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OBGYN > Review > Flashcards

Review Flashcards

1
Q

Bartholin cysts are located where?

A

4 and 8 o’clock

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2
Q

What does Estrogen do?

A

Thickens the endometrium

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3
Q

What does Progesterone do?

A

Maintains pregnancy and prevents endometrial sloughing and miscarriage

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4
Q

What does Prostaglandin do?

A

Contract the uterine causing endometrial ischemia and uterine cramping

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5
Q

During the follicular phase there is a a spike in what hormone?

A

Estrogen

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6
Q

Ovulation occurs on what day of cycle?

A

Day 14

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7
Q

During the luteal phase there is a spike in what hormone?

A

Progesterone

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8
Q

What is the phases of the uterine cycle?

A
  • Menstrual phase
  • Proliferative phase
  • Secretory phase
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9
Q

What structures are apart of the adnexa?

A

Fallopian tubes and ovaries

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10
Q

KOH (potassium hydroxide) is a dx test used for what?

A

Vulvovaginal Candidiasis

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11
Q

What are the risks of breast cancer?

A
  • > 50 yo
  • 1st degree relatives
  • postive BRCA1 and BRCA2
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12
Q

Is BRCA 1 or 2 associated with early onset of breast cancer and ovarian cancer?

A

BRCA 1

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13
Q

Medullary carcinoma (breast cancer) is MC in who?

A

Younger women and women with BRCA1

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14
Q

Where is breast cancer MC’ly located?

A

Upper outer quadrant

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15
Q

What age do you start screening (pap/hpv) for cervical cancer?

A
  • Age: 21-39 pap q3 yrs
  • Age: 30-65 Pap + HPV, q 5 yrs or pap q3 yrs
  • Age: >65: not needed
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16
Q

When do you give a pt the HPV vaccine?

A
  • 1st at age 11-12 yo

- catch up: 13-26 yo

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17
Q

When do you do mammograms?

A
  • Every yr starting at age 40 or high-risk pts
  • Every 1-3 yrs for women age 20-39 yo
  • Every other yr for women age 50-74
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18
Q

When do you do a colonoscopy, FIT/FOBT and sigmoidoscopy?

A
  • Colonoscopy: starting at age 50, then every 10 yrs
  • FIT or FOBT: annual
  • Sigmoidoscopy: every 5 yrs
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19
Q

What is the MC menopause complaint?

A

Sleep disturbances

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20
Q

What is the MC GYN cancer?

A

Breast cancer- Infiltrating ductal carcinoma

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21
Q

What GYN cancer has the highest mortality?

A

Ovarian cancer

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22
Q

What are S/Sxs of candidiasis?

A
  • Thick, curdy, white d/c
  • <4.5
  • KOH odor: Negative
  • Wet mount: WBC, Spores, hypae
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23
Q

What are txs for candidiasis?

A 
Topical or vaginal suppository OTC:
- Miconazole
- Clotrimazole
Rx:
- Fluconazole 
- Boric acid-fatal if swallowed
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24
Q

Ovulation occurs when?

A

30-36 hrs of LH surge

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25
Q

What are S/Sxs of trichomoniasis?

A
  • Frothy, green/yellow d/c
  • > 5
  • KOH odor: Positive
  • Wet mount: WBC, Motile, Trichomonas, flagella
  • Exam: petechia/strawberry patches
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26
Q

What is the tx for trichomoniasis?

A
  • Metronidazole

- Tinidazole

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27
Q

What is the S/Sxs of bacterial vaginosis?

A
  • Thin, white, gray d/c
  • > 4.5
  • KOH odor: positive “whiff cells”
  • Wet mount: few WBC, clue cells
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28
Q

What is the tx for bacterial vaginosis?

A
  • Metronidazole

- Clindamycin

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29
Q

What is the tx for PID caused by Gonorrhea?

A

Ceftriaxone or Cefixime

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30
Q

What is the tx for PID caused by Chlamydia?

A

Azithromycin or Doxy

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31
Q

What is PID also known as?

A

Salpingitis

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32
Q

What is the MC location for an ectopic pregnancy?

A

Fallopian tubes

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33
Q

What are some risk factors for ectopic pregnancy?

A
  • Non white
  • > 35 yo
  • untreated PID
  • hx of STI
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34
Q

What is the classic triad for ectopic pregnancy?

A
  • Amenorrhea
  • Pain
  • Vaginal bleeding
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35
Q

What are classic findings for malignant breast cancer?

A
  • Hard
  • Painless
  • Irregular edge
  • Fixation to skin or chest wall
  • Dimpling of skin
  • Unilateral bloody nipple d/c
  • Nipple retraction
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36
Q

What are classic findings for benign breast cancer?

