Flashcards in OB-GYN Review Deck (130)
The secretory phase of the mestraul cycle (day 14-28) is dominated by what hormone?
Who is the more likely to get pre-eclampsia a nulliparous woman or a multiparous woman?
Nulliparity is a risk factor for pre-eclampsia.
Since a genetic cause is the number one reason for primary amenorrhea what is one very important test?
Purulent cervical discharge should make you think of what diagnosis?
A description of a young girl with a web neck or wide shield chest should make you think of what diagnosis?
Cervical biopsy comes back as CIN1. What is the next step?
Repeat pap smear in 6 months and repeat colposcopy in 12 months.
What is the most common cause of secondary amenorrhea?
What three labs should you order if you are considering secondary amenorrhea?
beta HCG, TSH, Prolactin
Define premature birth.
Delivery of uterine contets between 20-36 weeks.
A unilateral, single, mobile, firm, nontender solid breast mass should make you think of what diagnosis?
Bleeding between menstrual cycles.
Postmenopausal bleeding is immediately believed to be what diagnosis?
Endometrial cancer until proven otherwise.
During what portion of the menstrual cycle does PMS occur?
By definition it is in the second half and menstruation should relieve the symptoms.
How do you treat bacterial vaginosis?
Metronidazole x 7 days
What location within the pelvis is endometriosis most commonly found?
On an ovary.
What lab test is the gold standard for chlamydia?
Nucleic acid amplification test.
Are fibrocystic breast masses usually bilateral or unilateral?
How do you definitively diagnose endometriosis?
What is the most common uterine tumor?
Leiomyoma, also known as fibroids.
What ethnic background is at an increased risk of fibroids?
African American are 5x more likely to have fibroids compared to Caucasian women.
How do you treat vaginal candida?
Fluconazole po 1 dose or azole cream x 1 week.
What is the first step of treatment for endometrial cancer?
Total hysterectomy and bilateral salpingo-oophorectomy.
If you see the term chocolate cyst it should make you think of what diagnosis?
A surge in what hormone leads to ovulation?
A patient presents with irregular menses, hirsutism and infertility. What is the most likely diagnosis?
Polycystic ovarian syndrome
What endocrine issue is associated with PCOS?
You have a patient with PCOS who would like to get pregnant. What are two medications you may start her on?
Metformin and Clomid
What is the medical treatment for an early ectopic pregnancy?
An ovarian cyst that contains hair and teeth should make you think of what diagnosis?
What is the mean age for ovarian cancer?
63, you will need to think of this in an older patient with vague abdominal symptoms.
Define the second stage of labor.
Fully dialated to delivery
A 66 year old female patient presents with bouts of nausea, weight loss and vague abdominal pain. What is the most likely diagnosis?
When is it recommended to begin pap smears?
When a woman becomes sexually active or when she is 21 years old.
Cervical biopsy comes back as CIN2 or CIN3. What is your next step?
Excision - LEEP, Cold knife (worry about incompetent cervix), Cryotherapy.
List two risk factors for cervical cancer.
Multiple sexual partners, smoking.
How much time needs to pass before diagnosing secondary amenorrhea?
If cycles have been normal 3 months. If cycles have been irregular 6 months.
What is a cystocele?
A herniation of the bladder into the vagina.
What is the treatment for Turner's syndrome?
Cyclical estrogen and progesterone.
What are three treatments for uterine prolapse?
Pessary, Kegel's maneuvers, surgical repair.
What is the most common organism that causes mastitis?
At approximately how many weeks pregnant is the uterus at the level of the umbilicus?
What is the most common cause of postpartum hemorrhage?
Define missed abortion.
No vaginal bleeding, cervix is closed, products of conception are still inside.
At what age is primary amenorrhea diagnosed?
Age 14 if no secondary sex characteristics. Age 16 if some secondary development.
What is the first line treatment for mastitis?
