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OB/GYN > OB uworld > Flashcards

OB uworld Flashcards

1
Q

How does obesity lead to increased estrogen

A

Adipose tissue converts androgens into estrogens

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2
Q

Is breast cancer associated with ovarian or endometrial cancer or both

A

Breast and ovarian cancer associated (BRCA), not endometrial

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3
Q

Which female hormone increases risk and which decreases risk of endometrial cancer

A

Estrogen increases risk - proliferation

Progesterone decreases risk - differentiation

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4
Q

How does breast feeding cause contraception

A

Prolactin inhibitd GnRH release, so prevents FSH LH ovulation and menstruation

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5
Q

What cancer drug causes endometrial huperproliferation and increased risk of endometrial cancer

A

Tamoxifen

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6
Q

Asherman syndrome
Etiology
Symptoms

A

Intrauterine adhesions eg from prior endometrial curettage

Amenorrhea and cyclic pelvic pain from obstruction of endometrial outflow

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7
Q

When postpartum do b-hCG levels become undetectable

A

2-4 weeks postpartum

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8
Q

Oral or intravaginal fluconazole for vaginal candidiasis?

A

Either works, oral usually preferred first line by patients, just easier

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9
Q

Define adenomyosis

A

Endometrium growing in the myometrium

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10
Q

Symptoms pf bicornuate uterus

A

Usually asymptomatic, discovered incidentally during unrelated surgery

May cause pregnancy complications – IUGR or preterm delivery

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11
Q

Treat PMS/PMDD in pt w migraines with aura

A

SSRI

OCPs contraindicated in migraines with aura

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12
Q

What phase of the menstrual cycle should symptoms arise in symptom diary to be consistent with PMS/PMDD

A

Luteal phase (1-2 weeks prior to menstruation, the phase when LH amd Progesterone are higher after ovulation)

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13
Q

Menopause is characterized by elevation in what hormone

A

FSH

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14
Q

TF

BMI of 20 rules out functional hypothalamic amenorrhea as a cause of amenorrhea in a competitive athlete

A

False
RELATIVE caloric deficiency causes decreased GnRH and decreased FSH LH E P and sc such as breast atrophy, infertility, vaginal atrophy, osteoporosis – all the manifestations of estrogen deficiency

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15
Q

Mechanism of functional hypothalamic amenorrhea in a competitive athlete

A

RELATIVE caloric deficiency causes decreased GnRH and decreased FSH LH E P and sx such as breast atrophy, infertility, vaginal atrophy, osteoporosis – all the manifestations of estrogen deficiency

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16
Q

Symptoms of androgenic steroid use in a female athlete

A

Virilization (male baldness, deep voice, big clit)
Hypertension
Aggressive behavior / Mood Disorders

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17
Q

Pathophys of HELLP Syndrome

A

Abnormal placentation causing systemic inflammation and activation of the complement and coagulation cascades

MAHA microangiopathoc hemolytic anemia hurts the liverin particular

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18
Q 
Prolonged PT and PTT
Hypoglycemia
Encephalopathy
In 3rd trimester or early postpartum
Think...
A

Acute fatty liver of pregnancy – acute hepatic failure in 3rd trimester or early postpartum

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19
Q

Treat HELLP syndrome

A

Antihypertensive med and/or mag for seizure prophylaxis

Then deliver baby when mom stabilized

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20
Q

When to consider transfusion for HELLP Syndrome

A

Preop before cesarean if plt v40,000/mm^3

Prophylactically if plt v 20,000/mm^3

Otherwise delivery of baby spontaneously resolves HELLP

so standard tx is Antihypertensive med and/or Mag for seizure prophylaxis, then Deliver baby when mom stabilized

