Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Step 2 CK > OB/Gyn > Flashcards

OB/Gyn Flashcards

1
Q

MC first symptom of pregnancy

A

Amenorrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What leads to sx in pregnancy

A

Surge in estrogen, progesterone and b-HCG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

First step in pt w/ sx of pregnancy

A

Pregnancy test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Cause of morning sickness

A

Increase in b-HCG by placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define embryo

A

Fertilization to 8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define fetus

A

8wks to birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Define infant

A

Birth to 1 yr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define developmental age

A

Days since fertilization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Define gestational age

A

Days/weeks since LMP (2 weeks longer than DA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Nagele rule

A

LMP - 3mos + 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

First trimester

A

Fertilization till 12wks (DA) or 14wks (GA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Second trimester

A

12/14 to 24/26

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Third trimester

A

24/26 until delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pre-viable fetus

A

Born before 24wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Preterm

A

Born 25-37wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Term

A

Born 38-42wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Postterm

A

Born after 42wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Gravidity

A

Number of times woman has been pregnant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Parity breakdown

A

Full term
Preterm
Abortion
Living children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

First sign of pregnancy on physical exam

A

Goodell - softening of cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is quickening

A

1st time mother feels baby kick

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When is Goodell sign seen

A

4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Ladin sign

A

Softening of the midline of the uterus

6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Chadwick sign

A

Blue discoloration of vagina and cervix

6-8wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
When are telangiectasias/palmar erythema seen in pregnancy
First trimester
26
What is cloasma
Hyperpigmentation of face on forehead, nose and cheeks | Can worsen with the sun
27
When is cloasma seen in pregnancy
16 weeks
28
Linea nigra in pregnancy
Line of hyperpigmentation from xyphoid to pubic symphisis | 2nd trimester
29
Best initial test when suspecting pregnancy
b-HCG
30
bHCG levels in pregnancy
Doubles every 48hrs for 4 wks Peak at 10wks Drops in 2nd trim Increases to 20,000-30,000 in 3rd trim
31
How to confirm intrauterine pregnancy
U/S - gestational sac seen at 5wks | bHCG = 1000-1500
32
Cardio changes in pregnancy
Increased CO | Slightly lower BP
33
GI changes in pregnancy
Morning sickness GE reflux as LES tone decreases Constipation as large intestine motility decreases
34
Renal changes in pregnancy
Increased size of kidneys and ureters - risk of pyelo Increased GFR Decreased BUN/Cr
35
Heme changes in pregnancy
Anemia Hypercoagulable state - Increased fibrinogen Venous stasis
36
How often should mother be seen in 1st trim
Every 4-6 weeks
37
What is checked at 11-14 weeks
U/S confirming GA and check nuchal translucency
38
What does a thickened/enlarged nuchal translucency indicate
Down
39
When can fetal heart sounds be heard
