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Clinical Medicine > OB/GYN final > Flashcards

OB/GYN final Flashcards

1
Q

advantages/disadvantages of radiation treatment in cervical cancer

A

advantage: able to use direct appliation of radiation
disadvantage: can damage the vaginal tissue so is reserved for older women

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2
Q

five tocolytic drugs

A

calcium channel blockers

magnesium sulfate

beta sympathomimetics

oxytocin

alcohol

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3
Q

why are submucosal fibroids concerning

A

because they interfere with the smooth muscle contraction of the uterus, preventing vasoconstriction and allowing for heavy bleeding

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4
Q

treatment of ovarian torsion

A

spontaneous revision with knee to chest position

laproscopy to untwist and fixate, oophorectomy if the ovary is necrotic

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5
Q

what is the effect of postmenopausal HRT on breast cancer

A

estrogen + progestin increases risk, estrogen alone does not

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6
Q

compare and contrast open, fine needle, and core needle biopsies for breast masses

A

open is the most reliable

fine needle is the least invasive but has a higher false negative rate and needs US or Xray guidance

core needle has fewer false negatives

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7
Q

what is the most common bone disorder in the US

A

involutional osteoporosis

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8
Q

gynecological menopause symptoms

A

amenorrhea

vaginal dryness

sexual dysfunction

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9
Q

patient presents with postive immunochemistry with an uneffaced cervix 1cm dilated and no regular contractions

what is the Dx

A

preterm PROM

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10
Q

mild preeclampsia

A

BP > 140/90 on two or more occasions 6 hours or more apart after 20 weeks

proteinura 300-2000 mg/24 hours

commonly have edema

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11
Q

four strategies to avoid hyperemesis

A

early intervention

outpatient IV hydration

corticosteroids (medrol)

antiemetics (compazine, zofran)

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12
Q

two characteristics of ovarian dysgenesis

A

early loss of oocytes

failure of germ cell migration

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13
Q

differentiate between CIN and CIS

A

CIN = cervical intrepithelial neoplasia, can be mild, moderate, or severe dysplasia

CIS = carcinoma in situ

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14
Q

menopause will cause a dramatic reduction in estrogen leading to an increase in FSH

what organ systems will this effect

A

reproductive

bone

CNS

CV

metabolic

skin

urinary tract

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15
Q

if estrogen is low, what other lab values should be high?

if they are low what is indicated

A

FSH and LH

there is a loss of GnRH from the hypothalamus

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16
Q

patient pregnant at 24 weeks complains of dyspnea. PE shows midsystolic murmur along the left sternal border, PMI displaced to the left, jugular venous distension

how concerned are you about this patient

A

only mildly concerned, all of these symptoms can be normal sequela of pregnancy

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17
Q

T/F quantitative HCG can help determine gestational age

A

false, HCG levels are too variable, unless the value is really low (indicates very early)

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18
Q

management of a threatened SAB

A

compassion

ultrasound

reassurance

arrange for follow up (1-2 weeks)

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19
Q

T/F screening is strong correlated with breast cancer survival

A

false, there is only a small increase in survival, a lot what we are picking out are not aggressively malignant similar to prostate cancer

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20
Q

what is the benefit treating bacterial vaginosis to manage preterm PROM

A

there isn’t any support

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21
Q

DES defined

uses

A

diethylstilbesterol, synthetic estrogen used to treat or prevent miscarriage, low birth weight, poor OB outcome

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22
Q

anencephaly

A

failure of the brain to develop

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23
Q

management options for hypothalamic amenorrhea

A

reduction in stress, gain weight, exogeneous GnRH pump, exogenous FSH and LH, birth control pills

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24
Q

cancer associated with BRCA2

A

breast cancer

ovarian cancer

pancreatic cancer

prostate

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25
Q

primary vs secondary amenorrhea

A

primary = none, never

secondary = had periods but stopped

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26
Q

nulliparous

A

never brought a pregnancy to term

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27
Q

patient 32wks G1P0 pregnant presents with borderline hypertension, trace protenuria, DTRs +2/4 at a bwt of 137.

what might you suspect?

two weeks later the patient presents with significant HTN, +2 proteinuria, hypereflexia, and 11lbs weight gain

what is indicated

A

beginings of a HTN disorder related to pregnancy

preeclampsia requiring hospitalization

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28
Q

nulligravida

A

never been pregnant

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29
Q

supplemental progesterone treatment for preterm labor

A

vaginal progesterone

injections of 17-OH progesterone

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30
Q

uterine prolapse

symptoms

incidence

A

pressure or heaviness, possible bowel and bladder symptoms

common 20-30%

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31
Q

intermediate forms of GTD

A

chorioadenoma destruans

placetal site-trophoblastic tumor

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32
Q
A

parous

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33
Q

how many couples will experience infertility in their lives

how many women

A

8-14%

25%

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34
Q

late deceleration

what do they indicate

A

bradycardia in response to a contraction

indicates that the baby is hypoxic

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35
Q

two highlights of the second trimester

A

time of rapid and major physiological adjustments

fetal viability happpens around 22 weeks

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36
Q

treatment for obesity associated with PCOS

A

diet and exercise along with metformin, possibly for life

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37
Q

examination of amenorrhea

A

pelvic exam

US

endoscopy *hysteroscope)

hysterosalpingogram

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38
Q

why does the risk of spontaneous abortion go up with age

A

because you have a higher risk for genetic abnormalities that will not produce a viable fetus

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39
Q

when is MRI mammography useful

A

high risk patients (BRCA1, 2, FHx)

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40
Q

best guess at a cause for preeclampisa

A

alteration of placental physiology that results in loss of substances that normally reduce vascular resistance

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41
Q

what is the trade off from mammography

A

reduce mortality by 8 per 100,000

increase false positives by 122 per 100,000

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42
Q

four types of emergency contraception

A

progestin only (plan B)

Yuzpe method

IUD insertion withine 5 days

Progesterone receptor blockers

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43
Q

T/F dermoids are maglignant

A

false, they are benign but they do destroy normal ovarian tissue if they grow

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44
Q

Rh hemolytic disease (Erythroblastosis Fetalis)

A

the reaction of anti-d IgG produced by the mother if exposed to Rh+ blood that can cross the placenta and cause hemoylsis

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45
Q

patient with narrow pelvic inlet and DMI is laboring with a fetus with a large biparietal diameter. The feus begins to experience late decelerations.

is oxytocin indicated

what if the presentation was breech

A

no to both

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46
Q

how common are abdominal pregnancies

what is the mortality rate

how is this managed

A

1/100,000 very rare

25% maternal, 90% fetal

delivery fetus, leave placenta in situ

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47
Q

acanthosis nigricans

A

dark, velvety skin in the folds and creases

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48
Q

what is the most significant risk factor for neural tube defects

A

folic acid deficiency

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49
Q

assessing preterm labor risk

A

cervical length by ultrasound

fetal fibronectin in maternal serum

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50
Q

general prognostic factors for breast cancer

A

best age is 40-70

preexisting conditions can limit treatment

staging

receptor status and genetic profile

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51
Q

placental abruption (abruptio placentae)

main symptoms

A

premature separation of the placenta

bleeding, pain at the sight of placental separation, labor pains

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52
Q

risk factors for involutional menopause

A

gender

genetics

smoking

low calcum intake

early menopause

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53
Q

four disadvantages of chemotherapy with methotrexate for ectopic pregnancy

A

mandatory follow up

frequent HCG testing (may take 2 months to go down)

works poorly on advanced gestations

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54
Q

what is the only cure for preeclampsia

T/F there can still be related issues up to 72 hrs later

A

delivery

true

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55
Q

preventing bladder atony

A

keep bladder empty during labor

watch for distended bladder post partum

catheterize as needed

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56
Q

which of the vaginitis big three is sexually transmitted

A

trichomonaisis

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57
Q

should EDD be revised when ultrasound indicated a different date than intial physical exam

A

yes, ultrasound is pretty accurate

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58
Q

what is the most common germ cell ovarian cancer

A

dysgerminoma

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59
Q

how is a breast cyst managed clincially

when should it be biopsied

A

outpatient aspiration

if its the first cyst, it is still present after aspriation, or the fluid aspirated is cloudy

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60
Q

types of estradiol used in HRT

A

tablets (estrace)

patch (estraderm)

spray (evamist)

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61
Q

differentiate between placenta accreta/increta/pancreta

A

accreta is less invasive, increta moderate, pancreta complete investion of the uterus and requires hysterectomy

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62
Q

dropping

A

descent of the baby’s head in to the pelvic inlet

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63
Q

what fetal measurements are taken during an OB ultrasound

A

skull

abdominal circumference

femur length

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64
Q

types of epithelial ovarian cancer

A

serous cystadenocarcinoma

mucinous cystadenocarcinoma

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65
Q

three ways to evaulate reccurreny SAB

A

chromosomal analysis of peripheral leukocytes from both partners

TSH and T4 screen

evaluate uterus (hysterosalpingogram, sonohysterography, hysteroscopy)

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66
Q

what causes a T shaped uterus when exposed to a fetus

A

DES

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67
Q

causes of osteoporosis

A

endocrine (cushings, hyperparathyroidism)

renal disease, esp ESRD

medication side effect

involutional

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68
Q

what suppresses lactation during pregnancy

what happens after delivery

A

estrogen, progesterone, placental lactogen

delivery ends suppression

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69
Q

complications of the third stage of labor (placenta delivery)

A

postpartum hemorrhage

PP infection (endometritis)

uterine inversion

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70
Q

hypothalamic/pituitary causes of amenorrhea

A

loss of GnRH from stress, low body fat, or congenital cause

hyperprolactinemia

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71
Q

biparietal diameter

A

a measurement of the skull through the septum pellucidum used to estimate gestational age accurately after 13 weeks

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72
Q

aglutination of enzmes lcan lead to what

A

hemoylsis and anemia, which can lead to heart failure

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73
Q

treatment of the big three vaginitis

A

oral or topical fungicides for monilia

oral or topical metronidazole for trichomoniasis and bacterial vaginosis

topical clindamycin for bacterial vaginosis

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74
Q

criteria for macrosomia

A

10lbs or more

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75
Q

premature rupture of membranes defined

how common is it?

risk factors

cause

A

rupture of membranes before labor

5-10%

similar to preterm labor

unknown

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76
Q

special risks associated with PCOS

A

unopposed estrogen increases risk of endometrial carcinoma

high androgens -> dyslipidemia

insulin resistance -> DMII

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77
Q

how will clue cells look like on a microscope slide

A

epithelial cells with granular bacterial inclusions

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78
Q

evaluation of a submucosal fibroid

A

pelvic exam may or may not reveal a submucosal mass, US is better

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79
Q

what is the most common cause of a septic abortion

diagnostic factors

A

contamination after uterine instrumentation following illegal abortions

fever; discharge; pelvic pain; leukocytosis; elevated SED rate

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80
Q

etiology and symptoms of cystadenomas

A

unknown, but they are benign

discomfort, bloating, constipation, gerd

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81
Q

T/F SERMs are useful for hot flashes but not osteoporosis

A

false, its the other way around

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82
Q

factors that increase risk for ovarian cancer

A

age

genetics (familial, BRCA1-2, ashkenazi)

high fat diet

PCOS

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83
Q

goals of HRT for menopause

A

reduce hot flashes

improve sleep to improve congition and reduce psychological symptoms

prevent bone loss

maintain health of the vagina, uterus, bladder

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84
Q

psychological menopause symptoms

A

mood changes

loss of concentration

irritability

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85
Q

three key assesment points during vaginal exam to determine if a laboring woman should be admitted

