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AIMS > Obs/Gyne Focus > Flashcards

Obs/Gyne Focus Flashcards

1
Q

Define meconium

A

first intestinal discharge of a newborn infant

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2
Q

when does meconium stained amniotic fluid occur? (Green)

A

fetus looses sphinter control bc (1) hypoxia stimulating vagus nerve

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3
Q

Preterm labor occurs btw which weeks? Signs of it?

A

20-37 weeks
Uterine contraction
Effacement of cervix and dilation

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4
Q

4 causes of preterm labor

A

uterine distension (if multiple gestation e.g. triplets or polyhydramnios)
stress
infection/inflammation
placental abruption

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5
Q

Tests for preterm labor

A

fetal fibronectin
CBC
urinalysis
Digital cervix check
US of cervix lenght

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6
Q

Preterm labor general TX

A

corticosteroids for sufactant production in baby lungs
tocolytics (to supress contractons) - nifedipine
MgSO4 - to help baby brain
Antibiotics - ampicillin/gentamicin (to avoid group B strep)

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7
Q

What are leopold manuvers

A

4 abdominal assessment maneuvers to determine position of fetus

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8
Q

What are the stages of labor

A

Stage 1 (latent, active, transition phases) - goal is to dilate and efface cervix
Stage 2 (complete cervical dilation finished and delivery of fetus)
Stage 3 (baby is out and delivery of placenta)
Stage 4 (placenta out, 2 hours of observation)

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9
Q

What is an umbilical cord prolapse?

A

umbilical cord prolapses through cervix - EMERGENCY

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10
Q

uterine rupture lineage of development

A

window - myometrium thinned
dehiscence: endo and myo are ruptured
rupture: endo, myo and perimetrium are ruputred

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11
Q

what is abruptio placentae

A

premature detachment of the placenta from the uterine wall

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12
Q

DX of ectopic pregnant

A

urine HCG
serum progesterone

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13
Q

TX for ectopic pregnancy

A

methotrexate (inhibits growth of embryo)
salpingostomy (salvage fallopian tubes if unruptured)
salpingectomy (removal of tube)

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14
Q

Define HELLP syndrome

A

is a form of pre-eclampsia that develops in 3rd trimester
Hemolysis Elevated liver enzymes Low Platelets

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15
Q

T/F GnRH is released by the hypothalamus in a pulsatile manner

A

T

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16
Q

What is the Graffian follicle

A

the one dominant follicle that becomes chosen for ovulation

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17
Q

The graffian follicle, once stimulated by FSH, releases what and to what effect?

A

It releases estrogen.
Estrogen goes back to the adenohypophysis and inhibits the release of more FSH.
The estrogen also stimulates the increase in LH to peak.
Estrogen causes proliferation of the endometrium.

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18
Q

once the dominant follicle has ovulated, the remaining cells in the ovary are called? They release what and why?

A

Corpus luteum
releases progesterone.
Tells endometrium to stop proliferate, and to differentiate instead into softer/be more nutritious

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19
Q

main risk for endometrial carcinoma?

A

Overproduction of estrogen

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20
Q

what triggeres menses?

A

fall in progesterone levels and consequent ischemia of endometrial layer

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21
Q

before the placenta can produce progesterone on its own (at 8 weeks), who keeps up the progesterone levels necessary to maintain the pregnancy?

A

the trophoblastic cells in the embryo produce hCG

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22
Q

days of follicular phase in menstrual cycle

A

day 1 - 14

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23
Q

LH stimulated the teca cells to do what?

A

to activate production of androgens

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24
Q

FSH acts on granulosa cells to do what?

A

to take the androgens produced by the teca cells and activate aromatase to change androgens into estrogens

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25
Q

T/F the ovary can produce cholesterol ex novo

A

T

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26
Q

Where is AMH produced? What does it signify in females?

