Flashcards in OBGYN Deck (246):
Lady with erosive cervical ulcer? Next step
If shows micoroinvasions = cone Bx
If shows invasive carcinoma = Rx
Next step if Pap smear shows ASCUS?
T/F: can't see fetal contents till 9wk GA
< 8 Wk + vaginal bleed + B-hCG 1500 + US not helpful?
Repeat B-HCG in 48hr
When to suspect uterine rupture during labor?
Rx hyperthyroidism in preggo?
PTU 1st trimester
MMI 2-3 trimesters
High a-FP in preggo? Next step
T/F: Nulliparity is risk of PROM
Risks of PROM?
Hx of PROM
Smoking during preg
Rx breast augmentation in nursing mom?
Frequent feeds 8-12x/d
T/F: clubfoot ass w/ oligohydramnios
Emergency contraception in Hx of DVT/PE?
Best Dx endometriosis
Constipation / painful defecation
Pelvic Exam of endometriosis
Adnexal mass (chocolate cyst)
Nodular broad ligament / ureteosacral
MC site of ectopic preg
When should a intrauterine preg appear clearly on US?
B-hCG > 1500
Suture for perianal laceration esp postpartum?
Decrease wound dehiscence + pain
Preggo is +Rh D-Ag
What happen to fetus?
Baby at risk of hemolysis if titter > 1:65
AGUS on pap indicate?
All gets a colposcopy
If > 35 Yrs = colposcopy + endometrial sample
No preg + high B-hCG?
Molar preg / Hydatidiform mole
Preg + vag bleed + adnexal tenderness
Rx of PID
Cefoxitin + doxy
Clinda + genta
Onset of postpartum thyroiditis
2-6 mo post delivery
T/F: ovaries are palpable in postmenopausal women
If can palpate = US to r/o ovarian mass
MCC of vulvar Ca in < 50
Tumors w/ high b-hCG
Molar preg / choriocarcinoma
Germ cell tumor
Risk for candida vaginitis
Infrequent diaper / underwear change
MC site of endometriosis
Ovaries > post cul-de-sac > ligaments
Preggo at 1st trimester + ovarian cyst
Corpus luteal cyst
Produces hormones in 1st trimester the resolves
Effect of OCP on Ca?
Protects against ovarian + endometrial
Preggo + HSV?
No C/S unless active lesions during labor
While inserting IUD pt BP drops + pale + loses consciousness
Place in recumbent position
Preggo exposed to HBV but HBsAg-ve?
Give Ig + vaccine!
IP could be long!
T/F: menopause Sx peak around 51 then subside
Preggo in labor but baby not engaged?
US to determine presentation
If breech = C/S
Rx of bacterial vaginosis in preggo?
Oral clinda or metro BID for 7days
T/F: Metro is safe throughout preg
Contraindicated in 1 trimester ONLY
T/F: topical clinda is safe in preg
Bad in 2-3 trimester => premature birth
Preggo w/ chlamydia trachomatis Rx?
Head:Abdo ratio > 1 indicates?
Deficient hormones in Sheehan's syndrome?
FSH, LH, ACTH, TSH, GH, prolactin
Preggo + anti phospholipid syndrome Rx?
ASA + Heparin
Teratogenic effect of isotretinoin
CVS = tetralogy of fallot, ASD, VAD, aortic
No ear / small ear
T/F: nulliparity increases risk of cervical ca
Risks of cervical Ca
+/- OCP long term
PID + fever 39 Rx?
IV cefoxitin + doxy for 2wk
Swelling in labia minora?
What's a bartholian cyst?
Mucus filled cyst at sides of vagina (minora or migora)
If big = irritates + hurts
If infected = painful + red
Rx: none if asymptomatic
Bartholian Abscess Rx?
Incision and insertion of word cath to prevent recurrence
Preggo in labor + 28wk GBS screen -ve + ProROM
Dx cervical incompetence
Normal UA findings in preggo? Why?
