Ob/Gyn COPY Flashcards
1
Q
Why do pregnant women get Anemia?
A
Due to the dilution effect: RBC rises 30%, but body volume rises 50%
2
Q
What are the degrees of Vaginal Lacerations?
A
1st Degree: Skin
2nd Degree: Muscle
3rd Degree: Anus
4th Degree: Rectum
3
Q
What is Vernix?
A
Cheesy baby skin. (protects the baby’s skin from the outside world and helps with passage through the birth canal)
4
Q
What is Meconium?
A
Green baby poop (first poop)
5
Q
What is Lochia?
A
Endometrial slough. (normal discharge and uterus after birth)
6
Q
What is normal blood loss during a Vaginal Deliver?
A
500 mL
7
Q
What is normal blood loss during a C-section?
A
1000 mL
8
Q
How do you treat A1 Gestational DM?
A
Diet
9
Q
How do you treat A2 Gestational DM?
A
Insulin
10
Q
What are Identical Twins?
A
Eggs split into perfect halves “Monochorionic”
11
Q
What are Fraternal Twins?
A
Multiple eggs fertilized by different sperm
12
Q
What is Ovarian Hyperstimulation syndrome?
A
Weight gain and enlarged ovaries after clomiphene use for infertility
13
Q
Who Makes the Trophoblast?
A
Baby
14
Q
Who makes the Cytotrophoblast?
A
Mom production of GnRH, CRH, TRH, and Inhibin
15
Q
Who makes the Syncytiotrophoblast?
A
Mom and baby production of HCG and HPL
16
Q
When does Implantation occur?
A
1 week after fertilization
17
Q
When is Beta HCG found in Urine?
A
2 weeks after fertilization
18
Q
When is B-HCG found in Blood?
A
8-10 days after fertilization
19
Q
What makes Progesterone in >10 weeks gestation?
A
Placenta
20
Q
What is the function of B-HCG?
A
Maintains Corpus Luteum, sensitizes TSH receptors to make body hyperthyroid (to raise BMR)
21
Q
What makes B-HCG?
A
Placenta (synctiotrophoblast)
22
Q
How fast should B-HCG rise?
A
Shoulde double every 2 days until 10 weeks, stops when placenta is fully formed
23
Q
What is the fucntion of AFP?
A
Regulates intravascular volume
24
Q
What is the function of HPL?
A
Blocks insulin receptors so the sugar stays high, (baby is stocking up - hibernating)
25
What is the function of Inhibin?
Inhibits FSH so there is no menstruation
26
What is the function of Cortisol in Pregnancy?
Decreases immune rejection of the baby out of mom and for lung maturation
27
What is the function Oxytocin?
Milk and baby ejection
28
What is the thyroid hormone levels during Pregnancy?
Increased TBG - leads to increased total T4 (Bound and free)
29
When can you first detect fetal heart tones?
Week 20
30
When can you tell the sex of the baby by US?
Week 16
31
What does an AFI <5 indicate?
Oligohydramnios (Cord compression)
32
What does an AFI >20 indicate?
Polyhydramnios (DM)
33
How fast should fundal height change?
Uterus grows 1 cm/week
34
What is the Pool Test?
Fluid in the vagina
35
What is Ferning?
Estrogen crystallizes on slide. (Amniotic fluid)
36
What is Nitrazine?
Detects presence of amniotic fluid. (pH indicator - strip will turn blue if pH is greater than 6.0)
37
What is the risk of Chorionic Villus Sampling?
Fetal limb defects. (Done at 9-12 weeks)
38
What is the risk of Amniocentesis?
Abortion (2% risk)
39
What is a Biophysical Profile (BPP)?
By US look for:
Non-stress test
AFI
Fetal heart tone
Fetal Activity
Breathing Movement
40
What is a normal BPP?
>8-10
41
How much weight should a woman gain during Pregnancy?
1 lb/ week
42
When should Intercourse be avoided during Pregnancy?
Cervical dilation, placenta previa, premature labor, vaginal bleeding, ruptured membranes, genital herpes
43
What are the Leopold Maneuvers?
To determine the position of the baby
Feel the fundus
Feel the baby's neck
Feel the pelvic inlet
Feel the baby's head
44
What is Stage 1 of Labor?
Starts with the onset of true labor and lasts until the cervix is completely dilated to 10 cm
45
What is the Stage II of Labor?
Continues after the cervix is dilated to 10 cm until the delivery of the baby
46
What is Stage III of Labor?
