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472 Cards in this Set

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Rx for advanced (Stages II+) ovarian cancer
Surgical removal, followed by adjuvant chemo (taxane + carboplatin)
When is magnesium sulfate given for preeclampsia?
During delivery and 24 hours postpartum
Therapeutic level of mag sulfate
Mag sulfate levels associated with respiratory depression and cardiac arrest
>12 and >15
Contraindications to expectant management of severe preeclampsia (e.g. indications for delivery)
Thrombocytopenia < 100,000,
Inability to control BP w/ max doses of 2 antihypertensives, Non-reassuring fetal surveillance,
LFTs < 2x nml,
Persistent CNS Sx
How fast should hCG rise in a normal pregnancy?
Should double (or increase by 66%) every 48 hours
Inappropriately rising (e.g. too low) beta-hCG levels indicate
Abnormal pregnancy (e.g. ectopic, incomplete abortion, or resolving complete abortion)
Distinction btwn a normal gestational sac and a pseudogestational sac
Pseudo is located in the midline
Serum progesterone <5 indicates
Specific for nonviable pregnancy
What is the Arias-Stella reaction?
Hypersecretory endometrium of prengnacy on histology that occurs w/ BOTH ectopic and intrauterine pregnancies
Culdocentesis is looking for
Blood in peritoneal cavity, e.g. from ruptured ectopic (or purulent fluid from infection)
Medical Rx for ectopic
Relative contraindications to MTX for ectopic
Cardiac activity
Mass >3.5cm (often correlates with b-hCG > 15,000)
Absolute contraindications to MTX
Breastfeeding, immunodeficient, alcoholic, blood dyscrasia, pulmonary disease, PUD, hepatic/renal/hematology dysfxn
When is more than one dose of MTX needed?
If beta-hCG levels plateau or increase after 7 days
Asherman's Syndrome includes the presence of what?
Uterine synechiae (intrauterine adhesions)
What is threatened abortion, what is the risk of subsequent spontaneous abortion, and what are the risks if carry to viability?
Bleeding in the first trimester without tissue or fluid loss
Greater risk of preterm and low birth weight
What is inevitable abortion?
Gross rupture of membranes w/ cervical dilation (contractions typically begin soon afterward)
After what time are the fetus and placenta typically expelled separately?
After how many days should surgical abortion be performed instead of medical?
49 days since LMP
3 drugs for early medical abortion
Mifepristone (antiprogestin), MTX (antimetabolite), misoprostol (prostaglandin)

All induce uterine contractility, either directly (misoprostol) or by decreasing progesterone inhibition
Rx for a septic abortion
Broad spectrum IV Abx, IVF, prompt evacuation of uterus
What is postabortal syndrome and how is it treated?
Uterus fails to remain contracted after spontaneous abortion or elective abortion (pain, bleeding, open cervix, hematometra)
Suction curettage
At what beta-hCG level can an intrauterine pregnancy be appreciated?
Most common abnormal karyotope in aborted fetuses
Autosomal trisomy
Systemic maternal diseases associated w/ early pregnancy loss
Rx for significant anemia during spontaneous abortion
Effect of single, prior first trimester surgical abortion on fertility/ likelihood of future early pregnancy losses
No effect/ no increased risk
Once pt at high risk for cervical cancer and has lesion, management option
Cervical biopsy (can skip Pap smear, a screening test, as well as colposcopy since lesion can already be visualized)
Screening tests for a normal African American couple wanting to conceive
CBC and Hb electrophoresis
Valproic acid is associated with an increased risk of these three abnormalities
Neural tube defects, hydrocephalus and craniofacial malformations
Women with poorly controlled DM during organogenesis are at risk for structural anomalies in these two systems
CNS and CV
Chorionic villus sampling is used to detect
Chromosomal abnormalities
Three components of triple screen + extra of quad screen
AFP, hCG, unconjugated estriol
Inhibin A
Test for Down's in first trimester
PAPP A (pregnancy associated plasma protein A)
Risk of fetal loss with CVS
Most sensitive screen for Down's in second trimester (and its sensitivity)
Quad screen, 80-85%
Risks of gestational diabetes
Shoulder dystocia, metabolic disturbances, preeclampsia, polyhydramnios and fetal macrosomia
Risk of pre-existing, but not gestational, diabetes
Most common anomaly associated with valproic acid
Definition of postpartum hemorrhage
>500cc in a vaginal delivery or >1000cc in a C section
Most common cause of postpartum hemorrhage
Uterine atony
Significant blood loss during delivery --> inability to breast feed, amenorrhea, constipation, slurred speech
Sheehan Syndrome
Cause of Sheehan Syndrome
Anterior pituitary necrosis after significant blood loss
Hormones affected by Sheehan Syndrome
Gonadotropin, TSH, ACTH
Increased risk of endometritis
C section
With vaginal delivery: prolonged labor, prolonged ROM, multiple vaginal exams, internal fetal monitoring, manual removal of placenta, low SES
Most common cause of postpartum fever
Most common bacteria in postpartum endometritis
Polymicrobial, aerobes + anaerobes (often staph and strep)
Sign that can distinguish postpartum depression from postpartum blues
Ambivalence toward newborn/ family
Safest method of suppressing lactation
Breast binding, ice packs and analgesics
Cause of a normocytic anemia in pregnancy
Hemodilution: maternal blood volume increases more than RBC volume

(iron deficiency would cause microcytic)
Physiologic respiratory/ acid base changes during pregnancy
Increased minute ventilation --> compensated respiratory alkalosis
Why does minute ventilation change in pregnancy?
