U-World: OB/GYN Flashcards by Grenville Fernandes

What does it mean when you palpate the vertex of the fetus at the fundus?

How do you deal with this? (2)

Fetus is in breech presentation

If 37 weeks, consider cephalic version, and if that fails, c-section

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How would you work up an adnexal mass in a postmenopausal woman?

First transvag U/S
-then-
CA-125 to monitor

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What happens to BUN/Cr in pregnancy and why?

Decrease; increased renal plasma flow and increased GFR 2/2 progesterone

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Main role of hCG in pregnancy?

Maintain corpus leuteum

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Which screening tests are recommended prenatally under all circumstances (across entities, etc.)

HIV, Hep B, Syphillis (RPR/VDRL/Fluroescent treponemal antibody absorption test if RPR or VDRL +),

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Abx choice for bacteruria during pregnancy?

Which ones are contraindicated?

Amoxicillin, cephalexin, fosfomycin, NITROFURANTOIN,

tetracyclines (doxycycline), fluoroquinolones (ciprofloxacin), and TMP-SMX are CONTRAINDICATED (teratogenic)

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Who should get HPV vaccine?

Who should get the rubella vaccine?

All non-pregnant women 9-26
All dudes 9-21

MMR vaccine CONTRAINDICATED IN PREGNANCY

ALL LIVE-ATTENUATED VACCINES ARE BAD IN PREGNANCY!

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Target blood sugars for gestational diabetes and lines of treatment.

Diagnostic levels?

When, who, and with what to screen?

first line: dietary modification
second line: insulin, metformin, glyburide

NOT THIAZOLIDINEDIONES (pioglitazone, rosiglitazone) OR SULFONYLUREAS (chlropropamide, tolbutamide)

target fasting less than 95, dx 95
target one hour tolerance less than 140, dx 180
target two hour tolerance less than 120, dx 155

ALL pregnant women at 24-28 weeks with oral glucose tolerance

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Does insulin cross the placenta?

Does levothyroixine cross the placenta?

NO!

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Indications for galactorrhea workup

1) UNILATERAL
2) BLOODY/SEROUS
3) PALPABLE LUMP/SKIN CHANGES

then workup with mammography +/- breast U/S, surgical evaluation

If bilateral, nonbloody, no skin changes, no lumps,

then workup with Prolactin, TSH, MRI pituitary, pregnancy test etc.

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What is the recommendation for suppression of lactation (say if an infant dies of sepsis and milk is no longer needed)

1) tight fitting bra
2) ice-packs
3) analgesia

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Criteria for chorioamnionitis (intra-amnionic infection)

maternal fever and 1 or more of the following:

maternal or fetal tachycardia
uterine tenderness
malodorous amniotic fluid
purulent vaginal discharge

(prolonged >18 hours rupture of membranes is an important risk factor)

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Two categories of etiologies for IUGR and examples of each

[<10th percentile]

1) Asymmetric [maternal factors], “head sparing”***
2) Symmetric [fetal factors], both head and body affected

a) vascular (HTN, DM, pre-E)
b) autoimmune
c) substance abuse (cocaine, tobacco, alcohol)

2)
a) intrauterine infection (toxo, rubella, CMV, malaria)
b) genetic (aneuploidy)
c) congenital heart disease

***BABY REDIRECTS BLOOD TO BRAIN AWAY FROM OTHER ORGANS

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Mother has vaginal vessicles and is going into labor. What is the dx? What is the best way to reduce mortality for this neonate?

