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Flashcards in OB/ Gyn Deck (111):
1

define the first stage of labor

effacement and early dilataion for latent/ dilation > 3cm for active

2

define second stage of labor

full dilation ro delivery of the infant

3

define the third stage of labor

delivery of infant to de;ivery of the placenta

4

criteria for preterm laboe

1. 4 contractions / 20 mniutes or 8 contractions in 60 min
2. cervical dilation >1cm
3. effacement >80%

5

Emergency contraception

works up to 120 hours (5 days) post unprotected intercourse
Types: Paraguard IUD; Ella (uiprisbe); Plan B/one step/myway; Yuzpe Regime (using certain OCPs)

6

HPV not associated with malignancy or neoplasia

types 6,11

7

Gardisil HPV prevents which types of HPV

6,11,16,18

8

Gardisil vaccine schedule

initial injection. 2 months and 6 months

9

pelvic floor muscles injured in childbirth that result in uterine prolapse

transverse and uterosacral ligaments

10

treatment for incompentent cervix

Surgery: cerclage. Additionally bed rest, devices and pharm agent may be used

11

Most common cause of spontaneous abortion in the first 12 weeks

chromosomal abnormalities (50%)

12

what is mcroberts maneuver?

For shoulder dystocia/macrosomia:
flex moms thighs / suprapubic pressure / and episiotomy

13

what is the significance of late FHR decelerations

uteroplacental insufficiency
fetal hypoxia
? cord compression that causes above.

14

diagnositc tool for secondary ammenorrhea and eitology of secondary ammenorrhea

TVUS/ABD US
why: endometriosis; adenomyosis; polyps; fibroids; IUD

15

how can you definitively diagnosis endometriosis?

laparaoscopy

16

what is the hallmark of endometrial cancer; risk factors

postmenopausal bleeding (90%)
exogenous unopposed estrogen therapy; >50lb above ideal body weight;

17

primary reason for dysfunctional uterine bleeding?

anovulatory cycles; best initial treatment: OCPs

18

what is the absolute contraindication for OCPS

female >35 yo smoker (increases risk for thromboembolism)

19

further treatment of cervical lesion that is visible?
not visible?

visible lesion: biospy and send
No visible lesion_ colposcopy

20

symptoms associated with cervical CA?
most common age?
describe a cervical lesion that needs biopsy

postcoital bleeding and abnomal uterine bleeding
average age at diagnosis 50yo
immediately biopsy a new exophytic, friable bleeding cervical lesion

21

patient is diagnosed with GTN (gestational trophobastic neoplasm how do you monitor this after D&C?

monitor b-hcg weekly until 3-4 normal values then monthly for 1 year

22

When do you screen for Gestational diabetes?
what are the tests for this?

usual screening is at 24 weeks with a nonfasting 1 hour glucose tolerance test. : administer 50gm glucose and 1 hour later result should be <140mg/dl IF they fail then 3 hour GTT: administer 100gm and fasting<95; 1 hour <180; 2 hour <155 and 3 hour <140

23

first line treatment for gestational daibetes

metformin/ glipzide/ diet modification

24

what is the best method for controling bleeding in DUB with fibroid

Depo Provera 150mcg/q 28 days - decreases bleeding and fibroid size.

25

how long can the DepoProvera injections alter the menstrual cycle and ovulation?

up to 18 months.

26

Describe the symptoms associated with vaginal atrophy

thin, clear, sometimes bloody vag discharge;
dyspareunia
pH 5-7
decreased vaginal ruggae

27

symptoms of and treatment for lichen sclerosis of the vulva

vulvar pruritis; dyspareunia
looks like white patches of the vuvar skin in a figure 8 down to the anus
Treatment : Clobetasol topical to area BID for 14 days

28

At what age can you recommend a woman to stop screening for PAP and then mammo ( without risk factors)

minimal age for stopping PAP is 65 - needs to have documented 3 consecutive normal paps
MAy stop if hysterectomy snf no history of invasive cervical disease.
May elect to stop mammos at 70`

29

how is PCOS diagnosed?

by history: hirsute(90%), moderately overweight with acne, menstrual irregularity(90%) and infertility (75%)

30

Can HIV cross the placenta?

no - it has to be due to contact of fluids - which can occur during delievery. hIV is screened in first trimester labs, and oral treatment initiated if tested positive. If treated 1-8% of maternal/fetal transmission

31

what are the classic symptoms of endometriosis?

