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Clinical Rotations > OBGYN > Flashcards

OBGYN Flashcards

1
Q

What can cause a vagal reaction and lead to an early deceleration of the fetal heart rate?

A

Compression of the fetal head

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2
Q

What is a normal and benign finding during labor?

A

Early fetal decelerations

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3
Q

What are the characteristics of a threatened abortion?

A

< 20 weeks gestation
Abdominal pain/bleeding
Closed cervical os
No passage of fetal tissue

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4
Q

What are the characteristics of an inevitable abortion?

A

< 20 weeks gestation
Abdominal pain/bleeding
Open cervical os
No passage of fetal tissue

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5
Q

What are the characteristics of an incomplete abortion?

A

< 20 weeks gestation
Abdominal pain/bleeding
Closed cervical os
Passage of some fetal tissue, but some tissue remains in the uterus

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6
Q

What are the characteristics of a complete abortion?

A

< 20 weeks gestation
Abdominal pain/bleeding
Closed cervical os
Passage of fetal parts & placenta
Uterus contracted

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7
Q

What is a missed abortion?

A

In utero death of the fetus/embryo prior to 20 weeks with retention of the pregnancy
Cervical os is closed
No passage of fetal tissue

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8
Q

What is the most common risk factor for uterine prolapse?

A

Childbirth and pregnancy

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9
Q

What are the daily micronutrient recommendations during pregnancy?

A

Iron: 27mg
Calcium: 1000mg
Vit D: 600 IU
Folate: 600mcg
Iodine: 220mcg

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10
Q

How is preeclampsia defined?

A

Hypertension plus either proteinuria or end-organ dysfunction

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11
Q

What is the best course of treatment for a pregnant patient who presents with preeclampsia with severe features (severe hypertension (> or = 160/110 mm Hg), severe headache, visual disturbances, kidney dysfunction, hepatic dysfunction, thrombocytopenia, and pulmonary edema)?

A

Delivery regardless of gestational age

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12
Q

What medication is recommended for women diagnosed with preeclampsia if the gestational age is < 34 weeks?

A

Antenatal corticosteroids (Betamethasone)

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13
Q

What is the most common type of benign breast mass?

A

Fibroadenomas

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14
Q

What medication is used in preeclampsia with severe features as seizure prophylaxis?

A

Magnesium sulfate

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15
Q

What test can be performed to determine if magnesium sulfate is at a therapeutic level?

A

Patellar reflexes

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16
Q

What is the most common cause of infertility?

A

Anovulation

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17
Q

How do you manage a breast abscess when the overlying skin is erythematous but not ischemic?

A

Needle aspiration, antibiotics, and continuing breastfeeding (if they are currently breastfeeding)

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18
Q

What are the degrees of perineal lacerations?

A

1st: perineal skin only
2nd: perineal body & deeper tissues
3rd: into the capsule & muscle of the rectal sphincter
4th: through the sphincter & into the rectal mucosa

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19
Q

What is the the treatment for trichomoniasis?

A

Single dose of metronidazole 2 g PO

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20
Q

What test should be ordered that will provide a quantitative measurement of the amount of fetal red blood cells in maternal blood if hemorrhage is suspected?

A

Kleihauer-Betke test

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21
Q

What is the most common cause of abnormal uterine bleeding in adolescent women?

A

Immature hypothalamic-pituitary axis

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22
Q

What is a genetic syndrome that affects collagen and increases the risk of cervical insufficiency?

A

Ehlers-Danlos syndrome

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23
Q

How is a diagnosis of cervical insufficiency made based on obstetrics history?

A

At least two consecutive 2nd trimester pregnancy losses or early premature births (< 28 weeks gestation) that are associated with relatively painless early cervical dilation or at least three preterm births prior to 34 weeks gestation in which other causes have been excluded

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24
Q

What are treatment options for cervical insufficiency?

A

Progesterone supplementation
Cervical cerclage placement

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25
Q

What is the first-line agent for tocolytic therapy in women between 32–34 weeks gestation?

A

Nifedipine

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26
Q

What is a normal fetal heart rate range?

