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Family Medicine > OB/GYN, Fem + Male Repro > Flashcards

OB/GYN, Fem + Male Repro Flashcards

1
Q

What sx categorize eclampsia as severe?

A

blood pressure of 160/110 mm Hg or above on two occasions, 6 hours apart.

proteinuria above 5 g/24 hr,

thrombocytopenia with a platelet count <100,000/mm3,

liver enzyme abnormalities,

epigastric or right upper quadrant pain,

alteration of mental status.

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2
Q

Effect of advanced emergency contraception on population

A

No study showed that giving advance EC reduced pregnancy rates on a population level.

However, women who were provided with advance EC took the pills an average of approximately 15 hours sooner than women without advance access.

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3
Q

initial screening test for late-onset male hypogonadism

A

serum total testosterone

NOT free b/c high cost - only do if total is borderline

LH and FSH used to distinguish primary from secondary

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4
Q

Can you use ibuprofen in pregnancy?

A

Ibuprofen can also be used but should be avoided late in pregnancy because it is associated with premature closure of the ductus arteriosus and oligohydramnios.

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5
Q

When do US in pregnancy?

A 
Eval uncertain gestational age
Size discrepancies
Vaginal bleeding
Multiple gestations
High risk situations
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6
Q

When is X-ray radiation concerning to baby?

A

> 5 rads

Dental rad is ok.

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7
Q

When screen for downs?

A

16-18 wk best

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8
Q

Screening tests for abnormal chromosomes

A

hCG
Unconj estriol
AFP
Inhibin a

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9
Q

Tx vaginal candidiasis

A

creams

oral fluconazole

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10
Q

Tx trichomoniasis

A

metronidazole

Strawberry cervix

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11
Q

Bacterial vaginosis

  • Mech
  • dx?
  • tx
A

Happens when overgrowth of aneaerobic bacteria + G. vaginalis
Not an STD but assoc w/ multiple sexual partners

Dx w/ 3/4:

1) thin homogeneous vaginal d/x
2) vaginal pH > 4.5 (most sensitive)
3) + KOH whiff test
4) Presence of clue cells in wet mount prep (most specific)

Tx: metronidazole

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12
Q

Tx bacterial vaginosis

A

1 cause of acute vaginitis

Metronidazole
Clindamycin

Need to tx preggers as can dec incidence of preterm delivery

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13
Q

Tx gonorrhea

A

ceftriaxone IM injection

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14
Q

Tx chlamydia

A

doxycycline or azithromycin

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15
Q

The most common pharmacologic cause of galactorrhea is

A

oral contraceptives

metoclopramide, cimetidine, risperidone, methyldopa, codeine, morphine, verapamil, SSRIs, butyrophenones, dopamine-receptor blockers, tricyclics, phenothiazines, and thioxanthenes

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16
Q

Which one of the following fetal ultrasound measurements gives the most accurate estimate of gestational age in the first trimester (up to 14 weeks)?

A

Crown-rump length is the distance from the top of the head to the bottom of the fetal spine.

It is most accurate as a measure of gestational age at 7-14 weeks.

In the second trimester, biparietal diameter and femur length are used.

During the third trimester, biparietal diameter, abdominal circumference, and femur length are best for estimating gestational age.

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17
Q

Late decelerations are thought to be associated with

A

uteroplacental insufficiency and fetal hypoxia due to decreased blood flow in the placenta.

This pattern is a warning sign and is associated with increasing fetal compromise, worsening fetal acidosis, fetal central nervous system depression, and/or direct myocardial hypoxia.

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18
Q

Early decelerations are thought to result from

A

vagus nerve response to fetal head compression, and are not associated with increased fetal mortality or morbidity.

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19
Q

Variable decelerations are thought to be due to

A

acute, intermittent compression of the umbilical cord between fetal parts and the contracting uterus

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20
Q

In the symptomatic patient with uterine fibroids unresponsive to medical therapy, myomectomy is recommended over fibroid embolization for patients who

A

wish to become pregnant in the future.

