OBGYN Flashcards Preview

CanQB > OBGYN > Flashcards

Flashcards in OBGYN Deck (246):
1

Lady with erosive cervical ulcer? Next step

Punch biopsy

If shows micoroinvasions = cone Bx


If shows invasive carcinoma = Rx

2

Next step if Pap smear shows ASCUS?

HPV DNA

3

T/F: can't see fetal contents till 9wk GA

T

4

< 8 Wk + vaginal bleed + B-hCG 1500 + US not helpful?

Repeat B-HCG in 48hr

5

When to suspect uterine rupture during labor?

Fetal bradycardia

6

Rx hyperthyroidism in preggo?

PTU 1st trimester
MMI 2-3 trimesters

7

High a-FP in preggo? Next step

US

8

T/F: Nulliparity is risk of PROM

F

9

Risks of PROM?

Hx of PROM
Multi parity
STD
Vag bleed
Cervical incompetence
Smoking during preg

10

Rx breast augmentation in nursing mom?

Frequent feeds 8-12x/d

11

T/F: clubfoot ass w/ oligohydramnios

T

12

Emergency contraception in Hx of DVT/PE?

Copper IUD

13

Best Dx endometriosis

Laparoscopy

14

Endometriosis triad

Other Sx?

Infertility
Dysmenorrhea
Dyspareunia

+
Constipation / painful defecation
Dysuria

15

Pelvic Exam of endometriosis

Adnexal mass (chocolate cyst)

Nodular broad ligament / ureteosacral

16

MC site of ectopic preg

Ampulla

17

When should a intrauterine preg appear clearly on US?

B-hCG > 1500

18

Suture for perianal laceration esp postpartum?

Why?

3-0 polyglactin

Decrease wound dehiscence + pain

19

Preggo is +Rh D-Ag
What happen to fetus?

Baby at risk of hemolysis if titter > 1:65

20

AGUS on pap indicate?
Next step?

CIN

All gets a colposcopy
If > 35 Yrs = colposcopy + endometrial sample

21

No preg + high B-hCG?

Uterine choriocarcinoma
Or
Molar preg / Hydatidiform mole

22

Preg + vag bleed + adnexal tenderness

Ectopic

23

Rx of PID

Cefoxitin + doxy

Or

Clinda + genta

24

Onset of postpartum thyroiditis

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