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OB/GYN > UWorld > Flashcards

UWorld Flashcards

1
Q

Most beneficial long-term Rx of Stress Incontinence

A

Urethroplexy

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2
Q

Why is a gonadectomy deffered until puberty in Androgen Insensitivity Syndrome?

A

Benefit of gonad-stimulated puberty outweighs the risk of malignancy (1-5%)

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3
Q

Risk factors for cervical insufficiency

A 
LEEP/Cone biopsy
Obstetric injury
Mullerian anomalies
Multiple gestation
Preterm delivery
2nd trimester abortion
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4
Q

What is physiologic leukorrhea

A

Non-malodorous copious white/yellow vaginal discharge in absence of other physical findings

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5
Q

Amsel Criteria for Bacterial Vaginosis

A

3/4 of:

  • Thin grey/white discharge
  • pH > 4.5
  • Positive whiff test with addition of KOH to discharge
  • Clue cells on wet mount
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6
Q

What are clue cells?

A

Vaginal epithelial cells with adherent coccobacilli

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7
Q

Complications of maternal HTN

A 
Abruption placentae
Superimposed pre-eclampsia
IUGR
Preterm
C-section
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8
Q

Fasting glucose in GDM

A

≤ 95mg/dL

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9
Q

1hr post-prandial glucose in GDM

A

≤ 140mg/dL

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10
Q

2hr post-prandial glucose in GMD

A

≤ 120mg/dL

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11
Q

Hallmarks of endometriosis

A

Dyspareunia
Dysmenorrhea
Dyschezia (pain with defecation)

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12
Q

Empiric Rx for suspected endometriosis

A

NSAIDS

OCPs

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13
Q

Indications for surgical rx for endometriosis

A 
Sx intolerable/refractory
Severe incapacitating pain
Need to exclude malignancy in adnexal mass
Need fertility rx
Evidence of complications
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14
Q

Greatest risk factor for clear cell adenocarcinoma

A

DES exposure in utero

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15
Q

Definition of infertility

A

Unable to conceive for >1 yr

>6mos if >35

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16
Q

Presenting Sx in Intrahepatic Cholestasis of Pregnancy (ICP)

A

Pruritis

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17
Q

Lab value changes in ICP

A

Elevated Bile Acids
Elevated Liver Enzymes
Dx of Exclusion

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18
Q

RFs for tubal torsion

A

Pregnancy
Ovarian masses
Ovulation induction in infertility rx

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19
Q

Which side is more at risk in tubal torsion

A

Right (longer)

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20
Q

What makes the confirmatory dx of tubal torsion

A

U/S with colour doppler

- Enlarged edematous ovary

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21
Q

Cervical mucous appearance in ovulatory phase

A

Profuse
Clear
Thin

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22
Q

Cervical mucous appearance in post and pre-ovulatory phases

A

Scant
Opaque
Thick

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23
Q

What causes amenorrhea in postpartum women

A

High levels of prolactin inhibiting GnRH

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24
Q

Definition of stillbirth

A

Fetal death at ≥20 wks

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25
Q

RFs for stillbirth

A

HTN
DM
Smoking >10cigs/day
Advanced maternal age

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26
Q

Most common presenting sx for stillbirth

A

Decreased/Absent fetal movement

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27
Q

Confirmatory test for stillbirth

A

U/S with no fetal cardiac activity

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28
Q

First step in management of stillbirth

A

Counseling risks/benefits of all delivery methods

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29
Q

Stillbirth delivery optionsin 2nd trim

A

D & C
IOL
NSVD

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30
Q

Stillbirth delivery options in 3rd trim

A

IOL +/- cervical ripening agents
NSVD
Repeat C-section on request if hx of previous

