Step-Up Obstetrics/gynecology

Front 1

about what weeks gestation can we tell the sex of the baby?

Back 1

12

Front 2

what is Naegle's rule?

Back 2

FDLMP-3 months +7 days + 1 yr

Front 3

what is adequate wt gain for mother?

Back 3

BMI <19 = 28-40 lbs
BMI 20-26 = 25-35 lbs
BMI >26 = 15-25 lbs

Front 4

the Function Residual Capacity and residual volume are (up or down) in preggo?

Back 4

decreased bc uterus pushes up on diaphragm decreasing all lung volume values.

Front 5

why is minute ventilation and tidal volume increased in preggo?

Back 5

progesterone

need for more O2 consumption

Front 6

why is minute ventilation and tidal volume increased in preggo?

Back 6

both increased

Front 7

what does hPL do?

Back 7

interacts with insulin and causes glucose intolerance

Front 8

RBC count will ? in preggo

GFR?
BUN? Cr?

Back 8

increase- need more O2

GFR- increase
BUN and Cr decrease

Front 9

why do u need prenatal iron and folate?

Back 9

Fe- help with RBC production
folate- prevent neural tube defects

Front 10

when is the quad screen done?

Back 10

2nd trimester

Front 11

what labs are done on initial visit?

Back 11

Fe- help with RBC production
folate- prevent neural tube defects

Front 12

when do u do the 1 hr glucose test? follow up with what if abnormal?

Back 12

~26 weeks- check for gestational DM that can lead to fetal MACROsomia (big baby)

f/u with 3hr glucose tolerance

Front 13

which can be done earliest?

amniocentesis or chorionic villus sampling

Back 13

chorionic villus sample

Front 14

trisomy 21 and 18 are associated with ? levels of PAPP-A

Back 14

low levels

Front 15

what will maternal serum AFP levels be with neural tube defects?

Back 15

high

Front 16

what will maternal serum AFP levels be with trisomy 21/18?

Back 16

low

Front 17

what will quad screen of trisomy 18 show?

Back 17

all levels low except inhibin A may be elevated

Front 18

what will quad show for trisomy 21?

Back 18

hCG- high
inhibin A- high
estradiol- low
msAFP- low

Front 19

pt has abnormally high (>130) 1 hr glucose tolerance....next step? start tx or another test?

Back 19

3hr glucose tolerance

if 3hr is abnormal (>140) tx is insulin

Front 20

a Gestation DM mom puts baby at risk for what?

at delivery what will the baby be in regards to glycemic control?

Back 20

macrosomia
polyhydramnios (polydipsia/polyuria????)

hypoglycemic bc it produces so much insulin...glucose from mom spills to baby

Front 21

A high fasting glucose presenting in the first trimester is what?

Back 21

not gestational DM

DM II or if anti-Beta islet cells DM I
gestational DM presents in 2nd or 3rd trimester

Front 22

what will quad show for trisomy 21?

Back 22

HTN
proteinuria >4g/24hr
edema

Front 23

preggo lady presents to you with edema, proteinuria, High BP, anemia, thrombocytopenia, and elevated LFTs

Back 23

HELLP Syndrome (another form of preeclampsia)

Front 24

Tx for preeclampsia?

Back 24

near term-induce delivery
bedrest
BP meds (NOT ACEI, use lebatolol)
MgSO4- for seizure prophylaxis

Front 25

eclampsia criteria? Tx?

Back 25

preeclampsia + seizures

MgSO4 and diazepam to prevent seizures

Front 26

in eclampsia, how long do you continue MgSO4 post-partum?

Back 26

48 hrs

Front 27

how do you treat epilepsy in preggo?

Back 27

any antiseizure med EXCEPT Valproic Acid

supplement folate and vit. K for teratogenic risk reduction

Front 28

when advising preggo pts about diet, what do u tell them about diet to prevent n/v?

