OBGYN Flashcards
Lady with erosive cervical ulcer? Next step
Punch biopsy
If shows micoroinvasions = cone Bx
If shows invasive carcinoma = Rx
Next step if Pap smear shows ASCUS?
HPV DNA
T/F: can’t see fetal contents till 9wk GA
T
< 8 Wk + vaginal bleed + B-hCG 1500 + US not helpful?
Repeat B-HCG in 48hr
When to suspect uterine rupture during labor?
Fetal bradycardia
Rx hyperthyroidism in preggo?
PTU 1st trimester
MMI 2-3 trimesters
High a-FP in preggo? Next step
US
T/F: Nulliparity is risk of PROM
F
Risks of PROM?
Hx of PROM Multi parity STD Vag bleed Cervical incompetence Smoking during preg
Rx breast augmentation in nursing mom?
Frequent feeds 8-12x/d
T/F: clubfoot ass w/ oligohydramnios
T
Emergency contraception in Hx of DVT/PE?
Copper IUD
Best Dx endometriosis
Laparoscopy
Endometriosis triad
Other Sx?
Infertility
Dysmenorrhea
Dyspareunia
+
Constipation / painful defecation
Dysuria
Pelvic Exam of endometriosis
Adnexal mass (chocolate cyst)
Nodular broad ligament / ureteosacral
MC site of ectopic preg
Ampulla
When should a intrauterine preg appear clearly on US?
B-hCG > 1500
Suture for perianal laceration esp postpartum?
Why?
3-0 polyglactin
Decrease wound dehiscence + pain
Preggo is +Rh D-Ag
What happen to fetus?
Baby at risk of hemolysis if titter > 1:65
AGUS on pap indicate?
Next step?
CIN
All gets a colposcopy
If > 35 Yrs = colposcopy + endometrial sample
No preg + high B-hCG?
Uterine choriocarcinoma
Or
Molar preg / Hydatidiform mole
Preg + vag bleed + adnexal tenderness
Ectopic
Rx of PID
Cefoxitin + doxy
Or
Clinda + genta
Onset of postpartum thyroiditis
2-6 mo post delivery
T/F: ovaries are palpable in postmenopausal women
F
If can palpate = US to r/o ovarian mass
MCC of vulvar Ca in < 50
HPV
Tumors w/ high b-hCG
Molar preg / choriocarcinoma
Seminoma
Germ cell tumor
Teratoma (rare)
Islet cell
Risk for candida vaginitis
Hot weather Tight clothes Poor hygiene Infrequent diaper / underwear change Abx Preg DM Steroids
MC site of endometriosis
Ovaries > post cul-de-sac > ligaments
Preggo at 1st trimester + ovarian cyst
Dx?
Corpus luteal cyst
Produces hormones in 1st trimester the resolves
Effect of OCP on Ca?
Protects against ovarian + endometrial
Preggo + HSV?
Acyclovir (B)
No C/S unless active lesions during labor
While inserting IUD pt BP drops + pale + loses consciousness
Vasovagal attack
Place in recumbent position
Preggo exposed to HBV but HBsAg-ve?
Give Ig + vaccine!
IP could be long!
T/F: menopause Sx peak around 51 then subside
T
Preggo in labor but baby not engaged?
US to determine presentation
If breech = C/S
Rx of bacterial vaginosis in preggo?
Oral clinda or metro BID for 7days
T/F: Metro is safe throughout preg
F
Contraindicated in 1 trimester ONLY
T/F: topical clinda is safe in preg
F
Bad in 2-3 trimester => premature birth
Preggo w/ chlamydia trachomatis Rx?
Azithromycin
Head:Abdo ratio > 1 indicates?
Asymmetrical IUGR
Deficient hormones in Sheehan’s syndrome?
FSH, LH, ACTH, TSH, GH, prolactin
Preggo + anti phospholipid syndrome Rx?
ASA + Heparin
Teratogenic effect of isotretinoin
Microcephaly MC
CVS = tetralogy of fallot, ASD, VAD, aortic
No ear / small ear
Parathyroid gland
T/F: nulliparity increases risk of cervical ca
F
Risks of cervical Ca
HPV 16+18
Early sex
Smoking
Multiple partners
+/- OCP long term
PID + fever 39 Rx?
Hospitalize
IV cefoxitin + doxy for 2wk
Swelling in labia minora?
Bartholian cyst
What’s a bartholian cyst?
