repro Flashcards

1
Q

when can you dx primary amenorrhea

A

13y w/o 2ndary sex characteristics

15y w/ 2ndary sex characteristics

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2
Q

primary amenorrhea. breasts and uterus are both present.

A

outflow obstruction

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3
Q

primary amenorrhea. breasts are absent, uterus is present.

A
  1. (if high FSH/LH) ovarian causes e.g. premature ovarian failure, Turners (XO)
  2. (if low FSH/LH) hypothalamus/pituitary failure or late puberty
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4
Q

primary amenorrhea. breasts present, uterus is absent

A
mullerian agenesis (46xx)
androgen insensitivity (46xy)
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5
Q

primary amenorrhea, short stature, webbed neck, low hairline, low set ears, wide nipples

A

turners syndrome (45xo)

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6
Q

acquired endometrial scarring

A

ashermans syndrome

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7
Q

tender and “boggy uterus” on exam

A

adenomyosis (endometrial tissue within the myometrium)

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8
Q

what is the most effective therapy for adenomyosis

A

total abdominal hysterectomy

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9
Q

what are medical treatments for leiomyomas

A

progestins

leuprolide* (shrinks uterus by 50%)

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10
Q

what is the mgmt of leiomyomas to preserve fertility

A

myomectomy

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11
Q

what is the definitive tx for leiomyomas

A

hysterectomy

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12
Q

postpartum uterine infx due to retained products of conception

A

endometritis

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13
Q

postpartum fever, abdominal pain, and uterine tenderness, think this

A

endometritis

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14
Q

tx for endometritis

A

abx

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15
Q

cyclic premenstrual pelvic pain, dysmenorrhea, dyspareunia, think this

A

endometriosis

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16
Q

definitive dx for endometriosis

A

laparoscopy with bx

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17
Q

chocolate cyst

A

endometrioma of the ovaries

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18
Q

mgmt for endometriosis

A
  1. suppress ovulation w meds
  2. laparoscopy with ablation (if fertility desired)
  3. TAH with salpingoophorectomy
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19
Q

screening test for endometrial hyperplasia

A

transvaginal ultrasound

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20
Q

consider endometrial hyperplasia if endometrial lining is greater than ____

A

4mm

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21
Q

definitive dx for endometrial hyperplasia

A

endometrial bx

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22
Q

tx for endometrial hyperplasia w/o atypia

A

progestin, repeat bx in 3-6mo

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23
Q

tx for endometrial hyperplasion w/ atypia

A

hysterectomy +/- BSO, treat as previous card if not surgical candidate or wish for fertility

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24
Q

what if a pt has postmenopausal bleeding, you do US, and endometrial stripe is < 4mm?

A

repeat US in 4mo if continued bleeding, consider bx

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25
Q

pt presents with vaginal bleeding + abd pain + recent amenorrhea. think?

A

threatened abortion or nonviable pg

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26
Q

what drug induces ovulation and is often given in infertility

A

clomiphene

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27
Q

what size ovarian cyst is usually functional and resolves on its own

A

< 6-8cm

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28
Q

when should you repeat US for functional cyst

A

6 weeks

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29
Q

tx for ovarian cancer

A

TAH-BSO, lymphectomy, chemo

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30
Q

a pg woman has painless dilation and effacement of the cervix in her 2nd trimester. what is this

A

cervical incompetency

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31
Q

how to manage cervical incompetency

A

1) bed rest, weekly injections of 17 a-hydroxyprogesterone

2) cerclage if you wanna

32
Q

older pt presents with vaginal itching and on exam you see red/white ulcerative, crusted lesions. suspect?

A

vulvar cancer

33
Q

included in the mgmt for an ectopic pregnancy, you should give rhogam if the mother is RH_____

A

negative

34
Q

painless vaginal bleeding. US shows snowstorm appearance

A

complete molar pregnancy

35
Q

painless vaginal bleeding .US shows cluster of grapes appearance

A

partial molar pregnancy

36
Q

US shows no products of conception (above scenario)

A

complete

37
Q

US shows gestational sac

A

partial

38
Q

mgmt of these trophoblastic diseases

A

uterine suction curretage asap, follow weekly Bhcg levels

39
Q

when is the screening for gestational diabetes

A

24-28 weeks

40
Q

what is a + result for the 50g oral glucose challenge test

A

> / 140mg/dl after 1h

41
Q

if they fail the 50g oral glucose challenge, they go onto the 3-hour oral glucose tolerance test. what is a + result for this

