OB/ Gyn Flashcards
define the first stage of labor
effacement and early dilataion for latent/ dilation > 3cm for active
define second stage of labor
full dilation ro delivery of the infant
define the third stage of labor
delivery of infant to de;ivery of the placenta
criteria for preterm laboe
- 4 contractions / 20 mniutes or 8 contractions in 60 min
- cervical dilation >1cm
- effacement >80%
Emergency contraception
works up to 120 hours (5 days) post unprotected intercourse
Types: Paraguard IUD; Ella (uiprisbe); Plan B/one step/myway; Yuzpe Regime (using certain OCPs)
HPV not associated with malignancy or neoplasia
types 6,11
Gardisil HPV prevents which types of HPV
6,11,16,18
Gardisil vaccine schedule
initial injection. 2 months and 6 months
pelvic floor muscles injured in childbirth that result in uterine prolapse
transverse and uterosacral ligaments
treatment for incompentent cervix
Surgery: cerclage. Additionally bed rest, devices and pharm agent may be used
Most common cause of spontaneous abortion in the first 12 weeks
chromosomal abnormalities (50%)
what is mcroberts maneuver?
For shoulder dystocia/macrosomia:
flex moms thighs / suprapubic pressure / and episiotomy
what is the significance of late FHR decelerations
uteroplacental insufficiency
fetal hypoxia
? cord compression that causes above.
diagnositc tool for secondary ammenorrhea and eitology of secondary ammenorrhea
TVUS/ABD US
why: endometriosis; adenomyosis; polyps; fibroids; IUD
how can you definitively diagnosis endometriosis?
laparaoscopy
what is the hallmark of endometrial cancer; risk factors
postmenopausal bleeding (90%) exogenous unopposed estrogen therapy; >50lb above ideal body weight;
primary reason for dysfunctional uterine bleeding?
anovulatory cycles; best initial treatment: OCPs
what is the absolute contraindication for OCPS
female >35 yo smoker (increases risk for thromboembolism)
further treatment of cervical lesion that is visible?
not visible?
visible lesion: biospy and send
No visible lesion_ colposcopy
symptoms associated with cervical CA?
most common age?
describe a cervical lesion that needs biopsy
postcoital bleeding and abnomal uterine bleeding
average age at diagnosis 50yo
immediately biopsy a new exophytic, friable bleeding cervical lesion
patient is diagnosed with GTN (gestational trophobastic neoplasm how do you monitor this after D&C?
monitor b-hcg weekly until 3-4 normal values then monthly for 1 year
When do you screen for Gestational diabetes?
what are the tests for this?
usual screening is at 24 weeks with a nonfasting 1 hour glucose tolerance test. : administer 50gm glucose and 1 hour later result should be <140mg/dl IF they fail then 3 hour GTT: administer 100gm and fasting<95; 1 hour <180; 2 hour <155 and 3 hour <140
first line treatment for gestational daibetes
metformin/ glipzide/ diet modification
what is the best method for controling bleeding in DUB with fibroid
Depo Provera 150mcg/q 28 days - decreases bleeding and fibroid size.
how long can the DepoProvera injections alter the menstrual cycle and ovulation?
up to 18 months.
Describe the symptoms associated with vaginal atrophy
thin, clear, sometimes bloody vag discharge;
dyspareunia
pH 5-7
decreased vaginal ruggae
symptoms of and treatment for lichen sclerosis of the vulva
vulvar pruritis; dyspareunia
looks like white patches of the vuvar skin in a figure 8 down to the anus
Treatment : Clobetasol topical to area BID for 14 days
At what age can you recommend a woman to stop screening for PAP and then mammo ( without risk factors)
minimal age for stopping PAP is 65 - needs to have documented 3 consecutive normal paps
MAy stop if hysterectomy snf no history of invasive cervical disease.
