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405 Cards in this Set
- Front
- Back
What percent of couples (woman under 35 y/o) are considered "infertile" (eligible for treatment) after one year of unprotected sex? |
10 to 15% (just remember 15)
|
|
What percent of couples will become pregnant in 1 year without a contraception method? |
85% (15% are considered "infertile")
|
|
What percent of women having unprotected sex who
1) are less than 6 months post partum 2) remain ammenorrheic will become pregnant? (Lactation Amenorrheic Method) |
2%
|
|
Feared complication of prolonged diaphragm use for contraception.
|
toxic shock (e.g. like tampons)
|
|
Only contraception method known to prevent STDs.
|
condom
|
|
Failure rate with typical condom use (as the only means of contraception)?
|
20% become pregnant
|
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What oral birth control can be recommended for a lactating woman?
|
Mini Pill (Progestin Only Pills aka POPs)
|
|
35 y/o patient who smokes wants birth control. What type is contraindicated? What is usually given instead?
|
Combined OCPs; give IUD
|
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Wilson's Disease patient wants birth control. What type is contraindicated?
|
copper IUD
|
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Increased risk of clotting (e.g. DVTs) with this type of contraception.
|
Combined OCPs
|
|
Common blood pressure change with OCPs.
|
HTN
|
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Patient with h/o pulmonary embolism. What type of contraception is contraindicated?
|
Combined OCPs
|
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Patient with h/o migraine. What type of contraception is contraindicated?
|
Combined OCPs
|
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Feared disease when patient has IUD in place.
|
PID
|
|
SLE patient desires contraception. What to give?
|
Depo-Provera shots
|
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Poorly compliant patient needs contraception. What to recommend.
|
Depo-Provera shots
|
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Which is safer: Vasectomy or Tubal Ligation?
|
Vasectomy
|
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Which is more effective: Vasectomy or Tubal Ligation?
|
Vasectomy
|
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Woman on calendar based contraceptive method, and using it perfectly. What is the failure rate?
|
1-2%
|
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Perfect condom use: what is the failure rate?
|
4-5%
|
|
Patient uses OCP with typical compliance and timing. What is the failure rate?
|
4-5%
|
|
What OCP requires consistent timing (i.e. same time each day)?
|
Mini Pill (Progestin Only Pills aka POPs)
|
|
Mechanism of Mini Pill (Progestin Only Pill)?
|
mostly barrier via increased cervical mucous
|
|
Mechanism of Combined OCP? (2)
|
Est decreases FSH = no follicle
Prog decreases LH = no ovulation |
|
Post Partum: which comes first: ovulation or menses?
|
ovulation
|
|
Failure rate in IUD?
|
0.1%
|
|
Most effective contraceptive method in lactating women?
|
IUD
|
|
Definition of Premature Ovarian Failure (Premature Menopause)?
|
Less than 40 y/o
|
|
Definition of EARLY Menopause?
|
Less than 45 y/o
|
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How long after LMP before you can you clinically diagnose menopause?
|
requires 6 months of amenorrhea
|
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What in social history will be a risk factor for early menopause?
|
tobacco use
|
|
What endocrine disorder is associated with early menopause?
|
DM Type 1
|
|
2 risk factors in an OB/GYN specific history which are associated with early menopause?
|
1) short cycles
2) nulliparity |
|
Usually the 1st sign of Ovarian Failure (Menopause).
|
Hot flashes
|
|
Confirmatory lab for Menopause diagnosis.
|
FSH increased (FSH/LH over 1)
|
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Treatment of dyspareunia secondary to vaginal dryness (e.g. Menopause patient)?
|
lubrication (e.g. Crisco oil)
|
|
2 tests in work-up to follow comorbidities of Menopause.
|
DEXA scan (osteoporosis)
Lipid profile (HLD) |
|
Menopause wreaks HAVOC mnemonic.
|
Hot flashes
Atrophy of the Vagina Osteoporosis Coronary artery disease |
|
2 cancers to think of in patient with HRT.
|
Endometrial and Breast
|
|
Why do post-hysterectomy patients not need progestin as a part of HRT?
|
unopposed estrogen causes increased risk of endometrial cancer, which does not apply to these patients
|
|
1st line treatment of Hot Flashes in Menopause (2)
|
1) Venlafaxine or 2) Clonidine
|
|
Supplements vital in Menopause patients.
|
Vit D and Calcium
|
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Medical treatment options for osteoporosis. (2)
|
Bisphosphonates (e.g. Fosamax)
SERMs (e.g. Roloxifine) |
|
Which patient is more likely to have Menopause symptoms: Obese or Thin? Why?
|
Thin patient will: obese patients have more estrogen produced by fat cells and endometrial hyperplasia
|
|
Vital lifestyle treatment for osteoporosis.
|
increase weight bearing exercise
|
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Most common cause of amenorrhea?
|
pregnancy
|
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Age definition of Primary Amenorrhea.
|
14 y/o without or 16 y/o with secondary sexual development
|
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No menarche, breast development, or pubic hair in female: age definitions of delayed puberty vs. primary amenorrhea
|
13 y/o = Delayed Puberty
14 y/o = Delayed Puberty AND Primary Amenorrhea |
|
Why get a hand XR in someone with Primary Amenorrhea?
|
check for lack of pubertal bone growth (Constitutional Growth Delay, which is the most common cause of primary amenorrhea)
|
|
1st lab to order in work-up for Amenorrhea (both primary and secondary).
|
beta-hCG
|
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After ruling out pregnancy, what is the 1st test in work-up of primary amenorrhea?
|
hand XR (bone age test)
|
|
Normal bone growth in primary amenorrhea. Next step?
