Ob/gyn Case Files Notes

Front 1

normal rate of dilation in nullparous woman in active phase?

Back 1

1.2CM/HR = should take 4-12 hrs to dilate last 6 cm's

Front 2

how long does it take to call a labor arrested in active phase?

Back 2

if >2 hrs in active phase with no progression

Front 3

what is ädequate amt of montevideo units / 10 mins?

Back 3

"200"although this usually means around 4-5 contractions while adequate # contractions should be anywhere form 2-6

Front 4

what type pelvis predisposes baby to posterior occiput position?

Back 4

anthropoid

Front 5

some progress during active phase but less than the expected (at least 1.2 cm/hr for nulliparious or 1.5cm/hr for multiparous

Back 5

= protracted active phase

Front 6

how to differentiate bloody show from antepartum bleeding?

Back 6

bloody show has thick mucus mixed in with it

Front 7

arrested active phase with decreased contractions, tx? with adequate contractions, tx?

Back 7

1) tx with oxytocin
2) tx with CS

Front 8

Any woman 7 weeks pregnant with lower abd px and vaginal spotting should be considered what?

Back 8

consider an ectopic pregnancy until otherwise proven!!

Front 9

what is a risk factor for ectopic preg?

Back 9

std's, PID,

Front 10

what is threshold after which transvag US may reveal intrauterine gestation?

Back 10

when hCG is at least 1500

Front 11

IF nothing found on US , AND bHCG levels are below threshold, how determine if normal uterine pregnancy vs abnormal (ectopic) pregnancy?

Back 11

check bHCG then check again 48hrs later. If rises by 66% - normal uterine. if rises <20% =she most likely has abnormal pregnancy

Front 12

what are best tools for evaluating a possible ectopic preg?

Back 12

bHCG (if < 66% rise in 48hrs) and US

Front 13

definition of threatened abortion?

Back 13

vag spotting (not heavy bleeding = either inevitable or compltee/incomplete abortion) in ist 1/2 of preg

Front 14

where is bhcg secreted from?

Back 14

chorionic villi

Front 15

If intrauterin pregnancy is not seen on US but bHCG levels are over 1500, what is probable?

Back 15

ectopic pregnancy

Front 16

viable vs non-viable pregnancy using progesterone measurement?

Back 16

prog > 25ng/mL =viable
<5ng/mL = non-viable

Front 17

prog <5ng/mL . NSIM?

Back 17

Could be ectopic preg or abnmormal preg. Do uterine curettage to assess if pt has a miscarriage (c villi seen) or ectopic preg (no c villi seen).

Front 18

if <3.5 cm ectopic preg, tx?

Back 18

IM MTX

Front 19

NSIM of determined non-viable uterine (not ectopic) pregnancy

Back 19

Either:
1) wait
2) D & C
3) Misoprostol (PGE1)

Front 20

effectivity of misoprostol in evacuating uterine miscarriage?

Back 20

80%!!

Front 21

tx for chlamydia?

Back 21

azithromycin (siongle dose),
doxycycline
or if with NG,
give ceftriaxone

Front 22

tx for bact vaginosis?

Back 22

metronidazole

Front 23

numerous keratotic papllary fernlike or flat lesions/ processes on surface of labia?

Back 23

venereal warts = condylomata acuminata = assoc with HPFV 6, 11

Front 24

type of hpv assoc with dysplasia/ scc?

Back 24

16, 18

Front 25

tx for NG std?

Back 25

ceftriaxone

Front 26

condylomata lata seen in ?

Back 26

secondary syphilis

Front 27

tx for trichomonas vaginalis?

Back 27

metronidazole for both partners!!

Front 28

dysplasia of vulva with HPV 16 association?

Back 28

VIN (similar to CIN)

Front 29

red, crusted vulvar lesion with PAS positive cells and intraepithelial adenocarcinoma on pathology?

