OBGYN Flashcards
Medical management of fibroids?
GnRH agonists -> only recommended for 3-6 months
Role of magnesium sulfate in preterm labor?
fetal neuroprotections to prevent cerebral palsy, etc
A fetus is showing minimal responsiveness to monitoring after water breaks, next step?
Digital scalp manipulation
How to manage cervical incompetence?
cervical cerclage at 14 weeks
Side effects of copper IUD?
Hypermemorrhea and anemia
What studies are completed at the initial prenatal visit?
Rh(D) type, antibody screen,
Hb, Hct, MCV
HIV, VDRL/RPR, HBsAG
Rubella and varicella immunity
Pap test (if indicated)
Chlamydia PCR
Urine culture
Urine protein
First step to managing a woman with suspected biopsy and heavy menstrual bleeding?
Endometrial biopsy
How to manage pelvic pain unresponsive to NSAIDS and oral contraceptives?
Diagnostic laproscopy
Findings in primaru ovarian insufficiency?
oligomenorrhea/amenorrhea, infertility, menopausal symptoms, and elevated FSH and estradiol levels
Supplement of which mineral/vitamin has been shown to improve PMS?
Calcium
When do you test for gonorrhea in pregnant patients?
High-risk- previous STD< <25, new or multiple partners
Examples of NSAID
Ibuprofen, naproxen
Transvaginal vs transabdominal US in pregnancy?
Transvaginal early in pregnancy, then transabdominal
abdominal pain, nausea, scant bleeding, and fever, after D&C?
uterine perforation
Management of an infant between 2 and 24 months following first febrile UTI?
Renal and Bladder US
Theca luteun tumor
Pregnancy (especially molar) and often bilateral
Amenorrhea with normal seconary sexual characteristics, development on cyclical abdominal pain
OUtflow tract ostruction
Risks for ovarian cancer?
Nulliparity, family history, early menarche, late manopause
Next test after suggestion of acanthosis nigricans?
Fasting insulin
Should pregnant woman be offered the influenza vaccine?
Yes, as soon as it becomes available, if inactivated.
What is the sniffling position?
ilting hed backwards and lifting the chin
Karyotype of complete/partial mole?
Complete: XY, XX
Partial XXY, XXX, XYY
How to treat involuntary constrction of vaginal musculature?
Vaginal dilators
Urge incontinence
overactivity of the detrusor muscle -> uninhibited contractions -> increased bladder preddure -> urine leakage
Chancre
`Primary syphilis infections caused by treponema pallidum
Alternative name for genital warts?
Condylomata acuminata
What testing may be indicated prior to starting tamoxifen?
Factor V leiden
Kleihauer-Betke test?
Determine necessary dose of Rh(D) andti-D IG needed after delivery of an Rh-positive infant to an Rh-negative mother
Lab test for the diagnosis of PCOS?
Testosterone
Treament for hemorrhagic cyst?
Monitor with US, most will resolve on their own
What factors are contained in cryoprecipitate?
Fibrinogen, factor VIII, von willebrand’s
What should be adminstrated in preterm labor?
Steroids, tocolytic (indomethicine, nifidipine), and magnesium sulfate
Woman with complex cyst without any other symptoms late in her cycle?
Hemorrhagic cyst
Risk factors for endometrial cancer?
Obensity, nullipartiy, late menopause, complex atypical hyperplasia of the endometrium
Risk associated with twin-twin transfusion syndrome?
Neurological morbidity, including cerebral palsy
To treat infertility due to endometriosis?
ovarian stimulation with clomiphene citrate -> IVF is last resort
Tamoxifen side effexts?
thermoregularory dysfuction (hot flashes), increased risk fo endometrial cancer (post-menopausal) or endometrial polyps (premanopausal patients)
After a molar pregnancy, what is the risk of a second?
1-2%
What are postterm pregnasncies associated with?
Placental sulfatase deficiency, fetal adrenal hyperplasia, anencephaly
What type of cancers do BRCA2 carrier tend to have?
