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Ob/Gyn APGO Flashcards

1
Q

abnormal pap test results… whats the best next step in management?

A

colposcopy

  • also do reflex HPV testing for high-risk HPV types
  • if negative then do repeat testing in one year
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2
Q

whens the earliest indication to give a pt a pap smear?

A

21 years old regardless of coitarche

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3
Q

cervical cancer screening for women ages 30-65

-whats special about pts ages 21-24

A

cytology and HPV cotesting every 5 years (preferred)
or
cytology alone every 3 years (acceptable)
-no need to HPV test alone

  • pts 21-24 –> considered a special population are ususally positive for HPV and end up clearing it anyways so its not worth it to test them for HPV
  • do expectant management and repeat cytology alone in 12 months if a pt does test positive for HPV
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4
Q

pt with lower abdominal pain, adenexal pain/tenderness, fever, cervical motion tenderness, and vaginal discharge

A

pelvic inflammatory disease (usually caused by chlamydia and gonorrhea)

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5
Q

gold standard to diagnose herpes

A

culture: highly specific not super sensitive (false negative 10-20% of the time)
best to culture very early in course

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6
Q

how often do you screen for colon cancer in a pt with average risk

A

start screening at age 45-50

  1. yearly hemoccult testing
  2. flexible sigmoidoscopy every 5 years
  3. colonoscopy every 10 years

if pt has a first degree relative with colon cancer before age 60 then screen at age 40 or 10 years before dx of their relative and repeat every 5 years

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7
Q

DEXA test

A

used to test for bone mineral density… specifically in women who show signs of osteoporosis prior to age 65

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8
Q

what age should annual mammograms start for women?

A

40

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9
Q

how much folate should you give a woman of reproductive age

A

daily 400 microgram supplement

note: non-high risk pts get at least 0.4mg/day
high risk pts (pts with neural tube defect in previous pregnancy) get 4mg/day

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10
Q

what are the normal physiologic changes to lung capacities during pregnancy

A

increases: inspiratory capacity (due to increases in tidal volume and inspiratory reserve volume)… minute ventilation also increases –> responsible for respiratory alkalosis in pregnancy

respiratory rate does not change

decreases: functional residual capacity

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11
Q

why are pregnant pts more likely to get pulmonary edema

A

decreased plasma osmolality

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12
Q

sickle cell anemia prevalence in black pts and how to test for it in a pregnant pt

A

1/500 (autosomal recessive)

carrier state is found in 1/10 blacks

*test for this and all other hemoglobinopathies via electrophoresis

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13
Q

mediterranean populations are most at risk for what

A

beta-thalassemia

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14
Q

ashkenazi jews are at risk for what

A

fanconi anemia, tay-sachs, neimen pick, cystic fibrosis (all are autosomal recessive)

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15
Q

what is the best test for trisomy 21 and 18

A

cell free DNA screening with a detection rate of over 99% at 0.2% false-positive rate

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16
Q

most common form of inherited mental retardation

A

fragile x

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17
Q

most reliable method for confirming gestational age

A

dating ultrasound (specifically during the first trimester)

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18
Q

what do you expect to see in a pt with pre-existing diabetes vs gestational diabetes

A

pre-existing –> intrauterine growth restriction

gestational diabetes –> shoulder dystocia, metabolic disturbances, preeclampsia, polyhydramnios, and fetal macrosomia

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19
Q

short in duration and less intense contractions associated with pain in the lower abdomen/groin

A

braxton-hicks contractions

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20
Q

how will a pregnant pt with dehydration present

A

maternal tachycardia and ketonuria

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21
Q

why would you do a nitrazine test

A

confirm rupture of membranes of if a pt is unsure about leakage of fluid

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22
Q

what do you do if the pt has an umbilical cord prolapse?

A

immediate c-section (even if the mom and baby both seem totally fine)

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23
Q

what is the single greatest risk factor for 3rd and 4th degree lacerations

A

median episiotomy

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24
Q

insufficient power of contractions

A

< 240 Montevideo units

give ptosin if this occurs

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25
Q

type 1 diabetic… what do you expect to see with the baby

A

small and hypoglycemic baby

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26
Q

fetal tachycardia and minimal variability

A

septic infant

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27
Q

treatment for sheehan syndrome?

