2014-03-07 USMLE OB_Gyn - USMLE OB_Gyn Flashcards Preview

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Flashcards in 2014-03-07 USMLE OB_Gyn - USMLE OB_Gyn Deck (406):
1

When does standard HCG test for pregnancy become positive?

2 weeks after conception

2

What is Heagar's sign

sofetening and compressivility of the lower uterine segment indicating pregnancy

3

What is Chadwick's sign

dark discoloration of the vulva and vaginal walls

4

What is the significance of linea nigra in preganancy?

normal benign finding

5

What is melasma?

hyperpigmentation of sun exposed areas; often in pregnancy

6

When does quickening occur?

primigravida: 18-20 weeks
multi: 16-18 weeks

7

When during pregnancy do you need a pap smear?

at first visit unless done in last 6 months

8

When during pregnancy do you need a urinalysis?

at every visit

9

Urinalysis in pregnancy is used to screen for...

- pre-eclamppsia
- bacteriuria
- diabetes

10

When during pregnancy do you need a CBC?

at first visit

11

When during pregnancy do you need a blood type/screen?

at first visit

12

When during pregnancy do you need a syphilis test?

at first visit, repeat later if high risk

13

When during pregnancy do you need a rubella titer?

first visit if vaccination history not known

14

When during pregnancy do you need diabetes screening?

- betwen 24-28 weeks; at first visit if high risk factors

15

High risk factors for gestational diabetes

- obese
- family history
- age over 30

16

When during pregnancy do you need a triple screen?

15-20 weeks for older/high risk women

17

Significance of low AFP on triple screen

- Down syndrome
- fetal demise
- inaccurate dates

18

Significance of high AFP on triple screen

- neural tube defects
- ventral wall defects
- multiple gestation
- inaccurate dates

19

What do you do if triple screen is abnormal.

- order an US to check dates and look for anomalies
- if US not helpful, order amnio for AFP level and cell culture for chromosomes

20

When during pregnancy do you need a Group b strep culture?

35-37 weeks

21

How do you treat group B strep in pregnant mom?

treat with amoxicillin during labor

22

When can fetal heart tones be heard?

- doppler: 10-12 weeks
- stethascope: 16-20 weeks

23

What is significant for size/date discrepency

uterine size difference of 2-3 cm to dates; get US

24

What do HCG levels do in the first trimester of pregnancy?

double every 2 days

25

Ongoing increase in HCG or increase after delivery indicates

- hydatiform mole
- choriocarcionma

26

HCG level at 5 weeks

>2000

27

Transvaginal US can detect intrauterine pregnancy at

5 weeks

28

Average weight gain of pregnancy

28 pounds

29

With extra weight gain in pregnancy think

diabetes

30

With poor weight gain during pregnancy think

- hyperemesis gravidum
- psych disorder
- major systemic disease

31

ESR in pregnancy

very elevated

32

Thyroid tests in pregnancy

- free T4 same
- overall total T4 and thyroid binding globulin increase

33

Hematocrit in pregancy

- decreased (increased red cells but fluid increases more)

34

BUN and Cr in pregnancy

decrease (GFR increases)

35

Alkaline phosphatase in pregnancy

very increased

36

Mild proteinuiria in pregnancy

normal

37

Mild glucosuria in pregnancy

normal

38

Electrolyte in pregnancy

unchanged

39

Liver function tests in pregnancy

unchanged

40

BP changes in pregnancy

decreases slightly

41

HR changes in pregnancy

increased 10-20 beats per minute

42

Stroke volume and cardiac output in pregnancy

increase, often by 50%

43

Minute ventillation in pregnancy

increases (increased tidal volume, rate about the same)

44

Residual lung volume in pregnancy

decreased

45

Respiratory alkalosis in pregnancy is

normal

46

Definition of IUGR

below 10th percentile for age

47

3 classes of causes of IUGR

- maternal
- fetal
- placental

48

US parameters to look for IUGR

- biparietal diameter
- head circumference
- abdominal circumference
- femur length

49

Components of biophysical profile (BPP)

- heart rate tracing
- US for:
* amniotic fluid ndex
* fetal breathing movements
* fetal body movements

50

If you are concerned about a fetus, but non-emergent, what is the series of investigations?