End of 1st trim
40
Tests done during 1st trim
Blood tests PAP Gonorrhea/Chlamydia Screening for chromosomal abnormalities
41
Most accurate method to determine GA at 11-14wks
U/S
42
What screen is done in 2nd trim
Triple or Quad - 15-20wks
43
What is the triple screen
MSAFP b-HCG Estriol
44
What is the quad screen
MSAFP b-HCG Estriol Inhibin A
45
What does an increase in MSAFP indicate
Dating error Neural tube defect Abd wall defect
46
What increases the sensitivity of MSAFP
b-HCG Estriol Inhibin A
47
What other tests are done in 2nd trim
Auscultation of fetal HR Quickening - 16-20wks U/S for fetal malformation - 18-20wks
48
How often are 3rd trim visits
Every 2-3 wks | Every week after 36wks
49
When do Braxton-Hicks contractions occur
3rd trim
50
What are Braxton-Hicks contractions
Sporadic contractions that do not cause cervical dilation
51
Difference between Braxton-Hicks contractions and preterm labor
Preterm labor opens cervix
52
What should be done starting at 37 weeks
Cervix checked every visit
53
Testing at 27 weeks
CBC - replace Fe if Hb
54
Testing at 24-28 wks
Glucose load | Glc >140 @ 1hr, do glucose tolerance test
55
Testing at 36 weeks
Cervical culture for chlamydia and gonorrhea - Rx if positive Rectovaginal Cx for GBS - ABX PPX in labor if positive
56
What is the glucose tolerance test
Ingest 100g glucose and check serum levels at 1, 2, 3hrs | Elevation in and 2 is gestational diabetes
57
What is given with Fe supplementation
Stool softeners
58
When is CVS done
10-13wks in advanced maternal age or known genetic disease in parent
59
What is the purpose of CVS
Fetal karyotype | Cathetier into intrauterine cavity to aspirate chorionic villi from placenta
60
When is amniocentesis done
11-14wks in advanced maternal age or known genetic disease in parent
61
What is the purpose of amniocentesis
Fetal karyotype | Needle transabdominally to remove amniotic fluid
62
When is fetal blood sampling done
Pts w/ Rh isoimmunization
63
How is fetal blood sampling done
Needle transabdominally into uterus to get blood from umbilical cord
64
MC site for ectopic pregnancy
Ampulla of fallopian tube
65
RFs for ectopic pregnancy
PID IUD Previous ectopic pregnancies
66
Presentation of ectopic pregnancy
Unilateral lower abd/pelvic pain Vaginal bleeding Hypotensive w/ peritoneal irritation if ruptured
67
Dx tests for ectopic pregnancy
b-HCG U/S - Locate Laparoscopy - Treat
68
Stabilize ruptured ectopic pregnancy
IV fluids Blood products DA
69
Baseline exams for medical rx of ectopic pregnancy
CBC Blood type and screen Tranaminases b-HCG
70
Medical management of ectopic pregnancy
MTX for 4-7 days If there is not a 15% drop in b-HCG, give 2nd dose Still no decrease in b-HCG, surgery
71
When to avoid MTX
``` Immunocompromised Non-compliant Liver disease Ectopic > 3.5cm Fetal heartbeat present ```
72
Removal of ectopic pregnancy
Salpingostomy to preserve fallopian tube | Salpingectomy
73
Give to Rh- mothers during removal of ectopic
RhoGAM - Anti-D Rh IG
74
What is abortion
Pregnancy ends before 20wks or fetus
75
When do spontaneous abortions occur
Prior to 12wks
76
MCC spontaneous abortions
Chromosomal abnormalities
77
Maternal factors that increase risk of abortion
``` Anatomic abnormalities STDs APL Uncontrolled hyperthyroidism or DM Malnutrition Trauma Rh isoimmunization ```
78
Presentation of spontaneous abortion
Cramping abd pain Vaginal bleeding Stable or unstable
79
Dx tests for spontaneous abortion
CBC Blood type and Rh U/S
80
Only way to know type of abortion
U/S
81
Medical management of abortion
Misoprostol to induce labor
82
Complete abortion
No products found | F/U in office
83
Incomplete abortion
Some products found | D&C/medical
84
Inevitable abortion
