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OB-Gyne > OB-Gyne > Flashcards

OB-Gyne Flashcards

1
Q

When does standard HCG test for pregnancy become positive?

A

2 weeks after conception

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2
Q

What is Heagar’s sign

A

sofetening and compressivility of the lower uterine segment indicating pregnancy

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3
Q

What is Chadwick’s sign

A

dark discoloration of the vulva and vaginal walls

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4
Q

What is the significance of linea nigra in preganancy?

A

normal benign finding

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5
Q

What is melasma?

A

hyperpigmentation of sun exposed areas; often in pregnancy

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6
Q

When does quickening occur?

A

primigravida: 18-20 weeks, multi: 16-18 weeks

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7
Q

When during pregnancy do you need a pap smear?

A

at first visit unless done in last 6 months

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8
Q

When during pregnancy do you need a urinalysis?

A

at every visit

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9
Q

Urinalysis in pregnancy is used to screen for…

A

pre-eclamppsia, bacteriuria, diabetes

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10
Q

When during pregnancy do you need a CBC?

A

at first visit

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11
Q

When during pregnancy do you need a blood type/screen?

A

at first visit

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12
Q

When during pregnancy do you need a syphilis test?

A

at first visit, repeat later if high risk

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13
Q

When during pregnancy do you need a rubella titer?

A

first visit if vaccination history not known

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14
Q

When during pregnancy do you need diabetes screening?

A
  • betwen 24-28 weeks; at first visit if high risk factors
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15
Q

High risk factors for gestational diabetes

A

obese, family history, age over 30

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16
Q

When during pregnancy do you need a triple screen?

A

15-20 weeks for older/high risk women

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17
Q

Significance of low AFP on triple screen

A

Down syndrome, fetal demise, inaccurate dates

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18
Q

Significance of high AFP on triple screen

A

neural tube defect, ventral wall defect, multiple gestation, multiple gestation

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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

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20
Q

When during pregnancy do you need a Group b strep culture?

A

35-37 weeks

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21
Q

How do you treat group B strep in pregnant mom?

A

treat with amoxicillin during labor

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22
Q

When can fetal heart tones be heard?

A

doppler: 10-12 week, stethascope: 16-20 weeks

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23
Q

What is significant for size/date discrepency

A

uterine size difference of 2-3 cm to dates; get US

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24
Q

What do HCG levels do in the first trimester of pregnancy?

A

double every 2 days

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25
Q

Ongoing increase in HCG or increase after delivery indicates

A

hydatiform mole, choriocarcionma

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26
Q

HCG level at 5 weeks

A

> 2000

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27
Q

Transvaginal US can detect intrauterine pregnancy at

A

5 weeks

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28
Q

Average weight gain of pregnancy

A

28 pounds

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29
Q

With extra weight gain in pregnancy think

A

diabetes

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30
Q

With poor weight gain during pregnancy think

A

hyperemesis gravidum, psych disorder, major systemic disease

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31
Q

ESR in pregnancy

A

very elevated

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32
Q

Thyroid tests in pregnancy

A

free T4 same, overall total T4 and thyroid binding globulin increase

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33
Q

Hematocrit in pregancy

A

decreased (increased red cells but fluid increases more)

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34
Q

BUN and Cr in pregnancy

A

decrease (GFR increases)

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35
Q

Alkaline phosphatase in pregnancy

A

very increased

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36
Q

Mild proteinuiria in pregnancy

A

normal

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37
Q

Mild glucosuria in pregnancy

A

normal

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38
Q

Electrolyte in pregnancy

A

unchanged

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39
Q

Liver function tests in pregnancy

A

unchanged

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40
Q

BP changes in pregnancy

A

decreases slightly

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41
Q

HR changes in pregnancy

A

increased 10-20 beats per minute

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42
Q

Stroke volume and cardiac output in pregnancy

A

increase, often by 50%

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43
Q

Minute ventillation in pregnancy

A

increases (increased tidal volume, rate about the same)

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44
Q

Residual lung volume in pregnancy

A

decreased

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45
Q

Respiratory alkalosis in pregnancy is

A

normal

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46
Q

Definition of IUGR

A

below 10th percentile for age

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47
Q

3 classes of causes of IUGR

A

maternal, fetal, placental

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48
Q

Components of biophysical profile (BPP)

A

heart rate tracin, amniotic fluid index, fetal breathing movements, fetal body movements

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49
Q

If you are concerned about a fetus, but non-emergent, what is the series of investigations?

