OB/Gyn Shelf Flashcards
what is normal arterial blood gas during pregnancy
compensated resp alkalosis
what physiologic change accounts for resp alk during pregnancy
incr minute ventilation
causes of pulm edema during pregnancy
use of tocolytics, preeclampsia, heart disease, fluid overload
what can cause hydronephrosis in pregnancy
compression of ureters and renal pelvis by uterus and ovarian vein complex
which kidney is more often affected by hydronephrosis in pregnancy
R side b/c left is cushioned by sigmoid colon
what’s most appropriate test to do when molar pregnancy is suspected?
CXR b/c lungs are most common site of metastatic dz in someone with gestational trophoblastic disease
recs for weight gain by BMI
BMI 18-25: 25-35; BMI 25-30: 15-25; BMI>30: 11-20
most effective screening tool for Down
cell-free DNA
blood glucose goals with fasting and 1-2 hrs post-prand
<90 fast, <135 at 1 hour, <120 at 2 hours
IUGR risk higher in diabetic pt?
in type I
symptoms of Sheehan syndrome
loss of TSH, gonadotropin, ACTH leads to no milk pdtion, poor mentation, weight gain, hypotens, amenorrhea
most common cause of postpartum fever
endometritis
Abx for mastitis
Dicloxacillin or cephalexin if no penicillin allergy. In the setting of a beta lactam allergy or MRSA, clindamycin
what must decrease in order to allow for milk pdtion?
estrogen and progesterone b/c they have inhib effects on milk pdtion by blocking pdtion of alpha-lactalbumin
what causes mastitis with severe nipple pain?
candida
suckling stimulates which hormone
oxytocin
what hormone is responsible for milk pdtion
prolactin
what role does oxytocin play in breastfeeding?
milk ejection
what fetal presentation is most commonly linked to cord prolapse
backup transverse lie
turtle sign indicates
shoulder dystocia
cervical ripening agents
prostaglandins, misoprostol
what’s the best BP med to use in preg
alpha-methyldopa
what other BP meds can be used in preg
labetalol, hydralazine
symptoms of severe pre-E
(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)
what do you give if you have mag toxicity?
calcium
freq cause of late decels
uterine tachysystole since contractions interrupt intervillous blood flow
first line abx for mastitis
dicloxacillin or cephalexin to cover MSSA. If MRSA cov needed, then vanc or clinda
2 indications for mag
1) seizure prophy 2) decr risk of CP in preterm
where is mag processed
renal excretion
treatment for postpartum endometritis
clinda + gent
treatment for pyelo in preg
ceftriaxone
female external genitalia with male internal genitalia (undescended testes): 2 possibilites
5-alpha-reduc defic or androgen insensitivity syndrome
how to distinguish 5-alpha-reduc defic from AIS at puberty
breast develop in AIS but not in alpha reduc
where are the bartholin glands located?
posterior vaginal introitus
lymphogranuloma venereum comes from what bacteria
chlamydia
granuloma inguinale comes from what bacteria
klebsiella
which lesions are painful: genital herpes, gran inguinale, chancre, chancroid, lymphogran venereum
herpes and chancroid (from haemophilus ducreyi)
papule that evolves into nonexudative ulcer
chancre of syphilis
multiple intrauterine fetal fractures assoc with
type II osteogenesis imperfecta
tests to determine if membs have ruptured
pooling w/ spec exam, nitrazene blue, ferning
woman comes in with pPROM. What’s the limit for immediate delivery w/o giving steroids?
34 weeks
how long is prolonged ROM?
