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Boards Studying > OB/GYN > Flashcards

OB/GYN Flashcards

1
Q

Initial prenatal visit tests

A

Rh(D) type, Ab screen, Hgb/Hct, MCV, HIV, VRDL/RPR, HBsAg, reubella and varicella immunity, pap, chlamydia, urine culture, dipstick for urine protein
- influenza vaccine

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2
Q

Active phase arrest

A

no cervical change in 4 or more hours with adequate contractions (>200) or 6 or more hours with inadequate contractions
- tx with c section

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3
Q

secondary amenorrhea with increased FSH in a pt <40

A

Primary ovarian insufficiency

  • accelerate ovarian follicle depletion
  • leads to decreased estrogen with thin endometrium and vaginal atrophy
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4
Q

Fetal sinusoidal heart rate tracing is associated with

A

fetal anemia (ruptured vasa previa)

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5
Q

Risk factors for hyperemesis gravidarum

A

Hydatidiform mole
multifetal gestation
hx of previous hyperemesis

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6
Q

Post menopausal woman with endometrial cells on pap smear

A

Requires endometrial biopsy

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7
Q

increased AFP during pregnancy most commonly related to

A

open neural tube defects
ventral wall defects
multiple gestations

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8
Q

Target blood glucose levels and tx options in gestational diabetes

A

fasting glucose: <95
1 hour PP: <140
2 hour PP: 120
Tx: dietary modifications (first line), insulin and metformin (second line)

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9
Q

Management of shoulder dystocia

A

BE CALM
B: Breath; do not push
E: Elevate the legs and flex hips (McRoberts)
C: Call for help
A: Apply suprapubic pressure
L: enLarge vaginal opening with episiotomy
M: Maneuvers: deliver posterior arm, rotate posterior shoulder (Wood’s screw), adduct posterior shoulder (Rubin), mother on hands and knees (Gaskin), replace fetal head into pelvis for cesarean (Zavanelli)

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10
Q

Lady at 28 weeks gestation has high grade squamous intraepithelial lesion on pap smear. Next best step?

A

Immediate colposcopy

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11
Q

tx for preterm labor

A

<32 weeks: betamethasone, tocolytics (indomethacin), mag sulf, penecillin if GBS + or unknown
32-33 6/7: betamethasone, tocolytics, penecillin if GBS + or unknow
34-36 6/7: betamethasone, penecillin

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12
Q

Management of pregnant patient with past HSV infection

A

Antiviral suppression beginning at 36 weeks

  • Lesions at time of delivery: C-section
  • no lesions: vaginal
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13
Q

When is an endometrial biopsy necessary

A

On TVUS if endometrium in >4 mm

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14
Q

Next best step in management of patient with mullerian agenesis?

A

Renal ultrasound

  • uterus comes from paramesonephric ducts
  • primitive kidneys come from mesonephric ducts
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15
Q

When to progress to c-section during arrest of labor

A

if no cervical change in 4 or more hours with adequate contractions
if no cervical change in 6 or more hours with inadequate contractions
*if cervix is not progressing as fast as it should (1.2cm/hr or 1.5cm/hr) give oxytocin

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16
Q

58 year old female presents with glazed, brightly erythematous vulvar erosions with a border of serpentine-appearing white striae. She also has serosanguinous vaginal discharge and lace like reticular erosions on the gingiva and palate

A

vulvar lichen planus

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17
Q

Side effect of OCPs on liver

A

hepatic adenoma

- well demarcated hyperechoic lesion

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18
Q

pregnant women with bilateral dilation of renal pelvis and proximal ureters

A

physiologic hydronephrosis of pregnancy

- no additional management

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19
Q

Young male with persistent cough and dull back pain. CXR shows retroperitoneal LAD and multiple pulmonary nodules

A

Metastatic testicular cancer

20
Q

28 year old male with left testicular mass that has increased in size. Ultrasounds shows hypoechoic, 5 cm left testicular mass