Dicloxacillin is fist line. Cephalexin or erythromycin are second line.
Should a breast feeding mother stop breast feeding if she develops mastitis?
Mastitis is not a reason to stop breast feeding, but an abscess is.
A physical exam revealing a retroverted uterus or uterosacral ligament nodularity should make you think of what diagnosis?
At how many weeks of pregnancy can an amniocentesis be done?
List four risk factors for breast cancer?
BRCA1 or BRCA2 positive, unopposed estrogen, nulliparity, early menarche, late menopause
What is the average age of menopause?
Cottage cheese discharge should make you think of what diagnosis?
The follicular phase of menstruation is dominated by what hormone?
About how much weight should a woman gain during pregnancy?
Thin, sticky, malodorous vaginal discharge should make you think of what diagnosis?
Vaginal infection with motile flagellated protozoa should make you think of what diagnosis?
List two medications commonly used for hypertension in pregnancy.
Methyldopa and labetalol
What is the classic triad of pre-eclampsia?
HTN, edema and proteinuria
Why is ovarian cancer so hard to diagnose?
There are no good markers and the symptoms are very vague.
What are two important things you need to tell you patients before putting them on metronidazole?
Stay out of the sun and avoid alcohol.
Define Inevitable abortion.
Vaginal bleeding, cervix is open, products of conception are still inside.
How is the first day of the menstrual cycle defined?
The first day of menstrual bleeding is the first day of the cycle.
What is the karyotype for patient with Turner's syndrome?
(45, X) They are missing one sex chromosome.
Give the time frame for preterm labor.
A patient presents with mucopurulent discharge and cervical motion tenderness. What is the most likely diagnosis?
Chlamydia - cervicitis
Which four human papillomaviruses are linked to cervical cancer?
HPV 16, 18, 31 and 33
Clue cells should make you think of what diagnosis?
What is the hallmark physical exam finding for placenta previa?
Trick questions - NEVER do a physical exam on someone with presumed placenta previa.
What medium do you need to grow out Neisseria gonorrhoeae?
What age range is the HPV vaccination recommended for?
9 to 26 years old
A patient with primary amenorrhea and a low FSH should make you think of what diagnosis?
Hypothalamic pituitary insufficiency.
What characteristic of pelvic inflammatory disease will help to differentiate it in a question stem from ectopic pregnancy, appendicitis, ovarian torsion and ovarian cyst?
It will be bilateral pain. Most other common abdominal complaints have unilateral pain.
List 2 risk factors for ovarian cancer.
BRCA1, Family history, Nulliparity, late menopause, caucasian, asian.
Delivery of uterine contents before 20 weeks.
Does mastitis tend to be unilateral or bilateral?
Unilateral and only one quadrant
Define full term.
Delivery at 37-42 weeks
When does quickening occur?
Nulliparous 18-20 weeks, multiparous 14-16 weeks.
List three risk factors for placental abruption.
HTN, smoking, AMA, cocaine use, PROM.
What is the treatment for ovarian cancer?
Total hysterectomy and bilateral salpingo-oophorectomy. Chemo + radiation.
A patient believes she is pregnant. You notice that her cervix appears a little blue. What is the name of this sign?
At approximately how many weeks pregnant is the uterus at the level of the symphysis pubis?
A snowstorm appearance on ultrasound should make you think of what diagnosis?
What medication can be used to control bleeding due to uterine atony?
What is the term for when the placenta has implanted directly over the cervical os?
At how many weeks of pregnancy can chorionic villus sampling be done?
Why is folic acid given as a prenatal vitamin?
Low folic acid can lead to neural tube defects.
What is the most common endometrial cancer?
75% are adenocarcinomas
A strawberry cervix with copious yellow/green discharge should make you think of what diagnosis?
What organism causes us to warn pregnant patients to stay away from deli meats and soft cheeses?
The baby was delivered several minutes ago. Suddenly there is a increase in blood flow from the vagina and the cord noticeably lengthens. What is the most likely cause of these signs?