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21
Q

Bartholin duct cyst
Typical age
Pathophys

A

Common v30yo

Duct obstruction by dried mucoid glandular secretions, trauma, or idiopathic

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22
Q

Condyloma accuminata
Derm description
Pathogen

A

Exophytoc or sessile vulvar growths that may be solitary or multiple

HPV 6 and 11

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23
Q

Gartner duct cysts
Number, Location
Pathophys

A

Single or multiple submucosal along upper anterior vagina

Incomplete regression of Wolffian duct during development

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24
Q

Most common symptom of vulvar swuamous cell carcinoma

A

Pruritus, long-standing vulvar pruritus

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25
Q

Treat bartholin cyst

A

Observation if asymptomatic.. may regress spontaneously

I and D if symptomatic or abscess, can place Word catheter to prevent recurrence

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26
Q

How do renal function and renal bmp labs change during pregnancy

A

inc RBF and GFR and protein excretion

so dec BUN and Cr

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27
Q

TF

Cr 1.2 mg/dl is normal in pregnancy

A

F
Normal in non-pregnant

Renal insufficiency in pregnant (GFR should ^^)

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28
Q

Mechanism of hypercoagulability in pregnancy

A

Dec protein S
Protein C resistance
Inc fibrinogen

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29
Q

TF

Urine dipstick +1 for protein is normal in pregnancy

A

T

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30
Q

HPV testing is recommended when _____ is identified on pap

A

HPV testing is recommended when ASCUS is identified on pap

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31
Q

Cerical cancer screening guidelines

A

v21 pap only if immunocompromised

21-30 pap q3

30-65 pap + hpv testing q5, or pap q3

65+ stop screening if prior screens negative for 10 years and most recent within 5 years

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32
Q

TF

Oophorectomy for an ovarian teratoma

A

F
Just cystectomy usually – young girls, benign mass, high risk of contralateral recurrence, don’t start taking ovaries out, just get the mass

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33
Q

BRCA1/2 increases risk for

A

All GYN cancers – breast ovarian uterine

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34
Q

Paclitaxel chemo for what kind of ovarian cancer

A

Dysgerminoma

Very sensitive to chemo, like seminoma in testicular cancer

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35
Q

Rokitansky nodule

A

Mural nodule in a benign ovarian teratoma / dermoid cyst

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36
Q

Mural nodule in a benign ovarian teratoma / dermoid cyst

A

Rokitansky nodule

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37
Q

Manage BRCA1/2+ pt with no signs of cancer yet (ca125 neg, mammo neg, tvus neg)

A

Prophylactic bilateral mastectomy at any age, if not willing then Tamoxifen chemoprevention, if not willing then semiannual screening with MRI and Mammo

TAH+BSO at 35yo, semiannual TVUS and CA-125 till then

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38
Q

Which ovarian cancers are hormone-secreting and what are their demographics

A

Granulosa-Theca cell tumor – child precocious puberty

Serous cystadenocarcinoma – old lady

39
Q

TF

Ovarian germ cell tumors secrete hormones

A

F
Stromal Granulosa-Theca cell tumors do
And
Epithelial Serous CystAdenoCarcinomas do

40
Q

What is the tumor marker for ovarian dysgerminoma

A

LDH

41
Q

TF

CA-125 is the tumor marker for ovarian dysgerminoma

A

F

LDH is the tumor marker for dysgerminoma

42
Q

Add tumor to tumor marker:

LDH
CA-125
CA19-9
bHCG
AFP
A

LDH - ovarian dysgerminoma
CA-125 - epithelial ovarian cancers, colon cancer
CA19-9 - pancreatic cancer
bHCG - choriocarcinoma, molar pregnancy
AFP - yolk sac tumors, hepatocellular carcinoma

43
Q

The Only tumor marker that Can be used diagnostically

A

AFP

eg characteristic lesion on ultrasound or triple phase CT and elevated AFP is HCC without need for biopsy

44
Q

Treat condyloma acuminata

A

Imiquimod and cryotherapy

45
Q

What cancer was caused by in utero DES exposure?