A

is produced by granulosa cells in women and sertoli cells in men.
It signifies the reserve of ovarian follicles

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27
Q

Progesterone secretion causes firm mucus or soft, permeable mucus?

A

Firm

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28
Q

Inhibin A is only in women, and its purpose is to stop the further release of FSH from the hypophysis when a dominant follicle has already been selected

A

T

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29
Q

accorciate cycle is called

A

polimenorrhea (cycle <21 days)

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30
Q

allungato cycle is

A

oligomenorrhea (>35 days)

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31
Q

Metrorragia means?

A

hemorrage irregular outside of the cycle

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32
Q

Metrorrhagia examples according to ages

A

Before menarcha: lesions from external bodies or abuse
Menopause: endometrial cancer (<= 5mm is the cut off width for not cancer)
First trimester: ectopic pregnancy, aborto, mola
Third trimester: placental detachment and placenta previa

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33
Q

Primary amenorrhea defintion

A

lack of menses at 14 y/o + no secondary characteristics

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34
Q

secondary amenorrhea definition

A

loss of menses for 6 months in a woman that previously had a normal cycle

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35
Q

causes of primary amenorrhea

A

Cromosomico: Turners syndrome (X0 - female-ish), Klinfelters syndrome (XXY - male-ish)
Gonadico: Sawyer syndrome (gonadic disgenesis pura - appears female-ish)
Fenotipici: Pseudohermapfroitisim; Morris syndrome (XY - insensibile to androgens), Rokistansky (XX - congential aplasia of uterus and 2/3 superior of vagina)

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36
Q

if a woman has PCOS and is amenorrhoic, will she have her mensis if you administer progesterone only?

A

yes

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37
Q

Asherman syndrome

A

occurs when scar tissue forms inside the uterus and/or the cervix. These adhesions occur after surgery of the uterus or after a dilatation and curettage with tuberculosis and schistosomiasis being a less common cause

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38
Q

PCOS hormone elevated is

A

LH

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39
Q

How to diagnose PCOS?

A

prove : (1) ovarian dysfunction (amenorrha/oligomenorrhea, echo)
(2) hyperandrogenism (hirsutism, acne, calvizia or increase testosterone in blood)

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40
Q

PCOS issue is?

A

doesnt have aromatase enzymes.
Give metformin, give estrogen and progesterone pills

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41
Q

what is the scale of hirsutism?

A

Score of Ferrimana nd Gallwey
if >8 points its positive

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42
Q

metaplastic theory of endometriosis

A

in the presence of an inflammatory estrogenic stimulus it produces endometrial tissue

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43
Q

Chocolate cysts for endometriosis is seen on

A

not on echo (is seen ground glass)
on laparoscopy

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44
Q

right and left ovarian arteries originate from

A

aorta

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45
Q

the uterine arteries originate from

A

anterior visceral branch of the internal iliac artery

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46
Q

the lymphatic vessels of the superior third of the vagina drain directly into

A

iliac lymph nodes

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47
Q

order of incidence of gynecological tumors

A

MECOV
mamella
endometrium
cervix
ovary
vulva

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48
Q

Types of endometrial cancer

A

Type 1: adenoK, 85% of cases, hormone dependant, has endometrial hyperplasia, good prognosis

Type 2: most commonly serous or serous papillary, bad prognosis

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49
Q

risk factors for endometrial cancer

A

estrogens (precocious puberty, late menopause)
obesity
tamoxifene

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50
Q

levels of prevention

A

priamry: vaccinations (avoid entire pop from encountering the RF)
Secondary: screening (for the pop already exposed to the RF)
Third: follow up

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51
Q

Does endometrium cancer have screening? How to diagnose?

