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OBGYN Flashcards

1
Q

Dx Antiphospholipid syndrome

A

Vascular thrombosis - TIA, DVT

Recurrent pregnancy

PLUS 
- > 1 of the following antibodies 
- anticardiolipin antibody 
Lupus anticoagulant 
anti B2 glycoprotein antibody
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2
Q

Tx of Antiphospholid antibody

A

Anticoagulant ( heparin , warfarin)

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3
Q

what type of fibroid is NOT ass. w/ pregnancy complications

A

subserosal fibroid

)located outside uterine cavity)

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4
Q

intrahepatic cholestasis of pregnancy labs

A

Elevated bile acid
Elevated Liver aminotransferases
Dx of exclusion

Clinical: intense puritis

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5
Q

risk factors for neonatal herpes simplex virus

A 
primary maternal infection 
longer duration of ruptured membrane 
vaginal delivery with active lesions 
impaired skin barrier ( fetal scalp electrode) 
Preterm birth
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6
Q

if women has active HSV infection - how do you limit transmission to baby?

A

C -section

antivirals ARE NOT proven to decrease the risk

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7
Q

PPH <24 hours after delivery - most likely cause

A

uterine atony

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8
Q

what would make retained placenta an unlikely cause of PPH

A

if there is a thin endometrial stripe on ultrasound exam - this means no placenta there

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9
Q

clinical of uterine atony

A

BOGGY and enlarged uterus

uterine atony - presents with profuse vaginal bleeding

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10
Q

treatment of PPH

A 
bimanual uterine massage PLUS OXYTOCIN 
IV fluids , O2 
Uterotonics ( methylergonovine, carboprost , misoprostol) 
intrauterine ballon tamponade 
Uterine artery embolization 
Hysterectomy
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11
Q

what HPA axis finding will be ass. w/ eating disorder?

A

hypothalamic hypogonadism ( low GnRh, low FSH, low estridaol)

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12
Q

who is C/i to attempt vaginal delivery

A
  1. classical cesarean delivery ( VERTICLE incision)
  2. Abdominal myomectomy WITHuterine cavity entry (removal of intramural or submucosal fibroids)

b/c at RISK of uterine rupture

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13
Q

when can you give HPV vaccine

A

administer age 11-12 and can be received until age 26

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14
Q

pregnant lady just gave birth - develops res failure,, purpuric rash and bleeding from IV site , heamodynacally unstable

A

Think - amniotic fluid embolism

  • cariogenic shock
    Hypoexmic res failure
    DIC
    coma / seizure
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15
Q

treatment of AFE (amniotic fluid embolism)

A

resp and hemodynamic support ( incubation) +/- transfusion

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16
Q

risk factor of Amniotic fluid embolism

A
  1. advanced maternal age
  2. gravida more than 5 births/ stilbirths
  3. C-section or instrument delivery
  4. Placenta previa or abruption
  5. Pre-eclampsia
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17
Q

Quad screen Trisomy 18

A

MSAFP - low
B-HCG- low
Estradiol - low
Inhibit A - normal

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18
Q

quad screen Trisomy 21

A

MSAFP - low
B-HcG - high
Estradiol - low
Inhibit A - high

(low, high, low, high)

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19
Q

quad screen for neural tube or abdominal wall defect

A

MSAFP = high
B-HCG - normal
Estriol - normal
Inhibit - normal

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20
Q

breast cycst- drain - how do you f/u

A

follow up in 2 months with another breast exam - b/c cystic fluid can reaccumulate

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21
Q

treatment of intra-amniotic infections

A

IV antibiotics and immediate delivery ( induction of labour)

C-section is only done if non reassuring fetal condition or breech pr if prior uterine surgery

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22
Q

8cm left ovarian cyst with calcifications and hyper echoic nodules - Dx?

A

Cystic teratoma

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23
Q

known cystic teratoma and patient pelops sudden lower quadrant pain and nausea - deep palpation - guarding

A

think ischemic necrosis - ovarian torsion

enlarged ovary gets decreased blood supply

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24
Q

smooth muscle tumours of uterus

A

leiomuomata uteri ( fibroids)

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25
Q

symmetrically enlarged uterus beneath the level of the pelvis brim that is consistent with 10 weeks in size?

