OB/GYN Flashcards

Question 1

Q

Dysmenorrhea

Answer

A

Primary Dysmenorrhea: (No Pelvic Pathology)
- E: ^Prostaglandins –> painful uterine muscle wall activity.
Secondary Dysmenorrhea: ( Pelvic Pathology)
- E: Pelvic Pathology
  - Endometriosis
  - Uterine Fibroids (Leiomyoma)
  - adenomyosis

Treatment:

Heat & Vit E
NSAID’s (1st line)
1. MOA: inhibits prostaglandin-mediated uterine activity.
Want Contraceptives:
1. 1st line for contraception and dysmenorrhea pain relief.
2. combined estrogen-progestin oral pills, transdermal patch, or vaginal ring

Question 2

Q

Dysfunctional Uterine Bleeding

Menorrhagia
Metrorrhagia
Oligomenorrhea
Polymenorrhagia

Answer

A

Polymenorrhea
- Frequent cycles <21 days
Menorrhagia
- Heavy or Prolonged Bleeding (Normal intervals)
Meterorhagia
- Bleeding between expected menstrual cycles
Oligomenorrhea
- infrequent menstruation ( >35 days between but not >6months)
Etiology:
- Chronic Anovulation (90%)
  - Hypothalamus Pituitary Axis issues
  - Extreme ages (starting or ending menopause)

Dysfunctional Uterine bleeding is a result of either no ovulation or ovulation with abnormal bleeding.

Anovulation = no progesterone because the ovum is what secretes that progesterone –> No progesterone to oppose the estrogen –> ^ risk of Endometrial cancer.
- The unopposed estrogen caused excessive endometrial growth –> outgrows its own blood supply –> dies and sluffs off at unpredictable times.
Ovulation:
- Ovulation with increased progesterone levels dilation of endometrial vessels + Prostaglandins which results in Menorrhagia.
Dx: Diagnosis of Exclusion
Tx:
- Acute:
  - High-dose IV estrogens titrated to stop bleeding.
- Anovulatory:
  - OCP: 1st line
    - reduces endometrial cancer risk by regulating unopposed estrogen.
  - Progesterone only for CI to Estrogen:
    - Medroxyprogesterone Acetate
- Ovulatory:
  - OCP: Regulates Cycle
- Surgery:
  - Hysterectomy: Definitive treatment

Question 3

Q

Vaginitis

Dia

Answer

A

Atrophic Vaginitis

Pathophysiology
- Caused by a decrease in estrogen
Patient
- Postmenopausal woman
Presentation
- Dyspareunia, dryness, bleeding, itching
Physical Exam
- • Show a pale, dry, shiny vaginal epithelium
Management
- • Lubricants, moisturizers, topical estrogen (second line)
SE of Vaginal Estrogens:
- PE, DVE, CVA
- endometrial cancer
- Less risk than PO estrogen
- breast Pain

Question 4

Q

Pelvic Inflammatory Disease

complications of PID?
1. What is the name of the syndrome associated with PID?
2. ??
Treatment:
1. Outpatient
2. Inpatient

Answer

A

Complications:

Fitz-Hugh Curtis Syndrome:
1. Perihepatitis with no LFT ^
2. RUQ pain
Infertility
Ectopic
Chronic Pelvic pain

Question 5

Q

Fibroadenoma

What is the difference between fibroadenoma and fibrocystic breast disorder?

Answer

A

Fibroadenoma does not wax/Wayne with menstruation.

Question 6

Q

Fibrocystic Breast Disease

Answer

A

Fluctuating Estrogen

Question 7

Q

Breast Cancer

Etiology
Risk Factors
Types
Presentation:
Physical Exam
Diagnosis:
Treatment:
Prevention in High-risk Patients:

