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Pance Prep Pearls > Obstetrics and Gynecology > Flashcards

Obstetrics and Gynecology Flashcards

1
Q

Most common agent in acute mastitis and treatment

A

Staph aureus, dicloxacillin or nafcillin or a cephalosporin or erythromycin if pcn allergic

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2
Q

Initial test of choice for suspected fibrocystic breast changes/fibroadenoma of the breast

A

Ultrasound

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3
Q

Paget disease of the breast definition

A

Ductal carcinoma presenting as an eczematous nipple lesion, may have bloody discharge, may present as chronic eczematous itchy scaly rash on the nipples and areola

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4
Q

Inflammatory breast cancer definition

A

Red swollen warm and itchy breast that presents like peau d’orange due to lymphatic obstruction and rarely has a lump but has a poor prognosis

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5
Q

Initial modality to eavluate breast masses in women <40 years vs >40 years

A

Ultrasound vs mammography

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6
Q

Hormone breast cancer therapy in premenopausal vs postmonopausal patients

A

Pre menopausal is tamoxifen, post menopausal is letrozole or anastrozole

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7
Q

Breast cancer screening guidelines

A

Mammogram every 2 years beginning at age 50-74 in average risk patients, in more moderate risk for those with first degree relative can start 10 years prior to age first degree relative was diagnosed if earlier than 50

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8
Q

2 HPV types responsible for majority of cervical and anal cancers

A

16 and 18

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9
Q

Gardasil vaccination schedule

A

Given in women age 11-26, men age 11-21, if <15 years 2 doses of HPV vaccine at least 6 months apart, if 15 years or older or immunocompromised 3 doses over minimum of 6 months at 0, 2, and 6 months with minimum dosing interval between first 2 being 4 weeks and between second and third 12 weeks

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10
Q

Management of cervical insufficiency (2)

A
  • Cerclage (suturing of cervical os) and bed rest

- Weekly injection of 17 alpha hydroxyprogesterone

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11
Q

Clomiphene drug function

A

Induces ovulation for infertility treatment

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12
Q

Definition of infertility

A

Failure to conceive after 1 year of regular unprotected sexual intercourse

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13
Q

Cervical cancer screening guidelines (NOTE THESE ARE THE 2020 GUIDELINES)

A

Testing begins at age 25 (change from 21 years previously) - 65, HPV test every 5 years or HPV/Pap co test every 5 years or Pap smear every 3 years

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14
Q

Most common gynecologic cancer

A

Endometrial cancer

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15
Q

Most common clinical manifestation of cervical cancer

A

Post coital bleeding or spotting

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16
Q

Spontaneous abortion diagnosis

A

Ultrasound or cervical exam, cbc, blood type and Rh screen, serial beta hCG titers (remember should see doubling), progestorone levels

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17
Q

Types of abortion

A

Threatened - cervical os is closed and potentially viable pregnancy still requiring close follow up and observation at home as well as serial b hCG
Inevitable - cervical os is dilated but products of conception retained, treated with surgical evacuation via dilation and curetage or misoprostal or expectant management
Incomplete - cervical os is dilated, some products of conception expelled, options include expectant management with transvaginal US to determine when complete, or surgical evacuation such as dilation and curettage or misoprostal
Complete - cervical os is closed, all products of conception are expelled, treated with RhoGAM if indicated and follow up beta hCG
Missed - cervical os is closed, products of conception are retained, treated with surgical evacuation such as dilation and curettage or misoprostal
Septic - Cervical os closed, some products of conception retained, cervical motion tenderness and foul brown discharge, fever, chills, treated with dilation and curettage to remove products of conception plus broad spectrum antibiotics

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18
Q

Elective induced abortion medical therapy vs surgical therapy

A

Mifepristone (dilates and softens cervix and causes placental separation) followed by misoprostal (causes uterine contractions, its also used to prevent stomach ulcers caused by nsaids!)

Dilation and curettage and evacuation

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19
Q

Common etiologies of placental insufficiency

A

Placenta previa, abruption, post term pregnancy, intrauterine growth restriction

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20
Q

Diagnosis of placental insufficiency

A

Late decelerations on fetal heart monitoring due to mechanical compression of maternal vessels during uterine contractions

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21
Q

Management of placental insufficiency

A

Place mother on side, administer oxygen, and correct hypotension

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22
Q

Diagnosis of uncomplicated pregnancy (2)

A

Serum quantitative B hCG 5 days after conception, urine B hCG 14 days after conception

