Obstetrics and Gynecology Flashcards
1
Q
2 types of amenorrhea
A
primary
secondary
2
Q
primary amenorrhea is no menses by _ yo with an absence of secondary sex characteristics
OR
by _ yo w. normal growth of secondary sex characteristis
A
13
15
3
Q
causes of primary menses
A
pregnancy
imperforate hymen
turner syndrome (dysgenesis)
HPO axis abnl
anorexia
bulimia
wt loss
exercise
4
Q
secondary amenorrhea is absence of menses for _ mo in women w. previously normal menstruation,
OR
_ mo in a woman w. a hx of irregular cyles
A
3
6
5
Q
mc cause of amenorrhea
A
pregnancy
6
Q
ascending infxn that ascends from the cervix or vagina to the endometrium and/or fallopian tubes
A
PID
7
Q
2 mc pathogens associated w. PID
A
GC
CT
8
Q
what is chandelier’s sign
A
cervical motion tenderness -> PID
9
Q
3 complications of PID
A
infertility
ectopic
tubo-ovarian abscess
10
Q
dx for PID
A
abdominal tenderness, cervical motion tenderness, and adnexal tenderness
PLUS 1 or more:
temp > 38
WBC > 10,000
pelvic abscess
11
Q
tx for PID: inpt vs outpt
A
outpt: ceftriaxone + doxy +/- metro
inpt: doxy + cefoxitin OR cefotetan x 48 hr, followed by doxy
12
Q
indications for inpt tx w. PID
A
severely ill/vomiting
dx uncertain
ectopic/appendicitis can’t be ruled out
pregnancy
pelvic abscess suspected
HIV
failed outpt tx
13
Q
excessive uterine bleeding w. no organic cause
A
dysfunctional uterine bleeding
14
Q
types of dysmenorrhea
A
menorrhagia
metorrhagia
menometrorrhagia
polymenorrhea
oligomenorrhea
15
Q
prolonged/heavy uterine bleeding
regular intervals
A
menorrhagia
16
Q
variable amt of bleeding
irregular, frequent intervals
A
metrorrhagia
17
Q
more blood loss during menses
frequent irregular bleeding btw menses
A
menometrorrhagia
18
Q
menses that occur more frequently (< 21 days)
A
polymenorrhea
19
Q
menses that occur less frequently (> 35 days)
A
oligomenorrhea
20
Q
what types of dysfunctional uterine bleeding to uterine lesions cause (2)
A
menorrhagia
metrorrhagia
21
Q
uterine lesions include (6)
A
endometrial ca/sarcoma
endometrial hyperplasia
submucosal fibroid
endometrial polyps
endometritis
adenomyosis
22
Q
blood disorders associated w. dysfunctional uterine bleeding (4)
A
vWD (von willebrand)
prothrombin deficiency
leukemia
severe sepsis
23
Q
which types of dysfunctional uterine bleeding is hypothyroidism associated w. (2)
A
menorrhagia
metrorrhagia
24
Q
which 2 types of dysfunctional uterine bleeding is hyperthyroidism associated w. (2)
A
oligomenorrhea
amenorrhea
25
continuous unopposed production of estradiol 17 beta causes
anovulatory dysfunctional uterine bleeding:
continuous proliferation of endometrium w.o corpus luteum -> sloughs off in irregular pattern
26
LH surge is associated w. what type of dysfunctional uterine bleeding
mid cycle spotting
27
gs dx for dysfunctional uterine bleeding
dilation and curettage
*diagnostic and therapeutic*
28
_ can be used acutely if pt presents w. hemorrhage due to DUB
IV estrogen
29
_ reduce menstrual blood loss
NSAIDs
30
dysmenorrhea prior to menses, not relieved by NSAIDs or OCPs
dyspareunia
endometriosis
31
2 types of dysmenorrhea
primary
secondary
32
primary menorrhea begins w.in _ to _ mos of menarche
6-12
33
dysmenorrhea is due to excess _ production (2)
PG
leukotriene
-> increased uterine contraction
34
describe pain w. dysmenorrhea
begins w. start of menses
lasts 2-3 days
worst on day 1
35
3 sx associated w. dysmenorrhea
ha
nausea
diarrhea
36
painful menstruation caused by clinical identifiable cause
secondary amenorrhea
37
causes of secondary amenorrhea (lots!)