Back 28

avoid large meals... small and often

stay hydrated

Front 29

can you use warfarin as DVT prophylaxis in preggo?

Back 29

NO

but you can breastfeed once delivered

Front 30

How do you treat UTIs in preggo?

Back 30

nitrofurantoin, amoxicillin, cephalexin x 3- days

DO NOT USE FQs or TMP-SMX because they are teratogenic

Front 31

what are TORCHeS?

Back 31

maternal infections that cross placenta to harm baby

Toxoplasmosis
Other- Grp B Strep, Gonorrhea, Chlamydia
Rubella/Rubeola
CMV
HIV/Herpes/Hep B
Syphilis

Front 32

pt presents with severe abdominal pain, nausea, and abdominal bleeding. she has + peritoneal signs. Next test?

Back 32

B-hCG
transvag/transabdominal US

Want to R/O ectopic pregnancy

Front 33

m/c site of ectopic?

Back 33

ampulla of fallopian tube

Front 34

PID, multiple sex partners, previous gynecological surgery and STDs put pt at risk for what when preggo?

Back 34

ectopic

Front 35

these meds can do what to baby?
1)ACEI
2)DES
3)VPA

Back 35

1) Renal agenesis

2) adenocarcinoma and clear cell

3) neural tube defects

Front 36

any woman of child bearing age with abdominal pain gets what?

Back 36

B-hCG

Front 37

match these with the correct TORCH infxn:

1)blueberry muffin
2) conjuctivitis
3) hydrocephalus
4)need for AZT (Zidovudine)

Back 37

1) Rubella
2) Chlamydia
3) Toxoplasmosis
4) HIV

Front 38

treatment for Hep B + preggo momma

Back 38

maternal vaccine

baby- vaccine and HBIG

Front 39

preggo 15 wk presents with bleeding, cervical os is closed, US detects a viable fetus

Back 39

threatened abortion

Front 40

preggo 16 wk presents with bleeding and pain, cervical os is open, no contents are seen in the vaginal vault

Back 40

inevitable abortion

Front 41

preggo 15 wk presents with bleeding, cervical os is open, pt reports multiple brown pieces have been coming out of vagina and some contents are still noted in the uterus

Back 41

incomplete abortion

Front 42

preggo 12 wk presents with bleeding, cervical os is open, US detects no intrauterine pregnancy. pt would report a hx of? what is the dx?

Back 42

products of conception being expelled

complete abortion

Front 43

preggo 10 wk presents with lower abdominal cramping pain. she has had bleeding in the past, cervical os is closed on speculum exam, US detects no fetus

Back 43

missed abortion

Front 44

how can you dx IUGR?

Back 44

when fundal height is less than 3cm what it should be post 20 wk.

do US to confirm abdominal circumference and head circumference and femur length (<10th percentile = IUGR)

Front 45

fundal height at 12 and 20 weeks?

Back 45

12 pubic symphysis
20- umbilicus

16- in between

Front 46

what can cause Oligohydramnios? Tx?

Back 46

IUGR, fetal renal abnormalities

hydrate and amnioinfusion

Front 47

what causes polyhydramnios? Tx?

Back 47

Gestation DM, esophogeal atresia (connot swallow amniotic fluid)

induce labor (if less than 32 weeks give corticosteroids for lung maturation)

Front 48

how do you determine if lungs are mature?

Back 48

lecithin:sphingomyelin ratio >2
this + presence of phosphatidylglycerol in amniotic fluid suggests lung maturity

Front 49

what will fluid in va vault show if fluid is b/c of PROM?

Back 49

ferning under microscope

nitrazine paper turns blue

Front 50

should you do a speculum exam if suspect PROM?

Back 50

NO can introduce infxn

Front 51

tx of preterm labor?

Back 51

Tocolytic Therapy- MgSO4, terbutaline (B2-agonist) ritodrine, indomethacin, nifedipine

(known as inhibiting labor)

Front 52

can you give NSAIDS in normal preggo?

