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1
Q

Vaginismus treatment

A

Relaxatin, Kegels, insertion of dilators/fingres to desensitize

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2
Q

Risks to fetus with GDM (6)

A 
Macrosomia
Hypocalcemia
Hypoglycemia
Hyperviscosity/polycythemia: Hyperglycemia induces increased BMR which leads to fetal hypoxia and increased EPO production
Respiratory problems
Cardiomyopathy and CHF
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3
Q

Management of LSIL on pap

A

Premenopausal women
-at higher risk of CIN 2/3 so always follow up with colpo

Postmenopausal women
-immediate colpo
or
-reflex HPV testing; colpo if positive
or
-repeat pap at 6 and 12 mos; colpo if abnormal
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4
Q

Management of CIN1 found on colpo

A

CIN1 preceded by low grade abnormalities
-repeat pap at 6 and 12 mos with colpo if pos
or
-HPV test in 12 mos and colpo if pos

CIN1 preceded by high grade abnormalities
-diagnostic excisional procedure (LEEP or cold knife)
or
-repeat pap and colpo at 6 and 12 mos with diagnostic excisional procedure or continued abnormlities

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5
Q

Work up of primary amenorrhea, uterus present

A

1) FSH level: distinguishes hypothalamic/pituitary (central) prolbem from gonadal problem
- if FSH elevated, gonadal, go to karyotype
- if FSH low, central, go to pituitary MRI

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6
Q

BPP: five parameters

A

1) NST - reactive
2) fetal tone - flexing or extending extremity
3) fetal movements - 2/30mins
4) fetal breathing movements - 20s/30m
5) amniotic fluid volume - pocket with greater than 2cm vertical diameter

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7
Q

BPP: management

A

8-10: normal
6without oligo: delivery if over 37 wks, repeat in 24 hours with delivery if unimproved if less than 37 wks
6 with loligo: delivery if over 32 weeks; daily monitoring if less than 32 weeks
4 or less: delivery if over 28 weeks

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8
Q

Management of excess N/V in pregnancy

A

1) measure beta hCG

2) if very high, ultrasound

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9
Q

Pathophys of stress incontinence

A

Weakened pelvic floor - urethral hypermobility with angle over 30% with increaesed intraabdominal pressure

Best rx is urethropexy to restore urethrovesicular angle

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10
Q

Physiologic leukorrhea

A

Copious white or yellow discharge without other symptoms

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11
Q

Management of symptoms of hyperprolactinemia

A

Measure both PRL and TSH beause hypothyroid can cause elevation of PRL; if isolated high PRL then MRI pituitary

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12
Q

Ruptured corpus luteum cyst in pregnancy

A

Causes hemoperitoneum in pregnancy: blood in abdomin irritates peritoneal lining resulting in severe pain, distension, and rebound. Can be confused with ectopic which is the most common cause of hemoperitoneum in setting of pos UPT.

If cyst is removed prior to 10-12 wks gestation, need to supplement progesterone

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13
Q

Surgical site infections

A

Fascial disruption: see copious peritoneal fluid escaping wound 7-10 days out; requires immediate surgical closure and broad spec antibiotics; usually caused by suture tearing through fascia

Superficial separation: open woun and drain purulence, broad spec antibiotic

Evisceration: protrusion of bowel or omentum through incision

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14
Q

Treatment of pyelonephritis

A

Treatment with antibiotics can cause bacterial lysis and endotoxemia, which can cause ARDS or preterm labor. Put on suppressive oral therapy for remainder of pregnancy due to high recurrence rate. Lack of improvement within 48 hrs of antibiotics suggests a urinary tract obstruction

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15
Q

CIs to mirena

A

recent STI, high risk for STI, anormal size/shape of uterus

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16
Q

Early HTN in pregnancy

A

HTN less than 20 wks either molar preg or chronic HTN

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17
Q

Third tri back pain etiology

A

Lumbar lordosis

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18
Q

Turner syndrome labs

A

Poor ovarian fx causes high FSH due to lack of neg feedback

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19
Q

PRemature ovarian failure/menopause labs

A

Elevated FSH and LH with FSH greater than LH due to slower clearance

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20
Q

BV vs trich presentation

A

Trich more associated with pruritus and inflammation

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21
Q

UTerine rupture presentation and distinguishing from previa

A

Presents with intesnse abdominal pain and vaginal bleeding. Pain progresses from acute pain of rupture to slight relief to diffuse pain. See retraction of presenting part and easier palpation of fetal limbs at abdomen, distinguishing from previa. Hypovolemia

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22
Q

Management of vaginal cancer

A

Stage I/II less than 2cm: surgery

Stage I/II greater than 2cm: radiation

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23
Q

Primary dysmenorrhea: presentation, pathophys, and treatment

A

Presentation: lower abdominal pain radiating to thighs and back; begins hours prior to menstruation
Pathophys: release of PGs during breakdown of endometrium (higher PG levels in women with primary dysmenorrhea)
Rx: NSAIDs to lower PGs

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24
Q

Treatment of AI

A

Gonadectomy to decrease testicular cancer risk AFTER completion of breast development and attainment of full adult height