Because tidal volume increases (RR stays constant)
Why are pregnant women susceptible to pulmonary edema?
Decreased plasma osmolality
Tocolysis with alpha agonists (e.g. terbutaline) increases the risk of this respiratory finding
Pulmonary edema
Hydronephrosis is more common on which side during pregnancy?
Snowstorm pattern on ultrasound
Gestational trophoblastic disease
First step in the work-up of GTD
CXR (will need weekly quants and a CBC as well)
Substance that produces insulin resistance?
Chorionic somatomammotropin (previously called human placental lactogen)
Does insulin cross the placenta?
Normal PVR
PVR > 300cc indicates
Overflow incontinence (due to underactive detrusor muscle or obstruction)
Name for detrusor overactivity incontinence (e.g. when bladder is contracting too frequently)
Urge incontinence
Incontinence due to increased abdominal pressure in the absence of a detrusor contraction
Genuine stress incontinence
What is used for measurement of hypermobility in genuine stress incontinence?
Straining Q-tip angle (if >30 degrees from horizon)
Best surgical options (2) for pts with genuine stress incontinence w/ hypermobility
Retropubic urethropexies or slings
When are urethral bulking procedures effective for incontinence?
When there is little to no mobility of the urethra
Urethral bulking procedures are best for this type of incontinence
Intrinsic sphincteric deficiency
Best medical Rx for urge incontinence (detrusor overactivity)
Anticholinergics, e.g. oxybutynin
Kegel exercises are useful for this type of incontinence
Stress urinary incontinence
What does vaginal estrogen help with in terms of incontinence?
Urgency, but NOT urge incontinence
What is repaired in rectoceles?
Defects in the rectovaginal fascia
What is repaired in central and lateral cystoceles?
Defects in pubocervical fascia
Rx for uterine prolapse
Vaginal hysterectomy
Cause of stress incontinence
Increase in intra-abdominal pressure (coughing, sneezing) when the patient is in the upright position
What structural defects are associated w/ stress incontinence?
Cystocele or urethrocele
Continuous loss of urine
Vesicovaginal fistula
Cause of mixed incontinence
Increased intra-abdominal pressure causes the urethral-vesical junction to descend causing the detrusor muscle to contract
Small amt of continuous leaking
Overflow incontinence
What is colpocleisis and what is it used to treat?
Surgical obliteration/ closure of the vaginal canal; vaginal prolapse
Best least invasive option for prolapse
Management of pt with FHR in the 60s and head at the introitus?
IF patient cannot deliver vaginally with 1-2 pushes, go to assisted operative vaginal delivery
Significant amt of vaginal bleeding after placement of an IUPC
Presume uterine perforation–remove, monitor fetus; if reassuring, can reattempt
Advantages of the midline episiotomy over the mediolateral episiotomy
Less pain, less blood loss, ease of repair
How long does the fourth stage of labor last?
From delivery of the placenta until two hours afterward
Abnormalities that may indicate Down's
Flattened nasal bridge, small size, small rotated/ cup-shaped ears, andal gap toes, hypotonia, a protruding tongue, short broad hands, Simian creases, epicanthic folds, and oblique palpebral fissures
Most likely fetal complication after maternal treatment with mag
Respiratory distress
Mom with T1DM will most likely have a baby that is small/large and hypo/hyperglycemic?
Appearance of a septic infant
Pale, lethargic, high temp
Infants born to diabetic mothers are at increased risk of these 5 complications:
Hypoglycemia, polycythemia, hyperbilirubinemia, hypocalcemia, respiratory distress
When to start treatment and testing in an infant born to an HIV+ mother
Treatment immediately
Testing starts at 24hrs
2 growth issues in diabetic mothers
Growth restriction
Other risks in diabetics
Caudal regression syndrome
CV defects
Preterm birth
Hypertensive complications
When should zidovudine be initiated in pregnancy?
