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ÅJJB 5th year > OBGYN Nagy Questions > Flashcards

OBGYN Nagy Questions Flashcards

1
Q

Definition of Preeclampsia and Eclampsia

A

After 20th week of gestation

Preeclampsia - BP > 140/90
proteinuria >300mg/24hr

Eclampsia - tonic-clonic seizures

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2
Q

Gestational Diabetes

A

Done in all pregnancies - screen between 24-28 weeks

Healthy = Fasting glucose < 5.6 mmol/L

FG 5.6 - 7.0 mmol/L - Do OGTT
FG > 7.0 mmol/L on 2 separate occasions - GDM

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3
Q

Oral Glucose Tolerance Test

A

OGTT - consume 25g of glucose after fasting

minute 0 <7.0 mmol/L

If <7.8 - 11.1 mmol/L - Impaired Glucose Tolerance (IGT)

If > 11.1 mmol/L - DM

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4
Q

Indications of C- section

A

Maternal-Fetus perspective
- cephalopelvic disproportion
- failed induction of labor

Maternal Perspective
- eclampsia
- cerival cancer
- fibroids, tumor
- herpes

Fetal
- “non-reassuring” fetal HR - bradycardia
- cord prolapse
- Malpresentation
- Multiple gestations

Fetal abnormalities
- hydrocephalus

Placenta
- previa
- abruptio

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5
Q

When is US in pregnancy done

A

week 6-7 - confirm pregnancy
- gestational sac, HR
Location: intra/extrauterine

week 11-13
- congenital malformations
- nuchal translucency (Down’s)
- Neural Tube defects
- Biometrics

week 18-20
- congenital malformations

week 30-31
- IUGR
- late congenital malformations

week 36-38
- fetal presentation
- fetal weight
- information for prep of delivery

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6
Q

Approach to Placental abruptio
and Placental previa

A

use hands to palpate the uterus

abruptio - painful, hard uterus –> C-section

previa - painless, CTG is normal

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7
Q

Post-partum hemorrahge

A

tissue - retain placenta

trauma - vaginal lacerations

thrombin - coagulopathy (DIC)

Tone - uterine atony (need to exclude other causes)

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8
Q

Stages of Birth

A
  1. onset of labor - longest stage
    - latent (3cm)
    - active (3-10 cm)
  2. baby: 30-90 mins
    - propulsive phase - full dilation, descend to pelvic floor
    - expulsion phase - ends with delivery of baby
  3. placenta: 5-30 mins, separation
    - expulsion of placenta
    - expulsion of membranes
  4. Recovery: 2 hours, after expulsion of placenta
    - inc. risk of bleeding
    - repair lacerations
    - RhoGAM - a medicine that stops your blood from making antibodies that attack Rh-positive blood cells
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9
Q

Techniques of C-section

A

Abdominal Wall
- transverse, pfannenstiel
- vertical, midline

Uterus
- lower segment incision - transverse
- classical - vertical

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10
Q

Pearl Index

A

number of pregnancies in 100 females/year with chosen contraceptive

  • OCP: 0.1-2.5
  • Plan B: 0.5 - 2.5
  • IUD 0.5-5
  • Condom 3-28
  • Sterilization 0.3-6
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11
Q

Routine Examiations

A

colposcopy
cytology
bimanual exam
breast exam

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12
Q

Long term OCP use

A

GOOD:
- dec ovarian/endometrial cancer
- dec bone loss
- dec dysmenorrhea
- dec acne
- dec risk of trisomies with inc in maternal age
- regulates cycle

BAD:
- inc DVT/stroke
- inc BP
- inc weight

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13
Q

Endometriosis

A

endometrial like tissue outside the uterine cavity

DX - Gold standard - Laparscopic visualization

TX - surgery
- pseudopregnancy
- pseudomenopause - GnRH analogue

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14
Q

Urinary incontinence

A

irritative:
- urinalysis – cystitis/tumor/foreign body

stress:
- loss of bladder support – cough – urge
- hypertonic – inc detrusor
TX - anticholinergics

overflow/neurogenic:
- hypotonic w/ dribbles
TX - cholinergics

bypass/fistula

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15
Q

Main Vaginal infections

A

bacterial vaginosis
trichomonas
mycosis (Candida)
Condyloma

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16
Q

Spontaneous abortion

A

pain and bleeding

DX: cervix, US, hCG

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17
Q

Contraindications to Tocolysis

A

Obstetric:
- severe abruption
- ruptured membranes
- chorioamnionitis

Fetal:
- lethal anomaly
- fetus has died
- fetal jeopardy

Maternal
- eclampsia
- advanced dilation

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18
Q

Leopold maneuvers

A
  1. Fundal grip
  2. Umbilical grip
  3. Pelvic Grip (first)
  4. Pawlick grip (2nd pelvic grip)
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19
Q

Leopold maneuver - 1. Fundal grip

A
  1. Fundal grip - palpate upper abdomen with both hands
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20
Q