A

adenomyosis

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26
Q

multiple small, papular growths at the vestibule of the vulva over the labia majora

A

condylomata acuminata ( hPV 6, 11)

Not genital herpes - cause these present as a single/ clustered blisters or superficial, tender ulcers

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27
Q

risk of placenta abruption

A

DIC

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28
Q

high grade squamous intraepithelial lesion pap result while patient is pregnant - what do you do?

A

do colposcopy and get Bx

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29
Q

painful itchy ulcerative lesion on labia very painful

A

think genital herpes - HSV 2 treatment with antivirals can speed resolution of outbreaks and decrease recurrences

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30
Q

when can postpartum thyroiditis occur

A

7-8% of women after childbirth within 6 months

brief hyperthyroid simp (anxiety, palpitation) THEN hypothyroid phase (fatigue, constipation, irritable)

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31
Q

RF for postpartum endometritis

A 
c-section 
 chorioamnionitis 
 group B  step colonization 
prolonged rupture of membranes 
operative vaginal delivery
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32
Q

treatment of postpartum endometritis

A

clindamycin and gentamicin

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33
Q

clinical of post part endometritis

A

fever > 24 hours, uterine fundal tenderness and purulent lochia

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34
Q

Dx lichen sclerosus

A

valvular punch biopsy

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35
Q

how to differential hypoestroginism vs. lichen sclerosus

A

hypoestrogenemia ( atrophic vaginitis ) menopause related atrophic - vulvovaginal dryness , loss of elasticity, thin vulvar skin

Lichen sclerosus - thin , white crinkled appearance and loses of normal anatomy

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36
Q

what vaccines are safe in pregnancy

A

influenza , tdap and RHo(D) immunoglobulin

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37
Q

what vaccines are not safe in pregnancy

A

MMR - live vaccine

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38
Q

46XY absence uterus and cervix , ovaries are not palpable

A

androgen insensitivity syndrome

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39
Q

mullein genesis

A

hypoplastic or absent mullein duct

absent rudimentary uterus and upper vagina, normal ovaries

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40
Q

what US findings for hydadidiform mole

A

snowstorm appearance

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41
Q

redness, ulceration , scaling and flaking of nipple

A

adenocarcinoma - Pagets disease of breast (eczematous or ulcerating rash localized to the nipple

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42
Q

permpartum cardiomyopathy

A

rapid onset of systolic heart failure ( fatigue, dyspnea, cough , edema) MUST BE AT > 36 weeks gestation or early puerperium

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43
Q

lichen simplex chronicus

A

hyperpastic response to repetitive scratching and irritation
Examination: leathery textured skin

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44
Q

use of Mg sulphate

A

weak tocolytic
not typically administered for tocolysis but instead lowering the risk of neurological comorbidities in neonates born at <32 week gestation

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45
Q

what test should be done 24-28 weeks

A

haemoglobin / hct
antibody screen for Rh D negative
50g 1 hour GCT

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46
Q

when do you do group B streptococcus culture

A

35 - 37 weeks

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47
Q

risk factor for breast cancer

A

chronological age ( increase > 50)
Nulliparity
obesity
prolonged hormone replacement

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48
Q

Dx of ectopic pregnancy

A

positive pregnancy test
Transvaginal ultrasound
(gestational sac at an ectopic site, most commonly FT)

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49
Q

indication for AntiD immune globulin in Rh negative patients

A 
28-32 weeks 
<72 hours after delivery of RhD positive infant 
< 72 hours after spontaneous abortion 
Ectopic pregnancy 
Threatening abortion 
hydadiform mole 
CVS, amniocentesis 
Abdo Trauma 
2nd or 3rd trimester bleeding 
external cephalic version
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50
Q

DO women go screening for asymptomatic bacteriuria

A

yes they do in third trimester - because 40% risk of progressing to pyelonephritis because smooth muscle relaxation and urethral dilatation allow urine to ascend from bladder to kidney

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51
Q

what contraceptive is used for a patient with breast cancer

A

COPPER IUD

b/c all hormonal therapies are c/i in patients with breast cancer

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52
Q

ABO incompatibility signs in newborn

A

mild hemolytic anemia

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53
Q

chancroid vs syphillis

A

chancroid - heamophilus ducreyi ( multiple deep ulcers , base may have gray to yellow exudate) (organisms often clump in long parallel strands )

syphillis - single indurated well circumscribed ulcer , clean base, thin delicate corkscrew shaped organism on dark field microscopy

