Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
PANCE Ob/Gyn
PANCE Obstetrics and Gynecology
| Question | Answer |
|---|---|
| Causes of secondary amennorhea? | Normal estrogen: Asherman's Syndrome and PCOS. Hyperestrogenic: Sheehan's sundrome, hyperprolactinemia, hypophysitis, premature ovarian failure (<40yo) and CNS tumor. |
| What two tests should you order when suspecting PMS? | TFTs and CBC to r/o hypothyroidism and anemia. |
| Treatment for PMS? | NSAIDs, diuretics (fluid retention), bromocriptine/evening primrose oil/pyridoxine or Vit. B6 for mastalgia. +/- SSRIs, anxiolytics (buspirone and alprazolam). OCPs not proven. |
| Classic lab finding for menopausal women? | FSH <30 mIU/mL. |
| At day 14, what hormones dec. and inc.? | Dec. FSH with LH and E2 surge. |
| Menstrual cycle divided btw. what? | Prolifterative, estrogen control vs. Secretory, progesterone control. |
| Treatment for osteoporosis? | Vit. D and Ca supplementation, bisphosphonates, calcitonin and SERMs. |
| Estrogen replacement therapy is contraindicated when? | Undiagnosed vaginal bleeding, acute vascular thombosis and hx of estrogen-dependent tumors. Inc risk for breast/endometrial/gallbladder cancer, migraines, CAD and cognitive changes. |
| Contraindications for OCPs? | HTN, DM, any CAD/PAD, breast cancer, liver disease or focal headaches. |
| Risks of leiomyomatas/uterine fibroids? Tx? | Spntaneous abortion and 4x endometrial cancer (presents in black women despite cancer more likely white women). Tx: GnRH agonists and mifepristone. |
| Two types of endometrial cancer? | Estrogen dependent (younger or perimenopausal) and estrogen independent (postmenopausal). #1 gyn malignancy and adenocarcinoma is most common type. |
| Treatment for endometriosis? | NSAIDs, prostaglandin synthetase inhibitors, OCPs/progestins and danazol/GnRH agaonist (fertility). |
| Pathophysiology of adenomyosis? | Extension of endometrial glands into uterine musculature. Cause of secondary dysmenorrhea with a tender, symmetrically enlarged "boggy" uterus. |
| What fucntional (follicular or corpus luteum) ovarian cysts must eb larparoscopically evaluated? | Any cysts >8cm or >2 menstrual cycles. |
| Risks of PCOS? | Endometrial hyperplasia and carcinoma from unopposed estrogen. Frank T2DM in 8% yet insulin resistance in 30% of PCOS pts. |
| Classic US finding of PCOS? | "String of pearls" like in primary biliary sclerosis. |
| Two types of hereditary ovarian cancer? | Breast and ovarian cancer (BOC) and hereditary nonpolyposis colorectal cancer syndrome (HNPCC). Yet both comprise 10% of total ovarian cancer cases w/ 90% sporadic. p53 tumor suppressor gene defect and BRCA1 involved in 5%. |
| Types of HPV linked to condyloma acuminata? | HPV Types 6 and 11. |
| How is the Gardasil/HPV vaccine administered? | Girls 11-12yo w/ 3 vaccinations over 6mo. Available 9-26yo and for types 6,11,16,18 causing 70% of all cervical cancers and 90% of all genital warts. Booster q5y. |
| Women exposed to diethylstilbestrol (DES) in utero at risk for what? | Clear cell vaginal adenocarcinoma, vaginal adenosis -> inc. risk of miscarriage, premature delivery and ectopic pregnancy. |
| Tx for mastodynia? | Vit. B6, bromocriptine, tamoxifen or danazol. |
| Tx for (S.aureus) mastitis? | Clox, diclox, or naficillin with hot compresses. Can continue breast feeding. |
| How common is BRCA 1 and 2 among breast cancer pts? | 5% and 10% of breast cancer pts and 1% of overall population. |
| Advantages of OCPs? | Dec. benign breast disease, iron deficiency anemia, PID and ovarian cysts. Also, dec. RA, acne, hirsutism and dysmenorrhea. |
| Disadvantages of OCPs? | Inc. thromboembolic disease, hyperlipidemia, mittleschmertz, nausea, headaches and wt. gain. |
| Absolute contraindications for IUD placement? | Pregnancy, prior salpingitis, acute infection, undiagnosed vaginal bleeding and suspected gyn malignancy. |