Leopold maneuver - 2. Umbilical grip

A
  1. Umbilical grip - palpate to localize fetal back. One palm fixed, while the other explores one side then change
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21
Q

Leopold Maneuver - 3. Pelvic Grip (first pelvic grip)

A
  1. Pelvic Grip (first) - determine what fetal part is lying above the inlet. grasp the lower portion of the abdomen just above the pubic symphysis with thumb and fingers of the right hand
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22
Q

Leopold Maneuver - 4. Pawlick grip (2nd pelvic grip)

A
  1. Pawlick grip (2nd pelvic grip) - face woman’s feet, attempt to locate fetus’ brow. Fingers of both hands move gently down the sides of the uterus to pubis. The side where there is resistance to the descent of the fingers is greatest where the brow is located.
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23
Q

How to stop uterine bleeding

A

Old - D&C

Young - progesterone – preserve fertility

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24
Q

What is Mayer-Rokitansky-Kuster-Hauser Syndrome

A

i.e. Mullerian agenesis

congenital malformation where the mullerian duct fails to develop
has missing uterus, cervix, vagina
there is a variable degree of upper vaginal hypoplasia (shortened)

causes 15% of primary amenorrhea
ovarias are still intact so ovulation occurs - will enter puberty and have secondary sex characteristics

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25
Pap Smear
P0 - improper sample P1 - Negative, superficial cells on slide P2 - Superficial cells and WBC P3 - unsure P4 - atypical cells -- suspect malignancy P5 - malignancy
26
Bethesda System
Results - reporting of cervical or vaginal cytology from Pap Smear steps: 1. quality of slide 2. whether the result is positive or negative 3. details of the slide - types of cells, LSIL/HSIL 4. physician recommendation on how to proceed
27
Prenatal care
starts before pregnancy
28
Puerperium
period beginning immediately after the birth of child and extends for 6 weeks
29
Neonatal mortality rate
number of neonatal deaths during the first month/1000 live births Early NMR is the first week Late NMR weeks 2-4
30
Perinatal Mortality Rate
number of perinatal deaths (stillbirths and neonatal deaths) from 22 w gestation to 7 w postpartum/1,000 live births
31
How to exclude ectopic pregnancy
measure beta-hCG: 1000 U/L - gestational sac 7,000 U/L - Yolk sac 10,000 U/L - Embryo brown spotting and abdominal pain indicates ectopic pregnancy Check Fallopian tubes beta-hCG doubles every 2nd day of pregnancy
32
Important questions for history taking
previous operations allergy to meds obstetric anamnesis illness, drugs first day of last period - Naegele Rule
33
Naegele Rule
used to calculate the expected date of delivery (due date) First day of the last menstrual period + 7 days + 1 year - 3 months can only be applied if menses are regular and cycle is 28 days Inaccurate if: - The date of the last menstrual period is uncertain or unknown - The patient has irregular menstruation cycles - The patient conceived while taking contraceptive pills
34
Signs of pregnancy Presumptive Signs
Presumptive sign - Chadwick's sign - bluish discoloration of the cervix and vagina due to pelvic vascular engorgement (6th week)
35
Signs of Pregnancy - Probable signs
Probable signs - positive home preg test, uterine and breast engorgement Piskacek sign - soft prominence over the site of implantation Goodell sign - softening of the cervix Hegar sign - softening of the cervical isthmus
36
Signs of Pregnancy - Positive Signs
Positive sign - detection of fetal hemoglobin recognition of fetal movement
37
Location of Bartholin's Cyst
lower 1/3 of labia major
38
Marsupialization of Bartholin's Cyst
cyst opened at the edges and sutured- forming an open pocket
39
Ashermn's Syndrome
adhesions/fiborsis of the uterine cavity usually from D&C reversible infertility
40
Types of anesthetics used in C-Section
determined by urgency of situation vaginal - epidural intrathecial narcosis - emergency c-section
41
Vitamin supplements
preconception - folic acid up to 6 weeks before - 400 microgram/day 2nd trimester - low dose iron and iodine 250 microgram/day
42
FIGO staging for Endometrial cancer 0-I
