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Step 2 > OBGYN > Flashcards

OBGYN Flashcards

1
Q

1st trimester testing options

A

To determine chromosomal abnormalities with advanced maternal age: chorionic villus sampling (10-13weeks) or amniocentesis (11-14weeks). AFP, estriol, HCG, and inhibin A serve similar purpose to screen for certain aneuploidy

To determine Rh isoimmunization: percutaneous umbilical blood sample

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2
Q

Tocolytic agents

A

used to slow cervical dilation in premature labor and allow betamethasone to take effect for fetal lung development

Magnesium sulfate
CCBs
terbutaline

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3
Q

Magnesium toxicity: clinical presentation and TX

A

respiratory depression and cardiac arrest

NOTE: check DTRs often
Tx with Ca

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4
Q

Magnesium sulfate: side effects

A

flushing
HA
diplopia
fatigue

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5
Q

CCBs: side effects

A

HA, flushing, dizziness

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6
Q

Terbutaline: side effects

A

palpitations

hypotension

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7
Q

PPROM: TX

A

with chorioamnionitis: delivery (can be vaginal)

without chorioamnionitis: betamethasona, tocolytics, ampicillin, and azithro + do fewer exams

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8
Q

Painless vaginal bleeding in 3rd trimester

A

placental previa

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9
Q

placenta previa: risk factors

A

previous C-section
previous uterine surgery
multiple gestations
previous placenta previa

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10
Q

5 types of placenta previa

A 
complete
partial
marginal
vasa previa (fetal vessel present over cervix)
low-lying placenta
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11
Q

placenta previa =

A

abnl implantation of the placenta over the internal cervical os

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12
Q

Placental abruption =

A

premature separation of the placenta from the uterus, resulting in hemorrhaging into the sparated space

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13
Q

Placental abruption vs previa vs uterine rupture

A

both 3rd trimester vaginal bleeding

abruption: severe abdominal pain and contractions

placenta previa: painless

uterine rupture: sudden onset severe abdominal pain, abnl bump in abdomen, no contxs, regression of fetus

NOTE: placental abruption and previa are distinguished via transabdominal US

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14
Q

Placental abruption: risk factors

A 
maternal HTN
prior placental abruption
cocain use
external trauma
smoking
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15
Q

Complications of a concealed placental abruption

A 
DIC
uterine tetany
fetal hypoxia
fetal death 
sheehan syndrome (postpartum hypopituitarism)
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16
Q

Scenarios when fetal RBCs may enter moms circulation

A 
amnocentesis
abortion
vaginal bleeding
placental abruption
delivery
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17
Q

Timeline for prenatal antibody screening

A

at 28 and 35 weeks

if unsensitized at 28wks, give rhogham (anti-D Rh immunoglobulin)

if baby found to be rh positive at delivery, give rhogham again

If mom sensitized, obtain antibody titer via indirect antiglobulin test and, if positive, do amnio to see if fetal RBCs Rh positive. If so, plan serial amniocenteses to assess fetal bili levels throughout pregnancy

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18
Q

Chronic vs gestational HTN

A

chronic: bp >140/90 before 20 weeks gestation or before pregnancy altogether
gestational: high bp after 20weeks gestation

both tx with methyldopa, labetalol, or nifedipine

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19
Q

Mild vs severe preeclampsia

A

Mild: >140/90, dipstick 1+ to 2+ protein, edema isolated to hands feet, and face, no AMS, no vision #, no impaired liver; TX without bp meds or mag sulf

severe: >160/110, dipstick 3+ to 4+ protein, generalized edma, AMS, vision changem impaired liver function; TX with mag sulfate, hydralazine, and delivery

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20
Q

HELLP: features

A

Hemolysis
elevated liver enzymes
low platelets

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21
Q

3 diseases of aneuploidy

A

Downs (21)
Edwards (18)
Pataws (13)

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22
Q

1st trimester screening measures

A

U/s looking at nuchal translucency
papp-A
HCG

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23
Q

2nd trimester screening measures

A

triple: HCG, AFP, estriol
quad: +inhibin A

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24
Q

2nd trimester screening measures: Downs vs Edwards

A

Downs: HCG up, AFP and estriol down, inhibin A up

Edwards: all down

“Downs is up”

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25
Q

Labs to get btw 20-28weeks

A

blood sugar
RH status
Hgb

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26
Q

Diagnosing gestational DM

A 
1-hr gtt (asymptomatic screen): if greater than 140 --> 3 hr gtt:
fasting >90
1hr >180
2hr >155
3hr >140
NOTE: any 2 = gDM
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27
Q

Accuracy of US in determing GA

A

1st trimester: GA +/- 1week
2nd trimester: GA +/- 2weeks
3rd trimester: GA +/- 3weeks

