Reproductive (OBGYN) Flashcards
What is the proposed pain mechanism for women w/ primary dysmenorrhea?
prostaglandin
What are the 2 MC laparascopic dxs that are made in a woman who is being evaluated for chronic pelvic pain?
adhesions & endometriosis
MC type of anemia that is seen w/ pregnancy
iron deficieny
MC organism causing UTI in pregnancy
E. coli
What is the appropriate timing for the 1hr GTT that is given during pregnancy?
24 - 28 wks (if no add’nal risk factors)
At what point in pregnancy is Grp B strep checked in the pregnant female?
36 wks gestation
If a pregnant woman is found to be a carrier for grp B strep, when is tx performed?
during labor
What is the TOC for a pregnant woman w/ syphillis who is allergic to PCN?
tx w/ PCN after desensitization
What vaginal infxn puts a pregnant woman at risk for pre-term labor, PROM, chorioamnionitis, & postpartum endometritis?
bacterial vaginosis
TOC for bacterial vaginosis
Metronidazole
MCC of congenital infxn of infants in the US
Cytomegalovirus
What is the method that is used to identify fetal CMV?
Cordocentesis for viral identification
What is the tx of HIV/AIDS in the pregnant woman in order to decrease risk of transmission of the virus to the fetus?
AZT (zidovudine)
What is the leading non-obstetrical cause of maternity mortality?
PE caused by thromboemolic dz
Tx for a pregnant woman w/ a DVT?
Heparin
What is the MC major neurological problem that complicated pregnancy?
seizure disorder
What are the 2 MC complications of pregnant women who are treated w/ anti-seizure medications?
- neural tube defect
2. heart defects
MCly employed therapy for seizure disorder during pregnancy?
carbamazepine (Tegretol)
What anti-seizure medication must be avoided in pregnant pt?
Valproic acid (Depakote) - highly teratogenic
What is the TOC for the vomiting that occurs w/ hyperemesis gravidarum?
Metochlopramide (Reglan)
Classic findings that are seen in pre-eclampsia
- HTN
- edema
- proteinuria
What part of the menstrual cycle will the pt w/ premenstrual syndrome be sx-free?
follicular phase
What type of med is most effective in the tx of premenstrual syndrome/premenstrual dysmorphic disorder?
SSRIs or meds that suppress ovulation
What 2 subtypes of HPV are MCly assoc. w/ cervical cancer?
HPV 16 & 18
What are the MC cell types for cervical cancer?
squamous cell (85%)
Name the 3 MC vasomotor sxs seen in a perimenopausal woman
- hot flashes
- night sweats
- night-time awakening
MCC of 2ndary amenorrhea
pregnancy
2nd cause = endometrial polyps
What agents are used to tx UTI during pregnancy?
Cephalexin (Keflex)
- other agents = sulfonamide, nitrofurantoin, & ampicillin
What 2 org are MCly encountered causing PNA in the pregnant pt?
- streptococcus
2. Mycoplasma
What is the recommended therapy for acute asthma attack in the pregnant pt?
inhaled beclomethasone & bronchodilators
What is the MC heart valve abnormality that is encountered during pregnancy that is a serious concern for complications?
Mitral stenosis
What is the MCly used serum screening test used in the assessment of possible neural tube defect?
maternal serum alpha fetoprotein level at 16-18 wks
What is the most effective therapy for genital atrophy in the perimenopausal woman?
estrogen
Pt w/ ongoing pain due to endometriosis who has a TAH BSO undergoes presacral neurectomy for the pain. What is the main SE of this procedure?
Constipation & urinary urgency
90% of vulvar cancers are due to what cell type?
squamous cell
What type of vaginitis is assoc. w/ an acidic pH on testing?
Candidiasis
A woman presents w/ a hx of dyspareunia & worsening dysmenorrhea that often begins before menses. Examination reveals a thickened rectovaginal septum or deviation of the cervix on pelvic examination. What is the most likely dx?
Endometriosis
MCC of infertility in women
tubal dz (usu due to PID)
What endocrine disorder are pts w/ Polycystic ovary syndrome at risk for acquiring?
T2DM
What is the major medication of choice for pts w/ PCOS who wish to lose weight & to decrease insulin resistance?
metformin (Glucophage)
The definitive procedure for the dx of endometrial carcinoma
D&C
A young adolescent female complains of recurrent menorrhagia & irregular periods that last for 6 mths. She denies any sexual encounter. Examination reveals a neg. pelvic, pap smear, sonogram, & endometrial bx. Most likely dx is:
Dysfxnal uterine bleeding (DUB)
What is the leading cause of pregnancy-related death in the 1st trimester?
