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OB/Gyn

Clinical Medicine

Question	Answer
Define Endometriosis	The presence of endometrial glands and stroma outside the uterus
Define Adenomyosis	The presence of endometrial glands and stroma that extends into uterine musculature
Bacterial Vaginosis Diagnosis	clue cells on wet prep*
Bacterial Vaginosis treatment	Flagyl (Metronidazole)
greenish/yellow, frothy vaginal discharge	Trichomonas vaginitis*
"strawberry cervix"	Trichomonas vaginitis*
"Cottage cheese" discharge	Yeast vaginitis*
Yeast vaginitis Diagnosis	clinically, hyphea/ pseudohyphea/ budding on KOH prep*
Yeast vaginitis Treatment	oral fluconazole
Neisseria Gonorrhoeae (Gonorrhea) is a gram	Gram-negative intracellular diplococci*
USPTF recommends screening yearly for Neisseria Gonorrhoeae (Gonorrhea)	from onset sexual activity-26yo
Most common STI	Chlamydiae Trachomatis (Chlamydia)*
Syphilis is caused by	Treponema pallidum (a spirochete)*
Syphilis treatment	PCN G 2.4 mill units IM x 1 dose
Average age in US for menopause	51.5 years
Define menopause	no menses >1 yr, or FSH >30mIU/ml
never give unopposed estrogen to a woman with a	uterus
Level of uterus at 12 weeks	pubic symphysis*
Normal Fetal heart rate	120-160bpm
Define Round ligament pain	Sharp, shooting, fleeting pain, unilateral- typically located in the groin
"Mask of pregnancy"	Chloasma
Maternal screening AFP screens for	open neural tube defects
Pregnancy implantation outside the uterine cavity	Ectopic Pregnancy
Treatment for ectopic pregnancy	surgery or methotrexate
bleeding, passing "grapelike tissue", partial may present like SAB	Gestational trophoblastic neoplasia (GTN or GTD)*
In Gestational trophoblastic neoplasia (GTN or GTD) HCG is over	>100,000mU/mL
Diagnosis criteria for Preeclampsia	(1)Hypertension, BP>140/90 (2)Proteinuria >300mg/24hrs (3)+/- Edema (often hands and face in addition to legs)
Diagnosis criteria for Eclampsia	(1) Hypertension, BP>140/90 (2) Proteinuria >300mg/24hrs (3) +/- Edema (often hands and face in addition to legs) (4) seizures
HA, visual changes, pulmonary edema, elevated LFTs, RUQ/epigastric pain	Preeclampsia
Define PROM	rupture of membranes prior to onset of labor at or after 37weeks
Define PPROM	rupture of membranes prior to onset of labor in patients less than 37 weeks gestation
Premature separation of the normally implanted placenta from the uterus after 20 weeks	Placental abruption*
Placenta partially or completely covers the cervical os	Placenta previa*
Bright red, painless, recurrent vaginal bleeding, no fetal distress (usually)	Placenta previa*
Placenta directly attached to the myometrium	Placenta accreta*
Placenta invades the myometrium	Placenta increta*
Placenta penetrates the myometrium	Placenta percreta*
Follicular/proliferative phase occurs during days	Days 1-14
Luteal/ secretory phase occurs during days	after ovulation (days after 14)
Short stature, web neck, lacks ovary or uterus	Turners syndrome*
'string of pearls' on ultrasound	Polycystic ovarian disease
Polycystic ovarian syndrome AKA	Stein levanthal syndrome*
MC organism of PID	GC*
PID etiology	GC, chlamydia, E. coli, mixed anaerobes and myco/ureaplasma
Most common STD	Chlamydia*
Treatment for chlamydia	Zithromax or doxycycline*
treatment for GC	Ceftriaxone, cefixime*
Primary syphilis presents with a	chancre*
Secondary syphilis presents with	Symmetric rash on palms and soles
Latent/ tertiary syphilis AKA	Neurosyphilis
Chancroid caused by	H. ducreyi
Painful genital ulcer with fluctuant inguinal adenitis	Chancroid
Painless genital ulcer	Granuloma Inguinale
PID treatment in pregnancy	Clindamycin with gentamycin
Most common metabolic disease in the U.S.	Osteoporosis*
