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ÅJJB 5th year > OBGYN Nagy Questions > Flashcards

OBGYN Nagy Questions Flashcards

1
Q

Definition of Preeclampsia and Eclampsia

A

After 20th week of gestation

Preeclampsia - BP > 140/90
proteinuria >300mg/24hr

Eclampsia - tonic-clonic seizures

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2
Q

Gestational Diabetes

A

Done in all pregnancies - screen between 24-28 weeks

Healthy = Fasting glucose < 5.6 mmol/L

FG 5.6 - 7.0 mmol/L - Do OGTT
FG > 7.0 mmol/L on 2 separate occasions - GDM

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3
Q

Oral Glucose Tolerance Test

A

OGTT - consume 25g of glucose after fasting

minute 0 <7.0 mmol/L

If <7.8 - 11.1 mmol/L - Impaired Glucose Tolerance (IGT)

If > 11.1 mmol/L - DM

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4
Q

Indications of C- section

A

Maternal-Fetus perspective
- cephalopelvic disproportion
- failed induction of labor

Maternal Perspective
- eclampsia
- cerival cancer
- fibroids, tumor
- herpes

Fetal
- “non-reassuring” fetal HR - bradycardia
- cord prolapse
- Malpresentation
- Multiple gestations

Fetal abnormalities
- hydrocephalus

Placenta
- previa
- abruptio

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5
Q

When is US in pregnancy done

A

week 6-7 - confirm pregnancy
- gestational sac, HR
Location: intra/extrauterine

week 11-13
- congenital malformations
- nuchal translucency (Down’s)
- Neural Tube defects
- Biometrics

week 18-20
- congenital malformations

week 30-31
- IUGR
- late congenital malformations

week 36-38
- fetal presentation
- fetal weight
- information for prep of delivery

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6
Q

Approach to Placental abruptio
and Placental previa

A

use hands to palpate the uterus

abruptio - painful, hard uterus –> C-section

previa - painless, CTG is normal

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7
Q

Post-partum hemorrahge

A

tissue - retain placenta

trauma - vaginal lacerations

thrombin - coagulopathy (DIC)

Tone - uterine atony (need to exclude other causes)

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8
Q

Stages of Birth

A
  1. onset of labor - longest stage
    - latent (3cm)
    - active (3-10 cm)
  2. baby: 30-90 mins
    - propulsive phase - full dilation, descend to pelvic floor
    - expulsion phase - ends with delivery of baby
  3. placenta: 5-30 mins, separation
    - expulsion of placenta
    - expulsion of membranes
  4. Recovery: 2 hours, after expulsion of placenta
    - inc. risk of bleeding
    - repair lacerations
    - RhoGAM - a medicine that stops your blood from making antibodies that attack Rh-positive blood cells
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9
Q

Techniques of C-section

A

Abdominal Wall
- transverse, pfannenstiel
- vertical, midline

Uterus
- lower segment incision - transverse
- classical - vertical

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10
Q

Pearl Index

A

number of pregnancies in 100 females/year with chosen contraceptive

  • OCP: 0.1-2.5
  • Plan B: 0.5 - 2.5
  • IUD 0.5-5
  • Condom 3-28
  • Sterilization 0.3-6
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11
Q

Routine Examiations

A

colposcopy
cytology
bimanual exam
breast exam

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12
Q

Long term OCP use

A

GOOD:
- dec ovarian/endometrial cancer
- dec bone loss
- dec dysmenorrhea
- dec acne
- dec risk of trisomies with inc in maternal age
- regulates cycle

