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Ob/gyn > OB/Gyn Shelf > Flashcards

OB/Gyn Shelf Flashcards

1
Q

what is normal arterial blood gas during pregnancy

A

compensated resp alkalosis

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2
Q

what physiologic change accounts for resp alk during pregnancy

A

incr minute ventilation

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3
Q

causes of pulm edema during pregnancy

A

use of tocolytics, preeclampsia, heart disease, fluid overload

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4
Q

what can cause hydronephrosis in pregnancy

A

compression of ureters and renal pelvis by uterus and ovarian vein complex

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5
Q

which kidney is more often affected by hydronephrosis in pregnancy

A

R side b/c left is cushioned by sigmoid colon

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6
Q

what’s most appropriate test to do when molar pregnancy is suspected?

A

CXR b/c lungs are most common site of metastatic dz in someone with gestational trophoblastic disease

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7
Q

recs for weight gain by BMI

A

BMI 18-25: 25-35; BMI 25-30: 15-25; BMI>30: 11-20

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8
Q

most effective screening tool for Down

A

cell-free DNA

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9
Q

blood glucose goals with fasting and 1-2 hrs post-prand

A

<90 fast, <135 at 1 hour, <120 at 2 hours

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10
Q

IUGR risk higher in diabetic pt?

A

in type I

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11
Q

symptoms of Sheehan syndrome

A

loss of TSH, gonadotropin, ACTH leads to no milk pdtion, poor mentation, weight gain, hypotens, amenorrhea

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12
Q

most common cause of postpartum fever

A

endometritis

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13
Q

Abx for mastitis

A

Dicloxacillin or cephalexin if no penicillin allergy. In the setting of a beta lactam allergy or MRSA, clindamycin

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14
Q

what must decrease in order to allow for milk pdtion?

A

estrogen and progesterone b/c they have inhib effects on milk pdtion by blocking pdtion of alpha-lactalbumin

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15
Q

what causes mastitis with severe nipple pain?

A

candida

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16
Q

suckling stimulates which hormone

A

oxytocin

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17
Q

what hormone is responsible for milk pdtion

A

prolactin

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18
Q

what role does oxytocin play in breastfeeding?

A

milk ejection

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19
Q

what fetal presentation is most commonly linked to cord prolapse

A

backup transverse lie

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20
Q

turtle sign indicates

A

shoulder dystocia

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21
Q

cervical ripening agents

A

prostaglandins, misoprostol

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22
Q

what’s the best BP med to use in preg

A

alpha-methyldopa

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23
Q

what other BP meds can be used in preg

A

labetalol, hydralazine

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24
Q

symptoms of severe pre-E

A

(think head to toe): HA, vision changes, pulm edema, elev LFTs (2x upper limit), RUQ pain, thrombocyto, elev Cr (>1.1 b/c normally low in preg)

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25
Q

what do you give if you have mag toxicity?

A

calcium

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26
Q

freq cause of late decels

A

uterine tachysystole since contractions interrupt intervillous blood flow

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27
Q

first line abx for mastitis

A

dicloxacillin or cephalexin to cover MSSA. If MRSA cov needed, then vanc or clinda

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28
Q

2 indications for mag

A

1) seizure prophy 2) decr risk of CP in preterm

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29
Q

where is mag processed

A

renal excretion

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30
Q

treatment for postpartum endometritis

A

clinda + gent

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31
Q

treatment for pyelo in preg

A

ceftriaxone

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32
Q

female external genitalia with male internal genitalia (undescended testes): 2 possibilites

A

5-alpha-reduc defic or androgen insensitivity syndrome

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33
Q

how to distinguish 5-alpha-reduc defic from AIS at puberty

A

breast develop in AIS but not in alpha reduc

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34
Q

where are the bartholin glands located?

A

posterior vaginal introitus

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35
Q

lymphogranuloma venereum comes from what bacteria

A

chlamydia

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36
Q

granuloma inguinale comes from what bacteria

A

klebsiella

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37
Q

which lesions are painful: genital herpes, gran inguinale, chancre, chancroid, lymphogran venereum

A

herpes and chancroid (from haemophilus ducreyi)

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38
Q

papule that evolves into nonexudative ulcer

A

chancre of syphilis

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39
Q

multiple intrauterine fetal fractures assoc with

A

type II osteogenesis imperfecta

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40
Q

tests to determine if membs have ruptured

A

pooling w/ spec exam, nitrazene blue, ferning

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41
Q

woman comes in with pPROM. What’s the limit for immediate delivery w/o giving steroids?

