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Clin Med > OBGYN: Reno questions/answers > Flashcards

OBGYN: Reno questions/answers Flashcards

1
Q

Differentiate b/w placenta previa and abrupto placentae

A
  1. Placenta Previa
    * placenta covers part or all of cervical os
    * PAINLESS bleeding
    * during 3rd tri MC
  2. Abrupto Placentae
    * placenta detaches from uterus
    * PAINFUL bleeding (seen or unseen)
    * MC during 3rd tri
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2
Q

define pre term

A

delivery before 37 week

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3
Q

list two diagnostic criteria for per term labor

A
  1. regular uterine contraction <4-6/hour

2. cervical change: effacement of 80% or dilation of 3+CM

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4
Q

explain management of preterm labor after 34 weeks and before 34 weeks
-when can u discharge?

A

BEFORE 34 WEEKS

  • admit
  • fetal monitoring
  • give betamethasone
  • attempt to delay delivery for 48 hrs using MAG SULFATE
  • ABX prophylaxis for GBS

AFTER 34 WEEKS

  • admit
  • monitor
  • deliver

**if 4-6 hours pass with no progression of cervical effacement or dilation—- can discharge

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5
Q

4 RF for PROM

A
  1. vaginal/cervical infection
  2. smoking
  3. multiple gestations
  4. prior pre-term delivery
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6
Q

list two methods used to diagnose PROM

A
  1. check for FERNING under microscope

2. use nitrazine paper to check for alkalinity– turns blue if +amniotic fluid

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7
Q

what should we never put inside a vagina in a woman with PROM

A

anything that is NOT sterile—she is already at incr risk of infection

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8
Q

explain difference b/w PROM and PPROM

A

PROM=rupture of mem at 37+ weeks

PPROM= rupture of mem prior 37 weeks

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9
Q

management for PROM and PPROM

A

PROM

  • admit
  • fetal monitoring
  • monitor mom for infection
  • induce labor if no spontaneous labor after 18 hours

PPROM

  • admit
  • fetal monitor
  • if 34 weeks or less–>bethamethasone
  • ABX +/-
  • induce labor–> if after 48 hours OR earlier if signs of distress
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10
Q

Describe dystocia, 3 reasons, and its tx

A

Dystocia=labor that does not progress normally

management based off which of the three problems are causing it

  1. POWERS (intensity of contractions)–>give IV Oxytocin
  2. PASSENGER (fetus too big)–>c section
  3. PASSAGE (maternal pelvis too small)–>c section
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11
Q

what constitues arrest of labor

A

no change in cervical dilation or effacement despite 4 hours of adequate contractions (>200 montevideo units)

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12
Q

describe shoulder dystocia and its management

A

shoulders wont come out—- managed by different maneuvers

*if they dont work— break fetus clavicles

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13
Q

describe breech presentation and its management

A

butt coming out first

-managed based on experience of the OB and if they feel confident to deliver a breech vaginally

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14
Q

describe umbilical cord prolapse and its management

A

umbilical cord extends beyond the presenting fetal part

-managed by trying to release pressure on cord from baby’s head

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15
Q

list four MC indications for c-section

A
  1. dystocia
  2. prior c section
  3. breech presentation
  4. fetal distress
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16
Q

list absolute indication for a c-section

A

prior non-transverse uterine incision

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17
Q

describe uterine rupture

  • list signs/symps (4)
  • RF (5)
A

*when all muscle layers of uterus tear apart

S/S

  • extreme pain (worse than labor)
  • absent contractions
  • bleeding
  • fetal bradycardia*****

RF=previous uterine rupture, prior c-section, induction of labor with oxytocin, trauma, previous myomectomy

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18
Q

define PP hemorrhage

A

loss of blood >500 mL vaginal delivery, >1,000 mL C-section

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19
Q

four main causes of PP hemorrahge

A
  1. tone (uterine atony)
  2. tissue (retained placental tissue)
  3. trauma/lacerations
  4. thrombin (coag disorder)
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20
Q

RF for uterine atony (6)

