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ObGyn Flashcards

0
Q

Steroid hormone contraception (MOA)

A
  • Gonadotropin suppression (E+P)
  • Alteration of cervical mucus (P only)
  • Endometrial atrophy (P only)
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1
Q

Estrogen-containing contraceptives contraindications (4)

A
  • Cardiovascular disease
  • Malignancy (Breast, Endometrium, Melanoma)
  • Hepatic disease
  • Pregnancy
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2
Q

Infertility (etiology 3)

A
  • Anovulation
  • Fallopian tube disease
  • Abnl semen analysis (volume, concentration, motility, form, pH)
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3
Q

Anovulation (tx 3)

A
  • Bromocriptine (tx hyperprolactinemia)
  • Clomiphene citrate (enhances GnRH release: ovulation induction)
  • Human menopausal gonadotropin
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5
Q

Fallopian tube disease (mgmt)

A

Surgical

  • Lysis of adhesions
  • Fimbrioplasty
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6
Q

Abnormal semen analysis (mgmt)

A
  • Intrauterine insemination (IUI)
  • Intracytoplasmic sperm injection (ICSI)
  • Donor insemination
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7
Q

Initial steps if endometrial cancer is suspected

A
  • Endometrial biopsy

- Hysteroscopy if negative biopsy w/ many risk factors or if persistent postmeno bleeding

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8
Q

IUD contraindications (5)

A
  • PREGNANCY
  • Undiagnosed uterine BLEEDING
  • Acute cervical, uterine, or tubal INFECTION
  • Hx of SALPINGITIS
  • Suspected gynecologic MALIGNANCY
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9
Q

Precursor lesion to endometrial cancer

A

Endometrial hyperplasia (complex hyperplasia w/ atypia)

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10
Q

How is endometrial cancer staged?

A

Surgically (TAH-BSO, omentectomy, LN sampling, peritoneal washings)

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11
Q

Endometrial cancer risk factors

A
  • Unopposed estrogen (early menar, late meno, chronic anovulation [PCOS])
  • Metabolic (DM, HTN, obesity)
  • Personal or Fam Hx: breast or ovarian cancer
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12
Q

Cause of CVA tenderness in the setting of cancer

A

Metastatic obstruction of the ureter

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13
Q

Best diagnostic test to evaluate cervical masses

A

Cervical biopsy (NOT PAP)

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14
Q

Cervical cancer risk factors

A
  • STDs: HPV, HIV
  • SexHx (early age of coitus, multiple sexual partners, early childbearing)
  • SocHx (low SEC status, cigarette smoke)
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15
Q

Abnl PAP (next step)

A

Colposcopy w/ biopsies

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16
Q

Mc cause of death in cervical cancer

A

Uremia 2* bilateral ureteral obstruction

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17
Q

Malodorous vaginal d/c in the setting of cancer

A

Necrotic tumor

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18
Q

Cervical cancer often spreads through this ligament to pelvic sidewalls

A

Cardinal ligament (contains uterine artery/vein)

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19
Q

Two types of radiotherapy employed in cervical cancer

A
  • Radiation brachytherapy: implants near tumor bed

- Radiation teletherapy: external-beam radiation

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20
Q

Carneous degeneration (fibroids)

A

Changes in fibroids due to rapid growth; center of the fibroid becomes red, causing pain

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21
Q

Leading cause of hysterectomy in the US

A

Fibroids

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22
Q

Mc tumors of pelvis

A

Fibroids

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23
Q

Physical examination of uterine leiomyoma

A

Midline, irregular, nontender mass that moves contiguous with the cervix

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24
Q

Medical mgmt of fibroids

A
  • NSAIDs
  • Medroxyprogesterone (Provera)
  • GnRH agonist (shrinks fibroid prior to surgery in 3mo)
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25
Q

Confirmatory step/test when uterine leiomyomatas are suspected

A

US

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26
Q

Surgical mgmt of fibroids

A
  • Hysterectomy (if pregnancy is undesired)
  • Myomectomy (if pregnancy is desired)
  • Uterine artery embolization
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27
Q

Type of leiomyoma most associated w/ recurrent abortions

A

Submucous

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28
Q

Confirmatory step/test when uterine leiomyosarcomas are suspected

A

ELAP w/ hysterectomy

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29
Q

Two types of emergency contraceptives (EC)

A

1) High-dose combination of estrogen and progestin (Yuzpe regimen)
2) High-dose progestin (Levonorgestrel: Plan B)

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30
Q

Associated sx w/ fibroids

A

Anemia 2* to menorrhagia

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31
Q

Major side effects of combination EC

A

Nausea and/or emesis

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32
Q

AFP (site of synthesis, analog in adults)