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31
Q

Management of placenta previa in active uncontrolled antepartum hemorrhage

A

Emergency C-section

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32
Q

Function of hCG

A

Maintenance of the corpus luteum

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33
Q

Most important risk of tamoxifen

A

Endometrial CA

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34
Q

Why is PID uncommon in pregnancy

A

Cervical mucus plug protects uterus from ascending bacteria

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35
Q

RFs for ectopic pregnancy

A 
Previous hx
Pelvic/tubal surgery
In utero DES exposure
Infertility rx
Current IUD use
PID
Multiple sex partners
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36
Q

Aggravating factors for stress incontinence

A

Morbid Obesity
Pregnancy
COPD
Smoking

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37
Q

Therapy for stress incontinence

A 
Kegels
Pessaries
Estrogen replacement
Burch procedure
Sling procedure
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38
Q

Thyroid related changes in pregnancy

A

Increased T3, T4

Normal TSH

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39
Q

Why do T3, T4 increase in pregnancy

A

Increased TBG due to Increased estrogen

TSHr stimulation by hCG

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40
Q

Safe HTN drugs in pregnancy

A

Methyldopa
Hydralazine
Labetalol
Nifedipine

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41
Q

Lab values in premature ovarian failure

A

Increased FSH/LH

Decreased estrogen

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42
Q

What is the most common cause of pregnancy while on DPMA

A

Missed shot

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43
Q

What stimulates prolactin production

A

Serotonin

TRH

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44
Q

What inhibits prolactin production

A

DA

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45
Q

Management if endometrial hyperplasia w/o atypia

A

Progestin

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46
Q

Management if endometrial hyperplasia w/ atypia

A

Hysterectomy

Progestin if wish for future pregnancy

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47
Q

Definition of secondary amenorrhea

A

Absence of menses for >3cycles or >6mos in women who previously had menses

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48
Q

RFs for chorioamnionitis

A

Prolongued ROM (>24hrs)
Prolongued labor
Internal fetal/uterine monitoring devices
Presence of genital tract pathogens

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49
Q

Delivery option with suspected placental abruption

A

Vaginal delivery with augmentation of labor if necessary

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50
Q

What is the most common cause of abnormal uterine bleeding in adolescents?

A

Dysfunction in hypothalamus-pituitary-ovarian axis leading to anovulatory cycles

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51
Q

First line therapy of abnormal uterine bleeding in hemodynamically stable patients

A

High dose estrogen

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52
Q

First step in management of suspected lichen sclerosus

A

Vulvar punch biopsy

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53
Q

Clinical manifestations of lichen sclerosus

A

Anogenital discomfort
Pruritis
Dyspareunia
Painful defecation

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54
Q

What does lichen sclerosus look like

A

Porcelain-white polygonal macules and patches with atrophic “cigarette paper” quality

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55
Q

Rx of lichen sclerosus

A

Topical steroids

BID x 4wks

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56
Q

Clinical presentation of placental abruption

A

Sudden-onset vaginal bleeding
Abd/back pain
High-frequency, low-intensity CTX
Hypertonic, tender uterus

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57
Q

Rx for placental abruption

A

Emergency C-section

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58
Q

Clinical presentation of uterine rupture

A 
Vaginal bleeding
Intraabdominal bleeding
Decels
Loss of station
Palpation of fetal parts
Loss if intrauterine pressure
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59
Q

RFs of uterine rupture

A

Prior uterine surgery
Induction of labor/prolongued labor
Congenital uterine anomalies
Fetal macrosomia

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60
Q

Sx control in breast engorgement

A

Cool compress
Acetaminophen
NSAIDs

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61
Q

Sx in breast engorgement

A

Fullness
Tenderness
Warmth

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62
Q

Only seen in false labor

A

Ctx in lower abd
Irregular CTX every 10-20min
No cervical chenges
CTX Relieved by sedation

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63
Q

Complications of DES exposure in utero

A

Clear cell adenoma
Pregnancy programs
Structural anomalies of the repro tract

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64
Q

Test for aneuploidy at 9-13wks

A

1st trim combined test

Pregnancy associated plasma protein, bHCG, nuchal translucency

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65
Q

Test for aneuploidy at 15-20 wks

A

2nd trim quadruple screen
(Maternal serum aFP, estriol, bHCG, inhibin A)