|
LH and FSH
|
|
High FSH and LH in patient with primary amenorrhea; no breasts. Your top 2 differential based on karyotype.
|
XX: premature ovarian failure
XO: turner's |
|
3 Most common causes of Primary Amenorrhea (in order).
|
1) Constitutional Growth Delay
2) Tuner Syndrome 3) Mullerian Agenesis |
|
LH and FSH levels in patient with Mullerian Agenesis.
|
normal
|
|
16 year old without menarche: normal breast development but no pubic hair. Diagnosis?
|
Androgen Insensitivity (XY)
|
|
16 year old without menarche, but has breast development. Next 2 steps in evaluation?
|
LH & FSH and get U/S abdomen
|
|
When to get karyotype in primary amenorrhea.
|
if abnormal uterus on u/s OR high LH&FSH
|
|
16 year obese female without menarche: normal breast development. Diagnosis?
|
PCOS
|
|
Primary Amenorrhea with normal LH and FSH and normal uterus on U/S. Most likely diagnosis?
|
Outflow Obstruction (Imperforate Hymen or Transvaginal Septum)
|
|
High FSH and LH in patient with primary amenorrhea; breasts present. Your top 2 differentials based on karyotype.
|
XX: PCOS
XY: androgen insensitivity |
|
2 labs to check in primary amenorrhea if FSH and LH are low.
|
PRL and TSH (tumor or Hypothyroidism)
|
|
Low GnRH with normal PRL. What is causing the primary amenorrhea?
|
Kallman's Syndrome
|
|
16 year thin female without menarche: normal breast development. Diagnosis?
|
Anorexia Nervosa (low estrogen)
|
|
Patient with secondary amenorrhea is not pregnant. 1st step in work-up?
|
TSH and PRL
|
|
Secondary Amenorrhea with high PRL. What test to order?
|
MRI
|
|
Definition of Secondary Amenorrhea.
|
Discontinued menses for 6 months
|
|
How does hypothyroidism sometimes cause amenorrhea?
|
TRH stimulates PRL release which blocks GnRH release
|
|
Secondary Amenorrhea with normal PRL and TSH. Next 2 steps?
|
Do Progestin Challenge and order FSH and LH
|
|
Define a positive and negative Progestin Challenge?
|
Positive: withdrawal bleed after medroxyprogesterone bolus
Negative: no bleed |
|
Secondary Amenorrhea: withdrawal bleed from progestin + high LH. Diagnosis?
|
PCOS
|
|
Medical Treatment for prolactinomas (2).
|
Bromocriptine or Cabergoline (Dopamine Agonists)
|
|
Medical Treatment for anovulation (2).
|
Clomid (SERM) +/- Leuprolide (GnRH analog)
|
|
Virulized patient with secondary amenorrhea. What 4 tests to order?
|
1) Dexamethasone suppression test or 24 hr Urine Cortisol
2) testosterone 3) DHEAS 4) 17-hydroxyprogesterone |
|
3 Adrenal causes of secondary amenorrhea.
|
CAH
Addisons Cushings |
|
Scarring (e.g. D&C) caused secondary amenorrhea. What is this called?
|
Asherman's Syndrome
|
|
SEVERE virulization with secondary amenorrhea. Diagnosis?
|
Tumor (adrenal or ovarian)
|
|
Of the 15% of "infertile" couples, what percent will have a child with the help of treatment?
|
85% (2% of couples are truly infertile)
|
|
Of the 15% of "infertile" couples, what percent will have a child withOUT treatment?
|
50%
|
|
Rule out these 2 disorders in the Male when working up a couple for infertility.
|
Hypogonadism (check FSH, TSH, PRL) and Disordered Sperm (semen analysis)
|
|
Lab tests to order for female in work-up for infertility? (FEpRTL mnemonic) (6)
|
FSH
Estradiol pRogesterone (midluteal) pRolactin TSH LH |
|
Why get a karytype in a male with infertility?
|
r/o Klinefelters (XXY)
|
|
Treatment for infertility 2/2 endometriosis.
|
Surgery: laparoscopic resection/ablation
|
|
How to check for tubal/pelvic factors as a source for infertility (e.g. PID, adhesions).
|
Hysterosalpingogram (HSG)
|
|
4 criteria for Bacterial Vaginosis
|
Gray discharge
pH over 4.5 + whiff test (fishy) Clue cells on KOH wet mount |
|
3 causes of Vaginitis.
|
Bacterial Vaginosis
Trichomonas Yeast (Candida) |
|
3 causes of Vaginitis: treat partners?
|
Bacterial Vaginosis: no
Trichomonas: yes Yeast (Candida): no |
|
3 causes of Vaginitis: treatment?
|
Bacterial Vaginosis: Metronidazole TID x 7 days
Trichomonas: Metronidazolex1 Yeast (Candida): Fluconazole PO or topical |
|
Pregnant patient with vaginal yeast infection. Oral or Topical treatment?
|
Topical
|
|
vaginal odor increases after sex. Diagnosis?
|
Bacterial Vaginosis (semen creates a positive wiff test)
|
|
pseudo hyphae on wet mount. Diagnosis?
|
Yeast Vaginitis
|
|
granular epithelial cells with indistinct cell margins. Diagnosis?
|
Bacterial Vaginosis (clue cells)
|
|
Painful Bleeding in the 1st Trimester. Diagnosis?
|
Ectopic Pregnancy
|
|
Painful Bleeding in the 3rd Trimester. Diagnosis?
|
Abruption
|
|
1st test to order in a woman with lower quadrant abdominal pain.
|
beta-hCG
|
|
AROPE mnemonic for acute pelvic pain ddx in a woman.
