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EORs > Women's Health > Flashcards

Women's Health Flashcards

1
Q

First prenatal visit workup

A
  1. BP
  2. Type and screen
  3. CBC
  4. UA
  5. Random glucose
  6. BHsAg
  7. HIV
  8. Syphilis
  9. Rubella titer
  10. SCD screen
  11. Cystic fibrosis screen
  12. Pap smear
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2
Q

First trimester screening tests

A
  1. Chromosomal screening (Biochemical and nuchal translucency ultrasound)
  2. Ultrasound
  3. Chorionic villus sampling may be performed up to 15 weeks
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3
Q

Second semester screening tests

A
  1. Triple screening
    -alpha-fetoprotein
    -Beta hCG
    -Unconjugated estraiol
  2. Gestational DM (24-28)
  3. Amniocentesis
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4
Q

Third semester screening tests

A
  1. Gestational DM (24-28)
  2. Repeat Rh titers
  3. Non stress testing
  4. Group B strep testing
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5
Q

Symmetrically enlarged, “boggy” uterus think….

A

Adenomyosis

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6
Q

What does “chandelier sign” indicate?

A

PID (cervical motion tenderness) (Can also be septic abortion or ectopic)

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7
Q

What do you treat PID with?

A

Ceftriaxone 250 IM + Doxy x 14 days (100mg) (2nd gen cephalosporin if inpatient)

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8
Q

What should “violin-string adhesions” make you think of?

A

Fitz Hugh-Curtis Syndrome

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9
Q

What is the most common case of PID and Fitz Hugh-Curtis Syndrome?

A

Chlamydia (Gonorrhea next most common)

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10
Q

Bacterial Vaginosis diagnostic criteria?

A
  1. Copious, thin, grayish-white discharge
  2. Vaginal pH > 4.5
  3. Whiff test with KOH
  4. Clue cells
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11
Q

“Copious grey white discharge”…

A

BV

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12
Q

pH of BV?

A

> 4.5

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13
Q

Clue cells….

A

BV

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14
Q

How do you treat BV?

A

Metronidazole (or Clindamycin)

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15
Q

What is trichomonas?

A

A flagellated protozoan

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16
Q

“Copious frothy yellow-green vaginal discharge”…

A

Trich

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17
Q

Cervical petechiae (strawberry cervix)…

A

Trich

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18
Q

What is trichomonas on microscopy?

A

Mobile protozoan trophozoites

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19
Q

Trich vaginal pH

A

> 4.5

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20
Q

Trich treatment

A

Metronidazole

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21
Q

Pink/red well-circumscribed, punctated lesion on colposcopy

A

Carcinoma in situ

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22
Q

Disarray of blood vessels and atypical vessels on colposcopy

A

Invasive carcinoma

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23
Q

Translucent or yellow lesions on the cervix

A

Nabothian cysts

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24
Q

Define first-stage labor arrest

A

6 cm or greater dilation with membrane rupture and no cervical change for :
- 4+ hours with adequate contractions or
- 6+ hours with oxytocin admin and inadequate contractions

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25
Q

Define second stage labor arrest

A

No progress for…
- 4+ hours, nullpari, with epidural
- 3+ hours, nullpari, without epidural
- 3+ hours, multipari, with epidural
- 2+ hours, multipari, without epidural

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26
Q

Define failed induction of labor

A

Failure to generate regular contractions after at least 24 hours of oxytocin and artificial membrane rupture if possible

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27
Q

What are the 4 causes of postpartum hemorrhage?

A

(The 4 T’s)
1. Tone (uterine atony)
2. Trauma to birth canal
3. Tissue retention (fetal or placental)
4. Thrombin disorder or coagulopathy

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28
Q

What is first line for uterine atony

A

Uterine massage/compression and then oxytocin

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29
Q

What are second lines for uterine atony

A

Carboprost and methylergonovine

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30
Q

When is carboprost contraindicated

A

Asthma

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31
Q

When is methylergonovine contraindicated?

A

HTN and CAD

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32
Q

What are the risk factors for endometrial cancer?

A

“ENDOMET”
Elderly
Nulliparity
DM
Obesity
Menstrual irregularity
Estrogen monotherapy
T HTN

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33
Q

Smooth palpable mass of ovary on exam…

A

Ovarian fibroma

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34
Q

What cancer might be associated with recurrent UTIs?