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54
Q

Dx syphillis

A

nontreponemal (RPR, VDRL) and treponema (FTA- ABS, TP - EIA)

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55
Q

Bartholin duct cyst

A

Asymptomatic - Observatio for spontaneous drainage

Symptomatic - I&D

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56
Q

Causes stress incontinece

A
  • decreased urethral sphincter tone

Urethral hyper mobility

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57
Q

cause of overflow

A
  • decrease detrusor activity

- bladder outlet obstruction

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58
Q

initial prenatal visit test

A 
- RhD type, antibody screen 
Hg / oct , MCV 
HIC, VDRL/ RPR, HBsAg 
Rubella and varicella immunity 
Pap test 
Chlamydia PCR 
Urine culture 
Urine protein
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59
Q

management of intrauterine fetal demise

A

20-23 weeks
- dilation and evacuation Or vaginal delivery

> 24 weeks - vaginal delivery

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60
Q

pseudpcyesis

A

condition in which non psychotic women presents with signs and symptoms of pregnancy ( amenorrhea, morning sickness, abode pain and breast enlargement)

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61
Q

retrovaginal fistula

A

occurs after obstetric trauma and presents with incontinence of flatus and feceres through vagina ( red , velvety rectal mucosa on posterior vaginal wall

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62
Q

red velvety rectal mucosa on posterior vaginal wall

A

Rectovaginal fistula

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63
Q

vulvovaginal parities and white vaginal discharge

A

vulvovaginal candidiasis

check patients HbA1C

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64
Q

ddx of white vaginal discharge

A
  1. Candiasis
    - thick white cottage discharge - vaginal inflammation
    - ph <4.5
  2. Bacterial vaginosis
    - thin, off white discharge, FISHY door
  3. Ph > 4.5 , clue cells , positive whiff test
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65
Q

can fibroids cause stress incontinece

A

yes - due to the direct pressure on bladder from irregularly large uterus

BEST WAY TO KNOW: US pelvis

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66
Q

if PID not treated what can it lead to?

A
  • tuba-ovarian abscess
  • abscess rupture
  • perihepaitis
  • sepsis
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67
Q

inpatient treatment of PID

A

cefotetan plus doxycycline

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68
Q

when to treat PID as inpatient

A
  • pregnancy
  • failed op treatment
  • inability to tolerate oral meds
  • non compliant with therapy
  • severe presentation ( high fever, vomitting)
  • severe presentation ( high fever, vomitting
  • Complications ( tubo–ovarian, perihepatitis)
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69
Q

what is most accurate method for estimating gestational age

A

first trimester ultrasound

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70
Q

postterm complications - fetus

A

OLIGOhydramniosis

  • meconium aspiration
  • stillbith
  • macrosomia
  • convulsion
71
Q

posters complication - maternal

A

c-section
infection
PPH
Perineal trauma

72
Q

risk factor of uterine rupture

A

UTERINE SX HX

73
Q

patient with hypothyroidism gets pregnant what do you do?

A

Increase levothyrocine dose when she becomes pregnant

74
Q

Rupture of membrane - treatment if < 34 weeks

A

1st : look for signs of infection

No: antibiotics (penicillin), corticosteroid, fetal survillance

Yes: antibiotics (penicillin) , corticosteroid , Mg< 32 weeks and delivery

75
Q

Rupture of membrane if 34 - 37 weeks

A

antibiotics (penicillin) - if GBS status unknown
+/- corticosteroid
delivery

76
Q

treatment of asymptomatic bacteriuria in pregnancy

A

Cephalexin
Amocillin calvulanate
nitrofurantoin

ALL first line

77
Q

can you take ciproflaxicin while pregnant ?

