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Women's Health > OB Gyn Case Files > Flashcards

OB Gyn Case Files Flashcards

0
Q

What’s menometrorrhagia?

A

Heavy and irregular menses

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1
Q

What’s some risk factors for endometrial cancer?

A

Hypertension, diabetes, anovulation, early age of menarche, late age of menopause, obesity, infertility, nulliparity

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2
Q

What’s menorrhagia?

A

Heavy menses

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3
Q

What kind of heart murmurs are common in pregnancy?

A

Systolic flow murmurs due to increased cardiac output

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4
Q

What does the grey turner sign indicate?

A

Dis colorization of the flank may indicate intra abdominal or retro peritoneal hemorrhage

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5
Q

What could ulcers in the external genitalia indicate?

A

HSV , vulvar carcinoma or syphilis

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6
Q

Where would a bartholin glad cyst or abscess be located?

A

Vulvar mass at the 5 or 7 o’clock position

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7
Q

What’s the concern with pigmented vulvar lesions?

A

Malignant melanoma - must biopsy

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8
Q

What could modularity and tenderness in the uterosacral lig on rectal exam be a sign of?

A

Endometriosis

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9
Q

What part of the gyn exam assesses the anterior vs posterior pelvis?

A

Vaginal exam - anterior pelvis

Rectal exam - posterior pelvis

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10
Q

What are some prenatal labs and purpose? (9)

A
  1. CBC - anemia and thrombocytopenia
  2. Blood type, Rh and Ab screen
  3. hep B surface antigen (HBsAg) - if + give newborn hep B Ig (HBIG) and hep B vaccine
  4. Rubella titer - if not immune, vaccine postpartum bc live-attenuated vaccine
  5. syphilis nontreponemal test (RPR or VDRL)
  6. HIV
  7. Urine culture or urinalysis - assess for asymptomatic bacteriuria
  8. Pap smear - assess for cervical dysplasia or cancer
  9. Assays for chlamydia or gonorrhea
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11
Q

How do you test for syphilis?

A

A nontreponemal serology RPR (rapid plasma reagin) or VDRL (venereal disease research lab)
If positive do confirmatory treponemal test like MHATP (microhemagglutination assay for Abs to treponema palladium) or FTA-ABS (fluorescent treponema Ab Absorbed)
Pt might not have developed Ab yet so may have neg serology,

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12
Q

How do you treat syphilis? What if someone pregnant?

A

IM Penicillin
Treat if pregnant to prevent congenital syphilis
If allergic to penicillin need to desensitize to receive it

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13
Q

How do you test for HIV?

A

Screening test: ELISA

Confirmatory test: western blot

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14
Q

When and how do u screen for gestational diabetes?

A

26-28 weeks

50- g oral glucose, assess after 1 he fasting

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15
Q

When do u culture a preg woman for GBS?

A

35-37 weeks gestation

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16
Q

What lab tests might you order for a threatened abortion? And why?

A

Quantitative hCG and/or progesterone to establish viability and risk of ectopic preg

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17
Q

What labs might be ordered for pt with menorrhagia due to uterine fibroids?

A

CBC, endometrial biopsy (assess for endometrial ca), Pap smear (assess for cervical dysplasia or cancer)

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18
Q

What labs might be ordered for a 55 yo or older lady with adnexal mass?

A

CA-125 and CEA tumor markers for epithelial ovarian tumors

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19
Q

In postmenopausal women what would a thickened endometrial stripe indicate?

A

Malignancy

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20
Q

What’s the purpose of a sonohysterogram?

A

Inject small amount Of saline into uterus to better see things like endometrial polyps or submucous myomata

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21
Q

What’s a intravenous pyelogram (IVP) and what’s it’s use?

A

IV dye used to assess concentrating ability of the kidneys, patency of the ureters and integrity of the bladder. Can also detect hydronephrosis, uretheral stone or obstruction

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22
Q

What’s a hysterosalpingogram (HSG)

A

Radiopaque dye thru transcervical canal and X-rays taken
Can detect intrauterine abdnormalities like submucosal fibroids or intrauterine adhesions and the patency of the Fallopian tubes (tubal obstruction or hydrosalpinx)

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23
Q

What 3 things is BV associated with?

