OBGYN Flashcards
1
Q
Lady with erosive cervical ulcer? Next step
A
Punch biopsy
If shows micoroinvasions = cone Bx
If shows invasive carcinoma = Rx
2
Q
Next step if Pap smear shows ASCUS?
A
HPV DNA
3
Q
T/F: can’t see fetal contents till 9wk GA
A
T
4
Q
< 8 Wk + vaginal bleed + B-hCG 1500 + US not helpful?
A
Repeat B-HCG in 48hr
5
Q
When to suspect uterine rupture during labor?
A
Fetal bradycardia
6
Q
Rx hyperthyroidism in preggo?
A
PTU 1st trimester
MMI 2-3 trimesters
7
Q
High a-FP in preggo? Next step
A
US
8
Q
T/F: Nulliparity is risk of PROM
A
F
9
Q
Risks of PROM?
A
Hx of PROM Multi parity STD Vag bleed Cervical incompetence Smoking during preg
10
Q
Rx breast augmentation in nursing mom?
A
Frequent feeds 8-12x/d
11
Q
T/F: clubfoot ass w/ oligohydramnios
A
T
12
Q
Emergency contraception in Hx of DVT/PE?
A
Copper IUD
13
Q
Best Dx endometriosis
A
Laparoscopy
14
Q
Endometriosis triad
Other Sx?
A
Infertility
Dysmenorrhea
Dyspareunia
+
Constipation / painful defecation
Dysuria
15
Q
Pelvic Exam of endometriosis
A
Adnexal mass (chocolate cyst)
Nodular broad ligament / ureteosacral
16
Q
MC site of ectopic preg
A
Ampulla
17
Q
When should a intrauterine preg appear clearly on US?
A
B-hCG > 1500
18
Q
Suture for perianal laceration esp postpartum?
Why?
A
3-0 polyglactin
Decrease wound dehiscence + pain
19
Q
Preggo is +Rh D-Ag
What happen to fetus?
A
Baby at risk of hemolysis if titter > 1:65
20
Q
AGUS on pap indicate?
Next step?
A
CIN
All gets a colposcopy
If > 35 Yrs = colposcopy + endometrial sample
21
Q
No preg + high B-hCG?
A
Uterine choriocarcinoma
Or
Molar preg / Hydatidiform mole
22
Q
Preg + vag bleed + adnexal tenderness
A
Ectopic
23
Q
Rx of PID
A
Cefoxitin + doxy
Or
Clinda + genta
24
Q
Onset of postpartum thyroiditis
A
2-6 mo post delivery
25
T/F: ovaries are palpable in postmenopausal women
F
| If can palpate = US to r/o ovarian mass
26
MCC of vulvar Ca in < 50
HPV
27
Tumors w/ high b-hCG
Molar preg / choriocarcinoma
Seminoma
Germ cell tumor
Teratoma (rare)
Islet cell
28
Risk for candida vaginitis
```
Hot weather
Tight clothes
Poor hygiene
Infrequent diaper / underwear change
Abx
Preg
DM
Steroids
```
29
MC site of endometriosis
Ovaries > post cul-de-sac > ligaments
30
Preggo at 1st trimester + ovarian cyst
Dx?
Corpus luteal cyst
| Produces hormones in 1st trimester the resolves
31
Effect of OCP on Ca?
Protects against ovarian + endometrial
32
Preggo + HSV?
Acyclovir (B)
No C/S unless active lesions during labor
33
While inserting IUD pt BP drops + pale + loses consciousness
Vasovagal attack
Place in recumbent position
34
Preggo exposed to HBV but HBsAg-ve?
Give Ig + vaccine!
IP could be long!
35
T/F: menopause Sx peak around 51 then subside
T
36
Preggo in labor but baby not engaged?
US to determine presentation
If breech = C/S
37
Rx of bacterial vaginosis in preggo?
