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OBGYN Flashcards

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1
Q

1st trimester testing options

A

To determine chromosomal abnormalities with advanced maternal age: chorionic villus sampling (10-13weeks) or amniocentesis (11-14weeks). AFP, estriol, HCG, and inhibin A serve similar purpose to screen for certain aneuploidy

To determine Rh isoimmunization: percutaneous umbilical blood sample

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2
Q

Tocolytic agents

A

used to slow cervical dilation in premature labor and allow betamethasone to take effect for fetal lung development

Magnesium sulfate
CCBs
terbutaline

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3
Q

Magnesium toxicity: clinical presentation and TX

A

respiratory depression and cardiac arrest

NOTE: check DTRs often
Tx with Ca

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4
Q

Magnesium sulfate: side effects

A

flushing
HA
diplopia
fatigue

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5
Q

CCBs: side effects

A

HA, flushing, dizziness

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6
Q

Terbutaline: side effects

A

palpitations

hypotension

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7
Q

PPROM: TX

A

with chorioamnionitis: delivery (can be vaginal)

without chorioamnionitis: betamethasona, tocolytics, ampicillin, and azithro + do fewer exams

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8
Q

Painless vaginal bleeding in 3rd trimester

A

placental previa

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9
Q

placenta previa: risk factors

A

previous C-section
previous uterine surgery
multiple gestations
previous placenta previa

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10
Q

5 types of placenta previa

A 
complete
partial
marginal
vasa previa (fetal vessel present over cervix)
low-lying placenta
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11
Q

placenta previa =

A

abnl implantation of the placenta over the internal cervical os

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12
Q

Placental abruption =

A

premature separation of the placenta from the uterus, resulting in hemorrhaging into the sparated space

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13
Q

Placental abruption vs previa vs uterine rupture

A

both 3rd trimester vaginal bleeding

abruption: severe abdominal pain and contractions

placenta previa: painless

uterine rupture: sudden onset severe abdominal pain, abnl bump in abdomen, no contxs, regression of fetus

NOTE: placental abruption and previa are distinguished via transabdominal US

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14
Q

Placental abruption: risk factors

A 
maternal HTN
prior placental abruption
cocain use
external trauma
smoking
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15
Q

Complications of a concealed placental abruption

A 
DIC
uterine tetany
fetal hypoxia
fetal death 
sheehan syndrome (postpartum hypopituitarism)
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16
Q

Scenarios when fetal RBCs may enter moms circulation

A 
amnocentesis
abortion
vaginal bleeding
placental abruption
delivery
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17
Q

Timeline for prenatal antibody screening

A

at 28 and 35 weeks

if unsensitized at 28wks, give rhogham (anti-D Rh immunoglobulin)

if baby found to be rh positive at delivery, give rhogham again

If mom sensitized, obtain antibody titer via indirect antiglobulin test and, if positive, do amnio to see if fetal RBCs Rh positive. If so, plan serial amniocenteses to assess fetal bili levels throughout pregnancy

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18
Q

Chronic vs gestational HTN

A

chronic: bp >140/90 before 20 weeks gestation or before pregnancy altogether
gestational: high bp after 20weeks gestation

both tx with methyldopa, labetalol, or nifedipine

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19
Q

Mild vs severe preeclampsia

A

Mild: >140/90, dipstick 1+ to 2+ protein, edema isolated to hands feet, and face, no AMS, no vision #, no impaired liver; TX without bp meds or mag sulf

severe: >160/110, dipstick 3+ to 4+ protein, generalized edma, AMS, vision changem impaired liver function; TX with mag sulfate, hydralazine, and delivery

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20
Q

HELLP: features

A

Hemolysis
elevated liver enzymes
low platelets

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21
Q

3 diseases of aneuploidy

A

Downs (21)
Edwards (18)
Pataws (13)

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22
Q

1st trimester screening measures

A

U/s looking at nuchal translucency
papp-A
HCG

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23
Q

2nd trimester screening measures

A

triple: HCG, AFP, estriol
quad: +inhibin A

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24
Q

2nd trimester screening measures: Downs vs Edwards

A

Downs: HCG up, AFP and estriol down, inhibin A up

Edwards: all down

“Downs is up”

