First Aid Side Boxes/quick Hits Obgyn

Front 1

Components of BPP (BioPhysical Profile); Mnemonic; and scoring results

Back 1

Test the Baby, MAN!

✶ Tone (fetal)
✶ Breathing (fetal)
✶ Movements (fetal)
✶ Amniotic fluid volume/index (5-25 normal)
✶ Nonstress test

Each gets a score of 2 (normal) or (absent or abnormal)
✧ 8-10: Reassuring
✧ 6: Equivocal
✧ 0-4: Very worrisome for fetal asphyxia

Front 2

1st step in diagnosis of Hyperemesis Gravidum:

Back 2

RULE OUT MOLAR PREGNANCY with β-hCG & ultrasound

Front 3

4 major components to mgmt of Gestational Diabetes

Back 3

1- ADA diet
2- insulin if needed
3-US for fetal growth
4- NST beginning at 30-32 weeks if requires insulin or an oral hypoglycemic

Front 4

Classic triad of ECTOPIC PREGNANCY and its Mnemonic

Back 4

"The classic triad of ectopic pregnancy PAVEs the way for diagnosis."

Pain (abdominal)
Amenorrhea
Vaginal bleeding
Ectopic pregnancy

Front 5

Clinical diagnosis of Endometritis (3)

Back 5

1) Fever > 38 (> 100.3 F)

2) Uterine tenderness

3) Malodorous lochia

Front 6

The 7 W'S OF Postpartum Fever (10 days postdelvery)

Back 6

1) WOMB (Endomyometritis)

2) WIND (Pnemonia, Atelectasis)

3) WATER (Urinary tract infection)

4) WALKING (DVT, pulm embolism)

5) WOUND (Incision, Episiotomy)

6) WEANING (Breast engorgement, abcess, mastitis)

7) WONDER DRUGS (Drug fever)

Front 7

Name 3 conditions in which breastfeeding is contraindicated

Back 7

▸ HIV infection

▸ Active Hepatitis

▸ Certain medications (Bromocriptine, Cyclophosphamide, Cyclosporine, Doxorubicin, Ergotamine, Lithium, Methotrexate, Estrogen-containing oral contraceptives (OCPs).

Front 8

⨁ Chandelier sign

Back 8

When you touch the cervix, there is so much pain that the patient jumps to the chandelier.
Likely Pelvic Inflammatory Disease.

Front 9

Acute causes of Pelvic Pain: (mnemonic)

Back 9

A ROPE

Appendicitis

Ruptured ovarian cyst

Ovarian torsion/abcess

Pelvic Inflammatory disease

Ectopic pregnancy

Front 10

If a uterine mass continues to grow after menopause:

Back 10

Suspect malignancy.

Front 11

Any palpable ovarian or adnexal mass in a premenarchal or postmenopausal patient is suggestive of:

Back 11

An ovarian neoplasm

Front 12

Causes of Urinary Incontinence w/o specific urogenital pathology (Mnemonic)

Back 12

DIAPPERS

Delirium/confusional state

Infection

Atophic vaginitis/urethritis

Pharmaceutical

Psych causes (depression)

Excessive urinary output (hyperglycemia, hypercalcemia, CHF)

Restricted mobility

Stool impaction

Front 13

DDX for a breast mass (5)

Back 13

❍ Fibrocystic disease
❍ Fibroadenoma
❍ Mastitis/abcess
❍ Fat necrosis
❍ Breast cancer

Front 14

__________ and _________ are common causes of bloody nipple discharge.

Back 14

Intraductal papilloma and Mammary duct ectasia

Front 15

1st step in workup of a suspicious mass. ➤.in a postmenopausal woman or woman > 30?
➤ in a woman < 30

Back 15

➤Mammogram
➤Ultrasound (for women <30)

Front 16

Naegele's rule

Back 16

EDD = LMP + 7 days - 3 months

Front 17

Hegar's sign

Back 17

= softening of the cervix

(Nonpregnant cervix feels like cartilage of nose. Pregnant cervix feels like the lips of the mouth)

Front 18

Chadwick's sign

Back 18

= bluish discoloration of the vaginal & cervical mucosa due to vascular congestion in pregnancy

Front 19

What does Quickening mean?