Oral clinda or metro BID for 7days
38
T/F: Metro is safe throughout preg
F
| Contraindicated in 1 trimester ONLY
39
T/F: topical clinda is safe in preg
F
| Bad in 2-3 trimester => premature birth
40
Preggo w/ chlamydia trachomatis Rx?
Azithromycin
41
Head:Abdo ratio > 1 indicates?
Asymmetrical IUGR
42
Deficient hormones in Sheehan's syndrome?
FSH, LH, ACTH, TSH, GH, prolactin
43
Preggo + anti phospholipid syndrome Rx?
ASA + Heparin
44
Teratogenic effect of isotretinoin
Microcephaly MC
CVS = tetralogy of fallot, ASD, VAD, aortic
No ear / small ear
Parathyroid gland
45
T/F: nulliparity increases risk of cervical ca
F
46
Risks of cervical Ca
HPV 16+18
Early sex
Smoking
Multiple partners
+/- OCP long term
47
PID + fever 39 Rx?
Hospitalize
| IV cefoxitin + doxy for 2wk
48
Swelling in labia minora?
Bartholian cyst
49
What's a bartholian cyst?
Sx?
Dx?
Rx?
Mucus filled cyst at sides of vagina (minora or migora)
ASx
If big = irritates + hurts
If infected = painful + red
Dx: clinical
Rx: none if asymptomatic
50
Bartholian Abscess Rx?
Incision and insertion of word cath to prevent recurrence
51
Preggo in labor + 28wk GBS screen -ve + ProROM
Rx?
None
52
Dx cervical incompetence
TVUS
53
Normal UA findings in preggo? Why?
Glucosuria
Inc GFR 50%
54
T/F: if vaginal ring expelled from vagina > 3hr, a backup must be used
T
Backup for 7 days
55
T/F: vaginal ring can be used for maximum of 3 mo
F
3wks then 1wk off to allow for withdraw bleeding
56
OCP risk of PE/DVT population
Hx of DVT/PE
Smoker > 35
57
BMS + mood swings impairing function
Dx
Rx
Premenstrual dysphoric disorder
Rx SSRI (Fluox or setraline)
58
Baby in labor + early decelerations
Next step
Observe
| Re-evaluate q2hr
59
Cause of early deceleration in NST of baby in labor
Head compression
60
Fetal vessel with highest O2 sat
Umbilical vein
61
Imaging w/ highest radiation to preggo
Fluoroscopic enema > IV pyelogram > spinal films > V/Q scans > CXR
62
< 8 girl + grape like vaginal lesion
Sarcoma Botryoides
63
2ry amenorrhea + no preg
MC abnormal hormone
FSH => anorexia,PCOS, hypothyroid, Cushing's, pituitary
64
What herbs proven to help dysmenorrhea / PMS
Fish oil
Vit E
Thiamine
Low fat vegetarian diet
65
T/F: untreated Chlamydia causes PID + infertility
T
66
If pt has chlamydia how long should they wait till have sex?
7 days
67
If Pt Dx with chlamydia what sexual partners should she inform
All partners 2 mo before Dx
68
What's urethral Syndrome
Dysuria + pyuria
-ve Cx
No response to Bactrium or nitrofurantoin
69
UTI Sx
Not responsive to Rx
-ve urine Cx
Dx?
Cause?
Rx?
Urethral Syndrome
Chlamydia or ureaplasma
Rx = Doxy or fluoro
70
T/F: having pre-eclampsia increases risk of HTN
True
HTN + Stroke 4x
IHD 2x
71
< 5cm asymptomatic ovarian cyst in premenopausal?
Next step
Rep US in 8-12 wk
72
Ovarian cyst in postmenopausal?
CA-125
73
Periods in leiomyomas?
Hypermenorrhea or menorrhagia
74
Preggo w/ PID?
Hospitalize for IV cefoxitin + oral azithromycin
75
Mg sulfate toxicity in pre-eclampsia?
D/C the Ca gluc
76
Mg sulfate toxicity
Dose?
Sx?
