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Ob-Gyn > uWISE > Flashcards

uWISE Flashcards

1
Q

CO increase in pregnancy

A

30-50%, w/50% of that occurring by week 8

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2
Q

mechanism of increased CO in pregnancy

A

increased stroke volume (first half), increased maternal heart rate (second)

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3
Q

what shunts blood in late pregancy when IVC may be occluded

A

paravertebral collaterals

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4
Q

CO and MAP in labor

A

40% increased CO, MAP increased by 10mmHg

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5
Q

normal hyperdynamic PE findings in late pregnancy

A

increased 2nd heart sound split w/inspiration, distended neck veins, low-grade systolic ejection murmur

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6
Q

total body oxygen consumption increase in preg

A

20%: 50% to uterus, 30% heart and kidneys, 18% respiratory muscles, rest to mammary tissue

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7
Q

ABG in pregancy

A

normally show respiratory alkalosis

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8
Q

plasma increase in single gestation

A

50% (blood volume increases 35% by term

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9
Q

iron needed in preg

A

60mg qD. (recommended supplement is 27mg) actively transported to fetus, so fetal hemoglobin is normal even if mother is Fe deficienct

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10
Q

clotting factor increase in preg

A

I, VII, VIII, IX, and X by 50%, rest normal

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11
Q

VTE risk increase in preg

A

5.5x

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12
Q

WBC in labor

A

may increase up to 30

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13
Q

trace glucose on dipstick in preg

A

normal! but proteinuria is concerning

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14
Q

renin and angiotensin increase in preg

A

renin activity increases 10x, angiotensin by 5x

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15
Q

creatinine and BUN in preg

A

decrease!

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16
Q

GI changes in preg

A

lower esophageal sphincter tone (GERD), decreased GI motility, impaired gallbladder contractility: gallstones, cholestatis of bile salts

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17
Q

estrogen on the liver in preg

A

increases synthesis of fibrinogen, ceruloplasmin, and binding proteins for corticosteroids, sex steroids, thyroid hormone and vit. D

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18
Q

ptyalism

A

sensation of excess saliva caused by decreased swallowing 2/2 nausea

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19
Q

LFTs in preg

A

alk phos doubles, cholesterol increases, albumin increases but appears dilutionally lowered

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20
Q

thyroid in early pregnancy

A

hCG stimulates transient rise in free T4, estrogen increases TBG, leading to lasting elevation of total T3 and T4

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21
Q

carb metabolism in preg

A

human placental lactogen (hPL) leads to decreased tissue response to insulin, hyperglycemia after meals, and hypoglycemia while fasting

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22
Q

hyperpigmentation of pregancy cause

A

elevated estrogen and melanocyte-stimulating hormone, cross-react with similarly structured hCG

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23
Q

skin changes in preg

A

vascular spiders, striae gravidarum, hyperpigmentation, linea nigra, chloasma (mask of pregnancy), eccrine sweating and sebum increase leading to acne

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24
Q

colostrum

A

thick yellow fluid expressed from breasts in late preg

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25
Q

placenta produces

A

estrogen, progesterone, hCG, hPL

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26
Q

why HgbF has higer oxygen affinity and saturation than HgbA

A

more avid 2,30DPG binding

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27
Q

primary source of amniotic fluid by mid second trimester

A

fetal urine

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28
Q

why neonatal vitamin K is given

A

fetal livers don’t do much; K prevents hemmorhagic disorders

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29
Q

when does fetus make own T3/T4

A

24-28 weeks

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30
Q

sex differentiation happens when

A

testes in week 6 (testosterone and mullerian inhibitory factor), ovaries in week 7 (no hormones, wolffian ducts regress)

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31
Q

passive immunity comes from

A

maternal IgG

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32
Q

Iron deficiency v. dilutional anemia

A

Fe deficiency comes w/microcytic anemia

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33
Q

contributes to pulmonary edema in pregnancy

A

decreased plasma osmolality

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34
Q

other causes of pulmonary edema in preg

A

tocolytic use, fluid overload, preeclampsia

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35
Q

if PVR exceeds SVR in the setting of VSD

A

left to right shunting, cyanosis

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36
Q

can cause hydronephrosis in late preg, usually R

A

right ovarian vein complex dilation

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37
Q

implanted egg w/o DNA, chorionic villi dilate with fluid (grape like), hyperplasia of tropoblastic tissue

A

molar pregancy, results in spontaneous abortion. check lungs for metastatic disease

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38
Q

wt gain in preg, BMI under 18.5

A

28-40lb

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39
Q

wt gain in preg, BMI normal

A

25-35lb

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40
Q

wt gain in preg, BMI over 25, under 30

A

15-25lb

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41
Q

wt gain in preg, BMI over 30

A

11-20lb

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42
Q

most common cause of PPH

A

uterine atony (more than 500cc if vag, 1000 if C)

