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OB GYN
| Question | Answer |
|---|---|
| on US what measurements most accurate for est GA | ~6-10 or 12 wks use crown rump, 12-18 use biparietal |
| general guidelines for accuracy of US | <20wk US considered pretty accurate, 1st tri can be off by 1wk, 2nd tri off by 2wk, 3rd tri off by 3wks |
| criteria for poor dates | mostly if don't have U/S <20wks |
| determination of pregnancy--cut off | hCG 25mU/ml |
| when gestational sac visible | 5wks |
| how AFI measured | deepest vertical pockets of amniotic fluid in 4 quadrants |
| how polyhydramnios defined? Oligo? | AFI>25 it's poly, if <5 it's oligo |
| where is top of fundus if 16wk? 20wk? | 1/2 pubis to umbilicus for 16wk, at umbilicus for 20wk |
| describe measures indicating symm IUGR | abd circ, head circ, biparietal dia, femur length all decrsd |
| causes of symmetric IUGR | usu insult in 1st trimester, due to fetal problems, ie aneuploidy or early infxn |
| US measures indicating asymm IUGR | abd circ decrsd, rest of measures are nml |
| causes of asymmetric IUGR | insult occurs >20wks, placental problems incl HTN and poor nutrition |
| types of abortions (5) | threatened, missed, inevitable, incomplete, complete |
| describe threatened and missed abortions | threatened=bleeding only; missed=nonviable preg, no bleeding or dilation |
| tx for missed abortion | D |
| describe inevitable abortion | heavy bleeding, dilation, NO passing of POC |
| woman comes in with heavy bleeding, passing of some pcs--what dx? What tx? | incomplete abortion if still cramping and bleeding, need emergent D |
| tx for inevitable abortion | emergent D |
| describe completed abortion | heavy bleeding, all POC have been passed and now cramping and bleeding minimal |
| tx for completed abortion | none |
| reasons why fundal size may be too small | 1) fetal (IUGR, fetal demise), 2) amniotic fluid (oligohydramios) |
| reasons for 2nd trimester loss | usu maternal, 1) uterine duplication, septum or submucous leiomyoma, 2) incompetent cervix |
| causes for fetal demise (5) | idiopathic (MC), placental, umbilical cord, fetal death, antiphospholipid |
| placental causes for fetal demise | abruptio placenta, infxn not allowing O2 xchg, macrosomia in DM outgrowing placenta |
| how dx antiphospholipid syndrome | need 1 of history: venous thrombosis, PE, stroke, reptd preg losses, fetal demise, and 1 of labs: cardiolipin Abs, lupus anticoag, incrsd PTT |
| what labs indicate anti phospholipid syndrome | cardiolipin Abs, lupus anticoag, incrsd PTT |
| if fetal demise in late 2nd tri--what do | need to induce labor (earlier can do D&C in 1st tri, D&E in 2nd tri) |
| describe hydatiform mole | 1) Complete (MC): 2 sperms fertilize an egg w/o a nucleus=46XX all from dad. Grape like vesicles w/o a fetus. 20% progress to malignancy; 2) Incomplete mole: 2 sperms fertilize nml egg->69XXY. No vesicles, fetus present, only 5% progress to malignancy |
| which hydatiform mole is more concerning for cancer | complete (46XX all from dad) |
| clinical findings suggestive of hydatiform mole | bleeding <16wks (MC), pre eclampsia <20wks, severe hyperemesis, new onset hyperthyroid, very high bHCG |
| if uterus larger than dates and bHCG very high, think… | hydatiform mole |
| US showing snowstorm pattern, unrecognizable detail of gestational sac…think | hydatiform mole |
| what w/u needed for hydatiform mole | bHCG for f/u, CXR to check for mets, D&C, need to make sure on contraception and follow bHCG ea mo for 1 yr if benign or good px malignant, 5 yrs if poor px malignant |
| when use chemo in hydatiform mole? Which agent? | malignant dz or recurrent dz, use MTX or actinomycin |
| sites of ectopic preg | MC is oviduct (95%), then uterine cornu, then abd |
| risk factors for ectopic preg | salpingitis (MC), previous ectopic preg, tubal ligation/sx, IUD |
