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obgyn > ObGyn2 > Flashcards

ObGyn2 Flashcards

1
Q

Salpingitis isthmic nodosa (definition)

A

-Tubal diverticuli: tubal epithelium penetrates into muscularis or even serosa

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2
Q

Chromotubation (definition)

A
  • Dye injected into uterus via transcervical catheter

- Tubal patency assessed via laparoscopy/laparotomy

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3
Q

Test used to assess tubal factor infertility

A

HSG: hysterosalpingogram

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4
Q

Risk factors for tubal infertility (x3)

A
  • PID
  • Previous pelvic or tubal surgery
  • Peritoneal factors
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5
Q

If first step in tubal infertility assessment is abnl, it should be confirmed with:

A

Laparoscopy

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6
Q

Proximal vs. distal vs. combined tubal obstruction (tx)

A
  • Proximal: tubocornual anastomosis
  • Distal: fimbrioplasty
  • Both: IVF
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7
Q

Tubal surgery increases the risk of:

A

Ectopic pregnancy

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8
Q

Which is more common, distal or proximal tubal disease?

A

-Distal, in U.S. (easier to treat surgically)

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9
Q

Amenorrhea (definition)

A

Lack of menses for 6mo

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10
Q

Sheehan’s syndrome vs. Asherman’s syndrome

A
  • Secondary amenorrhea in both
  • Lack of anterior pituitary function in Sheehan’s (prolactin [breast feeding], TSH [hypothyroidism], gonadotropins [amenorrhea])
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11
Q

First step in amenorrhea

A

Pregnancy test

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12
Q

Sheehan’s syndrome (tx)

A

Hormone replacement: thyroxine, cortisol, mineralocorticoid, and estrogen/progestin

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13
Q

5 hallmarks of PCOS

A
  • Hirsutism
  • Obesity
  • Excess estrogen
  • Anovulation
  • Glucose intolerance/insulin resistance
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14
Q

Hypothyroidism to galactorrhea link

A

Hypothyroidism -> high TRH -> high PRL -> galactorrhea (+irregular menses d/t loss of GnRH pulsatility)

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15
Q

Galactorrhea (ddx x5)

A
  • Pregnancy
  • Pituitary adenoma
  • Hypothyroidism
  • Breast stimulation
  • Chest wall trauma
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16
Q

Most sensitive test for pituitary adenomas/microadenomas

A

MRI

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17
Q

Primary hypothyroidism (tx)

A

Thyroxine

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18
Q

Indicated therapy for symptomatic microadenoma during pregnancy

A

Bromocriptine

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19
Q

Five causes of infertility

A

1) Ovulatory
2) Uterine
3) Tubal
4) Male factor
5) Peritoneal factor (endometriosis)

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20
Q

3D’s of endometriosis

A

(Though not necessary)

dysmenorrhea, dyspareunia, dyschezia

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21
Q

Infertility (definition)

A

Failure to get pregnant after 1yr of unprotected intercourse (10-15% NL)

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22
Q

Fecundability (definition)

A

Probability of pregnancy within one menstrual cycle (20-25% NL)

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23
Q

Assessing ovulatory factor in infertility (tests)

A
  • BBT
  • Serum progesterone
  • Serum LH
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24
Q

Assessing uterine factor in infertility (test)

A

HSG, followed by hysteroscopy

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25
Q

Assessing tubal factor in infertility (tests)

A

HSG, followed by laparoscopy (gold standard)

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26
Q

Assessing male factor in infertility (tests)

A
  • Volume (NL: at least 2ml)
  • Concentration (NL: at least 20million/ml)
  • Motility (NL: 50%)
  • Morphology (NL: 30% nl)
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27
Q

Assessing peritoneal factor in infertility (test)

A

Laparoscopy

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28
Q

Expected temperature change in biphasic BBT chart

A

Increase of 0.5* C

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29
Q

Septic abortion (definition)