Benign solid mass, typically painless in breast	Fibroadenoma*
Most common reason for fever after the immediate puerperium in nursing mothers	Mastitis*
Mastitis caused by	S. aureus*
Treatment for mastitis	dicloxacillin
Second most common cause of cancer death in women	Breast cancer
Most common type of breast cancer	Infiltrating intraductal carcinoma
Most common reason for spontaneous abortion	Chromosomal abnormalities*
Abruptio placentae	Painful vaginal bleeding*
Placenta praevia	Painless vaginal bleeding*
oligohydramnios	Decreased amniotic fluid levels
polyhydramnios	Excess amniotic fluid levels
Strawberry cervix	Trichomonas infection*
BRCA genes are associated with	Breast and ovarian cancer*
To delineate a solid vs. cystic breast mass, use a	Ultrasound
To evaluate for ovarian torsion, use a	Color Doppler
Clue cells for diagnosis of	Bacterial Vaginosis
UPSTF recommends mammograms every	2 yrs
inhibit ovulation, thicken cervical mucous and alter quality of endometrium	Oral contraceptives
Risk factors for oral contraception with female at 35 y/o	smoking
Yeast infection treatment	Diflucan
The USPSTF recommends biennial screening mammography for women aged	50 to 74 years
Most common cause of cancer death in women?	Lung cancer
Pap smear frequency	Every 3 years, may cease if all pap smears have been normal until 65; if never tested, stop after two negative smears
When do you do pap smear on a girl?	starting at age of 21 and doing every 3 years
USPSTF guideline for breast cancer screening in women	USPSTF recommends biennial screening mammography for women aged 50 to 74 years
Contraindications for Oral Contraceptives?	Thromboembolic (DVT past or present)
Hegar's Sign	softening of the lower uterine segment or uterine isthmus*
Chadwick's Sign	is bluish or purplish discoloration of vagina and cervix during pregnancy*
Goodell's sign	softening of the cervix*
Cervix becomes soft, blue and swollen when	pregnant
pt may need to be hospitalized. Excessive N/V, weight loss of 5% or greater from pre-pregnancy weight. Dehydration, ketones in urine	Hyperemesis Gravidum
20 WKS fundal height	AT UMBILICUS*
Patient unable to get pregnant, male sperm count ok, give	clomiphene citrate
Treatment for Mild Eclampsia	bedrest (BP 140/90, Protein +2,+3)
Consistent, Late decelerations are a sign of	uteroplacental deficiency
Corpus luteum produces	Progesterone
Choriocarcinoma is usually preceded by	PREGNANCY
Vaginal bleeding at 12 weeks can lead to	Threatened Abortion
lead to chocolate colored ovaries, raspberry colored nodules in the pelvic cavity but NOT cervical stenosis.	Endometriosis
contraindications of OCP (estrogen and progesterone)	active liver disease
The most common Gyn cancer is	endometrial cancer*
Cause Violin String adhesions between liver and abdominal wall (Perihepatitis:)	Fitz - Hugh - Curtis Syndrome*
are paraurethral glands that may be related to female ejaculation	Skene Glands
Nulliparity is a risk factors for	Ovarian Cancer*
is common cause of post partum hemorrhage	Uterine Atony*
Mastitis is treated with	dicloxacillin*
The rate Dizygotic or "fraternal" twins increases with	maternal age
Menopause or peri-menopause have this as first sign/symptom	HOT FLASHES
from excess Prostaglandin produced in endometrium	Primary Dysmenorrhea
C-section ALWAYS required with hx of previous C-section that had	CLASSICAL Incision (vertical incision)
adhesions in the uterine cavity	Asherman's syndrome
Fibroids, Fibroadenoma (common benign neoplasm), leiomyomas think	bleeding
most common medical abortions medications	Mifepristone and Misoprostol
luteal phase corresponds with what phase	secretory phase
women with fibroids have an increased risk of	endometrial cancer