A

110 - 160

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27
Q

What would a UA on an asymptomatic patient who has chlamydia show?

A

Pyuria with no organisms on Gram stain

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28
Q

What is the most common symptom of inflammatory breast cancer?

A

Rapidly enlarging (within the past 6 months) area of breast erythema and induration, occupying at least one-third of the breast

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29
Q

What are APGAR scores?

A

Appearance, pulse, grimace, activity, respiration
Calculated at 1 and 5 minutes after birth
Score of 0, 1, or 2 per section

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30
Q

What tumor marker will be elevated in a patient with ovarian cancer?

A

CA 125

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31
Q

What tumor marker would be expected to be elevated in patients with breast cancer?

A

CA 15-3

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32
Q

What is the treatment for syphillis?

A

Single IM injection of benzathine penicillin

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33
Q

What is the most common identifiable risk factor for preterm prelabor rupture of membranes (PPROM)?

A

Genital tract infection (ex: Gardnerella vaginalis infection)

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34
Q

What hormone is responsible for breast milk production following delivery?

A

Prolactin

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35
Q

What is the treatment for lactational mastitis?

A

Continue breast feeding and dicloxacillin
Can consider using cephalexin, TMP-SMX (MRSA), or clindamycin (PCN allergy)

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36
Q

If you suspect pre-eclampsia in a patient with HTN but no proteinuria, what other findings could be seen?

A

Thrombocytopenia
Kidney insufficiency
Impaired liver function
Pulmonary edema
Cerebral symptoms

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37
Q

What device is the only device approved by the FDA to treat menorrhagia (heavy menstrual bleeding)?

A

52 mg levonorgestrel-releasing IUD

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38
Q

What is the treatment for a patient who has a endometrial biopsy that shows hyperplasia with atypia who would like to preserve her ability to conceive?

A

Progestin therapy (megestrol acetate or depot medroxyprogesterone acetate)

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39
Q

What disorder can show bilateral enlarged ovaries with peripheral cysts, commonly referred to as “string of pearls” sign on a pelvic ultrasound?

A

PCOS

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40
Q

What are the stages of labor?

A

Onset: regular contractions every 3 to 5 minutes for at least 1 hour
1st: from the onset of labor until complete cervical dilation
2nd: time between complete cervical dilation and delivery of the baby
3rd: time between the delivery of the baby and the delivery of the placenta
4th: uterus regaining its tone and starting to involute

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41
Q

True or fale: HIV is a contraindication to breastfeeding

A

True

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42
Q

What the most common symptom of menopause?

A

Hot flashes

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43
Q

What protein level would qualify a patient suspected of having preeclampsia for the diagnosis?

A

> or = 300mg in a 24 hr urine collection
or = 2+ on dipstick

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44
Q

What is the recommended dose of folic acid for pregnant women in their 1st trimester?

A

0.4-0.8mg
If high risk (or hx of neural tube defect): 4mg

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45
Q

When should folic acid be recommended?

A

Start 1 month prior to conception and through the 1st trimester

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46
Q

What physical characteristics can be noted in postterm infants?

A

Meconium staining
Decreased vernix caseosa and lanugo hair
Dry and parchment-like peeling skin

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47
Q

What are the signs/symptoms of Paget disease of the vulva?

A

Vulvar pruritus
Well-demarcated, slightly raised, erythematous vulvar lesion with an eczematoid appearance

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48
Q

What glucose levels are considered positive for gestational diabetes?

A

Fasting glucose ≥ 95 mg/dL
1-hour glucose ≥ 180 mg/dL
2-hour glucose ≥ 155 mg/dL
3-hour glucose ≥ 140 mg/dL

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49
Q

How are patients tested for gestational diabetes?

A

Screening for women at 24-28 weeks
1-hr 50g dose of glucose (if > 130 go to 3-hr test)
3-hr 100g glucose w/8 hrs fasting prior

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50
Q

What are the two most commonly performed types of episiotomy?

A

Median (midline) and mediolateral

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51
Q

Which type of episiotomy is associated with a lower risk of anal sphincter injury but increased blood loss?

