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Flashcards in ob-gyn Deck (115):
1

most common uterine cancer

adenocarinoma

2

risk factor for uterine neoplasm?

estrogen

3

uterine cancer has similar risk to what other type of CA

breast

4

Endometriosis define

uterine tissue outside of the uterus

5

Dysfunctional Uterine Bleeding treatment

OCPs or hormonal therapy (Progesterone) to regulate/shorten cycle
○ NSAIDs for dysmenorrhea & reduce bleeding
decreases despite small relative platelet dysfunction)
○ Surgical ligation or embolization of uterine arteries, D&E, hysterectomy

6

most common site for endometriosis

most common site of implantation is peritoneal

7

how to dx endometriosis

laproscopy

8

tx for endometriosis

hormone replaced / OCP

9

symptoms of endometriosis

cyclic cramping and heavy bleeding during peroids

10

Leiomyomata

benign uterine fibroid

11

leiomyosarcoma

cancerous uterine fibroid

12

how are leiomyomata (uterine fibroids) dx

US

13

tx of uterine fibroids

depends on what location:hormonal control (symptomatic relief), ablation/ligation/embolization of uterine
arteries, hysterectomy

14

Why are Patty & Selma, Bart Simpson’s aunts at risk for endometrial cancer?

given their obesity, diabetes, hypertension, and alcohol consumption. Both had periods at 9 years old, never had children, suffered from infertility and PCOS. both had breast cancer and took Tamoxifen

15

what increases the risk of ovarian torsion

cysts >5cm are at increased risk of torsion, may check flow with doppler, fertile patient dealt with Emergent. pain meds should be offered

16

benign bleeders (another name for?)

leiomyomata

17

normal cycling cyst

follicular 2.5cm

18

chocolate cyst

Corpus Luteum: associated with pregnancy

19

Thecal cyst

often bilateral, result from excess hCG secretion in molar and multi gestation pregnancy

20

risk of ovarian cancer

ovulation

21

ovarian cancer is associated with what syndromes

BRCA mutations & Lynch
Syndrome/HNPCC

22

what is C125 used for

ovarian cancer

23

is bleeding common in ovarian cancer?

no

24

dx ovarian ca

US or CT

25

tx of ovarian ca

chemo or surgery

26

cancer is secreting tumor markers (alphaFP,
betahCG, LDH, alkaline phosphate. you should think:

germ cell or tetratoma

27

Gardnerella is.....

bacterial vaginosis ---tx is flagyl

28

tx of Trichomonas

metronizole

29

Asherman Syndrome

uterine scaring

30

Premenstrual Dysphoric Disorder (Premenstrual Syndrome)

must interact with daily function. try SSRI, hormonal replacement

31

what hormones do ovaries continue to produce after menopause

After menopause, the ovaries continue to produce testosterone and androstenedione
○ But estrone is the main postmenopausal
circulating estrogen

32

how do you dx menopause

FSH > 30 mIU/mL diagnostic

33

do not use hormonal replacement with what pts

Cannot use HRT with unexplained vaginal bleeding, history of DVT/PE, or history of GYN
tumors that may be estrogensensitive

34

breast are tender during what phase of menstral cycle

lutealphase

35

antibiotic for mastitis

dicloxacillin, nafcillin, or cephalosporin

36

risk for developing breast cancer

Nulliparity or delayed childbearing, Early menarche or late menopause, Longterm
estrogen exposure i.e. being on OCPs for years
○ Radiation exposure
○ First degree relative with breast cancer

37

more common breast cancer ductal or lobar

ductal

38

what is Paget’s Disease of the Breast

● Scaly, eczematous, erythematous nipple lesion
● Ductal carcinoma of the nipple

39

ddx for gactorrhea

Pituitary adenoma (hyperprolactinemia)
○ Thyroid disorders
○ Medication side effect: H2 blocker (cimetidine); antipsychotic
(risperdone)

40

Gynecomastia

Caused by an imbalance of testosterone and estrogen effect (too strong an effect)
● Can also be caused by medication: spironolactone

41

OCP benefits

Less dysmenorrhea and menorrhagia (less irondeficiency
anemia)
○ Less PID
○ Some protection against ectopic pregnancy
○ Less acne and hirsutism; benign breast disease
○ Reduced risk of ovarian and endometrial CA

42

work up for infertility

Semen analysis: first step
● Endocrine workup:
TSH, FSH, prolactin levels
● Anatomical workup
(hysterosalpingogram, ultrasound)

43

tx for infertility

Clomiphene citrate (Clomid): given to anovulatory women
○ Stimulates ovaries to produce eggs
● Artificial insemination
● Assisted reproductive therapy: IVF, GIFT, surrogate
● Therapies are expensive but about 75% effective

44

Cervical motion tenderness (chandelier’s sign)

PID

45

PID work up

GC and Chlamydia: DNA probe testing
● Pelvic ultrasound: to ruleout
TOA

46

prenatal care schedule

Visit once a month until 28 weeks, once every 23
weeks until 36 weeks, then once a
week until term

47

Quickening will start at what week (fetal movement):

about 18 weeks

48

during the first trimester: Low PAPPA (pregnancy associated
plasma protein A) and high hCG increased risk of what genetic disorders

trisomy 18,
trisomy 21

49

2nd trimester: if low estriol, low AFP, high inhibin→ increased risk of

genetic disorders

50

Nuchal translucency screening (nuchal fold scan)
what is this, when is done and what does it screen for?