Back 52

shouldn't b/c it blocks prostaglandins...prostaglandins promote cervical ripening

Front 53

pt presents with painless bright red blood from vagina in 3rd trimester...next step?

Back 53

US to dx placenta previa

DO NOT do speculum or bimanual b/c introduce infxn

Front 54

third trimester bleeding think about

Back 54

top Ddx:::: placenta abruption, placenta previa, labor bloody show


genital lesions, ruptured vasa previa (fetal vessels over the Os)

Front 55

first trimester bleeding think:

Back 55

top Ddx:::: ectopic, abortion types

fetal demise, molar pregnancies

Front 56

delivery plans for placenta previa?

Back 56

delay labor

probably C-section

Front 57

name risks for placenta abruption

Back 57

cocaine, HTN, tobacco, trauma (car accident jarring placenta loose)

Front 58

painful vagina bleeding in 3rd trimester dx? next test?

Back 58

placenta abruption

US- any abdominal pain in 3rd trimester you get an US to rule out this b/c you can trap the bleeding

Front 59

treatment and management for multiple gestation?

Back 59

activity restriction
frequent assessment and nonstress tests
probably deliver at 36 wks on avg.

Front 60

reactive (reassuring) nonstress requires what?

Back 60

2 accels of 15bpm for at least 15 secs.

Front 61

a nonreactive stress test is followed up with what?

Back 61

biophysical profile

Front 62

what are early decels and what do they represent?

Back 62

decels that begin and end with contractions

represent head compression

Front 63

what are late decels and what do they represent?

Back 63

decels that begin AFTER a contraction and end after the contraction finishes...

represent hypoxia/ uteroplacental insufficiency and fetal distress

promptly deliver the baby

Front 64

what do variable decels represent?

Back 64

umbilical cord compression...

change mother position

Front 65

name stages and phases of labor and what they represent

Back 65

1) a) latent- up to 20 hours 2/3 of the time (contractions to 4cm dilated)
b)active- up to 12 hours (4cm - 10cm)
2- 10cm (full dilation to delivery of baby)
3- delivery of baby to delivery of placenta (30mins)
4- post partum hr..control bleeding and uterine tone

Front 66

describe frank breech and complete breech and incomplete breech

Back 66

frank- hips/thighs flexed and knees extended

complete- hips/thighs and knees BOTH flexed

footling (incomplete)- one foot coming out birth canal

Front 67

indications for C-section maternal and fetal

Back 67

maternal- eclampsia, previous uterine surgery or classic (vertical cut) c-section, active herpes lesions, placenta abruption/previa, failure to progress to labor

fetal- breech presentation, fetal distress, fetal macrosomia

Front 68

APGAR parameters

Back 68

Appearance- want pink all over
Pulse- want >100
Grimace- want a strong cry...grimace 1 point
Activity- want active movement and muscle tone
Respirations- breathing fine with strong cry

Front 69

why breast feed? supplement what?

Back 69

good antibodies and cost-effective

Vitamin D supplement

Front 70

how do you treat uterine atony?

Back 70

uterine massage, oxytocin

Front 71

what is the karyotype of complete mole?

Back 71

46, XX all from father

Front 72

what is the karyotype of incomplete mole?

Back 72

69 XXY- egg fertilized by 2 sperm

Front 73

what will a molar pregnancy present like? and work up?

Back 73

preeclampsia like + the key of passing grape like vesicles from vagina brown in color

US-snowstorm pattern
B-hCG- very high

Front 74

complication of hyditaform mole

Back 74

choriocarcinoma

Front 75

after you are treated for a hydatiform mole, what do you do and advise your pt?

Back 75

follow B-hCG for 1 year

advise against pregnancy for 6mo - 1yr

Front 76

what is precocious puberty?

Back 76

puberty developing rather early (usually <8 y/o in girls and <9 yo in boys)

Front 77

m/c cause of precocious puberty in boys?

