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Obs and gyne Flashcards

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1
Q

Primary amenorrhea

A

Failure of menses to occur by

  • age 16 or 2 years after onset of puberty
  • age 14 without onset of puberty
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2
Q

Secondary amenorrhea

A

Cessation of menses (absent for >3 months or >3 cycles) after menarche as occured

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3
Q

Oligomenorrhea

A

Menses occuring >35 days appart

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4
Q

Most common causes of secondary amenorrhea

A

HPO-axis (stress, exercise, weight loss), PCOS, premature menopause, hypothyroidism, hyperprolactinemia, (antidopamine drugs), pregnancy, Asherman’s, pituitary tumor, Sheehan syndrome

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5
Q

Ovulatory DUB

A

Prolonged progesterone secretion -> excessive bleeding during regular menstrual cycles

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6
Q

Anovulatory DUB

A

No corpus luteum -> no progesterone secretion -> unpredictable bleeding patterns (not cyclic)

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7
Q

PCOS diagnostic criteria (Rotterdam)

A

Chronic anovulation, hyperandrogenism, polycystic ovaries

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8
Q

Cause of primary dysmenorrhea

A

Abnormally high prostaglandin levels

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9
Q

Treatment of dysmenorrhea

A

NSAIDs (ibuprofen, naproxen)

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10
Q

Severe form of premenstrual syndrome

A

Premenstrual dysphoric disorder

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11
Q

Morning after pill

A

Levonorgestrel or ulipristal acetate

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12
Q

Precocious puberty

A

Onset before age 8 in girls and 9 in boys

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13
Q

Delayed puberty

A

If no period by 16 or no signs of puberty (breast development) by 14

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14
Q

Perimenopause

A

From menstrual cycle irregularity (3-5 years before loss of menses) to 1 year after menopause

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15
Q

Menopause

A

1 year of amennorhea

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16
Q

Premenopause

A

4-7 years: early (variable cycle length) and late (2 or more skipped cycles, anovulation)

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17
Q

Vulvovaginitis

A

Bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis

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18
Q

Amsel criteria (bacterial vaginosis)

A

Vaginal discharge, pH above 4,5, clue cells on smear, positive whiff test

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19
Q

Structural causes of abnormal uterine bleeding

A

PALM: polyps, adenomyosis, leiomyomas, malignancy

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20
Q

Functional ovarian cysts

A

Follicular (estradiol), corpus luteum (progesterone) and theca-lutein cysts (androgens)

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21
Q

Ovarian risk of malignancy index (RMI)

A

US score (1 point for multilocus, solid, mets, ascites, bilat.) x menopausal status (1 pre, 3 post) x CA125 levels

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22
Q

Ovarian epithelial tumors

A

Serous cystadenoma, mucinous cystadenoma, endometroid tumor and Brenner/transitional tumor