A

1h > 180
2h > 155
3h > 140

42
Q

what is the gold standard test for gestational dm

A

3h GTT

43
Q

if a pt has gestational DM, when should they deliver

A

38 weeks

44
Q

when do you give rhogam if indicated

A

28 weeks gestation

within 72h of delivery

45
Q

tests for PROM

A
  1. Nitrazine
  2. Fern
  3. Speculum exam (infx)
46
Q

mgmt of PROM

A

await spontaneous labor OR give oxytocin/prostaglandin gel to induce labor

47
Q

what amount of cervical dilation + effacements indicates premature labor (before 37 weeks)

A

> 3cm dilation

> 80% effacement

48
Q

what drugs are given to suppress uterine contractions

A

tocolytics (terbutaline, mag sulfate, nifedipine, indomethacin)

49
Q

someone is going into premature labor. IDK what the L:S test is but it is less than 2:1. what is your management

A

give tocolytics to suppress ctx for 48 hours, give antenatal steroids for fetal lung development

50
Q

when can a pt expect morning sickness to go away

A

16 weeks

51
Q

what type of morning sickness is more severe and may persist past 16 weeks

A

hyperemesis gravidarum

52
Q

what anti-emetics are first line in pregnancy

A

pyridoxine (B6) +/- doxylamine

53
Q

what is the MC cause of 1st trimester bleeding

A

threatened abortion

54
Q

pregnant pt has bloody vaginal discharge, cramping, uterine size is normal for gestation, no POC expelled, a closed cervical os, what is it and how do you manage

A

threatened abortion

tx: rest, serial Bhcg

55
Q

pregnant pt has bleeding and cramping, uterine size is normal for gestation, there is progressive cervical dilation but no POC are expelled. what is it and how do you manage

A

inevitable abortion

tx: D&E, rhogam if indicated

56
Q

pregnant pt has bleeding and cramping with a boggy uterus, some POC has been expelled, cervix is dilated. what is it and how do you tx

A

incomplete abortion

tx: D&C, rhogam if indicated

57
Q

pregnant pt has bleeding and cramping, the size of her uterus is at a pre-pregnancy state. POC has been expelled. Cervix is closed. what is it and how do you tx

A

complete abortion

tx: rhogam if indicated

58
Q

pregnant pt presents with bleeding and cramping, no POC has been expelled, her cervix is closed. what is it and how do you manage

A

missed abortion

tx: D&C/E

59
Q

at what weeks do you perform a D&C

A

5-13 weeks

60
Q

at what weeks do you perform a D&E

A

> 12 weeks

61
Q

how do you dx placenta previa/placenta abrupta/vasa previa

A

pelvic US

62
Q

mgmt for placental previa

A

hospitalize, stabilize fetus (tocolytics, steroids), deliver when stable

63
Q

mgmt for abruptio placenta

A

hospitalize and immd delivery

64
Q

mgmt for vasa previa

A

immd c section

65
Q

after how many weeks can you dx gestation htn or pre eclampsia

A

after 20 weeks gestation

66
Q

when should you deliver a baby for someone who has gestation htn

A

34-36 weeks

67
Q

what should you give a pt with gestational htn (not a bp med, something else)

A

mg sulfate to prevent eclampsia

68
Q

fetal heart can be detected at ____ weeks and ______ is normal HR

A

10-12 weeks

120-160bpm

69
Q

pelvic US can detect fetus at ____ weeks

A

5-6 weeks

70
Q

fetal movement can be detected at _____ weeks

A

16-20 weeks

71
Q

what is triple screening and when is it done

A

1) a-feto protein
2) b-hcg
3) estradiol
done at 15-20 weeks

72
Q

when is GBS screening done

A

32-37 weeks

73
Q

components of apgar score

A
appearance/skin
pulse
grimace
activity
respiration
done at 1 + 5 mins after birth
74
Q

what qualities give a baby a perfect apgar score (2 pts per section = 10)

A

appears: pink
pulse: >100
grimace: cries or pulls away
activity: flexes arm and legs resist extension
respiration: strong cry

75
Q

what qualities give a baby a 0 apgar score

A

appears: blue all over
pulse: 0
grimace: no response to stimulation
activity: none
respiration: none

76
Q

MC cause of postpartum hemorrhage

A

uterine atony

77
Q

mgmt of uterine atony

A

massage, oxytocin, misoprostol to get uterus to contract