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Obs and gyne > Obs and gyne > Flashcards

Obs and gyne Flashcards

1
Q

Primary amenorrhea

A

Failure of menses to occur by

  • age 16 or 2 years after onset of puberty
  • age 14 without onset of puberty
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2
Q

Secondary amenorrhea

A

Cessation of menses (absent for >3 months or >3 cycles) after menarche as occured

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3
Q

Oligomenorrhea

A

Menses occuring >35 days appart

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4
Q

Most common causes of secondary amenorrhea

A

HPO-axis (stress, exercise, weight loss), PCOS, premature menopause, hypothyroidism, hyperprolactinemia, (antidopamine drugs), pregnancy, Asherman’s, pituitary tumor, Sheehan syndrome

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5
Q

Ovulatory DUB

A

Prolonged progesterone secretion -> excessive bleeding during regular menstrual cycles

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6
Q

Anovulatory DUB

A

No corpus luteum -> no progesterone secretion -> unpredictable bleeding patterns (not cyclic)

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7
Q

PCOS diagnostic criteria (Rotterdam)

A

Chronic anovulation, hyperandrogenism, polycystic ovaries

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8
Q

Cause of primary dysmenorrhea

A

Abnormally high prostaglandin levels

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9
Q

Treatment of dysmenorrhea

A

NSAIDs (ibuprofen, naproxen)

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10
Q

Severe form of premenstrual syndrome

A

Premenstrual dysphoric disorder

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11
Q

Morning after pill

A

Levonorgestrel or ulipristal acetate

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12
Q

Precocious puberty

A

Onset before age 8 in girls and 9 in boys

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13
Q

Delayed puberty

A

If no period by 16 or no signs of puberty (breast development) by 14

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14
Q

Perimenopause

A

From menstrual cycle irregularity (3-5 years before loss of menses) to 1 year after menopause

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15
Q

Menopause

A

1 year of amennorhea

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16
Q

Premenopause

A

4-7 years: early (variable cycle length) and late (2 or more skipped cycles, anovulation)

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17
Q

Vulvovaginitis

A

Bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis

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18
Q

Amsel criteria (bacterial vaginosis)

A

Vaginal discharge, pH above 4,5, clue cells on smear, positive whiff test

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19
Q

Structural causes of abnormal uterine bleeding

A

PALM: polyps, adenomyosis, leiomyomas, malignancy

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20
Q

Functional ovarian cysts

A

Follicular (estradiol), corpus luteum (progesterone) and theca-lutein cysts (androgens)

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21
Q

Ovarian risk of malignancy index (RMI)

A

US score (1 point for multilocus, solid, mets, ascites, bilat.) x menopausal status (1 pre, 3 post) x CA125 levels

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22
Q

Ovarian epithelial tumors

A

Serous cystadenoma, mucinous cystadenoma, endometroid tumor and Brenner/transitional tumor

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23
Q

Ovarian sex-cord stromal tumors

A

Granulosa-theca cell tumor, Sertoli-Leydig cell tumor, thecoma-fibromas

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24
Q

Germ-cell tumors

A

Cystic teratoma, dysgerminoma, gonadoblastoma, endometrial sinus/yolk sac tumor

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25
Q

Treatment of PID

A

Outpatient: ceftriaxone IM + doxycycline PO + metronidazole PO
Inpatient: cefoxitin + doxycycline or clindamycin + gentamycin IV

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26
Q

Treatment ectopic pregnancy

A

Methotrexate 50 mg IM

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27
Q

Sexual disorders

A

Sexual dysfunction, paraphilic disorders and gender dysphoria

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28
Q

Causes of virilism/hirsutism

A

PCOS, Sertoli-Leydig tumor, adrenal tumor, CAH, familial

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29
Q

Characteristic histopathological finding of complete molar pregnancy

A

Hydropic villi, absence of fetal vessels, hyperplasia of trophoblastic tissue

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30
Q

Metastatic choriocarcinoma chemo

A

Methotrexate, actinomycin D, cyclophosphamide, folate, etoposide, vincristine (MAC FEV)

31
Q

Early signs of pregnancy (gyn exam)

A

Chadwick (congested vaginal mucosa), Hegar (softening at isthmus) and Piskacek sign (soft prominence at site of implantation)

32
Q

Frequency of prenatal care

A

First at 6-8 GW, every 4th week until 28 GW, every 2nd week until 35 GW, weekly thereafter

33
Q

Naegele’s rule

A

1st day of last mens - 3 months + 7 days (+1 year)

34
Q

First signs of pregnancy

A

Cessation of menses, pos. UPT, hCG in blood/urine (8-9 days after ovulation), embryo of US

35
Q

Abnormal levels of hCG

A

Low: ectopic, abortion, inaccurate dates
High: multiple gest., molar preg., trisomy 21, inaccurate dates

36
Q

Phases of parturition

A

Quiescence (progesterone), activation (CRH), stimulation (estrogen), involution (oxytocin)

37
Q

1st trimester genetic screening

A

US (nuchal translucency), PAPP-A, hCG

38
Q

2nd trimester genetic screening

A

Triple: hCG, AFP, estriol
Quad: + inhibin-A

39
Q

Preeclampsia criteria

A

Mild: BP 140-149/90-99, proteinuria >300 mg
Moderate: BP 150-159/100-109
Severe: BP >160/110, proteinuria >5 g, S&S
after 20th GW

40
Q

Primary defect of preeclampsi

A

Failure of trophoblastic invasion of spiral arteries leaving them vasoactive (normally resistant to vasoconstrictors)