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43
Q

Sheehan syndrome

A

AP necrosis from PPH, causing lost of gonadotropin, ACTH and TSH. Tx estrogen, progesterone, thyroid and adrenal hormones

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44
Q

greatest risk for puerperal infection

A

protracted labor, prolonged rupture of membranes, multiple vaginal examinations, internal fetal monitoring, removal of the placenta manually and low socioeconomic statu

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45
Q

risk of endometritis in vag v C

A

3% of vaginal, 5-10x higher in C

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46
Q

most common cause of post-partum fever

A

endometritis (uterine fundal tenderness on PE)

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47
Q

bacteria in PP endometritis

A

polymicrobial resulting in a mix of aerobes and anaerobes in the genital tract. The most causative agents are Staphylococcus aureus and Streptococcus

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48
Q

PP blues, duration and prevalence

A

less than two weeks, 40-85%

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49
Q

most telling sign of PP depression

A

no love for family, indifferent toward infant

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50
Q

breastfeeding duration rec

A

six months

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51
Q

breast feeding benefits

A

decreased ovarian cancer, maybe breast cancer, and provides IgA to baby

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52
Q

vaccinations in pre-preg

A

rubella, varicella, pertussis and hep B. (don’t give attentuated vaccines, like rubella, to pregnant pt)

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53
Q

always test pregnant woman for

A

HIV

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54
Q

screening by background: african

A

sickle hemoglobinopathies

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55
Q

screening by background: Mediterranean, SE asian, african

A

alpha, beta thalassemia

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56
Q

screening by background: ashkenazi, french canadian, cajun

A

tay-sachs

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57
Q

screening by background: ashkenazi

A

tay-sachs, faconi anemia, neimann-pick, bloom, gauchier, canavan disease, familial dysautonomia, CF

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58
Q

recommended folic acid

A

0.4 mg, unless prior NTD pregancy or meds affecting folate, then 4mg)\

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59
Q

bluish vagina

A

chadwick sign

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60
Q

softening cervix

A

hegar sign

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61
Q

quickening happens when

A

16-18 weeks, sometimes as late as 20

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62
Q

standard urine hCG labs detect pregnancy

A

4 weeks after LMP

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63
Q

serum pregancy tests detect

A

unique b-subunit of hCG, so don’t count LH, and detect pregnancy sooner

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64
Q

mean doubling time for hCG in normal pregancy

A

1.5-2 days

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65
Q

doppler detects fetal HR at

A

12 weeks. fetoscopes at 18-20 weeks

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66
Q

fundal height in cm represents gestational age

A

when exits pelvis until 36 weeks

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67
Q

Naegele rule

A

add 7 days to LMP, then subtract three months

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68
Q

normal pregnancy

A

40 plus or minus two weeks

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69
Q

ultrasound can detect pregnancy

A

3-4 weeks (transvag) or 5-6weeks from lmp

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70
Q

b-hCG 1,500

A

should see gestational sac, if not consider ectopic

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71
Q

b-hCG over 4000

A

should see embryo and fetal heartbeat

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72
Q

antenatal appointment schedule

A

every 4 weeks for 28 weeks, every two until 36, and weekly after

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73
Q

gestational hypertension

A

140/90 (either) after 20 weeks w/o proteinuria

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74
Q

normal monthly weight gain

A

3-4 pounds

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75
Q

normal fetal HR

A

110-160 bpm

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76
Q

percent of fetuses in cephalic (head-down) position at term

A

95%

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77
Q

contraindications to external cephalic version

A

multifetal gestation, fetal compromise, uterine abnormalities, problems of placentation

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78
Q

optimal first ultrasound

A

18-20w

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79
Q

placenta accreta

A

chorionic villi attach to myometrium

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80
Q

placenta increta

A

chorionic villi invade into myometrium

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81
Q

placenta percreta

A

chorionic villi invade through myometrium and serosa, and sometimes into adjacent organs

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82
Q

first trimester screening (10-13w)

A

PAPP-A, b-hCG, u/s assessment of nuchal transparency

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83
Q

second trimester screening (15-20w)

A

triple (MSAFP, estriol, and inhibin), or quadruple (hCG) screening

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84
Q

third trimester screening (24-28w)

A

glucose challenge (then GTT if abnormal), group b strep at 35w, H/H, antibodie screening repeat in Rh- or HIV pt

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85
Q

big fetus ddx

A

incorrect age, multiples, macrosomia, hydatidiform mole, polyhydramnios

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86
Q

small fetus ddx

A

incorrect age, hydatidiform mole, FGR, oligohydramnios, or fetal demise

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87
Q

indications for fetal testing; prexisting

A

anti-phospholipid, cyanotic heart dz, SLE, renal dz, DM on insulin, HTN

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88
Q

indications for fetal testing: fetal

A

HTN of preg, decreased movement, oligo/polyhydramnios, growth restriction, postterm, isoimmunization, previous unexplained fetal demise, multiples, monochorionic diaminotic multiple gestation

