OB-Gyn Flashcards
1
Q
Flank pain that radiates to groin
A
Renal colic (kidney stones)
Dx: US of kidneys & pelvis in pregnant pt
2
Q
Ferning (Fern Test)
A
+amniotic fluid → Rupture of membranes (detects onset of labor)
- Occurs due to the presence of sodium chloride in cervical mucus under estrogen effect when the mucus dries on a glass slide. When high levels of estrogen are present, just before ovulation, the cervical mucus forms fern-like patterns due to crystallization of sodium chloride on mucus fibers. Also known as “arborization”.
- Disappearance of ferning suggests ovulation (when progesterone is dominant hormone)
- Persistence of ferning throughout menstrual cycle suggests anovulation
3
Q
Anterior vaginal wall tenderness
A
Bladder pain syndrome
(+urinary Sx)
4
Q
Postcoital bleeding/spotting
A
Cervical carcinoma
5
Q
Chronic pelvic pain + uniformly enlarged boggy uterus + HMB (heavy menstrual bleeding)
A
Adenomyosis
(trapped endometrial glands in myometrium)
6
Q
Tenderness in posterior cul-de-sac
(Pouch of Douglas; between uterus & colon)
A
Endometriosis
7
Q
Atypical glandular cells on Pap
A
Endometrial biopsy indication
- +colposcopy
- +endocervical curettage
- to r/o cervical or endometrial adenocarcinoma
8
Q
PCOS ovulation induction if wt loss fails
A
Letrozole > Clomiphene citrate
- Letrozole = nonsteroidal aromatase inhibitor
- Better fertility outcomes & fewer heterotrophic pregnancies compared to clomiphene
9
Q
PCOS first line Tx
A
Wt loss
10
Q
PCOS menstrual regulation Tx
A
OCPs
11
Q
Failure of follicle maturation
A
PCOS
MOA: High adipose tissue → High peripheral androgen conversion → Persistently elevated estrone → Inhibitory feedback to hypothalamus → FSH suppression (+lack of LH surge) →Failure of follicle maturation → Infertility
12
Q
Word catheter placement
A
for Bartholin gland cysts
- following I&D to allow for continued drainage & reepithelialization of a tract for future drainage
13
Q
Contraindicated in migraine w/ aura
A
OCPs
(Estrogen-containing medications)
14
Q
FSH in menopause
A
Elevated
15
Q
Dx of PMS
A
Symptom diary of luteal phase symptoms
(2 weeks before menses until menses)
16
Q
PMS Tx
A
SSRIs
17
Q
Eczematous/ulcerating, itchy rash localized to nipple
A
Paget disease of the breast → Underlying adenocarcinoma
(thought to be caused by migation of neoplastic cells through the mammary ducts to the nipple surface)
18
Q
UL bloody nipple discharge w/o lesions (clear breast)
A
Breast papilloma
- When a single tumor grows in a large milk duct, it’s called a solitary intraductal papilloma
19
Q
Breast binding/tight bras are NOT RECOMMENDED for lactation suppression due to
A
Risk of mastitis, plugged ducts, increased pain, & inadvertent nipple stimulation
20
Q
Failed induced progesterone withdrawal bleed
A
Asherman syndrome
(intrauterine adhesions)
- Secondary amenorrhea from previous uterine instrumentation or infection
21
Q
Mittelschmerz
A
UL abd pain w/ ovulation in young women
(Day 10-14)
22
Q
Clear, elastic, thin (uncooked egg white in appearance) cervical mucus secretion at cervical os
A
Corresponds to LH surge, indicating ovulation
(occurs just prior to ovulation & used to time intercourse in couples trying to conceive)
23
Q
Erythematous breast + dimpling or pitting
A
Inflammatory Breast Carcinoma
- Order mammography, US, & tissue biopsy
24
Q