Back 29

extra mammary Paget's disease = intraepithelial adenocarc

Front 30

red, crusted vulvar lesion with PAS negative cells

Back 30

malignant melanoma

Front 31

vaginitis with strawberry cervix and firey red vaginal mucosa and greenish, frothy discharge?

Back 31

trichomonas vaginalis

Front 32

absence of upper vag and uterus and primary amenorrhea?

Back 32

RKH
Rokitansky Kuster Hauser syndrome

Front 33

cyst on lateral wall of vag

Back 33

Gartner's duct cyst

Front 34

DES effects?

Back 34

inhibited mullerian differentiation of structures (tubes, ut, cerv, upper third of vag)
adenosis = ridge in upper portion of vag = precursor for clear cell carc

Front 35

DES associated cancer?

Back 35

clear cell cancer of upper vag or cervix

Front 36

cervical os incompetence caused by exposure to what drug?

Back 36

DES

Front 37

VIN may progress to what?

Back 37

vaginal sq cell carc

Front 38

what is primary source of chlamydial conjunctivitis and pneumonia in newborns?

Back 38

mother's chlamydial CERVICITIS

Front 39

order of management of cervical tests?

Back 39

Do pap smear; if visual lesion - do bx
do cytology on rest: if pap +, if high grade = do culposcopy + acetic acid...then if see white patch, do excisional bx and check for borders...if clear, f/u in 6 mo.
if + pap smear shows low grade = just observe, w/ f/u later to check for remission (90%)

Front 40

is a cervical polyp seen protruding from cerv os, and causing post-coital bleeding, precancerous?

Back 40

no

Front 41

pathological sign of hpv infection of sq cells?

Back 41

koilocytosis (clear halo containing a wriniled, pyknotic nucleus

Front 42

rf's for CIN / cerv cxr?

Back 42

MOLESH
Multiple high risk partners
OCP's
Lack of Immune system (AIDS)
Early age intercourse
Smoking (synergistic effect)
High risk HPV (16, 18) in bx

Front 43

avg age of cervical cxr (notCIN)

Back 43

45

Front 44

What age/how often to do pap smear?

Back 44

from age 21 or 3 yrs after init of sex intercourse, then every year. until age 30 then if 3 consecutive neg results, don't need anymore

Front 45

m/c gynecological cxrs in order?
Mortality?

Back 45

EOC = m/c
endom
ov
cerv
OEC = mort

Front 46

m/c cause of death in cerv cxr?

Back 46

RENAL FAILURE: post renal azotemia from spread to ureters and obstruction of ureteres causing renal failure; uremia

Front 47

why are l/n's not included in staging of cervical cxr?

Back 47

b/c classification is clinical, not surgical

Front 48

classif of cerv cxr?

Back 48

Ia1,2 = microscopic inv
Ib1,2 = macroscopic
II a, b = to vag but not beyond
III a to lower 1/3 of vag
b to pelvic wall
IV mets; or invasion to baldder, rectum

Front 49

tx of stages?

Back 49

IA1 = simple hyster
IA2 - IIA = rad hyst + chemo/rad
IIB-IV = chemo/rad only

Front 50

pap smear f/u timeline for CIN? cerv dysplasia tx?

Back 50

6mo; if dysplasia tx'd, f/u is in 3 mo

Front 51

ages to give gardasil

Back 51

9-26

Front 52

20% of cervical cxrs are?

Back 52

adenocarcinomas = arise in endocervical glands

Front 53

mean age of menarche?

Back 53

12.8 yrs

Front 54

in the ovary, how is estradiol synthesized?

Back 54

from testosterone released from theca cells -> aromatase in granulosa cells turns it into estradiol

Front 55

what causes LH surge?

Back 55

estrogen surge occuring 24-36 hours before ovul induces POSITIVE feedback to LH, neg to FSH = LH surge

Front 56

2 phases in menstrual cycle?

