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- Med School Review 🔥 > OB-Gyn > Flashcards

OB-Gyn Flashcards

1
Q

Flank pain that radiates to groin

A

Renal colic (kidney stones)

Dx: US of kidneys & pelvis in pregnant pt

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2
Q

Ferning (Fern Test)

A

+amniotic fluid → Rupture of membranes (detects onset of labor)

  • Occurs due to the presence of sodium chloride in cervical mucus under estrogen effect when the mucus dries on a glass slide. When high levels of estrogen are present, just before ovulation, the cervical mucus forms fern-like patterns due to crystallization of sodium chloride on mucus fibers. Also known as “arborization”.
  • Disappearance of ferning suggests ovulation (when progesterone is dominant hormone)
  • Persistence of ferning throughout menstrual cycle suggests anovulation
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3
Q

Anterior vaginal wall tenderness

A

Bladder pain syndrome

(+urinary Sx)

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4
Q

Postcoital bleeding/spotting

A

Cervical carcinoma

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5
Q

Chronic pelvic pain + uniformly enlarged boggy uterus + HMB (heavy menstrual bleeding)

A

Adenomyosis

(trapped endometrial glands in myometrium)

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6
Q

Tenderness in posterior cul-de-sac

(Pouch of Douglas; between uterus & colon)

A

Endometriosis

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7
Q

Atypical glandular cells on Pap

A

Endometrial biopsy indication

  • +colposcopy
  • +endocervical curettage
  • to r/o cervical or endometrial adenocarcinoma
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8
Q

PCOS ovulation induction if wt loss fails

A

Letrozole > Clomiphene citrate

  • Letrozole = nonsteroidal aromatase inhibitor
  • Better fertility outcomes & fewer heterotrophic pregnancies compared to clomiphene
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9
Q

PCOS first line Tx

A

Wt loss

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10
Q

PCOS menstrual regulation Tx

A

OCPs

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11
Q

Failure of follicle maturation

A

PCOS

MOA: High adipose tissue → High peripheral androgen conversion → Persistently elevated estrone → Inhibitory feedback to hypothalamus → FSH suppression (+lack of LH surge) →Failure of follicle maturation → Infertility

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12
Q

Word catheter placement

A

for Bartholin gland cysts

  • following I&D to allow for continued drainage & reepithelialization of a tract for future drainage
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13
Q

Contraindicated in migraine w/ aura

A

OCPs

(Estrogen-containing medications)

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14
Q

FSH in menopause

A

Elevated

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15
Q

Dx of PMS

A

Symptom diary of luteal phase symptoms

(2 weeks before menses until menses)

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16
Q

PMS Tx

A

SSRIs

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17
Q

Eczematous/ulcerating, itchy rash localized to nipple

A

Paget disease of the breast → Underlying adenocarcinoma

(thought to be caused by migation of neoplastic cells through the mammary ducts to the nipple surface)

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18
Q

UL bloody nipple discharge w/o lesions (clear breast)

A

Breast papilloma

  • When a single tumor grows in a large milk duct, it’s called a solitary intraductal papilloma
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19
Q

Breast binding/tight bras are NOT RECOMMENDED for lactation suppression due to

A

Risk of mastitis, plugged ducts, increased pain, & inadvertent nipple stimulation

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20
Q

Failed induced progesterone withdrawal bleed

A

Asherman syndrome

(intrauterine adhesions)

  • Secondary amenorrhea from previous uterine instrumentation or infection
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21
Q

Mittelschmerz

A

UL abd pain w/ ovulation in young women

(Day 10-14)

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22
Q

Clear, elastic, thin (uncooked egg white in appearance) cervical mucus secretion at cervical os

A

Corresponds to LH surge, indicating ovulation

(occurs just prior to ovulation & used to time intercourse in couples trying to conceive)

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23
Q

Erythematous breast + dimpling or pitting

A

Inflammatory Breast Carcinoma

  • Order mammography, US, & tissue biopsy
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24
Q

Chemotherapy + amenorrhea

A

Ovarian failure

  • Decreased Estrogen (due to loss of estrogen production from follicular granulosa cells)
  • Elevated FSH & LH
  • Normal PRL & TSH
  • Hypergonadotropic hypogonadism (primary ovarian insufficiency)
  • Tx: Hormone replacement therapy (HRT)
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25
Q

