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*****ObGYN > UWorld > Flashcards

UWorld Flashcards

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1
Q

what should be the first step after quad screen results suggestive of down syndrome?

A

U/S (confirm gestational age, assess amniotic fluid)

then can do amniocentesis after

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2
Q

when should women under 30 follow up for a simple cyst?

A

within 2-4 months for clinical breast exam

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3
Q

indications for RhoD ppx in pregnant pt?

A
  • 28-32 wks gestation
  • w/in 72 hrs delivery of Rh+ infant, spontaneous/threatened/induced abortion
  • ectopic preg
  • molar preg
  • CVS, amniocentesis
  • abdominal trauma
  • 2nd and 3rd trimester bleeding
  • external cephalic version
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4
Q

painless continuous leakage of fluid from vagina after surgery. dx?

A

vesicovaginal fistula

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5
Q

chronic pelvic pain, dyspareunia, urgency. dx?

A

interstitial cystitis (painful bladder syndrome)

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6
Q

common causes of hypogonadotropic hypogonadism?

A

excessive weight loss, strenuous exercise, chronic illness, eating disorder

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7
Q

what causes a dose dependent increase in risk of osteoporotic fx?

A

alcohol

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8
Q

how to first evaluate ovarian mass?

A

CA-125 with pelvic U/S

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9
Q

when is endometrial biopsy indicated?

A

AUB >45, postmenopausal bleeding, thickened endometrial stripe w. ovarian mass

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10
Q

what cancer is assoc w/ paget’s disease of the breast?

A

adenocarcinoma

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11
Q

midfacial hypoplasia, microcephaly, cleft lip/palate, digital hypoplasia, hirsutism, dev. delay. dx?

A

fetal hydantoin syndrome

MCC phenytoin, carbamezapine

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12
Q

early findings:

rhinitis (snuffles), HSM, skin lesions

A

congenital syphilis

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13
Q

late findings of congenital syphilis?

A

interstitial keratitis, Hutchinson teeth, saddle nose, saber shins, deafness, CNS involvement

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14
Q

midfacial hypoplasia, microcephaly, stunted growth, CNS damage (hyperactivity, MR, or learning disability)

A

fetal alcohol syndrome

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15
Q

what causes elevated 17-hydroxyprogesterone?

A

nonclassic CAH due to 21 hydroxylase deficiency -> hyperandrogenism in late childhood

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16
Q

homogenous cystic ovarian mass in young woman. dx?

A

ovarian endometrioma

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17
Q

risk factors for uterine inversion?

A

nulliparity
fetal macrosomia
placenta accreta
rapid L&D

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18
Q

What medications are common uterotonics?

A

oxytocin, misoprostol

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19
Q

What medications are common relaxants of the uterus (tocolytics)?

A

nitroglycerine, terbutaline, indomethacin, nifedipine

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20
Q

preferred endocrine drug for adjuvant tx of premenopausal women at low risk of breast cancer recurrence?

A

tamoxifen

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21
Q

what is mag sulfate usually used for?

A

(weak tocolytic)

used to lower risk of neuro complications in neonates born at <32 weeks

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22
Q

tx of symptomatic endometriosis options

A

conservative: NSAIDs, OCPs, progesterone IUD
definitive: surgical resection, hysterectomy w/ oophorectomy

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23
Q

management options for IUFD

A

20-23 wks: D&E or vaginal
>= 24 wks: vaginal delivery

  • usually induce labor to prevent coagulopathy
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24
Q

what hormonal deficiency causes secondary amenorrhea in female atheletes?