A

no screening
DX: hysteroscopy with biopsy

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52
Q

stages of endometrial cancer

A

Stage 1: only uterus
- 1a: with myometrium infiltration <50% (ONLY STAGE WHERE YOU CAN GIVE CONSERVATIVE TX)
-1b: >50%
Stage 2: uterus and cervix
Stage 3: local invasion
Stage 4: metastatis to bladder and rectum

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53
Q

what histotype of ovarian tumor is most frequently correlated to ovarian endometriosis

A

clear cell tumor and endometriod tumor

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54
Q

most common RF for cervical cancer

A

HPV 16 18
E6 E7 virus changes

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55
Q

screening of cervical cancer

A

from 25 years - 30 years: pap test ogni 3 anni
above 30 -65: HPV test ogni 5 anni
If HPV positive: PAP test next. PAP positive: go to colposcopia with biospy
LSIL or CIN1 regrades by itself or HSIL (CIN2/CIN3) needs conisation. – Bethesda systme for reading

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56
Q

most common ovarian cancer

A

epithelial

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57
Q

what is IOTA

A

international ovarian tumor analysis
A system to classify ovarian cysts according to echography

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58
Q

RMI or risk of malignancy index for ovarian cancer includes

A

age
ecography (IOTA)
Ca125

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59
Q

ovarian cancer therapy

A

surgery
carboplatin and toxolo with CHEMOtx that is always done after surgery
PARP inhibitor for maintenance

60
Q

At what stage of meiotic divsion do oocytes stop before ovulation

A

Prima prophase
(after ovulation it stops in second metaphase until fecondazione)

61
Q

what day is considered the start of pregnancy

A

the first day of the last menstruation

62
Q

the umbilical cord contains

A

2 umbilical arteries and one vein, with Wharton gelatin

63
Q

T/F hcg is first high in the blood, then in the urine

A

T

64
Q

hCG is a glycoprotein

A

T

65
Q

where is DHEAS produced

A

surrene fetale

66
Q

Bartolin glands is for?

A

is a gland (not visible, not palpable) at the vulvar lesion. Responisible for lubrification during sex.
Can be obstructed (cyst, abscess, carcinoma of Bartolin - adeno K)
TX: drenaggio

67
Q

Veginal dryness is often due to a deficiency of what hormone?

A

estrogen (often in menopause)

68
Q

uterine cervix parts (seen on colposcopy plus biopsy)

A

endo cervix: Has cyclindaral monostratitfed with glands

Junction squamous columnar - most sensitive to HPV

exocervix: squamous cells, not keratinised

69
Q

validity of a colposcopy is based on 3 hours

A

adequacy (no period, no leukorrhea)
visibility (must see the squamocolumnar junction)
describe the zone of transformation

70
Q

The uterus, the fallopian tubes and the upper third of the vagina all originate from the

A

Muller duct
(note that the ovaries have another origin)

71
Q

the external iliac artery supplies?

A

thigh

72
Q

internal iliac a divides into anterior (visceral) and posterior, which further divide into

A

anterior (visceral): Vescicale superior, vesciale inferior, vaginale. Obturator, ombelicale, uterine artery

73
Q

gluteal superior and inferior arteries origins

A

gluteal inferior comes from inferior branch of internal iliac
gluteal superior comes form posterior branch of the internal iliac

74
Q

define infertility

A

inability to get pregnant after 1 year of unprotected sex

75
Q

IUI means?

A

insemination intrauterine - take seminal fluid, concentrate it, put it in the opening of the cervix.
Is first line option.

76
Q

FIVIT stands for

A

fecondazione in vitro
implant blastocyst in the uterine

77
Q

IC SI stands for?