Amniocentesis

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66
Q

Test for aneuploidy at 10-13 wks

A

Chorionic villus sampling

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67
Q

Test for aneuploidy at 18-20 wks

A

2nd trim U/S

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68
Q

Test for aneuploidy at >10wks

A

Cell-free fetal DNA

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69
Q

Best next step in suspected unruptured ectopic pregnancy

A

Transvaginal U/S

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70
Q

Lab abnormalities in intrahepatic cholestasis of pregnancy

A

Elevated bile acids
Transaminitis
Dx of exclusion

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71
Q

Clinical presentation of adnexal torsion

A 
Sudden onset moderate-severe pelvic pain
Unilateral and tender adnexal mass
N/V
Low grade fever
Abnormal vaginal bleeding
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72
Q

RFs of adnexal torsion

A

Ovarian mass
Women of reproductive age
Pregnancy
Infertility rx with ovulation induction

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73
Q

Dx anf Rx of adnexal torsion

A

B-hCG
Pelvic color doppler U/S
Laparoscopy with detorsion
Salpingo-oophorectomy for necrosis or malignancy

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74
Q

Cervical appearance in the ovulatory phase

A

Abundant mucus

Clear cervical secretion

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75
Q

Clinical features of endometriosis

A

Pain with menses
Dyspareunia
Infertility

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76
Q

Clinical features of fibroids

A

Heavy menses with clots
Constipation, urination frequency, pelvic pain/heaviness
Enlarged uterus

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77
Q

Clinical features of adenomyosis

A

Dysmenorrhea, pelvic pain
Menorrhagia
Bulky, globular and tender uterus

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78
Q

Clinical features of endometrial cancer/hyperplasia

A

Hx obesity, nulliparity, chronic anovulation
Irregular intermenstrual or postmenopausal bleeding
Small, non-tender uterus

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79
Q

Clinical features of endometritis

A

Recent instrumentation of the uterus
Foul-smelling discharge
Fever

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80
Q

Pt with hypothyroidism gets pregnant. How should she manage it?

A

Increase her medication

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81
Q

Appearance of HPV lesions

A

Teardrop shaped growths at vestibule of vulva

82
Q

Rx of HPV lesions

A

Trichloroacetic acid

83
Q

Cause of amenorrhea in female athletes

A

Estrogen deficiency

84
Q

Features of threatened abortion

A

Vaginal bleeding
Closed os
Fetal cardiac activity

85
Q

Features of missed abortion

A

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

86
Q

Features of inevitable abortion

A

Vaginal bleeding
Dilated os
Products of conception may be seen or felt

87
Q

Features of incomplete abortion

A

Vaginal bleeding
Dilated os
Some products expelled and some remain

88
Q

Features of complete abortion

A

Vaginal bleeding
Closed os
Products completely expelled

89
Q

Precocious puberty definition

A

Secondary characteristics before 8 in girls and 9 in boys

90
Q

What causes central precocious puberty

A

Early activation of the hypothalamus-pituitary-ovarian-axis

91
Q

When do you do serial b-HCGs in a +preg test but no evidence of pregnancy?

A

Initial U/S is indeterminate

92
Q

What do you suspect with a-fib and pulm edema sx?

A

Mitral stenosis

93
Q

Other name for chorioamnionitis

A

Intraamniotic infection

94
Q

Who commonly has chorio?

A

Prolongued ROM

95
Q

Prolonged ROM definition

A

> 18hrs

96
Q

Dx criteria of chorio

A 
Maternal fever >1 and one of:
Uterine tenderness
Maternal/fetal tachy
Malodorous amniotic fluid
Purulent vaginal discharge
97
Q

Initial management step in chorio

A

Broad spectrum ABX

Oxytocin

98
Q

What lessens the adverse effects of menopause

A

Conversion of adrenal androgens to estrogens by adipose

99
Q

Severe pre-eclampsiais is any of:

A 
BP >160 sys or >110 dia on 2 occasions >4hrs apart
Plts 1.1 or doubling
Elevated transaminases
Pulm edema
New onset visual or cerebral sx
100
Q

HTN management in pregnancy

A

Hydralazine
Labetalol
Mg sulfate

101
Q

What prevents pre-eclampsia seizures?

