ObGyn Flashcards
(130 cards)
1
Q
How is the first day of the menstrual cycle defined?
A
The first day of menstrual bleeding is the first day of the cycle
2
Q
Rope like breast mass should make you think of what diagnosis?
A
Fibrocystic breast mass
3
Q
What is the formula for calculating estimated date of confinement or due date?
A
First day of last menstrual period + 7 days - 3 months
4
Q
What is the more popular term for Stein-Leventhal syndrome.
A
Polycystic ovarian syndrome
5
Q
What is the most common cause of postpartum hemorrhage?
A
Uterine atony
6
Q
Define procidentia.
A
Uterine prolapse beyond the the introitus
7
Q
What is the most common infection following a C-section?
A
Metritis
8
Q
Which reproductive cancer carries the highest rates of death in women?
A
Ovarian cancer
9
Q
Interference with work or school is part of which diagnosis premenstrual syndrome or premenstrual dysphoric disorder?
A
Premenstrual dysphoric disorder
10
Q
What medication(s) are used to treat a postpartum endometritis?
A
Clindamycin and gentamicin together
11
Q
What medication can be used to control bleeding due to uterine atony?
A
Oxytocin (pitocin)
12
Q
What are three causes for a postpartum hemorrhage?
A
Uterine atony, genital laceration, retained placenta
13
Q
What is the term for when the placenta has implanted directly over the cervical os?
A
Placenta previa
14
Q
What is the hallmark physical exam finding for placenta previa?
A
Trick questions - NEVER do a physical exam on someone with presumed placenta previa
15
Q
List three risk factors for placental abruption.
A
HTN, smoking, AMA, cocaine use, PROM
16
Q
Which is associated with painful third trimester bleeding placental abruption or placenta previa?
A
Placental abruption
17
Q
Who is the more likely to get pre-eclampsia a nulliparous woman or a multiparous woman?
A
Nulliparity is a risk factor for pre-eclampsia
18
Q
What is the classic triad of pre-eclampsia?
A
HTN, edema and proteinuria
19
Q
List two medications commonly used for hypertension in pregnancy.
A
Methyldopa and labetalol
20
Q
List three problems that gestational diabetes increases the risk for in pregnant mom and baby.
A
Preeclampsia, macrosomia (traumatic birth), slowing in fetal lung development
21
Q
At what point during pregnancy is Rhogam given if it is needed?
A
28 weeks
22
Q
What Rh combination for mom and dad might cause the mother to create antiboides against the babies red blood cells?
A
Mom Rh negative, Dad Rh positive
23
Q
What are three ways you can check for ruptured membranes?
A
Ferning pattern on a slide, visualize leakage from the cervix, pooling in the vagina
24
Q
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?
A
Give IV fluids
25
What are two tocolytic medications you should be aware of?
Magnesium sulfate and calcium channel blockers
26
What medication is used to increase surfactant levels and help with lung maturity if you are worried about preterm labor?
Betamethasone
27
Give the time frame for preterm labor.
20-37 weeks
28
A snowstorm appearance on ultrasound should make you think of what diagnosis?
Hydatidiform mole
29
Grape like vesicles or a sack of grapes on ultrasound should make you think of what diagnosis?
Hydatidiform mole
30
What is the medical treatment for a small ectopic?
Methotrexate
31
List 3 risk factors for an ectopic pregnancy.
Previous ectopic, scarred tubes (hx of PID or salpingitis), IUD
32
What is the most common site of an ectopic pregnancy?
Within a fallopian tube
33
Early on in pregnancy serial beta HCG should double over what time period?
every 48-72 hours
34
How many days after conception is a serum beta HCG positive?
8
35
Define missed abortion.
No vaginal bleeding, cervix is closed, products of conception are still inside
36
Define complete abortion.
Vaginal bleeding, cervix open, products of conception have passed
37
Define Incomplete abortion.
Vaginal bleeding, cervix is open, products of conception partially passed
38
Define Inevitable abortion.
Vaginal bleeding, cervix is open, products of conception are still inside
39
Define threatened abortion.
Vaginal bleeding, closed cervix, products of conception are still inside
40
What is the normal range of fetal heart rate?
120-160
41
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
42
As part of the antepartum testing a baby has a positive stress test. What does that mean?