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23
Q

Ovarian sex-cord stromal tumors

A

Granulosa-theca cell tumor, Sertoli-Leydig cell tumor, thecoma-fibromas

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24
Q

Germ-cell tumors

A

Cystic teratoma, dysgerminoma, gonadoblastoma, endometrial sinus/yolk sac tumor

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25
Treatment of PID
Outpatient: ceftriaxone IM + doxycycline PO + metronidazole PO Inpatient: cefoxitin + doxycycline or clindamycin + gentamycin IV
26
Treatment ectopic pregnancy
Methotrexate 50 mg IM
27
Sexual disorders
Sexual dysfunction, paraphilic disorders and gender dysphoria
28
Causes of virilism/hirsutism
PCOS, Sertoli-Leydig tumor, adrenal tumor, CAH, familial
29
Characteristic histopathological finding of complete molar pregnancy
Hydropic villi, absence of fetal vessels, hyperplasia of trophoblastic tissue
30
Metastatic choriocarcinoma chemo
Methotrexate, actinomycin D, cyclophosphamide, folate, etoposide, vincristine (MAC FEV)
31
Early signs of pregnancy (gyn exam)
Chadwick (congested vaginal mucosa), Hegar (softening at isthmus) and Piskacek sign (soft prominence at site of implantation)
32
Frequency of prenatal care
First at 6-8 GW, every 4th week until 28 GW, every 2nd week until 35 GW, weekly thereafter
33
Naegele's rule
1st day of last mens - 3 months + 7 days (+1 year)
34
First signs of pregnancy
Cessation of menses, pos. UPT, hCG in blood/urine (8-9 days after ovulation), embryo of US
35
Abnormal levels of hCG
Low: ectopic, abortion, inaccurate dates High: multiple gest., molar preg., trisomy 21, inaccurate dates
36
Phases of parturition
Quiescence (progesterone), activation (CRH), stimulation (estrogen), involution (oxytocin)
37
1st trimester genetic screening
US (nuchal translucency), PAPP-A, hCG
38
2nd trimester genetic screening
Triple: hCG, AFP, estriol Quad: + inhibin-A
39
Preeclampsia criteria
Mild: BP 140-149/90-99, proteinuria >300 mg Moderate: BP 150-159/100-109 Severe: BP >160/110, proteinuria >5 g, S&S after 20th GW
40
Primary defect of preeclampsi
Failure of trophoblastic invasion of spiral arteries leaving them vasoactive (normally resistant to vasoconstrictors)
41
Eclampsia + treatment
Tonic-clonic seizure + preeclampsia --> Mg-S, diazepam, labetalol
42
HELLP syndrome
LDH>600 U/L + ASAT/ALAT>40 U/L + PLT <150 G/L
43
Antihypertensives during pregnancy
Alpha-methydopa (1st), nifedipine (2nd), hydralazine (acute management), labetalol, urapidil
44
Hyperemesis gravidarum
Persistent N/V with ketosis and weight loss of >5% of pre-preg. weight
45
Abortion methods
Suction curettage <12 w, dilation and evacuation 12-23 w, medical induction 16-23 w
46
Preterm labor
Contractions (≥4 in 30 min) resulting in cervical effacement of 80% and ≥2 cm dilation, that begins before week 37
47
False labor
Braxton Hicks contractions of mild intensity (10-15 mmHg), lasting 30 sec once per hour
48
Types of uterine dysfunction
Hypotonic uterine dysfunction, hypertonic contractions (colicky uterus, hyperactive lower segment)
49
Causes of dystocia
Power (uterine dysfunction), passage (abnormal pelvis), passenger (abnormal fetal presentation, position and development)
50
Management of shoulder dystocia
HELPERR: call for Help, evaluate for Episiotomy, Legs (McRoberts), suprapubic Pressure (Rubin), Enter (Wood screw), Remove post. arm, Roll pt. on hands and knees
51
Size of contracted pelvis
Inlet: AP<10, transverse<12 Midpelvis: transverse + post. saggital <13,5 Outlet: interischial tuberous dm <8
52
Duration of stages of labor
1st (latent + active phase): 9-11/4,5-5 h 2nd (propulsive + expulsive phase): 50-60/20-30 min 3rd (separation + expulsion phase): 5-15 min (not >30) 4th: 2 h observation
53
Definition of labor
Strong, regular contractions every 10 min or less, leading to progressive cervical effacement of 80% and dilation >2cm
54
Types of obstetric anesthesia
Regional: epidural injection (vaginal delivery), spinal injection (c-section) Local: pudendal block (vaginal), paracervical block (abortion, fetal bradycardia) General: NO 40% (vaginal), thiopental (emergency c-section)
55
Bishop score of cervical effacement
Position, consistency, effacement %, dilation cm, station of fetal head (score 0-3: <6 unfavourable, ≥6 favourable for induction, ≥9 vaginal delivery likely)
56
Methods of labor induction
Membrane sweeping, intravaginal PGE2 (Bishop<6), Foley catheter, laminaria tent, amniotomy, IV oxytocin
57
When and what do give in Rh neg. mothers with Rh pos. fetus
Rh0 immunoglobulin at week 28 and 72 h before delivery or any procedure
58
5 T's of cyanotic heart diseases
Tetralogy of Fallot, Transposition of the great arteries, Tricuspid atresia, Truncus arteriosus, Total anomalous pulmonary venous return
59
Methods of induced abortion (<24 weeks)
<6 weeks: menstrual aspiration or medical (mifepristol + PG/methotrexate) <12 weeks: cervical dilation and evacuation (vacuum/curettage) <24 weeks: medical (laminaria, vaginal PG), oxytocin, curettage
60
Fertility rate
Number of live births/1000 women aged 15-44 years
61
Maternal mortality ratio
Maternal deaths/100 000 live births -> direct, indirect, nonmaternal
62
Stillbirth definition
Infants born >24 weeks or >350 grams with no signs of life
63
Layers of the placenta
Chorion (fetal part formed by extraembryonic mesoderm, cytotrophoblasts and syncytiotrophoblasts) and decidua (maternal part - endometrium)
64
Hormones secreted by the placenta
hCG (preserves corpus luteum), human placental lactogen (anti-insulin effect), estrogen (female sex, uterine growth), progesterone (maintain endometrium)
65
Fetal head diameters
Suboccipitobregmatic, occipitofrontal, supraoccipitomental, submentobregmatic
66
Pelvic shapes
Gynecoid (round, female), android (triangular, male), anthropoid (narrow), platypelloid (wide)
67
The 6 movements of normal labor
Decent, flexion, internal rotation, extension, external rotation, expulsion
68
Hormones of lactation
``` Estrogen: duct proliferation Progesterone: lobular-alveolar tissue Prolactin: galactopoiesis Pitocin and oxytocin: milk secretion Human placental lactogen: breast growth ```
69
Energy content of milk and energy need of infant
60-70 kcal/100 ml | 90-120 kcal/kg/day
70
General principles of surgery in pregnancy
Safest during 2nd trimester, regional analgesia is preferred, treated as if they have full stomach (give citrate and H2R blockers)
71
Rate of weight gain
320 g/w from 8-20 weeks, 450 g/w after 20 weeks, a total of 9-14 kg
72
Iron and folate supplementation during pregnancy
30 mg ferrous iron daily from 2nd TM, 400 mcg folate in periconceptional period (+ calcium, vitamin D)
73
Treatment of UTI in pregnancy
Asympt./UTI: cefalexin, nitrofurantoin (not 3rd TM), trimethoprim (not 1st TM), amoxicillin Pyelonephritis: cefuroxime
74
Timing of US screenings
0. Detection of pregnancy 1. 11+0 - 13+6 (malform., NT, CRL) 2. W 18 (genetic) 3. W 28-32 (IUGR) 4. W 38 (position, size, weight)

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