Sx?
Dx?
Rx?
Mucus filled cyst at sides of vagina (minora or migora)
ASx
If big = irritates + hurts
If infected = painful + red
Dx: clinical
Rx: none if asymptomatic
Bartholian Abscess Rx?
Incision and insertion of word cath to prevent recurrence
Preggo in labor + 28wk GBS screen -ve + ProROM
Rx?
None
Dx cervical incompetence
TVUS
Normal UA findings in preggo? Why?
Glucosuria
Inc GFR 50%
T/F: if vaginal ring expelled from vagina > 3hr, a backup must be used
T
Backup for 7 days
T/F: vaginal ring can be used for maximum of 3 mo
F
3wks then 1wk off to allow for withdraw bleeding
OCP risk of PE/DVT population
Hx of DVT/PE
Smoker > 35
BMS + mood swings impairing function
Dx
Rx
Premenstrual dysphoric disorder
Rx SSRI (Fluox or setraline)
Baby in labor + early decelerations
Next step
Observe
Re-evaluate q2hr
Cause of early deceleration in NST of baby in labor
Head compression
Fetal vessel with highest O2 sat
Umbilical vein
Imaging w/ highest radiation to preggo
Fluoroscopic enema > IV pyelogram > spinal films > V/Q scans > CXR
< 8 girl + grape like vaginal lesion
Sarcoma Botryoides
2ry amenorrhea + no preg
MC abnormal hormone
FSH => anorexia,PCOS, hypothyroid, Cushing’s, pituitary
What herbs proven to help dysmenorrhea / PMS
Fish oil
Vit E
Thiamine
Low fat vegetarian diet
T/F: untreated Chlamydia causes PID + infertility
T
If pt has chlamydia how long should they wait till have sex?
7 days
If Pt Dx with chlamydia what sexual partners should she inform
All partners 2 mo before Dx
What’s urethral Syndrome
Dysuria + pyuria
-ve Cx
No response to Bactrium or nitrofurantoin
UTI Sx
Not responsive to Rx
-ve urine Cx
Dx?
Cause?
Rx?
Urethral Syndrome
Chlamydia or ureaplasma
Rx = Doxy or fluoro
T/F: having pre-eclampsia increases risk of HTN
True
HTN + Stroke 4x
IHD 2x
< 5cm asymptomatic ovarian cyst in premenopausal?
Next step
Rep US in 8-12 wk
Ovarian cyst in postmenopausal?
CA-125
Periods in leiomyomas?
Hypermenorrhea or menorrhagia
Preggo w/ PID?
Hospitalize for IV cefoxitin + oral azithromycin
Mg sulfate toxicity in pre-eclampsia?
D/C the Ca gluc
Mg sulfate toxicity
Dose?
Sx?
> 4mg /dl
Sx:
No DTR
Low RR
Hemorrhage
Rx of exercise oligomenorrhea in well-nourished F?
Inc calorie intake to match energy expenditure
Complication of repetitive PID (>3)?
Ectopic preg
Mom receives meperidine during labor
Born baby has resp depression?
Next step
Dry skin
Clear airway
Naloxone IM
Oxygen
Effect of ketamine on baby?
Resp depression
Best measure of fetal age
Crown-rump > 13 wk
T/F: Multiparty protects against preeclampsia
T
T/F: DM increases risk of preeclampsia
T
ASCUS on Pap smear?
Rep smear at 6-12
Or
HPV DNA
MC indication for amniocentesis
Old mom
ProPROM complication
Abruptio placenta
MCC of UTI in preggo
E. coli
When to use 5 sticks LH test?
Periods length - 17 is starting day!
If 28 - 17 start on day 11
When does post part I’m visit occur
6 wk post delivery
When to give preggo Rhogam
28 wk + 72hrs of delivery
When to do triple screen for preggo
15-18 (2 trimester)
When to do OGTT for preggo
24-28 wks
< 35 F + heavy irregular periods + otherwise normal
Rx?
Abnormal uterine bleed
Combined oral contraceptive
Diff abortions Missed Threatened Inevitable Incomplete Complete
- Missed: Closed OS No bleeding No fetal heart Empty pole if > 8wk on US
- Threatened:
Closed OS
Bleeding
+ fetal heart - Inevitable:
Open OS
Bleeding - Incomplete:
Open OS
POC in uterus + vagina - Complete:
Close OS
Empty uterus + vagina
Trisomy 21 + 18 triple test
21: Low AFP Low estriol High hCG High inhibin
18:
All low
High LH + FSH in amenorrhea
Ovarian problem
Preggo not immunized against HBV?