Inc GFR 50%
T/F: if vaginal ring expelled from vagina > 3hr, a backup must be used
Backup for 7 days
T/F: vaginal ring can be used for maximum of 3 mo
3wks then 1wk off to allow for withdraw bleeding
OCP risk of PE/DVT population
Hx of DVT/PE
Smoker > 35
BMS + mood swings impairing function
Premenstrual dysphoric disorder
Rx SSRI (Fluox or setraline)
Baby in labor + early decelerations
Cause of early deceleration in NST of baby in labor
Fetal vessel with highest O2 sat
Imaging w/ highest radiation to preggo
Fluoroscopic enema > IV pyelogram > spinal films > V/Q scans > CXR
< 8 girl + grape like vaginal lesion
2ry amenorrhea + no preg
MC abnormal hormone
FSH => anorexia,PCOS, hypothyroid, Cushing's, pituitary
What herbs proven to help dysmenorrhea / PMS
Low fat vegetarian diet
T/F: untreated Chlamydia causes PID + infertility
If pt has chlamydia how long should they wait till have sex?
If Pt Dx with chlamydia what sexual partners should she inform
All partners 2 mo before Dx
What's urethral Syndrome
Dysuria + pyuria
No response to Bactrium or nitrofurantoin
Not responsive to Rx
-ve urine Cx
Chlamydia or ureaplasma
Rx = Doxy or fluoro
T/F: having pre-eclampsia increases risk of HTN
HTN + Stroke 4x
< 5cm asymptomatic ovarian cyst in premenopausal?
Rep US in 8-12 wk
Ovarian cyst in postmenopausal?
Periods in leiomyomas?
Hypermenorrhea or menorrhagia
Preggo w/ PID?
Hospitalize for IV cefoxitin + oral azithromycin
Mg sulfate toxicity in pre-eclampsia?
D/C the Ca gluc
Mg sulfate toxicity
> 4mg /dl
Rx of exercise oligomenorrhea in well-nourished F?
Inc calorie intake to match energy expenditure
Complication of repetitive PID (>3)?
Mom receives meperidine during labor
Born baby has resp depression?
Effect of ketamine on baby?
Best measure of fetal age
Crown-rump > 13 wk
T/F: Multiparty protects against preeclampsia
T/F: DM increases risk of preeclampsia
ASCUS on Pap smear?
Rep smear at 6-12
MC indication for amniocentesis
MCC of UTI in preggo
When to use 5 sticks LH test?
Periods length - 17 is starting day!
If 28 - 17 start on day 11
When does post part I'm visit occur
6 wk post delivery
When to give preggo Rhogam
28 wk + 72hrs of delivery
When to do triple screen for preggo
15-18 (2 trimester)
When to do OGTT for preggo
< 35 F + heavy irregular periods + otherwise normal
Abnormal uterine bleed
Combined oral contraceptive
No fetal heart
Empty pole if > 8wk on US
+ fetal heart
POC in uterus + vagina
Empty uterus + vagina
Trisomy 21 + 18 triple test
High LH + FSH in amenorrhea
Preggo not immunized against HBV?
Vaccine + IG now
Preggo w/ rubella ab titer < 10 IU/mL
Stay away from sick
Vaccine after delivery
Stress test results:
1. Variable decelerations
2. Early decelerations
3. Late decelerations
1. Cord compression
2. Head compression
3 placental insufficiency
Patient on St. John's + 5-HTP + meperidine at risk of?
Physiological galactorrhea after breast-feeding lasts up to?
T/F: steroids in Preterm labor decrease risk of Necrotizing enterocolitis
PE in preggo Rx
IV heparin for 5-10 days
SunQ heparin for rest of preg
Pap smear abnormal => colposcopy unsatisfactory => ?
Metronidazole + Alcohol
Cause disulfiram like reaction
T/F: partner of bacterial vaginosis pt must be Rx
MC complication of epidural anesthesia in preggo
Recommended Ca for preggo + nursing
T/F: A preggo shouldn't travel in 1 trimester
Last 4 wks of preg
Monitor Mg sulfate toxicity
DTR + RR
How soon can urine b-hCG detect preg
7 day of conception
Trichomoniasis vaginitis Rx
Rx of menstrual migraine
Most dangerous period during preg for teratogenicity
How to tell baby presentation leopold's?
Cephalic pole at symphysis
No pole at symphysis
No pole at symphysis
Back along side
Hard at RUQ
Renal agenesis (fetal)
T/F: IUD for ER contraception in nulliparous
Only used in women who wants to keep the device.
