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ObGyn Clerkship - Mostly OB Flashcards

1
Q

Daily calcium requirements

A

1000-15000 mg/day

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2
Q

Daily Vitamin D requirements

A

400-800 international units/day

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3
Q

DM screening timing

A

Begin at 45, every 3 years thereafter

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4
Q

Osteoporosis screening timing

A

BMD scan starting at age 65

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5
Q

BMD T-scores

A

> (-1): Normal
(-1) - (-2.5): Osteopenia
< (-2.5): Osteoporosis

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6
Q

Thyroid screening timing

A

TSH levels should be tested every 5 years, starting at age 50

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7
Q

HTN Parameters

A

Systolic >= 140

Diastolic >= 90

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8
Q

Cholesterol screening timing

A

Every 5 years, starting at age 45

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9
Q

Overweight BMI

A

25-29.9

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10
Q

Obese BMI

A

> 30

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11
Q

Beginning and end of the follicular phase

A

Begins with onset of menses, ends on the day of the LH surge

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12
Q

When does ovulation occur, in respect to the LH surge?

A

Within 30-36 hours of the LH surge

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13
Q

Beginning and end of the luteal phase

A

Begins on the day of the LH surge, and ends with the onset of menses

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14
Q

Which phase, luteal or follicular, remains constant, and which can vary?

A
  • Luteal remains constant

- Follicular can vary

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15
Q

MCC of vulvovaginitis

A

Bacterial vaginsosis

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16
Q

Normal vaginal pH

A

3.5 to 4.7

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17
Q

The diagnosis of BV is defined by any three of what four criteria?

A

1) Abnormal gray discharge
2) pH greater than 4.5
3) Positive “whiff test”
4) Presence of clue cells

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18
Q

Bacterial vaginosis treatment

A
  • Oral/topical metronidazole

- Oral/topical clindamycin

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19
Q

With what is a “strawberry cervix” associated?

A

Trichomonas vulvovaginitis

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20
Q

Trichomonas treatment

A

Oral metronidazole

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21
Q

MCC of preventable infertility

A

STDs

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22
Q

Most frequently reported infectious disease in the US

A

Chlamydia

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23
Q

Greatest risk factor for PID

A

Prior PID

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24
Q

Which HPV subtypes are usually associated with genital condyloma?

A

6 and 11

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25
Q

Which HPV subtypes are usually associated with cervical dysplasia/cancer?

A

16, 18, 31, 33, 45

Most common are 16 and 18

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26
Q

Causative organism of syphilis

A

Treponema pallidum

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27
Q

What is primary syphilis characterized by?

A

Painless chancre

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28
Q

What is secondary syphilis characterized by?

A

Skin rash that often appears as rough, red or brown lesions on the palms of the hands and soles of the feet

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29
Q

What is the conceptus called from the time of fertilization until the pregnancy is 8 weeks old?

A

Embryo

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30
Q

What is the conceptus called after 8 weeks of pregnancy?

A

Fetus

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31
Q

What is an infant called when it is born before 24 weeks gestation?

A

Previable

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32
Q

When should Rh (-) pregnant patients receive RhoGAM?

A

28 weeks

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33
Q

MCC of first-trimester abortions

A

Fetal chromosomal abnormalities

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34
Q

Is amniotic fluid acidic or alkaline?

A

Alkaline

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35
Q

Tests that can be used to diagnose rupture of membranes

A
  • Pool test
  • Nitrazine test
  • Fern test
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36
Q

When amniotic fluid is placed on nitrazine paper, what color will the paper turn?

A

Blue (amniotic fluid is alkaline)

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37
Q

5 components of the cervical examination (in a pregnant patient)

A
  • Dilation
  • Effacement
  • Fetal station
  • Cervical position
  • Consistency of the cervix
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38
Q

Bishop score

A

Score made up from the five aspects of the cervical examination (dilation, effacement, fetal station, cervical position, cervical consistency)

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39
Q

A Bishop score consistent with a cervix favorable for labor

A

> 8

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40
Q

Measurement that determines how thick/thin the cervix is

A

Effacement

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41
Q

The relation of the fetal head to the ischial spines of the female pelvis

A

Fetal station

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42
Q

Fetal station

A

The relation of the fetal head to the ischial spines of the female pelvis

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43
Q

How does the cervical position change during early labor?

