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OB/GYN > UWorld 1 > Flashcards

UWorld 1 Flashcards

1
Q

modifiable breast cancer RF

A
  • hormone replacement therapy
  • nulliparity
  • inc age at first live birth
  • alcohol consumption
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2
Q

non-modifiable breast cance RF

A
  • genetic mutation of breast cancer in first degree relatives
  • white race
  • increasing age
  • early menarche or later menopause
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3
Q

second stage arrest of labor-definition

A

insufficient fetal descent after pushing for

  • > 3 hr if nulliparous
  • > 2 hr is multiparous
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4
Q

second stage arrest of labor-RF

A
  • maternal obesity
  • excessive pregnancy weight gain
  • DM
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5
Q

second stage arrest of labor-etiology

A
  • cephalopelvic disproportion
  • malposition
  • inadequate contractions
  • maternal exhaustion
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6
Q

second stage arrest of labor-management

A
  • operative vaginal delivery

- cesarean delivery

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7
Q

pre-eclampsia definition

A

-new onset HTN (SBP >140 and/or DBP>90) at >20 weeks gestation
PLUS
-proteinuria and/or end-organ damage

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8
Q

pre-eclampsia severe features

A
  • SBP >160 or DBP >110 (2x, >4hr apart)
  • thrombocytopenia
  • inc Cr
  • inc transaminases
  • pulmonary edema
  • visual or cerebral s/s
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9
Q

pre-eclampsia management

A
  • without severe features: delivery at >37 weeks
  • WITH severe features: delivery at >34 weeks
  • magnesium sulfate (sz ppx)-IV or IM
  • antihypertensives (lower stroke risk): Hydralazine IV, Labetalol IV, or Nifedipine PO
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10
Q

RF for neonatal HSV infection

A
  • primary maternal infection
  • longer duration of ROM
  • vaginal delivery with active lesions
  • impaired skin barrier (eg fetal scalp electrode)
  • preterm birth
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11
Q

What are the (5) hypertensive disorders of pregnancy

A
  • chronic HTN
  • gestational HTN
  • preeclampsia
  • eclampsia
  • chronic HTN with superimposed preeclampsia
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12
Q

chronic HTN in pregnancy

A

-SBP: >140 and/or DBP >90 prior to conception or 20 weeks gestation

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13
Q

gestation HTN

A

-new onset elevated BP at >20 wk gestation
AND
-no proteinuria or signs of end-organ damage

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14
Q

eclampsia

A

preeclampsia AND new onset grand mal sz

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15
Q

chronic HTN with superimposed preeclampsia

A

chronic HTN AND one of the following:

  • new onset proteinuria or worsening of existing proteinuria at >20 wks gestation
  • sudden worsening of HTN
  • signs of end organ damage
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16
Q

pregnancy-related risks due to HTN (maternal)

A
  • superimposed preeclampsia
  • postpartum hemorrhage
  • gestational diabetes
  • abruptio placentae
  • cesarean delivery
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17
Q

pregnancy-related risks d/t HTN (Fetal)

A
  • fetal growth restriction
  • perinatal mortality
  • preterm delivery
  • oligohydramnios
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18
Q

(THREE) causes of abnml menstrual bleeding

A
  • Fibroids: heavy menses, constipation, urinary frequency, pelvic pain/heaviness, enlarged uterus
  • Adenomyosis: dysmennorhea, pelvic pain, heavy menses, bulky/globular/tender uterus
  • Endometrial ca/hyperplasia: h/o obesity, nulliparity, or chronic anovulation; irregular/intermenstrual/postmenopausal bleeding; nontender uterus
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19
Q

causes of acute abdomen/pelvic pain in women

A
  • mittelschmerz
  • ectopic pregnancy
  • ovarian torsion
  • ruptured ovarian cyst
  • PID
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20
Q

Mittelschmerz

A
  • recurrent mild and unilat mid-cycle pain prior to ovulation
  • pain lasts hours to days
  • US not indicated
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21
Q

ectopic pregnancy

A
  • amenorrhea, abdo/pelvic pain, vaginal bleeding
  • positive beta-hCG
  • US: no intrauterine pregnancy
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22
Q

ovarian torsion

A
  • sudden-onset, severe, u/l lower abdo pain; n+v
  • u/l, tendet adnexal mass on examination
  • US: enlarged ovary with dec or absent blood flow
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23
Q

ruptured ovarian cyst

A
  • sudden-onset, severe, u/l lower abdo pain immediately following strenuous or sexual activity
  • US: pelvic free fluid
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24
Q

PID

A
  • f/c, vaginal d/c, lower abdo pain and cervical motion tenderness
  • US: sometimes tubo-ovarian abscess
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25
Q

