Reproduction Flashcards
What is the first test that should be ordered in the evaluation of amenorrhea?
Pregnancy test. ALWAYS. Even if the patient denies the possibility; the first test is always a pregnancy test.
Dopamine antagonists will do what to prolactin?
Dopamine antagonists will INCREASE prolactin levels.
Normally medications won’t elevate prolactin levels past what value?
Medications rarely increase prolactin levels >100. If a prolactin level >100 is seen, others causes should be ruled out.
What hematologic etiology is a common cause of DUB?
Coagulation disorders such as Von-Willebrand (prolonged PTT). Screen with PT/PTT
Next best step when evaluating post menopausal bleeding?
Every patient requires endometrial biopsy to rule out endometrial cancer.
A post menopausal endometrial stripe over what value is suspicious for endometrial cancer?
> 5mm is suspicious for endometrial cancer. The next step should be biopsy.
What is the most accurate test to diagnose endometriosis?
Laparoscopy
What hormones are responsible for the growth of fibroids?
Progesterone and estrogen. This is the reason most will shrink after menopause.
When is drawing a serum CA-125 useful?
This is most useful in post menopausal women. There are many etiologies that can give false positives in pre menopausal women.
When should a simple cyst be explored surgically?
Any cyst >10cm should be surgically explored.
At what age should women start to have cervical cancer screening?
Pap smear screening starts at 21 years of age, regardless of pregnancy or sexually activity before 21 years of age.
What is the treatment of choice for chlamydia and gonorrhea?
- Chlamydia is treated with azithromycin or doxycycline
2. Gonorrhea is treated with ceftriaxone
What is the treatment of choice for chlamydia during pregnancy?
These patients should not receive doxycycline. First line treatment here is azithromycin.
What cervical length increases the risk of second trimester loss due to an incom- petent cervix?
Patients with a cervical length
What is the definition of menopause?
Menopause occurs after menses has stopped for >1 year.
Why is progesterone given with estrogen during HRT?
Patients with an intact uterus are given progesterone to protect against endometrial cancer.
What two genes increase the risk of breast cancer?
Those with BRCA 1 and BRCA 2 have an increased risk of developing breast cancer.
At what age should mammogram screening be started?
A yearly mammogram should be started at 40 years of age.
What is Fitz-Hugh Curtis syndrome?
This is seen in PID. Inflammation of the liver capsule will lead to RUQ pain.
When is it appropriate to begin a workup for infertility in those trying to conceive?
Patients who are 35 should have a workup done after 6 months of trying.
What is Naegles rule?
This is used to calculate the estimated date of delivery: (First day of LMP - 3 months) + 7 days = Due date
What are pap smear guidelines during pregnancy?
Identical to those in non pregnant women. If pregnant and
What are the genetic screening guidelines during pregnancy?
Patients should be screened with an NT and a first trimester serum testing at 11-13.6 weeks. Second trimester quadruple screening is done at 15-20 weeks gestation.
When should Rhogam be administered?
Rhogam is administered to RH negative mothers at 28 weeks gestation.
A patient is deemed to have a failed pregnancy. Products of conception are seen on ultrasound. The pelvic exam shows a closed cervical os. What type of
abortion is this?
This is consistent with missed abortion.
Painful third trimester bleeding is most likely what diagnosis?
Placental abruption
Painless second and third trimester bleeding is what until proven otherwise?
Placenta previa. These patients should not have a pelvic exam or transvaginal ultrasound due to an increased risk of hemorrhage.
What are three risk factors for ectopic pregnancy?
- Prior ectopic
2. Pregnancy with IUD 3. History of PID
After what HCG level should a gestational sac be visible on ultrasound?
A gestation sac should be seen after an HCG quant of 2,000 ml/ml is reached.
What are the indications for methotrexate use in ectopic pregnancy?
- Stable
2. HCG quant
How are patients screened for gestational diabetes?
- First trimester screening is done with HA1c.
- Second trimester screening (24-28 weeks) is done with a 2 hour OGTT. Alternatively can be done with 1 hour OGTT, and if abnormal, perform a 3 hour OGTT.
A 40 year old patient is coming in for a first prenatal visit. She is complaining of vaginal bleeding with pelvic pain. Ultrasound demonstrates a snow storm pattern. What is the most likely diagnosis?
This is classic for gestational trophoblastic disease. These patients will usually have an HCG quant >100,000 and will be rapidly rising.
What is the definition of chronic hypertension?
Hypertension diagnosed before 20 weeks gestation is termed chronic hypertension.
Preeclampisa before 20 weeks should clue you in to what diagnosis?
A molar pregnancy should be suspected if this occurs.
How is preeclampsia diagnosed?
Hypertension with proteinuria and/or end organ damage >20 weeks gestation. Edema is no longer part of the diagnostic criteria since most women will have edema during pregnancy.
What is HEELP syndrome?
- Hemolysis
- Elevated liver enzymes
- Low platelets
What is the treatment for preeclampsia, eclampsia, and HEELP syndrome?
Definitive treatment for all the above is induction.
Why is magnesium given to patients with severe preeclampsia?
This is given for seizure prophylaxis.
What are first line medications for the treatment of gestational hypertension?
Labetolol and methyldopa are first line medications.
What is the most common cause of post partum hemorrhage?
Uterine atopy is the most common cause. This occurs when the uterus does not con- tract after delivery.
