OBGYN Flashcards
(192 cards)
1
Q
Medical management of fibroids?
A
GnRH agonists -> only recommended for 3-6 months
2
Q
Role of magnesium sulfate in preterm labor?
A
fetal neuroprotections to prevent cerebral palsy, etc
3
Q
A fetus is showing minimal responsiveness to monitoring after water breaks, next step?
A
Digital scalp manipulation
4
Q
How to manage cervical incompetence?
A
cervical cerclage at 14 weeks
5
Q
Side effects of copper IUD?
A
Hypermemorrhea and anemia
6
Q
What studies are completed at the initial prenatal visit?
A
Rh(D) type, antibody screen,
Hb, Hct, MCV
HIV, VDRL/RPR, HBsAG
Rubella and varicella immunity
Pap test (if indicated)
Chlamydia PCR
Urine culture
Urine protein
7
Q
First step to managing a woman with suspected biopsy and heavy menstrual bleeding?
A
Endometrial biopsy
8
Q
How to manage pelvic pain unresponsive to NSAIDS and oral contraceptives?
A
Diagnostic laproscopy
9
Q
Findings in primaru ovarian insufficiency?
A
oligomenorrhea/amenorrhea, infertility, menopausal symptoms, and elevated FSH and estradiol levels
10
Q
Supplement of which mineral/vitamin has been shown to improve PMS?
A
Calcium
11
Q
When do you test for gonorrhea in pregnant patients?
A
High-risk- previous STD< <25, new or multiple partners
12
Q
Examples of NSAID
A
Ibuprofen, naproxen
13
Q
Transvaginal vs transabdominal US in pregnancy?
A
Transvaginal early in pregnancy, then transabdominal
14
Q
abdominal pain, nausea, scant bleeding, and fever, after D&C?
A
uterine perforation
15
Q
Management of an infant between 2 and 24 months following first febrile UTI?
A
Renal and Bladder US
16
Q
Theca luteun tumor
A
Pregnancy (especially molar) and often bilateral
17
Q
Amenorrhea with normal seconary sexual characteristics, development on cyclical abdominal pain
A
OUtflow tract ostruction
18
Q
Risks for ovarian cancer?
A
Nulliparity, family history, early menarche, late manopause
19
Q
Next test after suggestion of acanthosis nigricans?
A
Fasting insulin
20
Q
Should pregnant woman be offered the influenza vaccine?
A
Yes, as soon as it becomes available, if inactivated.
21
Q
What is the sniffling position?
A
ilting hed backwards and lifting the chin
22
Q
Karyotype of complete/partial mole?
A
Complete: XY, XX
Partial XXY, XXX, XYY
23
Q
How to treat involuntary constrction of vaginal musculature?
A
Vaginal dilators
24
Q
Urge incontinence
A
overactivity of the detrusor muscle -> uninhibited contractions -> increased bladder preddure -> urine leakage
25
Chancre
`Primary syphilis infections caused by treponema pallidum
26
Alternative name for genital warts?
Condylomata acuminata
27
What testing may be indicated prior to starting tamoxifen?
Factor V leiden
28
Kleihauer-Betke test?
Determine necessary dose of Rh(D) andti-D IG needed after delivery of an Rh-positive infant to an Rh-negative mother
29
Lab test for the diagnosis of PCOS?
Testosterone
30
Treament for hemorrhagic cyst?
Monitor with US, most will resolve on their own
31
What factors are contained in cryoprecipitate?
Fibrinogen, factor VIII, von willebrand's
32
What should be adminstrated in preterm labor?
Steroids, tocolytic (indomethicine, nifidipine), and magnesium sulfate
33
Woman with complex cyst without any other symptoms late in her cycle?
Hemorrhagic cyst
34
Risk factors for endometrial cancer?
Obensity, nullipartiy, late menopause, complex atypical hyperplasia of the endometrium
35
Risk associated with twin-twin transfusion syndrome?
Neurological morbidity, including cerebral palsy
36
To treat infertility due to endometriosis?
ovarian stimulation with clomiphene citrate -\> IVF is last resort
37
Tamoxifen side effexts?
thermoregularory dysfuction (hot flashes), increased risk fo endometrial cancer (post-menopausal) or endometrial polyps (premanopausal patients)
38
After a molar pregnancy, what is the risk of a second?