A

NO- can cause fetal bone deformities and arthropathy

78
Q

cause of endometrial hyperplasia

A

peripheral aromatization of androgen to estrone

79
Q

causes of bladder atony

A

prolonged labour
perineal trauma
opiod analgesia

bladder atony - is temporary

80
Q

RF for post part urinary retention

A 
primiparity 
regina anesthesia 
operative vaginal delivery 
perineal delivery 
C-section

Risk for bladder atony

81
Q

treatment of bladder atony following forceps delivery

A

temporary condition - self limiting

- can do intermitted cauterization

82
Q

when do you investigate amenorrhea in people who stopped the oral contraceptive

A

greater than or = 3 cycles or >/= to 6 months

if yes - then do TSH, prolactin

83
Q

how to confirm pre-eclampsia if 1+ protein and mild HTN

A

urine protein to creatinine ratio

84
Q

6 month history of vasomotor symptoms - insomnia, irregular menses , hot at night

A
  • most likely pre-menopause - but its important to outrun other causes so you should test FSH and LH
85
Q

define menopause

A

diagnosed after 12 months without sense plus casomotors symptoms

86
Q

causes of oligohydramnios

A

< 2cm pocket of amniotic fluid elected
cause
- fetal hypoxia due to platelet dysfunction ( tobacco use. HTN, DM)

87
Q

elevation in 17 hydroxyprogesteroe

A

non classical congenital adrenal hyperplasia

- also get a partial deficiency of 21 hydroxyls and typicaly hyperandrogegism

88
Q

low FSH and estradiol with irregular menses

A

hypogonadotropic hypogonadism

NOT PCos - b/c FSH and estradiol levels are usually increased

89
Q

why do you get abode pain in HELLP syndrome

A

b/c liver distension of hepatic (Glisson’s capsule)

90
Q

life threatening complication of pre eclampsia in patients with res symptoms

A

pulmonary edema - decrease albumin, decrease renal function and increase vascular permeability

91
Q

atypical glandular cells on pap test - what is your next step ?

A

cause

  • certical adenocarcinoma
  • endometrial adenocarcinoma

Next step

  • colposcopy
  • endocervical curettage
  • endometrial biopsy
92
Q

clear cervical discharge

A

think normal ovulation discharge

93
Q

what is the most common direct roles of HbG in pregnancy

A

maintenance of corpus luteum

94
Q

DVT treatment in pregnancy

A

LMWH

95
Q

C/i of exercise in pregnancy

A

antepartum haemorrhage
cardiopulmonary disease
cervical cleavage

96
Q

sickle cell disease increase risk of what in pregnancy

A

increase risk of vascooclusive crisis

fever, nausea, vomitting, elevated transaminases

97
Q

c/i epidural if platelets

A

<70 000 or rapidly drooping platelets

98
Q

bacteria Vaginosis in pregnancy

A

increase preterm birth
increase risk of other STI
Metronidazole
Clindamycin

99
Q

itchy skin w/o rash, no lab changes , no risk to baby - what is it and treatment?

A

pregnancy induced skin
Tx:
- antihistamines
oatmeal bath

100
Q

itchy skin with cholestatic lab in pregnancy

A

hepatic cholestasis
- intrauterine demise to baby

Tx: deoxycholic acid and antihistamine

101
Q

treatment of endometritis

A

clindamycin and gentamycin

102
Q

treatment of manic attack in pregnancy who recently stopped lithium

A

USE HALOPERIDOL

Others : lithium, secondary antipsychotic, ECT

103
Q

Adolescent pregnancy

A 
preterm 
low BW 
Increase risk of omphalocelea and gastroparesis 
Post partum depression 
pre-eclampsia
104
Q

Protracted active phase labour 6cm dilated

A

oxytocin

105
Q

condyoma accumunata = how do you do delivery of fetus

A

can still do vaginal delivery unless obstruction of birth canal

106
Q

geriatric Surgery and patient wants to get pregnant - what is you advice?