Estrogen receptor positive
Cell-free DNA vs quad screening?
Cell-free for high risk pregnancies at > 10 weeks
How should a fetus be managed when heart rate is less than 90?
Positive pressure ventilation and prepare to intubate
How much blood does 30mg of rhogam neutralize?
15cc of RBCs or 30mL whole blood
Signs of adenomycosis?
Dysmenorrhea, pelvic pain, heavy menses, bulky globular and tender uterus
First step in the evaluation of abnormal bleeding?
Pelvic Ultrasound
Extended wrist, hyperextended metacaopophalangeal joints flexed interphalangeal joints, absent grasp reflex? Cause?
Klumpke palsy, C8-T1
How to treat a missed abortion?
Medically with Misoprostol -> induce uterine cramping -> expulsion of fetus
Treatment for genital warts?
Small- trichloroacetic acid or podophullin resin
Large-excisional therapy
Signs of uterine rupture? Tx?
internse abdominal pain, loss of fetal station,
Tx- emergency laparotomy
high fever, hypotension, diffuse red maqcular rash involving the palms and soles, headache, vomiting, diarrhea
Toxic shock syndrome
Fetal complications from preeclampsia?
Fetal growth restriction, low birth weigt due to chronic uteroplacental insufficiency
What genetic test can rule out Down? All other chromorsome abnormalities?
Cell free DNA-down’s
All chromosomes-amniocentesis
Risk factors from preterm delivery? Best method of prediction in first time pregnancies?
Prior pregnancy (strongest), multiple gestations, hx of cervical surgery
Best method of prediction? Transvaginal US
Risks for a Bartholin gland mass in post-menopausal woman?
Malignancy, requiring biopsy, especially with rapid development
Treatment for moderately differentiated carcinoma?
Radical vulvectomy and groin node dissection
Changes in oxygenation during pregnancy?
Increase CO2 expulsion -> alkalosis due to hyperventilation from progesterone
Hypogonadotropic hypogonadism
hypothalamic dysfunction, due to severe life stressors
Associated with low LH and FSH
Findings suggesting polyps?
40-50 years of age, omcreased, increased menstrual flow, increased cramping and intermenstrual spotting
First step in the management of hrtuism with apparent genetic component?
Check 17-hydroxlprogesterone
Intraductal papilloma description
blood or serosanguinous dischange from the nipple
Trastuzumab: Use and side-effects
Use: Her2 positive breast carcinoma
Side-effects: Cardiotoxicity, get baseline echo. Howeer, damage is reversible with cessation of treatment
Functional ovarian cysts- US characteristics?
Unilocaular simple cyst without evidence of blood, soft tissue elements, or excrescences
Coarse facial hair in a pregnant woman with a solid mass found on US? Diagnosis? Treatment?
Leueoma, serial us and observation as they often resolve after delivery
How to treat Linchen sclerosus?
Hihg potency topical steroids
Spare pubic hair, loss of fullness of the labnia, vulvar and vaginal discomfort in post menopausal women?
Atrophic vaginitis -> due to decreased estrogen
Management of chirioamnionitis?
Broad spectrum antibiotics (ampicillin, gentamycin, clindamycin) and delivery. Oxytocin to speed up delivery
Amenorrhea for emenses for 3 cycles or > 6 months?
beta-HCG -> if negative, check prolactin, TSH, FSH
Endometriosis-us findings?
hemogenous cyst with internal echoes (“Ground glass”)
21-hydroxylase deficiency?
Unable to produce adequate cortisol due to a blockage of 17-hydroxyprogesterone
Also known as congenital adrenal hyperplasia
Anxiety, chest pain, palpitations, syncopy with systolic murmur with click?
Mitral valve prolapse, treat with beta blockers
What treatment(s) are most effective for menopause?
Estrogen
How do you diagnose choriocarcinoma?
b-HCG levels
How long can the latent phase of labor last in pregnancy?
20 hours in first time, 14 for multi-
ASCUS management options?
