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Boards and Wards Complete > ObGyn Part 2 (233- 267) Headache (306-308) > Flashcards

ObGyn Part 2 (233- 267) Headache (306-308) Flashcards

1
Q

Process of progressive effacement and dilation of the uterine cervix resulting from contractions of uterus

A

Labor

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2
Q

Uterine contractions without effacement or dilation of cervix

A

False labor - Braxton Hicks contractions

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3
Q

Under what criteria are patients told to come to the hospital?

A

Regular contractions q5minutes for atleast 1 hour, ROM, significant bleeding or decreased fetal movement.

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4
Q

What does Leopold maneuver help with?

A

Helps figure out fetal lie

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5
Q

What should you check for on vaginal exam when pt comes in L&D?

A

ROM
Cervical effacement
cervical dilation

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6
Q

What is fetal station

A

Level of fetal presenting part relative to the ischeal spines measured -3 to +3

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7
Q

Where is fetal station 0? Why is it significant?

A

Presenting part is at ischeal spines

Means that biparietal diameter of the head negotiated the pelvic inlet (smallest part of pelvis)

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8
Q

How many stages are in labor?

A

4

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9
Q

What defines stage 1 of labor?

A

onset of labor and full cervical dilation (10cm)

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10
Q

What stage of labor do latent and active phases occur? Definition?

A 
Latent = cervical effacement and early dilation
Active = more rapid cervical dilation usually at 3-4 cm
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11
Q

What 2 devices do you use to monitor the uterine activity?

A

External tocodynameter measures frequency and duration of contractions
IUPC - intrauterine pressure catheter measures intensity by measuring intrauterine pressure

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12
Q

What is the prefered analgesic during labor and when is it given?

A

Meperidene and/or epidural block w/ continuous infusion not given until active stage of labor

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13
Q

What is stage 2 of labor?

A

interval between complete cervical dilation and delivery of infant

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14
Q

How are episiotomies done?

A

Usually midline, but not preferred.

Better if delivery happens in a slow controlled fashion with natural tears

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15
Q

What is checked in the fetus after the head is delivered?

A

bulb suction of nose and mouth and neck evaluated for nuchal cord

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16
Q

How are shoulders delivered?

A

gentle downward pressure on head to deliver anterior shoulder followed by easy upward to deliver posterior shoulder

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17
Q

What should cord blood be sent for?

A

ABO and Rh testing

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18
Q

What is stage 3 of labor?

A

infant between delivery of infant and delivery of placenta

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19
Q

What are 3 signs of placental separation?

A
  1. Uterus rises in abdomen
  2. Gush of blood
  3. Lengthening of the umbilical cord
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20
Q

Excessive pulling on the placenta could cause what complication?

A

risk of uterine inversion
profound hemorrhage
retained placenta

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21
Q

How long could it take for placenta to be expulsed?

A

Up to 30 mins

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22
Q

What is stage 4 of labor?

A

immediate post partum period lasting 2 hours, during which pt undergoes significant physiologic attention.

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23
Q

What should be done by physician after pt delivers baby and placenta?

A

systematically evaluate cervix, vagina, vulva, perineum and periurethral area for lacerations

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24
Q

Serious post partum complications occur in what time frame?

A

1-2 hours post partum

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25
Q

Define dystocia

A

Difficult labor

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26
Q

How do you evaluate dystocia?

A

3 P’s
Power
Passenger
Pasasge

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27
Q

Define Power

A

refers to strength, duration and frequency of contractions

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28
Q

At what rate must contractions occur for cervical dilation to occur?

A

> 3 contractions per 10 minutes

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29
Q

Define Passenger

A

Refers to fetal weight, fetal lie, presentation and postion

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30
Q

What 3 presentations of the fetus can cause dystocia?

A

Occiput posterior, face presentation, hydrocephalus

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31
Q

Define Passage

A

Difficult to measure pelvic diameters.

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32
Q

What passage issues might contribute to dystocia?

A

distended bladder, uterine fibroids, adnexel or colon masses

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33
Q

What 2 prolongation disorders is dystocia divided into?

A

Prolonged latent phase

Prolonged Active phase

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34
Q

What is prolonged latent phase defined as in a multigravida vs primagravida woman?

A

> 20 hours in a primigravid

>14 hrs in a multigravida

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35
Q

What is prolonged active phase defined as in a multigravid vs primigravid woman?

A

> 12 hours of active phase

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36
Q

A prolonged active phase puts mom at risk for what 2 things?

A

Intrauterine infection

C-section

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37
Q

What is it called when cervical dilation during active phase stops for more than 2 hours? Why would this happen?