Back 77

adrenal hyperplasia

Front 78

increase FSH/LH in precocious puberty indicated what?
Tx?

Back 78

pituitary activation

Tx- GnRH analogs (leuprolide)

Front 79

increased estrogen and low FSH/LH in precocious puberty indicates what?

Back 79

excess estrogen either by neoplasm or exogenous

Front 80

T/F. precocious puberty can be caused by hypothyroidism?

Back 80

true if congenital hypothyroid

Front 81

McCune-Albright syndrome can be classified by what?

Back 81

precocious puberty, cafe-au-lait spots, and fibrous dysplasia of some bones (polyostotic fibrous dysplasia)

Front 82

Tanner stage?
a) coarse pubic hair in pubic region and on thighs
b) breast bud formation
c) raised areola and courser hair just on pubic region

Back 82

a) 5
b) 2
c) 4

Front 83

what conditions are estrogen containing OCPs contraindicated in?

Back 83

Hx of DVT
heavy smokers
estrogen related cancer
liver dz
hypertriglyceridemia

Front 84

in the normal menstrual cycle, what is role of estradiol and progesterone?

Back 84

E- endometrial proliferation

P- maintain the endometrium

Front 85

describe Sx of menopause

Back 85

hot flashes
amenorrhea
dysparunia- d/t vaginal atrophy

Front 86

what is required for Dx of menopause? what will labs show?

Back 86

AMENORRHEA for 1 year

decreased estradiol (ovarian failure), INCREASED FSH/LH

Front 87

tx of menopause and its sx?

Back 87

dysparunia- estrogen lube gels

osteoporosis- vit D, Calcium, bisphopshonates

possible hormone replacement

Front 88

major complication of menopause?

Back 88

OSTEOPOROSIS

Front 89

risk of reversed Bilateral tubal ligation?

Back 89

future ectopic pregnancy

Front 90

role of B-hCG?

Back 90

maintain viable corpus luteum and progesterone secretion in preganancy

Front 91

induce labor with what drugs?

Back 91

misoprostol/dinoprostone (prostaglandin analog)
oxytocin (Pitocin)
nipple stimulation
mifepristone (progesterone blocker
break water (artificial rupture of membranes with a hook)

Front 92

what is Asherman's syndrome?

Back 92

scarring of uterus following an infection, uterus insult, or postpartum infection

Front 93

first step in ANY workup of ANY type of amenorrhea?

Back 93

PREGNANCY B-hCG TEST!!!!!!!!!!!!!!


****** KNOW KNOW KNOW**********

Front 94

how do you treat prolactinomas?

Back 94

Dopamine agonists

Front 95

review the amenorrhea chart on pg 232

remember (thyroid and prolactin are good first tests b/c they are easy to interpret)

Back 95

order:
B-hCG- r/o preggo
Thyroid panels- r/o thyroid dysfxn
prolactin- r/o prolactinoma
DHEA, testosterone (androgens)- r/o PCOS in combo with an US
progestin/estrogen-progestin challenge- r/o blood outflow obstruction and/or ovarian failure such as ashermann, PCOS, anorexia, hypothalamus dysfxn

Front 96

describe amenorrhea work up in terms of assessing secondary sex characterisitics

Back 96

if present- due XY genotyping and chromosomal analysis

if not present- look at FSH/LH to see if there is gonadal failure or in cases of low FSH/LH maybe hypothalamic dysfxn and gonadotropin dysfxn.

Front 97

if patient presents with amenorrhea and a peculiar sense of NOT being able to smell, suspect what?

Back 97

Kallman syndrome

Front 98

if a female of child bearing age presents to you with abdominal pain? next step and why?

Back 98

hCG preg test to rule out ectopic

Front 99

how do you treat dysmenorrhea?

Back 99

NSAIDs

Front 100

PMS is only diagnosed when?

Back 100

if symptoms are only in 2nd half of cycle and are bad enough to affect daily living...

otherwise initiate a psych eval

Front 101

what is the presentation of endometriosis? workup? and DEFINITIVE tx?