endometriosis
adenomyosis
polyps
fibroids
PID
IUD
tumors
adhesions
cervical stenosis/lesions
psych
38
describe pain w. secondary menorrhea
pain begins mid cycle
increases in severity til the end
39
mc age for secondary dysmenorrhea
20-40
40
top 2 locations for ectopic pregnancy
1. fallopian tubes
2. ampulla of tube
41
3 hallmark findings of ectopic
abd pain
bleeding
adnexal mass
42
mc cause of ectopic
occlusion of tube 2/2 adhesions
43
6 rf for ectopic
previous ectopic
previous salpingitis
previous abd/tubal surgery
IUD
assisted reproduction
smoking
44
5 sx of ruptured ectopic
severe abd pain or shoulder pain
peritonitis
tachycardia
syncope
orthostatic hypotn
45
dx for ectopic
b hcg > 1,500 w. no fetus in utero on US
46
when bHCG > _ there should be evidence of developing intrauterine gestation on US
1,500
47
hallmark US finding of ectopic
**ring of fire (ring of vascularity)**
*hypervascular lesion w. peripheral vascularity*
48
what is this showing
ring of fire -> ectopic
49
indications for MTX for ectopic
b HCG < 5,000
ectopic mass < 3.5 cm
no FHR
hemodynamically stable
no blood d.o
no pulm. dz
no peptic ulcer
normal renal fxn
normal hepatic fxn
compliant pt
50
contraindications for MTX for ectopic (3)
bf'ing
active pulm dz
immunodeficiency
51
moa for MTX
folic acid antagonist -> inhibits DNA replication
52
indications for emergent laparoscopy salpingostomy for ectopic
rupture
MTX contraindicated
53
premature separation of all/sections of otherwise normally implanted placenta from uterine wall after 20 weeks gestation
placental abruption
54
mc cause of third trimester bleeding
placental abruption
55
5 rf for placental abruption
trauma
smoking
HTN
preeclampsia
cocaine
56
painful 3rd trimester bleeding is always _ until proven otherwise
placental abruption
57
dx for placental abruption
clinical...always
58
US findings of placental abruption
retroplacental blood collection
59
PE finding of placental abruption
blood stained amniotic fluid in vagina
60
_ indicate fetal hypoxia/bradycardia
decelerations
61
tx for placental abruption (5)
**delivery**
type and match
coag studies
large bore IV
steroids
62
management of small placental abruptions
expectant management
63
endometriosis is mc found in the (2)
ovary
peritoneum
64
t/f: the severity of endometriosis sx does not equate to severity of dz
t!
65
endometriosis is most likely caused by
retrograde menstruation: endometrium floats back out of fallopian tubes into ovary
66
rf for endometriosis
early menarche
short cycles
heavy/prolonged cycles
mullerian anomalies
fam hx
autoimmune dz
67
3 factors that decrease risk for endometriosis
multiparity
longer lactation
regular exercise
68
3 d's of endometriosis
dyspareunia
dyschezia
dysmenorrhea
69
PE finding of endometriosis
**uterus is fixed and retroflexed **
tender nodularity of cul de sac/uterine ligaments
70
gs dx for endometriosis
pelvic laparoscopy and bx
71
laparascopy findings of endometriosis
chocolate cysts
72
tx for endometriosis (5)
endometrial resection
NSAIDs
progestins/OCPs
danazol
GnRH agonist
73
max duration of tx w. danazol
6 mos
*risk for bone loss after*
74
increasing intake of _ can decrease risk of endometriosis
omega 3
75
placental lies very low in the uterus -> covers all or part of the cervix
placenta previa
76
painless third trimester bleeding is always _ until proven otherwise
placenta previa
77
5 types of placenta previa
complete
partial
marginal
low-lying
vasa previa
78
6 fetal complications associated w. placenta previa
preterm delivery
PPROM
intrauterine growth restrition
malpresentation
vasa previa
congenital abnl
79
4 rf for placenta previa
prior c section
multiple gestations
multiple induced abortions
advanced maternal age
80
dx for placenta previa
transvaginal US
81
what PE test is contraindicated in placenta previa
pelvic exam
82
management of placenta previa (4)
strict pelvic rest
+/- transfusion
c section
rhogam
83
preferred delivery for placenta previa
c section
84
3 types of fetal monitoring
non stress
contraction stress test
APGAR
85
good stress test findings
good = **reactive:**
