Obstetrics And Gynecology Flashcards
(131 cards)
1
Q
Normal menstrual cycle:
Two phases?
Two hormones per phase?
Two potential outcomes?
A
Follicular: FSH and Estrogen -> proliferative phase of the endometrium
Luteal phase: LH and Progesterone -> secretory phase of the endometrium
Outcomes: pregnancy or menstruation
2
Q
Physiologic cardiovascular changes during normal pregnancy
A
CO increases
SVR decreases more
Bloop pressure drops
3
Q
Physiologic changes seen in the GI system in normal pregnancy
A
- Delayed gastric emptying
- Increased relaxation of the lower esophageal sphincter
- Decreased motility
4
Q
Physiologic changes seen in the Renal system in normal pregnancy
A
GFR (CrCL) increases in pregnancy
Serum creatinine decreases
5
Q
Physiologic changes seen in the endocrine system in normal pregnancy
A
Beta-hCG doubles every 48 hrs
hPL confers resistance to insulin
6
Q
Hematopoietic changes during normal pregnancy
A
Hypercoagulable state
7
Q
When to go for surgery instead of methotrexate in ectopic pregnancy
A
- ruptured ectopic pregnancy
- patient unlikely to follow up
- fetal heart sound
- beta hCG > 5000
- GS > 3.5cm
8
Q
Define spontaneous abortion
A
Unprovoked fetal loss before 20 weeks gestation
9
Q
Most common cause of spontaneous abortion
A
Chromosomal abnormalities
10
Q
Complete abortion :
Vaginal bleeding
Cervix
Ultrasound
A
+/- vaginal bleeding
Closed cervix
Empty uterus
11
Q
InComplete abortion :
Vaginal bleeding
Cervix
Ultrasound
A
Vaginal bleeding present
Open cervix
Product of conception present in the uterus
12
Q
Inevitable abortion :
Vaginal bleeding
Cervix
Ultrasound
A
Vaginal bleeding
Open cervix
Live or dead product of conception
13
Q
Threatened abortion :
Vaginal bleeding
Cervix
Ultrasound
A
Vaginal bleeding
Closed cervix
Live fetus on ultrasound
14
Q
Missed abortion :
Vaginal bleeding
Cervix
Ultrasound
A
Vb hasn’t started yet
Closed cervix
Dead fetus
15
Q
Risk factor for 1st time ectopic pregnancy
A
History of
- PID
- Salpingitis
- Prior surgery
- Endometriosis
16
Q
Most common location of ectopic pregnancy
A
Ampulla
17
Q
Quad screen consists of
A
Beta-hCG
Estriol
MSAFP
Inhibin A
18
Q
Increase hCG and inhibin A, decrease estriol and AFP,
A
Trisomy 21
19
Q
Increased MSAFP
A
Open neural tube defect, gastroschisis
20
Q
When to screen for gestational diabetes
A
26- 28 weeks
21
Q
How do you screen for gestational diabetes?