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25
Labs to get btw 20-28weeks
blood sugar RH status Hgb
26
Diagnosing gestational DM
``` 1-hr gtt (asymptomatic screen): if greater than 140 --> 3 hr gtt: fasting >90 1hr >180 2hr >155 3hr >140 NOTE: any 2 = gDM ```
27
Accuracy of US in determing GA
1st trimester: GA +/- 1week 2nd trimester: GA +/- 2weeks 3rd trimester: GA +/- 3weeks
28
Percutaneous umbilical blood sampling: Use
done after postive trasncranial doppler Allows for access for transfusion in preterm baby in iso-immunized mom
29
asymptomatic UTI in pregnant woman: TX
amoxicillin | nitrofurantoin if penicillin allergic
30
Cystitis in a pregnant woman: TX
amoxicillin | nitrofurantoin if penicillin allergic
31
Pyelonephritis in pregnancy: TX
ceftriaxone inpatient then 10 day course of antibx if initial improvement if no initial improvement, get US to look for abscess
32
seizure ppx in pregnancy: ideal drugs
leveteracitam or lamotrigine NOTE: valproate and phenytoin more teratogenic
33
If pregnant woman seizes, give ___
phenobarbital
34
Adequate contractions during labor
3 contractions every 10 minutes or 200mV in 10 minutes
35
Preterm GA
weeks 24-37
36
Infectious premature rupture of membrane: most common cause and tx
GBS PROM (occurs during term but no contxs yet) TX with ampicillin if GBS positive or unknown
37
endometritis/chorioamnionitis: definition and TX
infection of endometrium vs chorion (sac) ampicillin + gentamycin +/- clindamycin
38
Worry about fetal lung maturity before____
34weeks
39
Severe features of pre-eclampsia
``` BP >160/110 thrombocytopenia elevated LFTs RUQ pain HA vision change Nl or elevated creatinine Generalized edema ```
40
Fraternal twins =
Di-zygotic (2 fertilizations), di-chorionic, di-amniotic gestation
41
Different types of mono-zygotic gestations (3)
(1) Mono-zygotic, di-chorionic, di-amniotic (early split of single fertilization) (2) Mono-zygotic, mono-chorionic, di-amniotic (split during blastocyst phase with 2 organisms sharing a placenta and at risk for twin-twin transfusion syndrome) (3) Mono-zygotic, mon-chorionic, mono-amniotic (split after day 12--> conjoined twins at risk for cord entanglement)
42
Post-partum hemorrhage: vaginal vs c-section
vaginal: 500cc | C-section: 1000cc
43
post-partum hemorrhage with firm uterus =
retained placenta (accreta, increta, percreta) NOTE: Follow Beta-HCG after getting the retained part out
44
Ways to stop uterine bleeding (3)
Uterine artery ligation (OB) Uterine artery embolization (IR) Hysterectomy (OB)
45
Post-partum hemorrhage and boggy uterus following prolonged labor =
uterine atony TX: oxytocin, methergine, hemabate
46
US-based biophysical profile: scores and components
8-10 (good) 0-2 (fetal demise imminent--> c-section) Occurs if there is a failed NST+vibro-acoustic stimulation ``` Components: NST (0-1) amniotic-fluid index (0-2) NL is btw 8 and 25 breathing (0-2) movement (0-2) tone (0-2) ```
47
Heart rate rises: NL
Hr rise of 15bpm in 15 minutes | 2 rises in 20 minutes
48
VEAL CHOP
Variable decels early decels accels late decels Cord compression (maybe OK) head compression (OK) OK utero-placental insufficiency (bad)
49
Delivery of fetus with anemia due to moms attack
greater than 32 weeks
50
Risk factors for GBS infection
previous GBS infection prolonged ROM intrapartum fever All of these neeed intrapartum antibx (ampicillin, cefazolin, clinda, or vanc)
51
What to give with mom who is Hep B positive
Hep B IVIG AND vaccine at delivery
52
What antiretroviral therapy to give in pregnancy
tenofavir + emtricibane + Nevirprine OR zidovidine + larunidine + atazanavir
53
Intranatal toxo infection
Mom with risk factors for exposure and mono-like illness during pregnancy (didnt have previous exposure to toxo and antibodies to protect herself) Baby: brain calcifications, ventriculomegaly, seizures
54
TX of late latent vs tertiary syphillis
late latent: IM qwk x3 | tertiary: IV q4hr x 7-10d
55