Most common position for the baby in utero	Vertex (head first)
the embryo or fetus dies in utero, but products of conception are retained	Missed abortion*
deliberate termination of pregnancy	Induced abortion
Any uterine cramping or bleeding in the presence of a closed cervix during the first 20 weeks	Threatened abortion*
Involves uterine bleeding or pain when the cervix is beginning to efface or dilate	Inevitable abortion
Passage of part of the POC through the cervix, cervix is dilated, bleeding is present	Incomplete abortion
Passage of all of the POC, with subsequent closure of the cervix and return of the uterus to normal size	Complete abortion
Death of a fetus and its retention in utero for 4 weeks or longer	Missed abortion
Infection of the uterine contents before, during, or after an abortion	Septic abortion
Fever, chills with painful erythema and induration of the breast. due to staph aureus	Mastitis*
Normal apgar score	At least 7 at one minute and 9 at five minutes
Follicular phase AKA	Proliferative phase
Do not give this medication during pregnancy (cat. D)	doxycycline
"abnormal bleeding in the absence of an anatomical lesion"	Dysfunctional uterine bleeding (DUB)
Bleeding for greater than 35 day intervals	oligomenorrhea
Bleeding for less than 21 day intervals	polymenorrhea
heavy menses (more than 80 mL)	menorrhagia
irr/ heavy bleeding	menometrorrhagia
clue cells on wet prep, fishy odor	Bacterial vaginosis*
"strawberry cervix"	Trichomonas vaginitis*
"Cottage cheese" discharge	Yeast vaginitis*
Nagele's rule:	EDD= LMP+7days- 3mon
Recurrent AB	3 SABs, or 2 SABs in a row
HELLP Syndrome	Hemolysis, elevated liver enzymes, low platelets
Detachment of a normally implanted placenta can cause severe hemorrhage	Abruptio placenta
Implantation of the placenta occurs over or near the cervical os	Placenta previa
Causes Fitz - Hugh - Curtis Syndrome	Neisseria gonorrhoeae
Shoulder Dystocia is common with a fetus of	4,500 grams and up
This becomes soft, blue and swollen when pregnant	Cervix
Severe Eclampsia treatment	Mag sulfate, antihypertensives (hydralazine, labetalol)
continues to produce ESTROGEN in uterus	follicle cyst*
produces Progesterone in uterus	Corpus luteum*
Endometriosis does not lead to	cervical stenosis
Decent of the bladder into the upper anterior vaginal wall	cystocele*
Bulging of the urethra into the lower anterior vaginal wall without urethral dilation	urethrocele
Involves prolapse of the rectum into the lower posterior vaginal wall	rectocele
Prolapse of a loop of intestine into the upper posterior vaginal wall	enterocele
Enteroceles are almost always due to	Herniation of the pouch of Douglas
Occurs when sudden increases in intraabdominal pressure such as coughing, sneezing or exercise cause leakage of small amount of urine	Stress incontinence
Detrusor instability; involves the loss of large amounts of urine immediately after the urge to void	Urge incontinence
Leiomyoma or fibroids are also known as	Uterine myoma
Most common benign breast tumors	Fibroadenoma
Obstruction of skin lymphatics causing lymphedema and skin thickening on the breast	Peau d orange
Intraductal carcinoma that involves the main excretory ducts of the breast	Paget's Disease
excess body hair in a male hair pattern often accompanied by acne and oily skin	Hirsutism
First stage of labor	Onset of labor to complete dilatation of the cervix
Second stage of labor	From cervical dilatation until the birth of the infant
Third stage of labor	Birth of infant until the delivery of the placenta
Signs of separation of the placenta	Sudden gush of blood from vagina, lengthening of the umbilical cord, and firming of the uterine fundus.
