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
2
Q
Tx of Antiphospholid antibody
A
Anticoagulant ( heparin , warfarin)
3
Q
what type of fibroid is NOT ass. w/ pregnancy complications
A
subserosal fibroid
)located outside uterine cavity)
4
Q
intrahepatic cholestasis of pregnancy labs
A
Elevated bile acid
Elevated Liver aminotransferases
Dx of exclusion
Clinical: intense puritis
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
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
7
Q
PPH <24 hours after delivery - most likely cause
A
uterine atony
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
9
Q
clinical of uterine atony
A
BOGGY and enlarged uterus
uterine atony - presents with profuse vaginal bleeding
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
11
Q
what HPA axis finding will be ass. w/ eating disorder?
A
hypothalamic hypogonadism ( low GnRh, low FSH, low estridaol)
12
Q
who is C/i to attempt vaginal delivery
A
- classical cesarean delivery ( VERTICLE incision)
- Abdominal myomectomy WITHuterine cavity entry (removal of intramural or submucosal fibroids)
b/c at RISK of uterine rupture
13
Q
when can you give HPV vaccine
A
administer age 11-12 and can be received until age 26
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
15
Q
treatment of AFE (amniotic fluid embolism)
A
resp and hemodynamic support ( incubation) +/- transfusion
16
Q
risk factor of Amniotic fluid embolism
A
- advanced maternal age
- gravida more than 5 births/ stilbirths
- C-section or instrument delivery
- Placenta previa or abruption
- Pre-eclampsia
17
Q
Quad screen Trisomy 18
A
MSAFP - low
B-HCG- low
Estradiol - low
Inhibit A - normal
18
Q
quad screen Trisomy 21
A
MSAFP - low
B-HcG - high
Estradiol - low
Inhibit A - high
(low, high, low, high)
19
Q
quad screen for neural tube or abdominal wall defect
A
MSAFP = high
B-HCG - normal
Estriol - normal
Inhibit - normal
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
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
22
Q
8cm left ovarian cyst with calcifications and hyper echoic nodules - Dx?
A
Cystic teratoma
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
24
Q
smooth muscle tumours of uterus
A
leiomuomata uteri ( fibroids)
25
symmetrically enlarged uterus beneath the level of the pelvis brim that is consistent with 10 weeks in size?
adenomyosis
26
multiple small, papular growths at the vestibule of the vulva over the labia majora
condylomata acuminata ( hPV 6, 11)
Not genital herpes - cause these present as a single/ clustered blisters or superficial, tender ulcers
27
risk of placenta abruption
DIC
28
high grade squamous intraepithelial lesion pap result while patient is pregnant - what do you do?
do colposcopy and get Bx
29
painful itchy ulcerative lesion on labia very painful
think genital herpes - HSV 2 treatment with antivirals can speed resolution of outbreaks and decrease recurrences
30
when can postpartum thyroiditis occur
7-8% of women after childbirth within 6 months
| brief hyperthyroid simp (anxiety, palpitation) THEN hypothyroid phase (fatigue, constipation, irritable)
31
RF for postpartum endometritis
```
c-section
chorioamnionitis
group B step colonization
prolonged rupture of membranes
operative vaginal delivery
```
32
treatment of postpartum endometritis
clindamycin and gentamicin
33
clinical of post part endometritis
fever > 24 hours, uterine fundal tenderness and purulent lochia
34
Dx lichen sclerosus
valvular punch biopsy
35
how to differential hypoestroginism vs. lichen sclerosus
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
36
what vaccines are safe in pregnancy
influenza , tdap and RHo(D) immunoglobulin
37
what vaccines are not safe in pregnancy
MMR - live vaccine
38
46XY absence uterus and cervix , ovaries are not palpable
androgen insensitivity syndrome
39
mullein genesis
hypoplastic or absent mullein duct
absent rudimentary uterus and upper vagina, normal ovaries
40
what US findings for hydadidiform mole
snowstorm appearance
41
redness, ulceration , scaling and flaking of nipple
adenocarcinoma - Pagets disease of breast (eczematous or ulcerating rash localized to the nipple
42
permpartum cardiomyopathy
rapid onset of systolic heart failure ( fatigue, dyspnea, cough , edema) MUST BE AT > 36 weeks gestation or early puerperium
43
lichen simplex chronicus
hyperpastic response to repetitive scratching and irritation
Examination: leathery textured skin
44
use of Mg sulphate
weak tocolytic
not typically administered for tocolysis but instead lowering the risk of neurological comorbidities in neonates born at <32 week gestation
45
what test should be done 24-28 weeks
haemoglobin / hct
antibody screen for Rh D negative
50g 1 hour GCT
46
when do you do group B streptococcus culture
35 - 37 weeks
47
risk factor for breast cancer
chronological age ( increase > 50)
Nulliparity
obesity
prolonged hormone replacement
48
Dx of ectopic pregnancy
positive pregnancy test
Transvaginal ultrasound
(gestational sac at an ectopic site, most commonly FT)
49
indication for AntiD immune globulin in Rh negative patients