A

34 weeks

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42
Q

how long is prolonged ROM?

A

> 18 hrs

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43
Q

endometritis vs chorioamnionitis

A

endo is infection when baby is out; chorio baby is still in

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44
Q

risks for preterm labor

A

smoking, young maternal age, multigestation, pPROM, anatomical defects

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45
Q

what do you give to moms in preterm labor

A

steroids and tocolytics

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46
Q

most common tocolytics

A

mag, nifedipine, indomethacin

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47
Q

cramping midline abdominal pain that starts 1-2 days before menses and abates in a few days

A

primary dysmenorrhea

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48
Q

cause of primary dysmenorrhea

A

excess prostaglandins

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49
Q

tamoxifen decr risk of what cancer? incr risk of what cancer?

A

decr for breast, incr for endometrium

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50
Q

MOA of tamoxifen in breast and uterus

A

estrogen receptor antag in breast, agonist in uterus

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51
Q

treatment for septic abortion

A

suction curettage

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52
Q

target fasting, 1-hour, 2-hour postprandial blood sugars in pregnancy

A

fast <95, 1-hr PP <140, 2-hr <120

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53
Q

pharm treatment for diabetes in pregnancy

A

insulin or metformin. use if dietary modification fails

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54
Q

painful menses with symmetrically enlarged uterus

A

adenomyosis (endometrial stroma and glands in myometrium)

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55
Q

pain during ovulation (2 wks before menses)

A

Mittelschmerz pain

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56
Q

painful menses w/ concurrent dysuria, dyschezia, and/or dyspareunia

A

endometriosis

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57
Q

physical exam findings for endometriosis

A

immobile uterus or adnexal masses

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58
Q

are pregnant women w/ h/o HSV but no active lesions treated

A

yes, they get acyclovir starting at 36 wks

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59
Q

what is Asherman syndrome

A

formation of intrauterine adhesions

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60
Q

risk factors for intrauterine adhesions

A

intrauterine surgery like curettage or infection

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61
Q

effects of estrogen and progesterone on endometrium

A

estrogen causes prolif; proges decr prolif

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62
Q

ovarian mass with breast tenderness and fibrocystic changes

A

granulosa tumor

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63
Q

tumor markers of granulosa tumor

A

incr estradiol and inhibin

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64
Q

elevated alpha-fetoprot is found in which type of germ cell tumor

A

yolk sac

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65
Q

what’s elevated with sertoli-leydig cell tumor

A

testosterone

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66
Q

elevated hcg in what conditions

A

embryonal carc and trophoblastic dz

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67
Q

most common pelvic tumor

A

fibroids aka uterine leiomyomata

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68
Q

thin wrinkled vulvar skin with normal vagina

A

lichen sclerosus (sclerosus spares vagina unlike planus)

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69
Q

what does hCG do?

A

maintains corpus luteum until placenta can produce enough progesterone

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70
Q

when does hCG peak?

A

about 10 weeks

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71
Q

subunit of hCG also found in

A

TSH, FSH, LH

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72
Q

do OCPs incr or decr the risk of the following: endometrial cancer, acne, HTN, ovarian cancer, benign breast, VTE, cervical cancer, stroke, MI

A

decr: endometrial and ovarian cancer, benign breast, acne; incr: cerv cancer, HTN, VTE, stroke, MI

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73
Q

maternal fever causes what change in fetal heart tones

A

tachy

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74
Q

unilateral bloody nipple discharge

A

intraductal papilloma

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75
Q

when can external cephalic version be performed

A

> 37 wks d/t risk of premature delivery

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76
Q

Fitz-Hugh-Curtis disease

A

perihepatitis (liver capsule inflamm) due to PID

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77
Q

what’s elevated in androgen-secreting tumor of ovary? of adrenal gland?

