OBGYN UWorld Flashcards
What are early decelerations caused by?
- fetal head compression
- not nonreassuring
What is the tx of HELLP in a woman >34 wks?
-immediate delivery!
Pseudocyesis?
- psychiatric condition
- woman presents w/ all the ssx of pregnancy, but ultrasound shows normal endometrial stripe and negative pregnancy test
- form of conversion disorder
Missed abortion?
- ultrasound shows intrauterine collapsed gestational sac + absent fetal cardiac activity
- office pregnancy test will be positive
Tx of small HPV lesions?
- trichloroacetic acid
- podophyllin
- both tx are in office tx
Tx of larger HPV lesions?
- Excision
2. Fulguration (electric current)
Tx for gonorrhea?
- ceftriaxone
- plus tx for co-infection with chlamydia with azithromycin or doxycyline
What beta hCG levek is necessary to view gestation sac with transabdominal US? Transvaginal US?
- transabdominal = > 6,500
- transvaginal = > 1,500
What rate of change of beta hCG is considered normal for a normal pregnancy?
- doubling every 48 hours
- slower rise = ectopic pregnancy
After what point is a breech presentation probably not going to change?
- > 37 wks
Major sfx of raloxifene?
-increased risk for venous thromboembolism
Raloxifene: MOA? Use?
- selective estrogen receptor modulator
- increases bone mineral density
- use = prevent osteoporosis
Lower pain that radiates to the thighs and back that begins hours before menstruation?
- primary dysmenorrhea
- believed to be caused by an increased release prostaglandins during the breakdown of the endometrium
Pregnant women and the influenza vaccine?
-CDC recommends that ALL pregnant women are vacinated!
Tx of syphilis?
-penicillin V, even in an allergic pt! (Desensitize and give it to them! )
What increases the risk for cervical insufficiency?
- Maternal obstetrical trauma
- Past GYN procedures, including LEEP or cone bx
- DES exposure
- Multiple gestation
- Hx of preterm birth or second trimester pregnancy loss
Short cervix?
-cervix that is below the 10th percentile for gestational age
What BPP suggests severe fetal asphyxia? Tx?
- biophysical profile score of 2 or less
- tx: immediate delivery
What 5 things make up the BPP?
- Nonstress test (reactive)
- Fetal tone (flexion or extension of an extremity)
- Fetal mvmnts (at least 2 in 30 min)
- Fetal breathing mvmnts (at least 20 sec in 30 min)
- Amniotic fluid volume (single pocket greater than 2 cm in vertical axis)
- each get a score of 0-2
Adipose tissue and estrogen?
-adrenal androgens get converted into estrogens by the adipose tissue
Cause of hypotension with epidural anesthesia?
- blood redistributes to lower extremities and venous pooling occurs
- due to fiber block that results in vasodilation of lower extremity vessels
What is the best test for fetal chromosomal abnormalities in the first trimester?
-chorionic villius sampling
When is chorionic villus sampling typically done? Why?
- usually done btwn 10-12 wks
- when done before 9 wks there is a greater risk of distal limb reduction defects
2 Major complications of chorionic villus sampling?
- Limb reduction defects
2. Fetal death
Intrauterine fetal demise?
-death of fetus in utero after 20 wks gestation
What should be done after the dx of IUFD? Why?
- Coagulation studies
- to detect DIC
- retention of dead fetus can cause chronic consumptive coagulopathy due to the gradual release of tissue factor from placenta into maternal circulation
- low levels of fibrinogen can be an early sign of consumptive coagulopathy –> tx = delivery!!
Tx of chorioamnionitis associated with PPROM?
-broad-spectrum antibiotic tx + delivery of fetus!
2 causes of HTN in < 20 wks gestation?
- Chronic HTN
2. Hydatidiform mole
What is the most common risk for placental abruption?
-HTN
What should be ruled out in any woman of child bearing age with secondary amenorrhea?
-PREGNANCY!!
Tx of BV?
-oral metronidazole (in both pregnant and nonpregnant women)
Threatened abortion?
- any hemorrhage that occurs before 20th week of gestation w/ a live fetus
- cervix is closed
- no passage of fetal tissue
Tx for threatened abortion?
- reassurance and outpt follow up
- bed rest and abstaining from sexual intercourse is also often reccommended
Mittelschmerz?
- midcycle pain
- common w/ regular menstrual periods in women who are not taking birth control pills (ie ovulating women)
- pain is the result of ovulation
- pain occurs 2 wks after the start of the LMP
- usually unilateral pain (on the side of the ovary that produced the ovum)
Classic clinical triad for hydatidiform mole?
- Enlarged uterus
- Hyperemesis
- Markedly elevated beta hCG (>100,000)
Gold standard for dx of endometriosis?
-laparoscopy
What are women with endometriosis at increased risk for?
-infertility or decreased fertility
What is the classic triad for uterine fibroids?
- Dysmenorrhea
- Heavy menses
- Enlarged uetrus
What is the cause of variable decelerations on fetal heart tracings?
-umbilical cord compression
What is the cause of late decelerations on fetal heart tracings?
-uteroplacental insufficiency –> fetal hypoxia –>fetal acidosis
What is a primary risk factor for adnexal torsion?
-ovarian enlargement
What should be done if atypical squamous cells of undetermined significance are found on cytology in a woman: 21-24 yo? > 25?
- 21-24 = repeat cytology in 1 yr
- > 25 = HPV DNA test –> if positive = do colposcopy
What is the most common cause of mucopurulent cervicitis?