A
  • Fetal liver

- Adult albumin

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33
Q

First-trimester screening

A
  • Biochemical markers

- Transvaginal sono for nuchal translucency

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34
Q

NTDs

A
  • Anencephaly

- Spina bifida

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35
Q

Two EC efficacy rates

A
  • Combination: 75% reduction in pregnancy rate

- Plan B: 85% reduction in pregnancy rate

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36
Q

Second-trimester screening

A

Quad screen:

  • msAFP
  • Estriol
  • HCG
  • Inhibin
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37
Q

Benign causes of elevated msAFP

A
  • Underestimated gestational age
  • Multiple gestations
  • Decreased maternal weight
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38
Q

Benign causes of decreased msAFP

A
  • Overestimated gestational age

- Increased maternal weight

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39
Q

Serum markers in Down’s syndrome

A
  • Low msAFP
  • Low estriol
  • High HCG
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40
Q

Suspicious msAFP

A

Multiples of the median (MOM): higher than 2.0-2.5

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41
Q

First-trimester test/screen results in Down’s syndrome

A
  • Low PAPP-A
  • High HCG
  • Thickened nuchal translucency
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42
Q

First step in the mgmt of an abnl serum screen

A

Ultrasound

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43
Q

Risks of amniocentesis

A
  • Fetal loss
  • ROM
  • Chorioamnionitis
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44
Q

Second step in the mgmt of an abnl serum screen (assuming first step is confirmatory)

A
  • Amniocentesis, or

- Targeted US

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45
Q

Window for serum screening

A

Between 15-21wks

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46
Q

Nontender ulcer with clean-appearing edges, often w/ painless inguinal adenopathy

A

Syphilitic chancre

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47
Q

Screening and confirmatory tests in syphilis

A
  • RPR, VDRL

- MHA-TP, FTA-ABS

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48
Q

Serum markers in trisomy 18

A
  • Low msAFP
  • Low estriol
  • Low HCG
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49
Q

Syphilis tx

A

Penicillin G (IM)

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50
Q

Initial algorithmic branch point in vulvar ulcers

A

RPR and HSV viral cultures

if all’s negative = presumed chancroid

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51
Q

Best diagnostic test for genital herpes

A

Viral cx (gold standard)

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52
Q

Presentation in primary vs recurrent episode of herpes

A

Primary: systemic and local
Recurrent: local

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53
Q

Herpes tx

A

Acyclovir

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54
Q

Three mc causes of vulvar ulcers in US

A
  • HSV
  • Syphilis
  • Chancroid
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55
Q

Next step in mgmt of painless ulcer if RPR/VDRL are negative

A

Dark-field microscopy

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56
Q

Syphilis tx for pts w/ allergies for traditional tx

A

PO erythromycin or doxycycline

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57
Q

Titers do not fall after 1yr tx of syphilis (dx)

A

Neurosyphilis (do an LP)

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58
Q

Tender ulcer w/ ragged edges on a necrotic base, possibly w/ tender LAD (dx)

A

Chancroid

Haemophilus ducrei

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59
Q

Confirmatory test(s) for chancroid

A
  • Biopsy and/or

- Cx

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60
Q

Presentation of secondary syphilis

A
  • Systemic: maculopapular rash on palms and soles

- Condylomata lata

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61
Q

Mode of syphilis transmission from mother to offspring

A

Transplacental infection

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62
Q

Syphilis during pregnancy (tx)

A

Desensitization and penicillin

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63
Q

Risk factors for PPROM

A
  • STDs
  • SocHx (Lower SEC status, smoking)
  • Cervix (Conization, emergency cerclage)
  • Uterus (Multiple gestations, hydramnios, abruption)
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64
Q

Two complications of PPROM

A
  • Infection (chorioamnionitis)

- Labor

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65
Q

Confirmatory findings on speculum examination in PPROM

A
  • Pooling of amniotic fluid
  • Alkaline changes of vaginal fluid
  • Ferning pattern
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66
Q

US finding in PPROM

A

Oligohydramnios

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67
Q

Chorioamnionitis signs

A
  • Maternal and fetal tachycardia (>160)
  • Maternal fever
  • Uterine tenderness
  • Malodorous vaginal d/c
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68
Q

Chancroid (tx)

A
  • PO azithromycin, or

- IM ceftriaxone

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69
Q

PPROM (tx)

A
  • Prior to 32wks: expectant mgmt

- After 34wks: delivery

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70
Q

PPROM w/ infx (tx)

A
  • Broad-spec ABX: ampicillin and gentamicin

- IOL

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71
Q

Sign of fetal lung maturity on speculum examination

A

Presence of PG (phosphatidylglycerol)

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72
Q

Bug that causes chorioamnionitis in setting of intact membranes

A

Listeria (unpasteurized milk products)

73
Q

Chorioamnionitis (intra-amniotic infection) confirmatory test

A

Amniocentesis w/ Gram stain

74
Q

Positive HIV on ELISA. Next step

A

Confirm w/ western blot or PCR

75
Q

What does chlamydia cause in neonates?