A

intra cytoplasmatic sperm injection

78
Q

contraception methods

A

natural: mucus, body temp
Barrier: condom, IUD
Hormonal: the pill (combined, or only progesterone)

79
Q

combined contraceptive options

A

(a) the pill
(b) the anello cervicale
(c) cerotto (transdermic)

80
Q

Index of pearl is

A

the number of unplanned pregnancies DIVIDED BY the number of cicli di esposizione
- the efficiency of contraception is inversely proportional to the pearl index

81
Q

Most efficient to least methods of contraception

A

1- steralisation
2- E+P pill, anello vaginale, cerotto
3- IUD, minipill (P), implant
4- condoms
5- mucus, temp, cycle monitor
6- interrupted orgasm

82
Q

contraindications to E+P contraception

A

pregnancy
liver disease
Malattia vascolare
K ormonodipendente
IPA
Fumo
emicrania con aura
DM con vasculopatia
trombofilia nota

RELATIVE CI:
emicrania
depression
DM
IPA cronica
dislipidemia

83
Q

what tumors are associated with oral contraceptive use?

A

hepatic adenoma

84
Q

Absolute contraindications for IUD implantation

A

the mechanism of IUD is to induce local inflammation
- past PID, ectopic pregnancy, or pain/hypermenorrhea

85
Q

Emergency contraception steps

A

Levonorgestin (within 72 hours of sex)
ilipristal acetate (within 120 hours of sex)
mifepristone: induce abortion (PGI activator)

86
Q

what drug is smeared in IUD?

A

levonorgesten

87
Q

T/F expiration volumes are reduced in pregnance

A

T

88
Q

T/F hCG causes nausea?

A

T
(note moles produce more hCG than normal pregnancy)

89
Q

Increase the cardiac gittata, si riducono le resistenze vascolari, aumenta il volume ematico

A

T

90
Q

Ecografia of the first trimester shows you

A

(at the 11-13 +6 wks)
camera gestazionale intrauterina
numero e vitalita degli embrioni
BCF (HR)
CRL (cranio-caudal lenght)
malformativa grave
annessiali/uterina patologica

91
Q

Ecographia of the 2nd trimester shows you

A

(done 19-21 +6 weeks)
Done to exclude severe malformations

92
Q

Ecografia of the 3rd trimester

A

(done 32-34 weeks) - aka flussiometry
- not compulsory, only in pts with risk of slow growth
- check presentation, placenta, crescita fetale, liquido amniotico

93
Q

screening of fetal malformation

A

ecografia
dosage of alfa-fetoprotein

94
Q

test combinato del primo trimestre includes

A

valutazoine biochemica: PaPP-A, free B-hCG
Ecografia: nuchal transparency
Mother’s age
(if risk > 1/250 then do invasive imaging)

95
Q

villocentesis is more risky than amniocentesis

A

Yes (1%)

96
Q

ecografia signs for downs syndrome

A

golf ball in the heart
no nasal bone
elevated nuchal transparency

97
Q

is the DNA fetal test diagnostic?

A

No
lets you see trisomy 21, 13, 18
Can be done before villocentesis (from 11 wks onwards, or amniocentesis from 14 weeks onwards)

98
Q

tests to check for fetal wellbeing are

A

CTG cardiotocography basal (non stress test)
test di contrazione (di Pose)
pH fetale intraparto
Pulsiossimetria fetale intraparto

99
Q

CTG tests

A

for 20 mins
fetal heartbeat (110-160bpm)
contraction of the uterine

100
Q

What is variablity on a CTG

A

the difference, during a minute, between two peaks which must be at least 5.
>= 5 is normal
<5 bpm for >=40 mins is non rassicurante
<5 for >=90 minutes is anormale!

101
Q

what are accelerations on a CTG

A

the increase of FCF >=15 bpm for >= 15 seconds - are a good sign, Must be at least 2 accelerations in 20 mins

102
Q

the three types of deceleration in CTG

A

(1) Type 1 (precoci): the peak of deceleration coincides with the peak of the contraction. is a vagal reflex of the fetus
(2) type 2 : (tardive) the peak of deceleration is after the peak of contraction
(3) Type 3 (variable) for cord compressions

