OBGYN stuff Flashcards by Richard Froude

Abd pain, n/v, in young patient with known adnexal mass WITHOUT doppler flow - think?
Tx?

ovarian torsion

Laparoscopy with cystectomy

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Syphilis is pregnancy - do you still treat?

YES

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Hypothyroidism - what happens to demand for levo during pregancy?
So do what?

Demand increases

So increase the dose when pregnant

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Gestational hypertension vs chronic hypertension?

Chronic needs two separate measurements BEFORE 20 weeks gestation

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Chronic hypertension in pregnancy - increases risks of what (5 major FAPPS)?

Fetal growth restriction
Abruptio placentae
Preterm labor
Preeclampsia (superimposed)
Stillbirth

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Urinary retention after birth (esp. with epidural) - due to?
do what?
To check what?

Bladder atony
Urethral cath
To check post void residual less than 150 (normal) otherwise likely to be overflow incontinence

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Persistent fever postpartum or postop, unresponsive to ABX - think?
Veins affected?
Treat?

Septic thromboembolism
Deep pelvic or ovarian veins
Anti-coag and broad-spectrum ABX

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Pharyngitis, fever, lower abd pain in sexually active woman?

Gonococcal pharyngitis with assoc PID

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Effect of OCPs on ovarian and endometrial cancer risk?

And on HTN?

Reduce it

Can worsen HTN

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How to stop HIV transmission from mom to baby?

Triple anti-retroviral tx for mom in pregnancy and zidovudine for neonate

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Pregnancy labs: up, down, or normal?

Hgb, Cr and BUN, PLT, LFTs, GFR, protein in urine?

Hgb down, Cr and BUN down, PLT normal/down, LFTs normal, GFR up, protein urine up (1+)

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Vaginal yeast infx tx?

topical nystatin or oral azole

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When is a diagnostic lap indicated in suspected endometriosis?

After failure of NSAIDs and hormonal contraceptives

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In placenta previa where is the placenta?

So what is contraindicated?

Over the internal cervical os

No labor or vaginal delivery (get CS 36-37 weeks)

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High grade intraepithelial lesion (HSIL) on PAP, next step? And for pregnant patients?

LEEP

If pregnant, colposcopy then LEEP if invasive cancer

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Raditing suprapubic pain after traumatic delivery, worse when walking - think?
treat?

Pubic symphysis diastasis

supportive care

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Heat exhaustion vs heat stroke?

No CNS probs in heat exhasution
Heat exhaustion caused by inadequate water and sodium replacement so drop in cardiac output
Heat stroke due to thermoregulation failure

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Pharm tx for PCOS (to induce ovulation)?

But not until you’ve tried what lifestyle mod?

Clomiphene

Weight loss

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Amenorrhea in athletes due to?

hypothalmus (eg GnRH defic), so decreased LH secretion and decreased estrogen (so decr bone density too)

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Oxytocin can cause what complications (3)?

Tachysystole (all induction agents can), hyponatremia, hypptension

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Contraindications to breastfeeding (mom 6) and kid (1)?

Mom: untreated TB, varicella infx, herpetic breast lesions, current chemo, illicit drug use, HIV
Kid: galactosemia

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Abnormal first trimester screen - next step?

10-13 weeks chorionic villi sampling

15-20 weeks amniocentesis

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Ectopic pregnancy mgmt - stable vs unstable?

Stable: methotrexate
Unstable: surgery

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Most accurate test for determining fetal gestational age?

First trimester US

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UNIateral bloody nipple discharge - suggests? | Benign or malignant?

Intraductal papilloma | benign

Vaginosis tx?

Metro or clinda

Week cutoff for delivery rather than tocolytics in preterm labor?

34 weeks

Postpartum endometritis presenting with fever ?24 hours postpartun, puluent lochia and uterine tenderness - bugs? and drugs?

polymicrobial | clinda and gentamicin

Acute onset unilateral pelvic pain after sex or exercise - think? Diagnose with

Ruptured ovarian cyst | US showing free fluid in pelvis

Etiologies of incontience: Stress? Urge? Overflow?

Urethral hypermobility Detrusor overactivity Impaired detrusor contractility or bladder outlet obstruction

Mechanism of hypotension after epidural anesthesia?

Vasodilation and venous pooling in LE (from sympathetic blockade)

Infertility in PCOS is due to?

failed follicular maturation

Greatest risk factor for clear cell adenocarcinoma of vagina and cervix

Daughters of women given DES in pregnancy

Lichen sclerosus dx test? | Rx?

Vulvar punch bx | Topical steroids

Nuchal cord decels?

variable

Loss of fetal station during labor - (with abd pain, bleeding, fetal HR abnormalities) - think?

uterine rupture

Do you treat partner in trichomonas?

YES

Palpable breast mass next steps: adolescents? <30? >30?

observe through 1-2 menstrual cycles ultrasound (+/- mammogram) mammogram (+/- US)

Amenorrhea after chemo - think?

ovarian failure

When fetus is anything but occiput anterior it's called?