A
Start with 1hr GTT (50g glucose) If > 140, do 3hr 100 GTT Fasting : 95 1hr: 180 2hrs: 155 3hrs: 135
Or random > 200 + symptoms
22
Q
Complications of pregestational diabetes mellitus
A
Caudal regression syndrome
Cardiac defects
23
Q
Complications of gestational diabetes
A
Macrosomia,
Shoulder dystonia
Polydramnios
Neonatal hypoglycemia
24
Q
Definition of oligohydramnios
A
Low amniotic fluid (< 5cm Amniotic Fluid Index)
25
Causes of oligohydramnios
```
Can’t pee or make urine:
Renal agenesis
GU obstruction ( posterior urethral valves in males)
Uteroplacental insufficiency
Ruptured membrane
```
26
Most common cause of oligohydramnios
Ruptured membranes
27
Definition of polyhydramnios
Increased amniotic fluid (>24 cm Amniotic Fluid Index on US)
28
Causes of polyhydramnios
Can’t absorb fluid to make urine or making too much urine:
- esophageal or duodenal atresia
- anencephaly
- maternal diabetes
29
Blood pressure criteria in pregnancy
- 4hrs apart
- systolic bp >/= 140mmHg or
- diastolic bp >/= 90mmHg
30
Gestational hypertension criteria
- bp criteria met
- after 20 weeks gestational age
- no features of preeclampsia
- no need for bp meds
- no need for aspirin
- deliver at 37 weeks
31
Chronic hypertension in pregnancy features
- bp criteria is met
- prior to 20 weeks gestational age
- no features of preeclampsia
- possibly need ongoing bp meds
- give aspirin at 12 weeks gestation
- deliver at 38 weeks if no meds and 37 weeks if on meds
32
Pre-eclampsia criteria
- blood pressure criteria met
- after 20 weeks gestation
- evidence of end-organ involvement: proteinuria or severe features
33
Organ systems that can be affected in preeclampsia
```
Renal
Neurologic
Pulmonary
Hepatobiliary
Hematopoietic
```
34
Proteinuria?
Protein/creatinine of 0.3mg/dL
300mg of protein in a 24 hour urine
Protein>/= 2+
35
Preeclampsia with severe features criteria
- Severe ranges of blood pressure:- >/= 160mmHg or >/= 110 mmHg
- Low platelet count (<100,000)
- Increased LFTs (> 2x the upper limit of normal conc)
- Pulmonary edema
- Creatinine >1.1 mg/dL or 2x baseline
- New onset headache and visual changes
- Right upper quadrant pain
36
Antihypertensives used in pregnancy
Labetalol
Hydralazine
Immediate release nifedipine
37
What is normal labor
Painful contractions that causes cervical changes
38
Explain the phases of the first stage of labor
Latent phase: prior - 6cm
| Active phase: after 6cm
39
What is normal second stage of labor
10 cm(complete dilation) to delivery for = 2hrs for multiparous patients and = 3hrs for nulliparous patients
40
Third stage of labor?
From delivery of baby to delivery of placenta
41
What is arrest of active phase in labor
No change in >/= 4 hrs with adequate contraction
| Or >/= 6hrs with inadequate contraction
42
Management of arrest of active phase of labor
Oxytocin
| Cesarean delivery
43
Four aspects of interpretation of fetal heart rate monitoring
Baseline heart rate (110-160 bpm)
Beat to beat variability
Accelerations
Decelerations
44
Early decelerations is due to
Head compressions
45
Variable decelerations is due to
Cord Compression
46
Late decelerations is due to
Uteroplacental insufficiency
47
Category 1 FHR tracing features:
110-160 bp.
Moderate Variability
No variable or late decelerations
48
Category 3 of FHR tracing
Absent baseline variability plus any of
- Bradycardia
- Recurrent late or variable decelerations
- Sinusoidal pattern
49
Treatment of choice for prevention of intrapartum seizures in pre-eclamptic patient and/or eclamptic patients
Magnesium sulfate
50
First sign of magnesium toxicity
Decreased deep tendon reflexes
51
Signs of magnesium toxicity
Decreased DTRs
Respiratory paralysis
Arrhythmia
52
Magnesium antidote
Calcium gluconate
53
Which type of patients can’t get magnesium sulfate
Myasthenia gravis patients
54
Ulcerative painful STI
HSV
Chancroid
LGV
55
Painless ulcerative STI
Syphilis
| Granuloma inguinale
56
Non-ulcerative STI
Chlamydia
Gonorrhea
Trichomonas
57
What is the most common STI
Human papilloma virus
58
Painful angry red ulcer(s) in genitals; painful lymphadenopathy that can rupture
Cause?
Haemophilus ducreyi
59
Painful angry red ulcer(s) in genitals; painful lymphadenopathy that can rupture
Treatment
Azithromycin, ceftriaxone or ciprofloxacin
60
Painless genital ulcers + painful lymphadenopathy
Diagnosis?