14wks (oral, switch to IV at delivery)
Most common cause of sepsis in pregnancy
Drug for thyroid storm contraindicated in pregnancy
Radioactive iodine (concentrates in fetus --> hypothyroidism)
Rx for thyroid storm in pregnancy
Thioamitdes, propanolol, sodium iodide, dexamethasone
White classification for diabetes in pregnancy
Class A1: gestational, diet controlled
Class A2: gestational, insulin controlled
Class B: onset >20yo w/ duration <10yrs
Class C: onset <20yo or duration >10yrs
Class D: onset <10yo or duration >20yrs
Class E: calcified pelvic vessels
Class F: nephropathy
Class R: retinopathy
Class H: ischemic heart disease
Class T: prior kidney transplant
Rx for bacterial vaginosis during pregnancy
Immediate oral metronidazole to reduce risk of preterm delivery (no partner treatment needed)
Highest mortality rates in pregnancy (>25-50%)
Pulmonary hypertension, Marfan's syndrome, aortic coarctation w/ valve involvement
Which uterotonic med is contraindicated in pts with HTN or preeclampsia?
Methylergonovine (is a vasoconstrictor)
Which uterotonic is contraindicated in pts with asthma?
Prostaglandin F2 (Hemabate) (is a smooth muscle constrictor and therefore a bronchoconstrictor)
Most common risk factor for uterine inversion?
Excessive traction on umbilical cord during 3rd stage
How might uterine inversion present?
Globular pale mass presenting at introitus while attempting to deliver placenta + signs of hypovolemia
How are prostaglandin F2 and methylergonovine delivered?
IM (never IV, b/c can cause bronchoconstriction and stroke, respectively)
Which vessel should be ligated in the case of an XL for refractory PPH?
Internal iliac (hypogastric) to decrease vascular pressure in the pelvis
4 signs of dizygotic twins
Dividing membrane thickness >2mm
Twin peak (lambda) sign
Different genders
2 separate placentas (anterior and posterior)
Time period of various types of monozygotic twins
Di-di: 3-4 days
Dichorionic-monoamniotic: 4-8 days
Mono-mono: 8-12 days
Conjoined: >13 days
Rx for mastitis
Breastfeeding with pink shiny nipples and peeling at the periphery + burning while feeding
Candidiasis (examine baby's mouth)
Signs that baby is getting sufficient milk
3-4 stools in 24 hours, 6 wet diapers in 24 hours, weight gain and sounds of swallowing
Rx for engorgement
Frequent feedings, warm compresses, analgesic 20min before feeding, expressing some milk, good support bra
Most Rh incompatible pregnancies have what amount of feto-maternal blood transfer
<0.1 cc of fetal blood in the maternal circulation; however, that is all that is required for sensitization
Noninvasive test for fetal anemia
Doppler ultrasound of middle cerebral artery peak systolic velocity
US findings of Rh disease
Excess fluid (from decreased hepatic protein production) --> ascites, pericardial and/or pleural fluid, scalp edema, hepatosplenomegaly, placentomegaly, polyhydramnios
What is the standard dose of RhoGAM and how much fetal blood does it neutralize?
Diagnostic tests for a fetus with poor growth
Amniotic fluid volume, NST, doppler umbilical artery systolic/diastolic
Most likely cause of asymmetric growth restriction
Uteroplacental insufficiency (whereas symmetric restriction indicates an earlier insult, e.g. aneuploidy)
Fetal growth restriction can have adult disease complications of (4)
Cardiovascular disease, chronic HTN, COPD, and diabetes
Pts with what type of diabetes are most likely to have macrosomic infants?
Pts with what type of diabetes are more likely to have growth restricted infants?
Long-standing diabetes with end-organ damage
Most common abnormal karyotype found in spontaneously aborted fetuses
Autosomal trisomy
When is the risk of developing microcephaly and severe mental retardation the greatest?
Weeks 8-15
Thrombophilic abnormality associated with stillbirth, preeclampsia, placental abruption and IUGR
Factor V Leiden
Fat tissue during a D&C?
Worry is omental tissue/bowel, proceed with laparoscopy to better visualize
Lab test to measure after a fetal demise
Fibrinogen: worry about coagulopathy developing (if was one fetus of a twin gestation, continue to monitor throughout the rest of the pregnancy)
Most significant reason for increase in C-section rate?
Declining rate of vaginal births after C/S
What is cytotec?
Meds used for IOL
Cytotec to increase favorability of cerix
Risk factors associated with breech presentation?
Prematurity, multiple pregnancy, genetic disorders, polyhydramnios, hydrocephaly, anencephaly, placenta previa, uterine anomalies and uterine fibroids
When should you not AROM?
