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from flashcardlet > OBGYN UWorld > Flashcards

OBGYN UWorld Flashcards

0
Q

What are early decelerations caused by?

A
  • fetal head compression

- not nonreassuring

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1
Q

What is the tx of HELLP in a woman >34 wks?

A

-immediate delivery!

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2
Q

Pseudocyesis?

A
  • psychiatric condition
  • woman presents w/ all the ssx of pregnancy, but ultrasound shows normal endometrial stripe and negative pregnancy test
  • form of conversion disorder
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3
Q

Missed abortion?

A
  • ultrasound shows intrauterine collapsed gestational sac + absent fetal cardiac activity
  • office pregnancy test will be positive
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4
Q

Tx of small HPV lesions?

A
  • trichloroacetic acid
  • podophyllin
    • both tx are in office tx
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5
Q

Tx of larger HPV lesions?

A
  1. Excision

2. Fulguration (electric current)

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6
Q

Tx for gonorrhea?

A
  • ceftriaxone

- plus tx for co-infection with chlamydia with azithromycin or doxycyline

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7
Q

What beta hCG levek is necessary to view gestation sac with transabdominal US? Transvaginal US?

A
  • transabdominal = > 6,500

- transvaginal = > 1,500

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8
Q

What rate of change of beta hCG is considered normal for a normal pregnancy?

A
  • doubling every 48 hours

- slower rise = ectopic pregnancy

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9
Q

After what point is a breech presentation probably not going to change?

A
  • > 37 wks
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10
Q

Major sfx of raloxifene?

A

-increased risk for venous thromboembolism

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11
Q

Raloxifene: MOA? Use?

A
  • selective estrogen receptor modulator
  • increases bone mineral density
  • use = prevent osteoporosis
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12
Q

Lower pain that radiates to the thighs and back that begins hours before menstruation?

A
  • primary dysmenorrhea

- believed to be caused by an increased release prostaglandins during the breakdown of the endometrium

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13
Q

Pregnant women and the influenza vaccine?

A

-CDC recommends that ALL pregnant women are vacinated!

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14
Q

Tx of syphilis?

A

-penicillin V, even in an allergic pt! (Desensitize and give it to them! )

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15
Q

What increases the risk for cervical insufficiency?

A
  1. Maternal obstetrical trauma
  2. Past GYN procedures, including LEEP or cone bx
  3. DES exposure
  4. Multiple gestation
  5. Hx of preterm birth or second trimester pregnancy loss
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16
Q

Short cervix?

A

-cervix that is below the 10th percentile for gestational age

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17
Q

What BPP suggests severe fetal asphyxia? Tx?

A
  • biophysical profile score of 2 or less

- tx: immediate delivery

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18
Q

What 5 things make up the BPP?

A
  1. Nonstress test (reactive)
  2. Fetal tone (flexion or extension of an extremity)
  3. Fetal mvmnts (at least 2 in 30 min)
  4. Fetal breathing mvmnts (at least 20 sec in 30 min)
  5. Amniotic fluid volume (single pocket greater than 2 cm in vertical axis)
    - each get a score of 0-2
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19
Q

Adipose tissue and estrogen?

A

-adrenal androgens get converted into estrogens by the adipose tissue

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20
Q

Cause of hypotension with epidural anesthesia?

A
  • blood redistributes to lower extremities and venous pooling occurs
  • due to fiber block that results in vasodilation of lower extremity vessels
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21
Q

What is the best test for fetal chromosomal abnormalities in the first trimester?

A

-chorionic villius sampling

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22
Q

When is chorionic villus sampling typically done? Why?

A
  • usually done btwn 10-12 wks

- when done before 9 wks there is a greater risk of distal limb reduction defects

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23
Q

2 Major complications of chorionic villus sampling?

A
  1. Limb reduction defects

2. Fetal death

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24
Q

Intrauterine fetal demise?

A

-death of fetus in utero after 20 wks gestation

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25
Q

What should be done after the dx of IUFD? Why?

A
  • Coagulation studies
  • to detect DIC
  • retention of dead fetus can cause chronic consumptive coagulopathy due to the gradual release of tissue factor from placenta into maternal circulation
  • low levels of fibrinogen can be an early sign of consumptive coagulopathy –> tx = delivery!!
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26
Q

Tx of chorioamnionitis associated with PPROM?

A

-broad-spectrum antibiotic tx + delivery of fetus!