Theca cells & granulosa cells produce:

A
  • Theca: Androstenedione (estradiol precursor)
  • Granulosa: Estradiol (conversion from aromatase)
  • Estradiol is later converted to estrogen, which is released from follicle during follicular phase;
  • Estrogen peaks at end of follicular phase causing LH surge
  • Progesterone is released from corpus luteum
  • Progesterone is elevated during luteal phase (following ovulation)
  • Hypothalamus (GnRH) → Anterior Pituitary (LH/FSH) → Ovary (theca/granulosa cells) → androstenedione, estrogen, progesterone (LH)
  • Males:
    • LH → Leydig → T → inhibits hypothalamus & AP
    • FSH → Sertoli → Inhibin → inhibits AP
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26
Q

PID can lead to this presentation w/ RUQ pain

A

Perihepatitis

(Fitz-Hugh-Curtis Syndrome)

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27
Q

Sharp or stabbing pain w/ intercourse

A

Ovarian cyst (ruptured)

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28
Q

Natural form of contraception for first 6 months postpartum

A

Elevated prolactin for lactation (production, not ejection)

  • PRL inhibits GnRH → decreased LH/FSH → Anovulation
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29
Q

Heterosalpingogram

A

Visualization of uterus/fallopian tubes to investigate infertility

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30
Q

Endometriosis after failing NSAIDs & OCPs

A

Diagnostic laparoscopy

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31
Q

Most common reason for female infertility

A

Endometriosis (~25%)

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32
Q

Pts w/ endometriosis are at an increased risk for

A

Infertility

(most common reason for female infertility; ~25%)

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33
Q

Adnexal mass w/o doppler flow

A

Ovarian torsion

(Adnexal torsion)

  • Dx: Ultrasound
  • Tx: Laparoscopy (cystectomy & detorsion)
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34
Q

Cervical lesion

A

“the answer is always colposcopy”

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35
Q

Proliferation of SM cells within the myometrium, irregular uterine enlargement, & chronic anemia/AUB (abnormal uterine bleeding)

A

Leiomyomata uteri

(fibroids)

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36
Q

Uniformly enlarged uterus

A

Adenomyosis

(proliferation of endometrial glands inside the uterine myometrium)

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37
Q

Irregularly enlarged uterus

A

Fibroids

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38
Q

Simple, small, thin-walled cyst

A

Follicular ovarian cyst

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39
Q

Adnexal mass w/ hyperechoic nodules, calcifications

A

Cystic teratoma

(non-seminomatous dermoid ovarian cyst)

  • Elevated B-hCG, Elevated AFP
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40
Q

Stress incontinence is associated with

A

Urethral hypermobility

Tx:

  • Kegels
  • Urethral sling surgery
  • Pseudoephedrine (alpha-adrenergic)
    • SUO POB
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41
Q

Urge incontinence Tx

A
  • Oxybutynin (antimuscarinic) and/or
  • Tamsulosin (alpha-blocker)
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42
Q

Overflow incontinence Tx

A

Bethanechol (cholinergic)

“Bethany call me to stimulate your bowels and bladder”

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43
Q

HTN + Proteinuria in pregnant pt

A

Preeclampsia

  • +seizures = Eclampsia
  • Tx:
    • Delivery
    • Magnesium for Sz PPX
    • Antihypertensive management
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44
Q

Hemolysis, elevated LFTs, thrombocytopenia in pregnant pt

A

HELLP Syndrome

(severe pre-eclampsia)

  • Tx:
    • Delivery
    • Magnesium for Sz PPX
    • Antihypertensive management
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45
Q

UL bloody nipple discharge w/o mass

A

Intraductal Papilloma

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46
Q

Ovarian mass + thick septations + ascites

A

Epithelial ovarian cancer

(from abnormal proliferation of tubal epithelium or ovarian epithelium)

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47
Q

CA-125 is used to detect epithelial ovarian cancer, particularly in:

A

Postmenopausal women

Also elevated in:

  • Leiomyomata
  • Endometriosis
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48
Q

Diminished ovarian reserve in women begins at

A

>35yo

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49
Q

Uterine synechiae

A

Asherman syndrome

(synechiae = adhesions)