A
  • Conjunctivitis

- PNA

76
Q

Chlamydial cervicitis in pregnancy (tx)

A
  • PO erythromycin
  • PO amoxicillin
  • PO azithromycin
77
Q

What does chlamydia cause in adults?

A
  • Urethritis
  • Mucopurulent cervicitis
  • Late post-partum endometritis
78
Q

Gonococcal infection (tx)

A
  • IM ceftriaxone

- ABX for concurrent chlamydia

79
Q

Presentation of disseminated gonococcal disease

A
  • Pustular skin lesions
  • Arthralgias
  • Septic arthritis
80
Q

How is chlamydia transmitted from mother to neonate?

A

Delivery

81
Q

How is HIV transmitted from mother to baby?

A
  • Transplacental
  • Delivery
  • Breast milk
82
Q

What kind of disease do ophthalmic ABX prevent in neonates?

A

Gonococcal, not chlamydial conjunctivitis

83
Q

What is used to monitor the HIV status of a woman in pregnancy?

A
  • Viral load (goal: <1000)

- CD4 T-cell count

84
Q

Fifth disease (aka; bug)

A
  • Erythema infectiosum

- Parvovirus B19 (ssDNA)

85
Q

Fetal causes of hydramnios (4)

A
  • CNS anomalies
  • GI tract malformations
  • Chromosomal abnormalities
  • Nonimmune hydrops
86
Q

Non-fetal causes of hydramnios (4)

A
  • Maternal diabetes
  • Isoimmunization
  • Multiple gestation
  • Syphilis
87
Q

Parvovirus B19 (adult presentation)

A
  • Myalgias
  • Arthralgias
  • Reticular (lacy) rash
88
Q

Fetal hydrops (definition)

A

Excess fluid in 2 or more body cavities (eg, ascites, skin edema, pericardial effusion, and/or pleural effusion)

89
Q

Confirmatory test in suspected parvovirus B19 infection

A

IgG and IgM serology

90
Q

What is one of the earliest manifestations of fetal hydrops?

A

Hydramnios

91
Q

Typical incubation period for HSV

A

2-7 days

92
Q

Prodromal symptoms of HSV

A

-Paresthesias
-Burning
-Tinging
(dormancy in sacral DRG)

93
Q

Fetal anemia to hydrops (pathophysiology)

A
  • HF

- Hematopoietic centers in liver (less albumin)

94
Q

HSV-1 vs HSV-2

A

1: above waist (oral/facial)
2: below waist (genitals)

95
Q

When to recommend C-section in HSV+ mom

A
  • Recurrent lesions
  • Ruptured membranes
  • Prodromal sxs
96
Q

Anemia in pregnancy (Hb level)

A

<10.5 g/dL

97
Q

Mild anemia w/ no risk factors (AfAm, SE Asian, Mediterranean) (tx)

A

Supplemental iron

98
Q

Anemia following tx of UTI w/ ABX

A

-G6PD deficiency (sulfonamides, nitrofurantoin, antimalarials)

99
Q

Persistent anemia (mgmt)

A
  • Ferritin levels

- Hb electrophoresis

100
Q

Hemolytic processes (5) causing anemia in pregnancy

A
  • G6PD deficiency
  • HELLP syndrome
  • Malaria
  • AIHA
  • SC crisis
101
Q

Mc cause of anemia in pregnancy

A

Iron deficiency

102
Q

Delivery of a baby in an HSV+ mom

A

Vaginal delivery is fine if

  • No active lesions
  • No prodromal symptoms
103
Q

Mc cause of megaloblastic anemia in pregnancy

A

Folate deficiency

104
Q

DVT in a pregnant woman (dx)

A

Doppler

105
Q

Thrombosis in pregnancy (tx)

A

Anticoagulation w/ heparin (IV then SC)

106
Q

Why is pregnancy a hypercoagulable state?