|
Appendicitis
Ruptured Ovarian Cyst Ovarian Torsion PID Ectopic Pregnancy |
|
Ectopic Pregnancy Treatment
|
methotrexate or surgery
|
|
Most common complication of Ectopic Pregnancy.
|
Rupture with internal hemorrhage (can cause hypovolemic shock)
|
|
When to get a CT scan of an unstable patient.
|
Never!
|
|
Test to rule out Ovarian Torsion in woman with lower quadrant abd pain.
|
U/S
|
|
Cervical Motion Tenderness (chandelier sign). Diagnosis?
|
PID
|
|
When to start antibiotics when suspecting PID.
|
should start empirically
|
|
2 most common causes of PID.
|
Gonorrhea and Chlamydia
|
|
Common history finding in patients with functional/chronic abdominal pain.
|
Sexual Abuse
|
|
Acute LRQ pain with negative beta hCG. Most likely diagnosis?
|
Appendicitis
|
|
Most common benign neoplasm in the female genital tract.
|
Uterine Leiomyoma (Fibroid)
|
|
Uterine Fibroids are benign, but are often removed. What 2 most common reasons?
|
Menorrhagia/dysmenorrhea
Infertility |
|
Why do Uterine Fibroids increase in size during pregnacy and decrease in size after menopause?
|
they are sensitive to estrogen and progesterone
|
|
Prevelance of Uterine Fibroids in Black women.
|
50%
|
|
Classic physical exam description of a uterus with fibroids.
|
Lumpy Bumpy
|
|
Imaging of choice to r/o uterine fibroids.
|
U/S
|
|
Woman diagnosed with uterine fibroids, but they do not regress after menopause. What to do?
|
biopsy to r/o malignancy
|
|
Most common indication for surgery in women in the U.S.
|
Uterine Fibroids
|
|
Post -menopausal woman w/ vaginal bleeding. Diagnosis?
|
Cancer until proven otherwise even though:
Atrophy causes 80% of bleeds Cancer causes 10% of bleeds |
|
Most (97%) of Uterine Cancers are this type.
|
Endometrial Carcinoma (glandular)
|
|
Define the 4 stages of Uterine Cancer
|
1-Uterus only
2-to Cervix 3-to Vagina/Pelvis (3c=lymph nodes) 4-to Bladder or Bowel or other |
|
Treatment for Uterine Cancer.
|
Hysterectomy
|
|
When to give radiation in Uterine Cancer. (What stage?)
|
If nodes are positive (stage greater than 3c)
|
|
How often to follow up on an asymptomatic Uterine Fibroid patient.
|
q6 months
|
|
At what age will oophorectomy automaticaly be recommended with hysterectomy?
|
over 45 y/o
|
|
Why luprolide (GnRH analog) for uterine fibroid?
|
supresses estrogen which sepresses fibroids (commonly used pre-op)
|
|
3 treatments of Fibroids are myomectomy, hysterectomy, or uterine artery embolization. What is the indication for each?
|
myomectomy: fertility desired
hysterectomy: fertility not desired uterine artery embolization: good for patients near menopause |
|
Pain and menorrhagia control in patient with Fibroids.
|
NSAIDS
|
|
Adnexal Mass is more commonly malignant in reproductive age or postmenopausal?
|
Postmenopausal (25% are malignant)
|
|
What is mittelschmirz?
|
brief midcycle pain (usually mild)
|
|
Adnexal Mass: with dyspareunia and dysmenorrhea. Diagnosis?
|
endometriosis
|
|
Adnexal Mass: with sudden severe pain and N/V. Diagnosis?
|
ovarian torsion
|
|
Adnexal Mass: amenorrheic, abd pain, vaginal bleeding. Diagnosis?
|
Ectopic Pregnancy
|
|
Adnexal Mass: with a large mobile uterus and menorrhagia/dysmenorrhea. Diagnosis?
|
Uterine Leiomyoma (Fibroid)
|
|
Adnexal Mass: with cervical motion tenderness and fever. Diagnosis?
|
PID
|
|
Adnexal Mass: in obese pt with hirsuitism and infertility. Diagnosis?
|
PCOS
|
|
Adnexal Mass: large, solid, irregular, non-mobile; ascites present. Diagnosis?
|
more likely malignancy
|
|
2 most common mutations known to be associated with Ovarian Cancer.
|
BRCA and HNPCC
|
|
Imaging for adnexal mass.
|
U/S
|
|
Imaging for adnexal mass which looks like Cancer on U/S.
|
CT scan (eval extent of disease)
|
|
4 types of ovarian tumors.
|
1) Epithelial
2) Germ cell 3) Stromal Tumors 4) Metastatic GI tumor |
|
Most common type of ovarian tumor?
|
Epithelial (90%)
|
|
Most common ovarian tumor in woman under 20.
|
Germ cell tumor (e.g. teratoma)
|
|
Why remove a mature teratoma if it is benign?
|
risk of torsion
|
|
Define the 4 stages of Ovarian Cancer
|
1-only ovaries
2-to pelvis 3-to abdominal cavity 4-distant (e.g. omentum) |
|
Why not get a fine needle aspirate to diagnose ovarian tumor?
|
can seed cancer along needle track
|
|
Palpable ovarian mass in post-menopausal. What to do?
|
laparotomy
|
|
When to do surgery on ovarian mass if pre-menopausal?
|
if large (over 8 cm) or symptomatic
|
|
When to give chemo (e.g. pacitaxel and carboplatin) for ovarian cancer.
|
for stage 2c or more
|
|
Age to start PAP smears.