Latent phase of labor
Likelihood of success of vaginal trial after C-section
70-80% (lower if have had multiple C-sections)
2nd trimester vaginal bleeding with reassuring maternal and fetal status: first step in management
US to r/o placenta previa (before vaginal exam b/c of risk of bleeding
2nd trimester vaginal bleeding with reassuring maternal and fetal status: first step in management
US to r/o placenta previa (before vaginal exam b/c of risk of bleeding
Hypertensive smoker with tense/tender smoker, FHR with poor variability and late decels
Placental abruption --> C section
Hypertensive smoker with tense/tender smoker, FHR with poor variability and late decels
Placental abruption --> C section
Smoking increases the risk of these five things during pregnancy
Placental abruption, placental previa, fetal growth restriction, preeclampsia and infection
2nd trimester vaginal bleeding with reassuring maternal and fetal status: first step in management
US to r/o placenta previa (before vaginal exam b/c of risk of bleeding
Smoking increases the risk of these five things during pregnancy
Placental abruption, placental previa, fetal growth restriction, preeclampsia and infection
Bloody show as the cause for bleeding must be associated with
Cervical dilation
Bloody show as the cause for bleeding must be associated with
Cervical dilation
Hypertensive smoker with tense/tender smoker, FHR with poor variability and late decels
Placental abruption --> C section
Causes of friable cervix/ bleeding in 2nd trimester
Trauma, cervicitis, cancer
Smoking increases the risk of these five things during pregnancy
Placental abruption, placental previa, fetal growth restriction, preeclampsia and infection
Causes of friable cervix/ bleeding in 2nd trimester
Trauma, cervicitis, cancer
Bloody show as the cause for bleeding must be associated with
Cervical dilation
Causes of friable cervix/ bleeding in 2nd trimester
Trauma, cervicitis, cancer
Most common cause of preterm labor?
Management of preterm contractions in a hydrated pt with a closed cervix
Continue to monitor
Management of preterm febrile pt with elevated WBC count presenting with ctx/cervical dilation
Amniocentesis to rule out intra-amniotic infection
Contraindications for tocolytics: terbutaline and ritodrine
Contraindications for tocolytics: magnesium sulfate
Myasthenia gravis
Contraindications for tocolytics: indomethacin
33wks or later due to risk of premature ductus arteriosus closure
How does mag sulfate work?
Competes with calcium for entry into cells
Side effects of terbutaline
Beta-adrenergic: tachycardia, hypotension, anxiety and chest tightening or pain.
Side effect of mag sulfate
Respiratory depression (12-15mg), cardiac depression (.15mg), flushing, headache
Betamethasone has shown decreased incidence of this non-pulm complication of prematurity
Intracerebral hemorrhage
When is fibronectin useful?
For its negative predictive value to demonstrate women unlikely to deliver in next 2 weeks
Sudden onset lower abdominal pain that radiates to the back + N/V
Ovarian torsion (mass usually palpable)
3 causes of late decels
Uteroplacental insufficiency --> fetal acidosis --> fetal hypoxia
When to think benign edema of pregnancy vs. DVT?
Bilateral symptoms, esp. w/o fever, redness, or tenderness
What % of cases of placenta accreta require a hysterectomy to stop the bleeding?
Rx for placenta previa with continued bleeding
Emergent C-section, even if premature
Management of nipple discharge with blood
Ulcerated papule w/ a punched out base and raised, indurated margins + painless inguinal LAD
Ulcer with red beefy base and no LAD
Granuloma inguinale (Donovanosis)
Best diagnosis of primary syphilis
Dark field microscopy (may not have Abs yet)
LH and FSH in PCOS
High LH, low FSH
4 indications for endometrial biopsy in pts with DUB
Age >35, diabetes, obesity, chronic HTN
Rx for DUB
Cyclic progestins (if fail, endometrial ablation or hysterectomy)
How does estrogen therapy affect thyroid hormones?
Increases their metabolism/ increases TBG, so increases the need for L-thyroxine in pts w/ hypothyroidism
Diabetes is often associated with this type of incontinence
Overflow incontinence
Rx for carpal tunnel syndrome (and back-up options)
Wrist splint, then injection of corticosteroids, then surgical decompression; avoid NSAIDs in pregnancy
Med to suppress endometriosis symptoms
GnRH agonists
Rx of DUB in adolescent with no abnormalities on US
Iron therapy if mild
Add progestin if moderate
Need high-dose estrogen if severe/ active bleeding
When is internal podalic version indicated?
Twin gestation when 2nd twin is transverse or oblique and want to --> breech
Where should the fluid be tested from for nitrazine/ ferning?
Vagina, NOT cervical mucous
Primary risk factor for PPROM?
Genital tract infection, usually BV
Nml cervical length
What can prolong the length of time before delivery by up to 7 days after PPROM?
What does a tender uterine fundus indicate?
