Flashcards in OB/GYN 8% Deck (161):
___ predominates in Phase 1 (a.k.a. ___)
Causes follicle and egg maturation in ___phase
Follicular (phase 1)
Stimulates maturing follicle ___ production
___ causes a sudden ___ surge causes ovulation
Estrogen causes a sudden LH surge
Phase 3 (a.k.a. ___, a.k.a. ____)
___ surge causes ruptured follicle to become ___, which secretes ___ to ___.
Luteal, Secretory phase
maintain endometrial lining and secretion
If pregnancy occurs, ___ keeps the corpus luteum functional until placenta can support itself
Estrogen is produced by ____
Provides (positive/negative) feedback on ___.
granulosa cells of follicle
Positive feedback on LH --> LH surge to cause ovulation
Inhibins is produced by ___.
Provides (positive/negative) feedback on ____.
Inhibin B levels rise during ___, highest during ___. Increase again during ___.
Inhibin A levels decrease during ___.
granulosa cells of follicle
Negative feedback for FSH
-highest during mid follicular phase
late luteal phase
Chronic anovulation is caused by ___.
Unopposed estrogen, no corpus luteum --> no ovulation, no progesterone --> continuous estrogen production and stimulation of endometrium w/o progesterone stabilization/induced bleeding
Ovulatory dysfunctional uterine bleeding caused by ___.
ovulation with prolonged progesterone secretion d/t low estrogen --> blood loss from endometrial vessel dilation and prostaglandins --> metrorrhagia
Tx of acute severe uterine bleed
High dose IV estrogens
D&C if IV estrogen fails
Tx of anovulatory dysfunctional uterine bleeding
Tx of ovulatory dysfunctional uterine bleeding
MC/most important diagnostic for DUB
Primary amenorrhea = failure of onset of menarche by ___.
High FSH in setting of primary amenorrhea suggests problem with ___
ovaries. FSH screaming at unresponsive ovaries
Low FSH in setting of primary amenorrhea suggests problem with ___
H-P axis problem. Ovaries don't know what to do without FSH.
Breasts that are present, with absent uterus, 46, XX suggests ____
Mullerian agenesis = congenital absence of vagina, uterine agenesis
Breasts that are present, with absent uterus, 46, XY suggests ____
Androgen insensitivity = female phenotype d/t testosterone resistance
Kallmann's Syndrome =
Hypogonadotropic hypogonadism --> pituitary secretion of FSH and LH VERY low
Anosmia (lack of smell)
Low stature, webbed neck, edema, low hairline, low ears, widely set nipples =
Turner Syndrome (45, XO)
Most common form of secondary amenorrhea
Induces a hypothalamic state in which reduced secretion of ___--> low ___ --> no stimulation of ____ --> ____ is not produced by follicles
LH and FSH
Progesterone challenge test used for ____
determining ovarian disorders in secondary amenorrhea
If withdrawal bleeding = ovarian cause --> anovulatory. Estrogen present to build up the endometrial lining.
If no bleeding = Hypoestrogenic (Hypothalamus-Pituitary failure OR uterine disorder
Hypothalamus dysfunction causing amenorrhea occurs when ____
disruption of pulsatile GnRH --> low FSH and/or LH from pituitary
Causes: Anorexia, weight loss, exercise**
Stress, nutritional deficiency, systemic disease
Clomiphene = estrogen agonist/antagonist actions to stimulate gonadotropin release and ovulation
Menotropin = gonadotropin secretion
Ovarian disorders causing amenorrhea will show (high/low) FSH, (high/low) LH, (high/low) (Estradiol/Prolactin).
High FSH and LH
Pituitary disorders causing amenorrhea will show (high/low) FSH, (high/low) LH, (high/low) (Estradiol/Prolactin).
Low FSH and LH
Bromocriptine (Dopamine agonists to inhibit prolactin)
Asherman's Syndrome =
Acquired endometrial scarring (overaggressive D and C)
"A"dhesions + "A"menorrhea
Pelvic US showing absence of normal uterine stripe
Primary dysmenorrhea is caused by ___
High prostaglandins = painful uterine muscular wall
Premenstrual Syndrome diagnostic criteria:
Minimum of ___ symptoms need to begin ___.
Must be in ____ (prior/during/after) menstruation.
Must be symptom free for ____ in ____ of cycle.
Must occur in ___ cycles.
Minimum of FIVE symptoms need to begin THE WEEK PRIOR TO MENSES.
Must be in 2 WEEKS PRIOR menstruation.
Must be symptom free FOR 7 DAYS in FIRST HALF of cycle.
Must occur in 2 CONSECUTIVE cycles.
