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OBGYN > U World Concepts > Flashcards

U World Concepts Flashcards

1
Q

rare polymorphonuclear leukocytes = microscopy
discharge post menses = copious white, mucoid, odorless

A

Physiologic Leukorrhea

Candidiasis = would be pruitic + erythemic

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2
Q

New onset of HTN (140/90+)
Protein in urine =

A

Pre-eclampsia

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3
Q

Pre-eclampsia risk factors

A

Nulliparity
Obesity
Preexisting medical condition (SLE, chronic HTN)
Multiple gestation
Advanced maternal age

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4
Q

Pre-eclampsia management

A

Labetalol = IV + Hydralazine = IV - 160/110+
Nifedipine = PO
Mg Sulfate = Prophlyxis Seziures (block Ca++ channel → higher seizure threshold)

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5
Q

Pre-eclampsia severe sx

A

160/110
Platelet <100,000
Creatinine 1.1+ or 2x normal
↑ transaminases
Pulmonary edema
Visionor cerebral sx (headache)

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6
Q

Fever 24 hr+ postpartum
Uterine fundal tenderness
Purulent lochia = malodorous discharge

A

Postpartum endometritis

Clindamycin + gentamicin

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7
Q

Amniotic fluid embolism vs Anaphylaxis

A

Amniotic fluid embolism = bleeding (DIC) + crackles due to pulmonary edema

Anaphylaxis = acute onset (dyspnea + HoTN + tachy) + wheezing - Hypersensitivity rxn 1

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8
Q

Fever postpartum
HoTN
Diffuse macular rash
Altered mentation

A

Staphylococcal toxic shock syndrome

Vancomycin + Cefepime + clindamycin

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9
Q

+/- Vaginal bleeding
Ab pain
High-frequency contraction
Tender uterus

PMHx = tobacco + drug use (cocaine)

A

Abruptio placentae = remature placental separation from uterus

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10
Q

Nausea + flushing + headache + ↓reflexes

Pre-eclampsia

A

Magnesium toxicity

Tx: Calcium gluconate (stablizes cardiac membranes)

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11
Q

Uterine atony managment

A
  1. Uterine massage
  2. high-dose oxytocin
  3. Tranexamic acid
  4. Carboprost tromethamine (prostaglandins) - C/I in pts w/ asthma (causes bronchospasm)
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12
Q

Progesterone effects on the kidney

A

Kidney Stones
↑ Ca++ excretion
↑ ureteral dilation
↓ peristalsis

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13
Q

Abruptio placentae vs Uterine rupture

A

Ab pain + vag bleeding + abnormal fetal heart rate tracing

Abruptio placentae = Similar to uterine rupture

Uterine rupture = irregulat ab protuberance (palpable fetal parts)

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14
Q

Fibrocystic changes vs Fibroadenoma

A

Fibrocystic changes = multiple small TENDER masses

Fibroadenoma = small, firm, wel-circumscrribed mobule mass

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15
Q

Painless cervical dilation
2+ painless 2nd trimester losses

A

Cervical insufficiency

Cerclage = suture to reinforce + add tensile strength to cervix

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16
Q

Lichen sclerosus dx & management

A

dx: Thin, white, wrinkled skin over the labia majora/minora; atrophic
∆ that may extend over the perineum & around the anus
Excoriations, erosions, fissures from severe pruritus
Dysuria, dyspareunia, painful defecation

Management: topical steroids

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17
Q

Parvo B19 infection

A

Hydrops Fetalis
- ascites
- pleural effusion

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18
Q

Rubella

A

hepatomegaly
growth restriction

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19
Q

Cytomegalovirus infection

A

Periventricular calcifications
Ventriculomegaly
Microcephaly
Intrahepatic calcifications
Fetal growth restriction
Hydrops fetalis = edema in 2+ regions