- BPP, if abnormal then contractile stress test. If decels, usually go to c-section

51

What is the contraction stress test

- looks for uretroplacental dysfunction.
- mom is given oxytocin and HR is monitored. If decels, then usually to c-section

52

Define oligohydramnios

<300-500 ml

53

4 major causes of oligohydramnios

- IUGR
- premature rupture of membranes
- postmaturity
- renal agenesis (Potter disease)

54

4 complications of oligohydraminios

- pulmonary hypoplasia
- cutaneous problems (compression)
- skeletal problems (compression)
- hypoxia (cord compression)

55

Define polyhydramnios

>1700-2000ml

56

5 major causes of polyhydramnios

- maternal diabetes
- multiple gestation
- neural tube defects
- GI anomolies
- hydrops fetalis

57

Maternal complications of polyhydramnios

- uterine atony
- dyspnea from large uterus

58

At term normal fetal heart rate is

110 to 160 bpm

59

Discuss early decelerations

- low point of fetal HR and high point of uterine contraction coincide
- from head compression
- normal

60

Discuss varible decelerations

- most common
- variable occurance with contractions
- signifies cord compression

61

Treatment of variable decelerations

- mom in lateral decub
- give O2 by facemask
- stop oxytocin
- if brady (t resolve measure fetal O2

62

Discuss late decelerations

- fetal HR nadir occurs after contraction
- uteroplacental insufficiency
- worrisome

63

Treatment in late decelerations

- lateral decub, O2, stop oxytocin
- give tocolytic
- give IVF if BP not optimal
- if persist, measure fetal O2

64

Examples of tocolytic agents

- ritodrine
- magnesium sulfate

65

Discuss the loss of fetal variability if heart rate in labor

- check fetal scalp pH
- if associated with variable or late decels, likely need to deliver

66

In labor, what are the scalp pH parameters that indicate need for delivery?

- fetal scalp pH < 7.2 or abnormal O2

67

How can you distinguish true labor

- regular contraction (every 3 minutes)
- associated with cervical changes

68

Describe "false labor"

aka Braxton-Hicks contraction
- irregular
- no cervical changes

69

Desribe the stages of labor

1st- true labor to full dilation
2nd- full dilation to dirth
3rd- delivery of baby
4th- placenta to stabilization

70

1st stage of labor lasts how long?

- nuligravida: < 20 hours
- multigravida: < 14 hours

71

In the active phase of 1st stage of labor, how fast does the cervix dilate?

- nuligravida: >1cm/hr
- multigravida: >1.2 cm/hr

72

Time from full cervical dilation to start delivery of baby

- nuligravida: 30min - 3 hrs
- multigravida: 5-30 min

73

Time to delivery baby

0-30 minutes

74

Time to delivery placenta and maternal stabilization

up to 48 hours

75

What is protraction disorder

Labor takes long than expected

76

What is labor arrest disorder?

No change in cervical dilation occurs over 2 hours and no change in fetal descent after 1 hour

77

Treatment of arrest disorder

- check fetal lie
- check for cephalopelvic disproportion
- augment labor

78

Name 3 ways to augment labor

- oxytocin
- prostaglandin gel
- amniotomy

79

Most common cause of "failure to progress" in labor

cephalopelic disporoprtion (labor augmentation contraindicated)

80

Half life of oxytocin

less than 10 minutes

81

Side effects of oxytocin

- uterine hyperstimulation
- uterine rupture
- fetal heart deccelerations
- hyponatremia

82

Side effects of PGE2 used for ripening cervix

uterine hyperstimulation

83

Decision of vaginal delivery with HSV based on...

if active lesions during labor, opt for c-section

84

Orientation of "classic" c- section incision

vertical

85

Signs of placental separation

- fresh blood from vagina
- umbilical cord lengthens
- fundus rises and becomes firm and globular

86

What is the first step during delivery with shoulder dystocia

- McRobert maneuver: mother sharpely flexes thighs against abdomen

87

List the order of labor positions

- descent
- flexion
- internal rotation
- extension
- external rotation
- expulsion

88

Postpartum discharge

- red the first few days, usually white by day 10

89

Foul smelling lochia is concerning for

endometritis

90

What is the underlying likely cause when new mom develops PE

PE from amniotic fluid

91

Definition of post-partum hemorrhage

>500 cc with vaginal
>1000cc with c-section

92

Most common cause of post-partum hemorrhage

uterine atony

93

Complication of severe post-partum hemorrhage

Sheeham sydrome

94

Risk factors for retained placenta after delivery

- previous uterine surgery
- previous c- section

95

Risk factors for uterine atony

- overdistended
- prolonged labor
- oxytocin
- more than 5 deliveries
- precipitous labor (<3h)

96

Treatment of uterine atony

1. uterine massage with low dose oxytocin
2. ergot drug or PGF2-alpha
3. hysterectomy

97

Treatment of retained products of conception

- remove placenta manually to stop bleeding
- curettage in OR
- if placental accreta, likely to need hysterectomy

98

Most common cause of uterine inversion

iatrogenic; pulling too hard on the cord

99

Treatment of uterine inversion

- manually replace uterus may need anesthesia)
- IVF, oxytocin

100

Definition of post-partum fever

fever for 2 days

101

5 most common causes of post-partum fever

- breast engorgement
- UTI
- endometritis
- endomyometritis
- puerperal sepsis

102

Risk factors for endometritis

- C-section
- PROM
- prolonged labor
- frequent vaginal exams
- manual removal of placenta

103

Treatment of endometritis

- obtain cultures of endometrium, vagina, blood and urine
- treat with broad spectrum antibiotics

104

If endometritis doesn't resolve, what's likely going on?