What are two medications used to induce labor?
Cervidil (prostoglandin gel applied to the cervix) which encourages cervical rippening and oxytocin which encourages uterine contractions.
As part of the antepartum testing a baby has a positive stress test. What does that mean?
They have had two heart rate accelerations in a 20 minute period of 15 beats above baseline for at least 15 seconds. This is a good thing.
Is FSH high or low in Turner's syndrome?
High, there are no ovaries to respond to FSH and so there is no negative feedback.
What is the most common type of ovarian cyst?
Functional cyst - no treatment necessary.
Define threatened abortion.
Vaginal bleeding, closed cervix, products of conception are still inside.
List 4 risk factors for endometrial cancer.
Chronic unopposed estrogen, nulliparity, early menarche, late menopause, Tamoxifen, DM, obesity, HTN, breast CA, ovarian CA
What would you expect to see on a KOH prep if the patient had vaginal candidiasis?
What is the #1 cause of septic arthritis in sexully active young adults?
How many days after conception is a serum beta HCG positive?
If the pap smear results come back anything other than negative or ASCUS what is your next step?
Colposcopy and biopsy
List three risk factors for an ectopic pregnancy.
Previous ectopic, scarred tubes (hx of PID or salpingitis), IUD.
Grape like vesicles or a sack of grapes on ultrasound should make you think of what diagnosis?
What medication is used to increase surfactant levels and help with lung maturity if you are worried about preterm labor?
What are two tocolytic medications you should be aware of?
Magnesium sulfate and calcium channel blockers.
A woman presents to the ED concerned she is in preterm labor. What treatment should you begin before even getting any imaging or lab results?
Give IV fluids (most often the patient is suffereing from dehydration).
A pap smear comes back as atypical squamous uncertain significance (ASCUS). What is your next step?
Repeat pap smear in 4-6 months.
What are three ways you can check for ruptured membranes?
Ferning pattern on a slide, visualize leakage from the cervix, pooling in the vagina.
What is the normal range of fetal heart rate?
Heavy prolonged menstraul flow.
What Rh combination for mom and dad might cause the mother to create antiboides against the babies red blood cells?
Mom Rh negative and dad Rh positive.
At what point during pregnancy is Rhogam given if it is needed?
Define complete abortion.
Vaginal bleeding, cervix open, products of conception have passed.
Gestational diabetes puts mom and baby at increased risk of for what three things?
Preeclampsia, macrosomia (traumatic birth), slowing in fetal lung development.
Which is associated with painful third trimester bleeding placental abruption or placenta previa?
What are three causes for a postpartum hemorrhage?
Uterine atony, genital laceration, retained placenta.
Define the third stage of labor.
Delivery of baby to delivery of placenta.
What medication(s) are used to treat a postpartum metritis?
Clindamycin and gentamicin together.
What organism is the most common sexually transmitted infection?
Interference with work or school is part of which diagnosis premenstrual syndrome or premenstrual dysphoric disorder?
Premenstrual dysphoric disorder
Which reproductive cancer carries the highest rates of death in women?
What is the most common infection following a C-section?
How do you treat a Trichomonas infection?
Define Incomplete abortion.
Vaginal bleeding, cervix is open, products of conception partially passed.
What is the most common site of an ectopic pregnancy?
Within a fallopian tube
Early on in pregnancy serial beta HCG should double over what time period?
every 48-72 hours
Uterine prolapse beyond the the introitus.
What is the more popular term for Stein-Leventhal syndrome?
Polycystic ovarian syndrome
What is the formula for calculating estimated date of confinement or due date?
First day of last menstrual period + 7 days - 3 months.
What are the five components of the biophysical profile as part of antepartum testing?
A non stress test, fetal breathing, two gross body movements, fetal tone, amniotic fluid index.
Define the first stage of labor.
Onset of contractions to full dilation of the cervix.