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20
Q

U/L Bloody nipple discharge

A

Intraductal papilloma

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21
Q

ulceration + crusting + sclaing nipple-areolar complexes

A

Invasive ductal carcinoma

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22
Q

Nausea + vomiting
RUQ pain/epigastric pain
hypoglycemia + hyperbilirubinema + thrombocytopenia = fulminant liver failure

A

Acute Fatty Liver

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23
Q

Magnesium Sulfate C/I

A

myasthenia gravis

severe renal failure = soley excreted in the kidney

cardiac ischemia

heart block

pulmonary edema = ADR made worse

Blocks Ca++

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24
Q

Infertility Workup

A
  1. Semen analysis
  2. Hysterosalpingogram
  3. Midluteal phase progesterone level = confirms ovulation
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25
Q

Increase progesterone level after ovulation causes molimina sx

A

fatigue
bloating
premenstrual breast tenderness

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26
Q

When is Terbutaline used

A

tocolytic = inhibit contractions of myometrial smooth muscle cells

recurrent late decelerations when 5+ contractions/ 10 min

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27
Q

When is amnioinfusion used

A

during variable decelerations = cord compression

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28
Q

when is Phenylephrine

A

Vasopressor =
late decelerations + maternal HoTN

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29
Q

Breast abscess vs Lactational mastitis

A

Breast absecess = axillary lymphadenopathy

Lactational mastitis = U/L breast pain + flulike sx

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30
Q

Galactocele vs Plugged duct

A

palpable mass

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31
Q

bladder filling pain + relief w/ voiding
↑ frequency + urgency - urinary
Dyspareunia = pain w/ sex + exercise

A

Interstitial cystitis = bladder pain syndrome

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32
Q

Parvovirus B19 vs Toxoplasma gondii

A

Ascites

Toxoplasma = intracranial calcification w/n basal ganglia (gray-white matter junction)

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33
Q

1st line tx for migraine headaches in pregos

A

BB

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34
Q

Post epidural
positional headache

A

Postdural puncture headache

Managment =
self-limiting = laying down
Epidural blood patch

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35
Q

Normal urterine contractions

A

5 or less in 10 mins
200 Montevideo units (MVU)

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36
Q

Tachysystole uterine contractions

A

5+ contractions
Montevideo units

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37
Q

SERM role in infertility in PCOS

A

SERM inhibits estradiol negative feedback at the pituitary → ↑ GnRH pulse frequency → ↑ secretion of FSH & LH = ovulation

38
Q

Oxytocin toxicity

A

Postpartum hemorrhage

39
Q

Wt loss = (↓ATCH & GH)
Amenorrhea = ↓FH/LH
Lactation failure = (↓ prolactin)
↓HR + fatigue = (↓ TSH)
blood loss

A

Sheehans Syndrome = Pituitary Ischemic Necrosis

40
Q

SLE flare vs Pre-eclampsia

A

Look for sx of SLE flare = macular rash + joint pain + swelling

Pre-eclampsia

41
Q

Vaginal discharge
vaginal pooling or granulation tissue

A

Vesicovaginal fistula

Dx: bladder dye
Tx: surgical repair

42
Q

Primary Ovarian Insuffiency

A

depletion or dysfunction of ovarian follicles with cessation of menses before age 40 years

  • hot flushes
  • vaginal sx = dryness + dyspareunia + AUB

FMR1 gene for fragile X + Turner syndrome

43
Q

Mass on the anterior vaginal wall

tender to palpation

expresses a purulent discharge from the urethra

A

urethral diverticulum

Dx: MRI

Tx: Surgical excision

44
Q

gestational trophoblastic neoplasia (GTN) management

A
  1. Suction
  2. Surveillance w/ OCP for 6 months
45
Q

Category 3

A
  • Absent variability + recurrent late decelerations
  • Absent variability + recurrent variable decelerations
  • Absent variability + bradycardia
  • Sinusoidal pattern

GET c-section

46
Q

No uterus or ovaries
Blind vagina pouch
breast

A

androgen insensitivity syndrome (AIS)

46, XY (no ovaries)