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21
Q

SSRI NOT safe in preggers

A

Paroxetine

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22
Q

Contraindications to breast feeding

A

following administration or use of radioactive isotopes, chemotherapeutic agents, “recreational” drugs, or certain prescription drugs

herpes lesions on breast

active TB

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23
Q

American Congress of Obstetricians and Gynecologists (ACOG) recommends consideration of cesarean delivery without a trial of labor if

A

the estimated fetal weight is 4500 g in a mother with diabetes mellitus, or 5000 g in the absence of diabetes.

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24
Q

The best initial imaging study for acute pelvic pain in women is

A

transvaginal ultrasonography

The initial evaluation for chronic pelvic pain should include a urinalysis and culture, cervical swabs for gonorrhea and Chlamydia, a CBC, an erythrocyte sedimentation rate, a β-hCG level, and pelvic ultrasonography

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25
Q

Which male condoms protect against STDs?

A

only latex

not natural skin

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26
Q

Absolute contraindications for IUD

A

abnormal uterus shape
Pregnancy
HIV
current/recurrent endometritis, STD, PID

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27
Q

1st line postpartum depression

A

SSRIs

safe for breastfeeding@

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28
Q

When do you take emergency contraception after unprotected sex?

A

Within 72 hrs of sex

Mifepristone is ok for > 72 hrs

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29
Q

Contraindications to breastfeeding

A

HIV
Active hep B

mastitis is OK

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30
Q

RIsk of pregnancy with each sex encounter?

A

8%

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31
Q

How long postpartum should you wait before starting birth control? IUD?

A

BReastfeeding = 6 weeks

Not breastfeeding = 3 weeks

IUD:
- ok to use IUD 6 weeks postpartum regardless of breastfeeding status

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32
Q

how long lactation induced amenorrhea provide natural contraception?

A

6 mo postpartum

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33
Q

how to screen for gonorrhea / chlamydia in sex active men?

A

Urine leukocyte esterase

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34
Q

POstpartum fever is sign of…

A 
usually endometritis
UTI
wound infection
DVT
mastitis
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35
Q

What is the effect of oxytocin on uterus?

A

increases uterine contraction

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36
Q

Vitamin D in newborns

A

recommended daily intake of vitamin D in infants, children, and adolescents to 400 IU/day

exclusive formula feeding probably provides adequate levels of vitamin D, but infants who consume less than 1 liter of formula per day need supplementation with 400 IU of vitamin D daily.

Vitamin D supplementation should be started within the first 2 months of birth

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37
Q

Most sensitive for determining if lesion is herpes

A

Viral polymerase chain reaction (PCR) testing

38
Q

Pt has urethral d/c and had tx for gonorrhea/chlamydia but still persists with urethral d/c and has not had new partner - what do you do for tx? What do you suspect?

A

Mycoplasma or Ureaplasma and Trichomonas from the urethra or urine.

Treatment should include
azithromycin or doxycycline
metronidazole

39
Q

bilateral nipple pain with and between feedings after initial soreness has resolved is usually due to .

A

Candida

Masitits is usually unilateral

40
Q

he best management of localized, well-differentiated prostate cancer in men older than 65 is: (check one)
A. radiation implants
B. external beam radiation therapy
C. watchful waiting
D. primary androgen deprivation therapy
E. robot-assisted prostatectomy

A

Waiting

For men older than 65 years of age with small-volume, low-grade disease and a 10- to 15-year life expectancy, the risk of complications from treatment outweighs any decreased risk of dying from prostate cancer

41
Q

1st line tx hirsutism

A

Spironolactone

42
Q

First-line agents for ovulation induction and treatment of infertility in patients with polycystic ovary syndrome (PCOS) include

A

metformin + clomiphene, alone or in combination,

also rosiglitazone

43
Q

What is the accepted standard for evaluation of the acutely swollen scrotum

A

ultrasonography with color Doppler imaging

44
Q

What has been shown to reduce the cumulative incidence of atopic dermatitis in the first 2 years of life for infants at high risk of developing atopic disease

A

Exclusive breastfeeding for the first 4 months of life

45
Q

The identification of a new breast solid mass particularly in women older than 35 years should prompt

A

triple assessment, which includes

a clinical breast examination,

imaging (mammography),

pathology assessment either by core biopsy or surgical excision.

