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ICM II > OB-GYN > Flashcards

OB-GYN Flashcards

1
Q

How is enlargement of the uterus achieved during pregnancy?

  • Where does most growth occur?
  • What other changes occur in the wall?
A
  • Enlargement by Hypertrophy
    • most in the fundus
  • Other changes
    • Increased size and number of vessels
    • Hypertrophy of nerves
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2
Q

Which way does the uterus rotate during pregnancy?

A

To the right

(Dextrorotation)

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3
Q

What is a change in contractility of the uterus that does not result in cervical dilation?

A

Braxton Hicks contractions

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4
Q

What changes occur in the cervix?

A
  • Hypertrophy and hyperplasia of glands
    • mucous plug
  • Increased vascularity
  • Edema
  • Increased mechanical strength
    • so it can stretchand not get ripped apart!!
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5
Q

What is the function of the corpus luteum? When does it function maximally? What takes over its role when it ceases to function?

A
  • Function
    • secrete progesterone
  • Time frame
    • 6-7 weeks
  • Placenta takes over
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6
Q

What is a luteoma? What can it cause?

A

Solid ovarian tumor of pregnancy

  • Effect:
    • virilization of mother
    • (not of female fetus)
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7
Q

What is a Hyperreactio Luteinalis? What does it secrete? What does it cause?

A

Cystic ovarian tumor of pregnancy

  • Secretes hCG
  • SE:
    • virilization
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8
Q

What is Chadwicks sign?

A

Violet vagina

  • Cause:
    • increased vascularity during pregnancy
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9
Q

How does colostrum benefit the fetus?

A

Provides passive immunity

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10
Q

What causes “vascular spiders” and palmar erythema during pregnancy?

A

Increased estrogen

  • Increased blood flow throughout the body
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11
Q

What is the most important factor in determining degree of striae gravidarum?

A

Genetics!

  • Striae gravidarum = stretch marks
  • Not a weight gain issue
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12
Q

What is the additional RDA of calories for pregnant women?

A

300 kcal/day

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13
Q

What common GI issues are experienced during pregnancy?

A
  1. Morning sickness
  2. Acid reflux
    • decreased sphincter tone
    • Increased time in stomach
  3. Constipation
    • Decreased bowel motility
  4. Gall stone production
    • Increased bile production
    • Decreased emptying
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14
Q

What is hyperemesis gravidarum? What are the physiological consequences?

A

Severe morning sickness

  • Weight loss
  • Ketonemia
  • Electrolyte imbalance
  • Dehydration
  • Liver/Kidney damage
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15
Q

What common upper respiratory tract conditions occur during pregnancy?

A
  1. Stuffiness
    • Hypersecretion
  2. Epistaxis
  3. Polyp
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16
Q

How does Expiratory Reserve Volume (ERV) change during pregnancy?

A

Decreases

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17
Q

How does Functional residual capacity change during pregnancy?

A

Decreases

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18
Q

How does Inspiratory Reserve Volume (IRV) change during pregnancy?

A

It stays the same

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19
Q

How does Reserve Volume (RV) change during pregnancy?

A

Decreases

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20
Q

How does Respiratory Rate (RR) change during pregnancy?

A

It stays the same

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21
Q

How does VItal Capacity change during pregnancy?

A

It stays the same

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22
Q

How does Total Lung Capacity (TLC) change during pregnancy?

A

Decreases

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23
Q

How does minute ventilation change during pregnancy? What is the result?

A
  • Minute ventilation Increases
  • Result:
    • increased alveolar and arterial Pa O2
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24
Q

How does PaCO2 levels change during pregnancy? What is the result?

A
  • PaCO2 levels decrease
  • Result:
    • increased gradient between mom and fetus
    • facilitates transfer from fetus
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25
Q

How does the mother’s body compensate for decreased CO2 levels? What is the result?

A
  • Compensation:
    • Increased renal excretion of bicarb
  • Result
    • No change in pH
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26
Q

What is believed to cause feelings of dyspnea during pregnancy?

A

Increased tidal volume that lowers PCO2

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27
Q

What is normal weight gain for each of the trimesters?

A
  • First
    • 2 lbs
  • Second / Third
    • 11-14 lbs each
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28
Q

What causes pitting edema of the feet during pregnancy?

