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Flashcards in OB-GYN Deck (141):
1

How is enlargement of the uterus achieved during pregnancy? 

  • Where does most growth occur?
  • What other changes occur in the wall?

  • Enlargement by Hypertrophy
    • most in the fundus
  • Other changes
    • Increased size and number of vessels
    • Hypertrophy of nerves

2

Which way does the uterus rotate during pregnancy?

To the right

(Dextrorotation)

3

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

Braxton Hicks contractions

4

What changes occur in the cervix?

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

5

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

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

6

What is a luteoma?  What can it cause?

Solid ovarian tumor of pregnancy

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

7

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

Cystic ovarian tumor of pregnancy

  • Secretes hCG
  • SE:
    • virilization

8

What is Chadwicks sign?

Violet vagina

  • Cause:
    • increased vascularity during pregnancy

9

How does colostrum benefit the fetus?

Provides passive immunity

10

What causes "vascular spiders" and palmar erythema during pregnancy?

Increased estrogen

  • Increased blood flow throughout the body

11

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

Genetics!

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

12

What is the additional RDA of calories for pregnant women?

300 kcal/day

13

What common GI issues are experienced during pregnancy?

  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

14

What is hyperemesis gravidarum?  What are the physiological consequences?

Severe morning sickness

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

15

What common upper respiratory tract conditions occur during pregnancy?

  1. Stuffiness
    • Hypersecretion
  2. Epistaxis
  3. Polyp

16

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

Decreases

17

How does Functional residual capacity change during pregnancy?

Decreases

18

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

It stays the same

19

How does Reserve Volume (RV) change during pregnancy?

Decreases

20

How does Respiratory Rate (RR) change during pregnancy?

It stays the same

21

How does VItal Capacity change during pregnancy?

It stays the same

22

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

Decreases

23

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

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

24

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

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

25

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

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

26

What is believed to cause feelings of dyspnea during pregnancy?

Increased tidal volume that lowers PCO2

27

What is normal weight gain for each of the trimesters?

  • First
    • 2 lbs
  • Second / Third
    • 11-14 lbs each

28

What causes pitting edema of the feet during pregnancy?

Decrease in interstitial colloid osmotic pressure

29

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

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

30

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

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

31

What is the iron requirement for normal pregnancy?

1 gram/day

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

32

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

  1. Decreased functioning
  2. Increased leukocytes

33

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

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

34

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

All increase!

35

How do heart sounds change during pregnancy? 

  • Exaggerated splitting of S1
  • Systolic murmur

36

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

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

37

How does kidney function change during pregnancy? 

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

38

Why are pregnant women more likely to get a UTI?

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

39

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

Prolactin

  • Function: lactation

40

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

Thyrotoxicosis

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

41

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

Supply fetus with calcium

42

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

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

43

What is a Blastocyst?

Fluid filled ball of cells

44

What is a zygote?

Fertilized egg

45

What is a Fetus?

Conceptus after 7 weeks

46

What is a Morula?

Solid ball of 16 cells

47

What is an embryo?

Conceptus that forms from the inner cell mass

48

What is a blastomere?

Conceptus after the first cell division

49

When does a blastocyst implant into the endometrium?

Day 21 of cycle

(normally first day of period)

50

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

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

51

What are the two placental membranes?

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

52

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

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

53

What can cause abnormally high hCG levels?

  1. Twins
  2. Hydatidiform moles
  3. Choriocarcinoma

54

What are the functions of hCG?

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

55

When does morning sickness usually occur?

6-12 weeks

56

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

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

57

Describe the following types of spontaneous abortion:

  • Threatened
  • Incomplete
  • Missed

  • 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

What are the symptoms of spontaneous abortion?

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

59

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

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

60

Ectopic Pregnancy

  • Symptoms
  • Diagnosis
  • Treatment

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

61

What is the most common site of ectopic pregnancy?

Ampulla

62

What is the main cell type of a molar pregnancy?

Placental trophoblast

63

What hCG level is associated with the following:

  • Ectopic pregnancy: 
  • Gestational Trophoblastic Disease (Molar pregnancy)

  • Ectopic pregnancy:  > 1500
  • Molar pregnancy:    > 100,000

64

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

"snowstorm" or "Swiss Cheese"

65

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

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

66

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

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

67

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

  • Immature fetus
    • PUBS infusion
  • Mature
    • Delivery

68

What are the causes of 2nd trimester abortions?

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

69

Incompetent Cervix / Premature Dilation

  • Symptoms
  • History
  • Treatment

  • 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

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

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

71

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

  • Incorrect dates
  • Multiple gestation
  • Molar pregnancy
  • Polyhydramnios
  • Maternal diabetes

72

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

When Placenta Previa has been excluded!

73

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

  • 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

How will a baby be delivered following placenta previa?

C section

75

What characterizes premature labor?

Contractions and cervical dilation

76

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

If given after 32 weeks, premature closure of ductus arteriosus

77

How is PPROM diagnosed?

  • 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

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

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

79

What is the difference between PIH and Preeclampsia?

  • Pregnancy Induced HTN (PIH)
    • No proteinuria
  • Preeclampsia
    • Proteinuria

80

What is the pathophysiology of Preeclampsia / Eclampsia?