A

testosterone if ovary; DHEAS if adrenal

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78
Q

partially calcified ovarian mass with echogenic bands

A

teratoma

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79
Q

why is mag sulfate given when woman is in preterm labor <32 wks

A

fetal neuroprotection against cerebral palsy

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80
Q

best treatment for endometriosis

A

OCPs

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81
Q

best test for endometrioma

A

laparoscopic ablation of cyst

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82
Q

where is most common location of ectopic preg

A

ampulla

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83
Q

solid adnexal mass with thick septations and ascites is concerning for

A

ovarian cancer

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84
Q

clue cells seen in

A

bacterial vaginosis

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85
Q

when should you deliver in preeclampsia w/ severe features?

A

34 wks

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86
Q

what type of incontinence do antimuscarinics treat? cholinergics?

A

antimusc for overactive bladder b/c inhibits bladder smooth musc. Chol for overflow incontinence b/c incr bladder contractility

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87
Q

what types of twins are at risk for TTTS?

A

monochorionic

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88
Q

at what days does zygote split for 1) di, di 2) mono di 3) mono mono

A

up to 4 for di di (tubal), 4-8 for mono di (blastocyst), 8-12 for mono mono, >12 for conjoined

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89
Q

who’s at risk for cord entanglement in mult gest

A

mono mono

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90
Q

name some modifiable risk factors for osteoporosis

A

smoking, alc, sedentary, vit D and calc defic, meds, low estrogen

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91
Q

when should mag be given in pprom

A

<32 wks

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92
Q

when can chorionic villus sampling be done? amniocentesis?

A

chor villus at 10-13, amnio at 15-20

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93
Q

what are tests in 1st trimester screen, 2nd tri quad screen?

A

1st: preg-assoc plasma protein, beta hcg, nuchal translucency; 2nd: AFP, estriol, beta hcg, inhibin A

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94
Q

oral glucose challenge cutoffs for GDM

A

should be <95 for fasting, <140 1 hr PP, <120 2 hr PP

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95
Q

when should GDM screening occur?

A

after 24 weeks

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96
Q

genital ulcers caused by what can turn into painful buboes

A

chlamydia (lymphogranuloma venereum)

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97
Q

pt with HTN at greatest risk for what fetal prob

A

preterm birth (doesn’t cause PPROM)

98
Q

type of germ cell tumor with high AFP

A

yolk sac

99
Q

type of germ cell tumor with high LDH or beta hcg

A

dysgerminoma (cells of placenta)

100
Q

what other organ should be examined in pts w/o uterus and cervix

A

kidney b/c both derive from intermed mesoderm

101
Q

what procedure do you do when you’re concerned about advanced ovarian cancer

A

laparotomy

102
Q

what causes elevated CA-125

A

ovarian cancer but also fibroids and endometriosis

103
Q

when should rhogam be given

A

28 weeks and within 72 hours of delivery (or anything that causes blood mixing)

104
Q

sudden onset abdominal pain with pelvic free fluid seen on u/s

A

ruptured ovarian cyst

105
Q

type of miscarriage without vaginal bleeding

A

missed abortion

106
Q

what are tests used to evaluate secondary amenorrhea

A

preg test then serum prolactin, FSH, TSH

107
Q

risk factors for vaginal cancer

A

cigarettes, age>60, HPV infect (similar to cerv cancer)

108
Q

what can you use to shrink fibroids

A

leuprolide (GnRH agonist): induces menopause

109
Q

best med to treat fibroids

A

OCP

110
Q

LH and FSH levels in PCOS

A

LH:FSH > 3:1

111
Q

what meds can be used to induce ovulation? (often used in ppl with PCOS)

A

clomiphene and metformin

112
Q

what happens to paO2 and paCO2 in pregnancy?

A

paO2 incr and PaCO2 decr (incr minute ventilation and tidal vol)

113
Q

severe hypoglycemia in pregnancy may be sign of which serious complication

A

acute fatty liver (glycogen can’t be converted to glucose)

114
Q

what’s biggest concern for postmenopausal bleeding and what’s workup

A

endometrial cancer with biopsy

115
Q

woman has life-threatening uterine bleed. you resuscitate and then do what to stop bleed

