ObGyn Flashcards
(179 cards)
0
Q
Steroid hormone contraception (MOA)
A
- Gonadotropin suppression (E+P)
- Alteration of cervical mucus (P only)
- Endometrial atrophy (P only)
1
Q
Estrogen-containing contraceptives contraindications (4)
A
- Cardiovascular disease
- Malignancy (Breast, Endometrium, Melanoma)
- Hepatic disease
- Pregnancy
2
Q
Infertility (etiology 3)
A
- Anovulation
- Fallopian tube disease
- Abnl semen analysis (volume, concentration, motility, form, pH)
3
Q
Anovulation (tx 3)
A
- Bromocriptine (tx hyperprolactinemia)
- Clomiphene citrate (enhances GnRH release: ovulation induction)
- Human menopausal gonadotropin
5
Q
Fallopian tube disease (mgmt)
A
Surgical
- Lysis of adhesions
- Fimbrioplasty
6
Q
Abnormal semen analysis (mgmt)
A
- Intrauterine insemination (IUI)
- Intracytoplasmic sperm injection (ICSI)
- Donor insemination
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
8
Q
IUD contraindications (5)
A
- PREGNANCY
- Undiagnosed uterine BLEEDING
- Acute cervical, uterine, or tubal INFECTION
- Hx of SALPINGITIS
- Suspected gynecologic MALIGNANCY
9
Q
Precursor lesion to endometrial cancer
A
Endometrial hyperplasia (complex hyperplasia w/ atypia)
10
Q
How is endometrial cancer staged?
A
Surgically (TAH-BSO, omentectomy, LN sampling, peritoneal washings)
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
12
Q
Cause of CVA tenderness in the setting of cancer
A
Metastatic obstruction of the ureter
13
Q
Best diagnostic test to evaluate cervical masses
A
Cervical biopsy (NOT PAP)
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)
15
Q
Abnl PAP (next step)
A
Colposcopy w/ biopsies
16
Q
Mc cause of death in cervical cancer
A
Uremia 2* bilateral ureteral obstruction
17
Q
Malodorous vaginal d/c in the setting of cancer
A
Necrotic tumor
18
Q
Cervical cancer often spreads through this ligament to pelvic sidewalls
A
Cardinal ligament (contains uterine artery/vein)
19
Q
Two types of radiotherapy employed in cervical cancer
A
- Radiation brachytherapy: implants near tumor bed
- Radiation teletherapy: external-beam radiation
20
Q
Carneous degeneration (fibroids)
A
Changes in fibroids due to rapid growth; center of the fibroid becomes red, causing pain
21
Q
Leading cause of hysterectomy in the US
A
Fibroids
22
Q
Mc tumors of pelvis
A
Fibroids
23
Q
Physical examination of uterine leiomyoma
A
Midline, irregular, nontender mass that moves contiguous with the cervix
24
Q
Medical mgmt of fibroids
A
- NSAIDs
- Medroxyprogesterone (Provera)
- GnRH agonist (shrinks fibroid prior to surgery in 3mo)
25
Confirmatory step/test when uterine leiomyomatas are suspected
US
26
Surgical mgmt of fibroids
- Hysterectomy (if pregnancy is undesired)
- Myomectomy (if pregnancy is desired)
- Uterine artery embolization
27
Type of leiomyoma most associated w/ recurrent abortions
Submucous
28
Confirmatory step/test when uterine leiomyosarcomas are suspected
ELAP w/ hysterectomy
29
Two types of emergency contraceptives (EC)
1) High-dose combination of estrogen and progestin (Yuzpe regimen)
2) High-dose progestin (Levonorgestrel: Plan B)
30
Associated sx w/ fibroids
Anemia 2* to menorrhagia
31
Major side effects of combination EC
Nausea and/or emesis
32
AFP (site of synthesis, analog in adults)
- Fetal liver
| - Adult albumin
33
First-trimester screening
- Biochemical markers
| - Transvaginal sono for nuchal translucency
34
NTDs
- Anencephaly
| - Spina bifida
35
Two EC efficacy rates