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28
Q

Percutaneous umbilical blood sampling: Use

A

done after postive trasncranial doppler

Allows for access for transfusion in preterm baby in iso-immunized mom

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29
Q

asymptomatic UTI in pregnant woman: TX

A

amoxicillin

nitrofurantoin if penicillin allergic

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30
Q

Cystitis in a pregnant woman: TX

A

amoxicillin

nitrofurantoin if penicillin allergic

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31
Q

Pyelonephritis in pregnancy: TX

A

ceftriaxone inpatient then 10 day course of antibx if initial improvement

if no initial improvement, get US to look for abscess

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32
Q

seizure ppx in pregnancy: ideal drugs

A

leveteracitam or lamotrigine

NOTE: valproate and phenytoin more teratogenic

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33
Q

If pregnant woman seizes, give ___

A

phenobarbital

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34
Q

Adequate contractions during labor

A

3 contractions every 10 minutes or 200mV in 10 minutes

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35
Q

Preterm GA

A

weeks 24-37

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36
Q

Infectious premature rupture of membrane: most common cause and tx

A

GBS

PROM (occurs during term but no contxs yet)

TX with ampicillin if GBS positive or unknown

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37
Q

endometritis/chorioamnionitis: definition and TX

A

infection of endometrium vs chorion (sac)

ampicillin + gentamycin +/- clindamycin

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38
Q

Worry about fetal lung maturity before____

A

34weeks

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39
Q

Severe features of pre-eclampsia

A 
BP >160/110
thrombocytopenia
elevated LFTs
RUQ pain
HA
vision change 
Nl or elevated creatinine
Generalized edema
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40
Q

Fraternal twins =

A

Di-zygotic (2 fertilizations), di-chorionic, di-amniotic gestation

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41
Q

Different types of mono-zygotic gestations (3)

A

(1) Mono-zygotic, di-chorionic, di-amniotic (early split of single fertilization)
(2) Mono-zygotic, mono-chorionic, di-amniotic (split during blastocyst phase with 2 organisms sharing a placenta and at risk for twin-twin transfusion syndrome)
(3) Mono-zygotic, mon-chorionic, mono-amniotic (split after day 12–> conjoined twins at risk for cord entanglement)

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42
Q

Post-partum hemorrhage: vaginal vs c-section

A

vaginal: 500cc

C-section: 1000cc

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43
Q

post-partum hemorrhage with firm uterus =

A

retained placenta (accreta, increta, percreta)

NOTE: Follow Beta-HCG after getting the retained part out

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44
Q

Ways to stop uterine bleeding (3)

A

Uterine artery ligation (OB)
Uterine artery embolization (IR)
Hysterectomy (OB)

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45
Q

Post-partum hemorrhage and boggy uterus following prolonged labor =

A

uterine atony

TX: oxytocin, methergine, hemabate

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46
Q

US-based biophysical profile: scores and components

A

8-10 (good)
0-2 (fetal demise imminent–> c-section)

Occurs if there is a failed NST+vibro-acoustic stimulation

Components:
NST (0-1)
amniotic-fluid index (0-2) NL is btw 8 and 25
breathing (0-2)
movement (0-2)
tone (0-2)
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47
Q

Heart rate rises: NL

A

Hr rise of 15bpm in 15 minutes

2 rises in 20 minutes

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48
Q

VEAL CHOP

A

Variable decels
early decels
accels
late decels

Cord compression (maybe OK)
head compression (OK)
OK
utero-placental insufficiency (bad)

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49
Q

Delivery of fetus with anemia due to moms attack

A

greater than 32 weeks

50
Q

Risk factors for GBS infection

A

previous GBS infection
prolonged ROM
intrapartum fever

All of these neeed intrapartum antibx (ampicillin, cefazolin, clinda, or vanc)

51
Q

What to give with mom who is Hep B positive

A

Hep B IVIG AND vaccine at delivery

52
Q

What antiretroviral therapy to give in pregnancy

A

tenofavir + emtricibane + Nevirprine

OR

zidovidine + larunidine + atazanavir

53
Q

Intranatal toxo infection

A

Mom with risk factors for exposure and mono-like illness during pregnancy (didnt have previous exposure to toxo and antibodies to protect herself)

Baby: brain calcifications, ventriculomegaly, seizures

54
Q

TX of late latent vs tertiary syphillis

A

late latent: IM qwk x3

tertiary: IV q4hr x 7-10d

55
Q

Intranatal rubella exposure: effects on baby

A

Primary viremia most dangerous

blueberry muffin rash (petechia and purpura)

Cataracts
Congenital heart defects
Deafness
IUGR (if contracted in first trimester)