Indicators of infection on amniocentesis
Low glucose (<20), presence of leukocytes (poor predictive value), presence of IL-6
Prevalence of PROM and PPROM
10-15% and 1%, respectively
Recurrence risk of PPROM
Definition of postterm pregnancy
42 completed weeks
Post-date pregnancies are associated with these 4 factors:
Placental sulfatase deficiency, fetal adrenal hypoplasia, anencephaly, extrauterine pregnancy
Postterm pregnancies are associated with these 5complications
Meconium aspiration
Uteroplacental insufficiency
Management of pt at 41wks with unfavorable cervix who doesn't want to be induced
Biweekly NST and AFI, induce for nonreactive or oligo
Usage (and non-indication) of amnioinfusion
Does not affect neonatal outcomes or decrease incidence of meconium aspiration

Used to treat repetitive variable decels
Findings of dysmaturity
Withered, meconium stained, long-nailed, fragile, small placenta
Dysmature infants are at great risk for?
Common cause of fetal tachy
Maternal fever/chorio
Common cause of variable decels (specific, not just umbilical cord compression)
Nuchal cord
Late decels do not begin until
At or after the peak of the uterine contraction
Acute/ fast decels are
3 complications of epidurals
Spinal headache, localized back pain, meningitis
Endometritis is a complication of these 3 things
Prolonged labor, prolonged ROM, multiple exams
Rx for endometritis
Amp and gent (G+ and G- coverage, respectively)
Cause of low-grade 3 day postpartum fever without other signs/symptoms
Breast engorgement
Ddx for postpartum fever
Endometritis, mastitis, cystitis
Persistent postpartum fever despite Abx, without other signs/symptoms
Septic thrombophlebitis
Rx for septic thrombophlebitis
Abx + anticoagulation
Maternal fever after vaginal repair with gray edges
Necrotizing fasciitis
Swollen, tender, and painful area of vaginal laceration repair that is expanding
Rx for necrotizing fasciitis
Extensive debridement
What category drug is sertraline?
Category C
2 most common side effects of fluoxetine
Sleep and sexual disturbances
Are SSRIs safe while breastfeeding?
Depression during luteal phase but not follicular phase
Premenstrual Dysphoric Disorder
Vacuums have a decreased rate of ___ compared to forceps
Maternal lacerations
When is external cephalic version contraindicated?
Active labor
Management of IUGR with polyhydramnios?
Amniocentesis to obtain fetal karyotype b/c of potential for Trisomy 18
Risk factors for cervical insufficiency
Prior gyne surgery (esp LEEP), prior obstetrical trauma, multiple gestation, Hx of preterm birth, 2nd trimester pregnancy loss
How long should the cervix be at 24 wks?
Rx for trichomonas
Oral metronidazole for pt and her partner
Amenorrhea, normally developed breasts, absent pubic/axillary hair
Androgen insensitivity syndrome; will have internal testicles and be 46XY w/ high male-level testosterone
Nml internal genitalia, ambiguous external genitalia, clitoral hypertrophy, high FSH/LH, low estrogen
Aromatase deficiency
How to differentiate aromatase deficiency from CAH
In CAH estrogen is still synthesized (nml level) and internal genitalia are nml
Rx for asymptomatic bacteriuria of pregnancy
7 days of nitrofurantoin, amox, or cephalosporin (TMP contraindicated in pregnancy)
When should gonadectomy be performed in androgen insensitivity syndrome?
After puberty (completion of breast dev't and attainment of adult height)
Rx for androgen insensitivity syndrome after gonadectomy/ puberty?
Estrogen therapy (no need for progesterone as there is no uterus)
Rx for mild pre-eclampsia in a preterm pt with immature fetal lunds
Bed rest and frequent f/u
Low grade fever and leukocytosis 12 hrs postpartum
Rx for endometritis
IV clinda (anaerobic coverage) and gent (G- coverage)
Karyotype and FSH and LH in Kallman's
Low and low
Low-normal platelets and fibrinogen in pt with IUFD
Worry about early consumptive coagulopathy, esp b/c fibrinogen is normally elevated in pregnancy
Rx for consumptive coagulopathy, or concern for it, post-IUFD
Bleeding patterns typical on Depo
Irregularity for first 2-3 months; amenorrhea in 50% after 1 yr
How to avoid the nausea associated with OCPs used as emergency contraception
Inserting second dose vaginally or taking anti-emetic 1hr beforehand
Which type of emergency contraception requires two doses?
OCPs; levonorgestrel can be taken in 1 or 2
Reduced risk of what with tubal ligation?
Ovarian cancer
Pts with poorly controlled HTN are not a candidate for which type of contraception
+ hcg, open cervix, fever
Septic abortion
Rx for septic abortion
Evacuation of uterus and broad spectrum Abx
Rx for pt wishing to get pregnant with antiphospholipid syndrome
Aspirin + heparin
Which has a higher blood loss, medical or surgical termination?
