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Step 2 > OBGYN > Flashcards

OBGYN Flashcards

1
Q

Her2+ Tx and screening?

A

Trastuzumab (Herceptin). ECHO beforehand to check for cardiotox

Detect oncogene via FISH

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2
Q

Breast Feeding OCP

A

Progesterone Only

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3
Q

Post partum Breast Engorgement. Presentation? What to do?

A

Bilateral tenderness. Peaks at 3-5 days. Resolves spontaneously.

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4
Q

Physiological galactorreha. What to do

A

Test prolactin. TSH

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5
Q

Breast Exam Screening

A

Mammo every 2 years from 50-75

US before 30 if concerned. Mammo after 30 for imaging.

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6
Q

Pagets DIsease gross appearance. Type of CA? Hitology?

A

Eczematous rash near nip
AdenoCA
Large cells surrounded by clear halos

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7
Q

Elderly female w/ erythematous edematous plaque over a mass + discharge/bloody or nonbloody.

What is dx + tx?

A

Inflammatory Breast CA.

Pagets WONT have a mass.

Biopsy

Tx based off of histo

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8
Q

Presentation of Mammary Duct Ectasia?

histology?

A

Inflam/dilation w/ green/brown nipple discharge. May feel mass.

Chronic inflame w/ plasma cells.

Usu in multiparous postmenopausal women (ducts have been dilated multiple times)

Histo: Plasma Cells

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9
Q

Contraindications to breast feeding

A

TB, HIV (untreated), active breast HSV, chemo, DRUGS

Hep B, C, not contraindicated

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10
Q

Stress incontinence vs urge incontinence?

Etiology/ Dx/ Tx

A 
Stress - Weak pelvic floor.
Swab Test (urethral straining over 30 degrees). Tx Kegels + Urethropexy

Urge incontinence - Detrusor Hyperactivity. Tx Oxybutynin

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11
Q

DES leads to? Where?

A

AdenoCA of vagina+cervix. Hooded cervix.

T shaped uterus

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12
Q

Type of CA causes by HPV?

A

Squamous Cell CA of vagina and cervix

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13
Q

CHlamydia and Gonorrhea screening?

A

Annual screening in sexually active women less than 26 y.o.

26+ w/ risk factors (new, multiple contacts, sx contact)

1st and 3rd trimester preg

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14
Q

How to distinguish chlamydia vs gonorrhea cervicitis

A

Indistinguishable. Both purulent, friable cervix. Gram stain not reliable. CHlamydia is more common.

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15
Q

Primary Syphilix dx testing?

A

Darkfield microscopy.

False negatives in VDRL/RPR due to lack of ab in Primary.

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16
Q

Genital Warts. Description. Causes. Tx.

A

Multiple teardrop shapes.

HPV.

Tx Acetic Acid or Podophyllin

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17
Q

Cervical mucous findings in ovulatory phase

A

Clear, stringy, pH 6.5 (more hospitable for spermies)

pre/post ovulation is thick and opaque

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18
Q

OCP side effects

Contraindications

A

HTN, NOT weight gain.

Contra:: Migrains w/ aura. Smoking .uncontrolled HTN

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19
Q

Persistent uterine bleeding in premenopausal? WOrkup?

A

Preg Test.

US + EMB

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20
Q

Adenomyosis s/sx + physical findings

A

boggy, enlarged uterus

Dysmenorrhea, pelvic pain

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21
Q

Endometriosis s/sx

Dx + Tx

A

Dyspareunia, dysmenorrhea, dyschezia

US to rule out CA

May see endometrioma.

Tx. OCP, NSaids. Lap if refractory.

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22
Q

Tx for erbs palsy post-birth

A

80% resolve spontaneously in 3 month.

Surg if no improvement in 3-6 months.

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23
Q

Lichen sclerosis. Apperanace. Tx.

A

Vulvar pruritis, porcelain white atrophy cigarette paper.

Biospy to rule out vulva SS CA.

Tx Steroids

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24
Q

EMB findings..

Tx for?

A

EMB -

Without Atypia: Progestin
With Atypia: Hysterectomy

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25
Q

PID Tx

2 reg

A

Clinda gent

Cefetetan + doxy.

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26
Q

Adnexal torsion vs Ruptured cyst presentation

A

Torsion has n/vv

Cyst rupture usu after exercise/sex

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27
Q

BV vs Trich

A

Both have pH > 4.5

BV - thin, white, fishy +Whiff test. No inflam. DONT tx partner

Trich - Thin yellow/green, malodorous, inflam, erythema. Tx partner

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28
Q

ASCUS Age grouping Screen

A

ASCUS
21-24 - repeat annually. Colpo if 3 consecutive + reading

25+ HPV test. If negative, revery to pap every 3 years.