| clinical findings suggestive of ectopic preg | amenorrhea, vaginal bleeding, abd pain incl cervical motion tenderness or adnexal tenderness |
| cut offs for bHCG and US=ectopic preg | if bHCG>1500 and no gestational sac visualized |
| tx for ectopic preg | if unruptured and bHCG<500 give IM MTX, otherwise need surgical |
| what are good px factors for gestationl tropho tumor | low bCHG (<40000) and mets to lung or pelvis (not brain or liver) |
| what are screening tools for Downs | 1st tri=PAPP, nuchal translucency, and mAFP, 2nd tri=triple screen/quad screen |
| causes of high MSAFP | neural tube, ventral wall, renal…twins and placental bleeding gives false high |
| what quad screen would suggest Downs | hi bHCG and inhibin, low MSAFP, estriol |
| what PAPP value suggests Downs | low along w high bHCG |
| what constitutes a negative CST | no late deccels w 3 cxns in 10min |
| what 5 parameters are measured in a BPP | NST reactivity, gross mvmts, extremity tone (flexion/extension), breathing, AFI |
| if 4-6 on a BPP what should you do | deliver if 36wks or grtr, rept in 24hr if <36wks |
| what constitutes a reactive NST | accels (2 in 20min) |
| when should accels become apparent | 30wks |
| when is GBS test done | 36wks |
| when should see gestational sac | 5wks |
| when check for gDM if not at incrsd risk | 24-28 |
| how is GDM checked | 50g glucose, check blood glucose in 1hr and 140 is cut off…need to f/u w 3hr unless have single fasting reading 110 or grtr or was 200 on glucola |
| amt of glu given and cut offs for 3hr GTT | 100g given, cut offs: 95/180/155/140 [only need 2 abnml] |
| management of mild PreE | "Mg during labor and 24 hr postpartum, keep DBP 90-100, give steroids <34wk, antenatal BPP/AFI and grwth q 3wks (need to check bc IUGR counts as sPreE), c linic q1 wk; once 37wk deliver" |
| management of sPreE | in patient, at 23-32wks can do expectant management as long as no end organ damage, >32 wks deliver |
| management of HELLP | stabilize pt and deliver--can't manage |
| management of preterm labor | tocolytics (Mg, terbutaline), steroids if 24-34 (24-28wks decrs risk IVH, 28-34 decrs RDS and help lung maturation) |
| cut offs for UTI | 100K CFU if midstream, 10K if cath |
| ways to manage non reassuring FHT | stop oxytocin if applicable, bolus mom 500ml so not hypotensive, change maternal position, give mom O2 |
| incidence of twin w spontaneous ovulation and fertility tx | 1:90 spontaneous, 1:10 if clomiphene, 1:3 if gonadotropins |
| causes of 3rd tri bleeding (PainLESS and PainFUL) | PainLESS: placenta previa, vasa previa; PainFUL: abruptio placenta, uterine rupture |
| what's MC OB cause of DIC | abruptio placenta |
| ROM leading to VB and fetal brady cardia, diagnosis is? | vasa previa |
| what features make preE severe? | if BP 160/110, 5g protein in 24hr, Cr 1.2, plt <100K, hemolysis (ie incrsd LDH), incrsd ALT/AST or sympt of epigastric pain, persistent HA, visual disturbances |
| which preE/gHTN pts are most likely to develop HTN later? | gHTN (NOT preE) |
| medical problems put at risk for preE? Demographics? | DM, cHTN, renal dz, SLE (vascular or connective tissue dz); demographics: nullip, age<20 or >34 |
| contraindications for expectant management or preE | contraindications for expectant management (ie need to deliver baby) incl plts <100,000, inability to control BP (DBP 90-100) on 2 anti-HTN, non reassuring fetal signs, LFTS>2x nml, eclampsia, CNS sympt, and oliguria |
| name criteria for DM B, C, D | B: onset <20 duration <10; C: 10-19, duration 10-19; D: <10, >20, vascular cxns |
| what are the White cxns letters for end organ damage | F=nephropathy, R=proliferative retinopathy, T=renal transplant, H=heart disease (Athero) |
| what are the MC congenital defects seen w DM | cardiac |
| what electrolyte disturbances can see in neonate of DM mother | hypoCa+ bc of immature parathyroid (+ hypogly) |
| what are goals for glu while in preg | fasting <90, 1hr <140, 2hr <120 |
