OBGYN Flashcards
OB-GYN
OB-GYN
The secretory phase of the menstrual cycle (day 14-28) is dominated by what hormone?
Progesterone
Is a nulliparous or mulitparous woman more likely to get preeclampsia?
Nulliparity is a risk factor for preeclampsia.
Since a genetic cause is the number one reason for primary amenorrhea what is one very important test?
Karyotype
Purulent cervical discharge should make you think of what diagnosis?
Neisseria gonorrhoeae
A description of a young girl with a web neck or wide shield chest should make you think of what diagnosis?
Turner’s syndrome
A cervical biopsy comes back as CIN1. What is the next step?
Repeat pap smear in 6 months and repeat colposcopy in 12 months.
What is the most common cause of secondary amenorrhea?
Pregnancy
What three labs should you order if you are considering secondary amenorrhea?
beta-HCG, TSH Prolactin
Define premature birth.
Delivery before 37 weeks.
A unilateral, single, mobile, firm, nontender, solid breast mass should make you think of what diagnosis?
Fibroadenoma
Define metrorrhagia.
Bleeding between menstrual cycles.
Postmenopausal bleeding is immediately believed to be what diagnosis?
Endometrial cancer until proven otherwise.
During what portion of the menstrual cycle does PMS occur?
By definition it is in the second half and menstruation should relieve the symptoms.
How do you treat bacterial vaginosis?
Metronidazole x 7 days
What location within the pelvis is endometriosis most commonly found?
On an ovary
What lab test is the gold standard for chlamydia?
Nucleic acid amplification test
Are fibrocystic breast masses usually bilateral or unilateral?
Bilateral
How do you definitively diagnose endometriosis?
Exploratory laparoscopy
What is the most common uterine tumor?
Leiomyoma, also known as fibroids
What ethnic background is at an increased risk of fibroids?
African Americans are 5x more likely to have fibroids compared to Caucasian women.
How do you treat vaginal candida?
Fluconazole po 1 dose or azole cream x 1 week
What is the first step of treatment for endometrial cancer?
Total hysterectomy and bilateral salpingo-oophorectomy
If you see the term chocolate cyst, it should make you think of what diagnosis?
Endometrioma
A surge in what hormone leads to ovulation?
Luteinizing hormone (LH)
A patient presents with irregular menses, hirsutism and infertility. What is the most likely diagnosis?
Polycystic ovarian syndrome
What endocrine issue is associated with PCOS?
Insulin insensitivity
You have a patient with PCOS who would like to get pregnant. What are two medications you may start her on?
Metformin and Clomid
What is the medical treatment for an early ectopic pregnancy?
Methotrexate
An ovarian cyst that contains hair and teeth should make you think of what diagnosis?
Teratoma
What is the mean age for ovarian cancer?
63, you will need to think of this in an older patient with vague abdominal symptoms.
Define the second stage of labor.
Fully dilated to delivery
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
When is it recommended to begin pap smears?
Guidelines suggest beginning at age 21 regardless of sexual history.
A cervical biopsy comes back as CIN2 or CIN3. What is your next step?
Excision - LEEP, Cold knife (worry about incompetent cervix) Cryotherapy
List two risk factors for cervical cancer.
Multiple sexual partners, smoking
How much time needs to pass before diagnosing secondary amenorrhea?
If cycles have been normal 3 months. If cycles have been irregular 6 months.
What is a cystocele?
A herniation of the bladder into the vagina.
What is the treatment for Turner’s syndrome?
Cyclical estrogen and progesterone
What are three treatments for uterine prolapse?
Pessary, Kegel’s maneuvers, surgical repair
What is the most common organism that causes mastitis?
Staph aureus
At approximately how many weeks pregnant is the uterus at the level of the umbilicus?
20w
What is the most common cause of postpartum hemorrhage?
Uterine atony
Define missed abortion.
No vaginal bleeding, cervix is closed products of conception are still inside.
At what age is primary amenorrhea diagnosed?
Age 14 if no secondary sex characteristics. Age 16 if some secondary development.
What is the first line treatment for mastitis?
Dicloxacillin is first line. Cephalexin or erythromycin are second line.
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.
A physical exam revealing a retroverted uterus or uterosacral ligament nodularity should make you think of what diagnosis?
Endometriosis
At how many weeks of pregnancy can an amniocentesis be done?
15-20 weeks
List four risk factors for breast cancer?
BRCA1 or BRCA2 positive, unopposed estrogen nulliparity early menarche late menopause
What is the average age of menopause?
51
Cottage cheese discharge should make you think of what diagnosis?
Vaginal candidiasis
The follicular phase of menstruation is dominated by what hormone?
Estrogen
About how much weight should a woman gain during pregnancy?
20-35 lbs
Thin, sticky, malodorous vaginal discharge should make you think of what diagnosis?
Bacterial vaginosis
Vaginal infection with motile flagellated protozoa should make you think of what diagnosis?
Trichomonas vaginitis
List two medications commonly used for hypertension in pregnancy.
Methyldopa and labetalol
What is the classic triad of pre-eclampsia?
HTN, edema and proteinuria
Why is ovarian cancer so hard to diagnose?
There are no good markers and the symptoms are very vague.
What are two important things you need to tell you patients before putting them on metronidazole?
Stay out of the sun and avoid alcohol.
Define inevitable abortion.
Vaginal bleeding, cervix is open products of conception are still inside
How is the first day of the menstrual cycle defined?
The first day of menstrual bleeding is the first day of the cycle.
