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Rotay-shuns > Spelunking (OB/GYN) > Flashcards

Spelunking (OB/GYN) Flashcards

1
Q

G5P2213 means?

A

G5 - number of pregnancies P2213- 2 term pregnancies, 2 premature pregnancies, 1 abortion and 3 living children

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2
Q

What is the Naegele Rule?

A

Add 7 days to the 1st day of the LMP, subtract 3 months and add 1 year

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3
Q

What is the most common congenital infection?

A

CMV

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4
Q

What is the definition of primary amenorrhea?

A

the absence of spontaneous menstruation by the age of 16

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5
Q

What hormone is diagnostic of menopause?

A

FSH - an FSH of greater than 30 mIU/mL is diagnostic of menopause

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6
Q

What HPV sub-types are linked to cervical cancer (5)?

A

subtypes: 16, 18, 31, 33 and 45

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7
Q

This type of breast cancer accounts for 80-85% of breast cancers …

A

ductal carcinomas

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8
Q

45% of breast cancers present in this region…

A

the upper outer quadrant

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9
Q

How long is the copper T-Paraguard (IUD) usable for?

A

10 years

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10
Q

Ectopic pregnancies can be managed with what medical drug?

A

methotrexate

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11
Q

HELLP syndrome is the presence of severe preeclampsia with the addition of:

A

Hemolysis Elevated Liver enzymes Low Platelets

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12
Q

Painless Vaginal Bleeding in a pregnant women is the hallmark of?

A

placenta previa

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13
Q

What is the diagnostic test of choice for establishing the diagnosis of placenta previa?

A

ultrasonography

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14
Q

How many stages of labor are there?

A

3; sometimes the hours after delivery is called the 4th stage

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15
Q

These type of decelerations denote fetal head compression…

A

early decelerations - considered benign

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16
Q

How long must pain be present in order to receive a dx of Chronic Pelvic Pain?

A

6 months

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17
Q

What are the two types of ovarian cysts?

A

Follicular cysts Corpus luteum cysts

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18
Q

A women’s last menstrual period is dated from the… A. First day of the last bleeding episode B. First day of the last “normal” period C. Last day of the last “normal” period D. Last day of the last bleeding episode

A

B. First day of the last “normal” period

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19
Q

What is the average weight gain during pregnancy?

A

25-35 lbs

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20
Q

Post-partum hypopititarism can be caused by postpartum hemorrhage. What is this life-threatening condition called?

A

Sheehan’s syndrome

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21
Q

What is the term for the ability to carry a baby to delivery?

A

fecundity

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22
Q

What are the three types of breech presentation?

A

Complete, frank, incomplete breech or footling

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23
Q

What area is most common to contain an ectopic pregnancy?

A

Ampullary

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24
Q

What do you administer to counteract magnesium sulfate toxicity?

A

Calcium gluconate, first sign is loss of DTRs

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25
Q

Vaginal bleeding is common in the first trimester, occurring in 20 to 40 percent of pregnant women. It may be any combination of light or heavy, intermittent or constant, painless or painful. The four major sources of bleeding in early pregnancy are:

A

Ectopic pregnancy [most serious], Miscarriage [most common] (threatened, inevitable, incomplete, complete), Implantation of the pregnancy, Cervical, vaginal, or uterine pathology (e.g., polyps, inflammation/infection, trophoblastic disease) -Uptodate

26
Q

Uterine bleeding in the presence of a closed cervix and sonographic visualization of an intrauterine pregnancy with detectable fetal cardiac activity is diagnostic of

A

Threatened miscarriage

27
Q

When miscarriage is _______, the cervix is dilated, uterine bleeding is increasing, and painful uterine cramps/contractions are present. The gestational tissue often can be felt or seen through the cervical os; passage of this tissue typically occurs within a short time. Management may be expectant, or a medical or surgical intervention to complete the miscarriage can be undertaken.

A

inevitable

28
Q

When a miscarriage occurs before 12 weeks of gestation, it is common for the entire contents of the uterus to be expelled, thereby resulting in a

A

complete miscarriage

29
Q

A complete miscarriage can be distinguished from an ectopic pregnancy by

A

examining the tissue that was passed to confirm products of conception, by demonstrating falling rather than rising or plateaued hCG levels, and by patient description of diminishing bleeding and pain. No further intervention is needed for complete miscarriage if chorionic villi are identified by pathologic examination of the products of conception. However, if no villi are identified or no specimens are available for pathologic examination, then serum hCG levels should be followed serially until the level is undetectable.

