OBGYN Flashcards
What can cause a vagal reaction and lead to an early deceleration of the fetal heart rate?
Compression of the fetal head
What is a normal and benign finding during labor?
Early fetal decelerations
What are the characteristics of a threatened abortion?
< 20 weeks gestation
Abdominal pain/bleeding
Closed cervical os
No passage of fetal tissue
What are the characteristics of an inevitable abortion?
< 20 weeks gestation
Abdominal pain/bleeding
Open cervical os
No passage of fetal tissue
What are the characteristics of an incomplete abortion?
< 20 weeks gestation
Abdominal pain/bleeding
Closed cervical os
Passage of some fetal tissue, but some tissue remains in the uterus
What are the characteristics of a complete abortion?
< 20 weeks gestation
Abdominal pain/bleeding
Closed cervical os
Passage of fetal parts & placenta
Uterus contracted
What is a missed abortion?
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
What is the most common risk factor for uterine prolapse?
Childbirth and pregnancy
What are the daily micronutrient recommendations during pregnancy?
Iron: 27mg
Calcium: 1000mg
Vit D: 600 IU
Folate: 600mcg
Iodine: 220mcg
How is preeclampsia defined?
Hypertension plus either proteinuria or end-organ dysfunction
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)?
Delivery regardless of gestational age
What medication is recommended for women diagnosed with preeclampsia if the gestational age is < 34 weeks?
Antenatal corticosteroids (Betamethasone)
What is the most common type of benign breast mass?
Fibroadenomas
What medication is used in preeclampsia with severe features as seizure prophylaxis?
Magnesium sulfate
What test can be performed to determine if magnesium sulfate is at a therapeutic level?
Patellar reflexes
What is the most common cause of infertility?
Anovulation
How do you manage a breast abscess when the overlying skin is erythematous but not ischemic?
Needle aspiration, antibiotics, and continuing breastfeeding (if they are currently breastfeeding)
What are the degrees of perineal lacerations?
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
What is the the treatment for trichomoniasis?
Single dose of metronidazole 2 g PO
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?
Kleihauer-Betke test
What is the most common cause of abnormal uterine bleeding in adolescent women?
Immature hypothalamic-pituitary axis
What is a genetic syndrome that affects collagen and increases the risk of cervical insufficiency?
Ehlers-Danlos syndrome
How is a diagnosis of cervical insufficiency made based on obstetrics history?
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
What are treatment options for cervical insufficiency?
Progesterone supplementation
Cervical cerclage placement
What is the first-line agent for tocolytic therapy in women between 32–34 weeks gestation?
Nifedipine
What is a normal fetal heart rate range?
110 - 160
What would a UA on an asymptomatic patient who has chlamydia show?
Pyuria with no organisms on Gram stain
What is the most common symptom of inflammatory breast cancer?
Rapidly enlarging (within the past 6 months) area of breast erythema and induration, occupying at least one-third of the breast
What are APGAR scores?
Appearance, pulse, grimace, activity, respiration
Calculated at 1 and 5 minutes after birth
Score of 0, 1, or 2 per section
What tumor marker will be elevated in a patient with ovarian cancer?
CA 125
What tumor marker would be expected to be elevated in patients with breast cancer?
CA 15-3
What is the treatment for syphillis?
Single IM injection of benzathine penicillin
What is the most common identifiable risk factor for preterm prelabor rupture of membranes (PPROM)?
Genital tract infection (ex: Gardnerella vaginalis infection)
What hormone is responsible for breast milk production following delivery?
Prolactin
What is the treatment for lactational mastitis?
Continue breast feeding and dicloxacillin
Can consider using cephalexin, TMP-SMX (MRSA), or clindamycin (PCN allergy)
If you suspect pre-eclampsia in a patient with HTN but no proteinuria, what other findings could be seen?
Thrombocytopenia
Kidney insufficiency
Impaired liver function
Pulmonary edema
Cerebral symptoms
What device is the only device approved by the FDA to treat menorrhagia (heavy menstrual bleeding)?
52 mg levonorgestrel-releasing IUD
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?
Progestin therapy (megestrol acetate or depot medroxyprogesterone acetate)
What disorder can show bilateral enlarged ovaries with peripheral cysts, commonly referred to as “string of pearls” sign on a pelvic ultrasound?
PCOS
What are the stages of labor?
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
True or fale: HIV is a contraindication to breastfeeding
True
What the most common symptom of menopause?
Hot flashes
What protein level would qualify a patient suspected of having preeclampsia for the diagnosis?
> or = 300mg in a 24 hr urine collection
or = 2+ on dipstick
What is the recommended dose of folic acid for pregnant women in their 1st trimester?
0.4-0.8mg
If high risk (or hx of neural tube defect): 4mg
When should folic acid be recommended?
Start 1 month prior to conception and through the 1st trimester
What physical characteristics can be noted in postterm infants?
Meconium staining
Decreased vernix caseosa and lanugo hair
Dry and parchment-like peeling skin
What are the signs/symptoms of Paget disease of the vulva?