47
Q

No uterus + cervix + upper 1/3 vagina
Has ovaries + pubic hair + breast

A

Müllerian agenesis (Mayer-Rokitansky-Küster-Hauser syndrome)

46,XX (ovaries)

48
Q

Vesicovaginal fistula vs urethral diverticulum

A

Vesicovaginal fistula = constant leakage + clear fluid collection

urethral diverticulum = dripple + associated anterior vaginal wall mass or purulent urethral discharge

49
Q

STI tx

A

Empiric: ceftriaxone + doxycycline*
Confirmed chlamydia: doxycycline*
Confirmed gonorrhea: ceftriaxone

50
Q

biophysical profile

A

Points given if:

Fetal movement = 3+ movements w/n 30 min
Fetal breathing = 1+ episodes of rhythmic breathing for 30+ secs
Fetal tone = 1+ episodes of extension w/ return to flexion or opening + closing hand
Volume = deepest vertical pocket 2+ cm & horizontal dimension 1+ cm
NST = 2+ acceleration

51
Q

Ectopic Management

A

Stable: Methotrexate
Unstable: Surgery

52
Q

Bishop Score

A

0: 0cm + < 30% effaced + -3 station + Firm consistency + OP

1: <2cm + < 50% effaced + -2 station + Medium consistency + Mid position

2: <4cm + < 70% effaced + -1/0 station + Soft consistency + OA

3: <6cm + 80% effaced + 2+ station

8+ = vaginal birth

52
Q

GBS prophylaxic if allergic to penicillin?

A

clindamycin or vancomycin

53
Q

carboprost tromethamine C/I

A

asthma

54
Q

methylergonovine maleate C/I

A

HTN

55
Q

stress incontinence (cough + sneeze) + urge incontinence (leaked on the way to the bathroom)

A

Mixed incontinence

Voiding dairy = to determine the predominant type of incontinence

56
Q

Emergency contraception up to 5 days

A

IUDs
Ulipristal acetate

57
Q

Indications for CVS include

A
  • maternal age > 35 years
  • abnormal 1st-trimester screen
  • abnormal US findings
  • FH of a chromosomal or genetic disorder
  • parents who are known carriers for a genetic disease
58
Q

Amniocentesis purpose

A

performed between 15–17 weeks’ gestation to detect fetal chromosomal abnormalities

59
Q

Amniocentesis indications

A
  • females aged > 35 years (at the time of delivery)
  • abnormal MSAFP, triple, or quad screen

Completed AFTER US

60
Q

Uteroplacental blood flow and gas exchange are maintained by

A

Using inhalational agents

61
Q

Using inhalational agents

A
  • uterine relaxation
  • amnioinfusion

to maintain uterine volume and avoid uterine collapse that could result in placental separation and/or cord compression

62
Q

nonsinusoidal category III patterns interventions

A
  1. Maternal repositioning
  2. Administer an intravenous (IV) fluid bolus
  3. Discontinue uterotonic drugs = Oxytocin + Misoprostol
63
Q

Complete

A

No products of conception
Closed cervix

before 20 weeks

64
Q

Incomplete

A

Vaginal bleeidng
Opened Cervix
Some product of conception expelled & some remain

before 20 weeks

65
Q

Inevitable

A

Vaginal bleeding
Dilated cervix
POC seen or felt at or above os

before 20 weeks

66
Q

Missed Abortion

A

No vaginal bleeding
Closed cervical os
No fetal cardiac activity or empty sac

before 20 weeks

67
Q

Threatened

A

Vaginal bleeding
Closed cervix
Fetal cardiac activity

before 20 weeks

68
Q

2nd trimester painless bleeding

A

Placenta previa
Vasa previa

69
Q

Soft boggy uterus (atony)
Postpartum bleeding

A

postpartum hemorrhage due to retained placenta or membranes

70
Q

Nipple discharge is considered pathologic if

A
  • spontaneous
  • U/L
  • persistent

Mammogram > US > MRI

71
Q

Late and post-term pregnancy
fetal complications

A

Macrosomia
Dysmaturity syndrome
Oligohydramnios
Demise

72
Q

Late and post-term pregnancy
maternal complications

A

Severe obstetric laceration
Cesarean delivery
Postpartum hemorrhage

73
Q

enlarged kidneys with thin renal cortices

A

hydronephrosis = posterior valve

74
Q

Risk factors for breech position

A

Advanced maternal age (≥35)
Uterine didelphys, septate uterus
Uterine leiomyomas
Fetal anomalies = anencephaly
Preterm (<37 weeks gestation)
Oligohydramnios/polyhydramnios
Placenta previa

