ObGyn Clerkship - Mostly OB Flashcards
(214 cards)
1
Q
Daily calcium requirements
A
1000-15000 mg/day
2
Q
Daily Vitamin D requirements
A
400-800 international units/day
3
Q
DM screening timing
A
Begin at 45, every 3 years thereafter
4
Q
Osteoporosis screening timing
A
BMD scan starting at age 65
5
Q
BMD T-scores
A
> (-1): Normal
(-1) - (-2.5): Osteopenia
< (-2.5): Osteoporosis
6
Q
Thyroid screening timing
A
TSH levels should be tested every 5 years, starting at age 50
7
Q
HTN Parameters
A
Systolic >= 140
Diastolic >= 90
8
Q
Cholesterol screening timing
A
Every 5 years, starting at age 45
9
Q
Overweight BMI
A
25-29.9
10
Q
Obese BMI
A
> 30
11
Q
Beginning and end of the follicular phase
A
Begins with onset of menses, ends on the day of the LH surge
12
Q
When does ovulation occur, in respect to the LH surge?
A
Within 30-36 hours of the LH surge
13
Q
Beginning and end of the luteal phase
A
Begins on the day of the LH surge, and ends with the onset of menses
14
Q
Which phase, luteal or follicular, remains constant, and which can vary?
A
- Luteal remains constant
- Follicular can vary
15
Q
MCC of vulvovaginitis
A
Bacterial vaginsosis
16
Q
Normal vaginal pH
A
3.5 to 4.7
17
Q
The diagnosis of BV is defined by any three of what four criteria?
A
1) Abnormal gray discharge
2) pH greater than 4.5
3) Positive “whiff test”
4) Presence of clue cells
18
Q
Bacterial vaginosis treatment
A
- Oral/topical metronidazole
- Oral/topical clindamycin
19
Q
With what is a “strawberry cervix” associated?
A
Trichomonas vulvovaginitis
20
Q
Trichomonas treatment
A
Oral metronidazole
21
Q
MCC of preventable infertility
A
STDs
22
Q
Most frequently reported infectious disease in the US
A
Chlamydia
23
Q
Greatest risk factor for PID
A
Prior PID
24
Q
Which HPV subtypes are usually associated with genital condyloma?
A
6 and 11
25
Which HPV subtypes are usually associated with cervical dysplasia/cancer?
16, 18, 31, 33, 45
| Most common are 16 and 18
26
Causative organism of syphilis
Treponema pallidum
27
What is primary syphilis characterized by?
Painless chancre
28
What is secondary syphilis characterized by?
Skin rash that often appears as rough, red or brown lesions on the palms of the hands and soles of the feet
29
What is the conceptus called from the time of fertilization until the pregnancy is 8 weeks old?
Embryo
30
What is the conceptus called after 8 weeks of pregnancy?
Fetus
31
What is an infant called when it is born before 24 weeks gestation?
Previable
32
When should Rh (-) pregnant patients receive RhoGAM?
28 weeks
33
MCC of first-trimester abortions
Fetal chromosomal abnormalities
34
Is amniotic fluid acidic or alkaline?
Alkaline
35
Tests that can be used to diagnose rupture of membranes
- Pool test
- Nitrazine test
- Fern test
36
When amniotic fluid is placed on nitrazine paper, what color will the paper turn?
Blue (amniotic fluid is alkaline)
37
5 components of the cervical examination (in a pregnant patient)
- Dilation
- Effacement
- Fetal station
- Cervical position
- Consistency of the cervix
38
Bishop score
Score made up from the five aspects of the cervical examination (dilation, effacement, fetal station, cervical position, cervical consistency)
39
A Bishop score consistent with a cervix favorable for labor
> 8
40
Measurement that determines how thick/thin the cervix is
Effacement
41
The relation of the fetal head to the ischial spines of the female pelvis
Fetal station
42
Fetal station
The relation of the fetal head to the ischial spines of the female pelvis
43
How does the cervical position change during early labor?