Products intact Intrauterine bleeding Dilation of cervix D&C/medical
85
Threatened abortion
Products intact Intrauterine bleeding No cervical dilation Bed rest, pelvic rest
86
Missed abortion
Death of fetus but all products present | D&C/medical
87
Septic abortion
Infection of uterus | D&C w/ IV ABX (Levo, metro)
88
What increases the chances of multiple gestations
Fertility drugs
89
Presentation of multiple gestations
Exponential growth of uterus Rapid wt gain by mother Elevated b-HCG and MSAFP (First clue)
90
Dx test for multiple gestation
U/S to visualize
91
Complications of multiple gestations
Spontaneous abortion of 1 fetus Premature labor and delivery Placenta previa Anemia
92
How is preterm labor diagnosed
Contractions w/ cervical dilation
93
RFs for preterm labor
PROM Multiple gestations Previous Hx Placental abruption
94
Maternal RFs for preterm labor
Uterine anatomic abnormalities Infection Preeclampsia Intraabdominal surgery
95
When does preterm labor occur
20-37wks
96
What must be evaluated in fetus during preterm labor
Wt GA Presenting part
97
When should delivery occur in preterm labor
``` Preeclampsia/eclampsia Maternal cardiac disease Dilation >4cm Maternal hemorrhage Fetal death Chorio 34-37 GA, >2500g ```
98
What should be given to stop preterm labor
Tocolytics | Betamethasone to mature lungs
99
MC used tocolytic
Mg sulfate
100
Side effects of Mg sulfate
Flushing HA Diplopia Fatigue
101
What should be checked in pts getting Mg sulfate
Toxicity - resp depression, cardiac arrest | Check DTRs
102
Other tocolytics
CCBs - HA, flushing, dizziness | Terbutaline - palpitations, hypotension
103
Presentation of PROM
Gush of fluid from vagina
104
Dx test for PROM
Fluid in posterior fornix Turns nitrazine paper blue Ferning
105
When is PROM a big problem
Prolongued (labor starts more than 24hrs before delivery)
106
What can PROM lead to
Preterm labor Cord prolapse Placental abruption Chorio - therefore do less exams w/ PROM
107
PROM w/ chorio, now what
Deliver
108
Term fetus, no chorio, PROM
Wait 6-12hrs for spontaneous delivery | Induce if there isn't
109
Preterm fetus, no chorio, PROM
Betamethasone Tocolytics Amp + 1 dose azithromycin
110
Chorio PPX w/ PCN allergy
Rash - cefazolin + 1 dose azithro | Anaphylaxis - clinda + 1 dose azithro
111
Placenta previa
Abnormal implantation over internal cervical os
112
Increased risk of placenta previa with
Previous C-section Previous uterine surgery Multiple gestation Previous placenta previa
113
Contraindication in 3rd trim bleeding
Digital vaginal exam
114
Next best step in 3rd trim bleeding
Transabdominal U/S
115
Presentation of placenta previa
Painless vaginal bleeding | Usually not till 28wks
116
Why is transvaginal U/S or digital vaginal exam not done in placenta previa
Can separate placenta from uterus
117
Complete placenta previa
Completely cover internal os (full moon)
118
Partial placenta previa
Partial covering of internal os (Half moon)
119
Marginal placenta previa
Placenta adjacent to internal os (crescent moon)
120
Vasa previa
Fetal vessel present over internal os
121
Low lying placenta
Implanted in lower segments of uterus but not covering internal os (
122
When is placenta previa treated
Large volume bleeding or drop in HCT
123
Rx placenta previa
Strict pelvic rest | No vaginal insertion
124
Indications for immediate C-section in placenta previa
Cervix >4cm Severe hemorrhage Fetal distress
125
How to prepare preterm fetuses for delivery
Betamethasone
126
Placenta accreta
Adheres to superficial uterine wall
127
Placenta increta
Adheres to myometrium
128
Placenta percreta
Invades uterine serosa, bladder wall or rectum wall
129
What happens if the placent doesn't detach in delivery
