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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) |
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