If HPV+ w/ ASCUS = Colpo

ASC-H - always colpo

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29
Q

Postmenopausal adnexal mass workup

A
  1. Transvags US
  2. CA 125

DONT biopsy (seeing)

CA125…
If + lap
If - periodic US

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30
Q

Atrophic vaginiits

USU sx. Odd sx/

Tx

A

Dryness. Scare pubic hair, pruritis, dyspareunia

Dysuria+ frequency (seems almost like a UTI)

Tx local estrogen

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31
Q

Anovulation secondary to morbid obesity hormonal findings

A

Normal FSH, LH

Low progesterone (and thus no withdrawal sloughing.

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32
Q

Maternal Graves Disease ->

Neonatal thyrotoicosis

Mech and tx?

A

Transplacental passage of anti-TSH receptors
.
Tx - Methimazole + b blocker in child.

Resolves in a few weeks/months.

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33
Q

In preg, what STi do we ALWAYS screen for.r

Which STI do we screen for if high risk?

A

Always - HIV, Syph, Hep B (blood tests)

Risk: GC/CT, Hep C

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34
Q

Thyroid levels in preg.

A

INC total T4, Free T4,

Dec/Normal TSH.

Estrogen INC TBG

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35
Q

Major mech of fat production of estrogen?

A

Fat has aromatase. COnverts adrenal androgens to estrogen

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36
Q

At what bHCG can we see preg?

A

bhCG 1500-2000.

Doubles every 2 days.

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37
Q

Premature Ovarian failure - Age?

hormonal levels. Assoc. Tx for Preg

A

40 y.o

HIGH FSH /LH

Assoc w/ autoimmune (Hashi, DM1, pernicious anemia)

ONLY option is IVF. Clomiphene does not work here.

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38
Q

Chorioamionitis s/sx

Tx

A

Maternal fever, fetal tachy, malodorous fluids, purulent discharge. WBC > 15k.

Polymicrobial. Tx broad (Amp, Gent, Clinda) and DELIVER IMMEDIATELY.

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39
Q

s/SX RUPTURED ectopic preg

Tx algorithm is based off of what?

A

Cervical motion tenderness, palpable adnexal mass. May have urge to defecate (blood in posterior cul de sac)

Tx Methotrexate or surgical (IF UNSTABLE VITALS.

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40
Q

When to correct breech?

A

Attempt leopold if it persists past 37 wk. Be ready for induce labor/c section

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41
Q

UTI in preg.

A

Nitrofurantoin, amox, cephalexin.

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42
Q

Hep C in preg. How to deliver?

A

2-5% vertical transmission.

Ribavarin is teratogenic. No Tx.

immunize against Hep A/B

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43
Q

Antihypertensives in preg

A

Methyldopa, labetalol, hydralazine. CCB

Avoid, ACEi ARB, etc

44
Q

Cause of hyperandrogenism during pregnancy.

Sx/sx

A

New onset hirsutism and acne during pregnancy.

LLuteomas and theca luteum cysts

Can be BILATERAL masses. BENIGN.

Regress after delivery

45
Q

Intense pruritis. Worse at palms/soles. No jaundice.

lab kfindings?

A

Biliary stasis/sludge

INC total bile acids. LFT may be over 1000, must rule out viral hep. INC alk phosph

Tx Ursodeoxycholic acid to INC bile flow.

46
Q

Gestation HTN criteria

Pre Eclampsia

SEvere Pre Eclampsia

A

Gestation - Over 140 after 20 wk.

Pre Ec 140+ proteinuria

Severe Pre EC 160+ proteinuria

Eclampsia: seizures

47
Q

Toxo signs

Rubella signs

A

Toxo: Chorioretinitis, Hydrocephalus, Intracranial calcifications

Rubella: CATARACTS, Hearing loss, PDA. Must vaccinate prior to preg (not during)

48
Q

Emergency Contraceptive options

A

Copper IUD (lastsup to 5 days)

Levonorgesterl (Mirena (3 days)

Ulipristal (Anti-Progestin) 5 days

Oral levonorgestrel (PLAN B 3 DAYS)

49
Q

HIV tx in preg?

During birthing>

A

HAART during preg REGARDLESS of viral levels.

Zidovudine for 6wk + after delivery.

If viral laod over 1000, Zidovudine + C section.

50
Q

Painless antepartum hemorrhage w/ fetal vital deterioration

A

Vasa previa.

Maternal vitals unchanged.

51
Q

RhoGam - When admistered?

A

Up to 32 wk. Within 7 2 hr/bleeding.