- Combination: 75% reduction in pregnancy rate
| - Plan B: 85% reduction in pregnancy rate
36
Second-trimester screening
Quad screen:
- msAFP
- Estriol
- HCG
- Inhibin
37
Benign causes of elevated msAFP
- Underestimated gestational age
- Multiple gestations
- Decreased maternal weight
38
Benign causes of decreased msAFP
- Overestimated gestational age
| - Increased maternal weight
39
Serum markers in Down's syndrome
- Low msAFP
- Low estriol
- High HCG
40
Suspicious msAFP
Multiples of the median (MOM): higher than 2.0-2.5
41
First-trimester test/screen results in Down's syndrome
- Low PAPP-A
- High HCG
- Thickened nuchal translucency
42
First step in the mgmt of an abnl serum screen
Ultrasound
43
Risks of amniocentesis
- Fetal loss
- ROM
- Chorioamnionitis
44
Second step in the mgmt of an abnl serum screen (assuming first step is confirmatory)
- Amniocentesis, or
| - Targeted US
45
Window for serum screening
Between 15-21wks
46
Nontender ulcer with clean-appearing edges, often w/ painless inguinal adenopathy
Syphilitic chancre
47
Screening and confirmatory tests in syphilis
- RPR, VDRL
| - MHA-TP, FTA-ABS
48
Serum markers in trisomy 18
- Low msAFP
- Low estriol
- Low HCG
49
Syphilis tx
Penicillin G (IM)
50
Initial algorithmic branch point in vulvar ulcers
RPR and HSV viral cultures
| if all's negative = presumed chancroid
51
Best diagnostic test for genital herpes
Viral cx (gold standard)
52
Presentation in primary vs recurrent episode of herpes
Primary: systemic and local
Recurrent: local
53
Herpes tx
Acyclovir
54
Three mc causes of vulvar ulcers in US
- HSV
- Syphilis
- Chancroid
55
Next step in mgmt of painless ulcer if RPR/VDRL are negative
Dark-field microscopy
56
Syphilis tx for pts w/ allergies for traditional tx
PO erythromycin or doxycycline
57
Titers do not fall after 1yr tx of syphilis (dx)
Neurosyphilis (do an LP)
58
Tender ulcer w/ ragged edges on a necrotic base, possibly w/ tender LAD (dx)
Chancroid
| Haemophilus ducrei
59
Confirmatory test(s) for chancroid
- Biopsy and/or
| - Cx
60
Presentation of secondary syphilis
- Systemic: maculopapular rash on palms and soles
| - Condylomata lata
61
Mode of syphilis transmission from mother to offspring
Transplacental infection
62
Syphilis during pregnancy (tx)
Desensitization and penicillin
63
Risk factors for PPROM
- STDs
- SocHx (Lower SEC status, smoking)
- Cervix (Conization, emergency cerclage)
- Uterus (Multiple gestations, hydramnios, abruption)
64
Two complications of PPROM
- Infection (chorioamnionitis)
| - Labor
65
Confirmatory findings on speculum examination in PPROM
- Pooling of amniotic fluid
- Alkaline changes of vaginal fluid
- Ferning pattern
66
US finding in PPROM
Oligohydramnios
67
Chorioamnionitis signs
- Maternal and fetal tachycardia (>160)
- Maternal fever
- Uterine tenderness
- Malodorous vaginal d/c
68
Chancroid (tx)
- PO azithromycin, or
| - IM ceftriaxone
69
PPROM (tx)
- Prior to 32wks: expectant mgmt
| - After 34wks: delivery
70
PPROM w/ infx (tx)
- Broad-spec ABX: ampicillin and gentamicin
| - IOL
71
Sign of fetal lung maturity on speculum examination
Presence of PG (phosphatidylglycerol)
72
Bug that causes chorioamnionitis in setting of intact membranes
Listeria (unpasteurized milk products)
73
Chorioamnionitis (intra-amniotic infection) confirmatory test
Amniocentesis w/ Gram stain
74
Positive HIV on ELISA. Next step
Confirm w/ western blot or PCR
75
What does chlamydia cause in neonates?