A

dilation

effacement

station

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86
Q

Whiff test for vaginosis

A

KOH on a vaginal secretion slide will produce a fishy smell with gardnerella vaginalis

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87
Q

treatment for ovarian cancer

A

surgery to cure stage 1-2, or debulk stage 3-4 for better chemo

chemo

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88
Q

DES increased risk for what four things in offspring

A

vaginal cancer in female offspring

miscarriage/ectopic pregnancy

premature labor

infertility

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89
Q

methods to suppress the ovaries in endometriosis treatment

how long should treatment last

A

pregnancy

steroid contraceptives

progestins

GnRH agonists

mild androgens

at least 6 months

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90
Q

three abruption risk factors

A

medical, gynlogical, other

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91
Q

30 yr old patient attempting to get pregnany comes to the clinic to seek infertility treatment after 1 month of unprotected sex.

how should be cancelled

what if she were 35+

40+

A

less than 35 should try 1 year of unprotected sex before attempting infertility treatment without obvious issues

6 months

immediately

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92
Q

what is the ultimate goal of infertility treatment

A

prenancy, adoption, or acceptance of life without children

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93
Q

causes of miscarriage

A

unhealthy embryo

hormone imbalances

uterine malformations

infections

immunologic problems

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94
Q

what is the goal of tocolysis to delay preterm labor

A

allow transport to appropriate place to deliver

allow time for glucocortcoid therapy

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95
Q

three types of surgical sterilization for women

A

postpartum “mini-laparotomy” tubal

laparoscopic coagulation or application of occlusive clips/rings

hysteroscopic

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96
Q

what might low amniotic fluid levels indicate

A

renal issues or an unhealthy fetus

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97
Q

what is the only method of breast cancer screening that is capable of finding non-palpable breast cancer

A

mammography

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98
Q

T/F hyper or hypo thyroid can cause reccurent abortion

A

true

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99
Q

what is the most common GYN problem in women from 15-45

symptoms

A

cervicitis/vaginitis/vulvovaginitis

vaginal discharge; vaginal or vulvar irritation; odor esp with bacterial vaginosis

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100
Q

21 y/o G0 presents with irregular menstrual cycles, hirsutism

Hx Menarche was at age 13, Periods always irregular (q 3-8 months), LMP 5 months ago

what might you suspect

A

polycystic ovarian syndrome

hyperprolactinemia

hyper/hypothyroid

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101
Q

define the perinatal death (mortality) rate

A

the number of still births and neonatal deaths per 1000 births

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102
Q

what constitutes complete cervical dilation

A

10cm

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103
Q

metabolic factors leading amenorrhea

A

hypothyroid

hyperprolactinemia

chronic illness

insulin resistance/anovulation (PCOS)

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104
Q

GI premature disease

A

necrotizing enterocolitis

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105
Q

what percentage of women have PCOS

what is the genetic transmission

A

4-6%

autosomal dominant transmission with variable pentrance

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106
Q

two types of epithelial carcinoma categorized as breast cancer

one special category

A

intermediate type ducts (ductal carcinoma)

terminal lobular ducts (lobular carcinoma)

carcinoma in-situ

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107
Q

patient with PCOS comes to clinic seeking to regulate periods and treat hirsutism

what is the best treatment option

A

birth control as long as she doesn’t want to get pregnany

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108
Q

patient G3P2002 presents at 33 weeks with bright red vaginal bleeding

DDx

A

loss of cervical plug

cervical bleeding from polyps or hyperemia

iatrogenic from digital cervical exams

placenta previa

placental abruption

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109
Q

two ways to augment labor and delivery

A

intravenous oxytocin and assisted fetal extraction

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110
Q

four ways to evaluate fetal health in late pregnancy

A

growth measurements

biochemical markers

biophysical assesments

placental assessment

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111
Q

cause of uterine prolapse

symptoms

incidence

A

weakening of uterine support caused by congenital causes, obstettrical causes, hypoestrogenism, or increased intraabdominal plressure

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112
Q

early deceleration

what does it indicate

are they concerning

A

transient bradycardia that looks to start when the contraction starts and ends when it ends

represents head compression

not really, it just means delivery is coming

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113
Q

two types of vertex malpresenstations

A

occiput transverse (OT)

occiput posterior (OP)

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114
Q

surgical treatment of mullarian agenesis

A

exicision of the transvaginal septum

inciision/resection of hymen

construction of a neovagina

hysteroscopic adhesiolysis

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115
Q

three accepted uterine causes of recurrent abortion

A

septum, scar, fibroids

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116
Q

common causes of oligomenorrhea

A

PCOS/PCOD

hyperprolactinemia

hyper/hypothyroid

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117
Q

treating hirsutism associated with PCOS

A

contraceptive steroids or antiandrogens (spirolactone/aldactone or finasteride/propecia)

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118
Q

apgar muscle tone scores

A

0 = none

1 = some flexion

2 = active movement

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119
Q

two indications of failed germ cell migration

A

streak or absent gonads

XX or XY chromosome

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120
Q

menstrual irregularity treatment

A

intermittent progestins (medroxyprogesterone acetate/provera 10mg x 10days every 1-3 months)

contraceptive steroids (birth control, contraceptive patch, nuva ring)

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121
Q

dermatologic menopause symptoms

A

dry skin

age spots

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122
Q

treatment for a molar pregnancy

A

suction curettage

monitor HCG for one year

2% risk of repeat molar pregnancy

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123
Q

three clinical forms of preeclampsia/eclampsia

A

mild preeclampsia

severe pre

eclampsia

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124
Q

menopause

A

cessation of menses for 6-12months due to natural, surgical or other causes

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125
Q

two methods of assisted fetal extraction

A

forceps

vacuum extraction

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126
Q

three distinctive presentations of a rupture ectopic pregnancy

A

massive blood loss

severe pain

syncope

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127
Q

why give glucocortcoids to someone in preterm labor

A

forces the development of the fetal respiratory system

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128
Q

clincal features of osteoporosis

A

wrist, hip, vertebra fracture

loss of height due to compression fractures

chronic back pain

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129
Q

treatment of abruption

A

delivery via emergency c section or expeditious vaginal deliver

tocolysis for fetal distress

volume replacement

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130
Q

treatment and hazards of cystadenomas

A

surgical excision

torsion, mucinous peritonitis if it ruptures, death due to size and pressure on other organs

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131
Q

how common is benign first trimester bleeding

where does it come from

what is a possible cause

A

common

from the cervix

possibly to the luteal-placental shift

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132
Q

can placenta previa be fatal

what is a major risk

A

yes

if an examining finger is inserted through the placenta

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133
Q

describe the process of engagement during labor

A
  1. head floating before engagement
  2. engagement (the lowest part of the fetus pressing against the pelvis) and flexion
  3. internal rotation (head turns anteriorly from transverse)
  4. begining extension of the neck
  5. complete extension (delivery of the head)
  6. external rotation (head turns transverse)
  7. delivery of the anterior shoulder with gentle downward traction
  8. delivery of the posterior shoulder with gental upward traction
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134
Q

methods of intrauterine contraception

A

IUD (Copper, mirena, Skyla, Liletta)

endometrial ablation

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135
Q

indications of supine hypotensive syndrome

treatment

A

anxiety, sympathetic discharge, syncope

lay on your side or on your back elevated 30 deg

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136
Q

pseudocyesis

A

false pregancy related to stress, bloating caused by gas

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137
Q

why are xrays not reccomended for imagining a fetus prior to 14 weeks

A

because the bones arent visible <14 weeks and the radiation is harmful

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138
Q

how long is a typically pregnancy from fertilization

from LMP

A

266 days after fertilization

40 weeks after LMP

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139
Q

why is the baby at risk for brain anoxia with shoulder dystocia

A

because it can take 5+ minutes to delivery the baby

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140
Q

33 y/o G2 P2002 presents with complaint of severe fatigue and shortness of breath. CBC shows severe anemia, Hgb = 6.2 g/dl. Menstrual cycles are regular (every 28-30 days) but increasingly heavy over the past 6 months

DDx

A

submucous leiomyoma

PCOS (but periods should not be regular)

coagulopathy

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141
Q

severe preeclampsia

A

BP 160/110 OR

severe proteinura (>2g/24hrs) OR

oliguria (<500mL/24hrs) OR

Liver abnormalities (RUQ pain) OR

thombocytopenia (<100,000/mm^3)

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142
Q

miscellaneous causes of placental abruption

A

trauma, heavy lifting, smoking

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143
Q

patient G3P2002 presents at 33 weeks with bright red vaginal bleeding, no recent cervical exams, normal painless uterus, low placenta

Dx

treatment options

A

probably placenta previa

Csection, expectant mangament if the bleeding stops

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144
Q

is there a value for mammography in ages below 40?

40-50

70+

A

no because the breast is more dense

maybe

no proven value after 70

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145
Q

two key lacatation hormones

A

prolactin

oxytocin

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146
Q

primipara

A

giving birth for the first time

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147
Q

respiratory premature disease

A

RDS

chronic lung disease

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148
Q

what is the anatomical landmark for a nonpregnant or nulliparous uterus

A

none, it is about the size of your fist or slightly smaller for nulliparous

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149
Q

prevention of cervical cancer

A

HPV vaccine

pap smear to detect cervical intraepithelial neoplasia

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150
Q

management of a total previa

partial

low lying

A

c section

vaginal delivery may be possible

vaginal delivery is usually possible

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151
Q

what would a cervical length of greater than 25mm indicate

A

very low risk for preterm labor

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152
Q

anesthetic options for the use of forceps

A

epidural

pudendal block

local anesthetic

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153
Q

surgical menopause

A

removal of both ovaries

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154
Q

Dx of ovarian torsion

A

ultrasound showing a mass with no arterial flow on doppler

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155
Q

four characteristics of a benign adnexal mass

A

unilateral, mobile, cystic, small (<5cm)

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156
Q

DDx for acute pelvic pain

A

PID

ovarian torsion

ruptured endometrioma

ectopic

SAB

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157
Q

surgical treatment of an unruptured ectopic

A

salpingostomy

salpingectomy

laparotomy

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158
Q

what is the anatomical landmark for a gravid uterus at 12 weeks

A

palpable at or just slightly above the pubic symphysis

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159
Q

two highlights of the first trimester

A

fetal stage of development starts at 10 weeks

most pregnancy losses happen here

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160
Q

preventing ecclampsia

what must be done during this time

A

IV magnesium sulfate

monitor for overdose (urine output, renal function, reflexs, mental status)

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161
Q

missed abortion

three patient issues associated

A

SAB where the uterus fails to evacuate the pregnancy within 8 weeks of embryo demise

patient anxiety; possible formation of a calcified mass; small risk of coagulopathy

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162
Q

is ovarian torsion common in a normal ovary

A

no, the ovary is usually enlarged from a benign cyst, dermoid, or hyperstimulation