May elect to stop mammos at 70`
how is PCOS diagnosed?
by history: hirsute(90%), moderately overweight with acne, menstrual irregularity(90%) and infertility (75%)
Can HIV cross the placenta?
no - it has to be due to contact of fluids - which can occur during delievery. hIV is screened in first trimester labs, and oral treatment initiated if tested positive. If treated 1-8% of maternal/fetal transmission
what are the classic symptoms of endometriosis?
dysmenorrhea deepthrust dyspareunia infertility abnormal uterine bleeding pelvic pain
Abruptio placenta
painful uterine bleeding; medical emergency to deliver baby if large abruption;if minor and baby stable and premature, may closely monotor and bed rest may occur after trauma
Risks for ectopic pregnancy
history of PID; endometriosis, previous tubal surgery; previous ectopic
treatment for ectopic pregnancy
goal: remove ovum if early and small , may try injection of methotrexate to dissolute cells and reduce size; otherwise - surgery
causes for Placenta previs
previous c-section/uterine surgery; leiomyoma, endometriosis.
Treat with bed rest, diagnosied with US, no digital exams for fear of disrupting the placenta
“Painless third trimester bleeding”
what hormone is the secretory phase of the menstrual cycle dominated by (days 14-28)?
progesterone
is a nulliparous or multiparous woman more likely to develop pre-eclampsia?
nulliparous
Purulent cervical discharge should raise your suspicions for what diagnosis?
neisseria gonorrhea
how could a girl with Turner’s syndrome appear?
Webbed neck, wide shield chest, history of primary ammenorrhea
Cervical biopsy comes back with CIN 1 - what is the next step?
repeat pap in 6 months and repete colposcopy in 12 months
what is the MOST COMMON CAUSE of secondary ammenorrhea?
pregnancy
what 3 labs should be ordered in the work up of secondary ammenorrhea?
b-hcg, TSH, prolactin level
define premature birth
delievery before 37 weeks
what is metrorrhagia?
bleeding between menstural cycles
A single mobile firm, nontender solid breast mass is most liekly?
fibroadenoma
What are 3 treatments for uterine prolapse?
pessary, Kegel’s maneuvers; surgical repair
what is the most common causative organism in mastitis?
Staph aureus
Approximately how many weeks pregnant are you when the top of the fundus reaches the pubis symphsis? the umbilicus? the xiphoid?
10-12; 18-20; 37
what is the most common cause of post partum hemmorhage?and the others?
uterine atony
retained products of conception
cervical/vaginal laceraction
Define missed abortion
no vaginal bleeding, cervical os is closed; products of conception are still intrauterine.
define incomplete abortion
open os, vaginal bleeding and passage of tissue; usually need to treat with D&C
define complete abortion
passage of tissue, pain and cramping subsided, cervical os is closed.
At what age is primary amenorrhea diagnosied?
Age 14 if no secondary sex characteristics; 16 if some secondary characteristics present.
What is the first line treatment of mastitis?
Dicloxacillan Cephalexin / Erythormycin second line
also hot compresses, may continue breast feeding
Should a breast feeding mom stop if she deveolps mastitis?
no, not a reason to stop but if abscess develops then she does need to stop.
Physical exam finding of retroverted uterus or uterosacral nodularity is consistent with what diagnosis?
Endometriosis
when should an amniocentesis be performed?
When should chorionic villa sampling be performed?
Triple screen?
15-20 weeks
10-13 weeks
15 week AFP/BHCG/estriol
list 4 factors for breast cancer
BRCA1 BRCA2 +; un-opposed estrogen; nulliparity; early menarche; late menopause
the follicular phase of the menstrual cycle (day 1-13) is dominated by which hormone/
estrogen
how much weight should a woman gain during normal pregnancy?
25-35 lbs
treatment for Trichomonas vaginalis is ?
2gm MEtronidazole one time dose
what 2 medications are commonly used to treat hypertension in pregnancy?
labetolol and methydopa
what is the classic triad of pregnancy?
HTN, edema and proteinuria
Why is ovarian cancer so hard to diagnose?
Symptoms are vague and there are no good markers available. however unexplained GI symptoms, nausea. vomiting, pelvic pain and adnexal mass are worrisome
What 2 important side effects should patients be counseled prior to prescribing metronidazole?
Avoid alcohol(Disulfram reaction) and avoid sun exposure.
Define inevitable abortion
Vaginal bleeding, cramping, open cervix and products of conception are still present.
How is the first day of the menstrual cycle defined?
the first day of bleeding
What is the karyotype for Turner’s syndrome?
45, X they are missing one sex chromosome
What culture medium do you need to grow out Neisseria Gonorrhea?
