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Kaplan Shelf prep > Obstetrics And Gynecology > Flashcards

Obstetrics And Gynecology Flashcards

1
Q

Normal menstrual cycle:
Two phases?
Two hormones per phase?
Two potential outcomes?

A

Follicular: FSH and Estrogen -> proliferative phase of the endometrium
Luteal phase: LH and Progesterone -> secretory phase of the endometrium
Outcomes: pregnancy or menstruation

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2
Q

Physiologic cardiovascular changes during normal pregnancy

A

CO increases
SVR decreases more
Bloop pressure drops

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3
Q

Physiologic changes seen in the GI system in normal pregnancy

A
  • Delayed gastric emptying
  • Increased relaxation of the lower esophageal sphincter
  • Decreased motility
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4
Q

Physiologic changes seen in the Renal system in normal pregnancy

A

GFR (CrCL) increases in pregnancy

Serum creatinine decreases

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5
Q

Physiologic changes seen in the endocrine system in normal pregnancy

A

Beta-hCG doubles every 48 hrs

hPL confers resistance to insulin

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6
Q

Hematopoietic changes during normal pregnancy

A

Hypercoagulable state

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7
Q

When to go for surgery instead of methotrexate in ectopic pregnancy

A
  • ruptured ectopic pregnancy
  • patient unlikely to follow up
  • fetal heart sound
  • beta hCG > 5000
  • GS > 3.5cm
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8
Q

Define spontaneous abortion

A

Unprovoked fetal loss before 20 weeks gestation

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9
Q

Most common cause of spontaneous abortion

A

Chromosomal abnormalities

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10
Q

Complete abortion :
Vaginal bleeding
Cervix
Ultrasound

A

+/- vaginal bleeding
Closed cervix
Empty uterus

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11
Q

InComplete abortion :
Vaginal bleeding
Cervix
Ultrasound

A

Vaginal bleeding present
Open cervix
Product of conception present in the uterus

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12
Q

Inevitable abortion :
Vaginal bleeding
Cervix
Ultrasound

A

Vaginal bleeding
Open cervix
Live or dead product of conception

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13
Q

Threatened abortion :
Vaginal bleeding
Cervix
Ultrasound

A

Vaginal bleeding
Closed cervix
Live fetus on ultrasound

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14
Q

Missed abortion :
Vaginal bleeding
Cervix
Ultrasound

A

Vb hasn’t started yet
Closed cervix
Dead fetus

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15
Q

Risk factor for 1st time ectopic pregnancy

A

History of

  • PID
  • Salpingitis
  • Prior surgery
  • Endometriosis
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16
Q

Most common location of ectopic pregnancy

A

Ampulla

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17
Q

Quad screen consists of

A

Beta-hCG
Estriol
MSAFP
Inhibin A

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18
Q

Increase hCG and inhibin A, decrease estriol and AFP,

A

Trisomy 21

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19
Q

Increased MSAFP

A

Open neural tube defect, gastroschisis

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20
Q

When to screen for gestational diabetes

A

26- 28 weeks

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21
Q

How do you screen for gestational diabetes?

A 
Start with 1hr GTT (50g glucose)
If > 140, do 3hr 100 GTT
Fasting : 95
1hr: 180
2hrs: 155
3hrs: 135

Or random > 200 + symptoms

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22
Q

Complications of pregestational diabetes mellitus

A

Caudal regression syndrome

Cardiac defects

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23
Q

Complications of gestational diabetes

A

Macrosomia,
Shoulder dystonia
Polydramnios
Neonatal hypoglycemia

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24
Q

Definition of oligohydramnios

A

Low amniotic fluid (< 5cm Amniotic Fluid Index)

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25
Q

Causes of oligohydramnios

A 
Can’t pee or make urine:
Renal agenesis
GU obstruction ( posterior urethral valves in males)
Uteroplacental insufficiency 
Ruptured membrane
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26
Q

Most common cause of oligohydramnios

A

Ruptured membranes

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27
Q

Definition of polyhydramnios

A

Increased amniotic fluid (>24 cm Amniotic Fluid Index on US)

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28
Q

Causes of polyhydramnios

A

Can’t absorb fluid to make urine or making too much urine:

  • esophageal or duodenal atresia
  • anencephaly
  • maternal diabetes
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29
Q

