OB-Gyne Flashcards
1
Q
When does standard HCG test for pregnancy become positive?
A
2 weeks after conception
2
Q
What is Heagar’s sign
A
sofetening and compressivility of the lower uterine segment indicating pregnancy
3
Q
What is Chadwick’s sign
A
dark discoloration of the vulva and vaginal walls
4
Q
What is the significance of linea nigra in preganancy?
A
normal benign finding
5
Q
What is melasma?
A
hyperpigmentation of sun exposed areas; often in pregnancy
6
Q
When does quickening occur?
A
primigravida: 18-20 weeks, multi: 16-18 weeks
7
Q
When during pregnancy do you need a pap smear?
A
at first visit unless done in last 6 months
8
Q
When during pregnancy do you need a urinalysis?
A
at every visit
9
Q
Urinalysis in pregnancy is used to screen for…
A
pre-eclamppsia, bacteriuria, diabetes
10
Q
When during pregnancy do you need a CBC?
A
at first visit
11
Q
When during pregnancy do you need a blood type/screen?
A
at first visit
12
Q
When during pregnancy do you need a syphilis test?
A
at first visit, repeat later if high risk
13
Q
When during pregnancy do you need a rubella titer?
A
first visit if vaccination history not known
14
Q
When during pregnancy do you need diabetes screening?
A
- betwen 24-28 weeks; at first visit if high risk factors
15
Q
High risk factors for gestational diabetes
A
obese, family history, age over 30
16
Q
When during pregnancy do you need a triple screen?
A
15-20 weeks for older/high risk women
17
Q
Significance of low AFP on triple screen
A
Down syndrome, fetal demise, inaccurate dates
18
Q
Significance of high AFP on triple screen
A
neural tube defect, ventral wall defect, multiple gestation, multiple gestation
19
Q
What do you do if triple screen is abnormal.
A
order an US to check dates and look for anomalies, if US not helpful, order amnio for AFP level and cell culture for chromosomes
20
Q
When during pregnancy do you need a Group b strep culture?
A
35-37 weeks
21
Q
How do you treat group B strep in pregnant mom?
A
treat with amoxicillin during labor
22
Q
When can fetal heart tones be heard?
A
doppler: 10-12 week, stethascope: 16-20 weeks
23
Q
What is significant for size/date discrepency
A
uterine size difference of 2-3 cm to dates; get US
24
Q
What do HCG levels do in the first trimester of pregnancy?
A
double every 2 days
25
Ongoing increase in HCG or increase after delivery indicates
hydatiform mole, choriocarcionma
26
HCG level at 5 weeks
>2000
27
Transvaginal US can detect intrauterine pregnancy at
5 weeks
28
Average weight gain of pregnancy
28 pounds
29
With extra weight gain in pregnancy think
diabetes
30
With poor weight gain during pregnancy think
hyperemesis gravidum, psych disorder, major systemic disease
31
ESR in pregnancy
very elevated
32
Thyroid tests in pregnancy
free T4 same, overall total T4 and thyroid binding globulin increase
33
Hematocrit in pregancy
decreased (increased red cells but fluid increases more)
34
BUN and Cr in pregnancy
decrease (GFR increases)
35
Alkaline phosphatase in pregnancy
very increased
36
Mild proteinuiria in pregnancy
normal
37
Mild glucosuria in pregnancy
normal
38
Electrolyte in pregnancy
unchanged
39
Liver function tests in pregnancy
unchanged
40
BP changes in pregnancy
decreases slightly
41
HR changes in pregnancy
increased 10-20 beats per minute
42
Stroke volume and cardiac output in pregnancy
increase, often by 50%
43
Minute ventillation in pregnancy
increases (increased tidal volume, rate about the same)
44
Residual lung volume in pregnancy
decreased
45
Respiratory alkalosis in pregnancy is
normal
46
Definition of IUGR
below 10th percentile for age
47
3 classes of causes of IUGR
maternal, fetal, placental
48
Components of biophysical profile (BPP)
heart rate tracin, amniotic fluid index, fetal breathing movements, fetal body movements
49
If you are concerned about a fetus, but non-emergent, what is the series of investigations?
