OB-Gyn Rd 2 Flashcards by Alex Hamidi

What lab value can tell you if there is hyperemesis gravidarum?

Most often occurs when?

What other CF?

Urine ketones

1st trimester

> 5% weight loss of prepregnancy weight

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Pt that is unstable and is having an inevitable abortion, what is the best step?

Suction curettage

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What is primary ovarian insufficiency?

Menopause before age 40

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How do you distinguish bw Mono and Gonococcal pharyngitis?

Mono will have TENDER cervical LAD

Gonorrhea will also have lower ABD pain

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How does abruptio placeta appear?

What classic symptom?

ABD pain, back pain, vaginal bleeding
Frequent contractions

Rising and FIRMING of the uterus

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Pt that has hypothyroid and wants to become pregnant, how do you manage it?

Inc dose WHEN she becomes pregnant NOT before

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Vaginal ulceration and bleeding in postemenopausal woman, what is the best next step?

Biopsy of lesion

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What causes pituitary apoplexy aka spontaneous pituitary hemorrhage?

Sx?

Pituitary adenoma

HA, visual field defects, no pituitary defects

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Age < 45 who needs endometrial biopsy?

AUB + unopposed Estrogen (obesity, anovulation)
AUB + failed medical management
AUB + Lynch syndrome

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Pt that is over 35 and has atypical glandular cells on Pap needs what?

Colpo
Endometrial biopsy
Endocervical curettage

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What is a RF for preterm labor in pt w/PMHx of cervical surgery?

Assess risk how?

How to decrease risk?

Short cervix

TV-US

Give progesterone

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Thiamine deficiency results in what?

Wernicke encephalopathy - AMS, nystagmus, gait ataxia

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What is responsible for preparing the endometrium for implantation of a fertilized ovum?

Progesterone

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Amphetamine use during pregnancy is associated w/what?

Preterm delivery, pre-E, FGR, abruptio placenta, IUFD

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How does a hydatidiform mole appear on US?

Snowstorm appearance

b-hCG will be > 100,000

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What does pseudocyesis mean?

Causes what symptoms?

D/t what etiology?

False pregnancy

Weight gain, amenorrhea, tender breasts

Somatization of stress

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Ovarian mass is found on pt that is cystic and measures 5cm on US. Pt is 62 y/o and has no symptoms. What is the best next step?

CA-125 marker and pelvic US

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What can cause ovarian failure aka primary ovarian insufficiency in a woman < 40 y/o?

PMHx of Chemotherapy

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Pt that comes in with size-date discrepancy and irregular contour of the uterus, what is the reason?

Fibroids

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Patient that is undergoing preterm labor and is < 32 weeks should receive what?

Betamethason
Tocolytics (indomethacin, nifedipine)
Magnesium sulfate (neuroprotective)
PCN if GBS+ or uncertain

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US shows an adnexal mass w/lack of Doppler flow, Dx?

Ovarian torsion

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When is the active stage of labor?

When has it been arrest of labor?

6cm to 10cm

NO change in 4 hours w/adequate contractions or >6 hours w/inadequate contractions

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What is uterine synechiae?

Asherman syndrome

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What does malpresentation mean?

Anytime the baby is not at vertex (occiput lowest)

Aka Face or breech

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Infant born w/thin, loose skin and a thin umbilical cord and wide anterior fontanel has what? What else is common? Best step in management?

Fetal growth restriction Meconium-stained amniotic fluid Send placenta for histopath exam

What fibroids are likely to compress organs?

Subserosal and pedunculated

What can occur d/t a traumatic delivery and presents w/radiating suprapubic pain that is exacerbated by ambulation or weight bearing? Treatment?

Pubic symphysis diastasis

Smooth, firm mass protruding through the labia majora w/cyclic ABD Pain indicates what?

Imperforate hymen

Friable cervix that bleeds w/manipulation and mucopurulent cervical discharge indicate what? D/t what?

Acute cervicitis GC

What contraception is contraindicated in breast cancer pts?

OCPs Progesterone IUD Patch Nuva ring

SERMs can cause what structural abnormality in premenopausal women?

Endometrial polyps

How do you manage intra-amniotic infections?

Give Abx and augment labor NO C-Section

What are the risks of external cephalic version? Can perform when?

Abruptio placenta IUFD At or beyond 37 weeks

What presents w/fever, heavy vaginal bleeding, purulent discharge that smells BAD, and uterine tenderness? Treat how?

Septic abortion Broad-spectrum ABx and Suction curettage

How does embryonal carcinoma present?

Teens w/ABD mass and elevated b-hCG | Major Sx: ASCITES

How do you differentiate bw endometritis and septic pelvic thrombophlebitis?

Endometriosis gets BETTER w/Abx Pelvic thrombophlebitis PERSISTS w/fever

Describe the uterus in adenoma oasis

Boggy (soft), TENDER, uniformly enlarged

When can menopause be clinically diagnosed? Otherwise need what in workup?