HSV

c-section (avoid contact on from vaginal delivery)

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When is endometrial biopsy indicated

cases with abnormal uterine bleeding

in all women >45 years
women <45 with high risk/concerning features

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With labs; treatment, distinguish:

HELLP
Intrahepatic Cholestasis of Pregnancy
Acute Fatty Liver of Pregnancy

HELLP - hemolysis, proteinuria, increased LDH; delivery w/mag to prevent convulsions
ICoP - NORMAL PT/PTT; ursodeoxycholic acid
AFLP - increased PT/PTT, increased creatinine/uric acid, hypoglycemia; delivery

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13 things that ALL patients should get when pregnant

5 things that SOME (at-risk) patients should get

offer Down’s screen, offer Cystic Fibrosis screen, rhesus testing, FLU VACCINE [!!!!!INACTIVATED! NOT LIVE-ATTENUATED], Pap as routine, H&H/MCV, varicella, rubella, syphillis, chlamydia, HepB, HIV, urine culture,

thyroid function/diabetes (family history), TB (at-risk), toxo (at risk), Hb electrophoresis (ethnic, MCV<80), lead (history)

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What is associated with prolonged gestation, polyhydramnios or oligohydramnios?

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OLIGO!!!!! (poly in diabetes, etc.)

Overview of approach to woman in preterm labor <34 weeks.

Def of preterm labor?

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Painful contractions at <34 weeks and regular contractions [aka 4 in 20 min or 8 in 1 hr]

1) MAG (neuroprotection)
2) STEROIDS (fetal lung maturation)
3) TOCOLYTICS (CCB, beta-agonist, NSAID.)

OLD lady with vulvar excoriations, thin white lesion, refractory pruritis

dx?
initial step?
tx?
[1ddx]

Pink, smooth, teardrop lesions on vulva that resolve following (insert 1st line tx here)

dx?
tx?
organism?
[1ddx]

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lichen SCLEROSUS
punch biopsy (r/o SSC)
tx. corticosteroids (autoimmune etiology)

[lichen PLANUS - MIDDLE AGED WOMEN, papulosquamous/hyperkeratotic appearance, vaginal discharge, pruritis, soreness]

condyloma ACUMINATA
acetic acid/podophyllin; treat large lesions with excision or fulguration (electric current)
HPV

[condyloma LATA: secondary syphilis, flat/velvety lesions, responds to penicillin]

GBS screen

when? tx with what?

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35-37 week, penicillin

Gold standard for evaluation of cervix

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Transvaginal ultrasound

In a patient presenting with menopause-like symptoms, what should you check as part of workup.

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FSH (bc estrogen decreases during menopause)

and

TSH!!!!! (bc hypothyroidism presents very similarly to menopause)

Easy way to think of premature ovarian failure?

Tx?
Labs and explain this finding

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Basically menopause1)

This is because FSH is cleared more slowly from circulation

NBS if quad screen is pos? When to do a quad screen?

2nd trimester (15-20 weeks); do cell-free fetal DNA test +/- U/S

False Labor a) definition b) characteristics unique to false labor (2) c) tx

a) 4-8 weeks prior to delivery, contractions felt in the lower abdomen, irregular interval that does not shorten nor increase in intensity, b) - not accompanied by cervical changes - usually relieved by sedation c) discharge and reassurance

Breast cancer (invasive ductal CA?) receptor? How to detect?

Either immunohistochemical staining or FISH

Tx for HER2 receptor positive breast adenoCA? Side effect with this? What to do before starting this therapy to address potential side effect?

Trastuzumab Cardiotoxicity (esp in low EF patients) Echocardiogram

General management strategy for threatened abortions?

Default to expectant management unless progression to inevitable, incomplete, missed, septic a) hemodynamically unstable (then D&C) b) septic abortion (blood/endometrial cultures, broad spectrum abx, then D&C)

Vaginismus definition and treatment

Involuntary psychosocial contractions of perineal musculature leading to dyspareunia tx kegel exercises and gradual dilation

You find on pap smear: atypical squamous cells of undetermined significance. NBS in >25 years? NBS in <25 years?

a) >25 years: FIRST do HPV DNA testing... if positive, do colposcopy if negative, repeat HPV test and Pap in 3 years b) 21-24 years: repeat cytology in 1 year

Explain the phenomenon of why fat people might have extra estrogen

Peripheral adipose tissue CONVERTS ANDROGENS TO ESTROGENS VIA AROMATASE!!!!! THE PERIPHERAL ADIPOSE DOES *NOT* PRODUCE ESTROGEN DIRECTLY

