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MS3 > OBGYN 10 > Flashcards

OBGYN 10 Flashcards

1
Q

What is an enterocele

A

Defect of the pelvic muscular support of the uterus and cervix (if still in situ) or the vaginal cuff (if hysterectomy). The small bowel and/or omentum descend into the vagina

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2
Q

What is a pessary

A

Synthetic device used to act as a “hammock” to suspend the pelvic organs

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3
Q

What can happen to a baby born to a mom with Graves

A

Neonatal thyrotoxicosis - due to transplacental passage of anti-TSH receptor antibodies during the third trimester

Baby born with sx of hyperthyroidism (warm skin, tachycardia, irritability, low birth weight)

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4
Q

Tx of neonatal thyrotoxicosi

A
  • Temporary Methimazole PLUS beta-blockers

- Self-resolves within 3 months

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5
Q

Tx of postpartum endometritis

A

♣ Clindamycin and Gentamicin

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6
Q

Treatment of hydatidiform moles

A

• D&C
• Monitoring of b-hCG
o Want to monitor until b-hCG is undetectable and then for another 6 months
o Newly elevated b-hCG is diagnostic for gestational trophoblastic neoplasia
o Contraception is necessary during surveillance period so you can accurately follow b-hCG levels

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7
Q

What is an ovarian tumor containing thyroid tissue called?

A

Struma ovarii

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8
Q

What are the subtypes of ovarian germ cell tumors

A

Teratoma, dysgerminoma, endodermal sinus tumor, choriocarcinoma

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9
Q

Most common complication of mature teratomas

A

Ovarian torsion

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10
Q

What are the subtypes of ovarian epithelial tumors

A

Serous, mucinous, endometriod, Brenner

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11
Q

What are the subtypes of ovarian sex cord-stromal tumors

A

Granulosa-theca
Sertolig-Leydig
Fibroma

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12
Q

Describe presentation of Granulosa-theca cell tumor

A
  • Precocious puberty
  • Menorrhagia/metrorrhagia
  • Postmenopausal bleeding
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13
Q

Describe the ovarian sizes that are concerning for tumor and management of different sizes

A

< 5 cm = most likely functional cyst; observe

5-10 cm = get US; septations, solid components, or growth on surface of inner lining are all indication for operation; if those all absent, can observe and re-US in 1 month

> 10 cm = operate

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14
Q

At what age is there a sharp decline in a woman’s follicle number

A

> age 35

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15
Q

How does ABO incompatibility present in a newborn

A

MILD hemolytic disease - most babies are asymptomatic or mildly anemia at birth

May need phototherapy for hyperbilirubinemia

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16
Q

What are the 2 levels that are decreased in both Trisomy 21 and 18

A

Alpha-fetoprotein and estriol

THINK: boy (alpha) and girl (estriol)

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17
Q

What are causes of elevated AFP

A

NTD, abd wall defects, multiple gestation

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18
Q

Describe potential side effect of epidural + treatment

A

Epidural can lead to hypotension in mom –> placental insufficiency (recurrent late decelerations)

Tx = IV fluids, then vasopressor (e.g. Ephedrine - causes vasoconstriction of the peripheral vasculature but spares the uterine arteries)

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19
Q

What is considered term pregancy

A

37-42 weeks

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20
Q

identify each type of Diabetes classification (A1, A2, B, C, D, R, F, H, T)

A
  • A1 = gestational; no meds
  • A2 = gestational; meds
  • B = onset >20 y/o; duration <10 years
  • C = onset 10-19 y/o; duration 10-19
  • D onset <10 y/o; duration >20 years
  • R = proliferative retinopathy
  • F = nephropathy (>500 mg/day)
  • H = atherosclerotic heart disease
  • T = prior renal transplant
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21
Q

Management of placenta previa

A

Expectant management as long as no excessive bleeding

C-section at 34 weeks

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22
Q

Management of placenta accreta

A

Hysterectomy

23
Q

Next step in managment of ASCUS on pap smear

A

HPV typing

24
Q

What might you expect to see in an arterial blood gas of a pregnancy woman

A

Compensated respiratory alkalosis (low CO2 with compensatory low HCO3)

Low CO2 is due to the increased minute ventilation during pregnancy

25
Q

Tx of amniotic fluid embolism

A

Mostly supportive with immediate delivery if there is rapid maternal or fetal decompensation

26
Q

Management of pre-eclampsia without severe features

A
  • Monitor closely for severe disease
  • Growth ultrasounds/NSTs
  • Delivery at 37 weeks
  • BPP once a week for fetal well being
  • Typically does not require magnesium sulfate (seizure prophylaxis)
27
Q