Catastrophic hemorrhage and shock | Pt needs hysterectomy
130
Placental abruption
Premature separation of placenta from uterus
131
Complications of placental abruption
``` Life threatening bleeding Premature delivery Uterine tetany DIC Hypovolemic shock Sheehan ```
132
Precipitating factors for placental abruption
``` Maternal HTN Prior placental abruption Cocaine use External trauma Smoking ```
133
Presentation of placental abruption
Painful 3rd trim bleeding Severe abd pain Contractions Fetal distress
134
Dx placental abruption
Transabdominal U/S, may not be seen
135
Concealed placental abruption
Blood is within uterine cavity | Placenta more likely to be completely detached
136
External placental abruption
Blood drains through cervix | Placenta more likely to be partially detached
137
Which placental abruption type has more complications
Concealed
138
Indications for C-section in placental abruption
Uncontrollable maternal hemorrhage Rapidly expanding concealed hemorrhage Fetal distress Rapid placental separation
139
Indications for vaginal delivery in placental abruption
Separation limited Fetal heart tracing assuring Separation extensive and fetus is dead
140
When does uterine rupture occur
During delivery
141
RFs uterine rupture
``` Previous C-sections - Longitudinal > Low transverse Trauma - MVA Myomectomy Uterine overdistention - Polyhydramnios - Multiple gestation Placenta percreta ```
142
Presentation of uterine rupture
Sudden onset extreme abd pain Abnormal bump in abd No CTX Regression of fetus
143
Rx uterine rupture
Immediate laparotomy w/ fetus delivery
144
Why is C-section not done in
Baby may not be in uterus but floating in abd
145
If uterus is repaired after rupture, how will future pregnancies be managed
Delivered via C-section at 36wks
146
When does Rh incompatibility occur
Mother is Rh- but baby is Rh+
147
What happens when Rh- mother delivers first Rh+ baby
Fetal RBCs cross placenta into mother bloodstream and she makes ABX against them
148
What happens in hemolytic disease of the newborn
Fetal anemia Extramedullary production of RBCs Erythroblastosis fetalis
149
What is characteristic of erythroblastosis fetalis
High fetal cardiac output (CHF)
150
What does Rh unsensitized mean
Rh- without Abs
151
When to give RhoGAM to Rh unsensitized mothers
Fetal RBCs may cross placenta - Amnio - Abortion - Vaginal bleeding - Placental abruption - Delivery
152
When is prenatal Rh Ab screening done
28-35wks
153
RhoGAM PPx
Mother unsensitized at 28wks
154
Ab titer in sensitized pts
> 1:4
155
Ab titer
No treatment
156
Ab Titer reaches 1:16 some time in pregnancy
Serial Amnio to evaluate fetal bili
157
Amnio shows low bili
Repeat in 2-3 wks
158
Amnio shows medium bili
Repeat in 1-2 wks
159
Amnio shows high bili
Fetus anemia Do percutaneous umbilical blood sample - If HCT low, do intrauterine transfusion
160
Characteristics of preeclampsia
HTN Edema Proteinuria
161
Eclampsia
Preeclampsia w/ seizures
162
HELLP
Preeclampsia w/ elevated liver enzymes and low platelets
163
Chronic HTN in pregnancy
BP>140/90 before pt became pregnant
164
Rx Chronic HTN in pregnancy
Methyldopa Labetalol Nifedipine
165
Gestational HTN
BP>140/90 starting after 20wks | No proteinuria or edema
166
Rx Gestational HTN
Rx only during pregnancy Methyldopa Labetalol Nifedipine
167
Preeclampsia RFs
Chronic HTN | Renal disease
168
Only definitive rx in preeclampsia
Delivery
169
Features of mild preeclampsia
BP > 140/90 | 1+ to 2+ proteinuria
170
Features of severe preeclampsia
BP > 160/110 | 3+ to 4+ proteinuria
171
Management of mild preeclampsia at term
Induce delivery
172
Management of preterm mild preeclampsia
Betamethasone | Mg sulfate
173
Management of severe preeclampsia at term
Mg sulfate Hydralazine Induce delivery