What is the karyotype for a patient with Turner’s syndrome?
(45, X) They are missing one sex chromosome.
Give the definition for preterm labor.
Contractions that open the cervix before 37 weeks.
A patient presents with mucopurulent discharge and cervical motion tenderness. What is the most likely diagnosis?
Chlamydia - cervicitis
Which four human papillomaviruses are linked to cervical cancer?
HPV 16, 18 31 and 33
Clue cells should make you think of what diagnosis?
Bacterial vaginosis
What is the hallmark physical exam finding for placenta previa?
Trick question - NEVER do a physical exam on someone with presumed placenta previa.
What medium do you need to grow out Neisseria gonorrhoeae?
Thayer-Martin
What age range is the HPV vaccination recommended for?
9 to 26 years old
A patient with primary amenorrhea and a low FSH should make you think of what diagnosis?
Hypothalamic pituitary insufficiency
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.
List 2 risk factors for ovarian cancer.
BRCA1, family history nulliparity late menopause Caucasian Asian
Define abortion.
Delivery of uterine contents before 20 weeks.
Does mastitis tend to be unilateral or bilateral?
Unilateral and only one quadrant
Define full term.
Delivery at 37-42 weeks
When does quickening occur?
Nulliparous 18-20 weeks, multiparous 14-16 weeks
List three risk factors for placental abruption.
HTN, smoking, AMA, cocaine use, PROM
What is the treatment for ovarian cancer?
Total hysterectomy and bilateral salpingo-oophorectomy. Then chemo and radiation.
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
At approximately how many weeks pregnant is the uterus at the level of the symphysis pubis?
12 weeks
A snowstorm appearance on ultrasound should make you think of what diagnosis?
Hydatidiform mole also grape-like vesicles
What medication can be used to control bleeding due to uterine atony?
Oxytocin (Pitocin)
What is the term for when the placenta has implanted directly over the cervical os?
Placenta previa
At how many weeks of pregnancy can chorionic villus sampling be done?
10-13 weeks
Why is folic acid given as a prenatal vitamin?
Low folic acid can lead to neural tube defects.
What is the most common endometrial cancer?
75% are adenocarcinomas
A strawberry cervix with copious yellow/green discharge should make you think of what diagnosis?
Trichomonas vaginitis
What organism causes us to warn pregnant patients to stay away from deli meats and soft cheeses?
Listeria
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
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.
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.
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.
What is the most common type of ovarian cyst?
Functional cyst - no treatment necessary.
Define threatened abortion.
Vaginal bleeding, closed cervix products of conception are still inside
List 4 risk factors for endometrial cancer.
Chronic unopposed estrogen, nulliparity early menarche late menopause tamoxifen DM obesity HTN breast CA ovarian CA
What would you expect to see on a KOH prep if the patient had vaginal candidiasis?
Pseudohyphae
What is the #1 cause of septic arthritis in sexully active young adults?
Neisseria gonorrhoeae
How many days after conception is a serum beta- HCG positive?
8
If the pap smear results come back anything other than negative or ASCUS what is your next step?
Colposcopy and biopsy
List three risk factors for an ectopic pregnancy.
Previous ectopic, scarred tubes (hx of PID or salpingitis) IUD
Grape-like vesicles or a sack of grapes on ultrasound should make you think of what diagnosis?
Hydatidiform mole
What medication is used to increase surfactant levels and help with lung maturity if you are worried about preterm labor?
Betamethasone
What are two tocolytic medications you should be aware of?
Magnesium sulfate and calcium channel blockers
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).
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.
What are three ways you can check for ruptured membranes?
Ferning pattern on a slide, visualize leakage from the cervix, pooling in the vagina
What is the normal range of fetal heart rate?
120-160
Define menorrhagia.
Heavy prolonged menstrual flow
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
At what point during pregnancy is RhoGAM given if it is needed?
28 weeks
Define complete abortion.
Vaginal bleeding, cervix open, products of conception have passed
Gestational diabetes puts mom and baby at increased risk of for what three things?
Preeclampsia, macrosomia (traumatic birth) slowing in fetal lung development
Which is associated with painful third trimester bleeding placental abruption or placenta previa?
Placental abruption
What are three causes for a postpartum hemorrhage?
Uterine atony, genital laceration, retained placenta
Define the third stage of labor.
Delivery of baby to delivery of placenta
What medication(s) are used to treat a postpartum metritis?
Clindamycin and gentamicin together
What organism is the most common sexually transmitted bacteria?
Chlamydia
Interference with work or school is part of which diagnosis, premenstrual syndrome or premenstrual dysphoric disorder?
Premenstrual dysphoric disorder
Which reproductive cancer carries the highest rates of death in women?
Ovarian cancer
What is the most common infection following a C-section?
Metritis
How do you treat a Trichomonas infection? Define incomplete abortion.
Metronidazole
What is the most common site of an ectopic pregnancy?
Vaginal bleeding, cervix is open products of conception partially passed
Early on in pregnancy serial beta-HCG should double over what time period?
Within a fallopian tube every 48-72 hours
Define procidentia.
Uterine prolapse beyond the introitus
What is the more popular term for Stein-Leventhal syndrome?
Polycystic ovarian syndrome
What is the formula for calculating estimated date of confinement or due date?
First day of last menstrual period + 7 days - 3 months
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
Define the first stage of labor.
Onset of contractions to full dilation of the cervix.
A rope-like breast mass should make you think of what diagnosis?
Fibrocystic breast mass