A

Decrease in interstitial colloid osmotic pressure

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29
Q

How does carb metabolism change during pregnancy? What is the result?

A
  • Metabolism:
    • mild fasting hypoglycemia
    • Postprandial hyperglycemia
    • Hyperinsulinemia
    • Peripheral resistance to insulin
  • Result:
    • Gives baby first dibs on glucose
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30
Q

How do blood volume and hematocrit change during pregnancy? What is the result?

A
  • Changes
    • Increased erythrocytes / reticulocytes
    • Increased plasma (more than erythrocytes)
  • Result:
    • Physiologic anemia
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31
Q

What is the iron requirement for normal pregnancy?

A

1 gram/day

  • Uses
    • Goes to fetus/placenta
    • Increase # RBCs
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32
Q

How do immunologic functions change during pregnancy? What is the result?

A
  1. Decreased functioning
  2. Increased leukocytes
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33
Q

How do levels of clotting factors change during pregnancy? What is the result?

A
  • Changes
    • Increased:
      • Fibrinogen
      • Factors VII, VIII, IX, X
    • Decreased:
      • Platelets
  • Result:
    • Decreased PT and PTT but still w/i normal limits
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34
Q

How do pulse, Stroke volume, and CO change during pregnancy?

A

All increase!

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35
Q

How do heart sounds change during pregnancy?

A
  • Exaggerated splitting of S1
  • Systolic murmur
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36
Q

How does BP change during pregnancy? How does it change in different body positions and why?

A
  • During pregnancy:
    • Decreases in 2nd tri
  • Body positions
    • Highest when sitting
    • Lowest when lying on left side
      • Uterus not compressing IVC
    • Intermediate when standing
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37
Q

How does kidney function change during pregnancy?

A
  • Increased flow
  • Increased GFR
    • decreased creatinine and urea
    • Glucosuria
    • Proteinuria is NOT normal!!!
      • at least 300 mg in 24 hours
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38
Q

Why are pregnant women more likely to get a UTI?

A
  • Dextrorotation puts pressure on ureter (esp. right side)
  • Increased length and pressure
  • Increased likeliness of infxn
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39
Q

What pituitary hormone is significantly increased during pregnancy? What is its function?

A

Prolactin

  • Function: lactation
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40
Q

What risk is present to the fetus of a woman with Graves Disease?

A

Thyrotoxicosis

  • Long-acting thyroid stimulator (LATS) may cross placenta
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41
Q

What is the result of the physiologic hyperparathyroidism found in pregnancy?

A

Supply fetus with calcium

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42
Q

What adrenal hormones increase during pregnancy? What are their functions?

A
  • Cortisol
    • Bound to transcortin, so no effect
  • Aldosterone
    • Counters natriuretic effect of progesterone
  • Adrostenedione and Testosterone
    • converted to estradiol in placenta
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43
Q

What is a Blastocyst?

A

Fluid filled ball of cells

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44
Q

What is a zygote?

A

Fertilized egg

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45
Q

What is a Fetus?

A

Conceptus after 7 weeks

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46
Q

What is a Morula?

A

Solid ball of 16 cells

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47
Q

What is an embryo?

A

Conceptus that forms from the inner cell mass

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48
Q

What is a blastomere?

A

Conceptus after the first cell division

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49
Q

When does a blastocyst implant into the endometrium?

A

Day 21 of cycle

(normally first day of period)

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50
Q

What cell types are present in blastocysts? Which are the progenitor cells?

A
  • Cytotrophoblasts
    • progenitor
    • Location: next to embryonic side
  • Syncytiotrophoblasts
    • Contiguous with decidua at first
    • Later form villi
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51
Q

What are the two placental membranes?

A
  • Chorion
    • outer cell layer
  • Amnion
    • forms delamination of cytotrophoblast or
    • extention of fetal ectoderm
    • Located on fetal side
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52
Q

When is hCG detectable in the serum? By what cells is it produced?

A
  • Detectable w/i 24 hours of implantation
  • Produced by syncytioblasts
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53
Q

What can cause abnormally high hCG levels?

A
  1. Twins
  2. Hydatidiform moles
  3. Choriocarcinoma
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54
Q

What are the functions of hCG?