Chemotherapy + amenorrhea
A
Ovarian failure
- Decreased Estrogen (due to loss of estrogen production from follicular granulosa cells)
- Elevated FSH & LH
- Normal PRL & TSH
- Hypergonadotropic hypogonadism (primary ovarian insufficiency)
- Tx: Hormone replacement therapy (HRT)
25
Theca cells & granulosa cells produce:
* Theca: **Androstenedione** (estradiol precursor)
* Granulosa: **Estradiol** (conversion from aromatase)
* Estradiol is later converted to _estrogen_, which is released from follicle during follicular phase;
* Estrogen peaks at end of follicular phase causing LH surge
* Progesterone is released from corpus luteum
* Progesterone is elevated during luteal phase (following ovulation)
* Hypothalamus (GnRH) → Anterior Pituitary (LH/FSH) → Ovary (theca/granulosa cells) → androstenedione, estrogen, progesterone (LH)
* Males:
* LH → Leydig → T → inhibits hypothalamus & AP
* FSH → Sertoli → Inhibin → inhibits AP
26
PID can lead to this presentation w/ RUQ pain
**Perihepatitis**
| (Fitz-Hugh-Curtis Syndrome)
27
Sharp or stabbing pain w/ intercourse
**Ovarian cyst (ruptured)**
28
Natural form of contraception for first 6 months postpartum
Elevated prolactin for lactation (production, not ejection)
* PRL inhibits GnRH → decreased LH/FSH → Anovulation
29
Heterosalpingogram
Visualization of uterus/fallopian tubes **to investigate infertility**
30
Endometriosis _after failing NSAIDs & OCPs_
**Diagnostic laparoscopy**
31
Most common reason for female infertility
**Endometriosis** (~25%)
32
Pts w/ endometriosis are at an increased risk for
**Infertility**
(most common reason for female infertility; ~25%)
33
Adnexal mass w/o doppler flow
**Ovarian torsion**
(Adnexal torsion)
* Dx: Ultrasound
* Tx: **Laparoscopy** (cystectomy & detorsion)
34
Cervical lesion
"the answer is always **colposcopy**"
35
Proliferation of SM cells within the myometrium, irregular uterine enlargement, & chronic anemia/AUB (abnormal uterine bleeding)
**Leiomyomata uteri**
| (fibroids)
36
Uniformly enlarged uterus
**Adenomyosis**
(proliferation of endometrial glands inside the uterine myometrium)
37
Irregularly enlarged uterus
**Fibroids**
38
Simple, small, thin-walled cyst
**Follicular ovarian cyst**
39
Adnexal mass w/ hyperechoic nodules, calcifications
**Cystic teratoma**
(non-seminomatous **dermoid** ovarian cyst)
* Elevated B-hCG, Elevated AFP
40
Stress incontinence is associated with
**Urethral hypermobility**
Tx:
* Kegels
* Urethral sling surgery
* Pseudoephedrine (alpha-adrenergic)
* **S**UO **P**OB
41
Urge incontinence Tx
* **Oxybutynin** (antimuscarinic) and/or
* **Tamsulosin** (alpha-blocker)
42
Overflow incontinence Tx
**Bethanechol** (cholinergic)
"Bethany call me to stimulate your bowels and bladder"
43
HTN + Proteinuria in pregnant pt
**Preeclampsia**
* +seizures = Eclampsia
* Tx:
* **Delivery**
* **Magnesium** for Sz PPX
* **Antihypertensive** management
44
Hemolysis, elevated LFTs, thrombocytopenia in pregnant pt
**HELLP Syndrome**
(severe pre-eclampsia)
* Tx:
* **Delivery**
* **Magnesium** for Sz PPX
* Antihypertensive management
45
UL bloody nipple discharge w/o mass
**Intraductal Papilloma**
46
Ovarian mass + thick septations + ascites
**Epithelial ovarian cancer**
(from abnormal proliferation of tubal epithelium or ovarian epithelium)
47