Ectopic pregnancy
A pt at 13 wks gestation presents w/ abdominal pain & vaginal bleeding for 6 hrs. The vaginal exam reveal the cervix to be dilated to 2 cm. FHT are 140. There has been no passage of any tissue. What is the correct dx?
inevitable abortion
What complication may be seen in pregnant woman who is given a sulfonamide for a UTI in 3rd trimester?
Kernicterus
What does HELLP Syndrome stand for?
Hemolyis
Elevated Liver enzymes
Low Platelets
What is the tx for severe pre-eclampsia?
immediate delivery of the baby
Causative org for Chancroid
Hemophilus ducreyi
2 MC tx for primary dysmenorrhea
- OCs
2. NSAIDs
What is the predominant hormone during the follicular phase of the menstrual cycle?
estrogen
What is the main hormone during the luteal phase of the menstrual cycle?
progesterone
Primary amenorrhea is lack of menstruation at what age?
16 yoa
MCC of 2ndary dysmenorrhea
endometriosis
TOC for lymphogranuloma venereum
doxycycline (or tetracycline)
FSH >70 is MCly due to…
ovarian failure
MCC of menorrhagia in the US
uterine fibroids
STD that is assoc w/ a PAINLESS mucosal lesion & INGUINAL BUBOES
Lymphogranuloma venereum
Type of smear that is done in order to asses for HSV infxn
Tzanck smear
Currently approved tx for Gonorrhea
Ceftriaxone (Rocephin)
- single IM or IV dose
What stage of syphilis does condyloma lata appear?
Secondary Syphillis
MC type of bleeding disorder that presents w/ prolonged & heavy menstrual bleeding
Von Willebrand Syndrome
MCC of significant post-menopausal bleeding
endometrial cancer
2 approved tx for Chlamydial STD:
- Doxycycline
2. Azithromycin (Zithromax)
STD that leads to cervical dysplasia & cervical cancer most often
HPV
Type of ovarian cyst that may contain teeth & hair as part of the cyst;
teratoma (type of dermoid cyst)
when performing a cervical specimen under the Bethesda system, what area is most vital to sample?
transformation zone
TOC for ACUS cells being seen under Bethesda sys.
Endometrial bx & colposcopy
Cyst that is normal to find following ovulation
corpus luteal cyst
chocolate cyst that may be a palpable mass felt on the ovary
endometrioma
MC reason for ovarian torsion to occur
dermoid cyst
Midcycle pain that occurs w/ ovulation
Mittlesmertz
Increased ratio of LH to FSH (3:1) is MCly caused by
PCOS
Gold standard for making the dx of Chlamydia STD
culture
Tumor marker MCly used in F/U of ovarian cancer
CA-125
Causative organism for granuloma inguinale
Calymmatobacterium granulomatis
failure to induce pregnancy despite one yr of unprotected sexual intercourse
infertility
primary bacterium that is part of the vaginal flora
lactobacillus
CLUE CELLS are seen in what gynecological condition?
Bacterial vaginosis
Substance that must be avoided in a pt who is taking metronidazole (Flagyl)
alcohol
Single dose therapy indicated for treating candidal vaginitis
fluconazole (Diflucan)
Vaginal condition producing a STRAWBERRY CERVIX
Trichomonas
MC new-onset STD in US
Chlamydia
STD caused by a painful ulcer w/ fluctuant inguinal adenitis
Chancroid
Type of birth control that is CI for use in a pt w/ cervical dysplasia
cervical cap
TOC for Paget’s dz of bone
bisphosphonates
defined as no menstrual cycles for 12 months or FSH >40
Menopause
SE that MCly occurs w/ the use of raloxifen (Evista) for the tx of osteoporosis
increased incidence of hot flashes
condition that results from low calcium & vitamin D intake in children resulting in poorly formed bones & bowed legs
Rickets
Laboratory abnormality that is seen in a pt w/ Paget’s dz
increased serum alkaline phosphatase
MCC of solid breast mass
Fibroadenoma
MCC of fever after the immediate puerperium in nursing mothers
mastitis
type of breast cancer that is MCly assoc. w/ “P’EAU D’ORANGE” skin changes
inflammatory BRCA
What is the main consideration for non-lactating women who develop mastitis?
breast cancer
MC organism causing mastitis
S. aureus
MC type of breast cancer
infiltrating intraductal carcinoma
The fundus of the uterus is at the level of the umbilicus at how many weeks gestation?