56
Q

Congenital herpes infection: clinical features

A

IUGR
preterm
blindness

57
Q

Lacerations during episistomies

A

Grade I: only involves vagina
II: extends into perineum
III: invades anal sphincter
IV: involves anal mucosa

58
Q

Post-coital bleeding

A

cervical cancer (SCC)

59
Q

black and itchy vulvar lesions

A

vulvar cancer (SCC)

60
Q

Symptoms of ovarian cancer

A

these are symptoms of invasion

renal failure, SBO, ascites

61
Q

Hyperemesis gravidarum, hyperthyroidism, and size-dates discrepancies =

A

choriocarcinoma

62
Q

If pap smear shows ASCUS

A

get either HPV DNA testing (if positive, do colpo) or another pap in 6months (if again ASCUS, do colpo)

63
Q

Features of colposcopy

A

brushing to sample endocervix

depresser-stick for ectocervix

64
Q

Endometrial carcinoma: TX

A

total abdominal hysterectomy and BSO +/- chemo and radiation if their are mets

65
Q

Risk factors of placenta accreta

A

prior c-section
h/o dilation and curettage
advanced maternal age

66
Q

Baby with small body size, microcephaly, digital hypoplasia, nail hypoplasia, midfacial hypoplasia, hirsutism, cleft palate, and rib anomalies

A

fetal hydentoin syndrome

67
Q

Follow-up of abnormal prenatal screen at 15wks

A

amnio

68
Q

Follow-up of abnormal prenatal screen at 10-13 weeks

A

chorionic villus sampling

69
Q

N/V, elevated serum aminotransferases, and hypoglycemia in 3rd trimester

A

acute fatty liver of pregancy

70
Q

Encephalopathy, oculomotor dysfunction (horizontal nystagmus), and postural and gait ataxia in setting of hyperemesis gravidarum

A

thiamine deficiency –> Wernicke encephalopathy

TX with IV thiamine followed by glucose infusion

71
Q

AA pregnant female with new facial hair and bilateral ovarian masses is most likely

A

luteoma

will spontaneously regress after pregnancy

72
Q

Intrahepatic cholestasis of pregnancy: TX

A

ursodeoxycholic acid

73
Q

Condylomata lata vs acuminata

A

lata: from secondary syphilis, flat velvety lesions
acuminata: from HPV(6 and 11), cauliflower-like and skin-colored

74
Q

Unilateral bloody discharge without a coexisting breat mass and with a normal mammogram

A

intraductal papilloma

75
Q

Prevention of preterm labor in female with past preterm delivery

A

serial cervical length measuremments

progesterone administration

cerclage placement

76
Q

Secondary amenorrhea due to intrauterine adhesions from endometrial infection or instrumentation

A

asherman syndrome

77
Q

Meds to give in preterm labor <32 weeks vs btw 32 and 34

A

<32: betamethasone, tocolytics, mag sulf, penicillin if GBSpositive or unknown

32-34: betamethasone, tocolytics, penicillin if GBSpositive or unknown

78
Q

Normal physiologic thyroid related changes in pregnancy: Total T4 vs free T4 vs TSH

A

Estrogen increases TBG

Total T4: increases
Free T4: unchaged or mildly increased
TSH: decreased (beta-HCG suppresses)

79
Q

Extraglandular features of Sjogren syndrome

A 
arthritis
raynauds
dyspareunia
cutaneous vasculitis
ILD
non-Hodgkin lymphoma
80
Q

Complications of cervical conization

A

cervical stenosis
cervical incompetence
preterm delivery

81
Q

Ovarian germ cell tumors

A

Dysgerminoma: chemo, LDH
Endometrial sinus: AFP
Teratoma: can cause stroma ovarii
Choriocarcinoma: beta-HCG

NOTE: these are nonmalignant and present as adenexal masses at stage I

82
Q

Ovarian epithelial cell tumors

A

seroud
mucinous
endometroid
brenners

NOTE: all considered cystoadenocarcinomas, extremely malignant, risk increases with age (more ovulations), present as stage IIIb, seed peritoneally producing ascites

83
Q

Genes that predispose risk for ovarian epithelial cell tumors

A

BRCA 1/2

HNPCC

84
Q

Marker to track ovarian epithelial cell tumors

A

Ca-125

85
Q

Ovarian stromal cell tumors

A

granulosa-theca–>estrogen

sertoli-leydig–>testosterone

86
Q

size-date discrepancy, hyperemesis gravidarum, markedly elevated beta-HCG , hyperthyoroidism

A

complete or incomplete molar pregnancy

87
Q

molar pregnancy: management

A

suction curretage

follow beta-HCG for year while on OCPs (so that you know rise in beta-HCG is from invasive disease)