|
21
|
|
Cause of cervical cancer
|
HPV
|
|
How often to do PAP smear on woman aged 21-29
|
every 2 years
|
|
When to test HPV DNA with PAP smear. (what age?)
|
at 30 y/o
|
|
At what age to recommendations for regular PAP smears stop.
|
stop at age 70
|
|
PAP shows LSIL (aka CIN1) or ASCUS. What to do (postmenopausal or premenopausal)?
|
Postmenopausal: HPV DNA test
Premenopausal: Colposcopy |
|
Positive HPV DNA test. What to do? (even if PAP is negative)
|
Colposcopy
|
|
PAP shows HSIL (aka CIN2). What to do?
|
excision (LEEP) or ablation
|
|
Colposcopy shows CIN1. What to do?
|
PAP&HPV DNA in 1 year
|
|
Colposcopy shows CIN2 (aka HSIL). What to do?
|
excision (LEEP) or ablation
|
|
Colposcopy shows CIN3 (aka carcinoma in situ). What to do?
|
Hysterectomy, staging, radiation
|
|
Colposcopy shows Carcinoma. What to do?
|
Hysterectomy, staging, radiation
|
|
Which HPV viruses are covered in Gardasil? (4)
|
6, 11 (warts)
16, 18 (cervical dysplasia) |
|
How often to get PAP smear on patient with HIV.
|
every year
|
|
Personal history of CIN2/3 or Cervical Carcinoma. How often to f/u with PAP smear?
|
every year for 20 years
|
|
How often to get PAP smear on patient who has been vaccinated with gardasil?
|
same as if she wasn't vaccinated
|
|
Atypical Glandular Cells (AGC) on PAP smear. What to do?
|
Endometrial biopsy
|
|
OCPs decrease the risk of this cancer
|
Ovarian
|
|
If you decide to screen a high risk woman for ovarian cancer, what do you do?
|
yearly CA-125 and Transvaginal U/S
|
|
Ovarian Tumor Marker: epithelial
|
CA-125
|
|
Ovarian Tumor Marker: endodermal sinus
|
AFP
|
|
Ovarian Tumor Markers: embryonal carcinoma
|
AFP, hCG
|
|
Ovarian Tumor Marker: Choriocarcinoma
|
hCG
|
|
Ovarian Tumor Marker: Dysgerminoma
|
LDH
|
|
Ovarian Tumor Marker: Granulsa Cell
|
Inhibin
|
|
Treatment for Gonorrhea
|
Ceftriaxone to pt and partners
|
|
Treatment for Chlaymida
|
Doxycycline to pt and partners
|
|
What portion of women have dysmenorrhea?
|
50%
|
|
2 part treatment for primary dysmenorrhea.
|
NSAIDS (scheduled 24 hr before menses)
OCP or Mirena |
|
Most common cause of secondary dysmenorrhea.
|
Endometriosis
|
|
Endometriosis vs. Adenomyosis: cyclic or noncylic dysmenorrhea/pelvic pain?
|
Endometriosis: cyclic
Adenomyosis: non-cyclic |
|
Medical treatment options for ENDOMetriosis.
|
Estrogen regulation (GnRH agonists e.g. Leuprolide)
NSAIDS Danazol OCP Medroxyprogesterone |
|
1st test to order in woman with pelvic pain.
|
beta-hCG
|
|
Leuprolide side effect to remember. What to do about it?
|
bone loss: needs vit D and calcium ("add back therapy")
|
|
Danazol side effect to remember (limiting treatment of endometriosis).
|
hirsuitism and voice chnages
|
|
Almost all Endometrial Cancer presents with this symptom.
|
vaginal bleeding
|
|
Test to evaluate concerning postmenopausal bleeding.
|
transvaginal u/s
|
|
When to biopsy endometrium in postmenopausal bleeding.
|
if transvaginal u/s shows stripe bigger than 5 mm
|
|
When to get u/s in patient with post-menopausal bleeding (2 reasons)?
|
if uterus enlarged on exam
if more than 6 months of sx |
|
SPURT of urine with exertion or straining e.g. laughing. Defines what?
|
Stress incontinence
|
|
Sudden NEED TO PEE. What type of incontinence?
|
Urge incontinence (detrusor instability)
|
|
Continuous, uncontrolled urine loss, What type of incontinence?
|
Total Incontinence (e.g. fistula)
|
|
Urine DRIBBLES ocassionally. What type of incontinence?
|
Overflow incontinence
|
|
Chronic urine retention causes what type of incontinence?
|
Overflow incontinence
|
|
1st line treatment for Stress incontinence.
|
kegels
|
|
Treatment for total incontinence.
|
surgery
|
|
Treatment for urge incontinence.
|
Anticholinergics or TCA (e.g. Imipramine)
|
|
1st line medical treatment for overflow incontinence.
|
Prazosin or Terazosin (alpha1antagonists)
|
|
1st test in woman with incontinence. Why?
|
UA and Cx to r/o infection
|
|
Confirmatory test for stress incontinence.
|
standing stress test (stands over towel and coughs)
|
|
Test to r/o fistula and total incontinence.
|
cystogram
|
|
Treatment for urethrocele, cystocele, rectocele, or enterocele.
|
Surgery (colporrhaphy)
|
|
Bleeding between menses/periods is called.
|
Metrorrhagia
|
|
Bleeding too much or too long during menses is called.
|
Menorrhagia
|
|
Menstrual cycle longer than 35 days is called.
|
Oligomenorrhea
|
|
Menstrual cycle shorter than 21 days is called.
|
Polymenorrhea
|
|
Most common cause of abnormal uterine bleeding.
|
pregnancy
|
|
1st test to order in woman with abnormal uterine bleeding
|
beta-hCG
|
|
Work-up for metrorrhagia.
