Obstetric/Gynecologic Disorders Flashcards
1
Q
hypertension in pregnancy prior to 20 weeks gestation
A
essential hypertension or molar pregnancy
2
Q
conditions associated with increased nuchal translucency
A
down’s syndrome, turner syndrome, neural tube defects, congenital heart defects
3
Q
decreased AFP, decreased unconjugated estriol, elevated inhibin A, elevated beta-hCG
A
down’s syndrome or turner’s syndrome
4
Q
at what hemoglobin level should physiologic anemia of pregnancy be treated as iron deficiency anemia
A
first trimester: hemoglobin < 11
second trimester: hemoglobin < 10.5
5
Q
what supplements should be given to women on anticonvulsants during pregnancy
A
folate and vitamin K (last month)
6
Q
what supplements should be given to complete vegetarians during pregnancy
A
vitamin B12, iron, vitamin D
7
Q
lab findings characteristic of HELLP syndrome
A
hemolysis, elevated liver enzymes, and low platelets
8
Q
difference between preeclampsia and gestational hypertension
A
proteinuria, gestational hypertension is usually third trimester only
9
Q
how long is magnesium sulfate continued after delivery in preeclampsia
A
24 hours
10
Q
how long is magnesium sulfate continued after delivery in eclampsia
A
48 hours
11
Q
what gestational age is maternal triple or quad screen offered to women?
A
16-18 weeks
12
Q
when is 1 hour OGTT performed?
A
24-28 weeks
13
Q
how does TSH change during pregnancy?
A
TSH stays the same, free T3/T4 stay the same
total T3/T4 increase because of increased thyroxine binding globulin
14
Q
how much folate is needed in pregnancy
A
400 micrograms/day
15
Q
how much iron is needed in pregnancy
A
30 mg/day
16
Q
how much calcium is needed in pregnancy
A
1200 mg/day
17
Q
when can amniocentesis be performed
A
after 16 weeks gestation
18
Q
when can chorionic villous sampling be performed
A
after 9 weeks gestation
19
Q
mccune-albright syndrome
A
females, pseudo-precocious puberty, cafe-au-lait macules, fibrous dysplasia of the bone
20
Q
estrogen generated by ovaries
A
estradiol
21
Q
estrogen generated by placenta
A
estriol
22
Q
estrogen generated by fat tissue
A
estrone
23
Q
nonhormonal options for menopausal hot flashes
A
desvenlafaxine, venlafaxine, clinidine, gabapentin, placebo, or just wait (most hot flashes resolve within 4-5 years)
24
Q
what lab findings distinguish true precocious puberty from pseudoprecocious puberty
A
elevations of LH, FSH in central/true precocious puberty, further increased by GnRH stimulation
25
definition of precocious puberty
< 8 in girls
| < 9 in boys
26
some causes of pseudoprecocious puberty
exogenous hormones, adrenal tumor, congenital adrenal hyperplasia, ovarian tumor, mccune-albright syndrome
27
definition of premature ovarian failure
> 1 year amenorrhea in women < 40
28
hormone associated with increase in basal body temperature
progesterone
29
how is body basal temperature increase associated with ovulation
1 degree increase occurs 1 day before ovulation
30
4 different options for emergency contraception
combination pill, progestin pill, copper IUD, anti-progestin
31
contraindications to OCP use
DVTs, smokers, breast/endometrial cancer, pregnancy, hepatic disease, migraine with aura
32
medications known for reducing effectiveness of OCPs
rifampin, griseofulvin, anti-epileptics, st. john's wort
33
definition of primary amenorrhea
no menses by 16 w/secondary sexual characteristics or no menses by 13 w/o secondary sexual characteristics
34
first step in any work-up of amenorrhea
beta-hCG
35
basic components of work-up for secondary amenorrhea
beta-hCG, LH, FSH, TSH, testosterone, DHEAS, progestin withdrawal test
36
diagnosis: primary amenorrhea, absent secondary sex characteristics, anosmia
kalmann's syndrome XXY, congenital absence of GnRH secretion
37