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163
Q

what are the three most common causes of infertility

A

egg or ovulation

sperm

tubal or pelvic

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164
Q

PP CV and metabolic changes

A

weight loss

blood loss (500-1000mL), usually normal at PP wk3

rapid fall in insulin resistance

coagulation changes (rapid decrease in fibrinogen, secondary peaks of fibrinogen and platelets)

lipid chemistry normal <1week

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165
Q

what is the source of many idiopathic cases of infertility and treatment failure

A

infertility due to female age

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166
Q

prevention of Rh hemolytic disease

A

give Rhogam, coats the d antigen in artificial IgG so mom never has a change to react

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167
Q

risk factors for ectopic pregnancy

what percent will have at least one risk factor

A

previous salpingitis (PID)

previos ectopic pregnancy

prior tubal surgery

cigarette smoking

50%

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168
Q

alternative causes of PCOS that should be excluded

A

nonclassical congenital adrenal hyperplasia

androgen secreting tumor

cushing syndrome

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169
Q

usual criteria for admission of a laboring pregnant woman

A

active labor

rupture of membranes

abnormal bleeding

maternal or fetal health issues

if you aren’t sure, reevaluate in 1-2 hours

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170
Q

other types of GYN cancer

vulvar

vaginal

A

vulvar: squamous carcinoma, malignant melanoma
vaginal: clear cell adenocarcinoma (DES) esxposure

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171
Q

what is the general strategy for the use of clomid

A

use as much as necessary but as little as possible

expect rapid response (1st 3-4 months)

no effect in continuing beyond 6 months

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172
Q

etiology of PID

A

infection (gonorrhea, chlamydia, anaerobes) or STI that causes bilaterally inflammation of the fallopian tubes that can form a tubo-ovarian abscess

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173
Q

why are choriocarcinomas dangerous but treatable

A

they grow very fast and become lifethreatening, but respond well to treatment

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174
Q

what is Ondansetron (zofran) used for in early pregnancy

A

to treat nausea

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175
Q

three types of breast mass biopsy

A

open (excisional)

fine needle

core needle

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176
Q

disseminated intravascular coagulopathy is a risk factor with placental abruption

what should you look for in this

A

falling platelet count

elevated fibrin split products

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177
Q

what is the common cause of subclinical PID

what are the symptoms

what is the risk

A

chlamydia

mild cramping, no pain or fever

can cause infertility or ectopics due to tubal damage

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178
Q

vagina pessaries

A

a plastic ring inserted into the vagina to help support a prolapse uterus

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179
Q

why is rupture of membranes relevant

A

can trigger labor

infection (chorioamnioitis)

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180
Q

what two things would make asherman’s syndrome more likely

A

some kind of trauma, possibly surgical, that leads to infection

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181
Q

what is the goal of delaying preterm labor

A

to allow for the production of surfactant to prevent alveolar collapse

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182
Q

what percent of breast cancer is associated with BRCA1-2

A

5-10%

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183
Q

what risk is associated with gestational HTN

should it be treated

A

higher risk of HTN later on

only if it is severe >160/110

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184
Q

16 yr old patient presents with positive HCG and ultrasound indicating 16 wks.

What are four issues that might be of concern

A

school issues

nutrition

substance abuse

social support/newborn care

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185
Q

PCOS characterized by what

A

enlarged ovaries with multiple arrested cysts, oligomenorrhea/amenorrhea, and hyperandrogenism

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186
Q

patients commonly afflicted with primary dysmenorrhea

possible cause?

treatment

A

young women with ovulatory menstrual cycles

abnormal prostaglandin metabolism

treatment with antiprostaglandins or suppression of ovulation

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187
Q

what is the percent breakdown of HTN during pregnancy

A

30% is chronic, 70% is pregnancy induced

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188
Q

what is the most common symptom of endometrial cancer

A

abnormal uterine bleeding or postmenopausal bleeding

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189
Q

issues to look for in the health portion of the HEST workup

A

pelvic exam

look for infection (HIV, HepB/C)

changes to immune status (rubella, hepatitis)

TSH

Genetic screening

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190
Q

why is the low transverse uterine incision preferred for a C section

what is the disadvantage of the classical incision on the fundus

A

the uterus is thin, it easy to get to and heals well

high rupture rate

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191
Q

are self breast exams positively correlated to survival

are they still useful

A

no

useful in a diligent patient using good protocol during cycle day 6-10

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192
Q

what is necessary treatment for a ruptured ectopic

A

salpingectomy and blood transfusions

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193
Q

velamentous insertion

A

the umbilical cord inserts into the chorioaminotic membranes and travels from there to the placenta

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194
Q

first trimester

2nd

3rd

A

conception through 13 weeks

14-27

28-40

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195
Q

where is prolactin produced

what does it do

A

anterior pituitary

stimulates milk production by breast glandular tissue

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196
Q

etiology and symptoms of adenomyosis

A

unknown etiology, common in women 35-45 and abates at menopause

dysmenorrhea and menorrhagia

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197
Q

patient presents with 45X genome, short stature, coartation of the aorta

what GYN issue would you expect

A

early loss of oocytes (turner syndrome)

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198
Q

two types of episiotomy

A

midline

mediolateral

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199
Q

when is placenta previa usually seen

what is the cause

A

after 36wks

gradual cervical effacement and dilation is the trigger

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200
Q

describe the relationship between breast cancer and age

before what age is breast cancer less likely

what is the mean age at diagnosis

what is the time from origin to dianosis

A

risk increases with age

40 unless genetically predisposed

60-61

2-8 years

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201
Q

management of adenomysosi

A

diagnosis with MRI or ultrasound

supportive treatment with nsaids, analgesics, or ovarian suppression

surgical treatment with hysterectomy or segmental resection

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202
Q

classic presentation of placental abruption

A

painful third trimester bleeding

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203
Q

why are triple negative breast cancer the ones with the worse prognosis

A

because they are not receptive to anti-estrogen/progesterone/HER-2 drugs

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204
Q

types of tubal contraception

A

surgical

inflammatory occulsion

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205
Q

HTN drugs to stop during pregnancy

A

ACE inhibitors

ARBs

beta blockers

thiazides

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206
Q

describe lobular CIS

A

localized carcinoma that is not truly malignany but increase the risk of later malignancy by 20%

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207
Q

five characteristics of a maglignant adnexal mass

A

bilateral, fixed, solid or semi-cystic, larger than 5cm, ascities

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208
Q

big three causes of vaginitis

A

monilia (candida albicans)

trichomonaisis

bacterial vaginosis (gardnerella vaginalis)

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209
Q

precipitate labor

A

delivery with in 2 hours of the start of labor most often seen in multiparous women

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210
Q

three factors that would warrant infertility evaluation at any time

A

amenorrhea

known tubal Hx

male infertilty Hx

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211
Q

egg/ovulation test for HEST workup

A

FSH and estradiol (E2) testing on cycle day 2 or 3

serum progesterone

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212
Q

when would a laparotomy be necessary surgical treatment for ectopic pregnancy

A

ruptured ectopics, interstitial (cornual) ectopics, significant pelvic adhesions

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213
Q

PE findings associated with acute salpingitis

A

cervical motion tenderness

bilateral adnexal tenderness usually present

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214
Q

three stages of labor

A

1st: from beginning of labor to complete cervical dilation
2nd: from complete cervical dialtion to delivery
3rd: ends with delivery of placenta

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215
Q

uterine inversion

what is the treatment

A

when the placenta fails to detach from the uterus and pulls the organ out of the vagina

put it back in

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216
Q

what causes decreased insulin sensitivity in the second and third trimesters

A

human placental lactogen, prolactin, cortisol

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217
Q

management of a submucosal leiomyoma that is causing anemia

A

possible transfusion if hemodynamically unstable

additional folic acid and iron

GnRH agonists to decrease FSH and LH to stop menstruation (leupron)

surgical resection

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218
Q

what is the action of clomphene citrate

what are the possible side effects

A

inhibits estrogen, induces the release of FSH and LH

functional ovarian cysts; decrease cervical mucus; decreased endometrial growth; hot flashes

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219
Q

chemotheraputic agent for unruptured ectopic

A

methotrexate

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220
Q

treat ment of mild preeclampsia

A

prevention

deliver +37 weeks

admit <37 weeks

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221
Q

three uses of OB ultrasound

A

check for fetal anomalies

evaluate the placenta

take fetal measurements

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222
Q

treatment of invasive cervical cancer

A

radiacl hysterectomy with lymph node dissection

radiation therapy

chemo (adjunctive)

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223
Q

McRoberts manuver

A

hyperflexing the mother’s legs against the abdomen that allows for rotation of the pelvis and delivery of the anterior shoulder

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224
Q

The presence of which of the following distinguishes eclampsia from preeclampsia?

A. hypertension

B. proteinuria

C. seizure

D. thrombocytopenia

A

The answer is C [Ob/Gyn].

A. Preeclampsia and eclampsia both manifest with hypertension, proteinuria, and thrombocytopenia.

B. See A.

C. When seizure occurs, the patient goes from a diagnosis of preeclampsia to that of eclampsia.

D. See A.

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225
Q

pregnant patient G2P0010 presents with positive home pregnancy test, LMP 9 weeks ago, intermittent vaginal bleeding for 1 week, LLQ pain getting worse for 12 hours, Hx of right tubal pregnancy 3 yrs ago

what is suspected

how is she evaluated

A

ectopic pregnancy

confirm or exclude by vaginal ultrasound

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226
Q

what type of US is best in the first trimester

why

A

vaginal

confirms location of gestation; determine embryo viability; relief of anxiety

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227
Q

NY heart assocation classification

A

Class I: asymptomatic with ordinary activities

Class II: symptomatic with greater than normal activity

Class III: symptomatic with normal activities

Class IV: symptomatic at rest

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228
Q

gravidity

A

how many times someone has been pregnant

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229
Q

gestational HTN

A

BP > 140/90 on two or more occasions 6 hours or more apart after 20 weeks with no proteinuria

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230
Q

chronic HTN is associated with what four pregnancy risks

A

preeclampsia/eclampsia

placental abruption

preterm labor

intrauterine growth retardation

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231
Q

fibroid etiology

what determines the symptoms

A

a single myometrial cell mutation found in 20-50% of women that is estrogen dependent

symptoms are depedent on location

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232
Q

how often do hot flashes usually occur

when does the activity peak

what percent will have significant problems

A

1-12 hours, even during sleep

3-5 after onset of menopause then declining

5-10%

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233
Q

when is vaginal ultrasound used for imaging a fetus

abdominal

A

first trimester

>12 weeks

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234
Q

symptoms of endometriosis

when would it cause severe abdominal pain

A

none, infertility, dysmenorrhea, dyspareunia

when there is a ruptured endometrioma

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235
Q

Young sexually active patient on birth control presents with pelvic pain. She is afebrile and WBC count is normal. Serum HCG <5 mIU/ml. Pelvic exam unsatisfactory due to guarding and severe pain left adnexa. Ultrasound shows 6 cm fluid-filled mass in left adnexa

DDx?