US at 12 weeks
○ Screen for trisomies, Turner’s
○ If abnormal→ offer CVS or amniocentesis

51

Fetal heart rate: normal (reactive) =

2 accelerations in 20 minutes of up to 15
bpm from baseline and no decelerations

52

stations of labor

Spine: 0 station, Above spine: 1,
2cm, etc; below spine: +1, +2cm

53

stage 1 first baby: labor can last up to ____hours and still be considered within a normal time frame

20 hours

54

stage 2 is defined by

complete dilation of cervix

55

third stage

delivery to delivery of placenta

56

benefits & cons of Internal (fetal scalp electrode;

need to have at least 2cm cervical dilation): most accurate
● Look for accelerations and decelerations

57

Late decels are

bad→ uteroplacental insufficiency with lack of blood flow to infant

58

If concerned about FHR then...

● change mom to lay on left side, given oxygen, stop pitocin

59

Cardinal movements of birth

engagement→ descent→ flexion→ internal rotation→
extension→ external rotation→ expulsion

60

Examine placenta and cord: there should be

3 vessels→ 2 arteries, 1 vein

61

APGAR score at 1 and 5 minutes stands for?

(Appearance, Pulse, Grimace, Activity, Respiration)
○ Categories: color, heart rate, respiration, reflex, motor tone

62

risks of c-section

higher risks of thromboembolism, bleeding, infection, longer length of stay

63

transfusion if blood loss is ____mL or hematocrit drops by ___%

Blood loss requiring transfusion or a 10% drop in hematocrit
○ Or >500ml blood loss from vaginal birth or 1000ml after csection

64

management of hemorrhage

Uterine massage
○ Manual compression
○ Oxytocin, ergonovine or prostaglandins to enhance contraction

65

uterus returns to normal size how many weeks about birth?

6 weeks

66

Most common etiology of ectopic pregnancy

adhesions (scars from previous surgery, infection, etc)
● Risk factors
○ Previous ectopic
○ PID
○ Tubal/abdominal surgery
○ IUD
○ Assisted reproductive therapy

67

symptoms of ruptured ectopic pregnancy

Hypotension, Shoulder pain (referred pain), Peritonitis
Bradycardia or tachycardia

68

hCG normally doubles every 48 hours → if less than doubling, suspicious, order what imaging?

transvaginal US

69

tx of ectopic pregnancy

methotrexate (if early, small, patient is stable, and good followup
available)
■ Folic acid antagonist → kills embryo

70

Gestational Trophoblastic DIsease

A group of diseases arising from the placenta
○ Hydatidaform mole
○ Trophoblastic tumors
○ Choriocarcinoma

71

○ Hydatidaform mole

partial and complete molar pregnancy
○ Chorionic villi that grow into a tumor

72

US of molar pregnancy

Complete: “grape like vesicles” or “snowstorm” on US with empty egg

73

can complete and incomplete molar pregnancy go on to be cancerous

Yes
20% of complete
5% of partial

74

high hCG level, uterine size bigger than date, nausea, and Hyperemesis gravidarum and abnormal uterine bleeding

molar pregnancy

75

tx of molar pregnancy

chemo or surgery

76

when to screen for gestational DM?

Screen at 24-28
weeks

77

how to test for Gestational DM

Nonfasting: 50g glucose tolerance test, then check glucose at 1 hr---- If >130mg/dL→ then do a 3hr
test
3hr GTT: 100g glucose load in Am after fasting. Then check glucose levels at 1,2 and 3 hours→ if 2 or more abnormal values, diagnosis is made.

78

Threatened abortion :

vaginal bleeding, os closed

79

Inevitable abortion :

vaginal bleeding, os open

80

Incomplete abortion :

vaginal bleeding, os open

81

important post abortion management

Give RhoGam if mom is Rh ()
○ If incomplete/missed abortion: may need D&C

82

Painless 3rd trimester vaginal bleeding

Placental Previa

83

Placental Previa

Risk factors
○ Advanced maternal age
○ Smoking
○ High parity
○ Scarring

84

dx of Placental Previa

US

85

Sympathomimetic use, smoking, heavy alcohol use
○ Trauma
○ HTN
○ Advanced maternal age
○ High parity
are risk factors for

Abruptio Placentae

86

aburptio placentea DX?

Diagnosis: US not diagnostic enough
○ Need to monitor fetus and fetal stress testing
○ Lack of blood flow would reflect in fetal heart rate with decelerations

87

Pelvic examination reveals a dilated cervical os with visible tissue in the endocervical canal. Which of the following types of abortion is best represented in this case?

incomplete abortion

88

Routine PAP smear reveals high grade squamous intraepithelial lesions (HGSIL). What is the next step in this patient’s management?