46
Q

For women with unrelenting breast pain in spite of modifications, what can you give?

A

danazol, an antigonadotropin,

is relatively expensive and has numerous side effects (hair loss, acne, weight gain, and irregular menses).

47
Q

treatment of choice in most patients with hyperprolactinemic disorders.

A

Dopamine agonists

Bromocriptine for tx of hyperprolactin-induced anovulatory infertilit

48
Q

Causes of hyperprolactinemia

A

Hypothyroidism
Prolactinemia
Drug

49
Q

Menstrual cycle

A

hypothalamus secretes GnRH, which stimulates the anterior pituitary to secrete FSH and LH.

As the FSH level rises, it causes an ovarian follicle to mature and it to release estrogen which induces endometrial proliferation.

A mid-cycle LH surge causes ovulation, and the follicle is transformed into the corpus luteum that secretes progesterone, which compacts and matures the endometrium.

If pregnancy does not occur, the production of progesterone abruptly decreases, resulting in sloughing of the endometrium and a menstrual bleed.

50
Q

Amenorrhea
Menorrhagia
Menometrorrhagia
Metrorrhagia

A

AMENORRHEA: Absence of menstrual bleeding for 6 or more months when a woman is not pregnant.

MENOMETRORRHAGIA: Heavy menstrual flow or prolonged duration of flow occurring at irregular intervals.

MENORRHAGIA: Excessive menstrual flow, or prolonged duration of flow (>7 days), occurring at regular intervals.

METRORRHAGIA: Bleeding occurring at irregular intervals.

51
Q

Asherman syndrome

A

a scarring within the uterine cavity caused by trauma from uterine curettage. It can result in reduction in the size of the uterus as the walls become scarred to each other

52
Q

Eval of dysfunctional uterine bleeding (Abnormal Bleeding Associated with Irregular Menstrual Cycles)

A

In the period after menarche, watchful waiting is usually indicated, with correction of the problem usually occurring within 1 to 2 years.

In women younger than 35 years who are not at increased risk of endometrial cancer, treatment may be offered without workup beyond the history and physical examination.

53
Q

When do you need further eval of dysfunctional uterine bleeding (Abnormal Bleeding Associated with Irregular Menstrual Cycles)?

A
  • women with risk factors for endometrial cancer,
  • women younger than age 35 years with continued symptoms in spite of treatment,
  • postmenopausal women with uterine bleeding.

Work up:
Transvaginal pelvic ultrasound
- endometrial biopsy

Or can do..
Hysteroscopy (endoscopic evaluation of the uterine cavity) can directly visu- alize endometrial masses, polyps, or other abnormalities, and can lead to directed biopsy. It is often performed with dilation and curettage (D&C), which sharply removes almost the entire endometrial lining for diagnostic and therapeutic purposes.

54
Q

Risk factors for endometrial cancer include

A 
anovulatory menstrual cycles, 
obesity, 
nulliparity, 
age greater than 35 years, 
use of tamoxifen or unopposed exogenous estrogen.

smoking is a negative risk factor for endometrial cancer.

55
Q

What are the initial tests for the evaluation of menstrual irregularities?

A

a pregnancy test,
TSH
prolactin level

56
Q

Pregestational diabetes vs gestational diabetes impact on baby

A

Pregestational diabetes
- associated with greater fetal malformations due to the higher serum glucose levels during organogenesis (5-10 weeks gestational age)

gestational diabetes
- associated with hyperglycemia after 20 weeks gestation, when the fetal organs have already formed (macrosomia and polyhydramnios).

57
Q

1st line for N/V in preggers

A

Doxylamine (Unisom) and vitamin B6

58
Q

Elevated early morning total testosterone is most often associated with

A

polycystic ovary syndrome

PCOS is a clinical dx and US has low sensitivity

59
Q

intrahepatic cholestasis of pregnancy. - tx?

A

Ursodiol has been shown to be highly effective in controlling the pruritus and decreased liver function

is safe for mother and fetus

60
Q

Tx infertility in woman w/ PCOS

A

Metformin and clomiphene alone or in combination are first-line agents for ovulation induction.