Performing HPV DNA testing or repeat cytology @12 months following abnormal Pap. If HPB is negative, then routine screening can be resumed at three years
If HPV is positive, or repeat is ASCUS or higher, then colposcopy should be performed
Which drugs require baseline audiometry?
Cisplatin, carboplatin
McCune Albright Syndromes sexual development?
Menarche, before breast and pubic hair development
Physical exam findings associated with down syndrome?
flattened nasal bridge, small size, small rotated cup-shaped ears, sandal gap toes, hypotonie, protruding tongue, short, broad hands, simian creases, epicanthic folds, and oblique palpebral fissueres
Which SSRI is now category D? Why?
Paroxetine, cardiac malformations and persistent pulmonary hypertension
Interstitial cystitis?
Chronic inflammatory condition of the bladder with in characterized by recurrent irritation, voiding symptoms of uregency and frequency, in the absence of other diseases
isolated cystic mass in the anterior vaginal wall?
Urethral diverticulum
Donovan bodies
Deeply straning gram-negative intracytoplasmic cysts caused by Klebsiella granulomatis
Most important prognostic factor in the treatment of patients with breast cancer?
TNM staging
Risk factors for delayed separation of placenta?
Uterine leiomyomas, prior c-section, prior uterine curettage and succenturiate lobe of placenta
How should an infant exposed to meconium-sained amniotic fluid be managed after delivery?
Intubate the trachea and suction merconium and other asporated material from beneath the flottis immediately after delivery only if the infant is depressed
Findings suggesting antiphospholipid syndrome in pregnancy?
prolonged dilute russell viper venom time, hx of 3 early pregnancy losses, hx of venous thrombosis
If OCPs fail to treat dysmenorrhea, what should be the next step?
Lapropscopy after 3 months of OCP trials
Most common risk associated with valprioc acid?
Neural tube defects (meningomyolocele)
Cordlike thickening and bilateral non-focal premenstrual tenderness in the breasts? Treatment?
FIbrocystic breast changes
Tx: NSAIDS, oral contraceptives
What is repaired by repairing the pubocervical fascia or reattaching it to the sidewall if separated from the white line?
Center and lateral cystoceles
Flinanserin-use
premanopausal hypoactive sexual desire disorder
multiple small, papular growths that are fragile and bleed upon manipulation?
Condylomatra acuminata
Why have c-sections increased in recent years?
Studies have demonstrated increased risks with VBAC
Where does lubrication in the vagina come from?
ransuldate of fluid across vaginal mucosa
What drugs are contraindicated in vaginal deliveries with a previous c-sections?
Prostaglandins -> increased risk of rupture
In pre-term labor, what medications must be included?
Ampicillin with known GBS status
Primary risk for preterm rupture of membrane?
Genital tract infection
continuous painless urine leakage after pelvic surgery? Diagnosis?
Vesicovaginal fistula
Diagnosis: cystourethroscopy
Mullarian agenesis
congenital absence of vagina, uterus, fallopian tubes
Treatment for multifocality VIN?
Laser ablation
Demoid tumor
Most common tumor in women of all ages
Contain teeth, sweat and sebaceous glands, cartilage, bone, fat
When do you administer Rho(D) immunoglobulins?
28 weeks gestation
Order of sexual development in girls?
Breast budding (thelarche), adrenarche (hair growth), growth spurt, menarche
Which race has the highest risk of molar pregnancies?
Asian
What drugs requirement baseline bone density scans?
Aromatase inhibitors (anastrozole, letrozole)
Gonorrhea/Chlamydia prophylactic treatment?
Ceftriaxone and Azithromycin
What components does fresh frozen plasma?
Fibrinogen, Factors V and VIII
What does molding of the fetal head mean?
Deformations in the skiull doe to fetal malpositioning during delivery
First step in the managment of a post-menopausal adenexal mass?
Transvaginal US (provides better visualization that transabdominal
What is atrophic vaginitis? Treatment?
