OB/Gyn Shelf Flashcards
1
Q
what is normal arterial blood gas during pregnancy
A
compensated resp alkalosis
2
Q
what physiologic change accounts for resp alk during pregnancy
A
incr minute ventilation
3
Q
causes of pulm edema during pregnancy
A
use of tocolytics, preeclampsia, heart disease, fluid overload
4
Q
what can cause hydronephrosis in pregnancy
A
compression of ureters and renal pelvis by uterus and ovarian vein complex
5
Q
which kidney is more often affected by hydronephrosis in pregnancy
A
R side b/c left is cushioned by sigmoid colon
6
Q
what’s most appropriate test to do when molar pregnancy is suspected?
A
CXR b/c lungs are most common site of metastatic dz in someone with gestational trophoblastic disease
7
Q
recs for weight gain by BMI
A
BMI 18-25: 25-35; BMI 25-30: 15-25; BMI>30: 11-20
8
Q
most effective screening tool for Down
A
cell-free DNA
9
Q
blood glucose goals with fasting and 1-2 hrs post-prand
A
<90 fast, <135 at 1 hour, <120 at 2 hours
10
Q
IUGR risk higher in diabetic pt?
A
in type I
11
Q
symptoms of Sheehan syndrome
A
loss of TSH, gonadotropin, ACTH leads to no milk pdtion, poor mentation, weight gain, hypotens, amenorrhea
12
Q
most common cause of postpartum fever
A
endometritis
13
Q
Abx for mastitis
A
Dicloxacillin or cephalexin if no penicillin allergy. In the setting of a beta lactam allergy or MRSA, clindamycin
14
Q
what must decrease in order to allow for milk pdtion?
A
estrogen and progesterone b/c they have inhib effects on milk pdtion by blocking pdtion of alpha-lactalbumin
15
Q
what causes mastitis with severe nipple pain?
A
candida
16
Q
suckling stimulates which hormone
A
oxytocin
17
Q
what hormone is responsible for milk pdtion
A
prolactin
18
Q
what role does oxytocin play in breastfeeding?
A
milk ejection
19
Q
what fetal presentation is most commonly linked to cord prolapse
A
backup transverse lie
20
Q
turtle sign indicates
A
shoulder dystocia
21
Q
cervical ripening agents
A
prostaglandins, misoprostol
22
Q
what’s the best BP med to use in preg
A
alpha-methyldopa
23
Q
what other BP meds can be used in preg
A
labetalol, hydralazine
24
Q
symptoms of severe pre-E
A
(think head to toe): HA, vision changes, pulm edema, elev LFTs (2x upper limit), RUQ pain, thrombocyto, elev Cr (>1.1 b/c normally low in preg)
25
what do you give if you have mag toxicity?
calcium
26
freq cause of late decels
uterine tachysystole since contractions interrupt intervillous blood flow
27
first line abx for mastitis
dicloxacillin or cephalexin to cover MSSA. If MRSA cov needed, then vanc or clinda
28
2 indications for mag
1) seizure prophy 2) decr risk of CP in preterm
29
where is mag processed
renal excretion
30
treatment for postpartum endometritis
clinda + gent
31
treatment for pyelo in preg
ceftriaxone
32
female external genitalia with male internal genitalia (undescended testes): 2 possibilites
5-alpha-reduc defic or androgen insensitivity syndrome
33
how to distinguish 5-alpha-reduc defic from AIS at puberty
breast develop in AIS but not in alpha reduc
34
where are the bartholin glands located?
posterior vaginal introitus
35
lymphogranuloma venereum comes from what bacteria
chlamydia
36
granuloma inguinale comes from what bacteria
klebsiella
37
which lesions are painful: genital herpes, gran inguinale, chancre, chancroid, lymphogran venereum
herpes and chancroid (from haemophilus ducreyi)
38
papule that evolves into nonexudative ulcer
chancre of syphilis
39
multiple intrauterine fetal fractures assoc with
type II osteogenesis imperfecta
40
tests to determine if membs have ruptured
pooling w/ spec exam, nitrazene blue, ferning
41
woman comes in with pPROM. What's the limit for immediate delivery w/o giving steroids?
34 weeks
42
how long is prolonged ROM?
