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OBGYN Flashcards

1
Q

letrozole

A

aromatase inhibitor
↓ estrogen
PCOS

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2
Q

Breech presentation

A

C-section, unless baby is already halfway out

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3
Q

nifedipine

A

Ca+2 channel blocker
tocolytic
Can be used to control BP in preganancy/preeclampsia
available sublingually for fast action

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4
Q

Turner Syndrome
FSH/LH levels
Estrogen levels

A

Primary amenorrhea and short stature
↓ estrogen (streak ovaries)
↑ FSH and LH

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5
Q

Chlamydia tx

A

azithromycin or doxycycline

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6
Q

Gonorrhea tx

A

ceftriaxone

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7
Q

CA-125

A

epithelial ovarian cancer

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8
Q

Hyditaform mole sequela

A

gestational trophoblastic neoplasia (GTN)

monitor ß-hCG until it is zero
if elevated ß-hCG persists → GTN

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9
Q

Uterine rupture

A

loss of fetal station
FHR monitoring abnormalities (late decelerations?)
intense abdominal pain
bleeding

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10
Q

Abruptio placentae

A

tectonic contractions (sinusoidal, frequent, small amplitude)

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11
Q

Hyditaform mole diagnosis

A

↑ ß-hCG
cyst-filled uterus that is larger than it should be for age
snowstorm appearance
vaginal bleeding

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12
Q

Ulipristal

A

Contraceptive
Can be taken up to 120 hours after intercourse
progestin receptor blocker
Delays ovulation and impairs implantation

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13
Q

inadequate contractions

A

<200 Montevideo units

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14
Q

Non-stress test

Reactive vs Nonreactive

A

Continuous FHR monitoring for 20-40 minutes
≥2 accelerations → Reactive (normal)
<2 accelerations → Nonreactive (abnormal)

accelerations = increase of 15bpm for 15 seconds

if nonreactive, complete a biophysical profile
biophysical profile of 8-10 = normal
0-7 means delivery (induction or C-section depending on how bad it is)

Nonreactive is nonspecific for fetal hypoxia/acidemia, or it could just mean baby is sleeping

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15
Q

Lochia

A

postpartum vaginal discharge
Lochia rubra → blood and clots (day 0-4)
Lochia serosa → serosanguinous (clear to pink) (day 4-10)
Lochia alba → white/yellow creamy (day 10-28)

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16
Q

retained products of conception

A

heavy postpartum bleeding

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17
Q

BV tx

A

Clindamycin or metronidazole

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18
Q

intrahepatic cholestasis of pregnancy

A

Risk of fetal demise due to bile acids in blood, which are toxic
the higher the bile acid levels, the higher the risk
pruritus of hands and feet

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19
Q

Syphilis tx

A

penicillin

Penicillin allergy → doxy or ceftriaxone

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20
Q

Phenytoin birth defects

A

Distal finger hypoplasia
cleft lip/palate
microcephaly

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21
Q

tamoxifen

A

SERM
treats and prevents breast cancer
↑ risk of endometrial cancer or uterine sarcoma

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22
Q

Osteogenesis imperfecta type II

A

Bone fractures
limb shortening
hypoplastic thoracic cage
fetal demise

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23
Q

lichen sclerosus tx

A

topical corticosteroids

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24
Q

Preeclampsia

A

HTN
proteinuria (elevated protein-creatinine ratio)
Lower extremity hyper-reflexia and ankle myoclonus