41
Q

Eclampsia + treatment

A

Tonic-clonic seizure + preeclampsia –> Mg-S, diazepam, labetalol

42
Q

HELLP syndrome

A

LDH>600 U/L + ASAT/ALAT>40 U/L + PLT <150 G/L

43
Q

Antihypertensives during pregnancy

A

Alpha-methydopa (1st), nifedipine (2nd), hydralazine (acute management), labetalol, urapidil

44
Q

Hyperemesis gravidarum

A

Persistent N/V with ketosis and weight loss of >5% of pre-preg. weight

45
Q

Abortion methods

A

Suction curettage <12 w, dilation and evacuation 12-23 w, medical induction 16-23 w

46
Q

Preterm labor

A

Contractions (≥4 in 30 min) resulting in cervical effacement of 80% and ≥2 cm dilation, that begins before week 37

47
Q

False labor

A

Braxton Hicks contractions of mild intensity (10-15 mmHg), lasting 30 sec once per hour

48
Q

Types of uterine dysfunction

A

Hypotonic uterine dysfunction, hypertonic contractions (colicky uterus, hyperactive lower segment)

49
Q

Causes of dystocia

A

Power (uterine dysfunction), passage (abnormal pelvis), passenger (abnormal fetal presentation, position and development)

50
Q

Management of shoulder dystocia

A

HELPERR: call for Help, evaluate for Episiotomy, Legs (McRoberts), suprapubic Pressure (Rubin), Enter (Wood screw), Remove post. arm, Roll pt. on hands and knees

51
Q

Size of contracted pelvis

A

Inlet: AP<10, transverse<12
Midpelvis: transverse + post. saggital <13,5
Outlet: interischial tuberous dm <8

52
Q

Duration of stages of labor

A

1st (latent + active phase): 9-11/4,5-5 h
2nd (propulsive + expulsive phase): 50-60/20-30 min
3rd (separation + expulsion phase): 5-15 min (not >30)
4th: 2 h observation

53
Q

Definition of labor

A

Strong, regular contractions every 10 min or less, leading to progressive cervical effacement of 80% and dilation >2cm

54
Q

Types of obstetric anesthesia

A

Regional: epidural injection (vaginal delivery), spinal injection (c-section)
Local: pudendal block (vaginal), paracervical block (abortion, fetal bradycardia)
General: NO 40% (vaginal), thiopental (emergency c-section)

55
Q

Bishop score of cervical effacement

A

Position, consistency, effacement %, dilation cm, station of fetal head (score 0-3: <6 unfavourable, ≥6 favourable for induction, ≥9 vaginal delivery likely)

56
Q

Methods of labor induction

A

Membrane sweeping, intravaginal PGE2 (Bishop<6), Foley catheter, laminaria tent, amniotomy, IV oxytocin

57
Q

When and what do give in Rh neg. mothers with Rh pos. fetus

A

Rh0 immunoglobulin at week 28 and 72 h before delivery or any procedure

58
Q

5 T’s of cyanotic heart diseases

A

Tetralogy of Fallot, Transposition of the great arteries, Tricuspid atresia, Truncus arteriosus, Total anomalous pulmonary venous return

59
Q

Methods of induced abortion (<24 weeks)

A

<6 weeks: menstrual aspiration or medical (mifepristol + PG/methotrexate)
<12 weeks: cervical dilation and evacuation (vacuum/curettage)
<24 weeks: medical (laminaria, vaginal PG), oxytocin, curettage

60
Q

Fertility rate

A

Number of live births/1000 women aged 15-44 years

61
Q

Maternal mortality ratio

A

Maternal deaths/100 000 live births -> direct, indirect, nonmaternal

62
Q

Stillbirth definition

A

Infants born >24 weeks or >350 grams with no signs of life

63
Q

Layers of the placenta

A

Chorion (fetal part formed by extraembryonic mesoderm, cytotrophoblasts and syncytiotrophoblasts) and decidua (maternal part - endometrium)

64
Q

Hormones secreted by the placenta

A

hCG (preserves corpus luteum), human placental lactogen (anti-insulin effect), estrogen (female sex, uterine growth), progesterone (maintain endometrium)

65
Q

Fetal head diameters

A

Suboccipitobregmatic, occipitofrontal, supraoccipitomental, submentobregmatic

66
Q

Pelvic shapes

A

Gynecoid (round, female), android (triangular, male), anthropoid (narrow), platypelloid (wide)

67
Q

The 6 movements of normal labor

A

Decent, flexion, internal rotation, extension, external rotation, expulsion

68
Q

Hormones of lactation

A 
Estrogen: duct proliferation
Progesterone: lobular-alveolar tissue
Prolactin: galactopoiesis
Pitocin and oxytocin: milk secretion 
Human placental lactogen: breast growth
69
Q

Energy content of milk and energy need of infant

A

60-70 kcal/100 ml

90-120 kcal/kg/day

70
Q

General principles of surgery in pregnancy

A

Safest during 2nd trimester, regional analgesia is preferred, treated as if they have full stomach (give citrate and H2R blockers)

71
Q

Rate of weight gain

A

320 g/w from 8-20 weeks, 450 g/w after 20 weeks, a total of 9-14 kg

72
Q

Iron and folate supplementation during pregnancy

A

30 mg ferrous iron daily from 2nd TM, 400 mcg folate in periconceptional period (+ calcium, vitamin D)

73
Q

Treatment of UTI in pregnancy

A

Asympt./UTI: cefalexin, nitrofurantoin (not 3rd TM), trimethoprim (not 1st TM), amoxicillin
Pyelonephritis: cefuroxime

74
Q

Timing of US screenings

A
  1. Detection of pregnancy
  2. 11+0 - 13+6 (malform., NT, CRL)
  3. W 18 (genetic)
  4. W 28-32 (IUGR)
  5. W 38 (position, size, weight)

Obs and gyne (1 decks)

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