A
  • Promotes ovulation
  • Maintain corpus luteum in early pregnancy
  • Promotes testosterone synthesis in fetal testis
    • male sexual differentiation
    • (LH surrogate)
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55
Q

When does morning sickness usually occur?

A

6-12 weeks

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56
Q

What are the most common causes of uterine bleeding during the first trimester?

A
  1. Spontaneous abortion
  2. Ectopic pregnancy
  3. Gestational Trophoblastic Disease
    • aka Molar Pregnancy
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57
Q

Describe the following types of spontaneous abortion:

  • Threatened
  • Incomplete
  • Missed
A
  • Threatened
    • bleeding but no passage of tissue
  • Incomplete
    • Bleeding with passage of tissue
  • Missed
    • No symptoms but ultrasound shows no evidence of viable pregnancy
58
Q

What are the symptoms of spontaneous abortion?

A
  • Bleeding
  • Cramping
    • pain is bilateral
    • Unilateral = more likely to be ectopic pregnancy
  • No fetal heart sounds
59
Q

What is the difference in treatment of spontaneous abortion if the woman is less than 8 weeks compared to over 8 weeks pregnant?

A
  • Less than 8 wks
    • More likely to allow absorption / spontaneous passage
  • Over 8 wks
    • D & C
    • Stimulate contractions
60
Q

Ectopic Pregnancy

  • Symptoms
  • Diagnosis
  • Treatment
A
  • Symptoms
    • Bleeding
    • Cramping (unilateral)
  • Diagnosis
    • hCG >1500
    • Empty uterus on Transvaginal ultrasound
  • Treatment
    • Methotrexate (kill dividing cells)
    • Surgery
61
Q

What is the most common site of ectopic pregnancy?

A

Ampulla

62
Q

What is the main cell type of a molar pregnancy?

A

Placental trophoblast

63
Q

What hCG level is associated with the following:

  • Ectopic pregnancy:
  • Gestational Trophoblastic Disease (Molar pregnancy)
A
  • Ectopic pregnancy: > 1500
  • Molar pregnancy: > 100,000
64
Q

What is seen on ultrasound that results in the diagnosis of a molar pregnancy?

A

“snowstorm” or “Swiss Cheese”

65
Q

What immunoglobulin class is associated with fetal complications in isoimmunization? Why? What results?

A
  • Immunoglobulin: IgG
  • Why?
    • can cross placenta
  • Result
    • Hemolysis of fetal RBCs
    • Severe anemia
    • Hydrops Fetalis (end stage)
66
Q

At what level antibody titer should you worry isoimmunization and fetal complications? What else can you check?

A
  • Ab titer:
    • follow until > 1:32
  • Also check fetal MCA flow via ultrasound
67
Q

What is the treatment for fetal anemia arising due to isoimmunization?

A
  • Immature fetus
    • PUBS infusion
  • Mature
    • Delivery
68
Q

What are the causes of 2nd trimester abortions?

A
  1. Intrauterine fetal demise (IUFD)
  2. Abruptio Placenta
  3. Placenta Previa
  4. Intrauterine Infxn
69
Q

Incompetent Cervix / Premature Dilation

  • Symptoms
  • History
  • Treatment
A
  • Symptoms
    • Feeling of a significant change in pressure
    • Discharge
  • History
    • Prior 2nd trimester pregnancy loss
  • Treatment
    • Cerciage = put stitch around cervix to prevent opening until baby is ready to be born
70
Q

What are some causes of a uterus that is small for gestational age (SGA)?

A
  • Incorrect dates
  • Chromosomal abnormality of fetus
  • Chronic illness (mom)
  • Smoking
  • Preterm Premature rupture of membranes
71
Q

What are some causes of a uterus that is large for gestational age (LGA)?

A
  • Incorrect dates
  • Multiple gestation
  • Molar pregnancy
  • Polyhydramnios
  • Maternal diabetes
72
Q

When is appropriate to do a vaginal exam to determine cause of 3rd trimester bleeding?

A

When Placenta Previa has been excluded!

73
Q

What are the most common causes of bleeding in the 3rd trimester?

A
  • Placenta Previa
    • Painless bleeding
    • Placenta covers cervical os
    • Do not do a vaginal exam until this is excluded!!!
  • Placenta Abrupta
    • Painful bleeding
    • Premature separation of placenta
    • Associated with DIC
74
Q

How will a baby be delivered following placenta previa?

