Ob/Gyn Flashcards
(120 cards)
1
Q
increased menstrual bleeding, pelvic pain, increased inhibin
A
granulosa cell tumor
2
Q
tocolytic contraindications
A
maternal hemorrhage
chorioamnionitis
Poor fetal testing
3
Q
closed cervix, empty uterus
A
complete abortion
4
Q
MC complication w / forceps
A
perineal laceration
5
Q
management of CIN 1
A
do nothing until 1) still there after 2 years or 2) gets worse.
1) → ablation (cryo or laser)
6
Q
advantage of laser VS. cryo ablation
A
maintain squamocolumnar jxn → Can do colps in future
7
Q
cardinal mvmts of labor
A
engagement descent flexion int. rotation extension ext. rotation expulsion
8
Q
Cardinal mvmt @ 0 station
A
engagement
9
Q
cardinal mvmt @ ischial spine
A
int. rotation
10
Q
deceleration starts after contraction and ends after contraction
A
late decelerations
11
Q
deceleration starts with contraction and ends with contraction
A
early decelerations
12
Q
rapid decelerations that resolve quickly
A
variable decelerations
13
Q
hysterosalpingography contraindication
A
active pelvic infection
14
Q
management of prolapsed cord
A
C-section!
Trendebnburg
fill bladder (500-700 mL)
elevate fetal presentation
15
Q
post-op fever – when is it ok?
A
first 48 hours
16
Q
weeks to do chorionic villus sampling
A
10-13
17
Q
weeks to do amniocentesis
A
14-18
18
Q
order of puberty/growing things (girls)
A
thelarche
pubarche
growth spurt
menarche
19
Q
enlarged, tender, erythematous, firm breasts
A
inflammatory breast cancer
ddx: cellulitis, mastitis, neglected breast CA
20
Q
dx: inflammatory breast cancer
A
mammography
21
Q
when do you do a Kleihauer-Betke test?
A
determine how much Rh Ig to give
dx placenta abruption (kinda)
22
Q
when do you use the Apt test?
A
dx vasa previa (but not really so much)
23
Q
tx: postpartum endometritis
A
clindamycin + gentamicin
pip-tazo if not
24
Q
ASCUS next steps
A
HPV testing
negative –> observe
positive –> colp
25
preg physio: SVR
decreases
26
preg physio: CO
increases (HR and SV both increase)
27
preg physio: BP
decrease (SVR down (MAP down), CO up)
28
preg physio: creatinine
decreases (clearance up)
29
preg physio: insulin resistance
increases
30
feedings: 1 wk old
8 - 12/day
31
type of abortion by weeks gestation
medical: up to 7 (internet says 10)
7 - 14 wks: suction D&C
14+: D&E
32
tx: pregestational DM, now gestational
insulin (or metformin + insulin)
33
possible GDM tx
metformin
glyburide
insulin
(not tolbutamide)
34
FSH level = low ovarian reserve
> 30
35
tx for low risk of rupture ectopic preg
methotrexate (+ check bHCG @ day 4 and 7 -- must go down by 15% or give a second dose/laproscopy)
36
why would someone be considered low risk ectopic preg
hemodynamically stable
beta-HCG < 5000
gestational sac < 4 mm
no fetal heart tones
37
pain in endometriosis
right before menses to end of menses
dyspareunia
dyschezia
uterosacral ligaments
38
dx: solid breast mass
core needle biopsy (even w/ negative mammography)