A

Changes from posterior to mid to anterior

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44
Q

Fetal presentation with the head down

A

Vertex

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45
Q

Fetal presentation with the buttocks down

A

Breech

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46
Q

Fetal presentation with neither the head nor the buttocks down

A

Transverse

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47
Q

Describe the location and shape of the anterior fontanelle

A
  • Between the two frontal bones and the two parietal bones

- Larger and diamond-shaped

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48
Q

Describe the location and shape of the posterior fontanelle

A
  • Between the two parietal bones and the occipital bone

- Smaller and more trianglular-shaped

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49
Q

Definition of ‘labor’

A

Contractions that cause cervical change in either effacement or dilation

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50
Q

Methods by which we can induce labor

A
  • Prostaglandins
  • Oxytocic agents (Pitocin)
  • Mechanical dilation of the cervix
  • Artificial rupture of the membranes
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51
Q

Methods by which we can ripen/dilate the cervix

A
  • Prostaglandin E2 (PGE2) gel
  • Prostaglandin E2 pessary (Cervidil)
  • Prostaglandin E1 M (Misoprostol)
  • Mechanical dilation
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52
Q

How is Pitocin administered? Why?

A

Continuously via IV because it is rapidly metabolized

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53
Q

Tool used to directly measure the absolute change in pressure during a contraction, thus estimating the strength of the contraction

A

Intrauterine Pressure Catheter (IUPC)

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54
Q

Normal range for fetal heart rate

A

110-160

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55
Q

Timing of early decelerations in relation to uterine contractions

A

Begin and end at approximately the same time as contractions

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56
Q

Cause of early decelerations

A

Increased vagal tone secondary to head compression during a contraction

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57
Q

Timing of variable decelerations

A
  • Can occur at any time and tend to drop more precipitously than either early or late decels
  • Timing is unrelated to contractions
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58
Q

Cause of variable decelerations

A
  • Result from umbilical cord compression

- Repetitive decels can result from entrapment of the cord under the arm or around the neck

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59
Q

Timing of late decelerations

A

Begin at the peak of a contraction and slowly return to baseline after the contraction has finished

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60
Q

Cause of late decelerations

A
  • Uteroplacental insufficiency

- These are the most worrisome

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61
Q

Baseline intrauterine pressure

A

10-15 mmHg

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62
Q

Cardinal movements of labor

A
  • Engagement
  • Descent
  • Flexion
  • Internal rotation
  • Extension
  • External rotation
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63
Q

First stage of labor timing

A

Begins with onset of labor, lasts until dilation and effacement are complete

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64
Q

Second stage of labor timing

A

Begins with full dilation and ends with delivery

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65
Q

Third stage of labor timing

A

Begins after delivery of the infant, ends with delivery of the placenta

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66
Q

MC tumor found on the vulva

A

Epidermal inclusion cyst

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67
Q

Cervical retention cysts caused by blockage of an endocervical gland

A

Nabothian cysts

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68
Q

Chadwick sign

A

Bluish discoloration of the cervix as seen in pregnancy

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69
Q

Bluish discoloration of the cervix as seen in pregnancy

A

Chadwick sign

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70
Q

Softening of the cervix, as seen in pregnancy

A

Hegar sign

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71
Q

Hegar sign

A

Softening of the cervix, as seen in pregnancy

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72
Q

Reactive/reassuring nonstress test

A

At least 2 fetal heart accelerations of at least 15 mins above the baseline HR in 20 minutes

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73
Q

How long does it take to determine that a nonstress test is “nonreactive”/”nonreassuring”?

A

40 minutes

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74
Q

What is a neoplasm of the uterine muscular wall called?

A

Sarcoma

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75
Q

What is a neoplasm of the endometrial lining called?