A

Testicular cancer

  • requires radical inguinal orchiectomy for confirmation of dx and tx
  • will also have elevated tumor markers: Bhcg, afp, and LDH
21
Q

Second stage labor arrest

A

10 cm and pushing for 4 or more hours in primigravid or 3 in multiple with lack of fetal descent
- move to operative vaginal delivery

22
Q

Pt is 10 days post partum and still having low back pain. She had a c-section due to failure to progress. She now has fever, weakness, and decreased sensation in her leg

A

epidural abscess

- needs urgent MRI

23
Q

Next step if atypical glandular cells are found on pap smear

A

colposcopy, endocervical curettage, and endometrial biopsy

24
Q

Follow up for a 29 year old after draining simple cyst

A

repeat breast exam in 2 months

25
Q

Pt in her third trimester with twin gestation presents with hepatic inflammation and fulminant liver failure

A

Acute fatty liver of pregnancy - deliver now

26
Q

Management of chorioamnionitis

A

Antibiotics

Delivery

27
Q

premature rupture of membranes at 34-37 weeks

A

deliver, give penicillin if GBS status unknown

28
Q

Pregnant patient in third trimester develops palmar erythema and pruritis. AST, ALT and bile acids are elevated.

A

Intrahepatic cholestasis of pregnancy

  • bile acids
  • tx with delivery at 37 weeks
  • ursodeoxycholic acid
  • antihistamines
29
Q

Genital and oral ulcers with uveitis

A

Behcet syndrome

- tx acute exacerbations with prednisone

30
Q

Pt with 2 prior miscarriages with + VDRL, thrombocytopenia and elevated PTT

A

Antiphospholipid syndrome - give LMWH

31
Q

Cause of primary dysmenorrhea

A

Increased endometrial prostaglandin production

32
Q

How to measure gestational age before and after 14 weeks with US

A

Before: crown-rump length
After: head circumference, femur length, abdominal circumference, biparietal diameter

33
Q

How to dx lichen sclerosis

A

punch biopsy

tx: potent topical steroids

34
Q

pregnancy is a hypercoagulable state because

A

decreased protein S activity, increased fibrinogen, and increased levels of factors II/VII/VIII/X.

35
Q

oligohydraminos

A

AFI < 5cm

36
Q

Fever, abdominal pain in RLQ, complex multi-loculated adnexal mass with thickened walls and internal debris

A

tubo-ovarian abscess

37
Q

Liver failure (hypoglycemia, thrombocytopenia and elevated LFTs) with severe RUQ pain and elevated bilirubin

A

Acute fatty liver of pregnancy

- immediate delivery

38
Q

Complications of PPROM

A

preterm labor
intraamniotic infection
placental abruption
umbilical cord prolapse

39
Q

intrapartum GBS tx

A

penicillin

- if allergic: cefazolin

40
Q

short interpregnancy interval puts you at risk for

A

maternal anemia
PPROM
preterm delivery
low birth weight

41
Q

generalized tonic-clonic seizure after delivery with hyponatremia

A

oxytocin toxicity

- causes water retention

42
Q

tx of asx bacteruria

A

beta-lactams (such as ampicillin), nitrofurantoin (macrobid), and fosfomycin (single dose)

43
Q

Bisphosphonates cannot be given when GFR is ___

A

30-35

must give denosumab

44
Q

Indications for starting bisphosphonate tx

A
  • DEXA (T-score ≤ -2.5) or the presence of a fragility fracture.
  • Patients with osteopenia (T-score between -1.0 and -2.5) should also be treated if they have a 10-year probability for hip fracture of ≥ 3%
45
Q

postpartum endometritis

A

IV gentamicin and clindamycin

46
Q

Tx of Toxic shock syndrome

A

IV fluids

IV Abx given to prevent recurrence but not as important in the acute setting

47
Q

How to detect semen on a vaginal sample

A

Alk Phos assay for up to 72 hours

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