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89
Q

reactive Nonstress test

A

2+ accelerations (15 beats above baseline for 15seconds) in 20 minutes. bad is no accelerations in 40minutes

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90
Q

decelerations in contraction stress test

A

postitive, equivocal, or unsatifcatory, depending on pattern, frequency and strength (high rate of false positives)

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91
Q

biophysical profile components

A

NST, fetal breathing movements, fetal movement, fetal tone, amniotic fluid at least 2cm

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92
Q

important phospholipids in the surfactant complex

A

lecithin/sphingomylen (L/S ration), phosphatidylglycerol (marks complete lung maturation at 35w)

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93
Q

RDS signs

A

grunting, chest retractions, nasal flaring, hypoxia leading to acidosis or death

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94
Q

recovery after delivery

A

4-6 weeks

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95
Q

exercise while preg

A

30minutes moderate daily

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96
Q

hot tubs, saunas, supine exercise

A

no

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97
Q

mineral supplementation while preg

A

just iron, 27 mg

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98
Q

avoid sex in preg if

A

placenta previa, premature rupture of membranes, hx or current preterm labor

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99
Q

air travel restrictions in preg

A

up to 36 weeks, unless poor DM, HTN, or sickle cell (should stay near providers or travel with records), and move every 1-2 hours

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100
Q

birth defect prevalence

A

2-3%, 5% results of enviromental chemicals or drugs, 15 pharmaceuticals

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101
Q

recommended limit on radiation exposure in preg

A

5 rad (CT ab/spine has max dx rad at 3.5)

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102
Q

fish restriction

A

methyl mercury. under 12oz (two servings0 per week, only 6oz albacore tuna

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103
Q

FAS triad

A

growth restriction, facial abnormalities (short palpebral fissures, low ears, mid-face hypoplasia, smooth philtrum, thin upper lip), CNS dysfunction (microcephaly, intellectual disability, behavior disorders)

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104
Q

tx for constipation of pregancy

A

docusate, psyllium hydrophlic mucilloid, lubricants

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105
Q

Women with poorly controlled diabetes immediately prior to conception and during organogenesis have a four- to eight-fold risk of having a fetus with a

A

structural anomaly, most likely CNS or cardiac

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106
Q

highest detection rate for trisomy 21

A

Sequential screen: (first trimester NT and PAPP-A + second trimester quad screen, 93% Detection Rate)

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107
Q

HPV strains in vaccine

A

(6,11) 16, 18

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108
Q

nonspecfic tests for syphilis

A

VDRL, RPR (nontreponemal)

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109
Q

strawberry cervix

A

trichomoniasis. frothy yellow-green discharge as well. tx:metronidazole, tinidazole

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110
Q

herpes culture sens/spec

A

highly specific, not sensitive (10-20% false negative rate)

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111
Q

How/where HPV causes cancer

A

carcinogenesis in the transformation zone of the cervix, where the process of squamous metaplasia replaces columnar with squamous epithelium

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112
Q

ACOG breast cancer screening

A

annually after 40

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113
Q

screening: first degree relative with colon cancer before 60

A

begin screening with colonoscopy at age 40, or 10 years before the youngest relative diagnosis, and repeat every five years

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114
Q

DEXA screening

A

age 65, or sooner with risk: early menopause, glucocorticoid therapy, sedentary lifestyle, alcohol consumption, hyperthyroidism, hyperparathyroidism, anticonvulsant therapy, vitamin D deficiency, family history of early or severe osteoporosis, or chronic liver or renal disease

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115
Q

cause of compensated respiratory alkalosis in pregnancy

A

increased minute ventilation

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116
Q

causes of acute pilmonary edema in pregnancy

A

tocolytic use, cardiac disease, fluid overload and preeclampsia

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117
Q

ureter prone to compression by uterus and ovarian veins

A

right. left is cushioned by sigmoid colon

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118
Q

why total T3 and T4 increase in pregnancy

A

Thyroid binding globulin (TBG) is increased due to increased circulating estrogens with a concomitant increase in the total thyroxine.

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119
Q

Poorly controlled DM prior to pregnancy most often leads to

A

cardiac anomolies

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120
Q

Can CVS dx neural tube defects?

A

No. just dna abnormalities

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121
Q

fragile X prevalence

A

1 in 3,600 males and 1 in 4,000 to 6,000 female

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122
Q

first trimester ultrasound gives dating within

A

3-5 days. second: within 1 week third: within 3 weeks

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123
Q

quad screening false positive rate

A

5%

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124
Q

GTT cutoffs

A

fasting under 95, one hour under 180, two hour under 155, three hour under 140.

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125
Q

seen with preexisting DM but not gDM

A

IUGR

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126
Q

When is ibuprofen dangerous in pregnancy?

