OB/GYNE Flashcards
HIGH YIELD REVIEW
A pregnant woman with b/p > 140/90 prior to conception or 20 weeks gestation has what?
Chronic Hypertension
The only advantage with gestational hypertension vs chroninc hypertension?
No end organ damage or proteinuria
Difference btw gestational hypertension and preeclampsia?
pre-eclampsia has proteinuria or signs of en-organ damage.
True or false, can a patient have chronic hypertension with superimposed pre-eclampsia?
yes. This is when a patient with chronic hypertension ends up having new-onset proteinuria, worsening of existing proteinuria at >20 weeks gestation, sudden worsening of htn and s/s of end-organ damage.
SERM used to treat post-menopausal osteoporosis?
Raloxifene
SERM that has the side effect of edometrial hyperplasia and carcinoma?
Tamoxifen (adjuvant treatment for breast cancer).
80% of moms with placenta abruption will present this way.
Sudden-onset vaginal bleeding.
2 substances that place a patient at risk for placental abruption?
Cocaine and tobacco use
Fasting blood glucose of how less than add equal to what is the cutoff point for gestational diabetes?
< and equal to 95mg/dl
First line treatment for gestational diabetes?
Dietary modifications
Congenital anomalies that occur in women with first trimester hyperglycemia.
congenital heart disease, neural tube defects, small left colon syndrome, spontaneous abortion.
The 4 consequences of fetal hyperinsulinemia due to maternal hyperglycemia.
Increased metabolic demand (fetal hypoxemia, increased erythropoesis, polyceythemia)
organomegaly (liver and heart)
Macrosomia (shoulder ditotia, birth injuries)
Neonatal hypoglycemia
Painless third trimester bleeding is a clinical feature of?
Placenta previa
Next step in management of placenta previa ?
Transabdominal, followed by transvaginal sonogram
Risk factors of placenta previa?
Prior placenta previa
prior c-section or other uterine surgery
multiparity
advanced maternal age
Treatment for confirmed gonorrhea?
Ceftriaxone
Treatment for confirmed chlamydia?
Doxycycline or Azithromycin
A polymicrobial infection characterized by fever, purulent vaginal discharge and uterine tenderness. Dx & Tx?
Clindamycin plus gentamycin
Contraindication to copper IUD
Wilson disease
Contraindication to progestin IUD
Active liver disease and current breast cancer
What are the family history risk factors for breast cancer?
- 2 first degree relatives with breast cancer including one <50
- 3 or more 1st or 2nd degree relatives with breast cancer.
- First or second degree relative with breast or ovarian cancer.
- First degree relative with bilateral breast cancer
- Breast cancer in a male relative
- Ashkenazi Jewish women with any 1st or second degree relative with breast or ovarian cancer.
Age of breast cancer screening recommendation q 2 yrs?
50 -75 yrs of age
treatment options for uretheral diverticula?
Manual decompression, surgical repair, needle aspiration
How to manage preterm premature rupture of membranes between 34 - 37 weeks?
Delivery
GBS prophylaxis/PCN G
+/- Steroids
How to manage preterm prelabor rupture of membranes in <34 weeks gestation when mother is infected and there is fetal/maternal compromise?
Delivery
IAI treatment (ampicillin, gentamycin)
steroids
Magnesium if < 32 weeks
How to manage preterm prelabor rupture of membranes in <34 weeks in an uncomplicated situation?
Expectant management
Latency antibiotics (ampicillin, Azitromycin)
Steriods
Fetal surveillance
Complex breast cysts must be biopsied. When should simple breast cysts be biopsied?
Biopsy and additional imaging is required if FNA aspirate was bloody.
A negative test result on a highly sensitive test does what?
Rules out the disease
The best epidemiological parameter used to compare screening tests when applied to individual patients?
Likelihood ratio: The probability of a given test result occuring in a patient with a given disorder vs a pt w/o the disorder. It does not vary with disease prevalence and provides clinically useful information for patients.
A type of measurement bias that uses gold standard testing selectively in order to confirm a negative or positive result of preliminary testing. This can result in overestimates or underestimates of sensitivity or specificity
Verification or work-up bias
Long philtrum, midfacial hypoplasia, short palpebral fissure, Microcephaly. Dx?
Fetal alcohol syndrome
Congenital deafness, congenital heart defects. What teratogen?
Isotretinoin/Accutane
Mother gets diabetes insipitus, baby gets Epstein’s anomaly. Teratogen?
Lithium
Damage to CN 8 leading to hearing impairment. Teratogen?
Streptomycin
Competes with calcium, teeth discoloration after 4 months, muscle contraction impairment, bone matrix. Teratogen?