A

C section

75
Q

What characterizes premature labor?

A

Contractions and cervical dilation < 36 weeks

76
Q

Why are NSAIDS only given to treat tocolysis if the fetus is less than 32 weeks?

A

If given after 32 weeks, premature closure of ductus arteriosus

77
Q

How is PPROM diagnosed?

A
  • Rupture of membranes < 36 wks
  • Dx:
    • History of leading fluid
    • Sterile speculum
      • Fern test: NaCl crystalizes on proteins
      • Sample fluid from vagina
      • Fern appearance if amniotic fluid is present
    • Ultrasound
      • Fluid volume
      • Fetal growth / position
78
Q

When are steroids given in the treatment of PPROM? Why?

A
  • Given if fetus < 35 wks
  • Purpose
    • Stimulate maturation of fetal lung
    • More surfactant
79
Q

What is the difference between PIH and Preeclampsia?

A
  • Pregnancy Induced HTN (PIH)
    • No proteinuria
  • Preeclampsia
    • Proteinuria
80
Q

What is the pathophysiology of Preeclampsia / Eclampsia?

A
  • Generalized increase in
    • Systemic vascular resistance
    • or
    • Vasoconstriction
81
Q

What is the goal in treatment of HTN in pregnancy?

A

Goal:

  • Make only mildly HTN, NOT normotensive
    • b/c Normotensive would lead to decreased blood flow to baby
82
Q

How long can a placenta can sustain a fetus?

A

42-44 weeks

83
Q

What are the 4 T’s of Postpartum Hemorrhage?

A
  1. Tissue
    • Are there pieces of placenta left behind
  2. Tone
    • Cause uterus to contract in order to stop bleed
      • massage, give meds
  3. Trauma
    • Is there a tear?
  4. Thrombin
    • DIC common
    • Must replace blood products immediately!
84
Q

Endometritis

  • Symptoms
  • Treatment
A
  • Symptoms
    • fever
    • uterine pain
    • foul drainage
  • Treatment
    • broad spectrum Abx
    • (mixed infxn)
85
Q

What is Septic Pelvic Thrombophlebitis?

A

Infected clot (“plegmon”) in veins around the uterus

86
Q

What is the definition of a reactive response to a non-stress test?

A

>2 HR accelerations of 15 bpm in 20 minutes

87
Q

What are some causes of non-reactivity of fetus in a non-stress test?

A
  • Fetal sleep
  • Drugs
  • At risk infant
88
Q

What is the definition of a Reactive/Negative Contraction Stress Test? What is its significance?

A
  • Definition
    • Positive accelerations
    • No decelerations with contractions
  • Significance
    • Positive sign
89
Q

What is the definition of a Negative Contraction Stress Test?

A

No decelerations with contractions

This is a positive sign

90
Q

In what order are fetal functions affected by hypoxia?

A

The reverse of embryogenesis!

  1. NST (non stress test; cerebral function)
    • Should be reactive
  2. Fetal bowel movement (FBM)
  3. Fetal Movements
  4. Fetal tone
91
Q

When is a Biophysical Profile routinely performed? What are the testing parameters?

A
  • Routine
    • Early gestation
      • <34 weeks
    • Multiple gestations
    • HTN
  • Parameters
    • Reactivity in NST
    • AFV (amnionic fluid volume)
    • Gross motor movement
    • Fetal Tone
    • FBM
92
Q

What is observed in FHR monitoring? What is normal?

A
  • Baseline HR
    • 120-160
  • Variability
    • should be present
    • Controlled by SNS/PSNS
  • Periodic changes
    • Should have accelerations
    • No decelerations
    • Controlled by carotid baroreceptors
93
Q

What are some causes of fetal bradycardia?

A
  • Maternal hypotension
    • this can happen with epidural
  • Fetal distress
  • Drugs
  • SLE
  • Congenital heart disease
94
Q

What are some causes of fetal tachycardia?

A
  • Maternal fever
    • Most common!
  • Fetal distress
  • Amnionitis
  • Fetal arrhythmia
  • Thyrotoxicosis
95
Q

What do the presence of accelerations indicate?

A

There is no hypoxia

96
Q

What are the types of decelerations and what do they indicate?

A
  • Early (vagal)
    • Less ominous
    • Occurs with contraction (symmetrical)
  • Variable (barometric, carotids)
    • caused by cord compression
  • Late (Myocardopathy)
    • Ominous
    • occurs after the contraction
97
Q

What is the cause of early decelerations?

A
  • Vagal effect
  • Fetal head compression
98
Q

What is the cause of variable decelerations?

A

Stimulation of carotid baroreceptors

  • Treatment:
    • Position change
    • O2
    • Amnioinfusion
99
Q

What is the cause of late FHR decelerations?

A

Myocardopathy secondary to acidosis

100
Q

What is the most common GYN CA?

A

Adenocarcinoma of the endometrium

101
Q

What are the risk factors of uterine carcinoma? What characteristics are common in patients?

A
  • Risk factors: Unopposed E2!
    • Chronic anovulation (PCOD)
    • Iatrogenic
      • Needs to be paired with progesterone
  • Characteristic pop.
    • Obese
    • HTN
    • Diabetes
102
Q

What is the presenting symptoms of uterine carcinoma?

A

Abnormal Uterine Bleeding

103
Q

What endometrial thickness is a risk factor for uterine carcinoma?

A

Over 4mm in postmenopausal patient

104
Q

When is an adnexal mass most likely neoplasm? What tumor markers are used to evaluate each case?

A
  • Premenarchal
    • Most likely germ cell in origin
    • AFP, hCG markers
  • Postmenarchal
    • ​esp if with ascites
    • Most likely epithelial in origin
    • CA 125 marker
105
Q

What is a clue that an adnexal mass is more likely metastatic?

A

Bilateral

  • Metastasis location
    • Breast
    • Colon
106
Q

What is the leading cause of gyn deaths? When do they normally occur?

A

Ovarian carcinoma

  • Usually postmenopausal
  • Found late
    • vague symptoms
107
Q

What is the most common type of ovarian carcinoma?

A

Epithelial (CA 125)

108
Q

What is the most common cervical carcinoma?

A

Squamous cell

109
Q

What does ASC-US mean? What is the next step in workup?

A

Atypical Cells of Undetermined Significance

  • (Pap result)
  • Presence of atypical cells
  • Workup;
    • High risk HPV screen
    • If positive, treat like LGSIL
    • If negative, treat same as normal
110
Q

What does LGSIL mean? What is the next step in workup?

A

Low Grade Squamous Intraepithelial Lesion

  • (Pap result)
  • Mild Dysplasia
  • Workup:
    • Colposcopy and Bx
111
Q

What does ASC-H mean? What is the next step in workup?

A

Atypical Squamous Cells cannot rule out High grade intraepithelial lesion

  • Pap result
  • Moderate dysplasia
  • Workup:
    • Colposcopy and Bx
112
Q

What does HGSIL mean? What is the next step in workup?

A

High Grade Intraepithelial Lesion

  • Pap result
  • Severe/Marked Dysplasia
  • May have CIS
  • Workup:
    • Colposcopy and Bx
113
Q

What does AGUS mean? What is the next step in workup?

A

Atypical Glandular Cells of Undetermined Significance

  • Pap result
  • In same class as adenocarcinoma in situ
  • Workup:
    • Colposcopy and Bx
114
Q

What is the most common vulvar infection?

A

Condyloma

115
Q

What is the most common Vulvar Carcinoma? What is the most common risk factor?

A
  • Type
    • Squamous cell CA
  • Risk Factor
    • HPV
116
Q

What hormones are present in DMPA (Depo injection)? What happens to the endometrium?

A
  • Hormones
    • Posgesterone only
  • Result
    • Thin endometrium
    • Bleeding
117
Q

What hormones are present in Levonorgestrel implants? What occurs in the endometrium?

A
  • Hormones
    • Progesterone only
  • Result
    • thin endometrium
    • bleeding
118
Q

What solution is used to visualize trichomonas and gardnerella vaginalis?

A

Saline solution

119
Q

What solution is used to visualize candida in vaginitis?

A

KOH

120
Q

OCPs, Ring, Patch

  • Protective against what diseases?
  • Non-contraceptive benefits
  • Side effects
A
  • Protective against what diseases?
    • Endometrial cancer
    • Ovarian cancer
  • Non-contraceptive benefits
    • Lightened / shortened period
  • Side effects
    • Breakthrough bleeding
    • Moodiness
121
Q

Proesterone-based IUD/ Implant

  • Protective against what diseases?
  • Non-contraceptive benefits
  • Side effects
A
  • Protective against what diseases?
    • Endometrial cancer
  • Non-contraceptive benefits
    • Light / absent period
  • Side effects
    • Breakthrough bleeding
    • Depressive symptoms
122
Q

Depo-Provera

  • Protective against what diseases?
  • Non-contraceptive benefits
  • Side effects
A

Progesterone only

  • Protective against what diseases?
    • Endometrial cancer
  • Non-contraceptive benefits
    • Light / absent period
  • Side effects
    • Breakthrough bleeding
    • Depressive symptoms
    • Weight gain
    • Delayed return to fertility
123
Q

What is characterized by a painful ulcer?

A
  • Herpes
  • Chlamydia
    • Lymphogranuloma Venerum
124
Q

What is characterized by a painless ulcer?

A
  • Syphilis
    • (Single ulcer)
  • Klebsiella granulomatis
    • Enlargening painless ulcer
125
Q

Symptoms of Primary Syphilis

A
  • Chancre
  • Develops into sinle, painless ulcer
126
Q

Symptoms of secondary syphilis

A
  • Fever
  • Arthritis
  • Rash (palms and soles)
127
Q

What are the neurologic symptoms of Syphilis?

A

Neurosyphilis

  • Argyll-Robertson pupil
    • small, accommodates but does not react to light
  • Tabes dorsalis
    • Sharp back pain
128
Q

What is Gummatous syphilis?

A

Tertiary syphilis

  • Sx:
    • Granuloma formation on skin and bone
129
Q

What are the cardiovascular manifestations of tertiary syphilis?

A

Destruction of elastic tissue

  • Aortic dilation
    • can cause regurg
  • Aortic aneurysm
130
Q

What tests are used to diagnose Syphilis?

A
  1. Cardiolipin Ab test (RPR or VDRL)
    • Not specific
  2. Fluorescent treponemal Ab absorption test (FTA-ABS)
    • If cardiolipin test is positive
131
Q

Patient has acute, unilateral pelvic pain. Doppler shows no flow. What is causing the pain?

A

Ovarian torsion

132
Q

Patient has acute, unilateral pelvic pain. Sonogram shows free fluid. What is causing the pain?

A

Ruptured ovarian cyst

(blood in caul-de-sac = free fluid)

133
Q

What reproductive problem can cause nodularity of the uterosacral ligaments?

A

Endometriosis

134
Q

What is the only way to definitively diagnose endometriosis?

A

Laparoscopy with biopsy

135
Q

What is the cause of Primary Dysmenorrhea? How is it treated?

A
  • Cause:
    • Increased endometrial prostaglandins
  • Treatment:
    • NSAIDS
    • OCPs
136
Q

What is Stress Incontinence? What is the cause?

A
  • Leaking of urine with activity
    • sneezing
    • Laughing
    • coughing
  • Cause
    • Intrabdominal pressure becomes greater than urethral sphincter closure pressure
137
Q

What is urge incontinence? What is the cause? Treatment?

A
  • Sudden urge followed by leaking before making it to the bathroom
  • Cause
    • Spontaneous bladder contractions
  • Treatment
    • Antimuscarinics
    • Alpha agonists
138
Q

What is the definition of menopause?

A
  • Cessation of follicular function
  • Absence of menses for 1 year
  • FSH > 40
139
Q

What are the advantages and disadvantages of hormone replacement in postmenopausal women?

A
  • Advantage
    • Improves lipid profiles
    • Bone health
    • Decreased colon cancer risk
  • Disadvantage
    • Increased risk CV disease
    • Increased risk stroke / PE / DVT
    • Increased risk breast cancer
140
Q

What are the characteristics of fibroadenoma?

A
  • Painless, solitary mass
  • Mobile
  • May be bilateral
141
Q

What are the characteristics of fibrocystic breast disease?

A
  • Diffuse, lumpy
  • Cyclical changes

ICM II (12 decks)

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