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1
Q

Ddx for 1st trimester bleeding

A

SAB
Postcoital bleeding
Ectopic pregnancy
Vaginal or cervical lesions or lacerations
Extrusion of molar pregnancy
Non pregnancy cause of bleeding

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2
Q

What are the 3 classes of leiomyomas (fibroids)?

A

Submucosal
Intramural
Subserosal

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3
Q

What is the most common type of leiomyoma?

A

Intramural

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4
Q

What type of leiomyoma is most commonly associated with heavy or prolonged bleeding?

A

Submucosal

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5
Q

Risk factors for leiomyomas

A

AA heritage
Nonsmoking
Increased estrogen exposure (Early menarche, Nulliparity, Perimenopause)
Increased EtOH use
HTN

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6
Q

What is the most common sx of leiomyomas?

A

Abnormal uterine bleeding (AUB)

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7
Q

Biannual exam for leiomyomas can often reveal…

A

A nontnder irregularly enlarged uterus

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8
Q

Do fibroids shrink with hormonal tx?

A

GnRH is the only hormone to decrease size. However, once any tx is stopped the fibroid will continue growing.

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9
Q

Endometrial hyperplasia can occur through what pathogenesis?

A

Unopposed estrogen

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10
Q

Endometrial hyperplasia is the abnormal proliferation of what elements of the endometrium?

A

Glandular and stromal elements

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11
Q

What causes the increased risk for endometrial hyperplasia?

A

Unopposed estrogen exposure

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12
Q

Tx for simple and complex hyperplasia with out atypia is …

A

Progestin therapy

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13
Q

Tx for endometrial hyperplasia with atypia

A

Hysterectomy

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14
Q

Most common sites of endometriosis

A

Ovary and pelvic peritoneum

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15
Q

What are 4 theories about the etiology of endometriosis

A

Lymphatic system
Metaplastic transformation
Retrograde menstruation
Altered immune system

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16
Q

Risk factors for endometriosis

A

Increased estrogen exposure (Nulliparity, Early menarche, Prolonged menses)
Mullerian anomalies
First degree relatives
Autoimmune disorders

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17
Q

Sx of endometriosis

A

Cyclic pelvic pain
Dysmenorrhea
Dyspareunia
AUB
Bowel and bladder sx
Subfertility

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18
Q

DDX of endometriosis

A

Chronic processes that result in recurring pelvic pain
Infection
PID
Interstitial cystitis
Masses
Ovarian mass
Final ovarian cysts
Adenomyosis
IBS
Pelvic adhesions
Ectopic
Ovarian neoplasms

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19
Q

Tx for endometriosis

A

NSAIDs
Estrogen-progestin contraceptives
Progestin
GnRH agonists
Aromatase inhibitors
Surgery if fertility is not wanted

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20
Q

Adenomyosis

A

Extension of endometrial tissue into the uterine myometrium

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21
Q

Tx of Adenomyosis

A

Progestin containing IUD and hysterectomy

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22
Q

Adenomyoma

A

Well-circumscribed non-encapsulated collection of endometrial tissue with the uterine wall

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23
Q

Difference in Adenomyosis and leiomyoma

A

Adenomyosis - endometrial tissue into the myometrium

Leiomyoma - proliferation of smooth muscle cells within the myometrium

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24
Q

Why does adenomyosis not respond to hormone tx?

A

Does not contain glandular and stromal endometrial tissue. Extends from the basal is layer.

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25
Adenomyoma
Well-circumscribed non-encapsulated smooth muscle cells and endometrial glands and stroma.
26
Most effective temporary management of adenomyosis
Levonorgestrel-containing IUD
27
Risk factors for endometritis
Retained products STIs Intrauterine foreign bodies/instrumentation
28
Risk factors for PID
Age 15-25 Non-white and non-Asian Multiple partners Recent douching PID Smoking IUD with chlamydial/gonorrhea
29
What 2 organisms are suspected to cause 40% of PID?
N. Gonorrhoeae and C. Trachomatis
30
What three components can an ovarian tumor be associated with?
Surface epithelium Ovarian germ cells Ovarian stroma
31
What is the most common type of ovarian tumor?
Epithelial tumors
32
What are the most common lymph nodes to be involved in ovarian cancer spread?
Retroperitoneal pelvic lymph nodes Para-aortic lymph nodes
33
What is the thought behind the cause of ovarian cancer?
Chronic uninterrupted ovulation - early menarche, infertility, nulliparity, delayed childbearing
34
Stage 1 broken in to what phases and distinguished by what?
Latent phase - 0-5 dilation Active phase - 6-10 dilation
35
What is the expected change in active phase?
1cm every hr
36
What two factors help determine the estimated time it takes to deliver?
Parity Epidural
37
What are the expected times to deliver in stage two based on different women and their factors?
Multip w/o epidural - 1 hr Multip w/ epidural - 3 hrs Nullip w/o epidural - 3 hrs Nullip w/ epidural 4 hrs
38
How long can the placenta take to deliver?
30 min
39
Types of lacerations
1st degree - mucosa or skin 2nd degree - extend to perineal body 3rd - into or completely through anal sphincter 4th - through the anal mucosa
40
3 types of variability
Minimal < 5 bpm Moderate 5-25 bpm Marked >25 bpm
41
What is considered a reactive NST ?
2 15 bpm within 20 minutes
42
3 types of decelerations
Early - begin and end with contraction Variable - occur at any time Late - begin at the peak of a contraction
43
Cause of the 3 types of decelerations
Early - head compression Variable - cord compression Late - placental insufficiency
44
Category I fetal heart rate
Normal fetal heart tracing with normal baseline (110-160), moderate variability, and no variables or late decelerations
45
Category III
Abnormal FHR tracing. Absent fetal heart variability and recurrent late or variable decelerations or bradycardia.
46
Cardinal movements of labor
Engagement Descent Flexion Internal rotation Extend External rotation
47
When is gonorrhea and chlamydia testing recommended?
Sexually active women under 25 yo
48
When does Pap screening test start?
21 yo
49
Is HPV testing recommend at 21 yo? Why or why not
No. Due to high prevalence of HPV infection in the age group. Most HPV infections will clear without treatment over two years?
50
What is the guideline for prevention and early detection of cervical cancer in women 30-65 years?
Screening with cytology and high-risk HPV co-testing q5yrs, high-risk HPV testing alone q5yrs or cytology alone q3yrs
51
What is the most appropriate next step for a HSIL cytology result?
Colposcopy, regardless of high-risk HPV
52
Lower abdominal pain, adnexal tenderness, fever, cervical motion tenderness and vaginal discharge suggestive of what?
PID
53
Multiple painful genital ulcerations, fever and dysuria are suggestive of what dx?
Herpes. Test with herpes cx.
54
Frothy, yellow-green vaginal discharge with erythematous patches on the cervix are characteristic of what?
Trichomoniasis Protozoan STI
55
Clue cells are seen in?
Bacterial vaginosis
56
Fishy order from a KOH prep is suggestive of?
Bacterial vaginosis
57
Multinucleate giant cells and inflammation are microscopic findings of?
Herpes
58
What test is done to confirm genital herpes?
Nucleic acid amplification test (NAAT) or culture
59
Osteoporosis RF
Female gender Caucasian ethnicity Chronic inflammatory dz Use of corticosteroids Adrenal, thyroid or parathyroid dz Sedentary lifestyle Low estrogen states
60
When should Rho(D) immune globin be administered to a Rh-negative mother?
28 wks of gestation After delivery of an Rh(D)-positive fetus After any invasive procedure And after any episodes of fetomaternal hemorrhage
61
Causes of fetal tachycardia (>160bpm)
Maternal fever Hypoxia Fetal anemia Intra-amniotic infection Maternal medications
62
Causes of fetal bradycardia (<110bpm)
Congenital heart malformations Hypoxia Fetal distress Maternal hypotension
63
When is glucose tolerance testing typically done?
24-28 weeks
64
What age do mammograms start?
40 q1yr
65
What contraceptive methods have the lowest pregnancy rate?
Depo, LARC, Sterilization
66
What is the most likely cause of anemia in pregnancy?
Hemodiluation
67
What is the most likely cause of respiratory alkalosis in pregnancy?
Progesterone is a respiratory stimulant
68
What contributes to pyleonephritis in pregnancy?
dextrorotation of the uterus. Compresses ureters at the pelvic brim.
69
In the first trimester is an US or LMP more accurate?
US (within about 5 days)
70
Which test has the highest sensitivity for down syndrome?
amniocentesis (especially in women with increased BMI)
71
Flattened nasal bridge, small size and small rotated, cup shaped ears, sandal gap toes, hypotonia are associated with...
Down syndrome
72
What are the benefits to delayed cord clamping?
Increase Hgb levels, improve iron stores in the first several months
73
Ddx of postpartum fever
Endometritis, UTI, lower genital tract infection, wound infections, pulmonary infections, thrombophlebitis, mastitis
74
Prolactin is responsible for (lactation)
Milk production
75
Oxytocin is responsible for (lactation)
Milk ejection
76
AE of magnesium sulfate
respiratory depression, muscle weakness, loss of deep tendon reflexes, nausea
77
Benefits of low dose aspirin
Decrease risk of recurrent preeclampsia ( given before 16 wks) Reduce likelihood of fetal growth restriction
78
Increased risks when smoking
Placenta previa Placental abruption Fetal growth restriction Infection
79
What is the post common cause of postpartum hemorrhage?
uterine atony
80
What uterotonic is contraindicated in asthmatics?
Prostaglandin F2 alpha (carboprost)
81
90% of vulvar cancers are..
squamous cell carcinoma

Obgyn (1 decks)

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