174
Management of severe preeclampsia preterm
Mg sulfate Hydralazine Betamethasone
175
What is Eclampsia
Tonic clonic seizures in pt w/ Hx preeclampsia
176
Rx Eclampsia
Stabilize pt, deliver baby | Mg sulfate, Hydralazine
177
HELLP features
Hemolysis Elevated liver enzymes Low platelets
178
Pregenstational diabetes
Diabetes before getting pregnant
179
Maternal complications of pregestational DM
4x more likely to have preeclampsia 2x more likely to have spontaneous abortion Increased infection rate Increased postpartum hemorrhage
180
Fetal complications of pregestational DM
Increase in congenital anomalies Macrosomia - shoulder dystocia Preterm labor
181
Evaluation of pregestational DM
EKG 24hr urine - Cr clearance, protein HbA1c Opthalmological exam
182
Rx type I pregestational DM
Insulin pump (NPH)
183
Rx type II pregestational DM
SubQ insulin (NPH, lispro)
184
What is NST done for
Fetal well-being
185
What is BPP done for
Amount of amniotic fluid and fetal well-being
186
What is lecithin/sphingomyelin (L/S) ratio done for
Assess fetal lung maturity
187
What is done at 32-36wks
Weekly NST and U/S
188
What is done >36wks
1 NST and BPP weekly
189
What is done at 37wks
L/S ratio
190
What is done at 38-39wks if pt refuses L/S ratio
Induction of labor
191
Complications of gestational DM
Preterm Fetal macrosomia and injuries from this Neonatal hypoglycemia Mother 4-10x more likely to develop DM II
192
When is gestational DM screened
24-28wks
193
How is gestational DM screened
Glucose load - 50g and measured 1hr later If >140, glucose tolerance (100g measured at 1,2,3hrs) If any are elevated, then confirmed
194
First line rx for gestational DM
Diabetic diet and exercise
195
When is medication indicated in gestational DM
Fasting > 95 | 1hr postprandial > 140
196
What medication is given for gestational DM
Insulin w/ NPH before bed | Aspart before meals
197
What do you not tell pregnant gestational DM pts to do
Lose weight
198
What is IUGR
Weight in bottom 10%for GA
199
What is symmetric IUGR
Brain in proportion | Occurs before 20wks
200
What is asymmetric IUGR
Brain weight not decreased Abd smaller than head Occurs after 20wks
201
Causes of IUGR
Chromosomal abnormalities Neural tube defects Multiple gestations Maternal HTN or renal disease
202
Number 1 preventable cause of IUGR in USA
Smoking
203
Dx IUGR
U/S
204
Complications of IUGR
``` Premature labor Stillbirth Fetal hypoxia Lower IQ Seizures Mental retardation ```
205
Prevent IUGR
Stop smoking | Prevent maternal infections w/ immunizations
206
What is macrosomia
> 4500g
207
RFs for macrosomia
Maternal DM or obesity Advanced maternal age Postterm pregnancy
208
Dx tests for macrosomia
Fundal height 3cm greater than GA
209
If fundal height indicates macrosomia what is the next step
Fetal U/S
210
What measurements in U/S are used to estimate gestational wt
Femur length Abd circumference Head diameter
211
Complications of macrosomia
Shoulder dystocia Birth injuries Low Apgar Hypoglycemia
212
When should induction of labor occur in macrosomia
Lungs are mature before fetus is >4500g
213
Delivery in macrosomia
C-section
214
What does NST measure
Fetal movements and assess fetal HR
215
What is a reactive NST
Detection of 2 fetal movements | Acceleration >15bpm lasting 15-20s over 20min
216
What does a nonreassuring NST often indicate
Fetus is sleeping | Wake with vibroacoustic stimulation
217
What does a BPP consist of
``` NST Fetal chest expansion (1 or more in 30min) Fetal movement (>3cm in 30min) Fetal muscle tone Amniotic fluid index ```
218
Interpretation of BPP
NL - 8-10 Inconclusive - 4-8 Abnormal -
219
NL fetal HR
110-160
220
Variable decels
Cord compression
221
Early decels
Head compression
222
