OBGYN Flashcards

Question

Cell-free fetal DNA - what is it - when

Answer 1

- screening test for trisomy 21, 18, 13 and sex aneuploidy | - after 10 wks

Answer 2

- between 11 and 13 wks - beta HCG elevated, AFP and inhibin A low - all are low - AFP high, everything else normal

Answer 3

- sample of chorionic villi taken through abdomen or cervix - only evaluates chrom abnormalities not NTD - 9-12 weeks - high risk of loss (1%), and limb defects if done before 9 wks - aspiration of amniotic fluid, done at 15-20 wks, lower risk

Answer 4

- 30-40 lb - 25-35 lb - 15-25 lb

Answer 5

- compulsive ingestion of non food substances with little or no nutritional value

Answer 6

- only 300 mg/day; can increase risk for spontaneous abortions - fine - caused by relaxing of LES bc of progesterone - caused by progesterone -> decrease in GI motility - LE -> thrombophlebitis - no restrictions unless there is ruptured membranes or placenta previa - not after 35 wks

Answer 7

- onset of labor and end at 4 cm; G1 -> 20 hrs, G2 -> 14 hrs - 4cm to 10 cm; 7-8 cm; G1 -> 1.2cm/ hr, G2 -> 1.5 cm/hr - 10 cm until fetus is delivered; G1 -> less than 2 hr or 3 with epi, G2 -> less than 1 hr or 2 with epi - usually less than 10 min, but abnormal if more than 30 min; gush of blood, lengthening of cord, firm fundus

Answer 8

- water breaks - pooling of fluid on speculum exam, fluid expeled with valsalva - ferning and positive nitrazine (turns blue bc it is basic compared to vaginal fluid)

Answer 9

- vertex: baby is face down - face up, so neck is extended - head between vertex and face presentation causing ant fontanelle to present first - eyebrows present first, must be converted to vertex in order for vaginal delivery - presentation is butt

Answer 10

- both legs flexed and down - one led extended and up, other flexed and down - both legs extended and up but babies butt still down and head still up

Answer 11

- umbilical cord wrapped around neck - slip finger under cord and slip over infants head - unable to slip around head so have to cut

Answer 12

- fourchette, perineal skin, vaginal mucosa but NO fascia or muscle - 1st + fascia and muscle or perineal body - 2nd + involvement of anal sphincter - extends through rectal mucoa and exposes lumen of rectum

Answer 13

- largest part of head through pelvic inlet - fetal head passes down through pelvis - chin to chest allowing for smallest diameter of head to pass through birth canal - turning of head so that occiput is by pubic symphysis - once fetal head is out, turn again so the baby is sideways and can deliver shoulders - delivery of ant shoulder then post

Answer 14

- only frequency of contractions | - frequency, duration, and strength of contraction (montevideo units)

Answer 15

- most common heart rate lasting for 10 or more min; usually 110-160 - periodic changes above or below baseline - two accelerations at leat 15 BPM above baseline lasting for 15 sec in 20 min

Answer 16

- caused by head compression and regulated by vagal stimulation -> benign - caused by uteroplacental insuff during contractions; gradula decrease below baseline that occur after contraction; O2, lateral decub position, pitocin off - abrupt onset deceleration that normally looks like a V or W; fetal autonomic response to cord compression; amnioinfusion to alleviate cord compression - isolated decelerations that are greater than 15 bpm that last for 2-10 min; caused by cervical exam, uterine hyperactivity, UC compression - fluctutations in FHR baseline with reg amplitude and frequency; baby is in distress

Answer 17

- variation of succive beats controlled by ANS, increase caused by symp and decrease caused by parasymp, and these two sxs are usually pushing and pulling - neuro immature, so decrease in varibaility is normal - fetal acidemia, asphyxia, maternal acidemia -

Answer 18

- normal FHR - anything that is not I or III - absent variability + recurrent late decelerations, recurrent variable decelerations, brady cardia; or sinusoidal pattern

Answer 19

- null: >20 hr, para: >14 hr - prolonged dilation (slow rate cervical dilation)- null: 1.2cm/hr, para: 1.5 cm/hr; prolonged descent (slow rate of fetal descent) - null: <1 cm/hr, para: <2 cm/hr - complete cessation of dilation or descent - abnormalities in contraction, presentation of baby, pelvis of mom, or birth canal - induction

Answer 20

- pitocin; stimulates uterine contractions - misoprostol (cytotec) - synthetic PGE1 analog used for cervical ripening intravaginally or orally OR cervidel - PGE2 analog in gel or vaginal insert for cervical ripening; sex, orgasm, breast stim increases prostaglandins - foley balloon (cook cath): passed through internal cervical os and into extra amniotic space, inflated and rested on internal os to cause traction; laminaria- seaweed sticks put into cervix and when wet start to expand;

Answer 21

- horizontal incision made in lower uterine segement - vertical incision made in contractile portion of uterus; premature, fetal transverse w/ back down or placenta previa - mandatory if prior classical or elective if prior low, failure to progress, breech, concern for fetal well being - risk of uterine rupture after c section, 10% with classical and 1% w/ low transverse

Answer 22

- lack of progress in second stage of labor, fetal distress, maternal exhaustion; cervix must be fully dilated - same indications as forcep; safer and easier to perform but only used during contractions and small increase in cepahlohematoma