A
  • Smooth, rubbery
  • Painful
  • Well-defined
  • Easily moves under skin
  • Green/yellow nipple discharge
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37
Q

What are the top 3 MC breast cancer?

A
  1. Invasive ductal carcinoma
  2. Invasive lobular carcinoma
  3. Medullary carcinoma
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38
Q

What mammogram finding is most concerning?

A

Speculated

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39
Q

What is mastitis?

A

Infection of breast tissue

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40
Q

What is the cause of mastitis?

A

Staph aureus

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41
Q

What is the tx for mastitis?

A
  • Antibiotics
  • Cont. breast feeding, safe in full term healthy babies
  • Cessation of breast feeding then pump
  • w/o emptying the breast the resolution will be delayed and painful with increased engorgement
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42
Q

What should you think if you treat a pt with mastitis but sxs persists?

A

Mastitis w/ abscess

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43
Q

What does bloody nipple d/c indicate?

A

Intraductal papilloma

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44
Q

What does green/brown nipple d/c indicate?

A
  • Mammary duct ectasia

- Fibrocystic breasts

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45
Q

What does milky nipple d/c indicate?

A

Galactorrhea

- Drug related, thyroid, prolactinoma

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46
Q

What does purulent nipple d/c indicate?

A

Acute mastitis

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47
Q

What is Adenomyosis?

A

Endometrial glands and stroma extend into the uterine musculature

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48
Q

What are S/Sxs of Adenomyosis?

A
  • Heavy prolonged bleeding
  • Dysmenorrhea
  • Cramps through menses, worsen when you get older
  • Large blood clots
  • Dyspareunia
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49
Q

What are leiomyomas?

A

Benign tumors derived from smooth muscle cells surrounded by pseudocapsule or compressed muscle fibers
- MC in AA women and 5th decade of life

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50
Q

What is the MC leiomyoma?

A

Fibroids

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51
Q

What are S/Sxs of leiomyomas?

A
  • MC: abnormal uterine bleeding, usually heavier
  • Iron def anemia
  • “something pressing down”
  • Urinary or defecation problems
  • Secondary dysmenorrhea
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52
Q

What are PE findings of leiomyomas?

A

Feels “hard” or solid quality; “lumpy-bumpy”

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53
Q

What is endometriosis?

A

Endometrial gland and stroma grow outside the uterine cavity

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54
Q

What is the S/Sxs of endometriosis?

A
  • Progressive dysmenorrhea
  • Progressive dyspareunia
  • Dyschzia
    “3 Ds”
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55
Q

What is a cause of endometriosis?

A

Retrograde menstruation

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56
Q

What is retrograde menstruation?

A
  • Fragments of endometrium pass through fallopian tubes to pelvic cavity
  • Once in pelvic cavity tissue implants on peritoneal surface, growing into endometriotic lesions
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57
Q

What is a classic finding of endometriosis during direct visualization?

A

Chocolate cysts

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58
Q

PCOS is due to what?

A

Hyperandrogenism

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59
Q

What are S/Sx of PCOS?

A
  • Hirsutism
  • Anovulation or oligo-ovulation
  • Obesity
  • Metabolic syndrome: insulin resistant
  • Increased acne
  • Infertility
  • Irregular menses
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60
Q

What is seen on the US in a pt with endometriosis?

A

“necklace” or “string of pearls”

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61
Q

What are S/Sxs of ovarian torsion (ischemic condition)?

A
  • Sudden onset severe unilateral lower abdominal pain

- Pain may occur after exertion

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62
Q

What is the hallmark finding during PE for a pt with ovarian torsion?

A

Tenderness

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63
Q

What is the Dx test and Tx for ovarian torsion?

A

Dx: Doppler US
Tx: Surgical emergency

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64
Q

What is the definition of infertility?

A

Failure of a couple to conceive after 12 mos of frequent, unprotected intercourse

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65
Q

What vaginal changes occur during menopause and what is the tx?

A
  • Vaginal changes: atrophy

- Tx: topical estrogen

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66
Q

What is the difference between primary and secondary amenorrhea?

A
  • Primary: has never had a period

- Secondary: have period and then doesn’t have one

67
Q

What is the criteria for secondary amenorrhea?

A
  • Absence of menses for >3 cycle intervals

- Absence of menses for 6 consecutive mos

68
Q

What is the MCC of amenorrhea?

A

Pregnancy

69
Q

What lab test are drawn for amenorrhea?

A
  • FSH
  • LH
  • Prolactin
  • TSH
70
Q

What is S/Sxs of primary dysmenorrhea?