Intranatal rubella exposure: effects on baby
Primary viremia most dangerous blueberry muffin rash (petechia and purpura) Cataracts Congenital heart defects Deafness IUGR (if contracted in first trimester)
56
Congenital herpes infection: clinical features
IUGR preterm blindness
57
Lacerations during episistomies
Grade I: only involves vagina II: extends into perineum III: invades anal sphincter IV: involves anal mucosa
58
Post-coital bleeding
cervical cancer (SCC)
59
black and itchy vulvar lesions
vulvar cancer (SCC)
60
Symptoms of ovarian cancer
these are symptoms of invasion renal failure, SBO, ascites
61
Hyperemesis gravidarum, hyperthyroidism, and size-dates discrepancies =
choriocarcinoma
62
If pap smear shows ASCUS
get either HPV DNA testing (if positive, do colpo) or another pap in 6months (if again ASCUS, do colpo)
63
Features of colposcopy
brushing to sample endocervix depresser-stick for ectocervix
64
Endometrial carcinoma: TX
total abdominal hysterectomy and BSO +/- chemo and radiation if their are mets
65
Risk factors of placenta accreta
prior c-section h/o dilation and curettage advanced maternal age
66
Baby with small body size, microcephaly, digital hypoplasia, nail hypoplasia, midfacial hypoplasia, hirsutism, cleft palate, and rib anomalies
fetal hydentoin syndrome
67
Follow-up of abnormal prenatal screen at 15wks
amnio
68
Follow-up of abnormal prenatal screen at 10-13 weeks
chorionic villus sampling
69
N/V, elevated serum aminotransferases, and hypoglycemia in 3rd trimester
acute fatty liver of pregancy
70
Encephalopathy, oculomotor dysfunction (horizontal nystagmus), and postural and gait ataxia in setting of hyperemesis gravidarum
thiamine deficiency --> Wernicke encephalopathy TX with IV thiamine followed by glucose infusion
71
AA pregnant female with new facial hair and bilateral ovarian masses is most likely
luteoma will spontaneously regress after pregnancy
72
Intrahepatic cholestasis of pregnancy: TX
ursodeoxycholic acid
73
Condylomata lata vs acuminata
lata: from secondary syphilis, flat velvety lesions acuminata: from HPV(6 and 11), cauliflower-like and skin-colored
74
Unilateral bloody discharge without a coexisting breat mass and with a normal mammogram
intraductal papilloma
75
Prevention of preterm labor in female with past preterm delivery
serial cervical length measuremments progesterone administration cerclage placement
76
Secondary amenorrhea due to intrauterine adhesions from endometrial infection or instrumentation
asherman syndrome
77
Meds to give in preterm labor <32 weeks vs btw 32 and 34
<32: betamethasone, tocolytics, mag sulf, penicillin if GBSpositive or unknown 32-34: betamethasone, tocolytics, penicillin if GBSpositive or unknown
78
Normal physiologic thyroid related changes in pregnancy: Total T4 vs free T4 vs TSH
Estrogen increases TBG Total T4: increases Free T4: unchaged or mildly increased TSH: decreased (beta-HCG suppresses)
79
Extraglandular features of Sjogren syndrome
``` arthritis raynauds dyspareunia cutaneous vasculitis ILD non-Hodgkin lymphoma ```
80
Complications of cervical conization
cervical stenosis cervical incompetence preterm delivery
81
Ovarian germ cell tumors
Dysgerminoma: chemo, LDH Endometrial sinus: AFP Teratoma: can cause stroma ovarii Choriocarcinoma: beta-HCG NOTE: these are nonmalignant and present as adenexal masses at stage I
82
Ovarian epithelial cell tumors
seroud mucinous endometroid brenners NOTE: all considered cystoadenocarcinomas, extremely malignant, risk increases with age (more ovulations), present as stage IIIb, seed peritoneally producing ascites
83
Genes that predispose risk for ovarian epithelial cell tumors
BRCA 1/2 | HNPCC
84
Marker to track ovarian epithelial cell tumors
Ca-125
85
Ovarian stromal cell tumors
granulosa-theca-->estrogen | sertoli-leydig-->testosterone
86
size-date discrepancy, hyperemesis gravidarum, markedly elevated beta-HCG , hyperthyoroidism
complete or incomplete molar pregnancy
87
molar pregnancy: management
