OB/GYN Flashcards
(149 cards)
1
Q
Mean age of menarche in the US?
A
13
2
Q
Definition of precocious puberty?
A
puberty
3
Q
Lab findings distinguish true precocious puberty from pseudoprecocious puberty?
A
True: incr LH/FSH, GnRH increases LH/FSH
Pseudo: decr LH/FSH, no response with GnRH
4
Q
Some causes of psuedoprecocious puberty?
A
Exogenous hormones, androgen/adrenal tumor, CAH
5
Q
Treatment for central precocious puberty?
A
continuous GnRH agonist
6
Q
Which phase of the menstrual cycle is fixed at 14 days, regardless of cycle length?
A
luteal
7
Q
FSH triggers the release of which hormone from the follicle?
A
estradiol
8
Q
Premature menopause is defined as menopause before what age?
A
40
9
Q
WHat is required for a diagnosis of menopause?
A
woman > 45 with 1 year of amenorrhea
10
Q
As periods become less frequent during perimenopause, what hormonal changes are occurring?
A
incr FSH/LH, fluctuating estrogen and decr response to FSH/LH
11
Q
Side effects of estrogen? Side effects of progesterone?
A
Estrogen - weight gain, nausea, breast tenderness, HA, endometrial proliferation
progesterone - acne, depression, HTN`
12
Q
Four different options for emergency contraception?
A
Combo OCP
levonorgestrel
copper IUD
mifepristone
13
Q
Mechanisms of action of OCPs?
A
inhibit follicle/ovulation, incr cervical mucous, decr chance of implantation
14
Q
OCP use decreases the incidence of what types of cancer?
A
endometrial CA
ovarian CA
colon CA
15
Q
Woman present with primary amenorrhea, absent secondary sexual characteristics, and anosmia. What is the diagnosis?
A
Kallmann syndrome
16
Q
What is the definition of premature ovarian failure?
A
1 year
17
Q
What is the most common cause of secondary amenorrhea?
A
pregnancy
18
Q
What is the initial step in the management of a woman presenting with secondary amenorrhea and new galactorrhea when the beta hcg is negative?
A
PRL level
TSH
19
Q
Basic components of a work up for secondary amenorrhea?
A
beta hcg PRL TSH/FSH DHEAS/testosterone progesterone; prog/estrogen challenge
20
Q
Treatment of choice for primary dysmenorrhea?
A
NSAIDS
OCP
21
Q
Medications effective in treatment of PMS and PMDD?
A
NSAIDS, OCP, exercise, vit B6, progesterone, SSRI, benzo
22
Q
first line tx for endometriosus?
A
NSAIDs/OCPS
laparoscopy
23
Q
Most common cause of female infertility?
A
Endometriosis
24
Q
3 D’s of endometriosis
A
dysmenorrhea
deep dyspareunia
dyschezia
25
What is the most common cause of irregular, heavy uterine bleeding?
ovulatory dysfunction
26
When is endometrial biopsy necessary part of work up for abnormal uterine bleeding?
> 45 year old
27
What is the most common clotting disorder that can cause menorrhagia? What lab values are abnormal?
von Willebrand disease
incr bleeding time, increase PTT
28
most common cause of hirsutism in US? What lab finding is used to make the diagnosis?
PCOS
incr LH, LH:FSH ratio, incr andorgens, pos progestin challenge
29
which type of cancer are women with PCOS at increased risk and why?
endometrial CA, unopposed estrogen
30
medications used in the treatment of PCOS?
OCP, progesterone, metformin, spironolactone, statin, clomiphene, abx cream
31
What can lactational amenorrhea be relied upon as an effective method of contraception?
if patient only breast feeds every 3-4 hours, and under 6 months from delivery
32
Distinguishing features of bacterial vaginosis, candida vaginitis, and trichomonas?
bact vag - PH > 4.5, clue cells on wet mount
candida - budding hyphae on wet mount
tricho - flagellated organisms on wet mount
33
treatment of gonorrhea?
ceftriaxone
34
treatment of chlamydia?
azithro, doxy
35
Sexually active woman presents with classic symptoms of cystitis. UA shows no organisms. What organism do you suspect is the cause of this patient's symptoms?
chlamydia
36
What medications can be used in the treatment of syphilis?