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23
Q

Goodell’s sign

A

cervical softening sign of pregnancy

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24
Q

Abortion is the term at < or =___ weeks

A

20

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25
Q

Fundal height at 12 weeks vs 20 weeks vs 38 weeks

A

Pubic symphysis, Umbilicus, Below xiphoid process

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26
Q

Neagele’s rule

A

((LMP+7 days)-3 months) + 1 year

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27
Q

PAPP-A first trimester screening

A

Low with down syndrome

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28
Q

Nuchal translucency ultrasound first trimester screening

A

Increased thickness is abnormal and may indicate chromosomal abnormalities such as trisomy 13 or 21, if abnormal chorionic villous sampling or amniocentesis is offered

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29
Q

1st trimester is from week

A

1-12

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30
Q

alpha feto protein a-FP second trimester screening

A

Usually part of triple screening including unconjugated estriol and b-hCG, low in down syndrome, high with neural tube defects like spina bifida

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31
Q

2nd trimester is from week

A

12-27

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32
Q

Gestational diabetes second trimester screening

A

at weeks 24-28 perform 50 gram 1 hr glucose challenge test, if positive do a 100 gram 3 hour oral glucose tolerance test (diagnostic gold standard)

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33
Q

Most common type of neural tube defect

A

Spina bifida with myelomeningocele

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34
Q

When is RhoGAM given in pregnancy?

A

28 weeks gestation and within 72 hrs of delivery of an RH(D) positive baby

35
Q

Leading cause of neonatal infection and sepsis in newborns

A

Group B strep

36
Q

GBS third trimester screening

A

Rectovaginal screening culture at 36-37 weeks gestation with exception of those with current bacteriuria and those who previous gave birth with GBS disease, those need intrapartum antibiotic prophylaxis (IV pen G first line)

37
Q

Toxic shock syndrome causative agent

A

Staph aureus

38
Q

Toxic shock syndrome treatment

A

IV fluids and antibiotics like clindamycin and vancomycin plus hospital admission and removal of offending agent

39
Q

At risk pregnancy for RH alloimmunization

A

Rh negative mother with Rh positive father or unknown father status because it is dominantly inherited

40
Q

Diagnosis of placenta previa (2)

A

Transabdominal ultrasound initially (screening) with confirmation via transvaginal ultrasound

41
Q

Vasa previa definition

A

Vessels present over cervical os that has high fetal mortality due to exsanguination, presents with rupture of membranes followed by painless vaginal bleeding and fetal distress in the form of bradycardia, managed with immediate cesarean section

42
Q

Hypertension vs transitional hypertension vs preeclampsia vs eclampsia

A

Hypertension is before 20 weeks gestation, transitional hypertension is after 20 weeks but no proteinuria, edema, or end organ dysfunction, preeclampsia is after 20 weeks and with proteinuria or end organ dysfunction, and eclampsia is preeclmapsia plus seizures or coma

43
Q

Medication for pre-existing hypertension during pregnancy or transitional hypertension

A

Labetalol, nifedipine, methyldopa first line agents, hydralazine second line

44
Q

Management of mild pre-eclampsia

A

if >37 weeks delivery, if <37 weeks expectant management such as antenatal corticosteroids for fetal lung maturity, planned delivery, weekly blood pressure monitoring, bed rest

45
Q

Management of severe pre-eclampsia

A

If viable 33 weeks or greater prompt delivery after hospitalization plus mag sulfate and blood pressure control with labetalol, nifedipine or methyldopa

46
Q

Management of gestational diabetes

A
  • Lifestyle mods initial treatment of choice
  • Insulin first line medical treatment of choice
  • Glyburide or metformin 2ndary choices
47
Q

Erb’s palsy

A

Brachial plexus injury most often occurs due to shoulder dystocia in delivery of newborn resulting in arm weakness, most often times self resolves

48
Q

Breech presentation diagnosis

A

Leopold maneuvers

49
Q

Umbilical cord prolapse presentation

A

Sudden onset of severe prolonged fetal bradycardia or variable decelerations after a previously normal tracing, requires emergent c-section

50
Q

Morning sickness vs hyperemesis gravidarum

A

Morning sickness is nausea and vomiting in the first trimester that should resolve, hyperemesis gravidarum is severe excessive form of morning sickness that persists into second trimester and can cause more severe symptoms like hypokalemia, metabolic alkalosis, weight loss

51
Q

Morning sickness/hyperemesis gravidarum treatment

A
  • Lifestyle mods

- Vit B6 with or without doxylamine

52
Q

Lightening definition

A

Fetal head descent into pelvis causing change in abdomen shape and sensation that baby has become lighter

53
Q

Bloody show definition

A

Passage of blood tinged cervical mucus late in pregnancy, occurs when the cervix begins thinning

54
Q

Stages of labor

A

I - true regular contractions to full dilation of cervix
II - Active expulsion of fetus to delivery
III - postpartum until delivery of placenta

55
Q

Diagnosis of PROM

A

Sterile speculum exam and nitrazine paper test (turns blue if pH is >6.5 indicating aminotic fluid) or fern test

56
Q

What % of patients go into spontaneous labor within 24 hrs after PROM

A

90%

57
Q

What to give if patient doesn’t go into labor spontaneously after PROM

A

Prostaglandin cervical gel or oxytocin

58
Q

When should delivery be delayed?

