ObGyn Flashcards
How is the first day of the menstrual cycle defined?
The first day of menstrual bleeding is the first day of the cycle
Rope like breast mass should make you think of what diagnosis?
Fibrocystic breast mass
What is the formula for calculating estimated date of confinement or due date?
First day of last menstrual period + 7 days - 3 months
What is the more popular term for Stein-Leventhal syndrome.
Polycystic ovarian syndrome
What is the most common cause of postpartum hemorrhage?
Uterine atony
Define procidentia.
Uterine prolapse beyond the the introitus
What is the most common infection following a C-section?
Metritis
Which reproductive cancer carries the highest rates of death in women?
Ovarian cancer
Interference with work or school is part of which diagnosis premenstrual syndrome or premenstrual dysphoric disorder?
Premenstrual dysphoric disorder
What medication(s) are used to treat a postpartum endometritis?
Clindamycin and gentamicin together
What medication can be used to control bleeding due to uterine atony?
Oxytocin (pitocin)
What are three causes for a postpartum hemorrhage?
Uterine atony, genital laceration, retained placenta
What is the term for when the placenta has implanted directly over the cervical os?
Placenta previa
What is the hallmark physical exam finding for placenta previa?
Trick questions - NEVER do a physical exam on someone with presumed placenta previa
List three risk factors for placental abruption.
HTN, smoking, AMA, cocaine use, PROM
Which is associated with painful third trimester bleeding placental abruption or placenta previa?
Placental abruption
Who is the more likely to get pre-eclampsia a nulliparous woman or a multiparous woman?
Nulliparity is a risk factor for pre-eclampsia
What is the classic triad of pre-eclampsia?
HTN, edema and proteinuria
List two medications commonly used for hypertension in pregnancy.
Methyldopa and labetalol
List three problems that gestational diabetes increases the risk for in pregnant mom and baby.
Preeclampsia, macrosomia (traumatic birth), slowing in fetal lung development
At what point during pregnancy is Rhogam given if it is needed?
28 weeks
What Rh combination for mom and dad might cause the mother to create antiboides against the babies red blood cells?
Mom Rh negative, Dad Rh positive
What are three ways you can check for ruptured membranes?
Ferning pattern on a slide, visualize leakage from the cervix, pooling in the vagina
A woman presents to the ED concerned she is in preterm labor. What treatment should you begin before even getting any imaging or lab results?
Give IV fluids
What are two tocolytic medications you should be aware of?
Magnesium sulfate and calcium channel blockers
What medication is used to increase surfactant levels and help with lung maturity if you are worried about preterm labor?
Betamethasone
Give the time frame for preterm labor.
20-37 weeks
A snowstorm appearance on ultrasound should make you think of what diagnosis?
Hydatidiform mole
Grape like vesicles or a sack of grapes on ultrasound should make you think of what diagnosis?
Hydatidiform mole
What is the medical treatment for a small ectopic?
Methotrexate
List 3 risk factors for an ectopic pregnancy.
Previous ectopic, scarred tubes (hx of PID or salpingitis), IUD
What is the most common site of an ectopic pregnancy?
Within a fallopian tube
Early on in pregnancy serial beta HCG should double over what time period?
every 48-72 hours
How many days after conception is a serum beta HCG positive?
8
Define missed abortion.
No vaginal bleeding, cervix is closed, products of conception are still inside
Define complete abortion.
Vaginal bleeding, cervix open, products of conception have passed
Define Incomplete abortion.
Vaginal bleeding, cervix is open, products of conception partially passed
Define Inevitable abortion.
Vaginal bleeding, cervix is open, products of conception are still inside
Define threatened abortion.
Vaginal bleeding, closed cervix, products of conception are still inside
What is the normal range of fetal heart rate?
120-160
What are the five components of the biophysical profile as part of antepartum testing?
A non stress test, fetal breathing, two gross body movements, fetal tone, amniotic fluid index
As part of the antepartum testing a baby has a positive stress test. What does that mean?
They have had two heart rate acceleratins in a 20 minute period of 15 beats above baseline for at least 15 seconds. This is good
What are two medications used to induce labor?