A
  • BPP, if abnormal then contractile stress test. If decels, usually go to c-section
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50
Q

What is the contraction stress test

A

looks for uretroplacental dysfunction,

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51
Q

Define oligohydramnios

A

<300-500 ml

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52
Q

4 major causes of oligohydramnios

A

IUGR, premature rupture of membrane, postmaturity, renal agenesis (Potter disease)

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53
Q

4 complications of oligohydraminios

A

pulmonary hypoplasia, cutaneous problems (compression), skeletal problems (compression), hypoxia (cord compression)

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54
Q

Define polyhydramnios

A

> 1700-2000ml

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55
Q

5 major causes of polyhydramnios

A

maternal diabete, multiple gestation, neural tube defects, GI anomolies, hydrops fetalis

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56
Q

Maternal complications of polyhydramnios

A

uterine atony, dyspnea from large uterus

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57
Q

At term normal fetal heart rate is

A

110 to 160 bpm

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58
Q

Discuss early decelerations

A

low point of fetal HR and high point of uterine contraction coincide, from head compression, normal

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59
Q

Discuss varible decelerations

A

most common, variable occurance with contractions, signifies cord compression

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60
Q

Treatment of variable decelerations

A

mom in lateral decub., give O2 by facemask, stop oxytocin, if brady (t resolve measure fetal O2

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61
Q

Discuss late decelerations

A

fetal HR nadir occurs after contraction, uteroplacental insufficiency, worrisome

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62
Q

Treatment in late decelerations

A

lateral decub, O2, stop oxytocin, give tocolytic, give IVF if BP not optimal, if persist, measure fetal O2

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63
Q

Examples of tocolytic agents

A

ritodrine, magnesium sulfate

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64
Q

Discuss the loss of fetal variability if heart rate in labor

A

check fetal scalp pH, if associated with variable or late decels, likely need to deliver

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65
Q

In labor, what are the scalp pH parameters that indicate need for delivery?

A

fetal scalp pH < 7.2 or abnormal O2

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66
Q

How can you distinguish true labor

A

regular contraction (every 3 minutes), associated with cervical changes

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67
Q

Describe “false labor”

A

aka Braxton-Hicks contraction, irregular, no cervical changes

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68
Q

Desribe the stages of labor

A

1st- true labor to full dilation, 2nd- full dilation to dirth, 3rd- delivery of baby, 4th- placenta to stabilization

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69
Q

1st stage of labor lasts how long?

A

nuligravida: < 20 hours, multigravida: < 14 hours

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70
Q

In the active phase of 1st stage of labor, how fast does the cervix dilate?

A

nuligravida: >1cm/hr, multigravida: >1.2 cm/hr

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71
Q

Time from full cervical dilation to start delivery of baby

A

nuligravida: 30min - 3 hrs, multigravida: 5-30 min

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72
Q

Time to delivery baby

A

0-30 minutes

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73
Q

Time to delivery placenta and maternal stabilization

A

up to 48 hours

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74
Q

What is protraction disorder

A

Labor takes long than expected

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75
Q

What is labor arrest disorder?

A

No change in cervical dilation occurs over 2 hours and no change in fetal descent after 1 hour

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76
Q

Treatment of arrest disorder

A

check fetal lie, check for cephalopelvic disproportion, augment labor

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77
Q

Name 3 ways to augment labor

A

oxytocin, prostaglandin gel, amniotomy

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78
Q

Most common cause of “failure to progress” in labor

A

cephalopelic disporoprtion (labor augmentation contraindicated)

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79
Q

Half life of oxytocin

A

less than 10 minutes

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80
Q

Side effects of oxytocin

A

uterine hyperstimulation, uterine rupture, fetal heart deccelerations, hyponatremia

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81
Q

Side effects of PGE2 used for ripening cervix

A

uterine hyperstimulation

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82
Q

Decision of vaginal delivery with HSV based on…

A

if active lesions during labor, opt for c-section

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83
Q

Orientation of “classic” c- section incision

A

vertical

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84
Q

Signs of placental separation

A

fresh blood from vagina, umbilical cord lengthens, fundus rises and becomes firm and globular

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85
Q

What is the first step during delivery with shoulder dystocia

A

McRobert maneuver: mother sharpely flexes thighs against abdomen

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86
Q

List the order of labor positions

A

descent, flexion, internal rotation, extension, external rotation, expulsion

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87
Q

Postpartum discharge

A

red the first few days, usually white by day 10

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88
Q

Foul smelling lochia is concerning for

A

endometritis

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89
Q

What is the underlying likely cause when new mom develops PE

A

PE from amniotic fluid

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90
Q

Definition of post-partum hemorrhage

A

> 500 cc with vaginal, >1000cc with c-section

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91
Q

Most common cause of post-partum hemorrhage

A

uterine atony

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92
Q

Complication of severe post-partum hemorrhage

A

Sheeham sydrome

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93
Q

Risk factors for retained placenta after delivery

A

previous uterine surgery, previous c- section

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94
Q

Risk factors for uterine atony

A

overdistended, prolonged labor, oxytocin, more than 5 deliverie, precipitous labor (<3h)