A
  1. multiple gestations
  2. fetal macrosomia
  3. prolonged labor
  4. IV oxytocin
  5. Mag Sulfate to manage preeclampsia
  6. uterine leiomyomas/fibroids
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21
Q

tx for uterine atony

A
  1. uterine massage
  2. oxytocin
  3. if oxytocin doesnt work–>Methylergonovine
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22
Q

tx for refractory PP hemorrahge

A

tamponade
surgical ligation or cauterization of arteries
hysterectomy

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23
Q

3 causes of PP pain and how to manage it

A
  1. afterpains
  2. episiotomy
  3. lacerations
  4. breast engorgement
  5. post-epidural HA
  • *tx=
  • acetaminophen–NOT NSAIDS
  • ASA
  • codeine
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24
Q

describe colostrum and its purpose

A

yellow thick substance–secreted thru breast in first weeks PP–carries extra minerals, AAs and immunoglobulins (IgA) to protect baby from GI infections

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25
Q

riskiest time for PP hemorrahge

A

first hour after delivery

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26
Q

list five contraindications to BF

A
  1. maternal illicit drug use
  2. Maternal HIV
  3. maternal ETOH
  4. maternal untx, actiev TB
  5. BCA tx
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27
Q

explain how and why to start contraception after delivery

A

should start immediately after birth as ovulation can occur as early first 4 weeks

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28
Q

contraindications for contraception after delivery

A

no estrogen for at least first 12 weeks bc it incrs risk of clots and decrs milk prod

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29
Q

describe four main differences b/w PP blues and PP depression and list management of both

A

PP BLUES

  • dep mood 2-4 days PP (up to 10)
  • no thoughts of harming baby
  • management=anticipatory guideance, recognition and reassurance

PP DEP

  • major depression
  • thoughts of harming baby
  • starts b/w 2-4 weeks and 2 MO after delivery
  • tx=antideps and CBT
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30
Q

how is HCG used to help diagnose early pregnancy loss

A

confirm that a pregnancy is no longer viable—- when HCG is falling at the approrapite rate

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31
Q

explain discriminatory zone of HCG and how it is used

A
  • occurs at HCG=2500—-at this time you sould see a uterine pregnancy on sonogram
  • if you dont see a pregnancy in uterus and HCG is 2500+, then it is ectopic until proven otherwise
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32
Q

when is it acceptable and not acceptable to use expectant management of an early pregnancy loss?

A

can be utilized in a pregnancy that is 12 weeks or less—aka during first trimester

cannot utilizze if pregnancy is >12 weeks OR if there are s/s of infection

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33
Q

describe medical management of early preg loss and how it is done

A

patient is given one does of mifepristone and then 24 hrs later one dose of misoprostol

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34
Q

explain gestational trophoblastic dz and how it is diagnosed and tx

A

diagnosed via physical exam—
*mismatch b/w gestational age and uterine size/fundal height and HCG (is very very very high)

sonogram: “snowstorm” or “cluster of grapes”

tx: surgical D/C
weekly and monthly HCG monitoring

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35
Q

RF for ectopic preg (6)

A
  1. previous
  2. tubal ligation
  3. IUD
  4. hx of PID
  5. smoking
  6. use of reproductive technology
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36
Q

MC location for ectpic and why?

A

fallopian tubes
WHY?
*fertilized egg’s trajectory is tubes then the uterus— it is very very very rare to have eg implant outside these two areas

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37
Q

s/s of a probable ectopic pregnancy

A 
missed period 
\+ 
vaginal bleeding 
\+ 
lower abd pain
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38
Q

s/s and tx for acute ruptured ectopic preg

A

severe abd pain, rebound tenderness, dizziness, refered shoudler pain, hypovolemci shock

tx=surgery

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39
Q

diff in s/s, diagnosis and tx of
1. possible
2. probably
ectopic pregnancy

A

POSSIBLE

  • vague s/s, +/- mild abd pain
  • exma=normal

PROBABLE

  • missed period, abd pain, vaiginal bleeding
  • exam may have abd tenderness or + CMT
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40
Q