A
  • Painful uterine muscle activity
  • Lower abdominal pain
  • SP pain
  • Intermittent pain
  • N/V/D
  • Fatigue
  • HA
71
Q

What is the PE finding and tx for primary dysmenorrhea?

A
  • PE: normal

- Tx: NSAIDs, heat, exercise, psychotherapy

72
Q

What are the S/Sxs for secondary dysmenorrhea?

A
  • caused by an identifiable cause
  • Pain persists after menses
  • Pain starts before menses
  • Gets worse before it gets better
73
Q

What are the Dx and Tx for secondary dysmenorrhea?

A
  • Dx study for suspected underlying disease

- Tx: treat underlying disease

74
Q

What is menorrhagia?

A
  • Regular flow, excessive flow or long duration

- “gushing” or “open faucet” bleeding

75
Q

What is metrorrhagia?

A
  • Irregular cycles

- Intermenstrual bleeding

76
Q

What is menometrorrhagia?

A
  • Irregular cycles
  • Excessive flow
  • Duration varies
77
Q

What is polymenorrhea?

A

Menses occurring too frequently <21 days

78
Q

What is oligomenorrhea?

A
  • Menses >35 days apart

- Bleeding usually decreased in amount.

79
Q

What is PMS?

A

Cyclic occurrence of sxs that are sufficient severity to interfere with some aspect of life and appear to be consistent and predictable in relationship to the menses

80
Q

What are S/Sxs of PMS?

A

1 affective sx:
- Depression, angry outburst, irritability, confusion, social w/d
1 somatic sx
- Mastodynia, bloating, HA

81
Q

What is the tx for PMS?

A
  • < caffeine, EtOH, tobacco, chocolate, sodium
  • Stress management, CBT, exercise
  • Meds: fluoxetine, sertraline, SSRIs, hormonal interventions
82
Q

When does spontaneous abortion occur?

A

<20 wks gestation

83
Q

What is the MCC of first trimester spontaneous abortion?

A

chromosomal anomalies

84
Q

What is the management for 1st trimester abortion?

A

D and C and emotional support!

85
Q

What is the MCC of 2nd trimester abortion?

A

pathological (can be treated)

86
Q

What is the management for 2nd trimester abortion?

A

D and E and emotional support!

87
Q

If pt has a hx of recurrent pregnancy lost what procedure can be done?

A

cervical cerclage procedure

88
Q

What is complete abortion?

A
  • Spontaneously passes all the produce of conception

- Closed cervical os

89
Q

What is incomplete abortion?

A
  • Internal cervical os opens and allows passage of blood and some tissues
  • Some retained placental tissue remains in cervical canal
  • Suction curettage may be needed to remove remaining POC
90
Q

What is threatened abortion?

A
  • Bleeding in 1st trimester w/o loss of fluid or tissue

- Closed cervical os

91
Q

What is inevitable abortion?

A
  • Vaginal bleeding and/or gross rupture of membranes in the presence of cervical dilation
  • Uterine contractions
  • No expulsion of POC
  • Open cervical os
92
Q

What is the effects of valproic acid on pregnancy?

A

NT defect- spina bifida

93
Q

What are the effects of warfarin on pregnancy?

A
  • Nasal and midface hypoplasia
  • Stippled femoral and vertebral epiphysis (focal bone calcification)
  • Later exposure: hydrocephalus
94
Q

What are the effects of EtOH on pregnancy?

A

Fetal alcohol syndrome:

  • Growth restriction
  • DNX dysfunction (microcephaly, mental retardation)
  • Behavior disorders
  • Facial abnormalities (low set ears, midfacial hypoplasia, shortened palpable fissures, thin upper lip)
95
Q

What are the effects of Tobacco on pregnancy?

A
  • Low birth weight
  • Intrauterine growth restriction
  • Fetal mortality
96
Q

What are the effects of tetracycline (doxy) on pregnancy?

A

Discoloration of deciduous teeth

97
Q

What are the effects of phenytoin on pregnancy?

A
  • Abnormal facies, cleft lip/palate
  • Microcephaly
  • Growth defects
98
Q

What are the effects of retinoids (accutane) on pregnancy?

A
  • Fetal loss

- Congenital malformation

99
Q

What are the effects of Lithium on pregnancy?

A

Cardiac defects- Ebstein anomaly (tricuspid valve defect and large right atria)

100
Q

Pt who is of eastern Europe decent is at high risk for a variety of genetic disorder, what test do you run?

A

Ashkenazi Jew panel

101
Q

What is molor pregnancy also known as?

