OB-Gyn Rd 2 Flashcards
What lab value can tell you if there is hyperemesis gravidarum?
Most often occurs when?
What other CF?
Urine ketones
1st trimester
> 5% weight loss of prepregnancy weight
Pt that is unstable and is having an inevitable abortion, what is the best step?
Suction curettage
What is primary ovarian insufficiency?
Menopause before age 40
How do you distinguish bw Mono and Gonococcal pharyngitis?
Mono will have TENDER cervical LAD
Gonorrhea will also have lower ABD pain
How does abruptio placeta appear?
What classic symptom?
ABD pain, back pain, vaginal bleeding
Frequent contractions
Rising and FIRMING of the uterus
Pt that has hypothyroid and wants to become pregnant, how do you manage it?
Inc dose WHEN she becomes pregnant NOT before
Vaginal ulceration and bleeding in postemenopausal woman, what is the best next step?
Biopsy of lesion
What causes pituitary apoplexy aka spontaneous pituitary hemorrhage?
Sx?
Pituitary adenoma
HA, visual field defects, no pituitary defects
Age < 45 who needs endometrial biopsy?
AUB + unopposed Estrogen (obesity, anovulation)
AUB + failed medical management
AUB + Lynch syndrome
Pt that is over 35 and has atypical glandular cells on Pap needs what?
Colpo
Endometrial biopsy
Endocervical curettage
What is a RF for preterm labor in pt w/PMHx of cervical surgery?
Assess risk how?
How to decrease risk?
Short cervix
TV-US
Give progesterone
Thiamine deficiency results in what?
Wernicke encephalopathy - AMS, nystagmus, gait ataxia
What is responsible for preparing the endometrium for implantation of a fertilized ovum?
Progesterone
Amphetamine use during pregnancy is associated w/what?
Preterm delivery, pre-E, FGR, abruptio placenta, IUFD
How does a hydatidiform mole appear on US?
Snowstorm appearance
b-hCG will be > 100,000
What does pseudocyesis mean?
Causes what symptoms?
D/t what etiology?
False pregnancy
Weight gain, amenorrhea, tender breasts
Somatization of stress
Ovarian mass is found on pt that is cystic and measures 5cm on US. Pt is 62 y/o and has no symptoms. What is the best next step?
CA-125 marker and pelvic US
What can cause ovarian failure aka primary ovarian insufficiency in a woman < 40 y/o?
PMHx of Chemotherapy
Pt that comes in with size-date discrepancy and irregular contour of the uterus, what is the reason?
Fibroids
Patient that is undergoing preterm labor and is < 32 weeks should receive what?
Betamethason
Tocolytics (indomethacin, nifedipine)
Magnesium sulfate (neuroprotective)
PCN if GBS+ or uncertain
US shows an adnexal mass w/lack of Doppler flow, Dx?
Ovarian torsion
When is the active stage of labor?
When has it been arrest of labor?
6cm to 10cm
NO change in 4 hours w/adequate contractions or >6 hours w/inadequate contractions
What is uterine synechiae?
Asherman syndrome
What does malpresentation mean?
Anytime the baby is not at vertex (occiput lowest)
Aka Face or breech
Infant born w/thin, loose skin and a thin umbilical cord and wide anterior fontanel has what?
What else is common?
Best step in management?
Fetal growth restriction
Meconium-stained amniotic fluid
Send placenta for histopath exam
What fibroids are likely to compress organs?
Subserosal and pedunculated
What can occur d/t a traumatic delivery and presents w/radiating suprapubic pain that is exacerbated by ambulation or weight bearing?
Treatment?
Pubic symphysis diastasis
Smooth, firm mass protruding through the labia majora w/cyclic ABD Pain indicates what?
Imperforate hymen
Friable cervix that bleeds w/manipulation and mucopurulent cervical discharge indicate what?
D/t what?
Acute cervicitis
GC
What contraception is contraindicated in breast cancer pts?
OCPs
Progesterone IUD
Patch
Nuva ring
SERMs can cause what structural abnormality in premenopausal women?
Endometrial polyps
How do you manage intra-amniotic infections?
Give Abx and augment labor
NO C-Section
What are the risks of external cephalic version?
Can perform when?
Abruptio placenta
IUFD
At or beyond 37 weeks
What presents w/fever, heavy vaginal bleeding, purulent discharge that smells BAD, and uterine tenderness?
Treat how?
Septic abortion
Broad-spectrum ABx and Suction curettage
How does embryonal carcinoma present?
Teens w/ABD mass and elevated b-hCG
Major Sx: ASCITES
How do you differentiate bw endometritis and septic pelvic thrombophlebitis?
Endometriosis gets BETTER w/Abx
Pelvic thrombophlebitis PERSISTS w/fever
Describe the uterus in adenoma oasis
Boggy (soft), TENDER, uniformly enlarged
When can menopause be clinically diagnosed?
Otherwise need what in workup?
> 45 y/o w/12 month hx of amenorrhea and no other concerning symptoms
TSH, FSH
What is an absolute contraindication to vaginal delivery?