Delivery of the placenta
47
How do you monitor Baby's Heart Rate?
Doppler or scalp electrode
48
How do you monitor the Uterus?
Tocodynamics, uterine pressure catheter. (Measure frequency and duration of contractions)
49
What are Braxton-Hicks Contractions?
Irregular contractions with closed cervix. (preparing for birth)
50
What is a Vertex Presentation?
Posterior Fontanel (triangle shape) presents first (normal)
51
What is a Sinciput Presentation?
Anterior Fontanel (Diamond shape) presents first
52
What is Face Presentation?
Mentum Anterior preform forceps delivery
53
What is a Compound Presentation?
Arm or hand on head, vaginal delivery. (Mean's Prolapse of fetal extremity with presenting part)
54
What is a Complete Breech?
Butt down, thighs, and legs flexed
55
What is a Frank Breech?
Butt down, thigh flexed, legs extended (Pancake)
56
What is a Footling Breech/Incomplete breech?
Butt down. Thigh flexed, one toe is sticking out of the cervical OS
57
What is a Double Footling Breech?
Two feet sticking outside the cervical OS
58
What is Shoulder Dystocia?
Head is out of vagina, shoulder is stuck. (Occurs in late term deliveries and DM in mom)
59
Can you try a Vaginal Delivery on a woman who has had a Classic Horizontal C-Section previously?
No, they must have C-Section for all future pregnancies
60
Can you try a Vaginal Delivery on a woman who had a LOW Transverse C-Section previously?
Yes, 70% are okay, Potential for uterine wall rupture
61
What is Early Deceleration?
Normal due to head compression
62
What is Late Deceleration?
Due to uteroplacental insufficiency because the placenta cannot provide oxygen and nutrients
Late deceleration is defined as a visually apparent, gradual decrease in the fetal heart rate typically following the uterine contraction. The gradual decrease is defined as, from onset to nadir taking 30 seconds or more.
VEAL: CHOP
Late Decelerations: Placental Insufficiency
Variable Decels - Cord Compression
Early decels - Head compression
Accelerations - OK, indicates fetal well being (Increases of the fetal heart rate of at least 15 beats per minute above baseline that start and peak within 30 seconds, but not less than 15 seconds are termed accelerations. These should subside within 2 minutes.)
Late decels - placental insufficiency
63
What is Variable Deceleration?
Cord Compression
variable decelerations are caused by compression of the umbilical cord. Pressure on the cord initially occludes the umbilical vein, which results in an acceleration followed by occlusion of the umbilical artery, which results in a sharp deceleration as the fetal blood supply is suddenly restricted
Variable decelerations are THE MOST COMMON TYPE of fetal deceleration.
They typically occur during the first and second stages of labor (i.e., the initial contractions and dilation of the cervix leading to the delivery of the infant, respectively) and vary in shape, duration, and intensity. They often resemble the letter “U,” “V” or “W” and may not have a constant relationship with uterine contractions.
64
What is increased beat-to-beat variability?
Fetal Hypoxia
65
What is Decreased beat-to-beat variability?
Acidemia
66
What are the SYmptoms of Pre-eclampsia?
Headaches, changes in vision, and epigastric pain
67
What is Pre-Eclampsia?
Ischemia to the placenta causes HTN greater than 140/90
68
What is the Treatment for Pre-Eclampsia?
Delivery, MgSO4 (seizures), Hydralazine (BP)
69
What is HELLP Syndrome?
Hepatic injury causing:
H- Hemolysis
EL- Elevated Liver Enzyme
LP- Low Platelets
70
What is Eclampsia?
HTN with seizures
71
What is the Treatment for Eclampsia?
4mg MgSO4 IV (Seizure prophylaxis)
72
What is Chorioamnionitis?
Fever, uterine tenderness, decreased fetal HR
73
What are the symptoms of Amniotic Fluid Emboli?
Mom just delivered Baby and mom has SOB, due to PE, leads to death
74
What is Endometritis?
Postpartum uterine tenderness
75
What is an Incomplete Molar Pregnancy?
2 Sperm + 1 egg (69, XXY) mom "cooks the parts" has embryo parts
76
What is a complete molar pregnancy?
2 Sperm and no egg (46, XX) both are paternal, bunch of graps, dad eats grapes, no embryo
(GROSS!)
77
What is Pseudocyesis
Fake pregnancy with all the signs and symptoms
78
What is the most common cause of first trimester maternal death?