Serum B-HCG increases by how much every 4 hrs	doubles
If serum B HCG does not double in 4 hrs. think	Ectopic pregnancy
Ectopic triad	Abdominal pain, missed period, vaginal bleeding
This accounts for most abortions	Chromosomal abnormalities*
Snowstorm pattern	Gestational Trophoblastic Disease (Molar Pregnancy)
Vaginal bleeding, enlarged uterus, pelvic pain, increased B-HCG, sever hyperemesis	Molar pregnancy (surgical evacuation)
Common cause of dysfunctional uterine bleeding or abnormal bleeding.	Anovulation
Most specific sign for a functional ovarian cyst	Menstrual irregularity
Most common benign breast tumor	Fibroadenoma*
During a colposcopy, a vinegar solution is used to turn abnormal tissue what color?	White*
47, XXY	Klinefelters
45 X	Turner Syndrome
Pregnant patient at term who presents with outbreak of genital herpes, treat with	C-section*
What is the most likely site of an ectopic pregnancy within the tube	Ampulla*
heterotopic pregnancy	is a multiple pregnancy with one normal implantation in the uterus and one ectopic pregnancy
MOA of Methotrexate	folic acid antagonist
Postmenopausal bleeding should essentially be considered	endometrial cancer
An obese patient with persistent abnormal bleeding unresponsive to medical therapy requires	endometrial biopsy to evaluate for endometrial cancer.
Most common GYN malignancy in U.S.	Endometrial cancer*
No breast development & elevated FSH	Gonadal dysgenesis*
Uterus absent & FSH normal	Mullerian agenesis*
Prolactin > 200	CT of Sella pituitary microadenoma
Prolactin < 200	psychotropics
Dysmenorrhea is	Painful periods
MCC of secondary dysmenorrhea	Endometriosis*
Dyspareunia is	Pain with sexual intercourse
Endometriosis presents with	Dysmenorrhea, dyspareunia, infertility & pelvic pain
Diagnosis of endometriosis is with	Laparoscopy with laser ablation (therapeutic & diagnostic)*
Treatment of endometriosis	Laser ablation, excision, electrocautery, hysterectomy
Medical treatment for endometriosis	NSAIDs, OCPs, Lupron & Danocrine
GnRH agonists used in endometriosis include	Lupron & Danocrine
Treatment for most dysplasias in an abnormal PAP	LEEP*
Treatment reserved for carcinoma in situ (CIN III)	Cold cone (conization)*
Cold cone (conization) is	Surgical removal of the entire transformation zone & the Endocervical canal
This GYN procedure may create an incompetent cervix	Conization
Failure of the fluid in an incompletely developed follicle to be reabsorbed	Follicle cysts
Chocolate cysts	Endometriomas*
Benign germ cell tumor	Dermoid
Remove dermoid to avoid	Torsion or bleeding
PCOS presents with	Hyperandrogenism, Insulin resistance, & anovulation
Cancer of vagina & vulva are due to	HPV*
Normal pH of vagina	< 4.5
Normal vaginal flora	Lactobacillus
Amsel's criteria for BV	pH > 4.5, clue cells, (+) whiff test, & malodorous, grey frothy discharge
If recurrent candidal vaginitis screen for	Diabetes*
Cervical motion tenderness/ adnexal tenderness	PID*
Outpatient PID treatment	Ceftriaxone, doxycycline, or metronidazole*
Inpatient PID treatment	Cefoxitin or cefotetan with doxycycline OR clindamycin with gentamycin*
PCOS is associated with	Insulin resistance*
Intrauterine devices include	Paragard (copper) & Mirena
Best users for IUD are	Monogamous & have children*
ADR of mirena	Light irregular bleeding
ADR of paragard	Irregular heavy bleeding & dysmenorrhea
Progesterone only methods include	Mini pill, Depo-Provera & Implanon
OCP for breast feeding women	Mini Pill*
Contraindications for mini pill	DVT, dysfunctional uterine bleeding, liver disease & breast cancer
Fertility is possibly delayed 18 months after discontinuation of this OCP	Depo-Provera*
fertility is delayed with Depo-Provera for	18 months*
OCP that is an IM injection	Depo-Provera (Medroxyprogesterone acetate)
OCP that is a single thin flexible rod	Implanon
Insertion of paragard in emergency contraception is done	Within 5 days of intercourse*
Demineralization of osteoporosis occurs in	Trabecular bone
Normal Dexa score is	T score of (+) 1.0 to (-)1.0