Answer 23

- collection of blood under periosteum of skull caused by ruptured vessels and does NOT cross suture lines - temporary swelling of fetal head from prolonged engagment, does cross suture lines

Answer 24

- local infiltration of pudendal nerve w/ lidocaine, sometimes used with epidural - injected at 3 and 9 o clock around cervix; helps with contractions during first stage of labor, but not anything after bc pudendal is not blocked - anesthetic into subarachnoid space, given for uncomplicated cesearean and vaginal delivery; must give 1 L of IV to prevent hypotension; severe pre-clampsia - injection in epidural space, lumbar IV space or sacral hiatus; abd (8th Thoracic to 1st Sacral) vs vaginl (10th thoracic to 5th sacral); longer second stage of labor; severe preeclampsia

Answer 25

- period of confinement between birth and 6 weeks after delivery - fundus at umbilicus after delivery and should start shrinking within 2 days postpartum, causing after pains. Will be back in true pelvis by 2 weeks post partum. - superficial part will become necrotic and slough off and basal layer becomes new endometrium - vessels become thrombosed and site decreases in size - large vessels are obliterated by hyaline changes and replaced by smaller vessels - external os contracts and narrows by end of first week, after vaginal delivery the external os is a horiztonal slit instead of small oval opening - broad and round ligaments relax and abdomen will be soft and flabby with stretch marks - bladder has increased capacity and insensitive to intravesical pressure so over distenetion, incomplete bladder emptying and excessive residual urine lead to UTI; ureters and renal pelvsises return to normal size - increased WBC during and after labor, hemoglobin and hematocrit should increase, blood vol returns to normal a week after delivery

Answer 26

- group A and B strep - clostridium and listeria - e coli, klebsiella, proteus - b. fragilis - fever and fundal tenderness

Answer 27

- infection involving decidua, C section, postpartum day 2-3, treat with IV antibiotics - usually caused by cath, urinary stasis, and frequent pelvic examinations - fever, wound erythema, tenderness, and purulent drainage; gram stain and should be drained, irrigated and debrided - pain at site and disruption of wound, r/o rectal vaginal fistula, open clean and debride wound

Answer 28

- when you exclusively breast feed it prevents ovulation for up to 6 months - combined or progestin only - progesterone injection lasts for 3 months, does not effect breast milk production - can be inserted immediately after giving birth or 6 weeks after - progesterone releasing implant in arm tht lasts for 3 years

Answer 29

- after delivery of baby the decrease in progesterone and estrogen allow for milk production - eveyrhting except vit K - more protein and IgA, less sugar and fat - colostrum turns into milk w/i 1 weeks of breast feeding and becomes fully mature milk by 4 weeks

Answer 30

- staph aureus from infant nasopharynx or strep viridans; 4 wks post-partum with fever and chills, focal erythema; culture milk; dicloxacillin and continue breast feeding - suspected when fever does not improve with abx in 48-72 hrs; US to see collection of fluid; broad spectrum abx; continue breast feeding

Answer 31

- HIV, active lesion on breast from herpes, TB - bromocriptine, CA drugs - none if used for CA, but if usde for dx like CT must pump and dump for while then resume

Answer 32

- transient lymphocytic thyroiditis in 5-10% of women after giving birth - 1-4 months post-partum; destruction induced hormone release; small painless goiter; bb - 4-8 months post-partum; thyroid insufficiency; goiter, fatigue, inability to concentrate; thyroxine for 6-12 months; 1/3 permanent hypothryoidism

Answer 33

- diabetes that existed before pregnancy - HTN, preeclampsia, preterm delivery, c section, polyhydraminos, infections - preterm birthm macrosomia, caudal regression (absence of sacrum), NTDs, neonatal hypoglycmia (bc hyperplasia of fetal beta cells from constantly elevated sugar) - at 20 weeks, increases risk of fetal congenital heart disease - 37 wks w/ poor glycemic control, need to do amniocentesis before to look for maturity by measuring level of lecithin;lor 38 wks with good glycemic control

Answer 34

- low TSH and high T4; only T3 and TBG increases in pregnancy - drug of choice for 1st trimester; inhibits conversion of T4 to T3 - used after T1 bc readily crosses placenta - only used when medical management fails - women who remain hyperthyroid despite treatment have higher risk of preeclampsia

Answer 35

- HTN before 20 wks of gestation - look for renal and cardiac dysfunction (left ventricle hypertrophy) - BP drops, so if seeing pt for first time could appear normotensive - super-imposed preeclampsia (preeclampsia in setting of chronic HTN) and abruptio placenta - fetus should be tested for adequate perfusion and receive US to monitor growth - at term, vaginal> C section - lebatalol and alpha methyldopa - ACE and ARB -> teratogens

Answer 36

- CHF - 4% - vaginal - pulm HTN bc increase in preload causes overload in left atrium which back up into lungs; 25% will have CHF - - asymptomatic, click on physical exam, safe

Answer 37

- 1/3 improve, worsen, stay same; fetal growth restrictions | - PROM or acidemia (bc unable to blow off CO2); CXR w/ abd shield; can use normal abx

Answer 38

- hydronephrosis from increase in fluid and stasis of urine caused by progesterone leads to ascend kidney infections; 50% of time only right side; E coli; renal dysfunction and pulm edema bc of endotoxin alveolar injury -> ARDS, preterm labor