Back 19

First fetal movements felt by mother

Front 20

Plasma β-hCG levels should double every 2 days prior to what gestational age?

Back 20

Prior to 10 weeks

Front 21

If fetal heart tones aren't heard by ____ weeks, a US should be done to document a viable pregnancy.

Back 21

by 10 weeks

Front 22

Up to _____ weeks, the ___________ is predictive of best. age by +/- 4 days

Back 22

up to 12 weeks, Crown-Rump length

Front 23

When is β-hCG detectable in maternal serum?

Back 23

After implantation has taken place (~8-10 days after conception)

Front 24

If mom has β-thalassemia trait/disease or Sickle cell trait/disease, what's your next step in management?

Back 24

Test the after to determine the risk of inheritance for the fetus.

Front 25

Normal acid-base status in pregnancy:

Back 25

Compensated Respiratory Alkalosis

(more CO2 blown off, pH 7.45)

Front 26

Thyroid hormone levels in pregnancy and why the change?

Back 26

◇ ⬆ total T4 & T3
◇ Normal Free T4
◇ Normal TSH

Elevated total because there's increased Thyroid-Binding Globulin (TBG)

Front 27

Definition of Reactive NST

Back 27

2 or more accelerations within 20 minutes = fetal well-being

(2 accelerations where it goes 15 beats above the baseline for 15 seconds.....within a 20-minute time period)

Front 28

Components of modified BioPhysical Profile (mBPP)?

Back 28

Nonstress test(NST)
and
AFI (Amniotic Fluid Index)

Front 29

Most common cause of Oligohydramnios:

Back 29

Rupture of Membranes

note: assoc'd w/ IUGR 60% of the time

Front 30

Fetal Tachycardia and Fetal Bradycardia

Back 30

<110 and >160 for 10 minutes or more

Front 31

First-Trimester Screen (FTS)
⦿ What is it & when performed?
⦿ What are the results if Downs syndrome

Back 31

⦿ b/w 11-13 weeks

⦿ Down syndrome:
⬆ Nuchal translucency,
⬆ β-hCG
⬇ PAPP-A

Front 32

High MSAFP is seen with:

Back 32

◇ Underestimation of gestational age
◇ Neural Tube defects
◇ Abdominal wall defects (Gastroschisis, Omphalocele)
◇ Multiple gestations
◇ Placental abnormalities (eg abruption)
◇ Fetal death
more...

Front 33

How do you monitor IUGR?

Back 33

Serial ultrasounds

Front 34

3 P's that affect the duration of Active phase of Labor:

Back 34

POWER: strength & freq. of CTX

PASSENGER: size of baby

PELVIS: size & shape of mom's pelvis

Front 35

Abnormal Labor table

Back 35

Indication Nullipara Multipara
Prolonged latent phase >20 h >14 h
Average second stage 50 min 20 min
Prolonged second stage without (with) epidural >2 h (>3 h) >1 h (>2 h)
Protracted dilation < 1.2 cm/h < 1.5 cm/h
Protracted descent < 1 cm/h < 2 cm/h
Arrest of dilation* >2 h >2 h
Arrest of descent* >2 h >1 h
Prolonged third stage >30 min >30 min
*Adequate contractions >200 Montevideo units [MVU] per 10 minutes for 2 hours. (Please refer to the Pathophysiology for information regarding adequate contractions.)

Front 36

What can cause a false positive nitrazine test? (3)

Back 36

Vaginal infection with Trich
Blood
Semen

Front 37

Which fontanelle is smaller?