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95
Q

Treatment of uterine atony

A
  1. uterine massage with low dose oxytocin, 2. ergot drug or PGF2-alpha, 3. hysterectomy
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96
Q

Treatment of retained products of conception

A

remove placenta manually to stop bleeding, curettage in or, if placental accreta, likely to need hysterectomy

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97
Q

Most common cause of uterine inversion

A

iatrogenic; pulling too hard on the cord

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98
Q

Treatment of uterine inversion

A

manually replace uterus may need anesthesia

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99
Q

Definition of post-partum fever

A

fever for 2 days

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100
Q

5 most common causes of post-partum fever

A

breast engorgement, UTI, endometritis, puerperal sepsis, endomyometritis

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101
Q

Risk factors for endometritis

A

C-section, PROM, prolonged labor, frequent vaginal exams, manual removal of placenta

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102
Q

Treatment of endometritis

A

obtain cultures of endometrium, vagina, blood and urine, treat with broad spectrum antibiotics

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103
Q

If endometritis doesn’t resolve, what’s likely going on?

A

pelvic abscess OR pelvic thrombophlebitis ( get a CT)

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104
Q

Treatment of post-partum pelvic thrombphlebitis

A

heparin

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105
Q

3 major things to think of with postpartum shock and no evident bleeding

A

amniotic fluid embolus, concealed hemorrhage, uterine inversion

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106
Q

Mastidis after delivery usually occurs

A

within 2 months

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107
Q

Usual organism of mastidis

A

staph aureus

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108
Q

Treatment of mastidis

A

keep breast feeding, analgesia, warm compresses, antibiotics if more than mild (cephalexin, dicloxacillin)

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109
Q

Contraindications to breast feeding

A

maternal HIV, illicit drug use, sedatives, stimulants, lithium, chemotherapy

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110
Q

Define abortion

A

termination of pregnancy before 20 weeks or fetus less than 500 grams

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111
Q

Define threatened abortion

A

uterine bleeding without cervical dilation and no expulsion of tissue

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112
Q

Treatment of threatened abortion

A

pelvic rest

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113
Q

What percentage of pregnancies with threatened abortion go on to be normal?

A

50%

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114
Q

Define inevitable abortion

A

uterine bleeding with cervical dilation, crampy pain and no tissue

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115
Q

Treatment of inevitable abortion

A

follow, D&C of uterine cavity

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116
Q

Define incomplete abortion

A

passage of some products of conception through cervix

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117
Q

Treatmetn of incomplete abortion

A

observation, often need D&C

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118
Q

Define complete abortion

A

expulsion of all products of conception from the uterus

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119
Q

Treatment of complete abortion

A

Serial HCGs to be sure returns to zero. D&C if pain or opeen cervical os

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120
Q

Define missed abortion

A

fetal death without expulsion of fetus

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121
Q

Treatment of missed abortion

A

most women go on to have spontaneous miscarriage but D&C often performed

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122
Q

Define induced abortion

A

intentional temination prior to 20 weeks (elective or therapeutic)

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123
Q

Define recurrent abortion

A

two or three successive unplanned abortions

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124
Q

4 infectious causes of recurrent abortion

A

syphilis, Listeria, Mycoplasma, Toxoplasma

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125
Q

3 environmental causes of recurrent abortion

A

alcohol, tobacco, drugs

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126
Q

2 metabolic causes of recurrent abortion

A

hypothyroidism, diabetes

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127
Q

3 autoimmune causes of recurrent abortion

A

lupus, anitphospholipid antibodies, lupus anticoagulant

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128
Q

3 anatomic causes of recurrent abortion

A

cervical incompience, congenital female tract abnormalities, fibroids

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129
Q

Classic cause of painless recurrent abortions in the second trimester

A

cervical incompetence

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130
Q

Treatment of cervical incompetence

A

cerclage at 14-16 weeks

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131
Q

Typical time when ectopic pregnancy presents

A

4-10 weeks.

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132
Q

Definitive diagnosis and treatment of ectopic pregnancy in unstable patient

A

laparoscopy

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133
Q

Major risk factors for ectopic pregancy

A

history of PID, previous ectopic, history of tubal ligation, pregnancy with IUD in place

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134
Q

In 3rd trimester bleeding always do a ______ before a ______

A

always do an UTZ before a pelvic exam

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135
Q

Ddx of 3rd trimester bleeding

A

placenta previa, abruptio placentae, uterine rupture, fetal bleeding, cervical/vaginal lesions, cervical/vaginal trauma, bleeding disorder, cervical cancer

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136
Q

In all patients with 3rd trimester bleeding, what do you do?

A

order CBC w/ coags, do UTZ, setup maternal and fetal monitoring, tox screen if suspected, give Rh immune globuline if mother Rh negative

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137
Q

Risk factors for placenta previa

A

multiparity, older age, multiple gestation, prior previa

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138
Q

Why do you do an US before a pelvic exam in 3rd trimester bleeding

A

because of placenta previa.