Severe PMS w/ FUNCTIONAL impairment
Premenstrual Dysphoric Disorder (PMDD)
Menopause: increased ___ levels, decreased ___ levels.
Increased FSH >25 (confirms dx)
Most effective tx for menopausal vasomotor symptoms (hot flashes/night sweats)
Tx of mood symptoms?
Which of the following is NOT a risk factor for uterine/endometrial polyps?
B. Cervical polyps
D. Tamoxifen (tx of breast cancer) is a RF
Medication tx of uterine/endometrial polyps
Leuprolide (GnRH inhibitor)
Polycystic Ovarian Syndrome has unknown etiology but possibly d/t ____, which results in ___
Elevated LH:FSH ratio
Suppression of pituitary FSH, constant LH stimulation, anovulation, multiple cysts, theca cell hyperplasia, excess androgens
LH stimulates ___ to produce ___, which are shunt to ___, which aromatize into ___.
-androstenedione and testosterone
-estrone and estradiol
Presentation of Polycystic Ovarian Syndrome
Signs of hyperandrogenism (hair, deep voice)
"String of pearls" on TVUS
LH:FSH > 2 or 3:1
Tx of PCOS
-Metformin: restore ovulatory menses
-Clomiphene: stimulate ovulation
-Low dose OCP or spironolactone: hirsutism and acne
MC pathogen of bacterial vaginosis
T/F: Candida vaginitis has acidic pH <4.5.
True. BV and Trichomonas have basic pH >4.5
Lymphogranuloma Venereum (LGV) is caused by ___.
- Complement fixation test >1:16
- Bubo aspiration and culture for chlamydia
Tx: Doxycycline, tetracycline or erythromycin
PAP smear for women age ___ Q ___.
PAP + HPV for age ___ Q ___.
21-65, Q 3 years
30-65, Q 5 years
What to do if PAP shows ASCUS?
When do you do colposcopy?
When do you redo pap in 1 year?
What do you do if negative HPV?
HPV reflex testing
If + HPV >24 y/o --> colposcopy
If + HPV and 21-24 y/o --> redo pap in 1 year
If - HPV --> back to routine schedule
Chancroid caused by what pathogen?
Co-infect: HSV, T. pallidum
Presentation: EXTREMELY painful ulcers w/ soft, ragged edges
Malaise, HA, anorexia
Leading cause of infertility and ectopic pregnancy in young, Nulliparous, sexually active women
Pelvic Inflammatory Disease (PID)
Broad spectrum abx, at least 2: Cetriaxone + doxycycline
Condyloma Acuminata caused by ____
HPV strain 6, 11
Dx: Acetic acid --> appear white raised plaques
Podofilox (CI in pregnancy)
Syphilis is caused by ____
Presentation of each stage:
Initial (10-60 days):
Secondary (1-3 months):
- Condylomata lata = soft, flat, moist papules scattered on perineum
- scattered discrete coppery papules on palms of hand/feet
Gummas: granulomas of skin
Dx of Syphilis
Dark field microscopy
Direct fluoresecent antibody tests
- Screening: VDRL, RPR (rapid plasma reagent)
- Confirm: TPPA (Treponema pallidum particle agglutination assay), FTA-ABS (Fluorescent treponemal antibody absorption test )
Screening for syphilis during pregnancy with ___
Tx of syphilis
Benzathine Penicillin G
PCN allergy: Doxycycline
F/u w/ VRDL titers at 3, 6, 12 months
Genital herpes most commonly caused by ___.
Viral shedding occurs for ___.
Time it takes to heal?
Dx of genital herpes
Precaution for pregnant women w/ active genital herpes lesions
Disseminated infection in neonates
Require C-section delivery
Encephalitis, eyes, skin, mucosa
Thinning of epidermis and fibrosis of dermis --> leukoplakia, thinning (parchment-like) vulvar skin
T/F: It causes increased risk for vulvar basal cell carcinoma.
Vulvar Lichen Sclerosus
False. Squamous carcinoma
Hyperplasia of vulvar squamous epithelium associated w/ chronic itching and irritation causing thicker, leathery skin
T/F: No risk of cancer development
Lichen Simplex Chronicus
Fetal complications of Erythema infectiosum (5th's dz)
Fetal viral myocarditis
Adults with 5th's dz present w/
Rash, fever, lymphadenopathy, arthritis
Acute transient aplastic crisis*
All of the following are risks of Ovarian Neoplasms EXCEPT:
A. Early menarche
C. Late menopause
D. OCPs are protective.
Risk = uninterrupted ovulation. Infertility
Protective = multiparity, breastfeeding, hysterectomy, chronic anovulation
Tumor marker used to monitor Ovarian Neoplasms
MC type of Ovarian neoplasm
Highest mortality of all gynecological cancers
T/F:OCPs are protective against breast cancer.