30
Q

The membranes may rupture and the fetus may be passed, but significant amounts of placental tissue can be retained, resulting in

A

an incomplete miscarriage

31
Q

Vaginal bleeding is less common in the second and third trimesters. The major causes of bleeding at these times are:

A

Bloody show associated with cervical insufficiency or labor (by definition, labor occurs after 20 weeks) Miscarriage (by definition, miscarriage occurs before 20 weeks) Placenta previa Abruptio placenta Uterine rupture Vasa previa Cervical, vaginal, or uterine pathology (eg, polyps, inflammation/infection, trophoblastic disease) and non-tubal ectopic pregnancy are other etiologies.

32
Q

Name the risk factors for placental abruption

A

HTN, tobacco, cocaine, multiple pregnancies, polyhydramnios, preterm premature rupture of membranes, trauma

33
Q

_________ often presents with marked inflammatory symptoms (pruritus and soreness), but scant discharge (thick, white, odorless, and curd-like)

A

Candida vulvovaginitis

34
Q

_______ is associated with only minimal inflammation and minimal irritative symptoms, but the thin, gray or yellow, malodorous discharge is a prominent complaint

A

Bacterial vaginosis

35
Q

_______ is characterized by purulent, malodorous, thin discharge, which may be accompanied by burning, pruritus, dysuria, frequency, and/or dyspareunia.

A

Trichomoniasis

36
Q

An 18 y.o. G1P0 Hispanic woman has a clinical presentation of intra-amniotic infection. She denies any leakage of fluid per vagina, and repeated speculum examinations fail to identify rupture of membranes. Which of the following organisms is most likely to be the underlying etiology?

A. Group B Strep

B. Listeria monocytogenes

C. Clostridium difficile

D. Chlamydia trachomatis

E. Escherichia coli

A

B. Listeria may induce chorioamnionitis without rupture of membranes; the mechanism is transplacental spread. A Hx of ingesting unpasteurized milk products should raise suspicion of Listeria. GBS and gram negative enterics are the most common organisms to affect neonates.

37
Q

What is the earliest sign (usually) of chorioamnionitis?

A

Fetal tachycardia

38
Q

What is the treatment of choice for BV?

A

Flagyl, 500 mg, PO, BID x 7 days

OR

Metronidazole gel 0.75%, one full applicator (5g) intravaginally, once daily for 5 days

OR

Clindamycin cream 2%, one full applicator (5g) intravaginally, qhs x 7days

Alternative: Metronidazole 2 g PO x1; OR Clindamycin*, 300 mg, PO, BID x 7days. *Good choice for pregnant pts

39
Q

Where are androgens produced in the female?

A

Androgens may be produced in the ovary, adrenal gland, or by peripheral conversion.

40
Q

A 6 y.o. girl is noted to have breast development and vaginal spotting. No abnormal hair growth is noted. A 10 cm ovarian mass is palpated on rectal examination. Which of the following is the most likely diagnosis?

A. Benign cystic tumor (dermoid)

B. Idiopathic precocious puberty

C. Sertoli-Leydig cell tumor

D. Congenital adrenal hyperplasia

E. Granulosa-theca cell tumor

A

E. Isosexual (no virilization) precocious puberty with an adnexal mass usually is a granulosa theca cell tumor of the ovary. Dermoid cysts are also found on the ovary. They present as a pelvic mass that causes pain due to its rapidly enlarging size, however, they do not cause isosexual precocious puberty. A sertoli-leydig cell tumor is the androgen counterpart to the granulosa-theca cell tumor. With a sertoli-leydig cell tumor, testosterone levels are markedly elevated and patients typically present with hirsutism, virilism, and an adnexal mass. CAH is the most common cause of ambiguous genitalia in the newborn; however, late onset can present in adult females with symptoms of hirsutism and anovulation.

41
Q

A 15 y.o. G0P0 c/o increasing hair over her face and chest. She also has a deepening voice and clitoromegaly. There have been two neonatal deaths in the family. Which of the following is the best diagnostic test for the likely diagnosis?

A. Testosterone level

B. Dexamethasone suppression test

C. 17-hydroxyprogesterone level

D. LH/FSH levels

E. Karyotype

A

C. The most common neonatal endocrine cause of death (salt wasting) is congenital adrenal hyperplasia (21-hydroxylase deficiency). An elevated testosterone level would be found with a sertoli-leydig cell tumor. A dexamethasone suppression test is used in the Dx of Cushing’s syndrome. An elevated LH-FSH ratio is found with PCOS. A karyotype may be used in finding the etiology behind a young girl’s presentation of primary amenorrhea or pubertal delay.