BAD:
- inc DVT/stroke
- inc BP
- inc weight

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13
Q

Endometriosis

A

endometrial like tissue outside the uterine cavity

DX - Gold standard - Laparscopic visualization

TX - surgery
- pseudopregnancy
- pseudomenopause - GnRH analogue

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14
Q

Urinary incontinence

A

irritative:
- urinalysis – cystitis/tumor/foreign body

stress:
- loss of bladder support – cough – urge
- hypertonic – inc detrusor
TX - anticholinergics

overflow/neurogenic:
- hypotonic w/ dribbles
TX - cholinergics

bypass/fistula

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15
Q

Main Vaginal infections

A

bacterial vaginosis
trichomonas
mycosis (Candida)
Condyloma

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16
Q

Spontaneous abortion

A

pain and bleeding

DX: cervix, US, hCG

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17
Q

Contraindications to Tocolysis

A

Obstetric:
- severe abruption
- ruptured membranes
- chorioamnionitis

Fetal:
- lethal anomaly
- fetus has died
- fetal jeopardy

Maternal
- eclampsia
- advanced dilation

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18
Q

Leopold maneuvers

A
  1. Fundal grip
  2. Umbilical grip
  3. Pelvic Grip (first)
  4. Pawlick grip (2nd pelvic grip)
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19
Q

Leopold maneuver - 1. Fundal grip

A
  1. Fundal grip - palpate upper abdomen with both hands
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20
Q

Leopold maneuver - 2. Umbilical grip

A
  1. Umbilical grip - palpate to localize fetal back. One palm fixed, while the other explores one side then change
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21
Q

Leopold Maneuver - 3. Pelvic Grip (first pelvic grip)

A
  1. Pelvic Grip (first) - determine what fetal part is lying above the inlet. grasp the lower portion of the abdomen just above the pubic symphysis with thumb and fingers of the right hand
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22
Q

Leopold Maneuver - 4. Pawlick grip (2nd pelvic grip)

A
  1. Pawlick grip (2nd pelvic grip) - face woman’s feet, attempt to locate fetus’ brow. Fingers of both hands move gently down the sides of the uterus to pubis. The side where there is resistance to the descent of the fingers is greatest where the brow is located.
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23
Q

How to stop uterine bleeding

A

Old - D&C

Young - progesterone – preserve fertility

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24
Q

What is Mayer-Rokitansky-Kuster-Hauser Syndrome

A

i.e. Mullerian agenesis

congenital malformation where the mullerian duct fails to develop
has missing uterus, cervix, vagina
there is a variable degree of upper vaginal hypoplasia (shortened)

causes 15% of primary amenorrhea
ovarias are still intact so ovulation occurs - will enter puberty and have secondary sex characteristics

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25
Q

Pap Smear

A

P0 - improper sample
P1 - Negative, superficial cells on slide
P2 - Superficial cells and WBC
P3 - unsure
P4 - atypical cells – suspect malignancy
P5 - malignancy

26
Q

Bethesda System

A

Results - reporting of cervical or vaginal cytology from Pap Smear

steps:
1. quality of slide
2. whether the result is positive or negative
3. details of the slide - types of cells, LSIL/HSIL
4. physician recommendation on how to proceed

27
Q

Prenatal care

A

starts before pregnancy

28
Q

Puerperium

A

period beginning immediately after the birth of child and extends for 6 weeks

29
Q

Neonatal mortality rate

A

number of neonatal deaths during the first month/1000 live births

Early NMR is the first week
Late NMR weeks 2-4

30
Q

Perinatal Mortality Rate

A

number of perinatal deaths (stillbirths and neonatal deaths) from 22 w gestation to 7 w postpartum/1,000 live births

31
Q

How to exclude ectopic pregnancy

A

measure beta-hCG:
1000 U/L - gestational sac
7,000 U/L - Yolk sac
10,000 U/L - Embryo

brown spotting and abdominal pain indicates ectopic pregnancy
Check Fallopian tubes
beta-hCG doubles every 2nd day of pregnancy

32
Q

Important questions for history taking

A

previous operations
allergy to meds
obstetric anamnesis
illness, drugs
first day of last period
- Naegele Rule

33
Q

Naegele Rule

A

used to calculate the expected date of delivery (due date)

