OB/GYN Flashcards
1
Q
3 indications for getting a QUANTitative BhCG
A
dx and follow ectopic pregnancy
monitor trophoblastic disease
screen for fetal aneuploidy
2
Q
Avg age of thelarche, adrenarche/pubarche and menarche
A
thelarche = 8-9 adrenarche/pubarche = 9-10 menarche = 12-13
3
Q
Ages for primary amenorrhea
A
14 w/o secondary sex characteristics
16 if secondary sex characteristics
4
Q
2 Cell hypothesis
A
LH -> Thecal cells -> androgen precursors
FSH -> Granulosa cells -> convert androgens into estradiol (therefore requires BOTH fxnal cells)
5
Q
Trigger for ovulation
A
E2 rises –> LH surge mid-cycle –> ovulation
6
Q
Corpus luteum prodoces…
A
progesterone
7
Q
role of progesterone
A
endometrial proliferation
8
Q
3 clinical signs of heavy periods
A
changes tampon q1hr, mutliple nighttime changes, anemia
9
Q
6 predisposing factors for vaginal candidiasis
A
Abx, steroids, immunodef, DM, OCPs, pregnancy
10
Q
vaginal pH in candidiasis
A
normal (3.8-4.2)
11
Q
Tx vaginal candidiasis? Recurrent?
A
Tx = topical antifungals (monistat) or oral (fluconazole)
recurrent Tx = antifungal monthly after menses OR oral med daily/weekly
12
Q
highly infectious vaginal infxn
A
trichomoniasis
13
Q
the pt c/o genial pruritus, frequency, dysuria, and dyspareunia. On PE you note erythema, yellow-green frothy discharge, and punctate cervical hemorrhages (“strawberry cervix”). What is the dx?
A
trichomoniasis
14
Q
4 Dx test trichomonas
A
vaginal pH >4.5, pap, saline prep (motile flagellated organisms), cx
15
Q
Tx trichomonas
A
DOC = metronidazole, 1x 2g dose, also tx partner
16
Q
Positive amine test
A
bacterial vaginosis
17
Q
Clue cells
A
bacterial vaginosis
18
Q
6 complications of bacterial vaginosis
A
PID, endometritis, post-op infxn, PPROM, chorioamnionitis, preterm delivery
19
Q
Tx bacterial vaginosis
A
oral metronidazole
20
Q
palpable mass on labia majora, painful and swollen but not fever, no drainage. Dx? Tx?
A
bartholin’s gland cyst
Tx = drain and catheter, sitz bath and marsupialization (definitive)
21
Q
palpable, fluctuant mass on labia majora. painful, swollen, erythematous with drainage. Dx, Tx?
A
bartholin’s gland abscess
Tx drainage, abx, catheter, sitz bath and marsupialization (definitive)
22
Q
4 causes of bartholin’s gland abscess
A
gonorrhea, chlamydia»_space;coliforms, anaerobes
23
Q
palpable, firm, indurated mass on labia majora. No pain but is swollen. Dx, Tx?
A
bartholin’s gland tumor, dx = bx
Tx = excision
24
Q
Abx for bartholin’s gland abscess (4)
A
doxy + metro
augmentin
azithromycin (chlamydia)
ceftriaxone (gonorrhea)
25
MC type of cervical cancer
SCCA
26
5 RF for cervical cancer
early 1st intercourse, multiple partners, High-risk HPV infxn, recurrent STDs, smoking
27
when can you switch from q2yr to q3yr pap smears?
30yo+ and 3 consecutive negative paps
28
2 indications for d/c pap smears
hysterectomy for a benign condition and no h/o high-grade cytologic abnormalities
OR
>65yo + 3 consec. neg. paps and normal for the past 10 yrs
29
management of ASC-US: low risk HPV
rescreen at 1yr
30
management of ASC-US: high risk HPV
colposcopy + bx
31
management of LSIL or HSIL
colposcopy and bx
32
Tx CIN I
close observation and repeat pap at 6 and 12mo AND/OR HPV DNA testing at 12mo. if negative, return to normal screening. Only applies if >21yo
33
Tx CIN II
ablation or ecision
34
f/u CIN 1-3 if negative margins
pap and/or HPV dna testing at 12mo
35
f/u if CIN 2-3 with positive margins
pap at 6mo +/- repeat endocervical curettage
36
what 4 strains of HPV does the quadrivalent vaccine (Gardasil) protect from?
is it effective?
what is the sequence of vaccination?
how long has it proven to last?