Concern with repeat D&C
Increased risk of Asherman's
After what gestational age is manual vacuum aspiration contraindicated?
D&E is performed in lieu of D&C in pts after how many weeks?
Drug used for induction for abortion if mom wants fetal autopsy
Intravaginal prostaglandins
Management of heavy bleeding post medical termination of pregnancy
Maternal fever two days after elective abortion
Postop endometritis
Management of postop endometritis
Abx + ultrasound to look for products of conception (if found, will need repeat D&C)
What reduces the risk of limb reduction defects with CVS?
Gestational age (lower risk if before 9-10wks)
Profuse, clear, thin cervical mucous indicates what stage of the menstrual cycle?
Thick, less-stretchy mucous indicates what stage of the menstrual cycle?
Inability to lactate after severe PPH?
Sheehan's Syndrome (anterior pituitary necrosis) has developed due to pituitary hypoperfusion --> decreased PRL (and TSH and FSH)
OCPs cause a decreased rate of these two kinds of cancer
Endometrial and ovarian
What is the general cause of asymmetric IUGR?
Non-ideal maternal factors (e.g. HTN) --> fetal redistribution of blood flow to vital organs (brain, heart) at the expense of other organs, e.g. abdominal viscera
Management of unknown MMR status?
Check to see if rubella immune; vaccinate post-partum (live vaccine, not safe in pregnancy)
Diagnostic management of Rh-negative woman
Test for Rh status and antibodies at 10 wks and again at 28 wks
When is GTT screening done and which test is it?
1 hr 50 gram glucose tolerance test
What is an abnl 1hr GTT and how is it managed?
>140 after 1hr; do a 3hr 100gram GTT
Thin/dry/white vulva with anogenital discomfort/pruritus, dyspareuna, dysuria
Lichen sclerosis
Why biopsy potential lichen sclerosis?
To rule out vulvar squamous cell carcinoma
Rx for lichen sclerosis
High potency topical corticosteroids
What causes RUQ pain in pre-eclampsia?
Distention of liver capsule
6 aspects of severe pre-eclampsia
HTN >160/110, proteinuria >5g on 24hr, oliguria, pulmonary edema, thrombocytopenia, elevated liver enzymes
Cause of irregular menstrual cycles in teens (e.g. shortly after menarche?
Inadequate LH/FSH secretion, often leading to anovulation and then breakthrough bleeding (HPG axis immaturity)
What effect does TSH have on prolactin?
Increases it
Goal of colposcopy during pregnancy
Exclusion of invasive cancer
Management of HSIL during pegnancy
Colpo and biopsy; if normal, second biopsy 6-8wks after delivery
Who is raloxifene (a SERM) contraindicated in?
Pts with a history of thromboembolism
Risk for endometrial cancer: tamoxifen vs. raloxifene
Increased with tamoxifen, not with raloxifene
Raloxifene is a first-line agent for prevention of
Osteoporosis (possibly also breast cancer)
Rx for lactation suppression
No meds! Tight bras, no nipple manipulation, ice packs, analgesics
Urinary urgency, urinary frequency, chronic pelvic pain
Interstitial cystitis
Causes and relief of pain in interstitial cystitis
Sex, full bladder, exercise, spicy foods

Relieved by voiding
Rx for young woman with a breast mass
Re-examine just after menstrual period; if no smaller, FNA or excisional biopsy (no role for mammography b/c of high density of breast tissue in young women)
3 potential causes of variable decels
Cord compression, low amniotic fluid, fetal hypoxia
Multi-step management of non-reassuring fetal heart tones
Maternal oxygenation and repositioning --> fetal scalp pH to assess for hypoxia --> amnioinfusion --> C-section
Affect of pregnancy on thyroid hormones
Increased TBG and stimulation of TSH receptor by hCG -->
Increased total T3/T4, normal free T3/T4, low-normal TSH
Rx for yeast infection
Oral fluconazole
Chronic pelvic pain, worse premenstrually; dysmenorrhea; pain with defection' rectovaginal tenderness; tenderness with movement of the uterus
Management of suspected endometriosis
Pts with endometriosis are at risk for developing
Management of repetitive late decels
Emergent C-section
Most common risk factor for placental abruption
Maternal HTN
Respiratory failure and cardiac shock during amniocentesis or labor
Amniotic fluid embolism
What is Stein-Levanthal syndrome?
Fertility option for patients with premature ovarian failure
Premature ovarian failure is associated with what class of diseases?
Autoimmune diseases
What is a luteal phase defect?
Failure of corpus luteum to produce sufficient progesterone to maintain endometrium and allow implantation
Rx for luteal phase defect
Progesterone supplement
How to distinguish btwn leiomyomas and adenomyosis?
