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OB/GYN > UWise > Flashcards

UWise Flashcards

1
Q

What is the sequential screen?

A

ComBines first trimester screen with quad screen - detects aneuploidies.

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2
Q

Asherman’s syndrome results from trauma to what?

A

Basal layer of endometrium

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3
Q

What blood pressures are needed for the diagnosis of preeclampsia with severe features?

A

SBP >160 or DBP >110

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4
Q

Early decelerations are thought to represent fetal response to what?

A

Head compression

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5
Q

What typically causes variable decelerations?

A

Cord compression

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6
Q

What is hyperthecosis?

A

More severe form of PCOS; associated with virilization due to the high androstenedione production and testosterone levels

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7
Q

Does a h/o SAB increase the risk of pre-E?

A

No

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8
Q

A baby born to a mother that is HIV + and has a positive PPD with a negative CXR is managed how?

A

Start zidovudine immediately and test for HIV at 24 hours; no need to isolate infant as CXR is negative

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9
Q

What is the risk of fetal loss associated with chorionic villus sampling?

A

1%

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10
Q

A patient presents with Mullerian agenesis, what other test should be completed?

A

Renal ultrasound - 25-35% of patients with Mullerian agenesis have renal anomalies

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11
Q

What are the risk factors for uterine atony?

A

Precipitous or prolonged labor, use of oxytocin, multiparity, general anesthesia, macrosomia, hydramnios, twins, chorioamnionitis

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12
Q

How does a neonate appear when septic from chorioamnionitis?

A

Tachycardic, minimal variability suggest sepsis; septic infant will appear pale, lethargic and have a high temp

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13
Q

What is the most effective screening test for Down syndrome?

A

Cell free DNA

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14
Q

What is the most common cause of elevated maternal serum alpha fetal protein?

A

Under estimation of gestational age

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15
Q

If a patient has an exposure to Hep B and has not get been vaccinated, what is the next steps for treatment of the patient?

A

Post-exposure prophylaxis should be initiated but no later than 7 days after blood contact and within 14 days after sexual exposure; should receive 1 dose of HBIG and the HBV series

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16
Q

What studies can be conducted using chorionic villus sampling?

A

Chromosomal abnormalities, biochemical or DNA-based

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17
Q

Patient presents in active labor with breech presentation, what should be done next?

A

C-section

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18
Q

Prolonged fetal tachycardia is seen when?

A

Maternal fever or chorioamnionitis

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19
Q

What is Chadwick’s sign?

A

Bluish color of cervix - seen in pregnancy

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20
Q

What is the definition of postpartum hemorrhage?

A

Vaginal - 500 cc; C-section - 1000 cc

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21
Q

G3P3 41 yo F presents with abnormal uterine bleeding, what test should be done first?

A

Ultra sound - less invasive than hysteroscopy

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22
Q

In what type of DM is associated with IUGR?

A

Pre-existing DM

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23
Q

What is Rokitansky-Kuster-Hauser syndrome?

A

Causes vaginal and uterine agenesis

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24
Q

What are the signs of magnesium toxicity?

A

Resp depression, nausea, muscle weakness and loss of DTRs; Mag in high doses can lead to cardiac arrest

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25
Q

What effect does estrogen have on the endometrium?

A

Stimulation of rapid endometrial growth, conversion of proliferative to secretory endometrium and regeneration of the functional layer

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26
Q

What is twin-twin transfusion syndrome?

A

Complication of monochorionic pregnancies - characterized by an imbalance in the blood flow through communicating vessels across a shared placenta leading to under perfusion of the donor twin

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27
Q

At what magnesium levels are there loss of DTRs?

A

7-10 mEq/L

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28
Q

Head compression typically causes what type of decelerations?

A

Early

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29
Q

What are potential neonatal complications of vacuum assisted delivery?

A

Lacerations to scalp, separation of fetal scalp from underlying structures, cephalohematoma, jaundice, transient lateral rectus paralysis (not of clinical importance apparently)

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30
Q

If CVS is performed before 10 weeks gestation there is an increased risk of what?

A

Limb abnormalities

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31
Q

What is the most common risk factor for uterine inversion?

A

Iatrogenic- excessive traction on the umbilical cord

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32
Q

What is the treatment for cervical insufficiency?

A

Prophylactic cerclage (transvaginal cerclage)

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33
Q

What defect can be seen in pregnancy with prenatal exposure to valproic acid?

A

Lots but most common is NEURAL TUBE DEFECT

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34
Q

What are the complications to each twin in twin-twin transfusion syndrome?

A

Donor twin becomes anemia, has IUGR, oligohydramnios; recipient has over perfusion and becomes polycythemic, experiences volume overload and polyhydramnios which may lead to heart failure and hydrops

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35
Q

What is the most common cause of inherited mental retardation?

A

Fragile X syndrome

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36
Q

What are the treatment options for vestibulodynia?