**CA-125** is used to detect **epithelial ovarian cancer**, particularly in:
**Postmenopausal women**
Also elevated in:
* Leiomyomata
* Endometriosis
48
Diminished ovarian reserve in women begins at
\>35yo
49
Uterine synechiae
**Asherman syndrome**
| (synechiae = adhesions)
50
Urethral hypermobility
**Stress Incontinence**
* Kegels
* Urethral sling surgery (long-term)
* Pseudoephedrine (alpha-adrenergic)
51
High-risk HPV
16 & 18
| (cervical cancer)
52
Non-high risk strains of HPV
**6** & **11**
(Condylomata acuminata--genital warts)
* Tx: Trichloroacetic acid or surgical removal
53
Tamoxifen (SERM) is contraindicated if
**h/o VTE**
54
Tamoxifen (SERM) can cause
**Endometrial carcinoma**
55
Antiestrogens/Estrogen antagonists (SERMs) are indicated in
(Tamoxifen, raloxifene, clomiphene citrate)
**ER+ breast cancer**
* ADE: Vaginal dryness, decreased libido
* Tamoxifen can lead to endometrial cancer
* Clomiphene is Tx for PCOS infertility
56
PPROM Tx
(preterm premature rupture of membranes; \<37 wks)
Abx + Steroids + Delivery @ 34 weeks
57
Pregnant pt w/ short cervix on TVUS or h/o preterm birth
**Vaginal progesterone**
(to maintain uterine quiescence & protect amniotic membranes against premature rupture)
* If short cervix AND h/o preterm birth = **Cerclage**
58
Short cervix on TVUS *_and_* h/o preterm birth
**Cerclage**
(if only one, then vaginal progesterone)
59
PPH \<24 hours
| (postpartum hemorrhage)
**Uterine atony**
Tx:
* **Uterine massage**
* **Oxytocin** (uterotonic; induces uterine contraction in PPH)
* Methylergonovine
60
Carboprost (Hemabate), uterotonic in PPH, is contraindicated in
**Asthma pts**
61
* Oxytocin
* Methylergonovine (contra in HTN)
* Carboprost (contra in Asthma)
* Misoprostol
**Uterotonics**
(Tx for PPH to induce uterine contraction)
62
Breastfeeding contraindications
| (**TB**/**HHV**/**CSG**)
* Active **T**B
* Maternal **H**IV
* **H**erpetic breast lesions
* **V**aricella (active)
* **C**hemotherapy/Radiation
* Active **S**ubstance abuse
* Infantile **G**alactosemia
63
Baseline OB intake labs (first visit)
CBC, A1C, Rubella, Depression screen
64
Ovarian neoplasm risk factors
* Nulliparity
* FHx
* BRCA1 or BRCA2
* Early menarche
* Late menopause
* White
* Increasing age
* Residence in North America or Northern Europe
65
Ovarian cancer protection w/ OCP use
Five years cumulative use decreases lifetime risk by 1/2
66
Vaccines contraindicated in pregnancy
MMR & Varicella
67
Thyroid levels in pregnancy
Total T3, T4, TBG all increase during pregnancy
(increase levothyroxine dose during pregnancy)
68
Appropriate gestational weight gain
**25-35 lbs** if normal weight
* If _underweight_: 28-40 lbs
* If _overweight_: 15-25 lbs
* If _obese_: 11-20 lbs
69
Valproic acid teratogenic effect
**Neural tube defects**
* Elevated AFP on 20-week quad screen (ABEI: AFP, Beta-hCG, Estriol, Inhibin A)
70
T1DM teratogenic effects
Structural anomalies
| (CV, neural tube)
71
Amniocentesis
US-guided diagnostic test for karytotype & DNA microarray testing if any pregnancy screen is positive
(_\>_15 weeks)
72
Low PAPP-A (pregnancy-associated plasma protein A) on first trimester screen
**Aneuploidy**
* +thicker NT
73
Risk of IUGR is elevated in
Pre-existing diabetes, but not GDM
74
Most common form of inherited mental retardation
**Fragile X syndrome**
| (AD Macroorchidism)
75
Most likely cause of elevated MSAFP
**Underestimation of GA**
| (5% are NTD)
