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*Pance Re-Up * > OBGYN Precision & Pearls #2 > Flashcards

OBGYN Precision & Pearls #2 Flashcards

1
Q

What is trophoblastic disease (molar pregnancy)?

Also, explain what complete vs partial means

A

Pregnancy due to nonviable fertilized egg implanting, leading to abnormal placental development

-Complete (Diploid 46XX): all paternal chromosomes and no fetal tissue

Partial (Triploid 69XXX or XXY): egg fertilized by 2 sperm. Fetal tissue present but not viable

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2
Q

A molar pregnancy has a higher risk of developing into _______ and some risk factors for a molar pregnancy include…..

A

Choriocarcinoma

Prior molar pregnancy and extremes of age (<20 and > 35)

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3
Q

What are some symptoms of a molar pregnancy?

A

-Painless vaginal bleeding
-Uterine size/date discrepancies (larger than expected)
-Preeclampsia before 20 weeks
-Hyperemesis gravidarum earlier than usual
-Choriocarcinoma (METS MC to lungs)

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4
Q

What labs are done for a molar pregnancy and what do they normally show?

A

-Beta HCG very high (>100,000)
-Alpha fetoprotein very low
-Pelvic US: snowstorm or cluster of grapes (no fetal parts or heart tones)

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5
Q

Treatment for a molar pregnancy

A

Surgical uterine evacuation (suction curettage). Followed weekly until Beta HCG levels fall to undetectable level.

Chest XR to check for METS for choriocarcinoma. If present, chemo/radiation.

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6
Q

Risks for developing gestational diabetes, fetal risks of diabetes, and maternal complications of gestational diabetes.

A

Risks for developing: Obesity, > 25 years old, African American race, Family history, birthing baby > 4000g, multiple gestations

Fetal complications: Macrosomia (MC), preterm labor, neonatal hypoglycemia, neonatal hypocalcemia

Maternal complications: 50% chance of developing DMII after pregnancy

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7
Q

How long postpartum should the mother be screened for diabetes?

A

Screen mom 6 weeks postpartum for DM and then yearly afterwards

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8
Q

Screening for gestational diabetes (2 step)

What is the GOLD STANDARD diagnostic?

A

Step 1: 50g 1 hr glucose challenge test: If 130-140g, do 3 hour test

Step 2: 100g 3 hr glucose challenge test: Positive if 2 or more of the following: (>95 after fasting, >180 at 1 hour, >155 at 2 hours, >140 at 3 hours)

Testing is done at 24-28 weeks

3 hour glucose challenge is the GOLD STANDARD

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9
Q

What is the treatment for gestational diabetes

A

1) Lifestyle modifications: diet and exercise/walking
2) Insulin (1st DOC)
3) Glyburide and Metformin also safe in pregnancy

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10
Q

What is another recommendation for gestational diabetes and delivery times?

A

Daily fingersticks overnight and after each meal

Labor induction at 38 weeks if uncontrolled/macrosomia.

Labor induction at 40 weeks if controlled/no macrosomia

Recommend C-section if diabetic

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11
Q

What is normal morning sickness considered?

A

Nausea and vomiting up until 16 weeks

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12
Q

What is hyperemesis gravidarum?

A

Severe, excessive morning sickness associated with weight loss and electrolyte imbalance. Persists > 16 weeks

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13
Q

Treatment for Hyperemesis gravidarum

A

-PO or IV Fluids
-Bland diet: BRAT (Bananas, Rice, Applesauce, Toast)
-Pyridoxine (B6) + Doxylamine

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14
Q

What is chronic preexisting hypertension and what is the treatment?

A

Hypertension before 20 weeks gestation

Treatment: Labetolol, Nifedipine, Methyldopa are first line agents

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15
Q

What two anti-hypertensive classes should NOT be used in treatment of gestational hypertension?

A

ACE and ARB

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16
Q

On the other hand, what is transitional hypertension? What is the treatment for this?

A

New onset hypertension after 20 weeks gestation with NO proteinuria or end organ dysfunction

Nifedipine, Labetolol, Methyldopa

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17
Q

When does transitional hypertension normally resolve?

A

12 weeks postpartum

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18
Q

For pregnancy HTN, what should you do to monitor the patient?

A

Check BP
Ask about symptoms of HTN such as headache, visual symptoms.
Check for fetal growth restriction.
Look for edema.
Increased DTR’s.