A

Secondary arrest

Could happen bc ccephalopelvic disproportion or ineffective uterine contractions

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38
Q

What cervical condition must be present to induce labor?

A

if cervix is “ripe”

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39
Q

What score can quatify cervical readiness and what 4 factors are used?

A

Bishop score

Dilation, effacement, station and postion

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40
Q

What Bishop score is associated with successful induction?

A

9-13

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41
Q

What bishop score is associated with high liklihood of failed induction?

A

0-4

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42
Q

What are some contraindications for induction?

A

placenta previa
active genital herpes
abnormal fetal lie
cord presentation

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43
Q

What agent can be used to attempt to ripen cervix?

A

Prostaglandin E2 gel

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44
Q

How do laminarias or rods work to dilate the cervix?

A

Absorb moisture and slowly expand dilating the cervix

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45
Q

If fetus has descended far enough, but is not delivering, what could be done?

A

Vaccum or forceps
OR
C-section

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46
Q

What is post partum hemorrhage defined as?

A

blood loss >500 ml associated with delivery

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47
Q

Whats the most common cause of post partum hemorrhage?

A

Uterine atony

Others: lacerations, retained placenta

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48
Q

What is uterus normally supposed to do after delivery?

A

quickly contracts, compressing spinal arteries and this prevents excessive bleeding

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49
Q

What are some risk factors for uterine atony?

A 
mutiple gestations
hydramnios 
multipariety 
macrosomia
previous hx of post partum hemorrhage
fibroids
magnesium sulfate
general anesthesia
prolonged labor
amnionitis
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50
Q

How to dx uterine atony?

A

clinically - boggy uterus

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51
Q

How to treat uterine atony?

A

Uterine massage
IVF and transfusions as needed
Medically - oxytocin, methykergonovine
If unsuccessful, surgery intervention needed

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52
Q

placental villi abnormally adhere to superficial lining of the uterine wall

A

placenta accreta

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53
Q

placental villi penetrate into uterine muscle layer

A

placenta increta

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54
Q

placental villi completely invade uterine muscle layer

A

placenta percreta

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55
Q

How many days post partum does engorgement occur?

A

3 days

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56
Q

What are 3 causes of tender, enlarged breasts post partum?

A

engorgement
mastitis
plugged duct

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57
Q

What vitamins does breast milk provide?

A

All vitamins except vitamin K

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58
Q

Are OCPs contraindicated in breast feeding women?

A

no

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59
Q

What are 2 post-partum immunizations to be considered?

A

Rubella if nonimmune

Rhogam is mother is Rh negative

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60
Q

What time frame does post partum blues occur?

A

2-3 days pp, resolves within 1-2 weeks

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61
Q

What symptom is especially worrisome?

A

Mother who has estranged herself from her newborn or become indifferent

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62
Q

What is the most common infection post c-section? Tx?

A

metritis (uterine infection)

Tx: first generation cephalosporin

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63
Q

At what week limit is it considered abortion?

A
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64
Q

Does a single pregnancy loss significantly increase risk of future pregnancy loss?

A

No

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65
Q

What is the cause of upto 50% of early spontaneous abortions

A

chromosomal abnormalities

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66
Q

Vaginal bleeding in first half of any pregnancy is presumed to be _____ unless another dx can be made

A

spontaneous abortion

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67
Q

Vaginal bleeding in the first 20 weeks of pregnancy without passage of tissue or ROM with cervix closed

A

Threatened Ab

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68
Q

Threatened abortion with dilated cervical os and or ROM accompanied by cramping with expulsion of POC

A

Inevitable Ab

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69
Q

Documented pregnancy that spontaneously aborts all POCs – suspect if bHCG fails to decline

A

Completed Ab

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70
Q

Cramping, bleeding passage of tissue with dilated cervix and visible tissue in vagina or endocervical canal

A

Incomplete Ab

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71
Q

Lack of uterine growth, lack of fetal heart tones and cessation of pregnancy sx, failure of expelling POC

A

Missed Ab

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72
Q

> 2 consecutive or total of 3 spontaneous abortions. Dx? Tx?

A

Recurrent abortions

Tx: surgical cerclage – sutures cervix closed

73
Q

Implantation outside the uterine cavity is called

A

Ectopic pregnancy

74
Q

Where can ectopic pregnancies refer pain to?

A

shoulder pain from hemiperitoneal irritation of diaphragm

75
Q

What lab finding may suggest non viable pregnancy?