-Chlamydia trachomatis
Presentation of androgen resistance?
- Primary amenorrhea
- normally developed breasts
- absent pubic hair
- absent axillary hair
- absent internal reproductive organs –> dont develop bc testes are still present and secrete mullerian inhibiting factor
- 46 XY karyotype
- serum testosterone levels (high, in the range for normal males)
What heart defect commonly presents during pregnancy? What is it often due to?
- mitral stenosis –> bc physiologically increased total blood volume
- due to rheumatic fever in the past, seen esp in pts from countries with limited antibiotic access
What is the most common cervical cytological abnormality?
-atypical squamous cells of undetermined significance (ASC-US)
What is the work-up for atypical squamous cells of undermined significance when they are found on pap smear in ages 21-24?
- HPV testing
- positive = do colposcopy
- negative = repeat smear AND HPV testing in 3 yrs
How do pts with androgen resistance present?
- Amenorrhea
- Normally developed breasts
- Absent pubic & axillary hair
- Absent internal reproductive organs –> testes are present and secrete mullerian inhibiting factor
- 46 XY karyotype
What is the best parameter to use to estimate the fetal weight?
-abdominal circumference
What is the single most prevalent preventable cause of FGF in the US?
-smoking cessation!
In an eclamptic patient who just had a seizure what is the next step in tx?
-administer mag, then deliver baby
2 Recommended tx options for stress incontinence?
- Kegel exercises
2. Urethroplexy
What are the 2 first-line agents for tx of HTN in pregnant women?
- Labetalol
2. Methyldopa
What is the best way to dx primary syphilis?
-dark field microscopy!
FSH & LH levels in anovulation?
-will be normal
What is the best screening test for hemoglobinopathies in pregnancy?
- CBC of the mother
- if abnormal, further testing is required (ex MCV)
Tx of mastitis?
- Analgesics
- Frequent breastfeeding
- Antibiotics (that target staph aureus)
At what levels of beta HCG can a pregnancy be seen via transvaginal US in the uterus?
-1,500-2,000
What does DES increase the risk of?
- clear cell adenocarcinoma of the vagina and cervix in the female offspring if the mother took the drug during pregnancy
- also at risk for cervical anomalies and uterine malformations
What are the 2 main causes of back pain in 3rd trimester of pregnancy?
- Increase in lumbar lordosis
2. Relaxation of the ligaments that support the joints of the pelvic girdle
What is the reason for anovulation and amenorrhea in lActating mothers?
-high levels of prolactin, which has an inhibitory effect on FSH and LH
Most common cause of postpartum hemorrhage?
-uterine atony
Describe cervical mucus during ovulation and post and pre?
- during = profuse, clear, thin
- post & pre = scant, opaque, thick
Painful 3rd trimester bleeding w/ normal US?
-think: placental abruption
What is the management for intrahepatic cholestasis of pregnancy? Prognosis?
- delivery baby as soon as there is fetal lung maturity
- maternal prognosis = good, resolves shortly after delivery
- baby = risk of prematurity, meconium-stained amniotic fluid, and IUFD
What is one situation when solid ovarian tumors do not need aggressive evaluation and tx?
-in pregnancy! = luteoma of pregnancy
Luteoma of pregnancy?
- usually bilateral, multinodular, solid masses on both ovaries that can occur during pregnancy
- the result of proliferation of luteinized stromal cells in response to beta HCG
- most commonly seen in multiparous african american women in their 30s or 40s
- can be asymptomatic, or cause hirsutism/virilization
3 Steps to working up primary amenorrhea?
- FSH measurement if there is no breast development
- Pit MRI if FSH is decreased
- Karyotyping if FSH is increased
What about nausea in pregnancy can make you suspect a missed abortion?
-suspect missed abortion when there is a disappearance of nausea/vomiting early in pregnancy
What is a reactive NST?
- when there are 2 fetal heart rate accelerations of at least 15 bpm lasting at least 15 sec each in 20min
- reactive = normal!
What should be done if there is a nonreactive NST?
- try vigorously to stimulate/wake the baby
- if still not retactive, do a biophysical profile
What should be done if there are repetitive late decelerations?
-emergent c-section!
Tx for mag toxicity?
-stop the mag and give calcium gluconate IV
What is a normal biophysical profile score? What should be done for a normal result?
- normal = 8-10
- if normal, repeat once or twice weekly until term for high risk pregnancies
What is the tx of choice for trich?
-metronidazole
What should be avoided when taking metronidazole? Why?
- alcohol should be avoided
- bc can cause a disulfram-like rxn = flushing, nausea, vomiting, & hypotension
What are the 3 red flags for nipple discharge?
- Unilateral
- Guaiac positive
- Breast lump
What are the 2 lab tests that should be done in the workup for galactorrhea?
- TSH level
2. Prolactin level
What is e most common cause of an abnormal alpha-fetoprotein level?
-gestational age error
What are the 9 causes of abnormal uterine bleeding in nonpregnant women?
- Polyp (endometrial)
- Adenomyosis
- Leiomyoma (submucosal & other)
- Malignancy & hyperplasia
- Coagulopathy
- Ovulatory dysfunction
- Endometrial (ex. Infection or inflammation)
- Iatrogenic (ex. Anticoagulants)
- Not yet classified
* *PALM COEIN
What L/S ratio should steroids be given at?
-less than 2
4 lab test that should be done with amenorrhea?
- Pregnancy test
- FSH = to r/o ovarian failure
- Prolactin = evaluate for hyperprolactinemia
- TSH = evaluate for hyper/hypoTH
