Ob-gyn Flashcards
The secretory phase of the menstrual cycle (days 14-28) is dominated by what hormone?
Progesterone
Is a nulliparous or multiparous woman more likely to get preeclampsia?
Nulliparity is a risk factor
Since a genetic cause is the number one reason for primary amenorrhea what is one very important test?
Karotype
Prurulent cervical discharge should make you think of what dx?
Neisseria gonorrhoeae
A description of a young girl with a web neck or wide shield chest should make you think of what dx?
Turner’s syndrome
A cervical bx comes back as C1N1. What is the next step?
Repeat Pap smear in 6 mos. repeat colposcopy in 12 mos.
What is the most common cause of secondary amenorrhea?
Pregnancy
What 3 labs should you consider if you are considering secondary amenorrhea?
Beta-HCG
TSH
Prolactin
Define premature birth
Delivery before 37 weeks
A unilateral, single, mobile, firm, nontender solid breast mass should make you think of what dx?
Fibroadenoma
Define metorrhagia
Bleeding between menstrual cycles
Postmenopausal bleeding is immediately believed to be what dx
Endometrial cancer until proven otherwise
During what portion of the menstrual cycle does PMS occur?
By definition it is in the second half and menstruation should relieve the symptoms
How do you tx Bacterial vaginosis?
Metronidazole x 7d
What location within the pelvis is endometriosis most commonly found ?
On an ovary
What lab text is the gold standard for chlamydia?
Nucleic acid amplification test
Are fibrocystic breast masses usually bilateral or unilateral?
Bilateral
How do you definitively dx endometriosis?
Exploratory laparoscopy
What is the most common uterine tumor?
Leiomyoma, aka fibroids
What ethnic background is at an increased risk for fibroids?
African Americans are 5x more likely to have fibroids compared to Caucasian women
How do you tx vaginal candida?
Fluconazole po 1 dose or azole cream x 1 wk
What is the first step of tx for endometrial cancer?
Total hysterectomy and bilateral salpingo-oophorectomy
If you see the term chocolate cyst, it should make you think of what dx?
Endometrioma
A surge in what hormone leads to ovulation?
Luteinizing hormone (LH)
A pt presents with irregular menses, hitsutism& infertility. What is the most likely dx?
Pcos
What endocrine issue is associated with PCOS?
Insulin insensitivity
You have a pt with PCOS who would like to get pregnant. What are two medications you may start her on?
Metformin and clomid
What is the medical tx for an early ectopic pregnancy?
Methotrexate
An ovarian cyst that contains hair and teeth should make you think of what dx?
Teratoma
What is the mean age for ovarian cancer!
63
You will need to think of this in an older pt with vague symptoms
Define the second stage of labor
Fully dilated to delivery
A 67 yo female pt presents with bouts of nausea, weight loss and vague abdominal pain. What is the most likely dx?
Ovarian cancer
When is it recommended to begin pap smears?
Guidelines suggest beginning at age 21 regardless of sexual activity
A cervical bx comes back as CIN2 or 3. What is your next step?
Excision-LEEP, cold knife (worry about incompetent cervix), cryotherapy
List 2 risk factors for cervical cancer.
Multiple sexual partners
Smoking
How much time needs to pass before diagnosing secondary amenorrhea?
If cycles have been normal 3 months. If cycles have been abnormal 6 months.
What is a cystocele?
A herniation of the bladder into the vagina
What is the tx for Turner’s syndrome?
Cyclical estrogen and progesterone
What are three treatments for uterine prolapse?
Pessary
Kegel’s maneuvers
Surgical repair
What is the most common organism that causes mastitis?
Staph aureus
At approximately how many weeks pregnant is the uterus at the level of the umbilicus?
20 weeks
What is the most common of postpartum hemorrhage?
Uterine atony
Define missed abortion
No baginal bleeding, cervical is closed, products of conception are still inside
At what age is primary amenorrhea diagnosed?
Age 14 if no secondary sex characteristics. Age 16 if some secondary development.
What is the first line tx for mastitis?