16,18 (cervical cancer)
6,11 (genital warts)
YES! > 90% efficacy
0 mos, 2 mos, 6 mos
2.5-3.5 years
37
Screening rec for any woman with prior tx for LSIL, HSIL or invasive cervical cancer? how long is she at risk for persistent/recurrent disease?
screen ANNUALLY, at increased risk for 20yrs
38
the pt presents with sudden onset of severe pain localized to one lower quadrant and is associated with nausea, vomiting, tachycardia, and sometimes fever. On PE the pt has direct tenderness in the lower quadrant, rebound tenderness (+psoas sign, +heel percussion sign) and an adnexal mass. 6 diff dx
```
adnexal torsion
ectopic pregnancy
appendicitis
ruptured ovarian cyst
tubo-ovarian absess (assoc with PID)
rapidly growing neoplasm
```
39
what 5 tests would you want to do to evaluate for adnexal torsion and why?
HCG- to r/o ectopic pregnancy
pelvic ultrasound: assess ectopic pregnancy and adnexal mass
CBC: Hct (bleeding) and WBC (infxn)
CT scan: r/o appendicitis and adnexal mass
PCR: screen for G and C (TOA)
40
3 (proposed) etiologies of endometriosis
tubal regurgitation
metaplasia of mesothelium
hematogenous dissemination
41
dysmenorrhea + dyspareunia + chronic pelvic pain + infertility
classic tetrad for endometriosis
42
3 dx tests for endometriosis
bx (laparotomy) > laparoscopic visualization > US
43
laparascopic feature suggesting endometriosis
"powder burns"
44
5 tx for endometriosis
OCP, depo-provera, GnRH agonist, laparascopic sgy, laparotomy
45
MC gyn cancer
endometrial CA
46
MC type endometrial CA
adenocarcinoma
47
9 RF for endometrial CA
age, FHx, early menarche/late menopause, low parity, PCOS / unopposed E2, HRT, HTN, DM, obesity
48
The pt c/o abnormal uterine bleeding (menorrhagia, menometrorragia and increasing abdominal girth. on exam you find ascites, hepatomegaly, pulmonary changes, and an enlarged uterus. what is your diagnosis?
Endometrial CA UPO
49
Tx Endometrial CA
child-bearing age = high-dose progrestin??
post-menopausal = TAH/BSO +/- radiation
advanced d/s = TAH/BSO +/- adjuvant chemo
50
MCC PID
Chlamydia, gonorrhea, mixed flora
51
outpatient tx for PID
ofloxacin/levofloxacin + metronidazole 14D
OR
ceftriaxone + probenecid + doxy +/- metro 14d
52
2 inpatient tx for PID
cefotetan + doxy
OR
clinda + gent
53
3 major sequelae of PID
chronic pelvic pain, infertility, ectopic pregnancy
54
MCC infertility in women
irregular ovulation
55
7 tests to w/u PCOS and why
LH; elevated
testosterone: ovary overproduction = PCOS
I:G ratio: hyperinsulinemia
FSH: r/o premature menopause
DHEA-sulfate: adrenal overprodction of androgen
prolactin: causes amenorrhea
TSH: hypothyroidism causes amenorrhea
56
3 possible sequelae of PCOS
infertility, endometrial hyperplasia, endometrial CA
57
Tx PCOS (desire pregnancy or not)
desire pregnancy = clomiphene citrate +/- metformin
| no desire = OCP, progestin, metformin
58
MC ovarian neoplasm in older women
serous (epithelial tumor)
59
MC ovarian neoplasm in teen/young adult
germ cell tumor
60
hormonally active ovarian mass
stromal cell tumors
61
MC ovarian mass in women of reproductive age
functional cyst
62
MC type of ovarian CA overall
epithelial tumors
63
5 tests for w/u of ovarian neoplasm
US, CA-125 level, exlap for bx
| mammogram +/- colonoscopy for mets
64
MC ovarian neoplasm in women of reproductive age
cystic teratoma?
65
5 major causes of non-anatomical secondary amenorrhea
pregnancy, hypothyroidism, PCOS, hyperprolactinemia (prolactinoma), premature ovarian failure
66
Dx premature ovarian failure
sx + elevated FSH
67
Progesterone withdrawal test, hows it work?
progesterone+medroxyprogesterone x 5d, should withdrawal within 7-14d
68
withdrawal bleeding after progesterone withdrawal test, dx? Tx?
PCOS
| Tx OCP+progestin+metformin vs. clomiphene + metformin
69
Negative progesterone withdrawal test and LOW FSH, dx tx?
hypothalamic-pituitary FAILURE --> HRT or gonadotropins
70
Negative progesterone withdrawal test and HIGH FSH, dx tx?