cause and tx of incompetent cervix

A

MCC= previous LEEP procedures

TX=cerclage— suture the cervix

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41
Q

s/s of abrupto placentae

A 
painful cramps 
abd pain 
vaginal bleeding (seen or unseen) 
back pain 
potential hemodynamic instability 
MC 3rd tri
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42
Q

tx for abrupto placentae

A

immediate delivery
iv fluids
blood transfussion for mom
control bleeding

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43
Q

use to tx women with HTN in pregnancy

A

methyldopa

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44
Q

list two diagnostic criteria for pre-eclampsia

A

new onset HTN and new onset proteinuria

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45
Q

list criteria for HELLP

A
  1. hemolysis
  2. elevated liver enzymes
  3. low platelets
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46
Q

s/s of eclampsia + tx

A

tonic-clonic seizures

TX= mag, HTN meds
DEFINITIVE TX=DELIVERY****

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47
Q

tx for GD and MC fetal consequence

A

insulin

macrosomia

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48
Q

how much folic acid should woman take and when to start and wht does it prevent

A
  1. 4mg/day for 1st tri

* prevents neural tube defects

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49
Q

list 5 common drugs contraindicated in pregnancy

A
  1. warfarin
  2. tetracycline
  3. valproic acid
  4. lithium
  5. benzos
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50
Q

5 physical exam findings that are common in pregnancy (but not cmmon otherwise)

A 
Sytolic murmurs 
S3 
spier angiomas 
striae 
linea nigra
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51
Q

chadwick’s sign, what does it indicate, and what does it look like

A

bluish color of cervix and vulva around 8-12 weeks gestation

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52
Q

how high is fundus at 20 weeks

A

umbilicus

53
Q

list 8 labs you need to order on every preg woman at her first prenatal visit

A 
UA 
Rh 
Rubella 
Syphilis 
Hep B 
HIV 
Gonorrhea 
Chlymida 
PPD
54
Q

be able to calculate delivery date based on Naegele’s rule

A

a. EDD= 1st day of LMP + 7 days – 3 months + 1 year

55
Q

deescribe genetic testing for the fetus in second trimester and how its done

A

triple screening w/ AFP, beta HCG and estradiol

56
Q

describe genetic screening for fetus in the first trimester and how its done

A

SONO–>NT thickness
MOM–>free HCG (if its up=risk of downs)
PAPP-A (LOW=risk of downs)

57
Q

3 lifestyle mods that can help morning sickness

A 
eat small and frequent meals 
avoid spicy or greasy food 
protein snacks at night 
saltine crackers by the bed 
room temp sodas
58
Q

about when should a first time mother feel the baby move

A

20 weeks

59
Q

list the 5 things that should be checked at every prenatal visit

A 
BP 
UA (protein + glucose) 
weight 
uterine size 
fetal HR
60
Q

purpose of Maneuvers of leopold

A

determine fetal position and lie

61
Q

describe differences b/w glucose screening test and glucose challenge test

A

screening test= 1 hour— if positive, then move to the diagnostic test= glucose challenge test–>3 hours

62
Q

what other dz should we screen mother for b/w 35 and 37 weks

A

GBS

63
Q

5 components of Biophysical profile

A 
non-stress testing 
fetal breathing 
fetal tones/heart rate 
amniotic fluid levels 
gross fetal movements
64
Q

describe a non stress test and what results are + and -

A

nonstres test is when we monitor the fetal HR and mom indicates when baby moves

  • –>we check the fetal tracing to make sure the HR goes up (>5 bpm from baseline >15 seconds) with movement
  • –>if this happens TWICE in 20 mins– REACTIVE (+)
  • —>this this does not happen— NONREACTIVE (-)
65
Q

define fetal monitor accelerations and variations and what causes them

A

ACCELERATIONS: incr in fetal HR in response to fetal movement or uterine contractions
–considered “good” bc they wil stop occuring if the fetus is hypoxic

Variations/variability:

