OBGYN UWorld Facts Flashcards
1
Q
PPD2 w/bilateral breast tenderness, warmth, redness, and tense ==> dx?
A
- likely breast engorgement
- most common during first 24-72h after delivery due to milk accumulation
- usually resolves @ 3-5 days
- tx = cool compresses, anti-inflammatory
2
Q
Mastitis presentation
A
- fever
- unilateral, isolated area of warmth, redness, tenderness on breast
- due to plugged milk ducts + infection
- tx = anti-staphylococcal agents
3
Q
Sheehan syndrome presentation
A
- ischemic necrosis (usually associated w/peri-partum bleeding) ==> hypopituitarism
- hypopituitarism ==>
- decreased prolactin ==> lactation failure
- hypothyroidism ==> lethargy, weight gain,etc.
- hypogonadism/amenhorrhea
4
Q
Common causes of hypopituitarism after pregnancy
A
- sheehan sydnrome
- lymphocytic hypophysitis
5
Q
Lymphocytic hypophysitis presentation
A
- H/A
- visual disturbance
- hypopituitarism
6
Q
Most accurate dating method
A
- first-trimester US w/crown rump length
7
Q
Management of hypothyroidism during pregnancy
A
- Most women will require increased dose of levothyroxine, esp. during first trimester
- usually frequently check TSH, every 2-3 months
- usually elevated levels of total T3/T4 due to increased TBG
- important to manage hypothyroidism b/c can lead to defects in fetus
8
Q
Early deceleration definition and etiology
A
- Early =
- symmetric w/contraction
- nadir of deceleration corresponds to peak of contraction
- gradual = >30s from onset to nadir
- Etiology
- fetal head compression
- can be normal
9
Q
Late develeration definition and etiology
A
- Late
- delayed compared to contraction
- nadir occurs after peak of contraction
- gradual - >30s from onset to nadir
- etiology
- uteroplacental insufficiency
10
Q
Variable deceleration definition and etiolgy
A
- Variable
- can be, but not necc., associated with contractions
- abrupt -
- decrease >15/min over >15s (but less than 2 min)
- etiology
- cord compression
- oligohydramnios
- cord prolapse
11
Q
Differential diagnosis of vaginitis
A
- bacterial vaginosis = gardnerella vaginalis
- trichomoniasis = trichomonas vaginalis
- candida vaginitis = candida albicans
12
Q
Bacterial vaginosis: exam findings, lab/wet mount findings, tx
A
- Exam
- thin, off-white discharge w/fishy odor
- no inflammation
- Lab
- pH>4.5 (basic)
- clue cells
- positive whiff test = amine odor w/KOH
- Tx = metronidazole (w/out partner tx)
13
Q
Trichomoniasis: exam findings, lab/wet mount findings, tx
A
- Exam
- thin, yellow-green, malodorous, frothy discharge
- vaginal inflammation
- Lab
- pH > 4.5
- motile trichomonads
- Tx
- metronidazole + sexual partner tx
14
Q
Candida vaginalis (yeast infection): exam findings, lab/wet mount findings, tx
A
- Exam
- thick, cottage cheese discharge
- vaginal inflammation
- Lab
- normal pH (3.8-4.2)
- pseudohyphae
- tx
- oral fluconazole
- intravaginal nystatin
15
Q
Secondary amenorrhea definition
A
- absence of menses for >=3 cycles or >=6 months in women who menstruated previously
16
Q
Evaluation of secondary amenorrhea
A
- Pregnancy test
- If negative + hx of prior uterine procedure or infection ==> hysteroscopy
- If negative w/out uterine procedure or infection hx ==> check prolactin, TSH, FSH
- Increased prolactin ==> brain MRI
- Increased TSH ==> hypothyroidism
- Increased FSH ==> premature ovarian failure
17
Q
Baby born with microcephaly, hypoplasia of diastal phalanges of fingers/toes, excess hair, & cleft palate ==> dx?
