1
Q
VB
A
Vaginal bleeding
2
Q
LOF
A
Leakage of fluid
3
Q
IOL
A
Induction of labor
4
Q
FM
A
Fetal movement
5
Q
CTX
A
Contractions
6
Q
FKCs
A
Fetal kick counts
7
Q
GBS
A
Groups B strep, swab at 35wks
8
Q
GTT
A
3hr glucose tolerance test
9
Q
EFW
A
Estimated fetal weight
10
Q
NST
A
No stress test-fetal HR test
11
Q
BPP
A
Biophysical profile
12
Q
RCS
A
Repeat c-section
13
Q
TOLAC
A
Trial of labor after c-section
14
Q
R/B/A
A
Risk, benefits, alternative
15
Q
ECV
A
External cephalon version (attempt to turn breech baby)
16
Q
PET
A
PreEclampsia
17
Q
EDD
A
Estimated delivery date
18
Q
PNV
A
Prenatal vitamin
19
Q
ROM
A
Rupture of membranes
20
Q
OBT
A
OB triage
21
Q
ROL
A
Rule out labor
22
Q
VBAC
A
Vaginal birth after c-section
23
Q
NSVD
A
Natural spontaneous vaginal delivery
24
Q
PIH
A
Pregnancy induced hypertension
25
UPT
Urine pregnancy test
26
SAB
Spontaneous abortion
27
PTL
Preterm labor
28
HROB
High risk pregnancy
29
MFM
Maternal fetal medicine
30
GDM
Gestational diabetes
31
AMA
Advanced maternal age (>35)
32
BSUS
Bedside ultrasound
33
BTO
Bilateral tubal occlusion
34
IUP
Intrauterine pregnancy
35
FHT
Fetal heart tones
36
YA
Yolk sac
37
GS
Gestational sac
38
CRL
Crown rump length
39
AGUS
Atypical glandular cells of unk significance
40
AFI
Amniotic fluid index
41
AROM
Artificial rupture of membranes
42
ASCUS
Atypical squamous cells of unk significance
43
BSO
Bilateral salpingo-oopherectomy
44
BTL
Bilateral tubal ligation
45
CIN
Cervical intraepithelial neoplasia
46
EMB
Endometrial biopsy
47
GTD
Gestational trophoblastic dz
48
HELLP
Hemolysis, elevated liver enzymes, low platelets
49
HGSIL
High-grade squamous intraepithelial lesion
50
HSG
Hysterosalingogram
51
IUFD
Intrauterine fetal death
52
IUP
Intrauterine pregnancy
53
LEEP
Loop electrical excision procedure
54
LGA
Large for gestational age
55
LGSIL
Low grade squamous epithelial lesion
56
MFM
Maternal fetal medicine
57
MVU
Montevideo units
58
PMB
Post menopausal bleeding
59
PTL
Preterm labor
60
SBE
Self breast exam
61
SGA
Small for gestational age
62
SROM
Spontaneous rupture of membranes
63
TAH
Total abdominal hysterectomy
64
TOA
Turbo-ovarian Abcess
65
TOL
Trial of labor
66
TVH
Total vaginal hysterectomy
67
VAVD
Vacuum assisted vaginal delivery
68
VB
Vaginal bleeding
69
VAIN
Vaginal intraepithelial neoplasm
70
VIN
Vulvar intraepithelial neoplasm
71
Most effective forms of contraception
IUD
Implanon
Sterilization
72
Moderately effective (9-6 in 100) contraception
Depo shot
Nuvaring
OCP
The patch
73
Benefit of Monophasic birth control
Good at regulating cycle
74
Benefit of triphasic birth control pill
Mimics normal hormones
75
Benefit of continuous birth control pills
Tx dysmenorrhea and anemia
76
Use birth control with caution in these patients
DM, HTN, smoking under age 35, common migraines, liver dz
77
Birth control contraindicated in these pts
Uncontrolled DM or htn, CAD, complex migraine, hx thromboembolism, hormone sensitive ca, smoking over age 35
78
Contraindications to estrogen
Postpartum period, lactation, bx of thromboembolism, bx of CAD, smoking >35yo, classic migraines, liver dysfunction
79
Additional contraception is needed after starting birth control for how long
5-7 days for most
80
Black box warning for depo shot
Loss of bone mineral density
*but they regain back all bone density after dc’ing med. Also women lose more bone density breast feeding than on depo
81
XO karyotype leads to
Ovarian dysgenesis/turner’s syndrome
82
Important genes on Y chromosome
SRY-sex determining region of Y makes TDF
TDF- testis determine factor which promotes testis defferentiation
83
Important hormones in embryonic male sex differentiation
Tested are composed of sterilized and leading cells
Sertoli cells secret anti mullerian hormone which degenerates mullerian ducts
Leydig cells secret testosterone which transforms wolffish ducts to make reproductive tract and is converted to dihydrotestosterone which promotes develop emend I’d make external genitalia
84
Granulosa cells produce
Estradiol stimulates by FSH
85
Thecal cells secrete
Androgens and progesterone
86
21-hydroxylase deficiency leads to
Genital ambiguity and adrenal insufficiency
| This enzyme is required to synthesize aldosterone and cortisol
87
5a-reductase deficiency causes
Testes, male internal genitalia, female external genitalia
88
Complete androgen insensitivity leads to ___________ and is treated by __________
Testes, No internal reproductive tract and female phenotype
Gonadectomy and estrogen therapy
89
When should puberty begin for girls?