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19
Q

What is preeclampsia? What does it mean to have MILD vs SEVERE?

A

New onset hypertension after 20 weeks gestation with proteinuria and end organ dysfunction.

MILD: >140/90, proteinuria > 300mg/24 hours (or dipstick 1+ or 2+)

SEVERE: >160/110, proteinuria >5g (or dipstick 3+)

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20
Q

What are some end-organ symptoms of preeclampsia?

A

Headache, flashes, blurry vision, RUQ pain, peripheral edema

-Progressive renal insufficiency: oliguria
-Thrombocytopenia
-HELLP Syndrome: Hemolytic anemia, elevated liver enzymes, low platelets

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21
Q

Treatment for preeclampsia (if >37 weeks vs < 37 weeks)

A

-If 37 or more weeks: prompt delivery
-If < 37 weeks, expectant management (daily weights, BP monitoring, dipsticks, bed rest, steroids for lung maturity)

-Give IV Mag Sulfate to prevent seizures

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22
Q

What is eclampsia? What is the treatment?

A

Preeclampsia + onset of tonic-clonic seizures, or coma
-Also can have hyperreflexia

Treatment: ABCD’s first, IV Mag Sulfate for seizures, Lorazepam is 2nd line for refractory.

Delivery of fetus once patient stabilized.

BP meds: Hydralazine or Labetolol IV

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23
Q

How long postpartum can preeclampsia continue?

A

6 weeks postpartum

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24
Q

Postpartum depression can occur in what time frame? What is the treatment?

A

2 weeks - 12 months postpartum

SSRI + CBT

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25
Q

MC type of vaginal cancer. What is the MC site of this cancer?

A

Squamous cell carcinoma

Posterior wall of the upper 1/3 of the vagina

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26
Q

Symptoms of vaginal cancer? What is the definitive diagnostic and treatment?

A

Abnormal vaginal bleeding (postcoital)

Biopsy is definitive

Surgical excision or radiation therapy is treatment

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27
Q

MC type of vulvar cancer? MC risk factor for this cancer? Symptoms? MC location?

A

Squamous cell carcinoma

HPV 16 and 18, DES exposure, 50 years old

Vulvar pruritis, bleeding, pain

Labia Majoris

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28
Q

What is seen on exam in a patient with vulvar cancer?

A

Red or white ulcerative or crusted lesion

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29
Q

Definitive diagnostic for vulva cancer

A

Biopsy with acetic acid

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30
Q

Explain the two types of multiple gestations and what diagnostics show if the patient does have multiple babies.

A

Dizygotic (Fraternal): 2 ova by 2 sperm
Monozygotic (Identical): 1 ovum that splits

Elevated B-HCG and maternal serum alphafetoprotein higher than normal

31
Q

What diagnostic is done to confirm multiple gestation?

A

US

32
Q

Explain what happens in Rh Alloimmunization

A

When an RH- mom carries an RH+ fetus, she develops anti-RH antibodies with any fetal blood that leaks into maternal circulation.

The antibodies attack fetal RBC of subsequent RH+ pregnancies, causing hemolysis.

33
Q

Symptoms of RH hemolysis attack

A

Jaundice, kernicterus, hydrops fetalis, anemia

34
Q

What are the 3 situations in which RhoGAM is given to an Rh-negative mom?

A

-at 28 weeks gestation
-within 72 hours of delivery of an RH+ baby
-after any potential mixing of blood (spontaneous abortion, vaginal bleeding, etc.)

35
Q

Explain vaginal bleeding in a neonate

A

This is normal and called false menses. It is cause by the sudden drop in mother’s estrogen after birth. The pink discharge should not last more than 3-4 days.

36
Q

What is placenta previa? What are the MC symptoms of this condition?

A

Abnormal placement of placenta over or close to the os

-Sudden onset of bright red painless bleeding in the 3rd trimester. No abdominal tenderness or uterine tenderness. Soft, nontender uterus

37
Q

What diagnostic can be done to confirm placenta previa? What should NOT be done?

A

Pelvic US (Transvaginal US)

Do NOT perform pelvic exam

38
Q

What is abruptio placentae and what is the pathophysiology of this condition?

A

Premature separation of a normally implanted placenta

Rupture of maternal blood vessels in the decidua basalis

39
Q

Risks for abruptio placentae as well as symptoms of this condition?