A

Mediolateral

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52
Q

Condylomata acuminata (anogenital warts) are typically caused by what?

A

HPV 6 & 11

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53
Q

What is the most common sexually transmitted infection in the world?

A

HPV

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54
Q

What surgical incision is the preferred approach for most cesarean section deliveries?

A

Pfannenstiel skin incision

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55
Q

What type of incision for a cesarean section may be useful in patients who warrant urgent or emergent delivery?

A

Vertical midline incision

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56
Q

What are the 4 types of female pelvis’?

A

Android
Anthropoid
Gynecoid
Platypelloid

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57
Q

Which type of pelvis is characterized by convergent side walls of the pelvic midcavity, forward inclination of the sacrum, and a narrow subpubic arch of the pelvic outlet?

A

Android

58
Q

Which pelvis type is most likely to lead to labor arrest?

A

Android

59
Q

Which pelvis types have a forepelvis that is wide, divergent, narrow, & straight?

A

Wide: gynecoid
Divergent: anthropoid
Narrow: android
Straight: platypelloid

60
Q

What type of contraception is contraindicated for the first 6 weeks postpartum?

A

Combined hormonal contraceptives (pills, patch, or ring)

61
Q

What fetal abnormality is associated with an elevated alpha-fetoprotein (AFP) level?

A

Neural tube defects

62
Q

What makes up the quadruple test (quad screen) & what does it test for?

A

Test typically done during the 2nd trimester between 15–18 weeks gestation to evaluate for increased risk of genetic abnormalities
Alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), estriol, and inhibin A

63
Q

What is the dosing for metronidazole in pregnant women when treating BV?

A

500 mg PO BID or 250 mg PO TID for 7 days

64
Q

What is the best way to diagnose menopause?

A

Clinical assessment

65
Q

What are Leopold maneuvers?

A

4 maneuvers used to determine the fetal lie, presentation, and position by palpating the uterus through the abdomen

66
Q

What organism causes chancroids?

A

Haemophilus ducreyi

67
Q

What is the classic presentation of a tubo-ovarian abscess (TOA)?

A

Acute lower abdominal pain, vaginal discharge, and systemic symptoms (fever, chills)

68
Q

Which hormone is responsible for uterine ripening to allow proper implantation of a fertilized ovum?

A

Progesterone

69
Q

What is considered a reactive fetal acceleration?

A

2 normal accelerations (≥ 15 bpm above baseline for 15 seconds to 2 minutes) within a 20-minute period

70
Q

What complications are associated with gestational diabetes?

A

Preeclampsia
Gestational hypertension
Polyhydramnios
Large for gestational age infant

71
Q

At what age does the United States Preventive Services Task Force recommend initiating screening for breast cancer?

A

Start at 50 with screenings every 2 years

72
Q

What condition is confirmed in patients with a fever (at or above 102.2°F or above 100.4°F twice at least 30 minutes apart) without another clear source?

A

Intra-amniotic infection (chorioamnionitis)

73
Q

How is a definitive diagnosis of ovarian torsion made?

A

Direct visualization of the torsion at the time of surgical evaluation

74
Q

What is the minimum amount of time a woman should wait to resume intercourse following an uncomplicated vaginal delivery?

A

2 weeks

75
Q

What is the most common type of invasive breast cancer?

A

Infiltrating ductal carcinoma

76
Q

What bacteria most commonly causes breast abscesses, and what does it show on culture?

A

S. aureus
Gram-positive cocci in clusters

77
Q

What is the most common side effect of oxytocin administration?

A

Tachysystole

78
Q

Which birth control has a black box warning because of the increased risk of thromboembolism?

A

Ethinyl estradiol and norelgestromin patch

79
Q

What is the recommended antibiotic regimen to treat gonorrheal cervicitis in pregnant women?

A

Ceftriaxone (500 mg intramuscularly) and azithromycin (1 g orally)

80
Q

When do ectopic pregnancies occur most frequently?

