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Outpatient Clerkships > OBGYN > Flashcards

OBGYN Flashcards

1
Q

Fetal survey

A

20 weeks

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2
Q

Quad screen

A

16 weeks

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3
Q

1 hour glucose tolerance test

A

28 weeks

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4
Q

Mom shots (TDAP)

A

after 28 weeks

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5
Q

Normal fetal heart rate

A

110-160

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6
Q

Anemia

A

28 weeks

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7
Q

GBS

A

urine 10 weeks

swab 36 weeks

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8
Q

Regular visit schedule

A

Monthly until 28 weeks
Every two weeks until 36 weeks
Weekly until delivery

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9
Q

Layers of the abdominal wall

A

Skin, campers fascia, scarpas fascia (where needle goes t o close), fascia, muscle (rectus for C section), peritoneum

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10
Q

Causes of abnormal uterine bleeding

A 
Polyp
Adenomyosis
Leimyoma
Malignancy (>40 years)
Coagulopathy (vWD)
Ovulatory dysfunction (every 21-35 days, change in ten days). If you don't ovulate, you don't get progesterone (need decrease in progesterone to trigger menses). Can be due to menarche, menopause
Endocrine (TSH, prolactin) - can be from PCOS, Athlete's triad
Iatrogenic/IUD
Not otherwise specified

More likely to be a structural cause after 35 years of age

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11
Q

How to tell placenta is ready for delivery

A

Cord lengthening, gush of blood, desire to push

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12
Q

Workup for abnormal uterine bleeding

A

Ultrasound, biopsy

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13
Q

Vulvovaginitis

A

Candida: Risks: DM, steroids, antibiotics.
Thick, white discharge, no odor
Wet prep: hyphae
Tx: antifungals (fluconazole)

Bacterial Vaginitis
Thin, gray/white discharge with fishy odor
Clue cells on saline
Tx: metronidazole

Trichomonas (ping-ponging)
Yellow-green frothy discharge, strawberry cervix
Flagellated motile
Metronidazole BOTH PARTNERS

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14
Q

Cervicitis

A

Inflammation of the cervix
Gonorrhea, chlaymdia or those that cause vulvovaginitis
Cervical motion tenderness, discharge, no other sxs of PID
Dx: GC/chlamydia and wet prep
Tx: Ceftriaxone x1 IM and doxy (not when pregnant) or azithro

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15
Q

Pelvic inflammatory disease

A

Ascending infection
Gonorrhea, chlamydia, or vaginal flora
Pelvic/abdominal pain, no other cause for sxs, any one fo the following: CMT, adnexal or uterine tenderness
Look for fever, WBC on wet prep, discharge
Dx: clinical
Tx: Inpatient if severe, with n/v, or pregnant
cefoxitin and doxy
OR clinda and gent

Outpatient: ceftriaxone + doxy + metro

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16
Q

Treatment of menopause

A

SSRI for hot flashes
Estrogen creams for vaginal atrophy

Screen for LDL - place on statin if needed
Screen for osteoporosis - tx with bisphosphonates. Prophylaxis with Vit D and calcium + exercise

17
Q

Stress incontinence

A

Big or multiple births - stretch the cardinal ligament
Increase in pressure - leaking. No urge or nocturnal sxs.
Dx: PE - cystocele
Tx: kegel, pessary, surgery

18
Q

Hypertonic, motor urge (Overactive bladder)

A

Random spasms of detrusor muscle
Has urge, nocturnal, leak with every spasms
Dx: cystometry will show spasms
Tx: antispasmotics (Oxybutynin)

19
Q

Hypotonic, overflow, neurogenic

A

Absent detrusor contractions (no sensation or signal from brain is disrupted)
-MS, trauma, antispasmotic medication
no urge, but there is nocturnal sxs
Dx: distended bladder, cystometry
Tx: bethanecol to induce spasms or intermittent versus indwelling catheter

20
Q

Irritative bladder

A 
Inflammation from stones, cancer, or UTI
Frequency, urgency, and dysuria
No nocturnal sxs. 
UA will show diagnosis 
Tx: UTI - antibiotics
stones - capture
cancer - surgery
21
Q

PCOS

A 
Anovulation. 
testosterone modestly elevated - hirsutism
DHEAS normal
Bilateral ovaries imaging
LH:FSH ratio greater than 3:1
or ultrasound that shows follicles

Tx: exercise, weight loss, metformin, OCP. If she wants to get pregnant, use clomiphene. Spironolactone to treat symptoms of testosterone

22
Q

Sertoli-lydig tumor

A

Cancer so testosterone very elevated - causes virilization
DHEAS normal
Imaging: unilateral ovary, ultrasound
Tx: resection

23
Q

Adrenal tumor

A

Cancer so DHEAS very elevated - causes virilization. Testerosterone normal
Imaging: unilateral adrenal, CT/MRI
Adrenal vein sampling to check which adrenal gland is hyper-functioning
resection

24
Q

Congenital adrenal hyperplasia

A

Elevations in DHEAS that are moderate = hirsuitism. testosterone normal.
Imaging would be bilateral adrenal by CT/MRI
17OH progesterone in urine (absent enzymes)
Tx: cortisol or fludrocortisone

25
Q

Causes of vaginal bleeding by age group

A

Premenarchal: foreign body, sexual abuse, precocious puberty

Reproductive: pregnancy, anatomy, abnormal uterine bleeding, cervical cancer

Post-menopausal: vaginal atrophy, endometrial cancer, HRT

26
Q

Difference between uterus in fibroids, adenomyosis, and polyp

A

Fibroid is lump in myometrium - creates asymmetric, nodular uterus

Adenomyosis is uniformly enlarged myometrium - creates symmetrically smooth and boggy uterus

Polyp is a dangly within the endometrium - normal uterus on exam

27
Q

Treatment of fibroids

A

Meds: OCP, IUD, NSAIDs
Surgery: If want kids - myomectomy. If no kids - TAH or

28
Q

Abnormal uterine bleeding

A

Diagnosis of exclusion: normal CBC, TSH, prolactin, U/S

Tx: OCP/IUD, NSAIDs. Surgery: ablation or TAH

29
Q

PCOS diagnostic criteria

A

Anovulatory
AND
biochemical elevation of testosterone or DHEAS or LH/FSH ratio > 3:1 OR ultrasound showing follicles

30
Q

Treatment of UTI in pregnancy

A

Amoxicillin

OR nitrofurantoin

31
Q

Treatment of pyelo in pregnancy

A

Admission for ceftriaxone for 10 days

32
Q

Treatment of thyroid in pregnancy

A

Hyperthryoid: use PTU. If surgery is necessary, during 2nd trimester
Hypothryoid: levothyroxine. Recheck q4weeks with f/u

Increase in TBG leads to increase in need for levothyroxine

33
Q

Treatment of epilepsy in pregnancy

A

L drugs are safe

Leviteracetam and lamotrigine

34
Q

Treatment of HTN in pregnancy

A

alpha methyldopa
labetalol
hydralazine
tighter screening for eclampsia

35
Q

Treatment of DM in pregnancy

A

Before: A1c <7% with diet, exercise and change orals to insulin
During: Increased insulin requirement!! Basal bolus insulin strategy with target of post-prandials
After: Decrease in insulin demand

36
Q

Vasa previa

A

Accessory lobe plants across the cervical os

37
Q

Diagnostic criteria for gestational diabetes

A 
1 hr GTT: >140
3 hr GTT:
Fasting: >90
1 hour: >180
2 hour >155
3 hour: >140
POST-PRANDIAL sugars for monitoring

Outpatient Clerkships (4 decks)

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