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25
Ruptured fetal umbilical vessels: presentation, diagnosis, pathophys, treatment
Presentation: antepartum hemorrhage with characteristic sinusoidal (bradycardia to tachycardia) FHR tracing Diagnosis: Apt test which differentiates maternal and fetal blood Pathophys: vaso previa (fetal vessels located between baby and cervical os) leaving them vulnerable to tearing during SROM or AROM Treatment: crash section due to high fetal mortality rate
26
Arrest of descent def
Lack of change in 2hours for nullip/1 hour for multip (add 1 hr if epidural)
27
Hypotension with epidural
Caused by symp fiber block that leads to vasodilation in lower extremities and venous pooling
28
Postterm pregnancy monitoring
twice weekly US to monitor for oligo
29
Risk factors for uterine inversion
Anything that overextends uterus (grand multiparity, multiple gestation, poly, macrosomia) Number one risk factor is iatrogenic- excess cord traction
30
Betamethasone effects on fetus
1) increases lung maturity and decreases resp distress syndrome 2) decreases ICH risk 3) decreases necrotizing enterocolitis risk NO increased risk of infection in newborn
31
IUGR management
If accompanied by oligo, induce labor | If reassuring fetal testing, deliver at 37 weeks
32
Folate dose in women with prior NTD
4mg
33
Amniotic fluid parameters in chorio
Decreased glucose Increased IL-6 Increased leukocytes but low pos predictive value
34
Weight gain recommendations
Underweight: 28 to 40 pounds Normal weight: 25-35 pounds Overweight: 15-25 pounds Obese to any degree: 11-20 pounds
35
Pelvic congestion syndrome
CPP in setting of pelvic varicosities; presents with pelvic fullness/heaviness
36
Tamoxifen therapy monitoring for endometriosis
Annual exams. Only do endometrial biopsy if symptoms (bleeding or abnormal discharge) present because not used for screening
37
Copocleisis
Surgical obliteration of the vaginal to treat severe prolapse. Good for those with comorbidities because can be done quickly without any general anesthesia
38
Management of newborns with mec-stained amniotic fluid
Don't suction routinely. If newborn depressed, intubate trachea and suction mec from beneath glottis
39
Cervical lesions: polyp vs cancer vs cyst
Cervical polyp: soft, bleeds Cervical cancer: hard/nodular, bleeds Nabothian cyst: doesn't bleed
40
Fetal dysmaturity
Associated with advanced gestational age and small placenta. Withered, mec-stained, long-neailed, fragile infant. High risk for stillbirth
41
Highest risk cardiac conditions in pregnancy
Pulm HTN, aortic coarct with valve involvement, and Marfan with aortic involvement have 25-50% mortality rate
42
Tocolytics
``` CCBs (nifedipine) Beta agonists (terbutaline and ritodrine): contraindicated in diabetics, not usually used Indomethacin: CI after 32 weeks due to risk of PDA closure ```
43
Pruritus gravidarum
Mild version of cholestasis of pregnancy. Retention of bile salts resulting in bile salt deposition in dermis. Initial rx: antihistamines and topical emollients If ineffective, ursodeoxycholic acid or naltrexone
44
Pre-e urine protein
Over 300mg for diagnosis | Over 5000mg for severe pre e
45
ABG in pregnancy
Compensated resp alkalosis due to increased minute ventilation
46
Lewis antibodies
IgM; don't cross placenta
47
IUGR complications
Fetal/perinatal demise Meconium aspiration Polycythemia
48
Preterm labor rx
Tocolytic + betamethasone + ampicillin if GBS status unknown
49
Lichen planus
Chronic derm disorder affecting hair-bearing skin, scalp, nails, oral mucosa, and vulva. Flares and remits. Vulvar irritation, burning, pruritus, burning, pain. Lacy reticulated pattern of labia and perineum. Can get scarring, erosions, adhesions
50
Lichen sclerosus
Whitening and thinning of perineal tissue seen in postmenopausal women, precursor to SCC. Extreme vulvar pruritus, burning, pain, dysparenunia
51
Management of heavy bleeding after medical abortion
Most likely due to retained products of conception. Manage with D&C
52
Indications for cold knife conization
Pos endocervical curretage; HSIL too large for LEEP; intolerance of exam; lesion beyond vision; rule out invasive cancer
53
Imipramine
TCAD that can increase prolactin level
54
Indications for colpo
Any pap abnormality (including ASCUS) associated with pos HPV
55
Cervical incompetance management
Progesterone can be used by not evidence based | Place cerclage at 14 weeks
56
Ovarian cyst management
Repeat US. Hemorrhagic cyst should self-resolve
57
Cystocele repair
Fix defects in pubocervical fascia or reattach it to sidewall if separated from white line
58
External cephalic version requirements
- reactive NST - no contraindications to vaginal delivery - 37wks to onset of labor
59
Amniotic fluid embolism presentation and management
Pres: sudden resp failure, cardiogenic shock, seizures, can lead to DIC Management: adequate resp support number one priority
60
Methyldopa
Centrally acting alpha agonist used for HTN in pregnancy
61
Indications for endometrial biopsy in women with dysfunctional bleeding
Age over 35, obesity, chronic HTN, diabetes
62
Fetal hydantoin syndrome
Caused by exposure to anticonvulsants in utero - most often phenytoin and carbamazepine. Midface hypoplasia, microcephaly, cleft lip/palate, digital hypoplasia, hirsutism, developmental delay
63
Septic abortion management
Obtain blood and cervical cultures, then start antibiotics immediately. Gentle suction curretage - risk of uterine ruptur if aggressive
64
3Ds of endo
Dyspareunia Dysmenorrhea Dyschezia
65
Treatment of dysfunctional uterine bleeding in adolescent
Mild - iron supplement | Mod to severe: iron + high dose estrogen
66
Graves disease in pregnancy
Thyroid stimulating antibody can persist for several months following thyroidectomy. Can cross placenta (IgG) and cause thyrotoxicosis in fetus. Levo does not cross
67
Luteoma of pregnancy
Benign bilateral solid ovarian masses. Can cause hirsutism and virilization. No treatment needed
68
L/S ratio
Greater than 2 indicates fetal lung maturity

OBGYN shelf (2 decks)

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