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139
Q

Accuracy of US in dx placenta previa

A

95-100%

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140
Q

Characteristics of bleeding in placenta previa

A

painless, may be profuse

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141
Q

Treatment of placenta previa

A

if premature, can try rest and tocolysis if stable, otherwise needs c-section

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142
Q

Risk factors for abruptio placentae

A

HTN, cocaine, trauma, polyhydramnios with rapid decompression with membrane rupture, tobacco, preterm PROM

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143
Q

3rd trimester bleeding where blood may not be visible

A

abruptio placentae

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144
Q

Woman in 3rd trimester with uterine pain/tenderness and hyperactive contraction pattern and fetal distress is concerning for

A

abruptio placentae

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145
Q

Use of US in diagnosing abruptio placentae

A

may be falsely normal

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146
Q

Complication of abruptio placentae

A

maternal DIC if fetal products enter blood stream

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147
Q

Treatment of abruptio placentae

A

rapid delivery (vaginal preferred)

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148
Q

Risk factors for uterine rupture

A

previous uterine surgery, trauma, oxytocin, grand multiparity, excessive uterine distention, abnormal fetal lie, CPD, shoulder dystocia

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149
Q

Sudden onset of abdominal pain in 3rd trimester with sudden materal hypotension most concerning for

A

uterine rupture

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150
Q

Treatment of uterine rupture

A

laparotomy for delivery, usually requires hysterectomy

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151
Q

2 major causes of 3rd trimester fetal bleeding

A

vasa previa, velamentous insertion of the cord

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152
Q

Major risk factor for 3rd trimester fetal bleeding

A

multiple gestation (higher # of fetuses = higher risk)

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153
Q

3rd trimester bleeding with painless bleeding, stable mom and fetal distress

A

from fetal bleeding

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154
Q

How do you differentiate maternal from fetal blood (such as in 3rd trimester bleeding?)

A

The Apt test

155
Q

Treatment of fetal bleeding in 3rd trimester

A

c-section

156
Q

Define preterm labor

A

labor between 20-37 weeks

157
Q

List the more common contraindications to tocolysis in preterm labor

A

herat disease, HTN, DM, hemorrhage, pre-eclampsia, chorioamnionitis, IUGR, ruptured membranes, cervical dilation >4cm, fetal demise, =- fetal abnormalities incompatible with survival

158
Q

What action for the fetus must be taken in a stable patient with possible pre-term labor and positive fetal fibronectin?

A

measures for lung maturity

159
Q

Amniocentesis results that indicate immature lungs

A

lecithin : sphingomyelin (L:S) ration less than 1:2

160
Q

At what age in premature labor do you give steroids to hasten lung maturity

A

between 26 and 34 weeks

161
Q

Define premature rupture of membrance

A

ruputre of amniotic sac prior to onset of labor

162
Q

3 critera for premature rupture of membranes

A

pooling of amniotic fluid, ferning pattern, positive nitrazine test

163
Q

What test should be done in confirmed premature rupture of membranes

A

US

164
Q

How long do you give a mom at full term with PROM before inducing labor?

A

6-8 hours

165
Q

Mom with PROM, fever and tender uterus likely has

A

chorioamnionitis

166
Q

Classic cause of chorioamnionitis

A

premature rupture of membranes

167
Q

Complications of chorioamnionitis in mom and fetus

A

neonatal sepsis, maternal sepsis, maternal endomyometritis

168
Q

Empiric treatment of chorioamnionitis

A

ampicillin

169
Q

Define preterm PROM

A

premature rupture of membranes before 36-37 weeks

170
Q

What do you need to test for with preterm PROM

A

culture fluid for group B step and treat mom with ampicillin if positive culture

171
Q

If placenta is monochorionic then twins are

A

monozygotic

172
Q

4 major maternal complications of multiple gestations

A

anemia, HTN/pre-eclampsia, postpartum uterine atony, postpartum hemorrhage

173
Q

9 major fetal complications of multiple gestations

A

polyhydramnios, malpresentation, placenta previa, abruptio placentae, velamentous cord/vasa previa, umbilical cord prolapse, IUGR, congenital anomalies, increased morbidity/mortality

174
Q

When can you try to delivery twins vaginally?

A

When they are BOTH vertex; any other combo, do c-section

175
Q

Define post-term pregnancy

A

after 42 weeks

176
Q

If dates for pregnancy are known and reach 42 weeks, what do you do?

A

induce labor

177
Q

If dates for pregnancy are unknown and reach 42 weeks, what do you do?

A

twice weekly BPP

178
Q

Post post-maturity for fetus increase risk of morbidity and mortality?

A

yes

179
Q

Prolonged gestation is classically associated with what congenital anomaly?

A

anencephaly

180
Q

Fetus with “frog-like” appearance on US likely has

A

anancephaly

181
Q

Hyperemesis gravidarum presents in which trimester?

