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*****ObGYN > UWorld > Flashcards

UWorld Flashcards

1
Q

what should be the first step after quad screen results suggestive of down syndrome?

A

U/S (confirm gestational age, assess amniotic fluid)

then can do amniocentesis after

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2
Q

when should women under 30 follow up for a simple cyst?

A

within 2-4 months for clinical breast exam

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3
Q

indications for RhoD ppx in pregnant pt?

A
  • 28-32 wks gestation
  • w/in 72 hrs delivery of Rh+ infant, spontaneous/threatened/induced abortion
  • ectopic preg
  • molar preg
  • CVS, amniocentesis
  • abdominal trauma
  • 2nd and 3rd trimester bleeding
  • external cephalic version
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4
Q

painless continuous leakage of fluid from vagina after surgery. dx?

A

vesicovaginal fistula

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5
Q

chronic pelvic pain, dyspareunia, urgency. dx?

A

interstitial cystitis (painful bladder syndrome)

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6
Q

common causes of hypogonadotropic hypogonadism?

A

excessive weight loss, strenuous exercise, chronic illness, eating disorder

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7
Q

what causes a dose dependent increase in risk of osteoporotic fx?

A

alcohol

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8
Q

how to first evaluate ovarian mass?

A

CA-125 with pelvic U/S

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9
Q

when is endometrial biopsy indicated?

A

AUB >45, postmenopausal bleeding, thickened endometrial stripe w. ovarian mass

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10
Q

what cancer is assoc w/ paget’s disease of the breast?

A

adenocarcinoma

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11
Q

midfacial hypoplasia, microcephaly, cleft lip/palate, digital hypoplasia, hirsutism, dev. delay. dx?

A

fetal hydantoin syndrome

MCC phenytoin, carbamezapine

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12
Q

early findings:

rhinitis (snuffles), HSM, skin lesions

A

congenital syphilis

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13
Q

late findings of congenital syphilis?

A

interstitial keratitis, Hutchinson teeth, saddle nose, saber shins, deafness, CNS involvement

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14
Q

midfacial hypoplasia, microcephaly, stunted growth, CNS damage (hyperactivity, MR, or learning disability)

A

fetal alcohol syndrome

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15
Q

what causes elevated 17-hydroxyprogesterone?

A

nonclassic CAH due to 21 hydroxylase deficiency -> hyperandrogenism in late childhood

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16
Q

homogenous cystic ovarian mass in young woman. dx?

A

ovarian endometrioma

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17
Q

risk factors for uterine inversion?

A

nulliparity
fetal macrosomia
placenta accreta
rapid L&D

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18
Q

What medications are common uterotonics?

A

oxytocin, misoprostol

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19
Q

What medications are common relaxants of the uterus (tocolytics)?

A

nitroglycerine, terbutaline, indomethacin, nifedipine

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20
Q

preferred endocrine drug for adjuvant tx of premenopausal women at low risk of breast cancer recurrence?

A

tamoxifen

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21
Q

what is mag sulfate usually used for?

A

(weak tocolytic)

used to lower risk of neuro complications in neonates born at <32 weeks

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22
Q

tx of symptomatic endometriosis options

A

conservative: NSAIDs, OCPs, progesterone IUD
definitive: surgical resection, hysterectomy w/ oophorectomy

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23
Q

management options for IUFD

A

20-23 wks: D&E or vaginal
>= 24 wks: vaginal delivery

  • usually induce labor to prevent coagulopathy
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24
Q

what hormonal deficiency causes secondary amenorrhea in female atheletes?

A

estrogen

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25
Q

when does symmetric fetal growth restriction occur?

A

first trimester

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26
Q

what causes symmetric FGR?

A

chromosomal abnormalities, congenital infection

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27
Q

what causes asymmetric FGR?

A

2nd or 3rd trimester uteroplacental insufficiency or maternal malnutrition
(head size not as small as abdominal size)

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28
Q

what are common causes of asymmetric FGR?

A

hypertension, diabetes

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29
Q

what is the management of IUGR?

A

weekly BPP, serial U/S, serial umbilical artery sonography

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30
Q

characteristics of Bartholin duct cyst

A

occur in women <= 30
at 4 or 8 o’clock position on vulva
cause: dried mucoid glandular secretions or trauma or idiopathic

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31
Q

treatment of Bartholin duct cyst: asx vs sx

A

asx: observation
sx: I&D; placement of word catheter decreases risk of recurrence

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32
Q

treatment options for bacteriuria/acute cystitis in pregnancy

A

5-7 days nitrofurantoin;
3-7 days amox or amox/clauv
single dose fosfomycin

33
Q

what tx to avoid for cystitis in preg?

A

avoid fluoruoquinolones always;

avoid bactrim in 1st and 3rd trimesters

34
Q

tx for acute pyelo in preg?

A

hospitalize and IV abx (B lactams, metopenem)
avoid aminoglycosides if possible
change to 10-14 days course oral abx after afebrile 24 hrs

35
Q

why is oxytocin not effective in stim uterine contraction/expelling retained pocs during T1 or T2?

A

there are few oxytocin receptors in the uterus during early pregnancy

36
Q

how does atrophic vaginitis contribute to urinary urgency, frequency, incont and infection?