20 wks
products of conception remain in uterus but not viable
incomplete (missed) abortion
What is the most likely dx in a woman who has positive BCG test, spotting & unilateral abdominal pain?
ectopic pregnancy
MC type of invasive breast cancer
invasive ductal carcinoma (90%)
What condition is assoc. w/ infiltrating intraductal cancer in the nipple & ducts of the nipple? This condition may be also assoc. w/ itching or burning of the nipple:
Paget’s dz of the breast
Softening of the uterus that is felt early in pregnacy
Hagar’s sign
test performed to determine the dosage for Rho-Gam to be given to a pregnant woman
Kleinhaur-Betke test
3 or more spontaneous abortions in succession
habitual abortion
MC location for tubal ectopic pregnancy
ampulla
MC location for metastasis from molar pregnancy
lung
time frame that RhoGam is given during pregnancy
28 wks
- this will last 12-14 wks & will cover her until delivery
Pt presents with pregnancy, edema, HA, RUQ pain, & blurred vision. What is the most likely dz?
pre-eclampsia
A pregnant pt has bleeding, hyperemesis, & a uterus that is measuring large for gestational size. Lab findings include an HCG that is markedly high for pregnancy date. What is the most likely dx?
hydatiform molar pregnancy
What class of antihypertensive meds is strictly CI when treating pregnancy- induced HTN?
ACE inhibitors - causes renal agensis
TOC for seizures due to eclampsia
Magnesium, delivery
1st sign for magnesium toxicity
loss of reflexes
complications of this pregnancy-related condition includes macrosomia & shoulder dystocia
gestational diabetes
cocaine users are at risk for what pregnancy-related condition?
placental abruption
Pt has IUGR wherein the entire bay is small. What is the primary consideration for this scenario?
chromosomal abnormality in baby
Medication which has a famous SE of causing scalp defects in the baby
PTU
At how many weeks does preterm labor occur?
prior to 37 weeks gestation
3 MCC of 3rd trimester bleeding
- placenta previa
- abruption placentae
- vasa previa
chronic gynecologic-related pruritus is MCly assoc. w/ what type of GYN cancer?
vulvar
How can fetal lung maturity be assessed?
Lecithin to Sphingomyelin ratio (L/S ratio)
- if >2 the fetal lungs are mature
A breast-feeding mother presents to the office complaining of fever, chills, & a swollen red breast. What is the most likely org. causing these sxs?
Staph aureus. (Mastitis is most likely 3-4 wks post partum)
excessive amount of blood or duration
menorrhagia
bleeding between menstrual periods
metorrhagia
excessive amt of blood at irregular frequencies
menometorrhagia
Ascites & hydrothorax in the presence of an ovarian tumor
Meig’s syndrome
The ovarian luteal phase corresponds to what phase of the uterus?
secretory phase
What does a biphasic curve on a basal body temperature chart of a 25 yr old woman indicate?
normal ovulation & the effect of progesterone
What does a monophasic curve on a basal body temperature mean?
anovulatory cycle
A basal body temperature graph reveals an elevated temperature that remains elevated throughout the month. What does this most likely mean?
pregnancy
What is the most accurate test of ovulation
endometrial bx
How do spontaneous abortions (miscarriages) MCly present?
pain followed by bleeding
Before what gestation age do most spontanous abortions occur?
8-9 weeks
No uterine growth, no cervical dilation, no passage of fetal tissue, & minimal cramping or bleeding. Absence of FHT & an empty sac on US. What is the dz?
missed abortion
Vaginal bleeding, ABDOMINAL PAIN & tetanic uterine contraction, uterine irritability, & fetal death may also be seen.
Abruptio placenta
When is amniocentesis commonly performed?
16-18 wks
A pt presents w/ pain in her eyes, canker sores in her mouth, & sores & scars in her genital areas. What is the dx?
Behcet’s dz
What secretes beta HCG?
placenta trophoblasts
What is the most accurate prognostic indicator for breast cancer?
axillary node involvement
Where does cervical cancer most likely metastasize?
liver
When does an ectopic pregnancy MCly present?
6-8 wks gestation
For a gestational sac to be visible on US, what must the B-hCG level be?
- transabdominal US = 6500
- transvaginal US = 2000
When can an intrauterine gestational sac be identified by abdominal US?
5th week
- fetal pole can be ID’d in the 6th wk
- embryonic mass w/ cardiac motion in the 7th wk
MC site for endometriosis
ovaries (60%)
DOC for treating endometriosis
Danazol
What 2 type of cancer that are increased in a pt w/ endometriosis?
endometrial & clear cell vaginal cancer
Non-invasive image method of choice for diagnosing endometriosis
Transvaginal US
What is the MCly regarded theory for the induction of endometriosis?
retrograde menstruation
3 MC sites for endometriosis
- Ovary
- cul de sac
- uterosacral ligaments
MC finding on a pelvic examination in a woman w/ endometrosis
normal exam
What is considered to be the gold standard in making the dx of endometriosis?
direct visualization during laparoscopy or laparotomy
Definitive surgical therapy for endometriosis
TAH BSO