A

1st

182
Q

With all high risk pregnancies, consider weekly _____ during the third trimester

A

biophysical profiles

183
Q

Can chorionic villi sampling detect neural tube defects?

A

no

184
Q

When can chorionic villi sampling be done?

A

at 9-12 weeks (earlier than amniocentesis)

185
Q

chorionic villi sampling is generally reserved for

A

testing of genetic diseases

186
Q

What is the miscarriage rate of chorionic villi sampling compared to amniocentesis

A

higher with chorio

187
Q

How do you know if a woman has pre-eclampsia if she already had HTN?

A

Increased greater than 30/15

188
Q

What does HELLP syndrome stand for?

A

H- hemolysis, EL-elevated liver enzymes, LP-low platelets

189
Q

S/s for pre-eclampsia

A

HTN, 2+ proteinuria, oliguria, facial/hand edema, headache, visual changes, HELLP syndrome

190
Q

Pain in what location often does with HELLP syndrome?

A

RUQ or epigastric pain

191
Q

When does pre-eclampsia usually occur?

A

3rd trimester

192
Q

Treatment of pre-eclampsia

A

Definitive treatment is termination of deliver

193
Q

Treatment for pre-eclampsia if fetus is not full term

A

hydralazine or labetalol, magnesium sulfate (seziure prophylaxis), bedrest, hospital observation

194
Q

Indications in pre-eclampsia to delivery baby regardless of gestational age

A

BP > 160/110, oliguria, mental status change, headache, blurred vision, pulmonary edema, cyanosis, HELLP, ecclampsia (seizures)

195
Q

Is severe ankle edema normal in pregnancy?

A

No, look for pre-ecclampsia

196
Q

HTN + proteinuria in pregnancy = ______ until proven otherwise

A

pre-eclampsia

197
Q

Complications of pre-eclampsia and eclampsia

A

uretoplacental insufficiency, IUGR, fetal demise, increased maternal morbidity and mortality

198
Q

Does pre-eclampsia during pregnancy mean higher risk for HTN later in life?

A

No, not generally

199
Q

Pre-eclampsia prior to the third trimester is likely

A

molar pregnancy

200
Q

Best way to prevent eclampsia?

A

routine prenatal care

201
Q

Initial treatment of choice for eclamptic seizures?

A

magnesium sulfate wthich also lowers blood pressure

202
Q

Toxic effects of magnesium sulfate

A

hyporeflexia (1st sign), respiratory depression, CNS depression, coma, death

203
Q

3 maternal complications of gestational diabetes

A

polyhydramnios, pre-eclampsia, complications of DM

204
Q

2 difference is fetus for gestational DM vs. pre-existing DM

A

gestational: macrosomia, pre-existing: IUGR

205
Q

What is caudal regression syndrome?

A

lower half of body incompletely formed (risk with gestational DM)

206
Q

Use of oral hypoglycemics in pregnancy

A

contraindicated (use insulin)

207
Q

Infants born to DM mothers are classically at risk for what right after birth?

A

postdelivery hypoglycemia

208
Q

Why do babies of DM mother’s get hypoglycemic after delivery?

A

fetal islet cell hypertrophy

209
Q

Only maternal antibody category to cross the placenta

A

IgG

210
Q

Meaning of elevated neonatal IgM concentration?

A

never normal

211
Q

Meaning of elevated neonatal IgG concentration

A

often represents maternal antibodies

212
Q

When does Rh incompatilbity occur

A

mom Rh negative, baby Rh positive

213
Q

At what time do you give Rh immune globulin

A

28 weeks, within 72 hours of delivery, after any procedures which may cause transplacental hemorrhage (amnio)

214
Q

What type of prevention is Rh immune globulin?

A

primary

215
Q

IS Rh immune globulin effective if maternal Rh antibodies are strongly postiive?

A

no

216
Q

What is hydrop fetalis

A

edema, ascites, pleural/pericardial effusions

217
Q

Undetected Rh incompatability can lead to

A

hemolytic disease of newborn (hydrops fetalis)

218
Q

Who do you test the severity of fetal hemolysis

A

Amniotic fluid spectrophotometry

219
Q

Treatment of hemolytic disease of the fetus

A

delivery if mature, intrauterine blood transfusion, phenobarbital (helps fetal liver break Down bilirubin)

220
Q

Mother with type O blood and baby with any other type, baby at risk for

A

hemolytic disease of the newborn

221
Q

Snow storm pattern on US =

A

hydatiform mole

222
Q

grape like vesicles with 1st or 2nd trimester bleeding

A

hydatiform mole

223
Q

uterine size/dates discrepancy brings concerns for

A

hydatiform mole

224
Q

Karyotype of complete moles

A

46XX or 46 XY (all from father)

225
Q

Do complete moles contain fetal tissue?