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50
Q

Urethral hypermobility

A

Stress Incontinence

  • Kegels
  • Urethral sling surgery (long-term)
  • Pseudoephedrine (alpha-adrenergic)
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51
Q

High-risk HPV

A

16 & 18

(cervical cancer)

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52
Q

Non-high risk strains of HPV

A

6 & 11

(Condylomata acuminata–genital warts)

  • Tx: Trichloroacetic acid or surgical removal
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53
Q

Tamoxifen (SERM) is contraindicated if

A

h/o VTE

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54
Q

Tamoxifen (SERM) can cause

A

Endometrial carcinoma

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55
Q

Antiestrogens/Estrogen antagonists (SERMs) are indicated in

(Tamoxifen, raloxifene, clomiphene citrate)

A

ER+ breast cancer

  • ADE: Vaginal dryness, decreased libido
  • Tamoxifen can lead to endometrial cancer
  • Clomiphene is Tx for PCOS infertility
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56
Q

PPROM Tx

(preterm premature rupture of membranes; <37 wks)

A

Abx + Steroids + Delivery @ 34 weeks

57
Q

Pregnant pt w/ short cervix on TVUS or h/o preterm birth

A

Vaginal progesterone

(to maintain uterine quiescence & protect amniotic membranes against premature rupture)

  • If short cervix AND h/o preterm birth = Cerclage
58
Q

Short cervix on TVUS and h/o preterm birth

A

Cerclage

(if only one, then vaginal progesterone)

59
Q

PPH <24 hours

(postpartum hemorrhage)

A

Uterine atony

Tx:

  • Uterine massage
  • Oxytocin (uterotonic; induces uterine contraction in PPH)
  • Methylergonovine
60
Q

Carboprost (Hemabate), uterotonic in PPH, is contraindicated in

A

Asthma pts

61
Q
  • Oxytocin
  • Methylergonovine (contra in HTN)
  • Carboprost (contra in Asthma)
  • Misoprostol
A

Uterotonics

(Tx for PPH to induce uterine contraction)

62
Q

Breastfeeding contraindications

(TB/HHV/CSG)

A
  • Active TB
  • Maternal HIV
  • Herpetic breast lesions
  • Varicella (active)
  • Chemotherapy/Radiation
  • Active Substance abuse
  • Infantile Galactosemia
63
Q

Baseline OB intake labs (first visit)

A

CBC, A1C, Rubella, Depression screen

64
Q

Ovarian neoplasm risk factors

A
  • Nulliparity
  • FHx
  • BRCA1 or BRCA2
  • Early menarche
  • Late menopause
  • White
  • Increasing age
  • Residence in North America or Northern Europe
65
Q

Ovarian cancer protection w/ OCP use

A

Five years cumulative use decreases lifetime risk by 1/2

66
Q

Vaccines contraindicated in pregnancy

A

MMR & Varicella

67
Q

Thyroid levels in pregnancy

A

Total T3, T4, TBG all increase during pregnancy

(increase levothyroxine dose during pregnancy)

68
Q

Appropriate gestational weight gain

A

25-35 lbs if normal weight

  • If underweight: 28-40 lbs
  • If overweight: 15-25 lbs
  • If obese: 11-20 lbs
69
Q

Valproic acid teratogenic effect

A

Neural tube defects

  • Elevated AFP on 20-week quad screen (ABEI: AFP, Beta-hCG, Estriol, Inhibin A)
70
Q

T1DM teratogenic effects

A

Structural anomalies

(CV, neural tube)

71
Q

Amniocentesis

A

US-guided diagnostic test for karytotype & DNA microarray testing if any pregnancy screen is positive

(_>_15 weeks)

72
Q

Low PAPP-A (pregnancy-associated plasma protein A) on first trimester screen

A

Aneuploidy

  • +thicker NT
73
Q

Risk of IUGR is elevated in

A

Pre-existing diabetes, but not GDM

74
Q

Most common form of inherited mental retardation

A

Fragile X syndrome

(AD Macroorchidism)

75
Q

Most likely cause of elevated MSAFP

A

Underestimation of GA

(5% are NTD)

76
Q

Ibuprofen in pregnancy

A

Can only be taken until 32 weeks of gestation

(due to risk of PDA closure)

