OBGYN UWorld Flashcards
0
Q
What are early decelerations caused by?
A
- fetal head compression
- not nonreassuring
1
Q
What is the tx of HELLP in a woman >34 wks?
A
-immediate delivery!
2
Q
Pseudocyesis?
A
- psychiatric condition
- woman presents w/ all the ssx of pregnancy, but ultrasound shows normal endometrial stripe and negative pregnancy test
- form of conversion disorder
3
Q
Missed abortion?
A
- ultrasound shows intrauterine collapsed gestational sac + absent fetal cardiac activity
- office pregnancy test will be positive
4
Q
Tx of small HPV lesions?
A
- trichloroacetic acid
- podophyllin
- both tx are in office tx
5
Q
Tx of larger HPV lesions?
A
- Excision
2. Fulguration (electric current)
6
Q
Tx for gonorrhea?
A
- ceftriaxone
- plus tx for co-infection with chlamydia with azithromycin or doxycyline
7
Q
What beta hCG levek is necessary to view gestation sac with transabdominal US? Transvaginal US?
A
- transabdominal = > 6,500
- transvaginal = > 1,500
8
Q
What rate of change of beta hCG is considered normal for a normal pregnancy?
A
- doubling every 48 hours
- slower rise = ectopic pregnancy
9
Q
After what point is a breech presentation probably not going to change?
A
- > 37 wks
10
Q
Major sfx of raloxifene?
A
-increased risk for venous thromboembolism
11
Q
Raloxifene: MOA? Use?
A
- selective estrogen receptor modulator
- increases bone mineral density
- use = prevent osteoporosis
12
Q
Lower pain that radiates to the thighs and back that begins hours before menstruation?
A
- primary dysmenorrhea
- believed to be caused by an increased release prostaglandins during the breakdown of the endometrium
13
Q
Pregnant women and the influenza vaccine?
A
-CDC recommends that ALL pregnant women are vacinated!
14
Q
Tx of syphilis?
A
-penicillin V, even in an allergic pt! (Desensitize and give it to them! )
15
Q
What increases the risk for cervical insufficiency?
A
- Maternal obstetrical trauma
- Past GYN procedures, including LEEP or cone bx
- DES exposure
- Multiple gestation
- Hx of preterm birth or second trimester pregnancy loss
16
Q
Short cervix?
A
-cervix that is below the 10th percentile for gestational age
17
Q
What BPP suggests severe fetal asphyxia? Tx?
A
- biophysical profile score of 2 or less
- tx: immediate delivery
18
Q
What 5 things make up the BPP?
A
- Nonstress test (reactive)
- Fetal tone (flexion or extension of an extremity)
- Fetal mvmnts (at least 2 in 30 min)
- Fetal breathing mvmnts (at least 20 sec in 30 min)
- Amniotic fluid volume (single pocket greater than 2 cm in vertical axis)
- each get a score of 0-2
19
Q
Adipose tissue and estrogen?
A
-adrenal androgens get converted into estrogens by the adipose tissue
20
Q
Cause of hypotension with epidural anesthesia?
A
- blood redistributes to lower extremities and venous pooling occurs
- due to fiber block that results in vasodilation of lower extremity vessels
21
Q
What is the best test for fetal chromosomal abnormalities in the first trimester?
A
-chorionic villius sampling
22
Q
When is chorionic villus sampling typically done? Why?
A
- usually done btwn 10-12 wks
- when done before 9 wks there is a greater risk of distal limb reduction defects
23
Q
2 Major complications of chorionic villus sampling?
A
- Limb reduction defects
2. Fetal death
24
Intrauterine fetal demise?
-death of fetus in utero after 20 wks gestation
25
What should be done after the dx of IUFD? Why?
- Coagulation studies
- to detect DIC
- retention of dead fetus can cause chronic consumptive coagulopathy due to the gradual release of tissue factor from placenta into maternal circulation
- low levels of fibrinogen can be an early sign of consumptive coagulopathy --> tx = delivery!!