88
Q

choriocarcinoma: TX

A

surgical + medical (with mtx, actinomycin D, and cyclophophamide if refractory)

89
Q

Vulvar cancers (3)

A

SCC: black and itchy
melanoma: black and itchy
NOTE: both the above involve vulvectomy and LN dissection

pagets: red and itchy (good prognosis)

90
Q

Grape like mass in vagina =

A

adenocarcinoma

think DES exposure in utero

91
Q

PCOS: Meds and MOAs

A

OCPs: regulate menses

clomiphene: ovulation induction
spironolactone: for hirsutism

NOTE: 1st line tx is weight loss

92
Q

PID: Empiric tx

A

Inpatient: for those who are severely ill, N/V, or pregnant–> cefoxitin + doxy or clind + gent
Go to surgery if no improvement

Outpatient: Ceftriaxone, Doxy, and metro

93
Q

Discriminatory beta-HCG

A

1,500 is threshold

94
Q

Causes of vaginal bleeding in a non-pregnant woman

A

Polyps
Adenomyosis
Leiomyoma
Malignancy

Coagulopathy
Ovarian dysfxn
Endometrium
Iatrogenic (IUDs)
Non-specified
95
Q

Symptomatic leiomyoma: TX

A

first line: OCPs
for pain: NSAIDs
Surgery: if need to first shrink, use leuprolide then myomectomy; if doesnt want kids TAH

96
Q

LH:FSH ratio in PCOS

A

3:1

97
Q

Congenital adrenal hyperplasia

A

Hirutism
Mildly elevated DHEAS from adrenals bilaterally

Dx with CT/MRI and elevated 17-OH-progesterone in urine

Tx with cortisol and/or fludrocortisone

98
Q

Signs of placental separation during stage 3 labor

A

fresh bleeding from vagina
umbilical cord lengthening
uterine fundus rising
uterus becomes firm

99
Q

Contraindications to hormone replacement therapy in menopause

A

estrogen-dependent carcinoma (breat or endometrial)

H/o PE/DVT

100
Q

Indications for endometrial biopsy

A

any patient older than 35 with AUB

101
Q

TX vaginal candidiasis

A

miconazole or clotrimazole, econazole, or nystatin

102
Q

Large, globular, and boggy uterus in woman btw 35 and 50 =

A

adenomysis

103
Q

Adenomyosis: risk factors

A

endometriosis

uterine fibroids

104
Q

Cyclic pelivc pain that starts 1-2 weeks before menses and peaks 1-2 days after menstruation begins

A

endometriosis

105
Q

Nodular uterus with adenexal mass =

A

endometriosis

106
Q

Leuprolide: MOA

A

GnRH agonist that when given continuously will turn off hypothalamic-pituitary-ovary axis (suppresses estrogen)

107
Q

Leuprolide: side effects

A

hot flashes

decreased bone density

108
Q

Diffuse breat erythema, warmth, pain, and edema with a peau dorange appearance and axillary LDN=

A

inflammatory breast carcinoma

109
Q

Amenorrhea/oligomenorrhea, sxs decreased estrogen (hot flashes) in woman < 40yo

A

Primary ovarian insufficiency

hypergonadotropic hypogonadism

110
Q

Causes of hypothalamic hypogonadism

A

relative caloric insufficiency
strenuous exercise

NOTE: will not see menopausal sxs as in POF

111
Q

Dysmenorrhea with heavy menstrual bleeding that starts later in the reproductive years with progression to chronic pelivc pain

A

adenomyosis

112
Q

Uterus in adenomyosis

A

boggy, tender, uniformaly enlarged

113
Q

pelvic US in adolescent showing adenexal mass with hyperechoic nodules and calcifications

A

dermoid ovarian cyst (aka mature cystic teratoma)

114
Q

Complication of ovarian dermoid cysts

A

ovarian torsion (presents as acute-onset unilateral lower abdominal pain that occus d/t necrosis of the ovarian from ischemia with lack of circulation)

115
Q

Holding position of arm with anterior shoulder dislocation vs posterior dislocation

A

anterior: arm held abducted and externally rotated
posterior: arm held adducted and internally rotated

116
Q

Oxytocin toxicity

A

seizures from free water reabsorption and hyponatremia

117
Q

Tx of pulmonary edema in preeclampsia

A

loop diuretic (furosemid)

118
Q

Beta-HCG levels in hydatidiform mole

A

> 100,000!

119
Q

Lichen sclerosis: TX

A

high-potency topical steroids

NOTE: vulvectomy is for SCC (transformed lichen sclerosis)

120
Q

Lichen sclerosis: clinical features

A

itchiness
dyspareunia
Loss of anatomical strcutures of the vulva (loss of clitoral hood)

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