PCN G
doxy/tetra
37
Indications for an endometrial biopsy?
woman > 35 with abnormal uterine bleeding
age
38
What is the next step in the management of a CIN 2 cervical lesion identified on biopsy in a woman who has completed fertility?
excision: LEEP, conization, laser
39
What is the next step in the management of an ASCUS pap smear with positive HPV test?
colposcopy
40
What is the next step in the management of an AGUS pap smear?
coloposcopy, endometrial sampling
endo biopsy if > 35
41
What are the symptoms of ovarian cancer?
asymptomatic, abd pain, ascites, wt loss, change in bowel habits, change in menstruation, fatigue, adnexal mass
42
What are the risk factors for ovarian cancer?
fam hx (BRCA 1/2), nulliparity, early menarche, late menopause, infertility
43
Serum marker may be elevated in cases of ovarian cancer?
CA 125
44
Ultrasound findings consistent with benign ovarian tumors? With malignant ovarian tumors?
simple cysts, smooth edges, few septae
complex cysts, irreg, nodularity, many septae, spreading
45
Type of ovarian tumor is associated with psammomma bodies? Estrogen excess? Andorgen secretion?
serous cystadenoma
granulosa/theca cell
sertoli/ leydig cell
46
complication of gonorrhea or chlamydia that infects the capsule of liver?
Fitz Hugh Curtis
47
Breast disease described as most common tumor in teen and young women
fibroadenoma
48
Breast disease described as most common mass in patients 35-50
fibrocystic changes
49
Breast disease described as often presents with serous or bloody nipple discharge
intraductal papilloma
50
Drugs notable for causing gynecomastia?
STACKED
```
spironolactone
THC
alcohol
cimetidine
ketoconazole
estrogen
dig
```
51
most common breast cancer? most common site for breast cancer?
invasive ductal CA
upper outer quadrant
52
Findings suspicious on a mammogram?
hyperdense regions, microcalcifications
53
Treatment for ductal carcinoma in situ of the breast?
lumpectomy + radiation
mastectomy
54
Once you have ruled out invasive cancer, what is the management of LCIS? Why is drug therapy so effective?
observe, SERMs, excisional biopsy
LCIS always ER (+), PR (+)
55
What term describes heavy bleeding during and between menstrual periods?
menometrorrhagia
56
SIgn of early pregnancy matching hyperpigmentation of sun exposed areas of the face
chloasma
57
SIgn of early pregnancy matching hyperpigmentation of midline of lower abdomen
linea nigra
58
SIgn of early pregnancy matching dark bluish red discoloration of the vaginal mucosa
chadwick sign
59
SIgn of early pregnancy matching softening of the cervix
Goodall
60
presence of what hormone is used to confirm pregnancy?
beta hcg
61
LMP February 8, 2015. What is her expected date of delivery?
November 15, 2015
62
What does G6P3214 mean?
6 pregnancies, 3 term births, 2 preterm, 1 abortion, 4 living children
63
How does Cardiac output change in pregnancy?
increase
64
how does plasma volume change in pregnancy?
increase
65
how does blood pressure change in pregnancy?
decrease
66
how does creatinine change in pregnancy
decrease
67
What vitamin should be supplemented during pregnancy? Why?
folic acid - prevent NTD
68
24 year old woman at 6 weeks gestation comes to the physician for her first prenatal visit. BMI is 28, WHat is the recommended weight gain for this patient during this pregnancy?
15-25
69
during pregnancy when should you screen for syphilis
first trimester, 3rd trimester
70
during pregnancy when should you screen for quadruple screen
15-20 weeks
71
during pregnancy when should you screen for gestational diabetes
24-28
72
during pregnancy when should you screen for administration of anti D immunoglobulin
28 weeks
73
during pregnancy when should you screen for GBS
34-36
74
40 year old G3P2 woman at 11 weeks gestation comes to the physician for a prenatal visit. Given her age she is concerned about the risk of down syndrome and would like a definitive test immediately. What test should you recommend?