dysmenorrhea
deepthrust dyspareunia
infertility
abnormal uterine bleeding
pelvic pain

32

Abruptio placenta

painful uterine bleeding; medical emergency to deliver baby if large abruption;if minor and baby stable and premature, may closely monotor and bed rest may occur after trauma

33

Risks for ectopic pregnancy

history of PID; endometriosis, previous tubal surgery; previous ectopic

34

treatment for ectopic pregnancy

goal: remove ovum if early and small , may try injection of methotrexate to dissolute cells and reduce size; otherwise - surgery

35

causes for Placenta previs

previous c-section/uterine surgery; leiomyoma, endometriosis.
Treat with bed rest, diagnosied with US, no digital exams for fear of disrupting the placenta
"Painless third trimester bleeding"

36

what hormone is the secretory phase of the menstrual cycle dominated by (days 14-28)?

progesterone

37

is a nulliparous or multiparous woman more likely to develop pre-eclampsia?

nulliparous

38

Purulent cervical discharge should raise your suspicions for what diagnosis?

neisseria gonorrhea

39

how could a girl with Turner's syndrome appear?

Webbed neck, wide shield chest, history of primary ammenorrhea

40

Cervical biopsy comes back with CIN 1 - what is the next step?

repeat pap in 6 months and repete colposcopy in 12 months

41

what is the MOST COMMON CAUSE of secondary ammenorrhea?

pregnancy

42

what 3 labs should be ordered in the work up of secondary ammenorrhea?

b-hcg, TSH, prolactin level

43

define premature birth

delievery before 37 weeks

44

what is metrorrhagia?

bleeding between menstural cycles

45

A single mobile firm, nontender solid breast mass is most liekly?

fibroadenoma

46

What are 3 treatments for uterine prolapse?

pessary, Kegel's maneuvers; surgical repair

47

what is the most common causative organism in mastitis?

Staph aureus

48

Approximately how many weeks pregnant are you when the top of the fundus reaches the pubis symphsis? the umbilicus? the xiphoid?

10-12; 18-20; 37

49

what is the most common cause of post partum hemmorhage?and the others?

uterine atony
retained products of conception
cervical/vaginal laceraction

50

Define missed abortion

no vaginal bleeding, cervical os is closed; products of conception are still intrauterine.

51

define incomplete abortion

open os, vaginal bleeding and passage of tissue; usually need to treat with D&C

52

define complete abortion

passage of tissue, pain and cramping subsided, cervical os is closed.

53

At what age is primary amenorrhea diagnosied?

Age 14 if no secondary sex characteristics; 16 if some secondary characteristics present.

54

What is the first line treatment of mastitis?

Dicloxacillan Cephalexin / Erythormycin second line
also hot compresses, may continue breast feeding

55

Should a breast feeding mom stop if she deveolps mastitis?

no, not a reason to stop but if abscess develops then she does need to stop.

56

Physical exam finding of retroverted uterus or uterosacral nodularity is consistent with what diagnosis?

Endometriosis

57

when should an amniocentesis be performed?
When should chorionic villa sampling be performed?
Triple screen?

15-20 weeks
10-13 weeks
15 week AFP/BHCG/estriol

58

list 4 factors for breast cancer

BRCA1 BRCA2 +; un-opposed estrogen; nulliparity; early menarche; late menopause

59

the follicular phase of the menstrual cycle (day 1-13) is dominated by which hormone/

estrogen

60

how much weight should a woman gain during normal pregnancy?

25-35 lbs

61

treatment for Trichomonas vaginalis is ?

2gm MEtronidazole one time dose

62

what 2 medications are commonly used to treat hypertension in pregnancy?

labetolol and methydopa

63

what is the classic triad of pregnancy?

HTN, edema and proteinuria

64

Why is ovarian cancer so hard to diagnose?

Symptoms are vague and there are no good markers available. however unexplained GI symptoms, nausea. vomiting, pelvic pain and adnexal mass are worrisome

65

What 2 important side effects should patients be counseled prior to prescribing metronidazole?

Avoid alcohol(Disulfram reaction) and avoid sun exposure.

66

Define inevitable abortion

Vaginal bleeding, cramping, open cervix and products of conception are still present.

67

How is the first day of the menstrual cycle defined?

the first day of bleeding

68

What is the karyotype for Turner's syndrome?

45, X they are missing one sex chromosome

69

What culture medium do you need to grow out Neisseria Gonorrhea?