76
Ibuprofen in pregnancy
Can only be taken **until 32 weeks of gestation**
(due to risk of PDA closure)
77
Irregular contractions
**Braxton-Hicks contractions**
| (begin at ~20 weeks, but varies)
78
Indications for prophylactic GBS Tx in unknown GBS status
1. Hx of GBS-infected delivery
2. Pre-term labor
3. PROM _\>_ 18 hours
4. Intrapartum fever (_\>_38.0)
5. GBS+ during pregnancy (Intrapartum NAAT+)
## Footnote
*If no indications for GBS PPX, recto-vaginal culture at 35-37 weeks*
79
PROM risk factors
1. H/o PROM
2. Genital tract infection (e.g. BV)
3. Shortened cervical length (\<22mm)
4. **Smoking**
80
First stage of labor (latent + active)
* Latent labor: 0-6cm
* Active labor: 6-10cm
81
Second stage of labor
**Delivery**
(from when cervix is completely open to full delivery of baby)
82
Third stage of labor
Placenta
83
Umbilical cord prolapse
Elevate fetal head + CSx
84
Meconium-stained fluid + depressed infant
Intubate trachea, then suction meconium & other aspirated material from beneath the glottis immediately after delivery
85
IUGR + hypoglycemia at birth
Maternal T1DM
86
Fetal tachycardia + minimal variability
Septic infant (chorioamnionitis)
| (pale, lethargic, febrile)
87
HIV + Birth: Protocol?
Start AZT on infant immediately
88
Postpartum Blues
Up to 2 weeks
89
PP-depression
2 weeks to 6mo + ambivalence toward newborn
90
Severe nipple pain
Candida
91
Decreases ovarian cancer
* Breastfeeding
* OCPs
92
Milk production vs. Milk ejection
* Milk production = Prolactin
* Milk ejection = Oxytocin
93
Female breast duct apparatus development during puberty
**Insulin** & **Cortisol** (steroid)
94
Tx for early ectopic pregnancy
Methotrexate (\<4 cm)
95
Hypovolemia + Peritoneal + Positive UPT
**Ruptured ectopic pregnancy**
| (Laparoscopy)
96
B-hCG doubles every 48 hours until
48d gestation
97
Stimulated by suckling
**Oxytocin**
| (milk ejection)
98
No IUP on US + B-hCG over discriminatory zone
**Ectopic Diagnosis**
* Discriminatory zone = **2000**; the level at which an IUP should be seen on US
99
B-hCG levels not rising fast enough w/ pregnancy (doubles every 2d until 48d GA)
Ectopic pregnancy
100
B-hCG levels do not fall following diagnostic dilation & curettage (D&C)
**Ectopic pregnancy**
101
Most common aberration leading to SAB
**Trisomy 16**
(14% of chromosomally abnormal abortions)
102
Prolonged Russell viper venom time (**dRVVT**)
**APLS**
(Antiphospholipid Antibody Syndrome)
* +recurrent pregnancy loss
* +h/o VTE
* Tx: **Aspirin + Heparin**
103
Medical abortion (mifepristone) is associated with a ___ blood loss than surgical abortion
Higher blood loss
104
Mifepristone can be offered in up to __ weeks GA
**49 days (7 weeks)**
* Vacuum aspiration up to 8w GA
105
Thin, gray homogenous vaginal d/c
Bacterial Vaginosis
* +positive whiff test (w/ potassium hydroxide)
* +clue cells
* +pH \>4.5
* Tx: MNZ
106
Itchy vag + thick, white d/c + pH \<4
Candidiasis
107
Lacy, reticulated labial/perineal pattern + remissions/flares of inflammatory mucocutaneous eruptions of _vulva_, _skin_, _scalp_ (alopecia), _nails_, & **_gums_**
**Lichen planus**
108
Itch-scratch-itch cycle w/ normal vaginal pH
**Lichen simplex chronicus**
109
"Cold" or malaise symptoms followed by pruritus/pain
**Primary HSV-1 infection**
110
Low pelvic pain, urinary urgency, hematuria, no d/c