8-13yo
90
First sign of female puberty
Thelarche-breast development
91
Female athlete triad
Osteoporosis
Disordered eating
Amenorrhea
92
The average menstrual cycle duration
24-38 days
3-8days of menses
93
Define primary amenorrhea
Absence of menses by age 15 in presence of normal secondary sexual characteristics or 13 without secondary sexual characteristics
94
MC cause of primary amenorrhea
Gonadal dysgenesis/primary ovarian insufficiency
95
Kallman’s syndrome
Congenital absence if GnRH
Abdominal and lack of pubertal development
96
Swyer syndrome
Mutation of SRY gene leads to infertile XY female
97
General order of female sexual development
Boobs, pubes, grow, flow
98
MC cause of secondary amenorrhea
PREGNANCY
99
Risk factors for Asherman’s Syndrome
Postpartum hemorrhage
Endometrial infection
D&C or other instrumentation
100
Structural and PCOS causes of AUB are most common in
Reproductive age women
101
Anovulatory bleeding is most common
At the extremes of age (puberty and menopause)
*also consider endometrial hyperplasia and cancer is menopausal women
102
When to get an EMB
Postmenopausal: any with bleeding
45-menopause: heavy, frequent, or prolonged ovulatory AUB
<45: AUB that is persistent, accompanied by risk factors for unopposed estrogen or failed medical therapy
103
When does primary dysmenorrhea pain occur?
Just before or just after onset of mensuration and last 12-72 hr
*caused by prostaglandins released when endometrial tissue lysis
104
Tx for primary dysmenorrhea
```
Heat
Lower abdominal message
Exercise/yoga
NSAIDs
Hormonal Contraceptives
```
105
What age group do we commonly see primary dysmenorrhea?
14-22/young women
106
What age group do we commonly see secondary dysmenorrhea?
30-40
107
PMS and PMDD sx occur when?
Before menses/luteal phase
108
Lifestyle/supplements for PMS/PMDD
Exercise/yoga
Calcium and magnesium
Decrease salt, caffeine, and alcohol
109
First line medical therapy for PMDD
SSRI
110
FSH level that indicates menopause
>30mIU/ml
111
When do maternal hCG LEvels peak?
9-12wk gestation
112
Causes of abn hCG levels
Hydatidiform mole: rises more slowly but continues after 10wk
Ectopic: rises slower than normal
Fetal death: fall with a half life of 24hrs
113
Why does uterus become more excitable/Braxton-Hicks occur in 3rd trimester?
Decreased inhibition from progesterone
114
Fetus releases this hormone to develops lungs and trigger the beginning of labor
Cortisol
115
How does prolactin prevent ovulation?
Inhibits GnRH release
Inhibits GnRH action on pituitary
Antagonizes LH and FSH at ovary
116
NT scan occurs at
11-13wk
117
AFP scan occurs at
16-27wk
118
US anatomy scan occurs at
20wk
119
GCT and Rh test occurs at
24-28wks
120
GBS pregnancy screen occurs at
35-36wks
121
DOC induced labor
Oxytocin/pitocin
122
Live vaccines that are contraindicated is pregnancy
MMR and varicella
123
When TDap given during pregnancy?
