OB/GYN Case Files and UWorld Flashcards
Def. of secondary amenorrhea
6 months of no menses in a woman with previously normal menses
Patient with amenorrhea s/p d&c
Asherman’s syndrome- dx with hysterosalpingogram
Elevation in prolactin is assciated with elevation in what other hormone?
Throid releasing hormone in hypothyroidism
Causes of galactorrhea
pituitary adenoma
pregnancy
breast stimulation
medication
chest wall trauma
hypothyroidism
Treatment of a prolactin secreting adenoma during pregnancy?
Oral bromocriptine
Hormone ratio that is elevated in PCOS
LH:FSH >2.0
Elevated ______ is indicative of ovarian failure
FSH
The major difference between the Dx of sheehan and intruterine adhesions
Withdrawl bleeding will take place in sheehan but not in intruterine adhesions
Treatment of post partum endometritis?
Clindamycin and Gentamicin
Insufficient tissue on endometrial biopsy of postmenopausal woman with abnormal uterine bleeding, next step?
D&C before ablation to ensure lack of endometrial CA
Diagnostic test for a patient with suspected PCOS
TSH, prolactin, DHEA-S, 17-hydroxyprogesterone, pelvic ultrasound
OCP of choice in PCOS?
Combination oral contraception (estrogen and progestin)
treatment of grade 1 endometrial adenocarcinoma in a patient the desires future pregnancy?
High dose progestin therapy
Patient in her 40s with new onset male pattern hair growth and clitoromegaly. 9cm ovarian mass palpated. Dx?
Sertoli-Leydig tumor. Androgen secreting.
6 year old girl with breast development, early menses, and an ovarian mass. Dx?
Granulosa-theca cell turmor– estrogen producing counterpart to the sertoli-leydig tumor
By what age are a lack of secondary sexual characteristics considered delayed puberty?
14
What lab test can help determine whether the cause of delayed puberty is central or ovarian?
Serum FSH
Low FSH points to a _____ cause, while high points to a _____ cause. (in delayed puberty)
Central (hpothalamic-pituitary axis)
Peripheral– no (-) fedback by the ovary
Most likely cause of primary amenorrhea in a Pt with normal breast and pubic hair development as well as urinary tract abnormalities?
Mullarian agenisis.
If no urnary tract abnormalities present, androgen in sensitivity is most likely
Testosterone level in mullarian agenisis?
normal
Five basic factors to examine in infertility:
ovulatory
uterine
Tubal
male factor
peritoneal factor (endometriosis)
Female with dymenorrhea, dyspareunia, and dyschezia
endometriosis
Most common cause of postmenopausal bleeding
atrophic endometritis
Age of initial pap smear
21 regardless of sexual practices
benign cystic ovarian tumor that can cuase hyperthyroidism
Struma Ovarii
Treatment for struma ovarii
exploratory laporotomy with ovarian cystectomy
Patient <30 with complex cyst, differential dx?
Dermoid or cystic teratoma
Thin white and puritic vulvar tissue
lichen sclerosis
Diagnostic test and treatment of lichen sclerosis
vulvar biopsy showing thinned epidermis, hyperkeratosis, and elongation of rete ridges
-Tx Corticosteroids
Patient reports symptoms of being pregnant and a +home preg test but her US is non-preg and the office test is negative
pseudocyesis
itchy palms and soles
intrahepatic cholestasis of pregnancy
increased bile salts
Abx of choice for lactation mastitis
Dicloxacillin and cefalexin
Bright red painless bleeding
placenta previa
risk factors for placenta previa
- previous c section
- smoking
- advanced maternal age
- prior placenta previa
length of a variable deceleration
<30s
patient with a LEEP or a cone biopsy of the cervix is at greatest risk for…
cervical incopetence/insufficiency
Gold standard method to diagnose cervical incompetence
transvaginal ultrasound
Threashold B-hCG level
1500-2000
this 2 hour glucose tolerance level is associated with insulin resistance
>140
A patient with PCOS and insuline resistance should be perscribed what medication
Metformin
BUN and sCr have this change during pregnancy
both decrease
At how many weeks are fetal lungs mature?