A

TCAs, pelvic floor rehabilitation, biofeedback, topical anesthetics. Surgery for patients who do not respond to standard therapies

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37
Q

Valproic acid exposure in utero is associated with an increased risk for what anatomical defects?

A

NTDs, hydrocephalus and craniofacial malformations

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38
Q

What is the treatment for Kallmann syndrome?

A

Pulsatile GnRH therapy

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39
Q

What are risk factors for uterine inversion?

A

Grand multiparity, multiple gestation, polyhydramnios, macrosomia

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40
Q

If a patient is exposed to Hep B but is a nonresponder to the vaccine, what is the course of treatment?

A

HBIG plus HBV or HBIG time two doses

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41
Q

What type of contraception should be used with caution in women with a history of depressoin?

A

Progestins

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42
Q

When is methergine contraindicated?

A

Hypertension

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43
Q

What weight is needed for menarche to occur?

A

85-106 lbs

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44
Q

What type of cancer has an increased incidence in patients with PCOS?

A

Endometrial and considered to increase the risk of ovarian

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45
Q

Prostaglandins are contraindicated in patients with what obstetrical history? Why?

A

C section - due to potential uterine rupture

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46
Q

What are the management options for endometrial polyps?

A

Observation, medical management with progestin, curettage, surgical removal and hysterectomy

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47
Q

Patient presents with anorexia nervosa and amenorrhea. You suspect hypothalamic-pituitary dysfunction. What hormone should be evaluated to confirm the diagnosis?

A

FSH level - would expect to be very low

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48
Q

What is the diagnostic criteria for PCOS?

A

Two of the following three criteria: chronic anovulation, hyperandrogenism (clinical or biological), polycystic ovaries on US

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49
Q

What does partial deletions of the long arm of the X chromosome cause?

A

Premature ovarian failure

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50
Q

What is the therapeutic range of magnesium?

A

4-7 mEq/L

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51
Q

A mother with a h/o substance abuse delivers a limp unresponsive infant with HR >90 bmp and no respiratory effort. What is the most appropriate next step?

A

Give positive pressure ventilation and prepare to intubate the infant

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52
Q

Newborns of mothers with T1DM are usually what size? Blood sugar levels?

A

Smaller in size and worry about hypoglycemia

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53
Q

What are initial measures to treat fetal hypoperfusion?

A

Maternal position to left lateral position - increases perfusion to uterus; maternal supplemental oxygen, treatment of maternal hypotension, d/c oxytocin

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54
Q

When is amnioinfusion used?

A

Repetitive variable decelerations

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55
Q

Late decelerations are associated with what?

A

Uteroplacental insuff.

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56
Q

What age are DEXA scans recommended?

A

65 for women, sooner if have risk factors

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57
Q

Why can anorexia nervosa result in amenorrhea?

A

Hypothalamic-pituitary dysfunction - lack of normal pulsatile secretion of GnRH

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58
Q

What is the normal and predictable sequence of sexual maturation?

A

Breast budding (thelarche) then adrenarche (hair growth), a growth spurt and then menarche

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59
Q

What is the recommended rate of oxygen flow for an infant needing positive pressure ventilation?

A

10 L/minute

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60
Q

What is the treatment for bacterial vaginosis?

A

Metronidazole 500 mg orally BID x7 days or vaginal metronidazole 0.75% gel QHS x 5 days

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61
Q

What is the recommended daily dose of folate for pregnancy with a h/o neural tube defect?

A

4 mg

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62
Q

When is an amniocentesis performed?

A

After 15 weeks

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63
Q

What is the treatment for uncomplicated vulvovaginal candidiasis?

A

Topical azoles (1-3 days)

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64
Q

During what weeks of gestation is chorionic villus sampling done?

A

Weeks 10-12

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65
Q

What organism is the likely cause of mucopurulent cervicitis with exacerbation in the symptoms during and after menstruation?

A

Gonorrhea

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66
Q

Infants born to diabetic mothers have an increased risk of developing what?

A

Hypoglycemia, polycythemia, hyperbilirubinemia, hypocalcemia, and respiratory distress

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67
Q

Acanthosis nigricans is associated with increased blood levels of what?

A

Elevated androgen levels and hyperinsulinemia

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68
Q

At what magnesium level does cardiac arrest occur?

A

15 mEq/L

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69
Q

When is hemabate contraindicated?

A

Asthmatics

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70
Q

Patient presents with thin, gray discharge with a fishy odor that is often worse after menses or intercourse. What is the likely cause? What is seen on wet prep? Vaginal pH?

A

Bacterial vaginosis; clue cells; pH >4.5

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71
Q

What is the most likely complication a patient will experience after postpartum tubal ligation?

A

Future pregnancy - failure rate of 1%

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72
Q

Patient presents with hirsutism, why can testing 17-hydroxyprogesterone be useful?