32-34 wk
124
Chadwick’s sign
Blue to purple tint of vaginal walls indicating pregnancy
125
Hegar’s sign
Palpable softening of isthmus indicating pregnancy
126
Food to avoid in pregnancy
Seafood-high in mercury
Raw meat/eggs-infection risk
Deli meat/hot dogs/unpasteurized milk-listeriosis
Caffeine->200mg linked to miscarriage
127
How much weight should a normal weight woman gain during pregnancy?
25-35lb
128
First trimester
1-12wks
129
Second trimester
13-26wk
130
3rd trimester
27-40wks
131
When does “quickening” occur?
18-20wk
132
3rd trimester Fetal kick counts should be?
10 kicks/rolls/flutters within 2hrs
133
Uterine fundus should be to pubic symphysis by...
12wk
134
Uterine fundus should be to umbilicus by...
20wks
135
What is lightening and when does it occur?
Fetus dropping into the pelvis making it easier to breath suddenly
Occurs after 36-38wks
136
How do you interpret 1hr GCT?
<140 pass
>140 reflex to 3hr test
>200 automatic fail
137
How do you interpret a 3hr GCT?
```
Normal values
Fasting <95
1hr <180
2hr<155
3hr<140
```
*2 abn values is a fail and any value >200 is a fail
138
Describe a reactive(reassuring) NST
Minimum of 2 FHR acceleration by 15bpm for at least 15seconds
139
Elements of a BPP
Fetal movement
Fetal muscle tone
Fetal breath movements
AFI
(NST)
140
3 tests for rupture of membranes
Fern testing
Amniosure
Nitrazine
141
Adequate labor
3-5 contractions in 10min averaged over 30min
*200MVu
142
Macro sonic infant is ________grams
>4,500
143
Signs of true labor
Regular intervals and increasing intensity
Cervical dilation
Back pain
Not altered by analgesia
144
Normal fetal HR
110-160bpm, highly variable with periodic changes
145
Aspects of APGAR score
```
Activity/muscle tone
Pulse
Grimace/reflex irritability
Appearance-skin color
Respirations
```
146
Immunoglobulin in breast milk
IgA
147
C/I to breastfeeding
```
Alcohol/drug abuse
HIV
TB
Ongoing Chemo
Herpatic breast lesion
Infant galactosemia
```
148
Physiologic jaundice
Presents after 24hr of life
149
Pathological jaundice
Presents in first 24hrs or after 2wks
150
When does anterior fontanelle close?
Between 7-19months
151
When does posterior fontanelle close?
By 2months
152
Infant should be able to fixate on objects by
1 month
153
Frenulum
Connection under tongue
154
Omphalitis
Infection of umbilical cord stump
155
Most umbilical hernias resolve by
1yr
156
Syndactyly
Webbed fingers
157
Polydactyly
Extra digits
158
Rooting reflex is present during this time
3-4months
159
Palmar grasp reflex is present during this time
4-6months
160
Define SAB
Spontaneous abortion/miscarriage
Loss occurs prior to 20wks
MC complication of pregnancy
161
Complete v. Incomplete abortion
Based on passage or retention of POC
162
Define threatened abortion
Closer cervical os
Bleeding during pregnancy
163
Define inevitable abortion
Open cervical os and bleeding
164
Define missed abortion
Absent heart tones
Cervix closed and no bleeding
165
Define recurrent abortion
>2 consecutive losses prior to 20wks
166
MC site of ectopic pregnancy
Fallopian tubes
167
When will ectopics in the Fallopian tubes rupture?
6-8wk in isthmic
| 8-12wk in ampulla
168
Progesterone level in early pregnancy
<5ng is abnormal/poss. Ectopic
| >20ng is normal
169
Double ring and fetal pole should be seen on TVUS by this time?
5-6wk
170
Medication for ectopic pregnancy
Methotrexate 50mg
171
When does ectopic need to be managed surgically?
>3.5cm
hCG >5000
Cardiac activity present
Ruptured
172
How long should hCG be monitored after a hydatidiform mole?
6-12months
173
Choriocarcinoma tx
Methotrexate
Chemo if Mets
174
How does Rh alloimmunization affect the 1st + baby?
Mild anemia and elevated bilirubin at birth
175
Dx of preeclampsia
>140 systolic or >90 diastolic
AND
>300 protein in 24hr or 2+ on dip
(Higher values, end organ damage, and fetal growth restrictions indicate severe)
176
Anti hypertensives that are safe in pregnancy
Labetalol, nifedipine, and hydralazine
177
If preterm delivery is indicated when are glucocorticoids indicated?