39
amniotic fluid pH
~ 7 (turns nitrazine paper blue)
40
when to test for GBS
35 - 37 wks
41
only thing continuous cardiotocography has been shown to improve
neonatal seizures (which lack long term effects)
42
causes of abnormal uterine bleeding
```
PALM E. COIN
polyps
adenomyosis
leiomyomas (fibroids)
malignancy
endometrial
coagulopathy
ovulatory dysfxn (menopause, PCOS, weight, thyroid)
iatrogenic
not yet classified
```
43
enlarged globular uterus + abnormal bleeding
adenomyosis
44
when to give anti-Rh (D)
~ 28 wks
| w/ vaginal bleeding
45
dx: endometriosis
pain, dysmenorrhea, menorrhagia refratory to tx w/ nsaids + OCPs
after U/S --> laparoscopy
46
first line tx for depression in preg
```
psychotherapy
then
1) sertraline (not paroxetine)
2) venlafaxine/bupropion
3) nortriptyline
```
47
why dyschezia in endometriosis
implanted tissue on rectal serosa --> dyschezia, constipation or cyclic heamtochezia
48
postpartum: fever, uterine tenderness, purulent lochia
postpartum endometritis
49
prophylactic ABx for cesarean section
cefazolin (or cefoxitin)
50
tx for Turners @ puberty
conjugated estrogens
51
tx for hyperprolactinemia
bromocriptine (or cabergoline)
52
tx for PCOS wanting kids
clomiphene citrate
| w/ or w/o metformin
53
tx for precocious puberty
leuprolide
| goserelin
54
how much folic acid for someone w/ previous spina bifida
4000 micrograms/day
55
tx for CIN 2+
LEEP
laser conization
cold-knife conization
56
MC complication after cesarean
postoperative ileus
57
preggo w/ hep B tx
tenofovir
| telbivudine
58
hormone levels in PCOS
increased DHEA/T
| LH:FSH = 3:1
59
tx PCOS
OCPs, metformin
60
amenorrhea + anosmia
Kallman's (problem in hypothalamus)
61
when to c section HSV pts
lesions present or prodromal sx (burning/tingling)
62
ABx for PROM
ampicillin + gentamicin
| use clinda w/ penicillin allergy
63
tx for lichen sclerosis
```
topical steroid (clobetasol)
biopsy first, apparently
```
64
dx endometriosis
laparoscopy (not EMB)
65
f/u after granulosa cell tumors
uterine sampling for endo hyperplasia/cancer
66
mgmt: visible cervical lesion
biopsy
67
body measurement that shows IUGR
abdominal circumference
68
fluid for hypovolemic shock (hemorrhage)
packed RBCs, FFP, platelets (1:1:1)
| if none --> lactated ringers or normal saline
69
changes to surgical protocol w/ shellfish allergies?
no iodine prep --> use alternative (chloroprep)
70
fetal acceleration =
up 15 bpm for 15 s
71
fetal deceleration =
drop 15 bpm for 15 s
72
warfarin in pregnancy
nope
switch to heparin
(if have antiphospholipid ab synd give ASA too)
73
risk of anemic preggo
PTL
74
how anemic can preggo be?
Hb < 6 increases risk of PTL
75
infertility tx: low motility sperm
```
intrauterine insemination (1st)
in vitro insemination (2nd)
```
76
LSIL in 21 - 24 yo
Pap next year
77
LSIL in > 25
colposcopy
| if >30 and HPV is neg, you can wait a year
78
what is EMB for?