Dicloxacillin
Cephalexein or erythromycin are second line
Should a breast feeding mother stop breastfeeding if she develops mastitis?
Mastitis is not a reason to stop, but an abscess is.
A physical exam revealing a retroverted uterus or uterosacral ligament nodularity should make you think of what dx?
Endometriosis
At how many weeks of pregnancy can an amniocentesis be done?
15-20 weeks
List four risk factors for breast cancer
BRCA1 or BRCA2 positive Unopposed estrous Nulliparity Early menarche Late menopause
What is the average age of menopause?
51
The follicular phase of menstruation is dominated by what hormone?
Estrogen
About how much weight should a woman gain during pregnancy?
20-35lbs
Thin, sticky malodorous vaginal discharge should make you think of what dx?
Bacterial vaginosis
Vaginal infection with motile flagellated Protozoa should make you think of what dx?
Trichomonas vaginitis
List 2 meds commonly used for hypertension in pregnancy
Methyldopa
Labetalol
What is the classic triad of preeclampsia?
HTN
Edema
Proteinuria
Why is ovarian cancer so hard to diagnose?
There are no good markers and the symptoms are very vague.
What are two important things you need to tell pts before putting them on metronidazole?
Stay out of the sun and avoid alcohol
Define inevitable abortion
Vaginal bleeding
Cervix is open
Products of conception are still inside
How is the first day of the menstrual cycle defined?
The first day of bleeding
What is the karotype for a pt with Turner’s syndrome?
45, X
They are missing one sex chromosome
Give the definition of preterm Labor
Contractions that open the cervix before 37 weeks
A pt presents with mucopurulent discharge and cervical motion tenderness. What is the most likely dx?
Chlamydia-cervicitis
Which four human papilloma viruses are linked to cervical cancer?
HPV 16, 18, 31, 33
Clue cells should make you think of what dx?
Bacterial vaginosis
What is the hallmark physical exam finding for placenta previa?
Trick: never do a PE on a pt with suspected placenta previa.
What medium do you need to grow out Neisseria gonorrhea?
Thayer-Martin
What age range is the HPV vaccination recommended for?
9-26 yo
A patient with primary amenorrhea and a low FSH should make you think of what dx?
Hypothalamic pituitary insufficiency
What characteristic of pelvic inflammatory disease will help differentiate it in a question stem from ectopic pregnancy, appendicitis, ovarian torsion and ovarian cyst?
It will be bilateral pain. Most other common abdominal complaints have unilateral pain.
List 2 risk factors for ovarian cancer.
BRCA1 family history nulliparity late menopause Caucasian Asian
Define abortion
Delivery of uterine contents before 20 weeks.
Does mastitis tend to be unilateral or bilateral?
Unilateral and only one quadrant.
Define full term.
Delivery at 37-42 weeks.
When does quickening occur?
Nulliparous 18-20 weeks, Multiparous 14-16 wks
List three risk factors for placental abruption.
HTN smoking AMA cocaine use PROM
What is the treatment for ovarian cancer.
Total hysterectomy and bilateral sapling-oophorectomy. then chemo and radiation.
A patient believes she is pregnant. You notice that her cervix appears a little blue. What is the name of this sign?
Chadwick’s sign
At approximately how many weeks pregnant is the uterus at the level of the symphysis pubis?
12 wks
A snowstorm appearance on ultrasound should make you think of what dx?
Hydatidiform mole
What medication can be used to control bleeding due to uterine atony?
Oxytocin (Pitocin)
What is the term when the placenta has implanted directly over the cervical os?
Placenta previa
At how many weeks of pregnancy can chorionic villus sampling be done?
10-13 wks
Why is folic acid given as a prenatal vitamin?
Low folic acid can leave to neural tube defects.
What is the most common endometrial cancer?
75% are adenocarcinomas
A strawberry cervix with copious yellow/green discharge should make you think of what dx?
Trichomonas vaginitis
What organism causes us to warm pregnant pts to stay away from deli meats and soft cheeses?