A

ovarian torsion

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236
Q

sources of morbidity associated with ovarian cancer

A

intra-abdominal spread

obstruction or malabsorption in the GI tract

distant mets (liver, lung, bone)

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237
Q

will giving progesterone during pregnancy hurt a fetus

A

no, progesterone goes up during pregnancy

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238
Q

patient in the first trimester has an HCG greater than 2,000 but no IUP on vaginal ultrasound

what is the probable cause

A

ectopic pregnancy

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239
Q

apgar categories

A

color

pulse

reflex/irritability

muscle tone

breathing

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240
Q

three risk factors associated with endometritis

treatment

A

long labors, multiple vagina exams, failure of sterile technique

IV ABx

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241
Q

treatment of severe preeclampsia

A

prevention

deliver regardless of gestational age

delay for 24-48 hrs for glucocortcoids if <34 weeks

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242
Q

T/F delayed childbearing decreases risk of breast cancer

A

false, pregnancy after 35 increases risk by 1.5x

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243
Q

natural menopause

A

exhaustion of the ovarian supply of oocytes

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244
Q

during the first trimester insulin needs will ______

during the second and third they will _______

A

stay the same or go down

increase dramatically

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245
Q

musculoskeletal menopause symptoms

A

fractures/osteoporosis

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246
Q

how does bisphosphonates work against osteoporosis

disadvantages

A

blocks bone resorption

increases bone mass

reduces plasma calcium levels

needs to be taken on a empty stomach due to poor absorption, can often cause GI issues

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247
Q

integrated theory of endometriosis

A

high retrograde menstruation allows for endometrial cells to implant or grow

attenuated immune system allows for aggressive spread through blood or lymph

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248
Q

use of the word miscarriage vs abortion

A

abortion should not be used with patients

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249
Q

vaginal septum

A

a septum in the uterus that can cause dyspariena or dysmenorrhea

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250
Q

what age is mostly likely to present with acute salpingitis

typical symptoms and signs

A

teens and early 20s

bilateral lower abdominal cramping and pain with possible fever, purulent discharge that begin during or after menses

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251
Q

risks of Estrogen HRT

A

increased breast cancer risk

increased risk of CVD

increased risk of DVT (thromboembolism)

increased risk of uterine cancer unless prgesterone is added

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252
Q

primigravida

A

first pregnancy

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253
Q

clubbed fallopian tubes

hydrosalpinx

what is the major concern with hydrosalpinx

A

scarring and inflammation has destroyed the fimbria

blocked fallopian tube filled with fluid

the mucosa inside will be damaged and even with surgery to open the tube it may not be functional

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254
Q

SAB first phase

A

6-9 weeks of gestation, intermittent bleeding and cramping

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255
Q

A 30-year-old female who is 32 weeks pregnant begins to experience tremors, heat intolerance, and irritability along with some fatigue, tachycardia, hypertension, and lower abdominal pain.

Labs reveal the following:

Hct 33%;
Hgb 12.8 g/dL;
WBC 14,600/L
am cortisol 42 g/dL (normal 5 to 20 g/dL)
Total thyroxine 13.1 g/dL (normal 5 to 12 g/dL)
Total T3 225 ng/dL (normal 70 to 205 ng/dL)
TSH 0.4 U/mL (normal 2 to 10 U/mL)

Which of the following therapies is the treatment of choice?

A. amiodarone

B. propranolol

C. propylthiouracil

D. radioactive iodine

A

The answer is C

A. Amiodarone can be a cause of hyperthyroidism and is not used for the treatment.

B. beta Blockers may alleviate symptomatology of hyperthyroidism but may cause fetal growth retardation.

C. Hyperthyroidism results in low TSH and elevated T3 and thyroxine (free T4). It may cause intrauterine growth retardation, prematurity, or transient thyrotoxicosis in the newborn. Propylthiouracil is the only drug recommended for treatment of hyperthyroidism during pregnancy and lactation. This drug does cross the placenta and, although rare, may result in excess TSH secretion and goiter in the fetus. Therefore, the smallest dose possible should be used. Very little is secreted in breast milk; adverse effects in the fetus have not been demonstrated.

D. Radioactive iodine would be harmful to the fetus.

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256
Q

screening protocol for cervical cancer

A

begin 3 years after sexual activity or 21-25

q3yrs as long as results have been normal

q5yrs after 50

stop at 65 (or 70) with 5 normal paps

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257
Q

causes of oligohydramnios

signs

A

urethral stricture, kidney malformation

distended bladder on ultrasound

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258
Q

when would you suspect ectopic pregnancy

A

first trimester bleeding accompanied by cramping midpelvic pain intially progressing to knife-like localized pain

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259
Q

T/F episiotomy is reccomended for a routine non-operative delivery

A

false

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260
Q

guidelines to determine if salpingitis should be admitted

A

fever above 39C

WBC +20,000

guarding and rebound tenderness with severe pain

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261
Q

what would result in paternal genome 46yy in a hydatidiform mole

A

dispermic fertilization or maternal pronucleus inactivation

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262
Q

what is the main cuase of cervical cancer

two synergistic factors

A

HPV

smoking and immunosuppression

263
Q

classic presentation of placenta previa

A

painless third trimester vaginal bleeding

264
Q

which of the Rh genes are most important

A

D

DD - Rh positive

Dd- Rh positive

dd - Rh negative

265
Q

evaluation of post menopausal bleeding

A

TV US to measure endometrial thickness, biospy if <3mm

endometrial biopsy >3mm

dilation and curettage in the case of cervical stenosis

266
Q

staging endometriosis

when is aggressive treatment warranted

A

mild I and II

moderate III

severe IV

with stage III, IV, or with a patient less than 25

267
Q

what is an effective treatment for HER-2 sensitive breast cancer

A

monoclonal antibodies against the receptors

268
Q

what drug is in Plan B

when are the best given

what is the method of action

what is the main side effect

A

levonorgestrel pills

best results within 72 hours

blocks ovulation

nausea

269
Q

puerperium

what happens to the uterus day 1 PP

what is a common procedure done at this time? why?

A

delivery to 6 weeks

it shrinks to size it was at during week 20 (palpable at the umbilicus

tubal ligation, because the uterus is right at the umbilicus for easy access

270
Q

changes in menstrual cycle during perimenopause

A

regular cycles with less bleeding and cramping

irregular cycles

271
Q

why would oral contraceptives stunt growth of a functional ovarian cyst

A

using the estrogen and progestone to decrease follical development through lower FSH and LH

272
Q

what is the most common form of GTD

A

hydatiform mole

273
Q

define adenomyosis

indicence

A

endometrial glands and stroma within the myometrium

8-40% of all hysterecyomes

274
Q

what is secreted during lactation in the intiial 1-3 days PP

what makes it special

A

colostrum

low in fat and CHO, high in vitamins and immunoglobulins

275
Q

5 minor risk factors for preterm labor

A

poor weight gain

working

smoking

anemia

infection

276
Q

succenturiate lobe

A

accessory lobe of the placenta

277
Q

T/F all the biochemical markers used to monitor fetal heatlh (estriol, human placental lactogen, HCG, etc) have not proved useful

A

true

278
Q

what type of ovarian cancer can secrete steroid hormones

A

granulosa cell tumors

279
Q

three types of PID

A

subclinical

acute salpingitis

chronic PID w/ sequlae

280
Q

when is conservative treatment of ovarian cancer warranted

A

young people with no children or those with stage one disease with low malignany potential

281
Q

three methods used to control pain during labor

A

controlled breathing during contractions

IV opiates

epidural anesthesia

282
Q

one accepted genetic cause of recurrent abortion

A

balanced translocations

283
Q

DDx for a breast mass

A

benign cyst (fibrocystic disease or cystic duct)

fibroadenoma (benign)

cancer

fat necrosis

lipoma

epidermal cyst

284
Q

eclampsia

A

preeclampsia with grand mal seizures

285
Q

management of HTN during pregnancy

A

keep blood pressure <140/90

reduce risks of preeclampsia

monitor fetal growth

286
Q

patient who is 30 wks pregnant arrives at the ER after experiencing a rush of fluid from vagina with painless uterine contractions Q45-60 minutes

DDx

A

rupture of the amniotic sac

urine

blood

287
Q

what triggers the let down reflex

A

nipple stimulation causes a release of oxytocin and prolactin from the pituitary, increasing milk production and letdown

288
Q

two strategies to manage heart disease during pregnancy

A

controlling blood pressure

avoid additional cardiac stress of L&D

289
Q

why are interstitial pregnancies dangerous

A

they can be mistaken for IUPs because they are in the uterus and the uterus has a much larger blood supply than the fallopian tubes

290
Q

causes of infertility along with percent incidence

A

egg/ovulation (25%)

sperm problems (30%)

tubal/pelvic (30%)

unusual problems (5%)

Unexplaned (10%)

291
Q

how is breast cancer usually discoved

A

90% are found as a painless lump in the breast

292
Q

Gravida

A

being pregnant

293
Q

six requirements to use forceps in augementation of delivery

A

completely dilated cervix

head engaged to pelvis (0 station or lower)

position of head must be known

position must be a deliverable one

membranes ruptured

no CPD

294
Q

what happens on the first transfusion from an Rh positive person to an Rh negative person

subsequent transfusions

A

nothing will happpen

the body will have sensitized and produce antibodies against Rh factor leading to hemolysis

295
Q

expectant management for preterm PROM

A

administer ABx, esp for group B streptococus

consider glucocorticoid if <32 weeks

296
Q

how long before the miscarriage does embryo death occur

A

2-6 weeks

297
Q

when are most people diagnosed with DM I

DM II

how many people

A

<25

>25

15-20 million, most with DM II

298
Q

three risks associated with pelvic adhesions from PID

A

chronic pelvic pain

infertility

increased risk of ectopic

299
Q

what is the racial and gender bias for involutional osteoporosis

A

more common in women

more common in caucasians than blacks

300
Q

why is ferning useful for determining PROM

A

amniotic fluid will fern on slide due to proteins

301
Q

what to look for on sterile speculum exam for PROM

A

pooling of fluid on the blade

pH of fluid

ferning on microscope

culture fluid of labor is not imminent or desirable

302
Q

treatment for endometriosis

A

expectant management with nsaids for benign form

ovarian suppression

surgery

303
Q

main fetal heart rate changes

A

normal variation

tachy/bradycardia

decelerations (late, early, variable)

304
Q

what is the normal fetal presentation for labor

A

vertex, occiput anterior (OA)

305
Q

what is the main endocrine changes associated with menopause

A

dramatic reduction in estrogen production resulting in an increase in FSH from the pituitary

306
Q

what is considered a full term pregnancy

premature pregnancy

A

37-41 weeks

anything before 37 weeks

307
Q

T/F total placenta previa will not change throughout the course of pregnancy

A

true, it can become marginal due to uterine growth

308
Q

advantages of endometrial ablation

A

it will make conception much less likely and can reduce dysmenorrhea or endometrial pain to managable levels

309
Q

preliminary signs of labor

A

dropping

false labor

loss of the mucus plug (ww/o bloody show)

310
Q

what percent of sperm in semen are normally motile

what is considered mild asthenospermia

severe

very severe

A

+40%

20-39%

10-19%

<10%

311
Q

are normally dosed birth control pills usually effective for adenomyosis

A

no, they need to be continuously dosed

312
Q

two causes of intrauterine adhesions

A

theraputic ablation

asherman’s syndrome (scar tissue forming from repeat surgical procedures or trauam

313
Q

changes in insulin needs during the first trimester

A

insulin secretion and sensitivity rise

fasting glucose falls (15mg/dL)

effect peaks at 12 weeks

314
Q

what type of breast cancer is the most aggresive but uncommon

A

inflammatory breast cancer

315
Q

divisions of first labor

A

prodromal: frequent irregular contractions with no cervical changes
latent: contracts become regular and cervix starts to change
active: strong, frequent contractions with fast progress

316
Q

how large are typical functional ovarian cysts

will they resolve on their own

what might have happened if the patient has mild to moderate pain

A

<5cm in diamter

yes, usually with 1-3 months possibly faster with oral contraceptives

the cyst may have ruptured

317
Q

factors the increase risk of endometrial cancer

decrease risk

A

estrogen exposure, genetic factors

oral contraceptives, progestin use

318
Q

primary radiation therapy for endometrial cancer

A

implants in the endometrium or vagina

lymph nodes irradiation for mets

319
Q

describe ductal CIS

A

a localized carcinoma with penetration of the basement membrane with 1-3% having + axillary nodes

320
Q

non-communicating uterine horn

A

a malformation of the uterus where one side is closed off from the body of the uterus

321
Q

apgar breathing scores

A

0 = none

1 = weak/irregular

2 = strong

322
Q

indications that a pregnant women in labor should present

A

frequency of contractions

strength of contractions

vaginal fluid loss

323
Q

patient pregnant at 12 weeks reports having one episode of syncope

what might be the cause?