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27
Q

2 causes of HTN in < 20 wks gestation?

A
  1. Chronic HTN

2. Hydatidiform mole

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28
Q

What is the most common risk for placental abruption?

A

-HTN

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29
Q

What should be ruled out in any woman of child bearing age with secondary amenorrhea?

A

-PREGNANCY!!

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30
Q

Tx of BV?

A

-oral metronidazole (in both pregnant and nonpregnant women)

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31
Q

Threatened abortion?

A
  • any hemorrhage that occurs before 20th week of gestation w/ a live fetus
  • cervix is closed
  • no passage of fetal tissue
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32
Q

Tx for threatened abortion?

A
  • reassurance and outpt follow up

- bed rest and abstaining from sexual intercourse is also often reccommended

33
Q

Mittelschmerz?

A
  • midcycle pain
  • common w/ regular menstrual periods in women who are not taking birth control pills (ie ovulating women)
  • pain is the result of ovulation
  • pain occurs 2 wks after the start of the LMP
  • usually unilateral pain (on the side of the ovary that produced the ovum)
34
Q

Classic clinical triad for hydatidiform mole?

A
  1. Enlarged uterus
  2. Hyperemesis
  3. Markedly elevated beta hCG (>100,000)
35
Q

Gold standard for dx of endometriosis?

A

-laparoscopy

36
Q

What are women with endometriosis at increased risk for?

A

-infertility or decreased fertility

37
Q

What is the classic triad for uterine fibroids?

A
  1. Dysmenorrhea
  2. Heavy menses
  3. Enlarged uetrus
38
Q

What is the cause of variable decelerations on fetal heart tracings?

A

-umbilical cord compression

39
Q

What is the cause of late decelerations on fetal heart tracings?

A

-uteroplacental insufficiency –> fetal hypoxia –>fetal acidosis

40
Q

What is a primary risk factor for adnexal torsion?

A

-ovarian enlargement

41
Q

What should be done if atypical squamous cells of undetermined significance are found on cytology in a woman: 21-24 yo? > 25?

A
  • 21-24 = repeat cytology in 1 yr

- > 25 = HPV DNA test –> if positive = do colposcopy

42
Q

What is the most common cause of mucopurulent cervicitis?

A

-Chlamydia trachomatis

43
Q

Presentation of androgen resistance?

A
  • Primary amenorrhea
  • normally developed breasts
  • absent pubic hair
  • absent axillary hair
  • absent internal reproductive organs –> dont develop bc testes are still present and secrete mullerian inhibiting factor
  • 46 XY karyotype
  • serum testosterone levels (high, in the range for normal males)
44
Q

What heart defect commonly presents during pregnancy? What is it often due to?

A
  • mitral stenosis –> bc physiologically increased total blood volume
  • due to rheumatic fever in the past, seen esp in pts from countries with limited antibiotic access
45
Q

What is the most common cervical cytological abnormality?

A

-atypical squamous cells of undetermined significance (ASC-US)

46
Q

What is the work-up for atypical squamous cells of undermined significance when they are found on pap smear in ages 21-24?

A
  • HPV testing
  • positive = do colposcopy
  • negative = repeat smear AND HPV testing in 3 yrs
47
Q

How do pts with androgen resistance present?

A
  1. Amenorrhea
  2. Normally developed breasts
  3. Absent pubic & axillary hair
  4. Absent internal reproductive organs –> testes are present and secrete mullerian inhibiting factor
  5. 46 XY karyotype
48
Q

What is the best parameter to use to estimate the fetal weight?

A

-abdominal circumference

49
Q

What is the single most prevalent preventable cause of FGF in the US?

A

-smoking cessation!

50
Q

In an eclamptic patient who just had a seizure what is the next step in tx?

A

-administer mag, then deliver baby

51
Q

2 Recommended tx options for stress incontinence?

A
  1. Kegel exercises

2. Urethroplexy

52
Q

What are the 2 first-line agents for tx of HTN in pregnant women?

A
  1. Labetalol

2. Methyldopa

53
Q

What is the best way to dx primary syphilis?

A

-dark field microscopy!

54
Q

FSH & LH levels in anovulation?

A

-will be normal

55
Q

What is the best screening test for hemoglobinopathies in pregnancy?

A
  • CBC of the mother

- if abnormal, further testing is required (ex MCV)

56
Q

Tx of mastitis?