| what are doses of insulin for DM in preg by trimester | 0.8U/kg for 1st tri, 1.0 for 2nd, 1.2 for 3rd |
| how are insulin doses distributed | 2/3 in am and 1/3 in eve, in am give 2/3 NPH and 1/3 regular, in eve 1/2 and 1/2 |
| besides control of glu with Rx, what other Rx do DM need | 4mg/d of folate bc incrsd risk of neural tube |
| what are indications to do c/s in DM | if baby EFW >4-4.5kg |
| in which DM pts do antenatal testing | if insulin dependent, macrosomia, or h/o still birth start testing at 32wk w NST and AFI 2x/wk |
| how tx pyelo | in patient, IV Abx until afebrile and CVA tenderness resolves, then out pt oral Abx 7d (I thgt 14days? And UTD says 14d) and redo Ucx to ensure eradication" |
| what are lab findings for acute cholestasis of preg | incrsd bile acids, +/- ALT/AST and pruritis |
| tx for acute cholestasis of preg | ursodeoxycholic acid (helps bile flow) w cholestyramine (prevents bile reabsorption) and anti His |
| tx of Graves during preg | use methimazole or PTU to make mom euthyroid--maternal IgG cross placenta |
| what syndrome can appear like acute cholestasis of preg | PUPP=pruritic uriticarial papules and plaques of preg--but these appear perimbulical and don't affect preg |
| management of the preg if cholestasis is present | if severe deliver 36wks if fetal lung matures, if not severe deliver by 38 |
| tx PUPP | steroids and anti His |
| what are three parts of a CVE? (xx/xx/xx) | dilation/effacement/station |
| what's ""presentation""? | which part of baby is presenting over os, ie cephalic |
| what's ""attitude""? | if chin of baby is flexed (MC) or extended |
| what's ""position""? | portion of baby ag pelvis, MC occiput anterior |
| how calculate MVU? What's adequate? | hgt of ctx over 10min, >200= adequate |
| define tachysystole | >5 ctx in 10min |
| FHR bradycardia | <110 |
| what’s moderate variability for FHT? Marked? | moderate=6-25, marked>25 |
| how till decel v change in baseline | change in baseline if it stays for >10min |
| what parameters define sinusoidal tracing | sinusoidal pattern w freq 3-5min and lasts >20min |
| what parameters defines early decel | 30sec to nadir, symmetric, matches ctx |
| "recurrent" decel v "intermittent" decals | recurrent if >50% in 20min, otherwise intermittent |
| parameters define variable decel | <30sec to nadir, change in 15bpm and lasts at least 15sec but less than 2 min |
| what causes variable decels? Early decels? Late decals? | variable=cord compression, early=head compression, late=uteroplacental insuffic |
| what makes cat I tracing | FHR 110-160, moderate variability, no late or variable decels, may have early decels |
| cat III tracing | absent variability AND ANY of : recurrent late or variable decels, bradycardia |
| what does cat III tracing indicate in baby | abnml acid base status |
| what are indication for c/s | nonreassuring FHT, prev c/s or myomectomy, arrest of labor, placental abnmlties, abnml presentation +/- mltpl gestations" |
| what are the 5 cardinal mvmts of labor | EDFIERE=engagement, descent, flexion, internal rotation, external rotation, expulsion |
| 3 stages of labor | 1 latent phase=(Effacement), ends with accel of cervical dilation ~4-5; 1 active phase=when cardinal mvmts of labor begin, ends w complete dilation; Stage 2=descent (ends w delivery of baby); Stage 3=expulsion, delivery of placenta |
| times for ea stage of labor | 1 latent=14 for multipara, 20 for primi; 1 active=1.2cm/hr for multi, 1.5 for prim; 2=2 hr primi, 1 hr for multi +1hr if epidural; 3=30min |
| tx of prolonged latent phase | ambulation or sedation, avoid oxytocin or c/s |
| tx of prolonged active | oxytocin if ctx inadequate |
| w/o IUPC how can tell if ctx are inadequate | if last less than 45 sec and <3 in 10min |
| how define prolonged 2nd stage | (from complete dilation to delivery of baby=descent), >2hrs of active pushing if primi or 1 hr multip (+1 epidural) |