A

wait 1 year post surgery before getting pregnant

107
Q

previous GBS in pregnancy

A

don’t necessarily needs prophylaxis again

108
Q

PCOS best treatment

A
  1. WEIGHT LOSS
  2. OCp
  3. Clompihine
109
Q

10cm complex adrenal mass in pregnancy

A

surgery - up until early 2nd trimester

110
Q

subcnrionic hematoma

A

expectant management

111
Q

ocp c/i

A
  1. migraine aura
  2. smoking > 15 cig / day PLUS >35 years old
  3. Breast Ca
  4. HTN > 160/90
112
Q

Mammogram vs. ultrasound

A

30 years is the cut off

113
Q

Ultrasound shows simple cyst - what do you do? what would you do if the US showed complex cyst

A

simple cyst - FNA

Complex cyst - Core Bx

114
Q

severe menorragia - how do you teat

A

combined OCP high dose

115
Q

number 1 treatment son dysmenorrhea in

A

NSAIDS

116
Q

treatment of condyloma accuminata

A

trichloritic acid

117
Q

uterine septum treatment

A

laparoscopy and repair

118
Q

girl rape pending cultures what do you do

A

treat clamydia and gonorrhoea

treat for HIV too

119
Q

Stress incontinance also known as

A

urethral hypermobility

120
Q

treatment of volvodynia

A

CBT and pelvic floor exercise

121
Q

number one contraceptive in young adolescents

A

IUD or inter muscular injections

122
Q

when do you do HPV testing

A

HPV 21

123
Q

Epilepsy and pregnancy - patient stops valproate acid - what do you do?

A

continue valproate acid

124
Q

pregnant women 3rd trimester vaginal blood with lose of fetal station

A

uterine rupture

125
Q

GBS treatment

A

35 Tx - Amoxicillin

Intrapartum –> Penicillin

126
Q

other name for GBS

A

step galacterase

127
Q

preterm labour

A

steroid
tocolytics
MgS
Penicillin

128
Q

Medical conditions C/i in pregnancy

A
  1. Severe pulm HTN
  2. Eisenmegirer syndrome
  3. EF < 40%
  4. NYHA 3 and 4
  5. prior permpartum cardiomyopathy
  6. obstructive cardiac lesions
  7. Aortic dilatation >40mm
129
Q

Treatment of lobular carcinoma insitu detected on FNA

A

INCISIONAL BX

130
Q

Women who have sex with women

A
  1. BACTERIAL VAGINOSIS
  2. heart disease
  3. diabetes
  4. Obesity
  5. Breast , cervicla, ovarian carcinoma
  6. Depression, Anxiety
131
Q

Best contraceptive for antiphospholipid syndrome

A

progestin

132
Q

unproductive intercouse for 1 year

A

serum analysis

133
Q

when do EVC breech

A

> 37 week

134
Q

adenomyosis

A

occurs in multifarious women > 40 years old

  • soaking pad or tampon more often than 2 hours
  • chronic pelvic pain
  • boggy (soft/ flaccid) uterus
  • uniformity enlarged uterus

Dx: pelvic US +/- MRI
GOLD STANDARD - hysterectomy

Tx: hysterectomy if hormonal methods ( oral contraceptive or iUD is not successful)

not endometriosis - b/c that normally presents in younger people

135
Q

what are late term pregnancy at risk for on Biophysical profile

A

late decelerations and oligohydraminiosis

uretoplacental insufficiency
- decrease fetus perfusion may actually cause poor urine output ( oligohydramnios )

136
Q

within 2 hours - the women does not increase cervix diameter or effacement BUT the fetus station moves rom 0 - -3 —> what has happen?

A

fetal loss of station

UTERINE RUPTURE

137
Q

what cancer is PCOS at risk of getting

A

en

dometrial carcinoma

138
Q

normal fetal heart monitoring

A

fetal head compression

  • symmetric to contractions
139
Q

delayed fetal response with mothers contraction - cause?

A

uretoplacental insufficiency

140
Q

when the tracing of fetus can not be associated with contractions

A

cord compression
oligohydramnios
cord prolapse

141
Q

causes of shoulder dystocia

A 
GDM 
material weight 
excessive pregnancy weight gain 
Post term pregnancy 
fetal macrosomnia
142
Q

complication of oxytocin use

A

tachysystole
hyponatremia
hypotension

143
Q

pooling of clear watery fluid in vagina

painless loss of urine into the vgina following a history after pelvic surgery

A

vesicovaginal fistula

144
Q

Dx of vesicovaginal fistula

A

physical exam
dye test
cystoourethroscopy

145
Q

difference in urethral prolapse vs. vesicovaginal fistula

A

both conditions will cause urinary incontinence

Prolapse - through the urethral meatus
Fistula - into the vagina

146
Q

causes of elevated AFP

A

open neural tube defects
ventral wall defects
multiple gestation

147
Q

suspected ectopic pregnancy with a B-Hcg 1000 - what do you do?