A

Mg sulfate

102
Q

Rx for pre-eclampsia-eclampsia

A

Delivery

103
Q

Screening test for secondary amenorrhea

A

Prolactin and TSH levels

104
Q

Pathophysiology of primary amenorrhea

A

Release PGs from endometrium causes uterine CTX

105
Q

What is IUFD?

A

Death of fetus in utero >20wks prior to labor

106
Q

Confirming dx of IUFD

A

Real-time ultrasonogram

107
Q

Postpartum management of IUFD

A

Autopsy of fetus and placenta

108
Q

Late/post-term fetal complications

A 
Oligo
Meconium aspiration
Stillbirth
Macrosomia
Convulsions
109
Q

Late/post-term maternal complications

A

Cesarean
Infection
Postpartum hemorrhage
Perineal trauma

110
Q

When do you perform PAP every 5 years

A

Age >30

111
Q

Definitive Rx for HELLP

A

Delivery

112
Q

Rx for Placenta Previa

A

Scheduled C/S

113
Q

Classic findings in aortic coarctation

A

Elevated BP in upper extremities

Low BP in lower extremities

114
Q

What causes poor ovarian function in Turner’s?

A

High FSH

115
Q

Rx options for acute abnormal uterine bleeding

A

High dose IV/oral estrogen
High dose combined OCPs
High dose progestin
Tranexamic acid

116
Q

What is NST?

A

Non-stress test

Recording FHR while monitoring for spontaneous perceived fetal movements

117
Q

What is a normal NST?

A

2 accels 15bpm or more above baseline lasting 15s within 20min

118
Q

What is a non-reactive NST?

A

<2 accels

119
Q

What is the most common cause of a non-reactive NST?

A

Fetal sleep cycle

120
Q

Rx for hyperemesis gravidum

A

Ginger
Hydration
Pyridoxine +/- doxylamine

121
Q

Does Sheehan affect the posterior pituitary?

A

Very rarely

122
Q

Common regimen for antepartum PID

A

Cefotetan and Doxy
Clinda and genta
Cefoxitin

123
Q

What does lithium use in 1st trim cause?

A

Increased risk of congenital heart disease

Classically Ebstein’s

124
Q

What does isoretinoin cause in pregnancy?

A

Craniofacial dysmorphism
Heart defects
Deafness

125
Q

Diagnostic test for endometriosis

A

Laparoscopy

126
Q

First line Rx for suspected endometriosis

A

NSAIDs +/- OCPs

127
Q

Classic presentation of endometriosis

A

Chronic pelvic pain worsening with the onset of menses

128
Q

Appearance of acne

A

Open and closed comedones and inflammatory nodules at various stages of evolution

129
Q

Appearance steroid-induced folliculitis

A

Monomorphous pink papules and absence of comedones

130
Q

Is alloimmunization a big concern in a first pregnancy?

A

No

131
Q

Clinical feature of Normal Labor

A

Intermittent pain with CTX

Small amount of blood tinged mucous (bloody show)

132
Q

Clinical feature of Placental abruption

A

Sudden onset vaginal bleeding
Abd pain
Hypertonic/tender uterus

133
Q

Clinical feature of Placental Previa

A

Painless vaginal bleeding

Low lying placenta

134
Q

Clinical feature of Uterine Rupture

A 
Sudden-onset vaginal bleeding
Constant abdominal pain
Cessation of uterine CTX
Palpable fetal parts
Fetal deterioration
135
Q

Clinical feature of Vasa previa

A

Painless vaginal bleeding on ROM

Fetal deterioration

136
Q

What is Vasa Previa?