Colposcopy

89

Pelvic ultrasound is ordered and reveals uterine fibroids. She is concerned because she would still like to have children in the future. Which of the following is the recommended therapy for this disease?

Myomectomy

90

complaints of spasmodic, cramping abdominal pain during her periods, which radiates to her upper thighs and her lower back. She states that she has had these symptoms for a long time but now the pain is getting so bad that she can’t bear it anymore. Which of the following medications would be the best choice for treatment of this patient?
A.

Mefenamic acid (Ponstel) is the only NSAID that is currently approved for use in spasmodic dysmenorrhea

91

lab work reveals no proteinuria; however she does have a trace of glucosuria. Which of the following best explains this finding?

The glomerular filtration rate increases during pregnancy and may lead to a finding of trace glucose in the urine.

92

In fetal heart monitoring, cord compression is most likely to cause which of the following?

Variable decelerations

93

Which of the following subtypes of ovarian cancer is the most common?

Epithelial cell
This is the cause of over 90% of ovarian malignancies.

94

Which of the following best represents the luteal phase of the menstrual cycle?

Decrease in estradiol and increase in progesterone
This most accurately describes the luteal phase of the menstrual cycle. These hormone changes occur during days 15 to the 1st day of menses with decrease in LH and FSH; if fertilization does not occur progesterone will drop rapidly.

95

Turner syndrome is suspected. Which of the following best describes this patient's menstrual disorder?

primary

96

A premenopausal patient presents to the clinic with the chief complaint of abnormal vaginal bleeding, irregular cycles and vaginal dryness. Which of the following is the most common cause of abnormal vaginal bleeding in this patient population?

Anovulation: This is the number one cause of dysfunction uterine bleeding.

97

Which of the following is considered first line therapy in the treatment of anovulation?

Clomiphene is indicated as first line therapy in the treatment of anovulation. This drug is an estrogen antagonist that will relieve the negative feedback on FSH allowing for follicular development. Sometimes OCP’s can also be used to treat anovulation.

98

edward syndrome is another name for

trisomy 18

99

A 41 year old pregnant woman comes to your OB/GYN clinic asking about screening for neural tube defects. Besides educating her on the need for folic acid supplementation you inform her that the best screening method is which of the following?

Maternal serum alpha fetoprotein levels
This is the primary method of screening for neural tube defects and is performed at around 16-18 weeks.

100

Endometriosis most commonly affects what other organ?

Ovaries are affected in greater than 60% of cases of endometriosis.

101

Which of the following is the earliest sign seen in preeclampsia?

Hypertension

102

Neurofibromatosis is inherited according to which of the following patterns?

Neurofibromatosis and achondroplasia are inherited in an autosomal dominant fashion.

103

1st line therapy for the treatment of pre-menstrual syndrome.

Fluoxetine
SSRI’s

104

Which of the immunoglobulins would you expect to be equal in both the mother and the fetus? Hint it is the smallest

IgG

105

Which of the following types of HPV is the most severe and has the worse prognosis?

11 & 16 (lost molly and parents divorce)

106

Lithotomy

position for pelvic exam

107

warfarin may not be used in __________

pregnancy

108

initial test of choice to dx PCOS

Total testosterone levels

109

A 26 year old woman presents for routine PAP smear. She is sexually active and has been for over 6 years, she also has a history of smoking and some recreational drug use. Her PAP smear results in atypical squamous cells of undetermined significance (ASC-US). What is the next step in the evaluation of this patient?
A.

Human Papilloma Virus Testing
The preferred strategy for Atypical Squamous Cells of Undetermined Significance (ASC-US) is reflex HPV testing. HPV-negative patients should be re-tested in 3 years. HPV-positive patients should undergo colposcopy.

110

A 27 year old female presents to the OB/GYN clinic complaining of dyspareunia and intermenstrual bleeding. She also states that she is noticing pain in her left abdominal region on the lower side. Ultrasound is ordered and reveals a simple 4cm left sided ovarian cyst. Pregnancy test is negative. Which of the following is the most appropriate therapy at this time?

Repeat US in one month
This is the correct answer and is the best initial approach to a patient with a simple ovarian cyst less than 5cm in diameter. Most cysts of this nature will resolve on their own, and 1 month follow-up is sufficient unless symptoms worsen.

111

In a patient with Polycystic Ovarian Syndrome, which of the following would most likely be found on laboratory studies?

2:1 LH:FSH ratio
This abnormality is seen in nearly 95% of patients with PCOS.

112

In a couple who is trying to conceive, the husband has already tested normal on semen analysis. What is the initial work up for the female?

This along with basal body temperature charting is usually the initial step in the work up of female infertility.

113

What is the treatment of choice for vaginal candidiasis in a pregnant patient?

Miconazole nitrate vaginal cream

114

Which of the following subtypes of ovarian cancer is the most common?

Epithelial cell
This is the cause of over 90% of ovarian malignancies.

115

A premenopausal patient presents to the clinic with the chief complaint of abnormal vaginal bleeding, irregular cycles and vaginal dryness. Which of the following is the most common cause of abnormal vaginal bleeding in this patient population?

anovulation