A

very low progesterone

76
Q

What drug can be used early on to abort pregnancy especially if size is

A

Methotrexate

77
Q

Sudden painless bleeding during pregnancy weeks 20-30. Dx? Tx?

A

Placenta previa

Ts with hemodynamic support, expectant management and deliver by C-Seciton when fetus is mature enough

78
Q

Painful bleeding and frequent uterine contractions any time after 20 weeks. Dx? Tx?

A

Placental abruption

Tx: hemodynamic support, urgent c-section or vaginal induction if pt is stable and fetus is not in distress

79
Q

Define pre-term labor

A

between 20-36 weeks gestation

contractions occuring at 30 seconds

80
Q

What drugs can be given for tocolysis to prolong delivery?

A

MgSO4
B2 agonists such as Terbutaline or Ritodrine
Ca blockers like nifedipine
Indomethacin

81
Q

What are contraindications to tocolysis?

A 
Cervical dilation >3 cm 
mature fetus 
chorioamnionitis 
significant vaginal bleeding
anomolous fetus
82
Q

During what weeks is betamethasone instituted to enhance pulmonary maturity?

A

24-34 weeks

83
Q

What 3 tests are done to see if pt had PROM

A

nitrazine test uses pH to distinguish alkaline amniotic vs acidic vaginal

Fern test - amniotic fluid dried on slide = fern pattern

Pool - US confirms dx by noting oligohydramnios

84
Q

2 sperate ova fertilized by 2 sperate sperm… incidence increaases with age and pariety… what kind of twins?

A

dizygotic twins

85
Q

Blood flow is inturrupted by a vascular anastomoses such that one twin becomes the donor twin and one twin is the recipient twin

A

twin-twin transfusion syndrome

86
Q

Under what conditions is vaginal birth tried in multiple gestation pregnancy?

A

if first baby is vertex then attempt to deliver vaginally

87
Q

What complication is it important to watch for after vaginal delivery of twins?

A

uterine atony and post partum hemorrhage because the overdistended uterus may not clamp down

88
Q

What stage of cell division are follicles arrested in?

A

prophase of meiosis

89
Q

When does ovulation begin?

A

puberty

90
Q

Once the dominant follicle ruptures, what happens to the corpus luteum?

A

Corpus luteum secretes progesterone to “prepare” the endometrium for implantation

91
Q

What are the 3 phases of the menstrual cycle?

A

Follicular (proliferative)
Ovulatory
Luteal (secretory)

92
Q

How long does the follicular phase of the menstrual cycle last?

A

days 1-13

93
Q

Why does LH surge happen on days 11-13?

A

Estadiol induced negative feedback on FSH and positive feedback on LH in anterior pituitary

94
Q

What days does the ovulatory phase occur?

A

Days 13-17

95
Q

How long after the LH surge does ovulation occur?

A

30-36 hours

96
Q

Day 15 to menses is what phase?

A

luteal (secretory phase)

97
Q

What hormone is predominant in the luteal phase?

A

progesterone

98
Q

What does progestin in an OCP do?

A

supresses LH and thus ovulation

Also, thickenes cervical mucus so it’s less favorable to semen

99
Q

What is Estrogen’s role in an OCP?

A

supresses FSH so it prevents seclection and maturation of a dominant follicle

100
Q

What effect do estrogen and progesterone together have on the endometrial lining?

A

Thin the endometrial lining and cause a light/missed menses

101
Q

What is the difference between monophasic and phasic OCPs?

A

monophasic deliver constant dose of estrogen and progestin

Phasic alter ratio slightly ususally by varying dose of progestin

102
Q

What are some absolute contraindications to using OCPs

A

pregnancy, DVT, thromboembolic dz, endometrial CA, smoking, >35, hyperlipiemia, cerebrovascular dz

103
Q

How often should women 21-30 get a PAP smear?

A

Every 2 years

104
Q

What are the PAP guidelines for women >30 with 3 negative paps?

A

screen once every 3 years

105
Q

What are some risk factors for CIN?

A

HIV
Immunosuppressed
exposure to DES
previous CIN

106
Q

If pap shows mild-low atypia, what should be done?

A

repeat pap - atypia may regress

107
Q

If pap shows mild-high grade atypia, what should be done?

A

Intense evaluation

Colposcopy

108
Q

How are colposcopies done?

A

cervix is washed with acetic acid solution and the white areas and abnormally vascularized areas are chosen for punctate biopsy

Endocervical curettage (ECC) is also done so disease further up in the canal may also be detected.

109
Q

What is the next step if the colposcopy is positive or unsatisfactory or +ECC comes back?