CVS
75
Condition suggested by quad screen with incr AFP
NTD, abd wall defect, multiple gest, incorrect dating
76
Condition suggested by quad screen with decr AFP, decr estriol, incr hCG, incr inhibin
Down's
77
Condition suggested by quad screen with decr AFP, decr estriol, decr hcg
edwards
78
hyperemesis gravidarum distinguished from nausea and vomiting of pregnancy?
wt loss > 5% pre pregnancy weight, dehydration, ketosis, abnormal labs
79
Treatment for nausea and vomiting of pregnancy?
lifestyle
vit B6, doxylamine
diphenhydramine, prometh, ondansetron
80
infants of mothers with pregestational diabetes are at increased risk for what complications?
macrosomia, hypoglycemia, spontaneous abortion, cong anomalies (cardiac defects, caudal regression), stillbirth
81
21 year old at 26 weeks gestation comes to the hospital because of fever and back pain. Her temp is 100.9, pulse is 110, resp 22. Physical exam shows left flank tenderness. WHat test confirms diagnosis?
UA and culture
82
next step in management of woman with uncomplicated cystitis?
nitrofurantoin, TMP-SMX, fospho
83
Condition described as patient with PMH of HTN becomes pregnant
chronic HTN
84
Condition described as new onset HTN during pregnancy with no proteinuria
gest HTN
85
Condition described as new onset HTN during pregnancy + proteinuria or end organ dysfunction
preeclampsia
86
Condition described as patient with preeclampsia has a seizure
eclampsia
87
Condition described as patient with preeclampsia has anemia, thrombocytopenia, thrombocytopenia, and high AST
HELLP
88
antihypertensives commonly used during pregnancy?
hydralazine, methyldopa, labetalol, nifedipine
89
diagnostic criteria for preeclampsia
HTN > 20 weeks 140/90
| proteinuria > 300 mg/24 hour or end organ damage
90
definitive treatment for preeclampsia?
delivery
91
Which anticoagulant should be avoided during pregnancy?
warfarin
92
33 year old woman at 39 weeks gestation is admitted to the labor and delivery unit in active labor. During second stage of labor she complains of SOB and then suddenly becomes unresponsive. Pulse cannot be detected. Most likely diagnosis?
amniotic fluid embolism
pulmonary embolism
93
Teratogen associated with ebstein anomaly
lithium
94
Teratogen associated with yellow-brown discoloration of teeth
tetracycline
95
Teratogen associated with phocomelia
thalidomide
96
Teratogen associated with short palpebral fissures, smooth philtrum
alcohol
97
Teratogen associated with clear cell adenocarcinoma of the vagina
DES
98
Teratogen associated with nasal hypoplasia, epiphyseal stippling
warfarin
99
Teratogen associated with neural tube defects
antiepileptic
100
Why should ACEI be avoided during pregnancy?
renal/CVS malformations, ossification of skull
101
19 year old G1P0 woman at 32 weeks gestation is brought to the hospital after the sudden onset of vaginal bleeding, abdominal pain, and contractions. She admits to recreational drug use. What drug most likely contributed to this patient's condition?
cocaine
102
Preferred medication for treatment of headache
acetaminophen
103
Preferred medication for treatment of hypertension
hydralazine, methyldopa, labetalol
104
Preferred medication for treatment of diabetes
insulin
105
Preferred medication for treatment of DVT
heparin, LMWH
106
Congenital infection associated with chorioretinitis + hydrocephalus + intracranial calcifications
toxo
107
Congenital infection associated with hydrops fetalis
parvovirus B19
108
Congenital infection associated with PDA + cataracts + deafness
rubella
109
Congenital infection associated with saddle nose, snuffles, hutchinson teeth, saber shints
syphilis
110
Abx used for prophylaxis against GBS? Which patient should receive prophylaxis?