A

Evaluation for late onset 21-hydroxylase

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73
Q

When trying to place an IUPC, frank vaginal blood and amniotic fluid are noted. What is the next step to management?

A

Monitor fetus - worried about placenta separation or uterine perforation

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74
Q

What is Kallmann syndrome?

A

Arcuate nucleus does not secrete GnRH and there is olfactory tract hypoplasia; no sense of smell and do not develop secondary sexual characteristics

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75
Q

When is a B-lynch suture used for postpartum hemorrhage?

A

Recalcitrant cases of PPH - needs to be laparoscopic.

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76
Q

What is the recommended daily dose of folate in a non-high risk pregnancy?

A

0.6 mg

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77
Q

What uterotonic agent is contraindicated in asthmatics?

A

Prostaglandin F2 alpha (Hemabate) - smooth muscle constrictor and brochio-constrictive effect

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78
Q

Placental insuff is associated with what type of decelerations?

A

Late

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79
Q

At what size is observation of a polyp not recommended?

A

If the polyp is >1.5 cm observation is not recommended

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80
Q

What screening test can be done in the first trimester for downs syndrome?

A

Combined test - beta hcg, PAPP-A and nuchal translucency.

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81
Q

What is the pathophysiology behind postpartum telogen effluvium?

A

High levels of estrogen during pregnancy increase synchrony of hair growth. Therefore, hair grows in the same phase and is shed at the same time

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82
Q

What uterotonic agent is contraindicated in patients with hypertension?

A

Methergine - ergot alkaloid

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83
Q

Patient presents with features of PCOS, what is a the next lab tests for evaluation?

A

Fasting insulin

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84
Q

What phase of the menstrual cycle is inhibin increased?

A

Luteal phase

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85
Q

At what age does breast development begin?

A

Age 10

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86
Q

Uterine hyperstimulation may produce what on FHT?

A

Prolonged fetal bradycardia

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87
Q

Why is testosterone elevated in patients with PCOS?

A

It is elevagted because sex hormone binding globulin is decreased by elevated androgens

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88
Q

What needs to be given in magnesium toxicity?

A

Calcium gluconate

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89
Q

What is the most appropriate treatment for PCOS?

A

OCPs

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90
Q

What position should the head be in for an infant needing positive pressure ventilation?

A

Sniffing position - tilting he neonate’s head back and lifting the chin

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91
Q

What are the early skin changes seen with lichen sclerosis?

A

Polygonal ivory papules involving the vulva and perianal areas, waxy sheen on labia minora and clitoris

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92
Q

What is the loss rate of amniocentesis vs CVS?

A

Amniocentesis 0.5% vs CVS 1-3%

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93
Q

What is the MOA of medroxyprogesterone acetate for anovulatory bleeding?

A

Converts endometrium from proliferative to secretory endometrium

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94
Q

What are the risk factors for retained placenta?

A

Cesarean delivery, uterine leiomyomas, prior uterine curettage and succenturiate lobe of placenta

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95
Q

What age doe leiomyomas typically present?

A

30s and 40s

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96
Q

What urine protein levels are requires for the diagnosis of preeclampsia? Severe pre-elcampsia?

A

Preeclampsia = 300 mg; severe preeclampsia = 5000

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97
Q

Patient had an abortion and is now complaining of cyclic midline abdominal cramping pain. What is the likely diagnosis?

A

Hematometra

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98
Q

What complications might occur after suction and dilatation?

A

Anesthesia risk, bowel and bladder injury, cervical lacerations, and uterine perforations

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99
Q

What is the most common abnormal karyotype encountered in spontaneous abortions?

A

Autosomal trisomy

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100
Q

What systemic disease are associated with early pregnancy loss?

A

Diabetes mellitus, chronic renal disease and lupus

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101
Q

What is fetal fibronectin? How is it used?

A

Fetal fibronectin leaks into the vagin if a preterm delivery is likely to occur; +fFN is inconclusive but used as a negative predictor of preterm delivery

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102
Q

When should a cervical cerclage be done when a patient has an incompetent cervix?

A

14 weeks

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103
Q

Patient presents with recurrent (successive) first trimester losses. What tests should be performed?

A

Testing for lupus anticoagulant, diabetes mellitus and thyroid disease; can also obtain maternal and paternal karyotypes

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104
Q

What position is best for breast feeding?

A

Baby and mom belly to belly

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105
Q

What hospital policies promote breastfeeding?

A

Getting baby on breast within half hour of delivery and rooming-in for the baby to ensure frequent breastfeeding on demand

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106
Q

What hormone has an inhibitory influence on alpha-lactalbumin?

A

Progesterone; prolactin has a positive influence

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107
Q

How does candida of the nipple present?

A

Intense nipple pain

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108
Q

If mother has candida of the nipple, what else should you check for?

A

Check babies mouth

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109
Q

What are the signs that baby is getting enough milk?