A

can close ductus arteriosis after week 32

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127
Q

tx umbilical cord prolapse

A

attempt to push head back and immeadiate c/s

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128
Q

wide spaced nipples and lymphadema in neonate

A

turner’s syndrome

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129
Q

Mother w/DM1, moderate glucose control, neonate with

A

small, hypoglycemic

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130
Q

TTTS effects on donor and recipient

A

recepient: volume overload, polyhydramnios, polycythemia, hydrops. Donor: IUGR, oligo

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131
Q

neonate, mother with gDM

A

hypoglycemia, polycythemia, hyperbilirubinemia, hypocalcemia and respiratory distress

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132
Q

in HIV+ mom, start neonate AZT

A

immeadiately at birth

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133
Q

neonate CPR position

A

sniffing position (tilting the neonate’s head back and lifting the chin (not flex, as in adult)

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134
Q

APGAR components

A

HR, RR, reflex, activity, color (2 each)

135
Q

breastfeeding is associated with decreased

A

ovarian cancer

136
Q

burning pain in breasts, shiny nipples with peeling periphery

A

candidiasis

137
Q

signs that baby is getting sufficient milk

A

3-4 stools in 24 hours, six wet diapers in 24 hours, weight gain and sounds of swallowing

138
Q

percent of spontaneous abortions w/chromosomal anomalies

A

50-60% (most often autosomal trisomy)

139
Q

when to place cerclage

A

hx of cervical incompenence, second trimester (14weeks)

140
Q

testing for multiple early pregnancy losses

A

Testing for lupus anticoagulant, diabetes mellitus and thyroid disease are commonly performed. Maternal and paternal karyotypes should also be obtained

141
Q

ACE inhibitors in pregnancy

A

beyond the first trimester of pregnancy has been associated with oligohydramnios, fetal growth retardation and neonatal renal failure, hypotension, pulmonary hypoplasia, joint contractures and death

142
Q

treat thyroid storm in pregnancy

A

thioamides (i.e. PTU), propranolol, sodium iodide and dexamethasone (NOT radioactive iodine)

143
Q

tx kidney stones in preg

A

aggressive hydration, double-J stent if needed

144
Q

tx lupus in preg

A

corticosteroids, hydroxychloroquine for skin symptoms

145
Q

tx breast cancer in preg

A

no radiotherapy (chemo okay?)

146
Q

antidepressant bad in preg

A

paxil (paroxetine). increased risk of fetal cardiac malformations and persistent pulmonary hypertension

147
Q

test for appendicitis in preg

A

graded compression ultrasound (remember, appendix could be anywhere!)

148
Q

pre-eclampsia!

A

systolic blood pressure of 160 mm Hg or higher, or diastolic blood pressure of 110 (2x, 4h apart) thrombocytopenia, LFTs x2, severe persistent right upper quadrant or epigastric pain unresponsive to medication, renal insufficiency, pulmonary edema or new-onset of cerebral or visual disturbances.

149
Q

Mg in preeclampsia

A

if BP over 160/110

150
Q

mg toxicity causes

A

respiratory depression

151
Q

thromobcytopenia over 100,000

A

contraindication to expectant management of severe preeclampsia remote from term.

152
Q

indicate immeadiate delivery in preeclampsia

A

high BP on max 2 meds, non-reassuring fetal surveillance, LFTs x2, eclampsia, persistent CNS symptoms and oliguria

153
Q

risk of isoimmunization w/o rhogam

A

2% antepartum, 7% after full term delivery, and 7% with subsequent pregnancy

154
Q

best test for the noninvasive diagnosis of fetal anemia

A

MCA peak systolic velocity

155
Q

how much rhogam at 28weeks

A

300mcg, which neutralizes 30cc of fetal blood

156
Q

determine dose of rhogam to give to mother after exposure

A

kleinhauer-betke test

157
Q

indicates the severity of materal Rh hemolytic disease

A

bilirubin

158
Q

tx severe fetal Rh disease

A

fetal transfusion, maternal plasmaphoresis is second line

159
Q

days and twins

A

di/di split within three days, mono/di 4-8, mono/mono 8-12, conjoined after 13

160
Q

risk of multiples with ArT

A

5-6%

161
Q

twinning is not related to

A

paternal family hx

162
Q

intellectual disabilities from x-rays

A

8-15 weeks

163
Q

ultrasound criteria for missed abortion

A

CRL over 7 with no fetal heart beat

164
Q

induce labor with closed cervix

A

cytotec (miso) prior to pitocin (no foley if cervix isn’t open)

165
Q

associated with breech

A

Prematurity, multiple gestation, genetic disorders, polyhydramnios, hydrocephaly, anencephaly, placenta previa, uterine anomalies and uterine fibroids

166
Q

AROM when?