A

Transitional cell carcinoma (bladder)

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35
Q

What cancer is associated with GI bleeding?

A

Rectal adinocarcinoma

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36
Q

What is the most common type of endometrial cancer?

A

Adenocarcinoma

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37
Q

What are the components of HELLP syndrome?

A

Hemolysis
Elevated
Liver enzymes
Low
Platelet count

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38
Q

What is the cut off for hemolysis in HELLP syndrome?

A

> 2 of the following:
-Abnormal smear
-Elevated serum bili >= 1.2
-Low serum haptoglobin
-Significant drop in Hgb (without blood loss)

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39
Q

What is the cut off for liver enzymes in HELLP syndrome?

A

AST or ALT >/= 2x the upper limit

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40
Q

What is the cut off for low platelets in HELLP syndrome?

A

< 100,000

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41
Q

What marker is often associated with ovarian malignancy?

A

Cancer antigen 125

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42
Q

T/F anti-D Rh should be given for abortions

A

True

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43
Q

What 2 meds are used for elective abortions?

A
  1. Mifepristone
  2. Misoprostol
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44
Q

Elective abortion is safe up to __ weeks

A

10

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45
Q

Mifepristone MOA

A

Progesterone receptor antagonist (leads to dilation and softening of the cervix)

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46
Q

Misoprostol MOA

A

Prostaglandin analog (causes uterine contractions)

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47
Q

Methotrexate MOA

A

Folic antagonist

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48
Q

What should you think with late decelerations?

A

Placental insufficiency

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49
Q

What is the classic triad of endometriosis?

A
  1. Cyclic premenstrual pelvic pain
  2. Dysmenorrhea
  3. Dyspareunia
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50
Q

What is diagnostic for preeclampsia?

A

> 140/90 and
-proteinuria
After 20 weeks gestation

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51
Q

What is diagnostic for severe pre eclampsia

A

> 160/110
and
proteinuria
OR
-thrombocytopenia < 100,000
-kidney insuf.
-Impaired liver
-Pulmonary edema
-Cerebral symptoms

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52
Q

What is the DOC for seizure prophylaxis in preeclampsia?

A

Magnesium

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53
Q

What should you think with early decelerations?

A

Fetal head compression

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54
Q

What can cause fetal heart accelerations?

A

Fetal movement or uterie contractions

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55
Q

What causes variable decelerations?

A

Umbilical cord compression

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56
Q

What is a normal fetal heart rate?

A

110-160

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57
Q

What does a complex multiloculated adnexal mass on imaging likely indicate?

A

Tubo-ovarian abscess

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58
Q

Below what age should you do u/s instead of mammography for a breast mass?

A

<30

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59
Q

What is the most common type of breast cancer?

A

Infiltrating ductal carcinoma

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60
Q

What is the most common organism in mastitis?

A

Staph aureus

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61
Q

What are first line abx for mastitis?

A

Dicloxacillin or cephalexin

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62
Q

What marker elevates in ovarian cancer?

A

CA-125

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63
Q

What marker elevates in endometrial and muscle sarcomas?

A

Desmin

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64
Q

What marker elevates in adrenocortiol carcinoma and stromal ovarian cancer?

A

Inhibin

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65
Q

What marker elevates in melanomas and sarcomas?

A

S100 protein

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66
Q

What is the primary etiology of hot flashes?

A

Decreased estradiol

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67
Q

What is most useful for decreasing pruritis in intrahepatic cholestasis of pregnancy?

A

Ursodiol

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68
Q

What is the most effective form of emergency contraception?

A

Copper IUD within 5-7 days

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69
Q

What is the MOA of levonogrestrel?

A

Inhibits of delays ovulation

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70
Q

When does Plan B need to be used?

A

Within 72 hours of intercourse

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71
Q

What is Ulipristal?

A

Emergency contraception

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72
Q

What is combined OCP protective against?

A
  1. Osteoporosis
  2. Ovarian cancer
  3. Endometrial cancer
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73
Q

What is used to enhance fertility in PCOS pts?

A

Clomiphene citrte

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74
Q

What is the MOA of leuprolide?

A

Inhibition of estrogen and testosterone if given continuously

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75
Q

What is the effect of using leuprolide in a pulsatile way?