A

Vaginal Adenocarcinoma

46
Q

TF

DES exposure in utero is a risk factor for Endometrial cancer

A

F

DES in utero raises risk of Vaginal Adenocarcinoma

47
Q

What does vulvar squamous cell carcinoma look like
Is it caused by HPV
What other cancer can it be confused with

A

Pruritic, darkly pigmented
Not caused by HPV (that’s vaginal amd cervical SCC)
Can be confused with vulvar Melanoma

48
Q

The more times a woman ____, the more likely she is to get ovarian adenocarcinoma

A

The more times a woman Ovulates, the more likely she is to get ovarian adenocarcinoma

49
Q

TF

Basal cell carcinoma of the vagina is common

A

F
Think more face and sun exposed areas for BCC

Vaginal cancers are pretty confined to SCC Melanoma and Pagets

50
Q

3 forms of vulvar cancer

A

SCC Melanoma and Pagets

51
Q

Itchy black lesion on vulva
Next step
What cancers are you looking for

A

Biopsy

diff SCC from Melanoma

52
Q

teardrop shaped growths at vestibule of vulva turn white with acetic acid application
Dx
Pathogen
Tx

A

Condyloma accuminata from HPV

Imiquimod, podophylin, or trichloroacetic acid if they are small

Excision or fulgerationif they are large

53
Q

What vulvar lesion do you treat with wide incision and resection

A

Invasive Melanoma

54
Q 
Itchy porcelain white atrophic thin skinned vulvar macules or patches
Dx
Pathophys
Next step
What must be ruled out 
How can it progress over time
A

Lichen sclerosis
Chronic inflammation

Punch biopsy to rule out SCC

With excoriations can erode minora clit and introitus, thicken, constrict, cause dyspareunia and dysmenorrhea

55
Q

4 things that make MTX a good option for extopic treatment

A

v3cm
bHCG quant v8,000
Not taking Folate
No Fetal Heart Tone

56
Q

Management options and indications for retained fetal parts in seting of spontaneous abortion

A

Expectant management if inevitable or incomplete abortion (admit, IVMF, determine RhD status, monitor for signs of sepsis or hemorrhage, wait for parts to pass)

D and C for missed abortion v24 weeks

Induced delivery for missed abortion ^24 weeks

57
Q

What os a “shock index”

A

HR greater than SBP

58
Q

Acute abdomen with peritoneal signs, intraperitoneal fluid on FAST, hemodynamic instability

Transfuse before ex lap?

A

No
Not going to admit to floor, prder blood, wait for type/cross, thaw blood product, wait for CBC after transfusion

You are going to take to OR for ex lap and get iv access and start fluids and get the transfusion process going as you operate

59
Q

TF

Ripening but closed os with dead fetus counts as an inevitable abortion

A

T

60
Q

Abx for tuboovarian abscess

A

IV cefoxitin and PO or IV Doxycycline

IV cefotetan and PO or IV Doxycycline

IV gent and clinda

IV azythro?

+- metronidazole

61
Q

Which is more important in inpatient infection management, source control or antibiotics?

A

Antibiotics

The sooner they are started, the better the outcome

62
Q

White coat htn is unlikely if diastolic is ^ _____

A

^105

63
Q

Fetal hydantoin syndrome

Drugs that cause

A

Phenytoin, carbamazepine, other anticonvulsants

64
Q

Early signs of congenital syphillis

Later signs of congenital syphillis

A

Snuffles (rhinitis)
Hepatomegaly
Skin lesions

Hutchinson teeth
Saddle nose
Saber shins
Deaf
Interstitial keratitis
65
Q

When is D and E vs induced vaginal delivery recommended for intrauterine fetal demise

A

20-23 wks can do either

24 wks or more, induce vaginal delivery

66
Q

3 things that ^ maternal serum AFP

1 thing that v

A

^ abdominal wall defect, neural tube defect, multiple gestation

v aneuploides (18, 21)

67
Q

TF

Alcohol is a risk cor breast cancer

A

T

68
Q

What kinds of cancer diagnoses indicate brca testing

A

Breast cancer v50yo

Ovarian cancer any age

69
Q

TF

OCPs decrease breast cancer risk

A

F
No effect on breast cancer

Decrease ovarian cancer risk (less ovulation)

70
Q

Adverse effects oxytocin

A

Water retension, Hyponatremia, Seizures (adh-like effect with prolongued administration)
Hypotension
Tachysystole