A

IV estrogen. if that doesn’t work, then surgery

116
Q

who is at risk for vulvar lichen sclerosus

A

hypoestrogenic peeps like premenarchal or postmenopausal

117
Q

what age group is most at risk for labial adhesions

A

<2

118
Q

when is trial of vaginal delivery contraindicated

A

after classical c-section or extensive myomectomy

119
Q

what hormone does prolactin inhibit

A

GnRH

120
Q

what tests should be done in a woman w/ postmenopausal bleeding

A

endometrial biopsy (or transvag u/s looking for thickened endometrium) and pap

121
Q

what fetal abnormality can lead to maternal virilization

A

placental aromatase defic

122
Q

what ovarian masses can cause hyperandrogenism during pregnancy

A

luteoma, theca lutein cyst, sertoli-leydig tumor

123
Q

pruritis and liver dysfunc in pregnant woman

A

cholestasis

124
Q

vulvar erosions with white striae and oral ulcers

A

lichen planus

125
Q

paraurethral glands

A

skene glands

126
Q

where are bartholin glands located

A

posterior vaginal introitus that drain into the vulvar vestibule at 4 and 8 o clock positions

127
Q

what type of cyst is result of incomplete regression of Wolffian duct

A

gartner

128
Q

complications of short interpregnancy period

A

PPROM, preterm delivery, low birth weight, maternal anemia

129
Q

short cervix is strong predictor for what

A

preterm labor

130
Q

what drug is used to prevent preterm labor

A

progesterone

131
Q

dimpling of breast along with erythema and edema

A

inflamm breast carcinoma (peau d’orange)

132
Q

treatment for lichen sclerosus, lichen planus

A

topical corticosteroid for sclerosus (clobetasol), topical steroids for planus as well

133
Q

chronic lichen sclerosus is risk factor for

A

vulvar cancer

134
Q

when is it safe to use tocolytics in preterm labor

A

up to 34 weeks

135
Q

at what age should women stop getting paps

A

65 or if they’ve had a hysterectomy

136
Q

what procedure do you do if you find ectocervical cancer? how about endocerv cancer?

A

for ecto, use local ablation with LEEP or cryo. For endo, use cone biopsy

137
Q

what’s next step when you find ASCUS on pap

A

test for HPV DNA

138
Q

who should get HPV vaccine?

A

girls 11-26, boys 11-21

139
Q

what are risk factors for endometrial cancer

A

anything that incr estrogen exposure: anovulation is worst, age, nulliparity, early menarche, late menopause, HRT or tamoxifen, obesity

140
Q

treatment for endometrial cancer

A

total abdominal hysterectomy + b/l salpingoophorectomy

141
Q

treatment for endometrial hyperplasia

A

progesterone

142
Q

types of ovarian germ cell tumors and their markers

A

1) dysgerminoma with LDH, 2) yolk sac with AFP, 3) teratoma have no real marker but can cause stroma ovarii with hyperthyr, 4) choriocarcinoma with beta-hcg

143
Q

if pregnant pt has severe HTN and bradycardia, what anti-HTN should be avoided

A

labetalol b/c it can lower pulse

144
Q

when during pregnancy should anti-D ab (Rhogam) be given

A

28-32 weeks and w/i 72 hrs after delivery

145
Q

eczematous nipple changes +/- bloody discharge

A

paget disease of breast which is ductal carcinoma (adeno)

146
Q

if mom is sensitized to Rh(D) meaning she already has the antibodies, how should she be treated

A

rhogam no longer helpful so just monitor for fetal hemolytic disease

147
Q

postpartum fever that is unresponsive to abx

A

septic pelvic thrombophlebitis

148
Q

2 first line abx for e coli bacteriuria

A

1) cephalexin 2) amox-clav 3) nitrofurantoin

149
Q

red, itchy lesion on vulva

A

paget’s

150
Q

grape like mass in vagina

A

adenocarc

151
Q

what chem exposure is related to vaginal adenocarc

A

DES (in utero)

152
Q

copious gray white discharge with fishy odor

A

bacterial vaginosis

153
Q

what do you see on KOH test for bact vaginosis?