Ectopic pregnancy
79
What is the most common cause of first trimester spontaneous abortions?
Chromosomal abnormalities
80
What are the most common causes of third trimester spontaneous abortions?
Anti-Cardiolipin Ab, placenta probelms, infection, incompetent cervix
81
What is a threatened Abortion?
Cervix is closed, baby is intact, treat with bed rest
82
What is inevitable Abortion?
Cervix is open, baby is intact
83
What is an incomplete Abortion?
Cervix is open, fetal remnants
Tx: D&C to prevent placenta infection
84
What is a Complete Abortion?
Cervix is closed, no fetal remnants, check B-HCG level
85
What is a Missed Abortion?
Cervix is closed, no fetal remnants ("empty sac")
"Cramping, loss of early pregnancy symptoms. NO BLEEDING. No fetal cardiac activity. products of conception present on US"
Tx. D&C
86
What is a Septic Abortion?
Fever greater than 100.4 F, malodorous discharge
87
What is Placenta Previa?
The placenta is implanted wholly or partially in lower uterine segment
88
Waht is Vasa Previa?
Babies blood over OS
89
What is Placenta Accreta?
Placenta is attached to the endometrium
90
What is Placenta Percreta?
Placenta perforates through serosa
91
What is Placenta Abruptio?
Severe pain due to premature separation of the placenta
92
What is Velamentous Cord Insertion?
Fetal vessels insert between chorion and amnion
93
What is Uterus Rupture?
Tearing sensation, halt of delivery
94
What is an Apt Test?
Detects HbF in the Vagina, detects baby's hemoglobin (Alkali denaturation test)
95
What is Wright's Stain?
Detects nucleated fetal RBC in mom's vagina
96
What is a Kleihauer-Betke Test?
Detects percentage of fetal blood in maternal circulation (Dilution test)
97
What is Materninty Blues?
Postpartum crying and irritability
98
What is Postpartum Depression?
Depression post-delivery for more than 2 weeks
99
What is Postpartum Psychosis
Hallucinations, suicidal/infaticidal thoughts
100
What does Seminal Vesicle give to Sperm?
Food (Fructose) and clothes (semen)
101
What does the Bulbourethral/ Cowper's Glands secrete?
Bicarb to neutralize lactobacilli, if sperm is too acidic. (Infertility until corrected)
102
What does the Prostate Secrete?
The prostate HAZ it.
H- Hyaluronidase
A- Acid Phosphatase
Z- Zinc
103
What is the Capacitation reaction?
Allow binding btwn sperm & egg
104
What is the Acrosomal reaction?
Sperm release enzymes to eat the Corona Radiata
105
What is the Crystallization reaction?
Wall formed after one sperm enters to prevent polyspermy
106
Where does Testosterone come from?
Adrenal gland and testicles
107
Where does DHT come from?
Testicles at puberty
108
What is Pseudohermaphrodite?
external genitalia problem
109
What is a True Hermaphrodite?
Internal genitalia problem (has both sexes)
110
What is a Female Hermaphrodite?
Impossible because female is the default formation
111
Classic congenital adrenal hyperplasia
XX with LOW 21-OHase and HIGH Testosterone
112
Androgen insensitive syndrome
XY with no MIF
113
congenital adrenal hyperplasia (CAH)
congenital adrenal hyperplasia (CAH)
XY with LOW 17-OHase and LOW Testosterone
results from loss-of-function mutations involving the CYP17 gene
.
114
What is Hirsutism?
Hairy female (Excess growth in normal male areas)
115
What is Virilization?
Female that is Man like
116
What is woman with a blind pouch vagina but an XY karyotype?
Androgen Insensitivity Syndrome: males with defective / bad DHT receptor
AKA Testicular Feminization
117
What is McCune-Albright?
Precocious sexual development, polyostotic fibrous dysplasia "whorls of connective tissue", "coast of Maine" pigemented skin macules
118
What is Cryptorchidism?
Testes never descended out of abdomen, sterility after 15 months, predisposed to seminomas and CA
119
Which stage of the Menstrual Cycle has the highest Estrogen levels?
Follicular stage (Has proliferative endothelium)
120
What stage of the menstrual cycle has the highest Temperature?
Ovulatory stage, body temp will rise One degree during ovulation
121
What stage of the Menstrual Cycle has the highest level of Progesterone?
Luteal stage (Has secretory endothelium)
122
What form of Estrogen is highest at Menopause?