Accelerations
OK
223
Late decels
Placental insufficiency (fetal hypoxia)
224
What is lightening in labor
Fetal descent into pelvic brim
225
What is bloody show
Blood-tinged mucous from vagina released w/ cervical effacement
226
What is stage 1 Labor
Onset to full dilation of cervix Prim - 6-18hrs Mulit - 2-10hrs
227
What is the latent phase of stage 1 labor
Onset to 4cm Prim - 6-7hrs Mulit - 4-5hrs
228
What is the active phase of stage 1 labor
4cm to full dilation of cervix Prim - 1cm/hr Mulit - 1.2cm/hr
229
What is stage 2 of labor
Full dilation to delivery of neonate Prim - 30min-3hr Multi - 5-30min
230
What is stage 3 of labor
Delivery of neonate to delivery of placenta | 30min
231
What to monitor in stage 1 of labor
``` Maternal BP and pulse Fetal HR and CTX Cervical dilation Cervical effacement Station ```
232
Steps in stage 2 of labor
Engagement - head enters pelvic occiput Descent - CTX and mom pushing Flexion Internal rotation - Rotates at ischial spines Extension - So that head can pass through vagina External rotation - Shoulder room to descent Delivery of anterior shoulder - Push down on head Delivery of posterior shoulder - Push up on head
233
What to do in Stage 3 of labor
Inspect and repair lacerations
234
Signs of placental separation
Fresh bleeding from vagina Umbilical cord lengthening Uterine fundus rising Uterus becomes firm
235
How to induce labor
Prostaglandin E2 - not to asthmatics Oxytocin Amniotomy - puncture w/ amnio hook
236
What is arrest of dilation
No dilation of cervix for more than 2hrs
237
What is prolonged latent stage
Latent phase lasts >20hrs in prim, >14hrs in multi
238
Causes of prolongued latent stage
Sedation Unfavorable cervix Uterine dysfunction w/ irregular or weak CTX
239
Rx prolongued latent stage of labor
Rest and hydration | Most convert to spontaneous delivery in 6-12hrs
240
What is protracted cervical dilation
Slow dilation during active phase, less than 1.2cm/hr primi,
241
Etiology of protracted cervical dilation
Power - strength and freq of uterine CTX Passenger - size and position of fetus Passage - cephalopelvic disproportion
242
Rx protracted cervical dilation
C-section | Give oxy if CTX weak
243
Types of labor arrest disorders
Cervical dilation arrest - None for 2hrs | Fetal descent arrest - None for 1hr
244
Etiology of labor arrest disorders
Cephalopelvic disproportion - 50% of all, rx c-section Malpresentation - older than 36wks Excessive sedation/anesthesia
245
Confirming breech position
U/S
246
Presentation of breech
Lower half of fetus is presenting part | Can be felt on PE
247
Dx breach
U/S
248
What is frank breech
Hips flex w/ extended knees b/l
249
What is complete breech
Hips and knees flexed b/l
250
What is footling breech
Feet first
251
When can external cephalic version be done
36wks
252
What is shoulder dystocia
Fetus head delivered but anterior shoulder stuck behind pubic symphysis
253
RFs shoulder dystocia
Maternal DM and obesity causing fetal macrosomia Postterm pregnancy Hx prior
254
First line rx shoulder dystocia
McRobert's maneuver
255
What is McRobert's maneuver
Maternal flexion of knees into abd w/ suprapubic pression
256
What is Rubin maneuver
Rotate fetus shoulders by pushing posterior shoulder towards the fetal head
257
What is Woods maneuver
Rotation of fetus shoulders by pushing posterior shoulder towards fetus back
258
What is Zavanelli maneuver
Push fetal head back into uterus and perform C-section
259
Other ways to fix shoulder dystocia
Deliver posterior arm | Deliberate Fx of fetal clavical
260
What is postpartum hemorrhage
More than 500mL after delivery
261
What is early postpartum hemorrhage
Within 24hrs
262
What is late postpartum hemorrhage
24hrs to 6 wks
263
Etiology of postpartum hemorrhage