Clomiphene does not improve hirsutism, metformin does.

61
Q

Tx hypothyroidism in pregnancy

A

often need to increase thyroid hormone dosage

62
Q

Abnormal uterine bleeding in < 30 yo..workup

A

patient who is younger than 30 years of age will rarely be found to have a structural uterine defect.

Once pregnancy, hematologic disease, and renal impairment are excluded,

administration of intramuscular or oral progesterone will usually produce definitive flow and control the bleeding.

No further evaluation should be necessary unless the bleeding recurs.

63
Q

Placenta previa

A

clinically manifested as vaginal bleeding in the late second or third trimester, often after sexual intercourse.
The bleeding is typically painless, unless labor or placental abruption occurs

Placenta previa can happen early on but migrate
- do not change delivery until after US @ 36 weeks

NO bleeding –> repeat the US in the 3rd trimester
DO NOT do digital cervical exam

Bleeding –> steroids @ 24-34 wks

In patients with a history of previous cesarean delivery who have a placenta previa at the site of the previous incision, a color-flow Doppler study should be performed to evaluate for a potential placenta accreta.
–In such cases, MRI may be helpful to confirm the diagnosis.

64
Q

Tx gestational diabetes

A

In addition to an appropriate diet and exercise regimen, pharmacologic therapy should be initiated in pregnant women with gestational diabetes mellitus whose fasting plasma glucose levels remain above 100 mg/dL despite diet and exercise.

Should have

  • fasting plasma glucose levels below 95 mg/dL
  • 1-hour postprandial levels below 140 mg/dL r

Insulin is best pharm tx
- intermediate insulin + short acting insulin BID

65
Q

Polycystic ovary syndrome usually results in what levels of LH vs FSH.

How does this compare to hypothalamic amenorrhea?

A

PCOS -
normal to slightly elevated LH levels and tonically low FSH levels.

Hypothalamic amenorrhea - tonically low levels of LH and FSH.

66
Q

Tx hirsuitism in premenopausal women

A

Antiandrogens such as spironolactone, along with oral contraceptives, are recommended for treatment of hirsutism in premenopausal women

67
Q

What med has considerable efficacy in treating obstructive symptoms in men, but it unfortunately falsely depresses PSA levels.?

A

Finasteride

68
Q

Type 2 DM preggers woman on oral DM meds - what do you do when she is now pregnant?

A

INSULIN!

all oral agents cross the placenta (in contrast to insulin), leading to the potential for severe neonatal hypoglycemia.

Need exquisitely tight glucose control to reduce fetal macrosomia and organ dysgenesis,

69
Q

Down’s screening in preggers

A

1st trimester:
- Chorionic villus sampling is best

2nd trimester:
- amniocentesis

70
Q

The recommended time to screen for gestational diabetes is

A

24–28 weeks gestation.

The patient may be given a 50-g oral glucose load followed by a glucose determination 1 hour later.

71
Q

What is the highest rate of cancer for pap smear results that are dysplasia?

A

atypical glandular cells not otherwise specified (AGC-NOS)

72
Q

Prepubertal labial adhesions

A

idiopathic

Tx if there is enough labial fusion to interfere with urination

Tx w/ topical estrogen

73
Q

What is a red flag varicocele?

A

Usually on L

Red flags:

  • on R
  • in a child < 10 years of age
  • may indicate an abdominal or retroperitoneal mass
74
Q

gestational hypertension

A

HIGH BP w/o proteinuria after 20 weeks’ gestation

BP return to nl within 12 weeks of delivery.

75
Q

Preeclampsia

A
  • new onset of hypertension (systolic pressure >140 mm Hg or diastolic pressure >90 mm Hg) after 20 weeks’ gestation
  • along with 300 mg protein in a 24-hour urine specimen.
76
Q

(HELLP) syndrome

A

hemolysis, elevated liver enzymes, and low platelets

HELLP syndrome is a form of severe preeclampsia.
Deliver ASAP

If the patient has a favorable cervical examination, labor induction with oxytocin is appropriate.