A

Increased fertility

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76
Q

What is the MOA of Danazol?

A

Hypoesterogenic and hyperadrogenic via LH and FSH supression

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77
Q

When should endometrial biopsy be performed in abnormal uterine bleeding? (4)

A
  1. > 35 and obese
  2. > 35 with HTN
  3. > 35 with DM
  4. Postmenopausal bleeding
78
Q

Primary dysmenorrhea is due to ____

A

increased prostaglandins

79
Q

Secondary dysmenorrhea is due to ____

A

pelvic or uterus pathology

80
Q

What is the main distinction between PMS and PMDD?

A

Functional impairment

81
Q

Define primary amenorrhea

A

Failure of menarche onset by 15 years with secondary characteristics or 13 years without secondary characteristics

82
Q

All primary amenorrhea should be worked up with _____

A

hCH and FSH testing

83
Q

Define secondary amenorrhea

A

Absence of menses for >3 months in a patient with normal menstruation

84
Q

What is delay of period due to exercise etc?

A

Functional hypothalamic amenorrhea

85
Q

What is the female athlete triad?

A
  1. Hypothalamic amenorrhea
  2. Eating disorder
  3. Osteoporosis
86
Q

What is Asherman’s Syndrome?

A

Acquired endometrial scarring secondary to postpartum hemorrhage, after D&C or endometrial infection

87
Q

What does absence of normal uterine stripe on ultrasound indicate ?

A

Asherman’s syndrome

88
Q

What is a leiomyoma?

A

A benign uterine smooth muscle tumor

89
Q

What type of leiomyoma is most likely to cause bleeding?

A

Submucosal

90
Q

What does a firm, nontender, asymmetric mobile mass or masses in the abdomen or pelvis on bimanual exam indicate?

A

Leiomyoma

91
Q

What bacteria causes TSS?

A

Staph aureus

92
Q

What is the classic skin presentation of TSS?

A

Erythroderma- diffuse erythematous macular rash

93
Q

What are the standard treatments of TSS?

A

Agressive fluid replacement and IV abx

94
Q

What abx are usually used for TSS?

A

Clindamycin and Vancomycin

95
Q

At what Rh(D) titer level do you need to perform amniocentesis?

A

1:16

96
Q

When do you do amniocentesis for Rh antibodies?

A

16-20 weeks

97
Q

When do you give RhoGAM?

A
  1. 28 weeks gestation
  2. Within 72 hours of deliver if baby is Rh+
  3. After any potential blood mixing
98
Q

What is adenomyosis?

A

Islands of endometrial tissue within the myometrium

99
Q

What does adenomyosis often present with?

A

Menorrhagia and dysmenorrhea

100
Q

What is a symmetrically enlarged, globular, boggy uterus usually?

A

Adenomyosis

101
Q

Define menorrhagia

A
102
Q

What is first line for endometritis after C section?

A

Clindamycin and Gentamycin (can also add ampicillin to cover additional GBS)

103
Q

What is used for endometritis prophylaxis?

A

First gen cephalosporin during C-section

104
Q

What is first line for endometritis after vaginal delivery or choriooamnionitis?

A

Ampicillin and Gentamicin

105
Q

What is a likely cause of painless bleeding in the third trimester?

A

Placenta previa

106
Q

What is the most common rf for placental abruption?

A

Maternal HTN

107
Q

What is a likely cause of painful third trimester vaginal bleeding/abdominal pain?

A

Placental abruption

108
Q

How does the uterus often present in placental abruption?

A

Tender and rigid

109
Q

What is the triad of vasa previa?

A
  1. Rupture of membranes
  2. Painless vaginal bleeding
  3. Fetal distress
110
Q

Define preexisting/chronic HTN in pregnancy

A

HTN of > 140/90 before 20 weeks gestation or prior to pregnancy

111
Q

What meds are first line for chronic/transitional HTN in pregnancy?

A

-Labetalol
-Nifedipine
-Methyldopa

112
Q

Can you use ACEI/ARBs in pregnancy?

A

No

113
Q

Define transitional HTN in pregnancy?

A

New onset HTN >140/90 after 20 weeks with no proteinuria, edema or end-organ dysfunction

114
Q

What is the cut off for the 1 hour glucose test?

A

140

115
Q

What is the amount for the 1 hour glucose test?