  • Generalized increase in
    • Systemic vascular resistance
    • or
    • Vasoconstriction

81

What is the goal in treatment of HTN in pregnancy?

Goal:

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

82

How long can a placenta can sustain a fetus?

42-44 weeks

83

What are the 4 T's of Postpartum Hemorrhage?

  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

Endometritis

  • Symptoms
  • Treatment

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

85

What is Septic Pelvic Thrombophlebitis?

Infected clot ("plegmon") in veins around the uterus

86

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

>2 HR accelerations of 15 bpm in 20 minutes

87

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

  • Fetal sleep
  • Drugs
  • At risk infant

88

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

  • Definition
    • Positive accelerations
    • No decelerations with contractions
  • Significance
    • Positive sign

89

What is the definition of a Negative Contraction Stress Test?

No decelerations with contractions

This is a positive sign

90

In what order are fetal functions affected by hypoxia?

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

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

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

92

What is observed in FHR monitoring?  What is normal?

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

93

What are some causes of fetal bradycardia?

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

94

What are some causes of fetal tachycardia?

  • Maternal fever
    • Most common!
  • Fetal distress
  • Amnionitis
  • Fetal arrhythmia
  • Thyrotoxicosis

95

What do the presence of accelerations indicate?

There is no hypoxia

96

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

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

97

What is the cause of early decelerations?

  • Vagal effect
  • Fetal head compression 

98

What is the cause of variable decelerations?

Stimulation of carotid baroreceptors

  • Treatment:
    • Position change
    • O2
    • Amnioinfusion

99

What is the cause of late FHR decelerations?

Myocardopathy secondary to acidosis

100

What is the most common GYN CA?

Adenocarcinoma of the endometrium

101

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

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

102

What is the presenting symptoms of uterine carcinoma?

Abnormal Uterine Bleeding

103

What endometrial thickness is a risk factor for uterine carcinoma?

Over 4mm in postmenopausal patient

104

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

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

105

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

Bilateral

  • Metastasis location
    • Breast
    • Colon

106

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

Ovarian carcinoma

  • Usually postmenopausal
  • Found late
    • vague symptoms

107

What is the most common type of ovarian carcinoma?

Epithelial (CA 125)

108

What is the most common cervical carcinoma?

Squamous cell

109

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

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

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

Low Grade Squamous Intraepithelial Lesion

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

111

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

Atypical Squamous Cells cannot rule out High grade intraepithelial lesion

  • Pap result
  • Moderate dysplasia
  • Workup:

    • Colposcopy and Bx

112

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

High Grade Intraepithelial Lesion

  • Pap result
  • Severe/Marked Dysplasia
  • May have CIS
  • Workup:

    • Colposcopy and Bx

113

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

Atypical Glandular Cells of Undetermined Significance

  • Pap result
  • In same class as adenocarcinoma in situ
  • Workup:

    • Colposcopy and Bx

114

What is the most common vulvar infection?

Condyloma

115

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

  • Type
    • Squamous cell CA
  • Risk Factor
    • HPV

116

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

  • Hormones
    • Posgesterone only
  • Result
    • Thin endometrium
    • Bleeding

117

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

  • Hormones
    • Progesterone only
  • Result
    • thin endometrium
    • bleeding

118

What solution is used to visualize trichomonas and gardnerella vaginalis?

Saline solution

119

What solution is used to visualize candida in vaginitis?

KOH

120

OCPs, Ring, Patch

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

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

121

Proesterone-based IUD/ Implant

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

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

122

Depo-Provera

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

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

What is characterized by a painful ulcer?

  • Herpes
  • Chlamydia
    • Lymphogranuloma Venerum

124

What is characterized by a painless ulcer?

  • Syphilis
    • (Single ulcer)
  • Klebsiella granulomatis
    • Enlargening painless ulcer

125

Symptoms of Primary Syphilis

  • Chancre
  • Develops into sinle, painless ulcer

126

Symptoms of secondary syphilis

  • Fever
  • Arthritis
  • Rash (palms and soles)

127

What are the neurologic symptoms of Syphilis?

Neurosyphilis

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

128

What is Gummatous syphilis?

Tertiary syphilis

  • Sx:
    • Granuloma formation on skin and bone

129

What are the cardiovascular manifestations of tertiary syphilis?

Destruction of elastic tissue

  • Aortic dilation
    • can cause regurg
  • Aortic aneurysm 

130

What tests are used to diagnose Syphilis?

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

131

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

Ovarian torsion

132

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

Ruptured ovarian cyst

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

133

What reproductive problem can cause nodularity of the uterosacral ligaments?

Endometriosis

134

What is the only way to definitively diagnose endometriosis?

Laparoscopy with biopsy

135

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

  • Cause:
    • Increased endometrial prostaglandins
  • Treatment:
    • NSAIDS
    • OCPs

136

What is Stress Incontinence?  What is the cause?

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

137

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

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

138

What is the definition of menopause?

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

139

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

  • 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

What are the characteristics of fibroadenoma?

  • Painless, solitary mass
  • Mobile
  • May be bilateral

141

What are the characteristics of fibrocystic breast disease?

  • Diffuse, lumpy
  • Cyclical changes