Answer

A

Breast Cancer

Risk Factors
- BRAC1
- BRAC2
- Increase exposure to ESTROGEN
Types
- Ductal Carcinoma
  - METS lymphatic
  - 75%
- Lobar Carcinoma
Presentation:
- Breast Mass:
  - Painless
  - Hard
  - Immobile
  - Upper Outer Quadrant
- Unilateral Nipple Discharge
  - Purulent/green/+- Bloody
Physical Exam
- Skin Changes:
- Pagets Disease of the Nipple:
  - chronic eczematous itchy, scaling rash on the nipple/areola
- Inflammation of the Breast
  - red, swollen, warm, itchy
  - Peau D’ Orange –> orange peel appearance
    - due to Lymphatic Obstruction
    - Poor prognosis
Diagnosis:
- Monogram:
  - Microcalcification
  - Spiculated
- Ultrasound:
  - BEST INITIAL TEST TO EVLATUTE BREAST MASS
- Biopsy:
Treatment:
- - Lumpectomy (w/ radiation) —> Mastectomy —> Regional removal of lymphnodes.
    - Pharmacology:
      - Based on if the tumor is Estrogen Receptor +, Progesterone Receptor +, or HER2 +
      - Anti Estorgen: (blocks estrogen receptor at breast tissue.
        Tamoxifen
      - ER + : Aromaatase Inhibitors: (< Estrogen Production)
        
        Letrozole
        
        Anastrozole
      - HER2 +: Monoclonal AB tx:
        Trastuzumab
        CARDIOTOXICITY
Prevention:
- Tamoxifen/Raloxifen
- PostMenopausal or
- >35 with High Risk

Question 8

Q

Cystocele

Question 9

Q

Rectocele

Risk Factors
Management

Answer

A

Risk Factors:

The Older you get the more kids you have the fatter you get.

Question 10

Q

Menopause

Tx:
- Vasomotor insufficiency/ Hot flashes
- Vaginal Atrophy
- Osteoporosis
- Hormone Replacement Therapy

Answer

A

E:
- Cessation of Menses >1 year due to Loss of Ovarian Function.
P:
- Hot Flashes
- Dyspareunia
  - Vaginal Atrophy
- Osteoporosis
Dx:
- ^ FSH, ^ LH, v Estrogen ( ovarian follicles depletion)
- FSH assay most sensitive Initial Test
Tx:
- Vasomotor insufficiency/ Hot flashes
  - Estrogen/Progesterone
  - Clonidine
  - SSRI
  - Gabapentin
- Vaginal Atrophy
  - Estrogen topical
- Osteoporosis
  - Calcium + VD
  - weight-bearing exercise
  - BISPHOSPHONATES
    - Alendronate (Fosamax™, Fosamax™ Plus D)
    - Risedronate (Actonel™, Actonel™ with Calcium, and Atelvia™)
    - Ibandronate (Boniva™)
    - Zoledronic acid (Reclast™)
  - SERM
    - Raloxifene
      - CVA
      - Pregnancy
    - Tamoxifen
      - ^ risk of Uterine Cancer past 5 years.
- Hormone Replacement Therapy
  - Estrogen Only (Most Effective) (No Uterus)
    - ^ Endometrial Cancer
    - ^Thromboembolism
  - Estrogen + Progesterone: (Yes Uterus)
    - Protective against Endometrial Cancer
      *

Question 11

Q

Contraception

Question 12

Q

Spontaneous Abortion

Question 13

Q

Cervicitis

Gonorrhea
Chlamydia
Herpes Simplex
HPV

Answer

A

Chlamydia:
- E: Chlamydia Trachomatis- MC std in US
- P: Cervical Motion Tenderness
- Dx: Nucleic Acid Amplification
  - Gonorrhea as well
- Tx:
  - Azithromycin/Doxy
  - Ceftriaxone

Question 14

Q

Syphilis

Answer

A

Treatment:

Primary, Secondary, Neuro
1. See Rosh Review

Question 15

Q

Lymphogranuloma Venereum

Answer

A

E: Chlamydia infection

P: Genital/Rectal Lesion with softening, suppuration, and Lymphadenopathy

Dx:

Question 16

Q

Chancroid

Answer

A

E: Haemophilus ducreyi
P: Painful Ulcer: Papule–> Pustule –> Ulcer
- Lymphadenopathy
Tx:
- Azithromycin
- Ceftriaxone

Question 17

Q

Premenstrual Syndrome

Answer

A

E: Luteal Phase mood changes
P:
- Physical
  - Breast Swelling, Bloating
- Emotional
  - Depression, Hostility
- Behavioral
  - Food Craving, Poor Concentration
Dx:
- Sx start in Luteal Phase (1-2 weeks before menses)
- Relieved 2-3 days after menses
- 7 symptom-free days during the follicular phase
Tx:
- SSRI
- OCP: induce Anovulation