A

no

226
Q

Karyotype of incomplete moles

A

69 XXY

227
Q

Do incomplete moles contain fetal tissue?

A

yes

228
Q

Treatment of moles

A

D&C, follow HCG levels to zero

229
Q

What happens if patient treated for hydatiform mole and HCG doesn’t return to zero

A

invasive mole or choriocarcinoma and patient needs chemo

230
Q

Chemo options for invasive mole or choriocarcinoma

A

methotrexate, actinomycin D

231
Q

Source of choriocarcinoma

A

complete mole

232
Q

Can choriocarcinoma develop from incomplete mole?

A

no

233
Q

Prevention of aborption in when with antiphsophlipid antibodies and previous pregnancy problems

A

Low dose ASA and heparin

234
Q

How do you treat TB in a pregnant patient

A

same treatment

235
Q

Drug to avoid if need to treat pregnant patient for TB

A

streptomycin

236
Q

Streptomycin given during preganancy risks causing ____ and ____ in the fetus

A

deafness & nephrotoxicity

237
Q

Fetal defect caused by thalidomide

A

phocomelia

238
Q

Fetal defect caused by tetracycline

A

yellow/brown teeth

239
Q

Fetal defect caused by aminoglycoside

A

deafness

240
Q

Fetal defect caused by valproic acid

A

spina bifida, hypospadias

241
Q

Fetal defect caused by progestersone

A

masculinization of females

242
Q

Fetal defect caused by cigarettes

A

IUGR, low birth weight, prematurity

243
Q

Fetal defect caused by llithium

A

Ebstein anomalies (atrialization of right ventricle)

244
Q

Fetal defect caused by aminopterin

A

IUGR

245
Q

Fetal defect caused by radiation

A

IUGR, CNS/face defects, leukemia

246
Q

Fetal defect caused by phenytoine (diphenyhydantoin)

A

craniofacial defects, limb defects, mental retardation, cardiac defects

247
Q

Fetal defect caused by trimethadione

A

craniofacial defects, cardiovascular defects, mental retardation

248
Q

Fetal defect caused by warfarin

A

craniofacial defects, CNS defects, IUGR, stillbirth

249
Q

Fetal defect caused by carbamazepine

A

fingernail hypoplasia, craniofacial defets

250
Q

Fetal abnormalities caused by iodine

A

goiter, cretinism

251
Q

Fetal abnormalities caused by cocaine

A

cerebral infarcts, mental retardation

252
Q

Fetal abnormalities caused by diazepam

A

clef lip/palate

253
Q

Fetal abnormalities caused by diethylstilbestrol

A

clear cell vaginal cancer, adenosis, cervical incompetence

254
Q

Is acetaminophen safe in preganancy?

A

Yes

255
Q

Is penicillin safe in preganancy?

A

Yes

256
Q

Is cepahlosporins safe in preganancy?

A

Yes

257
Q

Is erythromycin safe in preganancy?

A

Yes

258
Q

Is nitrofurantoin safe in preganancy?

A

Yes

259
Q

Is H2-blocker safe in preganancy?

A

Yes

260
Q

Is antacid safe in preganancy?

A

Yes

261
Q

Is heparin safe in preganancy?

A

Yes

262
Q

Is hydralazine safe in preganancy?

A

Yes

263
Q

Is methyldopa safe in preganancy?

A

Yes

264
Q

Is labetalol safe in preganancy?

A

Yes

265
Q

Is insulin safe in pregnancy?

A

yes

266
Q

Is docusate safe in pregnancy?