- pelvic abscess
OR
- Pelvic thrombophlebitis
(get a CT)

105

Treatment of post-partum pelvic thrombphlebitis

heparin

106

3 major things to think of with postpartum shock and no evident bleeding

- amniotic fluid embolus
- uterine inversion
- concealed hemorrhage

107

If a woman doesn't want to breastfeed, what would you prescribe

- tight bra
- ice
- analgesia
- bromocriptin
- birth control pills

108

Mastidis after delivery usually occurs

within 2 months

109

Usual organism of mastidis

staph aureus

110

Treatment of mastidis

* keep breast feeding
- analgesia
- warm compresses
- antibiotics if more than mild (cephalexin, dicloxacillin)

111

Contraindications to breast feeding

- maternal HIV
- illicit drug use
- sedatives
- stimulants
- lithium
- chemotherapy

112

Define abortion

termination of pregnancy before 20 weeks or fetus less than 500 grams

113

Define threatened abortion

uterine bleeding without cervical dilation and no expulsion of tissue

114

Treatment of threatened abortion

pelvic rest

115

What percentage of pregnancies with threatened abortion go on to be normal?

50%

116

Define inevitable abortion

uterine bleeding with cervical dilation, crampy pain and no tissue

117

Treatment of inevitable abortion

follow, D&C of uterine cavity

118

Define incomplete abortion

passage of some products of conception through cervix

119

Treatmetn of incomplete abortion

observation, often need D&C

120

Define complete abortion

expulsion of all products of conception from the uterus

121

Treatment of complete abortion

Serial HCGs to be sure returns to zero. D&C if pain or opeen cervical os

122

Define missed abortion

fetal death without expulsion of fetus

123

Treatment of missed abortion

most women go on to have spontaneous miscarriage but D&C often performed

124

Define induced abortion

intentional temination prior to 20 weeks (elective or therapeutic)

125

Define recurrent abortion

two or three successive unplanned abortions

126

4 infectious causes of recurrent abortion

- syphilis
- Listeria
- Mycoplasma
- Toxoplasma

127

3 environmental causes of recurrent abortion

- alcohol
- tobacco
- drugs

128

2 metabolic causes of recurrent abortion

- hypothyroidism
- diabetes

129

3 autoimmune causes of recurrent abortion

- lupus
- anitphospholipid antibodies
- lupus anticoagulant

130

3 anatomic causes of recurrent abortion

- cervical incompience
- congenital female tract abnormalities
- fibroids

131

Classic cause of painless recurrent abortions in the second trimester

cervical incompetence

132

Treatment of cervical incompetence

cerclage at 14-16 weeks

133

Typical time when ectopic pregnancy presents

4-10 weeks.

134

Definitive diagnosis and treatment of ectopic pregnancy in unstable patient

laparoscopy

135

Major risk factors for ectopic pregancy

** history of PID
- previous ectopic
- history of tubal ligation
- pregnancy with IUD in place

136

In 3rd trimester bleeding always do a ______ before a ______

always do an US before a pelvic exam

137

Ddx of 3rd trimester bleeding

- placenta previa
- abruptio placentae
- uterine rupture
- fetal bleeding
- cervical/vaginal lesions
- cervical/vaginal trauma
- bleeding disorder
- cervical cancer
- "bloody show"

138

In all patients with 3rd trimester bleeding, what do you do?

- IV
- blood if needed
- O2
- order CBC, coags
- do US
- setup maternal and fetal monitoring
- tox screen if suspected
- give Rh immune globuline if mother Rh negative

139

Risk factors for placenta previa

- multiparity
- older age
- multiple gestation
- prior previa

140

Why do you do an US before a pelvic exam in 3rd trimester bleeding

because of placenta previa.