Answer 39

- most common surgical condition in pregnancy - higher in T3 - appendectomy, laparoscopic when uterus small and laparatomy in later pregnancy

Answer 40

- before becoming pregnant should try to minimize amount and dosage of medications to control seizures if it all possible - must take folic acid - neural tube defects and congenital malformations

Answer 41

- calf pain, swelling, palpable cord in calf - doppler - PE if left untreated - LMWH - stop LMWH 12-24 hr before onset of labor

Answer 42

- dyspnea, CP, sough, syncope, hemoptysis - CT pulm angiography - LMWH

Answer 43

- most thrombogenic of all coagulopathies - 6-12x risk of DVT - 2-6x risk of DVT - most common heritable, 5-8x risk of DVT - preeclampsia, HELLP syndrome, placental abruption, recurrent abortion and still births - LMWH

Answer 44

- more common in pregnancy bc of stress - pleuritic chest pain, fever, cough, lung infiltrates, hypoxia - thromboses, pneumonia, pyelonephritis, sepsis, gestational HTN - placental abruption, preterm delivery, fetal growth restriction, stillbirth - supplementation of 4mg/day of folic acid to accomodate for rapid cell turnover, IV hyrdration and pain control for crisis

Answer 45

- 16-29 percent of pregnant women become anemic in T3 - preterm delivery, intrauterine growth restriction, low birth weight - Fe supplementation

Answer 46

- AI dx against mult proteins in body - lupus antibody, anticardiolipin antibodies, anti-B2 glycoprotein - low dose aspirin or heparin if needed

Answer 47

- itchy rash that appears a few days before or after delivery - starts on abdomen in stretch marks and spreads to arms and legs but spares face, palms, and soles - antihistamine and topical steroid

Answer 48

- preeclampsia, preterm labor, FUGR, congenital heart block | - try to get pregnant when dx is in remission, monitor for flare ups

Answer 49

- starts before 20 weeks of pregnancy, 140/90 - HTN after 20 weeks w/o proteinuria - HTN after 20 weeks w/ proteinuria or end organ dysfunction - BP 160/110 w/ neuro defects, renal/hepatic abnormalities, pulm edema or thrombocytopenia - preeclampsia in patients with chronic HTN - Vasospasm in various organs bc of the way the placental vasc developed - Eclampsia, renal failure, hepatic hematoma, uteroplacental insufficiency - Mg sulfate for seizure prophalaxis and delivery of baby is only true tx - always give Mg sulfate; preterm also give steroids for lung maturity; try to do vaginal delivery; 34 weeks

Answer 50

- Hemolysis, Elevated liver enzymes, low platelets | - immediate delivery

Answer 51

- seizure or coma w/o another cause in ot with preecalmpsia - control seizure with mg sulfate, control BP with lebatalol, and delivery is only definitive tx - null parity, more than 40 yrs old, chronic HTN, chronic renal dx, DM, mult gestation - 60% efore, 20% during and 20% after

Answer 52

- lebatalol: beta and alpha blocker, hydralazine: direct vasodilator - nifedipine: Ca channel blocker and methyldopa: false NT - not used in pregnancy bc decrease in plasma vol will be detrimental to fetal growth

Answer 53

- dx with DM prior to pregnancy - DM only develops in pregnancy - A1: controlled with diet, A2: controlled w/ insulin - over 35, prior pregnancy w GD, family hx of diabetes, obese, black/hispanic/native american - glucola, 28 wks, 1 hr and then 3 hr - 4x risk of preclampsia, increase risk of bact infections, high rate c section, increase risk of lifetime risk type 2 DM - increase risk of perinatal death, macrosomia -> birth injuries - maintain fasting under 96, and after eating under 135 - A1: wait until labor, A2: 38- 39 weeks

Answer 54

- ant shoulder is lodged behind pubic symphysis after head has been delivered - obstetric emergency, infant needs to be delivered quickly - obesity of mother, multiparity, post term pregnancy, macrosomia, male gender - brachial plexus injury, fetal clavicle fracture, hypoxia/ death - maternal thighs sharply flexed against maternal abdomen w/ suprapubic pressure -> flattens sacrum and pubic symphysis - pressure on the ant surface of posterior shoulder to rotate posterior shoulder and unscrew anterior shoulder - pressure applied to accessible part of fetal ant shoulder and rotated toward chest - post arm is pulled across chest and post arm and shoulder delivered -> shorter distance between ant shoulder and post axilla, allowing for ant shoulder to be delivered - fetal head returned to uterus y reversing cardinal movements and then csection is done

Answer 55

- severe vomiting in pregnancy that results in weight loss, dehydration and neuro sxs - high levels of hCG, estrogen, progesterone - vit B6, IV hydration and thiamine replacement

Answer 56

- antibodies in moms blood that can affect baby - kills - dies - lives - with US for hydrops

Answer 57

- D antigen on RBC - if mother is Rh- and baby is Rh + if exposed to babys blood during delivery then next Rh+ baby can be attacked - with US, look at MCA for anemia - give ALL Rh- moms anti-Ro to prevent mom from forming own antibodies at 28 weeks and within 72 hrs of delivery (if baby ends up being Rh+), standard is 300 micro grams, but dosage is claculated by KB test that tests for the amount of fetal RBC in maternal circulation - mild: 37-38, severe 32-34