A

3-4 stools in 24 hrs, 6 wet diapers in 24 hrs, weight gain and sounds of swallowing

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110
Q

What factors does fresh frozen plasma contain?

A

Fibrinogen, clotting factors V and VIII

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111
Q

What are the common presenting signs of placental abruption?

A

Abdominal pain, bleeding, uterine hypertonus and fetal distress

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112
Q

A patient presents with placental abruption and deteriorating fetal condition, what is the next best step?

A

Emergent cesarean delivery

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113
Q

Smoking increases the risk of what complications during pregnancy?

A

Placental abruption, placenta previa, fetal growth restriction, preeclampsia and infection

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114
Q

How does a cervical polyp appear on examination?

A

Bleeding and are typically soft (not hard)

115
Q

What is the treatment protocol for pregnant women with HIV?

A

HAART therapy, IV zidovudine at time of delivery, zidovudine treatment for neonate, cesarean section prior to labor

116
Q

What is the most common cause of sepsis in pregnancy?

A

Acute pyelonephritis

117
Q

Why is radioactive iodine (I-131) contraindicated in pregnancy?

A

Concentrates in fetal thyroid and can cause congenital hypothyroidism

118
Q

18 week pregnant woman presents with symptomatic mitral valve prolapse. What treatment should be used at this time?

A

Beta blockers; because she is symptomatic this should be treated

119
Q

What is seen on hemoglobin electrophoresis in Beta thalassemia?

A

Hemoglobin F and hemoglobin A2

120
Q

Women with obesity that are pregnant are at increased risk for developing what complications?

A

Chronic HTN, gestational DM, pre-E, fetal macrosomia

121
Q

What SSRI is contraindicated in pregnancy? Why?

A

Paroxetine (Paxil); increased risk of fetal cardiac malformations and persistent pulmonary hypertension

122
Q

What is pruritus gravidarum?

A

Pregnancy-related skin condition that is a mild variant of intrahepatic cholestasis of pregnancy; there is retention of bile salt which is deposited in the dermis which leads to pruritus

123
Q

What is the treatment for gravidarum pruritus?

A

Antihistamines and topical emollients should be used initially; refractory cases ursodeoxycholic acid is helpful; naltrexone can also be used

124
Q

Where is the appendix in pregnancy?

A

Enlarged uterus shifts the appendix upward and outward toward the flank (pain and tenderness may not be in RLQ)

125
Q

What is the chance an Rh negative mom who refuses Rhogam will have isoimmunization if she gives birth to an Rh positive fetus?

A

2% antepartum, 7% after full term delivery and 7% with subsequent pregnancy; less than 20%

126
Q

What test can be used to assess fetuses at risk for anemia?

A

Middle cerebral artery peak systolic velocity

127
Q

Anti-D antibodies increase the risk of what complication for the fetus?

A

Hydrops fetalis - defined as fluid in two more more cavities

128
Q

What amount of fetal blood is neutralized by 300 micrograms of rhogam?

A

30 cc of fetal blood is neutralized; this is equivalent to 15 cc of fetal red blood cells

129
Q

When is Rhogam administered?

A

28 weeks gestation after testing for sensitization and given following amniocentesis, CVS, delivery, and abortion

130
Q

What are Lewis antibodies?

A

IgM antibodies that do not cross the placenta

131
Q

Amniotic fluid ferritin is associated with what?

A

Spontaneous preterm delivery

132
Q

Patient’s amniotic fluid stains yellow, what does this indicate?

A

Yellow is bilirubin; this is due to erythroblastotic fetus - severe hemolysis

133
Q

Fetus at 30 weeks EGA has severe hemolytic disease (zone 3 of the Liley curve); what can be done to help the fetus at this time?

A

Intrauterine Intravascular transfusion

134
Q

What ultrasound markers are suggestive of dizygotic twins?

A

Dividing membrane thickness greater than 2 mm, twin peak (lambda) sign, different fetal genders and two separate placentas (posterior and anterior)

135
Q

What is the twin infant death rate in comparison to singletons?

A

Five times higher

136
Q

What is the risk for development of cerebral palsy in twin infants vs singletons?

A

5-6x higher

137
Q

Twin-twin transfusion most comonly occurs in what type of twins?

A

Monochorionic, diamniotic twins

138
Q

The surviving twin of a twin-twin transfusion syndrome has increased rates of what?

A

Neurological morbidity - including cerebral palsy

139
Q

The recipient twin in twin-twin transfusion can have what complications?

A

Cardiomegaly, tricuspid regurgitation, ventricular hypertrophy, plethoric

140
Q

What are the reasons for elevated alpha fetoprotein?

A

Twins, neural tube defects, pilonidal cysts, cystic hygroma, sacrococcygeal teratoma, fetal abdominal wall defects and fetal death

141
Q

What is the most common chromosomal aneuploidy in abortuses?