  • difference in HR from beat-beat
  • normal range of variability is 5-25 BPM difference between beats
66
Q

explain fetal monitor decelerations and what they means, including wht makes them + and -

  • early decel?
  • variable decel
  • late decel
A

DECELERATIONS=deceleration in fetal HR to fetal movement or uterine contractions

  • EARLY decelerations occur at the same time as contractions and are normal in final stages of labor
  • VARIABLE decelerations that have no correlation to moms contractions are also normal

LATE decelerations occur within 30 seconds of contraction and indicate fetal hypoxia
—repetative late decels in precense of 3 contractions within 10 min period= POSITIVE test and we need to deliver the baby ASAP

67
Q

what causes symptoms of lightening, braxton hicks, and bloody show

A

LIGHTENING
*descent of fetal head into the pelvis— pelvic bone is now supporting some of the weight of the baby means the mom feels like the baby “got lighter”– hence name to lighten

BRAXON

  • “practice” contractions occur prior to labor
  • diff from regular contractions in that they occur RANDOMLY and there is NO cervical dilation or effacement

BLOOD SHOW
*mucus plug is released because of cervical effacement and dilation—often causes a small amt of bleeding

68
Q

MC type of female pelvis

A

Gynecoid

69
Q

what is fetal lie? presentation?

A

LIE

  • relation of fetus to the longitudinal axis (think of mom’s spine) of the mother
  • has to be longitudinal (parallel to spine) in order to have successful vaginal delivery

PRESENTATION
*which fetal part is set to come out first

70
Q

4 stages of labor and ID the star and end of each pint

A

STAGE 1= onset of true labor

  • STARTS: cervical effacement and dilation
  • ENDS: dilation of 10 cm

STAGE 2= delivery stage
STARTS: complete dilation
ENDS: delivery of fetus—-fetus does six cardinal movements

STAGE 3: placenta
STARTS: once fetus is delivered
ENDS: placenta delivered

STAGE 4: first hour after delivery of placenta
***MC time for PP hemmorrahge

71
Q

how quickly should the cervix dilate

A

once cervix reached 3-4 cm, it should begin dilating at a rate of 1-1.2 cm/hr

72
Q

best position for mother to lie in during stage 1 labor and why

A

LEFT side— reduces compression of liver, hepatic blood flow and VC

73
Q

describe difference b/w cervical effacement and dilation

A

effacement=cervix thins

dilation= cervix opens

74
Q

6 cardinal movements of labor

A 
1=engagement 
2=descent 
3=flexion 
4=internal rotation 
5=extension 
6=external rotation
75
Q

episiotomy and what are inds?

A

cut in the perinium to aid in delivery

no strict indications—- but they are often performed when there is difficulty getting fetal head out

76
Q

3 signs of placental separation

A
  1. gush of blood
  2. lengthening
  3. uterus (fundus) becomes firmer
77
Q

if we need to induce labor in a mother of 30 weeks, four things we must do

A
  1. admit and start fetal monitoring
  2. give betamethasone
  3. delay labor by 48 hours if possible with tocolytics (MAG)
  4. give GBS prophylaxs ABX
78
Q

APGAR

A

a. Appearance
i. 0= blue-gray and pale all over
ii. 1= acrocyanosis: body pink but blue extremities
iii. 2=pink baby with no cyanosis

b. Pulse
i. 0=0 bpm
ii. 1= <100 bpm
iii. 2= >100bpm

c. Grimace
i. 0=no response to stimulation
ii. 1= grimaces feebly
iii. 2=pulls away, sneezes or coughs

d. Activity
i. 0=none
ii. 1=some flexion
iii. 2=flexes arms and legs and resists extension

e. Respiration
i. 0=absent
ii. 1=weak, irregular
iii. 2=strong, crying (30-60/min is normal)