Answer 58

- gestational age less than 37 w/ reg contractions and progressive cervical change - previous hx of preterm delivery, polyhydraminos, mult gestations, substance abuse, infections, placental abruptions - look for infection, confirm gestational age by US - cervical length greater than 33, high: cervical length less than 20 - hydration (prevent release of ADH bc it mimics oxytocin), tocolytics, steroids - progesterone supplementation between 16-20 weeks and continued through 36 weeks; 17 alpha hydroxy progesterone IM weekly or vaginal progesterone tab every day

Answer 59

- prevent delivery for 2-7 days to administer steroids when pt is delivering at less than 34 wks - supress uterine contractions by competing with Ca; flushing, lethargy, headache, muscle weakness; lethargy, resp depression, hypotonia; Ca gluconate; Myasthenia gravis - Ca channel blocker; flushing, headache, hypotension; maternal hypotension, caution with renal dx, do NOT give with Mg sulfate - Beta 2 stimulation on myometrial cells -> increase in cAMP -> decrease intracellular Ca -> decrease contractions; PE, tachycardia, headaches; tachy; CV dx, hyperthryoidism, uncontrolled DM - prostaglandin inhibitor; less than 32 weeks bc it can cause oligohydraminos; nausea, heartburn; premature closure of ductus arteriosus; renal or hepatic impairment - bleeding, abruptio placentae, death of fetus, chorioamnionitis, HTN, unstable maternal hemodynamics

Answer 60

- preterm 24-34 | - decrease resp distress syndrome. and intraventricular hemm

Answer 61

- phosphatidylglycerol (found in surfactant) in amniotic fluid, surfactant-albumin ratio in amniotic fluid, lecithin-sphingomyelin ratio (greater than 3) in amniotic fluid

Answer 62

- rupture of membranes before onset of labor - infections, incompetent cervix, nutritional deficiencies - bc of oligohydraminos; also premature labor - avoid vaginal exams to decrease risk of chorioamnionitis and check for pre-exisiting chorioamnionitis - 90% of term patients will go into labor by themselves w/i 24 hrs; 50% of preterm will go into labor by themselves w/i 24 hrs - if term then induce after 24 hrs; if pre term give assess for fetal lung maturity and give steroids then induce

Answer 63

- fever, tachycardia, uterine discharge, malordorous vaginal discharge - leukocytosis

Answer 64

- in third trimester w/ bleeding until placenta previa is r/o - check vitals and make sure stable, CBC, coagulation profile, type and cross match, UA, drug screen, look for placenta previa, monitor fetal wellbeing, determine if blood is moms or babies - placental abruption, placenta previa, vasa previa, uterine rupture, polyps, CA

Answer 65

- premature separation of placenta from uterine wall before delivery - trauma, previous hx of abruption, preeclampsia, smoking, cocaine abuse, high parity - vaginal bleeding, constant and severe abd pain, irritable/ tender uterus, maternal shock, DIC - retroplacental hematoma on US but clinical presentation most important - correct shock and deliver baby (preferably vaginal, but if fetus in distress then csection)

Answer 66

- when placenta implanted i the immediate vicinity of the cervical os - covers entire internal cervical os vs partially covers vs one edge of placenta touches one edge of os - painless vaginal bleeding in 2nd or 3rd trimester - US - if asx then recommend to avoid sex and exercise and repeat US to see if it moves, if not will need csection when at term VS if bleeding then depends on trimester, for 3rd then deliver (c-section) but for 2nd

Answer 67

- fetal cord vessels pass over os making them susceptible to rupture when the membranes rupture - fetal vessels insert into placenta and have no wharto jelly (protection) around them - vaginal bleeding with fetal distress - correct shock and deliver immediately

Answer 68

- disruption of uterine musculature through all of its layers w/ part of fetus protruding - maternal hemorrhage, hysterectomy, death and permanent neuro damage to baby - vertical C section

Answer 69

- excessive bleeding after delivery making the pt symptomatic and/or results in hypovolemia - uterine atony - early within first 24 hrs, and late is within 24 hr to 6 weeks after - manually compress and massage uterus, start two large bore IVs, explore uterine cavity to make sure all parts of placenta were removed, inspect cervix and vagina to make cure there are no lacerations, consider coagluopathy if continues to bleed - give dilute oxytocin bc undiluted will cause drop in BP

Answer 70

- abnormal implantation of placenta in uterus causes retention of placenta after delivery and heavy bleeding - villi attach to myometrium instead of endometrium, villi invade myometrium, villi go through muscle and into serosa - hemorrhage during labor - hysterectomy

Answer 71

- when uterus falls out of vagina during delivery - push it back in, give uterine relaxants (terbuline or nitro) so it can form normal shape, do not remove placenta until uterus is back in cavity, usually give antibiotics

Answer 72

- increase heart rate, stroke vol, CO - further increase in tidal vol and oxygen consumption - increase GFR and renal size - increase 600 calories/ day

Answer 73

- two ova fertilized by two diff sperm - one ovum fertilized by one sperm that then splits into 2 babies; dichorionic and diamniotic, monochorionic and diamniotic, mono/mono, conjoined twins - increased risk of congenital anomalies - mono must be checked every 4 weeks while di can be checked every 6-8 weeks

Answer 74

- show uterus with greater than expected size - determine chorionicty and amnions - at 38 weeks