Pt w/classic (vertical) prior cesarean section
Placenta previa
Prior extensive myomectomy
Pt w/infertility and dysmenorrhea and a FIXED, immobile uterus has what?
Endometriosis
What is a possible SE of oxytocin toxicity?
D/t what?
Seizure
Hyponatremia
Morbid obesity can cause what?
Anovulation
What presents w/fever, ABD pain, and a complex multiloculated adnexal mass w/thick walls and internal debris?
What labs are elevated?
Tubo-ovarian abscess
CRP, CA-125, leukocytosis
Pt is 29 y/o and has a tender, mobile mass, after aspiration yields yellow fluid and resolution of the mass, best next step?
Return in 2-4 months for breast eval
Inpatient treatment for PID is what?
Cefotetan + Doxycycline
Pt that is delivering a baby and has herpes, what is the best way to minimize infection?
C-section
What results from an incomplete regression of the Wolffian duct during fetal development?
Located where?
If symptomatic treat how?
Gartner duct cyst
Lateral upper anterior vagina
I+D w/Word catheter placement
Pt w/abnormal 1st trimester screen should be followed up how?
CVS weeks 10-13
Amniocentesis weeks 15-20
Pt that WANTS to stop breast feeding after death of a baby, treat how?
NSAIDs
Who needs an endometrial biopsy if over 45?
Age >/= 35
AUB w/postmenopausal bleeding
Atypical glandular cells on Pap test
In the 1st trimester, how does a woman’s thyroid change:
Total T4?
Free T4?
TSH?
Inc —> b-hCG stimulates thyroid hormone in 1st trimester
Unchanged
Dec —> b-hCG and thyroid hormone suppress it
Stress urinary incontinence can occur even when?
Pt coughs and no fluid leaks out
Pt that presents w/hyperandrogenism during pregnancy and has b/L ovarian mass on US has what?
D/t what?
Benign ovarian tumors
Luteoma or theca lutein cysts
Who is at risk for ABO incompatibility?
MC outcome?
Infants w/blood type A or B born to mother w/blood type O
Mild hemolytic disease
What can present w/pre-E w/severe features at < 20 weeks gestation?
Hydatidiform mole
What are the normal findings in a biophysical profile?
NST - reactive FHR Amniotic fluid index > 5 Fetal movements >/= 3 Fetal tone >/= 1 F/E Breathing >/= 1 episode > 30s
MC SE’s of SERMs (tamoxifen and raloxifene)?
Hot flashes
VTE
Endometrial hyperplasia (T only)
Pt w/multiple abortions and an episode of slurred speech and sudden right arm weakness has what?
Anti-phospholipid Ab syndrome —> that is a TIA moron
Endometrioma = ?
Chocolate cyst
How to treat confirmed Chlamydia infection with confirmed negative Gonnorhea?
If reverse is true?
Azithromycin ONLY
Ceftriaxone + Azithromycin (d/t inc cephalosporin resistance)
How does pregnancy effect ventilation and breathing?
What about acid/base status?
Inc ventilation d/t progesterone
Inc TV, Inc MV
Respiratory alkalosis
What is a tubo-ovarian abscess?
Presents how?
Severe form of PID
Foul smelling vaginal discharge, lower ABD pain, cervical motion tenderness
What maintains the corpus luteum?
Secreted by what?
B-hCG
Syncytiotrophoblast
What is the TARGET BG level for fasting pregnant pt?
1 hour postprandial?
2 hour?
< 95
< 140
< 120
Pt w/painful urination and pain with the passage of stool, and rectovaginal exam shows modularity in the posterior cul-de-sac has what?
D/t what?
Endometriosis
Implantation of endometrial glands and stroma
Postpartum woman w/enlarged uterus, irregular vaginal bleeding, pulmonary symptoms and multiple infiltrates on CXR has what?
Confirm how?
Choriocarcinoma
b-hCG
Pt w/US results that show an intrauterine gestational sac w/yolk sac but no fetal pole, b-hCG that starts at 27,000 but decreases to 25,000 most likely has what?
Missed abortion
Pt that is still bleeding after delivery of a baby w/forceps or vacuum needs to have what?
Why?
Genital tract inspection
To make sure all lacerations are repaired
What are the 4 RFs for placental abruption?
Puts you at risk for what?
Maternal HTN
Pre-E or E
Prior abruption
Cocaine/tobacco use
DIC and hypovolemic shock
L+D are contraindicated in what cases?
D/t what?
What symptoms?
Classic Cesarean or extensive myomectomy
Risk of uterine rupture
Intense ABD pain, persistent variable decelerations
What does phenytoin use in pregnancy cause?
Microcephaly, hypoplasia of distal phalanges of fingers and toes, excess hair, cleft palate
Also Hirsuitism and developmental delay
What is the optimal fetal position?
If it is Occiput transverse and there is an arrest of stage 2 labor, what is the cause?
Occiput anterior
Malposition