A

hydatidiform mole

102
Q

What is molar pregnancy?

A
  • Neoplasm resulting from abnormal placental development w/ trophoblastic tissue proliferation derived from gestational tissues.
    “Tumor pregnancy”
103
Q

What are the S/Sxs of molar pregnancy?

A
  • Painless vaginal bleeding
  • Uterine size/date discrepancies
  • Hyperemesis gravidarum
104
Q

What can occur d/t molar pregnancy?

A

Choriocarcinoma

-Mets to lungs is MC

105
Q

What is seen on a US in a pt with molar pregnancy?

A

snowballs/snowstorm, cluster of grapes

106
Q

What are S/Sxs of hyperemesis gravidarvum ?

A
  • Severe, excessive morning sickness
  • Weight loss
  • Significant fluid/electrolyte imbalance
  • Extends beyond 16 wks
107
Q

What is the tx for hyperemesis gravidarum?

A
  • Hospitalization required: IV fluids and electrolyte correlation
  • Antiemetics: pyridoxine (B6) + doxylamine
108
Q

What is the biggest difference between hyperemesis and morning sickness?

A

Hyperemesis requires hospitalization and fluid resuscitation.

109
Q

How and when do you screen for maternal DM?

A
  • Screen with 50 grams 1 hr glucose tolerance test at 24-28 wks
  • Abnormal results (>130-140): fasting 100mg 3 hr glucose tolerance test
110
Q

Group B streph is the MCC of what?

A

Sepsis in neonates

111
Q

How and when do you screen for group B strep?

A
  • Swab both the lower vaginal and rectum (in that order)

- Universal screening at 35 and 37 wks

112
Q

What is the tx for group B strep?

A

Penicillin is drug of choice

113
Q

What is Hegars sign?

A

Softening of the uterine isthmus

114
Q

What is chadwicks sign?

A

Blueish discoloration of cervix and vulva

115
Q

What is the tx for heartburn?

A

Smaller, more frequent meals and bland food recommended

116
Q

What are derm changes that occur during pregnancy?

A
  • Spider angiomata: telangiectasia located on the upper torso, face and arms
  • Striae gravidarum: stretch marks, appear pink/purple; eventually turn pale, no tx.
  • Melasma: Hyperpigmentation patches on cheeks
  • Linea nigra: Vertical hyperpigmented line down abdomen
117
Q

What is Naegels rule?

A

LMP + 7 days - 3 months

118
Q

What does folate supplement do and what is the recommended dose?

A
  • Prevents NT defect
  • 0.4 mg daily
  • 4mg if prior NT defect
119
Q

What is the MC event in which isoimmunization can occur?

A

Delivery of baby and placenta

120
Q

What occurs with first pregnancy of Rh incompatibility?

A

Rh + dad, Rh- mom = fetus Rh+

- no hemolysis

121
Q

What occurs with 2nd pregnancy of Rh incompatibility?

A

Anti Rh antibodies developed from first pregnancy which results in hemolysis in newborn

122
Q

What is the tx for Rh incompatibility?

A

RoGam

123
Q

If newborns heartbeat is less that 100 bpm what should you do?

A

Postive pressure ventilation (PPV)

124
Q

If newborns heartbeat is less that 60 bpm despite PPV, what should you do?

A

Chest compressions

125
Q

If newborns heartbeat is less that 60 bpm despite PPV and chest compressions, what should you do?

A

Give Epi

126
Q

When is APGAR testing done?

A

Right after birth; 1 min and again at 5 min

127
Q

What is the scoring for appearance?

A 
0 = no blood flow
1 = Poor blood perfusion to extremities
2 = full blood flow
128
Q

What is the scoring for pulse?

A 
0 = no pulse
1 = <100 bpm
2 = >100 bpm
129
Q

What is the scoring for grimace?

A 
0 = no facial expression/crying
1 = minor facial expressions
2 = full facial expressions/crying
130
Q

What is the scoring for activity?

A 
0 = no movement/floppy
1 = minor movements
2 = full body movements
131
Q

What is the scoring for respirations?

A 
0 = no respiration
1 = week/slow
2 = strong cry
132
Q

What is the complication of the vacuum used during delivery?

A

Cephalohematoma

133
Q

What is the MC postpartum hemorrhage?

A

Uterine atony (loose and floppy)

134
Q

What are the S/Sxs of the congenital infection: cytomegalovirus?

A
  • Blueberry muffin rash
  • Hepatosplenomegaly
  • Chorioretinitis
  • Periventricular calcifications
  • Sensorineural hearing loss
  • IU growth restrictions
135
Q

What are S/Sx of post partum depression?

