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Step 2 CK > OB/GYN > Flashcards

OB/GYN Flashcards

1
Q

Definition: amenorrhea

A

No menses in 3 months if regular at baseline

No menses in 6 months if irregular

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2
Q

Weeks 1-13

A

First trimester

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3
Q

Weeks 14-27

A

Second trimester

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4
Q

Weeks 28-40 and up

A

3rd trimester

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5
Q

Fetal movement is present when

A

16-20 wks GA

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6
Q

Born after or at 37 weeks GA

A

Term

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7
Q

Definition: preterm delivery

A

Born at 24 weeks to 36 weeks GA

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8
Q

Born at 42 weeks and above

A

Post term

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9
Q

Softening of cervix during 1st 4wks

A

Goodell sign

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10
Q

Softening of the midline of the cervical 6wks

A

Ladin sign

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11
Q

Blue discoloration of vagina and cervix 6-8wks

A

Chadwick sign

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12
Q

The mask of pregnancy hyperpigmentation of the face most commonly on the forehead, nose and cheeks; it can worsen with sun exposure second trimester 16wks

A

Chloasma

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13
Q

A line of hyperpigmentation that can extend from xiphoid process to pubic symphysis second trimester

A

Linea nigra

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14
Q

Which cells produce Beta hCG?

A

Cytotrophoblast or syncytiotrophoblast in placenta

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15
Q

What is the best diagnostic test to confirm intrauterine pregnancy?

A

Ultrasound

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16
Q

BHCG level of >1500 IU/L a gestational sac should be seen on U/S at what gestational age?

A

5 weeks

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17
Q

Ultrasound confirms gestational age and checks for nuchal translucency within what gestational age range?

A

Between 11 and 14 wks

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18
Q

Genetic testing, including the Harmony test, Triple and Quad screen are performed at what genstational age range?

A

15-20 wks gestation

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19
Q

What is the most important screening test performed at gestational age 24-28 weeks?

A

Glucose load

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20
Q

Chorionic villus sampling to obtain fetal karyotype is performed at what gestational age range?

A

10 to 13 wks

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21
Q

Amniocentesis to obtain fetal karyotype is performed at what gestational age range?

A

After 15-20 weeks

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22
Q

Most common site of ectopic pregnancy

A

Ampulla of Fallopian tube

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23
Q

Period of amenorrhea
Unilateral lower abdominal or pelvic pain
Vaginal bleeding
If ruptured, can be hypotensive with peritoneal irritation

A

Ectopic pregnancy

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24
Q

What would be the best next step in management of a suspected ruptured ectopic pregnancy?

A

Stable-laparoscopy

Unstable- supportive care (IVF, blood products, pressors if needed) followed by laparoscopy

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25
Q

What would be the next best step in management for ectopic pregnancy which is not suspected to have ruptured?

A

Choice of medical treatment (methotrexate) vs surgery (laparoscopy)

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26
Q

What are the exclusion criteria for methotrexate for treatment of ectopic pregnancy? [4]

A

Suspected rupture (absolute)

Size greater than 4.0cm or greater than 3.5cm with cardiac activity (relative)

B-hcg greater than 5000 (relative)

Severe comorbid conditions (hematologic abnormalities, renal/liver failure, active pulmonary disease, PUD, immunocompromise)

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27
Q

Ultrasound findings demonstrating NO products of conception in a patient with suspected spontaneous abortion have what significance?

A

Complete abortion

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28
Q

Ultrasound findings demonstrating some products of conception, but no intact fetus, in a patient with suspected spontaneous abortion have what significance?

A

Incomplete abortion

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29
Q

Ultrasound findings demonstrating intact products of conception in a pregnant patient with vaginal bleeding and cervical dilation have what significance?

A

Inevitable abortion

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30
Q

Ultrasound findings demonstrating intact products of conception in a pregnant patient with vaginal bleeding but no cervical dilation have what significance?

A

Threatened abortion

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31
Q

Ultrasound findings demonstrating intact products of conception with NO fetal heartbeat have what significance?

A

Missed abortion

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32
Q

Treatment: septic abortion

A

D&C

Antibiotics (levofloxacin, metronidazole)

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33
Q

At what gestational age is urine pregnancy test expected to become positive?

A

4 weeks

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34
Q

The B-hcg level is expected to follow what trend during pregnancy?

A

Doubling every 48hrs for the 1st 4wks
Peak level at 10 weeks gestation
level drops in 2nd trimester

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35
Q

GBS screening is indicated at what gestational age?

A

35-37 weeks

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36
Q

Glucose load testing is performed at what gestational age?