Changes from posterior to mid to anterior
44
Fetal presentation with the head down
Vertex
45
Fetal presentation with the buttocks down
Breech
46
Fetal presentation with neither the head nor the buttocks down
Transverse
47
Describe the location and shape of the anterior fontanelle
- Between the two frontal bones and the two parietal bones
| - Larger and diamond-shaped
48
Describe the location and shape of the posterior fontanelle
- Between the two parietal bones and the occipital bone
| - Smaller and more trianglular-shaped
49
Definition of 'labor'
Contractions that cause cervical change in either effacement or dilation
50
Methods by which we can induce labor
- Prostaglandins
- Oxytocic agents (Pitocin)
- Mechanical dilation of the cervix
- Artificial rupture of the membranes
51
Methods by which we can ripen/dilate the cervix
- Prostaglandin E2 (PGE2) gel
- Prostaglandin E2 pessary (Cervidil)
- Prostaglandin E1 M (Misoprostol)
- Mechanical dilation
52
How is Pitocin administered? Why?
Continuously via IV because it is rapidly metabolized
53
Tool used to directly measure the absolute change in pressure during a contraction, thus estimating the strength of the contraction
Intrauterine Pressure Catheter (IUPC)
54
Normal range for fetal heart rate
110-160
55
Timing of early decelerations in relation to uterine contractions
Begin and end at approximately the same time as contractions
56
Cause of early decelerations
Increased vagal tone secondary to head compression during a contraction
57
Timing of variable decelerations
- Can occur at any time and tend to drop more precipitously than either early or late decels
- Timing is unrelated to contractions
58
Cause of variable decelerations
- Result from umbilical cord compression
| - Repetitive decels can result from entrapment of the cord under the arm or around the neck
59
Timing of late decelerations
Begin at the peak of a contraction and slowly return to baseline after the contraction has finished
60
Cause of late decelerations
- Uteroplacental insufficiency
| - These are the most worrisome
61
Baseline intrauterine pressure
10-15 mmHg
62
Cardinal movements of labor
- Engagement
- Descent
- Flexion
- Internal rotation
- Extension
- External rotation
63
First stage of labor timing
Begins with onset of labor, lasts until dilation and effacement are complete
64
Second stage of labor timing
Begins with full dilation and ends with delivery
65
Third stage of labor timing
Begins after delivery of the infant, ends with delivery of the placenta
66
MC tumor found on the vulva
Epidermal inclusion cyst
67
Cervical retention cysts caused by blockage of an endocervical gland
Nabothian cysts
68
Chadwick sign
Bluish discoloration of the cervix as seen in pregnancy
69
Bluish discoloration of the cervix as seen in pregnancy
Chadwick sign
70
Softening of the cervix, as seen in pregnancy
Hegar sign
71
Hegar sign
Softening of the cervix, as seen in pregnancy
72
Reactive/reassuring nonstress test
At least 2 fetal heart accelerations of at least 15 mins above the baseline HR in 20 minutes
73
How long does it take to determine that a nonstress test is "nonreactive"/"nonreassuring"?
40 minutes
74
What is a neoplasm of the uterine muscular wall called?
Sarcoma
75
What is a neoplasm of the endometrial lining called?
Adenocarcinoma
76
Which type of ovarian cyst is associated with ovulation?
Follicular cyst
77
Which type of ovarian cyst is associated with pregnancy?
Corpus luteum cyst
78
Which type of cyst is often bilateral, resulting from excess hCG secretion in molar and multigestation pregnancy?
Thecal cyst
79
Which lab value is helpful in the assessment of a patient for ovarian cancer?
CA-125
80
What "surgical" procedure can be done to help an incompetent cervix?
Cerclage
81
With what pathology is a strawberry cervix associated?
Trichomonas cervicitis
82
Definition of primary amenorrhea
- No menses by 14 with normal sexual development, OR
| - No menses by 13 without normal sexual development
83
Definition of secondary amenorrhea
Cessation of menses for 6 months not associated with menopause
84
Most common cause of secondary amenorrhea
Pregnancy
85
Definition of dysmenorrhea
8-72 hours of pelvic pain with menstruation
86
Average age of menopause
51.5 years
87
Premature menopause (definition)
When menses stop before age 40
88
Lab used in the diagnosis of menopause
FSH
89
What FSH levels are diagnostic of menopause
> 30 mlU/mL
90
Instances in which you cannot use HRT
- Unexplained vaginal bleeding
- History of DVT/PE
- History of GYN tumors that may be estrogen-sensitive
91
Medical terms for breast pain
Mastalgia or mastodynia
92
MC organism responsible for mastitis
Staph aureus
93
MC benign condition of the breast
Fibrocystic changes
94
What breast pathology is associated with the following changes:
- Round
- Firm
- Smooth
- Mobile
- Non-tender
Fibroadenoma
95
Which breast pathology is associated with the following changes:
- Painful
- Fluctuating size
- Multiple masses
Fibrocystic changes
96
Most common type of breast cancer
Ductal carcinoma (80%)
97
Two types of breast cancer
Ductal carcinoma
| Lobular carcinoma
98
Paget's disease of the breast (definition)
Ductal carcinoma of the nipple
99
Skin changes associated with Paget's disease
-Scaly, eczematous, erythematous nipple lesion
100
Spontaneous flow of milk from the breast (term)
Galactorrhea
101
Why could a pituitary adenoma cause galactorrhea?
