OBGYN Flashcards
1
Q
OB-GYN
A
OB-GYN
2
Q
The secretory phase of the menstrual cycle (day 14-28) is dominated by what hormone?
A
Progesterone
3
Q
Is a nulliparous or mulitparous woman more likely to get preeclampsia?
A
Nulliparity is a risk factor for preeclampsia.
4
Q
Since a genetic cause is the number one reason for primary amenorrhea what is one very important test?
A
Karyotype
5
Q
Purulent cervical discharge should make you think of what diagnosis?
A
Neisseria gonorrhoeae
6
Q
A description of a young girl with a web neck or wide shield chest should make you think of what diagnosis?
A
Turner’s syndrome
7
Q
A cervical biopsy comes back as CIN1. What is the next step?
A
Repeat pap smear in 6 months and repeat colposcopy in 12 months.
8
Q
What is the most common cause of secondary amenorrhea?
A
Pregnancy
9
Q
What three labs should you order if you are considering secondary amenorrhea?
A
beta-HCG, TSH Prolactin
10
Q
Define premature birth.
A
Delivery before 37 weeks.
11
Q
A unilateral, single, mobile, firm, nontender, solid breast mass should make you think of what diagnosis?
A
Fibroadenoma
12
Q
Define metrorrhagia.
A
Bleeding between menstrual cycles.
13
Q
Postmenopausal bleeding is immediately believed to be what diagnosis?
A
Endometrial cancer until proven otherwise.
14
Q
During what portion of the menstrual cycle does PMS occur?
A
By definition it is in the second half and menstruation should relieve the symptoms.
15
Q
How do you treat bacterial vaginosis?
A
Metronidazole x 7 days
16
Q
What location within the pelvis is endometriosis most commonly found?
A
On an ovary
17
Q
What lab test is the gold standard for chlamydia?
A
Nucleic acid amplification test
18
Q
Are fibrocystic breast masses usually bilateral or unilateral?
A
Bilateral
19
Q
How do you definitively diagnose endometriosis?
A
Exploratory laparoscopy
20
Q
What is the most common uterine tumor?
A
Leiomyoma, also known as fibroids
21
Q
What ethnic background is at an increased risk of fibroids?
A
African Americans are 5x more likely to have fibroids compared to Caucasian women.
22
Q
How do you treat vaginal candida?
A
Fluconazole po 1 dose or azole cream x 1 week
23
Q
What is the first step of treatment for endometrial cancer?
A
Total hysterectomy and bilateral salpingo-oophorectomy
24
Q
If you see the term chocolate cyst, it should make you think of what diagnosis?
A
Endometrioma
25
A surge in what hormone leads to ovulation?
Luteinizing hormone (LH)
26
A patient presents with irregular menses, hirsutism and infertility. What is the most likely diagnosis?
Polycystic ovarian syndrome
27
What endocrine issue is associated with PCOS?
Insulin insensitivity
28
You have a patient with PCOS who would like to get pregnant. What are two medications you may start her on?
Metformin and Clomid
29
What is the medical treatment for an early ectopic pregnancy?
Methotrexate
30
An ovarian cyst that contains hair and teeth should make you think of what diagnosis?
Teratoma
31
What is the mean age for ovarian cancer?
63, you will need to think of this in an older patient with vague abdominal symptoms.
32
Define the second stage of labor.
Fully dilated to delivery
33
A 66 year old female patient presents with bouts of nausea, weight loss and vague abdominal pain. What is the most likely diagnosis?
Ovarian cancer
34
When is it recommended to begin pap smears?
Guidelines suggest beginning at age 21 regardless of sexual history.
35
A cervical biopsy comes back as CIN2 or CIN3. What is your next step?
Excision - LEEP, Cold knife (worry about incompetent cervix) Cryotherapy
36
List two risk factors for cervical cancer.
Multiple sexual partners, smoking
37
How much time needs to pass before diagnosing secondary amenorrhea?
If cycles have been normal 3 months. If cycles have been irregular 6 months.
38
What is a cystocele?
A herniation of the bladder into the vagina.
39
What is the treatment for Turner's syndrome?
Cyclical estrogen and progesterone
40
What are three treatments for uterine prolapse?
Pessary, Kegel's maneuvers, surgical repair
41
What is the most common organism that causes mastitis?
Staph aureus
42
At approximately how many weeks pregnant is the uterus at the level of the umbilicus?
20w
43
What is the most common cause of postpartum hemorrhage?
Uterine atony
44
Define missed abortion.
No vaginal bleeding, cervix is closed products of conception are still inside.
45
At what age is primary amenorrhea diagnosed?