141

Accuracy of US in dx placenta previa

95-100%

142

Characteristics of bleeding in placenta previa

**painless
- may be profuse

143

Treatment of placenta previa

- if premature, can try rest and tocolysis if stable
***otherwise needs c-section

144

Risk factors for abruptio placentae

- HTN
- cocaine
- trauma
- polyhydramnios with rapid decompression with membrane rupture
- tobacco
preterm PROM

145

3rd trimester bleeding where blood may not be visible

abruptio placentae

146

Woman in 3rd trimester with uterine pain/tenderness and hyperactive contraction pattern and fetal distress is concerning for

abruptio placentae

147

Use of US in diagnosing abruptio placentae

may be falsely normal

148

Complication of abruptio placentae

maternal DIC if fetal products enter blood stream

149

Treatment of abruptio placentae

rapid delivery (vaginal preferred)

150

Risk factors for uterine rupture

- previous uterine surgery
- trauma
- oxytocin
- grand multiparity
- excessive uterine distention
- abnormal fetal lie
- CPD
- shoulder dystocia

151

Sudden onset of abdominal pain in 3rd trimester with sudden materal hypotension most concerning for

uterine rupture

152

Changes in maternal abdomen that occur with uterine rupture

- fetal parts palpable in abdomen
- abdominal contour may change

153

Treatment of uterine rupture

- laparotomy for delivery
- usually requires hysterectomy

154

2 major causes of 3rd trimester fetal bleeding

- vasa previa
- velamentous insertion of the cord

155

Major risk factor for 3rd trimester fetal bleeding

multiple gestation (higher # of fetuses = higher risk)

156

3rd trimester bleeding with painless bleeding, stable mom and fetal distress

from fetal bleeding

157

How do you differentiate maternal from fetal blood (such as in 3rd trimester bleeding?)

The Apt test

158

Treatment of fetal bleeding in 3rd trimester

c-section

159

Cervical/vaginal lesions commonly causing 3rd trimester bleeding

- herpes
- gonorrhea
- chlamydia
- candida

160

How can you decide on the dose of rhogam needed in a pregnant mom with 3rd trimester bleeding?

Use the Kleihauer-Betke test to quantify fetal blood in maternal circulation and use this to calculate dose

161

Define preterm labor

labor between 20-37 weeks

162

1st line treatment of preterm labor

- lateral decub position
- fluids
- bed/pelvic rest
- O2
- tocolytics

163

Can a patient in preterm labor on tocolytics be discharged home?

yes, on oral tocolytics

164

List the more common contraindications to tocolysis in preterm labor

- herat disease
- HTN
- DM
- hemorrhage
- pre-eclampsia
- chorioamnionitis
- IUGR
- ruptured membranes
- cervical dilation >4cm
- fetal demise
- fetal abnormalities incompatible with survival

165

Describe the use of fetal fibronectin

- useful in preterm labor between 22-34 weeks
- if negative in vaginal secretions, very low chance of delivery in next 2 weeks

166

What action for the fetus must be taken in a stable patient with possible pre-term labor and positive fetal fibronectin?

measures for lung maturity

167

Amniocentesis results that indicate immature lungs

- lecithin : sphingomyelin (L:S) ration less than 2:1
OR
- phosphatidylglycerol negative

168

At what age in premature labor do you give steroids to hasten lung maturity

between 26 and 34 weeks

169

Define premature rupture of membrance

- ruputre of amniotic sac prior to onset of labor

170

3 critera for premature rupture of membranes

- pooling of amniotic fluid
- ferning pattern
- positive nitrazine test

171

What test should be done in confirmed premature rupture of membranes

US

172

How long do you give a mom at full term with PROM before inducing labor?

6-8 hours

173

Mom with PROM, fever and tender uterus likely has

chorioamnionitis

174

Classic cause of chorioamnionitis

premature rupture of membranes

175

Complications of chorioamnionitis in mom and fetus

- neonatal sepsis
- maternal sepsis
- maternal endomyometritis

176

Empiric treatment of chorioamnionitis

ampicillin

177

Define preterm PROM

premature rupture of membranes before 36-37 weeks

178

What do you need to test for with preterm PROM

culture fluid for group B step and treat mom with ampicillin if positive culture

179

2 major clues that twins are dizygotic

- different sexes
- different blood types

180

If placenta is monochorionic then twins are

monozygotic

181

What can you do to further investigate if twins are mono or dizygotic?

HLA typing

182

4 major maternal complications of multiple gestations

- anemia
- HTN/pre-eclampsia
- postpartum uterine atony
- postpartum hemorrhage

183

9 major fetal complications of multiple gestations

- polyhydramnios
- malpresentation
- placenta previa
- abruptio placentae
- velamentous cord/vasa previa
- umbilical cord prolapse
- IUGR
- congenital anomalies
- increased morbidity/mortality

184

When can you try to delivery twins vaginally?

When they are BOTH vertex; any other combo, do c-section

185

Define post-term pregnancy

after 42 weeks

186

If dates for pregnancy are known and reach 42 weeks, what do you do?

induce labor

187

If dates for pregnancy are unknown and reach 42 weeks, what do you do?

twice weekly BPP

188

Post post-maturity for fetus increase risk of morbidity and mortality?

yes

189

Prolonged gestation is classically associated with what congenital anomaly?

anencephaly

190

Fetus with "frog-like" appearance on US likely has

anancephaly

191

Risk factors for hyperemesis gravidarum

- younger
- first pregnancy
- underlying stressors

192

Hyperemesis gravidarum presents in which trimester?