A

Trisomy 16

142
Q

At what gestational age is the greatest fetal risk for developing neurological deficits when exposed to radiation?

A

8-25 weeks (8-15 weeks)

143
Q

Uncontrolled diabetes during organogenesis is associated with what?

A

High rate of birth defects - most common are spine and heart

144
Q

Advanced maternal age is associated with what pregnancy complications?

A

Stillbirth, preeclampsia, gestation DM, IUGR

145
Q

What is the ultrasound criteria for a missed abortion?

A

CRL >7mm with no cardiac activity

146
Q

What conditions are associated with breech presentation of a fetus?

A

Prematurity, multiple gestation, genetic disorders, polyhydramnios, hydrocephaly, anencephaly, placenta previa, uterine anomalies, uterine fibroids

147
Q

Whta is the definition of prolonged latent phase?

A

> 20 hours for nulliparous and >14 hours for multiparous

148
Q

What is the typical presentation of cervical incompetence?

A

Usually diagnosed in early 2nd trimester and is associated with painless cervical dilation

149
Q

Patient presents in preterm labor, what mediations are important for this patient?

A

Nifedipine - tocolytic; betamethasome - baby lungs; ampicillin (azithromycin + amoxicillin also)

150
Q

By what MOA does Magnesium work as a tocolytic?

A

Competes with calcium entry into the cells

151
Q

Indomethacin cannot be used as a tocolytic past what EGA?

A

32 weeks - premature closure of ductus arteriosus

152
Q

What side effects does nifedipine have when used in pregnancy?

A

Fetal hypoxia and decreased uteroplacental blood flow

153
Q

What is the statistical significant bullshit behind fetal fibronectin in a preterm labor lady?

A

Has a negative predictive value of 99.2% – MEANING…. 99/100 with a negative test result will not deliver in the next 14 days. HAS NOTHING TO DO WITH SENSITIVITY…. Also it has a low PPV.

154
Q

What complications can occur with a bacterial vaginosis infection?

A

PPROM

155
Q

What are the levels of glucose and IL-6 in chorioamnionitis?

A

Glucose levels are low and IL-6 would be increased

156
Q

What medication can reduce the risk of premature labor?

A

17 alpha hydroxyprogesterone (administered between 16-20 weeks until 36 weeks)

157
Q

What is the treatment for postpartum endometritis?

A

Clindamycin + gentamicin

158
Q

How is septic pelvic thrombophlebitis diagnosed?

A

Diagnosis of exclusion - characterized by high fever not responsive to antibiotics

159
Q

What is the treatment for septic thrombophlebitis in postpartum?

A

Anticoagulation and antibiotics;

160
Q

What is the most common cause of fever on the first postpartum day?

A

Lungs - especially if patient had general anesthesia

161
Q

Clindamycin covers what type of organisms?

A

Anaerobic organisms apparently…

162
Q

Patient is 24 weeks pregnant and starts treatment with fluoxetine (Prozac), what is the most common side effects?

A

Insomnia and sexual dysfunction

163
Q

Mother wishes to breastfeed her baby but is concerned about taking sertraline while breastfeeding. How do you counsel her?

A

Tell her its fine. She can take SSRIs if she wants. Its fine.

164
Q

What side effects does a neonate experience when a mother uses fluoxetine during pregnancy?

A

It has been associated with abnormal muscle movements (EPS) and withdrawal sxs (decreased muscle tone, tremor, sleepiness, severe difficulty breathing)

165
Q

At what time of the menstrual cycle do PMS and PMDD begin?

A

Luteal phase (second half) - resolves shortly after the onset of menses

166
Q

A patient is postterm, what diseases are associated with postterm pregnancies?

A

Placental sulfatase def, fetal adrenal hypoplasia, anencephaly, inaccurate or unknown dates

167
Q

Late term and postterm pregnancies are associated with what complications?

A

Macrosomia, oligohydramnios, meconium aspiration, uteroplacental insufficiency and dysmaturity; also increased risk preeclampsia

168
Q

What is a reasonable approach to repetitive variable decelerations?

A

Amnioinfusion

169
Q

How does an infant with dysmaturity appear?

A

Withered, meconium stained, long-nailed, fragile and have associated small placenta

170
Q

What is most commonly used for cervical ripening?

A

Prostaglandins applied locally (tablet)

171
Q

An increased systolic/diastolic ratio of the umbilical artery reflects what?

A

Increased vascular resistance

172
Q

Fetal growth restriction is a significant risk factor for developing what diseases as an adult?

A

COPD, type II DM, CVD, CHTN, stroke, obesity

173
Q

What are the characteristics of a threatened abortion?

A

Vaginal bleeding, positive pregnancy, positive pregnancy test and cervical os closed or uneffaced

174
Q

What is the management of septic abortion?

A

Broad spectrum antibiotics and uterine evacuation

175
Q

17-hydroxyprogesterone is indicated when?