Blood pressure criteria in pregnancy

A
  • 4hrs apart
  • systolic bp >/= 140mmHg or
  • diastolic bp >/= 90mmHg
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30
Q

Gestational hypertension criteria

A
  • bp criteria met
  • after 20 weeks gestational age
  • no features of preeclampsia
  • no need for bp meds
  • no need for aspirin
  • deliver at 37 weeks
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31
Q

Chronic hypertension in pregnancy features

A
  • bp criteria is met
  • prior to 20 weeks gestational age
  • no features of preeclampsia
  • possibly need ongoing bp meds
  • give aspirin at 12 weeks gestation
  • deliver at 38 weeks if no meds and 37 weeks if on meds
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32
Q

Pre-eclampsia criteria

A
  • blood pressure criteria met
  • after 20 weeks gestation
  • evidence of end-organ involvement: proteinuria or severe features
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33
Q

Organ systems that can be affected in preeclampsia

A 
Renal
Neurologic
Pulmonary 
Hepatobiliary
Hematopoietic
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34
Q

Proteinuria?

A

Protein/creatinine of 0.3mg/dL
300mg of protein in a 24 hour urine
Protein>/= 2+

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35
Q

Preeclampsia with severe features criteria

A
  • Severe ranges of blood pressure:- >/= 160mmHg or >/= 110 mmHg
  • Low platelet count (<100,000)
  • Increased LFTs (> 2x the upper limit of normal conc)
  • Pulmonary edema
  • Creatinine >1.1 mg/dL or 2x baseline
  • New onset headache and visual changes
  • Right upper quadrant pain
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36
Q

Antihypertensives used in pregnancy

A

Labetalol
Hydralazine
Immediate release nifedipine

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37
Q

What is normal labor

A

Painful contractions that causes cervical changes

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38
Q

Explain the phases of the first stage of labor

A

Latent phase: prior - 6cm

Active phase: after 6cm

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39
Q

What is normal second stage of labor

A

10 cm(complete dilation) to delivery for = 2hrs for multiparous patients and = 3hrs for nulliparous patients

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40
Q

Third stage of labor?

A

From delivery of baby to delivery of placenta

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41
Q

What is arrest of active phase in labor

A

No change in >/= 4 hrs with adequate contraction

Or >/= 6hrs with inadequate contraction

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42
Q

Management of arrest of active phase of labor

A

Oxytocin

Cesarean delivery

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43
Q

Four aspects of interpretation of fetal heart rate monitoring

A

Baseline heart rate (110-160 bpm)
Beat to beat variability
Accelerations
Decelerations

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44
Q

Early decelerations is due to

A

Head compressions

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45
Q

Variable decelerations is due to

A

Cord Compression

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46
Q

Late decelerations is due to

A

Uteroplacental insufficiency

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47
Q

Category 1 FHR tracing features:

A

110-160 bp.
Moderate Variability
No variable or late decelerations

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48
Q

Category 3 of FHR tracing

A

Absent baseline variability plus any of

  • Bradycardia
  • Recurrent late or variable decelerations
  • Sinusoidal pattern
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49
Q

Treatment of choice for prevention of intrapartum seizures in pre-eclamptic patient and/or eclamptic patients

A

Magnesium sulfate

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50
Q

First sign of magnesium toxicity

A

Decreased deep tendon reflexes

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51
Q

Signs of magnesium toxicity

A

Decreased DTRs
Respiratory paralysis
Arrhythmia

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52
Q

Magnesium antidote

A

Calcium gluconate

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53
Q

Which type of patients can’t get magnesium sulfate

A

Myasthenia gravis patients

54
Q

Ulcerative painful STI

A

HSV
Chancroid
LGV

55
Q

Painless ulcerative STI

A

Syphilis

Granuloma inguinale

56
Q

Non-ulcerative STI

A

Chlamydia
Gonorrhea
Trichomonas

57
Q

What is the most common STI

A

Human papilloma virus

58
Q

Painful angry red ulcer(s) in genitals; painful lymphadenopathy that can rupture

Cause?

A

Haemophilus ducreyi

59
Q

Painful angry red ulcer(s) in genitals; painful lymphadenopathy that can rupture

Treatment

A

Azithromycin, ceftriaxone or ciprofloxacin

60
Q

Painless genital ulcers + painful lymphadenopathy

Diagnosis?