103
Q

when can you order a induction of labor based on ECG

A

if you have an alteration of parameters or repeated decelerations on CTG

104
Q

in a woman with regular cycles, main cause of bleeding in between cycles are

A

fibromatosis and polyps

105
Q

Mola means

A

malattia trofoblastica gestazionale

106
Q

T/F mola vescicolare in 80% of cases cures spontaneously

A

T

107
Q

Mola idatiforme occurs because of

A

Mola idatiforme (has risk of giving malattia trofoblastica persistente MTP or metastatica)
forms due to a genetic defect at moment of fertilisation

108
Q

complete vs incomplete mole

A

complete: empty ova meets sperm cell
incomplete: one ova meets two sperm

109
Q

diagnosis of mole

A

bHCG>100 mila
Eco: fiocchi di neve o grappolo d’uva, citi ovarivhe, no sacco gestazionale
biochemica: fegato, rene, tiroide
RX torax: edema polmonare

110
Q

TX for mole

A

hysterectomia
raschiamento (<40 y/o)
RX torace
avoid pregnancy in the next year

111
Q

When is placenta previa diagnosed?

A

from the beginning of the routine ecographia.
Is a placenta implanted near the inferior uterus opening
Placenta forms from the 5th week and 5th month of pregnancy onwards

112
Q

classification of placenta previa

A

centrale: if it covers the orifizio uterino interno (complete or incomplete)
marginale: found within 3 cm from the border of the orifice uterine interno
laterale: found more than 3 cm from the uterine border

113
Q

RF for placenta previa

A

mother >35
pluriparti
previous cesarean
curettage of the uterus

114
Q

presentation of placenta previa

A

bright red blood bleeding
no pain
no ipertono uterino
no fetal suffering (variable)

115
Q

TX of placenta previa

A

if <34 weeks: light bleeding (wait+corticosteroids). Severe bleeding (cesarean)
If >34 weeks : light bleeding (if central/marginal PP then schedule cesarean, if lateral then natural birth).
Severe bleeding: cesarean

116
Q

distacco di placenta bleeds

A

dark coagulated blood, pain, fetal suffering (bradycardia)

117
Q

what is puerperale emorrhagia?

A

the first cause of death in obstetrics
>500 ml of blood

118
Q

What is the most common cause of post partum hemarrhage within the first 24 hours
after the first 24 hours: residual remains of the placenta in the uterus (need raschiamento)

A

Atonia uterina
(other common causes are: 4 T’S: tono, trauma, trombina, tessuto placentale)

119
Q

what are he main causes of atonia uterina?

A

stressed myometrium: over expansion of myometrium, etc

120
Q

TX of atonia uterina

A

massage
oxytocin
legatura dei vasi uterini (or balloon)
hysterctomy

121
Q

what drugs induce contraction of uterine

A

oxytocin
ergometrina (cant use in pre-eclampsia cases)
sulprostone

tocolytics (aka atosiban: are RELAXORS!!)

122
Q

define preterm labor

A

contractions (>6/hour for at least 2 hours) with modicatins of the uterine cervice (raccrociamento (is <2 cm on eco) and dilation)

123
Q

diagnose braxston hicks

A

> 6 contractions/hours for 2 hours with pain, and lasting more than 30s
NO CERCIX CHANGES

124
Q

TX of threats of preterm labor

A

<24 weeks: wait/high risk of abortion
>34 weeks: deliver
between 24 and 34 weeks: do echo, check cervix lenght (if <2cm - ricovera pz for incoming birth). Do fibronectin test (if + wait, if -ve wait.)
- corticosteroids for baby lungs (betamethaosne 12mg every 24 hours in 2 somministrazioni) (dexamethasone 6mg ogni 12 ore in 4 somministrazioni)
- Mg for baby brain
- antibiotics if needed
- tocolytics: to slow contractions - atosiban, ritodrina, nifedipine, indomethacin

125
Q

T/F when there is an opening of the membranes, tocolytics are NOT ALLOWED

A

T

126
Q

define premature rupture of membranes

A

rupture before the start of the travaglio (labor), indipendant of the epoca of gestasion