A

History of prior preterm birth

176
Q

What is the treatment for antiphospholipid antibody syndrome in a patient that wants to become pregnant?

A

Heparin and aspirin

177
Q

Prolonged diluted Russell viper venom time and 3 early pregnancy losses is suggestive of what?

A

Antiphospholipid antibody syndrome

178
Q

What is mifepristone? Misoprostol?

A

Mifepristone - antiprogestin; misoprostol - prostaglandin

179
Q

When can manual vacuum aspiration of a pregnancy be performed?

A

Less than eight weeks

180
Q

What is the management for ovarian torsion?

A

Surgery

181
Q

What is the first line treatment option for a woman with endometriosis trying to conceive?

A

Ovarian stimulation with clomiphene citrate

182
Q

What can be used for pain relief in mastitis?

A

Acetaminophen and ibu

183
Q

What is interstitial cystitis? What is the presenting complaint usually?

A

Chronic inflammatory condition of the bladder characterized by recurrent voiding symptoms of urgency and frequency; can also complain of pelvic pain and dyspareunia

184
Q

What is the MOA of GnRH agonists in treatment of endometriosis?

A

Down-regulates hypothalamic-pituitary gland production and the release of LH and FSH leading to dramatic reduction in estradiol level

185
Q

What is pelvic congestion syndrome?

A

Pelvic pain in the setting of pelvic varicosities

186
Q

The iliohypogastric nerve provides cutaneous sensation to what?

A

The groin and skin overlying the pubis

187
Q

The ilioinguinal nerve supplies sensation to what region?

A

Groin, symphysis, labium and upper inner thigh

188
Q

What are the common complications of a LEEP procedure?

A

Infection, bleeding, cervical stenosis, persistent disease, possibility risk for preterm delivery

189
Q

Hyperplastic overgrowth of endometrial glands/stroma is consistent with what disease?

A

Polyps

190
Q

What effect can quetiapine have on fertility?

A

Can cause hyperprolactinemia, resulting in subfertility

191
Q

What are the characteristic lab findings in exercise-induced hypothalamic amenorrhea?

A

Normal FSH with low estrogen levels

192
Q

What lab test can be used to asses ovarian reserve?

A

Anti-mullerian hormone levels

193
Q

What is a last resort treatment option for women with PMDD?

A

Bilateral oophorectomy

194
Q

Prior to bilateral oophorectomy for patients with refractory PMDD, what treatment option can be done short-term to evaluate the success of the surgery?

A

Administer a course of GnRH agonist to initiate a menopause-like state

195
Q

Who is at increased risk for molar pregnancies?

A

Asian women have a higher incidence, higher incidence in areas where people consume less beta-carotene and folic acid, increased risk in women with 2 or more miscarriages

196
Q

What is the risk of recurrence for molar pregnancies?

A

1-2% which is a 20-fold increase from background risk; the risk of recurrence after two molar pregnancies is 10%

197
Q

What is seen on ultrasound in a complete mole?

A

Snowstorm appearance; due to presence of multiple hydropic villi

198
Q

What is the standard management for molar pregnancies?

A

Suction and curettage

199
Q

What is the karyotype of a partial mole?

A

69XXY, 69XXX or 69XYY

200
Q

What type of molar pregnancy shows marked villi swelling?

A

Partial moles

201
Q

What needs to be done to evaluate a mass in the region of the Bartholin gland in a woman over the age of 40?

A

Should be biopsied; any finding of a new Bartholin gland cyst in a post-menopausal woman should be further investigated; worried about adenocarcinoma

202
Q

What are the risk factors for vulvar cancer?

A

HPV expsoure, smoking, vulvar dystrophy (lichen sclerosis), immunocompromised

203
Q

What are the follow-up guidelines for ASCUS?

A

Perform HPV DNA testing or repeat cytology in 12 months; if HPV testing was negative then routine screening can be resumed at 3 years; for women ages 21-24 with HPV positive - cytology should be repeated in 12 months

204
Q

What is the major symptom associated with leiomyomas?

A

Heavy menstrual bleeding

205
Q

What type of leiomyomas can cause infertility or miscarriages?

A

Submucosal (or intracavitary)

206
Q

What are the risk factors for endometrial carcinoma? Which is the strongest risk factor?

A

Nulliparity, obesity, late menopause, HTN, exposure to unopposed estrogens, tamoxifen therapy, diabetes; obesity is the greatest risk factor

207
Q

What is the recommended treatment to endometrial cancer?

A

TAH, BSO with pelvic and paraaortic lymphadenectomy

208
Q

When is a theca lutein cyst usually seen?

A

Pregnancy (molar usually) and is often bilateral

209
Q

What is a granulosa cell tumor?

A

An estrogen secreting tumor

210
Q

What is the most common cause of postmenopausal bleeding?