Atony - 80% of cases Laceration Retained parts Coagulopathy
264
RFs Atony
``` Anesthesia Uterine overdistention Prolongued labor Laceration Pretained placenta coagulopathy ```
265
Rx postpartum hemorrhage
Assume no rupture and no retained placenta Bimanual compression and massage Oxy if it doesn\t work
266
Presentation of sheehan after postpartum hemorrhage
Inability to breastfeed
267
Sx PMS or PMDD
HA Breast tenderness Pelvic pain and bloating Irritability or lack of energy
268
Difference between PMS and PMDD
PMDD interferes with daily activities
269
Dx criteria for PMDD
Sx present for 2 consecutive cycles Sx free for 1 week in first part of cycle Sx present in second half of cycle Dysfunction in life
270
Rx PMDD
Decrease consumption of coffee, alcohol, cigarettes and chocolate Exercise SSRIs if severe
271
Menopause
Permanent loss of estrogen | 48-52
272
How does menopause start
Irregular menstrual bleeding Oocytes produce less estrogen and progesterone FSH, LH rise
273
How long is menopause symptomatic
12 months
274
Sx of menopause
Menstrual irregularities Sweats and hot flashes Mood changes Dyspareunia
275
PE findings in menopause
Atrophic vaginitis Decreased breast size Vaginal and cervical atruphy
276
Dx menopause
Increased FSH
277
HRT in menopause
Short term symptomatic relief | Prevent osteoporosis
278
What is associated with HRT
Endometrial hyperplasia and carcinoma
279
Contraindications to HRT
Breast or endometrial CA | Hx PE or DVT
280
Post coital bleeding is
Cervical CA until proven otherwise
281
What is menorrhagia
Heavy and prolongued Gushing of blood Clots
282
What causes menorrhagia
Endometrial hyperplasia Uterine fibroids Dysfunctional uterine bleeding IUD
283
What is hypomenorrhea
Light menstrual flow | Only spotting
284
What causes hypomenorrhea
Obstruction | OCPs
285
What is metrorrhagia
Intermenstrual bleeding
286
What causes metrorrhagia
Endometrial polyps Endometrial/cervical CA Exogenous estrogen
287
What is menometrorrhagia
Irregular bleeding - Time intervals - Duration - Amount
288
What causes menometrorrhagia
Endometrial polyps Endometrial/cervical CA Exogenous estrogen Malignancy
289
What is oligomenorrhea
Menstrual cycle >35 days long
290
What causes oligomenorrhea
Pregnancy Menopause Significant wt loss Estrogen secreting tumor
291
What causes postcoital bleeding
Cervical CA!! Cervical polyps Atrophic vaginitis
292
Dx tests for abnormal uterine bleeding
CBC PT/PTT Pelvic U/S
293
What is DUB
Unexplained abnormal bleeding | Also occurs when pt is anovulatory
294
Pathophysiology of DUB
Ovary produces estrogen but no corpus luteum
295
What to r/o in DUB
Hypothyroid Hyperprolactinemia Carcinoma (Endometrial Bx in pts >35
296
Rx DUB
OCP - Adolescents/young women who are anovulatory - >35 w/ NL endometrial Bx D&C to stop acute hemorrhage
297
Rx DUB refractory to OCP/severe causing anemia
Endometrial ablation | Hysterectomy
298
Placement of vaginal diaphragm
6hrs before intercourse | Left there for 6hrs after intercourse
299
OCPs reduce risk of
Ovarian carcinoma Endometrial carcinoma Ectopic pregnancy
300
How long is vaginal ring inserted
3 weeks - withdraw bleeding when removed
301
How long does a transdermal patch placed
7 days
302
How log does a depot injection last
3 months
303
How long can an IUD last
10yrs
304
Types of IUDs
Copper | Levonorgestrel
305
IUDs are associated w/
PID | Genital Cx before placement
306
Tubal ligation increases the risk of
Ectopic pregnancy
307
MCC labial fusion
21-B hydroxylase deficiency | - Excess androgens
308
Rx labial fusion
Reconstructive surgery
309
Lichen sclerosis increases the risk of what
CA in postmenopausal women
310
What does lichen sclerosis look like
White, thin skin
311