> 45 y/o w/12 month hx of amenorrhea and no other concerning symptoms TSH, FSH

What is an absolute contraindication to vaginal delivery?

Pt w/classic (vertical) prior cesarean section Placenta previa Prior extensive myomectomy

Pt w/infertility and dysmenorrhea and a FIXED, immobile uterus has what?

Endometriosis

What is a possible SE of oxytocin toxicity? D/t what?

Seizure Hyponatremia

Morbid obesity can cause what?

Anovulation

What presents w/fever, ABD pain, and a complex multiloculated adnexal mass w/thick walls and internal debris? What labs are elevated?

Tubo-ovarian abscess CRP, CA-125, leukocytosis

Pt is 29 y/o and has a tender, mobile mass, after aspiration yields yellow fluid and resolution of the mass, best next step?

Return in 2-4 months for breast eval

Inpatient treatment for PID is what?

Cefotetan + Doxycycline

Pt that is delivering a baby and has herpes, what is the best way to minimize infection?

C-section

What results from an incomplete regression of the Wolffian duct during fetal development? Located where? If symptomatic treat how?

Gartner duct cyst Lateral upper anterior vagina I+D w/Word catheter placement

Pt w/abnormal 1st trimester screen should be followed up how?

CVS weeks 10-13 | Amniocentesis weeks 15-20

Pt that WANTS to stop breast feeding after death of a baby, treat how?

NSAIDs

Who needs an endometrial biopsy if over 45? Age >/= 35

AUB w/postmenopausal bleeding Atypical glandular cells on Pap test

In the 1st trimester, how does a woman’s thyroid change: Total T4? Free T4? TSH?

Inc —> b-hCG stimulates thyroid hormone in 1st trimester Unchanged Dec —> b-hCG and thyroid hormone suppress it

Stress urinary incontinence can occur even when?

Pt coughs and no fluid leaks out

Pt that presents w/hyperandrogenism during pregnancy and has b/L ovarian mass on US has what? D/t what?

Benign ovarian tumors Luteoma or theca lutein cysts

Who is at risk for ABO incompatibility? MC outcome?

Infants w/blood type A or B born to mother w/blood type O Mild hemolytic disease

What can present w/pre-E w/severe features at < 20 weeks gestation?

Hydatidiform mole

What are the normal findings in a biophysical profile?

``` NST - reactive FHR Amniotic fluid index > 5 Fetal movements >/= 3 Fetal tone >/= 1 F/E Breathing >/= 1 episode > 30s ```

MC SE’s of SERMs (tamoxifen and raloxifene)?

Hot flashes VTE Endometrial hyperplasia (T only)

Pt w/multiple abortions and an episode of slurred speech and sudden right arm weakness has what?

Anti-phospholipid Ab syndrome —> that is a TIA moron

Endometrioma = ?

Chocolate cyst

How to treat confirmed Chlamydia infection with confirmed negative Gonnorhea? If reverse is true?

Azithromycin ONLY Ceftriaxone + Azithromycin (d/t inc cephalosporin resistance)

How does pregnancy effect ventilation and breathing? What about acid/base status?

Inc ventilation d/t progesterone Inc TV, Inc MV Respiratory alkalosis

What is a tubo-ovarian abscess? Presents how?

Severe form of PID Foul smelling vaginal discharge, lower ABD pain, cervical motion tenderness

What maintains the corpus luteum? Secreted by what?

B-hCG Syncytiotrophoblast

What is the TARGET BG level for fasting pregnant pt? 1 hour postprandial? 2 hour?

< 95 < 140 < 120

Pt w/painful urination and pain with the passage of stool, and rectovaginal exam shows modularity in the posterior cul-de-sac has what? D/t what?

Endometriosis Implantation of endometrial glands and stroma

Postpartum woman w/enlarged uterus, irregular vaginal bleeding, pulmonary symptoms and multiple infiltrates on CXR has what? Confirm how?

Choriocarcinoma b-hCG

Pt w/US results that show an intrauterine gestational sac w/yolk sac but no fetal pole, b-hCG that starts at 27,000 but decreases to 25,000 most likely has what?

Missed abortion

Pt that is still bleeding after delivery of a baby w/forceps or vacuum needs to have what? Why?

Genital tract inspection To make sure all lacerations are repaired

What are the 4 RFs for placental abruption? Puts you at risk for what?

Maternal HTN Pre-E or E Prior abruption Cocaine/tobacco use DIC and hypovolemic shock

L+D are contraindicated in what cases? D/t what? What symptoms?

Classic Cesarean or extensive myomectomy Risk of uterine rupture Intense ABD pain, persistent variable decelerations

What does phenytoin use in pregnancy cause?

Microcephaly, hypoplasia of distal phalanges of fingers and toes, excess hair, cleft palate Also Hirsuitism and developmental delay

What is the optimal fetal position? If it is Occiput transverse and there is an arrest of stage 2 labor, what is the cause?

Occiput anterior Malposition

OB-Gyn Rd 2 Flashcards

(72 cards)