A

Atrophy of the endometrium

211
Q

A spiral fracture is indicative of what?

A

Abuse/violence associated with the Fx

212
Q

What are the risk factors for ovarian cancer?

A

Nulliparity, family history, early menarche, late menopause, white race, increasing age, residence in north America or northern europe

213
Q

How does a functional ovarian cyst appear on ultra sound?

A

As a simple cyst - unilocular simple cyst without evidence of blood, soft tissue elements or excrescences

214
Q

How does a dermoid tumor appear on ultrasound?

A

Echogenic, may contain teeth, cartilage, bone, fat and hair

215
Q

What type of ovarian tumor can produce estrogen and therefore cause endometrial hyperplasia/cancer?

A

Granulosa cell tumor

216
Q

What is the most common subtype of ovarian tumors?

A

Epithelial tumors

217
Q

Prognosis of ovarian cancer is based on what?

A

Tumor stage

218
Q

What is the standard of care for advanced ovarian cancer?

A

Tumor debulk followed by post-operative chemotherapy with combination of taxane and platinum adjunct

219
Q

What chemotherapeutic agents are used for ovarian cancers?

A

Taxane and platinum

220
Q

What is the most common ovarian tumor found in women of all ages?

A

Dermoid

221
Q

75 yo F presents with dyspareunia. Atrophic vaginal mucosa is noted on exam. What is a good treatment option for her?

A

Topical estrogen cream

222
Q

How can a female help prevent vaginal atrophy?

A

By staying sexually active

223
Q

What is the most important source of lubrication during intercourse for a female?

A

Transudate of the fluid across the vaginal mucosa

224
Q

What prescriptions should be offered to a rape victim?

A

Ceftriaxone, doxycycline, and anti-retrovirals; emergency contraception if desired

225
Q

What is peripartum cardiomyopathy? What are the presenting s/sx?

A

Heart failure secondary to left ventricular systolic function; fatigue, SOB, palpitations and edema

226
Q

What does peripartum cardiomyopathy usually present?

A

Towards the end of pregnancy or in the several months following delivery

227
Q

Why is there a compensated respiratory alkalosis during pregnancy?

A

Pregnancy increases minute ventilation - blow off more CO2, excrete by HCO3

228
Q

What happens to the inspiratory capacity during pregnancy?

A

It increases by 15% due to increases in TV and IRV

229
Q

How is the minute ventilation increased in pregnancy?

A

Increase in tidal volume, no change in RR

230
Q

What happens to the functional residual capacity in pregnancy?

A

Reduced to 80% of non-pregnant volume

231
Q

What ureter and renal pelvis becomes more dilated in pregnancy? Why?

A

R>L; the left is cushioned by the sigmoid colon

232
Q

What is the recommended weight gain in pregnancy for a woman with a pre-pregnancy BMI of <18.5?

A

28-40 lbs

233
Q

What is the recommended weight gain in pregnancy for a woman with a pre-pregnancy BMI of 18.5-24.9?

A

25-35 lbs

234
Q

What is the recommended weight gain in pregnancy for a woman with a pre-pregnancy BMI of 25-29.9?

A

15-25 lbs

235
Q

What is the recommended weight gain in pregnancy for a woman with a pre-pregnancy BMI of >30?

A

11-20 lbs

236
Q

Beta thalassemia anemia is seen in populations from what region?

A

Mediterranean

237
Q

In chorionic villus sampling, what region of the chorion is the sampling done from?

A

Chorionic frondosum

238
Q

What is the most common cause of inherited mental retardation?

A

Fragile X syndrome

239
Q

Women with poorly controlled diabetes prior to conception have an increased risk for having a fetus with what structural anomalies?

A

Lesions of the CNS (neural tube defects) and the cardiovascular system

240
Q

What is the risk of fetal loss with CVS?

A

1%

241
Q

Prior history of ectopic pregnancy increases the risk of ectopic pregnancy by how much?

A

10 fold

242
Q

Age between 35-44 increases the risk of ectopic pregnancy by how much?

A

3 fold

243
Q

What progesterone level suggests a healthy pregnancy?

A

Progesterone >25 ng/ml

244
Q

What criteria must be met for use of methotrexate?

A

Hemodynamically stable, non-ruptured ectopic pregnancy, size of ectopic mass <4 cm without a fetal heart rate or <3.5 cm in the presence of fetal hear rate, normal liver enzymes and renal function, normal white cell count, reliable to follow up

245
Q

What should be rule out and documented prior to starting HRT for menopause?

A

R/o endometrial hyperplasia/cancer; normal endometrial bx or US with endometrial stripe < or equal to 4 mm

246
Q

How often should bone mineral density testing be done in a patient with an osteoporotic fracture?

A

Repeated every two years

247
Q

HRT increases the risk for what cancer? And decreases the risk of what other cancer?