Vulvar pruritus
Well-demarcated, slightly raised, erythematous vulvar lesion with an eczematoid appearance
What glucose levels are considered positive for gestational diabetes?
Fasting glucose ≥ 95 mg/dL
1-hour glucose ≥ 180 mg/dL
2-hour glucose ≥ 155 mg/dL
3-hour glucose ≥ 140 mg/dL
How are patients tested for gestational diabetes?
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
What are the two most commonly performed types of episiotomy?
Median (midline) and mediolateral
Which type of episiotomy is associated with a lower risk of anal sphincter injury but increased blood loss?
Mediolateral
Condylomata acuminata (anogenital warts) are typically caused by what?
HPV 6 & 11
What is the most common sexually transmitted infection in the world?
HPV
What surgical incision is the preferred approach for most cesarean section deliveries?
Pfannenstiel skin incision
What type of incision for a cesarean section may be useful in patients who warrant urgent or emergent delivery?
Vertical midline incision
What are the 4 types of female pelvis’?
Android
Anthropoid
Gynecoid
Platypelloid
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?
Android
Which pelvis type is most likely to lead to labor arrest?
Android
Which pelvis types have a forepelvis that is wide, divergent, narrow, & straight?
Wide: gynecoid
Divergent: anthropoid
Narrow: android
Straight: platypelloid
What type of contraception is contraindicated for the first 6 weeks postpartum?
Combined hormonal contraceptives (pills, patch, or ring)
What fetal abnormality is associated with an elevated alpha-fetoprotein (AFP) level?
Neural tube defects
What makes up the quadruple test (quad screen) & what does it test for?
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
What is the dosing for metronidazole in pregnant women when treating BV?
500 mg PO BID or 250 mg PO TID for 7 days
What is the best way to diagnose menopause?
Clinical assessment
What are Leopold maneuvers?
4 maneuvers used to determine the fetal lie, presentation, and position by palpating the uterus through the abdomen
What organism causes chancroids?
Haemophilus ducreyi
What is the classic presentation of a tubo-ovarian abscess (TOA)?
Acute lower abdominal pain, vaginal discharge, and systemic symptoms (fever, chills)
Which hormone is responsible for uterine ripening to allow proper implantation of a fertilized ovum?
Progesterone
What is considered a reactive fetal acceleration?
2 normal accelerations (≥ 15 bpm above baseline for 15 seconds to 2 minutes) within a 20-minute period
What complications are associated with gestational diabetes?
Preeclampsia
Gestational hypertension
Polyhydramnios
Large for gestational age infant
At what age does the United States Preventive Services Task Force recommend initiating screening for breast cancer?
Start at 50 with screenings every 2 years
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?
Intra-amniotic infection (chorioamnionitis)
How is a definitive diagnosis of ovarian torsion made?
Direct visualization of the torsion at the time of surgical evaluation
What is the minimum amount of time a woman should wait to resume intercourse following an uncomplicated vaginal delivery?
2 weeks
What is the most common type of invasive breast cancer?
Infiltrating ductal carcinoma
What bacteria most commonly causes breast abscesses, and what does it show on culture?
S. aureus
Gram-positive cocci in clusters
What is the most common side effect of oxytocin administration?
Tachysystole
Which birth control has a black box warning because of the increased risk of thromboembolism?
Ethinyl estradiol and norelgestromin patch
What is the recommended antibiotic regimen to treat gonorrheal cervicitis in pregnant women?
Ceftriaxone (500 mg intramuscularly) and azithromycin (1 g orally)
When do ectopic pregnancies occur most frequently?
6-8 weeks
What HTN med should be avoided in pregnant women with a history of asthma, and what should be used instead?
Avoid: labetalol
Use: nifedipine
What is the most common site of endometriosis?
Ovaries
What is Sheehan syndrome?
Postpartum hypopituitarism
Will have failure to lactate after delivery and amenorrhea or oligomenorrhea
Primary dysmenorrhea is caused by what?
Prostaglandin production
If a newborn presents with skin edema, ascites, pericardial effusion, pleural effusion, and severe anemia, what would likely be causing these symptoms?
Rh incompatibility
Which type of HPV is most commonly associated with cervical cancer?
HPV 16 (50% of cases)
HPV 18 (20% of cases)
What is a classic ultrasound finding for placental abruption?
Retroplacental hematoma
What is the most common complication of placental abruption?
DIC
What is the preferred second-line treatment for fibrocystic breast changes?
Tamoxifen
What type of cancer risk is increased in women who are treated with combined menopausal hormone therapy?
Breast cancer
What vitamin, if taken in excess, is teratogenic in the first trimester and is associated with spontaneous abortion and fetal malformation?
Vitamin A
What physical exam finding is seen in patients with secondary syphilis?
Condyloma latum
Patients with PCOS are at increased risk for the development of what cancer?
Endometrial
Colostrum is high in what, as compared to mature milk?
Protein
Which sign associated with pregnancy is characterized by softening of the cervix?