First day of the last menstrual period + 7 days + 1 year - 3 months

can only be applied if menses are regular and cycle is 28 days
Inaccurate if:
- The date of the last menstrual period is uncertain or unknown
- The patient has irregular menstruation cycles
- The patient conceived while taking contraceptive pills

34
Q

Signs of pregnancy
Presumptive Signs

A

Presumptive sign -
Chadwick’s sign - bluish discoloration of the cervix and vagina due to pelvic vascular engorgement (6th week)

35
Q

Signs of Pregnancy - Probable signs

A

Probable signs - positive home preg test, uterine and breast engorgement

Piskacek sign - soft prominence over the site of implantation

Goodell sign - softening of the cervix

Hegar sign - softening of the cervical isthmus

36
Q

Signs of Pregnancy - Positive Signs

A

Positive sign - detection of fetal hemoglobin
recognition of fetal movement

37
Q

Location of Bartholin’s Cyst

A

lower 1/3 of labia major

38
Q

Marsupialization of Bartholin’s Cyst

A

cyst opened at the edges and sutured- forming an open pocket

39
Q

Ashermn’s Syndrome

A

adhesions/fiborsis of the uterine cavity
usually from D&C

reversible infertility

40
Q

Types of anesthetics used in C-Section

A

determined by urgency of situation
vaginal - epidural
intrathecial narcosis - emergency c-section

41
Q

Vitamin supplements

A

preconception - folic acid up to 6 weeks before - 400 microgram/day
2nd trimester - low dose iron and iodine 250 microgram/day

42
Q

FIGO staging for Endometrial cancer
0-I

A

0: CIS (Carcinoma in situ)

I: Limited to the uterus
Ia: < 50% myometrial invasion
Ib: > 50% myometrial invasion

43
Q

FIGO staging for Endometrial cancer
II - III

A

II: Cervical involvement

III: Local spread
IIIa: Adnexa/uterine serosa
IIIb: Vagina/parametrium

IIIc1: Pelvic nodes
IIIc2: Paraaortic nodes

44
Q

FIGO staging for Endometrial cancer
IV

A

IV: Metastasis
IVa: Bladder/rectal mucosa
IVb: Distant metastasis, ascites, peritoneum

45
Q

FIGO staging for Endometrial cancer

A

0: CIS (Carcinoma in situ)

I: Limited to the uterus
Ia: < 50% myometrial invasion
Ib: > 50% myometrial invasion

II: Cervical involvement

III: Local spread
IIIa: Adnexa/uterine serosa
IIIb: Vagina/parametrium
IIIc1: Pelvic nodes
IIIc2: Paraaortic nodes

IV: Metastasis
IVa: Bladder/rectal mucosa
IVb: Distant metastasis, ascites, peritoneum

46
Q

Vulvar cancer Staging
0 - I

A

0: VIN

I: Limited to vulva/perineum < 2cm
Ia: < 1mm stromal invasion
Ib: > 1mm stromal invasion

47
Q

Vulvar cancer Staging
II - III

A

II: Extension to adjacent perineum

III: Any size + extension to perineal structures with
positive inguinofemoral LN
IIIa1: 1 LN > 5mm
IIIa2: 1-2 LN < 5mm
IIIb1: > 2 LN > 5mm
IIIb2: > 3 LN < 5mm

48
Q

Vulvar cancer Staging
IV

A

IV: Metastasis
IVa: Bladder, urethra, rectum, bone
IVb: Distant metastasis (Pelvic LN)

49
Q

Vulvar Cancer Staging

A

0: VIN

I: Limited to vulva/perineum < 2cm
Ia: < 1mm stromal invasion
Ib: > 1mm stromal invasion

II: Extension to adjacent perineum

III: Any size + extension to perineal structures with
positive inguinofemoral LN
IIIa1: 1 LN > 5mm
IIIa2: 1-2 LN < 5mm
IIIb1: > 2 LN > 5mm
IIIb2: > 3 LN < 5mm