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25
Interstitial cystitis
Chronic bladder pain without infection | amitryptiline is first line tx
26
Fetal heart block
SLE | bradycardia
27
Uterine tachysystole
>5 contractions/10 minutes
28
Methylergonivine
Second line Uterotonic (↓ postpartum bleeding) | Contraindicated in HTN
29
Carbaprost
Second line uterotonic (↓ postpartum bleeding) | contraindicated in asthma
30
Tranexamic acid
Decreases blood loss after delivery | antifibrinolytic
31
fetal fibronectin
detects cervical prostaglandin release, which may indicate preterm labor
32
Magnesium toxicity
hyporeflexia, flushing, nausea respiratory depression → drowsiness tx → calcium gluconate
33
diethylstilbestrol
discontinued abortion medication | can cause vaginal adenocarcinoma (and infertility)
34
HSIL vs LSIL
HSIL → colposcopy | LSIL → HPV testing
35
ACE inhibitor or ARB use in pregnancy
Teratogens | Cause oligohydraminos and underdeveloped kidneys
36
Myomectomy
surgical removal of uterine fibroids
37
Adenomyosis
endometrium invades myometrium (more common right after pregnancy) heavy menstrual bleeding chronic pain uterus symmetrically enlarged and tender to palpation tx: hysterectomy or levonorgestrel IUD
38
Uric acid and LDH
elevated levels indicate hemolysis | used in workup of preeclampsia and possible HELLP syndrome
39
Bishop score
predicts probability of vaginal delivery based on cervical dilation, effacement, position, and fetal station Bishop score greater than 6-7 is favorable
40
Risk factors for preterm labor
prior hx | short cervical length
41
Androgen insensitivity vs Mullerian agenesis
androgen insensitivity → XY, phenotypically female due to lack of testosterone receptors, vagina withOUT ovaries, breast development (because defective testosterone receptors cannot inhibit breast proliferation) Mullerian agenesis → (Mayer-rokitansky-kuster, hauser) they have ovaries, but absent uterus, cervix, and fallopian tubes
42
ovarian mature cystic teratomas
calcified and hyperechoic on US | benign
43
Dehydroepiandrosterone
DHEA androgen produced by adrenal gland and gonads elevated levels indicate excess androgen production from adrenals
44
Sinusoidal wave pattern on FHR
Category III | indicate fetal anemia, (possibly secondary to hemorrhage)
45
choriocarcinoma
Malignancy that arises from placental tissue post partum irregular bleeding enlarged uterus pulmonary metastasis (can also metastasize to brain, vagina, and liver) ß-hCG levels to diagnose
46
What Gestational age is external cephalic version attempted
37 weeks, as it may trigger labor
47
Risk factors for endometrial cancer
``` unopposed estrogen (medication) obesity ``` smoking is protective, because it ↓ serum estrogen
48
Uterine rupture vs abruptio placentae
Very similar Late decelerations, vaginal bleeding, pain Uterine rupture → irregular protruding vaginal mass
49
maternal serum alpha fetal protein (AFP)
↑MSAFP → Neural tube defect | ↓MSAFP → Down or Edward syn
50
Magnesium sulfate
Seizure prophylaxis in preeclampsia Neuroprotection in preterm births, helps prevent cerebral palsy contraindicated in myasthenia gravis
51
stages of labor
First stage ends at complete cervical dilation - Latent (0-6cm) - Active (6-10cm) Second stage = cervical dilation → fetal expulsion - Passive - Active Third stage = fetal expulsion → placenta expulsion
52
5-α-reductase deficiency
46 XY, phenotypically female testis in labia majora, clitoromegaly, blind ended vagina no breast development (testosterone inhibits breast development) 5-α-reductase converts testosterone → DHT
53
trimesters
1st → 0-14 2nd → 14-28 3rd → 28-40
54
PPROM vs PROM
``` PPROM = Preterm premature rupture of membranes PROM = Premature rupture of membranes ``` PPROM is less than 34w PROM is rupture of membranes without active labor
55
folic acid prenatal dose
0.4 mg/day previous NTD → 4 mg/day
56
vasa previa
fetal vessels overlying cervix which are likely to tear during contractions causing some vaginal bleeding and fetal demise
57
chorioamnionitis
``` Intra-amniotic infection (IAI) PPROM patients at risk purulent amniotic discharge uterine tenderness immediate induction of labor ``` antibiotics (amp + gent + clinda)
58
PAPP-A and NT
markers of trisomies, measured in 1st trimester ↓ PAPP-A (pregnancy associated plasma protein A) ↑ NT (nuchal translucency) ``` In Down's, ß-hCG will be ↑ In Edwards (18) and Patau (13), ß-hCG will be ↓ ```
59
Cardinal motions of delivery
Every Decent Family In England Eats Eggs ``` Engagement Descent Flexion Internal rotation Extension External rotation Expulsion ```
60
Prolonged latent phase
``` latent phase (0-6cm) should take <20 hours (nulliparous) <14 (multiparous) ```
61
Prolonged active phase
Failure to progress (in cervical dilation) for 4 hours w/ adequate contractions, or 6 hours w/ inadequate/unknown contractions if contractions are adequate, then do C-section
62
Prolonged second stage of labor
It should only take 2-3 hours of pushing, but you can continue as long as progress is being made If baby is close to being out, and pelvic anatomy is adequate, consider operative vaginal delivery (vaccum, forceps) If baby is not close, consider C-section
63
Prolonged third stage of labor
Placental delivery should take 30 minutes
64
α-methyldopa
CHTN
65
Preeclampsia w/ and w/o severe features
Preeclampsia is BP > 140/90 + proteinuria >300mg/dL Severe features (just need 1) include: 1. BP > 160/110 2. Cr > 1.1 or 2x baseline 3. Plt <100,000 4. ↑ AST/ALT 5. RUQ or epigastric pain 6. Pulmonary edema 7. HA or visual distrubances if pt is over 34 weeks, induce labor, or C-section if unstable
66
GBS tx
Penicillin (ampicillin) | erythromycin if allergic
67
Cerclage
suturing cervix to support cervical insufficiency and prevent premature labor
68
Laceration grades
1st: vaginal 2nd: perineum 3rd: anal sphincter 4th: anal mucosa
69
naloxone
reverses opioid OD
70
Paget's disease
Red vulvar lesion benign, confined to epithelium resection

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