Tetracycline
Ocular hypertelorism (misalignement of cornea), strabismus, short fingers (distal phalangeal hypoplasia), short nose and low bridge, fetal hydantoin syndrome. Teratogen?
Dilantin/Phenytoin
Fetal valproate syndrome. Neural tube defect, CVS abnormalities, GU defects, developmental delay, limb defects. Teratogen?
Valproic Acid/Depakote
Chondrodysplasia: stippled epiphysis and multiple ossification centers. leads to weakening of the bone and bone necrosis/breakage.
Warfarin
Independent risk factors for endometrial cancer
Diabetes and HTN
ENDOMETRIUM
Will need Anastrozole to stop peripheral conversion of fat to estradiol.
EXCESS EXOGENOUS ESTROGEN
N: NULLIPARTY
D: DIABETES
O: OBESITY
M: Late menopause
E:ESTROGEN
T:
R:
I:
U:UNOPPOSED ESTROGEN
M: MENOPAUSE LATE
side effects of progesterone therapy
bleeding
The 4 d’s of endometriosis
Dysmennoria
Dysparinuea (retroflex uterus)
Dysfertility/Infertility
Dyschezia (painful bowel movements)
Dysuria
Retrograde mentruation
Age range for fibrocystic breast disease vs fibroadenoma?
Fibrocystic : 20 - 50
Fibroadenoma: younger
what is a biophysical profile?
non-stress test: 2
Amniotic fluid volume: 2
fetal tone:2
fetal activity:2
fetal breathing movements:2
High score is good/placenta is doing well
4-6 is non-reaasuring
2-3, deliver baby
key difference between mastitis and fat necrosis
staph in mastitis, give antibiotics and keep breastfeeding
Most common benign breast lesion?
Fibroadenoma
rubbery, smooth, well circumscribed, non-tender
women < 30
bartholin glad abscess or cyst position?
4pm or 8pm location
bloody nipple discharge? Negative US and mammogram?
It is on the duct hence the serosanguinous discharge. Intraductal papillloma. Involved the epithelial lining of the breast ducts
cluster Microcalcifications on mammography, no mass on mmammography =
DCIS
Does not spread to the stroma
treatment for DCIS?
Simple mastectomy with wide margins & radiation plus tamoxifen for 5 years.
Difference between lichen sclerosis and lichen planus chronicus
read
How do you know we have placental abruption?
Change in fetal position
Painful
Lots of blood loss/transfuse mom after getting baby out
90 yo f with estrogen positive breast cancer, Tx?
Aromatase inhibitor
Anatrozole, letrozole
Hair, skin, teeth, nails in these tumors, fast growers, benigh, hemorrhhage necrose and produce pelvic pain. Tx
benighn cystic teratoma/Detmoid cyst of the ovary
Unilateral oohorectomy
Hallmarks of a scc of the vulvar
ulcerated
slowly expanding
did not respond to topical treatments
labia majora
pruritus, pain and bleeding
tx with wide excision
local inflammatory reaction toxic to sperm and ovum. use in sexual assault victims, avoid in Wilson disease or bleeding patient
Copper IUD
Higher incidence of transforming into choriocarcinoma
Partial molar pregnancy
Why do a quantitative HCG in a patient after resecting choriocarcinoma?
Monitor, did we get all of the cancer?
How could a turner patient ave an extopic pregnancy?
IVF
MOST COMMON SITE FOR ECTOPIC PREGNANCY
AMPULLA, ISTHMUS AND FIMBRIAE
RF for ectopic pregnancy
PID, KARTAGENER,
PREGNANCY WITH LOW HCG?
ECTOPIC PREGNANCY
GIVE METHOTREXATE
Rh negative mom with Rh positive baby?
Give Rhogam
3 sets of epithelial cancers
Epithelial
Germ cell
Sex cord
serous cystadenocarinoma
(most common ovarian neoplasm)
Subset of epithelial
CA-125
produces psammoma bodies
Brenner Tumor
Bladder-like epithelium
mucinous cystadenocarcinoma of the ovaries
pseudotumor peritonei
lined by mucin producing epithelium
sex cord ovarian cancers
Granulosa
sertoli-leydig
thecoma
Fibroma
Ovarian fibroma
Will lead to meig’s syndrome
fibroma
spindle shaped
grey to yellow-brown mass, tubules/cords ined. Breast atrophy
Sertoli-leydig
Abnormal menstrual bleeding in a post-menopausal woman.