1-2%
39
What are postterm pregnasncies associated with?
Placental sulfatase deficiency, fetal adrenal hyperplasia, anencephaly
40
What type of cancers do BRCA2 carrier tend to have?
Estrogen receptor positive
41
Cell-free DNA vs quad screening?
Cell-free for high risk pregnancies at \> 10 weeks
42
How should a fetus be managed when heart rate is less than 90?
Positive pressure ventilation and prepare to intubate
43
How much blood does 30mg of rhogam neutralize?
15cc of RBCs or 30mL whole blood
44
Signs of adenomycosis?
Dysmenorrhea, pelvic pain, heavy menses, bulky globular and tender uterus
45
First step in the evaluation of abnormal bleeding?
Pelvic Ultrasound
46
Extended wrist, hyperextended metacaopophalangeal joints flexed interphalangeal joints, absent grasp reflex? Cause?
Klumpke palsy, C8-T1
47
How to treat a missed abortion?
Medically with Misoprostol -\> induce uterine cramping -\> expulsion of fetus
48
Treatment for genital warts?
Small- trichloroacetic acid or podophullin resin
Large-excisional therapy
49
Signs of uterine rupture? Tx?
internse abdominal pain, loss of fetal station,
Tx- emergency laparotomy
50
high fever, hypotension, diffuse red maqcular rash involving the palms and soles, headache, vomiting, diarrhea
Toxic shock syndrome
51
Fetal complications from preeclampsia?
Fetal growth restriction, low birth weigt due to chronic uteroplacental insufficiency
52
What genetic test can rule out Down? All other chromorsome abnormalities?
Cell free DNA-down's
All chromosomes-amniocentesis
53
Risk factors from preterm delivery? Best method of prediction in first time pregnancies?
Prior pregnancy (strongest), multiple gestations, hx of cervical surgery
Best method of prediction? Transvaginal US
54
Risks for a Bartholin gland mass in post-menopausal woman?
Malignancy, requiring biopsy, especially with rapid development
55
Treatment for moderately differentiated carcinoma?
Radical vulvectomy and groin node dissection
56
Changes in oxygenation during pregnancy?
Increase CO2 expulsion -\> alkalosis due to hyperventilation from progesterone
57
Hypogonadotropic hypogonadism
hypothalamic dysfunction, due to severe life stressors
Associated with low LH and FSH
58
Findings suggesting polyps?
40-50 years of age, omcreased, increased menstrual flow, increased cramping and intermenstrual spotting
59
First step in the management of hrtuism with apparent genetic component?
Check 17-hydroxlprogesterone
60
Intraductal papilloma description
blood or serosanguinous dischange from the nipple
61
Trastuzumab: Use and side-effects
Use: Her2 positive breast carcinoma
Side-effects: Cardiotoxicity, get baseline echo. Howeer, damage is reversible with cessation of treatment
62
Functional ovarian cysts- US characteristics?
Unilocaular simple cyst without evidence of blood, soft tissue elements, or excrescences
63
Coarse facial hair in a pregnant woman with a solid mass found on US? Diagnosis? Treatment?
Leueoma, serial us and observation as they often resolve after delivery
64
How to treat Linchen sclerosus?
Hihg potency topical steroids
65
Spare pubic hair, loss of fullness of the labnia, vulvar and vaginal discomfort in post menopausal women?
Atrophic vaginitis -\> due to decreased estrogen
66
Management of chirioamnionitis?
Broad spectrum antibiotics (ampicillin, gentamycin, clindamycin) and delivery. Oxytocin to speed up delivery
67
Amenorrhea for emenses for 3 cycles or \> 6 months?
beta-HCG -\> if negative, check prolactin, TSH, FSH
68
Endometriosis-us findings?
hemogenous cyst with internal echoes ("Ground glass")
69
21-hydroxylase deficiency?
Unable to produce adequate cortisol due to a blockage of 17-hydroxyprogesterone
Also known as congenital adrenal hyperplasia
70
Anxiety, chest pain, palpitations, syncopy with systolic murmur with click?
Mitral valve prolapse, treat with beta blockers
71
What treatment(s) are most effective for menopause?