Question 18

Q

Premenstrual Dysphoric Disorder

Answer

A

Severe PMS with functional impairment

“it is impairing their everyday life”

Question 19

Q

Amenorrhea

Definition:
Work UP
Primary Amenorrhea
Secondary Amenorrhea
- E:
  - Pregnancy
  - Hypothalamus Dysfunction
  - Pituitary Dysfunction
  - Ovarian Disorders
  - Uterine Disorders
    - Asherman’s Syndrome

Answer

A

Amenorrhea

Definition:
- Absence of Menses
Work up:
- Pregnancy Test
- serum Prolactin
- FSH, LH, TSH
Primary Amenorrhea (Never had Menarche)
- 15yo - Sex Character
- 13yo- NO sex Character
- Uterus/Breast Present:
  - Outflow Obstruction (Blocking blood flow)
    - transverse vaginal septum
    - imperforate hymen
- Uterus(OK)/NO Breasts:
  - ^FSH, ^LH –> Ovarian Cause
    - Turners Syndrome (Gonadal Dysgenesis)
  - vFSH, vLH –> Hypothalamus-Pituitary Failure
Secondary Amenorrhea
- E:
  - Pregnancy
    - MC cause of secondary Amenorrhea.
  - Hypothalamus Dysfunction
    - E:
      - Suppression of Hypothalamus
        
        Disorder of Hypothalamus
        
        Excessive Exercise
        
        Stress
        
        Nutritional Deficits
    - Dx:
      - normal/vFSR,vLH
    - Tx:
      - Clomiphene (SERM)
  - Pituitary Dysfunction
    - E: Prolactin-Secreting Pituitary Adenoma
    - Dx:
      - v FSH, LH, ^ PROLACTIN
      - Prolactin inhibits GnRH
    - Tx:
      - Tumor Removal
  - Ovarian Disorders
    - E: Premature Ovarian Failure
    - P:
      - Symptoms of Menopause (Estrogen Deficiency)
      - ^FSH & LH, v Estradiol
    - Dx:
      - Progesterone Challenge Test→ Causing Pseudo Mensis
      - Tests:
        
        Adequate Estrogen
        
        Competent Endometrium
        
        Patent Outflow tract

By giving progestin you can see if the ovaries are producing any estrogen (ovarian cause), if the endometrium of the uterus has been scarred (uterine cause) or if there is an anatomic anomaly.

Uterine Disorders
- Asherman’s syndrome= Acquired endometrial Scarring (postpartum hemorrhage, D&C).

Workup:

Amenorrhea ==> Breast/No Breast and Uterus/No uterus==> FSH, LH, estrodiol levels ==> Hypo/Pit (

Question 20

Q

Normal Physiology

When does Menstruation happen?
What phase does Ovulation happen in?
What causes GnRH to be secreted from Hypothalamus?
Follicular Phase
- What does GnRH cause to be secreted?
- What prevents the release of more LH and FSH?
Ovulation:
- What is the time frame when Ovulation happens?
- What happens to happen during ovulation
Luteal Phase
- What predominates
- Where does progesterone come from?
  *

Answer

A

Follicular Phase:
- 1-12 days
- Estrogen Predominates
- PULSATILE (the body stops the pulsatile secretion of GnRH when they don’t have enough stores in extreme athletes or poor nutrition)GnRH –> Pitutirary (FSH) & LH–> Overies –> Follicle Maturation (FSH) & Follicle Estrogen Secretion (LH)
- Estrogen BUILDS the endometrium
- NEGATIVE FEEDBACK of Estrogen on Hypothalamus.
Ovulation:
- ^ Estrogen from mature follicle –> Negative to Postive feedback—> ^ Estrogen, FSH, LH
- ^LH causes ovulation.
Luteal Phase:
- Progesterone predominates.
- Implantation occurs during this phase if there is fertilization.
When does Menstruation happen?
- 1st day of the Follicular phase.
- < in estrogen/progesterone stops the negative feedback.