A

Adenocarcinoma

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76
Q

Which type of ovarian cyst is associated with ovulation?

A

Follicular cyst

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77
Q

Which type of ovarian cyst is associated with pregnancy?

A

Corpus luteum cyst

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78
Q

Which type of cyst is often bilateral, resulting from excess hCG secretion in molar and multigestation pregnancy?

A

Thecal cyst

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79
Q

Which lab value is helpful in the assessment of a patient for ovarian cancer?

A

CA-125

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80
Q

What “surgical” procedure can be done to help an incompetent cervix?

A

Cerclage

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81
Q

With what pathology is a strawberry cervix associated?

A

Trichomonas cervicitis

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82
Q

Definition of primary amenorrhea

A
  • No menses by 14 with normal sexual development, OR

- No menses by 13 without normal sexual development

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83
Q

Definition of secondary amenorrhea

A

Cessation of menses for 6 months not associated with menopause

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84
Q

Most common cause of secondary amenorrhea

A

Pregnancy

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85
Q

Definition of dysmenorrhea

A

8-72 hours of pelvic pain with menstruation

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86
Q

Average age of menopause

A

51.5 years

87
Q

Premature menopause (definition)

A

When menses stop before age 40

88
Q

Lab used in the diagnosis of menopause

89
Q

What FSH levels are diagnostic of menopause

A

> 30 mlU/mL

90
Q

Instances in which you cannot use HRT

A
  • Unexplained vaginal bleeding
  • History of DVT/PE
  • History of GYN tumors that may be estrogen-sensitive
91
Q

Medical terms for breast pain

A

Mastalgia or mastodynia

92
Q

MC organism responsible for mastitis

A

Staph aureus

93
Q

MC benign condition of the breast

A

Fibrocystic changes

94
Q

What breast pathology is associated with the following changes:

  • Round
  • Firm
  • Smooth
  • Mobile
  • Non-tender
A

Fibroadenoma

95
Q

Which breast pathology is associated with the following changes:

  • Painful
  • Fluctuating size
  • Multiple masses
A

Fibrocystic changes

96
Q

Most common type of breast cancer

A

Ductal carcinoma (80%)

97
Q

Two types of breast cancer

A

Ductal carcinoma

Lobular carcinoma

98
Q

Paget’s disease of the breast (definition)

A

Ductal carcinoma of the nipple

99
Q

Skin changes associated with Paget’s disease

A

-Scaly, eczematous, erythematous nipple lesion

100
Q

Spontaneous flow of milk from the breast (term)

A

Galactorrhea

101
Q

Why could a pituitary adenoma cause galactorrhea?

A

It could cause hyperprolactinemia, which would cause the galactorrhea

102
Q

Definition of infertility

A

Failure to conceive after 1 year of unprotected intercourse

103
Q

What medication can be given to anovulatory women to stimulate ovulation?

A

Clomiphene citrate (Clomid)

104
Q

How does clomiphene citrate (Clomid) work?

A

By inhibiting estrogen receptors in the hypothalamus, removing the (-) feedback on gonadotropin release

105
Q

Cervical motion tenderness (what is this sign called?)

A

Chandelier’s sign

106
Q

What tool can be used for monitoring the fetus internally?

A

Fetal scalp electrode

107
Q

Most accurate method of monitoring the fetus during labor

A

Fetal scalp electrode

108
Q

What are some simple measures that can be taken if concerned about fetal heart rate during labor?

A
  • Lay mom on left side
  • Give mom oxygen
  • Stop pitocin
109
Q

Five categories of the APGAR score

A
  • Appearance (color)
  • Pulse
  • Grimace (reflex to nasal suctioning)
  • Activity (motor tone)
  • Respiration
110
Q

Causes of early postpartum hemorrhage

A
  • Laceration
  • Retained products of conception
  • Abnormal uterine involution
111
Q

Causes of late postpartum hemorrhage

A
  • Retained products of conception

- Endometritis

112
Q

What drugs can be given to treat postpartum hemorrhage?