A

LGV

61
Q

Treatment of LGV

A

Doxycycline

62
Q

Painless ulcer+ painless lymphadenopathy

A

Syphilis

63
Q

Management of a pregnant woman with syphilis and is allergic to Pencillin

A

Desensitize and treat with penicillin

64
Q

Acute febrile reaction accompanied by headache and myalgia within 24 hrs of syphilis treatment initiation

A

Jarisch-Herxheimer reaction

65
Q

Beefy red, velvety genital nodule that turns into a painless genital ulcers without lymphadenopathy

Organism?

A

Klebsiella granulomatis (granuloma inguinale)

66
Q

Treatment for cervicitis

A

Ceftriaxone and azithromycin

67
Q

Sexually actively female with chief complaint of lower abdominal or pelvic pain or tenderness in cervix raises suspicion for

A

PID

68
Q

Outpatient treatment for PID

A

Ceftriaxone and doxycycline

69
Q

Inpatient treatment for PID

A

Cefoxitin and doxycycline or clindamycin and gentamicin

70
Q

How long to treat PID with antibiotics

A

10-14 days

71
Q

Maternal fever+ purulent or foul smelling discharge; fetal tachycardia; maternal tachycardia; fundal tenderness

Most likely diagnosis?

A

Choriamnionitis

72
Q

How does someone become GBS positive

A

Previous neonate with GBS disease (positive for life)
GBS asymptomatic bacteriuria or UTI anytime in pregnancy (positive for length of pregnancy)
GBD screening rectovaginal culture (positive for labor)

73
Q

Treatment drug of choice for GBS chorioamnionitis

A

Penicillin

74
Q

Treatment drug of choice for GBS chorioamnionitis with non anaphylactic penicillin allergy

A

Cefazolin

75
Q

Treatment drug of choice for GBS chorioamnionitis with high risk anaphylaxis allergy

A

Require culture and susceptible testing for clindamycin

Sensitive to both: clindamycin
To non: Vancomycin

76
Q

Painful dark vaginal blood in 3rd semester is suspicious of

A

Placenta abruption

77
Q

Placenta blocks the exit (os) painless, bright red VB in third trimester

A

Placenta previa

78
Q

Risk factors for placenta abruption

A

Previous abruption
HTN diseases
Cocaine

79
Q

Management of placenta abruption

A

Emergent Delivery

80
Q

Risk factors for placenta previa

A

Prior cesarean delivery

History of placenta previa

81
Q

Management of placenta previa

A

Cesarean delivery

82
Q

Define postpartum hemorrhage

A

Blood loss if >500cc during vaginal delivery or >1000cc during C.delivery or signs and symptoms of hypovolemia within 24hrs of delivery

83
Q

Causes of postpartum hemorrhage

A 
Uterine atony
Genital trauma lacerations 
Uterine inversion
Coagulopathies
Retained placenta
84
Q

Uterotonic drugs

A

Oxytocin
Methylergonovine
Misoprostol
Prostaglandin F2 alpha

85
Q

A soft “boggy” uterus + postpartum hemorrhage

A

Uterine atony

86
Q

1st line management of uterine atony

A

Massage

87
Q

Meds that can be used for uterine atony

A 
Oxytocin 
Methylergonovine
Prostaglandins F2
Misoprostol 
Tranexamic acid
88
Q

Postmenopausal female with dyspareunia, vulvar itching (or incidental findings of) and symmetric, whitish, thinning of the labia, perineum and perineum. Labia minora can stick together
Diagnosis?

A

Lichen sclerosis

89
Q

Diagnostic test for lichen sclerosis

A

Punch biopsy

90
Q

Treatment of lichen sclerosis

A

High potency Topical corticosteroid (clobetasol)

91
Q

Normal pH for vaginal discharge

A

4 - 4.5

92
Q

Which vaginitis has normal pH

A

Candidiasis

93
Q

Malodorous discharge; off- white grayish homogeneous discharge

Diagnosis?

A

Bacterial vaginosis

94
Q

What is seen on microscopy in bacterial vaginosis

A

Clue cells and less lactobacilli

95
Q

Malodorous discharge, dyspareunia, dysuria; green-yellow discharge, vaginal erythema

Diagnosis?