A

TVUS - usually only see intrauterine / extrauterine pregnancy if bhcg 1500- 2000

since here the bHcg is <1000 - you can repeat the bhcg in 2 days

148
Q

why is hypotension a common cause post epidural

A

blood redistribution to the lower limbs and venous pooling from sympathetic blockage

149
Q

what exercise should be avoided in pregnancy

A

contact sports and sports with high fall risk

150
Q

core biopsy of great mass shows macrophages , fat globules - what do you do?

A

reassurance and routine follow up

the patients biopsy shows fat necrosis which is a benign finding

151
Q

women with a hooded cervix , t shaped uterus and small uterine cavity , vaginal septa and vaginal adenosis - what did they most likely get exposed to

A

diethylstilbestrol

152
Q

how do you evaluate a patients risk of preterm delivery - if they have a history of cervical biopsy, no previous pregnancy

A

transvaginal ultrsound

give progesterone - t o maintain uterine quiescence and decease risk of preterm labour

dont do cervical cerclage - unless they already had a preterm labour and short cervix

153
Q

arrest of active labour occurs when the cervix is dilated to > 6xm and no cervical change for > 4 hours - what do you do ?

A

move to c-sectio

154
Q

what do you tell a patient with placenta previa to do?

A

bed rest - NO b/c increase risk of TE

tell them to abstain form intercourse

155
Q

foul smelling body caginal discharge with a 1cm irregular lesion in the upper 1/3 of vagina - what do you do?

A

biopsy this lesion

most likely has squamous cell cancer of vagina - risk with smoking and HPV

156
Q

risk for clear cell adenocarcinoma of the vagina

A

in utereo exposure to DES

157
Q

s/e of oxytocin use

A

hyponatremia
hypotension
tachyssystole

158
Q

what level does magnesium become toxic

A

> 8

159
Q

intrauterine fetal demise at > 24 weeks - what is best treatment for them

A

vaginal delivery - induction induced when they are ready

160
Q

how do you treat CIN 3

A

cervical conization

- used for CIN 2 and CIN 3

161
Q

complication of cervical conization

A

cervical stenosis
preterm birth
preterm premature rupture of membrane
second trimester pregnancy loss

162
Q

what is the most effect emergency contraceptive

A

copper IUF
- offered a lot in nulliparous women and adolescent

  • emergency contraceptive pills are less effective
163
Q

moderate variability, fetal tachycardia , sustained HR > 160 and maternal PROM - what is the cause of change in fetal tracing

A

chorioamnionities

164
Q

umbilical cord compression - what will fetal tracing be like

A

variable decelerations, abrupt drop in fetal heart rate and varying depth and duration

165
Q

early deceleration causes

A

fetal head compression

166
Q

is weight gain associated with OCP

A

nope

S.e OCP
- breakthrough bleeding
hypertension
increase risk of VTE

167
Q

what counselling can you do to patients to decrease risk of breast cancer

A

decrease alcohol intake

168
Q

know hep C infection in pregnancy - what to you do

A

hep C has a 2-5% vertical transmission rate - therefore okay

BUT you should check hep A and hepB

169
Q

lactation mastitis tx

A

recall this is when the patient gets firm, red, tender swollen quadrant of unilateral breast , and fever

treat w/ analgesia and frequent breast pumping plus antibiotics

170
Q

cause of neonatal thyroidtoxicosis

A

Transplacental TSH receptro antibody

171
Q

maternal history of Graves, delivered with low birth weight, warm skin and irritability - what is Dx?

A

Dx is thyroidtoxicosis which will resolve within 3 months and give metronidazole and b blocker

172
Q

bes investigation of tubal scarring

A

hysterosalpingogram

173
Q

first prenatal visit - mom worried about having Down syndrome child what do you do?

A

you can do a cell free fetal DNA testing

174
Q

how do you do lactation suppression?

A

wearing comfortable supportive bran and avoid stimulation , placing ice packs on breast and giving NSAIDs to decrease inflammation

uworld (11 decks)

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