| Treatment for female infertility? | Clomiphene citrate 50 or 100mg x5d on day 3-5 of cycle. |
| Calculating EDC? | LMP - 3m + 7d. |
| Quickening begins when? | 18-20w primigravida or 14-18w multigravida. |
| Nuchal translucency at 10-13w tests for? | Trisomies 13 (Patau: polydactyly), 18 (Edwards: structural heart defects, clenched fists w/ overlapping 2nd&5th digits, microcephaly), 21 (Downs) and Turner's Syndrome. LOW PAPP-A, estriol, AFP and HIGH B-hCG or inhibin A -> amnio or CVS. |
| Prenatal labs for 1st trimester (10-13w)? | PAPP-A, B-hCG, US, nuchal translucency (13, 18, 21 and Turner's) and +/- CVS (but cannot be used for AFP testing for open neural tube defects like spina bifida or anencephaly). |
| Prenatal labs for 2nd trimester (15-18w)? | Unconjugated estriol, materal serum AFP, Inhibin A, US, amniocentesis. |
| Prenatal labs for 3rd trimester (24-28)? | Gestational DM screen , repeat Rh titer, GBS vaginal-rectal cx., Hgb and Hct, NST, US and biophysical profile (fluid, mvt, tone, breathing). |
| Most common location for ectopic pregnancies? | 95% in fallopian tube with 55% of these in the ampulla. 2/t adhesions from PID salpingitis, prior surgery, or IUD use. r/o ectopic if B-hCG not 2x/48h esp. if titer >1500 mU/mL. |
| Treatment for ectopic pregnancies? | Methotrexate (folic acid analog) 80% of time IF serum hCG <5000 mU, mass < 3.5cm on trasvaginal US, hemodynamically stable and will f/u. |
| How to diagnose gestational DM? | At 24-28w: 1h 50g >130 -> 3h 100g with 2+ abnormal of fasting >95, 1hr >180, 2hr >155, and 3hr >140. If at risk, screen @ 1st visit and repeat at 24-28w. |
| Classifications of spontaneuous abortions (by 20w and 80% by 12w)? | After nCG titer, serum progesterone, Rh status (or Rh Ig if of 15% Rh -) and serial US...consider vaginal bleeding, cervical dilation and any passed products of conception: threatened -> inevitable -> incomplete -> complete -> missed. |
| Active (pre/term) labor defined as what? | 20-36w (fetal fibronectin?) or >37w: regular uterine contractions of 4-6/hr., cervical dilation >2cm @ presentation or >1cm serial exams and cervical effacement >80%. |
| Treatment for preterm labor? | MgSo4, B-adrenergics (ridodrine or terbutaline), and CCBs. |
| Rx for MgSO4 toxicity? | Calcium gluconate. |
| Major risks of PROM (< labor) and PPROM (<37w)? | Infection: chorioamnionitis and endometritis (also s/p c-section) 2-3 postpartum. Tx. is abx + prostaglandin cervical gel or oxytocin (ripens cervix and lessens blood loss) +/- betamethasone for fetal lung maturity. |
| Treatment for PIH? | Methyldopa -> labetalol. |
| Triad of preeclampsia? | Proteinuria, HTN and edema (140/90-160/110) -> (>160/110) HELLP (hemolysis, elevated liver enzymes and low platelets) w/ DIC. |
| Rh factor is what? | Rhesus D factor. + Coombs test -> both Apt and Kleihauer-Betke tests screen for fetomateral hemorrhage/mixing esp. if s/p ectopic, spontaneous ab, CVS, amnio or trauma. If Ab develop, fetal hydrops occurs in future susceptible infants. |
| Rho-Gam given when? | 300mg at 28w and w/in 72h of delivery to Rh - women with Rh + infants. |
| Most common cause of 3rd trimester bleeding? | Abruptio placentae (PAINFUL) -> DIC due to inc. tissue thomboplastin and dec. fibrinogen. C-section delivery is definitive. |
| Hallmark of placenta previa? | PAINLESS vaginal bleeding. Dx'd <20w and <50% "migrate" up uterine wall prior to term. Abstain from vaginal penetration. |
| Stages of labor? | 1st onset of regular q3m contractions->full dilation of 10cm w/ potential amniotic fluid rupture (6-20h nulli 2-14h multiparous); 2nd full dilation->delivery (30m-3h nulli 5-60m multiparous; 3rd delivery of infant->placenta (0-30m). |