E1: Estrone (Made by Fat)
E2: Estradiol (Made by the ovaries)
E3: Estriol (Made by the placenta)
123
What states have increased Estrogen?
Pregnancy, liver failure, P-450 inhibition, and obesity
124
What is Adenomyosis?
Growth of the Endometrium, Myometrium, and patients will have an enlarged "boggy" uterus with cystic areas
125
What does DES taken by Mom cause in her Daughter?
Adenomyosis, menorrhagia, clear cell CA of the vagina, recurrent abortions
126
What is Kallmann's Syndrome?
No GnRH and Anosmia. (They can't smell)
127
What is Polycystic Ovarian Syndrome?
Increased cysts. No ovulation due to no Progesterone, leads to increased Endometrial CA, they cannot inhibit LH, obese, hairy, acne
128
What is Savage's Syndrome?
Ovarian resistance to LH/FSH
129
What is Turner's Syndrome (XO)?
High FSH, LOW E2, Ovarian Dysgenesis, Webbed Neck, Coarctation of the Aorta, Cystic Hydroma, bicuspid Aortic valve
130
What does the Progesterone Challenge Test tell you?
Progesterone withdrawn---> Vaginal bleeding if she has estrogen.
Progesterone withdrawn --> If she does NOT bleed, she has no E2 or ovaries
Increased FSH: Ovary problem
Decreased FSH: Pituitary problem
131
What is SHeehan Syndrome?
Postpartum hemorrhage in pituitary, no LH or FSH = no periods, hyperplasia infarcts, no prolactin = no milk
132
What is Asherman's Syndrome?
Uterine scars from multiple D&Cs
133
What is Oligomenorrhea?
Too few periods
134
What is Polymenorrhea?
Too many periods
135
What is the most common cause of post-coital Vaginal Bleeding?
Cervical CA
136
What is the most common cause of post-coital Vaginal Bleeding in Pregnant women?
Placenta previa
137
What is the most common cause of Vaginal Bleeding in Post-menopausal women?
Endometrial CA
138
What is Chronic Pelvic Pain?
Endometriosis until proven otherwise
139
What is Dysfunctional Uterine Bleeding?
Diagnosis of exclusion, usually due to anovulation
CAUSES of abnormal bleeding- PALM COEIN
Polyp
Adenomyosis
Leiomyoma
Malignancy
Coagulopathy
Ovarian dysfunction
Endometrial causes
Iatrogenic
Non identified
140
What is Dysmenorrhea?
PG-F causes painful menstrual cramps. (Teenagers miss school / work)
141
What is Endometriosis?
Painful cyclical heavy menstrual bleeding
"Powder burns and chocolate cysts" due to ectopic endometrial tissue. (Endometrial Tissue outside of uterus)
142
What is Kleine Rechnung?
Scant bleeding at ovulation
143
What is Menorrhagia?
Heavy menstrual bleeding
144
What are Fibroids (Leiomyoma's)?
Benign uterus smooth muscle tumor
submucosal type: they bleed
Subserosal type: they cause pain
145
What is Metorrhagia
Bleeding or spotting in btwn periods
146
What is Mittelschmerz
Pain with ovulation
147
What causes Syphilis?
Treponema Pallidum (Spirochete)
148
What is Herpes?
ds DNA virus
149
What is HPV?
ds DNA virus, vaccine out not covers 8-27 year old female to block HPV 6, 11, 18 STD
150
What is Chlamydia?
Obligate intracellular bacteria. Can present asymptomatic or PID Cervicitis (yellow pus)
Conjunctivitis
151
What causes Gonorrhea?
Gram-negative Diplococcus, presents with mucopurulent discharge. Can be present with Palmer Pustule, arthritis/joint pain, urethral discomfort
152
What causes Chancroid?
Haemophilus Ducreyi
153
What causes Granuloma Inguinale?
Calymmatobacterium
Granulomatosis
Klebsiella Granulomatis
154
What is Epididymitis?
Chlamydia Trachomatis. Unilateral scrotal pain decreased by support
155
What is the most common cause of Epididymitis?
Chlamydia Trachomatis, N. Gonorrhea, E. Coli
156
What is Condylomata Lata?
Flat fleshy warts, ulcerate = secondary syphilis
157
What is Condyloma Acuminata?
Verrucous "cauliflower" warts, koilocytes, due to HPV 6 and 11
158
How does Herpes present?
Primary: Painful grouped vesicles on red base
Secondary: Painful solitary lesion
159
How does Syphilis present?