A

arrest in active phase (more than 4cm)

167
Q

success rates in VBAC

A

70-80% after one c/s, 70% after two

168
Q

before digital exam in third trimester bleeding

A

pelvic ultrasound. determine placenta placement before further exam!

169
Q

steroids cutoff

A

under 34 weeks

170
Q

low anterior placenta and prior c/s means risk for

A

placenta accreta

171
Q

most preterm labor is

A

idiopathic

172
Q

most cervical incompetence is dx’d

A

early second trimester

173
Q

tocolytics contraindicated in DM

A

terbutaline (never use for more than 48h), ritodrine

174
Q

tocolytics contraindicated in myasthenia gravis

A

magnesium sulfate

175
Q

indomathcin contraindicated as tocolytic when

A

after 33 weeks (d. arteriosis closure) also associated with oligohydramnios

176
Q

magnesium toco mec

A

competing with calcium entry into cells.

177
Q

ritodrine, terbutaline, and salbutamol toco mec

A

Beta-adrenergic agents work by increasing cAMP in the cell, thereby decreasing free calcium.

178
Q

nifedipine toco mec

A

Calcium channel blockers prevent calcium entry into muscle cells by inhibiting calcium transport

179
Q

indomethacin toco mec

A

Prostaglandin synthetase inhibitors, such as Indomethacin, work by decreasing prostaglandin (PG) production by blocking conversion of free arachidonic acid to PG.

180
Q

associated w/nifedipine use

A

Fetal hypoxia and decreased uteroplacental blood

181
Q

betamathasone effects on neonate

A

increased lung maturity, decreased RDS, decreased ICH, decreased necrotizing enterocolitis(no increase in infections)

182
Q

fetal fibronectin NPV in symptomatic women

A

99% 99 out of every 100 patients with a single negative test result will not deliver in the next 14 days

183
Q

first test for PROM

A

vaginal fluid nitralazine or ferning

184
Q

risks for PPROM

A

mostly infection, also 2x inrease from smoking, prior pprom. Shortened cervix

185
Q

time from ROM to delivery

A

At term, 90% will spontaneously go into labor within 24 hours of PROM. At 28 weeks to 34 weeks, 50% will go into labor within 24 hours and 80% within 48 hours

186
Q

prolongs latency in PROM by 5-7 days

A

antibiotics (steroids prolong less)

187
Q

Neonatal survival when rupture occurs between 20 and 23 weeks

A

25%

188
Q

amniocentesis signs of infection

A

glucose under 20, increased interleukin 6 (leukocytes aren’t very helpful)

189
Q

tx fetal hypoperfusion

A

change in maternal position to left lateral position, supplemental O2, treatment of maternal hypotension, discontinue oxytocin, consider intrauterine resuscitation with tocolytics and intravenous fluids, fetal acid-base assessment with fetal scalp capillary blood gas or pH measurement

190
Q

smooth muscle constrictor, contraindicated in PPH in pt w/HTN

A

methylergovine

191
Q

smooth muscle constrictor, contraindicated in PPH in pt w/asthma

A

prostaglandin F-2 alpha (hemabate, always delivered IM)

192
Q

associated with retained placentas

A

prior Cesarean delivery, uterine leiomyomas, prior uterine curettage and succenturiate lobe of placenta (NOT Placental abruptions, labor augmentation, degree of parity and circumvallate placenta)

193
Q

tx endomyometritis

A

ampicillin (or other gram + coverage), gentatmicin (or other gram negatives)

194
Q

most common agents acute cystitis

A

. coli (75%), P. mirabilis (8%), K. pneumoniae (20%), S. faecalis (

195
Q

first tx of infected wound

A

open drainage, then abx if indicated

196
Q

tx septic thrombophlebitis

A

add anticoagulant to antibiotics

197
Q

most common source of fever first day postpartum

A

lungs! get cxr before starting abx

198
Q

FDA catergory C

A

Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well controlled studies in humans

199
Q

most common SSRI side effect

A

insomnia

200
Q

fluoxetine in preg

A

abnormal muscle movements (EPS) and withdrawal symptoms: agitation, abnormally increased or decreased muscle tone, tremor, sleepiness, severe difficulty breathing, and difficulty feeding

201
Q

peaks higher at ovulation

A

LH

202
Q

follicular phase

A

pre-ovulatio, selected tertiary follicle

203
Q

luteal phase

A

post ovulation, corpus luteum becomes albicans and degrades

204
Q

associated with post-term pregnancies

A

placental sulfatase deficiency, fetal adrenal hypoplasia, anencephaly, inaccurate or unknown dates and extrauterine pregnancy

205
Q

risks of postterm pregnancy

A

macrosomia, oligohydramnios, meconium aspiration, uteroplacental insufficiency and dysmaturity

206
Q

favorable cervix after 42 wks

A

induce!