Maternal thyroid testing in pregnancy, first trimester

A
  • Total T4 INC and Free T4 unchanged/mildly INC
  • –mech: beta hCG stimulates thyroid hormone production in 1T; estrogen stimulates TBG; thyroid INC hormone production to maintain steady free T4 levels
  • TSH DEC
  • –mech: INC beta-hCG and thyroid hormone suppress TSH secretion
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26
Q

complications of shoulder dystocia (FIVE)

A
  • fractured clavicle
  • fractured humerus
  • Erb-Duchenne palsy
  • Klumpke palsy
  • perinatal asphyxia
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27
Q

fractured clavicle 2/2 shoulder dystocia

A
  • clavicular crepitus/bony irregularity
  • dec Moro reflex d/t pain on affected side
  • intact biceps and grasp reflexes
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28
Q

fractured humerus 2/2 shoulder dystocia

A
  • upper arm crepitus/bony irregularity
  • dec Moro reflex d/t pain on the affected side
  • intact biceps and grasp reflexes
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29
Q

Erb-Duchenne palsy 2/2 shoulder dystocia

A
  • dec Moro and biceps reflexes on affected side
  • waiter’s tip: extended elbow, pronated forearm, flexed wrist and fingers
  • intact grasp reflex
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30
Q

Klumpke palsy 2/2 shoulder dystocia

A
  • claw hand: extended wrist, hyperextended metacarpophalangeal joints, flexed interphalangeal joints, absent grasp reflex
  • Horner syndrome (ptosis, miosis)
  • intact Moro and biceps reflexes
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31
Q

Perinatal asphyxia 2/2 shoulder dystocia

A
  • variable CP depending on duration of hypoxia

- AMS (irritability, lethargy), respiratory or feeding difficulties, poor tone, seizure

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32
Q

benign breast disease

A

breast cyst
-solitary, well-circumscribed, mobile mass, tenderness

fibrocystic changes

  • multiple diffuse nodulocystic masses
  • cyclic premenstrual tenderness

fibroadenoma

  • solitary, well-circumscribed, mobile mass
  • cyclic premenstrual tenderness

fat necrosis

  • post-trauma/surgey
  • firm, irregular mass
  • +/- ecchymosis, skin/nipple retraction
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33
Q

Palpable breast mass

A
  • <30 do ultrasonogram +/- mammo
  • –>simple cyst then needle aspiration if pt desires
  • –>complex cyst/(solid) mass then image-guided core biopsy

> 30 do mammo +/- ultrasonogram; if suspicious for malignancy do a core biopsy

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34
Q

obesity and amenorrhea

A
  • obesity is a common cause of amenorrhea
  • amenorrhea is a result of anovulation
  • the FSH and LH levels are usually nml
  • ovaries still producing estrogen, but progesterone is not being produced at the nml post-ovulation levels SO progesterone withdrawal menses at the end of the cycle doesnt occur
35
Q

post partum hemorrhage (PPH)

A
  • ob emergency, major cause of maternal mortality
  • hemostasis after placental delivery is achieved by clotting and by compression of the placental site blood vessels by myometrial contraction (disruption of either of these can lead to PPH)
36
Q

more PPH

A
  • occurs <24hr s/p delivery and is most commonly caused by uterine atony
  • atony occurs when uterus becomes fatigued (prolonged labor), over-distended (fetal weight >4000g/8.8lb, multiple gestation OR unresponsive to oxytocin from oxy receptor saturation
  • other RF for atony: operative (forceps-assisted) vaginal delivery and hypertensive d/o
  • uterus fails to contract and is soft “boggy” and enlarged (above the umbilicus) on PR
37
Q

PPH definition

A

> 500 mL after vaginal delivery

>1000 mL after cesarean delivery

38
Q

PPH RF

A
  • prolonged or induced labor
  • chorioamnionitis
  • multiple gestation
  • polyhydramnios
  • grand multiparity
  • operative delivery
39
Q

PPH causes

A
  • uterine atony (most common)
  • retained placenta
  • genital tract laceration
  • uterine rupture
  • coagulopathy
40
Q

PPH treatment

A
  • bimanual uterine massage, oxytocin
  • IVF, oxygen
  • uterotonics (methylergonovine, carboprost, misoprostol)
  • intrauterine balloon tamponade
  • uterine artery embolization
  • hysterectomy
41
Q

renal and urinary changes in nml pregnancy

A

Physiologic:
-inc renal blood flow, INC GFR, INC renal basement membrane permeability

Labs:
-DEC serum BUN, DEC serum Cr, INC renal protein excretion

42
Q

What are the FOUR antepartum fetal surveillance tests

A
  • nonstress test
  • Biophysical profile
  • contraction stress test
  • doppler sonography of the umbilical artery
43
Q

Nonstress test

A
  • external FHR monitoring for 20-40 mins
  • will see reactive >2 accels
  • abnml would be nonrxv: <2 accels, recurrent variable, or late decels
44
Q