- BPP, if abnormal then contractile stress test. If decels, usually go to c-section
50
What is the contraction stress test
looks for uretroplacental dysfunction,
51
Define oligohydramnios
<300-500 ml
52
4 major causes of oligohydramnios
IUGR, premature rupture of membrane, postmaturity, renal agenesis (Potter disease)
53
4 complications of oligohydraminios
pulmonary hypoplasia, cutaneous problems (compression), skeletal problems (compression), hypoxia (cord compression)
54
Define polyhydramnios
>1700-2000ml
55
5 major causes of polyhydramnios
maternal diabete, multiple gestation, neural tube defects, GI anomolies, hydrops fetalis
56
Maternal complications of polyhydramnios
uterine atony, dyspnea from large uterus
57
At term normal fetal heart rate is
110 to 160 bpm
58
Discuss early decelerations
low point of fetal HR and high point of uterine contraction coincide, from head compression, normal
59
Discuss varible decelerations
most common, variable occurance with contractions, signifies cord compression
60
Treatment of variable decelerations
mom in lateral decub., give O2 by facemask, stop oxytocin, if brady (t resolve measure fetal O2
61
Discuss late decelerations
fetal HR nadir occurs after contraction, uteroplacental insufficiency, worrisome
62
Treatment in late decelerations
lateral decub, O2, stop oxytocin, give tocolytic, give IVF if BP not optimal, if persist, measure fetal O2
63
Examples of tocolytic agents
ritodrine, magnesium sulfate
64
Discuss the loss of fetal variability if heart rate in labor
check fetal scalp pH, if associated with variable or late decels, likely need to deliver
65
In labor, what are the scalp pH parameters that indicate need for delivery?
fetal scalp pH < 7.2 or abnormal O2
66
How can you distinguish true labor
regular contraction (every 3 minutes), associated with cervical changes
67
Describe "false labor"
aka Braxton-Hicks contraction, irregular, no cervical changes
68
Desribe the stages of labor
1st- true labor to full dilation, 2nd- full dilation to dirth, 3rd- delivery of baby, 4th- placenta to stabilization
69
1st stage of labor lasts how long?
nuligravida: < 20 hours, multigravida: < 14 hours
70
In the active phase of 1st stage of labor, how fast does the cervix dilate?
nuligravida: >1cm/hr, multigravida: >1.2 cm/hr
71
Time from full cervical dilation to start delivery of baby
nuligravida: 30min - 3 hrs, multigravida: 5-30 min
72
Time to delivery baby
0-30 minutes
73
Time to delivery placenta and maternal stabilization
up to 48 hours
74
What is protraction disorder
Labor takes long than expected
75
What is labor arrest disorder?
No change in cervical dilation occurs over 2 hours and no change in fetal descent after 1 hour
76
Treatment of arrest disorder
check fetal lie, check for cephalopelvic disproportion, augment labor
77
Name 3 ways to augment labor
oxytocin, prostaglandin gel, amniotomy
78
Most common cause of "failure to progress" in labor
cephalopelic disporoprtion (labor augmentation contraindicated)
79
Half life of oxytocin
less than 10 minutes
80
Side effects of oxytocin
uterine hyperstimulation, uterine rupture, fetal heart deccelerations, hyponatremia
81
Side effects of PGE2 used for ripening cervix
uterine hyperstimulation
82
Decision of vaginal delivery with HSV based on...