A

estrogen

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25
when does symmetric fetal growth restriction occur?
first trimester
26
what causes symmetric FGR?
chromosomal abnormalities, congenital infection
27
what causes asymmetric FGR?
2nd or 3rd trimester uteroplacental insufficiency or maternal malnutrition (head size not as small as abdominal size)
28
what are common causes of asymmetric FGR?
hypertension, diabetes
29
what is the management of IUGR?
weekly BPP, serial U/S, serial umbilical artery sonography
30
characteristics of Bartholin duct cyst
occur in women <= 30 at 4 or 8 o'clock position on vulva cause: dried mucoid glandular secretions or trauma or idiopathic
31
treatment of Bartholin duct cyst: asx vs sx
asx: observation sx: I&D; placement of word catheter decreases risk of recurrence
32
treatment options for bacteriuria/acute cystitis in pregnancy
5-7 days nitrofurantoin; 3-7 days amox or amox/clauv single dose fosfomycin
33
what tx to avoid for cystitis in preg?
avoid fluoruoquinolones always; | avoid bactrim in 1st and 3rd trimesters
34
tx for acute pyelo in preg?
hospitalize and IV abx (B lactams, metopenem) avoid aminoglycosides if possible change to 10-14 days course oral abx after afebrile 24 hrs
35
why is oxytocin not effective in stim uterine contraction/expelling retained pocs during T1 or T2?
there are few oxytocin receptors in the uterus during early pregnancy
36
how does atrophic vaginitis contribute to urinary urgency, frequency, incont and infection?
hypoestrogenemia -> atrophy of superficial and int. layers of vagina/mucosal epithelium; decreased urethral pressure and compliance -> sxs
37
define missed abortion
no vaginal bleeding, closed cervical os, no fetal HR or empty sac; asx
38
define threatened abortion
vaginal bleed, closed cervical os, fetal cardiac activity present
39
define inevitable abortion
vaginal bleed, dilated cervical os, poc may be seen or felt at/above cervical os
40
define incomplete abortion
vaginal bleed, dilated os, some pocs expelled, some remain
41
define complete abortion
vaginal bleed or non; closed cervical os; pocs completely expelled
42
late/posterm preg (>= 41 weeks/>=42 weeks) complications for FETUS
``` oligohydramnios meconium aspiration stillbirth macrosomia convulsions ```
43
late/postterm preg complications for MOM
Csection infxn PPH perineal trauma
44
what does fetal heart tracing show with placenta previa?
usually unaffected. bleeding is maternal (even though it is painless)
45
what is pathognomonic for uterine rupture?
loss of fetal station; ability to feel fetal parts through abdominal wall
46
what does the fetal heart tracing look like with vasa previa?
rapid deterioration (bleeding is fetal)
47
define IUFD
fetal death at >= 20 wks
48
at what GA does IUFD need to be delivered vaginally?
24 or older
49
what are the absolute CI to combined hormonal contraceptives?
- migraine w aura - >= 15 cigs/day & age >=35 - stage 2 HTN (>=160/100) - hx stroke or ischemic heart dz - hx of venous thromboembolism - breast cancer - cirrhosis & liver cancer - major sx with prolonged immobilization - <3 wks postpartum
50
what is recommended for dx of lichen sclerosus?
punch bx; rule out SCC
51
how do you distinguish lichen sclerosus from vulvovaginal atrophy?
LS: presence of white plaques, severe retraction/loss of normal anatomy of clitoral hood/labia minora/introitus, possible perianal involvement
52
LS tx?
high dose topical steroids
53
definition of AUB
prolonged menstruation (>5 days) and heavy (>1 pad every 2 hours) with irregular frequency
54
proliferation of SM cells in myometrium. dx and sx.
``` leiomyomata uteri (fibroids) can cause profuse menses and irregular uterine enlargement ```
55
work up for fibroids
U/S
56
what other conditions can elevate CA-125 in a premenopausal woman?
endometriosis, fibroids, lupus
57
locations of vaginal cancer and dx.
upper 1/3 of POSTERIOR vaginal wall = SCC | upper 1/3 of ANTERIOR vaginal wall = clear cell
58
clear elastic mucus with consistency similar to uncooked egg white. dx
cervical mucus (secreted close to ovulation - late follicular phase)
59
most important direct role of BhCG in pregnancy?
maintenance of corpus luteum
60
what cell secretes B-hcG?
syncytiotrophoblast
61
timeline of hCG in pregnancy?
produced beginning 3 days after fertilization. doubles every 48 hours. peaks at 6-8 weeks GA.
62
what does cystoscopy typically evaluate for?
bladder cancer
63
common cause of SUI in nulliparous woman?
fibroids
64
term for malignancy involving ovary, fallopian tube, and peritoneum?
epithelial ovarian carcinoma
65
hyperechoic nodules and calcifications in ovarian cyst. dx?
dermoid ovarian cyst (mature cystic teratoma)
66
what is the most effective emergency contraception? also MOA?
copper IUD | -> inflamm rxn toxic to sperm/ova & impairs implantation
67
what are the gestational DM target blood glucose levels?
fasting: <= 95 mg/dl 1 hour PP : <=140 2 hour PP: <= 120
68
management of shoulder dystocia?
BECALM B: breathe, don't push; lower head of bed E: elevate legs into McRoberts position - sharp hip flexion C: call for help A: apply suprapubic pressure (down and lateral) to release anterior shoulder L: enLarge with episiotomy M: maneuvers; delivery of posterior arm; Woods corkscrew/Rubin (pressure against baby's posterior shoulder anteriorly or posteriorly & anterior rotation); mom on "all fours" (Gaskin maneuver); replace head in vagina then emergent C section (Zavanelli maneuver)
69
maternal risks of shoulder dystocia?
4th degree perineal lacs, PPH
70
contraindications to CST?
CI to labor: previa, prior myomectomy
71
define preclampsia
new onset htn (sbp >=140/90) at >= 20 weeks GA AND proteinuria and/or end-organ damage
72
what are considered severe features of preclampsia?
- sbp >=160 or dbp >=110 (2 times, 4 hours apart) - low platelets - increased Cr - increased transaminases - pulm edema - visual/cerebral symptoms
73
management of preclampsia?
without severe features: deliver at >= 37 wks WITH severe features: deliver at >= 34 weeks all: mag sulfate ppx, anti HTN
74
rf for preclampsia
- multiple gestation - nulliparity - preexisting DM - advanced maternal age - kidney dz - prior preclampsia
75
when is mag sulfate given for neuroprotection?
24-32 weeks gestation when preterm birth is anticipated within the next 24 hours
76
SE of oxytocin?
hyponatremia, hypotension, uterine tachysystole (abnormally frequent contractions - >5 in 10 minutes on average over 30 min period)
77
U/S findings of irregularity/absence of placental-myometrial interface and intraplacental villous lakes. dx?
placenta accreta
78
fluctuant tender palpable mass while breastfeeding. dx? tx?
breast abscess from untreated mastitis | tx: needle bx and abx

*****ObGYN (3 decks)

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