A

Maternal HTN (MC)
History of trauma (car crash, being hit in the stomach, etc.)

Sudden onset of dark red vaginal bleeding in 3rd trimester. Abdominal pain. Tender, rigid uterus. Fetal Distress!

40
Q

What is one maintenance/education thing that patients should be aware to control HSV-1 or HSV-2?

A

Educate patients about safe sex, condom use, etc.

41
Q

What are three indications to perform a C-section on a pregnant patient?

A

-Failure to progress during labor (MC)
-Nonreassuring fetal status
-Fetal malpresentation
-Multiple gestations

42
Q

What are two things that should be done to the patient if undergoing a C-section?

A

IV Cefazolin 60 minutes before incision

Mechanical thromboprophylaxis (get up and move around to avoid clots)

43
Q

Is vaginal birth after previous C-section safe? What are some cases in which it is NOT safe?

A

Yes, considered safe.

-Placenta previa, heart disease, SOB.

-The baby is less likely to have respiratory problems after birth, less pain/quicker recovery, less risk to future pregnancies, less risk of bleeding/infection/blood clots

44
Q

What are the periooperative ABX prophylaxis recommendations for a pregnant patient

A

C-section: IV Cefazolin +/- Azithromycin if performed after rupture of membranes.

If ROM or in labor, vaginal cleansing with povidone-iodine vaginal scrub for 30 seconds to reduce risk of endometritis.

45
Q

Risk factors for breast cancer

A

-BRCA1 and BRCA2 gene
-Age > 60 years old
-Increased # of menstrual cycles
-Increased exposure to estrogen: Obesity, ETOH, OCPs, endometrial cancer

46
Q

What is seen on exam in a patient with breast cancer? (Describe the mass)

A

-Painless, hard fixed mass MC in upper outer quadrant
-Skin changes: erythema, skin retraction, nipple inversion
-Axillary LAD

47
Q

Explain inflammatory breast cancer

A

Red, swollen, warm, itchy breast

Peau d’ Orange: lymphatic obstruction (poor prognosis)

48
Q

Where does breast cancer MC MET to (4 options)

A

-Bone, Brain, liver, lung

2B2L

49
Q

What diagnostics should be done if a patient has a breast mass (if patient > 40 and if patient < 40)

A

< 40: Initial is US
> 40: Initial is Mammogram

If positive, then biopsy. FNA or large needle/core biopsy.

50
Q

Explain the positives and negatives of FNA vs large needle/core biopsy

A

FNA: removes least tissue but no receptor testing

Core biopsy: greater deformity but allows for receptor testing

51
Q

Most accurate test for breast cancer

A

Open biopsy

52
Q

What are the three recommendations for breast cancer screening (mammogram, clinical breast exam, and self breast exam)

A

-Mammogram: annually for > 40 years old or 10 years prior to age of 1st degree relative diagnosed
-Clinical Breast Exam: age 20-39 at least every 3 hours, and > 40 annually
-Self Breast Exam: monthly > 20 years old (immediately after menstruation or on days 5-7 of menses in shower leaning forward)

53
Q

For breast cancer prevention, what can be given and to who? How long is the treatment usually given?

A

Tamoxifen or Raloxifene in postmenopausal women or >35 years old at high risk

-Treatment usually for 5 years
-Remember that Tamoxifen is preferred, but has an increased risk of DVT

54
Q

Treatment for breast cancer depends on staging. What does this mean?

A

Lumpectomy with sentinel node biopsy and follow up radiation if small and early

Mastectomy if large tumor

55
Q

Most useful drugs if breast cancer is ER positive and pre-menopausal women: ______

ER+ and postmenopausal women: _______

HER2 positivity: _______

A

Anti-Estrogen (Tamoxifen)

Aromatase inhibitors (Letrozole, Anastrozole)

Trastuzumab (Monoclonal Ab treatment)

56
Q

Ovarian cancer has the highest mortality of all gynecological cancers. What are some risk factors for this condition?

A

Increased number of ovulatory cycles (nulliparity, early menarche, late menopause, > 50 years old)
-BRCA1 and BRCA2
-Family history
-Lynch Syndrome
-Smoking
-Sedentary Lifestyle

57
Q

True or False: OCP use reduces risk of ovarian cancer?