> 4mg /dl
Sx:
No DTR
Low RR
Hemorrhage
77
Rx of exercise oligomenorrhea in well-nourished F?
Inc calorie intake to match energy expenditure
78
Complication of repetitive PID (>3)?
Ectopic preg
79
Mom receives meperidine during labor
Born baby has resp depression?
Next step
Dry skin
Clear airway
Naloxone IM
Oxygen
80
Effect of ketamine on baby?
Resp depression
81
Best measure of fetal age
Crown-rump > 13 wk
82
T/F: Multiparty protects against preeclampsia
T
83
T/F: DM increases risk of preeclampsia
T
84
ASCUS on Pap smear?
Rep smear at 6-12
Or
HPV DNA
85
MC indication for amniocentesis
Old mom
86
ProPROM complication
Abruptio placenta
87
MCC of UTI in preggo
E. coli
88
When to use 5 sticks LH test?
Periods length - 17 is starting day!
If 28 - 17 start on day 11
89
When does post part I'm visit occur
6 wk post delivery
90
When to give preggo Rhogam
28 wk + 72hrs of delivery
91
When to do triple screen for preggo
15-18 (2 trimester)
92
When to do OGTT for preggo
24-28 wks
93
< 35 F + heavy irregular periods + otherwise normal
Rx?
Abnormal uterine bleed
Combined oral contraceptive
94
```
Diff abortions
Missed
Threatened
Inevitable
Incomplete
Complete
```
```
- Missed:
Closed OS
No bleeding
No fetal heart
Empty pole if > 8wk on US
```
- Threatened:
Closed OS
Bleeding
+ fetal heart
- Inevitable:
Open OS
Bleeding
- Incomplete:
Open OS
POC in uterus + vagina
- Complete:
Close OS
Empty uterus + vagina
95
Trisomy 21 + 18 triple test
```
21:
Low AFP
Low estriol
High hCG
High inhibin
```
18:
All low
96
High LH + FSH in amenorrhea
Ovarian problem
97
Preggo not immunized against HBV?
Vaccine + IG now
98
Preggo w/ rubella ab titer < 10 IU/mL
Can't vaccine!
Stay away from sick
Vaccine after delivery
99
Stress test results:
1. Variable decelerations
2. Early decelerations
3. Late decelerations
1. Cord compression
2. Head compression
3 placental insufficiency
100
Patient on St. John's + 5-HTP + meperidine at risk of?
Serotonin syndrome
101
Physiological galactorrhea after breast-feeding lasts up to?
2 YRs
102
T/F: steroids in Preterm labor decrease risk of Necrotizing enterocolitis
T
103
PE in preggo Rx
IV heparin for 5-10 days
| SunQ heparin for rest of preg
104
Pap smear abnormal => colposcopy unsatisfactory => ?
Conization
105
Metronidazole + Alcohol
Cause disulfiram like reaction
106
T/F: partner of bacterial vaginosis pt must be Rx
F
107
MC complication of epidural anesthesia in preggo
Mom hypotension
108
Recommended Ca for preggo + nursing
1000-1300 mg/d
109
T/F: A preggo shouldn't travel in 1 trimester
F
Last 4 wks of preg
110
Monitor Mg sulfate toxicity
Creatinine
| DTR + RR
111
How soon can urine b-hCG detect preg
10-25 IU/L
| 7 day of conception
112
Trichomoniasis vaginitis Rx
Metronidazole
113
Rx of menstrual migraine
NSAIDs
114
Most dangerous period during preg for teratogenicity
3-8wk organogenesis
115
How to tell baby presentation leopold's?
1. Vertex
2. Transverse
3. Compound
4. Breech
1. Vertex
Cephalic pole at symphysis
2. Transverse:
No pole at symphysis
3. Breech:
No pole at symphysis
Back along side
Hard at RUQ
116
Oligohydramnios associations
```
Renal agenesis (fetal)
Placental insufficiency
```
117
T/F: IUD for ER contraception in nulliparous
F
Not proffered!