A

Fetal BVs traverse fetal membranes across lower segment of uterus between fetus and internal os

137
Q

Management of threatened abortion

A

Expectant management until:
Sx resolution
Progression to inevitable/incomplete/missed

138
Q

Management of incomplete/inevitable/missed abortion

A

Hemodynamically unstable, heavy bleeding: Surgical evac

Hemodynamically stable, mild bleeding: expectant, PGs, evac

139
Q

Management of Septic abortion

A

Blood, endometrial cx
Broad spectrum ABX
Surgical evac

140
Q

What is pseudocyesis?

A

Sx of pregnancy with no evidence of it

141
Q

Vertical HIV transmission ppx

A

Triple antiviral therapy throughout pregnancy

142
Q

Rx gonoccocal cervicitis

A

Ceftriaxone with azithro or doxy

143
Q

What causes RUQ pain in HELLP?

A

Liver swelling and distention of Glisson’s capsule

144
Q

Rare life-threatening complication of pre-eclampsia

A

Pulmonary edema

145
Q

Clinical feature of fibroids

A

Frequency, constipation
Havy, prolongued menses with clots
Pelvic pressure/pain
Pregnancy difficulties

146
Q

Fibroid workup

A

U/S

147
Q

Fibroid rx

A

Observation if no sx
Hormonal contraception
Embolization
Surgery if sx

148
Q

Benefits of combination OCPs

A

Prevent pregnancy
Endometrial and ovarian cancer risk reduction
Menstruation regulation
Reduction in benign breast CA risk

149
Q

RIsks of combination OCPs

A

VTE
HTN
Hepatic adenoma
Stroke/MI (very rare)

150
Q

What is a contraction stress test?

A

External FHR monitoring during spontaneous/induced CTX

151
Q

What is the purpose of umbilical artery doppler velocimetry?

A

Evaluation of umbilical artery flow in fetal IUGR only

152
Q

Delivery option in preterm labor with fetal distress

A

C/S 2/2 non-reassuring fetal tracing

153
Q

Arrest of dilation in first stage of labor

A

Dilation >6cm with ROM and either:
No cervical change for >4hrs with adequate CTX
No cervical change for >6hrs with inadequate CTX

154
Q

What causes epidural induced hypotension?

A

Vasodilation and venous pooling

155
Q

Clinical features of placental previa

A

Painless 3rd trim bleeding

Bleeding with uterine CTX

156
Q

Features of granulosa cell tumor

A

Estrogen releasing
Secondary sexual characteristics
Precocious puberty

157
Q

Changes in acid/base status in pregnancy

A

Increased pH
Some metabolic compensation
Decreased bicarb

158
Q

Physical manifestations of PMS

A

Bloating
Fatigue
HA
Breast tenderness

159
Q

Psychological manifestations of PMS

A 
Anxiety
Mood swings
Difficulty concentrating
Decreased libido
Irritability
160
Q

What is renal colic?

A

Flank pain that radiates to the groin with microscopic hematuria

161
Q

Test of choice to diagnose renal stones in pregnancy

A

Renal + Pelvic U/S

162
Q

Physical manipulation to correct breech position

A

External cephalic version

163
Q

What are the contraindications to external cephalic version

A 
Indications for C/S
Placental abnormalities
Oligo
ROM
Hyperextened fetal head
Fetal/Uterine abnormality
Multiple gestation
164
Q

When is external cephalic version performed

A

37 weeks until onset of labor

165
Q

Chlamydia rx

A

Single dose azithro

166
Q

What breast discharges are likely pathologic?

A

Unilateral
Bloody or serous
Palpable lump or skin changes

167
Q

What are physiological breast discharges

A 
Pregnancy
Pituitary prolactinoma
Medications
Hypothyroidism
OCPs
Chest wall/nipple stimulation
168
Q

Cervical cancer screening <21

A

None

169
Q

Cervical cancer screening 21-29

A

Cytology every 3 years

170
Q

Cervical cancer screening 30-65

A

Cytology every 3 years OR cytology + HPV testing every 5 years

171
Q

Cervical cancer screening >65

A

No screening if negative prior screen and not high risk

172
Q

When is GDM tested for?

