Ob Gyn 2

Front 1

Post partum hemorrhage definitions?

Back 1

Bleeding >500 cc in svd

Bleeding > 1000 cc in c-section

Front 2

Ddx of post partum hemorrhage

Back 2

Uterine atony

Retained POC's

Placenta accreta

Lacerations of vagina or cervix

Front 3

Treatment process for uterine atony

Back 3

1. Pitocin

2. Methergine

3. Prostin

4. D&C

Front 4

Surgical management of postpartum hemorrhage?

Back 4

D&c

Then laporotomy

Then artery ligation

Then hysterectomy

Possibly IR e!bolization

Front 5

How to treat endometriosis?

Back 5

Medical management can alleviate symptoms

Only surgical management can increase fertility

Front 6

How do previous abortion, uncomplicated pregnancy termination, intrauterine adhesions, and insulin dependent diabetes effect risk of spontaneous abortion?

Back 6

None effect except insulin dependent diabetes, which increases the risk

Front 7

Treatment of cervical incompetence?

Back 7

Cervical cerclage in the second trimester

Front 8

Uterotonics used in postpartum hemorrhage?

Back 8

Methergine

Prostaglandins

Oxytocin

Front 9

Which medication is contraindicated in pre ecclampsia and hypertension? Typically used in post partum hemorrhage.

Back 9

Methylergonovine

Front 10

Which medication is should not be used in asthma patients? Typically used in post partum hemorrhage.

Back 10

Hemabate ( prostaglandin F2-alpha)

Front 11

What type of factors lead to uterine inversion?

Back 11

Factors that lead to an over distended uterus

Front 12

In relation to post partum hemorrhage, what does the increased number of c sections increase the risk of?

Back 12

Placenta accreta

Front 13

What increases risk of placental retainment?

Back 13

Prior c section

Uterine leiomyoma

Prior uterine curettage

Succenturiate lobe of placenta

Front 14

What type of procedure can be done in a uterine atony picture of conservative management had failed?

Back 14

B Lynch suture

Front 15

What are patients with abnormal uterine bleeding at risk for?

Back 15

Endometrial cancer from unopposed estrogen

Front 16

In abnormal uterine bleeding, what must be ruled out before endometrial ablation?

Back 16

Endometrial carcinoma

Front 17

Which type of disorder may present like menstrual symptoms in a YOUNG woman?

Back 17

Clotting disorders

Front 18

When are you allowed to observe an endometrial polyp?

Back 18

If <1.5cm

Front 19

Ob gyn side effect of imipramine?

Back 19

Increased prolactin

Front 20

Of you are hypothyroid, what level is your prolactin?

Back 20

Elevated

Front 21

Lab values in exercise induced hypothalamic amenorrhea?

Back 21

Normal FSH

Low estrogen

Front 22

Purpose of the clomiphene challenge test?

Back 22

To determine ovarian reserve

Front 23

Does rise in basal body temp occur before or after ovulation??

Back 23

AFTER

Front 24

Normal cycle length?

Back 24

21-35 days

Front 25

Acronym for abnormal uterine bleeding

Back 25

PALM (polyp adenomyosis leiomyoma malignancy/hyperplasia)

COEIN (coag ovulatory dysfxn endometrial issues iatrogenic not otherwise specified)

Front 26

Tell tale imaging sign of adenomyosis?

Back 26

Differing diameter of uterine wall in AP view

Front 27

DX of pcos, need 2 of 3 ransons criteria

Back 27

An ovulation/menstrual irregularity

Hyper androgenism

Polycystic ovaries (string of pearls)

Front 28

Moa and use of tranexamic acid?

Back 28

Prevents breakdown of fibrin

Non hormonal

Only use 5 days per month

Front 29

2 things to know about depoprovera

Back 29

+weight gain (stimulates appetite)

+irregular bleeding

Front 30

Depolupron side effects

Back 30

(Decreases fibroid size)

Menopausal symptoms

Osteoporosis

Front 31

Risk of placenta previa accreta if 3 prior c sections?

Back 31

67%

Front 32

Which is more common and has higher chance o malignancy?complete or partial molar pregnancy?

Back 32

Complete

Front 33

Pathognomonic feature of complete mole?

Back 33

Snowstorm appearance

Front 34

Most common presentation of a partial molar pregnancy?

Back 34

Missed abortion

Front 35

Symptomatology of molar pregnancy?

Back 35

Similar to preeclampsia

Due to HCG

Front 36

Preop eval of molar pregnancy?

Back 36

1. Baseline HCG

2. Baseline CXR to check for metastatic disease

Front 37

Risk of congenital anomalies or complications in future pregnancies after molar pregnancy?

Back 37

No increase in anomalies

Front 38

Does a persistent Gestational Trophoblastic Neoplasia follow a molar pregnancy or a normal pregnancy?

Back 38

BOTH (see a lack of a fall in hCG)

Front 39

Biopsy or don't biopsy a metastatic gtn?

Back 39

Don't! It will bleed!

Front 40

Cure for malignant forms of GTN?

Back 40

Chemotherapy (methotrexate or actinomycin d)

Front 41

Metastatic gestational trophoblastic disease, high risk

Back 41

Not a molar pregnancy

>4 months since pregnancy

Titer >100,000

Failed chemo

Not in chest

NO CURE

Front 42

Cell composition of placental site tumors?

Back 42

Intermediate cytotrophoblastic cells

Front 43

What marker do you follow for a placental site tumor?

Back 43

Human placental lactogen

Front 44

What is needed to make the diagnosis of endometriosis?

Back 44

Tissue biopsy confirming endometrial tissue

Front 45

First line treatment for endometriosis?

Back 45

OCP'S and NSAIDS

Front 46

Endometriosis option if still trying to get pregnant?

Back 46

Daily oral medroxyprogesterone

Front 47

Moa of danazol in endometriosis? Side effect profile?

Back 47

Suppresses LH and FSH leading to hypoestrogenic state leading to endometrial atrophy

Lots of androgenic side effects

Front 48

Benefit of GnRH agonists vs danazol?

Back 48

Less androgenic side effects

But still hypoestrogenic so menopausal symptoms

Front 49

How long does sperm production take?

Back 49

70 days

Front 50

Moa of the #1 medication for ovulation induction?

Back 50

Clomiphene

SERM that inhibits estrogen mm binding in the pituitary leading to increased GnRH which simulator follicle development in the ovaries

Front 51

Malignant uterine tumor in young individual, what marker don't you use and why?

Back 51

CA-125

Because most likely it's a germ cell tumor (AFP and HCG)

Front 52

Therapy for cervical cancer?

Back 52

Radiation. Not surgery.

Front 53

Molar pregnancy definition:

Back 53

Abnormal proliferation of cytotrophoblast

Hydropic swollen villi

No fetal vessels -->no fetus

Front 54

How to diagnose a molar pregnancy? Management?

Back 54

US

Evacuation ( unless older, then hysterectomy)

Follow with HCG titers (0 by 12 weeks)

Front 55

Persistent gestational trophoblastic disease labs?

Back 55

Have HCG titers increase within a year

Front 56

Treatment for PGTD

Back 56

Chemotherapy

(Mac?)