IV: Metastasis
IVa: Bladder, urethra, rectum, bone
IVb: Distant metastasis (Pelvic LN)

50
Q

Vaginal cancer Staging

A

0: VAIN

I: Limited to vagina

II: Paravaginal invasion w/out extension beyond
pelvic side walls

III: Invasion of pelvic side wall

IV: Metastasis beyond pelvis
IVa: Bladder, rectum
IVb: Distant metastasis

51
Q

Cervical cancer Staging
0-I

A

0: CIN

I: Limited to cervix
Ia: Invasion dx by microscopy
Ia1: Stromal invasion < 3mm depth, < 7mm extension (microinvasive)

Ia2: Stromal invasion 3-5mm depth, > 7mm extension

Ib: Clinically visible lesion
Ib1: < 4cm
Ib2: > 4cm

52
Q

Cervical cancer Staging
II

A

II: Beyond cervix, NOT pelvic side walls, NOT lower 1/3 of vagina

IIa: Involved upper 2/3 of vagina, NO parametrial involvement

IIa1: < 4cm

IIa2: > 4cm

IIb: Parametrial invasion

53
Q

Cervical cancer Staging
III

A

III:
IIIa: Lower 1/3 of vagina, NO pelvic wall
extension

IIIb: Pelvic side wall extension, obstructive
uropathy

54
Q

Cervical cancer Staging
IV

A

IV: Metastasis
IVa: Bladder, rectum
IVb: Distant organs

LSIL: Condyloma
CIN I

HSIL: CIN II
CIN III –> In situ –> invasive cc

55
Q

Ovarian cancer Staging
I

A

I: Ovary/fallopian tube

Ia: 1 ovary/fallopian tube

Ib: 2 ovaries/fallopian tubes

Ic: a/b +
Ic1: Surgical spill
Ic2: Capsule rupture before surgery, tumor
on ovary/fallopian tube surface
Ic3: Malignant cells in ascites/peritoneum

56
Q

Ovarian Cancer Staging
II

A

II: Pelvic extension/primary peritoneal cancer
IIa: Uterus/fallopian tubes
IIb: Other pelvic tissues

57
Q

Ovarian Cancer Staging
III

A

III: Cytologically/histologically confirmed spread to peritoneum and retroperitoneal LN

IIIa: Retroperitoneal LN, microscopic
metastasis beyond pelvis

IIIa1(i): Retroperitoneal LN < 10mm

IIIa1(ii): Retroperitoneal LN > 10mm

IIIa2: Microscopic extrapelvic peritoneal
metastasis

IIIb: Macroscopic peritoneal metastasis < 2cm

IIIc: Macroscopic peritoneal metastasis > 2cm

58
Q

Ovarian Cancer Staging
IV

A

IV: Metastasis
IVa: Pleural effusion with positive cytology
IVb: Distant metastasis

59
Q

Breast cancer (TNM) Staging
T

A

Tis: DCIS (Ductal Carcinoma in situ), LCIS
(Lobular Carcinoma in situ)
T1: 2cm
- T1mi: 0.1cm
- T1a: 0.1cm – 0.5cm
- T1b: 0.5cm – 1cm
- T1c: 1cm – 2cm

T2: 2-5cm

T3: > 5cm

T4: Metastasis
T4a: Chest wall
T4b: Skin
T4c: Chest wall + Skin
T4d: Inflammatory cc

60
Q

Breast cancer (TNM) Staging
N

A

N: Lymph nodes
Nx: LN cannot be assessed
N0: NO Cancer cells
N1: Cancer cells in armpit LN but not stuck to
surrounding tissues
N2: Stuck to surrounding tissues
N3: Cancer cells in LN below collarbone,
behind breast bone, above collarbone

61
Q

Breast cancer (TNM) Staging
M

A

M: Metastasis
M0: No metastasis
M1: Metastasis

ÅJJB 5th year (5 decks)

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