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MS3 > OBGYN 6 > Flashcards

OBGYN 6 Flashcards

1
Q

What are fetal complications associated with late term and postterm pregnancy

A 
♣	Oligohydramnios (single deepest vertical pocket =2 cm)
♣	Meconium aspiration
♣	Stillbirth
♣	Macrosomia
♣	Convulsions
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2
Q

What are maternal complications associated with late term and postterm pregnancy

A

♣ Cesarean delivery
♣ Infection
♣ Postpartum hemorrhage
♣ Perineal trauma

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3
Q

Tx of stress incontinence

A
  • Lifestyle modification
  • Pelvic floor exercises
  • Pessary
  • Pelvic floor surgery
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4
Q

Tx of urge incontinence

A
  • Lifestyle modifications
  • Bladder training
  • Antimuscarinic drugs
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5
Q

What is the most accurate method for measuring gestational age

A

First trimester US

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6
Q

Diagnoses: laboring patient with intense abd pain, tachycardia, vaginal bleeding, and loss of fetal station (fetal part retracts)

A

Uterine rupture

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7
Q

What are the 2 pathways that lead to endometrial cancer

A

o (1) Hyperplasia pathway (75%)
♣ Carcinoma arising from endometrial hyperplasia
o (2) Sporadic pathway (25%)
♣ Carcinoma arising in atrophic endometrium

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8
Q

Describe risk factors for endometrial hyperplasia

A

Excess estrogen – Obesity, chronic anovulation/PCOS, nulliparity, early menarche/late menopause, Tamoxifen use

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9
Q

Tx of endometrial hyperplasia

A

o Progestin therapy or hysterectomy

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10
Q

Describe functional hypothalamic amenorrhea

A

♣ Caused by: excessive physical training, very low calorie diet, weight loss, chronic illness, stress and depression, anorexia nervosa
♣ This causes transmitters that affect the hypothalamus and decrease GnRH, with a subsequent deficiency in LH/FSH and estrogen

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11
Q

At what gestational age of preterm labor should corticosteroids be given

A

<37 weeks (all preterm labor)

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12
Q

At what gestational age of preterm labor should tocolytics be given

A

<34 weeks

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13
Q

At what gestational age of preterm labor should mag be given

A

< 32 weeks

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14
Q

Describe antepartum tx of woman with HIV

A

♣ HIV RNA viral load at initial visit, every 2-4 weeks after initiation or change of therapy, monthly until undetectable, then every 3 months
♣ CD4 cell count every 3-6 months
♣ Resistance testing if not previously performed
♣ ART initiation as early as possible
♣ Avoid amniocentesis unless viral load <1,000 copies/mL

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15
Q

What should be avoided during deliver in an HIV+ woman

A

♣ Avoid artificial ROM, fetal scalp electrode, operative vaginal delivery

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16
Q

Describe intrapartum tx of woman with HIV viral load <1000

A

ART + vaginal delivery

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17
Q

Describe intrapartum tx of woman with HIV viral load >1000

A

ART + zidovudine + cesarean section

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18
Q

Postpartum tx of infant born to mother with viral load <1000

A

Zidovudine

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19
Q

Postpartum tx of infant born to mother with viral load >1000

A

multi-drug ART

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20
Q

What is cut off for GDM after 1 hour GTT

A

Positive if >/= 140

21
Q

What is cut off for GDM after 3 hour GTT

A
  • Fasting positive > 90
  • 1 hour > 180
  • 2 hour > 155
  • 3 hour > 140
22
Q

What are the first steps in management of shoulder dystocia

A

o B = breathe; do not push
o E = elevate legs and flex hips, thighs against abdomen (McRoberts)
o C = call for help
o A = apply suprapubic pressure
o L = enLarge vaginal opening with episiotomy
o M = Maneuvers:

23
Q

Describe effects of Raloxifene and Tamoxifen on breast and endometrium

A

Both are used for prevention of breast cancer (have antagonist effects)

Raloxifene also has antagonist effects on endometrium but Tamoxifen can cause endometrial hyperplasia and carcinoma

24
Q

Recommendation for lactation suppression

A

o Wearing comfortable and supportive bra, avoidance of nipple stimulation and manipulation, application of ice packs to breast, and NSAIDs to reduce inflammation and pain
o Dopamine agonists (inhibits prolactin secretion) are no longer approved due to side effects

25
Q

Describe hallmark presentation of endometriosis

A

♣ Dysmenorrhea
♣ Deep dyspareunia
♣ Dyschezia (pain with defecation)
• Dyspareunia and dyschezia are caused by implants in the posterior cul-de-sac