Estrogen
72
How do you diagnose choriocarcinoma?
b-HCG levels
73
How long can the latent phase of labor last in pregnancy?
20 hours in first time, 14 for multi-
74
ASCUS management options?
Performing HPV DNA testing or repeat cytology @12 months following abnormal Pap. If HPB is negative, then routine screening can be resumed at three years
If HPV is positive, or repeat is ASCUS or higher, then colposcopy should be performed
75
Which drugs require baseline audiometry?
Cisplatin, carboplatin
76
McCune Albright Syndromes sexual development?
Menarche, before breast and pubic hair development
77
Physical exam findings associated with down syndrome?
flattened nasal bridge, small size, small rotated cup-shaped ears, sandal gap toes, hypotonie, protruding tongue, short, broad hands, simian creases, epicanthic folds, and oblique palpebral fissueres
78
Which SSRI is now category D? Why?
Paroxetine, cardiac malformations and persistent pulmonary hypertension
79
Interstitial cystitis?
Chronic inflammatory condition of the bladder with in characterized by recurrent irritation, voiding symptoms of uregency and frequency, in the absence of other diseases
80
isolated cystic mass in the anterior vaginal wall?
Urethral diverticulum
81
Donovan bodies
Deeply straning gram-negative intracytoplasmic cysts caused by Klebsiella granulomatis
82
Most important prognostic factor in the treatment of patients with breast cancer?
TNM staging
83
Risk factors for delayed separation of placenta?
Uterine leiomyomas, prior c-section, prior uterine curettage and succenturiate lobe of placenta
84
How should an infant exposed to meconium-sained amniotic fluid be managed after delivery?
Intubate the trachea and suction merconium and other asporated material from beneath the flottis immediately after delivery only if the infant is depressed
85
Findings suggesting antiphospholipid syndrome in pregnancy?
prolonged dilute russell viper venom time, hx of 3 early pregnancy losses, hx of venous thrombosis
86
If OCPs fail to treat dysmenorrhea, what should be the next step?
Lapropscopy after 3 months of OCP trials
87
Most common risk associated with valprioc acid?
Neural tube defects (meningomyolocele)
88
Cordlike thickening and bilateral non-focal premenstrual tenderness in the breasts? Treatment?
FIbrocystic breast changes
Tx: NSAIDS, oral contraceptives
89
What is repaired by repairing the pubocervical fascia or reattaching it to the sidewall if separated from the white line?
Center and lateral cystoceles
90
Flinanserin-use
premanopausal hypoactive sexual desire disorder
91
multiple small, papular growths that are fragile and bleed upon manipulation?
Condylomatra acuminata
92
Why have c-sections increased in recent years?
Studies have demonstrated increased risks with VBAC
93
Where does lubrication in the vagina come from?
ransuldate of fluid across vaginal mucosa
94
What drugs are contraindicated in vaginal deliveries with a previous c-sections?
Prostaglandins -\> increased risk of rupture
95
In pre-term labor, what medications must be included?
Ampicillin with known GBS status
96
Primary risk for preterm rupture of membrane?
Genital tract infection
97
continuous painless urine leakage after pelvic surgery? Diagnosis?
Vesicovaginal fistula
Diagnosis: cystourethroscopy
98
Mullarian agenesis
congenital absence of vagina, uterus, fallopian tubes
99
Treatment for multifocality VIN?
Laser ablation
100
Demoid tumor
Most common tumor in women of all ages
Contain teeth, sweat and sebaceous glands, cartilage, bone, fat
101
When do you administer Rho(D) immunoglobulins?
28 weeks gestation
102
Order of sexual development in girls?
Breast budding (thelarche), adrenarche (hair growth), growth spurt, menarche
103
Which race has the highest risk of molar pregnancies?
Asian
104
What drugs requirement baseline bone density scans?
Aromatase inhibitors (anastrozole, letrozole)
105
Gonorrhea/Chlamydia prophylactic treatment?
Ceftriaxone and Azithromycin
106
What components does fresh frozen plasma?
Fibrinogen, Factors V and VIII
107
What does molding of the fetal head mean?
Deformations in the skiull doe to fetal malpositioning during delivery
108
First step in the managment of a post-menopausal adenexal mass?