| Meaning of decelerations? | >15bpm for 15s good. Early are benign fetal head compression. Variable are benign cord compression. Late always bad and uteroplacental insufficiency (stop any oxytocin, change position, O2 and check fetal scalp pH). |
| Obtain Apgar scores when? | At 1 and 5 minutes after delivery +/- 10m if high-risk neonate. |
| Umbilical cords contains what? | 2 arteries and 1 vein. |
| Apgar Score comprised of what? | 0-2 scale of Activity, Pulse, Grimace, Appearance and Respiration. 7-10 normal, 4-7 partial resuscitation, 0-4 full resuscitation. |
| Absolute contraindications for inducing labor are? | Cephalopelvic and transverse presentations, placenta previa, uterine scar from previous c-section, and myomectomy (for leiomyoma removal). |
| Treatment for post-partum hemorrhage? | Type and cross with tranfusion, IV oxytocin/ergonovine/methylergonovine or prostaglandins + abx -> methlergonovine maleate or egonovine maleate. |
| Treatment for endometritis? | x1 Clinda + Gent at cord clamp or 2-3d postpartum -> Amp +/- Metronidazole if septic. |
| How long does lochia last? | 5-6 postpartum. Uterus shrinks by 2d, descends by 2w and normal by 6w. |
| When do menses resume for non-breastfeeding mother? | 6-8w postpartum. Breastfeeding mothers at risk for atrophic vaginitis (tx is PV estrogen). |
| Husband seen for infertility with long arms and legs, gynecomastia, mild-moderate mental retardation, and small testes. What is etiology? | Klinefelter 47, XXY karyotype. Inc. FSH and LH despite normal testosterone levels. |
| High LH to low FHS ratio suggestive of what? | PCOS. |
| Cause of PAINFUL bleeding in 3rd trimester? | Placenta abruptio (previa is PAINLESS). |
| INPATIENT Rx for pregnant woman with PID? | Cefoxitin + Azithro (since you can't give Doxy when pregnant). Pregnant PID = always inpatient admission. FQs not given to pregnant women. REMEMBER: Azithro is b/u for Doxy in Gonorrhea. |
| Rx for 29week gestation pregancy s/p gush of fluid with + fern test and normal fetal heart tracing? | Corticosteroids for lung maturity when before 32 weeks. |
| When do Braxton Hicks contractions occur? | LAST 4-8w, painless and DO NOT cause cervical dilation. |
| Clinical sign for softening of the cervix in 2nd month of pregnancy is called what? | Goodell's Sign. Hegar's Sign is softening of isthmus. Chadwick's Sign is bluish cervix from vascular congestion. McDonald's Sign is flexing uterus and cervix against each other. |
| Disorder with large for gestational age neonate w/ MACROGLOSSIA, ENLARGED FONTANELLES and UMBILICAL HERNIA (can add poor perfusion, weak cough and respirations, hypotonia, scarce lanugo)? | Congenital hypothyroidism -> order Total T4 and thyrotropin. |
| Period of greatest fetal sensitivity to EtOH? | 3-9th weeks. |
| Normal weight gain for neonate-infant? | 2x at 4mo and 3x at 12mo. |
| *Management of pregnant woman @ 34w gestation presents with abd cramping and backache, uterine contractions q 10-12/min, cervix 25% effaced and 1-2cm dilated w/ UA suggestive of UTI? | CERVICAL CX, REST & HYDRATION until you can r/o UTI (Admit + cephtriaxone, gent + amp, nitrofurantoin, or amox-clav...NO FQs!) from pre-term labor. NOTE: UTIs CAN CAUSE PRETERM LABOR. |
| Chances of fetus being Rh + if mother is RH - and father is Rh + and heterozygous? | 50% as mother is - and father can only pass on 1/2 of his positive antigens. |
| What is the most crucial time for maternal and fetal physiological changes to occur at or around the time of delivery? | 60m after birth (providing 1m and 5m APGAR) given maternal fluid shifts, hemorrhage, retained placenta and fetal lung CV transitions. |
| Treatment of choice for leiomyomas in women wishing to maintain fertility? | GnRH analog + myomectomy. |
| Organism invovled with positive KOH prep whiff test? | Gardnerella vagininalis. |
| Most likely cause for infertility among women WITH PID history? | Fallopian tube scarring 2/t STD or PID. |
Created by:
ed24