A

24-28 weeks

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37
Q

Definition: complete abortion

A

SAB with no products of conception on ultrasound

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38
Q

Definition: incomplete abortion

A

SAB with some passage of fetal tissue and some remaining on ultrasound

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39
Q

Definition: inevitable abortion

A

Vaginal bleeding and cervical dilation in early pregnancy with products of conception intact (< 20 weeks, greater than 20 would be PTL)

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40
Q

Definition: threatened abortion

A

Vaginal bleeding at less than 20 weeks with no cervical dilation and products of conception intact

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41
Q

Definition: missed abortion

A

SAB with products of conception intact but absence of fetal heartbeat

(may have no vaginal bleeding)

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42
Q

Preterm birth occurs at what gestational age?

A

<37 weeks

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43
Q

Definition: Preterm Labor

A

contractions + cervical change occurring b/w 20 and 37 wks gestation

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44
Q

Preterm Labor: best next step delivery if

A

EGA 34-37 weeks & EFW >2500g

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45
Q

Preterm Labor: stop delivery when

A

EGA 24-33 weeks, EFW 600-2500g

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46
Q

What is the first step in management for preterm labor in a pregnancy that does not meet criteria for viable delivery?

A

betamethasone & tocolytics (magnesium sulfate)

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47
Q

Magnesium toxicity during preterm labor leads to what findings (2) and what physical exam maneuver should be checked?

A
  1. respiratory depression
  2. cardiac arrest
    check deep tendon reflexes often
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48
Q

How can magnesium toxicity during preterm labor be reversed?

A

Calcium gluconate

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49
Q

Signs of PROM after sterile speculum exam [3]

A
  1. fluid pools in posterior fornix 2. fluid turns nitrazine paper blue 3. when dry, fluid has ferning pattern
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50
Q

PROM treatment before 32 weeks gestation

A

corticosteroids and Abx

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51
Q

PROM txt >37 weeks gestation, unknown GBS, >18 hours rupture

A

Penicillin is administered for prophylaxis

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52
Q

34-37 weeks gestation PROM, unknown GBS

A

Initiate Penicillin

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53
Q

PROM known GBS negative

A

NO Antibiotics

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54
Q

PROM,<34 weeks gestation, unknown GBS

A

Erythromycin and Ampicillin initiated

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55
Q

Third trimester bleeding differential diagnosis for Uterine bleed (4)

A

Uterine rupture, placenta previa, vasa previa, placental abruption

56
Q

Definition and presentation: placenta previa

A

abnormal implantation of placenta over internal cervical os. Presentation: PAINLESS vaginal bleed usually presents >28 weeks

57
Q

Digital vaginal exam is contraindicated in what trimester/circumstance

A

3rd trimester vaginal bleeding

or known placenta previa

58
Q

Definition: vasa previa

A

fetal vessel present over cervical os

59
Q

Treatment of placenta previa

A

strict pelvic rest

may require C-section (labor, severe hemorrhage, fetal distress)

60
Q

Definition: placental abruption

A

Abnormal, premature separation of placenta from uterus

61
Q

Risk factors for placental abruption (4)

A
  1. maternal HTN 2. prior placental abruption 3. tobacco and/or cocaine use 4. trauma
62
Q

Clinical presentation for placental abruption

A

PAINFUL vaginal bleeding, possible contractions and fetal distress

63
Q

Best diagnostic test for placental abruption

A

Transabdominal ultrasound

64
Q

Placental abruption treatment

A

C-section (uncontrolled hemorrhage, fetal distress), vaginal delivery (placental separation is limited, fetal heart rate is assuring, fetal death prior to presentation)

65
Q

uterine rupture risk factors (5)

A
  1. previous c-section (classical incision higher risk) 2. trauma 3. uterine myomectomy 4. uterine overdistention 5. placenta percreta
66
Q

clinical presentation of uterine rupture

A

extreme abdominal pain, abnormal bump in abdomen, lack of uterine contractions, regression of fetus

67
Q

treatment of uterine rupture

A

emergent laparotomy and delivery, repair of uterus or hysterectomy

68
Q

Rhogram indications for Rh “unsensitized patients”

A

28 weeks gestation, delivery, procedures (amniocentesis), bleeding (abortion, abruption)

69
Q

Rh incompatibility: Antibody titer <1:16 fetus is Rh + what diagnostic test do you order?

A

MCA doppler if peak MCA velocity >1.5MOM cordocentesis with transfusion if fetal Hct is <30%

70
Q

Complications of macrosomia

A

shoulder dystocia, birth injuries, low apgar scores, hypoglycemia

71
Q

Macrosomia treatment

A

Induction of labor: lungs mature EFW<4500g, c-section EFW>5000g

72
Q

hyperemesis gravidarum

A

severe nausea and vomiting in pregnancy, usually self-resolves

73
Q

Best initial therapy for hyperemesis gravidarum

A

dietary modification, avoidance of triggers, acupuncture, ginger, vitamin B6

74
Q

If pregnant patient with hyperemesis gravidarum does not improve what is the best next step in managment?