A

yes

267
Q

3 important features of PID

A

abdominal pain, adnexal tenderness, cervical motion tenderness

268
Q

4 supporting features of PID

A

elevated ESR, leukocytosis, fever, purulent cervical discharge

269
Q

3 biggest organisms in PID

A

Neiseria gonorrhoeae, chlamydia, e. coli

270
Q

Organism causing PID in patient with IUD

A

actinomyces israeli

271
Q

Most common preventable cause of infertility

A

PID

272
Q

Likely cause of infertility in woman under 30 with regular menstrual cycles

A

PID

273
Q

Treatment of PID

A

more than 1 antibiotic, oupt: ceftriaxone/doxycycline, Inpt: clinda/gent

274
Q

Unusual feature of tubo-ovarian abscess

A

may resolve with antibiotics alone

275
Q

Vaginal discharge like cottage chees

A

candida

276
Q

Vaginal discharge with pseudohypahe on KOH

A

candida

277
Q

Vaginal discharge with history of diabetes

A

candida

278
Q

Vaginal discharge with history of antibiotic treatment

A

candida

279
Q

Vaginal discharge with during pregancy

A

candida

280
Q

Treatment of candidal vaginitis

A

oral or topical antifungal

281
Q

Vaginal discharge with organisms seen swimming under microscope

A

trichomonas

282
Q

Vaginal discharge that is pale green, frothy, watery

A

trichomonas

283
Q

Vaginal discharge with strawberry cervix

A

trichomonas

284
Q

Treatment of trichomonas

A

metronidazole

285
Q

Vaginal discharge with fishy smell on KOH prep

A

Gardnerella

286
Q

Vaginal discharge with clue cells

A

Gardnerella

287
Q

Vaginal discharge that is malodorous

A

Gardnerella

288
Q

Treatment of Gardnerella

A

Metronidazole

289
Q

Venereal warts are caused by

A

human papillomavirus

290
Q

Koilocytosis on pap smear =

A

human papillomavirus venereal warts

291
Q

Multiple shallow painful vaginal ulcers =

A

herpes

292
Q

Treatment of vaginal herpes

A

acyclovir, valacyclovir

293
Q

Most common sexually transmitted disease

A

Chlamydia

294
Q

STD that often causes dysuria

A

Chlamydia

295
Q

Treatment of chlamydia

A

doxycycline, azithromycin

296
Q

One time oral treamtment option for chlamydia

A
  • 1 gram of azithromycin
297
Q

Treatment of chlamydia in pregnant patient

A

erythromycin or amoxicillin

298
Q

STD for mucopurulent cervicitis

A

Neisseria gonorhoeae

299
Q

Gram negative STD

A

Neisseria gonorhoeae

300
Q

Treatment of Neisseria gonorhoeae

A

ceftriaxone, cipro

301
Q

STD with intracellular inclusions

A

molluscum

302
Q

If a patient has gonorrhea, what should you also treat for?

A

chlamydia

303
Q

Typical treatment for fonorrhea

A

ceftraizone and doxycycline (assume also chlaymdia infection)

304
Q

STDs where the partner does NOT need to be treated

A

candida, Gardnerella

305
Q

Test to do in primary amenorrhea

A
  • if basic overview normal, administer progesterone; if no bleeding, likely no estrogen or anatomic abnormality
306
Q

If patient with primary amenorrhea bleeds with progesterone test, this means

A

estrogen is present, normal uterus

307
Q

If patient with primary amenorrhea has normal breasts but no pubic/axillary hair, likely

A

androgen insensitvity syndrome

308
Q

Secondary amenorrhea with + progesterine challenge and HIGH leutinizing hormone

A

polycystic ovarian syndrome

309
Q

In polycystic ovarian sydrome, LH is

A

high

310
Q

Ddx for secondary amenorrhea with + progesterine challenge and LOW leutinizing hormone

A

pituitary adenoma, hypothyroidism, low gonadotropin hormone

311
Q

Test to check is patient has secondary amenorrhea that you think is from pituitary adenoma

A

prolactin

312
Q

Patient with secondary amenorrhea with normal prolactin, normal TSH and low gonadotropin likely has

A

anorexia nervosa

313
Q

A patient with secondary amenorrhea with + progesterone bleeding test can likey become pregnant by using which drug?

A

clomiphene

314
Q

Secondary amenorrhea with no bleeding on progesterine challenge has (generally)

A

insuffecient estrogen

315
Q

Secondary amenorrhea with no bleeding on progesterine challenge with elevated FSH has

A

premature ovarian failure/menopause

316
Q

FSH is _____ in premature ovarian failure

A

elevated

317
Q

Secondary amenorrhea with no bleeding on progesterine challenge with low/normal FSH may have

A

neoplasm of hypothalamus (get MRI of brain)

318
Q

First test to order in amenorrhea

A

pregnancy test

319
Q

Nulliparous 35 yr woman with dyspareunia and dyschezia

A

endometriosis

320
Q

Most common site for endometriosis

A

ovaries

321
Q

Tender adnexa WITHOUT evidence of PID =

A

endometriosis

322
Q

Endometriosis may be associated with this uterine position

A

retroverted

323
Q

Gold standard for diagnosis of endometriosis

A

laparoscopy with visualization

324
Q

Mulberry spots

A

endometriosis

325
Q

flat brown colored powder burns

A

endometriosis

326
Q

chocolate cysts

A

endometriosis

327
Q

Most likely cause of infertility in menstruating woman over 30

A

endometreosis

328
Q

Treatment of endometriosis

A

1st: birth control pills, 2nd/3rd: danzol, GnRH agonists

329
Q

Effect of surgery for endometriosis on fertility

A

often improves it

330
Q

Define adenomyosis

A

ectopic endometrial glands within uterine musculature

331
Q

Typical characteristics of adenomyosis

A

dysmenorrhea, large boggy uterus

332
Q

Woman over 40 with large boggy uterus and dymenorrhea

A

adeomyosis

333
Q

Treatment of adenomyosis

A

D&C to r/o endometrial cancer, consider hysterectomy, may try GnRH agonists

334
Q

Define dysfunctional uterine bleeding

A

abnormal uterine bleeding not associated with tumor inflammation or pregnancy

335
Q

70% of dysfunctional uterine bleeding is associated with

A

anovulatory cycles

336
Q

When is dysfunction uterine bleeding common and physiologic?