0: CIS (Carcinoma in situ) I: Limited to the uterus Ia: < 50% myometrial invasion Ib: > 50% myometrial invasion
43
FIGO staging for Endometrial cancer II - III
II: Cervical involvement III: Local spread IIIa: Adnexa/uterine serosa IIIb: Vagina/parametrium IIIc1: Pelvic nodes IIIc2: Paraaortic nodes
44
FIGO staging for Endometrial cancer IV
IV: Metastasis IVa: Bladder/rectal mucosa IVb: Distant metastasis, ascites, peritoneum
45
FIGO staging for Endometrial cancer
0: CIS (Carcinoma in situ) I: Limited to the uterus Ia: < 50% myometrial invasion Ib: > 50% myometrial invasion II: Cervical involvement III: Local spread IIIa: Adnexa/uterine serosa IIIb: Vagina/parametrium IIIc1: Pelvic nodes IIIc2: Paraaortic nodes IV: Metastasis IVa: Bladder/rectal mucosa IVb: Distant metastasis, ascites, peritoneum
46
Vulvar cancer Staging 0 - I
0: VIN I: Limited to vulva/perineum < 2cm Ia: < 1mm stromal invasion Ib: > 1mm stromal invasion
47
Vulvar cancer Staging II - III
II: Extension to adjacent perineum III: Any size + extension to perineal structures with positive inguinofemoral LN IIIa1: 1 LN > 5mm IIIa2: 1-2 LN < 5mm IIIb1: > 2 LN > 5mm IIIb2: > 3 LN < 5mm
48
Vulvar cancer Staging IV
IV: Metastasis IVa: Bladder, urethra, rectum, bone IVb: Distant metastasis (Pelvic LN)
49
Vulvar Cancer Staging
0: VIN I: Limited to vulva/perineum < 2cm Ia: < 1mm stromal invasion Ib: > 1mm stromal invasion II: Extension to adjacent perineum III: Any size + extension to perineal structures with positive inguinofemoral LN IIIa1: 1 LN > 5mm IIIa2: 1-2 LN < 5mm IIIb1: > 2 LN > 5mm IIIb2: > 3 LN < 5mm IV: Metastasis IVa: Bladder, urethra, rectum, bone IVb: Distant metastasis (Pelvic LN)
50
Vaginal cancer Staging
0: VAIN I: Limited to vagina II: Paravaginal invasion w/out extension beyond pelvic side walls III: Invasion of pelvic side wall IV: Metastasis beyond pelvis IVa: Bladder, rectum IVb: Distant metastasis
51
Cervical cancer Staging 0-I
0: CIN I: Limited to cervix Ia: Invasion dx by microscopy Ia1: Stromal invasion < 3mm depth, < 7mm extension (microinvasive) Ia2: Stromal invasion 3-5mm depth, > 7mm extension Ib: Clinically visible lesion Ib1: < 4cm Ib2: > 4cm
52
Cervical cancer Staging II
II: Beyond cervix, NOT pelvic side walls, NOT lower 1/3 of vagina IIa: Involved upper 2/3 of vagina, NO parametrial involvement IIa1: < 4cm IIa2: > 4cm IIb: Parametrial invasion
53
Cervical cancer Staging III
III: IIIa: Lower 1/3 of vagina, NO pelvic wall extension IIIb: Pelvic side wall extension, obstructive uropathy
54
Cervical cancer Staging IV
IV: Metastasis IVa: Bladder, rectum IVb: Distant organs LSIL: Condyloma CIN I HSIL: CIN II CIN III --> In situ --> invasive cc
55
Ovarian cancer Staging I
I: Ovary/fallopian tube Ia: 1 ovary/fallopian tube Ib: 2 ovaries/fallopian tubes Ic: a/b + Ic1: Surgical spill Ic2: Capsule rupture before surgery, tumor on ovary/fallopian tube surface Ic3: Malignant cells in ascites/peritoneum
56
Ovarian Cancer Staging II
II: Pelvic extension/primary peritoneal cancer IIa: Uterus/fallopian tubes IIb: Other pelvic tissues
57
Ovarian Cancer Staging III
III: Cytologically/histologically confirmed spread to peritoneum and retroperitoneal LN IIIa: Retroperitoneal LN, microscopic metastasis beyond pelvis IIIa1(i): Retroperitoneal LN < 10mm IIIa1(ii): Retroperitoneal LN > 10mm IIIa2: Microscopic extrapelvic peritoneal metastasis IIIb: Macroscopic peritoneal metastasis < 2cm IIIc: Macroscopic peritoneal metastasis > 2cm
58
Ovarian Cancer Staging IV
IV: Metastasis IVa: Pleural effusion with positive cytology IVb: Distant metastasis
59
Breast cancer (TNM) Staging T
Tis: DCIS (Ductal Carcinoma in situ), LCIS (Lobular Carcinoma in situ) T1: 2cm - T1mi: 0.1cm - T1a: 0.1cm – 0.5cm - T1b: 0.5cm – 1cm - T1c: 1cm – 2cm T2: 2-5cm T3: > 5cm T4: Metastasis T4a: Chest wall T4b: Skin T4c: Chest wall + Skin T4d: Inflammatory cc
60
Breast cancer (TNM) Staging N
N: Lymph nodes Nx: LN cannot be assessed N0: NO Cancer cells N1: Cancer cells in armpit LN but not stuck to surrounding tissues N2: Stuck to surrounding tissues N3: Cancer cells in LN below collarbone, behind breast bone, above collarbone
61
Breast cancer (TNM) Staging M
M: Metastasis M0: No metastasis M1: Metastasis

ÅJJB 5th year (5 decks)

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