initial management of a woman presenting with secondary amenorrhea and new galactorrhea when beta-hCG is negative
TSH, free T4
38
positive beta-hCG, intrauterine pregnancy, closed os
threatened abortion
39
enlarged uterus, menometrorrhagia for months
uterine fibroids
40
bleeding associated with severe menstrual pelvic pain
endometriosis
41
menorrhagia, perimenopausal
endometrial hyperplasia until proven otherwise
42
abnormal uterine bleeding started with menarche
hereditary bleeding disorder
43
positive beta-hCG, severe pain, no fetus in uterus on US
ectopic pregnancy
44
metrorrhagia after intercourse, no pain, normal sized uterus
endometrial or cervical polyp
45
depression, constipation, abnormal uterine bleeding
hypothyroidism
46
outpatient treatment for abnormal uterine bleeding
estrogen 21-25 days
progesterone 10 days
heavy withdrawal bleed will occur
47
inpatient treatment for abnormal uterine bleeding with hemodynamic instability
2-4 L normal saline, transfuse PRBC
introduce tamponade transcervically and inflate to stop bleeding
IV premarin to stabilize and regrow endometrium
IV /phenergan to prevent N/V a/w high dose estrogen
48
medications used for PMS and PMDD
exercise, B6, NSAIDs, OCPs, progestins, SSRIs +/- alprazolam
49
treatment of choice for primary dysmenorrhea
OCPs, NSAIDs
50
most common cause of hirsutism in the US
PCOS
51
lab findings to diagnose PCOS
elevated LH, elevated total testosterone
52
medications used for syphillis
penicillin G, doxycycline, tetracycline
53
diagnosis of pelvic inflammatory disease
clinical diagnosis, abdominal/pelvic pain in the absence of other pathologies, cervical motion tenderness, leukocytosis, vagina/cervical discharge, elevated ESR/CRP
54
medications used for PCOS
exercise/weight loss
OCPs, clomiphene to induce pregnancy, metformin, sprionolactone
progestin withdrawal if cannot tolerate OCPs
55
which STD can be mistaked for IBD due to fistula formation
lymphogranuloma venereum due to L1, 2, L3 serotypes of chlamidya trachomatis
56
ASCUS on pap smear
surveillance, repeat pap smear 3-6 months
| perform HPV screening
57
ASCUS x 2 on pap smear
colposcopy
58
ASCH on pap smear
| atypical squamous cells, cannot exclude HSIL
colposcopy + ECC
59
AGUS on pap smear
| atypical glandular cells
colposcopy + ECC
| if age > 35, also perform endometrial biopsy
60
CIN1 on pap smear
surveillance, repeat pap smear 3-6 months
| alternatively, go straight to colposcopy
61
CIN1 x 2 on pap smear
colposcopy
62
HSIL with precancerous lesion on pap smear
colposcopy + LEEP or conization
| repeat cervical cytology every 6 months
63
management: squamous cell carcinoma of the cervix
surgical resection +/- chemotherapy
64
most important prognostic factor in endometrial cancer
histologic grade is more important than depth of invasion
65
management: squamous cell carcinoma of the vagina
< 2 cm, resection or internal radiation
> 2 cm, external beam radiation
generally, no chemotherapy
66
lichen sclerosis diagnosis and management
chronic inflammatory condition of anogenital region, most commonly affecting women
ivory/porcelain white macules and plaques with pruritis
treatment: low threshold for punch biopsy to r/o squamous cell carcinoma, steroids (clobetasol), or pimecrolimus
67
differential diagnosis for gynecomastia
```
puberty
medications (spironolactone, cimetidine, amiodarone, ketoconazole, haloperidol, HAART therapy, digoxin
herbal agents (tea tree oil, lavender oil), cirrhosis, hypogonadism, testicular germ cell tumor, hyperthyroidism, hemodialysis patients
```
68
herbal causes of gynecomastia
tea tree oil, lavender oil
69
most likely cause of bloody nipple discharge
intraductal papilloma
70
most common breast cancer
invasive ductal carcinoma
71
breast cancer often presents with serous or bloody nipple discharge
intraductal papilloma
72
most common breast mass in patients 35-50