A

Cone biopsy

Then if + excision of lesion

110
Q

Review Alternative OCPs chart

A

p. 251

111
Q

HPV vaccine protects against which strains?

A

16, 18 (cervical CA), 6 and 11 (genital warts)

112
Q

For what age range is HPV vaccination recommentded

A

11-26 (can be given as young as 9)

113
Q

What organism is likely to cause vaginitis in women who are diabetics, pregnant or have HIV?

A

Candida

114
Q

Endometrial tissue in extrauterine locations, most commonly ovaries. Dx?

A

Endometriosis

115
Q

Candida vs. Trichomonas vs. Gardnerella chart

A

p. 253

116
Q

Endometrial implants within the uterine wall, dx?

A

adenomyosis

117
Q

Endometriosis involving an ovary with implants large enough to be considered a tumor, filled with chocolate appearing fluid “chocolate cysts” Dx?

A

Endometrioma

118
Q

What are the 3D’s of Endometritis?

A

dysmenorrhea, dyspareunia, dyschezia

119
Q

How to you dx endometritis?

A

laparoscopy or laparotomy with histologic confirmation

120
Q

What is the pharmacologic treatment? Surgical treatment for endometritis?

A

NSAIDS + OCPs (other options p.255)

Defnitive treatment is hysterectormy + oophorectomy

121
Q

absence of menstruation

A

amenorrhea

122
Q

woman who has never mesntruated

A

primary amenhorrhea

123
Q

menstrual age woman who has not menstruated in 6 months

A

secondary amenhorrhea

124
Q

Whats the most common cause of amenhorrhea?

A

pregnancy

125
Q

What is the most common anatomic cause to secondary amenhorreha?

A

Asherman’s syndrome - scarring of uterine cavity after D&C

126
Q

How can you symptomatically distinguish estrogen deficiency from hypothalamic-pituitary failure vs. ovarian failure

A

Hypothalamic- pituitary failure does not cause hot flashes

127
Q

Irregular menstruation without anatomic lesions of the uterus. Dx? Cause? Tx?

A

Dysfunctional uterine bleeding - dx w/ transvag US
Usually due to chronic estrogen stimulation
Convert proliferative endometrium to secretory one by giving progestational agent for 10 days

128
Q

What are the 2 most common reasons for hirsuitism?

A

PCOS and/or adrenal hyperplasia

129
Q

What is the average age of menopause in US?

A

Age 51

130
Q

What is the first line treatment for menopause?

A

estrogen hormone replacement therapy (HRT)

- HRT increases the risk of stroke, MI and possibly breast CA

131
Q

Which SERM is known to decrease the risk of breast ca?

A

Raloxifene

132
Q

What is the number one cause of androgen excess and hirsuitism? Labs? Tx?

A

PCOS
Increased LH/FSH and testosterone
OCPs to decreased LH

133
Q

Pt with rapid onset of hirsuitism acne amenorrhea, virilization. Usuaully occuring in 20-40 years. Dx? Labs?

A

Sertoli-Leydig cell tumor
Decreased LH/FSH,
VER VERY high testosterone

134
Q

What does 21 alpha hydroxylase defect cause? Labs?

A

Congenital adrenal hyperplasia

Labs: increased LH/FSH and DHEA

135
Q

What is the most common cause of infertility?

A

Male partner is the MCC but also because workup is simpler

136
Q

Normal semen excludes male cause in ____% of couples

A

90%

137
Q

What should the female workup of infertility include?

A

Temperature (drops during menses and rises 2 days after LH surge at time of progesterone rise)

138
Q

What does temperature elevation >16 days suggest?

A

Pregnancy

139
Q

What is the best predictor of fertility potential in women?

What number is a poor prognosis?

A

FSH

>25 correlates with poor prognosis

140
Q

What is the most common reason for anatomic disorders (ie. scarring, adhesions, endometriosis, trauma)

A

Acquired bc of salpingitis secondary to nisseria gonorrhoeae and Chlamydia

141
Q

What is the first line drug for anovulation?

A

Clomiphene - an estrogen antagonist that relieves negative feedback on FSH allowing follicle development

142
Q

Prolapse of urethra

A

urethrocele

143
Q

prolapse of bladder

A

cystocele

144
Q

prolapse of rectum

A

rectocele

145
Q

Bladder pressure exceeds urethral pressure briefly at times of strain or stress such as coughing or laughing

A

Stress incontinence

146
Q

Neuropathic bladder resulting in loss of control of bladder function resulting in involuntary bladder contraction? Dx
Or bladder atony? Dx?

A

Urge incontinence

overflow incontinence

147
Q

What is the most common type of endometrial cancer?