Fibroid uterus is usually irregularly shaped, rather than symmetrically enlarged
Endometrial glands in the uterine muscle is called
Hyperventilation, agitation, and tachy in pt with prior C-section
Imminent uterine rupture
Maternal symptoms in vasa previa
None! Only fetal exsanguination
How to distinguish btwn uterine rupture and abruptio placenta?
Uterine rupture has abdominal exam with irregular contours (fetal limbs), more likely to cause hypovolemia/shock
Most common cause of increased MSAFP
Dating error
3 other causes of increased MSAFP
NTDs, abdominal wall defects, multiple gestation
Management of increased MSAFP
Ultrasound to look for multiple gestation/ fetal size for dating/ identifiable anomalies
Quad screen with low MSAFP, low estriol, high beta-hCG, high inhibin A
Down syndrome
Quad screen with low MSAFP, low estriol, low beta-hCG, normal inhibin A
Protein excretion in preeclampsia is >?
Rx for mild pre-eclampsia with pre-term fetus
Methyldopa and bed rest
Amsel criteria are used to diagnose
Waht are the 4 Amsel criteria?
Thin, gray-white vaginal discharge
Vaginal pH > 4.5
Positive whiff test w/ KOH
Clue cells
When is IOL used for a missed abortion?
After the 16th week of gestation
Management of inevitable abortion
Hospitalization, analgesics, observation (same as for incomplete abortion to monitor for sepsis, DIC, hemorrhage) + suction curettage
Dull, ill-defined pelvic ache worse prior to menstruation and relieved by menses; Hx of sexual problems
Pelvic congestion syndrome
5 aspects of a BPP
NST, tone, movements, breathing, amniotic fluid volume
BPP of 4 or less
Delivery if fetus is >26wks
pH of amniotic fluid
Definition of maternal leukocytosis
Amenorrhea eval
Uterus on pelvic U/S: if FSH increased --> karyotype; if FSH decreased --> cranial MRI

Uterus absent on U/S: if 46,XX/ nml testosterone, indicates abnormal Mullerian dev't; if 46,XY/male testosterone levels, indicates androgen insensitivity
How does FSH aid in the diagnosis of amenorrhea
If increased, is hypergonadotropic amenorrhea: peripheral problem

If decreased, is hypogonadotropic amenorrhea: central problem
Cause of amenorrhea in female athlete's trial
Decreased GnRH/LH --> estrogen deficiency
Test to determine whether vaginal bleeding is from a fetal hemorrhage
Apt test
Rx for gonorrhea or chlamydia
Ceftriaxone and azithro (or doxy)
Most common cause of a nonreactive NST
Sleeping baby: wake up with vibroacoustic stimulation
Cause of vaginismus
Involuntary contraction of perineal musculature (psychological)
Rx for vaginismus
Relaxation, Kegels, gradual dilation w/ dilators, fingers, etc.
Rx for primary anorgasmia
After what point are breech presentations attempted to be converted?
37wks (b/c most self-resolve by then)
When are fetuses at highest risk from ionizing radiation exposure?
Effects of ionizing radiation
Mental retardation, microcephaly, abnormal genitalia, growth restriction, microphthalmia, cataracts
Test when suspect anovulation as cause of infertility
Mid-luteal phase serum progesterone (should be increased to >10)
Monomorphous pink papules, absence of comedones
Steroid-induced folliculitis (steroid acne)
Most preventable cause of fetal growth restriction in the US
Smoking (causes 1 in 3 cases)
Most common infection leading to IUGR
DES exposure in utero increases the risk for
Adenocarcinoma of the vagina
pH of vaginitis infections
Normal (4-4.5) in yeast infections; elevated (5-6) in BV and trich
How to distinguish BV and tric clinically?
Pruritis and inflammation seen only in trichomonas
Decreased long-term variability can be due to this benign condition
Fetal sleep
Yellow mucopurulent discharge from the cervix
Most commonly chlamydia
Dyspareunia, dysmenorrhea, dyschezia
Rx for endometriosis
OCPs; GnRH analogs; danazol
Bilateral, multinodular, solid masses on both ovaries
Pregnancy luteoma: benign condition, no Rx
Things to rule out with hyperemesis in pregnancy
Hyaditiform mole
Enlarged uterus, hyperemesis, and greatly increased hCG
Hyaditiform mole
Vomiting, weight loss, ketonuria
Hyperemesis gravidum (can have mild increases in ALT/AST, amylase/lipase)
Definition of arrest of descent
No change in descent of fetal presenting part after 2hrs in nullips, 1 in multips (add an hr with epidural in place)
Definition of arrest of dilation
Dilation does not change (once >4cm) >1cm/hr in nullips or 1.2cm/hr
What is the Zavanelli maneuver?