>18 hrs
43
endometritis vs chorioamnionitis
endo is infection when baby is out; chorio baby is still in
44
risks for preterm labor
smoking, young maternal age, multigestation, pPROM, anatomical defects
45
what do you give to moms in preterm labor
steroids and tocolytics
46
most common tocolytics
mag, nifedipine, indomethacin
47
cramping midline abdominal pain that starts 1-2 days before menses and abates in a few days
primary dysmenorrhea
48
cause of primary dysmenorrhea
excess prostaglandins
49
tamoxifen decr risk of what cancer? incr risk of what cancer?
decr for breast, incr for endometrium
50
MOA of tamoxifen in breast and uterus
estrogen receptor antag in breast, agonist in uterus
51
treatment for septic abortion
suction curettage
52
target fasting, 1-hour, 2-hour postprandial blood sugars in pregnancy
fast <95, 1-hr PP <140, 2-hr <120
53
pharm treatment for diabetes in pregnancy
insulin or metformin. use if dietary modification fails
54
painful menses with symmetrically enlarged uterus
adenomyosis (endometrial stroma and glands in myometrium)
55
pain during ovulation (2 wks before menses)
Mittelschmerz pain
56
painful menses w/ concurrent dysuria, dyschezia, and/or dyspareunia
endometriosis
57
physical exam findings for endometriosis
immobile uterus or adnexal masses
58
are pregnant women w/ h/o HSV but no active lesions treated
yes, they get acyclovir starting at 36 wks
59
what is Asherman syndrome
formation of intrauterine adhesions
60
risk factors for intrauterine adhesions
intrauterine surgery like curettage or infection
61
effects of estrogen and progesterone on endometrium
estrogen causes prolif; proges decr prolif
62
ovarian mass with breast tenderness and fibrocystic changes
granulosa tumor
63
tumor markers of granulosa tumor
incr estradiol and inhibin
64
elevated alpha-fetoprot is found in which type of germ cell tumor
yolk sac
65
what's elevated with sertoli-leydig cell tumor
testosterone
66
elevated hcg in what conditions
embryonal carc and trophoblastic dz
67
most common pelvic tumor
fibroids aka uterine leiomyomata
68
thin wrinkled vulvar skin with normal vagina
lichen sclerosus (sclerosus spares vagina unlike planus)
69
what does hCG do?
maintains corpus luteum until placenta can produce enough progesterone
70
when does hCG peak?
about 10 weeks
71
subunit of hCG also found in
TSH, FSH, LH
72
do OCPs incr or decr the risk of the following: endometrial cancer, acne, HTN, ovarian cancer, benign breast, VTE, cervical cancer, stroke, MI
decr: endometrial and ovarian cancer, benign breast, acne; incr: cerv cancer, HTN, VTE, stroke, MI
73
maternal fever causes what change in fetal heart tones
tachy
74
unilateral bloody nipple discharge
intraductal papilloma
75
when can external cephalic version be performed
>37 wks d/t risk of premature delivery
76
Fitz-Hugh-Curtis disease
perihepatitis (liver capsule inflamm) due to PID
77
what's elevated in androgen-secreting tumor of ovary? of adrenal gland?
testosterone if ovary; DHEAS if adrenal
78
partially calcified ovarian mass with echogenic bands
teratoma
79
why is mag sulfate given when woman is in preterm labor <32 wks
fetal neuroprotection against cerebral palsy
80
best treatment for endometriosis
OCPs
81
best test for endometrioma
laparoscopic ablation of cyst
82
where is most common location of ectopic preg
ampulla
83
solid adnexal mass with thick septations and ascites is concerning for
ovarian cancer
84
clue cells seen in
bacterial vaginosis
85
when should you deliver in preeclampsia w/ severe features?
34 wks
86
what type of incontinence do antimuscarinics treat? cholinergics?
antimusc for overactive bladder b/c inhibits bladder smooth musc. Chol for overflow incontinence b/c incr bladder contractility
87
what types of twins are at risk for TTTS?
monochorionic
88
at what days does zygote split for 1) di, di 2) mono di 3) mono mono
up to 4 for di di (tubal), 4-8 for mono di (blastocyst), 8-12 for mono mono, >12 for conjoined
89
who's at risk for cord entanglement in mult gest
mono mono
90
name some modifiable risk factors for osteoporosis
smoking, alc, sedentary, vit D and calc defic, meds, low estrogen
91
when should mag be given in pprom
<32 wks
92
when can chorionic villus sampling be done? amniocentesis?
chor villus at 10-13, amnio at 15-20
93
what are tests in 1st trimester screen, 2nd tri quad screen?