LGV
61
Treatment of LGV
Doxycycline
62
Painless ulcer+ painless lymphadenopathy
Syphilis
63
Management of a pregnant woman with syphilis and is allergic to Pencillin
Desensitize and treat with penicillin
64
Acute febrile reaction accompanied by headache and myalgia within 24 hrs of syphilis treatment initiation
Jarisch-Herxheimer reaction
65
Beefy red, velvety genital nodule that turns into a painless genital ulcers without lymphadenopathy
Organism?
Klebsiella granulomatis (granuloma inguinale)
66
Treatment for cervicitis
Ceftriaxone and azithromycin
67
Sexually actively female with chief complaint of lower abdominal or pelvic pain or tenderness in cervix raises suspicion for
PID
68
Outpatient treatment for PID
Ceftriaxone and doxycycline
69
Inpatient treatment for PID
Cefoxitin and doxycycline or clindamycin and gentamicin
70
How long to treat PID with antibiotics
10-14 days
71
Maternal fever+ purulent or foul smelling discharge; fetal tachycardia; maternal tachycardia; fundal tenderness
Most likely diagnosis?
Choriamnionitis
72
How does someone become GBS positive
Previous neonate with GBS disease (positive for life)
GBS asymptomatic bacteriuria or UTI anytime in pregnancy (positive for length of pregnancy)
GBD screening rectovaginal culture (positive for labor)
73
Treatment drug of choice for GBS chorioamnionitis
Penicillin
74
Treatment drug of choice for GBS chorioamnionitis with non anaphylactic penicillin allergy
Cefazolin
75
Treatment drug of choice for GBS chorioamnionitis with high risk anaphylaxis allergy
Require culture and susceptible testing for clindamycin
Sensitive to both: clindamycin
To non: Vancomycin
76
Painful dark vaginal blood in 3rd semester is suspicious of
Placenta abruption
77
Placenta blocks the exit (os) painless, bright red VB in third trimester
Placenta previa
78
Risk factors for placenta abruption
Previous abruption
HTN diseases
Cocaine
79
Management of placenta abruption
Emergent Delivery
80
Risk factors for placenta previa
Prior cesarean delivery
| History of placenta previa
81
Management of placenta previa
Cesarean delivery
82
Define postpartum hemorrhage
Blood loss if >500cc during vaginal delivery or >1000cc during C.delivery or signs and symptoms of hypovolemia within 24hrs of delivery
83
Causes of postpartum hemorrhage
```
Uterine atony
Genital trauma lacerations
Uterine inversion
Coagulopathies
Retained placenta
```
84
Uterotonic drugs
Oxytocin
Methylergonovine
Misoprostol
Prostaglandin F2 alpha
85
A soft "boggy" uterus + postpartum hemorrhage
Uterine atony
86
1st line management of uterine atony
Massage
87
Meds that can be used for uterine atony
```
Oxytocin
Methylergonovine
Prostaglandins F2
Misoprostol
Tranexamic acid
```
88
Postmenopausal female with dyspareunia, vulvar itching (or incidental findings of) and symmetric, whitish, thinning of the labia, perineum and perineum. Labia minora can stick together
Diagnosis?
Lichen sclerosis
89
Diagnostic test for lichen sclerosis
Punch biopsy
90
Treatment of lichen sclerosis
High potency Topical corticosteroid (clobetasol)
91
Normal pH for vaginal discharge
4 - 4.5
92
Which vaginitis has normal pH
Candidiasis
93
Malodorous discharge; off- white grayish homogeneous discharge
Diagnosis?
Bacterial vaginosis
94
What is seen on microscopy in bacterial vaginosis
Clue cells and less lactobacilli
95
Malodorous discharge, dyspareunia, dysuria; green-yellow discharge, vaginal erythema
Diagnosis?