A

estrogen and progesterone replacement and supplementation with thyroid and adrenal hormones

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28
Q

what is the best positioning for breast feeding

A

mom and baby being belly to belly

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29
Q

how does candida of the nipple present

A
  • sore nipples and burning thats worse with breastfeeding
  • tips of nipples are pink and shiny with peeling at the periphery
  • make sure to check the babies mouth for candida and treat both mom and baby
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30
Q

what are the signs that the baby is getting enough breast milk

A

3-4 stools in 24hrs
6 wet diapers in 24hrs
weight gain
sounds of swallowing

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31
Q

what are the three ways an ectopic pregnancy can be diagnosed

A
  1. fetal pole is visualized outside the uterus on ultrasound
  2. the patient has a b-hCG level over the discriminatory zone (2,000 to be seen on ultrasound) and no intrauterine pregnancy is seen on ultrasound
  3. the patient has inappropriately rising b-hCG level (less than 50% increase in 48hrs) and has levels that do not fall following diagnostic dilation and currettage
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32
Q

signs of a ruptured ectopic pregnancy

A
  1. hypovolemia (tachycardia and hypotension)
  2. peritoneal signs (rebound, guarding, and severe abdominal tenderness)
  3. positive pregnancy test

*if you see a pt with this then perform a laparoscopy

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33
Q

most common abnormal karyotype that causes a spontaneous abortion

A

autosomal trisomy

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34
Q

most common cause of sepsis in pregnancy

A

acute pyelonephritis

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35
Q

how to treat a pregnant lady with thyroid storm

A

thioamides (PTU), propranolol, sodium iodide, and dexamethasone

*do not give radioactive iodine cause it may concentrate in the fetal thyroid and cause congenital hypothyroidism

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36
Q

gestational diabetes screenings

A

universal screening done for everyone between 24 and 28 weeks
-but for high risk pts you can screen them at their first visit

  1. 50g 1hr oral glucose challenge test
  2. diagnostic 100g 1hr oral glucose tolerance test if initial results exceed a predetermined plasma glucose concentration

OR

  1. just do a 75g 2hr oral glucose tolerance test
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37
Q

obese pregnant pts have a higher risk of what

A

increased maternal morbidity due to

  • chronic hypertension***
  • gestational diabetes
  • preeclampsia***
  • fetal macrosomia
  • higher rate of c-section
  • higher rate of postpartum complications
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38
Q

which depression med is contraindicated in pregnant pts

A

paroxetine (SSRI) –> other SSRIs are ok

-increased risk of fetal cardiac malformations and persistent pulmonary hypertension

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39
Q

whats the next step in a pregnant pt with suspected appendicitis

A

graded compression ultrasound

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40
Q

when is the “best” time to get varicella infection during a pregnancy

A

first trimester –> lowest risk of congenital anomalies

*give them oral acyclovir 5x/day for 7days

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41
Q

classic signs of magnesium toxicity

A

muscle weakness
loss of deep tendon reflexes
nausea
respiratory depression (11mEq/L)

*if mag is given in very high doses (15mEq/L) cardiac arrest is also possible

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42
Q

definitive treatment for preeclampsia

A

delivery of baby and placenta

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43
Q

what is a major indicator for delivery in a pt with preeclampsia/HELLP syndrome

A

thrombocytopenia (< 100,000)

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44
Q

define HELLP syndrome

A

hemolysis
elevated liver enzymes
low platelets

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45
Q

third trimester bleeding and fetus in tachysystole with evidence of fetal anemia

A

abruptio placentae

-hypertension and preeclampsia are risk factors

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46
Q

what is the goal for a pregnant pt with hypertension

A

not a normal blood pressure but into a safer range of diastolic 90-100 mmHg
*to prevent maternal stroke or abruption

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47
Q

risk factors for developing preeclampsia

A 
parity
family history
obesity 
chronic hypertension
chronic renal disease*** strongest factor
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48
Q

what non-invasive test can detect severe anemia

A

middle cerebral artery peak systolic velocity via doppler ultrasonography

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49
Q

lewis antibodies

A

IgM (does not cross the placenta)
-not associated with isosensitization or hemolytic disease of the fetus

memory device for certain antibodies: lewis lives, duffy dies, kell kills

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50
Q

ultrasound markers for twins

A
  • dividing membrane thickness more than 2mm
  • twin peak (lambda) sign
  • different fetal genders
  • two separate placentas (anterior and posterior)
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51
Q

twin infant death rate is how many times higher than singletons

A

5x higher in twins

-incidence of congenital anomalies is also increased

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52
Q

how can you try to avoid premature twin births

A

adequate weight gain in the first 20 to 24 weeks can reduce the risk of premature, preterm, low-weight babies

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53
Q

most accurate way to date a fetus that may already be dead

A

femur length cause long bone measurements are most reliable

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54
Q

uncontrolled diabetes during organogenesis

A

associated with high rate of birth defects (usually spine and heart affected)

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55
Q

what does a cone biopsy increase the risk of in a pregnant patient

A

cervical incompetence/insufficiency

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56
Q

all women with vaginal bleeding during pregnancy need to get what tested?