Morning after pill better
T/F: all preggos get flu vaccine
Regardless of trimester
What decreases iron absorption?
What improves iron absorption.
35 Y + Smoker + needs contraception
- heavy periods = etonogestrol implants
- normal periods = IUD
Sx of fetal alcohol
Thin upper lip
CNS Sx (microcephaly, agenesis of brain parts)
MC measure of age in 2 trimester?
Rx of cervical gonorrhea
IM ceftriaxone Once
T/F: hormonal replacement Rx prevents against breast Ca
T/F: hormonal replacement prevents CRC
Gold standard of ovarian torsion
Risks for uterine prolapse
Rx of endometritis
Genta + clinda
copper IUD MOA?
T/F: forceps delivery causes facial nerve
T/F: forceps > vacuums
True success rate of forceps is higher
Benefit of vacuum vs forceps
Vacuums cause less peroneal tears
HTN drug cause IUGR in preg
Atenolol + propranolol
Absolute contraindication to vaginal delivery after C/S
Complete hydatidifom chromosomes
Incomplete hydaitiform mole chromosome
2 sets paternal
What infection screened in preggo at 35-37 wks
MC indication for amniocentesis
Old mama (>35Yrs)
Why give a preggo Rhogam?
Prevent hemolytic disease of newborn in 2nd baby
Screen + confirm thalassemia
Screen => CBC + smear
Confirm => Hg electrophoresis
Friable well defined cervical lesion in a young asymptomatic pt?
Pap smear + colposcopy
Post mastectomy for breast Ca surveillance
Hx + PE q3-6 mo for 3 yrs
The q6-12 mo for 2 yrs
Medroxyprpgestrone inj vs OCP for migraine
Inj improve migraine
MC SE of mydroxyprogestrone inj?
Amenorrhea or irregular periods
T/F: IM flu vaccine for preggo protects baby for 6 mo
T/F: nasal flu vaccine is indicated in preg
It's live vaccine
Fetal fibronectin levels indicate?
Assess risk of preterm labor
Higher lever higher risk
Inc 7-10 days before labor
MOA of plan B ER contraception (Levonorgestrel)
Types of twin preg:
Division before D4 of fertilization?
Before 4: diamniotic dichorionic.
4-8: diamniotic monochromatic
8-12: monoamniotic, monochromatic
Cocaine use in preg results in?
Repetitive decelerations in otherwise healthy mom + OK delivery
1st left lateral position, O2, D/C oxytocin
Didn't help => C/S
1st line in N/V of preg
Diet +/- acupressure
Small amounts q1-2hr
eat before or as soon as feel Hungary (avoid empty stomach)
Snack before getting out of bed
Cervical procedure contraindicated in preg
Painless bright red bleeding in preg > 24wk
T/F: estrogen in postmenopausal protects form vertebral fracture
MC mom cause of IUGR
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)
T/F: carcinoma in situ of cervix indicates C/S
Indications for C/S in preg?
Preg w/ G-DM on diet control FPG 110 / 6.1
Start insulin short + basal
MC location of endometriosis
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
Dx PE in preg
Euthyroid in preg (labs)
T3RU resin uptake
Normal Free T4
T3 uptake low
Rx hot flashes in menopause
When is chorionic villus smapling done?
If newborn test HIV +ve on ELISA? Next step
HIV1/2 assay (western blot)
What age fetus quickens
Multi 18 wk
Primi 20-21 wk
Placenta previa by US at 20 wk?
Rep US at 3rd trimester
T/F: c. Trachomatis infection ass w/ dysuria + frequency
Uterine whorl-shaped lesions on US?
T/F: uterine leiomyomas suppressed by estrogen
Estrogen stimulates their growth
Rx of gestational intrahepatic cholestasis
What's black cohosh? Used for?
Used Rx menopause Sx
T/F: no need for PAP smear after total abdominal hysterectomy
When to stop Pap smears
If last 3 test were normal
If preggo got into accident what position should be kept at till spinal injury r/o
Supine w/ uterus manually deflected laterally
How to examine lower abdominal / pelvic mass in a young virginal girl?
Post D/C + amenorrhea put pain at time of periods + no flow w/ progesterone challenge
What's asherman syndrome?