Back 101

dysmonorrhea, dyspareunia, dyschezia and pelvic pain

dx by Bx and/or laporoscopy (powder burn)

laparoscopic ablation, (OCPs have benefit)

Front 102

How does PCOS present?

Back 102

infertile
amenorrhea
obese
hirsutism

Front 103

what labs does PCOS show? radiology study of choice?

Back 103

high LH:FSH ratio (lots of LH)
increased DHEA (androgens)

US to show cysts

Front 104

Tx of PCOS?

Back 104

Clomiphene (inhibits estrogen receptors thus inducing more FSH to stimulate more follicles)- this is tx of infertility.

OCPs, management of DM b/c of risk of DM

note: leuprolide is drug that is a GnRH agonist that stops pulsatile secretion of GnRH and downregulates FSH and LH

Front 105

describe vaginosis with gardnerella

Back 105

mild vag inflammation
CLUE CELLS
positive whiff test
vag pH is >4.5

Tx; Metronidazole

Front 106

describe vaginosis with trichomonas

Back 106

CERVICAL PETECHIA with vag and cervix inflammation
green discharge
motile trichomonads
+/- whiff test
pH >4.5

Tx: Metronidazole and tx of partners

Front 107

describe vaginosis with candida

Back 107

significant vag inflammation
cottage cheese white discharge
no whiff test
PSEUDOHYPHAE
VAGINAL PH IS ABOUT 3.5-4.5

Tx: Fluconazole, miconazole, nystatin, clotrimazole

Front 108

pt presents with diarrhea and hyoptension. she reports she's also has desquamation of hands and soles. vaginal exam reveals inflammation and a piece of tampon. platelets are decreased and LFTs are increased. dx?

Back 108

toxic shock syndrome caused by staph aureus endotoxin

Front 109

pt presents with multiple sex partners and discharge. gram stain is negative. dx?

Back 109

chlamydia trachomatis

Front 110

pt presents with multiple sex partners, cervical motion tenderness, and purulent discharge. gram stain shows gram negative diplococci. dx?

Back 110

neisseria gonorrhea

Front 111

tx of gonorrhea or chlamydia? what also is a complication?

Back 111

ceftriaxone + doxycycline

PID for either
septic arthritis for gonorrhea

Front 112

tx of pregnant woman with gonorrhea/chlamydia?

Back 112

ceftriaxone + azithromycin

Front 113

what is pelvic inflammatory disease?

Back 113

typically cervical infection that has ascended into fallopian tubes, uterus, ovaries, etc.

Front 114

complication of PID?

Back 114

tubo-ovarian abcess
infertility
risk of ectopic pregnancy

Front 115

describe the key presenting features in primary syphilis

Back 115

PAINLESS chancre

Front 116

describe the key presenting features in secondary syphilis

Back 116

chancre heals
maculopapular rash, HA, fever, fatigue
condyloma latas

Front 117

describe the key presenting features in tertiary syphilis

Back 117

granulomatous lesions (gummas)
tabes dorsalis (loss of proprioception, vibration, 2-point discrimination)

Front 118

what is the screening test for syphilis?

confirm with?

Back 118

VDRL and RPR

FTA-ABS ( fluorescent treponemal antibody absorption) or spirochetes on dark-field microscopy

Front 119

Tx of syphilis?

Back 119

Penn G

Front 120

painful genital lesions?

Back 120

Herpes and chancroid (H. ducrei)

Front 121

painful chancres and painful lymphadenopathy caused by?

Back 121

H. ducreyi

Front 122

pt who presents with swollen iguinal lymph node... he noted that he did have a recent painless ulcer heal up about 2 weeks ago. Dx? etiologY?

Back 122

Lymphogranuloma venereum

Chlamydia Trachomatis

Front 123

african american female presents with vaginal bleeding. work up to assess what??