Goodell sign
What is the earliest gestational trophoblastic disease can be diagnosed?
8 weeks
What accounts for about 75% of cases of vulvar cancer?
Squamous cell carcinoma
What is the appropriate dosing for treating a first time occurence of HSV?
Acyclovir PO 400mg TID
What type of mass has a ground-glass echogenicity appearance on ultrasound?
Endometrioma
What is the recommended treatment for hyperandrogenic symptoms in patients with PCOS?
Oral contraception pills
Lifestyle changes
Metformin
What is Naegele rule?
A method of dating the pregnancy and helping to calculate the estimated due date
What is the formula used in Naegele rule?
1st day of LMP + 7 days - 3 months + 1 year
What is the greatest risk factor for patients with placental abruption?
Previous placental abruption
At what age should a provider be concerned about primary amenorrhea?
15 for girls normal growth and secondary sex characteristics
13 for girls without secondary sex characteristics, such as breast development
What are the definitions of menometrorrhagia, menorrhagia, metrorrhagia, and polymenorrhea?
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)
What are the causes of abnormal uterine bleeding?
P: polyp
A: adenomyosis
L: leiomyoma (fibroid)
M: malignancy
C: coagulopathy
O: ovulatory dysfunction
E: endometrial
I: iatrogenic
N: not yet classified
What does the presence of a T sign on an ultrasound of twins mean in terms of their gestation?
Monochorionic, diamniotic gestation
The presence of two separate placentas indicates what type of gestation?
Dichorionic
The presence of a twin peak or lambda sign on ultrasound is indicative of what?
The original two placentas have fused into one larger placenta and is a dichorionic, diamniotic gestation
How is the baby positioned in a frank breech?
Buttocks is presenting and feet are at the head without knees bent
How is the baby positioned in a complete breech?
Buttocks presenting and feet are at the chest with knees bent
How is the baby positioned in an incomplete breech?
Foot/feet or buttocks presenting and other leg is bent at the knee
What is the most common breech position?
Frank breech (1st most common)
Incomplete breech (2nd most common)
What is a cervical cerclage and when do you use it?
Procedure to stitch the cervix to prevent premature delivery or spontaneous abortion
Placed between 12 and 24 weeks gestation
What test can help to support the diagnosis of pelvic inflammatory disease?
Nucleic acid amplification test (NAAT) for Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium
What condition results in the congenital absence of the vagina with variable uterine development?
Müllerian agenesis AKA vaginal agenesis or Mayer-Rokitansky-Küster-Hauser syndrome
What is the first-line therapy for gestational diabetes that has not responded to diet/lifestyle modifications?
Insulin
At how many weeks gestation can the uterine fundus be palpated at the pubic symphysis?
12
The uterine fundus can be palpated at the umbilicus at how many weeks gestation?
20
What are the clinician-administered options for treating condyloma acuminata (genital warts)?
Cryotherapy, surgical excision, and electrosurgery
What does a fetal fibronectin measurement test for?
Helps to predict preterm labor
What is the antibiotic regimen for patients who are admitted for PID?
Cefoxitin or cefotetan and doxycycline
During which phase of the menstrual cycle do women experience PMS?
At the end of the luteal phase
For patients who still have a uterus, hormone replacement therapy must include what?
Progesterone
When do women start to feel fetal movement?
1st pregnancy: 18-20 weeks
Prior pregnancies: as early as 14 weeks
What is oligohydramnios?
Lower than normal volume of amniotic fluid, which can lead to underdevelopment of fetal lung tissue as well as fetal death
What volume of amniotic fluid would constitute oligohydramnios?
< 5 cm or a single deepest pocket that is < 2 cm in depth on ultrasound
What is seen on wet mount in a patient with BV?
Epithelial cells with stippled borders (clue cells)
What is the most common type of invasive breast cancer?
Invasive ductal carcinoma
What is a medication that can be given to women for nausea and vomiting during pregnancy prior to initiating drugs such as Zofran?
Pyridoxine (vitamin B6)
Can add doxylamine if ineffective alone
What should the endometrial stripe (endometrial thickness) measure that would suggest low likelihood of hyperplasia or endometrial cancer in postmenopausal women?
< 4mm
What is the treatment of choice for endometritis in a women who had a delivery via c-section?
Clindamycin + gentamicin
What is the most common cause of primary amenorrhea?
Gonadal dysgenesis
What is the best test to evaluate the onset of menopause?
FSH
What is the recommendation for women with CIN 2 who consider the risks of treatment to outweigh the risks of cancer?
Pap smear and colposcopy in 6 months and 12 months
What are complications of PID?
Tubo-ovarian abscess
Chronic pelvic pain
Infertility
Ectopic pregnancy
What medication is used to treat an ectopic pregnancy?
Methotrexate
What is the treatment of choice for BV?
Metronidazole
Which placental complication has the greatest risk for postpartum hemorrhage due to the depth of invasion into the uterine myometrium?
Placenta percreta
What does VEAL CHOP stand for?
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