fibrocystic changes of the breast
73
most common breast tumor in teen and young women
fibroadenoma
74
breast mass accompanied by redness, pain, and heat
inflammatory breast carcinoma
75
risk factors for endometrial cancer
unopposed estrogen, PCOS, obesity, nulliparity, diabetes, hypertension, family history, high fat diet, HNPCC
76
risk factors for ovarian cancer
ovulation, nulliparity, family history, BRCA1, BRCA2
77
serum marker elevated in endometrial cancer
CA-125 sometimes
78
serum marker elevated in ovarian cancer
CA-125 frequently
79
next step in management of CIN 2 cervical lesion identified on biopsy
excise with LEEP or conization or laser
80
next step in management of ASCUS pap smear
repeat pap smear 3-6 months
81
next step in management of AGUS pap smear
colposcopy with ECC
| > 35, also endometrial biopsy
82
ovarian tumor associated with psammoma bodies
serous cyst adenocaricnoma
83
ovarian tumor associated with estrogen excess
granulosa cell tumor
84
ovarian tumor associated with androgen secretion
leydig cell tumor
85
treatment for DCIS
lumpectomy, possible radiation
| consider mastectomy in high-risk individuals
86
treatment for LCIS
observation, possible treatment with tamoxifen/raloxifene
87
normal reactive nonstress test
two or more 15 bpm accelerations lasting at least 15 seconds within 20 minutes
88
fetal tachycardia
> 160 bpm
caused by maternal infection, dehydration, chorioaminionitis, fetal anemia, maternal thyrotoxicosis, fetal tachyarrhythmias, tertbutaline (beta-agonist), fetal hypoxia
89
fetal bradycardia
< 110
90
what causes a fetal heart rate with a sinusoidal pattern
fetal anemia
91
normal fetal variability
x6-25 bpm
92
what is the definition of PROM
premature rupture of membranes before the onset of labor, increased risk with vaginal/cervical infection or cervical incompetence, prior to 37 weeks
93
when to suspect chorioamnionitis in a patient with PROM
if fever present with maternal or fetal tachycardia, maternal leukocytosis, or uterine tenderness or foul smelling discharge
94
at what gestational age is labor managed actively instead of expectantly in preterm labor
34 weeks or if there is proven fetal lung maturity in younger fetuses
95
what are the risk factors for placental abruption
trauma, cocaine, smoking, chronic HTN, preeclampsia, PROM, multiple gestations, multiparity
96
drugs used for tocolysis
tertbutaline, ritodrine, magnesium sulfate, or less commonly indomethacin, nifedipine
97
reversal agent in cases of magnesium toxicity
calcium gluconate
98
components of biophysical profile for assessment of fetal well being
amniotic fluid index, fetal tone, fetal breathing, fetal movement, non-stress test
99
early decelerations
fetal head compression, no treatment necessary
100
variable decelerations
cord compression, reposition mother
101
late decelerations
uteroplacental insufficiency, fluid resuscitation, address underlying problem if posisble
102
definition of oligohydramnios
AFI < 5
103
definition of polyhydramnios
AFI > 25
104
classic signs and symptoms of magnesium toxicity
decreased DTRs, respiratory arrest, cardiovascular arrest
105
infertility work-up
semen analysis, LH/FSH, HSP, endometrial biopsy
106
ideal fetal presenting position
occiput anterior
107
maternal indications for induction
preeclampsia, diabetes, chorioamnionitis, greater than 40-42 weeks
108
how should breech presentation be managed after 36 weeks
external cephalic rotation
109
definition of postpartum hemorrhage
> 500cc in vaginal delivery
| > 1000cc in c-section
110
treatment for woman who does not wish to breastfeed postpartum
ice packs, tight fitting bra, analgesics
| second line: OCPs, bromocriptine
111
diagnosis: postpartum female presents with pain in breast localized to one region, no redness or warm
galactocele
112