It could cause hyperprolactinemia, which would cause the galactorrhea
102
Definition of infertility
Failure to conceive after 1 year of unprotected intercourse
103
What medication can be given to anovulatory women to stimulate ovulation?
Clomiphene citrate (Clomid)
104
How does clomiphene citrate (Clomid) work?
By inhibiting estrogen receptors in the hypothalamus, removing the (-) feedback on gonadotropin release
105
Cervical motion tenderness (what is this sign called?)
Chandelier's sign
106
What tool can be used for monitoring the fetus internally?
Fetal scalp electrode
107
Most accurate method of monitoring the fetus during labor
Fetal scalp electrode
108
What are some simple measures that can be taken if concerned about fetal heart rate during labor?
- Lay mom on left side
- Give mom oxygen
- Stop pitocin
109
Five categories of the APGAR score
- Appearance (color)
- Pulse
- Grimace (reflex to nasal suctioning)
- Activity (motor tone)
- Respiration
110
Causes of early postpartum hemorrhage
- Laceration
- Retained products of conception
- Abnormal uterine involution
111
Causes of late postpartum hemorrhage
- Retained products of conception
| - Endometritis
112
What drugs can be given to treat postpartum hemorrhage?
- Prostaglandins
- Oxytocin
- Ergonovine (Ergometrine)
* All used to enhance uterine contraction
113
How long does it take the uterus to descend back into the pelvis?
2 weeks
114
How long does it take for the uterus to involute to normal size?
6 weeks
115
Medical term for the sloughing of decidual tissues in the postpartum period
Lochia
116
Most common location of ectopic pregnancy
Ampulla of the fallopian tube
117
Patient presents with RLQ pain and vaginal bleeding. On exam, you feel an adnexal mass. What do you suspect?
Ectopic pregnancy
118
What drug can be given to a patient with an ectopic pregnancy?
Methotrexate
119
If premature labor is a possibility, what drug can you give to the mother to increase fetal lung maturity?
Betamethasone (Celestone)
120
Triad of preeclampsia (mild)
- HTN >140/90
- Edema
- Proteinuria >300mg in 24-hour urine
121
Blood pressure requirements for a diagnosis of severe preeclampsia
SBP >160 mmHg, OR
DBP >110 mmHg
*On at least 2 occasions at least 6 hours apart with bed rest in between
122
Proteinuria requirements for a diagnosis of severe preeclampsia
> 5g in a 24-hour urine
123
HELLP Syndrome
Severe preeclampsia, plus:
- Hemolysis
- Elevated Liver enzymes
- Low platelets
124
If a patient has preeclampsia with one pregnancy, what is the risk of her developing preeclampsia with subsequent pregnancies?
25-33% risk
125
What drug do we give patients with preeclampsia for seizure prophylaxis and at what dose?
- Magnesium sulfate
| - 4g load and 2g/hour maintenance
126
In the case of magnesium sulfate overdose, what should be given for cardiac protection?
10mL of 10% calcium chloride or calcium gluconate
127
When is RhoGam given to Rh (-) moms?