A

Dopamine antagonist (Metoclopramide)

75
Q

hyperemesis gravidarum pt with severe symptoms best next step in management?

A

antihistamines such as diphenhydramine

76
Q

Asymptomatic bacteriuria is typically screened for in pregnant patients at what gestational age?

A

12 to 16 weeks

77
Q

Treatment for asymptomatic bacteriuria in a pregnant patient?

A

Nitrofurantoin, amoxicillin, cephalexin

78
Q

Symptoms of acute cystitis in a pregnant pt and txt…

A

urinary frequency, dysuria, presence of WBCs on UA, begin empiric thpy with nitrofurantoin or penicillin until senisitivity returns

79
Q

Antibiotics to avoid in pregnancy

A

Bactrim, aminoglycosides, doxycycline and fluoroquinolones

80
Q

If a pregnant patient presents with acute pyelonephritis how do you treat?

A

hospital admission and IV ceftriaxone. Nitrofurantoin or cephalexin is then given for the remainder of pregnancy to prevent recurrence.

81
Q

Best initial test for PE in pregnancy is

A

V/Q scan

82
Q

If V/Q scan is indeterminate in pregnancy what is the next best step in management?

A

CT pulmonary angiogram

83
Q

Treatment of PE/DVT in pregnancy

A

LMW heparin

84
Q

These PE/DVT meds are contraindicated in pregnancy

A

warfarin, direct thrombin inhibitors and factor Xa inhibitors

85
Q

When should LMW Heparin be stopped in pregnancy for PE/DVT?

A

24 hours before delivery, resume 12 hours after c-section, 6 hours after vaginal delivery, continue for 6 weeks post-partum

86
Q

How does one screen for cervical cancer during pregnancy?

A

Pap is safe during pregnancy, colposcopy is safe too, endocervical curettage should NOT be performed

87
Q

May cause during pregnancy fetal: microcephaly, facial disproportion, hypertonia, seizures, irritability, sensorineural hearing loss. Order IgM and PCR for…

A

congenital zika

88
Q

chronic HTN

A

BP >140/90 before 20 weeks gestation

89
Q

Gestational HTN

A

BP >140/90 after 20 weeks gestation

90
Q

Treatment for gestational or chronic HTN during pregnancy

A

labetalol, nifedipine, or methyldopa

91
Q

mild preeclampsia

A

HTN >140/90 dipstick 2+, 24 hr greater than 300mg, edema of hands, feet, face

92
Q

severe preeclampsia

A

HTN>160/110, dipstick 3+, 24 hr greater than 5g, generalized edema, impaired liver function, vision changes and mental status changes

93
Q

Mild preeclampsia at term what is the next best step in managment?

A

induce delivery

94
Q

Mild preeclampsia preterm what is the next best step in management?

A

Betamethasone (mature fetal lungs), Magnesium sulfate (seizure prophylaxis)

95
Q

severe preeclampsia preterm what is the next best step in management?

A
  1. prevent eclampsia (magnesium sulfate), 2. control bp (hydralazine) 3. delivery (betamethasone)
96
Q

severe preeclampsia term what is the next best step in management?

A
  1. prevent eclampsia (magnesium sulfate) 2. control bp (hydralazine) 3. delivery
97
Q

Eclampsia

A

Tonic-clonic seizures occurring in pts with preeclampsia

98
Q

Treatment for eclampsia

A

stabilize mother (seizure control: magnesium, BP control: hydralazine and labetalol) deliver baby

99
Q

HELLP syndrome

A

Hemolysis, Elevated Liver Enzymes, Low platelets Txt: stablize mother (hydralazine and labetalol for bp and deliver baby)

100
Q

How do you screen for gestational DM?

A

one hour glucose challenge test (50g glucose) non-fasting ingestion and serum measurement one hour later. If greater than 140mg/dL + test

101
Q

What if the glucose challenge test is positive what test is performed next in presumed gestational DM?

A

3 hour glucose tolerance test (100mg glucose) fasting ingestion followed by serum glucose measurements at 1,2,3 hours after ingestion

102
Q

early decelerations in OB are a sign of

A

head compression-normal (mirror mom’s contractions)

103
Q

variable decelerations in OB are a sign of

A

umbilical cord compression

104
Q

late decelerations in OB are a sign of

A

fetal hypoxia- intervention is needed (no return to baseline until contraction ends)

105
Q

Treatment for lactational mastitis

A

dicloxacillin or cephalexin

106
Q

Breast cancer screening starts at what age?