If the cervix is unfavorable, cesarean delivery should be considered to expedite delivery

77
Q

Acute fatty liver of pregnancy

A

is another rare condition occurring in the third trimester and is usually associated with preeclampsia (50%–100% of cases).

It presents with nausea and vomiting, anorexia, jaundice, abdominal pain, headache, and neurologic abnormalities.

Transaminase levels are moderately elevated, PT and PTT are prolonged, and profound hypoglycemia and renal failure are usually present

78
Q 
Which one of the following agents used for tocolysis has the unique adverse effect of respiratory depression?  (check one)
 A. Magnesium sulfate 
 B. Ritodrine (Yutopar) 
 C. Terbutaline (Brethine, Bricanyl) 
 D. Indomethacin (Indocin) 
 E. Nifedipine (Adalat, Procardia)
A

Magnesium sulfate infusions must be carefully monitored because respiratory depression is a potential lethal side effect. Reflexes are usually lost first.

79
Q

Intrahepatic cholestasis of pregnancy

A

is rare, occurring in 0.01% of pregnancies. It usually presents in the third trimester.

Approximately 80% of patients present with pruritus alone, and another 20% with jaundice and pruritus.

Laboratory results usually reveal normal or minimal elevation in transaminase levels, elevated bilirubin (usually <5 mg/dL), and occasional elevations in cholesterol and triglyceride levels.

It is important to recognize and diagnose this entity, as it is associated with prematurity, fetal distress, and increased perinatal mortality.

80
Q

Biochem marker to indicate preggers at high risk for impending preterm delivery

A

fetal fibronectin in cervical or vaginal secretions.

In symptomatic women, this is most accurate in predicting spontaneous preterm delivery within 7–10 days.

81
Q 
Inevitable abortion 
vs completed abortion 
vs. threatened abortion 
vs. incomplete abortion 
vs. missed abortion
A

Inevitable abortion

  • bleeding
  • open os
  • no passage of products of conception (POCs).

Completed abortion

  • bleeding
  • closed os
  • complete passage of POCs

Threatened abortion

  • bleeding
  • closed os
  • no passage of POCs

incomplete abortion

  • bleeding
  • open os
  • POCs in os or vaginal vault

Missed abortion

  • no sx
  • no embryo or fetus on US
82
Q

Diaphragm

  • when to replace?
  • when contraindicated?
A

A weight change of more than 15 lb, pregnancy, or pelvic surgery may necessitate refitting.

Diaphragm use is contraindicated in women with a history of toxic shock syndrome.

The diaphragm should remain in place for 6–24 hours after intercourse

83
Q

2nd and 3rd stages of birth?

A

2nd stage = period from complete cervical dilation to complete delivery of the baby.

3rd stage = begins with the delivery of the baby and ends with the delivery of the placenta

84
Q

Placenta abruptio

A

Abruption of the placenta is the most common cause of intrapartum fetal death but is associated not only with brisk vaginal bleeding, but also with uterine tenderness that may be marked.

85
Q

Delayed or interrupted puberty is defined as

A

failure to

  • develop any secondary sex characteristics by age 13,
  • to have menarche by age 16,
  • to have menarche 5 or more years after the onset of pubertal development.
86
Q

Tx Patients with PID and tubo-ovarian abscess and high fever

A

should be hospitalized and treated for at least 24 hours with intravenous antibiotics.

cefoxitin IM outpatient + probenecid

Ceftriaxone outpatient, no probenecid needed

87
Q

When do Group B strep screening in preggers? From where?

A

Cx from the vaginal introitus and the rectum are the most sensitive for detecting colonization.

35-37 weeks’ gestation.

Culture-positive women are then treated during labor.

88
Q

Tx genital warts during preggers

A

Cryotherapy (liquid nitrogen)

Trichloracetic acid

89
Q

How does oral contraceptives improve acne?

A

Raise sex hormone binding globulin –> decrease free testosterone

90
Q

Tx premenstrual dysphoria

A

Fluoxetine (Prozac, Serafem) for the last 2 weeks of the menstrual cycle

Family Medicine (11 decks)

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