79
Q

describe normal vaginal discarhge– where does it come from

A

whtie or transparents
odorless

vulvar secretions from sebacoues, sweat, bartholin and skene glands

80
Q

normal vaginal PH

A

3.8-4.5

81
Q

role of lactobacilli in vagina

A

keep ph acidic—produces lactic acid and hydrogen peroxide

–prev growth of pathogens

82
Q 
BV 
-cause 
s/s 
diagnose 
tx
A

a. Cause
i. Gardnerella anaerobic bacteria
ii. Recent ABX use

b. Signs/Symptoms
i. Vaginal itching, vaginal burning, +/- pain with sex
ii. Vaginal discharge looks like gray/white profuse with fishy odor

c. Diagnose
i. Saline and KOH wet mount will show +clue cells
ii. pH >4.5
iii. Positive whiff test due

d. Treatment
i. Metronidazole PO 500 mg BID x 7 days or Intravaginal metronidazole gel x 5 days

83
Q 
Candidiasis 
cause
s/s 
diagnose 
tx
A

a. Cause
i. Candida albicans—fungal infection
ii. Recent ABX use

b. Signs/symptoms
i. Thick cottage cheese/cheesy vaginal discharge
ii. Pruritis
iii. Dysuria
iv. Burning
v. Dyspareunia
vi. Vaginal or vulvar edema
vii. Erythema and vaginal inflammation

c. Diagnose
i. KOH wet mount will show hyphae or budding of yeast
ii. pH between 4-4.5 range

d. Treatment
i. Clotrimazole or Nystatin intravaginally 3-7 days OR Fluconazole 150 mg PO once

84
Q

Trich

  • cause
  • s/s
  • diagnose
  • tx
A

a. Cause
i. MC found in sexually active women—STD
ii. Comes from parasite: trichomonas vaginalis

b. Signs/symptoms
i. Purulent, thin, frothy, malodorous, yellow-green discharge
ii. Burning, pruritis, dysuria, frequency, lower abdominal pain, dyspareunia
iii. Cervical exam will show a “strawberry cervix” or petechiae on the cervix

c. Diagnose
i. Wet mount will show pear shaped mobile protozoa with flagella
ii. pH is > 4.5

d. Treatment
i. Patient AND partner need treatmentMetronidazole 2g one time

85
Q

list cause and s/s of cervicitis and PID

A

Cervicitis–> STDs/STIs like GC/Chlymadia, irritants, bac vaginosis

S/S: red inflammed cervix with green/yellow discahrge coming out of the os—— if additional +CMT and or fever it becomes PID
Cervicitis only= NOT CMT, no fever

INCR WBC on went mount for both

86
Q

long term risks of PID

A

scared tubes=ectopic pregs and infertility

87
Q

tx for PID–outPT

A

OUTPT

*ceftriaxone 250mg IM x1 and Doxycycline 100mgPO bid x14 days—recheck in 24 hours

88
Q

how and when do we screen women for cervical CA

A

pap smear and HPV testing starting at age 21

89
Q

which 3 HPV types do we screenwomen for

A

6
18
45

90
Q

colposcopy

A

microscopic look at cervix

91
Q

which pap/HPV results warrant colposcopy

A

anything ASCUS or higher
or
HPV 16, 18

92
Q

what are the tx for cervical CA

A

LEEP
Cold Knife Cone
Hysterectomy
Chemotherapy

93
Q

what is a leiomyoma

A

fibroid–collection of uterine muscle

94
Q

what are the s/s of leiomyomas

tx?

A 
AUB 
dysmenorrhea 
pelvic pressure 
fullness 
constipation and frequent urination (if pressing on bladder)

cyclic pelvic pain
bad cramps
heavy bleeding during menses
can cause infertility

TX= hormonal contraceptives
myomectomy

95
Q

what is endometriosis

A

endometrial glands and/or stroma OUTSIDE uterus

96
Q

s/s endometriosis

A

pelvic pain
dysmenorrhea
dyspareunia
dyschezia–constipation

97
Q

endometriosis often causes?