Only used in women who wants to keep the device.
Morning after pill better
118
T/F: all preggos get flu vaccine
T
| Regardless of trimester
119
What decreases iron absorption?
Antacids
Soy protein
Tannin (tea)
120
What improves iron absorption.
Vit C
| Ascorbic acid
121
35 Y + Smoker + needs contraception
- heavy periods = etonogestrol implants
| - normal periods = IUD
122
Sx of fetal alcohol
```
Mental retardation
Flat philtrum
Thin upper lip
IUGR
CNS Sx (microcephaly, agenesis of brain parts)
Hearing loss
```
123
MC measure of age in 2 trimester?
Biparietal diameter
124
Rx of cervical gonorrhea
IM ceftriaxone Once
125
T/F: hormonal replacement Rx prevents against breast Ca
F
126
T/F: hormonal replacement prevents CRC
T
127
Gold standard of ovarian torsion
Doppler
128
Risks for uterine prolapse
Multiparity
Smoking
Large baby
Postmenopausal
129
Rx of endometritis
Genta + clinda
130
copper IUD MOA?
Spermicidal
131
T/F: forceps delivery causes facial nerve
T
132
T/F: forceps > vacuums
True success rate of forceps is higher
133
Benefit of vacuum vs forceps
Vacuums cause less peroneal tears
134
HTN drug cause IUGR in preg
Atenolol + propranolol
135
Absolute contraindication to vaginal delivery after C/S
Vertical incision.
136
Complete hydatidifom chromosomes
Paternal diploid
137
Incomplete hydaitiform mole chromosome
Triploid
2 sets paternal
1 maternal
69 xxx
138
What infection screened in preggo at 35-37 wks
GBS
139
MC indication for amniocentesis
Old mama (>35Yrs)
140
Why give a preggo Rhogam?
Prevent hemolytic disease of newborn in 2nd baby
141
Screen + confirm thalassemia
Screen => CBC + smear
Confirm => Hg electrophoresis
142
Friable well defined cervical lesion in a young asymptomatic pt?
Pap smear + colposcopy
143
Post mastectomy for breast Ca surveillance
Hx + PE q3-6 mo for 3 yrs
The q6-12 mo for 2 yrs
Then annual.
144
Medroxyprpgestrone inj vs OCP for migraine
Inj improve migraine
145
MC SE of mydroxyprogestrone inj?
Amenorrhea or irregular periods
146
T/F: IM flu vaccine for preggo protects baby for 6 mo
T
147
T/F: nasal flu vaccine is indicated in preg
No
| It's live vaccine
148
Fetal fibronectin levels indicate?
Assess risk of preterm labor
Higher lever higher risk
Inc 7-10 days before labor
149
MOA of plan B ER contraception (Levonorgestrel)
Inhibits ovulation
150
Types of twin preg:
Division before D4 of fertilization?
During 4-8?
Drying 8-12?
After 12?
Before 4: diamniotic dichorionic.
4-8: diamniotic monochromatic
8-12: monoamniotic, monochromatic
>12: conjoined
151
Cocaine use in preg results in?
Placental insufficiency
Premature labor
Premature delivery
IUGR
152
Repetitive decelerations in otherwise healthy mom + OK delivery
1st left lateral position, O2, D/C oxytocin
Didn't help => C/S
153
1st line in N/V of preg
```
Diet +/- acupressure
Eat slowly
Small amounts q1-2hr
eat before or as soon as feel Hungary (avoid empty stomach)
Snack before getting out of bed
```
154
Cervical procedure contraindicated in preg
Endocervical curettage
155
Painless bright red bleeding in preg > 24wk
Placenta previa
156
T/F: estrogen in postmenopausal protects form vertebral fracture
T
157
MC mom cause of IUGR
HTN
158
APGAR score
A Activity = flex (1) or active (2)
P pulse = <100 (1) or >100 (2)
G Grimace = grimace (1) or cough/sneeze (2)
A appearance = blue (0) acral (1) pink (2)
R respiration = irregular / weak cry (1) or strong (2)
159
T/F: carcinoma in situ of cervix indicates C/S
F
160
Indications for C/S in preg?