26
Q

Tx of endometriosis

A

♣ NSAIDS and/or OCPs

27
Q

Describe current pap test recommendations

A

• First Pap test age 21
• Test every three years until age 30
• Age > 30, HPV test with Pap test every 5 years
o Almost all young women are infected with HPV, but only transiently
o Usually clear HPV around 30 y/o
o This is why we test at 30 – because if they haven’t cleared virus by then, then we start to worry
• No more testing after hysterectomy or age 65 (with negative Pap history)

28
Q

What do you do if you have abnormal pap smear results

A

Colposcopy
o If something positive on endo biopsy = Cone biopsy
o If something positive on ecto biopsy = Local excision (Leep or cryo)

29
Q

Describe specific causes of endometrial cancer

A

If it comes from the hyperplasia pathway (75%), then it is due to estrogen exposure:
♣ Obesity, chronic anovulation/PCOS, nulliparity, early menarche/late menopause, Tamoxifen use

30
Q

Tx of endometrial hyperplasoa

A

Progesterone therapy

31
Q

What are the 3 main categories of ovarian tumors

A
  1. Epithelial
  2. Germ cell
  3. Stroma/sex cell
32
Q

Describe presentation of germ cell tumors

A

♣ Are non-malignant
♣ Usually present in teenage girls as an adnexal mass and weight gain
♣ Dx: transvaginal US
♣ Tx: unilateral salpingoophorectomy

33
Q

What are the 4 types of germ cell tumors

A
  1. Teratoma
  2. Dysgerminoma
  3. Endodermal sinus tumor
  4. Choriocarcinoma
34
Q

Describe teratomas

A

♣ Tumor of fetal tissue
♣ Most common germ cell tumor in females
♣ Contains tissue from 2 or 3 embryologic layers
♣ Struma ovarii teratoma comprised of thyroid tissue, which can present with hyperthyroidism

35
Q

Dysgerminoma is a tumor of what cell type and can be followed by what tumor marker?

A

♣ Tumor of oocytes
♣ “Fried egg” cells – large cells with clear cytoplasm and central nuclei
♣ Equivalent to male seminoma
♣ Tumor markers = LDH (lactic dehydrogenase)

36
Q

Endodermal sinus tumor is a tumor of what cell type and can be followed by what tumor marker?

A

♣ Aka Yolk sac tumor
♣ Most common germ cell tumor in children
♣ Elevated serum AFP

37
Q

Choriocarcinoma is a tumor of what cell type and can be followed by what tumor marker?

A

♣ Tumor of placenta – mimics placental tissue but villi are absent
♣ Comprised of cytotrophoblasts and syncitiotrophoblassts
♣ Elevated bHCG (produced by syncytiotrophoblasts)

38
Q

What are the 4 types of epithelial ovarian tumors

A
  1. serous
  2. mucinous
  3. endometroid
  4. brenner
39
Q

Describe diagnosis, prognosis, and tx of epithelial tumors

A

These are the worst - usually malignant

  • no screening tool so usually discovered at stage III
  • Tx = TAH + BSO
40
Q

Describe Brenner tumor

A

Epithelial ovarian tumor composed of bladder-like (transitional) epithelium

41
Q

What are the types of stromal-sex cell tumors

A
  1. Granulosa-theca cell

2. Sertoli-Leydig cell

42
Q

Describe presentation of Granulosa-theca cell tumor

A 
♣	Produces estrogen/progesterone
♣	Presentation:
•	Precocious puberty
•	Menorrhagia/metrorrhagia
•	Postmenopausal bleeding
43
Q

Describe presentation of Sertoli-Leydig cell tumor

A

♣ May produce androgens hirsutism, virilization

44
Q

Describe difference between complete and partial moles

A

Complete:
o Empty ovum fertilized by sperm – 46 chromosomes
o Fetal tissue absent (only DNA is from dad)
o Increased risk of choriocarcinoma
o Will be p57 negative

Partial:
o Normal ovum fertilized by 2 sperm – 69 chromosomes (XXX, XXY, XYY)
o Fetal tissue present
o Minimal risk for choriocarcinoma

45
Q

What are the 3 cancers of the vulva

A
  1. squamous cell
  2. melanoma
  3. pagets
46
Q

Describe presentation, diagnosis, and tx of squamous cell carcinoma of the vulva

A
  • Presents as black and itchy
  • Dx: biopsy
  • Tx: vulvectomy and lymph node dissection
47
Q

Describe presentation, diagnosis, and tx of melanoma of the vulva

A

Same as SCC
• Presents as black and itchy
• Dx: biopsy
• Tx: vulvectomy and lymph node dissection

48
Q

Describe presentation, diagnosis, and tx of Paget disease of the vulva

A

• Presents as a red itchy lesion
• Dx: biopsy
• Tx: wide local resection
o Good prognosis so can be less aggressive

MS3 (88 decks)

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