Transvaginal US (provides better visualization that transabdominal
109
What is atrophic vaginitis? Treatment?
Vulvovaginal dryness, loss of vaginal elastacity/rugae, thinning vulvar skin/loss of minora, decreased vaginal diameter
Tx- low dose topical estrogen
110
Risk factors for PMS?
Family hx, vitamin B6, calcium, magnesium deficiencies
111
Slowly increasing b-HCG, think endometrial strip, think?
Ectopic pregnancy
112
cyclic midline abdominal cramping pain post D&C?
hematometra
113
Absolute contraindications for vacuum aspiration of pregnancy?
Greater than 8 weeks gestation
114
Risks associated with gestational diabetes?
Shoulder dystocia, metabolic disturbances, preeclampsia, polyhydramnios, fetal macrosomia
115
Side affects of fluoxetine?
Insomnia
116
Most concerning colpscopy findings?
Atypical blood vessels -\> greater degree of angiogenesis, this more concerning
117
Hemorrhage, uterine tenderness and contractions in a pregnant woman?
Abruptio placentae
118
What is overflow incontinence?
Failure to empty the bladder adequately -\> due to underactive detrusor muscle or obstruction
119
persistant, ulcerating, eczematous rash localized to the nipple, spreading to the areola
Most common co-malignancy?
Mammary paget disease
Common co-malignancy: Adenocarcimoma
120
121
Extended elbow, pronated forearm, flexed wrist and fingers with normal grasp reflex-name? Cause?
Erb-Duchenne palsy, C5-C6
122
Highest risk factor for ectopic pregnancies?
Prior ectopic pregnancy
123
What is the value of the fibronectin test?
Negative predictive value?
124
How to detect exercise-induced amenorrhea?
Check FSH and estrogen
High FSH, low estrogen
125
Signs of molar pregnancy?
US -\> than LMP dating, bleeding, high bHCG
126
Management of placenta previa during pregnancy?
No intercourse or dignital vaginal examination (pelvic rest)
127
Affects of STD on the cervix during pregnancy?
Causes bleeding -\> increased blood flow
128
Affect of type 1 diabetes on fetal size?
Fetus is generally smaller
129
Overflow incontinence
sensation of fullness, pressure, and frequency -\> small amount of continuous leaking
130
How to measure ovarian reserve?
Anti-mullerian hormone levels
131
Treatment for molar pregnancies?
Suction curettage
132
Chancriod
Painful ulcer caused by haemophilus ducreyi
133
Hyperthecosis?
More severe form of PCOS
134
If an unsatisfactory colposcopy is obtained, how should acetowhile stains that enter the cervical canal be managed?
Conization
135
Treatment for PCOS?
OCPs
136
Risk associated with endometriosis?
Infertility
137
HOw do treat bartholin cysts?
Asymptomatic- Observation
Symptomatic- Incision and drainage
138
bleeding and/or endomedtiral hyperplasia in a postmenopausal woman with large adnexal mass?
Granulosa cell tumor
139
What causes cervical cancer?
HPV infection
140
Treatment for fungal infection
"-azole" drug
141
Best place to place intimate partner handouts?
Bathrooms, or other private places
142
Ternitaline? side-effects?
Beta-adrenergic
Side-effects: Tachycardia, hypotension, anxiety, chest tightening/pain
143
What structural abnormaities can cause recurrent miscarraiges?
uterine cavity abnormalities (intrauterine adhesions, congenital anomalities, large submucous fibroids)
144
Most common fetal part to feel other than the head?
Buttocks in breech presentation
145
Affect of chorioamnionitis on fetal appearance?
Pale, lethargic, high temperature
146
Risk associated with polyhydramnios?
Placenta abruption due to rapid decompression in intrauterine cavity
147
Whaat are the risks for isoimmunization?
2% antepartum, 7% after full term delivery, and 7% with subsequent pregnancy
148
Mature teratoma- Alternative name? US findings? Tx?
Altermative name: dermoid ovarian cyst
Findings- hyperechoic nodules and calcifications
Tx: Removal of cyst
149
Weight needed for menses to begin?
85-106 lbs
150
Treatment for VINIII?
wide excision
151
What are methods for sterilization?
Laparoscopic tubal ligation
Essure placement
Mini-laparotomy with tubal ligation
152
pelvic pain in a patient with ovarian mass?