1st

193

With all high risk pregnancies, consider weekly _____ during the third trimester

biophysical profiles

194

Can chorionic villi sampling detect neural tube defects?

no

195

When can chorionic villi sampling be done?

at 9-12 weeks (earlier than amniocentesis)

196

chorionic villi sampling is generally reserved for

testing of genetic diseases

197

What is the miscarriage rate of chorionic villi sampling compared to amniocentesis

higher with chorio

198

How do you know if a woman has pre-eclampsia if she already had HTN?

Increased greater than 30/15

199

What does HELLP syndrome stand for?

H- hemolysis
EL-elevated liver enzymes
LP-low platelets

200

S/s for pre-eclampsia

- HTN
- 2+ proteinuria
- oliguria
- facial/hand edema
- headache
- visual changes
- HELLP syndrome

201

Pain in what location often does with HELLP syndrome?

RUQ or epigastric pain

202

When does pre-eclampsia usually occur?

3rd trimester

203

Main risk factors for pre-eclampsia

- chronic renal disease
- HTN
- family history
- multiple gestation
- nulliparity
- extremes of reproductive age
- DM
- black race

204

Treatment of pre-eclampsia

- stabilization
- if at term, delivery the baby

205

Treatment for pre-eclampsia if fetus is not full term

- hydralazine or labetalol
- magnesium sulfate (seziure prophylaxis)
- bedrest
- hospital observation

206

Indications in pre-eclampsia to delivery baby regardless of gestational age

- oliguria
- mental status change
- headache
- blurred vision
- pulmonary edema
- cyanosis
- HELLP
- BP > 160/110
- ecclampsia (seizures)

207

Is severe ankle edema normal in pregnancy?

No, look for pre-ecclampsia

208

HTN + proteinuria in pregnancy = ______ until proven otherwise

pre-eclampsia

209

Complications of pre-eclampsia and eclampsia

- uretoplacental insufficiency
- IUGR
- fetal demise
- increased maternal morbidity and mortality

210

Does pre-eclampsia during pregnancy mean higher risk for HTN later in life?

No, not generally

211

Pre-eclampsia prior to the third trimester is likely

molar pregnancy

212

Best way to prevent eclampsia?

routine prenatal care

213

Initial treatment of choice for eclamptic seizures?

- Magnesium sulfate wthich also lowers blood pressure

214

Toxic effects of magnesium sulfate

- hyporeflexia (1st sign)
- respiratory depression
- CNS depression
- coma
- death

215

3 maternal complications of gestational diabetes

- polyhydramnios
- pre-eclampsia
- complications of DM

216

2 difference is fetus for gestational DM vs. pre-existing DM

- gestational: macrosomia
- pre-existing: IUGR

217

6 fetal complications of gestational DM

- respiratory distress syndrome
- cardiovascular defects
- colon defects
- craniofacial defects
- neural tube defects
- caudal regression syndrome

218

What is caudal regression syndrome?

lower half of body incompletely formed (risk with gestational DM)

219

Use of oral hypoglycemics in pregnancy

contraindicated (use insulin)

220

Infants born to DM mothers are classically at risk for what right after birth?

postdelivery hypoglycemia

221

Why do babies of DM mother's get hypoglycemic after delivery?

fetal islet cell hypertrophy

222

Only maternal antibody category to cross the placenta

IgG

223

Meaning of elevated neonatal IgM concentration?

never normal

224

Meaning of elevated neonatal IgG concentration

often represents maternal antibodies

225

When does Rh incompatilbity occur

mom Rh negative
baby Rh positive

226

At what time do you give Rh immune globulin

- 28 weeks
- within 72 hours of delivery
- after any procedures which may cause transplacental hemorrhage (amnio)

227

What type of prevention is Rh immune globulin?

primary

228

IS Rh immune globulin effective if maternal Rh antibodies are strongly postiive?

no

229

What is hydrop fetalis

edema, ascites, pleural/pericardial effusions

230

Undetected Rh incompatability can lead to

- hemolytic disease of newborn
- hydrops fetalis

231

Who do you test the severity of fetal hemolysis

Amniotic fluid spectrophotometry

232

Treatment of hemolytic disease of the fetus

- delivery if mature
- intrauterine blood transfusion
- phenobarbital (helps fetal liver break down bilirubin)