A

as she is starting the second trimester blood pressure falls while blood volume is increased; can lead to positional or orthostatic hypotension

324
Q

mullerian agenesis

what is this called when its idiopathic

how do both present

A

testicular feminization due to androgen receptor insensitivity

mayer-rokitanski-kuster-hauser syndrome

primary amenorrhea

325
Q

two refuted causes of spontaneous abortion with exceptions

A

infection (except listeria and maybe ureaplasma)

luteal phase defects

326
Q

GPA

A

Gravity Parity Abortions

G2 P1 A1

327
Q

when are apgar scores taken

A

1 and 5 minutes post birth

328
Q

treatment of CIN

A

loop electrosurgical excision procedure (LEEP)

cervical cryotherapy

cold knife cone biopsy

329
Q

incidence of HELLP syndrome

A

10% incidence with severe preclampsia

330
Q

what is premarin

what is it used for

A

conjugated estrogen used in HRT for menopause

331
Q

T/F a positive HCG test doesn’t mean a patient is pregnant

A

true, but for OB/GYN purposes a positive HCG means pregnant

332
Q

DDx for a benign cyst

A

functional (follicular or luteal cyst)

benign cystic teratoma (dermoids)

endometrioma

serous cystadenoma

mucinous cystadenomas

333
Q

T/F you should inspect a placenta previa with a digital cervical exam

A

false, you should never examine a pregnany cervix when there is vaginal bleeding unless you know there is no placenta previa

334
Q

where does amniotic fluid come from

what is its function

A

the fetus, particularly the kidneys

shock absorption, participates in the development of lungs

335
Q

what is a double set up exam

what is it used for

A

a sterile speculum exam then a digital exam done in an OR prepped for c section when placenta previa is possible

336
Q

maternal mortality

two division

A

Death of a pregnant woman during pregnancy or within 6 weeks of delivery or termination

direct and indirect

337
Q

congenital abnormalities that would cause uterine amenorrhea

A

mullerian agenesis

transverse vaginal septum

imperforate hyman

338
Q

risks associated with bisphosphonate use

A

osteonecrosis of the jaw

increase risk of esophageal cancer

increased risk of atrial fibrilation

339
Q

what is the largest part of a normal fetus

what is the exception to this

A

the head

shoulders in large fetuses with macrosomia

340
Q

in the case of mild oligiospermia or asthenospermia, what action can be taken

what about a severe issue

A

fertility without treatment is possible but intrauterine insemination (IUI) may help

fertility without treatment is very unlikely, IVF is the only option

341
Q

when does normal labor occur

A

37-41 weeks gestational age

342
Q

treatment of pregnant patient with DM I

A

tight insulin control (multidose insulin, diet, exercise)

early delivery (37-39 wks)

343
Q

is there a benefit for performing an annual breast exam

important notes for the exam

A

yes, but a hurried or incomplete exam is useless

palpation supine with arm behind head, extra attention in the upper out quadrant, palpate axilla

344
Q

the essential work up for infertility (HEST)

A

health, eggs, sperm, tubes

345
Q

Apgar pulse scores

A

0 = absent

1 = <100/min

2 = >100 minute

346
Q

where is zero station

A

when the biparietal diameter passed through the pelvis inlet

347
Q

what is the anatomical landmark for a gravid uterus at 20 weeks

36 weeks

A

palpable at the umbilicus

palpable at the xiphoid

348
Q

treatments for hot flashes

A

estrogen

clonidine (slightly effective)

progestin (moderately effective)

SSRI (moderate to good efficacy)

gabapentin (moderate)

349
Q

how is carcinoma in situ usually diagnosed

A

mammography

350
Q

T/F there is no way to know if a person with hypothalamic amenorrhea will resume normal estrogen production

A

no, which is worrisome for osteoporosis

351
Q

criteria for a threatened spontaneous abortion

how will a person feel in regards to the pregnancy

A

any first trimester pregnancy with bleeding with or without cramping

some will still feel pregnant, others wont

352
Q

when checking FSH and estradiol for HEST workup, what should the values be

what about serum progesterone

A

FSH <10

E2 <80

SP >9 if taken 7-10 days after LH surge

353
Q

when will heterotopic pregnancy be more common

what will US show

A

in IVF

IUP with pelvic pain that mandates laparoscopy

354
Q

treatment of uterine amenorhea caused my mullarian agenesis

A

supportive (vaginal dilators and careful counselling)

surgical

355
Q

blind uterine horn (hematometra)

A

trapping of blood in the uterus due to a lack of opening

356
Q

hyperemesis gravidarum

A

severe vomitting related to pregnancy

357
Q

T/F the medical term for abortion as noted in the TPAL system G3 P0030 is always a medical abortion

A

false, it can be any reason why the fetus was not taken to term (ectopic pregnancy)

358
Q

what is the usual presentation of ovarian cancer

screening tests

conclusion?

A

pelvic mass with ascites

pelvic exams, CA-125 assays, ultrasound

there is no cost effective protocol

359
Q

treatment of fibroids

A

expectant

ovarian suppression

anti-progestational therapy

radiologica embolization

surgery (hysterectomy or myomectomy)

360
Q

breech presentation

why might this be converted to a csection

A

posterior, leg, or foot presents instead of the head

because the head comes out last, if it gets stuck delivery might take too long

361
Q

treatment of vasa previa

A

early recognition

c scetion is necessary, can be emergent if fetal bleeding occurs

362
Q

what are the advantages of barrier contraception

three types

A

they are very effective with the right population and they may provide protection against STI

diaphram, cervical cap, condoms

363
Q

an Rh negative wants to have a child with an Rh positive father after several SABs

can they have a kid

A

if the dad is Dd there is a 50/50 shot Rh factor won’t play a factor

if the dad is DD then the fetus will be 100% Rh+

364
Q

HELLP syndrome associated with preeclampsia

A

H hemolysis

EL elevated liver enzymes

LP low platelet count

365
Q

what is the risk associated with hyperemesis gravidarum

what is the treatment

what condition might you suspect to be associated with this

A

severe dehydration

IV hydration with anti-emetics; possible parenteral nutrition; pregnancy termination in severe cases

gestational trophoblastic disease

366
Q

take away messages for PCOS

A

focus on the patients main complaint

make sure to test for dyslipidemia/CVD, insulin resistance, endometrial carcinoma

367
Q

why is it important to maintain a high index of suspicion when symptoms point to ectopic pregnancy

A

1/200 have no risk factors, 20-50% result in high risk situations

368
Q

gestational diabetes

A

glucose intolerance seend during pregnancy with no hx of DM and normal glucose tolerance after pregnancy

369
Q

one factors that delays menopase

four factors that hasten menopause

A

obesity

cigarette smoking, chemo, pelvic radiation

370
Q

why isn’t US used to screen for ovarian cancer

A

increased survival by 50% but lead to many false positives

371
Q

three other producers of HCG

A

small cell lung cancer

testicular cancer

liver cancer

372
Q

when would expectant management of placenta previa be indicated

A

significantly preterm with minimal bleed and the patient is not in labor

373
Q

what is the effect of HRT for menopause on CV health

breast cancer risk

colon cancer risk

congition

A

not helpful, maybe harmful

slight increase in risk

maybe decrease risk

probably not useful

374
Q

non-stress test for fetal monitoring

when is it most useful

A

comparison of FHR to fetal movement

most useful in late pregnancy

375
Q

do theca-lutein cysts need to be removed

A

no, they will go away on their own when the molar pregnancy is removed

376
Q

SAB second phase

A

7-12 weeks, heavy cramping and bleeding for several hours followed by expulsion of the gestational sac

377
Q

in what age group does mammography increase survival

is it safe

what is the most common finding

A

50-70

yes there is fairly low radiation with modern equipment

microcalcification

378
Q

breast cancer treatments

A

surgery

radiation

chemo

endocrine modulation

immune modulation

379
Q

T/F oral contraceptives increase breast cancer risk

A

probably slightly

380
Q

HTN drugs for use in pregnancy

A

calcium channel blockers

methyldopa

clonidine

hydralizine

381
Q

treatment for infertility caused by PCOS

A

reduce insulin resistance (metformin)

induce ovulation (clomiphene citrate/clomid or aromatase inhibitor)

check for other fertility factors with no pregnacy after 3-4 normal ovulations or intially with risk factors

382
Q

16 yr old patient presents with weight gain, LMP 6 months ago

DDx?

A

ovarian cyst

GI tumor

ascities

bowel obstruction

fibroid

383
Q

patient presents with intermittent vaginal bleeding after three months of amenorrhea, persistant nausea and vomitting, high HCG, uterus palpable at the umbilicus

what might you suspect

A

molar pregnancy

384
Q

OB issues with diabetics

A

birth defects

late pregnancy intrauterine fetal death (stillbirth)

large fetal size (macrosomia)

385
Q

Diagnosis of PROM

A

immunochemistry (dipstick)

sterile speculum exam

386
Q

T/F a fallopian tube having undergone a salpingostomy will not heal properly and probably not be effective

A

false, there is a 70% chance it will heal and be useful for pregnancy

387
Q

types of breast reconstructuve surgery

A

saline implants

trans-rectus abdominis muscle flap

388
Q

six types of spontaneous abortion

A

threatened

complete

incomplete

missed

septic

recurrent

389
Q

three other types of fetal malpresentations for labor

A

face or brow

breech

transverse lie

390
Q

why do SERMs work

A

because the estrogen receptors in bone are different that those found elsewhere in the body

391
Q

multipara

A

given birth multiple times

392
Q

treatment for unruptured ectopics

A

chemotherapy or surgery

393
Q

why is it important tn HCG stay low after removal of a molar pregnancy

A

because the formation of a choriocarcinoma is likley

394
Q

patient G4P0030, 1st electively terminated at 7 weeks, SAB at 18, SAB at 14 with normal appearing fetuses

what is the concern

A

cervical incompetence

395
Q

26 yr old primigravid pt 7 weeks pregnant, DM I for 7 years

what happens to her insulin needs during pregnancy

A
396
Q

what is the male risk of breast cancer

A

1/150 that of women with similar risk factors and treatment

397
Q

four factors that cause conditions with prematurity

A

respiratory

GI

neurologic

visual

398
Q

three less classic symptoms of PCOS

A

obesity

sleep apnea

skin changes (acanthosis nigiricans and skin tags)