A

maternal blood type to check for their Rh-factor

57
Q

what is associated with a breech presentation

A 
prematurity 
multiple gestations
genetic disorders
polyhydramnios 
hydrocephaly
anencephaly 
placenta previa 
uterine anomalies 
uterine fibroids
58
Q

amniotomoy

A

artificial rupture of membranes

59
Q

what position is most associated with umbilical cord prolapse

A

back up, transverse lie

60
Q

first movement used in management of shoulder dystocia

A

McRoberts maneuver –> hyperflexing mothers legs to abdomen to widen pelvis and flatten lumbar spine

61
Q

biggest risk factor for placenta abruption

A

polyhydramnios with rapid decompression of intrauterine cavity

62
Q

pt in third trimester with abdominal pain, bleeding, uterine hypertonus, and fetal distress

risk factors: smoking, cocaine, chronic hypertension, trauma, prolonged premature rupture of membranes

A

placental abruption

63
Q

what is smoking a risk factor for

A
  1. placental abruption
  2. placental previa
  3. fetal growth restriction
  4. preeclampsia
  5. infection
64
Q

what is nifedipine used for in ob

A

its a calcium channel blocker and can be used as a tocolytic (helps to slow down/stop preterm labor)

65
Q

which tocolytics are contraindicated in pts with diabetes

A

terbutaline (also has bad side effects and doesn’t work that well) and ritodrine

66
Q

what does betamethasone from 24 to 34 weeks gestation do

A

its a steroid

  • increases pulmonary maturity and reduces the incidence/severity of RDS
  • decreased intracerebral hemorrhage and necrotizing enterocolitis in the newborn
67
Q

fibronectin

A

extracellular matrix protein that acts like an adhesive b/w fetal membranes and underlying decidua

  • if its in the cervical mucous b/w 22 and 34 weeks its thought to indicate a disruption or injury to the maternal-fetal interface
  • testing for this has a very strong negative predictive value (if its not there then you likely wont deliver in 14 days)
68
Q

magnesium sulfate mechanism of action

A

competes with calcium for entry into cells

69
Q

atosiban mechanism of action

A

oxytocin receptor antagonist that blocks the intracytoplasmic calcium release associated with contractions and downregulates prostaglandin synthesis

70
Q

if a woman has a tender fundus and ruptured membranes what should you think of

A

chorioamnionitis

71
Q

how to reduce the risk of PPROM in a woman who has already had it in a previous pregnancy

A

17 alpha-hydroxyprogesterone

72
Q

when a woman has PPROM when is the best time for delivery

A

34 weeks

73
Q

repetitive frequent painful contractions with vaginal bleeding is indicative of what

A

abruptio placetae

74
Q

prolonged periods of fetal tachycardia + maternal fever

A

chorioamnionitis

75
Q

how to evaluate and treat fetal hypoperfusion

A

change in maternal position to left lateral position (which increases perfusion to the uterus), maternal supplemental oxygen, treatment of maternal hypotension, discontinuation of oxytocin, intrauterine resuscitation with tocolytics and IV fluids

76
Q

most common cause of postpartum hemorrhage

A

uterine atony
risk factors: precipitous labor, multiparity, general anesthesia, oxytocin use in labor, macrosomia, hydramnios, twins, chorioamnionitis

77
Q

B-lynch suture

A

uterine compression suture

-helpful during unresponsive uterine atony

78
Q

most common source of fever on a 1 day postpartum woman

A

lungs (especially think of this if the woman was under general anesthesia)

79
Q

most common side effect of fluoxetine

A

insomnia (you can breastfeed while taking this med)

-third trimester use of SSRIs have been associated with poor neonatal adaptation (agitation, poor feeding, and insomnia)

80
Q

what is associated/at risk with late term and postterm pregnancies

A 
macrosomia
oligohydramnios 
meconium aspiration
uteroplacental insufficiency 
dysmaturity
81
Q

pt with intrauterine growth restriction at 36 weeks, oligohydramnios, and abnormal umbilical artery doppler studies…. best next step?

