OBGYN Flashcards
1
Q
In primary amenorrhea what should be done after a general gynecological examination?
A
Estrogen-progesterone test –> this will stimulate withdrawal bleeding & indicate if the endometrial layer is responsive
2
Q
Effects of Progesterone
A
- increase of basal body temperature
- development of breast acinars
- endometrial secretion
3
Q
In adolescents the time frame for 2nd amenorrhea?
A
Lack of menstrual cycle for 6 months
4
Q
Estimated amount of average mensuration
A
25-50 ml
5
Q
Where do the Lutein cells originate?
A
Granulosa cells
6
Q
Most frequent malignant tumor in adolescent females
A
Ovarian cancer
7
Q
Turner’s syndrome
A
Streak ovaries, congenital heart disease, horseshoe kidney, short stature, webbed neck, lymphedema, pigmented nevus, hypoplastic fingernails and toenails, high-arched roof of mouth
8
Q
Characteristics of PCOS
A
- increased GnRH pulsatility frequency
- increased LH/FSH ratio
- increased DHEAS level
- decreased estradiol levels
9
Q
Hematometra
A
This is the retention & collection of blood in the uterus. It is typically due to the imperforate hymen & the transverse vaginal septum
10
Q
What does the Mullerian duct form?
A
- Fallopian tubes
- Uterus
- Upper 2/3 of the vagina
11
Q
How do combined OCPs decrease mild hirsutism?
A
- decreases the amount of circulating testosterone
- Steroid hormone binding globulin (SHBG) levels increase
- Adrenal production of testosterone decreases
- LH-regulated androgen production is decreased
12
Q
Bacterial vaginosis
A
- Greyish- white vaginal exudate
- There are clue cells
- Vaginal PH is above 4.5
- There is a + KOH (amine) test
13
Q
Characteristics of Chlamydia Trachomatis
A
- Mucopurulent cervicitis
- Increased risk for HIV infection
- It can be an asymptomatic infection–> cause complications like PID
- Treating the partner is also necessary
14
Q
Treatment of uncomplicated Chlamydia trachomatis
A
1) doxycycline
2) erythromycin
3) azithromycin
4) clindamycin
15
Q
Causes of juvenile vaginal bleeds
A
- Foreign body in vagina
- Precocious puberty
- Botryoid sarcoma
- Injury
- Recurrent vulvovaginitis
- Exogenous hormone intake
16
Q
Malignant ovarian germ cell tumors
A
1) dysgerminoma
2) choriocarcinoma
3) endodermal sinus tumor
4) malignant teratomas
5) gonadoblastoma
17
Q
Aplasia Cutis
A
This is the congenital disorder that is characterized by either a focal or widespread absence of skin
18
Q
What drug causes Aplasia Cutis?
A
Methimazole
19
Q
Adrenogenital syndrome
A
This is also known as the Congenital Adrenal Hyperplasia (CAH)
20
Q
Can hypothyroidism cause premature sexual development?
A
Yes, this is due to the fact that the increased TSH may also be associated with increased GnRH
21
Q
Where is the typical location of the ovaries ?
A
Between the bifurcation of the internal iliac arteries & the fallopian tubes
22
Q
Why aren’t IUDs typically used in nulliparous women?
A
Due to the risk of the ascending pelvic infections. This can lead to: Ectopic pregnancy, infertility & scarring of the fallopian tubes
23
Q
Common causes of 2nd amenorrhea
A
- issues in the HPA axis
24
Q
Genital Tuberculosis
A
This occurs due to the dissemination of the mycobacterium bacilli via the bloodstream for them to reach the genitalia. It is a chronic disease with low grade symptoms
25
Management of abnormal uterine bleeding in adolescents
Continuous of cyclic progesterone therapy or OCPs
26
Endometrial polyps
* These arise from the inner lining of the uterus
* the prevalence increases with age
* they can cause infertility
* they are typically benign but malignant transformation can occur as a person ages
* removed by hysteroscopic resection
27
Copper IUDs
These work as reversible contraceptives by producing a localized sterile inflammation in the uterus--> preventing the fertilization & the implantation of the zygote
SE: Menorrhagia, dysmenorrhea
28
Hypomenorrhea
This is a period that is represented by scanty and short bursts of menstrual bleeding
29
Oligomenorrhea
This is more than 35 days between each menstrual cycle
30
What is polymenorrhea?
There is less then 21 days between two menstruations
31
What is metrorrhagia?