- Conjunctivitis
| - PNA
76
Chlamydial cervicitis in pregnancy (tx)
- PO erythromycin
- PO amoxicillin
- PO azithromycin
77
What does chlamydia cause in adults?
- Urethritis
- Mucopurulent cervicitis
- Late post-partum endometritis
78
Gonococcal infection (tx)
- IM ceftriaxone
| - ABX for concurrent chlamydia
79
Presentation of disseminated gonococcal disease
- Pustular skin lesions
- Arthralgias
- Septic arthritis
80
How is chlamydia transmitted from mother to neonate?
Delivery
81
How is HIV transmitted from mother to baby?
- Transplacental
- Delivery
- Breast milk
82
What kind of disease do ophthalmic ABX prevent in neonates?
Gonococcal, not chlamydial conjunctivitis
83
What is used to monitor the HIV status of a woman in pregnancy?
- Viral load (goal: <1000)
| - CD4 T-cell count
84
Fifth disease (aka; bug)
- Erythema infectiosum
| - Parvovirus B19 (ssDNA)
85
Fetal causes of hydramnios (4)
- CNS anomalies
- GI tract malformations
- Chromosomal abnormalities
- Nonimmune hydrops
86
Non-fetal causes of hydramnios (4)
- Maternal diabetes
- Isoimmunization
- Multiple gestation
- Syphilis
87
Parvovirus B19 (adult presentation)
- Myalgias
- Arthralgias
- Reticular (lacy) rash
88
Fetal hydrops (definition)
Excess fluid in 2 or more body cavities (eg, ascites, skin edema, pericardial effusion, and/or pleural effusion)
89
Confirmatory test in suspected parvovirus B19 infection
IgG and IgM serology
90
What is one of the earliest manifestations of fetal hydrops?
Hydramnios
91
Typical incubation period for HSV
2-7 days
92
Prodromal symptoms of HSV
-Paresthesias
-Burning
-Tinging
(dormancy in sacral DRG)
93
Fetal anemia to hydrops (pathophysiology)
- HF
| - Hematopoietic centers in liver (less albumin)
94
HSV-1 vs HSV-2
1: above waist (oral/facial)
2: below waist (genitals)
95
When to recommend C-section in HSV+ mom
- Recurrent lesions
- Ruptured membranes
- Prodromal sxs
96
Anemia in pregnancy (Hb level)
<10.5 g/dL
97
Mild anemia w/ no risk factors (AfAm, SE Asian, Mediterranean) (tx)
Supplemental iron
98
Anemia following tx of UTI w/ ABX
-G6PD deficiency (sulfonamides, nitrofurantoin, antimalarials)
99
Persistent anemia (mgmt)
- Ferritin levels
| - Hb electrophoresis
100
Hemolytic processes (5) causing anemia in pregnancy
- G6PD deficiency
- HELLP syndrome
- Malaria
- AIHA
- SC crisis
101
Mc cause of anemia in pregnancy
Iron deficiency
102
Delivery of a baby in an HSV+ mom
Vaginal delivery is fine if
- No active lesions
- No prodromal symptoms
103
Mc cause of megaloblastic anemia in pregnancy
Folate deficiency
104
DVT in a pregnant woman (dx)
Doppler
105
Thrombosis in pregnancy (tx)
Anticoagulation w/ heparin (IV then SC)
106
Why is pregnancy a hypercoagulable state?
- Increased levels of clotting factors (mainly fbg)
| - Venous stasis (uterus compresses vena cava)
107
Long-term complications of heparin
- Osteoporosis
| - Thrombocytopenia
108
Mc locations for DVT after gyn surgeries
- Lower extremities
| - Pelvic veins
109
Hemorrhagic corpus luteum (dx)
Laparoscopy
110
When does the corpus luteum stop making progesterone and the placenta takes over?