A
  1. Analgesics
  2. Frequent breastfeeding
  3. Antibiotics (that target staph aureus)
57
Q

At what levels of beta HCG can a pregnancy be seen via transvaginal US in the uterus?

A

-1,500-2,000

58
Q

What does DES increase the risk of?

A
  • clear cell adenocarcinoma of the vagina and cervix in the female offspring if the mother took the drug during pregnancy
  • also at risk for cervical anomalies and uterine malformations
59
Q

What are the 2 main causes of back pain in 3rd trimester of pregnancy?

A
  1. Increase in lumbar lordosis

2. Relaxation of the ligaments that support the joints of the pelvic girdle

60
Q

What is the reason for anovulation and amenorrhea in lActating mothers?

A

-high levels of prolactin, which has an inhibitory effect on FSH and LH

61
Q

Most common cause of postpartum hemorrhage?

A

-uterine atony

62
Q

Describe cervical mucus during ovulation and post and pre?

A
  • during = profuse, clear, thin

- post & pre = scant, opaque, thick

63
Q

Painful 3rd trimester bleeding w/ normal US?

A

-think: placental abruption

64
Q

What is the management for intrahepatic cholestasis of pregnancy? Prognosis?

A
  • delivery baby as soon as there is fetal lung maturity
  • maternal prognosis = good, resolves shortly after delivery
  • baby = risk of prematurity, meconium-stained amniotic fluid, and IUFD
65
Q

What is one situation when solid ovarian tumors do not need aggressive evaluation and tx?

A

-in pregnancy! = luteoma of pregnancy

66
Q

Luteoma of pregnancy?

A
  • usually bilateral, multinodular, solid masses on both ovaries that can occur during pregnancy
  • the result of proliferation of luteinized stromal cells in response to beta HCG
  • most commonly seen in multiparous african american women in their 30s or 40s
  • can be asymptomatic, or cause hirsutism/virilization
67
Q

3 Steps to working up primary amenorrhea?

A
  1. FSH measurement if there is no breast development
  2. Pit MRI if FSH is decreased
  3. Karyotyping if FSH is increased
68
Q

What about nausea in pregnancy can make you suspect a missed abortion?

A

-suspect missed abortion when there is a disappearance of nausea/vomiting early in pregnancy

69
Q

What is a reactive NST?

A
  • when there are 2 fetal heart rate accelerations of at least 15 bpm lasting at least 15 sec each in 20min
  • reactive = normal!
70
Q

What should be done if there is a nonreactive NST?

A
  • try vigorously to stimulate/wake the baby

- if still not retactive, do a biophysical profile

71
Q

What should be done if there are repetitive late decelerations?

A

-emergent c-section!

72
Q

Tx for mag toxicity?

A

-stop the mag and give calcium gluconate IV

73
Q

What is a normal biophysical profile score? What should be done for a normal result?

A
  • normal = 8-10

- if normal, repeat once or twice weekly until term for high risk pregnancies

74
Q

What is the tx of choice for trich?

A

-metronidazole

75
Q

What should be avoided when taking metronidazole? Why?

A
  • alcohol should be avoided

- bc can cause a disulfram-like rxn = flushing, nausea, vomiting, & hypotension

76
Q

What are the 3 red flags for nipple discharge?

A
  1. Unilateral
  2. Guaiac positive
  3. Breast lump
77
Q

What are the 2 lab tests that should be done in the workup for galactorrhea?

A
  1. TSH level

2. Prolactin level

78
Q

What is e most common cause of an abnormal alpha-fetoprotein level?

A

-gestational age error

79
Q

What are the 9 causes of abnormal uterine bleeding in nonpregnant women?

A
  1. Polyp (endometrial)
  2. Adenomyosis
  3. Leiomyoma (submucosal & other)
  4. Malignancy & hyperplasia
  5. Coagulopathy
  6. Ovulatory dysfunction
  7. Endometrial (ex. Infection or inflammation)
  8. Iatrogenic (ex. Anticoagulants)
  9. Not yet classified
    * *PALM COEIN
80
Q

What L/S ratio should steroids be given at?

A

-less than 2

81
Q

4 lab test that should be done with amenorrhea?

A
  1. Pregnancy test
  2. FSH = to r/o ovarian failure
  3. Prolactin = evaluate for hyperprolactinemia
  4. TSH = evaluate for hyper/hypoTH

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