399
Q

two highlights of the third trimester

A

labor becomes increasingly likely

fetal viability increases rapidly

400
Q

what causes bacterial vaginosis

incidence

s/s

treatment

A

gardnerella vaginalis in vaginal flora

common (15-40%)

asymptomatic or may cause vaginitis

metronidazole oral/cream, clindamycin vaginal cream

401
Q

late decelerations

what do they mean

are the concerning

A

transient bradycardia that starts when the contraction is ending

indicates fetal hypoxia

if they don’t go away with position change or oxygen progress to c section

402
Q

how is the placenta evaluated during an OB ultrasound

A

location and overall health

403
Q

postmenopausal bleeding DDx

A

postcoital (cervical polyp or carcinoma)

ovulatory

abnormal (endometrial hyperplasia/carcinoma)

404
Q

what is the estimated date of delivery

A

280 days after first day of the last menstrual cycle

405
Q

primary infertility

A

a couple (particularly the woman) has never been pregnant together

406
Q

at what gestational age is an incomplete SAB more common

what are two possible complications

what is required

A

more likely after 10 wks gestation

bleeding and cramping can be serious

requires uterine curettage

407
Q

false labor

A

contractions with no cervial changes due to braxton hicks contractions or early labor (prodromal)

408
Q

factors that lower ovarian cancer risk

A

pregnancy (-15% per pregnancy)

oral contraceptives (-50%)

409
Q

pregnant patient with class II heart failure sudden experiences shortness of breath during normal daily activies

is this concerning

A

yes, increasing class during pregnancy is an ominous sign

410
Q

ovarian causes of amenorrhea

A

primary ovarian failure

secondary ovarian failure caued by a pituitary issue or loss of GnRH

411
Q
A

nulliparous

412
Q

two complications with shoulder dystocia

A

brain anoxia

fetal trauma

413
Q

perimenopause

A

the period of about 10 years prior to menopause characterized by changes in menstrual cycles and vasomotor flushes (hot flashes)

414
Q

general menopause symptoms

A

vasomotor flushes

415
Q

distinguish between third trimester bleeding caused by previa vs abruption

A

previa is painless, abruption is painful

416
Q

what is the disadvantage of the transverse c section

when would you do a horizontal incision

A

it takes long because you have to separate the rectus from the rectus fascia

in the case of fetal distress

417
Q

DDx of chronic pelvic pain

A

dysmenorrhea

dysparunia

418
Q

natural course when not lactating

A

most will complain of engorgement, leaking, pain increasing over 2-3 days then subsiding

419
Q

heterotropic pregnancy

A

two fertilized eggs implant, one in the uterus one ectopically

420
Q

phases of a spontaneous abortion

A

first (6-9 weeks)

Second (7-12 weeks)

recovery

421
Q

what is the long term survivability of breast cancer

two big take aways to maximize survival

A

old standard is 5 years

most studies are showing 10 years

early diagnosis is crucial and long term surveillance is needed

422
Q

three types of endometrial hyperplasia

A

hyperplasia without atypia

hyperplasia with atypia

carcinoma in situ

423
Q

vasomotor flushes

what causes them

A

the inability to regulate temperature

cause by misreading by the hypothalamus that triggers cooling mechanisms

424
Q

what is in a gonadotropin fertility drug

what are the risks of treatment

A

FSH with or w/o LH

hyperstimulation, multiple births

425
Q

culdocentesis

A

needle aspiration of the pelvic cul-de-sac to look for free blood

426
Q

four examples of phosphonates

A

alendronate (fosamax)

risedronate (actonel)

etidronate (didronel)

pamidronate (aredia)

427
Q

key symptoms of PCOS

A

oligomenorrhea (sometimes with heavy bleeding) or amenorrhea

hyperandrogenism (hirsutism, acne, alopecia)

428
Q

T/F estrogen causes breast cancer

reasoning?

A

false, it opens the door to allow for breast cancer to form

women without esstrogen have a low risk, men with estrogen do, early menses + late menopause increases risk

429
Q

pro/con for episiotomy midline vs mediolateral

A

midline is more comfortable during healing

mediolateral is less comfortable but less likely to extend into the rectum

430
Q

hydatidform mole

risk factors

A

a neoplasm arising from trophoblastic cells

age (very old and very young)

diet/socioeconomic factors

paternal genome 46yy

431
Q

evaluating abnormal pap smears (ASC-US, LGSIL, HGSIL)

A

ASC-US: treat any vaginal infections and repeat in 3-6 months

for any others colposcopy with directed biopsy

432
Q

suspected cause of PCOS

A

prolonged anovulation caused by genetics, weight gain or stress that leads to hyperandrogenism, insulin resistance, which positively reinforces anovulation

433
Q

morbidity associated with cervical cancer

A

local spread and destruction of ureters, bladder, rectum

lymphatic spread

rare distant metastasis

434
Q

placenta previa

A

placenta within the zone of cervical effacment and dialtion

435
Q

standard tests for all amenorrhea/oligomenorrhea

A

Gondatropins: FSH, LH

Prolactin

TSH

HCG

Test

436
Q

two ways to evaluate fallopian tubes on a HEST workup

A

hysterosalpingogram

laparoscopy

437
Q

what are two sequlae of PID that might cause chronic problems

A

tubo-ovarian abscess that requires surgical removal

pelvic adhesions

438
Q

explain why coelemic metaplasia could be a cause of endometriosis

A

retrograde menstruation causea a metaplastic change in the peritoneum and ovarian lining

439
Q

TPAL notation examples

A

G3 P1101

three pregnancies, 1 term delivery, 1 preterm delivery, 1 living child, no abortsion

440
Q

advantages of SERM (raloxifene/Evista) over estrogen

A

action is limited to bone

safer than estrogen

side effects are mimicked by menopausal symptoms

may lower breast cancer risk

441
Q

at what point does managing blood pressure during pregnancy become difficult

A

after 24 weeks

442
Q

placenta accreta

treatment

why is this troublsome

A

an abnormality of placental attachment where the placenta is very tightly attached to the uterus

manual removal

there is no good dissection plane, may require hysterectomy

443
Q

diagnostic difficulties in relation to heart failure and a pregnant patient

A

normal physiologic changes cause systolic murmurs and JVD

pseudo-dyspnea can mimic symptoms

PMI shifts due to the uterus

444
Q

when evaluating a semen analysis for infertility what are three things to look at

what should happen if the results are abnormal

A

concentration, motility, volume

repeat at 4-8 weeks

445
Q

the difference between primigravida and primipara

A

the first time being pregnant vs the first time giving birth

446
Q

two medications that can cause osteoporosis

A

glucocorticoids and heparin

447
Q

traditional reccomendations for threatened spontaneous abortion

A

bed rest

NPV (nothing per vaginum)(

448
Q

managing the patient in premature labor

A

ABx (gram +)

glucocortcoids

bed rest

transport

449
Q

risk factors or preeclampsia

A

more common in first pregnancies

more common in black women

more common with multiple pregnancies

more common in low socioeconomic groups

450
Q

if the mother produces antibodies against the babies blood type can it effect the baby?

A

it might cause jaundice from hemolysis but AB antibodies are IgM and don’t pass the placenta

451
Q

what to look for in HCG monitoring following GTD

A

effective contraception for one year

rising HCG levels indicating invasive GTD (20-30%)

452
Q

if a mother is Rh negative and continues to have Rh positive children what is the effect

A

the mother’s anti-d reaction will become strong and stronger

453
Q

two situations where dysmenorrhea might be caused by outflow obstruction

A

pain at or soon after menarche caused by mullerian fusion or vaginal formation problem

pain after surgical procedure due to cervical stenosis

454
Q

why does gardnerella vaginalis cause bacterial vaginosis

A

unknown, but the bacteria is associated with sexual activity

455
Q

two types of pseudodyspnea due to pregnancy

A

progesterone-induced tachypnea

upward displacement of the diaphragm

456
Q

what happens during an incomplete SAB

how is it different from a normal SAB

A

products of conception ar not completely expelled

it is the same until expulsion (second phase)

457
Q

lab test for amenorrhea

A

HCG

FSH/LH

TSH

Prolactin

Test (in cases of hirsuitism)

chromosomal analysis (to check for congenital abnormalities)

458
Q

gardasil is most effective when

potential benefit

A

girls and boys 11-12, reccomended 9-26

prevent 70% of cervical cancer

90% genital warts

459
Q

gynecologic causes of placental abruption

A

uterine malformation or fibroids

460
Q

what other test might be considered for infertility treatment in the presense of oligomenorrhea or amenorrhea

what bout oligospermia

A

serum prolactin

chromosomal analysis

461
Q

risk factors for shoulder dystocia

A

fetal macrosomia

maternal obesity

previous Hx

maternal diabetes

post dates

multiparity

462
Q

why can “morning sickness” a misnomer

A

because it can last all day

463
Q

apgar color points

A

0 = blue all over

1 = body pink, limbs blue

2 = pink all over

464
Q

effects of estrogen that counter act osteoporosis

what is the result

A

stimulates estrogen receptors in bone

reduces the effect of parathyroid hormone

increases bone mass, reduces fractures

465
Q

preeclampsia/eclampsia

A

BP > 140/90 on two or more occasions 6 hours or more apart after 20 weeks WITH proteinuria

466
Q

TPAL

four classifications

A

gravidity plus four classifications of outcomes

Term deliveries, preterm deliveries, abortions, living children

467
Q

risk factors for preterm labor

A

prior preterm labor (6-8X)

multiple gestation (6-8x)

african american (3-4x)

low socioeconomic status (1.9-2.6x)

468
Q

what does the presence of fetal fibronectin in maternal serum indicate

A

increased risk for preterm labor

469
Q

HPV types 6, 11, 42, 43 are low risk for cervical cancer but are asociated with what

A

condlyomata and CIN I

470
Q

what is the treatment for cervical incompetence

A

cerclage (a band wrapped around the external os to keep it closed

471
Q

when would leiomyosarcoma be high on the DDx

how are they treated

A

when there is a rapidly growing uterine mass or suspected fibroid

excision

472
Q

causes for pelvic relaxation leading to uterine prolapse

A

obstetrical deliveries

decreased strength of connective tissue due to age

decreased estrogen

increased abdominal pressure from obesity, chronic cough, constipation

473
Q

treatment for SAB

incomplete SAB

missed abortion

A

none

curettage

D & C or prostaglandin therapy

474
Q

types of abnormal uterine bleeding

A

oligomenorrhea

amenorrhea (primary vs secondary)

menometrorrhagia

hypermenorrhea/menorrhagia

post menopauseal bleeding

475
Q

medical cases of placental abruption

A

gestational diabetes or HTN

476
Q

two immunochemistry test

A

amnisure (placental alpha microglobulin 1)

Actim prim (IGF bindining protein 1)

477
Q

two phenothiazines used to treat nausea in early pregnancy

A

promethazine (phenergan)

prochlorperazine (compazine)

478
Q

who does the blood from placenta previa come from

A

usually from the mom, but can be from the fetus in vasa previa

479
Q

compare and contrast lumpectomy vs mastetcomy

A

similar survival studies with post op radiation

lumpectomy is under utilized, but not everyone is a candidate (small breast and large tumor size)

480
Q

urinary menopause symptoms

A

frequency and incontinence

481
Q

what is a normal semen concentration

what is considered mild oligospermia

severe

very severe

A

+20million

10-19 million

5-9 million

<5million

482
Q

how do symptoms differ between submucosal and pedunculated fibroids

A

submucus will have menorrhagia and pressure discomfort from the mass

pedunculated will have acute pain due to infarct and dysmenorrhea

483
Q

two advantages of chemotherapy with methotrexate for ectopic

A

convenient (single dose IM)

good success rate (90% optimum success)

484
Q

two key incisions in a c section

two orientations of the skin incision

four orientations of the uterine incision

A

skin and uterine

midline verticle and pfannensteil (transverse suprapubic)

low transverse, low vertical, classical, T

485
Q

SAB symptoms (cramping and bleeding) based on gestational age

A

5-7 weeks: mild

8-9: moderate

>10 weeks: moderate to severe

486
Q

three types of placenta previa

A

marginal, complete, low lying

487
Q

causes of hyperprolactiemia that might lead to amenorrhea

A

pituitary adenoma

hypothyroidism

drug induced

idiopathic

488
Q

cervical incompetence

risks

when does it occur

A

painless gradual dilation of the cervix

surgery (D&C, conization, LEEP), trauma

14-27 weeks

489
Q

variable deceleration

what is the cuase

are they concerning

A

transient bradycardia that can be during or after contractions

compression of the umbilical cord

can be if the bradycardia goes low enough

490
Q

three ultrasound landmarks and when you would see them

A

gestational sack (5-5.5 wks)

2mm embryo (5.5-6wks)

cardiac activity (5.5-6 wks)

491
Q

two types of abortsion

A

spontaneous and inducd

492
Q

define gynecology

A

The study of… diseases & conditions that affect reproduction and the female reproductive system

493
Q

adjunctive therapy associated with breast cancer

what is the goal

types

is chemo needed?