| criteria for PTL | 20-37wks GA, ctxs (3 lasting 30 sec in 20min), resulting in cervical change (dilation or effacement) **have to have all of these, can't just be having ctxs" |
| when deliver someone w PROM | deliver right away: lungs mature (ie lecithin: sphingo >2 or + phosphatidylglycerol), chorio (ie maternal F unexplained), non reassuring FHT/BPP |
| definition of PROM | ROM before onset of labor (regular contraction resulting in cervical change) |
| if PROM and >36 wks | "deliver, may need to ripen cervix before IOL" |
| if PROM and <36wks how manage | goal prolong preg: bed rest w DVT prophylaxis, steroid for lung maturity if <32 wks, Abx after swab for GBS (they give even if GBS -); monitor w NST/BPP and deliver immed if non reassuring" |
| tocolytic agents and who you CAN't use them in | "Mg (don't use in myasthenia gravis), b adrenergic (terbutaline, ritodrine, don't use in DM bc incrs glu), indomethacin (don't use >32wks bc close PDA), CCB (nifedipine)" |
| describe dysmaturiy syndrome | "placental aging (postdates) leads to placental insuffic, babies come out looking very old w wrinkled skin, meconium stained, peeling skin" |
| "if mom rubella susceptible, what do" | "after delivery give live attenuated vaccine, ok for BF but make sure no preg for 1 mo" |
| "describe postpartum bladder issues, tx" | "may have postvoid residual (>250mls) from hypotonic bladder, give cholinergic ie bethanechol" |
| "differentiate bw postpartum blues, PP depression, " | "PP blues=<2wks, tearfulness, mood swings, feeling of inadequacy for taking care of self and infant--no tx; PP depression=<6wks feelings of despair, hopelessness, anxiety, neglect of self and baby--psychotherapy and Rx" |
| MC cause of PP hemorrhage | uterine atony |
| "tx uterine atony, when can't use certain agents" | "uterine massage, oxytocin, methylergonovine (methergine), PGF2/carboprost **can't use methergine in HTN or PreE, can't use carboprost in asthmatics" |
| what's the cut-off amt of blood for PP hemorrhage | 500ml if SVD, 1000 if c/s |
| pneumonic for fever after c/s | "wind, water, womb, wound, walk" |
| etiology of fever after c/s depending on time | "POD 0=wind (atelectasis), 1-2=water UTI, 2-3=womb endometriosis, 4-5=wound, 5-6 walk incl septic pelvic thrombophlebitis" |
| 2 MC cause of painful genital ulcers | HSV (MC) and chancroid (H Ducreyi) |
| describe the ulcer for herpes | starts as clear vesicle that ruptures leaving shallow, painful ulcer w raised edges" |
| how differentiate chancroid ulcers and herpes ulcers | chancroid have ragged edges whereas herpes has raised smooth edges |
| tx for chancroid | azithro or ceftriax (same as for gonorrhea) |
| MC painless genital ulcers | "syphillis, lymphogranuloma venereum (from C trachomatis L type--rare in US), granuloma inguinale (donovanosis-rare in US)" |
| describe lymphogranuloma venereum (from C trachomatis L type) | painless vulvar ulcer that heals, then painful inguinal LAD, these LN rupture become draining abscesses or fistulas (""groove sign""=depression bw groops of inguinal LAD)" |
| treatment of lymophogranuloma venereum | "doxy 21d or erythro 3-6wks, drain fluctulant LN so don't burst" |
| beefy red painless vulvar ulcer--think what? | granuloma inguinale (donovanosis) |
| tx for granuloma inguinale (donovanosis) | doxycycline or bactrim 21 d |
| tx for condyloma acuminatum | "podophyllin, TCA, imiquimod (no systemic tx available)" |
| "tx for chlamydia, gonorrhea" | chlamydia: azithro 1 dose PO or doxy 7d; gonorrhea: ceftriaxone IM 1x or azithro 1 dose + NEED TX chlamydia |
| what plating media do you use for gonorrhea | Thayer Martin |
| tx of PID | if outpatient 14 d of ceftriax or cefoxitin and add metronidazole if suspect anaerobes |
| 3 causes of vaginal discharge and how to differentiate | "back vaginosis, candida, trichomonas vaginitis" |
| describe bac vaginosis lab findings | "vaginal discharge pH>4.5, fishy amine odor/KOH whiff test, clue cells" |