A

infertility

98
Q

endometriosis tx

A

laparoscopy & ablation

oophorectomy (bc it relies on estrogen for growth)

99
Q

alarming sign for endometrial CA

A

abbnormal bleeding/spotting AFTER menopause

100
Q

3 protective factors against endometrial CA

A

decr exposure to estrogen (many pregs, late menarch)

combined contraceptives

101
Q

MC type of ovarian cyst

A

functional

102
Q

why do ovarian cysts occur

A

follicle that does not ovulate

103
Q

list two ways to differentiate ovarian cyst from ovarian CA

A

sonogram

biopsy— CA125

104
Q

s/s ovarian torsion

A

severe lower abd pain
nauea
pelvic tenderness

105
Q

how and when do we screen women for ovarian CA

A

we dont

106
Q

list 3 s/s ovarian CA

A

early satiety
bloating
pelvic or abdominal pain

107
Q

describe normal hormonal abnormalities of PCOS (3)

A
  • androgen excess (incr testosterone)
  • increased LH
  • insulin resistance
108
Q

s/s and tx PCOS

A

S/S

  1. menstrual dysfunctions/irregularities: oligomenorrhea (<9 periods/yr) or secondary amenorrhea
  2. Hirsutism
  3. acne
  4. androgenic alopecia
  5. insulin resistance—DM 2
  6. obesity

tx=hormonal contraceptives——– if that doesnt work enough then spironolactone

109
Q

MC benign breast condition

A

Fibrocystic breast dz

110
Q

what are breast cysts

A

small collections of fluid or a mix of fluid/debris in breast

111
Q

what are two common types of breast imaging

A

mammogran

sonogram

112
Q

list 8 RF for BCA

A
  1. age
  2. caucasian
  3. obesity
  4. tall
  5. more exposure to estrogen
  6. family hx with 1st deg relatives
  7. BRCA mutation
  8. ionizing radiation to chest
113
Q

how and when should avg risk women be screened for BCA

A

starting at 21, CBE q 1-3 years

Mammos starting at 40

114
Q

what breast s/s indicate possibility of BCA

A 
hard 
non-motile 
irreg boarders 
non-painful 
p'eau d'orange 
new onset nipple inversion 
unilateral nipple dsx
115
Q

two main types of atypical hyperplasia

A

atypical ductal hyperplasia (ADH)

Atypical lobular hyerplasia (ALH)

116
Q

if atypical hyperplasia is found on biopsy, what should happen next

A

excisional biopsy/lumpectomy

117
Q

what is the MC type of BCA

A

invasive ductal carcinoma

118
Q

what is the most aggressive BCA

-list s/s

A

inflammatory BCA

S/s

  • erythema
  • swelling
  • itching
  • tenderness
  • lymphadenopathy
119
Q

what prevents lactogenesis in preg woman

A

high progesterone—produced by placenta

120
Q

what hormone is released during suckling

A

prolactin

121
Q

what are s/s and tx for mastitis

A

Rubor, dolor, calor, tumor and FEVER

unilateral, single quadrant

TX

  • warm compress
  • dicloxacillin 500 MG PO qid x 10-14 days and KEEP BF
122
Q

what hormone is resp for preventing ovulation white BF

A

sucking + prolactin release causes inhibition of GnRH–>LH and FSH suppression

123
Q

what hormones decr in and after menopause

-effects of this decr?

A

FSH and estrogen

EFFECTS

  • hot flashes
  • skin dryness
  • hair loss
  • loss of libido
  • vaginal dryness
  • amenorrhea
124
Q

what is the main way hormonal contraception prevents pregnancy

A

inhib development and release of egg

125
Q

what 3 BC contain estrogen

A

COCs
Nuva ring
Patch–ortho evra

126
Q

3 types of EC

A

paraguard IUD
Ella
PLAN B

127
Q

six main contraindications for COC

A
  1. HTN
  2. migraines with aura
  3. previous blood clots/strokes
  4. smoking + >35
  5. known thrombogenic mutations
  6. lupus with phospholipid antibodies
128
Q

what must you warn patients about when starting combined hormonal contraceptives

A

ACHES

Abdominal pain 
Chest pain 
Headaches with aura 
Eye problems 
Severe leg pain

Clin Med (52 decks)

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