suction curretage follow beta-HCG for year while on OCPs (so that you know rise in beta-HCG is from invasive disease)
88
choriocarcinoma: TX
surgical + medical (with mtx, actinomycin D, and cyclophophamide if refractory)
89
Vulvar cancers (3)
SCC: black and itchy melanoma: black and itchy NOTE: both the above involve vulvectomy and LN dissection pagets: red and itchy (good prognosis)
90
Grape like mass in vagina =
adenocarcinoma | think DES exposure in utero
91
PCOS: Meds and MOAs
OCPs: regulate menses clomiphene: ovulation induction spironolactone: for hirsutism NOTE: 1st line tx is weight loss
92
PID: Empiric tx
Inpatient: for those who are severely ill, N/V, or pregnant--> cefoxitin + doxy or clind + gent Go to surgery if no improvement Outpatient: Ceftriaxone, Doxy, and metro
93
Discriminatory beta-HCG
1,500 is threshold
94
Causes of vaginal bleeding in a non-pregnant woman
Polyps Adenomyosis Leiomyoma Malignancy ``` Coagulopathy Ovarian dysfxn Endometrium Iatrogenic (IUDs) Non-specified ```
95
Symptomatic leiomyoma: TX
first line: OCPs for pain: NSAIDs Surgery: if need to first shrink, use leuprolide then myomectomy; if doesnt want kids TAH
96
LH:FSH ratio in PCOS
3:1
97
Congenital adrenal hyperplasia
Hirutism Mildly elevated DHEAS from adrenals bilaterally Dx with CT/MRI and elevated 17-OH-progesterone in urine Tx with cortisol and/or fludrocortisone
98
Signs of placental separation during stage 3 labor
fresh bleeding from vagina umbilical cord lengthening uterine fundus rising uterus becomes firm
99
Contraindications to hormone replacement therapy in menopause
estrogen-dependent carcinoma (breat or endometrial) H/o PE/DVT
100
Indications for endometrial biopsy
any patient older than 35 with AUB
101
TX vaginal candidiasis
miconazole or clotrimazole, econazole, or nystatin
102
Large, globular, and boggy uterus in woman btw 35 and 50 =
adenomysis
103
Adenomyosis: risk factors
endometriosis | uterine fibroids
104
Cyclic pelivc pain that starts 1-2 weeks before menses and peaks 1-2 days after menstruation begins
endometriosis
105
Nodular uterus with adenexal mass =
endometriosis
106
Leuprolide: MOA
GnRH agonist that when given continuously will turn off hypothalamic-pituitary-ovary axis (suppresses estrogen)
107
Leuprolide: side effects
hot flashes | decreased bone density
108
Diffuse breat erythema, warmth, pain, and edema with a peau dorange appearance and axillary LDN=
inflammatory breast carcinoma
109
Amenorrhea/oligomenorrhea, sxs decreased estrogen (hot flashes) in woman < 40yo
Primary ovarian insufficiency | hypergonadotropic hypogonadism
110
Causes of hypothalamic hypogonadism
relative caloric insufficiency strenuous exercise NOTE: will not see menopausal sxs as in POF
111
Dysmenorrhea with heavy menstrual bleeding that starts later in the reproductive years with progression to chronic pelivc pain
adenomyosis
112
Uterus in adenomyosis
boggy, tender, uniformaly enlarged
113
pelvic US in adolescent showing adenexal mass with hyperechoic nodules and calcifications
dermoid ovarian cyst (aka mature cystic teratoma)
114
Complication of ovarian dermoid cysts
ovarian torsion (presents as acute-onset unilateral lower abdominal pain that occus d/t necrosis of the ovarian from ischemia with lack of circulation)
115
Holding position of arm with anterior shoulder dislocation vs posterior dislocation
anterior: arm held abducted and externally rotated posterior: arm held adducted and internally rotated
116
Oxytocin toxicity
seizures from free water reabsorption and hyponatremia
117
Tx of pulmonary edema in preeclampsia
loop diuretic (furosemid)
118
Beta-HCG levels in hydatidiform mole
>100,000!
119
Lichen sclerosis: TX
high-potency topical steroids NOTE: vulvectomy is for SCC (transformed lichen sclerosis)
120
Lichen sclerosis: clinical features
itchiness dyspareunia Loss of anatomical strcutures of the vulva (loss of clitoral hood)

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