|
PAP smear
|
|
Treatment of Oligomenorrhea.
|
Progestin x 10 days to stimulate withdrawal bleed, then OCPs
|
|
Treatment of Polymenorrhea.
|
OCPs
|
|
Work-up for abnormal uterine bleeding. Rule out these 3 causes.
|
Anovulatory (TSH/PRL)
Bleeding disorder (PT/PTT) Uterine Mass etc. (U/S) |
|
1st line treatment for abnormal uterine bleeding.
|
NSAIDS
|
|
Treatment for HEAVY abnormal uterine bleeding.
|
High-dose Estrogen
|
|
When to do a D&C in patient with abnormal uterine bleeding.
|
if heavy bleeding despite estrogen
|
|
Work-up for menorrhagia: what imaging?
|
U/S
|
|
Most common complication of Menorrhagia.
|
Anemia
|
|
When to get hysterectomy in patient with abnormal uterine bleeding (2 criteria).
|
if 1) perimenopausal and 2) fail treatment (estrogen, D&C, and hormones)
|
|
Most common mechanism of abnormal uterine bleeding other than pregnancy.
|
anovulatory diseases (e.g. menarchal or menopausal)
|
|
When to get an endometrial biopsy in a premenopausal woman who has abnormal uterine bleeding. (3 rules)
|
if older than 35
or BMI over 35 or Diabetic |
|
When to start antenatal checkups.
|
10 weeks is first visit
|
|
Review of Systems at each prenatal appointment. (ABCEDF mnemonic.)
|
Amniotic fluid per vag?
Bleeding per vag? Contractions Dysuria Ecclampsia (HA, Edema, etc.) FHTs |
|
5 symptoms of pre-ecclampsia on review of systems.
|
HA
Edema Vision changes RUQ abd px SOB |
|
What week to listen to FHTs for the first time?
|
14 weeks
|
|
When do you see your prenatal patients every 4 weeks?
|
10-28 weeks
|
|
When do you see your prenatal patients every 2 weeks?
|
28-36 weeks
|
|
When do you see your prenatal patients every week?
|
36 weeks-birth (up to 42 weeks)
|
|
Weight gain expected in a pregnant woman with a normal BMI.
|
30 lbs
|
|
Weight gain expected in a pregnant woman with a BMI over 30
|
15 lbs
|
|
When to initiate Folate supplementation in pregancy?
|
3 months before conception
|
|
3 supplements for pregnant patients.
|
folic acid
Iron Calcium |
|
What week of pregancy to get the U/S?
|
20 weeks
|
|
When to get glucose tolerance test (GTT) during pregnancy?
|
28 weeks
|
|
When to get Rhogam (if needed)?
|
1) 28 weeks
2) under 72 hours post-partum |
|
When to screen for Group B Strep (GBS) in pregnancy?
|
36 weeks
|
|
Treatment for pregnant patient at 42 weeks?
|
induction or C/S
|
|
Fundus at umbilicus. How many weeks?
|
20 weeks
|
|
Fundus half way to umbilicus. How many weeks?
|
16 weeks
|
|
Treatment of VDRL positive pregnant woman.
|
Penicillin shot before 16 weeks
|
|
When is Rogam needed?
|
in mom who has Rh- and fetus who may have Rh+ (just give to all Rh- moms)
|
|
When the triple or quad screen might be offered to pregnant patients?
|
at 18 weeks
|
|
All four tests in the quad screen are elevated. Diagnosis?
|
Edwards syndrome (trisomy 18)
|
|
2 supplements necessary in pregnant vegetarians.
|
Vit D and B12
|
|
Step 2 questions says failure to lactate after delivery. What is your diagnosis?
|
Sheehan's Syndrome
|
|
3 most common causes of Post-Partum Hemorrhage.
|
Uterine Atony
Lacerations/direct trauma Retained products |
|
Most common cause of Post-Partum Hemorrhage (90%).
|
Uterine Atony
|
|
Bleeding after delivery of the placenta; uterus is soft and "boggy." What is the diagnosis?
|
Uterine Atony
|
|
Mechanism of Uterine Atony.
|
fatigued myometrium
|
|
3 part treatment of Post-Partum Hemorrhage 2/2 Uterine Atony (MOM mnemonic)
|
Manual Massage
Oxytocin Methergine or Misopristol |
|
Contraindication of Methergine
|
HTN
|
|
Contraindication of Hemabate (prostaglandin).
|
asthma
|
|
Cheapest and most stable uterotonic for Uterine Atony.
|
Misopristol (Cytotec)
|
|
Post Partum Hemorrhage fails to respond to Atony treatment. What to do?
|
D&C
|
|
Post Partum Hemorrhage fails to respond to treatment or D&C. What to do?
|
Bakri Balloon
|
|
Last resort therapy for Post-Partum Hemorrhage.
|
Surgery: uterine aa ligation then hysterectomy
|
|
Iatrogenic risk factor for placenta previa and/or accreta.
|
previous C-Section
|
|
Placenta invades too far. Defines what?
|
Accreta
|
|
Placenta invades all the way through the uterine wall. Defines what?
|
Percreta
|
|
defined as being between Accreta and Percreta.
|
Placenta Increta
|
|
Active management of this stage of labor has decreased maternal mortality the most.
|
3rd stage (placenta)
|
|
Painless bleeding in the 3rd trimester. Diagnosis?
|
Placenta Previa
|
|
Woman pregnant with twins: 3 total pregnancies (including this one) and has 4 children: 1 baby the first pregnancy at 37 weeks, Triplets the second pregnancy at 30 weeks. G/P? and G/TPAL?