Placenta previa
Fetal distress
Genital herpes
Prior urethropexy
161
Preg w/ G-DM on diet control FPG 110 / 6.1
Next step
Start insulin short + basal
162
MC location of endometriosis
Ovaries
163
What to do in stable preg at 37wk w/ mild pre-eclampsia?
Vagina exam + Bishop score
If > 9 = vaginal delivery
< 9 = ripening agents then labor
164
Dx PE in preg
V/Q scan
165
Euthyroid in preg (labs)
T4
Free T4
T3RU resin uptake
High T4
Normal Free T4
T3 uptake low
166
Rx hot flashes in menopause
SSRI
167
When is chorionic villus smapling done?
Wk 10-13
168
If newborn test HIV +ve on ELISA? Next step
HIV1/2 assay (western blot)
Or PCR
169
What age fetus quickens
Multi 18 wk
| Primi 20-21 wk
170
Placenta previa by US at 20 wk?
| Next step
Rep US at 3rd trimester
171
T/F: c. Trachomatis infection ass w/ dysuria + frequency
F
172
Uterine whorl-shaped lesions on US?
Leiomyomas
173
T/F: uterine leiomyomas suppressed by estrogen
F
| Estrogen stimulates their growth
174
Rx of gestational intrahepatic cholestasis
Ursodeoxycholic acid
175
What's black cohosh? Used for?
Actea racemosa
Used Rx menopause Sx
176
T/F: no need for PAP smear after total abdominal hysterectomy
T
177
When to stop Pap smears
At 70
| If last 3 test were normal
178
If preggo got into accident what position should be kept at till spinal injury r/o
Supine w/ uterus manually deflected laterally
179
How to examine lower abdominal / pelvic mass in a young virginal girl?
Rectal exam
180
Post D/C + amenorrhea put pain at time of periods + no flow w/ progesterone challenge
Asherman syndrome
181
What's asherman syndrome?
Sx?
Rx?
Scar tissue and adhesions in uterus after procedure esp. D/C.
No or minimal flow on periods
PMS Sx present
Miscarriage or infertility
Surgically cut adhesions
182
MCC of DIC in preg
Abruptio placenta
183
Most accurate way to Dx retained placenta
Inspect fetal placenta
| See large vessels beyond edge
184
T/F: sulfonamide contraindicated in 3rd trimester
T
Safe early
Bad late
185
Sx of bacterial vaginosis
Amsel criteria
PH > 4.5
Clue cells
Wiff test (fishy odor)
Homogenous discharge
186
T/F: 90% of immediate post parting hemorrhage is uterine atony
T
187
Rotterdam criteria for PCOS
1. Oligo/amenorrhea
2. Clinical / lab androgenism = hirsutism, acne
3. US = cystic ovaries
188
Major oncotic protein in fetus?
Where's it made?
When is peak value reached?
AFP
By fetal liver
Highest fetal serum concentrations at 12-14 wks.
Highest maternal serum levels at 13-24 wks.
189
Rx cervical chlamydia with single does?
Rx vaginal chlamydia with single does?
Urethral / cervical: azithro 1 g PO
Vaginal:
Metro
190
MC Sx of vulvar ca
Pruritus
191
T/F: gonorrhea can be treated with metro vaginal cream
F
192
T/F: public health should be notified for every vaginal gonorrhea
T
193
What maternal protein usually elevated in normal preg
Cholesterol
194
What protein decrease in normal preg?
Albumin = dilution
HCO3 = high renal execration
Fasting glucose (10-20%) = inc storage tissue
Creatinine = (50% drop)
195
During preg lactation is suppressed by?
Estrogen
196
Is palmar erythema sign of preg?
Yes
197
T/F: WBC count is decreased in preg
F
198
Sever headache + epigastric pain + HTN preggo?