Fetal malposition

Painful, heavy menstrual bleeding progressing to chronic pelvic pain - think? Uterus on exam?

adenomyosis | Boggy, tender, uniformly englarged

Major role of bHCG?

preservation of corpus luteum in early pregnancy

Dry vagina, and mucosal membranes, and dental caries - think?

lack of lubrication due to Sjogrens

Raloxifene when given for osteoporosis ... Indication: Contraindication:

High risk for breast cancer | Hx of thromboembolism (etc.)

Maternal complications of abruption?

Hypovolemic shock and DIC

Trisomy 21 AFP and bHCG levels? Neural tube marker? Trsiomy 18?

low AFP and high bHCG and inhibin A high AFP normal inhibin A and low everything else

Decels linked to: Early? Late? Variable?

fetal head compression/normal (same time as contraction) uteroplacental insuff cord compression/oligohydramnios/cord prolapse

Persistent variable contractions - next step?

Re position mom ( to alleviate cord compression)

Best test for risk of preterm delivery after cervical surgery?

Trans vaginal US

Best contraception for pts with breast cancer?

Copper IUD

3 modifiable breast cancer risk reducers?

reduce alcohol, increase exercise, breastfeed

Hypertension casues symmetric or asymmetric growth restriction?

Asymmetric

Inevitable abortion, hemodynamically unstable - next step?

suction curettage (surgery)

When can you perform external cephalic version (i.e. after how many weeks)?

Pelvic mass and ascites with highly suspected ovarian cancer - Next step?

Ex lap

#1 lifestyle mod to lower BP?

DASH diet

Maternal fever and fetal tachycardia - suspect?

Chorioamnionitis

Preeclampsia urine protein/Cr ratio?

>0.3

Magnesium is renally or hepatically excreted?

Renally

PPROM before 34 weeks - next step? | When to deliver (3)?

steroids and antibiotics | after 34 weeks, intrauterine infection, deteriorating fetal/maternal status

Major risk factor for chorioaminonitis? | Tx?

prolonged rupture of membranes | amoxicillin & genta plus oxytocin to speed up labor

Itchy rash on nipple, post-menopausal woman - think?

paget dz of breast (underlying adenocarcinoma)

Postmenopausal adnexal mass - next step? Then?

CA-125 if normal then periodic US if elevated or suspicious features on USthen MRI/CT

How close to cervical os does placenta need to be to be contraindication to vaginal delivery?

<2cm

When does quad screen take place?

Second trimester

Primary ovarian insuff vs hypogonadotropic hypogonadism?

FSH is high in ovarian insuff and low in in HH

AUB - indications for endometrial biopsy?

All with AUB >45 | If less than 45 with AUB then get biopsy if chronic anovulation due to obesity

Postaprum woman with enlarged uterus, irregular vaginal bleeding, pulm sx, CXR infiltrates - think? Best test?

Choriocarcinoma | bHCG

Which gyn cancer is smoking a risk factor for?

Cervical

Do graves TSH antibodies cross placenta?

yes

Gestational DM - 1st and 2nd line tx?

1st: diet mod and exercise 2nd: insulin, metformin, glyburide

Initial steps for shoulder dystocia?

suprapubic pressure and McRoberts (hip flexion toward abd)

Decreased fetal movement, first and possible second tests?

NST, then biophysical profile if nonreactive

When to give RhoGam (anti D immune globulin)?

in negatvie moms, 28-32 weeks and again if baby is positive | OR after miscarriage or abortion, whenever blood might mix

Preterm labor pharm?

Steroids (betamethasone) If <34 weeks add Tocolytics (indomethacin, nifedipine) If <32 weeks add Mg And if GBS positive add PCN

Lung complication to look out for in pre-eclampsia?

pulmonary edema

DA-agonsits to stop lactation?

NO! avoid stimulation wear a supportive bra and OTC analgeiscs and ice packs for engorgement pain

Risks for being underweight in pregnancy?

fetal growth restriction and preterm delivery

>35 yo with atypical gladular cells on PAP - what next?

endometrial biopsy

Most effective emergency contraception?

Copper IUD

Looks like breast cancer but bx shows foamy macrophages and fat globules, hx of surgery or trauma?

Fat necrosis

Gonorrhea and chlamydia tx?

Azithromycin + ceftriaxone | UNLESS it is confirmed to be only chlamydia, then ONLY azithro

Eclampsia/preeclampsia/HELPP - pathology?

abnormality in placents triggers SYSTEMIC inflammation and activation of coag system and complement, with PLT consumption

Fibroids: type of incontinence assoc? | Imaging modality?

Stress | US

Clear, thin cervical mucus (accompanied by LH surge haha) - due to?

Ovulation

Tamoxifen - estrogen acitivity in breast vs uterus?

Antagonist in breast, agonist in uterus/endometrium

Vaginal cancer, age >60, risk factors same as cervical, foul bloody discharge - type of cancer?

squamous cell carcinoma

Young woman, sexually active, no barrier contraception: PID with liver involvement (painful)?

Fitz-Hugh-Curtis dz

OBGYN stuff Flashcards

(88 cards)