A
  • Prostaglandins
  • Oxytocin
  • Ergonovine (Ergometrine)
  • All used to enhance uterine contraction
113
Q

How long does it take the uterus to descend back into the pelvis?

114
Q

How long does it take for the uterus to involute to normal size?

115
Q

Medical term for the sloughing of decidual tissues in the postpartum period

116
Q

Most common location of ectopic pregnancy

A

Ampulla of the fallopian tube

117
Q

Patient presents with RLQ pain and vaginal bleeding. On exam, you feel an adnexal mass. What do you suspect?

A

Ectopic pregnancy

118
Q

What drug can be given to a patient with an ectopic pregnancy?

A

Methotrexate

119
Q

If premature labor is a possibility, what drug can you give to the mother to increase fetal lung maturity?

A

Betamethasone (Celestone)

120
Q

Triad of preeclampsia (mild)

A
  • HTN >140/90
  • Edema
  • Proteinuria >300mg in 24-hour urine
121
Q

Blood pressure requirements for a diagnosis of severe preeclampsia

A

SBP >160 mmHg, OR
DBP >110 mmHg
*On at least 2 occasions at least 6 hours apart with bed rest in between

122
Q

Proteinuria requirements for a diagnosis of severe preeclampsia

A

> 5g in a 24-hour urine

123
Q

HELLP Syndrome

A

Severe preeclampsia, plus:

  • Hemolysis
  • Elevated Liver enzymes
  • Low platelets
124
Q

If a patient has preeclampsia with one pregnancy, what is the risk of her developing preeclampsia with subsequent pregnancies?

A

25-33% risk

125
Q

What drug do we give patients with preeclampsia for seizure prophylaxis and at what dose?

A
  • Magnesium sulfate

- 4g load and 2g/hour maintenance

126
Q

In the case of magnesium sulfate overdose, what should be given for cardiac protection?

A

10mL of 10% calcium chloride or calcium gluconate

127
Q

When is RhoGam given to Rh (-) moms?

A
  • 28-29 weeks

- If baby is Rh (+) at birth, give another dose to Mom at birth

128
Q

Most common cause of 3rd trimester bleeding

A

Abruptio placentae

129
Q

Classic presentation of abruptio placentae

A

Painful vaginal bleeding

130
Q

Classic presentation of placenta previa

A

Painless 3rd trimester vaginal bleeding

131
Q

Painful vaginal bleeding is the classic presentation for what? (During pregnancy)

A

Placental abruption

132
Q

Painless vaginal bleeding is the classic presentation for what? (During pregnancy)

A

Placenta previa

133
Q

Complete abortion (definition)

A

Complete expulsion of all POC before 20 weeks’ gestation

134
Q

Complete expulsion of all POC before 20 weeks’ gestation

A

Complete abortion

135
Q

Incomplete abortion (definition)

A

Partial expulsion of some, but not all POC before 20 weeks’ gestation

136
Q

Partial expulsion of some, but not all POC before 20 weeks’ gestation

A

Incomplete abortion

137
Q

Inevitable abortion (definition)

A

No expulsion of products, but bleeding and dilation of the cervix such that a viable pregnancy is unlikely

138
Q

No expulsion of products, but bleeding and dilation of the cervix such that a viable pregnancy is unlikely

A

Inevitable abortion

139
Q

Threatened abortion (definition)

A

Any intrauterine bleeding before 20 weeks’ gestation without dilation of the cervix or expulsion of any POC (no loss of fluid or tissue)

140
Q

Any intrauterine bleeding before 20 weeks’ gestation without dilation of the cervix or expulsion of any POC (no loss of fluid or tissue)

A

Threatened abortion

141
Q

Missed abortion (definition)

A
  • Death of the embryo/fetus before 20 weeks’ gestation, with complete retention of POC
  • Often proceed to complete abortion within 1-3 weeks, but are occasionally retained much longer
142
Q
  • Death of the embryo/fetus before 20 weeks’ gestation, with complete retention of POC
  • Often proceed to complete abortion within 1-3 weeks, but are occasionally retained much longer
A

Missed abortion

143
Q

Precipitous labor

A

Labor lasting < 3hours

144
Q

Precipitous delivery

A

Delivery to a non-sterile field

145
Q

Why do pregnant patients often require iron supplementation?

