OBGYN Flashcards
RF for osteoporosis
low ER, lo Ca, malnutrition, lo vit d, etoh, cigarettes, steroids, AEDs
pelvic pain worse w sex and bladder filling. nocturia, frequency, incontinence
interstitial cystitis
Amniotic fluid embolus
DIC can happen too. Resp failure - 1st step is to breathing support
How long is levognorgestrel good for (plan b)?
120 hrs
Screen all pregnant ladies for:
HIV, RPR, HBV regardless of RFs
ASCUS after 25
get HPV DNA too. If Pos - colpo
Chlamydia tx
Azithromycin (doxy too)
Gonorrhea tx
ceftriaxone. thayer martin media
Painless vaginal bleeding in 3rd trimester
Placenta previa
No vaginal exams in 3rd trimester bleeding unless you’re certain where placenta is
Get US plz
OCP while breastfeeding
progesterone only plz
Post partum hypoxia, cardiogenic shock and DIC
AF embolus
When to give rho gam
28 w and at delivery
Excessive fetal-maternal hemorrhage (like abruption), the standard rho gam dose is insufficient. can result in maternal isoimmunization
Excessive fetal-maternal hemorrhage (like abruption), the standard rho gam dose is insufficient. can result in maternal isoimmunization
Premature ovarian failure causes/ hormone levels
can be due to AI/chemo/radiation. Low ER, so high fsh and lh because no negative feedback. FH/LH >1
Symmetric v asymmetric causes of IUGR
Symmetric - fetus (chromosome, congenital, TORCH)
Asymmetric - maternal
How to dx endometriosis
Laparoscopy
What to do if fetus is dx’d with condition incompatible with life and labor is imminent
No steroids. Just let labor proceed
Endometritis tx
gent and clinda
Irregular shaped uterus, heavy and prolonged menstrual bleeding. Bowel/bladder incontinence
Fibroids can compress local structures
Endometrial hyperplasia without atypical features
Very low progression to to cancer. Tx cyclic progesterone
Low grade T, shaking chills, increased WBC and vaginal d/c immediate post partum
totally normal
Tx and dx for PMS
menstrual diary and ssri
tx for gestational dm
insulin. want fasting glucose below 95
How does peripheral fat make more androgens?
aromatizes androgens to ER made in adrenals
Irregular cycles in pubertal females
Normal, btw. But caused by HPA producing inadequate hmns
LH Levels in PCOS
Elevated
How to confirm IUFD
US. autopsy fetus and placenta to figure out why
Missed abortion
CLOSED OS. brownish discharge. no passage of contents. still in gest sac
Complete abortion
Empty uterus. Pain subsides after passage of contents. CLOSE OS
Amenorrhea, normal breasts, absent pubic and axillary hair, absent internal reproductive organs, 46 xy, male-range testosterone
Androgen insensitivity (Mullerian agenesis will have 46 xx)
How to suppress lactation ?
No drugs - just decrease nipple stimulation - tight bra and ice packs and such
Abnl MSAFP. Next step?
US - multiple gestations and dating error more common than NTD/Trisomy
Retained POC, increased vascularity, thick endometrial stripe, echogenic material in cavity on pelvic US. Fever, chills, abd pain, bloody/purulent d/c,
Septic Abortion - history will tip you off as well
Septic Abortion Tx
Broad spectrum Abx and suction and curettage - emergency
BPP score of 4 or less
Deliver, regardless of fetal lung maturity. If after 26 weeks.
BPP score of 6 with oligohydramnios
If less than 32 weeks - monitor daily
If greater than 32 weeks - deliver immediately
BPP score of 6 without oligohydramnios
If greater than 37 - deliver
If less than 37 - check again in 24 h, deliver if not improved`
Arrest of stage I labor, tx?
Amniotomy/pitocin. C Section if all else fails
Arrest of stage 2 labor, tx?