A

6-8 weeks

81
Q

What HTN med should be avoided in pregnant women with a history of asthma, and what should be used instead?

A

Avoid: labetalol
Use: nifedipine

82
Q

What is the most common site of endometriosis?

A

Ovaries

83
Q

What is Sheehan syndrome?

A

Postpartum hypopituitarism
Will have failure to lactate after delivery and amenorrhea or oligomenorrhea

84
Q

Primary dysmenorrhea is caused by what?

A

Prostaglandin production

85
Q

If a newborn presents with skin edema, ascites, pericardial effusion, pleural effusion, and severe anemia, what would likely be causing these symptoms?

A

Rh incompatibility

86
Q

Which type of HPV is most commonly associated with cervical cancer?

A

HPV 16 (50% of cases)
HPV 18 (20% of cases)

87
Q

What is a classic ultrasound finding for placental abruption?

A

Retroplacental hematoma

88
Q

What is the most common complication of placental abruption?

A

DIC

89
Q

What is the preferred second-line treatment for fibrocystic breast changes?

A

Tamoxifen

90
Q

What type of cancer risk is increased in women who are treated with combined menopausal hormone therapy?

A

Breast cancer

91
Q

What vitamin, if taken in excess, is teratogenic in the first trimester and is associated with spontaneous abortion and fetal malformation?

A

Vitamin A

92
Q

What physical exam finding is seen in patients with secondary syphilis?

A

Condyloma latum

93
Q

Patients with PCOS are at increased risk for the development of what cancer?

A

Endometrial

94
Q

Colostrum is high in what, as compared to mature milk?

A

Protein

95
Q

Which sign associated with pregnancy is characterized by softening of the cervix?

A

Goodell sign

96
Q

What is the earliest gestational trophoblastic disease can be diagnosed?

A

8 weeks

97
Q

What accounts for about 75% of cases of vulvar cancer?

A

Squamous cell carcinoma

98
Q

What is the appropriate dosing for treating a first time occurence of HSV?

A

Acyclovir PO 400mg TID

99
Q

What type of mass has a ground-glass echogenicity appearance on ultrasound?

A

Endometrioma

100
Q

What is the recommended treatment for hyperandrogenic symptoms in patients with PCOS?

A

Oral contraception pills
Lifestyle changes
Metformin

101
Q

What is Naegele rule?

A

A method of dating the pregnancy and helping to calculate the estimated due date

102
Q

What is the formula used in Naegele rule?

A

1st day of LMP + 7 days - 3 months + 1 year

103
Q

What is the greatest risk factor for patients with placental abruption?

A

Previous placental abruption

104
Q

At what age should a provider be concerned about primary amenorrhea?

A

15 for girls normal growth and secondary sex characteristics
13 for girls without secondary sex characteristics, such as breast development

105
Q

What are the definitions of menometrorrhagia, menorrhagia, metrorrhagia, and polymenorrhea?

A

Menometrorrhagia: abnormal uterine bleeding that is heavy or prolonged and occurs at irregular intervals (more frequently than normal)
Menorrhagia: abnormally prolonged (> 7 days per cycle) or heavy (> 80 mL of blood) uterine bleeding that maintains a normal menstrual cycle
Metrorrhagia: abnormal uterine bleeding in between normal cycles that recur at irregular intervals
Polymenorrhea: regular menstrual cycles that occur at shortened intervals (< 21 days)

106
Q

What are the causes of abnormal uterine bleeding?

A

P: polyp
A: adenomyosis
L: leiomyoma (fibroid)
M: malignancy

C: coagulopathy
O: ovulatory dysfunction
E: endometrial
I: iatrogenic
N: not yet classified

107
Q

What does the presence of a T sign on an ultrasound of twins mean in terms of their gestation?

A

Monochorionic, diamniotic gestation

108
Q

The presence of two separate placentas indicates what type of gestation?

A

Dichorionic

109
Q

The presence of a twin peak or lambda sign on ultrasound is indicative of what?

A

The original two placentas have fused into one larger placenta and is a dichorionic, diamniotic gestation

110
Q

How is the baby positioned in a frank breech?