75
Q

Polyhydramnios

A

Amniotic fluid index = ≥24 cm

76
Q

indomethacin as a tocolytic

not given after 32 weeks

A

MOA: cyclooxygenase inhibitor = ↓ prostaglandin production → fetal vasoconstriction

↓ renal perfusion + fetal oliguria can result in oligohydramnios = amniotic fluid index ≤5 cm

AFI = asses the amount of amniotic fluid by dividing the uterus in 4 quadrants

77
Q

```

Tocolytics =

A

Given up to 34 weeks = slow or stop the contractions of a woman’s uterus during pregnancy

Indomethacin = C/I after 32 due to potential closure of the ductus arteriosus

Nifedipine = C/I after 34 weeks due to material hypotension + tachycardia

Magnesium sulfate = weaker and good for neuroprotection up to 32 weeks

78
Q

Routine Lab test

A

Prenatal visit =
Rh(D) type & antibody screen
Hbg/Hct, MCV, ferritin
HIV, VDRL/RPR, HBsAg, anti-HCV Ab
Rubella & varicella immunity
Urine culture
Urine dipstick for protein
Chlamydia PCR (if risk factors are present)
Pap test (if screening indicated)

24-28 weeks =
Hbg/Hct
Antibody screen if Rh(D)-negative
1-hr 50-g GCT

36-38 = GBS cultures

79
Q

Cell-free fetal DNA testing indications

A

Maternal age ≥35
Abnormal maternal serum screening test
Sonographic findings associated with fetal aneuploidy
Prior pregnancy with fetal aneuploidy
Parental-balanced robertsonian translocation

80
Q

bupivacaine

A

local anesthetic = epidural

toxicity = metallic taste + tinnitis + Seizure

81
Q

brown rash palms + soles
plaques w/ rolled edges on the vulva

A

Syphilis

82
Q

Management in the presence of 1 STI

A

screening should be offered for other STIs

83
Q

Dx Chorioamnionitis

A

Fever + maternal leukocytosis + Fetal tachycardia + purulent fluid

84
Q

46 XX, 46XY
paternal disomy

A

Complete Mole = sperm fertilizes empty ovum

No fetal tissue

85
Q

69 XXY, 69 XXX, 69 XYY
Triploidy

A

Partial Mole = normal ovum fertilized by 2 sperm

Fetal tissue present

86
Q

a history of genital HSV receive antiviral prophylaxis w/ prego

A

beginning at 36 weeks gestation until delivery

87
Q

anti-D antibody titer of 1:32

A

Pt is alloimmunized = sensitized

88
Q

Risk factors for Vesicovaginal fistula

A

immediately following intraoperative bladder injury = cesarean delivery + hysterectomy

weeks or months following surgery or childbirth (eg, obstructed labor) due to tissue necrosis and sloughing

years after pelvic radiotherapy as a delayed presentation of radiation-induced microvascular injury (ie, endarteritis) and progressive tissue ischemia and breakdown (as seen in this patient)

89
Q

no dividing intertwin membrane

A

single amniotic sac

90
Q

Raloxifene C/I

A

deep venous thrombosis, renal vein thrombosis, pulmonary embolism, malignancy, active smoking, or any thrombophilia

91
Q

Fetal Growth Restriction management

A

Regular nonstress testing
Weekly biophysical profiles
Serial umbilical artery Doppler sonography
Serial growth ultrasounds

OBGYN (1 decks)

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