Pitocin, assisted vaginal delivery or c section
Initial tx for PCOS to induce fertility?
weight loss
Cone biopsy v colpo and targeted biopsy?
Cone - for higher grade lesions where cytology and targeted biopsy do not correlate
Colpo/targeted - for lower grade lesions to rule out CIN
How often should women over 50 get mammogram?
Every year, even if asx or no RFs
OCPs are associated with decreased risk of what cancers?
Ovarian and endometrial
dysmenorrhea causes?
endometriosis more common than leiomyoma
adnexal mass in postmenopausal female. Initial workup includes?
Transvaginal US, CA125. Don’t needle aspirate
First trimester. Mom wants to check for possible chromosomal abnormalities. What test do you do?
Chorionic villus sampling. Early amniocentesis can be done if CVS can’t
Most significant RF for fetal limb reduction in CVS?
Gestational age. Higher risk at less than 10 weeks
Vaginal d/c and vulvar pruritis. Thin, malodorous d/c, foul smelling with marked vaginal and vulvar erythema. Increased vaginal pH (5-6). Dx?
Trichomonas vaginalis - may look like BV, but BV does not typically have inflammation and pruritis.
Variable decelerations. Caused by and tx?
Cord compression. Give mom O2 and change position. Variables are typically abrupt (30s from onset to nadir)
Late decels. Caused by and Tx?
UP insuff. DELIVER. Gradual (greater than 30s from onset to nadir)
1) Most effective parameter to measure fetal weight in US in suspected growth restriction? 2) How do we differentiate asymmetrical from symmetrical growth restriction
1) Abd circumference
2) head to abdomen circumference ratio
Quad screen for Downs? for Edwards? (MSAFP, BhCG, Estriol, Inhibin A)
Downs: hi BhCG, hi inhibin A, lo MSAFP, lo estriol
Edwards: lo everything
LH/FSH in turners?
both elevated. Ovarian dysgenesis leads to no inhibitory feedback, so really high fsh and lh
Treatment for threatened abortion (which typically occurs in first trimester?)
REassurance and follow up. No need for hospitialization
Mom, multiple spontaneous abortions. Positive VDRL, prolonged PTT
Think Antiphospholipid abs - tx with LMWH and ASA
Abnormal uterine bleeding in adolescent. reason? tx?
Most likely due to immature HPA/ovarian axis, so you get anovulatory cycles. Persistent endometrial proliferation followed by heavy menses. Tx - oral progestins, estreogens, OCPs (all high dose), or tranexamic acid
respiratory distress in pre-E?
Probably due to pulm edema. Common sequelae of Pre-E. Magnesium tox would have NM probs and decreased Resp effort
Cervical mucous is thin/clear, can stretch to 6 cm, basic pH, will demonstrate ferning
This is ovulatory phase.
treatment for vaginismus?
kegels and pneumatic dilaiton
IUFD in a mom with low coag profile. What do you do?
Induce labor. Mom may develop DIC with retained fetus
What BhCG level do can wee see IUP on transvaginal US?
1500 +
Granulosa theca cell tumors secrete what hormone?
ER
What endocrine disorder can mimic menopause sx?
Hyperthyroid. Get FSH/TSH to figure out
Hypertensive drug of choice in pregnancy?
Hydralazine/labetalol > mdopa
how do you allow for premature ovarian failure patients to become pregnant?
in vitro fert with egg donor. GNRH and such wont help. low er, HIGH FSH and LH.
Cystic mass in premenopausal woman. Fluid aspirated is clear/yellow. What’s the next step?
Just observe. RTC in 4-6 weeks. Only send for cytology if fluid is bloody or foul smelling
Stress incontinence. Tx?
kegels and urethropexy
Vasa previa v Placenta previa. When there’s bleeding how do you know the difference?
Vasa: baby bleeding. So you;ll see late decels and UP insuff. Normal mom vitals
Placenta: mom’s vitals will be wacko