A

Any type of abortion associated with uterine infection

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30
Q

Septic abortion (mgmt)

A

1) Maintain/monitor BP, oxygenation, UOP
2) Broad spec ABXs (w/ anaerobic coverage)
3) Uterine curettage

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31
Q

Mechanism behind septic abortions

A

Ascending infections (polymicrobial)

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32
Q

Positive pregnancy, no IUP visualized and/or no chorionic villi on curettage (dx)

A

Ectopic pregnancy

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33
Q

Relative contraindications for methotrexate use (x2)

A
  • Ectopic pregnancy >4 cm

- Presence of fetal cardiac activity

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34
Q

Threshold HCG level (level @ which pregnancy should be seen on US)

A

1500 mIU/ml

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35
Q

How early can a transvaginal US detect a pregnancy?

A

6wks’ gestational age

36
Q

Two signs on US that are reassuring of an IUP

A
  • Crown rump length, or

- Yolk sac

37
Q

Two signs on US indicating extrauterine gestation

A
  • Embryo seen outside uterus

- Intra-abdominal free fluid (usually indicates blood)

38
Q

Next step if HCG is above threshold and transvaginal US reveals nothing

A

Laparoscopy

39
Q

Progesterone levels in NL and ABNL pregnancies

A
  • NL IUP: >25 ng/ml

- ABNL pregnancy: <5 ng/ml

40
Q

Surgical mgmt of ectopic pregnancies

A
  • Salpingectomy: (+) rupture, (-) future fertility, gestation too large for medical tx
  • Salpingostomy: (-) rupture, (+) future fertility
41
Q

For what gestational size is methotrexate an appropriate tx?

A

<4cm

42
Q

Benign ovarian neoplasms (surgical tx)

A

ELAP w/ cystectomy

43
Q

Functional ovarian cysts (x3)

A
  • Follicular
  • Corpus luteal
  • Theca lutein
44
Q

MC ovarian tumors in women <30yo

A

Benign cystic teratomas (aka, dermoid cysts)

45
Q

Ovarian cyst complications (x2)

A
  • Torsion

- Rupture (chemical peritonitis)

46
Q

MC ovarian tumors in women >30yo

A

Epithelial (serous/mucinous)

47
Q

Tumor marker for epithelial ovarian tumor

A

CA-125

48
Q

Mgmt of adnexal masses by age

A
  • Prepubertal: >2cm ovary: operate
  • Reproductive: 8cm: operate; 5-8: complex vs. simple
  • Menopausal: >4-5cm ovary: operate
49
Q

Common sign of ovarian malignancy

A

Ascites

50
Q

Ovarian cancer staging (x6)

A
  • TAH
  • BSO
  • Omentectomy
  • Peritoneal biopsies
  • Peritoneal washings/ascites sampling
  • LN sampling
51
Q

Ureteral injury/obstruction in a pt who s/p hysterectomy (dx)

A

IV pyelogram (IVP) or CT w/ contrast

52
Q

Ureteral injury post pelvic surgery presents with a picture that is identical to:

A

Pyelonephritis

53
Q

Intravenous pyelogram, IVP (structures visualized)

A
  • Bladder
  • Ureters
  • Kidneys
54
Q

Percutaneous nephrostomy (definition)

A

Placement of stent into renal pelvis through skin

55
Q

MC location for ureteral injury

A

Cardinal ligament (water under the bridge, uterine vessels)

56
Q

Less common locations of ureteral injury

A
  • Pelvic brim (during ovarian vessel ligation)

- Where ureter enters bladder (during vaginal cuff ligation)

57
Q

Ureteral injury/obstruction in a pt who s/p hysterectomy (mgmt)

A
  • ABXs

- Cystoscopy w/ stenting

58
Q

PAP smears should start at age:

A

21yo

59
Q

Frequency of PAP smears

A

21-29: q3yrs

30-65: q3yrs, q5yrs (combination: PAP+HPV testing)

60
Q

Wound dehiscence

A

Separation of part of surgical incision, but w/ intact peritoneum

61
Q

Surgical site infection, SSI (definition)

A

Infection post surgery at/near surgical incision w/in 30days of operation

62
Q

Wound complications (x3)

A
  • Superficial separation
  • Dehiscence
  • Evisceration
63
Q

What can help to differentiate urine from lymphatic fluid?