A

improve long term survival

endocrine modulation for estrogen sensitive patients (anti-estrogen and aromatase inhibitors)

chemo is not necessary for early stage cancer

494
Q

rectocele vs cystocele

A

rectocele is posterior vaginal wall weakness

cystocele is anterior vaginal wall weakness

495
Q

patient doing a hormone challenge for amenorrhea reports bleeding

what does that prove

A

that ovaries are producing estrogen and the uterus is intact

496
Q

treatment options for primary ovarian failure

A

HRT

egg donation or stem cell gametes for fertility

497
Q

how is it possible to have a full term pregnancy with a nulliparous cervix

A

cesarean

498
Q

TNM

A

Tumor: size, Node: lymph node involvement, Metastasis: presence of distant metastasis

499
Q

bethesda system to classify pap smears

A

normal: negative for CIN, CIS, cancer

atypical squamous cells, undetermined or cannot exclude (ASC)

low grade squamous intraepithelial lesion (LGSIL)

high grade squamous intraepthelial lesion (HGSIL)

500
Q

two types of dysmenorrhea

A

secondary (due to pelvic pathology

primary

501
Q

why are epidurals not reccomended during the latent phase of labor

A

because it can slow down cervical dilation if it occurs before 4cm dilation

502
Q

is endometriosis diagnosed with ultrasound

A

no, endometriomas can be seen but endometriosis is confirmed with laprascopy

503
Q

two step principle as it applies to breast cancer

A

make diagnosis with biopsy first, then treat

504
Q

two uterine causes of amenorrhea

A

intrauterine adhesion (synchiae)

congenital abnormalities

505
Q

patient no previous heart conditions presents with mitral reguritation and pleural edema on CXR

is this concerning?

A

yes, pregnancy will not normally cause diastolic murmurs, +gradeIII systolic murmurs, or pleural edema

506
Q

three preparations before forceps should be used

A

adquate anesthesia

bladder not distended (may require catherization

episiotomy

507
Q

glucocorticoid therapy for preterm labor treatment when less than 34 weeks

A

betamethasone 12 mg IM q24h x 2 doses

dexamethasone 6mg IM q6h x 4 doses

508
Q

when is eclampsia diagnosed

A

50% antepartum

25% intrapartum

25% post partum

509
Q

what is a likely cause of the hypothalamus causing vasomotor flushing

A

over production of FSH due to low estrogen stimulates the arcuate nucleus, which is near the thermoregulation center and causes spill over

510
Q

changes in insulin needs during the second and third trimester

A

insulin sensitivity falls (33-50%)

fasting and postprandial glucose levels reise

511
Q

hormonal challenge

A

progestin adminstered 10g x 5-7d, if bleeding starts that means that uterus and ovaries are intact

estrogen + progestin adminstered that leads too bleeding proves the uterus is intact

512
Q

T/F fertility drugs are “fertility enhancers”

what conditions are not treatable with fertility drugs

A

false

sperm, tubal, uterine issues

513
Q

three ovarian cancer origins

A

epithelial (90%)

germ cell origin

stromal/sex cord

514
Q

diagnosis of vaginitis

A

wet mount on two slides

one with saline to look for flagellated trichomonads or clue cells (bacterial vaginosis)

one with potassium hydroxide to look for budding yeast

515
Q

what are fertility drugs used for

two types

A

to cause or enhance ovulation

gonadotropins, clomiphene

516
Q

classification for neonatal death

A

death with in the first 28 days

517
Q

counselling for a patient experiencing nausea during pregnancy

A

rest/reduce stress

avoidance of triggers

small feedings with trial and error of foods

hydration

518
Q

dangers associated with unopposed estrogen

A
519
Q

strategy for dealing with infertility

A

discover the causes

correct the issue if possible

bypass if possible

provide support

520
Q

three things associated with monilia causing vaginitis

A

hormonal changes, ABx, immune status in frequent infections

521
Q

key lab finding for primary ovarian failure

A

very high FSH

522
Q

why is vasa previa difficult to recognize

what is the usualy initial sign

A

often it doesn;t cause an issue until membranes rupture

fetal tachycardia

523
Q

treatment of acute PID

A

remove IUD if present

admit toxic patient for IV ABx

outpatient with oral ABx

524
Q

mean age for the onset of natural menopause

A

51

525
Q

two types of placental abnormalities that can lead to postpartum hemorrhage

A

retained placental fragment or lobe

placenta accreta

526
Q

two types of internal fetal monitoring

A

fetal scalp electrode for HR

intrauterine pressure catheter

527
Q

managemnet of PCOS

A

screen for other causes of symptoms

screen for special health risks

treat main symptoms

528
Q

imperforate hymen

A

a hymen that doesn;t open during development and can trap blood to cause dysmenorrhea

529
Q

clinical factors to keep in mind when assessing a breast lump

A

most are benign (90% <20, 60-70>40)

is the mass solid vs cystic

mobile vs fixed

dimpling or nipple erosion

530
Q

treatment of preterm labor

A

glucocorticoid therapy

tocolysis to delay 1-2 days

531
Q

three aninotic fluid abnormailities

A

rupture of membranes

too much fluid (polyhydramnios)

too little fluid (oligohydramnios)

532
Q

two main systems to indicate gravidity and parity when charting

A

GPA and TPAL

533
Q

biohphysical assesments for to monitor the fetus

A

fetal movements (kick count)

non stress test

acoustic stimulation

contraction stress test

ultrasound assessment

534
Q

what will happen to insulin needs after delivery

A

insulin resistance decreases, DMII can usually stop all meds, DMI greatly reduce

535
Q

what types of patient would warrant vaginal ultrasounds and CA-125 assays every 6 months

A

BRCA1-2 positive patients with a first degree relative who had premenopausal ovarian cancer

536
Q

typical course for morning sickness during pregnancy

A

begins at 5-7 weeks

peaks at 8-10 wks

usually ends >12wks but can persist into the third trimester

537
Q

patient presents with

  • BPs range from 140-155/85-95
  • Reflexes +3/4
  • C/o slight headache
  • Mg SO4 started
  • Platelet count 100,000

can you deliver or should you do c-section

A

in cases of preeclampsia labor progresses quickly and since unlikey to have SZ, trial labor for 8-12 hours unless HELLP syndrome is suggested by lab work

538
Q

types of germ cell ovarian cancer

A

dysgerminoma

choriocarcinoma

embryonal cell carcinoma

539
Q

four accepted causes of reccurrent abortion

A

maternal age

genetic

uterine

thyroid

540
Q

24 y/0 gravida 1 para 1 complains of 10 days of progressive symptoms: Vaginal discharge, Vaginal itching and irritation, Good general health, Recently completed antibiotics for strep throat infection

DDx

A

vaginitis

541
Q

44 y/o woman, gravida 3 para 3003 reports no menses for 7 months. Also has frequent hot flushes. FSH blood test = 100 mIU/ml with a negative pregnancy test.

Is she menopausal?

A

by clinical standard yes, but occasionally patients can spontaneous restart menses

542
Q

prognosis of intraepithelial lesions

A

50% will regress to normal

25% will persist

25% will progress to invasive cancer

543
Q

what percent of placenta previa are complete vs partial

A

20% complete, 80% partial

544
Q

three ways to reduce risk of preeclampsia

A

BP control

rest

maybe diet

545
Q

what causes pain with placental abruption

A

uterine contractions, uterine pain and tenderness at tthe sight of placental separation

546
Q

SAB recovery phase

A

menstrual period like bleeding for up to 10 days

547
Q

etiology and treatment of a dermoid

A

etiology: suspected cleavage/growth of an unfertilized oocyte
treatment: surgical excision with careful observation

548
Q

criteria for reccurent abortion

incidence

A

3+ SABs especially with no live births

549
Q

contraction stimulation test

A

add a uterine tocodynamometer to ultrasonic fetal heart monitor, cause 3 contractions over a 10 minute period and observe the FHR in response

550
Q

treatment for uterine prolapse

A

reduce intraabdominal pressure

estrogen replacement

kegels

surgical repair

551
Q

what is the minimum gestational age for survival

A

22 weeks

552
Q

hydrops fetalis

A

fetal congestive heart failure

553
Q

three risk factors for placenta previa

A

uterine scar from prior c section

hypoperfused endometrium (age, multipparity)

enlarged placenta (multiple pregnancy)

554
Q

labor equals what

A

regular contractons that change the effacemtn and dilation of the cervix

555
Q

define obstetrics

A

The branch of medicine that concerns the management of pregnancy, childbirth and the puerperium

556
Q

complication common with fallope ring for laparoscopic sterlization

A

can cause cramping 12 hts post op

557
Q

three other treatments for osteoporosis other than estrogen

A

calcium supplementation 1200-1500 mg/day

SERM

bisphosphonates

558
Q

how to stimulate contractions for a contraction stimulation test

A

oxytocin/pitocin

breast stimulation

orgasm

559
Q

miscellaneous causes of menopause

A

destruction of oocytes from chemotherapy or autoimmune process

560
Q

endometritis signs

A

fever, cramping pain, malodorus discharge (lochia) often due to staph, strep, or E coli

561
Q

why is it important that a pregnant patient not lay supine after 20 wks

A

the uterus is large enough compress the vena cava, reducing venous return and cardiac output

562
Q

three causes of postpartum hemorrhage

A

uterine atony

cervical or vaginal lacerations

placental abnormalities

563
Q

why is abnormal prostaglanding production suspected to be the cause of endometriosis

A

because NSAIDs, which block prostaglandins, tend to work well for endometriosis

564
Q

what is prognosis of ovarian cancer dependent on

A

stage, age, health, tumor type, tumor grade

565
Q

two forms of neural tube defects

A

anencephaly

spina bifida

566
Q

in a patient with suspected PSOS what tests should be done to exclude alternative causes