Vaccine + IG now
Preggo w/ rubella ab titer < 10 IU/mL
Can’t vaccine!
Stay away from sick
Vaccine after delivery
Stress test results:
- Variable decelerations
- Early decelerations
- Late decelerations
- Cord compression
- Head compression
3 placental insufficiency
Patient on St. John’s + 5-HTP + meperidine at risk of?
Serotonin syndrome
Physiological galactorrhea after breast-feeding lasts up to?
2 YRs
T/F: steroids in Preterm labor decrease risk of Necrotizing enterocolitis
T
PE in preggo Rx
IV heparin for 5-10 days
SunQ heparin for rest of preg
Pap smear abnormal => colposcopy unsatisfactory => ?
Conization
Metronidazole + Alcohol
Cause disulfiram like reaction
T/F: partner of bacterial vaginosis pt must be Rx
F
MC complication of epidural anesthesia in preggo
Mom hypotension
Recommended Ca for preggo + nursing
1000-1300 mg/d
T/F: A preggo shouldn’t travel in 1 trimester
F
Last 4 wks of preg
Monitor Mg sulfate toxicity
Creatinine
DTR + RR
How soon can urine b-hCG detect preg
10-25 IU/L
7 day of conception
Trichomoniasis vaginitis Rx
Metronidazole
Rx of menstrual migraine
NSAIDs
Most dangerous period during preg for teratogenicity
3-8wk organogenesis
How to tell baby presentation leopold’s?
- Vertex
- Transverse
- Compound
- Breech
- Vertex
Cephalic pole at symphysis - Transverse:
No pole at symphysis - Breech:
No pole at symphysis
Back along side
Hard at RUQ
Oligohydramnios associations
Renal agenesis (fetal) Placental insufficiency
T/F: IUD for ER contraception in nulliparous
F
Not proffered!
Only used in women who wants to keep the device.
Morning after pill better
T/F: all preggos get flu vaccine
T
Regardless of trimester
What decreases iron absorption?
Antacids
Soy protein
Tannin (tea)
What improves iron absorption.
Vit C
Ascorbic acid
35 Y + Smoker + needs contraception
- heavy periods = etonogestrol implants
- normal periods = IUD
Sx of fetal alcohol
Mental retardation Flat philtrum Thin upper lip IUGR CNS Sx (microcephaly, agenesis of brain parts) Hearing loss
MC measure of age in 2 trimester?
Biparietal diameter
Rx of cervical gonorrhea
IM ceftriaxone Once
T/F: hormonal replacement Rx prevents against breast Ca
F
T/F: hormonal replacement prevents CRC
T
Gold standard of ovarian torsion
Doppler
Risks for uterine prolapse
Multiparity
Smoking
Large baby
Postmenopausal
Rx of endometritis
Genta + clinda
copper IUD MOA?
Spermicidal
T/F: forceps delivery causes facial nerve
T
T/F: forceps > vacuums
True success rate of forceps is higher
Benefit of vacuum vs forceps
Vacuums cause less peroneal tears
HTN drug cause IUGR in preg
Atenolol + propranolol
Absolute contraindication to vaginal delivery after C/S
Vertical incision.
Complete hydatidifom chromosomes
Paternal diploid
Incomplete hydaitiform mole chromosome
Triploid
2 sets paternal
1 maternal
69 xxx
What infection screened in preggo at 35-37 wks
GBS
MC indication for amniocentesis
Old mama (>35Yrs)
Why give a preggo Rhogam?
Prevent hemolytic disease of newborn in 2nd baby
Screen + confirm thalassemia
Screen => CBC + smear
Confirm => Hg electrophoresis
Friable well defined cervical lesion in a young asymptomatic pt?
Pap smear + colposcopy
Post mastectomy for breast Ca surveillance
Hx + PE q3-6 mo for 3 yrs
The q6-12 mo for 2 yrs
Then annual.
Medroxyprpgestrone inj vs OCP for migraine
Inj improve migraine
MC SE of mydroxyprogestrone inj?
Amenorrhea or irregular periods
T/F: IM flu vaccine for preggo protects baby for 6 mo
T
T/F: nasal flu vaccine is indicated in preg
No
It’s live vaccine
Fetal fibronectin levels indicate?