A

50, pts with a family hx of breast cancer 40

107
Q

primary amenorrhea

A

absence of menstruation by age 15 in a female who has normal secondary sexual characteristics

108
Q

causes for primary amenorrhea (6)

A

Turner syndrome (gonadal dysgenesis), Mullerian agenesis, delay of puberty, PCOS, hypopituitarism

109
Q

Initial testing for primary amenorrhea includes

A

beta-HCG, TSH, prolactin, FSH, pelvic ultrasound

110
Q

secondary amenorrhea

A

absence of menses for more than 3 months in a female who menstruates regularly or absence of menses for 6 months in a female who menstruates irregularly

111
Q

causes of secondary amenorrhea (6)

A

pregnancy, hypothalamic amenorrhea, hyperprolactinemia, primary ovarian insufficiency, PCOS, thyroid abnormalities

112
Q

best initial test for secondary amenorrhea

A

beta-HCG

113
Q

Lab exams ordered in secondary amenorrhea

A

TSH, FSH, Prolactin levels

114
Q

Abnormal uterine bleeding: menorrhagia

A

Heavy, prolonged menstrual bleeding, gushing of blood, clots may be seen (Endometrial hyperplasia, uterine fibroids, intrauterine devices, dysfunctional uterine bleed)

115
Q

Abnormal uterine bleeding: hypomenorrhea

A

light menstrual flow, may only have spotting (obstruction-hymen, cervical stenosis, OCPs)

116
Q

Abnormal uterine bleeding: metrorrhagia

A

intermenstrual bleeding: endometrial polyps, endometriral/cervical cancer, exogenous estrogen administration

117
Q

Abnormal uterine bleeding: menometrorrhagia

A

irregular bleeding (endometiral polyps, endometrial/cervical cancer, exogenous estrogen administration, malignant tumors)

118
Q

Abnormal uterine bleeding: oligomenorrhea

A

menstrual cycles >35 days long (pregnancy, menopause, anorexia, tumor secreting estrogen)

119
Q

Abnormal uterine bleeding: postcoital bleeding

A

bleeding after intercourse (cervical cancer, cervical polyps, atrophic vaginitis)

120
Q

Diagnosis/evaluation of abnormal uterine bleeding what test do you order?

A

CBC, pregnancy test, PT/PTT, pelvic ultrasound, endometrial biopsy, pap smear, thyroid studies, prolactin levels

121
Q

Treatment of dysfunctional uterine bleeding

A

OCPs, cyclic progesterone, acute hemorrhage (D&C, IV estrogen), Long-term (Endometrial ablation, hysterectomy)

122
Q

Bacterial vaginosis

A

Gardnerella, vaginal discharge with fishy odor, gray white , saline prep- clue cells treat with metronidazole or clindamycin

123
Q

Candidasis vagina

A

candida albicans, white, cheesy discharge KOHL psedohyphae treat with nystatin, miconazole or clotrimazole

124
Q

Trichomonas STD

A

Trichomonas vaginalis- profuse, green, frothy vaginal discharge, saline prep- motile flagellates. Treat both patient and partner with metronidazole

125
Q

Physical exam of adenomyosis in female & TXT

A

uterus is large, globular, boggy, TXT: hysterectomy

126
Q

Diagnosis: uterine abnormality: cyclical pelvic pain, abnormal bleeding, infertility. On physical exam nodular uterus with adnexal mass present

A

Endometriosis

127
Q

Treatment of Endometriosis mild and severe disease

A

Mild: NSAIDs, combined OCPs severe: Danazol, leuprolide acetate (leupron), surgery

128
Q

Diagnosis: OB/GYN amenorrhea or irregular menses, hirstuism and obesity, acne, insulin resistance

A

PCOS

129
Q

Diagnostic test for PCOS

A

Pelvic ultrasound, elevated free testosterone, LH to FSH ratio >3:1

130
Q

Treatment for PCOS

A

weight loss, OCPs, spironolactone (hirsutism), metformin (insulin resistance), colmiphene (infertility)

131
Q

post-partum hemorrhage: uterine atony

A

Boggy uterus massage and use meds (oxytocin)

132
Q

Post-partum hemorrhage: uterine inversion

A

Absent uterus on speculum exam manually reduce use tocolytics followed by oxytocin as needed to bring uterus down

133
Q

Post partum hemorrhage: retained placenta

A

Firm uterus, placental blood vessels go to the edge. Burrows deeply, accessory lobe, placental tear. Txt with D&C or TAH f/u BHCG

134
Q

Post-partum hemorrhage vaginal lacerations

A

Normal uterus txt with pressure and suture

135
Q

Fibroids

A

Heavy menses, enlarged uterus, constipation, urinary frequency, pelvic pain/heaviness

Step 2 CK (6 decks)

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