> 2 accelerations x 20 min
increased FHR 15 bpm lasting > 15 sec
86
bad stress test findings
nonreactive = **bad:**
no FHR accelerations OR < 15 bpm lasting < 15 sec
87
what do order if you see nonreactive stress test
order contraction test
88
good stress test findings
negative = good:
-no late decelerations in presence of 2 contractions in 10 min
*repeat as needed*
89
bad stress test findings
positive = bad:
-repetitive late decelerations in the presence of 2 contractions x 10 min
**prompt delivery**
90
what does apgar stand for
appearance
pulse
grimace
activity
respiration
91
when is apgar ordered
1 and 5 min after birth
92
clinical definition of PROM
rupture of membranes at >/= 37 weeks gestation *prior to start of uterine contractions*
93
clinical definition of PPROM
PROM < 37 weeks gestation
94
2 major comlications of PPROM
infxn
cord prolapse
95
sx of PROM
sudden gush of clear/pale/yellow fluid from vagina after 37 weeks gestation
96
dx for PROM
1. speculum: fuid pooling in posterior fornix
2. nitrazine test: blue = pH > 7.1 -> positive
3. microscopy: ferning
97
what is this showing
ferning: crystallization of estrogen and amniotic fluid
98
management of PROM based on gestational age
**> 34 weeks:** induce labor
**32-34 weeks:** collect fluid, check lung maturity, induce
**< 32 weeks:** stop contractions, 2 doses steroid injxn, deliver, abx
99
fetus/infant nomenclature: abortion, premature, full term, postmature
abortion: < 20 weeks OR < 500 g
premature: 20-36 weeks OR 1,000-2,500 g
full term: 37-42 weeks OR > 2,500 g
postmature: < 42 weeks
100
what does GTPAL stand for
gravidity (# pregnancies)
term (>/= 37 weeks)
preterm (20-36 weeks)
abortion (loss prior to 20 weeks)
living
101
how do twins count in GTPAL
one pregnancy
two live children
102
when are fetal movements (quickening) felt: nulliparas vs multiparas
nulliparas: 18-20 weeks
multiparas: 14-16 weeks
103
5 signs of pregnancy
chadwick sign
increased body temp
melasma/chloasma
linea nigra
hegar's sign
104
what is chadwick's sign
bluish discoloration of vagina/cervix
105
what is hegar's sign
softening btw fundux and cervix
106
normal uterine growth
12 weeks: pubic symphysis
20 weeks: umbilicus
> 20 weeks: 1 cm/week
107
normal FHR
when is it visible on US
120-160 bpm
6 weeks
108
2 important lab changes of pregnancy
cholesterol increase
BUN/Cr decrease
109
what labs are done at the firs prenatal visit
CBC
blood type
Rh factor
random BG
VDRL/RPR
hep B
rubella
UA
pap
GBS
+/- SSA, CF, Tay-Sachs
110
what is done at every prenatal visit
maternal weight
bp
fundal height
fetal size/presenting part
urine dipstick for protein/glucose/ketones
111
recommended wt gain during pregnancy
normal BMI: 20-35 lb
underweight: 40-45 lb
overweight: 10-15 lb
112
pregnancy nutrition to know
300 kcal/day
folic acid: 0.4 mg/day
iron: 30 mg/day
113
pregnancy nutrition to know
300 kcal/day
folic acid: 0.4 mg/day
iron: 30 mg/day
114
8 random things to avoid during pregnancy that we need to know
apple cider vinegar
deli meat
king mackerel
shark
swordfish
tuna
tilefish
farm salmon
115
5 rf for spontaneous abortion
smoking
infxn
maternal systemic dz
immunologic parameters
drug use
116
early pregnancy w. bleeding/pain is _ until proven otherwise
ectopic
117
gs evaluation of bleeding during pregnancy
transvaginal US
118
normal bHCG progression during pregnancy
doubles q 48 hr
119
management of spontaneous abortion
D&C
monitor bHCG
US
+/- Rh
120
management of septic/infected abortion
complete evacuation of uterine contents
abx
121
cervical os is open in what 2 types of abortions
inevitable
incomplete
122
cervical os is closed in what 2 types of abortions
threatened
complete
123
mastitis is caused by
skin/oral flora of bf'ing baby enter erosion/cracked nipple
124
mc cause of mastitis
clogged milk ducts
125
difference btw congestive and infectious mastitis
infectious: unilateral
congestive: bilateral
126
pathogen associated w. mastitis
s. aureus
127
abx for mastitis (3)
dicloxacillin
cephalexin
erythromycin
128
t/f: pt should continue bf'ing on affected side w. a breast abscess
f!