- 28-29 weeks
| - If baby is Rh (+) at birth, give another dose to Mom at birth
128
Most common cause of 3rd trimester bleeding
Abruptio placentae
129
Classic presentation of abruptio placentae
Painful vaginal bleeding
130
Classic presentation of placenta previa
Painless 3rd trimester vaginal bleeding
131
Painful vaginal bleeding is the classic presentation for what? (During pregnancy)
Placental abruption
132
Painless vaginal bleeding is the classic presentation for what? (During pregnancy)
Placenta previa
133
Complete abortion (definition)
Complete expulsion of all POC before 20 weeks' gestation
134
Complete expulsion of all POC before 20 weeks' gestation
Complete abortion
135
Incomplete abortion (definition)
Partial expulsion of some, but not all POC before 20 weeks' gestation
136
Partial expulsion of some, but not all POC before 20 weeks' gestation
Incomplete abortion
137
Inevitable abortion (definition)
No expulsion of products, but bleeding and dilation of the cervix such that a viable pregnancy is unlikely
138
No expulsion of products, but bleeding and dilation of the cervix such that a viable pregnancy is unlikely
Inevitable abortion
139
Threatened abortion (definition)
Any intrauterine bleeding before 20 weeks' gestation without dilation of the cervix or expulsion of any POC (no loss of fluid or tissue)
140
Any intrauterine bleeding before 20 weeks' gestation without dilation of the cervix or expulsion of any POC (no loss of fluid or tissue)
Threatened abortion
141
Missed abortion (definition)
- Death of the embryo/fetus before 20 weeks' gestation, with complete retention of POC
- Often proceed to complete abortion within 1-3 weeks, but are occasionally retained much longer
142
- Death of the embryo/fetus before 20 weeks' gestation, with complete retention of POC
- Often proceed to complete abortion within 1-3 weeks, but are occasionally retained much longer
Missed abortion
143
Precipitous labor
Labor lasting < 3hours
144
Precipitous delivery
Delivery to a non-sterile field
145
Why do pregnant patients often require iron supplementation?
Because RBC volume increases by 35%
146
Effects of progesterone on the GI system during pregnancy
Progesterone cause smooth muscle relaxation, resulting in:
- Decreased esophageal sphincter tone --> Reflux
- Decreased motility --> Constipation
- Decreased gallbladder contraction --> Increased risk of gallstones
147
Term used for thick, white vaginal discharge
Leukorrhea
148
What causes blurred vision in pregnancy?
Increased thickness of the cornea due to fluid retention
149
What type of antibodies can cross the placenta?
IgG anitbodies
150
Term used to describe the settling of the fetal head into the pelvis before the onset of labor
Lightening
151
What are Leopold's maneuvers used to determine?
- Lie (transverse or vertex)
- Presentation (breech or cephalic)
- Position (facing left or right)
152
Term for failure of the uterus to contract after delivery
Uterine atony
153
What drugs can be given in the case of uterine atony?
- Oxytocin
- Methergine
- Prostaglandins
154
Fourth stage of labor timing
Begins after delivery of the placenta, and ends 2 hours later
155
Difficult labor or childbirth (term)
Dystocia
156
What is it called when the fetal lie is with the head turned to one side?
Asynclitism
157
What is it called when the fetal lie is with one or more limbs prolapsed alongside the presenting part?
Compound presentation
158
At what point is the latent phase of labor considered abnormally prolonged?
> 20 hours in nulliparous patient
| > 14 hours in multiparous patient
159
Definition of arrested labor
- No fetal descent after 1 hour of pushing in a patient with anesthesia
- Descent < 1cm/hour in a patient with no anesthesia
160
Absence of a major portion of the brain, skull, and scalp that occurs during embryonic development
Anencephaly
161
Breech presentation in which the legs are brought up so the feet are near the head
Frank breech
162
Breech presentation in which the legs are crossed beside the bottom (baby is sitting cross-legged)
Complete breech
163
Breech presentation in which one of the legs is extended below the bottom
Footling (incomplete) breech
164
Attempt to rotate the fetus in a breech position to a vertex/cephalic position
External cephalic version (ECV)
165
External cephalic version (ECV)
Attempt to rotate the fetus in a breech position to a vertex/cephalic position
166
Turtle sign
- Associated with shoulder dystocia
| - Head retracts between contractions/pushing
167
- Signs associated with shoulder dystocia
| - Head retracts between contractions/pushing
Turtle sign
168
Positioning/maneuver involving hyperflexing the mother's legs up near her chest in an effort to widen the pelvis and flatten the lumbar spine
McRobert's position/maneuver
169
Bradycardic fetal heart rate
< 120 bpm
170
MCC of fetal tachycardia
Chorioamnionitis
171
Tachycardic fetal heart rate
> 160 bpm
172
Minimal fetal heart rate variability
< 5 bpm deviation from baseline
173
Moderate fetal heart rate variability
Between 6 and 25 bpm deviation from baseline
174
Marked fetal heart rate variability
>25 bpm deviation from baseline
175
White substance covering the baby when he's born to protect him from being in the amniotic fluid for so long
Vernix
176
What antibiotic ointment is applied to the eyes of a newborn if the mother has gonorrhea?