Age 14 if no secondary sex characteristics. Age 16 if some secondary development.
46
What is the first line treatment for mastitis?
Dicloxacillin is first line. Cephalexin or erythromycin are second line.
47
Should a breast feeding mother stop breast feeding if she develops mastitis?
Mastitis is not a reason to stop breast feeding, but an abscess is.
48
A physical exam revealing a retroverted uterus or uterosacral ligament nodularity should make you think of what diagnosis?
Endometriosis
49
At how many weeks of pregnancy can an amniocentesis be done?
15-20 weeks
50
List four risk factors for breast cancer?
BRCA1 or BRCA2 positive, unopposed estrogen nulliparity early menarche late menopause
51
What is the average age of menopause?
51
52
Cottage cheese discharge should make you think of what diagnosis?
Vaginal candidiasis
53
The follicular phase of menstruation is dominated by what hormone?
Estrogen
54
About how much weight should a woman gain during pregnancy?
20-35 lbs
55
Thin, sticky, malodorous vaginal discharge should make you think of what diagnosis?
Bacterial vaginosis
56
Vaginal infection with motile flagellated protozoa should make you think of what diagnosis?
Trichomonas vaginitis
57
List two medications commonly used for hypertension in pregnancy.
Methyldopa and labetalol
58
What is the classic triad of pre-eclampsia?
HTN, edema and proteinuria
59
Why is ovarian cancer so hard to diagnose?
There are no good markers and the symptoms are very vague.
60
What are two important things you need to tell you patients before putting them on metronidazole?
Stay out of the sun and avoid alcohol.
61
Define inevitable abortion.
Vaginal bleeding, cervix is open products of conception are still inside
62
How is the first day of the menstrual cycle defined?
The first day of menstrual bleeding is the first day of the cycle.
63
What is the karyotype for a patient with Turner's syndrome?
(45, X) They are missing one sex chromosome.
64
Give the definition for preterm labor.
Contractions that open the cervix before 37 weeks.
65
A patient presents with mucopurulent discharge and cervical motion tenderness. What is the most likely diagnosis?
Chlamydia - cervicitis
66
Which four human papillomaviruses are linked to cervical cancer?
HPV 16, 18 31 and 33
67
Clue cells should make you think of what diagnosis?
Bacterial vaginosis
68
What is the hallmark physical exam finding for placenta previa?
Trick question - NEVER do a physical exam on someone with presumed placenta previa.
69
What medium do you need to grow out Neisseria gonorrhoeae?
Thayer-Martin
70
What age range is the HPV vaccination recommended for?
9 to 26 years old
71
A patient with primary amenorrhea and a low FSH should make you think of what diagnosis?
Hypothalamic pituitary insufficiency
72
What characteristic of pelvic inflammatory disease will help to differentiate it in a question stem from ectopic pregnancy, appendicitis ovarian torsion and ovarian cyst?
It will be bilateral pain. Most other common abdominal complaints have unilateral pain.
73
List 2 risk factors for ovarian cancer.
BRCA1, family history nulliparity late menopause Caucasian Asian
74
Define abortion.
Delivery of uterine contents before 20 weeks.
75
Does mastitis tend to be unilateral or bilateral?
Unilateral and only one quadrant
76
Define full term.
Delivery at 37-42 weeks
77
When does quickening occur?
Nulliparous 18-20 weeks, multiparous 14-16 weeks
78
List three risk factors for placental abruption.
HTN, smoking, AMA, cocaine use, PROM
79
What is the treatment for ovarian cancer?
Total hysterectomy and bilateral salpingo-oophorectomy. Then chemo and radiation.
80
A patient believes she is pregnant. You notice that her cervix appears a little blue. What is the name of this sign?
Chadwick's sign
81
At approximately how many weeks pregnant is the uterus at the level of the symphysis pubis?
12 weeks
82
A snowstorm appearance on ultrasound should make you think of what diagnosis?
Hydatidiform mole also grape-like vesicles
83
What medication can be used to control bleeding due to uterine atony?
Oxytocin (Pitocin)
84
What is the term for when the placenta has implanted directly over the cervical os?
Placenta previa
85
At how many weeks of pregnancy can chorionic villus sampling be done?
10-13 weeks
86
Why is folic acid given as a prenatal vitamin?
Low folic acid can lead to neural tube defects.
87
What is the most common endometrial cancer?
75% are adenocarcinomas
88
A strawberry cervix with copious yellow/green discharge should make you think of what diagnosis?
Trichomonas vaginitis
89
What organism causes us to warn pregnant patients to stay away from deli meats and soft cheeses?