Question 21

Q

Ovarian Cancer

Risk Factors
Protective Factors
Presentation
Physical Exam
Diagnosis
- What type of tissue?
Management

Answer

A

Risk Factors
- Family History
- ^ # of ovulatory cycles
- Infertility, Nullparity
- >50yo/late menopause
Protective Factors
- OCP’s Protective by < number of ovulatory cycles
Presentation
- Asymptomatic until late in the disease
- Lower ABD pain/fullness /Irregular Menstruation……etc.
Physical Exam
- Palpable Mass +/- acites
Diagnosis
- Biopsy- Epithelial
Management
- ????????

Question 22

Q

Cervical Carcinoma

Etiology
- Tissue types
Risk Factors
Presentation
Diagnosis
Treatment:

Staging:

Answer

A

Cervical Carcinoma

Etiology:
- HPV 16,18, 31,32 (MC)
- 3rd MC Gynecologic Cancer
- Squamous 90%
- Adenocarcinoma 10%
Risk Factors
- RF of PID/HPV
Presentation
- Post Coital Bleeding/Spotting
Diagnosis
- Colposcopy with Biopsy
Treatment:
- Dependant on staging which determines the location of the tumor.

Staging:

0: Carcinoma In Situ: Excision/Ablation
1a: Microinvation: Surgery
IIb-4a: metastasis to cervix, vagina, bladder, rectum.
- II: beyond the cervix but local
- II: lower 1/3 vagina
- IVa: Local METS: bladder rectum
- RADIATION + CHEMO
4b:
- Distant METS: Palliative radiation/chemo

Question 23

Q

Pap Smear Schedule

When do you start getting a pap smear

Answer

A

21yo –> 3 years
>30 w/ negative –> 5 years
>25yo + HPV –> Cytology & HPV test 12 month
- or Genotyoe for HPV 16,18

Question 24

Q

HPV Vaccination

Age and number of does
CI

Answer

A

Gardasil Vaccine
<15yo 2 doses q 6months
>15 3doses over a minimum of 6 months.
CI:
- Immunosuppressed, pregnant, lactating

Question 25

Q

Mammography Screening

Mammography:
Clinical Exam
Self Exam
- When

Answer

A

Mamography:
- 45-55: Annual Mamogram
- >55 q 2y
Clinical Breast Exam:
- q 3y
Self Exam:
- >20yo Monthly
- Immediately after Menstruation or:
- 5-7 days of the menstrual cycle.

Question 26

Q

Endometrial Cancer

Etiology:
Risk Factors:
Protectives
presentation:
Diagnosis
Tx:
What is the Quick Picture

Answer

A

Endometrial Cancer

Etiology:
- MC GYN Cancer in US
- Estrogen Dependent Cancer
- MC Postmenopausal Cancer
- Adenocarcinoma MC
Risk Factors:
- ^ Estrogen Exposure
- Tamoxifen:
  - decreases estrogen in the breast but increases in the uterus and bones.
Protectives:
- OCP’s protective for Endometrial Cancer and Ovarian Cancer
Presentation:
- Postmenopausal Bleeding
Diagnosis
- Endometrial Biopsy
- Ultrasound
  - Endometrial Stripe>4mM
Tx:
- Stage I: Hysterectomy
QUICK PICTURE:
- Postmenopausal
- Vaginal Bleeding
- Dx: Endometrial Biopsy
- Adenocarcinoma MC
- Tx: Complete Hysterecotmy

Question 27

Q

Estimated Date of Delivery?

How do you calculate?

Answer

A

(1st day of Menstration + 7 days) - 3 MONTHS

Question 28

Q

1ST TRIMESTER SCREENING/TEST

Maternal Blood Screening?

Ultrasound?

Chorionic Villus Sampling?

Answer

A

Maternal Blood Screening
- Down Syndrome:
  - Free B-hCG
  - PAPP-A
  - Nuchal Translucency
- Uterine Size / Gestation
  - Do you want an abortion if abnormal?
Ultrasound
- Heartbeat 5-6 weeks
Chorionic Villus Sampling
- Increased risk for Spontaneous abortion.
- Do you want an abortion.

Question 29

Q

2nd Trimester Screening/Tests

What is a positive diagnosis for Down Syndrome?
Postive test for Spina Bifida?
When is Gestational diabetes tested?