42
Q

A 22 y.o. nulliparous woman with irregular menses of 7 years’ duration c/o primary infertility. She has a FHx of DM. She has mild hirsutism on examination. Which of the following is the most likely therapy?

A. Cortisol and mineralocorticoid replacement

B. Excision of an adrenal tumor

C. Surgical excision of an ovarian tumor

D. Oral clomiphene citrate

E. Intrauterine insemination

A

D. Most likely PCOS; the initial Tx for infertility is clomiphene citrate. Since the Sx were not of rapid onset, the etiology is not likely to involve a tumor. Intrauterine insemination is usually indicated for the rare cervical factor infertility; and not ovulatory dysfunction

43
Q

What are the 2 most common locations of androgen production and secretion

A

Ovary and adrenal gland

44
Q

The rapid onset of hirsutism or virilization usually indicates:

A

The presence of an androgen-secreting tumor

45
Q

The “quad screen” consists of:

A

alpha fetal protein (AFP), unconjugated estradiol (uE3), human chorionic gonadotropin (beta-hCG), and inhibin-A (inhA)

46
Q

A 23 y.o. female with long-standing history of irregular cycles, obesity, hirsutism, and acne. What labs do you want?

A

TSH, prolactin, serum testosterone, dehydroepiandosterone sulfate (DHEA-S), 17-dehydroxyprogesterone, and pelvic ultrasound. This is most likely PCOS, but need to exclude other secondary causes of hyperandrogenism (late-onset CAH, adrenal hyperplasia, hyperprolactinemia, adrenal/ovarian tumors, cushing syndrome, thyroid disorders). Depending on how ‘long standing’ the pt has had anovulation with unopposed estrogen, and endometrial biopsy may be considered.

Also consider: lipid profile and glucose-intolerance screening, as PCOS pts should be screened for these abnormalities.

47
Q

A 32 y.o. G0P0 woman is noted to have irregular menses and hirsutism. Which of the following is consistent with PCOS?

A. Elevated 17-hydroxyprogesterone level

B. A 9-cm right ovarian mass

C. Vaginal bleeding after a 5-day course of progesterone oral therapy

D. DEXA scan showing osteopenia

A

C. PCOS is characterized by obesity, anovulation, hyperandrogenism due to ovarian secretion of testosterone, after excluding other etiologies such as CAH, Sertoli-Leydig cell tumor, and hypothyroidism and hyperprolactinemia. An elevated 17-hydroxyprogesterone would indicate CAH. A 9-cm mass would suggest a Sertoli-Leydig cell tumor. With PCOS, the DEXA scan usually shows good bone density due to the excess estrogen environment. Women with PCOS usually will have a positive progestin challenge test

48
Q

Membrane rupture, painless vaginal bleeding, and fetal bradycardia is a classic triad for:

A

Vasa previa

49
Q

Define the latent phase of labor

A

The initial part of labor where the cervix mainly effaces (thins) rather than dilates (usual cervical dilation >4cm)

50
Q

Define the ‘active phase’ of labor

A

The portion of labor where dilation occurs more rapidly, usually when the cervix is greater than 4cm

51
Q

Define the stages of labor

A

First stage: onset of labor to complete dilation of cervix.

Second stage: complete cervical dilation to delivery of infant

Third stage: delivery of infant to delivery of placenta

52
Q

What is the expected rate of dilation in a primiparous woman in the active phase of labor?

A

1 cm/ hr

53
Q

What is the expected rate of dilation in a multiiparous woman in the active phase of labor?

A

1.2 cm/ hr

54
Q

Define: “arrest of active phase”

A

No progress in the active phase of labor for 2 hours

55
Q

What are the five cardinal movements of labor?

A

Engagement, Descent, Flexion, Internal rotation, Extension

56
Q

The most common cause of post partum hemorrhage is

A

uterine atony

57
Q

What are the risk factors for uterine atony?

A

Magnesium sulfate, oxytocin use during labor, rapid labor/delivery, overdistention of the uterus (macrosomia, multifetal pregnancy, hydramnios), intra-amniotic infection (chorioamnionitis), prolonged labor (uterine fatigue), high parity

58
Q

What is methylergonovine maleate (methergine)?

A

An ergot alkyloid agent that induces myometrial contraction as a treatment of uterine atony. Contraindicated in HTN

59
Q

What Carboprost (hemabate)?

A

A prostaglandin (F2-alpha) compound that causes smooth muscle contraction. Contraindicated in asthmatic pts.

60
Q
A

Rotay-shuns (10 decks)

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