Assess risk of preterm labor
Higher lever higher risk
Inc 7-10 days before labor
MOA of plan B ER contraception (Levonorgestrel)
Inhibits ovulation
Types of twin preg:
Division before D4 of fertilization?
During 4-8?
Drying 8-12?
After 12?
Before 4: diamniotic dichorionic.
4-8: diamniotic monochromatic
8-12: monoamniotic, monochromatic
> 12: conjoined
Cocaine use in preg results in?
Placental insufficiency
Premature labor
Premature delivery
IUGR
Repetitive decelerations in otherwise healthy mom + OK delivery
1st left lateral position, O2, D/C oxytocin
Didn’t help => C/S
1st line in N/V of preg
Diet +/- acupressure Eat slowly Small amounts q1-2hr eat before or as soon as feel Hungary (avoid empty stomach) Snack before getting out of bed
Cervical procedure contraindicated in preg
Endocervical curettage
Painless bright red bleeding in preg > 24wk
Placenta previa
T/F: estrogen in postmenopausal protects form vertebral fracture
T
MC mom cause of IUGR
HTN
APGAR score
A Activity = flex (1) or active (2)
P pulse = <100 (1) or >100 (2)
G Grimace = grimace (1) or cough/sneeze (2)
A appearance = blue (0) acral (1) pink (2)
R respiration = irregular / weak cry (1) or strong (2)
T/F: carcinoma in situ of cervix indicates C/S
F
Indications for C/S in preg?
Placenta previa
Fetal distress
Genital herpes
Prior urethropexy
Preg w/ G-DM on diet control FPG 110 / 6.1
Next step
Start insulin short + basal
MC location of endometriosis
Ovaries
What to do in stable preg at 37wk w/ mild pre-eclampsia?
Vagina exam + Bishop score
If > 9 = vaginal delivery
< 9 = ripening agents then labor
Dx PE in preg
V/Q scan
Euthyroid in preg (labs)
T4
Free T4
T3RU resin uptake
High T4
Normal Free T4
T3 uptake low
Rx hot flashes in menopause
SSRI
When is chorionic villus smapling done?
Wk 10-13
If newborn test HIV +ve on ELISA? Next step
HIV1/2 assay (western blot)
Or PCR
What age fetus quickens
Multi 18 wk
Primi 20-21 wk
Placenta previa by US at 20 wk?
Next step
Rep US at 3rd trimester
T/F: c. Trachomatis infection ass w/ dysuria + frequency
F
Uterine whorl-shaped lesions on US?
Leiomyomas
T/F: uterine leiomyomas suppressed by estrogen
F
Estrogen stimulates their growth
Rx of gestational intrahepatic cholestasis
Ursodeoxycholic acid
What’s black cohosh? Used for?
Actea racemosa
Used Rx menopause Sx
T/F: no need for PAP smear after total abdominal hysterectomy
T
When to stop Pap smears
At 70
If last 3 test were normal
If preggo got into accident what position should be kept at till spinal injury r/o
Supine w/ uterus manually deflected laterally
How to examine lower abdominal / pelvic mass in a young virginal girl?
Rectal exam
Post D/C + amenorrhea put pain at time of periods + no flow w/ progesterone challenge
Asherman syndrome
What’s asherman syndrome?
Sx?
Rx?
Scar tissue and adhesions in uterus after procedure esp. D/C.
No or minimal flow on periods
PMS Sx present
Miscarriage or infertility
Surgically cut adhesions
MCC of DIC in preg
Abruptio placenta
Most accurate way to Dx retained placenta
Inspect fetal placenta
See large vessels beyond edge
T/F: sulfonamide contraindicated in 3rd trimester
T
Safe early
Bad late
Sx of bacterial vaginosis
Amsel criteria
PH > 4.5
Clue cells
Wiff test (fishy odor)
Homogenous discharge
T/F: 90% of immediate post parting hemorrhage is uterine atony
T
Rotterdam criteria for PCOS
- Oligo/amenorrhea
- Clinical / lab androgenism = hirsutism, acne
- US = cystic ovaries
Major oncotic protein in fetus?
Where’s it made?
When is peak value reached?
AFP
By fetal liver
Highest fetal serum concentrations at 12-14 wks.
Highest maternal serum levels at 13-24 wks.
Rx cervical chlamydia with single does?
Rx vaginal chlamydia with single does?