Answer

A

15-20 weeks
- Triple Screen
  - Downs:
    - a-FP: LOW
    - Estradiol: LOW
    - B-hCG: HIGH
  - Spina Bifida:
    - a-FP: HIGH
Ultrasound
- Fetal Growth
Amniocentesis
24-28weeks
- Gestational Diabetes

Question 30

Q

3rd Trimester Screening/Tests:

When is RhoGam administered?
Non-Stress Testing Readings?
Contraction Stress Testing Reading?

Answer

A

28 WEEKS
- RhoGam
- - 72 hours after birth
32-37 weeks:
- Group B Strep
Non-Stress Testing Readings
- SEE PPP - 292
Contraction Stress Testing Reading
- SEE PPP 292

Question 31

Q

Stages of Labor:

Stage 1:

Stage 2:

Stage 3:

Answer

A

Stage 1:
- ONset to Full 10cm dilation of cervixs
  - Latent Phase:
    - SLOW cervical Dilation and effacement.
  - Active Phase:
    - 3-4cm –> 10cm
    - FAST dilation
Stage 2:
- 10cm —> Delivery of Baby.
  - Passive Phase:
    - 10cm –> maternal expulsive efforts
    - Maternal expulsive efforts —> delivery
  - Active Phase:
Stage 3:
- Fetus —> Placenta Delivery
  - Signs of Placental Separation:
    - Gush of blood
    - Lengthening of the umbilical cord
    - Anterior-cephalad movement
      - uterus becomes globular and firmer.
        *

Question 32

Q

Cardinal Movements of Labor: (mechanism of labor)

Answer

A

Engagement
Flexion:
Descent:
Internal Rotation:
Extension:
External Rotation:

https://www.youtube.com/watch?v=ruIa1bC4tsw

Question 33

Q

Physiologic Changes of Pregnancy

Question 34

Q

Multiple Gestations

Question 35

Q

APGAR

Question 36

Q

ECTOPIC PREGNANCY

Definition:
Risk Factors:
- High vs. Intermediate
Presentation:
- Classic Triad:
- Signs of Ruptured Ectopic
Physical Exam
Diagnosis
Management:
- Stable/Unruptured
- Unstable/Ruptured

Answer

A

Definition:
- Implantation outside the Uterus
Risk Factors:
- High:
  - ABD Surgery (Adhesions)
  - PID
  - IUD
- Intermediate:
  - STD
Presentation:
- Classic Triad:
  - Unilateral Lower ABD Pain
  - Vaginal Bleeding
  - Amenorrhea
- Signs of Ruptured Ectopic
  - Severe Pain
  - Signs of Shock
Physical Exam
- Cervical Motion Tenderness
- Adnexal Mass
Diagnosis
- Serial Quant B-hCG
  - Should: Double q 24-48hrs.
  - Ectopic: Fails to Double in 24-48hrs
- Transvaginal Ultrasound:
  - Absense of Sac w/ B-hCG > 2000
Management:
- Stable/Unruptured
  - Methotrexate:
    - MOA: detroys trophoblastic tissue
    - Criteria:
      - Stable
      - Early Gestation <4cm
      - B-hCG < 5000
      - No Fetal Tones
    - CI:
      - Ruptured Ectopic
      - history of TB
    - Administer RoGham if mom is Rh-Negative.
- Unstable/Ruptured
  - Laparoscopic Salpingostomy
    - 1st Choice

Question 37

Q

Placental Previa vs Abruptio Placenta

What is the diagnosis?

Treatment:

What is DIC?

Risk Factors of AP?

Answer

A

Placental Previa:
- Painless Bright Blood
- Soft Uterus
- No fetal distress
  - Treatment:
    - Hospitalization/Bed Rest
    - Delivery:
      - Vaginal +/-: partial/marginal obstruction of the cervical os.
      - C-Section: in complete when mature.
    - Stabilize Fetus:
      - Tocolytics: MAGNESIUM SULFATE
      - Amniocentesis to determine lung stability.
Abruptio Placenta:
- Risk Factors:
  - Maternal HTN
  - Drugs/Alcohol
- Painful Dark blood
- Firm/Tender Uterus
- - Fetal distress
    - Treatment:
      - C-Section
    - Complications:
      - Disseminated Intravascular Coagulation