77
Q

Irregular contractions

A

Braxton-Hicks contractions

(begin at ~20 weeks, but varies)

78
Q

Indications for prophylactic GBS Tx in unknown GBS status

A
  1. Hx of GBS-infected delivery
  2. Pre-term labor
  3. PROM > 18 hours
  4. Intrapartum fever (_>_38.0)
  5. GBS+ during pregnancy (Intrapartum NAAT+)

If no indications for GBS PPX, recto-vaginal culture at 35-37 weeks

79
Q

PROM risk factors

A
  1. H/o PROM
  2. Genital tract infection (e.g. BV)
  3. Shortened cervical length (<22mm)
  4. Smoking
80
Q

First stage of labor (latent + active)

A
  • Latent labor: 0-6cm
  • Active labor: 6-10cm
81
Q

Second stage of labor

A

Delivery

(from when cervix is completely open to full delivery of baby)

82
Q

Third stage of labor

A

Placenta

83
Q

Umbilical cord prolapse

A

Elevate fetal head + CSx

84
Q

Meconium-stained fluid + depressed infant

A

Intubate trachea, then suction meconium & other aspirated material from beneath the glottis immediately after delivery

85
Q

IUGR + hypoglycemia at birth

A

Maternal T1DM

86
Q

Fetal tachycardia + minimal variability

A

Septic infant (chorioamnionitis)

(pale, lethargic, febrile)

87
Q

HIV + Birth: Protocol?

A

Start AZT on infant immediately

88
Q

Postpartum Blues

A

Up to 2 weeks

89
Q

PP-depression

A

2 weeks to 6mo + ambivalence toward newborn

90
Q

Severe nipple pain

A

Candida

91
Q

Decreases ovarian cancer

A
  • Breastfeeding
  • OCPs
92
Q

Milk production vs. Milk ejection

A
  • Milk production = Prolactin
  • Milk ejection = Oxytocin
93
Q

Female breast duct apparatus development during puberty

A

Insulin & Cortisol (steroid)

94
Q

Tx for early ectopic pregnancy

A

Methotrexate (<4 cm)

95
Q

Hypovolemia + Peritoneal + Positive UPT

A

Ruptured ectopic pregnancy

(Laparoscopy)

96
Q

B-hCG doubles every 48 hours until

A

48d gestation

97
Q

Stimulated by suckling

A

Oxytocin

(milk ejection)

98
Q

No IUP on US + B-hCG over discriminatory zone

A

Ectopic Diagnosis

  • Discriminatory zone = 2000; the level at which an IUP should be seen on US
99
Q

B-hCG levels not rising fast enough w/ pregnancy (doubles every 2d until 48d GA)

A

Ectopic pregnancy

100
Q

B-hCG levels do not fall following diagnostic dilation & curettage (D&C)

A

Ectopic pregnancy

101
Q

Most common aberration leading to SAB

A

Trisomy 16

(14% of chromosomally abnormal abortions)

102
Q

Prolonged Russell viper venom time (dRVVT)

A

APLS

(Antiphospholipid Antibody Syndrome)

  • +recurrent pregnancy loss
  • +h/o VTE
  • Tx: Aspirin + Heparin
103
Q

Medical abortion (mifepristone) is associated with a ___ blood loss than surgical abortion

A

Higher blood loss

104
Q

Mifepristone can be offered in up to __ weeks GA

A

49 days (7 weeks)

  • Vacuum aspiration up to 8w GA
105
Q

Thin, gray homogenous vaginal d/c

A

Bacterial Vaginosis

  • +positive whiff test (w/ potassium hydroxide)
  • +clue cells
  • +pH >4.5
  • Tx: MNZ
106
Q

Itchy vag + thick, white d/c + pH <4

A

Candidiasis

107
Q

Lacy, reticulated labial/perineal pattern + remissions/flares of inflammatory mucocutaneous eruptions of vulva, skin, scalp (alopecia), nails, & gums

A

Lichen planus

108
Q

Itch-scratch-itch cycle w/ normal vaginal pH

A

Lichen simplex chronicus

109
Q

“Cold” or malaise symptoms followed by pruritus/pain

A

Primary HSV-1 infection

110
Q

Low pelvic pain, urinary urgency, hematuria, no d/c

A

UTI

111
Q

HBV exposure treatment (HBsAg positive)