endometrial hyperplasia/cancer
79
urge incontinence path
detrusor muscle instability
80
urge incontinence tx
```
muscarinic antagonists (anticholinergics)
2nd: TCAs but not great
```
81
IUD relative contraindications
STI in past 3 months
weird uterus
hx of ectopic preg
82
toxic shock syndrome organisms
group A strep
staph aureus
clostridium sordellii
83
postpartum, high fever, hTN, diffuse desquamating rash, 2 organ systems involved
toxic shock syndrome (endometritis)
84
tx for hot flashes
1. HRT (E+P) if they have a uterus
2. E (w/o uterus)
3. SSRI (w/ hx of thromboembolic events)
85
tx for PMS/PMDD
SSRI
86
metrorrhagia/menorrhagia in 40 - 50
endometrial polyps
87
trisomy 13
Patau: facial cleft, rockerbottom feet, digital malforms, holoprosencephaly , cystic hygroma
88
trisomy 18
Edward: overlapping digits, NTDs, rockerbottom feet, diaphragmatic hernia, choroid plexus cysts
89
breast lump > 30
usually fibroadenoma
90
causes of postabortal hemorrhage
common: uterine atony, cervical lac
rare: uterine perf, retained tissue, infection, coagulopathy
91
trisomy 21 quad
AFP down
Estriol down
hCG up
inhibin up
92
trisomy 18 quad
AFP down
Estriol down
hCG down
93
mgmt: PROM
after 34 wks --> induce labor
before 34 wks, not in labor --> expectant management
before 34 wks, in labor --> tocolytics, antenatal corticosteroids
94
what can you see on hysteroscopy
```
endo polyps
adhesions
foreign bodies
endocervical lesions
uterine septum
```
95
risks of IUGR
cerebral palsy
96
HA, fever and flushing after syphilis tx
Jarisch-Herxheimer rxn
| tx w/ acetaminophen + IV fluids
97
cervical insufficiency vs PTL
in CS, dilation is painless
| in PTL there are painful contractions
98
recurrent preg loss definition
3+ spontaneous abortions w/ same partner
99
mgmt of recurrent preg loss
```
maternal anatomu exam
immuno workup (anticardiolipin abs and lupus anticoag)
mat/pat karyotype analysis
```
100
cervical ripening agents
misoprostol
dinoprostol
(contraindicated w/ hx c section)
101
mgmt: postmenopausal bleeding
EMB > TVUS
102
tx asrhma during preg
albuterol PRN
| add daily budesonide if needed
103
wtf is the Kleihauer-Betke test
tests for fetomaternal hemorrhage (detects/measures fetal blood cells in maternal circulation)
104
stillbirth postmortem testing
```
CBC
UDS
RPR (or past)
blood Ab screen
glucose/glycosylated glucose (or past GTT)
Kleihauer-Betke/flow cytometry
```
105
HIV viral load that --> c-section
> 1000 copies/mL
106
ABx for GBS (+) mom
penicillin G @ onset of labor
107
vaccines for HIV (+) preggers
pneumococcal
flu (inactivated)
TDaP
Hep A/B
108
other name for human placental lactogen (HPL)
chorionic somatomammotropin
109
monozygotic twins: chorio/amnio/split time
MC: monochorionic, diamniotic, split btwn 4 - 8 days
110
recommended weight gain for under/normal/over/obese preggers
28 - 40 lbs (under)
25 - 35 lbs (normal)
15 - 25 (over)
11 - 20 (obese)
111
CA a/w DES exposure
clear cell adenocarcinoma of vagina/cervix
112
cheapest birth control
IUD (if use for at least 2 yrs)
113
mgmt: postpartum hemorrhage, boggy uterus
bimanual uterine massage
oxytocin
uterotonics:
1. misoprostol (PGE1 analogue)
2. carboprost (PGF2-alpha analogue) -- not w/ asthma
3. methylergonovine (ergot) -- not w/ HTN
if all else fails --> surgery, even TAH if encessary
114
Rh alloimmunization test
indirect Coombs
115
cause of bleeding 2 weeks post spontaneous abortion
no infection clues --> retained products of conception
| infection --> septic abortion, endometritis
116
imaging for bulging vagina/cyclic pain w/o bleeding
pelvic MRI > TVUS
117
measurement limiting head engagement
obstetrical conjugate - shortest AP diameter in females -- shortest distance from sacral promontory to pubic symphysis
118
intrapartum varicella infection consequences
scarring rash (cicatricial)
limb hypoplasia
chorioretinitis
119
normal post-void value
50 mL
| >200 --> retention
120
mgmt: postmenopausal w/ terrible hot flashes
combination E+P (if have uterus)
| E only if uterus-less