52
Q

Fetal Growth Restriciton

Symetrical vs Asymmetric (examples)

A

Symmetric: Fetal (infection, genetic )

Asymmetric - Maternal (Vascular, APA, SLE, Substance abuse)

53
Q

Fetal hydrantoin syndrome

A

Phenytoin/Carbamazepine ->

hypoplasia of distal phalanges, hirsutism, cleft palate.

54
Q

Molar Preg US findings

A

Can see bilaterally enlarged, MULTILOCULAR cystic ovaries secondary to HYPERSTIMULATION and ovarian cysts (theca luteal cysts)

55
Q

Preg Women over 35? Offer? When?

A

Cell Free DNA tests for Downs.

10+ wks

56
Q 
Placenta Previa
vs
Placenta Abruptio
vs
Uterine Rupture
A

Previa - Painless 3rd Trim bleeding. Dx - US. Pelvic Rest.

Abruptio - Painful, HYPERTONIC. If over 34 wk, trial vaginal birth (unless baby unstable)

Uterine rupture - Painful. Past Hx C section. Recession of fetal station. Contractions STOP (opposed to hypertonic. Fetal hands/etc.

57
Q

Post term and late term preg complications

A

Oligohydramnios

Meconium aspiration. Macrosomia

58
Q

Definition of false labor

A

Contractions w/.o cervical changes

59
Q

80% cause of postpartum bleeding.

A

Uterine Atony

Soft, boggy, poorly contracted uteurs.

Tx Fundal massage. IV fluids + Oxytocin

60
Q

When to give

GBS ppx?

Steroids?

Tocolysis

Mag Sulf

Rho Gam

A

GBS - before 37 wk. ROM > 18hr. Past GBS+ birth.

Steroids - before 34wk

Tocolysis - before 34wk

Mag SUlf - Before 34/32 for neuroprotection

Rho Gam - before 28-32 wk + bleeding.

61
Q

Ovarian CA - most common?

- 3 types

A

Eptihelailn , 70%
Stroma
Germ Cell

62
Q

Ovarian CA

Epithelial:

A

70% of ovarian cA - if 30-40 bening, 60-70 concern.

Benign cystado - single flat lining (30-40)
CystadenoCA - complex, shag, 60-70 - PSAMOMMA
Borderline
Endometroid Surface CA - Malig, ~Endometriosis + Endometrial CA

63
Q

Stromal Ovarial CA

A

Fibroma - Benign, white fibrotic bands. Meigs (pleural effusion, ascites)

Granulosa Theca - INC Estrogen, Call Exner. Uterine bleeding

Sertoli Leydig - Androgen - Leydig : Renke crystals

64
Q

Ovarian Germ Cell CA

A

Endodermal (Yolk) - INC AFP, Schiller Duval

ChorioCA - INC HCG, hemorrhagic, lung

Dysgerminoma - HCG, LDH - clear cytoplasm w/ centrla nuceli. Fried egg - responds to RTX

Embryonal (fetal)- large primitive cells. early mets

Cystic teratoma - mature - benigni -> struma ovarii

Imamature - maligant neuroectoderm

65
Q

parital move

vs

Total mole

A

Partial - egg + 2 sperm (69) Fetal parts. Inc HCG.

total - 2 sperm (46) - REALLY INC HCG - Cluster of grapes, snw storm. ENLARGED UTEUR, MULTILOCULAR BILT CYSTS. ChorioCA risk factor.

66
Q

HIV in preg - tx? delivery?

A

Intrapartum HAART, regardless of load.

Postnatal ZIDOVUDINE

If viral load >1000, C section + Zidovudine

67
Q

Fetal presentation

syph

rubella

CMV

toxo

A

syph - hsm, ULCERS ON HANDS AND FEET, anemia, rhinorrhea, JAUNDINCE

Rubella - hsm - cataracts, hearing, skin

CMV - hsm - chorioretinitns, hearing, skin

toxo - intracranial Calcifications, chorioretinints, hydrocephalus

68
Q

Thyroid lab findings in preg

A

DEC TSH, INC Free T4, BIG INC in Total T4

69
Q

When to give oral glucose tolerance test?

A

End of 2nd trimester (24-28)

70
Q

Threatened abortion (blood, closed cervix) - What to do?

A

If fetal monitoring norml - reassure with 1 wk followup

71
Q

Mechanism of HTn in preeclampsia?

A

Generalized arterial vasospasm. ICN bp can lead to pulm edema

72
Q

Small for gestational age have risk to go on to develop what metabolic abnormalities?

A

Polycythemia, hypoxia, hypothermia, hypoglycemia, hypocalcemia,

73
Q

OCP associate ICN and DEC risk of CA

A

DEC endometrial and ovaria. INC breast and cervical.

74
Q

When do perform amniotomy

A

After 6 hr of labor w/o complete dilation.

75
Q

3rd Trimester bleeding, dx algorithim/ 2 dx concerns –

A

Previa, abruption. Must rule out w/ abd ultrasound BEFORE SPECULUM OR BIMANUAL.

76
Q

Screening test proven to lower mortality?

A

Mammo after 50

77
Q

Most beneficial to asx pt w/ multiple 1st degree relatives w/ breast CA?

A

SERMS (Tamoxifen or Raloxifene)

78
Q

First physical signs of preg?

A

Goodells sign - softeningof the cervix

79
Q

Postpartum fever unersponve to broad spectrum antibiotics

A

septic pelvic thrombophlebitis.

80
Q

TVUS vs TA-US in regards to beta HCG

A

– TVUS as low as 1500. TA-US – Over 6500.

81
Q

breast Cyst drainage in young women, clear fluid

A

What next? – Observe 4-6 wk . No cytology first tiem.

82
Q

Chorio! Algorithim?

A

Oxytocin and deliver. NOT an indication for C section

83
Q

Chorio tx

vs

Endometritis tx?

A

Chorio - amp gent clinda

Endometritis - clinda gent

84
Q

Arrest of labor definition and algorith

A

After greater or equal to 6cmand ROM : If NO CERVICAL CHANGE A in 4 hr w/ adequate contractinos; No cervical changes in 6 hr with inadequate contractions -» C section.

oxytocin is not in the picture sinc eif they had adequate contractions you wouldnt need oxytocin

85
Q

Abnormal uterine bleeding in young female w/ anovulation, t

A

in hemodynamically stable – High dose Estrogen (or High dose OCP). In unstable, dilation and curettage.

86
Q

Eclampsia/HELP delivery Labor or Csection?

A

Labor or Csection? If stable, labor+ augmentation. If fetal distress, then C section. Almost always try to deliver unless fetal distress.

87
Q

Breast feeding dec risk of which cancers?

A

Ovarian and breast. Does not affect endometrial CA.

88
Q

Placental abruption/previa delivery alogirthm

A

Abruption if stable can trial delivery. If not C section. Previa always C section.

89
Q

PID tx

A

clinda/gent or cefotetan doxy

90
Q

No movemetns felt and fetal heart sounds not heard.

A

What next? – US. NOT nonstress test (pointless, no heart sounds heard)

91
Q

Fibrinogen in stillbirth

A

– higher is better. Lower suggest consumption. Remember lower than 200 is concern!

92
Q

De Quervain tenosynovitis

A

inflame of abductor pollicus longus and extensor pollicis brevis. Tenderness at radial side of wrist. “MOMMY THUMB!!” Not ulnar side.

93
Q

Constant pain with no bleeding, frequent contractions

A

– Placenta previa. Labor should not be constant pain. 20% have
no bleeding. Blood is uterotonic -> frequent contractions every 1-2 minutes.

94
Q

Tamoxifen CA risk

A

INC endometrial/uterine CA. No INC ovarian, or cervical or breast.

95
Q

During preg, pap smear with HIGH GRADE SIL, wath to do ?

A

– Pap and COLPO after delivery

MTB said do colpo..

96
Q

Hgih grade SIL in 21-24 and 25+ algorithm.

A

Colpo everyone.

97
Q

GBS meningitis transmission?

A

– not vertically transmitted and from hospital acquire dinfection. GBS pneumo/sepsis is from momma.

98
Q

Tx of infiltrating ductal breast CA

A

– lumpectomy and RTX. Standard of care. Add hormonal if receptor fpositive.

99
Q

When do you give tamoxifen vs aromatise

A

? Standard of care in POSTMENOPAUSAL is AromataseI – more effective than tamoxifen (duh!)

100
Q

When is chemo added to lumpectomy and RTX

A

(always screen for receptor positive. If positive give hormonal therapy)? Tumor size >1cm or lymph node positive.

101
Q

Prolonged bleeding -> EMB shows adenoCA, then what?

A

Surgical staging. Hysterectomy. RTX if LN mets, Chemo if mets.

102
Q

Physical findings in Mulleraian Agenesis

A

– Absence of uterus cervix and upper vagina. Ovaries intact. Normal E.

103
Q

When do you do a progesterone challenge test?

A

? Secondary amenorrhea after TSH, FSH, Prolactin

104
Q

Guidelines for Hormone Replacment Therapy, recommendations

A

Only for hot flash, GU atrophy, dyspareunia. Reevauate annually, and do NOT exceed 4 ye therapy (INC breast CA risk)

105
Q

Differnetiating postpartum blues from depression and tx

A

Blues care about baby. Depression may have htoughts about hurting baby/depressive sx. Baby blues self liminited. Depression is SSRI.

106
Q

Postpartum psychosis in breastfeeding pt tx

A

ECT

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