when can OCPs be initiated in women who do not wish to breast feed
wait 6 weeks due to risk of DVT
113
diagnosis: postpartum woman develops sudden onset of hypoxia, cardiogenic shock, and DIC
amniotic fluid embolism
114
diagnosis: patient loses 500cc of blood postpartum and now has anemia, attempts at breast feeding have been unsuccessful as she is unable to secrete milk
sheehan syndrome
115
medications used to control postpartum hemorrhage
uterine massage, oxytocin
| second line: methergen, hemabate, surgical options
116
definition of prolonged latent phase in labor
> 20 hours in nulliparous
| > 14 hours in multiparous
117
definition of prolonged active phase in labor
< 1.2 cm/hr in nulliparous
| < 1.5 cm/hr in multiparous
118
definition of arrest of descent in labor
> 2 hours in nulliparous
> 1 hour in multiparous
add 1 hour for epidural injection
119
first steps in management of uterine hyperstimulation, nonreassuring fetal heart tones
remove stimulating agent, maternal oxygen, turn the mom to the left lateral decubitus position, may need to adminster tertbutaline to stop contractions, place fetal scalp electrode and IUPC
120
treatment for lichen planus
high dose steroids (clobetasol)
| biopsy to rule out malignancy
121
sinusoidal fetal heart changes (tachycardia to bradycardia)
ruptured fetal umbilical vessel
122
condition where fetal blood vessels traverse fetal membranes across lower segment of uterus between baby and internal cervical os
vasa previa
123
most significant risk factor for distal limb reduction defects associated with chorionic villi sampling
< 9-10 weeks associated with greater risk of limb defects
124
BPP: score 8-10
normal
125
BPP: score 6 without oligohydramnios
> 37 weeks: deliver
| < 37 weeks: repeat BPP in 24 hours and deliver if unimproved
126
BPP: score 6 with oligohydramnios
> 32 weeks: deliver
| < 30 weeks: daily monitoring
127
BPP: score 4
> 26 weeks: deliver
128
high FSH/LH with low estrogen
ambiguous genitalia at birth
polycystic ovaries later in life
aromatase deficiency
129
cafe-au-lait macules, fibrous dysplasia of bone, precocious puberty
mccune-albright syndrome
130
pseudohermaphroditism, salt wasting, virilization
congenital adrenal hyperplasia
131
etiology of lower abdominal pain during periods that radiates to the thighs
prostaglandins
132
management of fetal demise < 24 weeks
dilation and evacuation
133
management of fetal demise < 28 weeks
prostaglandin E2
134
management of fetal demise > 28 weeks
misoprostol or oxytocin
135
PROM < 32 weeks
steroids, antibiotics
| induce when amniotic fluid indicates fetal lung maturity
136
PROM 32-34 weeks
aminotic fluid analysis to determine lung maturity dictates management
137
PROM > 34 weeks
antibiotics and delivery is induced
138
painless genital ulcer with beefy red base
granuloma inguinale (donovania/klebsiella granulomatis)
139
painless ulcer with subsequence inguinal buboes, associated with fistula formation
lymphogranuloma venereum (c. trachomatis)
140
painful ulcer from tropical regions, gray base and foul odor, possible inguinal lymphadenopathy
chancroid (haemophilus ducreyi: gram-positive rod)
141
induces ovulation midcycle
LH surge
142
stimulates development of ovarian follicle
FSH
143
stimulates endometrial proliferation
estrogen
144
stimulates endometrial gland development
progesterone
145
decrease in levels leads to menstruation
progesterone
146
increases basal body temperature
progesterone
147
inhibits uterine contractions
progesterone
148
increases thickness of cervical mucus
progesterone
149
inhibits LH and FSH secretion
progesterone
150
inhibits FSH secretion
estrogen
151
induces LH surge
estrogen
152
maintains corpus luteum
hCG
153
benign ovarian cyst in beginning of cycle
follicular cyst
154
benign ovarian cyst in later weeks of cycle
corpus luteum cyst of theca cells