A

Preterm delivery, endometritis and vaginal cuff cellulitis (following hysterectomy)

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24
Q

What’s the definition of postpartum hemorrhage? (PPH)

A

> 500 mL blood loss with vaginal delivery

>1000 mL blood loss with c-section

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25
Q

What’s the MC cause of postpartum hemorrhage? How do to check?

A

Uterine atony

Check to see if uterus is boggy

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26
Q

What would be like cause of postpartum hemorrhage with a pt with a firm uterus?

A

Genital tract laceration usu involving the cervix (no atony if firm well-contracted)

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27
Q

What’s the liking diagnosis for a pt with lower abd tenderness, Cervical motion tenderness, vaginal discharge, dyspareunia, and adnexal tenderness?

A

PID

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28
Q

What are some symptoms of severe PID?

A

High fever, evidence of sepsis, peritoneal signs, tubo-ovarian abscess seen on US

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29
Q

Treatment for PID?

A

IM ceftriaxone and oral doxycycline

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30
Q

What’s the gold standard for diagnosing acute salpingitis?

A

Laparoscopy to visualize the tubes for purulent drainage

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31
Q

What’s the concern with a preg pt. Who develops dyspnea 2 days post pyelonephritis tx? What’s the MOA?

A

Acute respiratory distress syndrome post Abx due to endotoxins from GN bacteria causing pulmonary injury and capillary leakage of fluid into pulm interstitial space

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32
Q

What’s the classical presentation for pyelonephritis? What causes it?

A

Fever, flank tenderness and pyuria

Usu GN bacteria like E. Coli

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33
Q

What’s long term consequences of PID?

A

Ectopic preg or infertility from tubal damage

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34
Q

What’s the end stage of a tubal infection?

A

Tubo-ovarian abscess with life threatening complication of rupture seen as shock, hypotension. Tx with immediate surgery

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35
Q

What’s the most likely cause of tubal factor infertility?

A

Chlamydia trachomatis cervicitis which ascended to the tubes causing damage

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36
Q

What are the 3 ways to surgically assess the abd cavity?

A
  1. Laparotomy: Incision of the abdomen
  2. Laparoscopy: small incisions using scope
  3. Robotic
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37
Q

What’s a hysteroscopy

A

Insert a media into intrauterine cavity to visualize the endometrial cavity

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38
Q

What does at term mean?

A

Btwn 37-42 weeks from LMP

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39
Q

What’s the cervix like in active labor?

A

> 4 cm dilated

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40
Q

For nulliparous, what’s the rate of cervical dilation?

A

1.2 cm/hr during active labor

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41
Q

What dictates normalcy in labor?

A

Change in cervix per time (not uterine contraction pattern)

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42
Q

How’s the clinical pelvimetry done?

A

Digital Palpation of the pelvic bones

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43
Q

Define labor

A

Cervical changes accompanied by regular uterine contractions

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44
Q

Define the latent phase of labor

A

Inital part where the cervix mainly effaces (thins) rather than dilates (< 4 cm)

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45
Q

Define the active phase of labor

A

Dilation occurs more rapidly usually when cervix > 4 cm dilated

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46
Q

What’s protraction of active phase

A

Cervical dilation in the active phase that’s less than expected (norm nulliparous >= 1.2 cm/hr, multiparous >= 1.5 cm/hr)

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47
Q

What’s arrest of active phase of labor

A

No progress in active stage for 2 hours

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48
Q

What’s the 3 stages of labor?

A

First stage: onset of labor to complete dilation of the cervix
Second stage: complete cervical dilation to infant delivery
Third stage: delivery of infant to delivery of the placenta

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49
Q

What’s the baseline fetal heart rate?

A

110-160 bpm

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50
Q

What are fetal decelerations

A

Fetal HR episodic changes below baseline

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51
Q

What are the 3 types of fetal decelerations?

A

Early: mirror image of uterine contraction
Variable: abrupt jagged dips below the baseline
Late: offset following the uterine contractions

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52
Q

What’s fetal acceleration?

A

Episodes of fetal hear rate that increases above baseline for at least 15 bmp for at least 15 sec (15x15)

53
Q

What are the 3 things that need to be considered if diagnosed with labor abnormality?