A

adenocarcinoma

148
Q

What are some risk factors to endometrial ca?

A

unopposed post menopausal estrogen replacement therapy

menopause after age 52

Obesity, nulliparity, feminizing ovarian tumors, PCOS

149
Q

Abnormal proliferation of glandular and stromal elements .. ddx?

A

endometrial hyperplasia

150
Q

Pap smear is not reliable in diagnosing endometrial ca, but what finding would mandate an endometrial evaluation?

A

Atypical glandular cells of undetermined significance? (AGCUS)

151
Q

How can you treat simple/ complex hyperplasia?

A

progesterone to reverse hyperplastic process promoted by estrogen

152
Q

What is the most important prognostic factor of endometrial ca?

A

histologic grade

153
Q

What is the 2nd most important prognostic factor of endometrial ca?

A

depth of myometrial invasion

154
Q

Whats another name for fibroids?

A

leiomyomas

155
Q

What is the most common indication for a hysterectomy?

A

Fibroids

156
Q

Whats the medical tx for fibroids?

A

estrogen inhibitors such as GnRH agonists to shrink uterus

157
Q

What is the surgical option for pts who have fibroids but still want to preserve fertility?

A

Myomectomy

158
Q

Rare malignancy of uterine corpus accounts for 3% of ca

A

leiomyosarcoma

159
Q

What are some risk factors for cervical ca?

A 
esrly sexual intercourse
multiple sexual partners 
HPV  esp 16, 18
Cigarette smoking 
Early childbearing 
immunocompromised
160
Q

Whats the average age of cervical ca dx?

A

50

161
Q

What type of cells are most cervical cancers?

A

squamous

162
Q

Review ovarian neoplasms

A

p.265

163
Q

What is the most common epithelial cell ovarian neoplasm?benign or malignant?

A

Serous cystadenoma, bengin unless bilateral

164
Q

What is the most common germ cell ovarian neoplasm?

A

teratoma aka dermoid cyst

165
Q

What are functional tumors that secrete hormones?

A

stromal cell
Glanulosa tumor makes estrogens
Sertoli Leydig makes androgens

166
Q

Tx for all ovarian benign tumors

A

excision

167
Q

What is the most lethal gynecologic ca?

A

Ovarian because of lack of early detection and increased rate of metastasis

168
Q

What is chromosomal makeup if a complete mole?

A

no fetus 46 XX

169
Q

What is the chromosomal make up of an incomplete mole

A

has a fetus and molar degneration 69 XXY

170
Q

How to diagnose molar pregnancy?

A

Ultrasound and EXTREMELY high bHCG levels

171
Q

What is the tx for molar pregnancy?

A

removal by D&C
Nonmetastatic perisistant = methotrexate
f/u with HCG levels

172
Q

Pt with band like bilateral HA dull in quality, Dx? Tx?

A

Tension HA

Nsaids, acetaminophen

173
Q

Male with unilateral HA associated with ipsilateral lacrimation, ptosis, nasal congestion and rhinorrhea. Dx? Tx?

A

Cluster HA

100% O2 or a triptan, 2nd line is dihydroergotamine

174
Q

Female with unilateral, HA with aura. Associated with scotoma, teichopsia, photopsias, rhodopsias, nausea and photophobia. Dx? Tx?

A

Migrane
Tx acutely with triptan
Prophylax with B blocker or ca channel blocker

175
Q

Female with unilateral temporal HA a/w jaw claudication, temporal artery tenderness with palpation ESR>50. Dx? Tx? Complication?

A

Termporal Arteritis (Giant cell) - screen with ESR, dx with Bx
Tx with corticosteroids
Complication of optic neuritis and blindness

176
Q

Episodic severe pain shooting from mouth to ipsilateral ear/eye/nose, peaks at age 60. Dx? Tx?

A

Trigeminal neuralgia - Dx with CT/ MRI

Tx: Carbamazepine (1st line) or phenytoin

177
Q

Worst HA of life bc of ruptured berry aneurysm. Dx? Tx?

A

Subarachnoid hemorrhage - Dx with CT

Tx with immediate neuro surg evaluation and nimodipine

178
Q

Medical and dental conditions affecting the TMJ and/or the muscles of mastication. Dx? Tx?

A

TMJ

Tx: nsaids, muscle relaxants, mouth gaurd

179
Q

What should you suspect in pts who wake up in the middle of the night by a headache who have projectile vomiting or who have had focal neuro deficits? What to order?

A

Increased ICP

Get a head CT

Boards and Wards Complete (13 decks)

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