T score of (-) 1 to (-) 2.5	Osteopenia
T score of < (-) 2.5	Osteoporosis
Osteoporosis treatment	Calcium, Vit D, weight bearing exercise, estrogen & Bisphosphonates
Bisphosphonates include	Alendronate, Risedronate, Ibandronate, calcitonin, forteo*
Selective estrogen receptor modulator (SERMC) is	Raloxifene (Evista)*
Drug that increases bone density and decreases risk for breast cancer	Raloxifene (Evista)*
MCC of fever after the immediate puerperium in nursing mothers	Mastitis*
Mastitis presentation	Flu-like with HAs & myalgias, unilateral pink area on breast
Treatment for mastitis	Antibiotics, keep breastfeeding*
If mastitis in non-lactating woman think	Cancer
Causes of Galactorrhea	Psychotropics, cimetidine, TCAs, OCPs, Depo Provera, hypothyroidism & pituitary Microadenoma
MCC of bloody nipple discharge	Papilloma*
This is indicated in bloody nipple discharge regardless of cause	Excision of bloody duct system
Differential of a breast mass	Fibrocystic disease of the breast, fibroadenoma, carcinoma
Treatment of fibrocystic breast disease	Wear supportive bra, NSAIDs, acetaminophen, OCPs, Danocrine/ Lupron
MCC of breast lump	Fibroadenoma*
Definitive diagnosis of solid breast tumor with	Excisional biopsy*
MC site of Mets in breast cancer	Lymph nodes*
Sites of metastases of breast cancer	Lymph nodes, lung, pleura, liver, bone, brain
MC type of breast cancer	Infiltrating ductal carcinoma*
Most lethal type of breast cancer	Inflammatory*
Peau d' orange	Inflammatory breast cancer*
Infiltrating intraductal carcinoma in the nipple & ducts of nipple	Paget's disease of the breast
First symptom of Paget's disease	Itching or burning of the nipple*
Herpes zoster vaccine given after 60 is	Zostavax
Screening at 16 - 20 weeks	Fundal heights, QS-AFP, US
Screening at 24 - 28 weeks	1 Hour GTT, H&H
Screening at 34 - 36 weeks	Group B strep screen
Prenatal vitamins	800 mcg folic acid
Foods that contain folic acid	Green leafy vegetables, orange, cantaloupe, banana, milk, grains & organ meats*
Anembryonic pregnancy	Blighted ovum, embryonic sac with no tissue
Risk factors for ectopic pregnancy	Previous ectopic or PID, BTL, hx of pelvic surgery, current IUD, infertility & assisted reproductive technology
Presentation of ectopic pregnancy	Unilateral pelvic pain, spotting, (+) HCG, US
Management of ectopic	Check Rh & type, surgery, methotrexate
RhoGam is given at	28 weeks or after complications
Heterotopic pregnancy is	Co-existence of intrauterine pregnancy with an ectopic pregnancy
Pre-eclampsia in first or second trimester is pathognomic for	Molar pregnancy*
Complications of molar (hydatidiform) pregnancy	Metastasize to the lungs, choriocarcinoma*
After a molar pregnancy, unable to get pregnant for	1 year (follow sHCG weekly to zero)*
Gestational HTN	BP > 140/90 at or after 20 weeks gestation
Treat gestational HTN with	Labetalol/ methyldopa*
This signals magnesium toxicity	Absence of DTRs*
If loss of DTRs	Delivery
Treatment of HELLP	Delivery
Treatment of premature rupture of membranes	Antibiotics, corticosteroids, tocolysis, delivery
Contraction stress test is looking for	Presence or absence of late fetal heart rate decelerations in response to uterine contractions
Variable decelerations are due to	Cord compression, oligohydramnios
Components of the biophysical profile include	Non-stress test, fetal breathing movements, fetal movements, fetal tone & amniotic fluid index
Risk factors of shoulder dystocia	Fetal macrosomia (>4500g), maternal diabetes*
Maternal complications of shoulder dystocia	Post-partum hemorrhage, 4 degree laceration
Fetal complications of shoulder dystocia	Brachial plexus palsies, clavicle fractures, fetal death*
Meds associated with reduced risk of post-menopausal osteoporosis	Diuretics*
Meds that decrease risk of ovarian cysts	OCPs*
Drug to cause uterine relaxation in order to turn the fetus from outside	Terbutaline (Brethine)

Created by: duanea00

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