Listeria
90
The baby was delivered several minutes ago. Suddenly there is a increase in blood flow from the vagina and the cord noticeably lengthens. What is the most likely cause of these signs?
Placental separation: ready to deliver the placenta
91
What are two medications used to induce labor?
Cervidil (Prostoglandin gel applied to the cervix) which encourages cervical rippening and oxytocin which encourages uterine contractions.
92
As part of the antepartum testing a baby has a positive stress test. What does that mean?
They have had two heart rate accelerations in a 20 minute period of 15 beats above baseline for at least 15 seconds. This is a good thing.
93
Is FSH high or low in Turner's syndrome?
High, there are no ovaries to respond to FSH and so there is no negative feedback.
94
What is the most common type of ovarian cyst?
Functional cyst - no treatment necessary.
95
Define threatened abortion.
Vaginal bleeding, closed cervix products of conception are still inside
96
List 4 risk factors for endometrial cancer.
Chronic unopposed estrogen, nulliparity early menarche late menopause tamoxifen DM obesity HTN breast CA ovarian CA
97
What would you expect to see on a KOH prep if the patient had vaginal candidiasis?
Pseudohyphae
98
What is the #1 cause of septic arthritis in sexully active young adults?
Neisseria gonorrhoeae
99
How many days after conception is a serum beta- HCG positive?
8
100
If the pap smear results come back anything other than negative or ASCUS what is your next step?
Colposcopy and biopsy
101
List three risk factors for an ectopic pregnancy.
Previous ectopic, scarred tubes (hx of PID or salpingitis) IUD
102
Grape-like vesicles or a sack of grapes on ultrasound should make you think of what diagnosis?
Hydatidiform mole
103
What medication is used to increase surfactant levels and help with lung maturity if you are worried about preterm labor?
Betamethasone
104
What are two tocolytic medications you should be aware of?
Magnesium sulfate and calcium channel blockers
105
A woman presents to the ER concerned she is in preterm labor. What treatment should you begin before even getting any imaging or lab results?
Give IV fluids (most often the patient is suffereing from dehydration).
106
The pap smear results on a 23 year old patient come back as atypical squamous cell uncertain significance (ASCUS). What is your next step?
Repeat pap smear in 12 months although HPV test is acceptable.
107
What are three ways you can check for ruptured membranes?
Ferning pattern on a slide, visualize leakage from the cervix, pooling in the vagina
108
What is the normal range of fetal heart rate?
120-160
109
Define menorrhagia.
Heavy prolonged menstrual flow
110
What Rh combination for mom and dad might cause the mother to create antibodies against the baby’s red blood cells?
Mom Rh-negative and dad Rh- positive
111
At what point during pregnancy is RhoGAM given if it is needed?
28 weeks
112
Define complete abortion.
Vaginal bleeding, cervix open, products of conception have passed
113
Gestational diabetes puts mom and baby at increased risk of for what three things?
Preeclampsia, macrosomia (traumatic birth) slowing in fetal lung development
114
Which is associated with painful third trimester bleeding placental abruption or placenta previa?
Placental abruption
115
What are three causes for a postpartum hemorrhage?
Uterine atony, genital laceration, retained placenta
116
Define the third stage of labor.
Delivery of baby to delivery of placenta
117
What medication(s) are used to treat a postpartum metritis?
Clindamycin and gentamicin together
118
What organism is the most common sexually transmitted bacteria?
Chlamydia
119
Interference with work or school is part of which diagnosis, premenstrual syndrome or premenstrual dysphoric disorder?
Premenstrual dysphoric disorder
120
Which reproductive cancer carries the highest rates of death in women?
Ovarian cancer
121
What is the most common infection following a C-section?
Metritis
122
How do you treat a Trichomonas infection? Define incomplete abortion.
Metronidazole
123
What is the most common site of an ectopic pregnancy?
Vaginal bleeding, cervix is open products of conception partially passed
124
Early on in pregnancy serial beta-HCG should double over what time period?
Within a fallopian tube every 48-72 hours
125
Define procidentia.
Uterine prolapse beyond the introitus
126
What is the more popular term for Stein-Leventhal syndrome?
Polycystic ovarian syndrome
127
What is the formula for calculating estimated date of confinement or due date?
First day of last menstrual period + 7 days - 3 months
128
What are the five components of the biophysical profile as part of antepartum testing?
A non-stress test, fetal breathing two gross body movements fetal tone amniotic fluid index
129
Define the first stage of labor.
Onset of contractions to full dilation of the cervix.
130
A rope-like breast mass should make you think of what diagnosis?
Fibrocystic breast mass