Discuss the physiologic changes with the following systems during pregnancy: a) Renal/Urinary (3) b) Hematologic (2) c) Cardiovascular (2) d) Pulmonologic (1)

a) - mild hyponatremia (ADH) - decreased BUN/Cr (decreased RPF and GFR 2/2 progesterone) - urinary output/nocturia b) - dilutional anemia (increased plasma volume and RBC mass) - hypercoagulability (increased fibrinogen & coag. factors; decrease in protein S antigen) [all hormone mediated] c) - increased blood volume (increased CO) - DECREASED systemic vascular resistance (increased HR) d) - chronic respiratory alkalosis (progesterone stimulates hyperventilation centrally) - increased tidal volume and minute ventilation - increased pO2, decreased pCO2

Are inhaled corticosteroids safe in pregnancy?

YES

What are the first and second signs of Magnesium Sulfate toxicity? MOA of each? NBS?

First - loss of DTRs (interference at the neuromuscular junction) Second - respiratory depression (CNS depressant) d/c Magnesium and replace with Calcium Gluconate

Mittelschmerz: definition epidemiology px path

- midcycle pain - young ovulating females - 2 weeks following LMP, lower quadrant pain, often unilateral, with no other clinical findings - result of ovulation itself

Cervicitis: dx 1st MC causative agent, features, tx 2nd MC, features, tx 3rd, tx, buzzword

-can gram stain but nucleic acid amplification can distinguish - Chlamydia D-K, 1 day azithromycin -or- 7 day doxycycline, mucopurulent dcg/friable cervix - Gonorrhea, azithromycin/doxycycline + ceftriaxone, mucopurulent dcg/friable cervix -Trichomonas can cause strawberry cervix (usually vaginitis though?) tx metronidazole + partner

Postpartum woman, pulmonary symptoms, multiple nodules on CXR. Dx? Best confirmatory test?

Choriocarcinoma b-HCG

What is the triad of gestational trophoblastic disease in general. Examples of GTD?

vaginal bleeding, enlarged uterus, pelvic pain choriocarcinoma

Abnormal Uterine Bleeding (AUB) - MC cause in adolescents? - 1st line tx

- anovulatory 2/2 immature hypothalamic-pituitary axis | - estrogen (to regenerate endometrium that has sloughed off from bleeding)

Androgen insensitivity syndrome vs mullerian agenesis

Cryptorchid testes, [absent uterus], absent upper vagina, breasts (androgens converted to estrogens), vs normal ovaries, [absent uterus], absent upper vagina, external genitalia normal

False positive VDRL (syphilis), thrombocytopenia, prolonged PTT dx? tx? [false positive VDRL would be confirmed with a negative fluorescent treponemal antibody (FTA) test result]

anti-phospholipid antibody syndrome LMWHeparin

OB/GYN select abx regimens: List regimen and which diseases get them (2) (avoid teratogens, aka TMP-SMX, tetracyclines, fluroquinolones)

a) Clindamycin + Gentamycin - endometritis - PID/tubo-ovarian abscess b) Azithromycin/Doxycycline + ceftriaxone - chlamydial cervicitis unconfirmed by PCR - all gonococcal cervicitis c) 1 day Azithromycin/7 day doxycycline - chlamydial cervicitis confirmed by PCR d) metronidazole - gardnerella vaginalis - trichomonas vaginitis (+partner tx) e) fluconazole/clotrimazole/miconazole/nystatin - vaginal candidiasis f) penicillin G - syphillis g) acyclovir - herpes h) cephalexin/nitrofurantoin/amoxicillin - bacteruria/UTI i) amoxicillin - GBS ppx

Menstrual cycle:a) Which phase is variable in time?b) hormone dominated by the phase in (a)? Function?c) Which phase is NON-variable?d) hormone dominated by the phase in (c)? Function?e) How to determine what day someone ovulated?

a) follicular phaseb) estrogen; endometrial PROLIFERATIONc) luteal phase (ALWAYS *14* DAYS)d) progesterone; endometrial SECRETION e) [Total cycle length]-14= day of ovulation (LH surge)

U-World: OB/GYN Flashcards

(44 cards)