|
G3P2 and G3P1104
|
|
Vaginal bleeding before 20 weeks. What is this called?
|
Threatened Abortion
|
|
How to diagnose placenta previa
|
U/S
|
|
Rule about prenatal manual pelvic exam with vaginal bleeding.
|
Don't do it
|
|
Treatment of Complete Previa.
|
C-Section
|
|
Why does trauma in a pregnant woman often require immediate delivery.
|
Abruption often occurs with trauma
|
|
When to schedule delivery for a patient with complete previa?
|
Elective C-Section at 36 weeks.
|
|
What indicates delivery for a patient with placental abruption? (2)
|
if fetal or maternal distress
or if past 36 weeks |
|
Fetal Bleeding from vagina with quick fetal demise. Cause?
|
Vasa Previa
|
|
Quickly rule these 2 causes of 3rd trimester out when taking the history.
|
Post-Coital bleeding
Hemorrhoids |
|
Pain typical of placental abruption.
|
constant severe back pain
|
|
U/S shows macrosomia of fetus. At what estimated fetal weight (EFW) to consider elective C/S?
|
4000 g in Diabetic; 4500 g in others
|
|
Complications of macrosomia. (2)
|
shoulder distocia which can lead to Erb-duchenne palsy
|
|
HELPER mnemonic for shoulder dystocia treatment.
|
Help reposition
Epesiotomy Leg elevation Pressure (suprapubic) Enter vagina to rotate Reach for the fetal arm |
|
What defines the beginning of active Stage 1 of normal labor?
|
4 cm dilated
|
|
What defines Stage 2 of normal labor?
|
completely dilated to delivery of baby
|
|
How many stages of labor are there?
|
3
|
|
What defines the end of stage 3 of normal labor?
|
delivery of placenta
|
|
What test will confirm the suspicion that active phase of Stage 1 of labor is protracted from insufficient contraction strength?
|
Intrauterine Pressure Catheter (IUPC)
|
|
Woman in labor is passed cut-off limit for Stage II of labor. How to decide to go to C/S?
|
If slowly but surely progressing, then wait. If COMPLETE ARREST, then C/S.
|
|
What to try for failure to progress before bringing to C/S in Stage 2 of labor?
|
vacuum and/or forceps
|
|
How to reduce mortality in Stage 3 of labor. (3)
|
ACTIVE MANAGEMENT:
cord traction fundal massage oxytocin *manual evacuation and D&C if needed |
|
3 rules that define adequate uterine contraction power.
|
q5 min or less
last at least 60 seconds Over 200 MVU by IUPC |
|
Pregnant woman at 37 weeks presents with irregular contractions and no cervical change over 4 hours. What to do?
|
send her home
|
|
Treatment for insufficient contraction power during labor.
|
oxytocin
|
|
C/S indication during Active phase of Stage 1 of labor is Arrest. Define Arrest (3)
|
NO change
for 3 hours despite adequate contraction power |
|
What is "protracted" active phase of Stage 1 of labor?
|
passed cut-off limit, but still progressing (not a c/s indication)
|
|
What is "prolonged" Stage 2 of labor?
|
passed cut-off limit, but still progressing (not a c/s indication)
|
|
Latent Phase of Stage 1 of labor: what is the cut-off time limit in Nulliparous? in Multiparous?
|
Nullip: 20 hours
Multip: 14 hours |
|
What is the cut-off time limit for active phase of Stage 1 of labor in Nulliparous? in Multiparous?
|
Nullip: less than 1 cm/hr = protracted
Multip: less than 1.5 cm/hr = protracted |
|
What is the cut-off time for Stage 2 of labor in Nulliparous? in Multiparous?
|
Nullip: over 2 hours (or 3 if epidural) = prolonged
Multip: over 1 hour (or 2 if epidural) = prolonged |
|
Race which has multiple gestation more often?
|
Black
|
|
Why has the incidence of dizygotic twins increased, but monozygotic twin rate has not increased?
|
reproductive technology causes hyperovulation, but has little/no effect on embryonic division
|
|
cheapest way to confirm diangosis of twins.
|
separate heart beats
|
|
1 twin is small at birth and has anemia; the other has CHF and polycythemia. Diagnosis?
|
Twin-Twin Transfusion
|
|
When to start activity restrictions in a multiple gestation pregnancy to avoid preterm labor?
|
24 weeks
|
|
When can a multiple gestation pregnancy be delivered vaginally.
|
If 1st twin is cephalic presentation
|
|
How often to get U/S in a multiple gestation?
|
q4 wks after 20 wks
|
|
Embryonic division before 3 days. What form of monozygotic twin? (1/3 of twins)
|
diamniotic dichorionic (separate placentas)
|
|
Embryonic division 3-8 days. What form of monozygotic twin? (2/3s of twins)
|
diamniotic monochorionic
|
|
Embryonic division 8-13 days. What form of monozygotic twin? (1% of twins)
|
monoamnionic (50% die)
|
|
Embryonic division after 13 days. What form of monozygotic twin?
|
conjoined
|
|
hCG, MSAFP, and hPL are all high for gestational age. Suspect what?
|
multiple gestation
|
|
What antihypertensive for pregnant woman?
|
methyldopa
|
|
Why not ACEI or Diuretics for pregnant woman.
|
risk of uterine ischemia
|
|
Gestational Hypertension (aka Pregnancy Induced Hypertension) is defined as developing when?
|
after 20 weeks
|
|
Pre-Ecclampsia is diagnosed when a woman has PIH plus what?
|
proteinuria
|
|
What is HELLP syndrome?