BPP

A

nonstress test plus US assessment of:-amniotic fluid
-fetal breathing movement
-fetal tone
TWO points per category if nml and 0 points if abnml (max: 10/10)

nml results: 8 or 10 pts

equivocal: 6 pts
abnml: 0,2,4 pts; oligohydramnios

45
Q

contraction stress test

A

external FHR monitoring during spontaneous or induced (eg oxytocin, nipple stim) uterine contractions

nml: no late or recurrent variable decels
abnml: late decels with >50% of contractions

46
Q

Doppler sonography of the umbilical artery

A

eval of the umbilical artery flow in fetal IUGR only

  • nml: high velocity diastolic flow in umbilical artery
  • abnml: dec, absent, or reversed end-diastolic flow
47
Q

HELLP

A
  • complication of preeclampsia
  • thrombocytopenia, microangiopathic hemolytic anemia, and inc liver enzymes
  • path: hepatic and systemic inflammation, activation of coag cascade, and platelet consumption
48
Q

HELLP clinical features

A
  • preeclampsia
  • n/v
  • RUQ abdo pain
49
Q

HELLP tx

A
  • delivery
  • magnesium for seizure ppx
  • antihypertensive drugs
50
Q

Osteoporosis nonmodifiable RF:

A
  • advanced age
  • postmenopausal
  • low body weight
  • white or asian ethnicity
  • malabsorption disorders
  • hypercortisolism, hyperthyroidism, hyperparathyroidism
  • inflammatory d/o (RA)
  • chronic liver or renal dz
51
Q

Osteoporosis modifiable RF

A
  • smoking
  • excessive alcohol intake
  • sedentary lifestyle
  • meds (GC, anticonvulsants)
  • VIt D deficiency, inadequate calcium intake
  • estrogen deficiency (premature menopause, hysterectomy/oophorectomy)
52
Q

risks for pre-term labor

A
  • prior spontaneous preterm delivery
  • multiple gestation
  • short cervical length
  • cervical surgery (cold knife conization)
  • cigarette use
53
Q

screening and prevention of preterm labor

A
  • cervical length measured by TVUS
  • progesterone administration
  • cerclage placement
54
Q

Adolescent cycles

A
  • often anovulatory with irregular, heavy menstrual bleeding d/t an immature hypothalamic-pituitary axis
  • progesterone normalized menstruation by stabilizing unregulated endometrial proliferation
55
Q

What are the FOUR disorders of sexual development

A
  • complete androgen insensitivity syndrome
  • Mullerian agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome)
  • transverse vaginal septum
  • turner syndrome
56
Q

complete androgen insensitivity syndrome

A

cause: x-linked mutation of androgen R
- absent uterus and upper vagina; cryptorchid testes
- minimal to absent axillary and pubic hair
- 46 XY

57
Q

Mullerian agenesis

A

cause: hypoplastic or absent mullerian ductal system
- absent or rudimentary uterus and upper vagina; nml ovaries
- nml axillary and pubic hair
- 46 XX

58
Q

transverse vaginal septum

A

cause: malformation of urogenital sinus and mullerian ducts
- nml uterus, abnml vagina, nml ovaries
- nml axillary and pubic hair
- 46 XX

59
Q

Turner syndrome

A

cause: complete/partial absence of 1 X chromosome
- variable breast development depending on ovarian function
- nml uterus and vagina, streak ovaries
- nml axillary and pubic hair
- 45X

60
Q

Follicular phase and luteal phase

A

(F) primary follicle, secondary follicle, vesicular follicle
–day 14: ovulation–
(L) corpus luteum, regression, corpus albicans

61
Q

cervical mucus

A

-just prior to ovulation is profuse, clear, thin, corresponds with an LH surge

62
Q

post partum urinary retention RF

A
  • primiparity
  • regional anesthesia
  • operative vaginal delivery
  • perineal injury
  • cesarean delivery
63
Q

post partum urinary retention clinical features and management

A

CF:

  • inability to void or small-volume voids
  • incomplete bladder emptying
  • dribbling of urine

Management:

  • self-limited condition
  • intermittent catheterization
64
Q

Trial of labor is contraindicated for:

A
  • classical cesarean delivery (vertical incision)

- abdominal myomectomy with uterine cavity entry

65
Q

medically emancipated minors

A
  • emergency care
  • STI
  • substance abuse
  • pregnancy care
  • contraception
66
Q

emacipated minor

A
  • homeless
  • parent
  • married
  • military service
  • financially independent
  • high school graduate
67
Q

Prenatal testing

A

first trimester combined test (9-13wk)
-early screening, not diagnostic

cell-free fetal DNA (>10wk)
-high sn and sp for aneuploidy, not diagnostic

chorionic villus sampling (10-13wk)