A

Power
Passenger
Pelvis

54
Q

If power is believed to be the cause of labor abnormality what should be done?

A

Give IV oxytocin to augment contraction strength and or frequency

55
Q

Whats cephalopelvic disproportion?

A

Pelvis thought to be too small for fetus bc abnorm pelvis or large baby

56
Q

What’s adequate uterine contractions?

A

Contractions every 2-3 min, firm on Palpation, last for at least 40-60 sec

57
Q

What’s Montevideo units used for?

A

Unit of mm hg rise in assessment tool uses to assess contractions over 10 mins. Add each unit if >200 Montevideo = adequate uterine contraction pattern

58
Q

What’s the most common fetal deceleration and what could cause it?

A

Variable

Caused by cord compression

59
Q

What causes early fetal deceleration

A

Fetal head compression - benign

60
Q

What does late deceleration indicate?

A 
Fetal hypoxia (uteroplacental insufficiency)
If recurrent (>50%) can mean fetal acidosis
61
Q

When is fetal acidosis strongly suspected?

A

When late decelerations occur with decreased variability

62
Q

What’s fetal HR pattern category I?

A

Norm baseline and variability

No late or variable decelerations

63
Q

What’s fetal HR pattern category II?

A

Bears watching

May have some aspect that’s concerning but not ominous (ex: feral tachycardia without decelerations)

64
Q

What’s fetal HR pattern category III?

A

Ominous with high likelihood of severe fetal hypoxia or acidosis
Ex: absent baseline variability with recurrent late or variable decelerations or bradycardia
ex: sinusoidal HR pattern (prompt delivery of no improvement!)

65
Q

What’s the lower limits of normal for latent period timeframe?

A

Nullipara: <= 14 hr

66
Q

What’s the lower limits or normal for second stage of labor timeframe?

A

Multipara: <=2 hr (3 if had epidural)

67
Q

What’s the lower limits or normal for third stage of labor timeframe?

A

<= 30 mins

68
Q

What’s an anthropoid pelvis and what does it predispose you to?

A

Anteroposterior diameter greater than the transverse diameter with prominent ischial spines and a narrow anterior segment
Predisposes to persistent fetal occipital posterior position

69
Q

What does 0 station mean?

A

The presenting part (usu the bony part of the fetal head) is at the plane of the ischial spine and not at the pelvic inlet

70
Q

What does station mean?

A

The relationship of the presenting bony part of the fetal head in relation to the ischial spines (and not the pelvic inlet)

71
Q

What’s engagement mean?

A

The relationship of the widest diameter of the presenting part and it’s location with reference to the pelvic inlet

72
Q

What’s blood show?

A

Loss of cervical mucus plug - sticky mucus admixed with blood
A sign impending labor

73
Q

How can you differentiate bloody show from antepartum bleeding?

A

Bloody show has sticky mucus admixed with blood

74
Q

Delivery at less than what # of weeks is associated with an increased risk of neonatal complications?

A

<39 weeks

75
Q

C section for labor abnormalities in the absence of clear cephalopelvic disproportion is generally reserved for what?

A

Arrest of active phase with adequate uterine contractions

76
Q

What’s the MC cause of anemia? How would you treat it?

A

Iron deficiency - microcytic anemia

Give iron and recheck Hg in 3 weeks

77
Q

What would a hemoglobin electrophoresis show for B-thalassemia trait? (Heterozygous for B-thal)

A

Elevated A2 hemoglobin

78
Q

What’s the levels for anemia in pregnancy?

A

Hbg < 10.5
Mild: 8-10
Severe: < 7

79
Q

What would you do with a patient with continued anemia after 3-4 weeks of iron supplement?

A

Eval for iron stores - ferritin (low in iron deficiency) and hemoglobin electrophoresis

80
Q

What’s thalassemia

What can it result in?

A

Decreased production of one or more globin peptide chains (alpha or beta)
Can result in ineffective erythropoiesis, hemolysis and anemia

81
Q

What’s hemolytic anemia

A

Abnormally low Hbg due to RBC destruction

82
Q

What’s G6PD deficiency

A

X linked condition where RBC may have a decreased capacity for anaerobic glucose metabolism
Certain oxidizing agents like nitrofurantoin- used for UTIs, sulfonamides, and antimalarials can lead to hemolysis
Have dark urine due to bilirubenia, jaundice and fatigue

83
Q

What’s B-thalassemia minor?