Week 10
111
Earliest indicator of hypovolemia in a young healthy person
Decreased UOP
112
Hemoperitoneum in pregnancy (causes)
- Ruptured ectopic pregnancy
- Ruptured corpus luteum
- Splenic injury or rupture
113
Culdocentesis (clotted vs. nonclotted blood)
- Clotted: arised from vaginal blood vessel
| - Nonclotted: intra-abdominal hemorrhage
114
Tissue that floats w/ a "frond" pattern in saline
Products of conception
115
Postpartum hemorrhage, PPH (definition)
>500mL loss after vaginal delivery
| >1000mL loss after C-section
116
Mc cause of early PPH
Uterine atony (myometrium hasn't contracted)
117
Required supplement if corpus luteum is removed before 10wks
Progesterone
118
First step in early PPH mgmt
Uterine massage and dilute oxytocin (IV)
119
Second-line tx in PPH
PGFa2 (IM) or Methylergonovine (IM)
120
Early PPH vs Late PPH
- Early: w/in first 24hrs
| - Late: after 24hrs
121
Mgmt if medical therapy is ineffective in PPH
ELAP:
- Ascending branch of uterine artery or internal iliac artery ligation
- Hysterectomy
122
Boggy uterus vs. firm uterus in PPH (causes)
- Boggy: uterine atony
| - Firm: genital tract laceration
123
Drugs used in PPH that are contraindicated in (1)HTN and (2)asthma
1) Methylergonovine (Methergine)
| 2) Prostaglandin F 2a
124
Late PPH (causes x2)
- Mc: Subinvolution of placenta (eschar over placental bed falls off -> lack of myometrial ctx)
- Retained POC
125
Thyroid storm (signs and sxs)
- CNS dysfunction (coma or delerium)
| - Autonomic instability (hyperthermia, HTN or hypotension)
126
Hyperthyroidism (labs)
- High free T4
| - Low TSH
127
Hyperthyroidism in pregnancy (tx)
-Propylthiouracil (PTU)
128
Mc cause of hyperthyroidism in US
Grave's
129
Thyroid storm (tx)
- Beta blockers
- Corticosteroids
- PTU
130
Most likely dx of postpartum thyroiditis
Destructive lymphocytic thyroiditis
131
Mc cause of fever after C-section
Endomyometritis
132
Endomyometritis (mechanism)
Ascending infection of vaginal organisms
133
Effect of pregnancy on thyroid hormones (Free T4, TSH, total T4, TBG)
- Free T4: unchanged
- TSH: unchanged
- Total T4: increased
- TBG: increased
134
Fever
38*C
| 100.4 F
135
Septic pelvic thrombophlebitis, SPT (definition)
Bacterial infection of pelvic venous thrombi, usually involving the ovarian vein
136
Most significant risk factor for postpartum endomyometritis
Cesarean section
137
Mc bug isolated in endomyometritis complicating pts after a C-section
Bacteroides sp
138
First trimester (definition)
conception-12wks
139
Second trimester (definition)
13-26wks
140
Fever after C-section (causes x5)
- Endomyometritis
- Wound infection
- Mastitis
- Pyelonephritis
- Atelectasis
141
Third trimester (definition)
27wks-40wks
142
Optimal time frame for sono in fetal anomaly screening
18-20wks
143
Abnl msAFP and triple marker screens should be followed by:
- Sono
| - Amniocentesis
144
When are triple screen and msAFP done?