  • definitive karyotype diagnosis
  • invasive, r/o spontaneous abortion

second trimester quad screen (maternal serum AFP, estriol, beta-hcg, inhibin A) (15-22 wk)

  • screends for NTD and aneuploidy
  • not diagnostic

amniocentesis (15-20wk)

  • definitive karyoptype diagnosis
  • invasive, r/o membrane rupture, fetal injury and pregnancy loss

second trimester US (18-20)

  • measures fetal growth, evaluates fetal anatomy, confirms placenta position
  • cant id all abnormalities, some findings are of uncertain significance
68
Q

imperforate hymen

A
  • anatomic cause of primary amenorrhea
  • pubertal pts typically present w/ cyclic lower abdo pain, amenorrhea, hematocolpos
  • pelvic exam: smooth, blue, bulging vaginal mass that swells with inc intraabdominal pressure
69
Q

transverse lie

A
  • occurs when fetal longitudinal axis is perpendicular to the longitudinal axis of the uterus
  • most fetuses in transverse lie spontaneously convert to vertex presentation prior to term.
  • persistent malpresentation at term can be managed with external cephalic version or cesarean delivery
70
Q

functional hypothalamic amenorrhea

A

-cause: excessive weight loss, strenuous exercise, chronic illness, eating disorder…leads to….dec adipose tissue/fat reserves, dec leptin production…leads to…hypothalamus (dec GnRH)…leads to…pituitary (dec LH, FSH)…leads to…ovaries (dec estrogen)

71
Q

emergency contraception options

A
  • copper IUD
  • ulipristal pill
  • levonorgestrel pill
  • OCPs
72
Q

copper IUD

A
  • copper causes inflammatory rxn that is toxic to sperm and ova and impairs implantation
  • 0-120 hours after intercourse
  • 99% effective
73
Q

Ulipristal pill

A
  • antiprogestin; delays ovulation
  • 0-120 hours after intercourse
  • > 85% efficacy
74
Q

Levonorgestrel pill

A
  • progestin, delays ovulation
  • 0-72 hours after intercourse
  • 85% efficacy
75
Q

OCPs

A
  • progestin; delays ovulation
  • 0-72 hr after intercourse
  • 75% effective
76
Q

LBP during pregnancy Etiology

A
  • enlarged uterus–>exaggerated lordosis
  • joint/ligament laxity from INC progesterone/relaxin
  • weak abdo muscle–>dec lumbar support
77
Q

LBP d/r pregnancy RF and management

A

RF: xs weight gain, chronic back pain, back pain in prior pregnancy, multiparity

management: behavioral modifications, heating pads, analgesics

78
Q

suspected endometriosis

A
  • chronic pelvic pain
  • dysmenorrhea
  • deep dyspareunia
  • dyschezia (pain with defecation)
  • infertility

manage with either laparoscopy or NSAIDS (ibuprofen, naproxen) +/- combined (estrogen and progestin) OCP.

  • if yes to the following do laparoscopy:
  • -contraindications to medical therapy
  • -need for definitive diagnosis
  • -h/o infertility
  • -concern for malignancy or adnexal mass
79
Q

Complications in DES daughters

A
  • clear cell adenocarcinoma of the vagina and cervix
  • structural anomalies of the reproductive tract: hooded cervix, T-shaped uterus, small uterine cavity, vaginal septae, vaginal adenosis
  • pregnancy problems (ectopic pregnancy, pre-term delivery)
  • infertility
80
Q

Endometriosis Clinical Features

A
  • immobile uterus
  • cervical motion tenderness
  • adnexal mass
  • recto-vaginal septum, posterior cul-de-sac, uterosacral ligament nodules

(diagnosis with visualization and surgical biopsy)

81
Q

fetal growth restriction

A

symmetric: 1T, chromosomal abnormalities, congenital infection, global growth lag
asymmetric: 2T/3T, utero-placental insufficiency or maternal malnutrition; head sparing growth lag

both: US estimated fetal weight <10th percentile for gestational age
management: weekly BPP, serial umbilical artery Doppler sonography, serial growth US

82
Q

Management of hydatidiform mole

A
  • suction currettage
  • followed by serial beta-hcg levels until levels are undetectable for at least 6 months
  • contraception is required during the surveillance period
83
Q

Septic pelvic thrombophlebitis

A

RF:

  • cesarean delivery
  • pelvic surgery
  • endometritis
  • PID
  • pregnancy
  • malignancy

Path:

  • hypercoagulability
  • pelvic venous dilation
  • vascular trauma
  • infection

Presentation:

  • fever unresponsive to ABx
  • no localizing s/s
  • negative infectious evaluation
  • diagnosis of exclusion

tx: anticoagulation, broad-spectrum Abx

OB/GYN (7 decks)

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