1st: preg-assoc plasma protein, beta hcg, nuchal translucency; 2nd: AFP, estriol, beta hcg, inhibin A
94
oral glucose challenge cutoffs for GDM
should be <95 for fasting, <140 1 hr PP, <120 2 hr PP
95
when should GDM screening occur?
after 24 weeks
96
genital ulcers caused by what can turn into painful buboes
chlamydia (lymphogranuloma venereum)
97
pt with HTN at greatest risk for what fetal prob
preterm birth (doesn't cause PPROM)
98
type of germ cell tumor with high AFP
yolk sac
99
type of germ cell tumor with high LDH or beta hcg
dysgerminoma (cells of placenta)
100
what other organ should be examined in pts w/o uterus and cervix
kidney b/c both derive from intermed mesoderm
101
what procedure do you do when you're concerned about advanced ovarian cancer
laparotomy
102
what causes elevated CA-125
ovarian cancer but also fibroids and endometriosis
103
when should rhogam be given
28 weeks and within 72 hours of delivery (or anything that causes blood mixing)
104
sudden onset abdominal pain with pelvic free fluid seen on u/s
ruptured ovarian cyst
105
type of miscarriage without vaginal bleeding
missed abortion
106
what are tests used to evaluate secondary amenorrhea
preg test then serum prolactin, FSH, TSH
107
risk factors for vaginal cancer
cigarettes, age>60, HPV infect (similar to cerv cancer)
108
what can you use to shrink fibroids
leuprolide (GnRH agonist): induces menopause
109
best med to treat fibroids
OCP
110
LH and FSH levels in PCOS
LH:FSH > 3:1
111
what meds can be used to induce ovulation? (often used in ppl with PCOS)
clomiphene and metformin
112
what happens to paO2 and paCO2 in pregnancy?
paO2 incr and PaCO2 decr (incr minute ventilation and tidal vol)
113
severe hypoglycemia in pregnancy may be sign of which serious complication
acute fatty liver (glycogen can't be converted to glucose)
114
what's biggest concern for postmenopausal bleeding and what's workup
endometrial cancer with biopsy
115
woman has life-threatening uterine bleed. you resuscitate and then do what to stop bleed
IV estrogen. if that doesn't work, then surgery
116
who is at risk for vulvar lichen sclerosus
hypoestrogenic peeps like premenarchal or postmenopausal
117
what age group is most at risk for labial adhesions
<2
118
when is trial of vaginal delivery contraindicated
after classical c-section or extensive myomectomy
119
what hormone does prolactin inhibit
GnRH
120
what tests should be done in a woman w/ postmenopausal bleeding
endometrial biopsy (or transvag u/s looking for thickened endometrium) and pap
121
what fetal abnormality can lead to maternal virilization
placental aromatase defic
122
what ovarian masses can cause hyperandrogenism during pregnancy
luteoma, theca lutein cyst, sertoli-leydig tumor
123
pruritis and liver dysfunc in pregnant woman
cholestasis
124
vulvar erosions with white striae and oral ulcers
lichen planus
125
paraurethral glands
skene glands
126
where are bartholin glands located
posterior vaginal introitus that drain into the vulvar vestibule at 4 and 8 o clock positions
127
what type of cyst is result of incomplete regression of Wolffian duct
gartner
128
complications of short interpregnancy period
PPROM, preterm delivery, low birth weight, maternal anemia
129
short cervix is strong predictor for what
preterm labor
130
what drug is used to prevent preterm labor
progesterone
131
dimpling of breast along with erythema and edema
inflamm breast carcinoma (peau d'orange)
132
treatment for lichen sclerosus, lichen planus
topical corticosteroid for sclerosus (clobetasol), topical steroids for planus as well
133
chronic lichen sclerosus is risk factor for
vulvar cancer
134
when is it safe to use tocolytics in preterm labor
up to 34 weeks
135
at what age should women stop getting paps
65 or if they've had a hysterectomy
136
what procedure do you do if you find ectocervical cancer? how about endocerv cancer?
for ecto, use local ablation with LEEP or cryo. For endo, use cone biopsy
137
what's next step when you find ASCUS on pap
test for HPV DNA
138
who should get HPV vaccine?