Torsion until proven otherwise -\> ischemia and necrosis of the ovary
153
beta-HCG level required to detect fetus with transvaginal US? transabdominal?
2000
Transabdominal- 5000
154
Most common causes of pelvic pain?
Adhersion, endometriosis
155
What are Lewis antibodies?
igM antibodies that do not cross the placenta, therefore do not cause isosensitization or hemolytic disease
156
Does a granulosa tumor secrete anything?
Yes, estrogen
157
How does a history of depression affect a new mother?
Much higher risk of depression
158
What type of fibroids cause recurrent pregnancy loss? Why?
Submucosal or intracavitary
1. focal endometrial vascular disturbance
2. endometrial inflammation
. secretion of vasoactive substances
159
Treatment for antiphospholipid syndrome?
Aspirin plus heparin
160
When to suspect ectopic pregnancy?
missed menstrual period, vaginal bleeding
161
With a t-score of -1.7 what should be discussed with patients?
Evaluation of factors for fracture
162
Benefit of breast feeding, to the mother?
Decreased incidence of ovarian cancer
163
Neonatal thyrotoxicosis? Cause? Treatment?
materal hx of grave's diese, low birth weight, tachycardia, warm skin, irrtability
Cause: passage of anti-TSH receptor antibodies during third trimerster
Treatment: beta blockers, methimazole; eventually self resolves
164
Initial management for a woman with late decellerations?
Maternal position adjustments to left lateral position
165
Epithelial ovarian carcinoma-US finding?
US-solid mass, thick septations, ascites
166
Affects of hypothyroidism in woman?
Irregular periods, infertility
167
When should pap smears begin?
21 years
168
Fetal dysmaturity
"postmaturity syndrome" 0\> fetal growth has beens restricted post-term
Described as withered, meconium stained, long-nailed, gradile, with a small placenta
169
Next step in management of mullerian agenesis?
Renal US, high association with renal abnormalities
170
First step in the management of urine leakage?
Obtain urinalysis and cultures
171
management of an actively bleeding patient with anemic after spontaneous aborption
D & C
172
What causes positive nitrates in urine?
Enterobaceteria special (gram-negative E. Coli)
173
Are chronic medical conditions associated with early spontaneous abortions?
Yes
174
Risks associated with HRT?
Increased risk of breast cancer, however, decreased risk of colon
175
Cause of stress urinary incontinence?
Cystocele or increased intraabdomianl pressure (obesity, etc)
176
Affect of anorexia on hypothalamic-pituitary dysfunction?
Can cause amenorrhea
177
Papillomas vs ductal carcinoma of the breast?
ductal carcinoma of the breast contains microcalcifications
178
Benefits of progesterone IUD
protective against endomedrial cancer,
low failue rate
179
How can a total hysterectomy and bilateral salpingo-oophorectomy lead to menopausal-like symptoms in a post-menopausal woman?
Decrease circulating androgens due to loss of androgens being produces in the ovaries
180
Histology of fat necrosis? MRI?
Foamy histocytes and fat globules
MRI: calcifications and hyperechoic mass
181
Decreased fetal movement, asymmetrical growth with a young women with DVT prior?
Factor V liiden
182
When do screen for Hep C during pregnancy?
HIV positive, intravenous drug use
183
After physical exam, what is the next step is the work up of abnormal uterine bleeding?
Pelvic US
184
Risk factors for vulvar cancer?
HPV exposure, smoking, vulvar dystrophy, immunocompromised states
185
How to myomas grow after removal of GNRH?
At same pace as prior to treatment
186
Missed aborption findings?
Embryo without caridac activity, empty gestations sax without fetal pole
187
Signs of placental abruption?
Abdominal pain, bleeding, uterine hypertonus, fetal distress
188
How to manage arrest in the second stage of labor?
Augmentsation with amniotomy, oxyton
189
Stages of grief?
Denies, abger, bargaining, depression, acceptance
190
Microinvasive cervical cancer?
Invasion into the basement membrane less than 3mm
191
Delivery for twins when the first twin is breeched?
C-section
192
Treatment for chlamydia? Gonorrhea
Azithromycin-chlamydia
Ceftriaxone- gonorrhea