- Sever preeclampsia
Needs Mg sulfate + delivery
199
Rx urethral chlamydia
Doxycycline
200
Rx cause erythema nodosum
OCP
201
Rx of hot flushes if can't take estrogen?
Clonidine
| SSRI
202
Leiomyoma in preg Rx
Observe + vaginal delivery
203
Rx of fibroids
OCP
GnRH
Best: myomectomy, hysterectomy, endometrial ablation
204
Fibroids in preg
Bigger
205
Fibroids in menopause
Smaller
206
When to do intracytoplasmic sperm inj?
Low sperm motility
Low sperm count
207
Benefits of amniocentesis
Chromosomal anomalies
NTD
Metabolic error
208
Investigations before starting >40 on OCP
Pap smear
BMI
FPG
209
Drugs cause galactorrhea
Resperidone
Cimetidine
Verapamil
Morphine
210
T/F: nasal body temperature used for Dx infertility
T
211
T/F: hystroscopy is initial test to Dx infertility
F
212
Rx post partum thyroiditis
BB
213
T/F: hypothyroidism causes galactorrhea
T
214
1st step in abnormal uterine bleed (<40 Yrs)
TVUS
215
Rx of asymptomatic uterine fibroids?
Expectant / observation
216
MC presentation of twin preg
Vertex/vertex
217
Migraine Rx contraindicated in preg
Ergotamine
218
Why is ergotamine contraindicated in preg
Vasoconstriction = low placental flow = IUGR
219
Lacy white rash on genital mucosa
Lichen planus
220
Preg + HTN + no proteinuria
G HTN
221
T/F: placental abruption is Sx of placenta previa
T
222
T/F: placenta previa ass w/ fetal malformation
T
223
Indication of tocolytic use
- preterm
| - immature fetus + intact membrane + cervix <4
224
Contraindication to tocolysis
Twins gestation one IUFD
Chorioamnionitis
34 wks
Maternal HTN, heat disease
Congenital anomaly
Bleeding
225
T/F: IUD contraindicated in smoking
F
226
T/F: Copper IUD contraindicated in Wilson's disease
T
227
Internal iliac branches
Anterior + posterior divisions
Posterior = superior gluteal, iliolumbar, lateral sacral.
Anterior = interior pudendal (middle + inferior rectal), uterine, superior + inferior vesical, vaginal.
228
Preg exposed to rubella.
Next sept?
Test rubella IgG ab
+ => immune
- => rep in 2-3 wk if + pt is exposed
229
T/F: rubella Ig isn't recommended to preg exposed to rubella
T
230
Absolute contraindication to hormonal replacement Rx
Acute/sever liver disease
Undiagnosed vaginal bleed
Venous thrombosis
Breast/uterine Ca
231
Acid base disturbance in hyperemesis gravidarum
Metabolic acidosis + alkalosis
232
MCC of jaundice in preg
Acute viral hep
233
Dx Criteria for molar preg
US = snowstorm
234
How to calculate length of menstrual cycle
Days from beginning of one period to the next
235
Other name for vaginal candidiasis
Moniliasis
236
Rx pyelonephritis in preg
IV ceftriaxone
237
STI + mucous discharge
Chlamydia
Rx doxy or azithromycin
238
Fleshy exophytic lesion on urethral meat is ?
| Age?
Caruncle
Postmenopausal F
Dx clinical if hematuria = cystoscope
239
2 stage labor + baby face presentation
SVD
No C/S or assisted delivery
240
MC site of endometriosis outside pelvis
Liver
241
Dx placenta previa
TVUS
242
Cause of vaginismus
Involuntary contractions
243
Retinal change in preeclampsia
Spasm of arterioles
244
Rx of Sever HTN in preg
Labetalol IV
Nifodipine oral
Hydralazine IV
245
14 + no period + no 2ry sexual + low FSH / LH
Wait
| Mostly constitutional delay
246
Rx of symptomatic uterine prolapse
Vagina hysterectomy