girls 11-26, boys 11-21
139
what are risk factors for endometrial cancer
anything that incr estrogen exposure: anovulation is worst, age, nulliparity, early menarche, late menopause, HRT or tamoxifen, obesity
140
treatment for endometrial cancer
total abdominal hysterectomy + b/l salpingoophorectomy
141
treatment for endometrial hyperplasia
progesterone
142
types of ovarian germ cell tumors and their markers
1) dysgerminoma with LDH, 2) yolk sac with AFP, 3) teratoma have no real marker but can cause stroma ovarii with hyperthyr, 4) choriocarcinoma with beta-hcg
143
if pregnant pt has severe HTN and bradycardia, what anti-HTN should be avoided
labetalol b/c it can lower pulse
144
when during pregnancy should anti-D ab (Rhogam) be given
28-32 weeks and w/i 72 hrs after delivery
145
eczematous nipple changes +/- bloody discharge
paget disease of breast which is ductal carcinoma (adeno)
146
if mom is sensitized to Rh(D) meaning she already has the antibodies, how should she be treated
rhogam no longer helpful so just monitor for fetal hemolytic disease
147
postpartum fever that is unresponsive to abx
septic pelvic thrombophlebitis
148
2 first line abx for e coli bacteriuria
1) cephalexin 2) amox-clav 3) nitrofurantoin
149
red, itchy lesion on vulva
paget's
150
grape like mass in vagina
adenocarc
151
what chem exposure is related to vaginal adenocarc
DES (in utero)
152
copious gray white discharge with fishy odor
bacterial vaginosis
153
what do you see on KOH test for bact vaginosis?
clue cells
154
first and second line abx for PID inpatient
1st: cefoxitin and doxy, 2nd: clinda and gent
155
outpatient PID treatment
ceftriaxone IM, doxy, metronidazole
156
first thing you do for retained placenta
D&C; amp
157
first thing for uterine inversion
manually put it back in place
158
elevated AST and ALT (2-3x normal) in 3rd trimester
acute fatty liver of pregnancy
159
treatment for acute fatty liver of pregnancy
delivery
160
what should you check after delivery with retained placenta
beta hcg
161
what are 2 reasons to give oxytocin
to induce/augment labor and in PPH
162
urethral hypermobility causes which type of incontinence
stress incontinence
163
what's rate of dilation in active phase of stage 1 of labor
>=1cm every 2 hours
164
sinusoidal fetal heart rate tracings most often assoc with what fetal condition
anemia (and big risk of fetal compromise)
165
what fetal abnormalities have elevated maternal AFP?
open neural tube defects, gastroschisis, omphalocele
166
what's the chemical change that happens with cervical change in labor
breakage of disulfide bonds
167
what's avg contraction in montevideo units
200 MVU in 10min
168
most effective method of emergency contraception
copper IUD
169
what are contraindications to placing copper IUD
acute cervicitis or PID
170
for how many days is copper IUD effective for emergency contraception
3-5 days
171
treatment for cervicitis with confirmed chlamydia
azithro only
172
treatment for cervicitis with confirmed gonorrhea
azithro + ceftriaxone due to incr resistance
173
what hormone is responsible for incr insulin resistance in pregnancy
human placental lactogen
174
cervical conization is risk factor for what in pregnancy
cervical insufficiency
175
oxybutynin (antimusc) treats what type of incontinence
urge (promotes relaxation)
176
cholinergic agonists like bethanechol treat what kind of incontinence
overflow (incr contractility to promote emptying)
177
types of vaginitis with elevated pH (>4.5)
vaginosis (gardnerella) and trich
178
asymptomatic bacteriuria in preg should be treated due to risk of what
pyelo
179
what does newborn with fetal growth restriction look like
thin, loose skin, thin umb cord, wide anterior fontanelle
180
Erb-Duchenne palsy caused by damage to which nerves
C5-7
181
claw hand and Horner syndrome in newborn
Klumpke palsy caused by damage to C8 and T1
182
what cancer does tamoxifen treat? what cancer does it cause?
treats breast cancer (estrogen antag) but can cause endometrial (has estrogen agonist activity in uterus)
183
what are adnexal masses seen with hydatidiform moles?