A

True

58
Q

Symptoms of ovarian cancer

A

Asymptomatic until late in disease
-Ascites, solid/fixed/irregular ovarian mass
-Sister Mary Joseph nodule (METS to umbilical lymph nodes)
-Change in bowel habits
-Early satiety

59
Q

Diagnostics done for ovarian cancer

A

Pelvic US (initially)
Ca-125 levels
CT of abdomen and pelvis to stage

60
Q

Treatment for ovarian cancer

A

-Early stage: TAH-BSO + selective lymphadenectomy
-Surgery: tumor debulking, CA-125 used to monitor treatment progress
-Chemotherapy (Cisplatin or Carboplatin)

61
Q

MC type of ovarian cyst

Symptoms of an ovarian cyst

Diagnostics done for this condition

A

Follicular cyst

Unilateral pelvic pain, mobile adnexal mass

Transvaginal US

62
Q

Treatment for an ovarian cyst if < 8 cm:

If > 8 cm:

If post-menopausal:

A

<8 cm: Supportive. Most resolve. NSAIDs, rest.

> 8 cm: Laparoscopy or Laparotomy

Post-Menopausal: Laparoscopy or Laparotomy if large or CA-125 levels elevated. Malignant in this population until proven otherwise.

63
Q

For mucopurulent cervicitis, what should you do first?

A

Obtain culture for gonorrhea and chlamydia

See strawberry cervix on exam

64
Q

Treatment for cervicitis

A

Empirically while you wait for culture

Ceftriaxone + Azithromycin + Metronidazole +/- Doxy

-Week of abstinence

65
Q

When is induction of labor done and why?

What are some absolute contraindications to this?

What is used to induce labor (based on Bishop Score).

A

if >40-42 weeks or any gestational age where complications may occur

-Placenta Previa, Active Genital Herpes, Breech Presentation, Uterine Scar from C-Section

Bishop Score < 6: cervical ripening with Prostaglandin gel (Misoprostol)

Bishop Score > 6: IV Oxytocin (Pitocin)

66
Q

Health Maintenance, Patient Education, and Preventative Measures for puberty

A

-Recommend HPV vaccine for boys and girls
-Recommend HepB and TDaP boosters
-Protected sex and condom use discussed
-Gynecomastia in males can be normal and will usually resolve spontaneously

67
Q

What are the cardinal movements of labor in order

A

-Engagement
-Descent
-Flexion
-Internal Rotation
-Extension
-External Rotation
-Expulsion

68
Q

Normal pregnancy is the MCC of _______. What is the nausea and vomiting due to?

A

Secondary amenorrhea

Rise in beta-HcG

69
Q

On a patient who is pregnant, uterus and cervix changes occur. Explain these and what they are.

Ladin’s Sign:
Hegar’s Sign:
Goodell’s Sign:
Chadwick’s Sign:

A

-Ladin: uterus softening after 6 weeks
-Hegar: uterine isthmus softening after 6-8 weeks
-Goodell: cervical softening with increased vascularization at 4-5 weeks
-Chadwick: bluish discoloration of cervix and vulva at 8-12 weeks

70
Q

Explain fetal distress (why it occurs and what you seen on diagnostics)

A

Occurs when a fetus does not receive adequate amount of oxygen

Abnormal fetal HR, repetitive variable decelerations, low biophysical profile, and late decelerations

71
Q

What is menorrhagia?

What treatment options can be given for this?

A

heavy bleeding at normal intervals

OCPs: regulates the cycles, thins endometrial lining. Progesterone, Mirena, Leuprolide + Progesterone

72
Q

What diagnostics should be done if a patient has Fragile X Syndrome?

A

XR of spine: check for scoliosis
Echo to exclude MVP
Molecular testing (DNA - FMR1 gene, PCR)
Ophthalmology exam
Audiology exam

73
Q

Explain the karyotype of the following genetic conditions:

Turner Syndrome:
Klinefelter’s Syndrome:
Fragile X:
Down Syndrome:
Prader-Willi Syndrome:
Tay-Sach’s Disease:

A

-Turner: 45, XO (female)
-Klinefelter: 47,XXY (male)
-Fragile X: MC gene related cause of Autism, FMR1 gene (male)
-Down Syndrome: 3 copies of chromosome 21
-Prader Willi: deletion of genes on chromosome 15
-Tay Sachs: Autosomal recessive mutation of HEXA gene on chromosome 15

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