207
Q

withered, meconium stained, long-nailed, fragile and have an associated small placenta

A

dysmaturity, 10% of babies born after 43 weeks

208
Q

low birth weight, overlapping fingers, micronathia, and cardiac defects

A

trisomy 18

209
Q

extremem DM causes IUGR by

A

uteroplacental insufficiency (vascular disease)

210
Q

increased S/D ratio on umbical doppler

A

reflects increased vascular resistance. It is a common finding in IUGR fetuses.

211
Q

head-sparing growth asymetry

A

uteroplacental insufficincy (as in HTN)

212
Q

infective causes of IUGR

A

will be symmetric. rubella, CMV, syphilis, varicella, protozoan toxoplasmosis. No bacteria are known to cause IUGR.

213
Q

morbities of IUGR

A

oligo, fetal demise, perinatal demise, meconium aspiration, polycythemia

214
Q

adult complications of fetal IUGR

A

cardiovascular disease, chronic hypertension, chronic obstructive lung disease and diabetes

215
Q

most reliable first trimester dating

A

ultrasound crown rump

216
Q

when do fibriods indicate c/s

A

when in lower uterine sgement

217
Q

requirements for forceps

A

complete cervical dilation, head engagement, vertex presentation, clinical assessment of fetal size and maternal pelvis, known position of the fetal head, adequate maternal pain control and rupture of membranes

218
Q

vaccuums v. forceps

A

decreased lacs, increased cephalohematoma, jaudice, lateral rectus paralysis (resolves sponaneously)

219
Q

BTL failure rate

A

1%

220
Q

CVS v. amnio

A

CVS is earlier (12 v. 15), more rare limb abnormalities, more alloimmunization, more repeat attempts, higher procedure loss rate

221
Q

Depot irregular bleeding should resolve by

A

2-3 months. (amenorrhea in 50%)

222
Q

window for emergency contraception

A

72-130 hr

223
Q

contraception that decreases ovarian and endometrial cancer

A

combined OCPs

224
Q

slightly reduced the risk of ovarian cancer

A

BTL

225
Q

strongest predictor of regret of BTL

A

age (40% under age 25)

226
Q

patch fails more in pts

A

over 198 lbs

227
Q

associated with early recurrent pregnancy loss

A

antiphosopholidid antibody. work-up: anticardiolipin, beta-2 glycoprotein antibody, PTT, russel viper venom test.

228
Q

tx: antiphospholipid antibody in pregnancy

A

aspirin and heparin

229
Q

medical abortion v. surgical

A

more blood loss

230
Q

manual vacuum aspiration cut-off

A

less than eight weeks

231
Q

asherman’s syndrome

A

adhesions/fibrosis associated with d/c (up to 32% after 3 d/cs)

232
Q

squamous cell carcinoma from lichen sclerosis?

A

less than 5%

233
Q

inflammatory mucocutaneous lesions with relapsing obliterating rashes and lesions in skin, hair, nails, oral and vulvar mucosa

A

lichen planus, tx topical superpotent corticosteroids

234
Q

severe vulvar pruritis, worse at night, thick rugose labia

A

lichen simplex chronicus. tx topical steroids and antihistamines

235
Q

mucopurulent cervicitis tx

A

may be gonorrhea or chamydia–tx both

236
Q

post-exposure prophylaxis for hep B

A

within 7 days of blood exposure, 14 days of sexual. give HBIG and start vaccination series (known exposure)

237
Q

incubation period for hep B

A

6 weeks to 6 months

238
Q

outpatient PID treatment

A

ceftriaxone, cefoxitin, or other third-generation cephalosporin (such as ceftizoxime or cefotaxime) PLUS doxycycline WITH or WITHOUT metronidazole

239
Q

inpatient PID treatment

A

Cefotetan or cefoxitin PLUS doxycycline or clindamycin PLUS gentamicin

240
Q

tubal infertility rates in PID

A

tubal infertility has been reported as 12% after one episode of PID, 25% after 2 episodes and 50% after three episodes

241
Q

cause of overflow incontinence

A

underactive detrusor (neuro, MS, DM) or obstruction (postop, severe prolapse)

242
Q

cause of urge incontinence

A

detrusor instability

243
Q

best surgical option for genuine stress incontinence

A

retropubic urethoplexy (needle suspensions and anterior repairs have lower rates of success)

244
Q

tx “drain pipe urethra”, intrinsic sphincteric deficiency

A

urethral bulking is first line, then tight sling. artificial sphinter as last resort

245
Q

anticholinergics for parasympathetic detrusor instability (urge incontinence)

A

oxybutynin.

246
Q

complex mass in postmeno woman

A

exploratory surgery!