233

Mother with type O blood and baby with any other type, baby at risk for

hemolytic disease of the newborn

234

Snow storm pattern on US =

hydatiform mole

235

"grape like vesicles" with 1st or 2nd trimester bleeding

hydatiform mole

236

uterine size/dates discrepancy brings concerns for

hydatiform mole

237

Karyotype of complete moles

46XX or 46 XY (all from father)

238

Do complete moles contain fetal tissue?

no

239

Karyotype of incomplete moles

69 XXY

240

Do incomplete moles contain fetal tissue?

yes

241

Treatment of moles

D&C, follow HCG levels to zero

242

What happens if patient treated for hydatiform mole and HCG doesn't return to zero

invasive mole or choriocarcinoma and patient needs chemo

243

Chemo options for invasive mole or choriocarcinoma

- methotrexate
- actinomycin D

244

Source of choriocarcinoma

- denove
- complete mole

245

Can choriocarcinoma develop from incomplete mole?

no

246

Prevention of aborption in when with antiphsophlipid antibodies and previous pregnancy problems

Low dose ASA and heparin

247

How do you treat TB in a pregnant patient

same treatment

248

Drug to avoid if need to treat pregnant patient for TB

streptomycin

249

Streptomycin given during preganancy risks causing ____ and ____ in the fetus

- deafness
- nephrotoxicity

250

Fetal defect caused by thalidomide

phocomelia

251

Fetal defect caused by tetracycline

yellow/brown teeth

252

Fetal defect caused by aminoglycoside

deafness

253

Fetal defect caused by valproic acid

- spina bifida
- hypospadias

254

Fetal defect caused by progestersone

masculinization of females

255

Fetal defect caused by cigarettes

- IUGR
- low birth weight
- prematurity

256

Fetal defect caused by birth control pills

VACTRERL syndrome:
- veterbral
- anal
- cardiac
- tracheal
- esophageal
- renal and
- limb malformations

257

Fetal defect caused by llithium

Ebstein anomalies (atrialization of right ventricle)

258

Fetal defect caused by aminopterin

- IUGR
- CNS defects
- cleft lip/palate

259

Fetal defect caused by radiation

- IUGR
- CNS/face defects
- leukemia

260

Fetal defect caused by phenytoine (diphenyhydantoin)

- craniofacial defects
- limb defects
- mental retardation
- cardiac defects

261

Fetal defect caused by trimethadione

- craniofacial defects
- cardiovascular defects
- mental retardation

262

Fetal defect caused by warfarin

- craniofacial defects
- CNS defects
- IUGR
- stillbirth

263

Fetal defect caused by carbamazepine

- fingernail hypoplasia
- craniofacial defets

264

Fetal defect caused by isotretinoin

- CNS defects
- craniofacial/ear defects
- cardiovascular defects

265

Fetal abnormalities caused by iodine

- goiter
- cretinism

266

Fetal abnormalities caused by cocaine

- cerebral infarcts
- mental retardation

267

Fetal abnormalities caused by diazepam

- clef lip/palate

268

Fetal abnormalities caused by diethylstilbestrol

- clear cell vaginal cancer
- adenosis
- cervical incompetence

269

Is acetaminophen safe in preganancy?

Yes

270

Is penicillin safe in preganancy?

Yes

271

Is cepahlosporins safe in preganancy?

Yes

272

Is erythromycin safe in preganancy?

Yes

273

Is nitrofurantoin safe in preganancy?

Yes

274

Is H2-blocker safe in preganancy?

Yes

275

Is antacid safe in preganancy?

Yes

276

Is heparin safe in preganancy?

Yes

277

Is hydralazine safe in preganancy?

Yes

278

Is methyldopa safe in preganancy?

Yes

279

Is labetalol safe in preganancy?

Yes

280

Is insulin safe in pregnancy?

yes

281

Is docusate safe in pregnancy?

