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OBG > OBG > Flashcards

OBG Flashcards

1
Q

Maternal fever, tachycardia, uterine tenderness, malodorous and purulent amniotic fluid, vaginal discharge, and fetal tachycardia indicates ____

A major risk factor is ____

A

chorioamnionitis

premature rupture of membranes (PROM)

Tx
Vag birth: (IV ampicillin + gentamicin)
C-sec: (IV ampicillin + gentamicin + clindamycin)

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2
Q

A tender, erythematous, palpable cord with nodular thickening at the lower extremities that remains visible when the limb is raised suggests

A

superficial thrombophlebitis (ST)

get a duplex u/s

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3
Q

Uterine atony can be managed with bimanual uterine massage + uterine stimulant (uterotonic) ____ + additional uterotonic agents like (1-3)

Surgical interventions (hysterectomy) may be necessary if conservative therapy has no effect within 30 minutes.

A

oxytocin
misoprostol, methylergonovine &
tranexamic acid (TXA)

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4
Q

____ is indicated as a first-line test in the diagnostic workup of patients with AUB who are >45 years old, or in < 45 with risk factors for endometrial cancer (obesity, PCOS, nulliparity, early menarche, DM, on tamoxifen) or do not respond to medical management.

A

Endometrial biopsy

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5
Q

Name 2 gonadotropins

A

FSH

LH

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6
Q

____ is the best management option for patients with endometrial cancer who do not wish to preserve fertility or have reached menopause.

A

Total hysterectomy and bilateral salpingo-oophorectomy (TAH/BSO)

For patients with advanced disease (myometrial invasion) Additional therapy should be given (Radiation therapy, chemotherapy).

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7
Q

____ can be considered in young patients with
early-stage ENDOMETRIAL CANCER
confined to the uterus
who desire future pregnancies.

A

High-dose progestins

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8
Q

Women with GBS bacteriuria occurring anytime during pregnancy or history of a previous newborn with GBS infection should _____.

A

receive ppx Penicillin
&
don’t need screening for GBS

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9
Q

Intrauterine Fetal Demise

what do next?

A

Induction of labor with IV Oxytocin

NOT C-Section!

Offer grief counseling and AUTOPSY

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10
Q

Pregnant woman with Asymptomatic Bacteuria

what do next?

A

Treat and get a test of cure

Nitrof, Amoxicillin, Phosphamycin

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11
Q

Pregnant woman with Pyelonephritis

what do next?

A

Treat with IV Ceftriaxone

+ Nitro for rest of pregnancy

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12
Q

Isolated increase in AFP (5)

what mean?

A 
Incorrect dating (MCC)
Neural Tube defect, 
Abdominal wall defect, 
Twins, 
fetal Hypothyroidism
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13
Q

+ Quad screen

what do next?

A

get u/s

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14
Q

What week do we give

RhD Ig in Rh (-) mom

A

28w

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15
Q

GBS vaginal swab when?

A

35-37w

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16
Q

NTD screen via U/S

when?

A

18-20w

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17
Q

Elevated prolactin inhibits what?

A

GnRH thus FSH, LH

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18
Q

Contraindications to breast feeding?

4

A

HIV
Active HSV
Galactosemia
Drugs (PCP, Cocaine, Cannabis etc.)

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19
Q

MCC of Fever s/p C-Section

tx:

A

Endometritis

Clinda + Gent

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20
Q

Prolonged rupture of membranes can cause:

A

Chorioamnionitis
(foul amnio smell)
tx: Oxytocin, Ampicillin + Gentamicin, GBS ppx

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21
Q

Baby ≥ __g

do a C-section

A

5,000g (11 Ibs) (really 4990g)

4,540g (10 Ibs) → Diabetic Mothers

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22
Q

Complications of Gestational Diabetes?

4

A 
Polyhydraminos, 
Pre-eclampsia, 
Polycythemia
Fetal Hypoglycemia,
Macrosomia
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23
Q

Chronic maternal DM baby complications?

3

A

Hypertrophic Cardiomyopathy
Caudal Regression
small left colon (Meconium Illeus)

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24
Q

MCC of Post-Menopausal Bleeding?

A

Genital Tract Atrophy

MCC (lethal): Endometrial Cancer

Other causes: HRT, Radiation, Polyps, Fibromas, Endometrial Hyperplasia, Adenomyosis

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25
Q

Symptoms of Endometriosis (6)

A 
Pelvic Pain
Spotting
Dysmenorrhea 
Dyschezia
Dyspareunia
INFERTILITY

(Dis-poh-rue-nia)

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26
Q

Non-cyclical Pelvic pain

+/- Menorrhagia, Dysmenorrhea

A

Adenomyosis

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27
Q

Pelvic masses differential:

5

A

Fibroids
Ovarian Cyst
TO-Abscess
Endometriomas

Tumors (Teratomas, etc.)

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28
Q

HIV mom w/ a viral load < 50 copies/mL
what give baby?

If viral load 50 or MORE, then what?