247
Q

first line endometriosis management

A

combined OCPs

248
Q

pelvic “fullness” or “heaviness,” which may extend to the vulvar area and legs. Associated symptoms include vaginal discharge, backache and urinary frequency

A

pelvic congestion syndrome

249
Q

provides cutaneous sensation to the groin and the skin overlying the pubis

A

iliohypogastric nerve (T12 L1)

250
Q

provides cutaneous sensation to the groin, symphysis, labium and upper inner thigh

A

ilioinguinal nerve (T12 L1)

251
Q

May increase pain of fibrocystic breast changes

A

caffeine

252
Q

nipple itch is usually

A

chemical irritation! (rarely, paget’s)

253
Q

abx for breastfeeding mastitis

A

dicloxacillin (or penicillin type, for s. aureus. can give erythro if allergic)

254
Q

sequence of sexual maturation

A

breast budding, then adrenarche (hair growth), a growth spurt and then menarche. In a minority of cases, pubarche (pubic hair growth) can occur before thelarche (breast/areolar development).

255
Q

body weight for menses

A

at least 85 lbs

256
Q

olfactory tract hypoplasia and the arcuate nucleus does not secrete GnRH

A

Kallman syndrome (no smell, no secondary sex characteristics) tx: pulsatile GnRH

257
Q

premature menses before breast and pubic hair development

A

McCune Albirght syndrome

258
Q

tx precocious puberty

A

GnRH agonist

259
Q

normal age of menarche

A

9-17

260
Q

check in patients with mullerian agenisis

A

renal utrasound! 25-35% have renal ageneisi

261
Q

secondary amenorrhea resulting from intrauterine scarring/synechiae.

A

asherman’s syndrome

262
Q

causes of hypothalamic-pituitary amenorrhea

A

functional (weight loss, obesity, excessive exercise), drugs (marijuana and tranquilizers), neoplasia (pituitary adenomas), psychogenic (chronic anxiety and anorexia nervosa). Get LH/FSH

263
Q

dyspareunia in premature ovarian failure

A

due to vaginal dryness from decreased estrogen

264
Q

initial laboratory assessment for a patient with amenorrhea and no other symptoms or findings on physical exam

A

Prolactin! Prolactinoma is most common pituitary tumor causing amenorrhea

265
Q

Asian e/short duration hirsutism and the significantly elevated DHEAS

A

adrenal tumor

266
Q

looks lik PCOS w/normal serum testosterone

A

check 17-hydroxyprogesterone for 21-hydroxylase deficiency

267
Q

terminal hair growth, depression, striae

A

cushings! check dexa suppression test

268
Q

post pregnancy hair loss

A

high estrogen in preg causes synchrony, leading to increased shedding 1-5 months postpartum

269
Q

unilateral tumor in pt 20-40; hirsutism and virilization.

A

sertoli-leydig cell tumors

270
Q

estrogen secreting tumors

A

granulosa cell, thecomas

271
Q

ancanthosis nigricans, temporal balding, clitoral enlargement and deepening of the voice

A

hyperthecosis (severe PCOS)

272
Q

second line (after OCPs) for idiopathic hirsutism

A

spironalactone

273
Q

leuprolide

A

GnRH agonist. Precocious puberty, fibroids, enodmetriosis, breast and prostate cancer, pedophilia

274
Q

progestin mechanism for AUB

A

inhibit further endometrial growth, converting the proliferative to secretory endometrium.

275
Q

polyp observation cutoff

A

bigger than 1.5cm

276
Q

tx for submucosal fibroid

A

hysteroscopic myomectomy (can’t access with laproscopy)

277
Q

dysmenorrhea failing OCPs and depot

A

ex lap

278
Q

Hyperplastic overgrowth of endometrial glands/stroma

A

polyps

279
Q

Endometrial glands/stroma and hemosiderin-laden macrophages

A

endometriosis

280
Q

adenomyosis and GnRH agonists

A

pain recurs after therapy

281
Q

physical examination in patients with primary dysmenorrhea

A

normal!

282
Q

should be performed on all women over age 40 with irregular bleeding to rule out endometrial carcinoma

A

endometrial biopsy

283
Q

good endometrial strip postmeno

A

less than 4 cm

284
Q

premature ovarian failure occurs

A

before age 35

285
Q

postenopausal calcium requirement

A

1200 mg qd

286
Q

repeat DEXA how often

A

q2y

287
Q

HRT and cholesterol

A

HDL levels increase and LDL levels decrease (good!)