| describe trichomonas vaginitis lab findings | "profuse yellow-green discharge, pH>4.5, flagellated organisms" |
| tx trichomonas vaginitis | metronidazole (same as bac vaginosis but need to treat sex partner) |
| types of abnml placenta attachment | "previa=att is near or covering os, accreta=attach to myometrium, increta=goes through myometrium, percreta=to uterine serosa" |
| name degrees of uterine prolapse | "1st degree if in vagina, 2nd degree if at introitus, 3rd degree if both vagina and cervix out of introitus" |
| name types of vaginal prolapse | "cystocele (bladder, so anterior), rectocele (rectum, posterior), enterocele (small bowel upper posterior)" |
| tx for stress incontinence | "kegel exercises, urethroplexy (move urethra up back into pelvic cavity)" |
| tx for urge incontinence | "anitchol (oxybutinin, ie ditropan), propantheline (""Pro-Bantheline""), B adrenergic (Ursipas)" |
| contrast sympt for difft types of incontinence | "stress: small amts urine lost w cough or sneeze, not at night, cystometry is nml; urge: detrusor ctx involuntarily w larger amts of urine, incl at night but also can occur when cough/sneeze, cystometry shows hypertonic bladder; hypotonic: constantly lose |
| tx of hypotonic | cholinergic (bethanecol), a adrenergic blocker (phenoxybenzamine)" |
| 3 common sympt of endometriosis | dysmenorrhea, dyspareunia, constipation" |
| tx of endometriosis | progestin, OCPs" |
| "describe adneomyosis, sympt, treatment" | "endometrial glands and stroma in myometrial wall (ie type of endometriosis) w cyclic bleeding (dysmenorrhea or menorrhagia), tx=hysterectomy" |
| physical exam for fibromas v adenomyosis | "fibromas=enlarged, firm, nontender and asymmet uterus; adenomyosis=tender, symmetric enlarged uterus" |
| risks for endometrial hyperplasia and cancer | unopposed estrogen (nulliparity, late menopause), DM, HTN, obesity" |
| types of endometrial hyperplasia | "simple, cystic & complex w/o atypia rarely progress to cancer; complex w atypia 1/3 progress to cancer" |
| tx endometrial hyperplasia | "if w/o atypia cyclic progestins may reverse it, would need f/u bx 3-6mos; if done w childbearing do hysterectomy" |
| 2 key abnml bleeding | "endometriosis the bleeding isn't bw cycles, just dysmenorrhea (MC location ovaries); if bleeding bw cycles its anovulatory or endometrial hyperplasia/cancer" |
| how dx anovulatory bleeding | if don't have reg cycles then give progestin and see if wdrawal bleeding…if get wdrawal bleeding its anovulatory and tx w cyclic progestin |
| if ovulatory and still bleeding bw cycles | usu structural ie polyps |
| MC causes of dysmenorrhea | "endometriosis (incl adenomyosis), fibroids" |
| menorrhagia in ovulatory usu due to | fibroids |
| staging for endometrial cancer | "I limited to uterus (a if <1/2, b if >1/2 myometrium), II cervix, III a=ovary or tube, b=vagina, c=pelvic nodes; IV a=bladder, bowel, b=distant incl inguinal nodes (v pelvic or paraaortic)" |
| tx for difft stages of endometrial cancer | "I=TAH BSO don't need anything post op, I if high grade and II=pelvic radiation, III=radiation +/- chemo, IV=chemo" |
| what give for hyperprolactin | bromocriptine |
| "how tell ovarian reserve, when test" | "test women >35 if fertility issues, measure FSH on day 3 of cycle (if >12 then impending ovarian failure)" |
| name 2 main types of fxnl benign ovarian masses | follicular/corpus luteum cysts; theca lutein cysts |
| compare follicular/corpus luteum cyst and theca lutein cyst | "follicular/corpus lutein cysts=unilateral and resolve ~2cycles, theca lutein cyst=bilateral due to high bHCG or overstimulation, ie see in preg [note an early IUP will always present w corpus luteum cyst]" |
| what's a choc ovarian cyst | endometrioma (non fxnl ovarian cyst) |
| types of nonfxnl ovarian masses | endometriomas and PCOS |
| benign ovarian neoplasms | "serous and mucinous cystadenomas, cystic teratoma" |