A

early morning serum 17-hyrooxyprogesterone to rule out non-classical congenital adrenal hyperplasia

testosterone +2ng/mL to rule out androgen secreting tumor

cortisol levels to rule out cushings syndrome

567
Q

treatment of endomettrial cancer

A

radiation therapy adjuct to surgery or primary

surgery (TAH, BSO)

progestin, tamoxifen

chemotherapy

568
Q

shoulder dystocia

A

difficulty delivering the shoulders

569
Q

primary surgical treatment for breast cancer

A

conservative (lumpectomy)

mastetctomy

axillary nodes

570
Q

what is the genetic paradox in breast cancer

A

first degree relative with breast cancer increases risk by 3-4x

BUT

85% of patients have no family Hx

571
Q

patient presents with early labor at 21 weeks

what is the reccomendation

A

it is up to the patient, but delaying labor will only buy so much time and there is good chance the baby will die

572
Q

T/F most people in the world are Rh positive

A

true

573
Q

special risk situation for placenta previa

A

amniotomy (artificial rupture of membranes) can rupture the umbilical cord

574
Q

differentiate between benign and aggressive endometriosis

A

benign is usually dx at a later age with more superficial lesions and slower progression

aggressive with an early onset, more invasive lesions, and rapid progression

575
Q

two types of external fetal monitoring

A

ultrasound for HR

tocodynamometer for detecting contractions

576
Q

preterm labor

incidence

A

labor between 22-36 weeks

11-12&%

577
Q

four types of forceps used for operative delivery

A

outlet

low

mid

vacuum extractor

578
Q

fetal station

A

how high is the presenting part of the fetus in relation to the ischial tuberosities

579
Q

pain associated with ovarian torsion

A

sudden, severe, unilateral pain with no positional relief and possible nausea

580
Q

what is the risk of vasa previa

when would you suspect vasa previa

A

very high risk of fetal death +30%

vaginal bleeding with signs of fetal distress

581
Q

suppression of lacatation

A

avoid nipple stimulation

where a very supportive bra

estrogen or dopaminergic drugs

582
Q

two types of pregnany induced hypertension

A

gestational hypertension

preeclampsia/eclampsia

583
Q

patient 10 wks pregnant presents with dark/black spotting especially after pap or sexual intercourse. IUP confirmed, fetal assessment via ultrasound shows no signs of fetal distress

what is the Dx? how can you be sure?

A

benign bleeding

because the most likely other answers have been excluded

584
Q

why is pH used to determine PROM

A

if the fluid is acid it probably urine, basic probably amniotic fluid

585
Q

secondary dysmenorrhea causes

A

endometriosis

adenomyosis

fibroids

outflow obstruction from congenital malformation or cervical stenosis

586
Q

when is methotrexate prefered over surgical management of an ectopic

A

early on in the pregnancy

587
Q

visual premature disease

A

retinopathy

588
Q

weeks of pregnancy are calculated used what start date

A

the first day of the last menstrual period

589
Q

why would a dopamine blocking drug cause hyperprolactinemia

A

dopamine inhibits release of prolactine from the anterior pituitary

590
Q

apgar reflex/irritability scores

A

0 = no response

1 = grimace/feeble cry

2 = cough, pulls away

591
Q

types of estrogens combined with progestin used in HRT

A

combipatch

prempro

fem HRT

592
Q

what is the prognosis of endometrial hyperplasia w/o atypia

with atypia

carcinoma in situ

A

80% regress, 1% progress to cancer

considered premalignant, 8-29% progress to CA

considered the same as CA

593
Q

risk factors for nausea and vomitting during pregnancy

A

multiple pregnancy

prior motion sickness or migraines

personal or family history of morning sickness

social factors

594
Q

two things that can be assessed in the first trimester via vaginal ultrasound

A

IUP vs ectopic pregnancy

cardiac activity and size

595
Q

when is fine needle biopsy the only reasonable method for breast cancerq

A

when assessing masses that are too small to palpate

596
Q

three changes in cardiac output linked to pregnancy

A

30-50% increase during pregnancy

30% increase during labor

45% increase while pushing

597
Q

three less common presentations of breast cancer

A

nipple erosion or discharge (pagets)

skin dimpling (retraction)

inflammatory breast cancer

598
Q

where does oxytocin come from

what does it do

A

posterior pituitary

causes contraction of smooth muscle in the breast ducts (let down)

599
Q

prevention of preterm labor

A

reduce risk factors

supplemental progesterone treatment

600
Q

what should be monitored for labor progress

A

cervical changes

strenth and frequency of contractions

FHR

maternal vital signs, bladder status, discomfort

601
Q

potential PP issues

A

bladder can be come edematous or atonic

rapid cardiovascular changes

intiation of lactation

602
Q

what happens to blood volume during pregnancy

A

increase starting at 8 weeks progressing to a 45% increase in blood volume by weeks 34

603
Q

how common is breech presentation

A

3-4% of all deliveries are breech

604
Q

five indications for c section

A

failure to progress

fetal distress

abnormal fetal lie or presentation

prior c section

elective

605
Q

T/F vascular resistance falls during the 1st and 2nd semester

A

true

606
Q

risk of calcium supplementation for osteoporosis

A

people will overdose themselves thinking more is better and give themselves a kidney stone

607
Q

two types of GTD

A

hydatidiform mole

choriocarcinoma

608
Q

health risk screens for PCOS

A

endometrial biopsy after age 35 or 15+ years of PCOS

lipid profiule

screen for insulin resistance and glucose tolerance

609
Q

two types of fetal trauma seen with shoulder dystocia

A

brachial plexus injury (Erb’s palsy)

clavicle fracture

610
Q

T/F IUD can be used to treat menorrhagia

A

true

611
Q

what prevents the uterus from becoming contaminated

A

cervical mucus plug

amniochorion membrane

612
Q

how common are ovarian dermoids

what is the age bias

are the bilateral or unilateral

A

25% of all ovarian neoplasms

20-40

15% are bilateral

613
Q

three key factors of labor

A

powers, pelvis, passenger

614
Q

possible risk factor for polyhydramnios

A

diabetes, infections, mostly idiopathic

615
Q

what is the single most important cause of perinatal deaths and neonatal morbidity

A

preterm labor

616
Q

four causes for amenorrhea other than pregnancy

A

hypothalamic or pitiuitary problem

ovarian problem

uterine problem

metabolic/endocrine issue

617
Q

T/F 50% of pregnancies end +/- 3 wks from LMP

A

false, 90%

618
Q

HPV 16, 18, 33, 35, 45 are high risk and are associated with what

A

CIN II, III, cervical cancer

619
Q

four growth measurements used to evaluate fetal health during late pregnancy

A

uterine size

biparietal diameter

abdominal circumference

femur length

620
Q

three specialistst that should be part of the care team when dealing with a pregnant patient who has heart failure

A

obstetrician/perinatologist

cardiologist

anesthesiologist

621
Q

environmental factors associated with breast cancer

A

high rate in developed nations related to fat intake

ETOH slightly increases risk

622
Q

at what point in delivery is the brachial plexus at risk

why

A

delivery of the anterior shoulder

too much downward traction can stretch the nerves

623
Q

25 y/o G2 P2002 returns for annual checkup and pap smear

On pelvic exam a 4-5 cm mass is palpated in the right adnexa

DDx

A

Benign ovarian cyst

ovarian cancer

pedunculated leiomyoma

624
Q

causes of functional adnexal cysts

A

persistant follicle (follicular cyst)

persistant cystic corpus luteum (luteal cyst)

625
Q

ovarian cancer stagin

A

stage one: tumor only in ovaries

stage II: tumor limited to pelvis

stage III: tumor limited to abdomen

Stage IV: distant mets

626
Q

what is the goal of primary breast cancer treatment

intial recurrence

after that

A

surgical or medical therapy for a cure

still hope with endocrine, chemo, occasional surgical follow up

eventually palliative care

627
Q

cephalopelvic disproportion

A

when the baby’s head is too large for the mother’s pelvis

628
Q

macrosomia

risks

A

fetus >10lbs

birth trauma such as shoulder dystocia

629
Q

describe the increase in maternal and fetal mortality related to eclampsia

A

increases maternal mortality 4-5%

fetal mortality 13-30%

630
Q

labor defined

A

regular contractions with cervical effacement and dilation

631
Q

spina bifida

A

a open defect of the spinal cord where the duramater is exposed

632
Q

gestational diabetes treatment

A

diet

insulin if needed

metformin to increase sensitivity

633
Q

definative surgical treatment for endometriosis

A

total abominal hystectomy with bilateral salpingo-oopherectomy via laparotomy

resection or ablation of endometroima laparoscopicly

634
Q

how are breast cancers identified by their hormone receptor

A

estrogen positive or negative

HER-2 positive or negative

basal (“triple negative”)

635
Q

treatment options for idiopathic infertility

A

IVF

egg donation

surrogate IVF

636
Q

why would obesity delay the onset of menopause

A

adipocytes contain aromatase to convert androgens to estrogens

637
Q

pharmaceutical treatment of nausea during pregnancy

A

pyridoxine (B6) + doxylamine (diclegis)

antihistamine (benadryl)

phenothiazines

serotonin antagonists

638
Q

partiy

A

the number of times someone has successfully taken a pregnancy to term

639
Q

what will happen if an Rh negative mom encounters and Rh positive fetus

A

they will produce IgG against the Rh factor and attack the fetus’ blood cells

640
Q

what cllasses of heart failure are at severe risk of death during pregnancy

A

Class III: symptomatic with normal activies

Class IV: symptomatic at rest

641
Q

when is the most common time for a ruptured ectopic pregnancy

A

between 9-11 weeks

642
Q

stromal/sex cord ovarian cancer

A

granulosa cell tumor

643
Q

health care issues with the big three vaginitis causes

A

frequent monilia: immunosuppression

trichomonaiasis: other STDs

bacterial vaginosis: increased risk of premature labor, increased risk of PID with clap, increased risk of post GYN surgery infection

644
Q

immunologic therapy associated with breast cancer

A

trastuzumab for HER-2 sensitive cancer

trastuzumab emtansine is a chemo drug bonded to trastuzumab

645
Q

how common are spontaneous abortions

what is the age bias

A

15-20% of clinical pregnancies end in spontaneous abortion

risk increases with age

646
Q

menometrorrhagia

A

more frequent menstrual bleeding

647
Q

describe the process of laparoscopic tubal sterlization

what are the advantages

A

coagulation, cutting, or binding the fallopian tube

no incisions, very effective, can be reversed, IVF still effective

648
Q

treatment septic abortion

A

hospitalization with IV ABx and curettage to evacuate uterine contents

649
Q

cancers associated with BRCA1

A

breast cancer

ovarian cancer

pancreatic cancer

fallopian tube

650
Q

what is the most common cause of secondary ammenorrhea

A

pregnancy

651
Q

vasa previa

what is needed for this to occur

A

when the fetal blood vessels run across the internal os

velamentous insertion or succenturiate lobe

652
Q

breast cancer prognosis divided by receptor status

A

good: estrogen and progesterone receptors
neutral: HER-2
poor: tipple negative, HER-2 without monoclonal antibodies

653
Q

how common is pregnancy related nausea and vomitting

A

70-85% will have some nausea

.5-2% will have severe form (hyperemesis gravidarum)

Clinical Medicine (11 decks)

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