```
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
```
50
DO women go screening for asymptomatic bacteriuria
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
51
what contraceptive is used for a patient with breast cancer
COPPER IUD
| b/c all hormonal therapies are c/i in patients with breast cancer
52
ABO incompatibility signs in newborn
mild hemolytic anemia
53
chancroid vs syphillis
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
54
Dx syphillis
nontreponemal (RPR, VDRL) and treponema (FTA- ABS, TP - EIA)
55
Bartholin duct cyst
Asymptomatic - Observatio for spontaneous drainage
Symptomatic - I&D
56
Causes stress incontinece
- decreased urethral sphincter tone
| Urethral hyper mobility
57
cause of overflow
- decrease detrusor activity
| - bladder outlet obstruction
58
initial prenatal visit test
```
- RhD type, antibody screen
Hg / oct , MCV
HIC, VDRL/ RPR, HBsAg
Rubella and varicella immunity
Pap test
Chlamydia PCR
Urine culture
Urine protein
```
59
management of intrauterine fetal demise
20-23 weeks
- dilation and evacuation Or vaginal delivery
> 24 weeks - vaginal delivery
60
pseudpcyesis
condition in which non psychotic women presents with signs and symptoms of pregnancy ( amenorrhea, morning sickness, abode pain and breast enlargement)
61
retrovaginal fistula
occurs after obstetric trauma and presents with incontinence of flatus and feceres through vagina ( red , velvety rectal mucosa on posterior vaginal wall
62
red velvety rectal mucosa on posterior vaginal wall
Rectovaginal fistula
63
vulvovaginal parities and white vaginal discharge
vulvovaginal candidiasis
| check patients HbA1C
64
ddx of white vaginal discharge
1. Candiasis
- thick white cottage discharge - vaginal inflammation
- ph <4.5
2. Bacterial vaginosis
- thin, off white discharge, FISHY door
2. Ph > 4.5 , clue cells , positive whiff test
65
can fibroids cause stress incontinece
yes - due to the direct pressure on bladder from irregularly large uterus
BEST WAY TO KNOW: US pelvis
66
if PID not treated what can it lead to?
- tuba-ovarian abscess
- abscess rupture
- perihepaitis
- sepsis
67
inpatient treatment of PID
cefotetan plus doxycycline
68
when to treat PID as inpatient
- 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)
69
what is most accurate method for estimating gestational age
first trimester ultrasound
70
postterm complications - fetus
OLIGOhydramniosis
- meconium aspiration
- stillbith
- macrosomia
- convulsion
71
posters complication - maternal
c-section
infection
PPH
Perineal trauma
72
risk factor of uterine rupture
UTERINE SX HX
73
patient with hypothyroidism gets pregnant what do you do?
Increase levothyrocine dose when she becomes pregnant
74
Rupture of membrane - treatment if < 34 weeks
1st : look for signs of infection
No: antibiotics (penicillin), corticosteroid, fetal survillance
Yes: antibiotics (penicillin) , corticosteroid , Mg< 32 weeks and delivery
75
Rupture of membrane if 34 - 37 weeks
antibiotics (penicillin) - if GBS status unknown
+/- corticosteroid
delivery
76
treatment of asymptomatic bacteriuria in pregnancy
Cephalexin
Amocillin calvulanate
nitrofurantoin
ALL first line
77
can you take ciproflaxicin while pregnant ?
NO- can cause fetal bone deformities and arthropathy
78
cause of endometrial hyperplasia
peripheral aromatization of androgen to estrone
79
causes of bladder atony
prolonged labour
perineal trauma
opiod analgesia
bladder atony - is temporary
80
RF for post part urinary retention
```
primiparity
regina anesthesia
operative vaginal delivery
perineal delivery
C-section
```
Risk for bladder atony
81
treatment of bladder atony following forceps delivery
temporary condition - self limiting
| - can do intermitted cauterization
82
when do you investigate amenorrhea in people who stopped the oral contraceptive
greater than or = 3 cycles or >/= to 6 months
if yes - then do TSH, prolactin
83
how to confirm pre-eclampsia if 1+ protein and mild HTN
urine protein to creatinine ratio
84
6 month history of vasomotor symptoms - insomnia, irregular menses , hot at night
- most likely pre-menopause - but its important to outrun other causes so you should test FSH and LH
85
define menopause
diagnosed after 12 months without sense plus casomotors symptoms
86
causes of oligohydramnios
< 2cm pocket of amniotic fluid elected
cause
- fetal hypoxia due to platelet dysfunction ( tobacco use. HTN, DM)
87
elevation in 17 hydroxyprogesteroe
non classical congenital adrenal hyperplasia
| - also get a partial deficiency of 21 hydroxyls and typicaly hyperandrogegism
88
low FSH and estradiol with irregular menses
hypogonadotropic hypogonadism
| NOT PCos - b/c FSH and estradiol levels are usually increased
89
why do you get abode pain in HELLP syndrome
b/c liver distension of hepatic (Glisson's capsule)
90
life threatening complication of pre eclampsia in patients with res symptoms
pulmonary edema - decrease albumin, decrease renal function and increase vascular permeability
91
atypical glandular cells on pap test - what is your next step ?
cause
- certical adenocarcinoma
- endometrial adenocarcinoma
Next step
- colposcopy
- endocervical curettage
- endometrial biopsy
92
clear cervical discharge
think normal ovulation discharge
93
what is the most common direct roles of HbG in pregnancy
maintenance of corpus luteum
94
DVT treatment in pregnancy
LMWH
95
C/i of exercise in pregnancy
antepartum haemorrhage
cardiopulmonary disease
cervical cleavage
96
sickle cell disease increase risk of what in pregnancy
increase risk of vascooclusive crisis
fever, nausea, vomitting, elevated transaminases
97
c/i epidural if platelets
<70 000 or rapidly drooping platelets
98
bacteria Vaginosis in pregnancy
increase preterm birth
increase risk of other STI
Metronidazole
Clindamycin
99
itchy skin w/o rash, no lab changes , no risk to baby - what is it and treatment?
pregnancy induced skin
Tx:
- antihistamines
oatmeal bath
100
itchy skin with cholestatic lab in pregnancy
hepatic cholestasis
- intrauterine demise to baby
Tx: deoxycholic acid and antihistamine
101
treatment of endometritis
clindamycin and gentamycin
102
treatment of manic attack in pregnancy who recently stopped lithium
USE HALOPERIDOL
Others : lithium, secondary antipsychotic, ECT
103
Adolescent pregnancy
```
preterm
low BW
Increase risk of omphalocelea and gastroparesis
Post partum depression
pre-eclampsia
```
104
Protracted active phase labour 6cm dilated
oxytocin
105
condyoma accumunata = how do you do delivery of fetus
can still do vaginal delivery unless obstruction of birth canal
106
geriatric Surgery and patient wants to get pregnant - what is you advice?
wait 1 year post surgery before getting pregnant
107
previous GBS in pregnancy
don't necessarily needs prophylaxis again
108
PCOS best treatment
1. WEIGHT LOSS
2. OCp
3. Clompihine
109
10cm complex adrenal mass in pregnancy
surgery - up until early 2nd trimester
110
subcnrionic hematoma
expectant management
111
ocp c/i
1. migraine aura
2. smoking > 15 cig / day PLUS >35 years old
3. Breast Ca
4. HTN > 160/90
112
Mammogram vs. ultrasound
30 years is the cut off
113
Ultrasound shows simple cyst - what do you do? what would you do if the US showed complex cyst
simple cyst - FNA
Complex cyst - Core Bx
114
severe menorragia - how do you teat
combined OCP high dose
115
number 1 treatment son dysmenorrhea in
NSAIDS
116
treatment of condyloma accuminata
trichloritic acid
117
uterine septum treatment
laparoscopy and repair
118
girl rape pending cultures what do you do
treat clamydia and gonorrhoea
| treat for HIV too
119
Stress incontinance also known as
urethral hypermobility
120
treatment of volvodynia
CBT and pelvic floor exercise
121
number one contraceptive in young adolescents
IUD or inter muscular injections
122
when do you do HPV testing
HPV 21
123
Epilepsy and pregnancy - patient stops valproate acid - what do you do?
continue valproate acid
124
pregnant women 3rd trimester vaginal blood with lose of fetal station
uterine rupture
125
GBS treatment
35 Tx - Amoxicillin
| Intrapartum --> Penicillin
126
other name for GBS
step galacterase
127
preterm labour
steroid
tocolytics
MgS
Penicillin
128
Medical conditions C/i in pregnancy
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
Treatment of lobular carcinoma insitu detected on FNA
INCISIONAL BX
130
Women who have sex with women
1. BACTERIAL VAGINOSIS
2. heart disease
3. diabetes
4. Obesity
4. Breast , cervicla, ovarian carcinoma
5. Depression, Anxiety
131
Best contraceptive for antiphospholipid syndrome
progestin
132
unproductive intercouse for 1 year
serum analysis
133
when do EVC breech
>37 week
134
adenomyosis
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
what are late term pregnancy at risk for on Biophysical profile
late decelerations and oligohydraminiosis
uretoplacental insufficiency
- decrease fetus perfusion may actually cause poor urine output ( oligohydramnios )
136
within 2 hours - the women does not increase cervix diameter or effacement BUT the fetus station moves rom 0 - -3 ---> what has happen?
fetal loss of station
UTERINE RUPTURE
137
what cancer is PCOS at risk of getting
en
| dometrial carcinoma
138
normal fetal heart monitoring
fetal head compression
- symmetric to contractions
139
delayed fetal response with mothers contraction - cause?
uretoplacental insufficiency
140
when the tracing of fetus can not be associated with contractions
cord compression
oligohydramnios
cord prolapse
141
causes of shoulder dystocia
```
GDM
material weight
excessive pregnancy weight gain
Post term pregnancy
fetal macrosomnia
```
142
complication of oxytocin use
tachysystole
hyponatremia
hypotension
143
pooling of clear watery fluid in vagina
| painless loss of urine into the vgina following a history after pelvic surgery
vesicovaginal fistula
144
Dx of vesicovaginal fistula
physical exam
dye test
cystoourethroscopy
145
difference in urethral prolapse vs. vesicovaginal fistula
both conditions will cause urinary incontinence
Prolapse - through the urethral meatus
Fistula - into the vagina
146
causes of elevated AFP
open neural tube defects
ventral wall defects
multiple gestation
147
suspected ectopic pregnancy with a B-Hcg 1000 - what do you do?
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
why is hypotension a common cause post epidural
blood redistribution to the lower limbs and venous pooling from sympathetic blockage
149
what exercise should be avoided in pregnancy
contact sports and sports with high fall risk
150
core biopsy of great mass shows macrophages , fat globules - what do you do?
reassurance and routine follow up
the patients biopsy shows fat necrosis which is a benign finding
151
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
diethylstilbestrol
152
how do you evaluate a patients risk of preterm delivery - if they have a history of cervical biopsy, no previous pregnancy
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
arrest of active labour occurs when the cervix is dilated to > 6xm and no cervical change for > 4 hours - what do you do ?
move to c-sectio
154
what do you tell a patient with placenta previa to do?
bed rest - NO b/c increase risk of TE
tell them to abstain form intercourse
155
foul smelling body caginal discharge with a 1cm irregular lesion in the upper 1/3 of vagina - what do you do?
biopsy this lesion
| most likely has squamous cell cancer of vagina - risk with smoking and HPV
156
risk for clear cell adenocarcinoma of the vagina
in utereo exposure to DES
157
s/e of oxytocin use
hyponatremia
hypotension
tachyssystole
158
what level does magnesium become toxic
> 8
159
intrauterine fetal demise at > 24 weeks - what is best treatment for them
vaginal delivery - induction induced when they are ready
160
how do you treat CIN 3
cervical conization
| - used for CIN 2 and CIN 3
161
complication of cervical conization
cervical stenosis
preterm birth
preterm premature rupture of membrane
second trimester pregnancy loss
162
what is the most effect emergency contraceptive
copper IUF
- offered a lot in nulliparous women and adolescent
- emergency contraceptive pills are less effective
163
moderate variability, fetal tachycardia , sustained HR > 160 and maternal PROM - what is the cause of change in fetal tracing
chorioamnionities
164
umbilical cord compression - what will fetal tracing be like
variable decelerations, abrupt drop in fetal heart rate and varying depth and duration
165
early deceleration causes
fetal head compression
166
is weight gain associated with OCP
nope
S.e OCP
- breakthrough bleeding
hypertension
increase risk of VTE
167
what counselling can you do to patients to decrease risk of breast cancer
decrease alcohol intake
168
know hep C infection in pregnancy - what to you do
hep C has a 2-5% vertical transmission rate - therefore okay
BUT you should check hep A and hepB
169
lactation mastitis tx
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
cause of neonatal thyroidtoxicosis
Transplacental TSH receptro antibody
171
maternal history of Graves, delivered with low birth weight, warm skin and irritability - what is Dx?
Dx is thyroidtoxicosis which will resolve within 3 months and give metronidazole and b blocker
172
bes investigation of tubal scarring
hysterosalpingogram
173
first prenatal visit - mom worried about having Down syndrome child what do you do?
you can do a cell free fetal DNA testing
174
how do you do lactation suppression?
wearing comfortable supportive bran and avoid stimulation , placing ice packs on breast and giving NSAIDs to decrease inflammation