127
Q

TORCH infections in pregnancy

A

toxoplasmosis
others
rosolia (most dangerous)
CMV
HSV

128
Q

greg triad of fetal danni that manifest with a maternal infection of rubeola

A

sordita sensoriale
problemi oculari
problemi cardiaci

129
Q

fetal manifestations when mother contracts toxoplasmosis

A

tetrad of sabin
hydrocephalus
corloretinite
intracranial calcifications
mental retardation

130
Q

CMV fetal manifestations if materal infection occurs

A

microcephalus
hydrocephalus
periventricular calcifications

131
Q

the hodge plains are

A

Hodge’s system of parallel pelvic planes is conventionally used to determine the fetal head height. Hodge’s system subdivides the region from the pelvic inlet to the tip of the coccyx into three equidistant parallel planes

132
Q

how to define dystocia of the shoulder

A

more than 60 seconds of difference between the expulsion of the fetal head and fetal shoulders

133
Q

mcrobets manuver

A

This is commonly the first maneuver performed along with suprapubic pressure. The patient’s thigh is hyper-flexed towards the abdomen. This will straighten the maternal sacrum on the lumbar spine.

134
Q

can you use heparin in pregnancy?

A

yes, bc it doesnt pass the placental barrier
also insulin
Vaccines that can’t be used in pregnancy are: morbillo, rosolia, poliomelitite, parotidite, varicella, febbre gialla

135
Q

two types of anesthesia for labor

A

epidural: before labor, many doses
spinal: is deeper, in the subarachnoid space. One single dose, during labor

136
Q

inducing labor how

A

prostaglandin vaginal: misoprostolo
oxytocin
amniorexi
Fail of induction: when you cant induce labor even after 12 hours of oxytocin administration and ruptured membranes

137
Q

sniff test lets you diagnose?

A

vaginosi batteria - fish smell (gardenerella)
TX with metronidazole

138
Q

trichomonas infections of cervix appears as

A

cervicite a fragola

139
Q

PID therapy

A

cerftriaxone 500mg single dose IM
doxycyclinexos for 14 days
metronidazole per ox 14 days

140
Q

Anna discovers she is pregnant, goes to her gynecologist for the first screening visit, she is obese and has a fasting blood sugar level of around 120mg/dl. The next step that the patient will have to follow is

A

Perform an OGTT at 16-18 weeks. Being a high-risk patient, she will have to carry out a glucose load of 75 g at 16-18 weeks of gestation

141
Q

Ritodrine, a b2 agonist. Is used in preterm labor bc it is a

A

tocolytic

142
Q

Abundant, liquid leucorrhoea is a typical symptom of

A

bacterial vaginosis
The typical vaginal discharge is a white, milky, non-viscous discharge, which is adherent to the vaginal wall and has a fishy odour. The pH of the discharge is >4.5.
Metronidazole 400mg 2/die for a week

143
Q

Which is the predominant class of immunoglobulins in colostrum?

A

igA

144
Q

Taking vitamin A derivatives during pregnancy can lead to neural tube defects and skeletal abnormalities.

A

T

145
Q

vulvar lesions in this way: “large rounded cells, without cell bridges”. Among the clinical information you can read: red, itchy lesions. What do you suspect?

A

The clinic and histological characteristics allow us to diagnose vulvar Paget’s disease. Precisely those large cells without cell bridges are called Paget cells. Treatment is simple vulvectomy.

146
Q

Laparoscopy shows, on the left, an indistinct fallopian tube embedded in a 5 cm circumscribed, brownish-red mass involving the adnexal region. Which of the following infectious agents is most likely associated with these signs?

A

Sexually transmitted diseases are the most common cause of inflammation of the fallopian tubes.
Chlamydia trachomatis

147
Q

The sniff test is able to identify:

A

gardenella vaginalis

AIMS (18 decks)

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