A

Buttocks is presenting and feet are at the head without knees bent

111
Q

How is the baby positioned in a complete breech?

A

Buttocks presenting and feet are at the chest with knees bent

112
Q

How is the baby positioned in an incomplete breech?

A

Foot/feet or buttocks presenting and other leg is bent at the knee

113
Q

What is the most common breech position?

A

Frank breech (1st most common)
Incomplete breech (2nd most common)

114
Q

What is a cervical cerclage and when do you use it?

A

Procedure to stitch the cervix to prevent premature delivery or spontaneous abortion
Placed between 12 and 24 weeks gestation

115
Q

What test can help to support the diagnosis of pelvic inflammatory disease?

A

Nucleic acid amplification test (NAAT) for Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium

116
Q

What condition results in the congenital absence of the vagina with variable uterine development?

A

Müllerian agenesis AKA vaginal agenesis or Mayer-Rokitansky-Küster-Hauser syndrome

117
Q

What is the first-line therapy for gestational diabetes that has not responded to diet/lifestyle modifications?

A

Insulin

118
Q

At how many weeks gestation can the uterine fundus be palpated at the pubic symphysis?

A

12

119
Q

The uterine fundus can be palpated at the umbilicus at how many weeks gestation?

A

20

120
Q

What are the clinician-administered options for treating condyloma acuminata (genital warts)?

A

Cryotherapy, surgical excision, and electrosurgery

121
Q

What does a fetal fibronectin measurement test for?

A

Helps to predict preterm labor

122
Q

What is the antibiotic regimen for patients who are admitted for PID?

A

Cefoxitin or cefotetan and doxycycline

123
Q

During which phase of the menstrual cycle do women experience PMS?

A

At the end of the luteal phase

124
Q

For patients who still have a uterus, hormone replacement therapy must include what?

A

Progesterone

125
Q

When do women start to feel fetal movement?

A

1st pregnancy: 18-20 weeks
Prior pregnancies: as early as 14 weeks

126
Q

What is oligohydramnios?

A

Lower than normal volume of amniotic fluid, which can lead to underdevelopment of fetal lung tissue as well as fetal death

127
Q

What volume of amniotic fluid would constitute oligohydramnios?

A

< 5 cm or a single deepest pocket that is < 2 cm in depth on ultrasound

128
Q

What is seen on wet mount in a patient with BV?

A

Epithelial cells with stippled borders (clue cells)

129
Q

What is the most common type of invasive breast cancer?

A

Invasive ductal carcinoma

130
Q

What is a medication that can be given to women for nausea and vomiting during pregnancy prior to initiating drugs such as Zofran?

A

Pyridoxine (vitamin B6)
Can add doxylamine if ineffective alone

131
Q

What should the endometrial stripe (endometrial thickness) measure that would suggest low likelihood of hyperplasia or endometrial cancer in postmenopausal women?

A

< 4mm

132
Q

What is the treatment of choice for endometritis in a women who had a delivery via c-section?

A

Clindamycin + gentamicin

133
Q

What is the most common cause of primary amenorrhea?

A

Gonadal dysgenesis

134
Q

What is the best test to evaluate the onset of menopause?

A

FSH

135
Q

What is the recommendation for women with CIN 2 who consider the risks of treatment to outweigh the risks of cancer?

A

Pap smear and colposcopy in 6 months and 12 months

136
Q

What are complications of PID?

A

Tubo-ovarian abscess
Chronic pelvic pain
Infertility
Ectopic pregnancy

137
Q

What medication is used to treat an ectopic pregnancy?

A

Methotrexate

138
Q

What is the treatment of choice for BV?

A

Metronidazole

139
Q

Which placental complication has the greatest risk for postpartum hemorrhage due to the depth of invasion into the uterine myometrium?

A

Placenta percreta

140
Q

What does VEAL CHOP stand for?

A

Fetal heart rates and what causes it
V: variable C: cord compression
E: early decel H: head compression
A: accelerations O: okay
L: late decel P: placental insufficiency

Clinical Rotations (9 decks)

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