Thayer Martin
Which four HPV viruses are linked to cervical cancer?
16, 18, 31,and 33
What is the age recommendation for HPV vaccination?
9 - 26 yo
List risk factors for Ovarian Cancer
BRCA1, family history, nulliparity, late menopause, late menopause, Caucasian, Asian
What characteristic subjective complaint will help to differentiate PID from ectopic pregnancy, appendicitis, ovarian torsion and ovarian cyst?
PID has bilateral pelvic pain, the others are usually unilateral.
A patient with primary amenorrhea and low FSH should make you think of what diagnosis?
Hypothalmic pituitary insufficiency
define abortion
delievery of uterine products of conception prior to 20 weeks
is mastitis unilateral or bilateral ?
Unilateral and in only one quadrant
what is full term gestation?
37-42 weeks
when does the quickening occur?
Nulliparous - 18-20 weeks
Multiparous - 14-16 weeks
List 3 risk factors for placentall abruption
PROM, HTN, smoking, cocaine use, AMA
what is the treatment for ovarian cancer?
TAH-BSO, chemo and radiation
what is the name given to the bluish tint to the cervix in early pregnancy?
Chadwick’s sign
A patient has a higher than expected BHCG level and is measuring fundal height more than expected. on Ultrasound there is a snowstorm appearance in the uterus. What do you suspect?
Hydatidiform mole
What medication may be used to control bleeding in uterine atony post delievery
Oxytocin (pitocin)
why is folic acid given as a prenatal vitamin?
to prevent neural tube defects.
what is the most common endometrial cancer?
75% are adenocarcinomas
A patient has Strawberry cervix with copious yellow/green discharge on examination - what does she have??
Trichomonas vaginitis
What organism is present in soft cheese and deli meats that pregnant women are warned to avoid in pregnancy?
Listeria monocytogenes. can cause menigitis
The baby was delivered several minute ago. Suddenly there is an increase in blood flow from the vagina and the cord noticable lengthens. what is the most likely cause of these signs?
Placental separation
What is the most type common type of ovarian cyst?
Functional cyst no treatment is needed.
Is FSH high or low in Turners syndrome?
High - there are no ovaries to respond to the FSH - so there is no negative feed back.
what is the cause of septic arthritis is sexually active young adults?
Neisseria gonorrhea
How many days after conception is a serum bHCG positive?
8 days
If PAP smear come back with anything other than negative or ASCUS what is your next step?
Colposcopy and biopsy
What medication is used to increase surfactant levels and help with fetus lung maturity in preterm labor?
Betamethasone
Name 2 tocolytic agents
MAgnesium sulfate and calcium channel blockers
A woman presents to the ER concerned that she is in preterm labor. What is your first treatment even prior to getting any imaging or lab results?
Give IV fluids - she is likely dehydrated
Name 3 ways to check for ruptured membranes
Pooling in the vagina
Ferning on a slide
Nitrazine test testing the pH
visulize leakage from the cervix with a sterile speculum.
What is the normal range for fetal heart rate?
120-160
What is menorrhagia?
heavy prolonged menstrual flow
What RH combination for mom and dad can cause the mom to create antibodies against the baby’s red blood cells
RH negative mom and Rh positive dad.
When do you give Rhogam to mom?
28 weeks
What are the risks for mom and baby in Gestational Diabetes?
Preeclampsia, macrosomia causing traumatic birth, slowing fetal lung development
What medications are used to treat postpartum metritis?
Clindamycin and gentamycin together
What is the most common infection following a C-section?
Metritis
where is the most common site for ectopic pregnancy?
within a fallopian tube
in a normal early pregnancy , serial bHCG should double over what time?
every 48-72 hours
what is procidentia?
uterine prolapse that extends beyond the introitus
What is the common term for Stein-Levinthal syndrome?
polycystic ovary syndrome.
What is Neigels rule in calcuating a pregnacy EDC?
First day of the last menstrual period +7 days - 3 months
What are the 5 components of the biophysical profile?
non-stress test fetal breathing, 2 body movements, fetal muscle tone and amniotic fluid index
what is a reassuring fetal non-stress test
a positive (reactive) stress test is 2 fetal heart rate accelarations in 20 minutes