PCN G
pos GBS, unknown status + 1/3 (intrapartum fever, prolonged ROM, preterm labor)
111
risk factors for ectopic pregnancy?
previous ectopic, PID, tubal surgery, smoking, infertility, IUD
112
Patient has vaginal bleeding, LMP 8 weeks ago. beta hcg is 1000. Transvaginal US is unremarkable. Next step in diagnostic evaluation of this patient?
beta hcg in 48-72 hours
113
management options for intrauterine fetal demise
expectant
D&E
misoprostol, mifepristone, oxytocin
114
Potter sequence?
```
pulmonary hypoplasia
oligo
twisted skin
twisted face
extremitities
renal agenesis
```
115
Causes of poly?
```
esophageal/ duodenal atresia
cong infection
multiple gestation
anencephaly
maternal DM
RH alloimmunization
```
116
recipient of twin twin transfusion is at risk for what complications?
polycythemia
vol overload
heart failure
polyhydramnios
117
Term described by implantation of the placenta over the cervical os
placenta previa
118
Term described by fetal blood vessels overlie the cervical os
vasa previa
119
Term described by abnormal adherence of the placenta to the myometrium
placenta accreta
120
Term described by invasion of the placenta into the myometrium
placenta increta
121
Term described by invasion of the placenta through the myometrium
placenta percreta
122
Term described by premature separation of the placenta from the uterus before delivery
placental abruption
123
presentation of placental abruption differ from that of placenta previa
painful vs painless vag bleeding
124
medication used to promote fetal lung maturity
corticosteroids
125
what agents are used for tocolysis?
mg sulfate, indomethacin, nifedipine, terbutaline
126
What hormone is elevated in gestational trophoblastic disease?
beta hcg
127
Type of hydatidiform mole associated with an increased risk of choriocarcinoma?
complete
128
What is the treatment for choriocarcinoma?
chemo (MTX)
surgery
no pregnancy for 1 year
129
What is Rhogam administered?
28 weeks, delivery, any risk of fetomaternal hemorrhage
130
antibiotics avoided during pregnancy due to potential teratogenic effects?
```
fluoroquinolones
tetracycline
chloramphenicol
aminoglycoside
sulfonamide
```
131
laparoscopic findings can be seen in endometriosis?
choc cysts, powder burn lesions
132
Normal reactive nonstress test?
2 accelerations > 15 bpm lasting 15 seconds
133
Components of biophysical profile? What is considered a reassuring biophysical profile?
```
nonstress
AFI
fetal breathing
fetal movement
fetal tone
```
8-10
134
Medication is used to produce contractions in a contraction stress test?
oxytocin
135
Fetal heart rate of variable deceleration indicates?
cord compression
136
Fetal heart rate of sinusoidal pattern indicates?
severe anemia
137
Fetal heart rate of early deceleration indicates?
head compression
138
Fetal heart rate of late deceleration indicates?
uteroplacental insufficiency
139
Stages of labor?
1st stage: latent - 0-6cm
active - 6 cm - 10 cm
2nd stage: fully dilated to delivery infant
3rd stage: delivery infant to placenta delivery
140
Signs of placental separation?
gush of fluid
umb cord lengthening
uterus changes shape
141
Agents used to induce labor?
prostaglandin, oxytocin, amniotomy
142
Clinical features of chorioamnionitis?
maternal fever
maternal and fever tachy
uterine tenderness
purulent fluid
143
treatment for chorioamnionitis?
broad spectrum antibiotics
| delivery
144
Signs of uterine rupture? Management?
```
fetal brady
abd pain
loss of fetal station
change in uterus shape
maternal tachy and hypotension
```
treatment: c section, hysterectomy, surgical repair
145
Medications used in management of uterine atony?
oxytocin
methylgervonivine
carboprost
misoprostol
146
Male newborn with pulse 110, respirations regular, moves arms and legs spontaneously, gives a strong cry. Pink with bluish hands and feet. Apgar score?
9
147
Antibiotics used in treatment of postpartum endometritis?
gentamicin and clinda
148
What organism is most commonly implicated in postpartum mastitis? what is the treatment?
s aureus
dicloxacillin or clinda, TMP-SMX, vanco
149
Cardinal movements of labor?
```
engaged
descent
flexion
internal rotation
extension
external rotation
expulsion
```