This is irregular uterine bleeding
32
What’s the cause of the raised temperature in the second half of the menstruational period?
progesterone stimulates the thermoregulation centre which will cause an increase in the basal temperature
33
Contraindications of hysteroscopy
1. heavy uterine bleeding
| 2. acute pelvic inflammatory disease
34
Drugs that treat dysmenorrhea
1. hormonal contraceptive pills
| 2. inhibitors of the prostaglandin synthesis
35
Side effects of chemical and barrier contraceptives
* Toxic shock syndrome
* Urogenital infections
* Congenital fetal malformations
* Pregnancy rates between 5-15%
36
Action of spermicides
A) killing sperm
B) immobilizing the sperm
C) attacking the acrosomal membranes of the sperm
D) dissolving the external lipoprotein film
37
Which contraceptives can be used during lactation
1. IUD
| 2. Progestin only pill
38
Lifespan of an oocyte after ovulation
12-24 hours
39
indications for intrauterine Insemination
1. Unexplained infertility
2. Cervical factor
3. Ovulation dysfunction
4. mild Oligozoospermy (<20 M/ml)
40
Effects of combined OCPs on on the lipid levels
1. Increases the plasma HDL levels
| 2. Decreases the plasma LDL levels
41
How do combined OCPs cause contraception?
1) prevent ovulation
2) contribute to atrophy of the endometrium
3) thickening of the cervical mucusa
4) slowing of tubal transport
42
When is the best time to insert an IUD?
This is best done when the uterine cavity is slightly open. This is typically during menstruation or 6 weeks after giving birth
43
Can combined OCP be used during lactation?
No due to the fact that estrogen decreases the mild production
44
Folliculometry
This is a procedure that involves performing a series of ultrasound examinations in order to monitor the growth of follicles in the ovary.
45
Contraindications of IUD insertion
1) PID (pelvic infflamation disease)
2) abnormal bleeding (metrorrhagia, spotting)
3) leiomyomas
46
What do long lasting contraceptives contain?
Long lasting contraceptive methods such as implant, injection, vaginal ring, LNG –IUS contains only progestin
47
Ovarian hyperstimulation syndrome
This is an exaggerated response to excess hormones, typically seen when women are taking injectable hormone medications to stimulate the development of the eggs.
It causes the ovaries to swell and become painful
48
Chiari-Frommel syndrome
This is a rare endocrine disorder that affects women who have recently given birth (postpartum) and is characterized by the over-production of breast milk (galactorrhea), lack of ovulation (anovulation), and the absence of regular menstrual periods (amenorrhea).
49
Medications used to induce ovulation
1. Clomiphene citrate
2. hMG
3. hCG
50
Corpus Luteum Insufficiency
This implies a deficiency in the progesterone production via the corpus luteum. This can lead to sub fertility
51
Medications used for inducing ovulation
* Pure FSH
* Clomifene citrate
* HMG ( Human menopausal gonadotropin)
52
What is typical of normal ejaculation
1) Volume: 2-5 ml
2) Motility: at least two-third of the sperms are moving
3) Morphology: at least 60 % is normal-shaped sperms
4) Physiological sperm count is 20 million/ml.
53
Tests to check the quality of the cervix
1) Post coital cervical mucus test--> This exams the interaction between the cervical mucus and the sperm
2) Spinnbarkeit test--> Checks the stringiness of the cervical mucous after ovulation
3) Sims-Huhner test---> This exams the interaction between the cervical mucus and the sperm
54
Oradexon
Type of corticosteroid
55
Parlodel
This is a type of bromocriptine
56
Hemodynamic changes in pregnancy
A) increase in cardiac output
B) decrease in blood pressure in the first half of pregnancy
C) increase in heart rate
D) increase in venous pressure in the lower limbs
E) Increased systolic pressure
57
CTG changes in IVC syndrome
This will cause impaired IVC return, which will in turn lead to decreased placental perfusion --> decreased fetal heart rate
58
Physiological changes in pregnancy
A) the pH and composition of the saliva changes
B) pyelectasia, especially in the right side
C) serum levels of T3, T4 increase but TSH level is unchanged
D) the ligaments are loosened
59
IVC syndrome
The pressure of the Uterus will lead to a rise in the peripheral resistance and thus a fall in the maternal BP. There can also be dizziness, nausea & discomfort
60
Daily calcium intake in pregnancy
1200 mg per day
61
Daily Iron intake in pregnancy
30 mg per day
62
Amniotic fluid index
This is the measurement of the amniotic fluid in 4 quadrants, and a value < 5
is considered abnormal, thud delivery is indicated
63
Hydatidiform mole
This is the cystic swelling of the chorionic villi & proliferation of the trophoblasts.
Presentation: vaginal bleeds, uterine enlargement, pelvic pain.
It is associated with: hyperemesis gravid arum, early preeclampsia, hyperthyroidism & theca-lutein cysts
TX: D&C, MTX
64
Complications associated with polyhydramnios
1) prolapse of umbilical cord
2) Uterine dysfunction
3) Preterm birth
4) Placental abruption
5) Abnormal fetal presentations
65
Are oral anti diabetics used to treat maternal hyperglycemia?