Answer 75

- blood shunted from one baby to another - monochorionic twins - unbalanced vascular anasatamoses - laser coagulation of anastamoses

Answer 76

- miscarriage; before 20 weeks; chromosomal abnormalities, infections, structural abnormalities (bicornate septate uterus, leiomyoma, intrauterine adhesion), immuno (lupus), environmental (tobacco, alcohol, irradiation) - intentional termination of pregnancy, elective vs therapeutic

Answer 77

- bleeding from cervical os before 20 weeks w/o cervical dilation or passage of tissue; pelvic rest - bleeding from cervical os before 20 weeks w/ cervical dilation w/o passage of tissue; surgical eval of uterus w/ dilation and curretage and medical uterine evacuation w/ misoprostol - passage of some but not all POC from uterine cavity before 20 weeks gestation; enlarged, boggy uterus, POC present in both vagina and uterus; stabilize w/ fluids, D&C to remove - complete passage of POC w/ cervical os closed after abortion complete - fetal demise before 20 weeks of gestation w/o expulsion of any POC; pregnant uterus fails to grow and sxs pregnancy gone, intermittent vaginal bleeding w/ closed cervix, US confirms absent fetal cardiac activity; expectant (wait 2 weeks for mom to spontaneously deliver POC) but D&C or misoprostol if they don't - Infected POC; induced abortion; speculum exam will have malodorous vaginal and cervical discharge, fever, hypotnesion, tachycardia, pelvic discomfort, leukocytosis, US with retained POC; culture vaginal discharge and blood, UA, LFTs, BUN; broad spectrum antibiotics then D&C (hysterectomy if unable to get out products)

Answer 78

- severe maternal dx where continuation of pregnancy can be life threatening, severe CV dx, poor controlled DM - major malformations or genetic reasons

Answer 79

- E2, E1, F2 alpha; oral or vaginal; every 2-6 hrs until uterus is evacuated; T2; can be used in patients with prior csection; diarrhea, fever - T1; anti-progesterone followed by misoprstol (cytotec -> prostaglandin); used before 7 weeks pregnancy

Answer 80

- T1 or T2 - T1: involves dilation of cervix and suction curettage of uterine contents; T2: dilation and extraction using mult instruments - only performed if there are contraindications to other methods

Answer 81

- death of fetus after 20 weeks gestation - aneuploidy, infection - abruption (most common -> maternal cocaine, smoking, HTN), placental infarction, infection, twin-twin transfusion - nullparity, advanced maternal age, obesity, HTN, DM, smoking, drug use

Answer 82

- when embryo implants somewhere besides the uterus - fallopian tube (ampulla > isthmus) - rupture - PID, IUD, congenital malformation of uterus, in utero DES exposure - enlarged uterus, pelvic pain, vaginal bleeding, adnexal mass - positive urine pregnancy test or high HCG w/ low progesterone (less than 5), TVUS w/o gestational sac in uterus - if patient is RH - administer Rhogam incase of rupture; then start MTX if not ruptured; if hemodynamically stable do laparoscopy or if unstable do laparotomy - if ruptured, remove (salpingectomy); if non ruptured then open up tube and shell out the pregnancy (salpingostomy)

Answer 83

- mechanical obstruction - breast feeding, not wanting hormones, decrease STI - expensive and inconvenient - inexpensive, but latex can be allergic and can break - ring w/ flexible dome that has to be fitted by gynecologist to create barrier between cervix and lower part of vagina ; must insert spermicide and wear for 6-8 hrs after sex; if left in too long can cause infection - small version of diaphragm that fits directly over cervix; good efficacy in women who have not given birth and decreased in women that have - foams, gels, creams placed in vagina up to 30 min before intercourse, does not help with STI; need to use other barrier method as well - polyurethane sponge placed over cervix with non-oxybol-9 that is inserted less than 24 hours before sex and taken out 6 hrs after sex

Answer 84

- inhibit ovulation, thicken cervical mucous to inhibit sperm penetration, alters motility of uterus and FT, thins endometrium... estrogen supresses FSH and and prevents emergence of follicle whicle progesterone prevents surge of LH inhibiting ovulation - inro def anemia, dysmenorrhea, ovarian cyst, endometriosis - OCP, ring, patch - 92-99%, based on consistency of use - fixed is same dose every single time and phasic increases in dose of progestin - nausea, headache, bloating - decrease risk of ovarian CA, endometrial CA, bleeding and dysmenorrhea, anemia, and reg menses - stroke, MI, mood changes, migraines - known thrombogenic mutations, prior thromboembolic events, CAD, cigarette smoking over 35, uncontrolled HTN, known or suspected breast/endometrial CA, migraines - ortho evra: same as OCP but apply patch once a week for three weeks then 4th week no patch. - nuva ring: place in vagina for 3 weeks then remove

Answer 85

- thickens cervical mucus to inhibit sperm penetration, inhibit ovulation, alter motility of uterus and FT, thin endometrium - breast feeding - mature follicle formed but not ovulated - break through bleeding and nausea

Answer 86

- sustained high progesterone to block LH surge -> inhibit ovulation, thin endometrium - breast feeding, iron def anemia, sick cell disease, epilepsy, dysmenorrhea, ovarian cyst, endometriosis - bleeding irregularly, unsure when fertility will come back after it is stopped, increase hair shedding, change in mood, decrease HDL, decrease libido - known/suspected pregnancy, undiagnosed vaginal bleeding, breast CA