Vulvovaginal dryness, loss of vaginal elastacity/rugae, thinning vulvar skin/loss of minora, decreased vaginal diameter
Tx- low dose topical estrogen
Risk factors for PMS?
Family hx, vitamin B6, calcium, magnesium deficiencies
Slowly increasing b-HCG, think endometrial strip, think?
Ectopic pregnancy
cyclic midline abdominal cramping pain post D&C?
hematometra
Absolute contraindications for vacuum aspiration of pregnancy?
Greater than 8 weeks gestation
Risks associated with gestational diabetes?
Shoulder dystocia, metabolic disturbances, preeclampsia, polyhydramnios, fetal macrosomia
Side affects of fluoxetine?
Insomnia
Most concerning colpscopy findings?
Atypical blood vessels -> greater degree of angiogenesis, this more concerning
Hemorrhage, uterine tenderness and contractions in a pregnant woman?
Abruptio placentae
What is overflow incontinence?
Failure to empty the bladder adequately -> due to underactive detrusor muscle or obstruction
persistant, ulcerating, eczematous rash localized to the nipple, spreading to the areola
Most common co-malignancy?
Mammary paget disease
Common co-malignancy: Adenocarcimoma
Extended elbow, pronated forearm, flexed wrist and fingers with normal grasp reflex-name? Cause?
Erb-Duchenne palsy, C5-C6
Highest risk factor for ectopic pregnancies?
Prior ectopic pregnancy
What is the value of the fibronectin test?
Negative predictive value?
How to detect exercise-induced amenorrhea?
Check FSH and estrogen
High FSH, low estrogen
Signs of molar pregnancy?
US -> than LMP dating, bleeding, high bHCG
Management of placenta previa during pregnancy?
No intercourse or dignital vaginal examination (pelvic rest)
Affects of STD on the cervix during pregnancy?
Causes bleeding -> increased blood flow
Affect of type 1 diabetes on fetal size?
Fetus is generally smaller
Overflow incontinence
sensation of fullness, pressure, and frequency -> small amount of continuous leaking
How to measure ovarian reserve?
Anti-mullerian hormone levels
Treatment for molar pregnancies?
Suction curettage
Chancriod
Painful ulcer caused by haemophilus ducreyi
Hyperthecosis?
More severe form of PCOS
If an unsatisfactory colposcopy is obtained, how should acetowhile stains that enter the cervical canal be managed?
Conization
Treatment for PCOS?
OCPs
Risk associated with endometriosis?
Infertility
HOw do treat bartholin cysts?
Asymptomatic- Observation
Symptomatic- Incision and drainage
bleeding and/or endomedtiral hyperplasia in a postmenopausal woman with large adnexal mass?
Granulosa cell tumor
What causes cervical cancer?
HPV infection
Treatment for fungal infection
“-azole” drug
Best place to place intimate partner handouts?
Bathrooms, or other private places
Ternitaline? side-effects?
Beta-adrenergic
Side-effects: Tachycardia, hypotension, anxiety, chest tightening/pain
What structural abnormaities can cause recurrent miscarraiges?
uterine cavity abnormalities (intrauterine adhesions, congenital anomalities, large submucous fibroids)
Most common fetal part to feel other than the head?
Buttocks in breech presentation
Affect of chorioamnionitis on fetal appearance?
Pale, lethargic, high temperature
Risk associated with polyhydramnios?
Placenta abruption due to rapid decompression in intrauterine cavity
Whaat are the risks for isoimmunization?
2% antepartum, 7% after full term delivery, and 7% with subsequent pregnancy
Mature teratoma- Alternative name? US findings? Tx?
Altermative name: dermoid ovarian cyst
Findings- hyperechoic nodules and calcifications
Tx: Removal of cyst
Weight needed for menses to begin?
85-106 lbs
Treatment for VINIII?
wide excision
What are methods for sterilization?
Laparoscopic tubal ligation
Essure placement
Mini-laparotomy with tubal ligation
pelvic pain in a patient with ovarian mass?