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
MCC of DIC in preg
Most accurate way to Dx retained placenta
Inspect fetal placenta
See large vessels beyond edge
T/F: sulfonamide contraindicated in 3rd trimester
Sx of bacterial vaginosis
PH > 4.5
Wiff test (fishy odor)
T/F: 90% of immediate post parting hemorrhage is uterine atony
Rotterdam criteria for PCOS
2. Clinical / lab androgenism = hirsutism, acne
3. US = cystic ovaries
Major oncotic protein in fetus?
Where's it made?
When is peak value reached?
By fetal liver
Highest fetal serum concentrations at 12-14 wks.
Highest maternal serum levels at 13-24 wks.
Rx cervical chlamydia with single does?
Rx vaginal chlamydia with single does?
Urethral / cervical: azithro 1 g PO
MC Sx of vulvar ca
T/F: gonorrhea can be treated with metro vaginal cream
T/F: public health should be notified for every vaginal gonorrhea
What maternal protein usually elevated in normal preg
What protein decrease in normal preg?
Albumin = dilution
HCO3 = high renal execration
Fasting glucose (10-20%) = inc storage tissue
Creatinine = (50% drop)
During preg lactation is suppressed by?
Is palmar erythema sign of preg?
T/F: WBC count is decreased in preg
Sever headache + epigastric pain + HTN preggo?
- Sever preeclampsia
Needs Mg sulfate + delivery
Rx urethral chlamydia
Rx cause erythema nodosum
Rx of hot flushes if can't take estrogen?
Leiomyoma in preg Rx
Observe + vaginal delivery
Rx of fibroids
Best: myomectomy, hysterectomy, endometrial ablation
Fibroids in preg
Fibroids in menopause
When to do intracytoplasmic sperm inj?
Low sperm motility
Low sperm count
Benefits of amniocentesis
Investigations before starting >40 on OCP
Drugs cause galactorrhea
T/F: nasal body temperature used for Dx infertility
T/F: hystroscopy is initial test to Dx infertility
Rx post partum thyroiditis
T/F: hypothyroidism causes galactorrhea
1st step in abnormal uterine bleed (<40 Yrs)
Rx of asymptomatic uterine fibroids?
Expectant / observation
MC presentation of twin preg
Migraine Rx contraindicated in preg
Why is ergotamine contraindicated in preg
Vasoconstriction = low placental flow = IUGR
Lacy white rash on genital mucosa
Preg + HTN + no proteinuria
T/F: placental abruption is Sx of placenta previa
T/F: placenta previa ass w/ fetal malformation
Indication of tocolytic use
- immature fetus + intact membrane + cervix <4
Contraindication to tocolysis
Twins gestation one IUFD
Maternal HTN, heat disease
T/F: IUD contraindicated in smoking
T/F: Copper IUD contraindicated in Wilson's disease
Internal iliac branches
Anterior + posterior divisions
Posterior = superior gluteal, iliolumbar, lateral sacral.
Anterior = interior pudendal (middle + inferior rectal), uterine, superior + inferior vesical, vaginal.
Preg exposed to rubella.
Test rubella IgG ab
+ => immune
- => rep in 2-3 wk if + pt is exposed
T/F: rubella Ig isn't recommended to preg exposed to rubella
Absolute contraindication to hormonal replacement Rx
Acute/sever liver disease
Undiagnosed vaginal bleed
Acid base disturbance in hyperemesis gravidarum
Metabolic acidosis + alkalosis
MCC of jaundice in preg
Acute viral hep
Dx Criteria for molar preg
US = snowstorm
How to calculate length of menstrual cycle
Days from beginning of one period to the next
Other name for vaginal candidiasis
Rx pyelonephritis in preg
STI + mucous discharge
Rx doxy or azithromycin
Fleshy exophytic lesion on urethral meat is ?
Dx clinical if hematuria = cystoscope
2 stage labor + baby face presentation
No C/S or assisted delivery
MC site of endometriosis outside pelvis
Dx placenta previa
Cause of vaginismus
Retinal change in preeclampsia
Spasm of arterioles
Rx of Sever HTN in preg
14 + no period + no 2ry sexual + low FSH / LH
Mostly constitutional delay