Cervidil (prostoglandin gel applied to the cervix) which encourages cervical rippening and oxytocin which encourages uterine contractions
The baby was delivered several minutes ago. Suddenly there is a increase in blood flow from the vagina and the cord noticeably lengthens. What is the most likely cause of these signs?
Placental separation
Define the third stage of labor.
Delivery of baby to delivery of placenta
Define the second stage of labor.
Fully dialated to delivery
Define the first stage of labor.
Onset to full dilation
What organism causes us to warn pregnant patients to stay away from deli meats and soft cheeses?
Listeria
About how much weight should a woman gain during pregnancy?
20-35 lbs
Why is folic acid given as a prenatal vitamin?
Low folic acid can lead to neural tube defects
At how many weeks of pregnancy can an amniocentesis be done?
15-20 weeks
At how many weeks of pregnancy can chorionic villus sampling bed done?
10-13 weeks
At approximately how many weeks pregnant is the uterus at the level of the umbilicus?
20 weeks
At approximately how many weeks pregnant is the uterus at the level of the symphysis pubis?
12 weeks
A patient believes she is pregnant and you notice her cervix appears a blue tinged. What is the name of the sign?
Chadwick’s sign
When does quickening occur?
Nulliparous 18-20 weeks, multiparous 14-16 weeks
Define full term
Deliveray at 37-42 weeks
Define premature birth
Deliveray of uterine contnts between 20-36 weeks
Define abortion.
Deliveray of uterine contnts before 20 weeks
What characteristic of pelvic inflammatory disease will help to differentiate it in a question stem from ectopic pregnancy, appendicitis, ovarian torsion and ovarian cyst?
It will be bilateral pain. Many other common gyn complaints are unilateral pain
What age range is the HPV vaccination recommended for?
9 to 26 years old
What medium do you need to grow out Neisseria gonorrhoeae?
Thayer martin
What is the #1 cause of septic arthritis in sexully active young adults?
Neisseria gonorrhoeae
Purulent cervical discharge should make you think of what diagnosis?
Neisseria gonorrhoeae
What lab test is the gold standard for chlamydia?
Nucleic acid amplification test
A patient presents with mucopurulent discharge and cervical motion tenderness. What diagnosis should you be thinking of?
Chlamydia - cervicitis
What organism is the most common sexually transmitted infection?
Chlamydia
What are two important things you need to tell you patients before putting them on metronidazole?
Stay out of the sun and avoid alcohol
How do you treat a Trichomonas infection?
Metronidazole
Vaginal infection with motile flagellated protozoa should make you think of what diagnosis?
Trichomonas
A strawberry cervix with copious yellow/green discharge should make you think of what diagnosis?
Trichomonas
How do you treat bacterial vaginosis?
Metronidazole x 7 days
Clue cells should make you think of what diagnosis?
Bacterial vaginosis
Thin, sticky, malodorous vaginal discharge should make you think of what diagnosis?
Bacterial vaginosis
How do you treat vaginal candida?
Fluconazole po 1 dose, azole cream x 1 week
What would you expect to see on a KOH prep if the patient had vaginal candidiasis?
Pseudohyphae
Cottage cheese discharge should make you think of what diagnosis?
Vaginal candidiasis
What is the average age of menopause?
51
List four risk factors for breast cancer?
BRCA1 or BRCA2 positive, unopposed estrogen, nulliparity, early menarche, late menopause
A unilateral, single, mobile, firm, nontender solid breast mass should make you think of what diagnosis?
Fibroadenoma
Are fibrocystic breast masses usually bilateral or unilateral?
Bilateral
Should a breast feeding mother stop breast feeding if she develops mastitis?
There is no reason to stop breast feeding at this point.
Does mastitis tend to be unilateral or bilateral?
Unilateral and only one quadrant
What is the first line treatment for mastitis?
Dicloxacillin is fist line. Cephalexin or erythromycin are second line.
What is the most common organism that causes mastitis?
Staph aureus
What are three treatments for uterine prolapse?
Pessary, Kegel’s maneuvers, surgical repair
What is a cystocele?
A herniation of the bladder into the vagina
Which four herpes viruses are linked to cervical cancer?
HPV 16, 18, 31 and 33
List two risk factors for cervical cancer.