Back 37

Posterior fontanelle (smaller triangle shape)
vs ant fontanelle is larger and diamond shape

Front 38

Most common cause for postpartum hemorrhage:

Back 38

Uterine atony

Treat with uterotonic agents (piton, methergine, hem abate, misoprostal)

Front 39

Causes of PosTparTum Hemorrhage & Mnemonic

Back 39

THE 4 T's

TISSUE: Retained placental tissue

TRAUMA: Instrumentation,lacerations, episiotomy

TONE: Uterine atony

THROMBIN: Coag defects, DIC

Front 40

DefineArrest of Labor

Back 40

Lack of cervical change in active first stage for >2 hour with >200 Montevideo units of uterine activity

(Montevideo units are calculated by subtracting the baseline uterine pressure from the peak contraction pressure for each contraction in a 10-minute window and by adding the pressures generated by each contraction. Or easier way is to take the avg peak pressure minus the baseline resting tone and multiply that value times the number of contractions in 10 minutes)

Front 41

Management of worrisome decal's: and Mnemonic

Back 41

"STOP when you see decelerations"

Sterile vaginal exam
Turn the pt to her left side
Oxygen
Pitocin off

Front 42

Most common indication for C-section:

Back 42

Dystocia (difficult labor--characterized by abnormally slow or no progress of labor)

Front 43

The most common reason for C-section:

Back 43

Previous C-section

Front 44

Most common cause of persistent pyelonephritis (in pregnancy) despite adequate therapy:

Back 44

Nephrolithiasis (Kidney stones)

Front 45

Most common indications for surgery in pregnancy: (3)

Back 45

Appendicitis
Cholecystitis
Adnexal masses

Front 46

In pregnant patients with SLE, presence of anti-Ro (SS-A) and anti-La (SS-B) are associated with:

Back 46

Congenital Heart Block

Front 47

Shoulder Dystocia management (& Mnemonic)

Back 47

HELPERRR

call for Help
Episiotomy
Legs up (McRobert’s position)
Pressure suprapubically
Enter vagina for shoulder rotation (Woods corkscrew)
Reach for posterior arm
Rupture clavicle or pubic symphysis
Return head into vaginafor C-section (Zananelli).

Front 48

Standard dose of RhoGAM is 300 µg, which is sufficient for:

Back 48

30 mL of whole fetal blood (15 mL of D-positive fetal RBCs)

Front 49

Fetal Hydrops = collection of fluid in 2 or more body cavities: (name the 4)

Back 49

◆ Scalp edema
◆ Pleural effusion
◆ Pericardial effusion
◆ Ascites

Front 50

Contraindications to Tocolysis (& Mnemonic)

Back 50

BAD CHU

▷ Bleeding (severe--from any cause)
▷ Abruption
▷ Death-fetal death/life-incompatible anomaly
▷ Chorioamnionitis
▷ Hypertension (severe PIH)
▷ Unstable maternal hemodynamics

Front 51

2 most common causes of 3rd-trimester bleeding:

Back 51

Placenta Previa (usu painless)
& Placental Abruption (painful)

Front 52

US reveals that baby is lying transversely. What are you suspicious of?

Back 52

Placenta Previa

Front 53

Biggest risk for uterine rupture:

Back 53

A Prior C-section

Front 54

Causes of postpartum hemorrhage: (& Mnemonic)

Back 54

CARPIT

❖ Coagulation defect
❖ Atony
❖ Rupture of uterus
❖ Placenta retained
❖ Implantation site bleeding...?
❖ Trauma to GU tract

Front 55

What are the types of Placental Attachment disorders (& Mnemonic)

Back 55

Accreta = Attaches
(plac. villi attach directly to myometrium instead of decidua
basalis)

Increta = Invades
(plac. villi invade the myometrium)

Percreta = Penetrates
(plac. villi penetrate thru the myometrium, and may even
invade the bladder!)