A

50 g

116
Q

What is the amount for the 3 hour “gold standard” glucose test?

A

100 g

117
Q

What are the cut offs for the 3 hour tests?

A

-Fasting >95
-1 hour >180
-2 hours >155
-3 hours >140

118
Q

First line for gestational DM

A

Insulin

119
Q

Second line for gestational DM

A

Metformin or glyburide

120
Q

What is the most common instance of shoulder dystocia?

A

Macrosomic infants of diabetics

121
Q

What is a Tzank smear for?

A

HSV

122
Q

How does HSV appear on Tzank smear?

A

Giant multinucleated cells

123
Q

What 2 maneuvers can be done to deliver a baby with shoulder dystocia?

A

McRoberts and Woods corckscrew

124
Q

What should you think with a sudden onset of severe, prolonged fetal bradycardia or variable decelerations after previously normal tracing?

A

Umbilical cord prolapse

125
Q

What likely needs to be done in umbilical cord prolapse?

A

Emergency C-section

126
Q

What antibiotic is used for prophylaxis in a C-section?

A

IV Cefazolin

127
Q

Hyperemisis gravidarum is commonly associated with ____

A

Weight loss and electrolyte imbalance

128
Q

What labs may be seen in hyperemesis gravidarum

A

Hypokalemia
Hypocholeremic metabolic acidosis
Ketones

129
Q

What is first line treatment for hyperemesis gravidarum

A

Pyridoxine (B6) with or without Doxylamine

130
Q

What labor complication should you consider for “sudden onset of extreme abdominal pain with decreased or absent uterine contractions”?

A

Uterine rupture

131
Q

What are Braxton-Hicks?

A

Spontaneous contractions not associated with cervical dilation

132
Q

What is lightening?

A

Fetal head descending into pelvis, feels “lighter”

133
Q

What are the Cardinal Movements of labor (7)?

A
  1. Engagement
  2. Descent
  3. Flexion
  4. Internal rotation
  5. Extension
  6. External rotation
  7. Expulsion
134
Q

Define engagement

A

Fetal presenting part enters the pelvic inlet

135
Q

Define descent

A

Passage of head into pelvis (lightening)

136
Q

Define flexion

A

Flexion of head to allow the smallest diameter to present the pelvis

137
Q

Define internal rotation

A

Fetal vertex moves from transverse position to sagittal suture parallel to anteroposterior diameter of pelvis

138
Q

Define extension

A

Vertex extends as it passes beneath pubic symphysis

139
Q

Define external rotation

A

Fetus externally rotates after head is delivered so shoulder can be delivered

140
Q

What is considered premature rupture of membranes?

A

Before 37 weeks

141
Q

What can prolonged ROM lead to?

A

Chorioamnionitis or endometritis

142
Q

How can you confirm presence of amniotic fluid?

A

Nitrazine paper test or Fern Test

143
Q

What pH does Nitrazine paper turn blue at?

A

> 6.5

144
Q

What do you use to induce labor if needed after ROM?

A

Prostaglandin cervical gel or oxytocin

145
Q

What should be given for fetal lung development if PROM occurs at <34 weeks?

A

Corticosteroids

146
Q

Define preterm labor

A

Cervical dilation 3 cm or greater + 80% effacement or presence of fetal fibronectin between 20 and 34 weeks

147
Q

What value suggests fetal lung immaturity?

A

L:S ratio < 2

148
Q

What should you do for preterm labor <34 weeks

A

Delay with tocolytics and Betamethasone for lung immaturity

149
Q

What can be given in preterm labor to provide neuroprotection?

A

Magnesium sulfate

150
Q

What are absolute contraindications to induction of labor? (C section indicated)

A
  1. Transmural myomectomy
  2. Placenta previa
  3. Prolapsed cord
  4. Active genital herpes
  5. Transverse fetal lie
  6. Uterine scar from classical C-section incision
  7. Cephalopelvic disproportion
151
Q

What does APGAR stand for?

A

Appearance
Pulse
Grimace
Activity
Respiration

152
Q

What is a normal APGAR score?

A

> /= 7

153
Q

What is a fairly low APGAR score?

A

4-6

154
Q

What is a critically low APGAR score?

A

</= 3

155
Q

When is the uterus back to normal size after pregnancy?

A

6 weeks

156
Q

What is Lochia serosa?

A

Pink/brown vaginal bleeding after pregnancy for up to 3-4 weeks

157
Q

Define postpartum hemorrhage

A

> 500 ml after vaginal or >1000 ml if after C section

158
Q

What is the classic description of uterine atony?

A

Soft, flaccid, boggy uterus

159
Q

What is the strongest risk factor for ectopic?

A

Previous ectopic

160
Q

What is the classic triad of ectopic pregnancy?

A
  1. Unilateral pelvic or lower pelvic pain
  2. Vaginal bleeding
  3. Amenorrhea
161
Q

What is Kehr sign?

A

L shoulder pain (ectopic, with severe abdominal pain)

162
Q

How often should hCG double?

A

Every 48-72 hours

163
Q

When is methotrexate indicated in ectopic pregnancy?

A

-Hemodynamically stable
-Early gestation: <4 cm, beta-hCG < 5,000, no fetal tones)

164
Q

What is indicated for unstable/ruptured ectopics?

A

Laparoscopic salpingostomy

165
Q

Define complete molar pregnancy

A

Diploid, egg is absent of DNA, no fetal tissue

166
Q

Define incomplete molar pregnancy

A

1 egg fertilized by 2 sperm, may have nonviable fetal tissue

167
Q

APGAR A

A

Appearance
0= blue-grey, pale all over
1=acrocyanosis: body pink, extremities blue
2=all pink

168
Q

APGAR P

A

Pulse
0= none
1= <100
2= >100

169
Q

APGAR G

A

Grimace (reflex)
0=No response to stimulation
1=Grimaces feebly
2=Pull away, sneezes or coughs

170
Q

APGAR A

A

Activity (muscle tone)
0=None
1=Some flexion
2=Flexes arms and legs, resists extension

171
Q

APGAR R

A

Respiration
0=Absent
1=Weak, irregular
2= Strong, crying, 30-60 per min

172
Q

What areas does Pruritic Urticarial Papules/Plaquees of pregnancy usually spare?

A

Face, palms and soles

173
Q

What four clinical signs should indicate molar pregnancy?

A
  1. Painless vaginal bleeding
  2. Preeclampsia before 20 weeks
  3. Hyperemisis gravidarum
  4. Abnormally high hCG
174
Q

What does complete molar pregnancy look like on u/s?

A

“Snowstorm” or “Cluster of grapes”

175
Q

What is the guideline for average risk mammography?

A

Every 2 years from 50-74

176
Q

Define incompetent cervix

A

Cervical length 25 mm or less before 24 weeks

177
Q

What can induce ovulation in infertility?

A

Clomiphene

178
Q

What is the most common type of cervical cancer?

A

Squamous cell carcinoma

179
Q

What. is the classic triad of endometriosis?

A
  1. Cyclic premenstrual pelvic pain
  2. Dysmenorrhea
  3. Dyspareunia
180
Q

Endometrial hyperplasia is a precursor to _____ and the main risk factor is _____

A

Endometrial carcinoma, prolonged unopposed estrogen

181
Q

What u/s finding indicates endometrial hyperplasia?

A

Thickened endometrial stripe > 4 mm

182
Q

Tx for endometrial hyperplasia without atypia

A

Progestin

183
Q

Tx for endometrial hyperplasia with atypia

A

Total hysterectomy

184
Q

What is the most common type of endometrial cancer?

A

Adenocarcinoma

185
Q

Name the locations of a cystocele, rectocele and enterocele

A
  1. Cystocele: anterior
  2. Rectocele: posterior
  3. Enterocele: upper vagina
186
Q

Ovarian cysts < ___ usually resolve spontaneously

A

8 mm

187
Q

What is the most common benign ovarian neoplasm?

A

Dermoid

188
Q

What is diagnostic of PCOS?

A

(2/3) Rotterdam criteria
1. Lab or clinical signs of androgens
2. Amenorrhea or oligomenorrhea
3. Cystic ovaries on ultrasound

189
Q

What should “bilateral enlarged, smooth, mobile ovaries” make you think of

A

PCOS

190
Q

What labs are characteristic of PCOS?

A

-Increased testosterone
-LH:FSH >/= 3:1

191
Q

What ultrasound finding is consistent with PCOS?

A

String of pearls

192
Q

What strains of HPV cause cancer?

A

16 and 18

EORs (1 decks)

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