|
Hemolysis
Elevated Liver enzymes Low Platelets |
|
Ecclampsia is Pre-Ecclampsia plus what?
|
new seizure
|
|
The only cure for Pre-Ecclampsia known.
|
delivery
|
|
When is delivery indicated in mild Pre-Ecclampsia?
|
at 37 weeks
|
|
When is delivery indicated in severe Pre-Ecclampsia? (2)
|
at 34 weeks
or if end-organ damage |
|
Diet for a Pre-Ecclampsia patient.
|
low salt; protein restriction not shown to help
|
|
2 part medical treatment for Pre-Ecclampsia
|
Steroids
Mg |
|
How to control HTN crisis in Pre-Ecclampsia: Short-term or Long-term?
|
Short-term: Labatelol or Hydralazine
Long-term: Nifedipine |
|
Severe pre-ecclampsia diagnosed when . . . What lung problem?
|
SOB (pulmonary edema)
|
|
Severe pre-ecclampsia diagnosed when . . . What renal problems? (3)
|
Crt over 2
Proteinuria over 5 g Oliguria |
|
Severe pre-ecclampsia diagnosed when . . . What fetal problems? (2)
|
Oligohydramnios
IUGR |
|
Severe pre-ecclampsia diagnosed when . . . What CNS changes? (3)
|
HA
vision changes Seizure (Ecclampsia) |
|
Severe pre-ecclampsia diagnosed when . . . What liver problems? (2)
|
RUQ pain (hepatic capsular swelling)
HELLP |
|
Severe pre-ecclampsia diagnosed when BP reaches this threshold?
|
over 160/110
|
|
Ecclamptic seizure: prevention and treatment?
|
Prevention: Mg
Treatment: diazepam |
|
What kind of decel indicates fetal hypoxemia (uteroplacental insufficiency)?
|
late (decel starts around the peak of contraction)
|
|
What is White DM Class A1?
|
GDM, diet controlled
|
|
What is White DM Class A2?
|
GDM, insulin controlled
|
|
What is White DM Class B?
|
onset >20 y/o or duration <10 yrs
|
|
What is White DM Class C?
|
onset 10-19 y/o or duration 10-19 yrs
|
|
What is White DM Class D?
|
onset <10 y/o or duration <20 yrs
|
|
What is White DM Class F?
|
diabetic neFropathy
|
|
What is White DM Class R?
|
Proliferative retinopathy
|
|
What is White DM Class RF?
|
Retinopathy and nephropathy
|
|
What is White DM Class H?
|
Ischemic heart disease
|
|
What is White DM Class T?
|
Prior renal transplant
|
|
2 numbers to remember after screening Glucose Tolerance Test (GTT) of 50g.
|
over 200 = GDM
over 140 = needs 3 day glucose tolerance test |
|
What is the 3 day prep for the 100g Oral Glucose Tolerance Test (OGTT) as follow up for a high screening GTT?
|
3 day carbo diet
8 hr fast overnight then 100 mg glucose load |
|
4 numbers to remember after confirmatory 100g OGTT. (any 2 = GDM)
|
before glucose load: over 95
after 1 hr: over 180 after 2 hr: over 155 after 3 hr: over 140 |
|
Diabetic patient gets pregnant. What lab to run along with initial screening labs at first visit?
|
A1C
|
|
Treatment for Diabetes during pregnancy. (2)
|
Insulin and ADA diet
|
|
Biophysical Profile: 5 parts (Test the Baby MAN mnemonic)
|
Tones (FHTs)
Breathing Movement Amniotic fluid volume Nonstress test |
|
What is a "Reactive" (reassuring) nonstress test (NST)?
|
2 or more accelerations within 20 minutes in Fetal Heart Rate (increase in at least 15 bpm for at least 15 seconds)
|
|
Difference between a variable and a late decel. (2)
|
Late ones decelerate for over 30 seconds before coming back up AND have consistent onset points compared to contractions
|
|
Fetus should "kick" at least this many times per hour while it is awake.
|
6
|
|
Complication which can occur in baby if diabetic mom is not controlled on insulin drip during labor.
|
Mom's hyperglycemia will cause fetal hyperinsulinemia which will result in hypoglycemia after birth.
|
|
Most common identifiable cause of Preterm Premature Rupture of Membranes (PPROM).
|
UTI
|
|
What is Premature (or Prolonged) Rupture of Membranes (PROM)?
|
ROM for over 18 hours before birth (may or may not have contractions)
|
|
When to do a manual pelvic exam on a patient whose water has broken?
|
DON'T DO IT
|
|
Test to confirm amniotic fluid pooling (ROM)? (2)
|
Nitrazine positive
Ferning under microscope |
|
When to deliever PPROM? (2)
|
if fetal or maternal distress
or if past 32 weeks (some say 34) |
|
Most common complication of PROM.
|
chorioamnionitits
|
|
3 symptoms of Chorioamnionitis
|
tender fundus
fever tachycardia (mom and fetus) |
|
Most common neonatal complication after PROM.
|
ARDS
|
|
Treatment for fetus during PROM if fetal lung immaturity exists.
|
corticosteroids
|
|
Treatment of PROM if less than 32 weeks to prevent labor (2)
|
Tocolytics
Bedrest |
|
Treatment of PROM to prevent infection.
|
Prophylactic Ampicillin and Erythromicin
|
|
Monitoring of PROM patient.
|
Inpatient and frequent NSTs
|
|
What to give for inadequate dilation during stage 1 of labor? (2)
|
Misopristol (Cytotec) and Oxytocin (Pitocin)
|
|
What is a Blighted ovum?
|
zygote attaches & sac may develop, but no embryo 2/2 chromosomal abnormalities
|
|
What is a Complete Abortion?