A

Trichomoniasis

96
Q

Treatment for bacterial vaginosis

A

Metronidazole

97
Q

What is seen on microscopy in trichomoniasis

A

Mobile flagellated trichomonads

98
Q

Pruritus, soreness, dyspareunia; vulvar erythema, clumpy white discharge

Diagnosis?

A

Candidiasis

99
Q

What is seen on microscopy in candidiasis

A

Pseudohyphae- candida albicans

Budding yeast - non-albicans

100
Q

Treatment of candidiasis

A

Azole antifungal

101
Q

Painful grouped vesicles or ulcer with painful lymphadenopathy

Most likely Diagnosis?

A

HSV

102
Q

Diagnostic test for HSV

A

PCR

103
Q

Treatment for HSV

A

Acyclovir
Valacyclovir
Famciclovir

104
Q

Management of a pregnant patient with history of HSV

A

Use suppressive medication around 36 weeks

105
Q

Management of a pregnant patient who has prodromal symptoms or active lesions at time of labor

A

Cesarean delivery

106
Q

Condyloma lata + maculopapular rash on palms and soles

A

Secondary Syphilis

107
Q

PALM COEIN of AUB

A 
Polyp
Adenomyosis 
Leiomyoma
Malignancy/ hyperplasia
Coagulopathy
Ovarian dysfunction 
Endometrial dysfunction 
Iatrogen
Not otherwise classified
108
Q

AUB -intermenstrual bleeding

A

Endometrial polyps

109
Q

AUB - smooth, boggy uterus

A

Adenomyosis

110
Q

AUB in post menopausal women is what until proven otherwise

A

Endometrial hyperplasia vs. cancer

111
Q

AUB basic work up includes

A 
Pregnancy test
CBC
TSH
Cervical cancer screening 
STI screening
112
Q

Work up for suspected ovarian cause of AUB

A

Pregnancy test
TSH
prolactin
Endometrial biopsy for high risk patients

113
Q

Important indicators of unopposed estrogen exposure

A 
Early menarche 
Late menopause 
No breast feeding
Nulliparity 
Obesity
Polycystic ovarian syndrome
Hyperprolactinemia
Thyroid disease
114
Q

When should endometrial sampling be performed

A 
Post menopausal bleeding
AUB in women older than 45
AUB in women younger than 45 with unopposed estrogen exposure risk factors: 
Early menarche/ late menopause 
Nulliparity 
Chronic anovulation
Obesity 
Diabetes 
Others: Lynch Syndrome, Family history, estrogen secreting tumor
115
Q

Ultrasound features of potential malignancy that can make an adnexal mass be a big deal

A

Solid (hypoechoic) component
Septations
Doppler flow in the solid component
Ascites

116
Q

Germ cell tumor is the most common ovarian malignancy in what age group of women

A

Women under 20

117
Q

What is the treatment for germ cell tumor with the exception of dysgerminomas

A

Bleomycin
Cisplatin
Etoposide

118
Q

Tumor marker for dysgerminoma

A

LDH

119
Q

What is dysgerminoma very sensitive to

A

Radiation

120
Q

Tumor marker for endodermal sinus

A

Increased AFP

121
Q

Tumor marker for choriocarcinoma

A

Beta-hCG

122
Q

Sertoli leydig celllz tumors presents with

A

Virilization
Oligo/amenorrhea
Elevated levels of testosterone or androstenedione

123
Q

Meigs Syndrome triad

A

Fibroma
Right sided hydrothorax
Ascites

124
Q

hiw do you Screen for ovarian cancer in a patient with BRCA mutations

A

Ultrasound and CA- 125

125
Q

What hormone is responsible for the development of the external male genitalia

A

Dihydrotestosterone

126
Q

What converts testosterone to dihydrotestosterone

A

5 alpha reductase

127
Q

primary Amenorrhea + virilization+ internal male genitalia

Diagnosis?

A

5 alpha reductase deficiency

128
Q

Normal appearing female with elevated testosterone, dihydrotestosterone and estrogen

Diagnosis?

A

Androgen insensitivity Syndrome

129
Q

normal female external genitalia + Primary amenorrhea + absent sex characteristics + absent uterus

A

Androgen insensitivity Syndrome

130
Q

Normal ovaries and female external genitalia + absent uterus, cervix and upper third of vagina

A

Mullerian agenesis

131
Q

What hormone is increased in menopause

A

FSH

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