A

<34 weeks, delay with tocolytics and betamethasone to enhance fetal lung maturity

59
Q

Placenta previa typically requires what kind of delivery?

A

C section

60
Q

APGAR scoring

A

Appearance 0 - blue all over 1 - acrocyanosis 2 - no cyanosis
Pulse 0 - not detected 1 - <100bpm 2 - >100 bpm
Grimace 0 - no response 1 - feeble 2 - pulls away
Activity 0 - none 1 - some flexion 2 - flexes arms and legs, resists extension
Respiration 0 - absent 1 - weak 2 - strong crying

7 or greater is normal, done at 1 and 5 minutes and repeated at 10 if abnormal

61
Q

Cervical motion tenderness might indicate 1 of these 2 conditions

A

Ectopic pregnancy, PID

62
Q

Pelvic ultrasound description of molar pregnancy

A

Central heterogenous mass with muliple discrete anechoic spaces, snowstorm or cluster of grapes appearance

63
Q

Most effective postcoital emergency contraception method

A

Copper IUD if inserted within 5-7 days after unprotected intercourse

64
Q

When should OCP’s be stopped in smokers?

A

> 35 years due to thrombotic potential

65
Q

Most common cause of abnormal uterine bleeding

A

Anovulatory

66
Q

What should be done with all abnormal uterine bleeding patients >35 years

A

Endometrial biopsy to rule out endometrial carcinoma

67
Q

Work up for primary amenorrhea

A
  • bHCG and FSH
  • TSH and prolactin
  • Karyotyping for turner syndrome (xo)
68
Q

Most common clinical presentation of leiomyoma and diagnosis

A

Most are asymptomatic but bleeding is most common symptom

Transvaginal ultrasound most widely used initial imaging test

69
Q

Most sensitive initial test for menopause

A

FSH assay

70
Q

Management of hot flashes in menopause

A

Hormone replacement therapy first line (risks and benefits must be weighed)
2nd line SSRI’s like paroxetine or gabapentin

71
Q

Endometritis definition

A

Infection of pregnancy endometrium, c section is biggest risk factor, typically occurs 2-3 days after delivery and may have vaginal bleeding or discharge (foul smelling lochia), managed with clindamycin+gentamycin first line

72
Q

Endometriosis clinical manifestations

A
  • Cyclic premenstrual pain, dysmenorrhea, dyspareunia
  • Dyschezia or abnormal bleeding
  • Infertility
73
Q

Physical exam description of endometriosis

A

May have fixed tender adenexal mass, a fixed retroverted uterus, or nodular thickening of uterosacral ligament

74
Q

Endometriosis diagnosis

A
  • Clinical
  • Ultrasound to rule out other causes
  • Laparoscopy with biopsy definitive diagnosis, may see endometrioma (chocolate cyst)
75
Q

Endometrial hyperplasia or cancer diagnosis

A

Transvaginal ultrasound initial diagnostic test, endometrial biopsy definitive diagnosis

76
Q

Normal LH:FSH ratio vs LH:FSH ratio in PCOS

A

normally 1:2, >3:1 in pcos

77
Q

PID outpatient management

A

Ceftriaxone 250 mg IM one dose plus doxycycline 100 mg bid x 14 days, metronidazole 500 mg bid x14 can be added

78
Q

Fitz Hugh Curtis syndrome definition

A

Perihepatitis in the setting of pelvic inflammatory disease, sees RUQ pain that may radiate to the right shoulder, often LFT’s unchanged

79
Q

BV vaginal pH

A

Basic >4.5

80
Q

Trichomoniasis vaginal pH

A

Basic >4.5

81
Q

BV treatment

A

Metronidazole x 7 days

82
Q

Trichomoniasis treatment

A

Metronidazole 2 g oral dose or 500 mg bid x7 days, partners must be treated because it is an STI

83
Q

Vulvovaginal candidiasis treatment

A

Fluconazole 1 dose

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