|
bleeding + passing tissue + NO retained products
|
|
What is a Incomplete Abortion?
|
bleeding + passing tissue + retained products
|
|
What is a Threatened Abortion?
|
bleeding + FHTs (happens in 25% of pregnancies: half of the 25% proceed to abort)
|
|
What is a Missed Abortion?
|
completely retained failed pregnancy
|
|
What is a Septic Abortion?
|
infection + bleeding + dilation etc.
|
|
What is a Inevitable Abortion?
|
ROM and dilation
|
|
What is a Induced Abortion?
|
elective: medical or surgical
|
|
Unknown blood type with vaginal bleeding in pregnant woman. Immediate treatment?
|
Rhogam!
|
|
What blood level to follow in an abortion?
|
quantative beta-hCG
|
|
What to do about a incomplete abortion?
|
most will resolve on their own; otherwise D&C
|
|
Does emotional/psychological stress cause spontaneous abortion?
|
NO
|
|
Can physical stress/trauma cause spontaneous abortion?
|
yes
|
|
Most common reason for abortion (other than elective murder)?
|
chromosomal abnormalities
|
|
Early multiple gestation pregnancies can have high hCG even when too small to see by U/S. How to rule out ectopic?
|
follow hCG (multiples will increase faster); if over 2000 re-ultrasound remains negative = ectopic
|
|
What is the doubling time for hCG in a normal pregnancy?
|
every 2 days (during 1st trimester)
|
|
race which has increased incidence of molar pregnancies.
|
asian
|
|
Chromosome count and source of a Complete Mole (90% of moles)?
|
46 XX (both sets from Dad)
|
|
Chromosome count and source of a Partial Mole (10% of moles)?
|
69 XXY (triploid: one from egg, 1 each from 2 different sperm)
|
|
Snow Storm uterus on ultrasound. Diagnosis?
|
Molar pregnancy
|
|
Multiple gestation pregnancies can have high hCG and large uterus for gestational age. How to rule out molar pregnancy?
|
U/S (will show multiple gestation or snow storm)
|
|
Preparation for D&C to remove a molar pregnancy.
|
get 4 units of blood ready (lots of bleeding usually)
|
|
Medicine treatment for molar pregnancy and malignant disease from molar pregnancy.
|
Methotrexate (100% cure rate)
|
|
What blood level to follow after treatment of a molar pregnancy (monthly for 1 year)? Why?
|
beta-hCG to rule out metastasis or missed invasive molar tissue
|
|
A1C greater than 8 in pregnant woman. What test? Why?
|
U/S to look for congenital defects
|
|
When to start U/S screening q 4 weeks for DM in pregnancy?
|
start at normal time (20 weeks)
|
|
Treatment for headache during pregnancy?
|
tylenol; watch for CNS signs of Pre-Ecclampsia
|
|
What is the BRAT diet for morning sickness?
|
Bananas
Rice Applesauce Toast and Tea |
|
3 risk factors for hyperemesis gravidum.
|
Molar pregnancy
Multiple gestation Nulliparous |
|
2 treatments for more mild hyperemesis gravidum
|
B6
Doxylamine (antihistamine) |
|
Treatment for severe hyperemesis gravidum.
|
antiemetics and IVF
|
|
Treatment of constipation in pregnancy.
|
Fiber and water! (can use stool softeners too)
|
|
2 supplements which have been shown to have some efficacy in morning sickness.
|
B6 and Ginger
|
|
Lifestyle change to manage morning sickness.
|
frequent small meals
|
|
Lifestlye treatment of GERD (e.g. during pregnancy).
|
no food before bed
elevate head of bed while sleeping |
|
Vaginal discharge during pregnancy is probably normal. 2 things to r/o.
|
Ruptured Membranes (SROM)
and Vaginitis (infectious) |
|
1st line antiemetic for morning sickness.
|
Phenergen (promethazine)
|
|
2nd line antiemetic for morning sickness.
|
Ondansetron (Zofran)
|
|
Mortality rate of hydrops fetalis from rhesus hemolytic disease if untreated?
|
100% die without treatment
|
|
Postnatal treatment of rhesus hemolytic disease.
|
Phototherapy (and exchange transfusion if severe)
|
|
What monitoring of Rh- pregnant woman who has history of Rh sensitization (previous pregnancy or otherwise)?
|
u/s q4 weeks
|
|
What do you check for on U/S for Rh hemolytic disease?
|
increased viscosity
|
|
If Rh hemolytic disease evidence found on U/S, what to do?
|
Umbilical Blood sample and transfuse if Hct less than 30.
|
|
When to deliver a fetus with Rh hemolytic disease?
|
at 32 weeks (some say 34)
|
|
What to test for in woman with h/o recurrent miscarriages: 2 things.
|
coagulation/bleeding disorders
uterine abnormalities |
|
What is Fetal Fibronectin test?
|
Negative = 99% sensitive for NO deliver innext 7 days
|
|
Treatment for Preterm labor if mom and fetus are not distressed.
|
Tocolytics
|
|
Preterm labor without signs of infection. Why give antibiotics?
|
GBS prophylaxis
|
|
Why give steroids to mom with preterm labor?
|
helps with fetal lung development
|
|
3 general categories of causes of preterm labor
|
Infection
Uterine causes Fetal causes |
|
Treatment of uterine causes of preterm labor.
|
Bedrest and tocolytics
|
|
2 neonatal complications of prematurity to remember.
|
NEC and ARDS
|
|
what is complete breech?
|
bum down, knees flexed (feet at bum)
|
|
What is frank breech?
|
bum down, knees extended (feet at head)
|