> 18 hrs
endometritis vs chorioamnionitis
endo is infection when baby is out; chorio baby is still in
risks for preterm labor
smoking, young maternal age, multigestation, pPROM, anatomical defects
what do you give to moms in preterm labor
steroids and tocolytics
most common tocolytics
mag, nifedipine, indomethacin
cramping midline abdominal pain that starts 1-2 days before menses and abates in a few days
primary dysmenorrhea
cause of primary dysmenorrhea
excess prostaglandins
tamoxifen decr risk of what cancer? incr risk of what cancer?
decr for breast, incr for endometrium
MOA of tamoxifen in breast and uterus
estrogen receptor antag in breast, agonist in uterus
treatment for septic abortion
suction curettage
target fasting, 1-hour, 2-hour postprandial blood sugars in pregnancy
fast <95, 1-hr PP <140, 2-hr <120
pharm treatment for diabetes in pregnancy
insulin or metformin. use if dietary modification fails
painful menses with symmetrically enlarged uterus
adenomyosis (endometrial stroma and glands in myometrium)
pain during ovulation (2 wks before menses)
Mittelschmerz pain
painful menses w/ concurrent dysuria, dyschezia, and/or dyspareunia
endometriosis
physical exam findings for endometriosis
immobile uterus or adnexal masses
are pregnant women w/ h/o HSV but no active lesions treated
yes, they get acyclovir starting at 36 wks
what is Asherman syndrome
formation of intrauterine adhesions
risk factors for intrauterine adhesions
intrauterine surgery like curettage or infection
effects of estrogen and progesterone on endometrium
estrogen causes prolif; proges decr prolif
ovarian mass with breast tenderness and fibrocystic changes
granulosa tumor
tumor markers of granulosa tumor
incr estradiol and inhibin
elevated alpha-fetoprot is found in which type of germ cell tumor
yolk sac
what’s elevated with sertoli-leydig cell tumor
testosterone
elevated hcg in what conditions
embryonal carc and trophoblastic dz
most common pelvic tumor
fibroids aka uterine leiomyomata
thin wrinkled vulvar skin with normal vagina
lichen sclerosus (sclerosus spares vagina unlike planus)
what does hCG do?
maintains corpus luteum until placenta can produce enough progesterone
when does hCG peak?
about 10 weeks
subunit of hCG also found in
TSH, FSH, LH
do OCPs incr or decr the risk of the following: endometrial cancer, acne, HTN, ovarian cancer, benign breast, VTE, cervical cancer, stroke, MI
decr: endometrial and ovarian cancer, benign breast, acne; incr: cerv cancer, HTN, VTE, stroke, MI
maternal fever causes what change in fetal heart tones
tachy
unilateral bloody nipple discharge
intraductal papilloma
when can external cephalic version be performed
> 37 wks d/t risk of premature delivery
Fitz-Hugh-Curtis disease
perihepatitis (liver capsule inflamm) due to PID
what’s elevated in androgen-secreting tumor of ovary? of adrenal gland?
testosterone if ovary; DHEAS if adrenal
partially calcified ovarian mass with echogenic bands
teratoma
why is mag sulfate given when woman is in preterm labor <32 wks
fetal neuroprotection against cerebral palsy
best treatment for endometriosis
OCPs
best test for endometrioma
laparoscopic ablation of cyst
where is most common location of ectopic preg
ampulla
solid adnexal mass with thick septations and ascites is concerning for
ovarian cancer
clue cells seen in
bacterial vaginosis
when should you deliver in preeclampsia w/ severe features?
34 wks
what type of incontinence do antimuscarinics treat? cholinergics?
antimusc for overactive bladder b/c inhibits bladder smooth musc. Chol for overflow incontinence b/c incr bladder contractility
what types of twins are at risk for TTTS?
monochorionic
at what days does zygote split for 1) di, di 2) mono di 3) mono mono
up to 4 for di di (tubal), 4-8 for mono di (blastocyst), 8-12 for mono mono, >12 for conjoined
who’s at risk for cord entanglement in mult gest
mono mono
name some modifiable risk factors for osteoporosis
smoking, alc, sedentary, vit D and calc defic, meds, low estrogen
when should mag be given in pprom
<32 wks
when can chorionic villus sampling be done? amniocentesis?
chor villus at 10-13, amnio at 15-20
what are tests in 1st trimester screen, 2nd tri quad screen?
1st: preg-assoc plasma protein, beta hcg, nuchal translucency; 2nd: AFP, estriol, beta hcg, inhibin A
oral glucose challenge cutoffs for GDM
should be <95 for fasting, <140 1 hr PP, <120 2 hr PP
when should GDM screening occur?
after 24 weeks
genital ulcers caused by what can turn into painful buboes
chlamydia (lymphogranuloma venereum)
pt with HTN at greatest risk for what fetal prob
preterm birth (doesn’t cause PPROM)
type of germ cell tumor with high AFP
yolk sac
type of germ cell tumor with high LDH or beta hcg
dysgerminoma (cells of placenta)
what other organ should be examined in pts w/o uterus and cervix
kidney b/c both derive from intermed mesoderm
what procedure do you do when you’re concerned about advanced ovarian cancer
laparotomy
what causes elevated CA-125
ovarian cancer but also fibroids and endometriosis
when should rhogam be given
28 weeks and within 72 hours of delivery (or anything that causes blood mixing)
sudden onset abdominal pain with pelvic free fluid seen on u/s
ruptured ovarian cyst
type of miscarriage without vaginal bleeding
missed abortion
what are tests used to evaluate secondary amenorrhea
preg test then serum prolactin, FSH, TSH
risk factors for vaginal cancer
cigarettes, age>60, HPV infect (similar to cerv cancer)
what can you use to shrink fibroids
leuprolide (GnRH agonist): induces menopause
best med to treat fibroids
OCP
LH and FSH levels in PCOS
LH:FSH > 3:1
what meds can be used to induce ovulation? (often used in ppl with PCOS)
clomiphene and metformin
what happens to paO2 and paCO2 in pregnancy?
paO2 incr and PaCO2 decr (incr minute ventilation and tidal vol)
severe hypoglycemia in pregnancy may be sign of which serious complication
acute fatty liver (glycogen can’t be converted to glucose)
what’s biggest concern for postmenopausal bleeding and what’s workup
endometrial cancer with biopsy
woman has life-threatening uterine bleed. you resuscitate and then do what to stop bleed
IV estrogen. if that doesn’t work, then surgery
who is at risk for vulvar lichen sclerosus
hypoestrogenic peeps like premenarchal or postmenopausal
what age group is most at risk for labial adhesions
<2
when is trial of vaginal delivery contraindicated
after classical c-section or extensive myomectomy
what hormone does prolactin inhibit
GnRH
what tests should be done in a woman w/ postmenopausal bleeding
endometrial biopsy (or transvag u/s looking for thickened endometrium) and pap
what fetal abnormality can lead to maternal virilization
placental aromatase defic
what ovarian masses can cause hyperandrogenism during pregnancy
luteoma, theca lutein cyst, sertoli-leydig tumor
pruritis and liver dysfunc in pregnant woman
cholestasis
vulvar erosions with white striae and oral ulcers
lichen planus
paraurethral glands
skene glands
where are bartholin glands located
posterior vaginal introitus that drain into the vulvar vestibule at 4 and 8 o clock positions
what type of cyst is result of incomplete regression of Wolffian duct
gartner
complications of short interpregnancy period
PPROM, preterm delivery, low birth weight, maternal anemia
short cervix is strong predictor for what
preterm labor
what drug is used to prevent preterm labor
progesterone
dimpling of breast along with erythema and edema
inflamm breast carcinoma (peau d’orange)
treatment for lichen sclerosus, lichen planus
topical corticosteroid for sclerosus (clobetasol), topical steroids for planus as well
chronic lichen sclerosus is risk factor for
vulvar cancer
when is it safe to use tocolytics in preterm labor
up to 34 weeks
at what age should women stop getting paps
65 or if they’ve had a hysterectomy
what procedure do you do if you find ectocervical cancer? how about endocerv cancer?
for ecto, use local ablation with LEEP or cryo. For endo, use cone biopsy
what’s next step when you find ASCUS on pap
test for HPV DNA
who should get HPV vaccine?
girls 11-26, boys 11-21
what are risk factors for endometrial cancer
anything that incr estrogen exposure: anovulation is worst, age, nulliparity, early menarche, late menopause, HRT or tamoxifen, obesity
treatment for endometrial cancer
total abdominal hysterectomy + b/l salpingoophorectomy
treatment for endometrial hyperplasia
progesterone
types of ovarian germ cell tumors and their markers
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
if pregnant pt has severe HTN and bradycardia, what anti-HTN should be avoided
labetalol b/c it can lower pulse
when during pregnancy should anti-D ab (Rhogam) be given
28-32 weeks and w/i 72 hrs after delivery
eczematous nipple changes +/- bloody discharge
paget disease of breast which is ductal carcinoma (adeno)
if mom is sensitized to Rh(D) meaning she already has the antibodies, how should she be treated
rhogam no longer helpful so just monitor for fetal hemolytic disease
postpartum fever that is unresponsive to abx
septic pelvic thrombophlebitis
2 first line abx for e coli bacteriuria
1) cephalexin 2) amox-clav 3) nitrofurantoin
red, itchy lesion on vulva
paget’s
grape like mass in vagina
adenocarc
what chem exposure is related to vaginal adenocarc
DES (in utero)
copious gray white discharge with fishy odor
bacterial vaginosis
what do you see on KOH test for bact vaginosis?
clue cells
first and second line abx for PID inpatient
1st: cefoxitin and doxy, 2nd: clinda and gent
outpatient PID treatment
ceftriaxone IM, doxy, metronidazole
first thing you do for retained placenta
D&C; amp
first thing for uterine inversion
manually put it back in place
elevated AST and ALT (2-3x normal) in 3rd trimester
acute fatty liver of pregnancy
treatment for acute fatty liver of pregnancy
delivery
what should you check after delivery with retained placenta
beta hcg
what are 2 reasons to give oxytocin
to induce/augment labor and in PPH
urethral hypermobility causes which type of incontinence
stress incontinence
what’s rate of dilation in active phase of stage 1 of labor
> =1cm every 2 hours
sinusoidal fetal heart rate tracings most often assoc with what fetal condition
anemia (and big risk of fetal compromise)
what fetal abnormalities have elevated maternal AFP?
open neural tube defects, gastroschisis, omphalocele
what’s the chemical change that happens with cervical change in labor
breakage of disulfide bonds
what’s avg contraction in montevideo units
200 MVU in 10min
most effective method of emergency contraception
copper IUD
what are contraindications to placing copper IUD
acute cervicitis or PID
for how many days is copper IUD effective for emergency contraception
3-5 days
treatment for cervicitis with confirmed chlamydia
azithro only
treatment for cervicitis with confirmed gonorrhea
azithro + ceftriaxone due to incr resistance
what hormone is responsible for incr insulin resistance in pregnancy
human placental lactogen
cervical conization is risk factor for what in pregnancy
cervical insufficiency
oxybutynin (antimusc) treats what type of incontinence
urge (promotes relaxation)
cholinergic agonists like bethanechol treat what kind of incontinence
overflow (incr contractility to promote emptying)
types of vaginitis with elevated pH (>4.5)
vaginosis (gardnerella) and trich
asymptomatic bacteriuria in preg should be treated due to risk of what
pyelo
what does newborn with fetal growth restriction look like
thin, loose skin, thin umb cord, wide anterior fontanelle
Erb-Duchenne palsy caused by damage to which nerves
C5-7
claw hand and Horner syndrome in newborn
Klumpke palsy caused by damage to C8 and T1
what cancer does tamoxifen treat? what cancer does it cause?
treats breast cancer (estrogen antag) but can cause endometrial (has estrogen agonist activity in uterus)
what are adnexal masses seen with hydatidiform moles?
theca lutein cysts
when do you see incr alpha fetoprot in pregnancy
neural tube or abdominal wall defects
quad screening for trisomy 21
elev bHCG and inhibin, low AFP and estriol
what chronic disease can cause overflow incontinence
MS
what’s LH:FSH ratio in PCOS
3:1
what do you test for if you suspect CAH
17-hydroxyprogesterone
what age should ppl be screened for osteoporosis
65 for everyone, 60 for smokers
call-exner bodies found in
granulosa cell tumor
contraindications to HRT
h/o CAD, thromboembolism, TIA/stroke, breast or endometrial cancer
what’s the one thing HRT is approved to treat
vasomotor sx’s
fetal fibronectin used for what
id patients w/ preterm contractions who are at risk for preterm delivery
what’s time limit to determine active phase arrest of labor
4 hours w/ adequate contractions or 6 hours w/ inad contracts
what’s proper fetal presentation during labor
occiput anterior
what uterotonic should not be given to asthmatics
prostaglandin f2-alpha/hemabate
what uterotonic should not be given to hypertensives
methergine
treatment options for stress incontinence
1) pelvic floor muscle strengthening 2) pessary 3) urethral sling
ultrasound finding of placental lakes is sign of what
placenta accreta
dilation and evacuation is used up til when
24 wks
in what type of abortion is fetal cardiac activity present
threatened: pt has bleeding with closed os
suprapubic pain that radiates down legs after traumatic delivery
pubic symphysis diastasis
order of -arches in puberty
usually thelarche–>pubarche–>menarche. Men about 2-2.5 years after thel and after growth spurt
inflammatory nodules w/ sinus tract formation in intriginous areas (inguinal, axillary, gluteal, inframammary folds)
hidradenitis suppurativa
treatment for hidradenitis suppurativa
doxycycline
initial prenatal labs
ID: HIV, syph, chlam, HBsAg, rubella, varicella, urine culture. Other: Rh type and ab screen, Hgb, dipstick for urine prot, pap if needed
when is GBS test?
35-37
medical management for endometrial hyperplasia
progestin
findings on TVUS that indicate need for endometrial biopsy
endo thickness >4mm
when are PPROMers delivered?
34 wks or sooner if there are complications
which causes of vaginitis alter vaginal ph? which don’t?
bact vaginosis and trich make pH>4.5; candida doesn’t change it (3.8-4.5)
newborn with severe microcephaly, thin cerebral cortices, intracran calcifications
Zika
what’s urodynamic testing for
evaluation of mixed urinary incontinence (urge + stress)
2 fetal complications from preeclampsia
IUGR and oligo
2 maternal complications from preeclampsia
abruption, DIC
at what week should IUFD be delivered (instead of abortive procedure)
24
what could you find on UA in someone with hyperemesis gravidarum?
ketonuria
what’s the most common cause of spontaneous abortion in the 1st trimester?
genetic anomalies of fetus
risk factors for preeclampsia
high risk: previous pregnancy with it, HTN, renal dz, diabetes, multigestation, autoimmune; moderate risk: obesity, fam hx, AMA, nulliparity
what’s first test to do for mom who is Rh sensitized (has Ab)
transcranial doppler
what test can show fetal anemia
increased flow on transcranial doppler
when do you deliver baby that has fetal anemia
32 weeks
what can be used to transfuse baby with fetal anemia
Percutaneous umbilical blood sampling (PUBS) that also allows you to test fetal Hgb
first step in labor induction in woman with unfavorable cervix
cervical ripening with prostaglandin (miso) or balloon
first step in labor induction in woman with favorable cervix
oxytocin
2 things pessaries are used for
pelvic organ prolapse and stress incontinence
medications used to treat pelvic pain
NSAIDs, OCPs, GnRH agonists (leuprolide)
quad screen findings for Downs, for Edwards (18)
elevated hCG and inhibin in Downs (downs is up); decr for Edwards; both have low AFP and estriol
what’s normal hgb at 28 weeks?
10
contraindications to meno hormone therapy
h/o breast cancer, CAD, VTE, stroke, active liver disease
loss of fetal station during labor could be sign of
uterine rupture
3 causes of normal 3rd trimester bleeding
cervical lesions, cerv dilation, bloody show
ovarian tumor made of ectoderm
dermoid cyst/teratoma
ovarian tumor made of epithelium
epithelial carcinoma that can involve ovary, tube, and peritoneum
def of fetal hydrops
collection of fluid in 2 or more body cavities: scalp, pleural effusion, pericard effusion, ascites
elevated AFP in preg? decr AFP?
elev with neural tube and ab wall defects. Decr with trisomy
when do you deliver preeclamp? preeclamp w/ severe features?
37 for preeclamp; 34 for severe
best anti-HTN drugs in preg?
labetalol, hydralazine, nifedipine
contraind to labetalol in pregnancy
bradycard
how should pts with prior h/o preterm labor be managed in next preg?
given progesterone starting in T2 and serial TVUS to monitor cerv length until 24 wks with cerclage placement if nec