71
Q

Normal Mg level

Therapeutic ramge for preeclampsia

A

1.5-2 normal

5-8 therapeutic

72
Q

Gastroschisis is associated with forst trimester use of _____

A

NSAIDS

73
Q

4 contributing factors to pathophys of pulmonary edema in preeclampsia/eclampsia

A
  • vasospasm, increased afterload, back up into lungs
  • increased vascular permeability
  • decreased albumin / intravascular oncotic pressure
  • decreased renal function
74
Q

4 contributing factors to pathophys of pulmonary edema in preeclampsia/eclampsia

A
  • vasospasm, increased afterload, back up into lungs
  • increased vascular permeability
  • decreased albumin / intravascular oncotic pressure
  • decreased renal function
75
Q

Manage pulmonary edema in preeclampsia/ eclampsia

A

Supplemental oxygen

Fluid restriction and diuresis very cautiously amd sparingly because intracascular volume depleted from third spacing

76
Q

First line mgmgt for restoration of ovulatory cycle in pcos

A

Weight loss

Then OCPs

77
Q

Premature ovarian failure often concomitant with a ______ disorder

A

Autoimmune disorder

78
Q

Delivery is indicated for PPROM at what gestational age

A

34 weeks

79
Q

Cause of paget disease of the nipple

A

We think migration of breast cancer (Adenocarcinoma most common in pagets and breast cancer in general) down ducts to nipple surface

80
Q

TF

Pts w functional hypothalamic amenorrhea get hot flashes and night sweats

A

F
No vasomotor symptoms
But decreased estrogen

(Primary ovarian insufficiency may get hot flashes…)

81
Q

Diagnose and treat antiphospholipid syndrome

Pathophys

A

Hypercoagulability eg tia dvt stroke
Or
Recurrent miscarriages, fetal growth restriction, preeclampsia

And
1 or more positive
-anti-cardiolipin antibody
-lupus anticoagulant
-anti-beta2 glycoprotein antibody

Treat by anticoagulating - heparin, warfarin

AI antibodies against membrane phospholipids

82
Q

How does antiphospholipid syndrome cause recurrent miscarriages

A

Placental thrombosis

83
Q

TF

Subserosal fibroid is associated with recurrent pregnancy loss

A

F

Too far from cavity

84
Q

TF

Uncontrolled hyper or hypothyroidism can cause recurrent pregnancy loss

A

T… but more often causes menstrual irregularities and infertility

85
Q

How does hemorrhagoc shock redistribute blood relative to the uterus

A

Toward brain heart lungs kidneys… so away from uterus

86
Q

Kleihauer-Betke test is used to

A

Determine amount antiRhD immunoglobulin to give to Rh negative mother of Rh+ fetus

87
Q 
Pseudocyesis
Define
Pathophys
Presentation
Treatment
A

Define
Pathophys
Presentation
Treatment

88
Q

Erb-Duchenne vs Klumpke palsy
Aka
Nerves involved

A

Waiter’s tip vs Claw hand

C5-6 vs C8-T1

89
Q

Normal contracted fundal hight on postpartum physical

A

1-2cm above or below umbilicus

90
Q

What is vulvar paget disease

How is it different from breast paget disease

How do you diagnose it

How do you treat it

A

Intraepithelial adenocarcenoma that has an erythematous eczematous appearance and intense pruritus

Not different from breast, just not in the breast

Dx with biopsy

Tx with local resection

91
Q

Forst trimester combined test analyzes risk of ________ by measuring ________
Is it screening or diagnlstic?

A

Forst trimester combined test analyzes risk of ________ by measuring ________
Is it screening or diagnlstic?

92
Q

Synovial fluid leukocyte count in prosthetic joint infection

A

^1 but often less than 50 like in septic native joints

93
Q

Tome to onset of prosthetic joint infection implicates which bugs accordingly

A

v3 months postop — suspect birulent organisms like staph aureus amd pseudomonas

94
Q

Pick new antidepressant for pt failed trial of 2 ssris with weigt gain and sleeping a lot

A

Buproprion
ndri
promotes weigjt loss and

OB/GYN (5 decks)

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