A
  • Increased levels of clotting factors (mainly fbg)

- Venous stasis (uterus compresses vena cava)

107
Q

Long-term complications of heparin

A
  • Osteoporosis

- Thrombocytopenia

108
Q

Mc locations for DVT after gyn surgeries

A
  • Lower extremities

- Pelvic veins

109
Q

Hemorrhagic corpus luteum (dx)

A

Laparoscopy

110
Q

When does the corpus luteum stop making progesterone and the placenta takes over?

A

Week 10

111
Q

Earliest indicator of hypovolemia in a young healthy person

A

Decreased UOP

112
Q

Hemoperitoneum in pregnancy (causes)

A
  • Ruptured ectopic pregnancy
  • Ruptured corpus luteum
  • Splenic injury or rupture
113
Q

Culdocentesis (clotted vs. nonclotted blood)

A
  • Clotted: arised from vaginal blood vessel

- Nonclotted: intra-abdominal hemorrhage

114
Q

Tissue that floats w/ a “frond” pattern in saline

A

Products of conception

115
Q

Postpartum hemorrhage, PPH (definition)

A

> 500mL loss after vaginal delivery

>1000mL loss after C-section

116
Q

Mc cause of early PPH

A

Uterine atony (myometrium hasn’t contracted)

117
Q

Required supplement if corpus luteum is removed before 10wks

A

Progesterone

118
Q

First step in early PPH mgmt

A

Uterine massage and dilute oxytocin (IV)

119
Q

Second-line tx in PPH

A

PGFa2 (IM) or Methylergonovine (IM)

120
Q

Early PPH vs Late PPH

A
  • Early: w/in first 24hrs

- Late: after 24hrs

121
Q

Mgmt if medical therapy is ineffective in PPH

A

ELAP:

  • Ascending branch of uterine artery or internal iliac artery ligation
  • Hysterectomy
122
Q

Boggy uterus vs. firm uterus in PPH (causes)

A
  • Boggy: uterine atony

- Firm: genital tract laceration

123
Q

Drugs used in PPH that are contraindicated in (1)HTN and (2)asthma

A

1) Methylergonovine (Methergine)

2) Prostaglandin F 2a

124
Q

Late PPH (causes x2)

A
  • Mc: Subinvolution of placenta (eschar over placental bed falls off -> lack of myometrial ctx)
  • Retained POC
125
Q

Thyroid storm (signs and sxs)

A
  • CNS dysfunction (coma or delerium)

- Autonomic instability (hyperthermia, HTN or hypotension)

126
Q

Hyperthyroidism (labs)

A
  • High free T4

- Low TSH

127
Q

Hyperthyroidism in pregnancy (tx)

A

-Propylthiouracil (PTU)

128
Q

Mc cause of hyperthyroidism in US

A

Grave’s

129
Q

Thyroid storm (tx)

A
  • Beta blockers
  • Corticosteroids
  • PTU
130
Q

Most likely dx of postpartum thyroiditis

A

Destructive lymphocytic thyroiditis

131
Q

Mc cause of fever after C-section

A

Endomyometritis

132
Q

Endomyometritis (mechanism)

A

Ascending infection of vaginal organisms

133
Q

Effect of pregnancy on thyroid hormones (Free T4, TSH, total T4, TBG)

A
  • Free T4: unchanged
  • TSH: unchanged
  • Total T4: increased
  • TBG: increased
134
Q

Fever

A

38*C

100.4 F

135
Q

Septic pelvic thrombophlebitis, SPT (definition)

A

Bacterial infection of pelvic venous thrombi, usually involving the ovarian vein

136
Q

Most significant risk factor for postpartum endomyometritis

A

Cesarean section

137
Q

Mc bug isolated in endomyometritis complicating pts after a C-section

A

Bacteroides sp

138
Q

First trimester (definition)

A

conception-12wks

139
Q

Second trimester (definition)

A

13-26wks

140
Q

Fever after C-section (causes x5)

A
  • Endomyometritis
  • Wound infection
  • Mastitis
  • Pyelonephritis
  • Atelectasis
141
Q

Third trimester (definition)

A

27wks-40wks

142
Q

Optimal time frame for sono in fetal anomaly screening

A

18-20wks

143
Q

Abnl msAFP and triple marker screens should be followed by:

A
  • Sono

- Amniocentesis

144
Q

When are triple screen and msAFP done?