A
- fetal hydantoin syndrome = small body size, microcephaly, dital hypoplasia, midface hypoplasia, hirsutism, cleft palate,, rib anomalies, developmental delay
- associated w/exposure to anticonvulsant medication during fetal development
- esp. phenytoin and carbamazepine
18
Q
Presentation of congenital syphilis
A
- rhinitis
- hepatosplenomegaly
- skin lesions
- later findings…
- interstitial keratitis
- hutchunson teeth
- saddle nose
- saber shins
- deafness/CNS invovlement
19
Q
Presentation of fetal alcohol syndrome
A
- midface hypoplasia
- microcephaly
- stunted growth
- CNS damage ==>
- hyperactivity
- cognitive disability
- learning disability
20
Q
Dx and risks of PCOS
A
- PCOS
- suspected in any women with menstrual irregularity and clinical/biochemical signs of hyperandrogenism
- no need to see ovarian cysts to make dx
- unopposed estrogen ==> increased risk for endometrial carcinoma
21
Q
Approach to management of endometriosis
A
- suspected endometriosis ==>
- if no contraindications or immediate need for dx ==> NSAIDs +/- combined hormonal contraceptives
- if no improvement ==> laparascopy
- if following conditions, proceed directly to laparoscopy ==>
- contraindications to medical therapy
- need for dx
- exclude malignancy or adnexal mass
- treat infertility
- urinary tract/bowel obstruction
22
Q
Presentation/risks of endometriosis
A
- usually affects mulliparous women age 25-35
- ectopic endometrial tissue @: ovaries, ant/post cul-de-sac, broad ligaments, uterosacral ligmanets
- also @ fallopian tubes, sigmoid colon, appendix, round ligmanets
- often dysmenorrhea, dyspareunia, chronic pelvic pain that is worse before the onset of menses
- pelvic exam:
- rectovaginal tenderness
- tenderness w/movement of uterus
- can lead to infertility
23
Q
Indications for prophylactic anti-D immune globulin administration (for unsensitized RH-neg pregnant patient)
A
- @ 28-32 weeks
- w/in 72hours of delivery of Rh-positive infant or spontaneous, threatened or induced abortion
- ectopic pregnancy
- hydatidiform molar pregnancy
- chorionic villus samping, amniocentesis
- abdominal trauma
- 2nd and 3rd trimester bleeding
- external cephalic version
24
Q
Major types of vaginal cancer
A
- squamous cell carcinoma
- clear cell adenocarcinoma
25
Squamous cell vaginal cancer: epidemiology, risk factors, location, clinical features
* Age \> 60
* Risk factors
* HPV 16/18
* Hx of cervial dysplasia/cancer
* cigarette use
* Location: upper 1/3 of posterior vaginal wall
* Clinical features
* malodorous vaginal discharge
* postmenopausal or postcoital vaginal bleeding
* irregular mass, plaque, ulcer on vagina
26
Clear cell adenocarcinoma: Epidemiology, Risk factors, location, clinical features
* Age
* Risk factors
* in utero exposure to diethylstilbestrol
* location: upper 1/3 of anterior vaginal wall
* clinical
* malodorous vaginal discharge
* postmenopausal or postcoital vaginal bleeding
* irregular mass, plaque, ucler on vagina
27
General presentation of uterine fibroids (leiomyoma)
* uterine leiomyoma = benign smooth muscle cell tumor of myometrium
* most common pelvic tumor found in women
* higher rates in African American women
* can cause extrinsic compression of bladder/colon ==\> sx of urinary frequency or constipation
* can distort/enlarge uterus
* ==\> heavy/prolonged menstrual bleeding
28
Raloxifene: MOA, use, contraindications
* MOA = mixed agonist/antagonist of estrogen receptors
* @ breast/vaginal tissue = antagonist
* @ bone = agonist
* use = first-line in prevention of osteoporosis
* decreases breast cancer risk
* risks/contraindications
* increased risk of thromboembolism
29
Definition and management of IUFD
* IUFD = death of fetus in utero occuring after 20 weeks and before onset of labor
* after dx of IUFD (lack of cardiac activity on US) ==\> coagulation profile to check for DIC
* low-normal fibrinogen can indicate developing consumptive coagulopathy
* if coagulation derangement is suspected ==\> immediate delivery
* if coagulation parameters are normal ==\> expectant management vs. induction based on patient preference
30
Common liver disorders of pregnancy (3)
* intrahepatic cholestasis of pregnancy
* HELLP syndrome
* acute fatty liver of pregnancy
31
Intrahepatic cholestasis of pregnancy: presentation, lab abnormalities
* presentation: intense pruritis
* laboratory abnormalities