Primary ovarian failure
| Tx = HRT, donor eggs
71
5 major causes of anatomic-related secondary amenorrhea
uterine leiomyoma, uterine malformation, endometrial polyp, endometriosis, IUD
72
menorrhagia vs. menometrorrhagia
excessive menstrual bleeding vs. excessive inter and itnra-menstrual bleeding
73
Tx anovulatory bleeding
progestin, OCPs
74
3 phases of menstrual cycle and timing
1. follicular phase: first day of menses to the day of LH surge (14 days)
2. Ovulation: occurs within 30-36 hrs of the LH surge
3: luteal phase: day of LH surge to the onset of menses (14 days)
75
principal hormone secreted/elevated in E2 deficient state
FSH b/c stimulates granulosa cells to convert androgens into estrodiol
76
Eggs are arrested in what cell cycle phase?
prophase of meiosis I
77
when are E2, progesterone and LH the lowest?
end of luteal phase (FSH already begins rising again during luteal phase to recruit new cohort of follicles!)
78
E2 vs. progesterone relationship to FSH and LH
E2 =negative feedback on FSH, positive feedback on LH
| Progesterone = decreases BOTH
79
what induces endoervical secretion of watery mucus during follicular phase?
E2
80
What induces breast / temp changes during pregnancy
progesterone
81
What US abnormality are you looking for in postmenopausal woman NOT on HRT? next step?
endometrial stripe thickness, if 5mm+ then get bx
82
US technique used to look for polyps AND submucosal leiomyomas
sonohysterography saline infusion
83
utility of cervical conization
definitive dx of abnormal pap smear if colposcopy is inadequate/equivocal. Also possible tx for CIN
84
Tx Chlamydia
DOC = azithromycin 1x PO dose
OR
erythromycin, doxycycline
85
obilgate intracellular parasite that can only be grown in tissue culture
chlamydia trachomatis
86
STD symptoms plus pharyngitis, chlamydia or gonorrhea?
gonorrhea
87
Tx gonorrhea
DOC ceftriaxone IM x1
88
Tx syphilis in pregnant woman
ONLY penicillin (even if have to desensitize) bc only drug effective in preventing fetal infection too
89
MoA OCPs
inhibit ovulation, alter cervical mucus, alter endometrium
90
what are 8 absolute contraindications for combination oral contraceptives?
```
Smoking and age >35
Hyperlipidemia (congenital)
Ischemic heart disease
Pregnancy
Bleeding from genitl tract (undiagnosed)
Liver disease
Estrogen-dependent tumor (breast ca)
DVT/PE in history
```
91
what is the ingredient in Plan B?
when should it be taken?
what is an alternative to it?
levonorgestrel (progestin only)
within 72 hrs of unprotected intercourse
copper IUD within 5 days
92
SEs of depo-provera
breakthrough bleeding, wt gain, depression, bone loss
93
w/u of suspected menopause
pregnancy test, FSH!, TSH, bone mineral density
94
Menopause, increased LH or FSH?
FSH
95
what is the difference btw T score and Z score in BMD tests?
T score compares BMD to young population-important value when determining risk for vertebral or hip fx in postmenopausal women
Z score compared BMD to age matched population- important to use in young athletic women (ballerinas, gymnasts, marathon runners)
96
what is the T score for osteopenia? osteoporosis? normal?
normal: at or above -1 SD
osteopenia: -1 to -2.5 SD
osteoporosis: below -2.5 SD
97
3 antidepressants for post-menopausal women
SSRIs, venlafaxine, buproprion
98
5 PROVEN benefits of HRT
decrease: hot flashes, vaginal dryness, risk of fractures, colorectal cancer
improve sleep
99
4 adverse effects of HRT
increased risk of CAD, CVA, DVT/PE, Breast CA
100
Naegel's rule
LMP -3mo + 7d
101
11 teratogens and assoc. problems
ACE inbit- renal injury
ARBs- renal injury
antineoplastic agents: varied defects
anticoagulant (oral): facial deformity, intracerebral bleeding
Beta blockers: growth restriction
Carbamazepine: spina bifida, facial abnormalities
valproic acid: spinda bifida
lithium: cardiac malformations
tetracycline; stains teeth
quinolones: cartilage injury
isotretinoin: brain, face, thymus, heart defects
102
tests during FIRST prenatal visit
CBC, blood type, rubella, VDRL, STD screen?? recheck