A

HBIG + HBV vaccine series

112
Q

GC/CT Tx

A

CTX + [Azithromycin or Doxycyline]

No doxy if pregnant

113
Q

Order of maturation

A

Thelarche > Adrenarche > Growth spurt > Menarche

  • Thelarche = breast/areolar development (10yo)
  • Adrenarche = onset of axillary/pubic hair growth (pubarche)
  • Menarche = onset of menses (12.7yo; > 85 lbs)
  • Coitarche = age of first intercourse
114
Q

Q-tip test straining angle > 30 degrees

A

Urethral hypermobility

(Genuine Stress Incontinence)

  • Surgical Tx:
    • Retropubic Urethropexy (surgically attaching slings to Cooper’s ligament–retropubic to urethra) to provide tension on urethra)
    • Urethral bulking procedure (collagen injections into external bladder to compress lumen) if 2/2 intrinsic sphincteric deficiency w/o urethral hypermobility
115
Q

Cystometrogram

A

Bladder scan

116
Q

Least invasive tx for pelvic prolapse

A

Pessary fitting

117
Q

Nodularity along back of the uterus along the uterosacral ligaments

A

Endometriosis

118
Q

Chocolate cyst

A

Endometrioma

(Complex ovarian cyst)

  • Functional hemorrhagic cyst = shorter duration
119
Q

Endometriosis first line Tx

A

NSAIDs + OCPs

  • 2nd-line Tx: GnRH agonist (e.g. leuprolide)
  • If still refractory: Diagnostic laparoscopy
  • First-line surgical Tx: Laser ablation
  • Definitive Tx: Hysterectomy w/ BSO
120
Q

Sudden onset pain + nausea + cyst on abd/pelvic US

A

Ovarian torsion

(pain + nausea + cyst = torsion)

121
Q

Tx of mastitis

A

Penicillins

(most commonly staph aureus)

122
Q

CIN III

A

LEEP

  • CIN I = LSIL (low-grade squamous intraepithelial lesion) = No Tx

(becuase not invasive cervical cancer)

123
Q

Acetowhite

A

Staining done during colposcopy to detect areas of high-grade lesions

124
Q

PCOS increases the risk of these cancers

A

Endometrial & ovarian

(due to chronic unopposed estrogen)

125
Q

PP hair loss due to high levels of estrogen is highest at

A

3mo PP

126
Q

AUB (Abnormal Uterine Bleeding) mnemonic

A

PALM-COEIN

(Structural-Nonstructural)

  • Polyp
  • Adenomyosis
  • Leiomyoma
  • Malignancy and hyperplasia
  • Coagulopathy
  • Ovulatory dysfunction
  • Endometrial
  • Iatrogenic
  • Not yet classified
127
Q

Normal endometrial stripe thickness

A

< 4mm

128
Q

Thickened endometrial stripe

A

> 4mm

  • Endometrial cancer
  • Normal aging
  • Tamoxifen
129
Q

Age range of premature ovarian failure

A

<35yo

130
Q

HRT for osteoporosis is contraindicated in

A

CVD

  • Tx: Vit D, 1200mg Calcium, Bisphosphonates
    • ​Bisphosphonates inhibit bone resorption, preserving bone integrity
131
Q

Imipramine (TCA) can cause

A

Hyperprolactinemia

132
Q

Tx for PMDD (severe PMS; PMS refractory to OCPs or SSRIs)

A

BL oophorectomy

133
Q

Nosebleeds during pregnancy

A

Pyogenic granulomas

“Pregnancy tumors”

(vascular lesions on anterior nasal septum common in pregnant women; hormonal)

134
Q

PPROM Tx

A

Ampicillin + Erythromycin to prolong labor

135
Q

Normal FHT

A

110-170

136
Q

Low amniotic fluid glucose

A

Intraamniotic infection

137
Q

Positive phosphatidylglycerol in vaginal fluid

A

Indicator of lung maturity

(or: 34w GA)

138
Q

HTN Tx in pregnancy

A

Hypertensive Moms Love Nifedipine

  • Hydralazine
  • Methyldopa
  • Labetalol
  • Nifedipine
139
Q

Mammography Screening

A

Every 2 years for women age 50-74

- Med School Review 🔥 (23 decks)

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