* elevated bile acids
* elevated liver aminotransferases
* ICP = dx of exclusion
32
HELLP syndrome: presentation, lab abnormalities
* presentation
* Pre-E
* RUQ pain
* N/V
* lab abnormalities
* hemolysis (elevated bili's)
* moderate elevation in aminotransferases
* thrombocytopenia
33
Acute fatty liver of pregnancy: presentation, lab abnormalities
* presentation
* malaise
* RUQ pain
* N/V
* sequelae of liver failure
* lab abnormalities
* hypoglycemia
* mildly elevated liver aminotransferases
* elevated bilirubin
* possibly DIC
34
Presentation of pruritic urticarial papules and plaques of pregnancy (PUPPP)
* skin condition that develops during 3rd trimester
* red papules within striae with sparing of umbilicus
* sometimes extend to extremities
* palms, soles, face are rarely involved
* no lab or liver abnormalities
35
Initial step in management with decreased fetal movement
* non-stress tess
36
Criteria for reactive/nonreactive NST
* w/in 20 mins: at least 2 accelerations \> 15bpm for at least 15s = reactive
* nonreactive if those are not met
* most common cause = fetal sleep cycle
* nonreactive ==\> vibroacoustic stimulations to awake fetus and try again
37
Normal amniotic fluid index
between 5-25
38
Lecithin/sphingomyelin ratio meaning
* test that can be run on amniotic fluid and is an indicator of fetal lung maturity
*
39
Types of spontaneous abortion
* Threatened
* Incomplete, inevitable, missed
* Septic
40
Management of threatened abortion
* expectant management until either:
* symptom resolution OR
* progression to inevitable, incomplete, missed abortion
41
Management of incomplete, inevitable, or missed abortion
* hemodynamically unstable, heavy bleeding: surgical evacuation (e.g. dilation and suction curettage)
* hemodynamically stable, mild bleeding: expectant management, PGs, or surgical evacuation
42
Management of septic abortion
* blood and endometrial cultures
* broad-spectrum antibiotics
* surgical evacuation of uterine contents
43
Severe features in Pre-E
* BP \>160/110
* on 2 occasions 4 hours apart w/bed rest
* thrombocytopenia
* serum Cr \> 1.1 or doubling of serum Cr
* elevated transaminases
* pulmonary edema
* new-onset visual or cerebral symptoms
44
Treatment of hypertensive emergencies in pregnancy
* IV hydralazine and labetalol
* oral nifedipine
45
Criteria for dx of PID
* fever \> 38C
* leukocytosis
* elevated ESR
* purulent cervical discharge
* adnexal tenderness
* cervical motion tenderness
* lower abdominal tenderness
46
Management of PID
* if stable and can take PO meds, can be managed as an outpatient
* hospitalization and parenteral antibiotics recommended for:
* high fever
* no response to oral abx
* inability to take PO abx 2/2 N/V
* pregnancy
* concerns about compliance
* IV abx regimens for inpatients:
* cefoxitin or cefotetan/doxycycline +
* clindamycin/gentamycin
47
Missed AB: clinical presentation, cervix, US findings
* clinical
* variable from no sx to light vaginal bleeding
* decrease of pregnancy sx
* cervix = closed
* US
* nonviable fetus
48
Inevitable AB: clinical presentation, cervix, US findings
* clinical
* vaginal bleeding, uterine cramps
* possible intrauterine fetus w/heartbeat
* cervix = open
* US = fetus with possible heartbeat
49
Incomplete AB: clinical presentation, cervix, US findings
* clinical
* vaginal bleeding w/passage of large clots or tissue
* uterine cramps
* products of concetion often visualized in dilated cervical os
* cervix = open
* US findings = products of conception often in cervix
50
Threatened AB: clinical presentation, cervix, US findings
* clinical
* variable amount of vaginal bleeding
* pregnancy can proceed to viable birth
* cervix = closed
* US = viable preganancy
51
Septic AB: clinical presentation, cervix, US
* clinical
* fever, malaise, signs of sepsis
* foul-smelling vaginal discharge, CMT, uterine tenderness
* rarely occurs after SAB, usually with induced AB
* cervix = usually open
* US = retained products of conception
52
Approach to AUB in post-menopausal women
* high risk for endometrial cancer ==\>
* endometrial sampling OR
* transvaginal US
53
Major causes of AUB in pre-menopausal women
1. Rule-out pregnancy w/serum B-hCG
2. Structural causes:
1. fibroids
2. adenomyosis
3. endometrial polyp
3. Non-structural causes
1. coagulopathy
2. infection
4. Ovulatory dysfunction: prolactinoma, PCOS, thyroid disorder, eating disorder, severe weight loss