A

Creatinine level (elevated in urine)

64
Q

What active immunizations should pregnant women get before conception?

A
  • Rubella

- HBV

65
Q

Chadwick’s sign

A
  • Presumptive sign of pregnancy

- Bluish discoloration of vulva, vagina, and cervix

66
Q

Hegar’s sign

A
  • Probably sign of pregnancy

- Softening bw fundus and cervix

67
Q

Naegele’s rule

A

EDD=LMP+7d-3mo

68
Q

Sonogram dating

A
  • Crown-rump length at 12wks or less (accurate +/-5d)

- Biparietal diameter 12-18wks (accurate +/7d)

69
Q

Frequency of prenatal visits

A
  • q4wks up to 28wks
  • q2wks up to 28-36wks
  • q1wk after 36wks
70
Q

Recommended pregnancy weight gains

A
  • Underweight ( < 18.5): 28-40
  • NL (18.5 - 24.9): 25-35
  • Overwt (25-29.9): 15-25
  • Obese ( > 30): 11-20
71
Q

Uterine size by gestational age

A
  • 12wks @ pubic symphysis
  • 16wks @ 1/2 bw pubic symph and umb
  • 20wks @ umbilicus
72
Q

Discrepant fundal height (ddx x4)

A
  • FETUS: Macrosomia, twins, IUGR, fetal demise
  • AF
  • PLACENTA: molar pregnancy, edema
  • UTERINE WALL: fibroids, adenomyosis
73
Q

Sum of AFI in all 4quads

A

NL: 5-25

74
Q

Symmetric IUGR (origin)

A

fetal (karyotype abnl’s, infections, severe anomalies)

75
Q

Asymmetric IUGR (origin)

A

placental (HTN, poor nutrition)

76
Q

Spontaneous abortions (bleeding, dilation, POC, mgmt)

A
  • Threatened: +B, -D, [observation]
  • Missed: -B, -D, [D&C]
  • Inevitable: +B, +D, -POC, [D&C]
  • Incomplete: +B,+D, +POC [D&C]
  • Completed: +B, -D, +POC [observation]
  • Septic: +B, +D, FEVER
77
Q

Abortions (first trimester loss <20wks vs second trimester loss)

A
  • Fetal (karyotype)

- Maternal (uterine duplication, uterine septum, incompetent cervix)

78
Q

How do you confirm fetal demise?

A

Absence of cardiac activity on sono

79
Q

Antiphospholipid syndrome (patho)

A

Maternal autoantibodies attack the lipid membranes of fetoplacental unit

80
Q

Antiphospholipid syndrome (dx criteria)

A
  • Any positive history (DVT, PE, repetitive loss, fetal demise)
  • Any positive lab (anticardiolipin ab’s, lupus anticoagulant, prolonged PTT)
81
Q

Antiphospholipid syndrome (tx)

A

Aspirin+heparin

82
Q

Serious complication of fetal demise

A

DIC

83
Q

Ectopic pregnancy tx modalities based on HCG

A
  • HCG < 5000: MTX

- HCG > 5000: surgical (salpingostomy, segmental resection, salpingectomy)

84
Q

Ectopic pregnancy mgmt (4 steps)

A

HCG ->transvaginal US -> MTX/surg -> serial HCG

85
Q

First prenatal visit (tests/labs)

A
  • HEME: t/s, CBC, Rh status, Hbg electroph
  • INFX: syph, HIV, GC/Chlam, HepB surf ag, Rubella Ab’s, PAP
  • UA/UCX
  • US (if at least 7wks)

obgyn (5 decks)

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