26
Tx of chorioamnionitis associated with PPROM?
-broad-spectrum antibiotic tx + delivery of fetus!
27
2 causes of HTN in < 20 wks gestation?
1. Chronic HTN
| 2. Hydatidiform mole
28
What is the most common risk for placental abruption?
-HTN
29
What should be ruled out in any woman of child bearing age with secondary amenorrhea?
-PREGNANCY!!
30
Tx of BV?
-oral metronidazole (in both pregnant and nonpregnant women)
31
Threatened abortion?
- any hemorrhage that occurs before 20th week of gestation w/ a live fetus
- cervix is closed
- no passage of fetal tissue
32
Tx for threatened abortion?
- reassurance and outpt follow up
| - bed rest and abstaining from sexual intercourse is also often reccommended
33
Mittelschmerz?
- midcycle pain
- common w/ regular menstrual periods in women who are not taking birth control pills (ie ovulating women)
- pain is the result of ovulation
- pain occurs 2 wks after the start of the LMP
- usually unilateral pain (on the side of the ovary that produced the ovum)
34
Classic clinical triad for hydatidiform mole?
1. Enlarged uterus
2. Hyperemesis
3. Markedly elevated beta hCG (>100,000)
35
Gold standard for dx of endometriosis?
-laparoscopy
36
What are women with endometriosis at increased risk for?
-infertility or decreased fertility
37
What is the classic triad for uterine fibroids?
1. Dysmenorrhea
2. Heavy menses
3. Enlarged uetrus
38
What is the cause of variable decelerations on fetal heart tracings?
-umbilical cord compression
39
What is the cause of late decelerations on fetal heart tracings?
-uteroplacental insufficiency --> fetal hypoxia -->fetal acidosis
40
What is a primary risk factor for adnexal torsion?
-ovarian enlargement
41
What should be done if atypical squamous cells of undetermined significance are found on cytology in a woman: 21-24 yo? > 25?
- 21-24 = repeat cytology in 1 yr
| - > 25 = HPV DNA test --> if positive = do colposcopy
42
What is the most common cause of mucopurulent cervicitis?
-Chlamydia trachomatis
43
Presentation of androgen resistance?
- Primary amenorrhea
- normally developed breasts
- absent pubic hair
- absent axillary hair
- absent internal reproductive organs --> dont develop bc testes are still present and secrete mullerian inhibiting factor
- 46 XY karyotype
- serum testosterone levels (high, in the range for normal males)
44
What heart defect commonly presents during pregnancy? What is it often due to?
- mitral stenosis --> bc physiologically increased total blood volume
- due to rheumatic fever in the past, seen esp in pts from countries with limited antibiotic access
45
What is the most common cervical cytological abnormality?
-atypical squamous cells of undetermined significance (ASC-US)
46
What is the work-up for atypical squamous cells of undermined significance when they are found on pap smear in ages 21-24?
- HPV testing
- positive = do colposcopy
- negative = repeat smear AND HPV testing in 3 yrs
47
How do pts with androgen resistance present?
1. Amenorrhea
2. Normally developed breasts
3. Absent pubic & axillary hair
4. Absent internal reproductive organs --> testes are present and secrete mullerian inhibiting factor
5. 46 XY karyotype
48
What is the best parameter to use to estimate the fetal weight?
-abdominal circumference
49
What is the single most prevalent preventable cause of FGF in the US?
-smoking cessation!
50
In an eclamptic patient who just had a seizure what is the next step in tx?
-administer mag, then deliver baby
51
2 Recommended tx options for stress incontinence?
1. Kegel exercises
| 2. Urethroplexy
52
What are the 2 first-line agents for tx of HTN in pregnant women?
1. Labetalol
| 2. Methyldopa
53
What is the best way to dx primary syphilis?
-dark field microscopy!
54
FSH & LH levels in anovulation?
-will be normal
55
What is the best screening test for hemoglobinopathies in pregnancy?
- CBC of the mother
| - if abnormal, further testing is required (ex MCV)
56
Tx of mastitis?