A

15-20wks

145
Q

Nonreactive NST

A

FHR accelerations:

absent or less than 15x15

146
Q

Positive CST

A

Late decels w/ 3 consecutive UCs (worrisome)

147
Q

Next steps in nonreactive NST

A
  • First, vibroacoustic stimulation (VAS)

- If still nonreactive, then contraction stress test (CST) or biophysical profile (BPP)

148
Q

Negative CST

A

No late decels in presence of 3 UCs in 10min (reassuring)

149
Q

NST, CST combinations in order of increasing severity

A

+accels, -late decels

  • accels, -late decels
  • accels, +late decels
150
Q

Tachycardia and bradycardia on electronic fetal monitoring (EFM)

A

Tachy: >160
Brady: <110

151
Q

Reactive NST

A

FHR accelerations:

15bpm x 15sec

152
Q

NL variability on EFM

A

5-10bpm from baseline

153
Q

Severe variable decels (definition)

A

> 60sec
Drops 60bpm below baseline, or
Drops to less than 60bpm

154
Q

Variable decels (etiology and significance)

A
  • Umbilical cord compression

- Sometimes worrisome (if severe)

155
Q

Late decels (etiology and significance)

A
  • Uteroplacental insufficiency

- Always worrisome

156
Q

Early decels (etiology and significance)

A
  • Head compression (vagal)

- Benign

157
Q

Baseline tachy on EFM (nonhypoxemic maternal causes x3)

A
  • Scopolamine
  • Atropine
  • Beta agonists
158
Q

Decreased variability on EFM (nonhypoxemic maternal causes x3)

A
  • Parasympatholytics
  • Sedatives
  • Tranquilizers
159
Q

EFM signs in prematurity (x2)

A
  • Tachy

- Decreased variability

160
Q

Fetal scalp pH values (NL vs ABNL)

A

7.20 or higher = NL

<7.20 = ABNL

161
Q

EFM signs in cardiac arrhythmia (x3)

A
  • Tachy
  • Brady
  • Increased variability
162
Q

Baseline brady on EFM (nonhypoxemic maternal causes x2)

A
  • Local anesthetics

- Beta blockers

163
Q

EFM signs w/ sleep (x1)

A

-Increased variability

164
Q

Increasing fetal oxygenation w/ nonreassuring tracings (x4)

A
  • Stop oxytocin
  • 500ml IV isotonic bolus to mom
  • Change maternal position
  • High-flow oxygen (8-10L)
165
Q

Biophysical profile, BPP (components x5)

A
  • NST reactivity
  • AF volume (>2cm in at least 1 vertical pocket)
  • Extremity tone
  • Breathing movements
  • Gross body movements
166
Q

EFM signs w/ fetal movement (x2)

A
  • Tachy

- Increased variability

167
Q

Neonatal hazards (x4) associated w/ PROM if fetus remains in utero

A
  • Infection and sepsis
  • Deformations
  • Umbilical cord compress
  • Pulmonary hypoplasia
168
Q

Maternal hazards (x3) associated w/ PROM if fetus remains in utero

A
  • Chorioamnionitis and sepsis
  • DVT
  • Psychosocial separation
169
Q

Neonatal hazards (x7) associated w/ PROM if preterm delivery occurs

A
  • RDS, BPD
  • IVH, CP
  • ROP
  • PDA
  • NEC
170
Q

Chorioamnionitis (tx)

A

-clindamycin+gentamicin (IV)

171
Q

Preterm labor (dx)

A
  • 20-37wks, and
  • 3 or more ctx’s in 20min
  • 2cm or more dilation or change in dilation/effacement
172
Q

Fetal contraindications for tocolysis (x4)

A
  • Fetal demise
  • Fetal distress
  • Severe IUGR
  • Lethal anomaly
173
Q

Maternal contraindications for tocolysis

A
  • Severe PEC
  • Eclampsia
  • Uncontrolled DM
  • Advanced cervical dilation
174
Q

Placental/membrane-related contraindications for tocolysis

A
  • SROM
  • Severe placental abruption
  • Unstable placenta previa
  • Chorioamnionitis
175
Q

Tocolytic agents (x4)

A
  • Magnesium sulfate
  • Beta agonists (ritordine, terbutaline)
  • PG synthetase inhibitors (indomethacin)
  • Ca channel blockers (nifedipine)
176
Q

Posterm hazards (x2)

A
  • Macrosomia (mc)

- Dysmaturity syndrome: fetal hypoxia and meconium aspiration syndrome

177
Q

Dating accuracy of early sono

A

+/- 5 days (<12wks)

+/- 7days (12-18wks)

178
Q

Postdate triage mgmt

A
  • Certain dates and favorable cervix: IOL (oxytocin)
  • Certain dates, unfavorable cervix: IOL (PGE)
  • Uncertain dates: manage expectantly
179
Q

PROM (mgmt)

A

25-35 wks: prolong pregnancy (BMZ and ABX)

>35wks: deliver

obgyn (5 decks)

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