yes

282

3 important features of PID

- abdominal pain
- adnexal tenderness
- cervical motion tenderness

283

4 supporting features of PID

- elevated ESR
- leukocytosis
- fever
- purulent cervical discharge

284

3 biggest organisms in PID

- Neiseria gonorrhoeae
- Chlamydia
- e coli

285

Organism causing PID in patient with IUD

actinomyces israeli

286

Most common preventable cause of infertility

PID

287

Likely cause of infertility in woman under 30 with regular menstrual cycles

PID

288

Treatment of PID

* more than 1 abx
- oupt: ceftriaxone/doxycycline
- Inpt: clinda/gent

289

Unusual feature of tubo-ovarian abscess

may resolve with antibiotics alone

290

Vaginal discharge like cottage chees

candida

291

Vaginal discharge with pseudohypahe on KOH

candida

292

Vaginal discharge with history of diabetes

candida

293

Vaginal discharge with history of antibiotic treatment

candida

294

Vaginal discharge with during pregancy

candida

295

Treatment of candidal vaginitis

oral or topical antifungal

296

Vaginal discharge with organisms seen swimming under microscope

trichomonas

297

Vaginal discharge that is pale green, frothy, watery

trichomonas

298

Vaginal discharge with strawberry cervix

trichomonas

299

Treatment of trichomonas

metronidazole

300

Vaginal discharge with fishy smell on KOH prep

Gardnerella

301

Vaginal discharge with clue cells

Gardnerella

302

Vaginal discharge that is malodorous

Gardnerella

303

Treatment of Gardnerella

Metronidazole

304

Venereal warts are caused by

human papillomavirus

305

Koilocytosis on pap smear =

human papillomavirus venereal warts

306

Multiple shallow painful vaginal ulcers =

herpes

307

Treatment of vaginal herpes

acyclovir, valacyclovir

308

Most common sexually transmitted disease

Chlamydia

309

STD that often causes dysuria

Chlamydia

310

Treatment of chlamydia

- doxycycline
- azithromycin

311

One time oral treamtment option for chlamydia

- 1 gram of azithromycin

312

Treatment of chlamydia in pregnant patient

erythromycin or amoxicillin

313

STD for mucopurulent cervicitis

Neisseria gonorhoeae

314

Gram negative STD

Neisseria gonorhoeae

315

Treatment of Neisseria gonorhoeae

- ceftriaxone
- cipro

316

STD with intracellular inclusions

molluscum

317

Treatment of pediculosis

(crabs)
- permethrin cream

318

If a patient has gonorrhea, what should you also treat for?

chlamydia

319

Typical treatment for fonorrhea

ceftraizone and doxycycline (assume also chlaymdia infection)

320

STDs where the partner does NOT need to be treated

candida, Gardnerella

321

Test to do in primary amenorrhea

- if basic overview normal, administer progesterone; if no bleeding, likely no estrogen or anatomic abnormality

322

If patient with primary amenorrhea bleeds with progesterone test, this means

- estrogen is present
- normal uterus

323

If patient with primary amenorrhea has normal breasts but no pubic/axillary hair, likely

androgen insensitvity syndrome

324

Features of androgen insensitivity syndrome

- phenotypically female
- no uterus
- genetically XY

325

Secondary amenorrhea with + progesterine challenge and HIGH leutinizing hormone

polycystic ovarian syndrome

326

In polycystic ovarian sydrome, LH is

high

327

Ddx for secondary amenorrhea with + progesterine challenge and LOW leutinizing hormone

- pituitary adenoma
- hypothyroidism
- low gonadotropin hormone

328

Causes of low gonadotropin hormone

- drugs
- stress
- exercise
- anorexia nervosa

329

Test to check is patient has secondary amenorrhea that you think is from pituitary adenoma

prolactin

330

Patient with secondary amenorrhea with normal prolactin, normal TSH and low gonadotropin likely has

anorexia nervosa

331

A patient with secondary amenorrhea with + progesterone bleeding test can likey become pregnant by using which drug?

clomiphene

332

Secondary amenorrhea with no bleeding on progesterine challenge has (generally)

insuffecient estrogen

333

Secondary amenorrhea with no bleeding on progesterine challenge with elevated FSH has

premature ovarian failure/menopause

334

FSH is _____ in premature ovarian failure

elevated

335

Secondary amenorrhea with no bleeding on progesterine challenge with low/normal FSH may have

neoplasm of hypothalamus (get MRI of brain)

336

First test to order in amenorrhea

pregnancy test

337

Nulliparous 35 yr woman with dyspareunia and dyschezia

endometriosis

338

Most common site for endometriosis

- ovaries

339

Tender adnexa WITHOUT evidence of PID =

endometriosis

340

Endometriosis may be associated with this uterine position

retroverted

341

Gold standard for diagnosis of endometriosis

laparoscopy with visualization

342

Mulberry spots

endometriosis

343

flat brown colored powder burns

endometriosis

344

chocolate cysts

endometriosis

345

Most likely cause of infertility in menstruating woman over 30

endometreosis

346

Treatment of endometriosis

1st: birth control pills
2nd/3rd: danzol, GnRH agonists

347

Effect of surgery for endometriosis on fertility

often improves it

348

Define adenomyosis

ectopic endometrial glands within uterine musculature

349

Typical characteristics of adenomyosis

- over 40
- dysmenorrhea
- large boggy uterus

350

Woman over 40 with large boggy uterus and dymenorrhea

adeomyosis

351

Treatment of adenomyosis

- D&C to r/u endometrial cancer
- consider hysterectomy
- may try GnRH agonists

352

Define dysfunctional uterine bleeding

abnormal uterine bleeding not associated with tumor inflammation or pregnancy

353

70% of dysfunctional uterine bleeding is associated with

anovulatory cycles

354

When is dysfunction uterine bleeding common and physiologic?