A

Zidovudine for 4 weeks

Zidovudine + Nevirapine
or
Zidovudine + Nevirapine/Raltegravir + Lamivudine

(Neh-vee-ruh-peen)
(Raal-teh-gruh-veer)
(Luh-mi-vyuh-deen)

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29
Q

A low lecithin-sphingomyelin ratio in amniotic fluid
( Less than ___) indicates fetal lung immaturity

or a low foam stability index (< __)

A

< 1.5

< 0.48

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30
Q

Neonatal respiratory distress syndrome (NRDS) is characterized by low levels of surfactant (lecithin).

alveolar surface tension is ___ causing alveolar atelectasis and decreased lung ____

All lung volumes become ____

Pulmonary vascular resistance becomes _____

A

increased
compliance
decreased (including FRC)
increased

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31
Q

Neonatal respiratory distress syndrome (NRDS)

causes an increased risk of _____

A

persistent ductus arteriosus

32
Q

An excisional procedure such as ___ is an acceptable option for nonpregnant patients 25 and older with HSIL on Pap smear.

A

LEEP

33
Q

A ____ is indicated for patients ages 21 – 24 years with a Pap smear remarkable for ASC-US or LSIL.

A

repeat Pap smear at 12 months

ASC-US: Atypical squamous cells of undetermined significance

34
Q

If Pap smear shows AGC, HSIL, AND ASC-H should urgently undergo

A

Colposcopy & Endocervical Curettage and

  • +Endometrial Biopsy if pt 35+ w/ risk factors

ASC-H: Atypical squamous cells (cannot exclude HSIL)
AGC: atypical glandular cells

35
Q

HPV testing may be performed for patients with ___ on Pap smear

A

ASC-US

Atypical squamous cells of undetermined significance

36
Q

Pap smear and colposcopy every __ months for up to __ years is the next best step in a patient 21–24 years of age with HSIL (CIN II/III) on Pap smear, which are NOT confirmed on colposcopy examination.

A

6 months

2 years

37
Q

Endometriosis treatment

A

1st NSAIDs

2nd OCPs

38
Q

Pediatric patients with estrogen secreting tumors typically present with (2)

A

bone age above their chronological age

Precocious Puberty

39
Q

Pre-eclampsia without severe features what do next?

Mom is fine otherwise

A

Induce labor at 37 weeks

40
Q

If a breech presentation does not resolve by 37 w the patient has several options:
1.
2.
3.

A
  1. external cephalic version (ECV) before spontaneous labor with a trial of vaginal birth (either normal vaginal delivery or breech delivery)
  2. Scheduled c-section w/o ECV
  3. Trial of vaginal birth w/o ECV
41
Q

___ are usually asymptomatic and ultrasound usually shows diffusely thick walls with wall vascularity.

Commonly hemorrhage or rupture

A

Corpus luteum cysts

42
Q

A ____ is seen a single unilateral thin-walled and unilocular on u/s

forms when a Graafian follicle fails to ovulate and continues to grow instead.

While mostly asymptomatic, they may cause dull pelvic pain due to mass effect or menstrual cycle irregularities due to ____ production and endometrial hyperplasia.

A

follicular cyst

estrogen

43
Q

_____ are commonly asymptomatic and appear on ultrasound as thin-walled, multiple, multilocular, and BILATERAL ovarian cysts .

A

Theca lutein cysts

44
Q

Ultrasound typically shows a asymptomatic, multilocular UNILATERAL cystic ovarian mass with numerous thin septations.

A

mucinous cystadenoma

45
Q

Ultrasound typically shows a complex cystic mass with calcifications and solid components.
Most common type of ovarian neoplasm.
More common in women 20–40 years old.

A

Cystic teratoma (Dermoid cysts)

46
Q

A thin-walled, homogeneous, and unilocular cyst without solid components with sxs of endometriosis may raise suspicion for an ____.

A

endometrioma

47
Q

Pelvic ultrasound of a ___ shows a single fluid-filled, unilocular, anechoic cyst with a thin and smooth wall and without solid components.

In the absence of complications watchful waiting is recommended because they often regress spontaneously.

A

Follicular cyst

48
Q

______ is the first step in the diagnosis of patients with suspected PPROM

A

Sterile speculum examination

49
Q

The diagnostic criteria for HELLP syndrome:
Hemolysis (low Hb and elevated LDH)
Elevated AST
Low platelets

Most women also have ___ and ___, although this is not required for the diagnosis of HELLP.

A

hypertension

proteinuria

50
Q

DELETE

A

DELETE

51
Q

____ (not AFP increase) most commonly occur in the setting of
multiple gestations
gestational trophoblastic disease
or exogenous ovarian hyperstimulation
(ex: ovulation induction with clomiphene)

A

Theca lutein cysts

52
Q

DELETE

A

DELETE

53
Q

One feared complication of HELLP syndrome is _____, which can rupture, resulting in exsanguination.

All pregnant patients with HELLP thus require an immediate _____ if they develop severe abdominal pain.