54
Evaluation of AUB in pre-menopausal women
1. CBC, coag studies, TSH
2. Prolactin, androgens, FSH, LH
3. Pelvic US
4. Endometrial sampling for persistent symptoms, age \> 45, risk factors for endometrial cancer
55
B-hCG discriminatory zone definition
* serum B-hCG = 1,500 - 2,000
* levels at which an intrauterine pregancy should be seen on TVUS
56
Quant B-hCG purpose
* evaluate pregnancies of unknown location and/or SABs
* B-hCG usuall doubles every 48hours in viable pregnancies, but does not in ectopic or nonviable pregnancies
57
Method for evaluation of possible cervical incompetence
* TVUS to measure cervical length
* CL \> 25mm @ 24 weeks
* CL
58
Clinical presentation of congenital rubella
* sensorineural hearing loss
* illectual disability
* cardiac anomalies
* cataracts, glaucoma
59
Presentation of endometritis
* fever, uterine tenderness in post-partum period
* often assoc. w/foul-smelling lochia
* risk factors
* prolonged ROM/labor
* operative baginal delivery
* c-section
60
Typical presentation/managment of ruptured ectopic
* positive B-hCG with empty uterus
* lightheadedness, diffuse abdominal pain, adnexal tenderness
* hemodynamic instability
* typical management involves surgical evaluation
61
Endometritis causal organisms
* typically polymicrobial
* gram positive
* gram negative
* aerobic
* anaerobic
62
Tx of endometritis
IV clindamycin and gentamicin
63
Vasa previa vs. Placenta previa
* both painless antepartum hemorrhage
* vasa previa = fetal vessels cross fetal membranes in lower segment of uterus between fetus and internal cervical os
* ==\> rapid deterioration of fetal heart tracing once starts bleeding
64
Advice regarding vaccines right before and during pregnancy
* women should avoid **live** vaccines immediately before/during pregnancy
* e.g. MMR, rubella
* women given rubella vaccine relatively close to pregnancy have not shown adverse effects
65
Cervical cancer screening guidelines
* immunocompromised individuals
* @ onset of sexual intercouse
* every 6 months for first year then annually
* * 21-29
* cytology every 3 years
* 30-65
* cytology every 3 years OR
* cytology plus HPV every 5 years
* \>65 = no screening if prev. negative on screening
* hysterectomy (w/cervix removed)
* no screening of no hx of precancerous/cancerus lesion and no exposure to DES in utero
66
Rh-negative mother anti-D immune globulin administration timing and dosing
* first dose @ 28 weeks + repeat dose w/in 72hours of delivery
* standard dose = 300 micrograms
* increased dosing may be required after delivery, placental abruption, or procedures
* Kleihauer-Betke test used to determine dose
67
Kleihauer-Betke test procedure
* used to calculate neccesary Rhogam dose
* maternal serum on slide
* apply acidic solution ==\> lysing of adult RBCs ==\> "ghost cells"
* fetal RBCs remain brightly colored
* dose calculated based on % of fetal cells remaining
68
Test to confirm IUFD
realt time US to demonstrate absence of fetal cardiac activity
69
Characteristics of aromatase deficiency
* caused by absence/poor function of aromatase = enzyme that converts androgens into estrogens
* masculinization of mother during pregnancy that resolves with delivery
* if XX, normal internal female genitalia, but with virilization of external genitalia
* clitoromegaly
* delayed puberty
* undetectable circulating estrogens
* polycystic ovaries
* osteoporosis
70
CAH charactericteristics
* commonly: 21-a-hydroxylase deficiency
* leads to salt wasting
* can lead to virilization in females
71
Characteristics of McCune-Albright syndrome
* triad: cafe-au-lait, polyostotic fibrous dysplasia, autonomous endocrine hyperfxn
* can lead to gonadotropin-independent precocious puberty
72
Kallman syndrome characteristics
* hypogonadotropic hypogonadism with anosmia
* leads to delayed puberty
* in females: low/absent LH and FSH
73
Management of asymptomatic bacturia/acute cystitis in pregnancy
* Nitrofurantoin for 5-7days OR
* Amox or Amox-Clav for 3-7 days OR
* Single-dose Fosfomycin
* AVOID:
* fluoroquinolones in all trimesters
* avoid TMP-SMX in 1st and 3rd trimester
74
Genital warts cause, appearance, tx
* cause = HPV
* clusters of pink lesions on genitalia
* tx w/trichloroacetic acid or podophyliin in office
75
Types of prenatal testing for aneuploidy + timing, adv./disadv.