A

Because RBC volume increases by 35%

146
Q

Effects of progesterone on the GI system during pregnancy

A

Progesterone cause smooth muscle relaxation, resulting in:

  • Decreased esophageal sphincter tone –> Reflux
  • Decreased motility –> Constipation
  • Decreased gallbladder contraction –> Increased risk of gallstones
147
Q

Term used for thick, white vaginal discharge

A

Leukorrhea

148
Q

What causes blurred vision in pregnancy?

A

Increased thickness of the cornea due to fluid retention

149
Q

What type of antibodies can cross the placenta?

A

IgG anitbodies

150
Q

Term used to describe the settling of the fetal head into the pelvis before the onset of labor

A

Lightening

151
Q

What are Leopold’s maneuvers used to determine?

A
  • Lie (transverse or vertex)
  • Presentation (breech or cephalic)
  • Position (facing left or right)
152
Q

Term for failure of the uterus to contract after delivery

A

Uterine atony

153
Q

What drugs can be given in the case of uterine atony?

A
  • Oxytocin
  • Methergine
  • Prostaglandins
154
Q

Fourth stage of labor timing

A

Begins after delivery of the placenta, and ends 2 hours later

155
Q

Difficult labor or childbirth (term)

156
Q

What is it called when the fetal lie is with the head turned to one side?

A

Asynclitism

157
Q

What is it called when the fetal lie is with one or more limbs prolapsed alongside the presenting part?

A

Compound presentation

158
Q

At what point is the latent phase of labor considered abnormally prolonged?

A

> 20 hours in nulliparous patient

> 14 hours in multiparous patient

159
Q

Definition of arrested labor

A
  • No fetal descent after 1 hour of pushing in a patient with anesthesia
  • Descent < 1cm/hour in a patient with no anesthesia
160
Q

Absence of a major portion of the brain, skull, and scalp that occurs during embryonic development

A

Anencephaly

161
Q

Breech presentation in which the legs are brought up so the feet are near the head

A

Frank breech

162
Q

Breech presentation in which the legs are crossed beside the bottom (baby is sitting cross-legged)

A

Complete breech

163
Q

Breech presentation in which one of the legs is extended below the bottom

A

Footling (incomplete) breech

164
Q

Attempt to rotate the fetus in a breech position to a vertex/cephalic position

A

External cephalic version (ECV)

165
Q

External cephalic version (ECV)

A

Attempt to rotate the fetus in a breech position to a vertex/cephalic position

166
Q

Turtle sign

A
  • Associated with shoulder dystocia

- Head retracts between contractions/pushing

167
Q
  • Signs associated with shoulder dystocia

- Head retracts between contractions/pushing

A

Turtle sign

168
Q

Positioning/maneuver involving hyperflexing the mother’s legs up near her chest in an effort to widen the pelvis and flatten the lumbar spine

A

McRobert’s position/maneuver

169
Q

Bradycardic fetal heart rate

170
Q

MCC of fetal tachycardia

A

Chorioamnionitis

171
Q

Tachycardic fetal heart rate

172
Q

Minimal fetal heart rate variability

A

< 5 bpm deviation from baseline

173
Q

Moderate fetal heart rate variability

A

Between 6 and 25 bpm deviation from baseline

174
Q

Marked fetal heart rate variability

A

> 25 bpm deviation from baseline

175
Q

White substance covering the baby when he’s born to protect him from being in the amniotic fluid for so long

176
Q

What antibiotic ointment is applied to the eyes of a newborn if the mother has gonorrhea?