Listeria
The baby was delivered several minutes ago. Suddenly there is an increase in blood flow from the vagina and the cord noticeably lengthens. What is the most likely cause of these signs?
Placental separation
What are two medications used to induce labor?
Cervidil (prostaglandin gel applied to the cervix) which encourages ripening and oxytocin which encourages uterine contractions.
As part of the antepartum testing a baby has a positive stress test. What does that mean?
They have have 2 heart rate accelerations in a :20 period of 15 beats above baseline for at least 15 seconds. This is a good thing.
Is FSH high/low in Turner’s syndrome?
High, there are no ovaries to respond to FSH and so there is no negative feedback.
What is the most common type of ovarian cyst?
Functional cyst: no tx necessary
Defined threatened abortion.
Vaginal bleeding, closed cervix, products of conception are still inside.
List 4 risk factors for endometrial cancer
Chronic unopposed estrogen nulliparity early menarche late menopause tamoxifen DM obesity HTN breast CA ovarian CA
What would you expect to see on a KOH prep if the pt had vaginal candidiasis?
Pseudohyphae
What is the #1 cause of septic arthritis in sexually active young adults?
Neisseria gonorrheae
How many days after conception is a serum beta-HCG positive?
8
If the pap smear results come back anything other than negative or ASCUS what is your next step?
Colposcopy and biopsy
Grape-like vesicles or a sack of grapes on ultrasound should make you think of what dx?
hydatidiform mole
What med is used to increase surfactant levels and help c lung maturity if you are worried about preterm labor?
Betamethasone
What are two tocolytic medications you should be aware of? (to suppress preterm labor)
Magnesium sulfate and CCB
A woman presents to the ED concerned she is in preterm labor. What tx should you begin before even getting any imaging or lab results?
give IV fluids: most often the pt is suffering from dehydration
The pap smear results on a 23yo pt come back as atypical squamous cell uncertain significance (ASCUS). What is your next step?
Repeat pap smear in 12 dos although HPV test is acceptable.
What are three ways you can check for ruptured membranes?
Ferning pattern on a slide
visualize leakage from the cervix
pooling in the vagina
What is the normal range of fetal HR?
120-160
Define menorrhagia.
Heavy prolonged menstrual flow
What Rh combo for mom and dad might cause the mom to create antibodies against the baby’s RBC?
Mom Rh-negative and Dad Rh-positive
At what point during pregnancy is RhoGAM given if it is needed?
28 wks
Define complete abortion.
vaginal bleeding
cervix open
products of conception have passed
Gestational diabetes puts mom and baby at increased risk for what 3 things?
Preeclampsia
Macrosomia (traumatic birth)
slowing in fetal lung development
Which is associated with painful third trimester bleeding: placental abruption or placenta previa?
Placental abruption
What are three causes for postpartum hemorrhage?
Uterine atony
genital laceration
retained placenta
What meds are used to tx a postpartum metritis?
Clindamycin and gentamicin together
What is the most common sexually transmitted bacteria?
Chlamydia
Interference with work or school is part of which dx: premenstrual syndrome or premenstrual dysphoric disorder?
Premenstrual dysphoric disorder
Which reproductive CA carries the highest rates of death in women?
Ovarian CA
What is the most common infection following a C-section?
Metritis
How do you treat a trichomonas infection?
Metronidazole
Define incomplete abortion.
Vaginal bleeding
cervix is open
products of conception partially passed
What is the most common site of an ectopic pregnancy?
within a fallopian tube
Early on in pregnancy serial beta-HCG should double oner what time period?
every 48-72 hrs
Define procidentia
Uterine prolapse beyond the introitus
What is the more popular term for Stein-Leventhal syndrome?
PCOS
What is the formula for calculating estimated date of confinement or due date?
first day of LMP + 7d - 3 months
What are the five components of the biophysical profile as part of antepartum testing?
a non stress test fetal breathing two gross body movements fetal tone amniotic fluid index
Define the first stage of labor
Onset of contractions to full dilation of the cervix.
A rope like breast mass should make you think of what dx?
Fibrocystic breast mass