A

clue cells

154
Q

first and second line abx for PID inpatient

A

1st: cefoxitin and doxy, 2nd: clinda and gent

155
Q

outpatient PID treatment

A

ceftriaxone IM, doxy, metronidazole

156
Q

first thing you do for retained placenta

A

D&C; amp

157
Q

first thing for uterine inversion

A

manually put it back in place

158
Q

elevated AST and ALT (2-3x normal) in 3rd trimester

A

acute fatty liver of pregnancy

159
Q

treatment for acute fatty liver of pregnancy

A

delivery

160
Q

what should you check after delivery with retained placenta

A

beta hcg

161
Q

what are 2 reasons to give oxytocin

A

to induce/augment labor and in PPH

162
Q

urethral hypermobility causes which type of incontinence

A

stress incontinence

163
Q

what’s rate of dilation in active phase of stage 1 of labor

A

> =1cm every 2 hours

164
Q

sinusoidal fetal heart rate tracings most often assoc with what fetal condition

A

anemia (and big risk of fetal compromise)

165
Q

what fetal abnormalities have elevated maternal AFP?

A

open neural tube defects, gastroschisis, omphalocele

166
Q

what’s the chemical change that happens with cervical change in labor

A

breakage of disulfide bonds

167
Q

what’s avg contraction in montevideo units

A

200 MVU in 10min

168
Q

most effective method of emergency contraception

A

copper IUD

169
Q

what are contraindications to placing copper IUD

A

acute cervicitis or PID

170
Q

for how many days is copper IUD effective for emergency contraception

A

3-5 days

171
Q

treatment for cervicitis with confirmed chlamydia

A

azithro only

172
Q

treatment for cervicitis with confirmed gonorrhea

A

azithro + ceftriaxone due to incr resistance

173
Q

what hormone is responsible for incr insulin resistance in pregnancy

A

human placental lactogen

174
Q

cervical conization is risk factor for what in pregnancy

A

cervical insufficiency

175
Q

oxybutynin (antimusc) treats what type of incontinence

A

urge (promotes relaxation)

176
Q

cholinergic agonists like bethanechol treat what kind of incontinence

A

overflow (incr contractility to promote emptying)

177
Q

types of vaginitis with elevated pH (>4.5)

A

vaginosis (gardnerella) and trich

178
Q

asymptomatic bacteriuria in preg should be treated due to risk of what

A

pyelo

179
Q

what does newborn with fetal growth restriction look like

A

thin, loose skin, thin umb cord, wide anterior fontanelle

180
Q

Erb-Duchenne palsy caused by damage to which nerves

A

C5-7

181
Q

claw hand and Horner syndrome in newborn

A

Klumpke palsy caused by damage to C8 and T1

182
Q

what cancer does tamoxifen treat? what cancer does it cause?

A

treats breast cancer (estrogen antag) but can cause endometrial (has estrogen agonist activity in uterus)

183
Q

what are adnexal masses seen with hydatidiform moles?

A

theca lutein cysts

184
Q

when do you see incr alpha fetoprot in pregnancy

A

neural tube or abdominal wall defects

185
Q

quad screening for trisomy 21

A

elev bHCG and inhibin, low AFP and estriol

186
Q

what chronic disease can cause overflow incontinence

A

MS

187
Q

what’s LH:FSH ratio in PCOS

A

3:1

188
Q

what do you test for if you suspect CAH

A

17-hydroxyprogesterone

189
Q

what age should ppl be screened for osteoporosis

A

65 for everyone, 60 for smokers

190
Q

call-exner bodies found in

A

granulosa cell tumor

191
Q

contraindications to HRT

A

h/o CAD, thromboembolism, TIA/stroke, breast or endometrial cancer

192
Q

what’s the one thing HRT is approved to treat

A

vasomotor sx’s

193
Q

fetal fibronectin used for what

A

id patients w/ preterm contractions who are at risk for preterm delivery

194
Q

what’s time limit to determine active phase arrest of labor

A

4 hours w/ adequate contractions or 6 hours w/ inad contracts

195
Q

what’s proper fetal presentation during labor

A

occiput anterior

196
Q

what uterotonic should not be given to asthmatics

A

prostaglandin f2-alpha/hemabate

197
Q

what uterotonic should not be given to hypertensives

A

methergine

198
Q

treatment options for stress incontinence

A

1) pelvic floor muscle strengthening 2) pessary 3) urethral sling

199
Q

ultrasound finding of placental lakes is sign of what

A

placenta accreta

200
Q

dilation and evacuation is used up til when

A

24 wks

201
Q

in what type of abortion is fetal cardiac activity present

A

threatened: pt has bleeding with closed os

202
Q

suprapubic pain that radiates down legs after traumatic delivery

A

pubic symphysis diastasis

203
Q

order of -arches in puberty

A

usually thelarche–>pubarche–>menarche. Men about 2-2.5 years after thel and after growth spurt

204
Q

inflammatory nodules w/ sinus tract formation in intriginous areas (inguinal, axillary, gluteal, inframammary folds)

A

hidradenitis suppurativa

205
Q

treatment for hidradenitis suppurativa

A

doxycycline

206
Q

initial prenatal labs

A

ID: HIV, syph, chlam, HBsAg, rubella, varicella, urine culture. Other: Rh type and ab screen, Hgb, dipstick for urine prot, pap if needed

207
Q

when is GBS test?