A

24-28 wks

173
Q

If GDM test shows glucose <140

A

No GDM

174
Q

If GDM test shows glucose >140

A

Administer 100g glucose

Check fasting serum each hour for 3 hrs

175
Q

GDM test

A

Administer 50g glucose

Check serum 1hr later

176
Q

How is the diagnosis of GDM made?

A 
2 or more of the following:
Fasting >95
1hr >180
2hr >155
3hr >140
177
Q

Conditions causing increased MSAFP

A

Neural tube defects
Ventral wall defects
Congenital nephrosis, obstructive uropathy
Multiple gestation

178
Q

Side effects of OCPs

A 
Breakthrough bleeding
Breast tenderness, nausea, bloating
Amenorrhea
HTN
VTE
Decreased ovarian & endometrial cancer risk
Increased cervical cancer risk
Liver disorders
Increased triglycerides
179
Q

PCOS treatement

A

Clomiphene citrate

180
Q

Lactation suppression means

A

Tight fitting bra
Ice packs
Analgesics for pain
Avoid nipple stimulation

181
Q

Before when can abortion be considered

A

20wks

182
Q

Painful genital ulcers

A

HSV

H. ducreyi

183
Q

Painless genital ulcers

A

Syphilis
Chlamydia
Klebsiella

184
Q

Evaluating primary amenorrhea

A

Pelvic U/S for presence of uterus
Present = FSH testing
Absent = Karyotyping + Testosterone

185
Q

Atrophic vaginitis sx

A 
Dryness
Pruritis
Dyspareunia
Dysuria
Frequency
186
Q

Atrophic vaginitis rx

A

Moisturizers and lubricants

Vaginal estrogen replacement

187
Q

What kind of sports should be discontinued in pregnancy

A

High impact and contact

188
Q

Modifiable risk factors for osteoporosis

A 
Low estrogen
Malnutrition
Decreased vit D
Meds
Smoking
Excess drinking
189
Q

Sx premature ovarian failure

A

Amenorrhea
Hot flashes
Vaginal and breast atrophy
Anxiety, depression, irritability

190
Q

Lab values in premature ovarian failure

A

Markedly Elevated FSH

Elevated LH

191
Q

Most appropriate initial test for Hb identification

A

CBC

192
Q

Best emergency contraception option

A

Copper IUD

193
Q

Sx of fetal hydantoin syndrome

A 
Midfacial hypoplasia
Microcephaly
Cleft lip and palate
Digital hypoplasia
Hirsuitism
Developmental delay
194
Q

What causes fetal hydantoin syndrome?

A

Phenytoin

195
Q

What is the earliest sign of Mg toxicity?

A

Decreased DTRs

196
Q

What is the rx of Mg sulfate toxicity?

A

Calcium gluconate

197
Q

What is the initial workup of an adnexal mass in a postmenopausal woman?

A

Transvaginal U/S and serum CA-125

198
Q

Indications for ppx anti-D IG

A 
28-32wks
Within 72hrs of Rh+ or spontaneous/threatened abortion
Ectopic preg
Molar preg
CVS, amniocentesis
2nd/3rd trim bleeding
ECV
199
Q

Non-recommended vaccines in pregnancy

A 
HPV
MMR
Varicella
Smallpox
Live attenuated influenzae
200
Q

Routine pregnancy vaccines

A

Tdap

Inactivated influnzae

201
Q

Preg vaccines for special circumstances

A 
Hep B
Hep A
Pneumococcus
H. influenzae
Meningicococcus
Anti-D
202
Q

Defect in Kallman

A

No migration of GnRH and olfactory nerves

OB/GYN (3 decks)

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