Thecoma
sex cord tumor
produces estrogen
4 types of germ cell ovarian cancers
Immature teratoma
Mature teratoma
dysgerminoma
yolk sac
Fried egg apearance, uniform cells in the ovary, adolescent,
Dysgerminoma
less than 20 yo
has all 3 germ layers
Immature Teratoma
schiller-duval bodies
AFP markedly elevated
Yellow mass
yolk sac
Call-exner bodies
post-menopausal women
breast tenderness
Granulosa tumor
most common
produces lots of estrogen, sexual percosity
endometrial hyperlasia
post-menopausal bleed
male > 20
painless, testicular enlargement
large cells in lobule with fried egg apperance
increased placental alkaline phosphatase
no change in AFP
Increased b-HCG
seminoma
Brother tumor of dysgerminoma
< 3 years old (mc testicular tumor in kids under 30
no change placental alkaline phosphatase
increase in AFP
Increased b-HCG
Schiller-Duval (resembles primitive glomeruli)
yolk sac tumor/endodermal sinus tumor
yellow in color
no change placental alkaline phosphatase
no change in AFP
Increased b-HCG (leads to hyperthyroidism/since similar to TSH)
Gynecomastia
cytiotrophoblast and cytotrophoblast
malignant disorder
syn
choriocarcinoma
mets in lungs (cannenball)
Mets in brain
no change placental alkaline phosphatase
no change in AFP
Increased b-HCG
Biopsy of testicle, golden brown color, eosinophilic, cytolplasic inclusion (Reinke crystals), produces androgens
gynacomastia (excess estrogen)
Sertol-leydig
benign
Any cell with inclusions in it? Ex inclusion body
Benign
Any cell with no inclusions
Cancerous
GnRH analog with agonist (pulsatile) and antagonistic properties (continuous)
Shrink fibroids, cut down estrogen, prostate cancer (continuous)
Ex. Lupron/Leuprolide
GnRh Antagonist
Ganirelix
Orlissa
GnRh Agonist
Goserelin
breast biopsy with orderly row cells and duct formation
can have bloody or non-bloody discharge
Intraductal papilloma
paget cells
adenocarcinoma cells
increased lymphocytes/plasma cells
large anaplastic cells growing i sheets, well circumscribed
Invasive medullary breast Cancer
SERM Good for osteoporosis AND antagonist in the endometrium and agonist in the breast
Raloxifene
progesterone receptor blocker/A
Mifipristone (progesterone/kills the baby)
Ullipristol (plan B)/RAPE KIT CART
Misopristol (prostaglandin/takes it out)
Rape kit drugs
NRTI/NNRTI
Ceftriaxone and Azithro
Mifiprisone (abortion, higher dose) & Ullipristal (pregnancy termination)
Synthetic androgen/agonist
Hereditary Angiodema and fibroids?
Danazol
SE:Hepatotoxicity
Elevated intracranial pressure
Dihydrofolate reductase blocker
Finesteride
se: gynecomastia (give anastrazole)
treat BPH, HTN, & PTSD
Prazosin
Do not give with nitrates
Androgen Antagonist
Decreases steroid binding to the receptor
Flutamide
Good for protate cancer
gleason score of 9
Mets to the spine
Alpha antagonist
Tamsulosin
SE: Orthostatic hypertension
Direct arterial vasodilator
Used for refractive hypertension as well
Minoxidil
se: Reflex tachycardia, give them a beta blocker. If they are asthmatic and on a B2 agonist
‘hair loss
Why not give hydralazine to pre-eclampsia patient?
Lupus-likereaction
causes reflex tachycardia
choose labetalol instead, will decrease blood pressure and heart rate
outer layer of chorionic villi synthesis and secrete hormone like B-HCG (SIMILAT TO LH & FSH)
SYNCYTIOTROPHOBLAST: PRODUCE PROGESTERONE
How does hypothyroidism cause amenorrhea?
TRH causes prolactin secretion
hormones affected in sheehans
anterior pituitary
type of necrosis caused by pituitary apolexy?
Necrosis
paramesonephric duct/Mullerian duct
female parts: uterus, fallopian, proximal vagina
Mesonephic Duct
Wolfian duct
male plumbing: vas deferens, seminal vesicles, ductus
Associated with bladder extrophy and dorsal
Epispadias
dorsal
failure of the uretheral folds to fuse. Associated with inguinal hernias
Hypospadias
Are testes descended?
- genetic male XY
- No uterus
- No breasts
- Normal testes
- Normal penis
High testosterone
Converted to estradiol
vagina made
AIS (Androgen Insensitivity syndrome). Insensitive to testosterone.
Complete mole vs partial mole
Tripple,triplicates XXY= partial mole (Maternal contribution)
fetal arts
Complete mole
No fetal parts
5% risk of choriocarcinoma/higher
snow storming
paternal contribution