Rx lichen sclerosis
Topical steroids
312
RF squamous cell hyperplasia
Chronic vulvar pruritis
313
What does squamous cell hyperplasia look like
Hyperkeratosis - raised white lesion
314
Rx squamous cell hyperplasia
Sitz baths or lubricants to relieve pruritis
315
Who gets lichen planus
30s-60s
316
What does lichen planus look like
Violet, flat papules
317
Rx Lichen planus
Topical steroids
318
Sx of bartholin cyst
Pain Tenderness Dyspareunia
319
Rx bartholin cyst
I&D | Cx fluid for STIs
320
What marsulialization
I&D where open cyst is kept open | Decreases risk of recurrence of bartholin cyst
321
RFs vaginitis
Anything that increases vaginal pH - ABX use - DM - Overgrowth of normal flora
322
Sx of vaginitis
Itching Pain Abnormal odor Discharge
323
Cause of bacterial vaginosis
Gardnerella
324
D/C in bacterial vaginosis
Gray-white | FIshy odor
325
Dx bacterial vaginosis
Saline wet mount | Clue cells
326
Rx bacterial vaginosis
Metro | Clinda
327
D/C in candidal vaginosis
White, cheesy
328
Dx candidal vaginosis
KOH showing pseudohyphae
329
Rx candidal vaginosis
Miconazole Clotrimazole Econazole Nystatin
330
Most common nonviral STI
Trichomonas
331
D/C in trichomonas vaginalis
Profuse, frothy green
332
Dx trichomonas vaginalis
Saline wet mount | Motile flagellates
333
Rx trichomonas vaginalis
Both partners w/ Metro
334
Who gets vaginal paget
Postmenopausal caucasian women
335
Presentation of vaginal paget
Red lesion w/ superficial white coating
336
Definitive Dx of vaginal paget
Bx
337
Rx b/l vaginal paget
Radical vulvectomy
338
Rx unilateral vaginal paget
Modified vulvectomy
339
MC type of vulvar CA
Squamous cell carcinoma
340
Presentation of vulvar squamous cell carcinoma
Pruritis Vaginal discharge Postmenopausal bleeding Large cauliflower-like lesion
341
Dx vulvar squamous cell carcinoma
Bx
342
Stages of vulvar squamous cell carcinoma
``` 0 - in situ I - Vaginal wall, 2cm III - Lower urethra/anus, unilateral LN IV - Bladder, rectum or B/L LN IVa - Distant mets ```
343
Rx vulvar squamous cell carcinoma
Unilateral, no LNs - modified radical vulvectomy B/L - Radical vulvectomy Lymadenectomy as required
344
Adenomyosis
Invasion of endometrial glands into myometrium
345
Who gets adenomyosis
35-50
346
RFs adenomyosis
Endometriosis | Uterine fibroids
347
Presentation of adenomyosis
Dysmenorrhea | Menorrhagia
348
Uterus on PE for adenomyosis
Large, globular, boggy
349
Most accurate test for adenomyosis
MRI
350
Only Rx adenomyosis
Hysterectomy
351
Endometriosis
Implantation of endometrial tissue outside the endometrial cavity
352
MC sites for endometriosis
Ovary | Pelvic peritoneum
353
Who gets endometriosis
Women of reproductive age | 4x more likely if 1st degree relative has it
354
Presentation of endometriosis
Cyclic pelvic pain 1-2 weeks before menstruation Peaks 1-2 days after menstruation Dysmenorrhea, Dyspareunia Nodular uterus and adnexal mass
355
Only way to dx endometriosis
Direct visualization via laparoscopy
356
Rx endometriosis
NSAIDs for pain OCPs for mild sx Danazole or leuprolide for moderate/severe
357
Danazol AE
Acne Oily skin Wt gain Hirsuitism
358
Leuprolide AE
Hot flashes | Decreased bone density
359
Rx endometriosis in pt who has finished having children
Total abdominal hysterectomy w/ b/l salpingoophorectomy
360
Sx PCOS
Amenorrhea, irregular menses Hirsuitism and obesity Acne DM 2
361
Pelvic U/S in PCOS
B/L enlarged ovaries w/ multiple cysts
362
Labs in PCOS
Elevated free testosterone Increased estrogen outside ovary LH stimulation inhibiting FSH - Ratio > 3:1
363
Rx PCOS
Wt loss decreases insulin resistance OCPs if pt doesn't want children Clomiphene and metformin in pts who want to conceive

Step 2 CK (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions