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MS3 > OBGYN 7 > Flashcards

OBGYN 7 Flashcards

1
Q

Where do ovarian arteries branch from?

A

Directly off the aorta

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2
Q

Where do ovarian veins branch from

A

R side branches directly off the IVC (think that R is closer to IVC than left)

L side branches off renal vein

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3
Q

Where do uterine arteries branch from

A

Off the internal iliac arteries

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4
Q

What are the size cut-offs for ovarian cysts that can be ignored vs. removed

A

If it is <3 cm = most likely simple cyst, can ignore

If it is <10 cm = most likely simple cyst, but should reimage

If it is >10 cm = less likely to resolve on it’s own / possibly a tumor - remove

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5
Q

What is an endometrioma

A

♣ Chocolate cyst
Caused by endometriosis
♣ Dx: diagnostic laparoscopy with laser ablation

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6
Q

Tx of endometriosis

A

♣ NSAIDS and/or OCPs

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7
Q

What is the discriminatory zone

A

• “Discriminatory zone” when BHCG >1500-2000, should see some findings of IUP (i.e. gestational sac) on US

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8
Q

Describe pH of different causes of vulvovaginitis

A 
BV = pH > 4.5
Trich = pH > 4.5
Candida = pH < 4.5
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9
Q

What are the causes of cervicitis

A

♣ Gonorrhea/Chlamydia

♣ Or organisms that cause vulvovaginitis (BV, Trich, Candida)

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10
Q

Describe subtypes of PID

A

♣ Endometritis
♣ Salpingitis
♣ Tuboovarian abscess
♣ Peritonitis

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11
Q

What are the causative organisms of PID

A
  • Gonorrhea (33%)
  • Chlamydia (33%)
  • Vaginal flora (33%)
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12
Q

Diagnosis of PID

A 
♣	Pelvic or abd pain
♣	No other cause for symptoms
♣	1 of the following positive:
•	Cervical motion tenderness
•	Adnexal tenderness
•	Uterine tenderness
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13
Q

Tx of PID

A

• Ceftriaxone IM x1 + Doxy + Metronidazole
o Ceftriaxone cover gonorrhea
o Doxy covers chlamydia
o Metro covers anaerobes

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14
Q

What is criteria to be able to use methotrexate as tx for an ectopic pregnancy

A

bhCG < 5000
Gestational sac < 3.5 cm
No fetal heart tones

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15
Q

What are the causes of abnormal uterine bleeding

A

PALM COIEN

PALM = structural
P = poly
A = adenomyosis
L = leiomyoma
M = malignancy 
COEIN = nonstructural
C = coagulopathy
O = ovulatory dysfunction
E = endometrial
I = iatrogenic
N = not yet classified
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16
Q

What is a leimyoma

A
  • Benign neoplastic proliferation of smooth muscle arising from myometrium
  • are estrogen responsive
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17
Q

Tx of fibroids

A

♣ First line:
• OCP/IUD +/- NSAIDs for pain

♣ Surgery:
• Leuprolide to shrink prior to surgery
• Myomectomy if want to maintain fertility
• TAH if she doesn’t want kids

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18
Q

How do you diagnose PCOS

A

(1) + (2) or (3)

(1) Oligo- or anovulation
(2) Hyperandrogenism
♣ Elevated DHEAS
♣ Elevated Testosterone
♣ LH:FHS > 3:1
(3) Polycystic ovaries on US

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19
Q

Treatment of PCOS

A
  • Metformin
  • OCPs (if don’t want kids)
  • Ovulation induction (if wants kids) - Clomiphene
  • Spironolactone (for hirsutism)
  • Weight loss
20
Q

Describe order of events of puberty in women

A 
(Think: Tits, pits, mits, and lips) 
♣	Breasts (8)
♣	Axillary (9)
♣	Growth (10) 
♣	Menarche (11)
21
Q

Define: False pregnancy – appearance of clinical or subclinical signs and symptoms associated with pregnancy when a person is not actually pregnant

A

Pseudocyesis

22
Q

Tx of pseudocyesis

A

Psychiatric eval and tx

23
Q

Tx of Bartholin duct cyst

A

Observation - most resolve spontaneously

If it is symptomatic you can treat it as you would a Bartholin duct abscess - with I&D

24
Q

At what gestational age do you screen for GBS in a pregnant woman

A

35-37 weeks

25
Q

At what gestatioal age should RHOGAM be given in a Rh negative patient

A

28 weeks and after delivery if infant is Rh(D) positive

26
Q

What antidepressant is contraindicated in pregnancy

A

Paroxetine - increased risk of cardiac malformations and persistent pulmonary HTN

27
Q

Describe intrahepatic cholestasis of pregnancy (ICP)

A
  • Intrahepatic cholestasis of unknown etiology in pregnancy whereby the patient usually complains of pruritus with or without jaundice and no skin rash
  • Bile salts are incompletely cleared by the liver, accumulate in the body, and are deposited in the dermis, causing pruritus
28
Q

Tx of ICP

A

• Ursodeoxycholic acid (UDCA) – decreases total serum bile acid levels and helps to relieve the itching

29
Q

Describe Pruritic urticarial papules and plaques of pregnancy (PUPP)

A

♣ A common skin condition of unknown etiology unique to pregnancy characterized by intense pruritic and erythematous papules on the abdomen that spread extremities and often the buttocks

30
Q

Tx of PUPP

A

♣ Therapy includes topical corticosteroids and antihistamines

31
Q

What proteinuria values are diagnostic for Pre-E

A

> 300 mg on a 24 hour urine, P:C >0.3

32
Q

What proteinuria value is diagnostic for Pre-E with severe features

A

> 500 mg*

33
Q

Tx of 39 week woman with new Pre-E without severe features

A

Delivery

Do not need mag

34
Q

Tx of eclampsia

A
  • Magnesium IM or IV

- Delivery after maternal stabilization

35
Q

What is the therapeutic level of magnesium

A

4-7 mEq/L

36
Q

At what level of magnesium does loss of DTR occur

A

7-10 meq/L

37
Q

What can occur at mag levels of 11-15

A

Respiratory depression

38
Q

What can occur at mag levels >15

A

Cardiac arrest

39
Q

What is the risk of isoimmunization in an Rh- woman who gave birth to a Rh+ baby without Rhogam

A

2% antepartum
7% after full term delivery
7% with subsequent pregnancy

So less than 20% total

40
Q

Best non-invasive test to detect fetal anemia in an Rh- mom

A

US - middle cerebral artery peak systolic velocity

41
Q

What will be seen on US on fetal hydrops

A
  • Collection of fluid in two or more body cavities (e.g. ascites, pericardial fluid, pleural fluid, scalp edema)
  • Placentomegaly (placental edema)
  • Polyhydramnios
42
Q

Describe theory for etiology of hydrops fetalis

A

Severe anemia may cause heart failure, or induction of the hematopoietic centers in the liver to replace normal liver tissue, leading to low serum protein

43
Q

What intervention has shown to decrease preterm delivery of twins

A

Adequate weight gain in the first 20-24 weeks of pregnancy

44
Q

What type of twins can experience twin twin transfusion syndromr

A

Monochorionic/diamniotic

45
Q

What is the most concerning complication for multiple gestation

A

Preterm delivery

46
Q

What gestational age time frame is most at risk for developing intellectual disability in response to radiation exposure

A

8-15 weeks

47
Q

Most common cause of preterm labor

A

Idiopathic

MS3 (88 decks)

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