| how differentiate serous and mucinous ovarian cystadenomas | "serous=unilocular, mucinous=multilocular, if rupture can lead to pseudomyxoma peritonei" |
| MC benign ovarian neoplasm <30yo | "cystic teratoma, any combo of germ layers, often on long pedicle" |
| risks for ovarian cancer | "BRCA gene, fam hx, grtr |
| staging ovarian cancer | "I a=1 ovary, b=2 ovaries, c=limited to ovary but malignant ascites; II a=tubes/uterus, b=other pelvic, c=also malignant ascites; III=beyond pelvis, a=microscopic, b=<2cm implants, c=>2cm; IV=distant mets or pl effusion" |
| w/u if ASCUS | "rep pap q4-6mos until 2x nml, if 2nd abnml then colpo" |
| differentiate bw cystic (aka fibrocystic dz) and fibroadenoma | "fibrocystic=MC in young, painful, often cyclic w menses, confirm w U/S; fibroadenoma=solid, painless, smooth rubbery" |
| tx for fibrocystic breast | "reduce caffeine, vit E, OCPs, bromocriptine, tamoxifen" |
| "bloody discharge from a benign tumor, think…" | "intraductal papilloma, will have unilateral discharge w/o palpable mass" |
| "non tender, rapidly enlarging firm, smooth mass" | "cystosarcoma phylloides, benign, need excision w wide margin to avoid recurrence" |
| 4 types of malignant breast tumors | "infiltrating ductal (MC 80%), infiltrating lobular (more often bilateral and better px), inflammatory, Pagets" |
| describe inflammatory breast cancer course | "grows rapidly w early met potl, blocks lymph vessels leading to redness, peau d orange" |
| mammography guidelines | "start at 40yo q1-2yrs, if genetic risk start earlier " |
| when need breast bx | **need core needle bx for any nonpalpable suspicious mass on mammo or any palpable mass |
| when lumpectomy v mastectomy | lumpectomy if <4cm |
| what's the diff simple mastectomy v modified radical | "modified radical also take axillary nodes [radical is when also remove chest wall mscl, don't do that anymore]" |
| "what tx if hormone receptor + (ie estrogen, progesterone)" | tx w tamoxifen (selective estrogen receptor modulator) |
| which benign breast mass more assoc w menses | fibrocystic dz (v fibroadenoma) |
| absolute contraindication to OCPs | "CVS: any thromboembolic event, CAD; Cancer: breast, endomet, melanoma; Liver: abnml LFTs, liver tumor; undiagnosed uterine bleeding" |
| relative contraindication to OCPs | "DM, SC, HTN, hyperlipidemia, migraines, depression, smoking, >35yo" |
| how OCPs effect risks for cancers | decrsd risk of endometrial and ovarian and colon, incrsd cervical and maybe breast cancer as well as CAD and thromboembolic dz" |
| names of IUDs | Mirena and ParaGuard (copper) |
| how often is Depo given | q3mo IM injxn, takes 18mos for fertility to return" |
| "subQ progestin names, advantages" | "Jadelle/Implanon/Norplant, rapid return of fertility s/p removal" |
| what's nml semen | "2-5ml, >20million/ml, motility >50%, nml forms >70%, pH 7.2-7.8" |
| staging for endometrial cancer | I limited to uterus (a if <1/2, b if >1/2 myometrium), II cervix, III a=ovary or tube, b=vagina, c=pelvic nodes; IV a=bladder, bowel, b=distant incl inguinal nodes (v pelvic or paraaortic)" |
| tx for difft stages of endometrial cancer | I=TAH BSO don't need anything post op, I if high grade and II=pelvic radiation, III=radiation +/- chemo, IV=chemo" |
| staging ovarian cancer | I a=1 ovary, b=2 ovaries, c=limited to ovary but malignant ascites; II a=tubes/uterus, b=other pelvic, c=also malignant ascites; III=beyond pelvis, a=microscopic, b=<2cm implants, c=>2cm; IV=distant mets or pl effusion" |
| staging cervical cancer | "I a=<3mm deep, b <=5mm, <7mm horiz, c=above that; II= ebyond cervix, a=parametria not involved, b=parametria involved; III a=lower 1/3 vagina, b=pelvic wall or hydronephrosis; IV=beyond true pelvis or to bladder or rectum" |
| tx of cervical cancer | "Ib, II in premeno=hysterectomy and LN; Ib, II if postmenopause=also radiation; III,IV=radiation" |