A

hepatic subcapsular hematoma
ultrasound

***Abdominal pain 2/2 stretching of Glisson capsule (fibrous layer of the heptic capsule covering the liver) from hepatic swelling is a common symptom.

54
Q

Amniotic fluid leaking from the cervix and pooling in the vaginal vault
Confirmation of dx via:
positive nitrazine test
positive fern test
or
rapid detection test for IGF- 1 or placental alpha microglobulin-1.

A

PPROM

55
Q

PPROM in stable patients at 34+ weeks’ gestation, both expectant management and ____ can be considered.

If patients are managed expectantly, a single course of ANTEnatal ___ should be administered.

A

induction of labor
corticosteroids

  • **No antibiotic ppx for pt w/ PPROM at 34+ weeks
  • **STILL screen for (GBS) on admission & manage accordingly
56
Q

A ____ is recommended for patients with secondary amenorrhea who are not pregnant and have normal levels of hypothalamic-pituitary hormones (prolactin, FSH, and TSH).

A

progesterone withdrawal test

57
Q

excessive ___ also stimulates the lactotroph cells of the anterior pituitary to release prolactin (prolactinemia)

A

TRH (which causes release of TSH)

hypothyroidism

58
Q

The status of ___ in patients with breast cancer is considered the most important prognostic factor for disease outcome.

A

axillary lymph nodes

+axillary nodes = worse prognosis

59
Q

HIV postexposure prophylaxis (PEP) should be offered to all individuals who present within 72 hours after experiencing a sexual assault involving vaginal penetration, and it usually includes a triple regimen of

A

Raltegravir/ Dolutegravir (integrase inhibitor)
Emtricitabine
Tenofovir

(Doll-you-teh-gruh-veer)
(Em-truh-sai-duh-bean)

60
Q

Empiric antibiotic therapy with ____ is indicated for the treatment of common STIs (chlamydia/gonorrhea/trich)
in pts who have experienced a sexual assault.

A

ceftriaxone, azithromycin & tinidazole

61
Q

OCP contraindications

A

Age 35+ years and smoking 15+ cigarettes per day

2+ CAD risk factors (Smoking, DM, and HTN)

HTN: 140 mmHg or diastolic 90 mmHg

h/o Thrombotic event not on AG (Stroke, TIA, VTE, PE, subacute bacterial endocarditis, A-fib, pulm HTN)

h/o ischemic heart disease

h/o Breast cancer

h/o Cirrhosis

Migraine with aura

Hepatocellular adenoma or malignant hepatoma

62
Q

There are no known interactions between OCPs and ___ anticoagulation

However, it is generally recommended that women with acute DVT USING anticoagulation use ____.

A

warfarin

progestogen-only or other contraceptive methods (IUD).

(there are no contraindications to COC use in women USING oral anticoagulation)

63
Q

3rd Trimester dark vaginal bleeding and lower abdominal and back pain, together with a history of smoking, suggest

A

abruption placentae

64
Q

Echogenic tubal ring (tubal ring sign) is suggestive of tubal

A

ectopic pregnancy (EP)

65
Q

A complex, echogenic intrauterine mass interspersed with many hypoechogenic cystic spaces would be a typical finding in

A

complete hydatidiform mole

other typical findings include:
vaginal bleeding, preeclampsia, hyperemesis, or hyperthyroidism

66
Q

A distended fallopian tube with incomplete septations is characteristic of ____, a complication of ____, in which inflammation of the fallopian tubes leads to stenosis and accumulation of fluids in the tubes.

A

hydrosalpinx

pelvic inflammatory disease (PID)

67
Q

Hypoechoic mass with a thin smooth wall and posterior wall enhancement (no signs of blood flow or septae) suggests

A

Ovarian Cyst

*monitor

68
Q

Combination therapy with ___ & ___ is used to treat pelvic inflammatory disease (PID) and its complications, such as tuboovarian abscesses.

A

clindamycin and gentamicin

69
Q

A maneuver done in cases of breech presentation in order to maximize the chances of vaginal cephalic delivery.
This maneuver is usually done NEAR term but PRIOR to labor.

A

External cephalic version

70
Q

__ is used to strengthen uterine contractions when there is a prolonged latent phase of labor.

A

Oxytocin

71
Q

Prolonged latent phase
Slow progression (contraction frequency) with a cervical dilation ≤ __ cm for more than:
Nullparity > __ hours
Multiparity > __ hours

A

6cm

20

14

72
Q

The nitrazine test is used for the diagnosis of ____, which typically presents with significant leakage of vaginal fluid before labor onset.

A

premature rupture of membranes

73
Q

___ can be used for cervical ripening and labor induction

A

Misoprostol

74
Q

__ is a topical antifungal agent and the first-line treatment for vulvovaginal candidiasis in pregnancy.

A

Intravaginal clotrimazole

75
Q

all patients who undergo lumpectomy require ___ in order to minimize the risk of recurrence.

A

Radiation or chemotherapy

(if E,P,HER2 + hormone therapy is also indicated

OBG (8 decks)

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