Multiple sexual partners, smoking,
Cervical biopsy comes back as CIN2 or CIN3. What is your next step?
Excision - LEEP, Cold knife (worry about incompetent cervix), Cryotherapy
Cervical biopsy comes back as CIN1. What is the next step?
Repeat pap smear in 6 months and repeat colposcopy in 12 months
If the pap smear results come back anything other than negative or ASCUS what is your next step?
Colposcopy and biopsy
A pap smear comes back as atypical squamous uncertain significance (ASCUS). What is your next step?
Repeat pap smear in 4-6 months
When is it recommended to begin pap smears?
When a woman becomes sexually active or when she is 21 years old
What is the treatment for ovarian cancer
Total hysterectomy and bilateral salpingo-oophorectomy. Chemo + radiation
A 66 year old female patient presents with bouts of nausea, weight loss and vague abdominal pain. What diagnosis should you be thinking of?
Ovarian cancer
Why is ovarian cancer so hard to diagnosis?
No good makers and very vague abdominal symptoms
List 2 risk factors for ovarian cancer.
BRCA1, Family history, Nulliparity, late menopause, caucasian, asian
What is the mean age for ovarian cancer?
63, you will need to think of this in an older patient with vague abdominal symptoms
An ovarian cyst that contains hair and teeth should make you think of what diagnosis?
Teratoma
You have a patient with PCOS who would like to get pregnant. What are two medications you may start her on?
Metformin and Clomid
What endocrine issue is associated with PCOS?
Insulin insensitivity
A patient presents with irregular menses, hirsutism and infertility. What diagnosis should you be thinking of?
Polycystic ovarian syndrome
If you see the term chocolate cyst it should make you think of what diagnosis?
Endometrioma
What is the most common type of ovarian cyst?
Functional cyst - no treatment necassary
What is the first step of treatment for endometrial cancer?
Total hysterectomy and bilateral salpingo-oophorectomy
List 4 risk factors for endometrial cancer.
Chronic unopposed estrogen, nulliparity, early menarche, late menopause, Tamoxifen, DM, obesity, HTN, breast CA, ovarian CA
What is the most common endometrial cancer?
75% are adenocarcinomas
What ethnic background is at an increased risk of fibroids?
African American are 5x more likely to have fibroids compared to Caucasian women
What is the most common uterine tumor?
Leiomyoma, also known as fibroids
How do you definitively diagnose endometriosis?
Exploratory laparoscopy
A physical exam revealing a retroverted uterus or uterosacral ligament nodularity should make you think of what diagnosis?
Endometriosis
Endometriosis is most commonly found in what location??
On an ovary
During what portion of the menstrual cycle does PMS occur?
By definition it is in the second half and menstruation should relieve the symptoms
Postmenopausal bleeding is immediately believed to be what diagnosis?
Endometrial cancer until proven otherwise
Define metrorrhagia.
Bleeding between menstraul cycles
Define menorrhagia.
Heavy prolonged menstraul flow
What three labs should you order if you are considering secondary amenorrhea?
beta HCG, TSH, Prolactin
What is the most common cause of secondary amenorrhea?
Pregnancy
How much time needs to pass before diagnosing secondary amenorrhea?
If cycles have been normal 3 months. If cycles have been irregular 6 months.
A patient with primary amenorrhea and a low FSH should make you think of what diagnosis?
Hypothalamic pituitary insufficiency
What is the treatment for Turner’s syndrome?
Cyclical estrogen and progesterone
A description of a young girl with a web neck or wide shield chest should make you think of what diagnosis?
Turner’s syndrome
Is FSH high or low in Turner’s syndrome?
High, there are no ovaries to respond to FSH and so there is no negative feedback.
What is the karyotype for patient with Turner’s syndrome?
(45, X) They are missing one sex chromosome
Since a genetic cause is the number one reason for primary amenorrhea what is one very important test?
Karyotype
At what age is primary amenorrhea diagnosed?
14 if no secondary sex characteristics. 16 if some secondary development.
The secretory phase day 14-28 is dominated by what hormone?
Progesterone
The follicular phase of menstruation is dominated by what hormone?
Estrogen
A surge in what hormone leads to ovulation?
LH