How would you treat a preg pt with this?

A

Decreased production of the B-globin chain

Prophylactic folic acid and genetic counseling

84
Q

How would a neonate with B-thalassemia major present?

A

May appear healthy at birth but as HgF decreases and no B-chains to replace gamma-chains, the infant becomes severely anemic, failure to thrive if not transfused

85
Q

What’s sickle cell anemia

A

Recessive disorder caused by a point mutation in the B-globin chain in which AA gluts mic acid is replaced with valine causing improper Hgb folding

86
Q

What happens to pts with sickle cell during preg?

A

Increased anemia, sickle cell crisis and more freq infections and pulm complications
Also have higher incidence of fetal growth retardation and perinatal mortality so do serial US

87
Q

What are the causes of macrocytic anemia?

A

Vit B 12 deficiency and folate deficiency (more common bc B11 storages last for years)

88
Q

What causes physiologic anemia of prgnancy?

A

Hemodilution due to the disproportionate increase in plasma volume over the increased RBC volume

89
Q

What’s a Hgb electrophoresis look like for a-thalassemia

A

Elevated Hbg F

90
Q

What’s the MC cause of uterine inversion?

A

Undue traction of the cord before placental separation

91
Q

What are the 4 signs of placental separation?

A
  1. Gush of blood
  2. Lengthening of the cord
  3. Globular and firm uterus
  4. Uterus rises up to the anterior abdominal wall
92
Q

What does the endometrial surface of the uterus look lik

A

Red shaggy appearance

93
Q

What’s abnormally retained placenta

A

Third stage of labor that’s exceeded 30 mins

94
Q

What’s uterine inversion?

A

A turning inside out of the uterus where the fungus of the uterus moves through the cervix thru the vagina

95
Q

What’s the best method for avoiding uterine inversion?

A

Await spontaneous placenta separation before placing traction on the umbilical cord

96
Q

Who’s most at risk for uterine inversion?

A

Grand-multiparous pt with placenta implantation in the fundus (top of uterus) or placenta accreta

97
Q

How do you treat uterine inversion?

A

Uterine relaxant like halothane, terbutaline or Mg sulfate and cupping fingers to replacement then give uterotonic agent like oxytocin to prevent reinversion

98
Q

What’s the MC finding in uterine rupture?

A

Fetal HR abnormality like fetal bradycardia, deep variable decelerations or late decelerations

99
Q

How do you treat uterine rupture

A

Immediate c-section

100
Q

What can be used to ripen the cervix?

A

Vaginal misoprostol (prostaglandin )

101
Q

What are associated complications of misoprostol cervical ripening?

A

Prolonged decelerations, fetal bradycardia, uterine hyperstimulstion

103
Q

What’s uterine hyperstimulation?

What can cause it?

A

> 5 uterine contractions in 10 mins

Causes: prostaglandin cervical ripening agents (misoprostol), oxytocin

104
Q

What’s the first step in assessing fetal bradycardia? How can you do it?

A

Differentiate fetal & maternal HR via fetal scalp electrode or ultrasound

105
Q

What’s a fetal scalp pH assess? what does it require?

A

Assesses if the fetus is receiving sufficient oxygen during labor
Requires 4cm dilation to get blood sample from fetal scalp

106
Q

Why does epidural-induced hypotension occur and how do you treat it?

A

Sympathetic blockade leads to vasodilation -> hypotension and fetal late decelerations
Tx: IV fluids, if still persists vasopressors like ephedrine

106
Q

What increases the risk for cord prolapse?

A

Footling breech or transverse lie

107
Q

Whats the best therapy for umbilical cord prolapse?