FALSE: unopposed estrogen is a risk factor of breast cancer.
Other risk factors: AGE ***, nulliparity, early menarche, late menopause
OCP is protective in Ovarian Cancer.
MC type of breast cancer
Invasive ductal carinoma
Most common gynecological cancer
Gynecological cancer that is ESTROGEN dependent
Biggest risk factor = high estrogen exposure
MC site of metastasis in endometrial cancer
90% of vulvar cancers are ____.
Develop from 2 pathways:
squamous cell carcinoma
1. HPV 16 and 18
2. Long standing lichen sclerosus
T/F: You should stop breastfeeding if you have mastitis.
False. Stop breastfeeding w/ breast abscess. Continue breastfeeding in mastitis.
T/F: Fibroadenomas may fluctuate with menstrual cycle.
False. Fibroadenomas do NOT change. Fibrocystic breast changes fluctuate w/ menstrual cycle.
Cystocele presents with ____
Stress urinary incontinence
Feeling of vaginal fullness
Cervix extends beyond vulva
Definitive dx of ovarian torsion
US can't r/o
All of the following are ABSOLUTE CI for estrogen EXCEPT:
D. Thromboembolic d/o
E. Breast/endometrial cancer
D. Thromboembolic d/o is a RELATIVE CI
1st line tx for endometriosis
Combination OCPs + NSAIDs
--> severe cases: Depot Leuprolide injections (GnRH agonist) --> decrease pituitary, no LH and FSH
Decreased pelvic organ mobility, endometrium proliferates outside of uterus and leads to pain, eventual scar tissue development in pelvis =
Ectopic endometrial tissue within myometrium (muscle layer of uterine wall) =
Tender symmetrically, "boggy uterus"
Tx of Adenomyosis:
Total Abdominal Hysterectomy (TAH) = only effective treatment
#1 risk factor of Leiomyomas/fibroids:
#1 presentation symptom:
multiparity, late/menopause/early menarche, oral estrogen
All of the following are charcteristics of Leiomyomas EXCEPT:
D. Asymmetric. Adenomyosis is symmetric, soft, tender.
Leiomyomas are differentiated from adenomyosis by ____ seen on MRI/US
Treatment of Leiomyomas
-Observation if asymptomatic other than menorrhagia
- Saline infusion sonohysterography
-Progestins, Leuprolide, Mifepristone
Causes of ovarian cysts include all EXCEPT:
B. Early Menarche
C. Use of Tamoxifen
D. Early menopause
Detrusor muscle is under ___ control.
Internal sphincter is under ___ control.
External sphincter is under ___ control.
Detrusor muscle is under PARAsympathetic (Beta-adrenergic) control.
Internal sphincter is under ALPHA-adrenergic control.
External sphincter is under ___ control.
History of Imipramine use for postpartum depression may cause ___
Hyperprolactinemia --> infertility
(and visual changes)
Most common cause of infertility
Polycystic Ovarian Syndrome --> causes increased levels of estrogen production --> inhibit FSH and LH
Criteria for PCOS dx:
2 of 3:
-Oligo and/or anovulation
-Hyperandrogenism --> test Testosterone
-Polycystic ovaries on US --> "string of pearls"
Tx of Polycystic Ovarian Syndrome (PCOS)
-METFORMIN: lowers glucose, insulin, testosterone levels --> spontaneous ovulation
-Estrogen receptor modifiers
-Clomiphene (Clomid) --> inhibit negative feedback of estrogen on release of gonadotropin
Ladin's Sign =
Piscacek's Sign =
Goodell's or Hagar Sign =
Chadwick's Sign =
Ladin's Sign = uterus softening at 6 weeks
Piscacek's Sign = palpable uterus lateral bulge at 7-8 weeks
Goodell's or Hagar Sign = cervical softening at 4-5 weeks
Chadwick's Sign = Cervix/vulvar bluish at 8-12 weeks
G = # of times women has been pregnant
P = number of pregnancies that resulted in birth at or beyond 20 weeks
TPAL = Term, Preterm, Abortuses, Living children
Woman gave birth to set of preterm twins, 1 38 week infant, 2 miscarriages
Expected Due Date =
1st day of LMP - 3 months + 1 week, + 1 year
___ weeks = pubic symphysis
___ weeks = umbilicus
___ weeks = elevates ~ 1 cm above umbilicus for each week of pregnancy
12 weeks = pubic symphysis
20 weeks = umbilicus
After 20 weeks = elevates ~ 1 cm above umbilicus for each week of pregnancy
24-37 weeks = preterm
37-42 weeks = term
Triple Screening at ___ weeks
What is tested?
alpha Fetoprotein (a-FP), b-HCG, Estradiol
low a-FP, HIGH b-HCG, low estradiol suggests ___
HIGH a-FP suggests ___
Open neural tube defect
low a-FP, low b-HCG, low estradiol suggests ___
Trisomy 18 --> stillborn or die w/i 1 year
Fetal imaging start at ____ weeks.