Thayer Martin

70

Which four HPV viruses are linked to cervical cancer?

16, 18, 31,and 33

71

What is the age recommendation for HPV vaccination?

9 - 26 yo

72

List risk factors for Ovarian Cancer

BRCA1, family history, nulliparity, late menopause, late menopause, Caucasian, Asian

73

What characteristic subjective complaint will help to differentiate PID from ectopic pregnancy, appendicitis, ovarian torsion and ovarian cyst?

PID has bilateral pelvic pain, the others are usually unilateral.

74

A patient with primary amenorrhea and low FSH should make you think of what diagnosis?

Hypothalmic pituitary insufficiency

75

define abortion

delievery of uterine products of conception prior to 20 weeks

76

is mastitis unilateral or bilateral ?

Unilateral and in only one quadrant

77

what is full term gestation?

37-42 weeks

78

when does the quickening occur?

Nulliparous - 18-20 weeks
Multiparous - 14-16 weeks

79

List 3 risk factors for placentall abruption

PROM, HTN, smoking, cocaine use, AMA

80

what is the treatment for ovarian cancer?

TAH-BSO, chemo and radiation

81

what is the name given to the bluish tint to the cervix in early pregnancy?

Chadwick's sign

82

A patient has a higher than expected BHCG level and is measuring fundal height more than expected. on Ultrasound there is a snowstorm appearance in the uterus. What do you suspect?

Hydatidiform mole

83

What medication may be used to control bleeding in uterine atony post delievery

Oxytocin (pitocin)

84

why is folic acid given as a prenatal vitamin?

to prevent neural tube defects.

85

what is the most common endometrial cancer?

75% are adenocarcinomas

86

A patient has Strawberry cervix with copious yellow/green discharge on examination - what does she have??

Trichomonas vaginitis

87

What organism is present in soft cheese and deli meats that pregnant women are warned to avoid in pregnancy?

Listeria monocytogenes. can cause menigitis

88

The baby was delivered several minute ago. Suddenly there is an increase in blood flow from the vagina and the cord noticable lengthens. what is the most likely cause of these signs?

Placental separation

89

What is the most type common type of ovarian cyst?

Functional cyst no treatment is needed.

90

Is FSH high or low in Turners syndrome?

High - there are no ovaries to respond to the FSH - so there is no negative feed back.

91

what is the cause of septic arthritis is sexually active young adults?

Neisseria gonorrhea

92

How many days after conception is a serum bHCG positive?

8 days

93

If PAP smear come back with anything other than negative or ASCUS what is your next step?

Colposcopy and biopsy

94

What medication is used to increase surfactant levels and help with fetus lung maturity in preterm labor?

Betamethasone

95

Name 2 tocolytic agents

MAgnesium sulfate and calcium channel blockers

96

A woman presents to the ER concerned that she is in preterm labor. What is your first treatment even prior to getting any imaging or lab results?

Give IV fluids - she is likely dehydrated

97

Name 3 ways to check for ruptured membranes

Pooling in the vagina
Ferning on a slide
Nitrazine test testing the pH
visulize leakage from the cervix with a sterile speculum.

98

What is the normal range for fetal heart rate?

120-160

99

What is menorrhagia?

heavy prolonged menstrual flow

100

What RH combination for mom and dad can cause the mom to create antibodies against the baby's red blood cells

RH negative mom and Rh positive dad.

101

When do you give Rhogam to mom?

28 weeks

102

What are the risks for mom and baby in Gestational Diabetes?

Preeclampsia, macrosomia causing traumatic birth, slowing fetal lung development

103

What medications are used to treat postpartum metritis?

Clindamycin and gentamycin together

104

What is the most common infection following a C-section?

Metritis

105

where is the most common site for ectopic pregnancy?

within a fallopian tube

106

in a normal early pregnancy , serial bHCG should double over what time?

every 48-72 hours

107

what is procidentia?

uterine prolapse that extends beyond the introitus

108

What is the common term for Stein-Levinthal syndrome?

polycystic ovary syndrome.

109

What is Neigels rule in calcuating a pregnacy EDC?

First day of the last menstrual period +7 days - 3 months

110

What are the 5 components of the biophysical profile?

non-stress test fetal breathing, 2 body movements, fetal muscle tone and amniotic fluid index

111

what is a reassuring fetal non-stress test

a positive (reactive) stress test is 2 fetal heart rate accelarations in 20 minutes