Management of pre-eclampsia with severe features

A

• Maintain sufficient oxygen saturation
• If >34 weeks, deliver
• Administer MgSO4 for seizure prophylaxis
• If severe HTN (>160/110), therapy should be initiated to prevent stroke
o Labetalol, Hydralazine, or Nifedipine
• If <34 weeks, evaluate if expectant management is appropriate
o If deciding to deliver, give antenatal corticosteroid (for lung maturity) and GBS prophylaxis

28
Q

Management of preterm labor

A

♣ Antenatal corticosteroids to enhance fetal lung maturity
♣ Tocolysis: attempts to stop preterm contractions
♣ Magnesium sulfate for neuroprophylaxis (protection against cerebral palsy)
♣ GBS prophylaxis

29
Q

Management of gestational HTN

A
  • Rule out preeclampsia
  • Growth ultrasounds/NSTs
  • BPP once a week for fetal well being
  • Delivery at 37 weeks
30
Q

What test can confirm the diagnosis of menopause

A

Elevated FSH

31
Q

Diagnose: uniformly enlarged uterus

A

Adenomyosis

32
Q

1st step in management of short cervix

A

Transvaginal progesterone

33
Q

Describe how obesity can lead to amenorrhea

A

Due to anovulation - ovaries are still producing estrogen, but progesterone is not being produced therefore progesterone withdrawal menses does not occur

FSH and LH are normal

34
Q

Management of chorioamnionitis

A

Broad spectrum abx + induction of labor

35
Q

Most common organisms of endometritis

A

Staph and strep

36
Q

Why does it take a while for mothers to produce milk after delivery

A

Needs time for estrogen and progesterone levels to decrease in order to remove the inhibitory effect on prolactin

37
Q

How do you diagnose chorioamnionitis

A 
♣	Maternal fever PLUS >/=1 of the following:
•	Fetal tachycardia (>160)
•	Maternal leukocytosis
•	Purulent amniotic fluid
•	Maternal tachycardia (>100)
•	Uterine fundal tenderness
38
Q

Tx of endometrial hyperplasia

A

Progesterone or hysterectomy

39
Q

Describe presentation of germ cell tumor

A

♣ Are non-malignant
♣ Usually present in teenage girls as an adnexal mass and weight gain
♣ Dx: transvaginal US
♣ Tx: unilateral salpingoophorectomy

40
Q

What are the 4 types of germ cell tumor

A
  1. Choriocarcinoma
  2. Teratoma
  3. Dysgerminoma (tumor of oocytes)
  4. Endodermal sinus tumor (yolk sac tumor)
41
Q

What are diagnostic values of GDM after 3 hr GTT

A

Fasting > 90
1 hour > 180
2 hour > 155
3 houe > 140

42
Q

Compare tx of 3 vulvar cancers

A
  • SCC = vulvectomy and lymph node dissection
  • Melanoma = vulvectomy and lymph node dissection
  • Pagets = wide local excision (less aggressive)
43
Q

Describe effects of Raloxifene and Tamoxifen on breast and endometrium

A

Both used for prevention of breast cancer (estrogen antagonist)

Raloxifene antagonist in endometrium and Tamoxifen agonist (increased risk of endometrial hyperplasia)

44
Q

Tx of fibroids

A

♣ First line:
• OCP/IUD +/- NSAIDs for pain

♣ Surgery:
• Leuprolide to shrink prior to surgery
• Myomectomy if want to maintain fertility
• TAH if she doesn’t want kids

45
Q

How do you diagnose PCOS

A

(1) + (2) or (3)

(1) Oligo- or anovulation
(2) Hyperandrogenism
♣ Elevated DHEAS
♣ Elevated Testosterone
♣ LH:FHS > 3:1
(3) Polycystic ovaries on US

46
Q

Tx of postpartum endometritis

A

Clindamycin + Gentamicin

47
Q

Order of events of puberty

A

THINK: Tits, pits, mits, lips

♣ Thelarche (Breasts) (8)
♣ Pubarche (Axillary and pubic hair) (9)
♣ Growth (10)
♣ Menarche (11)

48
Q

Tx of breast fibrocystic change

A

o Decreasing caffeine, adding NSAIDs, tight-fitting bra, OCP, oral progestin

49
Q

Management of single, mobile, firm, rubbery breast mass

A

Most likely benign fibroadenoma

FNA to confirm

50
Q

Management of single, mobile, firm, rubbery breast mass

A

Most likely benign fibroadenoma

FNA to confirm

51
Q

Managment of Intraductal papilloma

A

Mammography + US

Biopsy to rule out malignancy +/- excision

52
Q

Managment of Intraductal papilloma

A

Mammography + US

Biopsy to rule out malignancy +/- excision

53
Q

How often should women have breast exams

A

Age 20-39 = q3 years

>40 = annually

MS3 (88 decks)

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