NO!!! They can cross the placenta and lead to teratogenic effect
66
How can we differentiate placenta previa from placental abruption?
* Previa --> painless vaginal bleeding
| * abruption--> vaginal bleeding accompanied by severe abdominal pain
67
How often is Leiden mutation associated with thromboembolism in pregnancy?
60%
68
How often does cystopyelitis develop in pregnant women with asymptomatic bacteriuria?
25%
69
What are endotoxins?
These are lipopolysaccharide molecule that arise from the membranes of Gram negative bacteria
70
Signs & symptoms of gestational cholelithiasis
nausea and vomiting, right upper quadrant tenderness and guarding, pain radiating to
back and shoulder
increased WBC count, ALP, and bilirubin levels, jaundice may be seen, increased
thickness of the gallbladder wall on US
71
Subclinical abortion
Termination of pregnancy 2-3 weeks after conception occurs
72
Early abortion
Termination of pregnancy about 12 weeks after the last menstrual period
73
Late abortion
Termination of pregnancy about 24 weeks after the last menstrual period
74
Habitual abortion
The miscarriage of 3 or more consecutive pregnancies
75
Missed abortion
This is a miscarriage in which your fetus didn't form or has died, but the placenta and embryonic tissues are still in your uterus.
There may/may not be vaginal bleeding, but the cervix is closed and there is no passage of tissues
76
Tubal abortion
This is the extrusion of an ectopic product of conception implanted in the fallopian tube through the abdominal ostium into the peritoneal cavity. It is accompanied by bleeding & abdominal pain
77
Incidence of spontaneous abortion
15–20%
78
In juvenile girls until what week can we perform an artificial abortion?
18th week of pregnancy
79
Types of abortion
```
Threatened
Inevitable
Complete
Incomplete
Missed
```
80
Threatened abortion
There is vaginal bleeding, the cervix is closed & there is no passage of fetal tissues
81
Inevitable abortion
There is vaginal bleeding. The cervix is open, but there is no passage of fetal tissues
82
Complete abortion
There is vaginal bleeding, there may or may not be cervical dilation & there is passage of the fetal tissues
83
Incomplete abortion
There is vaginal bleeding, there is cervical dilation & there is passage of the fetal tissues
84
Menstrual regulation
During menstrual regulation, about 6 weeks from the 1st day of last period we enter into the uterus with a 4-5mm plastic tube, sucking out the pregnancy. This is done without the dilation of the cervix
85
Menstrual induction
This is the early uterine evacuation by mechanical or medical means in women with a delay in the expected onset of menses without a laboratory confirmation of pregnancy. Done via the insertion of prostaglandin products into the cervix.
86
If the genetic and/or teratogenic harm risk is more than 10%, until what week can we perform an abortion?
12th week of gestation
87
Blighted Ovum
This is also known as an anembryonic pregnancy. so the amniotic sac & placenta develop, but the fetus doesn't
88
Febrile abortion
This is a condition in which abortion is associated with a febrile state. This can lead to PID and in severe cases it can cause toxic shock syndrome
89
Bandl ring
This is a pathological retraction ring which separates the upper contractile portion of the uterus from the lower uterine segment. This leads to impairment of the fetus moving to the cervical os --> obstruction of labour
90
Bracht-maneuver
The breeched infant is delivered up to their umbilicus. The fetal head is then held against the maternal symphysis, along with the uterine contractions--> spontaneous delivery
91
Complete breech
Flexed hips & the knees are flexed as well. There is the so called "cannonball" like appearance. The feet can be palpated
92
Frank breech
Flexed hips, but the knees are extended, with the feet being by the ears. You palpate the bum
93
Incomplete breech
One or both of the
hips are not flexed so the foot or the knee lies below the
breech in the birth canal
94
Müller maneuver
This can work to deliver the arms of a breeched infant (especially when the arms re above the head)
95
Normal process of internal rotation of fetus
Inlet: transverse
Canal: oblique
Outlet : anterioposterior
96
Short Umbilical cord
This is when an umbilical cord is under 35 cm in length. A major complication is placental abruption due to the sudden pulling of the fetus can cause the detachment
97
Complications of polyhydramnios
* Preterm contractions and possibly labor, PROM
* Fetal malposition, fetal death *Maternal respiratory compromise
* Umbilical cord prolapse
* Uterine atony, placental abruption
98
What is the presenting diameter of the brow presentation?
The presenting diameter is the supraoccipitomental diameter which makes vaginal delivery impossible
99
Maternal consequences of prolonged labour
Uterus rupture, obstetric fistulas developing
| Heavy postpartum haemorrhage