Answer 87

- progestin containing rod inserted in sub cu tissue of arm, should replace every 3 years - inhibits ovulation (surpresses LH surge), thins endometrium, thicken cervical mucus - breast feeding, long term contraception, iron def anemia, dysmenorrhea, ovarian cyst, endometriosis, smokers 35 and older - irregular bleeding, acne, decreases libido, adnexal enlargement

Answer 88

- thickens cervical mucus and thins out endometrium -> 5 yrs - causes sterile inflamm reaction causing hostile environment, damages ovum, inhibit sperm migration -> 10 yrs; causes heavier bleeding because of inflammation - breast feeding, long term, stable monogamous relationship, dysmenorrhea - mult sex partner, immuno deficient, recent hx of PID, wilson dx, copper allergy - PID, uterine perforation, ectopic pregnancy, IUD expulsion, actinomyces infection

Answer 89

- mechanical obstruction of tubes - does not desire future fertility - complete tubal ligation - excision of small section of both vas deferens followed by sealing of proximal and distal portions, must use contraception for 12 weeks or ejaculate 20 times and have 2 consecutive negative sperm counts

Answer 90

- increases factors VII and X and decreases antithrombin III

Answer 91

- breast tenderness, nausea, headache | - depression, acne, weight gain, irregular bleeding

Answer 92

- Levonorgestrel (Plan B): progesterone that causes shedding of the endometrial lining - copper T IUD -> left in uterine cavity and provide contraception for 10 yrs

Answer 93

- woman records body temp as soon as she wakes up every single day, temp will increase by 0.3-1 degree for 3 consecutive days -> progesterone surge -> indicating that she is ovulating - woman checks for presence and change of cervical mucus to indicate if ovulating; at ovulation the discharge becomes clear, stretchy, wet and after ovulation will become thick again. Patients should not have sex from the day the discharge starts until 4 days after peak day. - combination of checking both temp and cervical mucus - using breast feeding as way to space pregnancies by exclusively breast feeding

Answer 94

- breast budding; 10 yrs, increase in estradiol - axillary and pubic hair growth; 11 yrs; increase in adrenal hormones - first menses; age 12; increase in estradiol

Answer 95

- pre-pubescent - puberty - adult hood

Answer 96

- appearance of secondary sex characteristics before the age of 8 - increase in GnRH; idiopathic, tumor of pit, inflammation of hypothal, 21 hydroxylase def - estrogen secreting tumor, excess exogenous estrogen, adernal/thyroid abnormalities, McCune Albright (precocious puberty, cafe au lait, and fibrous bone dysplasia)

Answer 97

- withdrawal of progesterone causes sloughing off of endometrium - increase fsh causes follicle to grow and estrogen to be secreted and estrogen causes proliferation of endometrium - increase in LH causes oocyte to be released - corpus luteum secretes progesterone, causes endometrial maturation and decrease in LH and FSH

Answer 98

- depression, angry outburst, irritability, anxiety, confusion, social withdrawal - breast tenderness, and bloating, headache, extremity swelling - shortly after onset of menses - SSRI and OCP - see counselor, exercise, NSAIDs

Answer 99

- depression, anxiety, mood lability, persistent anger - problems concentrating, anhedonia, decreased energy, feeling overwhelmed, physical sxs, sleep disturbances - interferes w/ daily activity

Answer 100

- inability to conceive after 12 months of unprotected sex in women under 35 - infertility w/o any pregnancies - infertility after a previous pregnancy - ovulatory dysfunction, tubal dx, endometriosis - abnormal sperm function, production, or obstruction in ductal system

Answer 101

- 48 hrs of abstinence - sperm count and motility - refer to urologist, avoid lubricant w/ intercourse, stop smoking and EtOH, clomiphene or aromatase inhibitors to block negative feedback of estrogen and increase LH and FSH

Answer 102

- strong indicator of normal ovulation especially with breast tenderness - increases by .03-1 degree during luteal phase bc of increased progesterone - if greater than 3 then they are ovulating - OTC, tests for LH surge which is highly predictive of ovulation

Answer 103

- hypothalamic amenorrhea from stress or starvation -> lifestyle modification +/- ovulation induction - administer bromocriptine to surpress prolactin - PCOS; ovulation +/- metformin and weight loss - premature ovarian failure -> treat w/ IVF from donor eggs

Answer 104

- early low levels of FSH indicate adequate production of ovarian hormones - 100 mg of clomiphene on days 5-9 with measurement of FSH on day 3 and 10 and estriol on day 3 - TVUS in early follicular phase to count antral follicles, low count indicated poor reserve - biochemical marker of ovarian function and serum levels decrease as primordial follicle pool declines w/ age

Answer 105

- hystersalpingogram | - adhesions -> surgery to fix tubes or IVF

Answer 106

- laprascopic surgery | - adhesions -> lysis of adhesion, endometriosis -> excision/ablation of implants

Answer 107

- washed sperm is injected into uterus - eggs fertilized by sperm outside uterus - sperm put inside egg - egg and sperm are placed in normal fallopian tube for fertilization - zygote created in lab then pplaced into FT for normal implantation - same thing as intrauterine but with donor