They have had two heart rate acceleratins in a 20 minute period of 15 beats above baseline for at least 15 seconds. This is good
43
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
44
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?
Placental separation
45
Define the third stage of labor.
Delivery of baby to delivery of placenta
46
Define the second stage of labor.
Fully dialated to delivery
47
Define the first stage of labor.
Onset to full dilation
48
What organism causes us to warn pregnant patients to stay away from deli meats and soft cheeses?
Listeria
49
About how much weight should a woman gain during pregnancy?
20-35 lbs
50
Why is folic acid given as a prenatal vitamin?
Low folic acid can lead to neural tube defects
51
At how many weeks of pregnancy can an amniocentesis be done?
15-20 weeks
52
At how many weeks of pregnancy can chorionic villus sampling bed done?
10-13 weeks
53
At approximately how many weeks pregnant is the uterus at the level of the umbilicus?
20 weeks
54
At approximately how many weeks pregnant is the uterus at the level of the symphysis pubis?
12 weeks
55
A patient believes she is pregnant and you notice her cervix appears a blue tinged. What is the name of the sign?
Chadwick's sign
56
When does quickening occur?
Nulliparous 18-20 weeks, multiparous 14-16 weeks
57
Define full term
Deliveray at 37-42 weeks
58
Define premature birth
Deliveray of uterine contnts between 20-36 weeks
59
Define abortion.
Deliveray of uterine contnts before 20 weeks
60
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. Many other common gyn complaints are unilateral pain
61
What age range is the HPV vaccination recommended for?
9 to 26 years old
62
What medium do you need to grow out Neisseria gonorrhoeae?
Thayer martin
63
What is the #1 cause of septic arthritis in sexully active young adults?
Neisseria gonorrhoeae
64
Purulent cervical discharge should make you think of what diagnosis?
Neisseria gonorrhoeae
65
What lab test is the gold standard for chlamydia?
Nucleic acid amplification test
66
A patient presents with mucopurulent discharge and cervical motion tenderness. What diagnosis should you be thinking of?
Chlamydia - cervicitis
67
What organism is the most common sexually transmitted infection?
Chlamydia
68
What are two important things you need to tell you patients before putting them on metronidazole?
Stay out of the sun and avoid alcohol
69
How do you treat a Trichomonas infection?
Metronidazole
70
Vaginal infection with motile flagellated protozoa should make you think of what diagnosis?
Trichomonas
71
A strawberry cervix with copious yellow/green discharge should make you think of what diagnosis?
Trichomonas
72
How do you treat bacterial vaginosis?
Metronidazole x 7 days
73
Clue cells should make you think of what diagnosis?
Bacterial vaginosis
74
Thin, sticky, malodorous vaginal discharge should make you think of what diagnosis?
Bacterial vaginosis
75
How do you treat vaginal candida?
Fluconazole po 1 dose, azole cream x 1 week
76
What would you expect to see on a KOH prep if the patient had vaginal candidiasis?
Pseudohyphae
77
Cottage cheese discharge should make you think of what diagnosis?
Vaginal candidiasis
78
What is the average age of menopause?
51
79
List four risk factors for breast cancer?
BRCA1 or BRCA2 positive, unopposed estrogen, nulliparity, early menarche, late menopause
80
A unilateral, single, mobile, firm, nontender solid breast mass should make you think of what diagnosis?
Fibroadenoma
81
Are fibrocystic breast masses usually bilateral or unilateral?
Bilateral
82
Should a breast feeding mother stop breast feeding if she develops mastitis?
There is no reason to stop breast feeding at this point.
83
Does mastitis tend to be unilateral or bilateral?
Unilateral and only one quadrant
84
What is the first line treatment for mastitis?
Dicloxacillin is fist line. Cephalexin or erythromycin are second line.
85
What is the most common organism that causes mastitis?
Staph aureus
86
What are three treatments for uterine prolapse?
Pessary, Kegel's maneuvers, surgical repair
87
What is a cystocele?
A herniation of the bladder into the vagina
88
Which four herpes viruses are linked to cervical cancer?
HPV 16, 18, 31 and 33
89
List two risk factors for cervical cancer.