A

delivery

82
Q

compare fetal heart tracings for fetal anemia vs hypoxia

A

fetal anemia: sinusoidal pattern with regular smooth sine waves with regular amplitude and frequency

fetal hypoxia: absent variability, bradycardia, and/or recurrent late decelerations

83
Q

what type of birth control decreases the risk of endometrial and ovarian cancer

A

OCPs

84
Q

manual vacuum aspiration

A

can be used to terminate a pregnancy less than 8 weeks GA

-complications of ashermans syndrome increases with every termination

85
Q

what to do if a pt wants a surgical abortion

A

D&C + doxycycline

86
Q

pink-red appearance with overlying white keratin

A

squamous cell hyperplasia

87
Q

different treatments for vestibulodynia

A
  • tricyclic antidepressants to block to block sympathetic afferent pain loops
  • pelvic floor rehabilitation
  • biofeedback and topical anesthetics
  • surgery as last resort
88
Q

compare lichen sclerosis to lichen simplex chronicus

A

lichen sclerosis –> thin skin (epidermis), fibrosis of dermis, postmenopausal women, benign but slight increased riks for squamous cell carcinoma

lichen simplex chronicus –> thick skin (hyperplasia of vulvar squamous epithelium), leathery skin, chronic irritation and scratching (ITCHY), benign with no increased risk of squamous cell carcinoma

*NOTE –> both of them + vulvar carcinoma all present with leukoplakia

89
Q

dental dam

A

latex product used to prevent STI transmission

90
Q

if a pt has sex with someone who is hepB positive what should you do

A

post-exposure prophylaxis (within 7 days with blood contact and 14 days with sexual exposure)

if pt is unvaccinated and exposed –> 1 dose HBIG + HB vaccine series
if source status is unknown –> HB vaccine series only
pt had vaccine and responded –> do nothing
pt is had vaccine and did not respond –> HBIG + HBV vaccine series OR 2 doses of HBIG

91
Q

if a pt was treated for PID in the past what should you keep an eye out for in pts

A

tubal infertility
1x PID 12%
2x PID 25%
3x PID 50%

92
Q

first line treatment for pt with intrinsic sphincteric deficiency

A

urethral bulking procedure

  • minimally invasive
  • 80% success rate
93
Q

mirabegron

A

beta 3 adrenergic agonist

  • can give to pts with detrusor overactivity (urge incontinence)
  • relaxes the detrusor muscle

-not for pts with hypertension, ESRD, or liver disease

94
Q

tolterodine

A

acceptable treatment for urge incontinence

-not for pts with narrow-angle glaucoma

95
Q

urge incontinence

A

overactivity of the detrusor muscle causing uninhibited contractions
-you can do a mid-urethral sling for this

96
Q

colpocleisis

A

vagina is surgically obliterated and can be performed quickly without general anesthesia
-used for vaginal prolapse

97
Q

adenomyosis

A

endometrial lining in the myometrium

98
Q

danazol

A

synthetic androgen used to treat endometriosis but OCPs are still first line cause danazol has more androgenic side effects

99
Q

definitive diagnosis in a pt for endometriosis who has failed the two most common treatments (OCPs and NSAIDs)

A

exploratory surgery and biopsies

100
Q

interstitial cystitis

A

chronic inflammatory condition of the bladder

  • recurrent irritative voiding symptoms of urgency and frequency
  • kinda looks like a pt with a UTI but negative cultures and possible pelvic pain/pain with sex
  • possibly more common in women with endometriosis
101
Q

whats one of the biggest factors associated with chronic pelvic pain

A

physical and/or sexual abuse

102
Q

pt has a low transverse incision and subsequent nerve problems

A

nerve entrapment syndrome (you should be most worried about the following 2 nerves)

  1. iliohypogastric nerve (T12, L1)
  2. ilioinguinal nerve (T12, L1)
103
Q

what can increase pain levels in a pt with fibrocystic breast changes

A

caffeine intake

104
Q

criteria for MRI breast cancer screening

A
  1. BRACA carriers or 1st degree family of BRACA carriers
  2. Li-Fraumeni pts or other genetic cancer disorders
  3. 20-25% risk of breast cancer
  4. women with history of chest radiation b/w 10 and 30 years old
105
Q

complications from a LEEP procedure

A

infection, bleeding, cervical stenosis, persistent disease, and possibly risk for preterm delivery