**UTI**
111
HBV exposure treatment (HBsAg positive)
**HBIG** + **HBV vaccine series**
112
GC/CT Tx
**CTX** + [**Azithromycin** or **Doxycyline**]
## Footnote
*No doxy if pregnant*
113
Order of maturation
**Thelarche** \> **Adrenarche** \> **Growth** **spurt** \> **Menarche**
* Thelarche = breast/areolar development (**10yo**)
* Adrenarche = onset of axillary/pubic hair growth (**pubarche**)
* Menarche = onset of menses (**12.7yo; \> 85 lbs**)
* Coitarche = age of first intercourse
114
Q-tip test straining angle \> 30 degrees
**Urethral hypermobility**
(Genuine Stress Incontinence)
* Surgical Tx:
* **Retropubic Urethropexy** (surgically attaching slings to Cooper's ligament--retropubic to urethra) to provide tension on urethra)
* **Urethral bulking procedure** (collagen injections into external bladder to compress lumen) if 2/2 intrinsic sphincteric deficiency w/o urethral hypermobility
115
Cystometrogram
Bladder scan
116
Least invasive tx for pelvic prolapse
**Pessary fitting**
117
Nodularity along back of the uterus along the uterosacral ligaments
**Endometriosis**
118
Chocolate cyst
Endometrioma
(Complex ovarian cyst)
* Functional hemorrhagic cyst = shorter duration
119
Endometriosis first line Tx
**NSAIDs** + **OCPs**
* 2nd-line Tx: *GnRH agonist* (e.g. leuprolide)
* If still refractory: *Diagnostic laparoscopy*
* First-line surgical Tx: *Laser ablation*
* Definitive Tx: *Hysterectomy w/ BSO*
120
Sudden onset pain + nausea + cyst on abd/pelvic US
**Ovarian torsion**
| (pain + nausea + cyst = torsion)
121
Tx of mastitis
**Penicillins**
| (most commonly staph aureus)
122
CIN III
**LEEP**
* CIN I = LSIL (low-grade squamous intraepithelial lesion) = No Tx
| (becuase not invasive cervical cancer)
123
Acetowhite
Staining done during colposcopy to detect areas of high-grade lesions
124
PCOS increases the risk of these cancers
**Endometrial** & **ovarian**
| (due to chronic unopposed estrogen)
125
PP hair loss due to high levels of estrogen is highest at
3mo PP
126
AUB (Abnormal Uterine Bleeding) mnemonic
**PALM-COEIN**
(Structural-Nonstructural)
* **P**olyp
* **A**denomyosis
* **L**eiomyoma
* **M**alignancy and hyperplasia
* **C**oagulopathy
* **O**vulatory dysfunction
* **E**ndometrial
* **I**atrogenic
* **N**ot yet classified
127
Normal endometrial stripe thickness
\< 4mm
128
Thickened endometrial stripe
\> 4mm
* Endometrial cancer
* Normal aging
* Tamoxifen
129
Age range of premature ovarian failure
\<35yo
130
HRT for osteoporosis is contraindicated in
CVD
* Tx: **Vit D**, 1200mg **Calcium**, **Bisphosphonates**
* Bisphosphonates inhibit bone resorption, preserving bone integrity
131
Imipramine (TCA) can cause
**Hyperprolactinemia**
132
Tx for PMDD (severe PMS; PMS refractory to OCPs or SSRIs)
BL oophorectomy
133
Nosebleeds during pregnancy
**Pyogenic granulomas**
"Pregnancy tumors"
(vascular lesions on anterior nasal septum common in pregnant women; hormonal)
134
PPROM Tx
**Ampicillin** + **Erythromycin** to prolong labor
135
Normal FHT
110-170
136
Low amniotic fluid glucose
Intraamniotic infection
137
Positive phosphatidylglycerol in vaginal fluid
Indicator of lung maturity
| (or: 34w GA)
138
HTN Tx in pregnancy
**H**ypertensive **M**oms **L**ove **N**ifedipine
* Hydralazine
* Methyldopa
* Labetalol
* Nifedipine
139
Mammography Screening
**Every 2 years for women age 50-74**