if active lesions during labor, opt for c-section
83
Orientation of "classic" c- section incision
vertical
84
Signs of placental separation
fresh blood from vagina, umbilical cord lengthens, fundus rises and becomes firm and globular
85
What is the first step during delivery with shoulder dystocia
McRobert maneuver: mother sharpely flexes thighs against abdomen
86
List the order of labor positions
descent, flexion, internal rotation, extension, external rotation, expulsion
87
Postpartum discharge
red the first few days, usually white by day 10
88
Foul smelling lochia is concerning for
endometritis
89
What is the underlying likely cause when new mom develops PE
PE from amniotic fluid
90
Definition of post-partum hemorrhage
>500 cc with vaginal, >1000cc with c-section
91
Most common cause of post-partum hemorrhage
uterine atony
92
Complication of severe post-partum hemorrhage
Sheeham sydrome
93
Risk factors for retained placenta after delivery
previous uterine surgery, previous c- section
94
Risk factors for uterine atony
overdistended, prolonged labor, oxytocin, more than 5 deliverie, precipitous labor (<3h)
95
Treatment of uterine atony
1. uterine massage with low dose oxytocin, 2. ergot drug or PGF2-alpha, 3. hysterectomy
96
Treatment of retained products of conception
remove placenta manually to stop bleeding, curettage in or, if placental accreta, likely to need hysterectomy
97
Most common cause of uterine inversion
iatrogenic; pulling too hard on the cord
98
Treatment of uterine inversion
manually replace uterus may need anesthesia
99
Definition of post-partum fever
fever for 2 days
100
5 most common causes of post-partum fever
breast engorgement, UTI, endometritis, puerperal sepsis, endomyometritis
101
Risk factors for endometritis
C-section, PROM, prolonged labor, frequent vaginal exams, manual removal of placenta
102
Treatment of endometritis
obtain cultures of endometrium, vagina, blood and urine, treat with broad spectrum antibiotics
103
If endometritis doesn't resolve, what's likely going on?
pelvic abscess OR pelvic thrombophlebitis ( get a CT)
104
Treatment of post-partum pelvic thrombphlebitis
heparin
105
3 major things to think of with postpartum shock and no evident bleeding
amniotic fluid embolus, concealed hemorrhage, uterine inversion
106
Mastidis after delivery usually occurs
within 2 months
107
Usual organism of mastidis
staph aureus
108
Treatment of mastidis
keep breast feeding, analgesia, warm compresses, antibiotics if more than mild (cephalexin, dicloxacillin)
109
Contraindications to breast feeding
maternal HIV, illicit drug use, sedatives, stimulants, lithium, chemotherapy
110
Define abortion
termination of pregnancy before 20 weeks or fetus less than 500 grams
111
Define threatened abortion
uterine bleeding without cervical dilation and no expulsion of tissue
112
Treatment of threatened abortion
pelvic rest
113
What percentage of pregnancies with threatened abortion go on to be normal?
50%
114
Define inevitable abortion
uterine bleeding with cervical dilation, crampy pain and no tissue
115
Treatment of inevitable abortion
follow, D&C of uterine cavity
116
Define incomplete abortion
passage of some products of conception through cervix
117
Treatmetn of incomplete abortion
observation, often need D&C
118
Define complete abortion
expulsion of all products of conception from the uterus
119
Treatment of complete abortion
Serial HCGs to be sure returns to zero. D&C if pain or opeen cervical os
120
Define missed abortion
fetal death without expulsion of fetus
121
Treatment of missed abortion
most women go on to have spontaneous miscarriage but D&C often performed
122
Define induced abortion
intentional temination prior to 20 weeks (elective or therapeutic)
123
Define recurrent abortion
two or three successive unplanned abortions
124
4 infectious causes of recurrent abortion
syphilis, Listeria, Mycoplasma, Toxoplasma
125
3 environmental causes of recurrent abortion
alcohol, tobacco, drugs
126
2 metabolic causes of recurrent abortion
hypothyroidism, diabetes
127
3 autoimmune causes of recurrent abortion
lupus, anitphospholipid antibodies, lupus anticoagulant
128
3 anatomic causes of recurrent abortion
cervical incompience, congenital female tract abnormalities, fibroids
129
Classic cause of painless recurrent abortions in the second trimester
cervical incompetence
130
Treatment of cervical incompetence
cerclage at 14-16 weeks
131
Typical time when ectopic pregnancy presents
4-10 weeks.
132
Definitive diagnosis and treatment of ectopic pregnancy in unstable patient
laparoscopy
133
Major risk factors for ectopic pregancy
history of PID, previous ectopic, history of tubal ligation, pregnancy with IUD in place
134
In 3rd trimester bleeding always do a ______ before a ______
always do an UTZ before a pelvic exam
135
Ddx of 3rd trimester bleeding
placenta previa, abruptio placentae, uterine rupture, fetal bleeding, cervical/vaginal lesions, cervical/vaginal trauma, bleeding disorder, cervical cancer
136
In all patients with 3rd trimester bleeding, what do you do?
order CBC w/ coags, do UTZ, setup maternal and fetal monitoring, tox screen if suspected, give Rh immune globuline if mother Rh negative
137
Risk factors for placenta previa
multiparity, older age, multiple gestation, prior previa
138
Why do you do an US before a pelvic exam in 3rd trimester bleeding
because of placenta previa.
139
Accuracy of US in dx placenta previa
95-100%
140
Characteristics of bleeding in placenta previa
painless, may be profuse
141
Treatment of placenta previa
if premature, can try rest and tocolysis if stable, otherwise needs c-section
142
Risk factors for abruptio placentae
HTN, cocaine, trauma, polyhydramnios with rapid decompression with membrane rupture, tobacco, preterm PROM
143
3rd trimester bleeding where blood may not be visible
abruptio placentae
144
Woman in 3rd trimester with uterine pain/tenderness and hyperactive contraction pattern and fetal distress is concerning for
abruptio placentae
145
Use of US in diagnosing abruptio placentae
may be falsely normal
146
Complication of abruptio placentae
maternal DIC if fetal products enter blood stream
147
Treatment of abruptio placentae
rapid delivery (vaginal preferred)
148
Risk factors for uterine rupture
previous uterine surgery, trauma, oxytocin, grand multiparity, excessive uterine distention, abnormal fetal lie, CPD, shoulder dystocia
149
Sudden onset of abdominal pain in 3rd trimester with sudden materal hypotension most concerning for
uterine rupture
150
Treatment of uterine rupture
laparotomy for delivery, usually requires hysterectomy
151
2 major causes of 3rd trimester fetal bleeding
vasa previa, velamentous insertion of the cord
152
Major risk factor for 3rd trimester fetal bleeding
multiple gestation (higher # of fetuses = higher risk)
153
3rd trimester bleeding with painless bleeding, stable mom and fetal distress
from fetal bleeding
154
How do you differentiate maternal from fetal blood (such as in 3rd trimester bleeding?)
The Apt test
155
Treatment of fetal bleeding in 3rd trimester
c-section
156
Define preterm labor
labor between 20-37 weeks
157
List the more common contraindications to tocolysis in preterm labor
herat disease, HTN, DM, hemorrhage, pre-eclampsia, chorioamnionitis, IUGR, ruptured membranes, cervical dilation >4cm, fetal demise, =- fetal abnormalities incompatible with survival
158
What action for the fetus must be taken in a stable patient with possible pre-term labor and positive fetal fibronectin?
measures for lung maturity
159
Amniocentesis results that indicate immature lungs
lecithin : sphingomyelin (L:S) ration less than 1:2
160
At what age in premature labor do you give steroids to hasten lung maturity
between 26 and 34 weeks
161
Define premature rupture of membrance
ruputre of amniotic sac prior to onset of labor
162
3 critera for premature rupture of membranes
pooling of amniotic fluid, ferning pattern, positive nitrazine test
163
What test should be done in confirmed premature rupture of membranes
US
164
How long do you give a mom at full term with PROM before inducing labor?
6-8 hours
165
Mom with PROM, fever and tender uterus likely has
chorioamnionitis
166
Classic cause of chorioamnionitis
premature rupture of membranes
167
Complications of chorioamnionitis in mom and fetus
neonatal sepsis, maternal sepsis, maternal endomyometritis
168
Empiric treatment of chorioamnionitis
ampicillin
169
Define preterm PROM
premature rupture of membranes before 36-37 weeks
170
What do you need to test for with preterm PROM
culture fluid for group B step and treat mom with ampicillin if positive culture
171
If placenta is monochorionic then twins are
monozygotic
172
4 major maternal complications of multiple gestations
anemia, HTN/pre-eclampsia, postpartum uterine atony, postpartum hemorrhage
173
9 major fetal complications of multiple gestations
polyhydramnios, malpresentation, placenta previa, abruptio placentae, velamentous cord/vasa previa, umbilical cord prolapse, IUGR, congenital anomalies, increased morbidity/mortality
174
When can you try to delivery twins vaginally?
When they are BOTH vertex; any other combo, do c-section
175
Define post-term pregnancy
after 42 weeks
176
If dates for pregnancy are known and reach 42 weeks, what do you do?
induce labor
177
If dates for pregnancy are unknown and reach 42 weeks, what do you do?
twice weekly BPP
178
Post post-maturity for fetus increase risk of morbidity and mortality?
yes
179
Prolonged gestation is classically associated with what congenital anomaly?
anencephaly
180
Fetus with "frog-like" appearance on US likely has
anancephaly
181
Hyperemesis gravidarum presents in which trimester?
1st
182
With all high risk pregnancies, consider weekly _____ during the third trimester
biophysical profiles
183
Can chorionic villi sampling detect neural tube defects?
no
184
When can chorionic villi sampling be done?
at 9-12 weeks (earlier than amniocentesis)
185
chorionic villi sampling is generally reserved for
testing of genetic diseases
186
What is the miscarriage rate of chorionic villi sampling compared to amniocentesis
higher with chorio
187
How do you know if a woman has pre-eclampsia if she already had HTN?
Increased greater than 30/15
188
What does HELLP syndrome stand for?
H- hemolysis, EL-elevated liver enzymes, LP-low platelets
189
S/s for pre-eclampsia
HTN, 2+ proteinuria, oliguria, facial/hand edema, headache, visual changes, HELLP syndrome
190
Pain in what location often does with HELLP syndrome?
RUQ or epigastric pain
191
When does pre-eclampsia usually occur?
3rd trimester
192
Treatment of pre-eclampsia
Definitive treatment is termination of deliver
193
Treatment for pre-eclampsia if fetus is not full term
hydralazine or labetalol, magnesium sulfate (seziure prophylaxis), bedrest, hospital observation
194
Indications in pre-eclampsia to delivery baby regardless of gestational age
BP > 160/110, oliguria, mental status change, headache, blurred vision, pulmonary edema, cyanosis, HELLP, ecclampsia (seizures)
195
Is severe ankle edema normal in pregnancy?
No, look for pre-ecclampsia
196
HTN + proteinuria in pregnancy = ______ until proven otherwise
pre-eclampsia
197
Complications of pre-eclampsia and eclampsia
uretoplacental insufficiency, IUGR, fetal demise, increased maternal morbidity and mortality
198
Does pre-eclampsia during pregnancy mean higher risk for HTN later in life?
No, not generally
199
Pre-eclampsia prior to the third trimester is likely
molar pregnancy
200
Best way to prevent eclampsia?
routine prenatal care
201
Initial treatment of choice for eclamptic seizures?
magnesium sulfate wthich also lowers blood pressure
202
Toxic effects of magnesium sulfate
hyporeflexia (1st sign), respiratory depression, CNS depression, coma, death
203
3 maternal complications of gestational diabetes
polyhydramnios, pre-eclampsia, complications of DM
204
2 difference is fetus for gestational DM vs. pre-existing DM
gestational: macrosomia, pre-existing: IUGR
205
What is caudal regression syndrome?
lower half of body incompletely formed (risk with gestational DM)
206
Use of oral hypoglycemics in pregnancy
contraindicated (use insulin)
207
Infants born to DM mothers are classically at risk for what right after birth?
postdelivery hypoglycemia
208
Why do babies of DM mother's get hypoglycemic after delivery?
fetal islet cell hypertrophy
209
Only maternal antibody category to cross the placenta
IgG
210
Meaning of elevated neonatal IgM concentration?
never normal
211
Meaning of elevated neonatal IgG concentration
often represents maternal antibodies
212
When does Rh incompatilbity occur
mom Rh negative, baby Rh positive
213
At what time do you give Rh immune globulin
28 weeks, within 72 hours of delivery, after any procedures which may cause transplacental hemorrhage (amnio)
214
What type of prevention is Rh immune globulin?
primary
215
IS Rh immune globulin effective if maternal Rh antibodies are strongly postiive?
no
216
What is hydrop fetalis
edema, ascites, pleural/pericardial effusions
217
Undetected Rh incompatability can lead to
hemolytic disease of newborn (hydrops fetalis)
218
Who do you test the severity of fetal hemolysis
Amniotic fluid spectrophotometry
219
Treatment of hemolytic disease of the fetus
delivery if mature, intrauterine blood transfusion, phenobarbital (helps fetal liver break Down bilirubin)
220
Mother with type O blood and baby with any other type, baby at risk for
hemolytic disease of the newborn
221
Snow storm pattern on US =
hydatiform mole
222
grape like vesicles with 1st or 2nd trimester bleeding
hydatiform mole
223
uterine size/dates discrepancy brings concerns for
hydatiform mole
224
Karyotype of complete moles
46XX or 46 XY (all from father)
225
Do complete moles contain fetal tissue?
no
226
Karyotype of incomplete moles
69 XXY
227
Do incomplete moles contain fetal tissue?
yes
228
Treatment of moles
D&C, follow HCG levels to zero
229
What happens if patient treated for hydatiform mole and HCG doesn't return to zero
invasive mole or choriocarcinoma and patient needs chemo
230
Chemo options for invasive mole or choriocarcinoma
methotrexate, actinomycin D
231
Source of choriocarcinoma
complete mole
232
Can choriocarcinoma develop from incomplete mole?
no
233
Prevention of aborption in when with antiphsophlipid antibodies and previous pregnancy problems
Low dose ASA and heparin
234
How do you treat TB in a pregnant patient
same treatment
235
Drug to avoid if need to treat pregnant patient for TB
streptomycin
236
Streptomycin given during preganancy risks causing ____ and ____ in the fetus
deafness & nephrotoxicity
237
Fetal defect caused by thalidomide
phocomelia
238
Fetal defect caused by tetracycline
yellow/brown teeth
239
Fetal defect caused by aminoglycoside
deafness
240
Fetal defect caused by valproic acid
spina bifida, hypospadias
241
Fetal defect caused by progestersone
masculinization of females
242
Fetal defect caused by cigarettes
IUGR, low birth weight, prematurity
243
Fetal defect caused by llithium
Ebstein anomalies (atrialization of right ventricle)
244
Fetal defect caused by aminopterin
IUGR
245
Fetal defect caused by radiation
IUGR, CNS/face defects, leukemia
246
Fetal defect caused by phenytoine (diphenyhydantoin)
craniofacial defects, limb defects, mental retardation, cardiac defects
247
Fetal defect caused by trimethadione
craniofacial defects, cardiovascular defects, mental retardation
248
Fetal defect caused by warfarin
craniofacial defects, CNS defects, IUGR, stillbirth
249
Fetal defect caused by carbamazepine
fingernail hypoplasia, craniofacial defets
250
Fetal abnormalities caused by iodine
goiter, cretinism
251
Fetal abnormalities caused by cocaine
cerebral infarcts, mental retardation
252
Fetal abnormalities caused by diazepam
clef lip/palate
253
Fetal abnormalities caused by diethylstilbestrol
clear cell vaginal cancer, adenosis, cervical incompetence
254
Is acetaminophen safe in preganancy?
Yes
255
Is penicillin safe in preganancy?
Yes
256
Is cepahlosporins safe in preganancy?
Yes
257
Is erythromycin safe in preganancy?
Yes
258
Is nitrofurantoin safe in preganancy?
Yes
259
Is H2-blocker safe in preganancy?
Yes
260
Is antacid safe in preganancy?
Yes
261
Is heparin safe in preganancy?
Yes
262
Is hydralazine safe in preganancy?
Yes
263
Is methyldopa safe in preganancy?
Yes
264
Is labetalol safe in preganancy?
Yes
265
Is insulin safe in pregnancy?
yes
266
Is docusate safe in pregnancy?
yes
267
3 important features of PID
abdominal pain, adnexal tenderness, cervical motion tenderness
268
4 supporting features of PID
elevated ESR, leukocytosis, fever, purulent cervical discharge
269
3 biggest organisms in PID
Neiseria gonorrhoeae, chlamydia, e. coli
270
Organism causing PID in patient with IUD
actinomyces israeli
271
Most common preventable cause of infertility
PID
272
Likely cause of infertility in woman under 30 with regular menstrual cycles
PID
273
Treatment of PID
more than 1 antibiotic, oupt: ceftriaxone/doxycycline, Inpt: clinda/gent
274
Unusual feature of tubo-ovarian abscess
may resolve with antibiotics alone
275
Vaginal discharge like cottage chees
candida
276
Vaginal discharge with pseudohypahe on KOH
candida
277
Vaginal discharge with history of diabetes
candida
278
Vaginal discharge with history of antibiotic treatment
candida
279
Vaginal discharge with during pregancy
candida
280
Treatment of candidal vaginitis
oral or topical antifungal
281
Vaginal discharge with organisms seen swimming under microscope
trichomonas
282
Vaginal discharge that is pale green, frothy, watery
trichomonas
283
Vaginal discharge with strawberry cervix
trichomonas
284
Treatment of trichomonas
metronidazole
285
Vaginal discharge with fishy smell on KOH prep
Gardnerella
286
Vaginal discharge with clue cells
Gardnerella
287
Vaginal discharge that is malodorous
Gardnerella
288
Treatment of Gardnerella
Metronidazole
289
Venereal warts are caused by
human papillomavirus
290
Koilocytosis on pap smear =
human papillomavirus venereal warts
291
Multiple shallow painful vaginal ulcers =
herpes
292
Treatment of vaginal herpes
acyclovir, valacyclovir
293
Most common sexually transmitted disease
Chlamydia
294
STD that often causes dysuria
Chlamydia
295
Treatment of chlamydia
doxycycline, azithromycin
296
One time oral treamtment option for chlamydia
- 1 gram of azithromycin
297
Treatment of chlamydia in pregnant patient
erythromycin or amoxicillin
298
STD for mucopurulent cervicitis
Neisseria gonorhoeae
299
Gram negative STD
Neisseria gonorhoeae
300
Treatment of Neisseria gonorhoeae
ceftriaxone, cipro
301
STD with intracellular inclusions
molluscum
302
If a patient has gonorrhea, what should you also treat for?
chlamydia
303
Typical treatment for fonorrhea
ceftraizone and doxycycline (assume also chlaymdia infection)
304
STDs where the partner does NOT need to be treated
candida, Gardnerella
305
Test to do in primary amenorrhea
- if basic overview normal, administer progesterone; if no bleeding, likely no estrogen or anatomic abnormality
306
If patient with primary amenorrhea bleeds with progesterone test, this means
estrogen is present, normal uterus
307
If patient with primary amenorrhea has normal breasts but no pubic/axillary hair, likely
androgen insensitvity syndrome
308
Secondary amenorrhea with + progesterine challenge and HIGH leutinizing hormone
polycystic ovarian syndrome
309
In polycystic ovarian sydrome, LH is
high
310
Ddx for secondary amenorrhea with + progesterine challenge and LOW leutinizing hormone
pituitary adenoma, hypothyroidism, low gonadotropin hormone
311
Test to check is patient has secondary amenorrhea that you think is from pituitary adenoma
prolactin
312
Patient with secondary amenorrhea with normal prolactin, normal TSH and low gonadotropin likely has
anorexia nervosa
313
A patient with secondary amenorrhea with + progesterone bleeding test can likey become pregnant by using which drug?
clomiphene
314
Secondary amenorrhea with no bleeding on progesterine challenge has (generally)
insuffecient estrogen
315
Secondary amenorrhea with no bleeding on progesterine challenge with elevated FSH has
premature ovarian failure/menopause
316
FSH is _____ in premature ovarian failure
elevated
317
Secondary amenorrhea with no bleeding on progesterine challenge with low/normal FSH may have
neoplasm of hypothalamus (get MRI of brain)
318
First test to order in amenorrhea
pregnancy test
319
Nulliparous 35 yr woman with dyspareunia and dyschezia
endometriosis
320
Most common site for endometriosis
ovaries
321
Tender adnexa WITHOUT evidence of PID =
endometriosis
322
Endometriosis may be associated with this uterine position
retroverted
323
Gold standard for diagnosis of endometriosis
laparoscopy with visualization
324
Mulberry spots
endometriosis
325
flat brown colored powder burns
endometriosis
326
chocolate cysts
endometriosis
327
Most likely cause of infertility in menstruating woman over 30
endometreosis
328
Treatment of endometriosis
1st: birth control pills, 2nd/3rd: danzol, GnRH agonists
329
Effect of surgery for endometriosis on fertility
often improves it
330
Define adenomyosis
ectopic endometrial glands within uterine musculature
331
Typical characteristics of adenomyosis
dysmenorrhea, large boggy uterus
332
Woman over 40 with large boggy uterus and dymenorrhea
adeomyosis
333
Treatment of adenomyosis
D&C to r/o endometrial cancer, consider hysterectomy, may try GnRH agonists
334
Define dysfunctional uterine bleeding
abnormal uterine bleeding not associated with tumor inflammation or pregnancy
335
70% of dysfunctional uterine bleeding is associated with
anovulatory cycles
336
When is dysfunction uterine bleeding common and physiologic?
Right are menarche and before menopause
337
If dysfunctional uterine bleeding that doesn't appear simple, think
polycystic ovarian syndrome
338
What needs to be done in woman over 35 with dysfunctional uterine bleeding?
D&C to r/o endometrial cancer
339
Why should you get a CBC in patient with polycystic ovarian syndrome?
excess blood loss
340
4 uncommon causes of dysfunctional uterine bleeding
infections, end, ocrine disorders, coagulation defects, estrogen producing neoplasms
341
First line treatment for idiopathic dysfunctional uterine bleeding
NSAIDs or OCPs
342
First line treatment for dysmenorrhea
NSAIDs
343
Treatment of severe bleeding with dysfunctional uterine bleeding
progesterone
344
Overweight woman with infertility and amenorrhea
polycystic ovarian syndrome
345
Most common cause of infertility in woman under 30 with ABnormal menstruation
polycystic ovarian syndrome
346
LH:FSH in polycystic ovarian syndrome
greater than 2:1
347
Cancer risk in polycystic ovarian syndome
unopposed estrogen causes increased risk for endometrial hyperplasia and enodmetrial carcinoma
348
Treatment of polycystic ovarian syndrome
OPCs, cyclic progesterone, Metformin, if wants pregnancy, use clomiphene
349
Treatment of premenstrual dysphoric disorder
NSAIDs; antidepressants
350
Increase parabasal cells on vaginal cytology indicates
menopause
351
Fibroids aka
leimyoma
352
Are leiomyomas malignant or benign?
benign
353
Most common indication for hysterectomy
leiomyoma
354
Rate of malignant transformation of leimyoma
<1%
355
When do leiomyomas often grow rapidly?
During pregnancy or high estrogen (OCPs)
356
Anemia with fibroids is an indication for
hysterectomy
357
Test that should be done in woman over 40 with leiomyoma
D&C to r/o endometrial cancer
358
Polyp protruding through cervix is likely
leiomyoma
359
If a patient has bilateral non-bloody breast discharge, what are the chances that it's cancer?
very low
360
Unilateral breast discharge is concerning for
cancer
361
Most common breast disorder
fibrocystic disease
362
Treatment of fibrocystic breast disease if under 35
if symptoms are very severe can do progesterone or danazol for a week at the end of each month
363
Features of fibrocystic breast disease
under 35, bilateral, multiple cystic lesions, tender
364
A painless, shaprly circumscribed, rubbery, mobile breast mass is likely
fibroadenoma
365
Most common benign tumor of the female breast
fibroadenoma
366
Age when you become more concerned about breast cancer
35
367
Treatment of fibroadenoma of the breast
excision is curative but often not needed
368
Fibroadenoma of the breast often growns quickly in the setting of
OCPs or pregnancy (estrogen)
369
Is mammogram useful under the age of 35?
No. Breast tissue too dense. Proceed directly to biopsy
370
This potentially malignant tumor often masquerades as a rapidly growing fibroadenoma of the breast
phylloides tumor
371
In a woman over 35 with a breast mass, when in doubt...
get a biopsy
372
A new breast mass in a postmenopausal woman...
is breast cancer until proven otherwise
373
Pelvic heaviness that is worse with standing and improves with lying down may be
vaginal prolapse
374
A bulge into the upper vaginal wall is likely
a cystocele
375
Symptoms of cystocele
urianry urgency, frequency and incontinence
376
A bulge into the lower posterior vaginal wall is likely
a rectocele
377
Symptoms of rectocele
difficultly defecating
378
What is an enterocele
bulding of loops of bowel into upper posterior vaginal wall
379
Treatment of -celes (cystocele, etc)
pelvic strengthening
380
1st step in eval of infertility (after based H&P)
semen anlysis
381
Risk factor for uterine synechiae
D&C
382
What radiographic test do you order to look for uterine structural abnormalities?
hysterosalpingogram
383
Clomiphene can be used to stimulate ovulation in what setting
need adequate estrogen