A

Manual elevation of presenting part and emergency c section

108
Q

Name 7 steps to take with fetal bradycardia

A
  1. Confirm fetal HR vs maternal
  2. Vaginal exam to assess for cord prolapse
  3. Positional changes - left lateral decubitus
  4. O2 with mask
  5. IV fluids
    6 pressors if hypotension persists (like ephedrine)
    7 discontinue oxytocin
109
Q

What’s engagement

A

Largest transverse (biparietal) diameter of the fetal head has negotiated the bony pelvic inlet

110
Q

What’s fetal bradycardia

A

Baseline fetal HR <110 bpm for greater than 10 mins

111
Q

What’s umbilical cord prolapse

A

Cord enters they cervical is presenting in front of the presenting part

112
Q

What’s artificial rupture of membranes

A

Maneuver used to cause perforation in the fetal chorioamniotic membranes
Don’t do it unless fetal head is engaged

113
Q

What are risk factors for shoulder dystocia

A

Fetal macrosomia, maternal obesity, multiparous, post term delivery, prolonged second stage of labor, gestational diabetes - elevated insulin assoc with increased central shoulder and abd weight of fetus

114
Q

What’s the MC injury in shoulder dystocia

A

Brachial plexus injury like Erb palsy (C5-6 injury- weak forearm flexors, infraspinatous and deltoid muscles with arm at side and internally rotated)

115
Q

What are the first actions for shoulder dystocia?

A

McRoberts maneuver or supra public pressure

116
Q

What are the 5 possible maneuvers for treating shoulder dystocia?

A
  1. McRoberts maneuver -hyperflex maternal hips to straight sacrum and anteriorly move symphysis pubis
  2. Suprapubic pressure- push fetal shoulder Into oblique position
  3. Delivery posterior arm
  4. Woods corkscrew maneuver - rotate posterior shoulder 180 degrees
  5. zavanelli maneuver - cephalic replacement with immediate c-section
117
Q

What’s a fetal sign of shoulder dystocia

A

Turtle sign - fetal heads retracted back toward maternal introitus

119
Q

What’s uterine atony ?

A

Lack myometrial contraction to cut off uterine spiral arteries that supply the placental bed

120
Q

What can increase the risk of uterine atony?

A

overdistended uterus (polyhydroamniosis, multi fetal preg, macrosomia), rapid or prolonged labor and/or delivery, oxytocin use during labor, magnesium sulfate, intraamniotic infection (chorioamnionitis), high parity

121
Q

What’s methylergonovine maleate (IM Methergine)? What can it tx? Contraindications?

A

An ergot alkaloid agent that induces myometrial contractions.
Tx: Uterine atony
Contraindications: HTN (increased risk of stroke)

122
Q

What does IM prostalandin F2-a do? Contraindications?

A

causes SM contraction

Contraindiciation: asthmatics (potential for bronchospasms)

123
Q

What’s the difference btwn early and late PPH?

A

early < 24 hr after delivery; late >24 hr

124
Q

Initial tx for PPH?

A

uterine massage (bimaunal compression) w/ IV dilute oxytocin

125
Q

What’s the second line tx options for PPH?

A

Uterotonic agents: ergot akyloids (IM methergine), IM prostaglandin F2-a, rectal misoprostol
2 large-bore IVs, foley cathetic, blood, monitor vitals, move to OR

126
Q

What are options for PPH if in OR?

A

laparotomy for compression stitches (B-lynch stitch), ligation of blood supplies (ascending branch of uterine artery or internal iliac artery hypogastric artery), hysterectomy, intrauterine balloon, embolizatoin

127
Q

Causes of early PPH?

A

uterine atony (MC), coagulopathies, genital tract lacerations, uterine inversion, placenta accreta or retained placenta

128
Q

causes of late PPH?

A

subinvolution of the placental site - occurs 10-14 days post delivery
retained products of conception (POC) - uterine cramping, bleeding, fever, foul-smelling lochia

129
Q

How do you tx subinvolution of the placental site late PPH bleeding?

A

oral ergot alkaloid and careful f/u; other options IV dilute oxytocin or IM prostaglandin F2a
(bleeding 2 weeks post partum)

130
Q

How do you treat POC (products of conception)?

A

uterine curettage and broad-spectrum abx

131
Q

What are ways to reduce the incidence of PPH?

A

oxytocin (Pitocin) after infant delivery, early cord clamping, gentle cord traction w/ uterine counter traction w/ a well-contracted uterus

Women's Health (5 decks)

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