Back 56

prolif phase = estrogen mediated
secretory phase= prog mediated

Front 57

endom bx confirming ovulation?

Back 57

on DAY 21 = secretory endometrial cells seen

Front 58

pregnancy endometrium? menses endometrium?

Back 58

preg =exaggerated secretory phase
menses= apoptosis,

Front 59

LH fxn in prolif phase? in secr phase?

Back 59

increases 17 Ketosteroids (DHEA and androstenedione) synth which ultimately increases estradiol;
in sec phase = increases 17-OH progesterone

Front 60

where is HCG synthed? what are chagnes it causes in pregnancy?

Back 60

in syncytiotrophoblast lining the chor villus; acts as LH analogue by maintinaing corpus luteum --> corp luteum in turn synth's progesteron for 8-10 weeks after fert, then involutes and PLACENTA takes over synthing HCG

Front 61

estrogen inhibits what/ prog inhibits what?

Back 61

e -- FSH
p -- LH

Front 62

how do OCP's work( 2) ?

Back 62

1) baseline levels of est prevent estrogen surge = no LH surge;
2) progesterone arrest prolif stage (first stage) and cause gland atrophy; they also inhibit LH and help prevent LH surge

- overall, render cerv mucus hostile to sperm and decr ftube motility

Front 63

type of est produced in menopause?

Back 63

estrone = comes from ADRENAL cortex's androstendione aromatization in adipose cells (as opposed to premenopause = est made from DHEA/ androstendione made in theca cells of ovary and converted to estradiol by aromatase in granulosa cells)

Front 64

estrogen of pregnancy? where is it primarily made from?

Back 64

estriol; made from fetal adrenal, placental, and maternal liver!

Front 65

what kid changes in normal preg?

Back 65

increased bvol = increased GFR = increased Cre clearance (so Cr serum are lower limit of normal)

Front 66

what norm changes in thyroxine/cortisol in preg?

Back 66

TBG and transcortin (the binding proteins) are INCREASED so total serum thyroxine and cortisol are increased but FREE = stays the same so no clinical signs of overactivity

Front 67

fsh and lh levels in menopause?

Back 67

since est and prog are decreasing due to ov fxn decrease, FSH and LH are increased

Front 68

PCOS pathophys?

Back 68

increased pit synth of LH and decr synth of FSH --> increased estrogen prod --> neg feedback on fsh, pos on LH--> suppressed FSH = follicle degeneration and cyst formation

Front 69

clinical sx of pcos?

Back 69

oligomenorrhea / amenorrhea (M/C),
hirsutism, infertility, obesity

Front 70

other causes of hirsutism besides PCOS?

Back 70

1 obesity, hypothyroidism = due to decr shbg synth = incr free testost
2 Ovarian tumors = incr androgen synth
3 adrenogenital and cushing syndrom

Front 71

m/c causes of abnormal bleeding by age groups?

Back 71

(of course, always r/o pregnancy)
prepuberty - vulvovaginitis, std, foreign body
menarche - 20 = anovulatory DUB, VWdisease
20-40 = Ovulatory DUB (inadequate lut phase; irreg shedding of endom), PID, hypoth, leiomyomas, adenomyosis, endom polyp, endometriosis
40+ = endom cxr!!!, or hyperplasia

Front 72

ddx of amenorrhea?

Back 72

constit delay (m/c cause of primary)
*hypothal/pit disorder
*ovar disorder
*end-organ defect ie imperf ymen, RKH syndrome Asherman syndrome,
*= these have NO w/drawla bleeding after progestin stim b/c endom is not pre- estrogen stimulated, or b/c end organ defect prevents the normal egress of blood

Front 73

what are the only 2 types of amenorrhea that would cause a positive w/drawla bleeding test with progestin challenge?

Back 73

MILD hypoth dysfxn
and
PCOS

all the rest cause neg w/drawal bleeding test, including severe hypoth dysfxn