<37wk gestation
178
TORCH infections
```
Toxoplasmosis
Other (syphilis and varicella)
Rubella
Cytomegalovirus
Herpes
```
179
Aspects of BPP
```
Fetal tone
Movement
Breath
NST
AFI
```
180
How should GDM pts be tested postpartum?
75g 2hr OGTT at 6wk
181
Define preterm labor
Regular CXT after 20wk but before 37wk
182
What do variable decelerations indicate?
Cord compression
183
What do late decelerations indicate?
Uteroplacental insufficiency/hypoxia
184
Describe treponema pallidum
Gram negative spirochete, obligate intracellular
185
Describe neisseria gonorrheae
Gram negative kidney bean shaped diplococus
186
Tx of gonorrhea
3rd gen cephalosporins
187
Describe chlamydia trachomatis
Intracellular gram negative cocci
188
Tx for chlamydia
Azithromycin or tetracycline
189
Chancroid is more common in these countries
Tropical
190
Tx for chancroid
3rd gen cephalosporins
191
MC causative organism of vulvovaginal candadiasis
C albicans
192
Why is it important to recognize c glabrata in candadiasis?
Resistant to fluconazole
193
How does candidiasis affect caginal pH?
It doesn’t
194
How does BV and trich affect vaginal pH?
Elevated (>4.5)
195
Tx for uncomplicated candida
Short course (1-3D) topical azole
OR
Single 150mg fluconazole dose
196
Tx of severe/recurrent candida or candida in prego/dm/immunocomp
7-14topical azoles (pregos)
OR
150fluconazole repeat q72hr x2-3doses
197
Tx for BV
```
500mg flagyl bid for 7d
OR
Metrogel 0.75% intravaginally daily for 5d
OR
Clindagel 2% intavaginally nightly 7d
```
198
Strawberry cervix and postcoital bleeding should make you think of this
Trich
199
Tx for trich
2g metronidazole once
200
Antibiotic resistance is particularly concerning in this common sti
Gonorrhea
201
Percent of women that are asympyomatic with chamyldia
At least 85%
202
Tx for chlamydia
Azithromycin 1g oral (pregos)
OR
foxy 100mg bid 7d
203
Tx for gonorrhea
Ceftriaxone 250mg IM PLUS azithromycin 1g oral
204
Emerging cause of PID
Mycoplasma genitalium
205
Tx for PID
Ceftriaxone 250IM PLUS doxy 100 bid 14d
| F/u in 48-72hr!!!!
206
Safe allergy treatment in pregnancy
Lora radon’s
Benadryl(diphenhydramine)
Chlorpheniramine
Zyrtec (cetrizine)
207
Safe constipation treatment in pregnancy
```
Fiber
Colace (docusate na) 100mg 1-2xd
```
208
Safe cough treatment in pregnancy
Cough drops
Robitussin DM (dextromephorphan)
Mycinex(guaifenesin)
209
Safe diarrhea treatment in pregnancy
Clear liquids for 24hr
BRAWT diet
Then immodium (loperamide) up to two doses
210
Safe fever treatment in pregnancy
Tylenol (325q3hr or 650q6hr or 500q4hr)
* max 3000mg daily
* go to ER if temp >100 for over 2hr
211
Safe headache/pain treatment in pregnancy
Tylenol (325q3hr or 650q6hr or 500q4hr)
212
Safe treatment of heartburn in pregnancy
Pepcid (famotidine)
Prevacid (lansoprazole)
Tums
Zantac (ranitidine 150mg)
213
Safe treatment of hemorrhoids in pregnancy
Anusol cream
Sits bath
Preparation h
Tucks medicated pad
214
Safe treatment of nausea in pregnancy
Ginger/peppermint candy or tea
B6 (pyridoxine) 25mg tid
Unisom(doxylamine only) 1/2tab at bedtime
215
Safe treatment of sinus congestion in pregnancy
Steam, saline nasal sprays, Sudafed PE (phenylephrine 5-10mg c/I with htn)
216
MC strains of HPV
6 and 11
217
HIV targets these cells
CD4 T (helper) cells
218
Presentation of primary/acute HIV
Flu/mono like sx, rash on trunk, mucocutaneous ulcers
219
Oral hairy leukoplakia should make you think of
HIV
220
Kaposi’s sarcoma should make you think of
HIV
221
How is AIDS dx’d?