| staging of vulvar cancer | "I <=2cm, II= >2cm, III= + unilateral inguinal LN, spread to lower urethra, vagina, or anus; IV a=upper urethrea, bladder/rectum, pelvic bone + bilateral inguinal LN; b=any distant mets of pelvic LN" |
| what percentage of gHTN develop preE | 25% |
| what are signs/sympt of placental abruption | "uterine tachysystole, VB, FHR very high w sinusoidal pattern (fetal anemia)" |
| if PTL and mom has F | "look for source of infxn, incl intramnionic--so don't give steroids until r/o intramniotic infxn" |
| when is fetal fibronectin helpful | "24-34wk, in sympt women >95% that won't deliver in next 14d" |
| what are limits for active phase I | <1.2cm/hr in multipara, <1.5cm/hr in primip] |
| what are limits for latent phase I | 20hrs nullip, 14 hrs multip" |
| how define arrest of dilation | no change dilation for 2hrs |
| signs/sympt of ROM | "nitrazine, ferning, pooling" |
| what on amnio would indicate lung maturity | + phosphatidylglycerol (also lecithin:sphingo >2 or TDX-FLM test is mature) |
| lab test/value most predictive of chorioamniotis | IL6 |
| "if PROM and 36wks, what do?" | IOL (lungs should be mature) |
| what's Kelihauer-Betke test? | "Kleihauer-Betke test, which is an acid elution test (mom’s RBCs become pale while fetal cells remain stained" |
| smoking puts at risk for | "placenta abruption, placenta previa, fetal grwth restriction, preE, infxn" |
| dizygotic twins have how many chorions? Amnions? | always di chorionic |
| uterine tenderness indicates | chorioamnionitis |
| "how much RhoGAM do you give, how much fetal RBC does it cover" | "300ug given after delivery, covers 30ml of blood (15ml of RBCs)" |
| which events can lead to Rh sensitization | "amniocentesis, chorionic villus sampling, sp/threatened abortion, ectopic preg, D&E, placental abruption, ?PreE??, manual removal of placenta, external version, antepartum hemorrhage" |
| "when referring to twins, what does mono di mean" | monochorionic diamnionic |
| "what are difft types of twins, which are identical" | "di di, mono di, mono mono; di di can be identical or fraternal but any of the monochorionic (mono di or mono mono are identical)" |
| when is cerclage usu placed | 12-16wks |
| when is cerclage usu removed | 37wks |
| tx of mastitis | dicloxacillin |
| "paper thin, bluish vulva, most likely dx? How dx? Tx?" | "most likely lichen sclerosis seen in post menopause w itching, dx w bx, tx w clobestrol" |
| "what differentiate lichen sclerosis from, how tx the two?" | "squamos hyperplasia which has more white, firm, cartilaginous lesion and tx w steroids (v high dose clobestrol for lichen sclerosis)" |
| tx PCOS | OCPs |
| dx of PCOS by lab | LH/FSH>2 or 3 (also elevated androgens) |
| what ovarian tumors can cause elevated androgens | Sertoli-Leydig and hilar cell |
| Cushing's disease: how respond to dexamethasone test | suppressed by low doses but not high doses |
| "how tx hereditary hirsutism, how does it work" | spironolactone; inhibits 5alpha reductase in hair follicle which causes terminal differentiation of the hair follicle |
| pale areola and blind pouch vagina--dx? Tx? | androgen insensitivity; need to remove intra-abdominal testicles |
| "rireg VB PP continues for >4-6wks, think? Test for?" | "gestational troph neoplasia, test bHCG if above nml its choriocarcinoma or trophoblastic tumor" |
| how amenorrhea defined ( | mos) |
| at what point start tx BP during delivery | if DBP consistently above 100 |
| how is tx of breast cancer different for preg woman | "same exc no radiation at all during preg and no chemo during 1st tri, can undergo surgery" |
| what's Asherman syndrome | "endometrial scarring, ie after D&C, can cause amenorrhea afterwords" |
| how is precocious puberty defined | "2ry sex characteristics <8girls, <9boys" |
| order of puberty | "thelarche (breast), adrenarche (pubic/axillary hair), then hgt wgt and then menarche" |