A
  • Sxs begin immediately and can last up to 1 yr postpartum
  • More pronounced feelings of sadness, anxiety despair
  • Interferes w/ daily functioning
  • Worsening over wks
136
Q

What are S/Sxs of baby blues?

A
  • Onset 2-4 days postpartum, resolves in 1-2 wks postpartum

- Mild, intermittent feelings of sadness, anxiety, or anger

137
Q

What are S/Sxs of postpartum psychosis?

A
  • Sxs begin in the 1st-3 mos postpartum
  • Severe sxs: attempt to harm self or baby, obsessive thoughts about baby, hallucinations
  • More common in women with hx of bipolar or schizophrenia
  • Medical emergency and urgent referral!!
138
Q

What the the 3 different breech presentations?

A
  • Frank (MC) - hips and knees flexed, feet at head
  • Complete: both hips and knees are flexed (criss cross apple sauce)
  • Footling: one or both hips not completely flexed, presenting park may be butt or one or both feet
139
Q

What is cervical effacement?

A
  • % of cervical thinning

- Occurs in latent phase (1st stage of labor)

140
Q

What is the tx for maternal HTN?

A
  • Methyldopa

- Labetalol

141
Q

What is placenta accrete?

A
  • Placenta extending into superficial layer of myometrium

- Complication of placenta previa

142
Q

What is placenta previa?

A
  • Placenta overlaps and implants on the cervix covering the internal os to varying degrees
  • occurs in 3rd trimester
143
Q

What are the S/Sxs of placenta previa?

A
  • PAINLESS, bright red virginal bleeding
144
Q

What are the risk factors for placenta previa?

A
  • Prior c-section
  • Multiple gestation
  • Multiple induced abortions
  • Advanced maternal age
145
Q

What is placenta abruption?

A

Premature separation of the implanted placenta from the uterine wall

146
Q

What are the S/Sxs of placenta abruption?

A

PAINFUL vaginal bleeding, but bleeding may not always be present

147
Q

What are the risk factors of placenta abruption?

A
  • HTN
  • Cocaine use
  • Trauma
  • Multiparity
148
Q

What is preeclampsia?

A

Development of HTN after 20 wks gestation age w/ proteinuria
- Proteinuria: >400mg on 24hr specimen

149
Q

What are S/Sxs of preeclampsia?

A

Edema and rapid weight gain

150
Q

What is the tx for preeclampsia and when do you start tx?

A

Magnesium sulfate

  • Mild: start when induction is initiated
  • Severe: institute at time of dx
151
Q

What are S/Sxs of hypermagnesium?

A
  • Loss of DTR
  • Flushing, feeling warm
  • Somnolence, slurred speech
  • MS paralysis
152
Q

What is eclampsia?

A

Seizures

153
Q

What are the effects of eclampsia on mom and baby?

A
  • Mom: MSK injury, hypoxia, aspiration

- Baby: seizures may often cause HR abnormalities

154
Q

What is HELLP syndrome?

A 
H: hemolysis
E: elevated
L: liver enzymes (AST, ALT, LDH)
L: low
P: platelet count (thrombocytopenia)
155
Q

What are the effects of Glucose intolerance/Gestational DM on baby?

A
  • Macrosomia: estimated fetal weight > 4,000 - 4,5000 grams

- Large gestational age: >90th percentile

156
Q

What are preterm labor sxs?

A
  • LLB
  • Braxton-hicks contractions
  • Lightening
  • Bloody show
157
Q

What is sxs of “lightening” in preterm labor?

A

Fetal head descending into maternal pelvis causing increased pelvic pressure, lower abdominal pain and thigh pain

158
Q

What occurs during “bloody show” in preterm labor?

A

Extrusion of mucus from endocervical glands, bleeding from small vessels, associated with cervical thinning (effacement)
[occurs before water breaks]

159
Q

What is the MC warning sign of a still birth?

A

No fetal movement

160
Q

What is the most common age for vulva cancer?

A

postmenopausal: 70-80 years old

161
Q

What are the causes of vulva cancer?

A
  • Squamous cell: 90%, may develop thru a precancerous condition
  • Melanoma: 2% found on the clitoris or labia minora
  • Adenocarcinoma: starts in the Bartholin glands
162
Q

What is the most common age for vaginal cancer to occur?

A

> 55

163
Q

What are the causes of vaginal cancer?

A
  • Squamous cell: 80-90%

- Usually 2nd to cervical or vulvar cancers

164
Q

What is the clinical feature of vaginal cancer?

A

most often found in upper 1/3 of vagina

OBGYN (5 decks)

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