Question 38

Q

Gestational Diabetes

Risk Factors:
Diagnosis:
Management:
Maternal Complications:

Answer

A

Gestational Diabetes

Risk Factors:
- Prior GD
- Culture
  - Black, Asian, Islander, American Indian
- Obesity
Diagnosis:
- 50g Glucose test: >140 in 1 hour –> (perform)–> 3hour 100g GTT (GOLD STANDARD) >140 after 3 hours
- NORMAL: <95 Fasting.
Management:
- Diet/Exercise
- Insulin: Treatment of Choice
  - DOES NOT CROSS PLACENTA
  - Indications:
    - FBG >105
    - Post-Prandial>120
- Glyburide
- Metformin
- 38 WEEKS and Uncontrolled = INDUCTION
Maternal Complications:
- 50% Chance of DM
- 50% Chance of Recurrence GD
- 6weeks postpartum screening for DM
  - Yearly afterward

Question 39

Q

Preeclampsia vs Eclampsia

Similarities
- Criteria for BP
Differences:
What do you have to watch out for in Severe Preeclampsia/Eclampsia?
What is the difference between treating Pre/Eclamptic BP than chronic preexisting HTN?
What do you avoid when treating HTN in pregnancy?

Answer

A

Similarities
- > 20weeks
- Criteria for BP
  - Mild: >140/90
    - +Protienuria
  - Severe: >160/110
    - - Proteinuria
Differences:
- Eclampsia:
  - HYPERREFLEXIA
Severe Complications:
- Thrombocytopenia +/- DIC
- HELLP Syndrome:
  - Hemolytic anemia
  - Elevated LIver enzymes,
  - Low platelets
PRECLAMPSIA:
- Treatment:
  - Mild:
    - >37 Weeks: Delivery
    - <34 weeks: Bedrest + Steroids in Delivery
  - Severe:
    - DELIVERY–> MAG Sulfate–> Hydralazine/Labetalol.
ECLAMPSIA:
- Seizures:
  - Mag Sulfate
  - Lorazepam -2nd line
- DELIVERY
- BP: Hydralazine/Labatolol
What is the difference between treating Pre/Eclamptic BP than chronic preexisting HTN?
- Chronic= Methyldopa 1st line
What do you avoid in treating HTN in pregnancy?
- ACE-I
- Diuretics

Question 40

Q

Endometriosis

Answer

A

Treatment:

Mild:
- OCP + NSAIDs
- Leuorolide (GnRH analog) Suppresses FSH/LH
Surgical:
- Ablation = Preserves Fertiligy
- Total Hysterectomy

Question 41

Q

Ovarian Cyst

Question 42

Q

Leiomyoma

Answer

A

Treatment:

Observation:
Pharm:
- Leuprolide (gnrh analog- < fsh/lh)
Surgery:
- Hysterecomy- Not fertile
- Myomectomy: Preserves fertility

Question 43

Q

Sexual Assault

Question 44

Q

Domestic Violence

Question 45

Q

Urinary Incontinence

Question 46

Q

Infertility

Question 47

Q

Pelvic Organ Prolapse:

Uterine Prolapse
Cystocele:
Enterocele
Rectocele
Uterine Prolapse Stages:
Treatment:

Answer

A

Cystocele: Anterior Vagina
Enterocele: Upper Vagina
Rectocele: Posterior Vagina
Stages: (4 total)
- II: Cervix at introitus
Treatment:
- Kegal
- Hysterectomy
  *

Question 48

Q

Ovarian torsion

Question 49

Q

Breast Abscess vs Mastitis

Answer

A

Etiology:
- Infection: Staph Aureus- Early BF
- Congestion: Bilateral
Presentation:
- Infection: Unilateral breast pain/nipple discharge
- Congestion: Bilateral
- Abscess: Induration with fluctuance
Management:
- Infection:
  - Anti-Staphlococcal:
    - Dicloxacillin, Nafcillin
  - KEEP BREASTFEEDING
- Congestion:
  - No BF: Stop stimulating and support for breast
  - Yes BF : Empty Breast after feeding
- Abscess:
  - I&D
  - STOP BREASTFEEDING