GBS screening at ___.
Chorionic VIllus Sampling can be performed at ___.
Amniocentesis can be performed at ____.
9-12 weeks (earlier than amniocentesis)
> 15 weeks
Macrocytic anemia, tongue soreness, numbness/tingling of feet, impaired cognitive function suggests ___ deficiency
Cobalamin (B12) deficiency
Quad screen includes:
alpha Fetoprotein (a-FP), b-HCG, Estradiol AND Inhibin-A
Detects Down Syndrome 81%, 5% false positive
Gestational diabetes screen performed at ___ weeks with ____. If elevated > ____, f/u w/ ____. Diagnosis established when ___.
1 hr glucose tolerance test
3 hr GTT
2 or more of 4 tests are abnormal
Sex of fetus determined at ___ weeks via US.
#1 tx of Hyperemesis gravidarum
Pyridoxine (vit B6) +/- doxylamine (Unisom)
hCG levels double every ____, peaks at ____ in normal pregnancy
pruritic urticarial papules and plaques of pregnancy = papulovesicular lesions on trunk and extremities
T/F: Mother is considered G1P2 if she is pregnant with twins
False: Still G1P1
APGAR scoring evaluated at ____ after birth.
Score and meaning:
7-10 = good
4-6 = assist, stimulate
<4 = resuscitate
APGAR stands for? How is each category scored?
Appearance: 2 = pink all over; 1 = pink w/ blue extremities; 0 = blue/pale
Pulse: 2 = > 100 bpm, 1 = <100 bpm, 0 = absent
Grimace: 2 = cough/sneeze/vigorous cry; 1 = grimace/slight cry, 0 = no response
Activity: 2= active movement, 1 = some movement/flexed extremities, 0 = limp
Respiration: 2 = slow/crying, 1 = slow, irregular, 0 = absent
What type of abortion?
Bleeding before 20 weeks gestation
Threatened abortion. "Catch-all" dx
What type of abortion?
Some but not all intrauterine contents expelled
Tx: D and C
What type of abortion?
Dilated cervical os, cramping, +/- bleeding
What type of abortion?
POCs have been completely expelled from uterus
What type of abortion?
Fetal demise w/o cervical dilatation
What type of abortion?
With intrauterine infection
Medical abortion most commonly use ____.
Mifepristone + Misoprostol
24-48 hrs --> up to 9 weeks gestation
Spontaneous abortion = loss of pregnancy without outside intervention before ___.
20 weeks gestation
Placenta previa =
PainLESS uterine bleeding 27-32 weeks
C section if 37 weeks OR unstable
Otherwise: observe, hgb checks, steroids
Premature placenta separation from uterine wall with hemorrhage =
Placental abruption (abruption placentae)
US is NOT HELPFUL in dx. Pelvic exam and hx ONLY.
Toxoplasmosis during pregnancy can cause ___ in newborn.
T/F: Rubella vaccine is administered at 16 weeks of pregnancy to prevent congenital disease.
FALSE: DO NOT give vaccine during pregnancy
Most common congenital infection =
Women with 1-2 prior second-trimester pregnancy losses or preterm births + cervical length < 25 mm on TVUS or advanced cervical changed on PE before 24 weeks =
Tx of incompetent cervix for
elective termination OR
Cerclage placement (suture cervix to hold it closed)
Betamethasone (glucocorticoid to enhance fetal lung maturity) + strict bed rest
Tocolytics (Ritodrine) = prevent contractions and progression of labor if there is preterm labor contractions
Universal Gestational Diabetes screening is recommended for all pregnant women at ____ weeks.
Definitive diagnosis =
-Random blood sugar >200 OR fasting glucose >126 on 2 occasions = diagnostic
-Non-fasting 50 gm oral glucose challenge test > 140 = positive
3 hour glucose tolerance test
Tx of choice for gestational diabetes
If fasting blood glucose is high, use ___
If postprandial glucose is high, use ___
If both fasting and postprandial glucose are high, then ___
Fasting: NPH insulin at bedtime
Postprandial: regular insulin before meals
Both: NPH before breakfast and bedtime + regular insulin before each meal
Gestational HTN = Persistent ___ mmHg, (with/without) proteinuria, at or after ___ weeks.