Right are menarche and before menopause

355

If dysfunctional uterine bleeding that doesn't appear simple, think

polycystic ovarian syndrome

356

What needs to be done in woman over 35 with dysfunctional uterine bleeding?

D&C to r/o endometrial cancer

357

Why should you get a CBC in patient with polycystic ovarian syndrome?

excess blood loss

358

4 uncommon causes of dysfunctional uterine bleeding

- infections
- endocrine disorders
- coagulation defects
- estrogen producing neoplasms

359

First line treatment for idiopathic dysfunctional uterine bleeding

NSAIDs or OCPs

360

First line treatment for dysmenorrhea

NSAIDs

361

Treatment of severe bleeding with dysfunctional uterine bleeding

progesterone

362

Overweight woman with infertility and amenorrhea

polycystic ovarian syndrome

363

Most common cause of infertility in woman under 30 with ABnormal menstruation

polycystic ovarian syndrome

364

LH:FSH in polycystic ovarian syndrome

greater than 2:1

365

Cancer risk in polycystic ovarian syndome

unopposed estrogen causes increased risk for endometrial hyperplasia and enodmetrial carcinoma

366

Treatment of polycystic ovarian syndrome

- OPCs
- cyclic progesterone
- if wants pregnancy, use clomiphene

367

Treatment of premenstrual dysphoric disorder

NSAIDs; antidepressants

368

Average age of menopause

50

369

Increase parabasal cells on vaginal cytology indicates

menopause

370

Fibroids aka

leimyoma

371

Are leiomyomas malignant or benign?

benign

372

Most common indication for hysterectomy

leiomyoma

373

Rate of malignant transformation of leimyoma

<1%

374

When do leiomyomas often grow rapidly?

During pregnancy or high estrogen (OCPs)

375

Anemia with fibroids is an indication for

hysterectomy

376

Test that should be done in woman over 40 with leiomyoma

D&C to r/o endometrial cancer

377

Polyp protruding through cervix is likely

leiomyoma

378

4 non-cancerous causes of breast discharge

- birth control pills
- hormone therapies
- antipsychotic medications
- hypothyroidism

379

If a patient has bilateral non-bloody breast discharge, what are the chances that it's cancer?

very low

380

Unilateral breast discharge is concerning for

cancer

381

Most common breast disorder

fibrocystic disease

382

Treatment of fibrocystic breast disease if under 35

if symptoms are very severe can do progesterone or danazol for a week at the end of each month

383

Features of fibrocystic breast disease

- under 35
- bilateral
- multiple cystic lesions
- tender

384

A painless, shaprly circumscribed, rubbery, mobile breast mass is likely

fibroadenoma

385

Most common benign tumor of the female breast

fibroadenoma

386

Age when you become more concerned about breast cancer

35

387

Treatment of fibroadenoma of the breast

excision is curative but often not needed

388

Fibroadenoma of the breast often growns quickly in the setting of

OCPs or pregnancy (estrogen)

389

Is mammogram useful under the age of 35?

No. Breast tissue too dense. Proceed directly to biopsy

390

Approach to fibrocystic breast disease in woman over 35

- aspirate fluid
- baseline mammogram
* if fluid is bloody or cyst recurrs, do biopsy

391

This potentially malignant tumor often masquerades as a rapidly growing fibroadenoma of the breast

phylloides tumor

392

Treatment of fibroadenoma of the breast if over 35

- baseline mammogram
- can observe if very low risk, but low threshold for biopsy

393

In a woman over 35 with a breast mass, when in doubt...

get a biopsy

394

A new breast mass in a postmenopausal woman...

is breast cancer until proven otherwise

395

Pelvic heaviness that is worse with standing and improves with lying down may be

vaginal prolapse

396

A bulge into the upper vaginal wall is likely

a cystocele

397

Symptoms of cystocele

urianry urgency, frequency and incontinence

398

A bulge into the lower posterior vaginal wall is likely

a rectocele

399

Symptoms of rectocele

difficultly defecating

400

What is an enterocele

bulding of loops of bowel into upper posterior vaginal wall

401

Treatment of -celes (cystocele, etc)

- pelvic strengthening
- pessary
- surgery

402

Male/female ratio for "problem source" in infertility

- male 1/3
- female 2/3

403

1st step in eval of infertility (after based H&P)

semen anlysis

404

Risk factor for uterine synechiae

D&C

405

What radiographic test do you order to look for uterine structural abnormalities?

hysterosalpingogram

406

Clomiphene can be used to stimulate ovulation in what setting

need adequate estrogen