A

Right are menarche and before menopause

337
Q

If dysfunctional uterine bleeding that doesn’t appear simple, think

A

polycystic ovarian syndrome

338
Q

What needs to be done in woman over 35 with dysfunctional uterine bleeding?

A

D&C to r/o endometrial cancer

339
Q

Why should you get a CBC in patient with polycystic ovarian syndrome?

A

excess blood loss

340
Q

4 uncommon causes of dysfunctional uterine bleeding

A

infections, end, ocrine disorders, coagulation defects, estrogen producing neoplasms

341
Q

First line treatment for idiopathic dysfunctional uterine bleeding

A

NSAIDs or OCPs

342
Q

First line treatment for dysmenorrhea

A

NSAIDs

343
Q

Treatment of severe bleeding with dysfunctional uterine bleeding

A

progesterone

344
Q

Overweight woman with infertility and amenorrhea

A

polycystic ovarian syndrome

345
Q

Most common cause of infertility in woman under 30 with ABnormal menstruation

A

polycystic ovarian syndrome

346
Q

LH:FSH in polycystic ovarian syndrome

A

greater than 2:1

347
Q

Cancer risk in polycystic ovarian syndome

A

unopposed estrogen causes increased risk for endometrial hyperplasia and enodmetrial carcinoma

348
Q

Treatment of polycystic ovarian syndrome

A

OPCs, cyclic progesterone, Metformin, if wants pregnancy, use clomiphene

349
Q

Treatment of premenstrual dysphoric disorder

A

NSAIDs; antidepressants

350
Q

Increase parabasal cells on vaginal cytology indicates

A

menopause

351
Q

Fibroids aka

A

leimyoma

352
Q

Are leiomyomas malignant or benign?

A

benign

353
Q

Most common indication for hysterectomy

A

leiomyoma

354
Q

Rate of malignant transformation of leimyoma

A

<1%

355
Q

When do leiomyomas often grow rapidly?

A

During pregnancy or high estrogen (OCPs)

356
Q

Anemia with fibroids is an indication for

A

hysterectomy

357
Q

Test that should be done in woman over 40 with leiomyoma

A

D&C to r/o endometrial cancer

358
Q

Polyp protruding through cervix is likely

A

leiomyoma

359
Q

If a patient has bilateral non-bloody breast discharge, what are the chances that it’s cancer?

A

very low

360
Q

Unilateral breast discharge is concerning for

A

cancer

361
Q

Most common breast disorder

A

fibrocystic disease

362
Q

Treatment of fibrocystic breast disease if under 35

A

if symptoms are very severe can do progesterone or danazol for a week at the end of each month

363
Q

Features of fibrocystic breast disease

A

under 35, bilateral, multiple cystic lesions, tender

364
Q

A painless, shaprly circumscribed, rubbery, mobile breast mass is likely

A

fibroadenoma

365
Q

Most common benign tumor of the female breast

A

fibroadenoma

366
Q

Age when you become more concerned about breast cancer

A

35

367
Q

Treatment of fibroadenoma of the breast

A

excision is curative but often not needed

368
Q

Fibroadenoma of the breast often growns quickly in the setting of

A

OCPs or pregnancy (estrogen)

369
Q

Is mammogram useful under the age of 35?

A

No. Breast tissue too dense. Proceed directly to biopsy

370
Q

This potentially malignant tumor often masquerades as a rapidly growing fibroadenoma of the breast

A

phylloides tumor

371
Q

In a woman over 35 with a breast mass, when in doubt…

A

get a biopsy

372
Q

A new breast mass in a postmenopausal woman…

A

is breast cancer until proven otherwise

373
Q

Pelvic heaviness that is worse with standing and improves with lying down may be

A

vaginal prolapse

374
Q

A bulge into the upper vaginal wall is likely

A

a cystocele

375
Q

Symptoms of cystocele

A

urianry urgency, frequency and incontinence

376
Q

A bulge into the lower posterior vaginal wall is likely

A

a rectocele

377
Q

Symptoms of rectocele

A

difficultly defecating

378
Q

What is an enterocele

A

bulding of loops of bowel into upper posterior vaginal wall

379
Q

Treatment of -celes (cystocele, etc)

A

pelvic strengthening

380
Q

1st step in eval of infertility (after based H&P)

A

semen anlysis

381
Q

Risk factor for uterine synechiae

A

D&C

382
Q

What radiographic test do you order to look for uterine structural abnormalities?

A

hysterosalpingogram

383
Q

Clomiphene can be used to stimulate ovulation in what setting

A

need adequate estrogen

OB-Gyne (1 decks)

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