Preeclampsia = ___ mmHg + ____
Porteinuria of 0.3 gm or greater in 24 hr urine
Tx: bedrest, Methyldopa
HELLP syndrome =
Seen in ___
Hemolysis, Elevated Liver enzyme, Low Platelet
Severe preeclampsia (>160/110, >5 gm protein in 24 hrs)
Tx of severe preeclampsia
-Mg sulfate = seizure prophylaxis
-Betamethasone x2 24 hrs apart = speed up lung development if under 33 weeks
Occurrence of 1 or more conuslions in presence of preeclampsia =
Tx: Mg sulfate for seizures --> may cause hyporeflexia --> Ca gluconate
Painless, abnormal vaginal bleeding, preeclampsia, tachycardia, tachypnea is presentation of ___.
Dx of molar pregnancy:
US shows ___
US: cluster of grapes, snowstorm appearance
Complete mole =
Partial mole =
Fertilization of egg that had no chromosomes
Fertilization of ovum by 2 sperms
Complete moles have a 2 % chance of developing into ___.
Sheets of anaplastic cytotrophoblasts and syncytiotrophoblasts w/o chorionic villi =
Tx of Rh-Incompatibility
300 mg Rh immunoglobulin given to Rh - mother at 28 weeks and within 72 hours of delivery
Fetal brachial plexus injury
Complication d/t shoulder dystocia
medication that suppresses premature labor
-Betaminmetics* (ritodrine, terbutaline)
Tx of preterm labor =
-Dexamethasone/betamethasone (stimulate fetal lung development)
-GBS prophylaxis: PCN
Prenatal screening for vaginal and rectal GBS at ____ weeks.
MC cause of life-threatening infections in newborns.
Sepsis, meningitis, newborn pneumonia
Prolapsed umbilical cord will cause ____ after membrane rupture
severe variable deceleration or bradycardia
Abnormal accumulation of fluid in fetal tissue =
Hydrops fetalis (fetal hydrops)
All of the following are reassuring fetal status EXCEPT:
A. Minimal variability
B. Active fetal movement
C. 2 accelerations in 20 minute period
A. Moderate variability (6-20 bpm) is good. Minimal (<5 bpm), marked (>20 bpm) or absent variability is bad.
Reactive strip = 2 accelerations of >15 seconds w/ peak of >15 bpm in 20 min period
Uterine myometrium fails to contract following delivery =
- Bimanual uterine massage*
- Uterotonic agents =
Prostaglandins (CI in asthma)
Methylergonovine (CI HTN/pre-eclampsia)
Bakri Balloon (good for HTN)
Bloody mass seen near introitus after delivery =
Tx: ** Steps
1. Uterine relaxants/tocolytics (Mg sulfate, terbutaline)
2. Replace proper position (place fist inside uterus)
3. Uterotonics agents (oxytocin)
Pituitary infarct d/t hypovolemia and hypotension
--> absence of lactation d/t loss of prolactin OR no restart of menstruation d/t loss of gonadotropins
Tx: find cause, fluid resuscitation, blood transfusion
Tx of endometritis
W/ vaginal delivery:
Prophylaxis: 1st gen cephalosporin during C-section
W/ C-section: Clindamycin + gentamicin
W/ vaginal delivery: Ampicillin + gentamicin
What congenital disorder?
Rocker bottom feet
Klinefelter syndrome = ___ karyotype
(high/low) testosterone, (high/low) FSH/LH
low testosterone, high FSH/LH
Decreased intelligence, behavioral problems
Low birth weight, poor muscle tone, microcephaly, language difficulties, profound retardation =
Results from ___.
Cri Du Chat
Deletion of long arm of chromosome 5
Diagnosis of Premature Rupture of Membranes (PROM)
Fern test OR nitrazine paper: pH >6.5
MC cause of infertility
Classic triad presentation of Endometriosis
Premenstrual pelvic pain
Dyspareunia (pain w/ sex)
Definitive diagnosis of Endometriosis
Premature labor = Regular uterine contractions w/ progressive cervical changes before ___ weeks gestation.
Cervical dilation =
>3 cm cervical dilation
> 80% effacement
Tx of choice of chronic HTN in pregnancy
What meds should be avoided?
Methyldopa if BP > 150/100
Avoid ACEI** and diuretics
BP med should be started if BP > ____ in preeclampsia
Hydralazine**, Labetalol, Nifedipine