuritic chest pain and a tender liver.
Fitz-Hugh-Curtis syndrome
What are the recommended treatment options for chlamydia?
Azithromycin or doxycycline
What are the potential complications of gonorrhea infection?
Pelvic inflammatory disease - Septic arthritis - Perihepatitis - Infertility
What is the preferred treatment for Gonorrhea?
Ceftriaxone
Name the common causes of cervicitis.
Chlamydia - Gonorrhea - Trichomonas - Herpes - HPV
Pap smear comes back with ASCUS. What’s next step?
HPV testing
Most common type of cervical cancer?
Squamous cell
Virus associated with cervical cancer?
Human papillomavirus (HPV)
High risk types of HPV virus?
HPV types 16 & 18
What must be considered in female patient complaining of feeling a bulge in the vagina and pelvic pressure?
Uterine prolapse - Cystocele
Most common surgical treatment for symptomatic leiomyoma?
Hysterectomy
Symptoms seen in patients with Leiomyoma?
Range from asymptomatic to irregular/abnormal-heavy uterine bleeding pelvic pressure/pain back pain urinary symptoms
Most common solid benign pelvic tumor in women?
Leiomyoma (Uterine fibroids)
Treatment options for endometriosis?
NSAIDs - Oral contraceptives - Danazol - GnRH agonists (e.g. leuprolide)
List the more common endometriosis symptoms
Abnormal vaginal bleeding - Pelvic pain - Dyspareunia - Infertility - Pain with BM or urination
Growth of endometrial tissue/stroma outside of the uterus in aberrant locations?
Endometriosis
How do you diagnose endometrial cancer?
Endometrial biopsy
Most common type of endometrial cancer?
Adenocarcinoma
Vaginal bleeding in a post-menopausal women is _______ until proven otherwise?
Endometrial cancer
List the treatment options for premenstrual syndrome?
NSAIDs - Selective serotonin reuptake inhibitors - Oral contraceptives - Calcium - Exercise
What do the following define? Weight gain edema mood changes breast tenderness 1-2 weeks before menstruation?
Premenstrual Syndrome
Name 2 preferred treatments for dysmenorrhea.
NSAIDs - Oral contraceptives
Define primary amenorrhea.
Absence of menstruation by age 16
When is the luteal phase of the menstrual cycle?
Days 15-28
When is the follicular phase of the menstrual cycle?
Days 1-14
How many weeks gestation does a fundal height at the level of the umbilicus represent?
20 weeks gestation
Medication used to induce ovulation?
Clomiphene
When should a pregnant women have screening for gestational diabetes?
28 weeks gestation
What is likely in a non-pregnant female with galactorrhea and visual field loss?
Pituitary adenoma
Organism that causes Chancroid?
Haemophilus ducreyi
List the two available HPV vaccines.
Gardasil and Cervarix
What is the most common organism that causes mastitis?
Staph aureus
What organism causes syphilis?
Treponema Pallidum
Treatment for Trichomonas vaginitis?
Metronidazole vaginal or oral
What is the Dx? Foul vaginal discharge with motile flagella on a wet prep?
Trichomonas
Lifetime risk for women for developing breast cancer?
1 in 8 (12%)
Second leading cause of cancer death in women?
Breast cancer
Most common type of Gyn malignancy?
Endometrial cancer
Will estrogen levels in a patient in menopause be elevated or decreased?
Decreased
How do you diagnose menopause?
Lack of menses x 12 months - FSH >30 - Low estradiol levels
Most common organism seen with toxic shock syndrome?
Staph aureus
Name common causes of secondary amenorrhea.
Pregnancy - Thyroid disease - PCOS - Medication/drugs
What is the number 1 cause of secondary amenorrhea?
Pregnancy
If uterine massage fails to stop postpartum hemorrhage, what medications may be used?
Oxytocin - Methylergonovine - Carboprost tromethamine
What is the most common cause of postpartum hemorrhage?
Uterine atony
Which placental disorders can be differentiated by the presence or absence of pain with vaginal bleeding?
Abruptio placentae has painful vaginal bleeding - Placenta previa has painless vaginal bleeding
What is the mode of delivery for a complete placenta previa?
C-section
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?
Abruptio placentae
What is most likey with absent fetal heart tones, vaginal bleeding and a betaHCG level lower than expected for gestation?
Spontaneous abortion
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?
Gestational Trophoblastic Disease
What medication may be used for ectopic pregnancy if surgical management is not appropriate?
Methotrexate
What condition should patients who have recurrent 2nd trimester miscarriages be evaluated for?
Incompetent cervix
A 28 year old pregnant patient presents concerned about “leaking” fluid. The fluid has a positive Fern test. What is the most likely diagnosis?
Premature rupture of membranes
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?
3 hour glucose tolerance test
What electrolyte should be given to a patient who has eclampsia?
Magnesium sulfate
A 28 year old female presents with hypertension and edema and now has seizures. What diagnosis may be confirmed?
Eclampsia (Preeclampsia is HTN and edema without seizures)
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?
Multiple Gestation
An expectant mother has a blood type of B positive. How should you manage her case in regards to Rh incompatibility?
No concern (Rh positive mothers will not have Rh incompatibility)
A 29 year old female is O negative. The father has AB positive blood type. What complication of pregnancy is she at risk for?
Rh incompatibility
What is a normal fetal heart rate?
Normal fetal heart rate is 120-160 - < 120 for > 10 minute = bradycardic - > 160 for > 10 minutes = tachycardic
A newborn is pink, has a heart rate of 110, good respiratory effort, some flexion and grimaces when suctioned. What is the APGAR score?
8
What is a turtle sign during delivery and what does it indicate?
Shoulder dystocia (Turtle sign-retraction of the delivered head against the maternal perineum)
What are some risk factors which would increase the chance for shoulder dystocia?
Fetal macrosomia - Diabetes - Maternal obesity - Postdate pregnancy - Prolonged second stage of labor
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?
Active Phase
Which stage of labor consists of complete dilation of the cervix to delivery of the fetus?
Second stage
A 23 year old pregnant female presents for her prenatal visit. What should be checked at every prenatal visit?
Fetal movement - Blood pressure - Fundal height - Fetal heart tones - Urinalysis
Is the cause of infertility more likely to be a female factor or a male factor?
65% of infertility is due to a female factor
What specific preconception counseling should be given regarding folic acid?
Folic acid should be supplemented at a minimum of 400 mcg
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?
12 months
Can a 16 year old patient buy emergency contraception at the pharmacy without a prescription?
No (17 and older may purchase without a prescription)
When prescribing a contraceptive method, what four parameters must be considered?
Effectiveness - Safety - Reversibility - Acceptability
A 26 year old female presents concerned about white milky bilateral nipple discharge. What are the initial indicated laboratory tests? (3)
Prolactin - TSH - betaHCG
What is considered to be the gold standard for screening patients for breast cancer?
Mammogram
How does a patient’s history regarding pregnancy, menarche and menopause affect her chances of developing breast cancer?
Nulliparity, early menarche and late menopause all increase breast cancer risk
What is the most common type of breast cancer?
Ductal carcinoma is seen in 85% of cases
A 30 year old female presents complaining of bilateral swollen painful breasts prior and during menses. What is the most likely diagnosis?
Fibrocystic breast disease
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?
Fibroadenoma
What is the most common causative agent in a patient with a breast abscess?
Staphylococcus aureus
What antibiotics may be considered in a patient with mastitis and concern for MRSA?
Clindamycin or trimethoprim-sulfamethoxazole
A 68 year old female is diagnosed with a rectocele. What conservative treatment would you recommend?
Kegel exercises - Pelvic floor retraining - Behavioral changes - Bowel regimen
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?
Cystocele
A 50 year old female has a descended uterus with the cervix positioned beyond the hymen. What grade is her uterine prolapse?
Grade 3
What type of vulvar neoplasm is associated with lichen sclerosis, vulvitis, Paget’s and psoriasis?
Differentiated vulvar intraepithelial neoplasm
What is the presence of clue cells on a wet prep associated with?
Bacterial vaginosis
How does vaginal pH affect a woman’s chance of getting bacterial vaginosis?
Increased pH (>4.5) increases the chance of getting bacterial vaginosis
How does vaginal pH affect a woman’s chance of getting vaginal candidiasis?
Lower pH (<4.5) increases the chance of vaginal candidiasis
Which types of human papillomavirus cause 70% of cervical cancer?
16 and 18 cause 70% of cervical cancer
Which types of human papillomavirus cause 90% of genital warts?
6 and 11 cause 90% of genital warts
A 28 year old female presents with finds small flesh colored “cauliflower-like” painless lesions. What is the most likely causative agent?
Human Papillomavirus (HPV)
Name two oral treatments given for vaginal herpes?
Acyclovir and valacyclovir
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?
Genital Herpes
What type of bacteria causes syphilis?
Syphilis is caused by a spirochete bacteria
What is the name of the causative organism of syphilis?
Treponema pallidum
What treatment is recommended for a pregnant patient who has syphilis but is allergic to penicillin?
In pregnant patients allergic to penicillin, it is recommended to desensitize and treat with penicillin
What three antibiotics may be used to treat chancroid?
Azithromycin (or erythromycin) - Ceftriaxone - Ciprofloxacin
A 28 year old female presents with two painful ulcerated genital lesions and inguinal lymphadenopathy. What is the most likely causative agent?
Haemophilus ducreyi (Chancroid)
Pelvic inflammatory disease is often polymicrobial. What are the three most common organisms associated with pelvic inflammatory disease?
Neisseria gonorrhea - Chlamydia trachomatis - Mycoplasma spp.
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?
Fitz-Hugh-Curtis
An 18 year old female with a history of recent unprotected sex has purulent vaginal discharge and dysuria. What is the appropriate treatment?
Ceftriaxone and azithromycin to cover both gonorrhea and chlamydia
A 23 year old female presents with frothy grey-white malodorous discharge. Wet prep finds flagellated protozoa. What treatment is indicated?
Metronidazole or tinidazole for patient with trichomonas
When should a woman have her first Pap smear?
At age 21 as of the 2012 guideline update
Which types of human papillomavirus are responsible for 70% of cervical cancers?
16 and 18
What sexually-transmitted virus increases a woman’s chance of getting cervical cancer?
Human papillomavirus
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?
Cervical Cancer
A 25 year old female has an ASC-US PAP and HPV positive test. What is the most appropriate next step?
Colposcopy
A 27 year old female has Atypical Squamous Cells of Undetermined Significance (ASC-US) on her PAP. What test should be ordered next?
HPV by hybrid 2 capture
The mother of a 12 year old female patient is inquiring about HPV vaccine? Is her daughter eligible for the vaccine?
Yes. Ages 9-26 are eligible for vaccine
What type of ovarian neoplasm will have Micro-Schiller-Duval bodies seen on histology?
Yolk sac/Endodermal Sinus Tumor
What type of ovarian cyst will have hemosiderin laden macrophages on histology?
Chocolate cyst (endometrioma)
What type of ovarian cyst can cause carcinoid syndrome?
Teratoma
What is the chromosomal makeup of the benign cystic teratoma?
46XX
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?
Polycystic Ovarian Syndrome
What is the most likely cause of excessive uterine bleeding with no demonstrable organic cause?
Anovulation or endocrine abnormality
What must always be ruled out in postmenopausal women with vaginal bleeding?
Endometrial Cancer
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?
Nulliparity - Early menarche - Late menopause all increase endometrial cancer risk
What are the three D’s of endometriosis which describe symptoms?
Dyspareunia - Dyschezia -Dysmenorrhea
Almost all uterine fibroids are benign. What type of cancer occurs in the case of a malignant fibroid?
Leiomyosarcoma
What bone disorder must be screened for all postmenopausal women?
Osteoporosis
What hormone would be most definitive in diagnosing menopause in a 54 year old female with amenorrhea?
FSH levels > 30
What are the two most likely causes of her secondary amenorrhea?
Asherman’s Syndrome or Polycystic Ovarian Syndrome
What is the most common cause of secondary amenorrhea?
Pregnancy
What physical exam findings are most important in determining the cause of primary amenorrhea?
Development of sexual characteristics
Primary amenorrhea is defined as the absence of menses by what age?
Primary amenorrhea is defined as absence of menstruation by age 16
What two pathogens are most commonly associated with toxic shock syndrome?
What two pathogens are most commonly associated with toxic shock syndrome?
What is the first line antibiotic for a septic patient with toxic shock syndrome from a retained tampon?
IV clindamycin
Which type of dysmenorrhea usually occurs shortly after menarche?
Primary dysmenorrhea
Which type of dysmenorrhea occurs mostly later in life?
Secondary dysmenorrhea
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?
Secondary