Answer 108

- absence of menses by age 16 with normal growth and secondary sex characteristics OR absence of menses and secondary sex characteristics by age 13; genetic - gonadal dysgenesis (ovaries replaced with fibrous band of tissue -> no folllicles -> no estrogen produced -> no breast dev and high FSH and LH), - turners (XO; webbing neck, short 4th metacarpal, cardiac abn; give estrogen and progesterone to allow for secondary sex characteristics to develop), - structurally abnormal X chrom (similar to turners), - 17 alpha hydroxylase def (decrease cortisol and androgens and increase aldosterone -> HTN), - anatomic lesion: lesion of hypothalamus or pituitary; inadequate gonadotropin releasing hormone release: normal levels of gonadotropins if given GnRH, isolated gonadotropin deficiency: caused by pituitary dx - absence of androgen receptors or lack of responsiveness; XY karyotype w/ functioning male gonads that produce normal levels of testosterone but bc receptors dont work the wolffian ducts never form - mullerian agenesis: no uterus but shortened vagina

Answer 109

- amenorrhea caused by another disorder or dx - pregnancy - low level of gonadtropins, estrogen, and absent withdrawal bleed with progesterone; lesions, OCPs, anorexic - neoplasm (chromophobe adenoma), lesion, sheehan syndrome (pit damage caused by pregnancy), simmonds dx (pit damage not caused by pregnancy) - premature ovarian failure (menopause before age of 40), PCOS - asherman syndrome (intrauterine adhesions of endometrial cavity bc of uterine curettage), endometrial ablation (bc of menorrhagia), infection (endometriosis or TB) - stenosis bc of loop electrosurgical excision procedure - hyper/hypothyroidism, DM, hyperandrogenism

Answer 110

- excessive production of androgens - adrenal tissues, 21- hydroxylase def, 11- beta hydroxylase def - PCOS, stromal hyperthecosis (LH stimulates theca cells in ovary resulting in excess amount of testosterone being produced), theca lutein cyst (theca cells produce androgens and a cyst will produce abnormally high levels of androgens so much so that not all of them can be converted to estrogen), luteoma of pregnancy (benign tumor that grows in response to HcG causing virilization in female and baby)

Answer 111

- increased prolactin in the blood - TRH and seretonin will stimulate and dopamine inhibits usually - inhibits pulsatile release of GnRH causing amenorrhea - tranquilizers, TCA, antipsychotics, antihypertensives, narcotics, OCPs - decreased negative feedback of T4 on hypothal-pit axis causing a decrease in TRH - prolactinoma -> Bromocriptine, cabergoline - intrasellar extension of subarachnoid space which causes compression of pituitary gland and an enlarged sella turcica

Answer 112

- bleeding that occurs more often than every 21 days - prolonged or excessive uterine bleeding occurring at reg intervals - uterine bleeding that occurs less frequently than every 35 days - bleeding that occurs in between periods or at irregular intervals - uterine bleeding that is prolonged or excessive, frequent and irregular - bleeding that occurs after organic, systemic, or iatrogenic causes have been r/o

Answer 113

- 8 or fewer soaked pads/day w/ usually no more than 2 heavy days

Answer 114

- hypoestrogen causes atrophy and collapsed surface is unable to produce fluid so friction occurs -> local estrogen cream - progestin + estrogen given after menopause to help with vaginal dryness - caused by excessive estrogen production from ovarian or adrenal tumor or adipose tissue -> if not malignant can use progestin cream - endometrial CA -> post menopausal bleeding is always thought to be endometrial CA until proven otherwise - inner lining of the uterus (the endometrium) breaks through the muscle wall of the uterus - endometrial growths w/ unknown etiology and can be benign, pre-malignant or malignant -> hysteroscopy w/ D&C - US, endometrial biopsy

Answer 115

- leiomyoma - endometriosis/itis - adhesions/adenomyosis - psychological - pelvic floor myalgia - infections - neoplasia - GI tract (IBD, diverticulosis) - PID - endometriosis

Answer 116

- pelvic pain that lasts less than 6 months | - appendicitis/abcess/abortion, ru[tured ovarian cyst, ovarian torsion, PID, Ectopic pregnancy

Answer 117

- endometrial glands and stroma grow outside the uterus, often causing pain and/or infertility - women in 20's and 30's - the ectopic endometrial tissue is physiologically functional and responds to hormones -> causes bleeding and inflammation in that area - ovary, peritoneum of uterus, ligament, bowel, appendix, cervix, vagina, bladder, nasopharynx, lungs, abd wall - endometrial tissue transported in a retrograde fashion through fallopian tubes and implants in the pelvis specifically at the ovaries and pelvic peritoneum - peritoneum goes through metaplasia into endometrial tissue bc of certain conditions - endometrial tissue is transported via blood and lymph - deficient or inadequate NK cells - endometrial tissue implanted during a procedure (c-section) - pelvic pain w/ dymenorrhea starting 2-3 days before period and throughout it, dypareunia and dyschezia w/ deep penetration in the pouch of douglas - induce amenorrhea with OCP and treat dysmenorrhea with NSAID - conservative is to cut out endometriotic implants while definitive is a hysterectomy - younger, multiparous women; responsive to hormones; cyclic pain

Answer 118

- ectopic endometrial glands and stroma w/i the myometrium resulting in symmetrically enlarged and globular uterus - parous women from 30-50 - US or MRI to differentiate between adenomyosis and uterine fibroid - OCP to control bleeding but definitive is hysterectomy - found in older, multiparous women; tissue not as responsive to hormonal stimulation; non-cyclic pain