Torsion until proven otherwise -> ischemia and necrosis of the ovary
beta-HCG level required to detect fetus with transvaginal US? transabdominal?
2000
Transabdominal- 5000
Most common causes of pelvic pain?
Adhersion, endometriosis
What are Lewis antibodies?
igM antibodies that do not cross the placenta, therefore do not cause isosensitization or hemolytic disease
Does a granulosa tumor secrete anything?
Yes, estrogen
How does a history of depression affect a new mother?
Much higher risk of depression
What type of fibroids cause recurrent pregnancy loss? Why?
Submucosal or intracavitary
- focal endometrial vascular disturbance
- endometrial inflammation
. secretion of vasoactive substances
Treatment for antiphospholipid syndrome?
Aspirin plus heparin
When to suspect ectopic pregnancy?
missed menstrual period, vaginal bleeding
With a t-score of -1.7 what should be discussed with patients?
Evaluation of factors for fracture
Benefit of breast feeding, to the mother?
Decreased incidence of ovarian cancer
Neonatal thyrotoxicosis? Cause? Treatment?
materal hx of grave’s diese, low birth weight, tachycardia, warm skin, irrtability
Cause: passage of anti-TSH receptor antibodies during third trimerster
Treatment: beta blockers, methimazole; eventually self resolves
Initial management for a woman with late decellerations?
Maternal position adjustments to left lateral position
Epithelial ovarian carcinoma-US finding?
US-solid mass, thick septations, ascites
Affects of hypothyroidism in woman?
Irregular periods, infertility
When should pap smears begin?
21 years
Fetal dysmaturity
“postmaturity syndrome” 0> fetal growth has beens restricted post-term
Described as withered, meconium stained, long-nailed, gradile, with a small placenta
Next step in management of mullerian agenesis?
Renal US, high association with renal abnormalities
First step in the management of urine leakage?
Obtain urinalysis and cultures
management of an actively bleeding patient with anemic after spontaneous aborption
D & C
What causes positive nitrates in urine?
Enterobaceteria special (gram-negative E. Coli)
Are chronic medical conditions associated with early spontaneous abortions?
Yes
Risks associated with HRT?
Increased risk of breast cancer, however, decreased risk of colon
Cause of stress urinary incontinence?
Cystocele or increased intraabdomianl pressure (obesity, etc)
Affect of anorexia on hypothalamic-pituitary dysfunction?
Can cause amenorrhea
Papillomas vs ductal carcinoma of the breast?
ductal carcinoma of the breast contains microcalcifications
Benefits of progesterone IUD
protective against endomedrial cancer,
low failue rate
How can a total hysterectomy and bilateral salpingo-oophorectomy lead to menopausal-like symptoms in a post-menopausal woman?
Decrease circulating androgens due to loss of androgens being produces in the ovaries
Histology of fat necrosis? MRI?
Foamy histocytes and fat globules
MRI: calcifications and hyperechoic mass
Decreased fetal movement, asymmetrical growth with a young women with DVT prior?
Factor V liiden
When do screen for Hep C during pregnancy?
HIV positive, intravenous drug use
After physical exam, what is the next step is the work up of abnormal uterine bleeding?
Pelvic US
Risk factors for vulvar cancer?
HPV exposure, smoking, vulvar dystrophy, immunocompromised states
How to myomas grow after removal of GNRH?
At same pace as prior to treatment
Missed aborption findings?
Embryo without caridac activity, empty gestations sax without fetal pole
Signs of placental abruption?
Abdominal pain, bleeding, uterine hypertonus, fetal distress
How to manage arrest in the second stage of labor?
Augmentsation with amniotomy, oxyton
Stages of grief?
Denies, abger, bargaining, depression, acceptance
Microinvasive cervical cancer?
Invasion into the basement membrane less than 3mm
Delivery for twins when the first twin is breeched?
C-section
Treatment for chlamydia? Gonorrhea
Azithromycin-chlamydia
Ceftriaxone- gonorrhea