15-20wks
145
Nonreactive NST
FHR accelerations:
| absent or less than 15x15
146
Positive CST
Late decels w/ 3 consecutive UCs (worrisome)
147
Next steps in nonreactive NST
- First, vibroacoustic stimulation (VAS)
| - If still nonreactive, then contraction stress test (CST) or biophysical profile (BPP)
148
Negative CST
No late decels in presence of 3 UCs in 10min (reassuring)
149
NST, CST combinations in order of increasing severity
+accels, -late decels
- accels, -late decels
- accels, +late decels
150
Tachycardia and bradycardia on electronic fetal monitoring (EFM)
Tachy: >160
Brady: <110
151
Reactive NST
FHR accelerations:
| 15bpm x 15sec
152
NL variability on EFM
5-10bpm from baseline
153
Severe variable decels (definition)
>60sec
Drops 60bpm below baseline, or
Drops to less than 60bpm
154
Variable decels (etiology and significance)
- Umbilical cord compression
| - Sometimes worrisome (if severe)
155
Late decels (etiology and significance)
- Uteroplacental insufficiency
| - Always worrisome
156
Early decels (etiology and significance)
- Head compression (vagal)
| - Benign
157
Baseline tachy on EFM (nonhypoxemic maternal causes x3)
- Scopolamine
- Atropine
- Beta agonists
158
Decreased variability on EFM (nonhypoxemic maternal causes x3)
- Parasympatholytics
- Sedatives
- Tranquilizers
159
EFM signs in prematurity (x2)
- Tachy
| - Decreased variability
160
Fetal scalp pH values (NL vs ABNL)
7.20 or higher = NL
| <7.20 = ABNL
161
EFM signs in cardiac arrhythmia (x3)
- Tachy
- Brady
- Increased variability
162
Baseline brady on EFM (nonhypoxemic maternal causes x2)
- Local anesthetics
| - Beta blockers
163
EFM signs w/ sleep (x1)
-Increased variability
164
Increasing fetal oxygenation w/ nonreassuring tracings (x4)
- Stop oxytocin
- 500ml IV isotonic bolus to mom
- Change maternal position
- High-flow oxygen (8-10L)
165
Biophysical profile, BPP (components x5)
- NST reactivity
- AF volume (>2cm in at least 1 vertical pocket)
- Extremity tone
- Breathing movements
- Gross body movements
166
EFM signs w/ fetal movement (x2)
- Tachy
| - Increased variability
167
Neonatal hazards (x4) associated w/ PROM if fetus remains in utero
- Infection and sepsis
- Deformations
- Umbilical cord compress
- Pulmonary hypoplasia
168
Maternal hazards (x3) associated w/ PROM if fetus remains in utero
- Chorioamnionitis and sepsis
- DVT
- Psychosocial separation
169
Neonatal hazards (x7) associated w/ PROM if preterm delivery occurs
- RDS, BPD
- IVH, CP
- ROP
- PDA
- NEC
170
Chorioamnionitis (tx)
-clindamycin+gentamicin (IV)
171
Preterm labor (dx)
- 20-37wks, and
- 3 or more ctx's in 20min
- 2cm or more dilation or change in dilation/effacement
172
Fetal contraindications for tocolysis (x4)
- Fetal demise
- Fetal distress
- Severe IUGR
- Lethal anomaly
173
Maternal contraindications for tocolysis
- Severe PEC
- Eclampsia
- Uncontrolled DM
- Advanced cervical dilation
174
Placental/membrane-related contraindications for tocolysis
- SROM
- Severe placental abruption
- Unstable placenta previa
- Chorioamnionitis
175
Tocolytic agents (x4)
- Magnesium sulfate
- Beta agonists (ritordine, terbutaline)
- PG synthetase inhibitors (indomethacin)
- Ca channel blockers (nifedipine)
176
Posterm hazards (x2)
- Macrosomia (mc)
| - Dysmaturity syndrome: fetal hypoxia and meconium aspiration syndrome
177
Dating accuracy of early sono
+/- 5 days (<12wks)
| +/- 7days (12-18wks)
178
Postdate triage mgmt
- Certain dates and favorable cervix: IOL (oxytocin)
- Certain dates, unfavorable cervix: IOL (PGE)
- Uncertain dates: manage expectantly
179
PROM (mgmt)
25-35 wks: prolong pregnancy (BMZ and ABX)
| >35wks: deliver