theca lutein cysts
184
when do you see incr alpha fetoprot in pregnancy
neural tube or abdominal wall defects
185
quad screening for trisomy 21
elev bHCG and inhibin, low AFP and estriol
186
what chronic disease can cause overflow incontinence
MS
187
what's LH:FSH ratio in PCOS
3:1
188
what do you test for if you suspect CAH
17-hydroxyprogesterone
189
what age should ppl be screened for osteoporosis
65 for everyone, 60 for smokers
190
call-exner bodies found in
granulosa cell tumor
191
contraindications to HRT
h/o CAD, thromboembolism, TIA/stroke, breast or endometrial cancer
192
what's the one thing HRT is approved to treat
vasomotor sx's
193
fetal fibronectin used for what
id patients w/ preterm contractions who are at risk for preterm delivery
194
what's time limit to determine active phase arrest of labor
4 hours w/ adequate contractions or 6 hours w/ inad contracts
195
what's proper fetal presentation during labor
occiput anterior
196
what uterotonic should not be given to asthmatics
prostaglandin f2-alpha/hemabate
197
what uterotonic should not be given to hypertensives
methergine
198
treatment options for stress incontinence
1) pelvic floor muscle strengthening 2) pessary 3) urethral sling
199
ultrasound finding of placental lakes is sign of what
placenta accreta
200
dilation and evacuation is used up til when
24 wks
201
in what type of abortion is fetal cardiac activity present
threatened: pt has bleeding with closed os
202
suprapubic pain that radiates down legs after traumatic delivery
pubic symphysis diastasis
203
order of -arches in puberty
usually thelarche-->pubarche-->menarche. Men about 2-2.5 years after thel and after growth spurt
204
inflammatory nodules w/ sinus tract formation in intriginous areas (inguinal, axillary, gluteal, inframammary folds)
hidradenitis suppurativa
205
treatment for hidradenitis suppurativa
doxycycline
206
initial prenatal labs
ID: HIV, syph, chlam, HBsAg, rubella, varicella, urine culture. Other: Rh type and ab screen, Hgb, dipstick for urine prot, pap if needed
207
when is GBS test?
35-37
208
medical management for endometrial hyperplasia
progestin
209
findings on TVUS that indicate need for endometrial biopsy
endo thickness >4mm
210
when are PPROMers delivered?
34 wks or sooner if there are complications
211
which causes of vaginitis alter vaginal ph? which don't?
bact vaginosis and trich make pH>4.5; candida doesn't change it (3.8-4.5)
212
newborn with severe microcephaly, thin cerebral cortices, intracran calcifications
Zika
213
what's urodynamic testing for
evaluation of mixed urinary incontinence (urge + stress)
214
2 fetal complications from preeclampsia
IUGR and oligo
215
2 maternal complications from preeclampsia
abruption, DIC
216
at what week should IUFD be delivered (instead of abortive procedure)
24
217
what could you find on UA in someone with hyperemesis gravidarum?
ketonuria
218
what's the most common cause of spontaneous abortion in the 1st trimester?
genetic anomalies of fetus
219
risk factors for preeclampsia
high risk: previous pregnancy with it, HTN, renal dz, diabetes, multigestation, autoimmune; moderate risk: obesity, fam hx, AMA, nulliparity
220
what's first test to do for mom who is Rh sensitized (has Ab)
transcranial doppler
221
what test can show fetal anemia
increased flow on transcranial doppler
222
when do you deliver baby that has fetal anemia
32 weeks
223
what can be used to transfuse baby with fetal anemia
Percutaneous umbilical blood sampling (PUBS) that also allows you to test fetal Hgb
224
first step in labor induction in woman with unfavorable cervix
cervical ripening with prostaglandin (miso) or balloon
225
first step in labor induction in woman with favorable cervix
oxytocin
226
2 things pessaries are used for
pelvic organ prolapse and stress incontinence
227
medications used to treat pelvic pain
NSAIDs, OCPs, GnRH agonists (leuprolide)
228
quad screen findings for Downs, for Edwards (18)
elevated hCG and inhibin in Downs (downs is up); decr for Edwards; both have low AFP and estriol
229
what's normal hgb at 28 weeks?
10
230
contraindications to meno hormone therapy
h/o breast cancer, CAD, VTE, stroke, active liver disease
231
loss of fetal station during labor could be sign of
uterine rupture
232
3 causes of normal 3rd trimester bleeding
cervical lesions, cerv dilation, bloody show
233
ovarian tumor made of ectoderm
dermoid cyst/teratoma
234
ovarian tumor made of epithelium
epithelial carcinoma that can involve ovary, tube, and peritoneum
235
def of fetal hydrops
collection of fluid in 2 or more body cavities: scalp, pleural effusion, pericard effusion, ascites
236
elevated AFP in preg? decr AFP?
elev with neural tube and ab wall defects. Decr with trisomy
237
when do you deliver preeclamp? preeclamp w/ severe features?
37 for preeclamp; 34 for severe
238
best anti-HTN drugs in preg?
labetalol, hydralazine, nifedipine
239
contraind to labetalol in pregnancy
bradycard
240
how should pts with prior h/o preterm labor be managed in next preg?
given progesterone starting in T2 and serial TVUS to monitor cerv length until 24 wks with cerclage placement if nec