CD4<200
OR
1 of 27 AIDS defining conditions
222
PCP tx
Bactrim DS
223
MC intracranial lesion in HIV
Toxoplasmosis (also causes encephalitis)
224
MC retinal infection in HIV
CMV
225
When should you start prophylaxis for PCP in an HIV pt?
CD4<200
226
When should you start prophylaxis for MAC in an HIV pt?
CD4<50
227
Syphillitic chancre takes how long to resolve?
4-6wk
228
Secondary syphillis presentations
Rash on palms and soles
Condyloma lata
Mucous patches
229
Tx for syphilis
Benzathine pen G 2.4 my IM (additional doses required if present for >1yr)
*azithro or doxy if pcn allergic
230
Tx for lymphogranuloma venereum (LGV)
Erythromycin or doxy
231
Tx for chancroid
Azithromycin, ceftriaxone or cipro
232
Define menopause
Permanent cessation if menses for 12 consecutive months
233
Sx of perimenopause
Irregular menses
Hot flashes/night sweats
Mood sx
Vaginal dryness
234
How do you choose appropriate HRT therapy?
Intact uterus:estrogen and progestin
Hysterectomy: estrogen only
235
When to stop HRT?
After 5yr therapy or age 60
236
Risks of HRT
Thromboembolic dz and breast ca
237
C/I of HRT
```
Breast ca
CAD
he thromboembolic dz
Acute liver dz
Unexplained vb
TIA
```
238
Pathophysiology of lichen sclerosis
Autoantibody attach of extra cellular matrix and basement membrane
239
Spread of lichen sclerosis
Periclitorally to perineal skin
240
Cancer associated with lichen sclerosis
SCC (5%)
241
First line to lichen sclerosis
Temovate 0.05% steroid OINTMENT
242
Empiric abx therapy for bartholin cyst
Keflex or doxy
243
What is unique about vulvodynia?
Pain is limited to vestibule
*associated with anxiety and mood disorders
244
Vulvodynia tx
Sitz bid followed by petroleum jelly
Vaginal estrogen\testo
Nortriptylin or gaba
245
Standard tx for VINU
surgical-CO2 laser, local wide excision, or vulvectomy
246
Where does most invasive vaginal cancer originate?
Endometrium, ovary or cervix
247
MC type of vaginal cancer
SCC
248
Characteristics of benign adnexal masses
Thin walled
| <3cm (or <1 after menopause)
249
Thin walled adnexal mass with homogenous echos
Endometrioma
250
Thin walled hyperechoic nodule with distal acoustic shadowing
Teratoma
251
Thin walled adnexal mass with network of linear or curvilinear pattern
Hemorrhagic cyst
252
Characteristics of malignant adnexal masses
Thick >2mm septations
Solid modular or papillary component
Blood flow
253
Bilateral cysts with clear/straw colored fluid and elevated hCG
Theca lutein cysts
254
Theca lutein cysts are associated with these 3 conditions
Hydatidiform mole
Choriocarcinoma
Clinic therapy(? Idk)
255
Mature teratomas most often originate from this germ layer
Ectoderm (hair teeth)
256
Thin walled locust cyst filled with gelatinous mucin
Serous/mutinous cystadenoma
257
High-grade serous carcinoma of the ovary originated from where?
Fallopian tube
258
Ovarian germ cell tumors often produce these blood markers
Alpha fetopeotein
| HCG
259
Blood marker for epithelial ovarian cancer
CA-125
260
What type of cancer is HPV 16 associated with?
Cervical SCC
261
What type of cancer is HPV 18 associated with?
Cervical adenocarcinoma
262
Who needs annual PAP smears?
```
HIV + pts
Immunocompromised
Hx of cervical ca
Hx CIN II/III
Exposure to DES in utero
```
263
When to stop cervical cancer screening?
At 65 if
3 negative cytology
2 negative co tests
No hx CIN II in 20 yr
264
ASCUS or LSIL follow up
Repeat in 1yr
265
HSIL or ASCH follow up
Colposcopy
266
Fibroids are more common in this population
African Americans
267
Diffuse globular uterine enlargement
Adenomyosis
268
Pathophysiology of adenomyosis
Proliferation of glandular uterine tissue
269
Pathophysiology of leiomyoma/fibroids
Proliferation of uterine muscle
270
Most important risk factor for endometrial hyperlasia
OBESITY
*any thing associated with unopposed estrogen is a risk factor
271
MC type of endometrial cancer
Adenocarcinoma
PANCE prep JQ
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