34
Best contraception for once ovulation has occured?
Copper IUD
Effective 99% up to 5 days
Most important side effect of raloxifene
DVT
Abx used in pregnant woman with asymtomatic bacturia
Amoxicillin
Nitrofurantoin
Amoxicillin-clavinulate
Cefalexin
What STD should all pregnant women be screened for regardless of risk factors?
Syphillis
Most common cause of mucopurulent cervicitis in reprodutive age females
Chlamydia
Clitoromegaly with high concentrations of gonadotropins and maternal masculinization during pregnancy
Aromatase deficiency
Next dx test in a patient who has period pain refractory to OCPs and ibuprophen
laproscopy (endometriosis)
Endometriosis carries a high risk for this future complication
infertility
WHen to remove testes in ovarin insensitivity syndrome
after putberty to ensure proper breast development
after rupture fetal heart tones assume a sinusoidal, tachycardia-bradycardia rhythm. There is profuse uterine bleeding. Dx?
Vasa previa leading to rupture of uterine vessels
Best Dx test for acute appendacitis of pregnancy
Ultrasound
Dx test of choice for renal colic in pregnancy
Ultrasound of the kidney and ureter
Angle of cotton swap that indicates urethral hypermobility
>30 degrees
Treatment for stress incontinence
Kegal exercises followed by urethorpexy (restoration of the vesicourethreal angle)
When should Rho-Gam be administered, why?
28-32 weeks and again within 72hrs of birth
-because the half life of anti-d is about 6 weeks which will cover most of the third trimester
Measurement of this is the most reliable index for fetal growth restriction
abdominal circumference
causes of symmetric IUGR
Chromosomal abnormalities
TORCH infections
Maternal substance abuse
anemia
Causes of assymtric IUGR
HTN, malnutrition and genetic abnormalities
Appropriate management of incomplete abortion in a stable woman
Misoprostol
OR
Observation and Expectant management
Bilateral solid cystic ovarian tumors in pregnant woman with hirsutism
luteoma
–expectant management
Management of a female with intrauterine fetal demise and borderline coagulation studies
Induction of labor– suspicious for DIC
Cause of DIC in an intrauterine fetal demise
release of tissue factor (thromboplastin) from the placenta into maternal circulation
Tx of Trichomonas
Metronidazole for female and husband
Biopsy shows hyperplasia without atypia in a woman who does no desire fertility- Tx?
Progestin therapy
Ovarian torsion more common on this side
right
B-hCg is produced in the _______ and functions to ________.
Produced by syncitiotrophoblast and maintains the corpus luteum
Prolactin production is induced by
TRH and Serotonin
Which two hormones are decreased in a quad screen indicative of down syndrome?
msAFP and Estriol
What is mittleschmerz
mid cycle pain caused by ovulation
Who are the only patients to get a CA-125 level?
Postmenopausal women with mass
Combined OCPs cause worsened ______
HTN
What is the genotype in Kallman syndrome?
Normal
Trichomonas pH
>4.5
Tx of high post void residuals in a patient with epidural anesthesia
intermittant catheterization
Turner syndrome causes FSH to be _______
High
Classic triad for hydatidiform mole
Hyperemisis
Gravid uterus beyond gestational dates
B-hCG >100,000
Hyperemisis gravidum is associated with increased levels of what enzymes
LFT
Goddell Sign
Softening of the cervix
Apparent at 4 weeks gestation
Chadwick sign
blue discoloration of vagina and cervix
elements in tripple screen? quad screen?
Performed when?
MS AFP
B-HCG
Estriol
Quad screen= above + inhibin A
15-20wks
Time when chorionic villus sampling is performed
10-13 wks
Pregnanacy that ends before 20wks gestation
abortion
Critical mass for delivery of fetus
>2500g
To be considered gestational HTN, it must occur after this point
20wks