pump and dump affected side
bf unaffected side
129
pathogen associated w. breast absces
s aureus
130
abx for breast abscess
nafcillin/oxacillin
OR
cefazolin PLUS metro
131
3 sx of ovarian cyst
bloating
lower abd pain
lbp
132
classification of ovarian cysts
-functional: variant of normal menstruatal cycle
-non functional: non associated w. menstrual cycle
133
mc type of ovarian cyst
follicular
134
3 types of functional cyst
follicular
corpus luteum
theca lutein
135
3 characteristics of functional ovarian cysts
2-10 cm
clear serous liquid
smooth internal lining
136
dominant follicle fails to rupture
follicular ovarian cyst
137
dominant follicle ruptures but closes again and doesn't dissolve
corpus luteum cyst
138
-overstimulation of hcg produced by placenta
-only seen in pregnancy
theca lutein cysts
139
5 types of non functional/neoplastic cysts
PCOS
endometriomas
dermoid (teratomas)
ovarian serous
mucinous cystadenoma
140
amenorrhea
hirsutism
PCOS
141
chocolate cyst
endometrioma
142
3 characteristics of non functional/neoplastic cysts
> 10 cm
irregular borders
internal septations
143
3 main complications of ovarian cysts
hemorrhagic
rupture
torsion
144
hemorrhage is mc w. what 2 types of cyst
follicular
corpus luteal
145
ovarian cyst rupture mc occurs after
sex
146
torsion mc occurs w. cysts > _
5 cm
147
sx of ruptured ovarian cyst
pain
hypotn
abd/shoulder pain
tachycardia
148
3 sx of torsed ovarian cyst
waxing/waning pain
n/v
low grade fever
149
dx for ovarian torsion
1. US
**2. direct visualization during surgery -> gs**
150
tx for ovarian cysts based on size
< 5 cm: obs
> 5 cm: laprascopic removal
uncomplicated rupture: NSAIDs, expectant management
+/- surgery
151
4 types of vaginitis
BV
candidiasis
trichomonas
atrophic vaginitis
152
-low hydrogen peroxide -> lack of lactobacilli
-pH > 4.5
-gradnerella
BV
153
2 PE findings of BV
milky d.c
fishy odor
154
microscopy findings of BV
clue cells
*stipled epithelial cells*
155
AMSEL criteria
thin, white homogenous d.c
presence of clue cells
pH > 4.5
fishy odor
**must have 3/4**
156
tx for BV
metro
157
2 PE findings of vaginal candidiasis
thick white d.c
beefy red vaginal mucosa
158
tx for vaginal candidiasis
fluconazole
159
rf for recurrent vulvovaginal candidiasis
DM
160
which type of vaginitis can affect fertility
trichomonas
161
2 PE finding of trichomonas
grothy white/grey d.c
strawberry cervix
162
tx for trichomonas
metro
test of cure
full STI screen
treat partner
163
PE findings of atrophic vaginitis
fragile tissue
fissures
petechiae
labia minoa resorption
loss of rugae/elasticity
prominent meatus
urethral eversion/prolapse
164
tx for atrophic vaginitis
1. non hormonal OTC lubricants
2. topical estrogen vs estrogen ring