| treatments for osteoporosis | "alendronate (fosamax, a biphosphanate), or raloxifene (SERM where estrogen agonist in bone but antagonist in breast and endometrium)" |
| what's the diff bw true and pseduo precocious puberty | "true or central=gonadotropin, just the hypothal-pituit-ovarian axis is activated early; pseudo or peripheral=estrogen comes from ovaries but not from gonadotropins" |
| ex of pseudo precocious puberty | McCune Albright, granulosa cell tumor of ovary" |
| what's the diff premature ovarian failure and premature menopause | premature ovarian failure <30 (usu autoimmune), premature menopause 30-40" |
| describe hypothal axis for pubertal hormones | "hypothal secretes GnRH, Pit secretes FSH, LH, these act on ovary" |
| how does FSH level help in determining hormone trbls in amenorrhea | "if FSH low it’s a hypothal problem, if high its ovarian (ie premature ovarian failure)" |
| adnexal mass and hyperthyroid symptoms--think? | struma ovarii (dermoid cyst w >50% thyroid component) |
| what type of tumor has high AFP | yolk sac |
| "besides treating hyperprolactinemia w bromocriptine, what else do?" | scan brain! |
| "if abnml pap, when do need to do colpo in preg? What can't do?" | "CIN1 can be deferred till PP, HGSIL or smthg like that should have colpo--can do everything exc ECC" |
| what can Rx for hyperemesis of preg | doxylamine (anti His) |
| delayed sex develop defined as | no breast by 13 and no menses by15 |
| what progesterone level indicates nml IUP | ">25, if <5 then nonviable preg" |
| cytotec aka | misprostol |
| which shoulder gets stuck in shoulder dystocia | anterior |
| tx placenta accreta | usu requires hysterectomy |
| tx for shoulder dystocia | "try McRoberts where flex mom's thighs ag abdomen w suprapubic pressure, also corkscrew 180 degrees" |
| "CVA tenderness, hi T s/p hysterectomy" | "might not just be pyelo, can be ureteral injury from dissection around ureter during hysterectomy" |
| painLESS 3rd tri bleeding think | placenta previa |
| any visualizable cervical mass should get… | "bx!! Pap smear is just a screening test, if see smthg it should get biopsied!" |
| which HPV assoc w warts? Which assoc w cancer? | "6,11=warts; 16,18=cancer" |
| "amenorrhea PP and low thyroid, think" | "Sheehan's=infarct of pit leading to low thyr, FSH/LH, cortisol (ACTH is from pituitary along w TSH)" |
| tx of PE in preg | "IV heparin 5-7 days, then 3mos subQ and low dose heparin for remainder of preg and up to 4wk PP" |
| where do ovarian arteries come off of? Ovarian veins feed into? | "ovarian arteries come off of aorta, R ovarian vein goes into vena cava, L ovarian goes into L renal vein" |
| "dark urine, had just had UTI" | "think G6PD and likely was treated w a sulfa, ie nitrofurantoin" |
| which UTI Abx can't be used in preg | "bacterium and fluoroquinolones, also doxycycline (any tetracyclines)--so often use nitrofurantoin" |
| when steroids given for pts going into labor? What does it help w at difft GA? | "steroids if 24-34 (24-28wks decrs risk IVH, 28-34 decrs RDS and help lung maturation)" |
| what need to check while preg pt on Mg | "UOP (since excreted by kidney), pul edema/respir depression, loss of DTR" |
| which ovarian tumors secrete estrogen? Androgen? | estrogen=granulosa cell; androgen=Sertoli-Leydig |
| how differentiate mullerian agenesis and androgen insensitivity | both have absnet uterus and blind vagina and nml breast, but mullerian agenesis often has renal abnmlties should have nml testosterone and nml pubic hair (androgen insensitiv has decrsd)" |
| when can not use MTX for ectopic preg | if >3.5 or cardiac activity |
| 1ry amenorrhea think | Turner but be sure to check preg test |
| MC time for mastitis | "3-4wks PP, tx w dicloxacillin" |
| "polyhydramnios and mom had ""flu""" | "think hydrops s/p Parvo infxn, most at risk infxn <20wks" |
| tx endometritis | gent and clinda |
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ehstephns
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