A

hypoestrogenemia -> atrophy of superficial and int. layers of vagina/mucosal epithelium; decreased urethral pressure and compliance -> sxs

37
Q

define missed abortion

A

no vaginal bleeding, closed cervical os, no fetal HR or empty sac; asx

38
Q

define threatened abortion

A

vaginal bleed, closed cervical os, fetal cardiac activity present

39
Q

define inevitable abortion

A

vaginal bleed, dilated cervical os, poc may be seen or felt at/above cervical os

40
Q

define incomplete abortion

A

vaginal bleed, dilated os, some pocs expelled, some remain

41
Q

define complete abortion

A

vaginal bleed or non; closed cervical os; pocs completely expelled

42
Q

late/posterm preg (>= 41 weeks/>=42 weeks) complications for FETUS

A 
oligohydramnios
meconium aspiration
stillbirth
macrosomia
convulsions
43
Q

late/postterm preg complications for MOM

A

Csection
infxn
PPH
perineal trauma

44
Q

what does fetal heart tracing show with placenta previa?

A

usually unaffected. bleeding is maternal (even though it is painless)

45
Q

what is pathognomonic for uterine rupture?

A

loss of fetal station; ability to feel fetal parts through abdominal wall

46
Q

what does the fetal heart tracing look like with vasa previa?

A

rapid deterioration (bleeding is fetal)

47
Q

define IUFD

A

fetal death at >= 20 wks

48
Q

at what GA does IUFD need to be delivered vaginally?

A

24 or older

49
Q

what are the absolute CI to combined hormonal contraceptives?

A
  • migraine w aura
  • > = 15 cigs/day & age >=35
  • stage 2 HTN (>=160/100)
  • hx stroke or ischemic heart dz
  • hx of venous thromboembolism
  • breast cancer
  • cirrhosis & liver cancer
  • major sx with prolonged immobilization
  • <3 wks postpartum
50
Q

what is recommended for dx of lichen sclerosus?

A

punch bx; rule out SCC

51
Q

how do you distinguish lichen sclerosus from vulvovaginal atrophy?

A

LS: presence of white plaques, severe retraction/loss of normal anatomy of clitoral hood/labia minora/introitus, possible perianal involvement

52
Q

LS tx?

A

high dose topical steroids

53
Q

definition of AUB

A

prolonged menstruation (>5 days) and heavy (>1 pad every 2 hours) with irregular frequency

54
Q

proliferation of SM cells in myometrium. dx and sx.

A 
leiomyomata uteri (fibroids)
can cause profuse menses and irregular uterine enlargement
55
Q

work up for fibroids

A

U/S

56
Q

what other conditions can elevate CA-125 in a premenopausal woman?

A

endometriosis, fibroids, lupus

57
Q

locations of vaginal cancer and dx.

A

upper 1/3 of POSTERIOR vaginal wall = SCC

upper 1/3 of ANTERIOR vaginal wall = clear cell

58
Q

clear elastic mucus with consistency similar to uncooked egg white. dx

A

cervical mucus (secreted close to ovulation - late follicular phase)

59
Q

most important direct role of BhCG in pregnancy?

A

maintenance of corpus luteum

60
Q

what cell secretes B-hcG?

A

syncytiotrophoblast

61
Q

timeline of hCG in pregnancy?

A

produced beginning 3 days after fertilization. doubles every 48 hours. peaks at 6-8 weeks GA.

62
Q

what does cystoscopy typically evaluate for?

A

bladder cancer

63
Q

common cause of SUI in nulliparous woman?

A

fibroids

64
Q

term for malignancy involving ovary, fallopian tube, and peritoneum?

A

epithelial ovarian carcinoma

65
Q

hyperechoic nodules and calcifications in ovarian cyst. dx?

A

dermoid ovarian cyst (mature cystic teratoma)

66
Q

what is the most effective emergency contraception? also MOA?

A

copper IUD

-> inflamm rxn toxic to sperm/ova & impairs implantation

67
Q

what are the gestational DM target blood glucose levels?

A

fasting: <= 95 mg/dl
1 hour PP : <=140
2 hour PP: <= 120

68
Q

management of shoulder dystocia?

A

BECALM
B: breathe, don’t push; lower head of bed
E: elevate legs into McRoberts position - sharp hip flexion
C: call for help
A: apply suprapubic pressure (down and lateral) to release anterior shoulder
L: enLarge with episiotomy
M: maneuvers; delivery of posterior arm; Woods corkscrew/Rubin (pressure against baby’s posterior shoulder anteriorly or posteriorly & anterior rotation); mom on “all fours” (Gaskin maneuver); replace head in vagina then emergent C section (Zavanelli maneuver)

69
Q

maternal risks of shoulder dystocia?

A

4th degree perineal lacs, PPH

70
Q

contraindications to CST?

A

CI to labor: previa, prior myomectomy

71
Q

define preclampsia

A

new onset htn (sbp >=140/90) at >= 20 weeks GA AND proteinuria and/or end-organ damage

72
Q

what are considered severe features of preclampsia?

A
  • sbp >=160 or dbp >=110 (2 times, 4 hours apart)
  • low platelets
  • increased Cr
  • increased transaminases
  • pulm edema
  • visual/cerebral symptoms
73
Q

management of preclampsia?

A

without severe features: deliver at >= 37 wks
WITH severe features: deliver at >= 34 weeks
all: mag sulfate ppx, anti HTN

74
Q

rf for preclampsia

A
  • multiple gestation
  • nulliparity
  • preexisting DM
  • advanced maternal age
  • kidney dz
  • prior preclampsia
75
Q

when is mag sulfate given for neuroprotection?

A

24-32 weeks gestation when preterm birth is anticipated within the next 24 hours

76
Q

SE of oxytocin?

A

hyponatremia, hypotension, uterine tachysystole (abnormally frequent contractions - >5 in 10 minutes on average over 30 min period)

77
Q

U/S findings of irregularity/absence of placental-myometrial interface and intraplacental villous lakes. dx?

A

placenta accreta

78
Q

fluctuant tender palpable mass while breastfeeding. dx? tx?

A

breast abscess from untreated mastitis

tx: needle bx and abx

*****ObGYN (3 decks)

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