Answer 119

- pregnancy test - follicular vs lutein; PE + US - localized benign SM tumors of uterus; found in reproductive age and balck women; submucous (below endometrium protruding into uterine cavity), intramural (w/i uterine wall), subserosa (just below serosa), cervical, parasitic (fibroid pbtains blood supply from another organ), interligamentous (grows laterally into broad ligament); usually asymptomatic, but can have increased bleeding, pain, pelvic pressure, infertility; PE + US; no tx in asymptomatic women or in symptomatic women then use OCP or IUD; endometrial ablation, uterine a embolization, myomectomy, hysterectomy - epi: serous, mucinoid, sex chord: granulosa, sertoli, fibroma, or germ cell: teratoma, dysgerminoma, yolk sac; GI sxs, urinary urgency, pelvic discomfort; US, CT to look for mets, CA 125; stage and remove then radiation/chemo - benign mature cystic teratoma -> contains tissue from ecto, meso and endoderm -> arrest in meosis I; 12-30 yrs old; PE, US; excision of teratoma w/ cystectomy in those who are not of childbearing age - Abcess that involves ovary and FT; primary is caused by ascending infection while secondary is caused by bowel perforation; pelvic pain, leukocytosis, fever, discharge, and mass; PE, US/CT, hx PID; antibiotic and drainage of cyst w/o response to antibiotics

Answer 120

- Failure of rupture or incomplete reabsorption of ovarian follicle causing a cyst; asymptomatic if smaller than 5 cm but will cause pain the bigger they get, abnormal uterine bleeding, unilateral abd/ pelvic pain, acute pelvic pain w/ findings of rebound and guarding on exam often signifying rupture; pelvic and abd exams, US; most resolve on own but start OCP to prevent new formation and recheck after 2 months -> if not resolved then most likely neoplasm - corpus luteum fails to involute and continues to enlarge continuing to produce progesterone which can delay menses; unilateral adnexal pain and abnormal uterine bleeding; observe for 2 months and can start OCP; increased levels of hCG can cause follicular overstimulation and lead to theca lutein cysts

Answer 121

- endometriosis of ovary - chocolate cysts - pelvic pain, dysmenorrhea, dysparuneia - woman with hx of endometriosis, pelvic pain and ovarian cyst - conservative would be just taking out cyst and definitive would be oophrectomy

Answer 122

- procedure that utilizes staining and low magnification microscope to view cervix. vagina. and vulva - cone shaped biopsy is removed using scalpel - loop electrosurgical excision procedure -> small wire loop with electrical current is used to excise the TZ and endocervix - probe cooled with nitrous oxide to ablate lesions for treatment of low grade lesions - high energy photon beam generates heat and vaporizes tissue to excise or ablate cervical intraepi neoplasia

Answer 123

- 45-55 - AA - none, irregular bleeding/pink discharge, poistcoital bleeding - post void bleeding, dysuria - weight loss, blood/ malordorous discharge, severe pain if spreads to sacral plexus - squamous (80%, associated with HPV), adeno (20%, maternal DES, from columnar cells lining endocervical canal and glands - simple hysterectomy (uterus and cervix) - removal of uterus, cervix, parametrial tissue and upper 1/3 of vagina w/ lymph node dissection - must do pap, only real treatment is chemo, depending on size of tumor, most have to have c section -

Answer 124

- proliferation of endometrial glands that can progress to endometrial CA - 1%, 3%, 10%, 30% - no atypia -> tx w/ progestin, w/ atypia -> hysterectomy - 40-60% risk of endometrial CA

Answer 125

- 61 yrs old - estrogen dependent neoplasm beginning as proliferation of normal tissue and with chronic proliferation becomes hyperplasia and then neoplasia - unrelated to estrogen, presents as higher grade more aggressive tumor - hysterectomy, bilateral salpingo-oophrectomy, pelvic and para-aortic lymphadenectomy, peritoneal washings

Answer 126

- pruritic, erythematous, ecxemoid lesion; postmenopausal caucasian women; can be associated w/ local invasive carcinoma ; biopsy of lesion; if solitary lesion w/o malignancy then excise to subcutaneous layer - hypertrophy caused by chronic irritation (itching and scratching) resulting in raised, whit thickened lesions - atrophic lesion w/ paper-like appearance on both sides of vulva and epidermal contracture leads to loss of architecture - women 50-60 yrs; shiny, purple lesions on vulva and skin becomes very thickened causing scarring - steroid cream and diphenhyradmine to prevent itching during sleeping

Answer 127

- vulva | - pruritis, red plaques covered w/ silver scales

Answer 128

- inflammation of vestibular gland -> tenderness, erythema, pain - unknown- may turn it white but it is not dysplastic - lightly touch vulvar vestibule w/ applicator and positive if there is severe pain - sex abstinence, TCA, xylocaine jelly for anesthesia

Answer 129

- reviewed earlier - most common vulvar cyst; asymptomatic; beneath labia majora when pilosebaceous ducts occluded; palpable, nontender, smooth mass that expresses yellow, thick, cheesy material extruded; do not treat unless symptomatic - chronic infection of apocrine glands; foul smelling discharge, pruritis; biopsy; topical steroid and long term oral antibiotics-> excision by infected skin

OBGYN Flashcards

(153 cards)