Urethral / cervical: azithro 1 g PO
Vaginal:
Metro
MC Sx of vulvar ca
Pruritus
T/F: gonorrhea can be treated with metro vaginal cream
F
T/F: public health should be notified for every vaginal gonorrhea
T
What maternal protein usually elevated in normal preg
Cholesterol
What protein decrease in normal preg?
Albumin = dilution
HCO3 = high renal execration
Fasting glucose (10-20%) = inc storage tissue
Creatinine = (50% drop)
During preg lactation is suppressed by?
Estrogen
Is palmar erythema sign of preg?
Yes
T/F: WBC count is decreased in preg
F
Sever headache + epigastric pain + HTN preggo?
- Sever preeclampsia
Needs Mg sulfate + delivery
Rx urethral chlamydia
Doxycycline
Rx cause erythema nodosum
OCP
Rx of hot flushes if can’t take estrogen?
Clonidine
SSRI
Leiomyoma in preg Rx
Observe + vaginal delivery
Rx of fibroids
OCP
GnRH
Best: myomectomy, hysterectomy, endometrial ablation
Fibroids in preg
Bigger
Fibroids in menopause
Smaller
When to do intracytoplasmic sperm inj?
Low sperm motility
Low sperm count
Benefits of amniocentesis
Chromosomal anomalies
NTD
Metabolic error
Investigations before starting >40 on OCP
Pap smear
BMI
FPG
Drugs cause galactorrhea
Resperidone
Cimetidine
Verapamil
Morphine
T/F: nasal body temperature used for Dx infertility
T
T/F: hystroscopy is initial test to Dx infertility
F
Rx post partum thyroiditis
BB
T/F: hypothyroidism causes galactorrhea
T
1st step in abnormal uterine bleed (<40 Yrs)
TVUS
Rx of asymptomatic uterine fibroids?
Expectant / observation
MC presentation of twin preg
Vertex/vertex
Migraine Rx contraindicated in preg
Ergotamine
Why is ergotamine contraindicated in preg
Vasoconstriction = low placental flow = IUGR
Lacy white rash on genital mucosa
Lichen planus
Preg + HTN + no proteinuria
G HTN
T/F: placental abruption is Sx of placenta previa
T
T/F: placenta previa ass w/ fetal malformation
T
Indication of tocolytic use
- preterm
- immature fetus + intact membrane + cervix <4
Contraindication to tocolysis
Twins gestation one IUFD
Chorioamnionitis
34 wks
Maternal HTN, heat disease
Congenital anomaly
Bleeding
T/F: IUD contraindicated in smoking
F
T/F: Copper IUD contraindicated in Wilson’s disease
T
Internal iliac branches
Anterior + posterior divisions
Posterior = superior gluteal, iliolumbar, lateral sacral.
Anterior = interior pudendal (middle + inferior rectal), uterine, superior + inferior vesical, vaginal.
Preg exposed to rubella.
Next sept?
Test rubella IgG ab
+ => immune
- => rep in 2-3 wk if + pt is exposed
T/F: rubella Ig isn’t recommended to preg exposed to rubella
T
Absolute contraindication to hormonal replacement Rx
Acute/sever liver disease
Undiagnosed vaginal bleed
Venous thrombosis
Breast/uterine Ca
Acid base disturbance in hyperemesis gravidarum
Metabolic acidosis + alkalosis
MCC of jaundice in preg
Acute viral hep
Dx Criteria for molar preg
US = snowstorm
How to calculate length of menstrual cycle
Days from beginning of one period to the next
Other name for vaginal candidiasis
Moniliasis
Rx pyelonephritis in preg
IV ceftriaxone
STI + mucous discharge
Chlamydia
Rx doxy or azithromycin
Fleshy exophytic lesion on urethral meat is ?
Age?
Caruncle
Postmenopausal F
Dx clinical if hematuria = cystoscope
2 stage labor + baby face presentation
SVD
No C/S or assisted delivery
MC site of endometriosis outside pelvis
Liver
Dx placenta previa
TVUS
Cause of vaginismus
Involuntary contractions
Retinal change in preeclampsia
Spasm of arterioles
Rx of Sever HTN in preg
Labetalol IV
Nifodipine oral
Hydralazine IV
14 + no period + no 2ry sexual + low FSH / LH
Wait
Mostly constitutional delay
Rx of symptomatic uterine prolapse
Vagina hysterectomy