Question 50

Q

Fibrocystic Breast Disorder

Answer

A

Breast Cyts ^/< with menstrual changes.
*

Question 51

Q

Gestational HTN

Answer

A

>20 weeks

Asymptomatic

NO PROTEINURIA

Diet/Exercise

+/- Hydralazine or Labetalol

Question 52

Q

Gestational Trophoblastic Disease

(Molar Pregnancy)

Definition:
Complete Molar Pregnancy:
Partial Molar Pregnancy:
Manifestation:
Diagnosis:
Management:

Answer

A

Definition:
- A tumor arising from GESTATIONAL TISSUE (not mom)
- Abnormal Placental Development
Complete Molar Pregnancy:
- All Parental chromosomes (48xx)
Partial Molar Pregnancy:
Manifestation:
- Painless Vaginal Bleeding
- LARGER uterine size than expected.
- Hyperemesis Gravidarum: ^ homres
- CHORIOCARCINOMA: METS to LUNGS
Diagnosis:
- EXTREMELY HIGH B-hCG (>100,000)
- Ultrasound:
  - SNOWSTORM
  - CLUSTER OF GRAPES
Management:
- Surgical Evacuation
  - Suction Curettage- MAINSTAY
- METS:
  - Chemo with METHOTREXATE.

Question 53

Q

RH Incompatibility

Etiology:
Complications:
Diagnosis
Management

Answer

A

Etiology:
- Rh-Negative Mom
- Rh Positive Baby
Complications:
- If mom exposed to fetal blood –> Antiboties –> attack next fetus —> Hemolysis of fetal RBC
Diagnosis
- - Management
- RhoGam
  - 28 weeks
  - 72 hours after delivery
  - After any potential mixing of blood.

Question 54

Q

Shoulder Dystocia

Question 55

Q

Premature Rupture of Membranes

Risk Factors
Diagnosis
Management:

Answer

A

Risk Factors:
- Smoking
- STD’s
Diagnosis
- Sterile Speclulum Exam:
  - Visual Inspection –> Pooling of Secretions
- Nirazine Paper Test:
  - turns blue= PROM
- Fern Test:
  - Amniotic Fluid —> Fern pattern
Management:
- Wait for Spontaneous Labor

Question 56

Q

Premature Labor

Criteria:
Diagnosis
- How to tell if fetal lungs are immature?
Management

Answer

A

Criteria:
- Regular uterine Contractions
- Cervical Changes
- <37 weeks
Diagnosis
- Nitrazine pH paper test: <6.5 pH BLUE
- Fern Test:
- - FETAL FIBRONECTIN (20-34 weeks)
- L:S Ratio <2:1 ===> Fetal Lung Immaturity
Management
- Betamethasone ===> Fetal Lung
- Given between 34-36 weeks
- TOCOLYTICS:
  - Give for 48hrs to allow Lung Developement
    - Indomethacin: Inhibits prostaglandin uterine contraction.
    - Nifedipine:
    - Magnesium Sulfate: Admit, No Nifedipine w/
    - Beta2 Agonist:
      - SE: Maternal Pulmonary HTN
- ABx Prophylaxis
  - Group B strep
    *

Question 57

Q

Breech Presentation

Question 58

Q

Postpartum Hemorrhage

Answer

A

Treatment:

Bimanual Uterine massage
Uterotonic Agents:
- Oxytocin
- Methylergonovine
- Prostaglandin Analogs:
  - Carboprost
  - Tromethamine
  - Misoprostol

Question 59

Q

Endometritis

Question 60

Q

Perineal Laceration/Episiotomy Repair

Question 61

Q

Normal Physiology Changes of Puerperium

Uterus

Lochia Serosa

Breast/Menstruation

Answer

A

Uterus:
- After Delivery: level of the umbilicus
- 2 weeks: descends into the pelvic cavity
Lochia Serosa
- Post-Partum Bleeing:
  - Pink/Brown: 4-10 days
    - Resolves by 3-4 weeks
Breast/Menstruation
- Breast Milk 3-5 days
- Menstruation return: 6-8 weeks.

Question 62

Q

Vulvar/Vaginal Cancer

Question 63

Q

Incompetent Cervix

Question 64

Q

Umbilical Cord Prolapse