Front 56

Most common cause of perinatal infection:

Back 56

CMV

Front 57

Name 3 infections associated with preterm delivery:

Back 57

Bacterial Vaginosis, Trichomonas, & Gonorrhea

Front 58

DDX for size/date discrepancy in pregnancy: (8)

Back 58

❂ Twins
❂ Uncertain LMP
❂ Molar pregnancy
❂ Fetal macrosomia
❂ Maternal obesity
❂ Adnexal mass
❂ Distended bladder
❂ Hydramnios

Front 59

Top 5 etiologies of spontaneous abortion

Back 59

1. Chromosomal abnormalities
2. Unknown
3. Infection
4. Anatomic defects
5. Endocrine factors

Front 60

DDX for 1st trimester bleeding (4)

Back 60

1. Spontaneous abortion
2. Ectopic pregnancy
3. Molar pregnancy
4. Vaginal/cervical lesions/lacerations

Front 61

DDX for 3rd trimester bleeding (4)

Back 61

Placental Abruption
Placenta Previa
Uterine Rupture
Rupture of Vasa Previa

Front 62

Medical methods of abortion are best used within the 1st ___ days

Back 62

up to 49 days (i.e. 1st 7 weeks)

Front 63

Most common site of ectopic pregnancy:

Back 63

Ampulla of fallopian tube

Front 64

Biggest risk factor for ectopic pregnancy:

Back 64

Prior ectopic pregnancy

Front 65

Which method of contraception may be less effective in obese females? More effective in obese?

Back 65

Less effective: Implant (Nexplanon) and Transdermal patch (>200 lbs)

More effective: Nuvaring and DepoProvera

Front 66

4 mechanisms of Combined OCPs

Back 66

1-prevent ovulation
2-alterine uterine and fallop tube mobility
3-thicken cervical mucus to prevent sperm penetration
4-cause endometrial atrophy

Front 67

Definition of Oligomenorrhea

Back 67

Absence of menses for more than 35 days up to 6 months

Front 68

Definition of Secondary Amenorrhea

Back 68

6 months of amenorrhea after a history of normal menses

Front 69

Definition of Primary Amenorrhea

Back 69

Primary amenorrhea definition: age 14 without secondary sex characteristics, age 16 with secondary sex characteristics

Front 70

3 findings in Premature Ovarian Failure

Back 70

✾ Age <40
✾ Amenorrhea
✾ ⬆ FSH

Front 71

A baby with ambiguous genitalia is born to a mother who complains of increased facial hair growth over the last few months. Suspect:

Back 71

Luteoma of pregnancy

Front 72

How much blood loss is necessary to define monrrhagia?

Back 72

> 80 mL

Front 73

Most common cause for hospital admission for menorrhagia in adolescents:

Back 73

von Willebrand disease

Front 74

Vaginal bleeding + foul-smelling discharge in a postmenopausal woman =

Back 74

Cervical cancer

Front 75

➜ DDX for thickened endometrial stripe (endometrial lining seen on US) in a postmenopausal woman

➜ What thickness should the stripe be to prompt an evaluation?

Back 75

◇ Endometrial cancer
◇ Endometrial hyperplasia
◇ Leiomyoma
◇ Polyp

Front 76

Endometrial stripe > ______ in a patient with postmenopausal bleeding should prompt an evaluation.

Back 76

> 4-5 mm

Front 77

Name for pain associated with ovulation (in the middle of the cycle).

Back 77

Mittelschmerz

Front 78

DDX for Chronic Pelvic Pain (& Mnemonic)

Back 78

"LEAPING pain"

✴ Leiomyoma
✴ Endometriosis & Endometritis
✴ Adhesions & Adenomyosis
✴ Pelvic Inflammatory disorder
✴ Infections other than PID
✴ Neoplasia
✴ Gastrointestinal

Front 79

DDX for Acute Pelvic Pain (& Mnemonic)

Back 79

A ROPE

❄ Appendicitis/Abcess/Abortion
❄ Ruptured ovarian cyst
❄ Ovarian torsion
❄ PID (tubo-ovarian abcess)
❄ Ectopic pregnancy

Front 80

A female with new-onset pelvic pain and a negative pregnancy test has an echogenic adnexal mass on ultrasound. What is the diagnosis?