288
Q

osteopenia DEXA T-score

A

-1 to -2.5. review risk factors, encourage increased vit. D and Ca intake

289
Q

menopausal symptoms in postmeno hysterectomy

A

decreased circulating androgens

290
Q

conception over time in healthy couples

A

After one month, 20% of couples will conceive; after three months, 50%; after six months, 75%; and after 12 months, 90% will conceive

291
Q

infertility after salpingitis

A

15%

292
Q

characterized by normal FSH and low estrogen levels

A

exercise-induced hypothalamic amenorrhea. tx is less exercise, then exogenous gonadotropins (LH, FSH)

293
Q

test for decreased ovarian reserve

A

clomiphene challended. give days 5-9, the check FSH on day 3 & 10. Elevated FSH means diminished reserve

294
Q

male role in infertility

A

35%

295
Q

PMDD timing

A

last week of luteal phase, resolve with follicular phase

296
Q

vitamin deficiency associated with PMS

A

A, E, B6 (also Ca, Mg, and positive family hx)

297
Q

SSRIs for PMS

A

daily, or for ten days of luteal phase

298
Q

molar pregnancy risk factors

A

Asian, under 20 or over 40, 2 or more miscarriages, low beta-carotene and folic acid consumption.

299
Q

recurrent risk in molar pregnancy

A

1-2% (20 fold!), 10% after two

300
Q

enlarged uterus and vaginal bleeding, a Beta-hCG value >1,000,000 mIU/mL

A

mole!

301
Q

partial mole

A

Karyotype 69XXY (or other triploid), fetus present, lower risk of developing post-molar GTD

302
Q

complete mole

A

diploid resulting from fertilization of “empty egg” by single sperm (46XX, 90%) or by two sperm (X & Y = 46XY 6-10%

303
Q

partial v complete mole presentation

A

partials have marked villi swelling, lower bHCG, older pts, longer gestations. completes are larger uteri, PEC, more GTD

304
Q

new pregnancy after mole

A

6 mos after negative HCG

305
Q

GTD risk in complete moles

A

20% (5 in partials)

306
Q

tissue diagnosis needed for choriocarcinoma?

A

No! bHCG is sufficient

307
Q

only vulvar carcinomas treated with excisional biopsy (all others radical vulvectomy and groin node dissection)

A

microinvasive squamous cell carcinoma of the vulva only made after pathology evaluation of a small (

308
Q

90% of vulvar cancers

A

squamous cell carcinoma. (over 65, smoking, not pigmented)

309
Q

pigmented vulvar lesion

A

melanoma or high-grade vulvar intraepithelial neoplasia

310
Q

erythematous with lacy white mottleing of the surface

A

Paget’s

311
Q

VIN 3 tx

A

local superficial excision (precancerous!)

312
Q

condyloma tx

A

TCA (thrichloroacetic acid), Aldara,

313
Q

cervical dysplasia tx

A

cryotherapy

314
Q

VIN 2 tx

A

lasers if multifocal, or vulvevtomy

315
Q

in situ carcinoma associated with breast cancer

A

paget’s disease of the vulva

316
Q

ASGUS under 30

A

repeat pap in one year if HPV positive, three years if negative

317
Q

white plaque on cervix

A

leukoplacia! biopsy asap

318
Q

most concerning on colposcopy

A

disorderly vessels most of all, then punctations and mosiacism.

319
Q

dx lesion in endocervical canal

A

conization of lesion can’t be visualized (ECC has high flase negatives)

320
Q

HSIL with normal biopsy

A

LEEP or conization, then cotesting at 12 and 24 months

321
Q

CIN grading

A

extent of involvement of the epithelial layer. CIN does not extend below the basement membrane. Carcinoma in situ (CIS) involves the basement membrane. In cancer, the cells invade beyond the basement membrane. In microinvasive cancer, they invade less than 3 mm

322
Q

indicated in positive ECC

A

cervical conizations

323
Q

most common symptom of fibroids

A

menorrhagia

324
Q

fibroid size reduction in GnRH treatment

A

estradiol level and with body weight, resumes growth potential if treatment is stopped

325
Q

untreated CAH on endometrial biopsy

A

30% will have endometrial cancer

326
Q

weight and endometrial cancer

A

10x increase if more than 50 lbs overweight

327
Q

abnormal bleeding in postmenopausal woman, enlared endometrial stripe, rare atypia on biopsy

A

d/c for further eval

328
Q

screening in patients on tamoxifen

A

none, just annual exams

329
Q

risk factors for ovarian cancer

A

nulliparity, family history, early menarche and late menopause, white race, increasing age and residence in North America and Northern Europe. Not smoking

330
Q

BRCA contribution to cancer

A

5 to 10 percent of breast cancers and 10 to 15 percent of ovarian cancers in white American women

331
Q

The most useful radiologic tool for evaluating the entire peritoneal cavity and the retroperitoneum

A

CT (PET scan is not useful in diagnozing ovarian malignancy

332
Q

The five-year survival of patients with epithelial ovarian cancer is directly correlated with

A

tumor stage

333
Q

tx advanced ovarian cancer

A

debulking, post-op chemo with taxane and platinum adjunct

response rate is 60-80%, five-year surivival in stage III ans IV is 30%

334
Q

most common tumor in women of all ages

A

dermoid tumor (median 30y, 80% in reproductive age)

Ob-Gyn (2 decks)

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