A

Erythromycin or Tetracycline

177
Q

Normal size of a nonpregnant uterus

A

60-80 grams

178
Q

Individual sections of the placenta that implant in the uterus

A

Cotyledons

179
Q

Placental invasion of the superficial lining of the uterus

A

Placenta accreta

180
Q

Placental invasion into the myometrium

A

Placenta increta

181
Q

Placenta increta

A

Placental invasion into the myometrium

182
Q

Placenta accreta

A

Placental invasion of the superficial lining of the uterus

183
Q

Placenta percreta

A

Placental invasion through the full thickness of the uterine muscle

184
Q

Placental invasion through the full thickness of the uterine muscle

A

Placenta percreta

185
Q

What meds can be given to cause uterine relaxation?

A

Terbutaline, Magnesium sulfate

186
Q

Substance secreted by the breasts in the early postpartum period that contains more minerals and proteins, but less sugar and fat than mature milk

187
Q

How long does colostrum secretion persist?

A

About 5 days

188
Q

What should happen to hCG levels with a spontaneous abortion?

A

They should drop by 15% by the next day

189
Q

When should a transvaginal and abdominal ultrasound be able to visualize the pregnancy? (hCG levels, not time)

A

hCG of 1000-2000 with transvaginal

hCG of 5000-6000 with abdominal

190
Q

What effect on hCG levels should you see with administration of methotrexate for an ectopic pregnancy?

A

15% decline between days 4 and 7

191
Q

Ectopic pregnancy candidates for methotrexate therapy

A

hCG < 5000
Ectopic size < 3.5cm
No cardiac activity

192
Q

Ectopic pregnancy implanted in the proximal tube (what is it called?)

A

Cornual ectopic

193
Q

Placenta previa in which the entire cervical os is covered by the placenta

A

Total placenta previa

194
Q

Placenta previa in which the placenta covers a portion of the internal os

A

Partial previa

195
Q

Placenta previa in which the edge of the placenta reaches the margin of the internal os

A

Marginal previa

196
Q

Types of placental abruption

A

Complete, Partial, Marginal

197
Q

MCC of coagulopathy in pregnancy

A

Placental abruption (clotting factors run low because they’re all being used up in the uterus)

198
Q

What is it called when fetal blood vessels are present over the internal os, below the fetus?

A

Vasa previa

199
Q

Why does HCT normally decrease in pregnant patients?

A

Because plasma volume expands proportionally greater than that of RBC mass

200
Q

What placental hormone increases insulin resistance?

A

Human placental lactogen (hPL)

201
Q

What should the 1-hour 50gm glucose challenge test glucose levels be?

A

< 140 mg/dL

202
Q

When is the glucose challenge test performed?

A

Between 24 and 28 weeks

203
Q

What should the fasting, 1hour, 2hour, and 3hour glucose levels be in a 3-hour glucose tolerance test?

A

Fasting: < 105
1-hour: < 190
2-hour: < 165
3-hour: < 145

204
Q

For gestational diabetic patients monitoring their glucose at fasting and 2 hours after meals, what should the values be?

A

Fasting: < 95

2-hour Postprandial: < 120

205
Q

Chronic hypertension (definition as it relates to pregnancy)

A

HTN present before the 20th week of pregnancy

206
Q

Gestation hypertension definition

A

HTN that develops after 20 weeks’ gestation in the absence of proteinuria and returns to normal in the postpartum period

207
Q

1st line tx for pregnant patients with asthma

A

Inhaled corticosteroid Budesonide

208
Q

Most significatn cause of morbidity with multifetal gestation

A

Preterm labor and delivery

209
Q

Describe the chorionicity when zygote divides within 3 days of conception

A

Diamnionic/dichorionic with either one or two placentas

210
Q

Describe the chorionicity when zygote divides between 4-8 days of conception

A

Diamnionic/monochorionic

211
Q

Describe the chorionicity when zygote divides between 9-12 days of conception

A

Monoamnionic/monochorionic

212
Q

What happens if a zygote divides after day 13?

A

Conjoined twins

213
Q

What chorionicity allows for twin-twin transfusion syndrome?

A

Monochorionic pregnancies

214
Q

What pathognomic ultrasound findings are associated with gestational trophoblastic neoplasia?

A

“Snowstorm” and absence of fetal parts or partially developed fetal parts

OB/GYN Clerkship (2 decks)

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