Back 80

A ruptured corpus luteum cyst

Front 81

A 37 y.o. has hemptysis during their menstrual period. Suspect:

Back 81

Endometriosis of the lung or nasopharynx

Front 82

Long-term complications of Endometriosis

Back 82

• Adhesions (prolonged bleeding causes scarring)
• Adhesions then cause:
⁍ Infertility
⁍ Small bowel obstruction
⁍ Pelvic pain
⁍ Difficult surgeries

Front 83

Classic findings of enDometriosis

Back 83

3 D's

Dysmenorrhea
Dysparuenia
Dyschezia

Front 84

Classic findings on physical exam of pt with Endometriosis

Back 84

Nodularities on the uterosacral ligament and a fixed retroverted uterus

Front 85

"Enlarged, globular, boggy uterus"

Back 85

Adenomyosis

Front 86

Bilateral ___________ are usually seen in molar pregnancies, due to elevated β-hCG levels.

Back 86

Bilateral theca lutein cysts

Front 87

Leiomyomas are most commonly which type:

Back 87

Subserosal

Front 88

Submucosal and intramural leiomyomas usually present as ________________, whilecan present with ________________.

Back 88

Submucosal and intramural leiomyomas--> menorrhagia

Subserosal leimyomas-->become pedunculated and may present with acute pain & torsion

Front 89

What risks are increased in a pregnancy with fibroids (5)

Back 89

✻ Abruption
✻ 1st trimester bleeding
✻ Dysfunctional labor
✻ Breech
✻ C-section

Front 90

Risk factors for Cervical dysplasia (& Mnemonic)

Back 90

OSHA Ends Dirt, Garbage, & Chemicals

❃ OCP's
❃ Sex
❃ HPV
❃ Alcohol
❃ Education/poverty
❃ DES (Diethylstilbestrol)
❃ Genetics
❃ Cigarettes

Front 91

Regarding cervical dysplasia, both _______ and ________ are needed for a histologic/pathologic diagnosis.

Back 91

Colposcopy and Biopsy (confirmatory tests)

(Pap smear and results only gives you cytology--a screen)

Front 92

What must be visualized for adequate colposcopic evaluation?

Back 92

1- TZ (Transition zone)
2- Extent of lesion in its entirety

Front 93

Radical hysterectomy requires removal of:

Back 93

1-Uterus
2-Cervix
3-Upper Vagina
4-Parametrial tissue

Front 94

Basic treatment for Invasive Cervical cancer:

Back 94

➜ If confined to cervix: Radical hysterectomy, and Pelvic and Para-aortic Lymphadenectomy

➜ If beyond cervix: Chemo & Radiation

Front 95

Side effects of progestins (5)

Back 95

◆ Weight gain
◆ Edema
◆ Throbophlebitis
◆ Headache
◆ Hypertension

Front 96

______ is the most prognostic indicator of Endometrial cancer

Back 96

Grade

Front 97

What type of ovarian cancer accounts for 85% of all ovarian cancers?

And what subtype of this type is the most common type of ovarian cancer?

Back 97

Epithelial cell ovarian cancer

➤ Serous type of epithelial ovarian cancer...and it's bilateral 65% of the time

Front 98

_______________ is a fixed pelvic and upper abdominal mass when associated with ascites, and is pathognomic for ovarian cancer.