Back 123

pelvic US to assess uterine fibroids then you will need to do Bx once a mass is confirmed to r/o cancer

Front 124

definitive treatment for fibroids?

Back 124

hysterectomy

GnRH agonists (leuprolide) if pt wants to remain fertile)

Front 125

risks for endometrial cancer?

Back 125

exposure to high estrogen levels

Front 126

m/c causes (3) of vaginal bleeding in order?

Back 126

1. atrophic vagina
2. fibroids
3. endometrial cancer

Front 127

how do you diagnose endometrial cancer?

Back 127

endometrial Bx or examine cells collected during D&C

Front 128

what is the tumor marked for endometrial and ovarian tumors?

Back 128

CA-125

Front 129

definitive tx for endometrial cancer?

Back 129

hysterectomy

Front 130

Pap smear results come back ASCUS, next step?

Back 130

HPV test
colposcopy
repeat PAP in 6 months

Front 131

PAP smear comes back HSIL (high grade squamous intraepithelial lesion), next step?

Back 131

colposcopy
Biopsy
LEEP procedure next appt.

Front 132

Guardisil (HPV vaccine) protects against what?

Back 132

HPV 6, 11, 16, 18 - last 2 most malignant

Front 133

an ovarian cyst with hair and teeth is what? complication?
tx?

Back 133

benign dermoid cyst (name dermoid b/c it contains dermal layers)

notorious for causing ovarian torsion

tx- cystectomy- try to save ovary

Front 134

risks for ovarian cancer?

Back 134

BRCA-1, BRCA-2
FAMILY Hx
nulliparity

Front 135

increased CA-125 at menopause indicative of what?

Back 135

ovarian cancer

Front 136

mass on bimanual exam needs to be followed up with what?

Back 136

US to assess ovarian CA (or endometrial CA)

Front 137

Bilateral small tender masses in breasts that are mobile and change with menstrual cycle are probably what dx?

Back 137

fibrocystic changes

Front 138

painful unilateral red breast mass...pt reports she breast feeds. dx?

Back 138

breast abcess etiology staph aureus.

Front 139

mammograms that show hyperdense region with calcification is considered what?

Back 139

suspicious

Front 140

solitary unilateral mass that is mobile and changes with menstrual cycle. dx?

Back 140

fibroadenoma- Benign

Front 141

bloody discharge from the nipple with mass behind areola is what? tx?

Back 141

intraductal papilloma

Bx to r/o cancer and surgically excise

Front 142

m/c breast cancer?

Back 142

infiltrating ductal carcinoma

Front 143

risks for breast CA?

Back 143

BRCA 1, BRCA 2
family hx
ovarian or endometrial cancer
increased estrogen exposure

Front 144

presentation of breast CA?

definitive tx?

Back 144

upper outer quadrant
solid, immobile tumor
lymph obstruction
orange peel appearance and retraction

tx- widespread= mastectomy
local= lumpectomy

Front 145

next step in working up a palpable mass

Back 145

mammography

Front 146

palpable mass worked up and mammography shows high probability of cancer...next?

Back 146

Bx by FNA

Front 147

palpable mass worked up and mammography shows low probability of cancer...next?

Back 147

ultrasound to see if cystic....

if cystic-observe
if solid- Bx/FNA

Front 148

what are Selective estrogen receptor modulators? (SERMs)

Back 148

Tamoxifen- estrogen blocker in breast, agonist in endometrium (uterus) and bone--- (used in breast CA with hysterectomy women and menopause/osteoporosis)


Raloxifene- estrogen blocker in breast and uterus...agonist in the bone -----(used in menopause and osteoporosis)


both carry risks of DVTs

Front 149

a fissures and crusted nipple with ulcerations is what?

Back 149

Paget's disease of the nipple

Front 150

breast tumor with leaf shape appearance

Back 150

Phylloides tumor

Front 151

HER-2/neu receptor positive breast CA pharm tx?

Back 151

trastuzumab- her-2/neu antibody