Erythromycin or Tetracycline
177
Normal size of a nonpregnant uterus
60-80 grams
178
Individual sections of the placenta that implant in the uterus
Cotyledons
179
Placental invasion of the superficial lining of the uterus
Placenta accreta
180
Placental invasion into the myometrium
Placenta increta
181
Placenta increta
Placental invasion into the myometrium
182
Placenta accreta
Placental invasion of the superficial lining of the uterus
183
Placenta percreta
Placental invasion through the full thickness of the uterine muscle
184
Placental invasion through the full thickness of the uterine muscle
Placenta percreta
185
What meds can be given to cause uterine relaxation?
Terbutaline, Magnesium sulfate
186
Substance secreted by the breasts in the early postpartum period that contains more minerals and proteins, but less sugar and fat than mature milk
Colostrum
187
How long does colostrum secretion persist?
About 5 days
188
What should happen to hCG levels with a spontaneous abortion?
They should drop by 15% by the next day
189
When should a transvaginal and abdominal ultrasound be able to visualize the pregnancy? (hCG levels, not time)
hCG of 1000-2000 with transvaginal
| hCG of 5000-6000 with abdominal
190
What effect on hCG levels should you see with administration of methotrexate for an ectopic pregnancy?
15% decline between days 4 and 7
191
Ectopic pregnancy candidates for methotrexate therapy
hCG < 5000
Ectopic size < 3.5cm
No cardiac activity
192
Ectopic pregnancy implanted in the proximal tube (what is it called?)
Cornual ectopic
193
Placenta previa in which the entire cervical os is covered by the placenta
Total placenta previa
194
Placenta previa in which the placenta covers a portion of the internal os
Partial previa
195
Placenta previa in which the edge of the placenta reaches the margin of the internal os
Marginal previa
196
Types of placental abruption
Complete, Partial, Marginal
197
MCC of coagulopathy in pregnancy
Placental abruption (clotting factors run low because they're all being used up in the uterus)
198
What is it called when fetal blood vessels are present over the internal os, below the fetus?
Vasa previa
199
Why does HCT normally decrease in pregnant patients?
Because plasma volume expands proportionally greater than that of RBC mass
200
What placental hormone increases insulin resistance?
Human placental lactogen (hPL)
201
What should the 1-hour 50gm glucose challenge test glucose levels be?
< 140 mg/dL
202
When is the glucose challenge test performed?
Between 24 and 28 weeks
203
What should the fasting, 1hour, 2hour, and 3hour glucose levels be in a 3-hour glucose tolerance test?
Fasting: < 105
1-hour: < 190
2-hour: < 165
3-hour: < 145
204
For gestational diabetic patients monitoring their glucose at fasting and 2 hours after meals, what should the values be?
Fasting: < 95
| 2-hour Postprandial: < 120
205
Chronic hypertension (definition as it relates to pregnancy)
HTN present before the 20th week of pregnancy
206
Gestation hypertension definition
HTN that develops after 20 weeks' gestation in the absence of proteinuria and returns to normal in the postpartum period
207
1st line tx for pregnant patients with asthma
Inhaled corticosteroid Budesonide
208
Most significatn cause of morbidity with multifetal gestation
Preterm labor and delivery
209
Describe the chorionicity when zygote divides within 3 days of conception
Diamnionic/dichorionic with either one or two placentas
210
Describe the chorionicity when zygote divides between 4-8 days of conception
Diamnionic/monochorionic
211
Describe the chorionicity when zygote divides between 9-12 days of conception
Monoamnionic/monochorionic
212
What happens if a zygote divides after day 13?
Conjoined twins
213
What chorionicity allows for twin-twin transfusion syndrome?
Monochorionic pregnancies
214
What pathognomic ultrasound findings are associated with gestational trophoblastic neoplasia?
"Snowstorm" and absence of fetal parts or partially developed fetal parts