Back 98

Omental caking

Front 99

How does ovarian cancer usually spread:

Back 99

By exfoliation of cancerous cells into the peritoneal fluid/ thru the peritoneal fluid, which carries cancer cells to other abdominal structures

Front 100

Palpable nodule on the umbilicus of a patient with known ovarian cancer:

Back 100

Sister Mary Josephs nodule = ovarian cancer metastasis to umbilicus

Front 101

➤ Malignant conditions that cause ⬆ CA-125: (5) ➤ Benign conditions that cause ⬆ CA-125: (6)

Back 101

➤ Ovarian cancer
➤ Endometrial cancer
➤ Breast cancer
➤ Lung cancer
➤ Pancreatic cancer

➤ Endometriosis
➤ Leiomyomas
➤ PID
➤ Pregnancy
➤ Hemorrhagic ovarian cyst
➤ Liver disease

Front 102

Name for a tumor that has metastasized from another primary cancer to the ovaries

Back 102

Krukenberg tumor (usu from the GI tract)

Front 103

Most common complaint in vulvar cancer:

Back 103

Itching & burning of the vulva

So always biopsy itchy, white lesions on exam!!!

Front 104

3 possible precursors to Vulvar cancer

Back 104

• a lump or wart-like lesion
• Lichen sclerosus
• Lichen planus

Front 105

If an itch-scratch-itch cycle is mentioned, think:

Back 105

LSC (lichen simplex chronicus)

Front 106

Preeclampsia prior to 20 weeks gestational age:

Back 106

Suspicious for Molar pregnancy

Front 107

What substances are secreted by Gestational Trophoblastic disease?

Back 107

• β-hCG
• Lactogen
• Thyrotropin

Front 108

3 things required for a clinical diagnosis of PID

Back 108

1) Abdominal tenderness
2) Adnexal tenderness
3) Cervical motion tenderness

Front 109

5 Criteria for hospitalization for PID (& Mnemonic)

Back 109

GU PAP

• G.I. symtoms
• Uncertain diagnosis
• Peritonitis
• Abcess
• Pregnancy

Front 110

Screening tests for Syphilis:

Confirmatory tests for Syphilis:

Back 110

Screening: RPR & VDRL

Confirmatory: FTA-ABS & MHA-TP

Front 111

Most common infection with an IUD

Back 111

Actinomyces

Front 112

Suspicious findings for breast cancer on a breast exam:

Back 112

➜ Hard, fixed, irregular mass
➜ > 2 cm

Front 113

Suspicious findings for breast cancer on a mammogram

Back 113

➜ Cluster of calcifications
➜ ⬆ breast density
➜ Irregular margins of mass (speculations)

Front 114

Risk factors for breast cancer (7)

Back 114

✶ Personal hx of breast cancer
✶ Early menarche
✶ Nulliparity
✶ Alcohol intake
✶ Obesity
✶ Decreased physical activity
✶ Use of prolonged HRT (> 5 years) during menopausal years

Front 115

In which obstetrical conditions should pregnant patients avoid sex?

Back 115

❂ Placenta previa
❂ Placental abruption
❂ Preterm labor
❂ Premature rupture of membranes

Front 116

3 factors that can decrease the age of menopause (menopause at a younger age)

Back 116

1) Smoking (age down by 3 years!)
2) Chemo
3) Genetics

Front 117

Menopause is considered "late" if it occurs after age:

Back 117

after age 55

Front 118

Estrogen creates a hypercoaguale state due to:

Back 118

⬆ production of hepatic coagulation factors

Front 119

What muscles make up the pelvic diaphragm

Back 119

Levator ani and Coccygeal muscles

Front 120

Risk factors for developing Prolapse (9)

Back 120

❍ Advancing age
❍ Chronic obstruction
❍ Constipation
❍ Genetic predisposition
❍ Menopause
❍ Parity
❍ Prior surgery
❍ Pulmonary disease
❍ Tumor/mass

Front 121

Name 5 complications of Pelvic organ prolapse

Back 121

⦿ Urinary retention
⦿ Constipation
⦿ UTI's
⦿ Ulcerations
⦿ Vaginal bleeding

Front 122

Name the 5 types of urinary incontinence (& MNEMONIC)

Back 122

"This Urine Flow is So Outrageous"

Total
Urge
Functional
Stress
Overflow

What is Total Incontinence--> continuous urinary and/or fecal leakage due to a fistula. This occurs as a result of either prior pelvic surgery, obstetric trauma, or radiation.

Front 123

What is the Q-tip test?