1. Analgesics
2. Frequent breastfeeding
3. Antibiotics (that target staph aureus)
57
At what levels of beta HCG can a pregnancy be seen via transvaginal US in the uterus?
-1,500-2,000
58
What does DES increase the risk of?
- clear cell adenocarcinoma of the vagina and cervix in the female offspring if the mother took the drug during pregnancy
- also at risk for cervical anomalies and uterine malformations
59
What are the 2 main causes of back pain in 3rd trimester of pregnancy?
1. Increase in lumbar lordosis
| 2. Relaxation of the ligaments that support the joints of the pelvic girdle
60
What is the reason for anovulation and amenorrhea in lActating mothers?
-high levels of prolactin, which has an inhibitory effect on FSH and LH
61
Most common cause of postpartum hemorrhage?
-uterine atony
62
Describe cervical mucus during ovulation and post and pre?
- during = profuse, clear, thin
| - post & pre = scant, opaque, thick
63
Painful 3rd trimester bleeding w/ normal US?
-think: placental abruption
64
What is the management for intrahepatic cholestasis of pregnancy? Prognosis?
- delivery baby as soon as there is fetal lung maturity
- maternal prognosis = good, resolves shortly after delivery
- baby = risk of prematurity, meconium-stained amniotic fluid, and IUFD
65
What is one situation when solid ovarian tumors do not need aggressive evaluation and tx?
-in pregnancy! = luteoma of pregnancy
66
Luteoma of pregnancy?
- usually bilateral, multinodular, solid masses on both ovaries that can occur during pregnancy
- the result of proliferation of luteinized stromal cells in response to beta HCG
- most commonly seen in multiparous african american women in their 30s or 40s
- can be asymptomatic, or cause hirsutism/virilization
67
3 Steps to working up primary amenorrhea?
1. FSH measurement if there is no breast development
2. Pit MRI if FSH is decreased
3. Karyotyping if FSH is increased
68
What about nausea in pregnancy can make you suspect a missed abortion?
-suspect missed abortion when there is a disappearance of nausea/vomiting early in pregnancy
69
What is a reactive NST?
- when there are 2 fetal heart rate accelerations of at least 15 bpm lasting at least 15 sec each in 20min
- reactive = normal!
70
What should be done if there is a nonreactive NST?
- try vigorously to stimulate/wake the baby
| - if still not retactive, do a biophysical profile
71
What should be done if there are repetitive late decelerations?
-emergent c-section!
72
Tx for mag toxicity?
-stop the mag and give calcium gluconate IV
73
What is a normal biophysical profile score? What should be done for a normal result?
- normal = 8-10
| - if normal, repeat once or twice weekly until term for high risk pregnancies
74
What is the tx of choice for trich?
-metronidazole
75
What should be avoided when taking metronidazole? Why?
- alcohol should be avoided
| - bc can cause a disulfram-like rxn = flushing, nausea, vomiting, & hypotension
76
What are the 3 red flags for nipple discharge?
1. Unilateral
2. Guaiac positive
3. Breast lump
77
What are the 2 lab tests that should be done in the workup for galactorrhea?
1. TSH level
| 2. Prolactin level
78
What is e most common cause of an abnormal alpha-fetoprotein level?
-gestational age error
79
What are the 9 causes of abnormal uterine bleeding in nonpregnant women?
1. Polyp (endometrial)
2. Adenomyosis
3. Leiomyoma (submucosal & other)
4. Malignancy & hyperplasia
5. Coagulopathy
6. Ovulatory dysfunction
7. Endometrial (ex. Infection or inflammation)
8. Iatrogenic (ex. Anticoagulants)
9. Not yet classified
* *PALM COEIN
80
What L/S ratio should steroids be given at?
-less than 2
81
4 lab test that should be done with amenorrhea?
1. Pregnancy test
2. FSH = to r/o ovarian failure
3. Prolactin = evaluate for hyperprolactinemia
4. TSH = evaluate for hyper/hypoTH