Multiple sexual partners, smoking,
90
Cervical biopsy comes back as CIN2 or CIN3. What is your next step?
Excision - LEEP, Cold knife (worry about incompetent cervix), Cryotherapy
91
Cervical biopsy comes back as CIN1. What is the next step?
Repeat pap smear in 6 months and repeat colposcopy in 12 months
92
If the pap smear results come back anything other than negative or ASCUS what is your next step?
Colposcopy and biopsy
93
A pap smear comes back as atypical squamous uncertain significance (ASCUS). What is your next step?
Repeat pap smear in 4-6 months
94
When is it recommended to begin pap smears?
When a woman becomes sexually active or when she is 21 years old
95
What is the treatment for ovarian cancer
Total hysterectomy and bilateral salpingo-oophorectomy. Chemo + radiation
96
A 66 year old female patient presents with bouts of nausea, weight loss and vague abdominal pain. What diagnosis should you be thinking of?
Ovarian cancer
97
Why is ovarian cancer so hard to diagnosis?
No good makers and very vague abdominal symptoms
98
List 2 risk factors for ovarian cancer.
BRCA1, Family history, Nulliparity, late menopause, caucasian, asian
99
What is the mean age for ovarian cancer?
63, you will need to think of this in an older patient with vague abdominal symptoms
100
An ovarian cyst that contains hair and teeth should make you think of what diagnosis?
Teratoma
101
You have a patient with PCOS who would like to get pregnant. What are two medications you may start her on?
Metformin and Clomid
102
What endocrine issue is associated with PCOS?
Insulin insensitivity
103
A patient presents with irregular menses, hirsutism and infertility. What diagnosis should you be thinking of?
Polycystic ovarian syndrome
104
If you see the term chocolate cyst it should make you think of what diagnosis?
Endometrioma
105
What is the most common type of ovarian cyst?
Functional cyst - no treatment necassary
106
What is the first step of treatment for endometrial cancer?
Total hysterectomy and bilateral salpingo-oophorectomy
107
List 4 risk factors for endometrial cancer.
Chronic unopposed estrogen, nulliparity, early menarche, late menopause, Tamoxifen, DM, obesity, HTN, breast CA, ovarian CA
108
What is the most common endometrial cancer?
75% are adenocarcinomas
109
What ethnic background is at an increased risk of fibroids?
African American are 5x more likely to have fibroids compared to Caucasian women
110
What is the most common uterine tumor?
Leiomyoma, also known as fibroids
111
How do you definitively diagnose endometriosis?
Exploratory laparoscopy
112
A physical exam revealing a retroverted uterus or uterosacral ligament nodularity should make you think of what diagnosis?
Endometriosis
113
Endometriosis is most commonly found in what location??
On an ovary
114
During what portion of the menstrual cycle does PMS occur?
By definition it is in the second half and menstruation should relieve the symptoms
115
Postmenopausal bleeding is immediately believed to be what diagnosis?
Endometrial cancer until proven otherwise
116
Define metrorrhagia.
Bleeding between menstraul cycles
117
Define menorrhagia.
Heavy prolonged menstraul flow
118
What three labs should you order if you are considering secondary amenorrhea?
beta HCG, TSH, Prolactin
119
What is the most common cause of secondary amenorrhea?
Pregnancy
120
How much time needs to pass before diagnosing secondary amenorrhea?
If cycles have been normal 3 months. If cycles have been irregular 6 months.
121
A patient with primary amenorrhea and a low FSH should make you think of what diagnosis?
Hypothalamic pituitary insufficiency
122
What is the treatment for Turner's syndrome?
Cyclical estrogen and progesterone
123
A description of a young girl with a web neck or wide shield chest should make you think of what diagnosis?
Turner's syndrome
124
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.
125
What is the karyotype for patient with Turner's syndrome?
(45, X) They are missing one sex chromosome
126
Since a genetic cause is the number one reason for primary amenorrhea what is one very important test?
Karyotype
127
At what age is primary amenorrhea diagnosed?
14 if no secondary sex characteristics. 16 if some secondary development.
128
The secretory phase day 14-28 is dominated by what hormone?
Progesterone
129
The follicular phase of menstruation is dominated by what hormone?
Estrogen
130
A surge in what hormone leads to ovulation?
LH