Primary: Painless Chancre (1-6 weeks)
Secondary: Rash and Condyloma Lata (After 6 weeks)
Tertiary: Neurological and Cardiac issues, in Bone (after 6 years)
160
How does Chancroid present?
Painful with necrotic center, due to Haemophilus Ducreyi (Gram Negative rod)
"School of Fish" pattern
161
How does Lymphogranuloma Venereum present?
Painless Ulcers, Abscessed Nodes, Genital, and Elephantiasis, due to Chlamydia Trachomatis
162
How does Granuloma Inguinale present?
Spreading ulcer, Donovan bodies, due to Klebsiella Granulomatis (rod shaped, oval organism that can be seen in the Cytoplasms of Phagocytes or in tissue of grauloma inguinale)
163
How does chlamydia present?
Cervicitis (Yellow pus), conjunctivitis, PID
164
How does Gonorrhea present?
Palmar pustules, arthritis/joint pain, urethral discomfor
165
What is Epididymitis?
Unilateral scrotal pain decreased by support
166
What causes Congenital Blindness?
CMV
167
What causes Neonatal Blindness
Chlamydia
168
What is Lichen Simplex Chronicus?
Raised white (VIOLET) lesions, chronic scratching
169
What is Lichen Sclerosis?
Paper like vulva, itching, CA risk
170
What is Hidradenoma?
Sweat gland cysts
"Hidradenitis suppurativa is a chronic inflammatory skin disease involving the hair follicles and sweat glands"
171
What causes non-bacterial Fetal infections?
"TORCHS
T- Toxoplasma
O - Others (HIV, Measles, B-19)
R - Rubella
C - CMV
H - HSV-2
S - Syphilis
172
What is Toxoplasmosis?
Multiple ring enhancing lesions, loves parietal love, from cat urine and feces
173
What happens with Rubella infections in utero?
Cataracts, hearing loss, PDA, "blueberry muffin" rash (Rash on face that spreads to trunk)
174
What do you see in CMV in utero infections?
Spastic diplegia of legs, hepatosplenomegaly, blindness, central calcifications
175
What is seen in newborn with HSV-2 in utero infections?
Temporal Lobe encephalitis, must offer C-section to mom with active lesions
176
What is seen in newborns with Syphilis in utero infection?
Rhages (lip fissue), Saber shin legs (anterior bowing of the tibia), Hutchinson's Razor teeth,Mulberry Molars
177
What is Paget's disease of the Breast?
Rash and ulcer around the nipple, breast CA
178
What is Lobular Carcinoma?
Cells line up single file, contralateral breast is primary site of CA
179
What is Comedocarcinoma?
Multiple focal areas of necrosis (blackheads) DCIS
180
What is Inflammatory Carcinoma?
Infiltrates Lymphatics, pulls on Cooper's Ligaments "Peau d'Orange"
181
What is Cystosarcoma Phylloides?
Exploding Mushroom
182
What is Intraductal Papilloma?
Bleeding from the nipple
Most common Breast CA
183
What is Ductal Carcinoma?
Worst prognosis Breast CA
184
What is Sarcoma Botryoides?
Vaginal CA, looks like a ball of grapes
185
What is a Sister Mary Joseph Nodule?
Ovarian CA that has spread to the umbilicus
(Also GI cancers can cause)
(Indicates metastasis)
186
What is Meig's Syndrome?
Pleural effusion, ovarian fibroma, ascites
187
What are the side effects of Estrogen?
Weight gain, breast tenderness, nausea, headaches, muscle relaxant, causes constipation, increased protein production, irritability, and varicose veins
188
What are the side effects of Progesterone?
Acne, depression, HTN, increase appetite, acne causes dilution anemia, quiescent uterus, PICA, hypotension, melisma (AKA Chloasma)
189
What makes Progesteron <10 week gestation?
Corpus Luteum
190
What are the four Painful Genital Lesions?
Herpes
Chancroid (It makes you cry... H. Ducreyi) Lymphogranuloma Venereum
Lymphogranuloma Inguinale
191
How do you predict a due date with Nagele's rule?
Subtract 3 mo. from LMP (last menstrual period)
Add 7 days, if her cycle is 28 days (i.e: LMP Jan 7, 2016 would have an estimated date of Oct. 14, 2016)
If her cycle is more than 28 days add 1 day for each extra day of the cycle
192
Why is Nagele's Rule Inaccurate?
Because it does not start from Ovulation date