106
Q

best way to workup incidental finding of adnexal mass in an otherwise healthy pt

A

pelvic ultrasound

107
Q

breast budding

A

thelarche (usually the first step in puberty)

108
Q

chadwicks sign

A

blue-ish cervix that indicates extra blood flow to the cervix usually due to pregnancy

109
Q

why would you test for 17-hydroxyprogesterone

A

to test for late onset 21-hydroxylase deficiency

110
Q

high levels of what hormone can cause an increase of the synchrony of hair growth

A

high estrogen levels in pregnancy cause this
then….
postpartum telogen effluvium (hair loss) affects 40-50% of women

111
Q

hyperthecosis

A

more severe form of PCOS

-associated with much higher levels of androstenedione and testosterone

112
Q

why does dysmenorrhea improve with OCPs

A

progestin in them causes endometrial atrophy (endometrium is where the prostaglandins are formed so less are formed if its atrophic)

113
Q

most helpful treatment for a pt with hot flashes

A

estrogen therapy at the smallest dose possible for the shortest amount of time

114
Q

for a woman in menopause and otherwise good health… what are the benefits and risks of using combined hormone replacement therpy

A

increase in breast cancer risk

decrease in colon cancer risk

115
Q

T-scores

A 
osteopenia = -1 to -2.5
osteoporosis = less than -2.5
116
Q

what should you look out for in a bipolar pt trying to get pregnant

A

if they are on quetiapine then look out for hyperprolactinemia as this can cause difficulty in getting pregnant

117
Q

exercise induced hypothalamic amenorrhea is characterized by what lab values

A

normal FSH and low estrogen

118
Q

how to determine ovarian reserve in a pt struggling to conceive at an older age

A

anti-mullerian hormone

119
Q

what medication helps with PMS

A

OCPs

120
Q

what vitamins and minerals have been shown to help with the symptoms of PMS

A

calcium

vitamins B6 and E

121
Q

what race is more likely to get a molar pregnancy

A

asians (and more in women younger than 20 and older than 40)

122
Q

treatment for a molar pregnancy

A

suction curettage

123
Q

what type of mole is more likely to cause GTD

A

complete mole

124
Q

how is choriocarcinoma diagnosed

A

presence of beta-hCG around 3 months post partum

125
Q

histopathology of atypical immature parabasal cells with high nucleus to cytoplasm ratio and numerous mitotic figures with enlarged hyperchromatic nuclei
-full thickness involvement without invasion into the basement membrane

this is a lesion on the vulva

A

VIN III (do a wide local incision)

126
Q

when is cryotherapy used

A

cervical dysplasia treatment (cancer must be completely ruled out)

127
Q

whats the next step in a pt who has had an endocervical curettage that came back positive

A

cervical conization

128
Q

what medication can make vaginal atrophy worse

A

tamoxifen because it can antagonize the estrogen receptors in the vagina

129
Q

what is deep dyspareunia associated with

A

conditions that cause pelvic inflammation

  • endometriosis
  • prior pelvic surgery
130
Q

lubrication during the arousal phase of intercourse is most dependent on what

A

transudate of fluid across the vaginal mucosa as genitalia become increasingly engorged with blood

note: vulvar glands play a small role in keeping the introitus moisturized

131
Q

flibanserin

A

indicated for premenopausal hypoactive sexual desire disorder but is not appropriate if it might get better on its own

132
Q

how to decrease a womans risk of ovarian cancer

A

OCPs help do this (long-term suppression of ovulation)

133
Q

adnexal mass + endometrial hyperplasia

A

granulosa cell tumor

134
Q

whats a common etiology of ovarian torsion

A

enlarged ovary with a dermoid cyst (contain oily contents that are less dense than surrounding tissue) this causes it to raise and has the infundibulopelvic ligament become unstable more likely to have an ovarian torsion

135
Q

sonographic characteristics that make cancer more likely

A
  • complexity with solid components
  • size greater than 10cm
  • mural nodules or excrescences
  • presence of ascites and bilaterally
136
Q

most common ovarian neoplasm in women less than 30

A

germ cell tumor

137
Q

what medications do you give to a pregnant pt with mitral valve prolapse (palpitations, intermittent chest pain, systolic ejection murmur with a click)

A

beta-blocker

138
Q

if a pt has a positive nitrazine test and negative ferning/normal AFI… what should you look out for in the question

A

if she just had sex semen (blood can too) can cause a false positive for the nitrazine test

Step 2 (12 decks)

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