Trichomoniasis
96
Treatment for bacterial vaginosis
Metronidazole
97
What is seen on microscopy in trichomoniasis
Mobile flagellated trichomonads
98
Pruritus, soreness, dyspareunia; vulvar erythema, clumpy white discharge
Diagnosis?
Candidiasis
99
What is seen on microscopy in candidiasis
Pseudohyphae- candida albicans
| Budding yeast - non-albicans
100
Treatment of candidiasis
Azole antifungal
101
Painful grouped vesicles or ulcer with painful lymphadenopathy
Most likely Diagnosis?
HSV
102
Diagnostic test for HSV
PCR
103
Treatment for HSV
Acyclovir
Valacyclovir
Famciclovir
104
Management of a pregnant patient with history of HSV
Use suppressive medication around 36 weeks
105
Management of a pregnant patient who has prodromal symptoms or active lesions at time of labor
Cesarean delivery
106
Condyloma lata + maculopapular rash on palms and soles
Secondary Syphilis
107
PALM COEIN of AUB
```
Polyp
Adenomyosis
Leiomyoma
Malignancy/ hyperplasia
Coagulopathy
Ovarian dysfunction
Endometrial dysfunction
Iatrogen
Not otherwise classified
```
108
AUB -intermenstrual bleeding
Endometrial polyps
109
AUB - smooth, boggy uterus
Adenomyosis
110
AUB in post menopausal women is what until proven otherwise
Endometrial hyperplasia vs. cancer
111
AUB basic work up includes
```
Pregnancy test
CBC
TSH
Cervical cancer screening
STI screening
```
112
Work up for suspected ovarian cause of AUB
Pregnancy test
TSH
prolactin
Endometrial biopsy for high risk patients
113
Important indicators of unopposed estrogen exposure
```
Early menarche
Late menopause
No breast feeding
Nulliparity
Obesity
Polycystic ovarian syndrome
Hyperprolactinemia
Thyroid disease
```
114
When should endometrial sampling be performed
```
Post menopausal bleeding
AUB in women older than 45
AUB in women younger than 45 with unopposed estrogen exposure risk factors:
Early menarche/ late menopause
Nulliparity
Chronic anovulation
Obesity
Diabetes
Others: Lynch Syndrome, Family history, estrogen secreting tumor
```
115
Ultrasound features of potential malignancy that can make an adnexal mass be a big deal
Solid (hypoechoic) component
Septations
Doppler flow in the solid component
Ascites
116
Germ cell tumor is the most common ovarian malignancy in what age group of women
Women under 20
117
What is the treatment for germ cell tumor with the exception of dysgerminomas
Bleomycin
Cisplatin
Etoposide
118
Tumor marker for dysgerminoma
LDH
119
What is dysgerminoma very sensitive to
Radiation
120
Tumor marker for endodermal sinus
Increased AFP
121
Tumor marker for choriocarcinoma
Beta-hCG
122
Sertoli leydig celllz tumors presents with
Virilization
Oligo/amenorrhea
Elevated levels of testosterone or androstenedione
123
Meigs Syndrome triad
Fibroma
Right sided hydrothorax
Ascites
124
hiw do you Screen for ovarian cancer in a patient with BRCA mutations
Ultrasound and CA- 125
125
What hormone is responsible for the development of the external male genitalia
Dihydrotestosterone
126
What converts testosterone to dihydrotestosterone
5 alpha reductase
127
primary Amenorrhea + virilization+ internal male genitalia
Diagnosis?
5 alpha reductase deficiency
128
Normal appearing female with elevated testosterone, dihydrotestosterone and estrogen
Diagnosis?
Androgen insensitivity Syndrome
129
normal female external genitalia + Primary amenorrhea + absent sex characteristics + absent uterus
Androgen insensitivity Syndrome
130
Normal ovaries and female external genitalia + absent uterus, cervix and upper third of vagina
Mullerian agenesis
131
What hormone is increased in menopause
FSH
