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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
Q

Ruptured fetal umbilical vessels: presentation, diagnosis, pathophys, treatment

A

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

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26
Q

Arrest of descent def

A

Lack of change in 2hours for nullip/1 hour for multip (add 1 hr if epidural)

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27
Q

Hypotension with epidural

A

Caused by symp fiber block that leads to vasodilation in lower extremities and venous pooling

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28
Q

Postterm pregnancy monitoring

A

twice weekly US to monitor for oligo

29
Q

Risk factors for uterine inversion

A

Anything that overextends uterus (grand multiparity, multiple gestation, poly, macrosomia)

Number one risk factor is iatrogenic- excess cord traction

30
Q

Betamethasone effects on fetus

A

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
Q

IUGR management

A

If accompanied by oligo, induce labor

If reassuring fetal testing, deliver at 37 weeks

32
Q

Folate dose in women with prior NTD

A

4mg

33
Q

Amniotic fluid parameters in chorio

A

Decreased glucose
Increased IL-6
Increased leukocytes but low pos predictive value

34
Q

Weight gain recommendations

A

Underweight: 28 to 40 pounds
Normal weight: 25-35 pounds
Overweight: 15-25 pounds
Obese to any degree: 11-20 pounds

35
Q

Pelvic congestion syndrome

A

CPP in setting of pelvic varicosities; presents with pelvic fullness/heaviness

36
Q

Tamoxifen therapy monitoring for endometriosis

A

Annual exams. Only do endometrial biopsy if symptoms (bleeding or abnormal discharge) present because not used for screening

37
Q

Copocleisis

A

Surgical obliteration of the vaginal to treat severe prolapse. Good for those with comorbidities because can be done quickly without any general anesthesia

38
Q

Management of newborns with mec-stained amniotic fluid

A

Don’t suction routinely. If newborn depressed, intubate trachea and suction mec from beneath glottis

39
Q

Cervical lesions: polyp vs cancer vs cyst

A

Cervical polyp: soft, bleeds
Cervical cancer: hard/nodular, bleeds
Nabothian cyst: doesn’t bleed

40
Q

Fetal dysmaturity

A

Associated with advanced gestational age and small placenta. Withered, mec-stained, long-neailed, fragile infant. High risk for stillbirth

41
Q

Highest risk cardiac conditions in pregnancy

A

Pulm HTN, aortic coarct with valve involvement, and Marfan with aortic involvement have 25-50% mortality rate

42
Q

Tocolytics

A 
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
Q

Pruritus gravidarum

A

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
Q

Pre-e urine protein

A

Over 300mg for diagnosis

Over 5000mg for severe pre e

45
Q

ABG in pregnancy

A

Compensated resp alkalosis due to increased minute ventilation

46
Q

Lewis antibodies

A

IgM; don’t cross placenta

47
Q

IUGR complications

A

Fetal/perinatal demise
Meconium aspiration
Polycythemia

48
Q

Preterm labor rx

A

Tocolytic + betamethasone + ampicillin if GBS status unknown

49
Q

Lichen planus

A

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
Q

Lichen sclerosus

A

Whitening and thinning of perineal tissue seen in postmenopausal women, precursor to SCC. Extreme vulvar pruritus, burning, pain, dysparenunia

51
Q

Management of heavy bleeding after medical abortion

A

Most likely due to retained products of conception. Manage with D&C

52
Q

Indications for cold knife conization

A

Pos endocervical curretage; HSIL too large for LEEP; intolerance of exam; lesion beyond vision; rule out invasive cancer

53
Q

Imipramine

A

TCAD that can increase prolactin level

54
Q

Indications for colpo

A

Any pap abnormality (including ASCUS) associated with pos HPV

55
Q

Cervical incompetance management

A

Progesterone can be used by not evidence based

Place cerclage at 14 weeks

56
Q

Ovarian cyst management

A

Repeat US. Hemorrhagic cyst should self-resolve

57
Q

Cystocele repair

A

Fix defects in pubocervical fascia or reattach it to sidewall if separated from white line

58
Q

External cephalic version requirements

A
  • reactive NST
  • no contraindications to vaginal delivery
  • 37wks to onset of labor
59
Q

Amniotic fluid embolism presentation and management

A

Pres: sudden resp failure, cardiogenic shock, seizures, can lead to DIC

Management: adequate resp support number one priority

60
Q

Methyldopa

A

Centrally acting alpha agonist used for HTN in pregnancy

61
Q

Indications for endometrial biopsy in women with dysfunctional bleeding

A

Age over 35, obesity, chronic HTN, diabetes

62
Q

Fetal hydantoin syndrome

A

Caused by exposure to anticonvulsants in utero - most often phenytoin and carbamazepine. Midface hypoplasia, microcephaly, cleft lip/palate, digital hypoplasia, hirsutism, developmental delay

63
Q

Septic abortion management

A

Obtain blood and cervical cultures, then start antibiotics immediately. Gentle suction curretage - risk of uterine ruptur if aggressive

64
Q

3Ds of endo

A

Dyspareunia
Dysmenorrhea
Dyschezia

65
Q

Treatment of dysfunctional uterine bleeding in adolescent

A

Mild - iron supplement

Mod to severe: iron + high dose estrogen

66
Q

Graves disease in pregnancy

A

Thyroid stimulating antibody can persist for several months following thyroidectomy. Can cross placenta (IgG) and cause thyrotoxicosis in fetus. Levo does not cross

67
Q

Luteoma of pregnancy

A

Benign bilateral solid ovarian masses. Can cause hirsutism and virilization. No treatment needed

68
Q

L/S ratio

A

Greater than 2 indicates fetal lung maturity

OBGYN shelf (2 decks)

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