* first-trimester combined test = PAPP, B-hCG, nuchal transluceny
* 9-13 weeks
* second-trimester quad screen = a-fetoprotein, B-hCG, inhibin A, estriol
* 15-20 weeks
* chorionic villouis sampling ==\> karyotype/dx
* 10-13 weeks
* amniocentesis ==\> karyotype/dx
* 15-20 weeks
* second trimester US ==\> fetal anatomy
* 15-20 weeks
* cell-free fetal DNA
* \>10 weeks
76
Major disorders of sexual development
* complete androgen insensitivity syndrome
* mullerian agenesis
* transverse vaginal septum
* turner syndrome
77
Complete androgen insensitivity syndrome: karyotype, cause, reproductive organs, breast development, axillary/pubic hair
* XY w/X-linked mutation of androgen receptor
* externally female appearing, absent uterus/upper vagina, cryptorchid testes
* + breast development
* minimal/absent axillary/pubic hair
78
Mullerian agenesis: karyotype, cause, reproductive organs, breast development, axillary/pubic hair
* XX w/out formation of mullerian ductal system
* externally female appearing, absent or rudimentary uterus/upper vagina; normal ovaries
* + breast development
* normal axillary/pubic hair
79
Transverse vaginal septum: karyotype, cause, reproductive organs, breast development, axillary/pubic hair
* XX w/malformation of urogenital sinus and mullerian ducts
* externally female appearing, normal uterus uterus, abnormal vagina, normal ovaries
* + breast development
* normal axillary/pubic hair
80
Tamoxifen MOA and risks
* MOA: mixed estrogen agonist/antagonist
* commonly used in tx of ER positive breast cancer
* increases risk of uterine related cancer:
* endometrial cancer
* uterine sarcoma
81
Common physiologic changes in pregnancy: renal/urinary
* increased GFR, decreased BUN/Cr
* mechanism = increased CO and renal blood flow due to progesterone
* increased renal excretion
* urinary frequency, nocturia
* increased urine output, sodium excretion
* mild hyponatremia
* hormones reset threshold for increased ADH release from pituitary
82
Common physiologic changes in pregnancy: Heme
* dilutional anemia
* 2/2 increased plasma volume and RBC mass
* prothrombotic state
* hormone-mediated decrease in total protein S antigen and activity
* increase in fibrinogen and coagulation facotrs
83
Common physiologic changes in pregnancy: CV/Pulm
* increased CO and HR
* increased blood volume
* decreased systemic vascular resistance
* chronic respiratory alkalosis w/metabolic compensation (increased PaO2 and decreased PaCO2)
* progesterone directly stimulates central respiratory centers to increase tidal volume and minute ventilation
84
Normal ABG in pregnancy
* pH = 7.45 (increased)
* PCO2 = 28 (decreased)
* HCO3 = 18 (decreased)
85
Evaluation of decreased fetal movement
1. NST
2. Contraction stress test (CST)
3. biophysical profile
86
Normal & Abnormal CST results
* normal =
* \>3 ctx lasting 30-40s in 10 min (induced)
* no late or recurrent variable decels
* abnormal
* late decels following \>50% of ctx
* equivical
* recurrent variables
* intermittent late decels
87
Tx for infertility in premature ovarian failure
in-vitro fertilization w/donor oocyte
88
Initial uncomplicated neonatal care
* initial physical assessment
* removal airway secretions
* dry and warm infant
* early preventative measures
* gonococcal opthalmia prevention
* vitamin K administration
89
Components of biophysical profile
1. nonstress test
2. amniotic fluid volume
3. fetal movements
4. fetal tone
5. fetal breathing movements
6. scoring: 0=abnormal, 2=normal
90
Risk factors for osteoporosis
* advacned age
* thin body habitus
* tobacco use
* excess alcohol consumption
* corticosteroid use
* menopause
* malnutrition
* Fhx of osteoporosis
* Asian or Caucasion
91
STI screening recommendations in pregnant women
* screen all for:
* syphillis, HIV, Hep B
* screen women
* gonorrhea, chlamydia
* screen women @ increased risk for:
* hep C
92
Cause of abdominal pain in HELLP syndrome
2/2 liver swelling with distension of hepatic (Glisson's) capsule
93
Mechanism of pulmonary edema in severe pre-e
* increased systemic vascular resistance
* increased capillary permeability
* increased pulmonary capillary hydrostatic pressure
* decreased albumin
94
Management/prognosis of Erb-Duchenne palsy
* reassurance
* most spontaneously recover arm fxn within a few months
95
Risks/definition of fetal macrosomia
* fetal macrosomia = \>4kg (4000g)
* maternal risks
* advanced age
* DM
* excessive weight gain in preg or pre-existing obesity
* multiparity
* fetal risks
* african-american or hispanic ethnicity
* male sex
* post-term pregnancy