A

35-37

208
Q

medical management for endometrial hyperplasia

A

progestin

209
Q

findings on TVUS that indicate need for endometrial biopsy

A

endo thickness >4mm

210
Q

when are PPROMers delivered?

A

34 wks or sooner if there are complications

211
Q

which causes of vaginitis alter vaginal ph? which don’t?

A

bact vaginosis and trich make pH>4.5; candida doesn’t change it (3.8-4.5)

212
Q

newborn with severe microcephaly, thin cerebral cortices, intracran calcifications

A

Zika

213
Q

what’s urodynamic testing for

A

evaluation of mixed urinary incontinence (urge + stress)

214
Q

2 fetal complications from preeclampsia

A

IUGR and oligo

215
Q

2 maternal complications from preeclampsia

A

abruption, DIC

216
Q

at what week should IUFD be delivered (instead of abortive procedure)

A

24

217
Q

what could you find on UA in someone with hyperemesis gravidarum?

A

ketonuria

218
Q

what’s the most common cause of spontaneous abortion in the 1st trimester?

A

genetic anomalies of fetus

219
Q

risk factors for preeclampsia

A

high risk: previous pregnancy with it, HTN, renal dz, diabetes, multigestation, autoimmune; moderate risk: obesity, fam hx, AMA, nulliparity

220
Q

what’s first test to do for mom who is Rh sensitized (has Ab)

A

transcranial doppler

221
Q

what test can show fetal anemia

A

increased flow on transcranial doppler

222
Q

when do you deliver baby that has fetal anemia

A

32 weeks

223
Q

what can be used to transfuse baby with fetal anemia

A

Percutaneous umbilical blood sampling (PUBS) that also allows you to test fetal Hgb

224
Q

first step in labor induction in woman with unfavorable cervix

A

cervical ripening with prostaglandin (miso) or balloon

225
Q

first step in labor induction in woman with favorable cervix

A

oxytocin

226
Q

2 things pessaries are used for

A

pelvic organ prolapse and stress incontinence

227
Q

medications used to treat pelvic pain

A

NSAIDs, OCPs, GnRH agonists (leuprolide)

228
Q

quad screen findings for Downs, for Edwards (18)

A

elevated hCG and inhibin in Downs (downs is up); decr for Edwards; both have low AFP and estriol

229
Q

what’s normal hgb at 28 weeks?

A

10

230
Q

contraindications to meno hormone therapy

A

h/o breast cancer, CAD, VTE, stroke, active liver disease

231
Q

loss of fetal station during labor could be sign of

A

uterine rupture

232
Q

3 causes of normal 3rd trimester bleeding

A

cervical lesions, cerv dilation, bloody show

233
Q

ovarian tumor made of ectoderm

A

dermoid cyst/teratoma

234
Q

ovarian tumor made of epithelium

A

epithelial carcinoma that can involve ovary, tube, and peritoneum

235
Q

def of fetal hydrops

A

collection of fluid in 2 or more body cavities: scalp, pleural effusion, pericard effusion, ascites

236
Q

elevated AFP in preg? decr AFP?

A

elev with neural tube and ab wall defects. Decr with trisomy

237
Q

when do you deliver preeclamp? preeclamp w/ severe features?

A

37 for preeclamp; 34 for severe

238
Q

best anti-HTN drugs in preg?

A

labetalol, hydralazine, nifedipine

239
Q

contraind to labetalol in pregnancy

A

bradycard

240
Q

how should pts with prior h/o preterm labor be managed in next preg?

A

given progesterone starting in T2 and serial TVUS to monitor cerv length until 24 wks with cerclage placement if nec

Ob/gyn (1 decks)

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