A

HRT increases the risk for breast cancer but decreases the risk for colon cancer

248
Q

HRT has what effect on lipid levels?

A

Increases HDL and decreases LDL

249
Q

What race increases the risk for osteoporotic fracture?

A

White/Asian

250
Q

What is the size and blood sugar levels of neonates of a type 1 diabetic with moderately controlled sugars during pregnancy?

A

Small and watch for hypoglycemia

251
Q

Infants born to diabetic mothers are at increased risk for what?

A

Hypoglycemia, polycythemia, hyperbilirubinemia, hypocalcemia, and respiratory distress

252
Q

What is overflow incontinence?

A

Failure to empty the bladder adequately - due to underactive detrusor muscle

253
Q

What is a normal post-void residual? What is considered elevated?

A

Normal is 50-60 cc; elevated is >300 cc

254
Q

Family history of pelvic organ prolapse increases the risk of POP by how much?

A

2.5 fold increase

255
Q

How is urethral hypermobility genuine stress incontinence diagnosed?

A

Straining Q-tip angle >30 degrees for horizontal

256
Q

What is the best surgical treatment option for genuine stress incontinence?

A

Retropubic urethropexy

257
Q

What is the best surgical treatment option for intrinsic sphincter deficiency?

A

Urethral bulking procedures

258
Q

What neurotransmitter stimulates the bladder to contract?

A

Ach through muscarinic receptors

259
Q

How is vaginal vault prolapse treated?

A

Supporting the vaginal cuff to the uterosacral or sacrospinous ligaments or by sacrocolpopexy

260
Q

How are central and lateral cystoceles repaired?

A

Repaired by fixing defects in the pubocervical fascia or reattaching it to the sidewall if separated from the white line (arcus tendineus fascia)

261
Q

How are rectoceles repaired?

A

Repairing defects in the rectovaginal fascia

262
Q

What is the cause of urge incontinence?

A

Overactivity of the detrusor muscle

263
Q

What is Sheehan syndrome?

A

Patient experiences significant blood loss (eg PPH) resulting in anterior pituitary necrosis

264
Q

What factors are related to increased rates of infection with a vaginal birth?

A

Prolonged labor, prolonged ROM, multiple vaginal examinations, internal fetal monitoring, removal of the placenta manually and low SES

265
Q

What is the most common cause of postpartum fever?

A

Endometritis; DDx includes UTI, lower genital tract infection, wound infections, pulmonary infection, thrombophlebitis, and mastitis

266
Q

What bacteria are responsible for endometritis?

A

Bacterial isolates related to postpartum endometritis are usually polymicrobial resulting in a mix of aerobes and anaerobes in the genital tract. The most causative agents are Staphylococcus aureus and Streptococcus.

267
Q

What is the safest method to suppress lactation?

A

Breast binding, ice packs and analgesics

268
Q

Why are prostaglandins inhibited for cervical ripening in a patient with a prior cesarean section?

A

Risk of uterine rupture

269
Q

What is the first initial step for fetal stimulation?

A

Digital scalp stimulation with the goal to elicit acceleration of 15x15

270
Q

Fetal head with measurements great than what diameter would benefit from a cesarean?

A

Diameter >12cm

271
Q

When is a patient a candidate for prophylactic cerclage?

A

Cervical insuff. - painless cervical dilation before 24 weeks with expulsion of pregnancy in second trimester, in absence of labor or other clear pathology such as infection or ROM

272
Q

What is the MOA of medroxyprogesterone acetate?

A

Inhibits endometrial growth converting the proliferative to secretory endometrium

273
Q

A polyp of what size or greater is an indication for polypectomy in a woman trying to conceive.

A

Polyp >1.5 cm in a woman with infertility a polypectomy is a treatment of choice

274
Q

Which non-invasive test can detect severe fetal anemia?

A

Doppler study of middle cerebral artery peak systolic velocity

275
Q

What about of fetal blood is neutralized by a dose of 300 micrograms of rhogam?

A

30 cc of fetal blood = 15 cc of fetal RBCs

276
Q

What is the definition of prolonged latent phase labor?

A

> 20 hours for nullips; >14 hours for multips

277
Q

What is the most common type of breech presentation?

A

Frank breech - buttocks is presenting part

278
Q

What is the most common cause of preterm labor?

A

Idiopathic

279
Q

What tocolytics are contraindicated in diabetic patients?

A

Terbutaline and ritodrine

280
Q

What tocolytic is contraindicated in myasthenia gravis?

A

Mag

281
Q

What treatment option is first line for a woman presenting with infertility secondary to endometriosis?

A

Ovarian stimulation with clomiphene citrate

282
Q

Preterm rupture of membranes is especially associated with what genital tract infection?

A

Bacterial vaginosis

283
Q

What findings are seen on amniocentesis in triple I?

A

Chorioamnionitis - increased IL-6, low glucose, leukocytes

OB/GYN (3 decks)

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