Last resort for a shoulder dystocia: pushing baby back into uterine cavity followed by C-section
Mechanism of hypotension post-epidural
Sympathetic block --> vasodilation of lower extremity vessels --> blood redistribution and venous pooling in lower extremities
Relationship btwn hypothyroidism and hyperprolactinemia
TRH stimulates prolactin production
When is a contraction stress test indicated?
When the BPP score is 6
Best Abx for UTIs in pregnancy
Amox, nitrofurantoin, cephalexin
Why is the risk of UTI increased in pregnancy?
Progesterone causes smooth muscle relaxation --> ureteral dilation --> facilitates bacterial colonization and ascension
Post-delivery, woman with respiratory failure, cardiogenic shock, and DIC
Amniotic fluid embolism (can also occur post-amniocentesis)
Rx for AFE
Respiratory support first; then IVF
How to differentiate btwn central and peripheral precocious puberty?
Central: high basal LH that increases with GnRH stimulation

Peripheral: low LH with no response to GnRH
Rx for central precocious puberty and reasoning
GnRH agonist; prevention of premature epiphyseal plate fusion
How to distinguish mastitis from breast engorgement
Mastitis is usually unilateral
What lecithin/sphingomyelin ratio indicates lung maturity?
> 2.0
Management of decreased fetal movements with no fetal heart tones heard on Doppler
Ultrasonography to confirm IUFD
When is serial fibrinogen monitoring necessary after IUFD?
Only if monitored expectantly to look for DIC (e.g. not if fetus is evacuated)
What is the cause of primary dysmenorrhea
Increased prostaglandins
Rx for women with refractory PMS
Low-dose SSRIs; if unsuccessful, alprazolam
Precocious puberty is defined as before what age
8yo in girls
Cause of central precocious puberty
Early activation of the HPO axis
Cause of peripheral precocious puberty
Gonadal or adrenal release of excess sex hormones
Rx for HELLP syndrome
Immediate delivery if >34wks; otherwise steroids, monitoring, etc.
What is pseudocyesis
Woman who desperately wants to be pregnant presents with all the signs and symptoms, but has a normal endometrial stripe and negative hCG
Best measurement on U/S for estimation of fetal size
Abdominal circumference (b/c affected in both symmetric and asymmetric fetal growth restriction)
At what antibody titer level is the mother already sensitized (i.e. RhoGAM not helpful), and at what level is the fetus at risk for hemolytic disease

Role of beta-hCG and what secretes it
Syncytiotrophoblast: to maintain corpus luteum (for its progesterone production until placenta takes over)
Definition of missed abortion
IUFD <20wks w/ complete retained products of conception and a closed cervix
Sx of missed abortion
Brown vaginal discharge and loss of pregnancy symptoms
Medical Rx for spontaneous vs. elective abortion
Misoprostol/mifepristone can eliminate products of conception from uterus

Methotrexate is an abortifacient (useful for ectopic as well)
FSH and LH levels in Turner's
High (due to poor estrogen function: lack of negative feedback)
Inhibin levels in Turner's
Low (b/c is a marker of ovarian function)
When do you not need to treat for both chlamydia and gonorrhea?
When the other infection has been ruled out with a highly sensitive test, e.g. NAAT
Management of pt with antepartum hemorrhage
Resuscitation first! IVF, etc.; then ultrasound, then emergency C-section if needed
Cause of neonatal thyroidtoxicosis if mother has just had thyroidectomy due to Graves?
Thyroid stimulating Ig levels remain high for several months after thyroidectomy and can cross placenta
Increased osteoporosis/fracture risk in pts who drink more than ___ drinks/day
Why is asymptomatic bacteriuria treated in pregnant women?
Progresses to pyelo in 30-40%, which may cause septicemia, preterm labor, and low birth weight
Management of placental abruption if pt and fetus are stable
What two lab values raise concern for DIC after IUFD?
Low fibrinogen and low platelets
How do granulosa cell tumors present in postmenopausal women?
Breast enlargement, lack of menopausal symptoms
4 methods of treating vaginal warts
Trichloroacetic acid, podophyllin, excision, fulguration (electric current)
Condyloma acuminata vs. condyloma lata?
Former is HPV (pink, clustered, teardrop lesions); latter is secondary syphilis (flat, velvety lesions)
Which common STD is always tested for, even if asymptomatic, in pregnancy?
Chlamydia (not gonorrhea)
Indications for inpatient Rx for PID
High fever, unresponsive to orals, inability to take orals b/c of N/V, pregnancy, non-compliance
Unexpected potential Abx regimen for PID
Clinda + gent
FSH and LH in premature ovarian failure
Both increased due to lack of negative feedback from estrogen; FSH/LH >1 b/c FSH is cleared slower
Flank pain and hematuria in pregnancy
Nephrolithiasis (which may lead to hydronephrosis beyond the physiologic amt in pregnancy)
BUN and Cr levels in pregnancy
Both decrease due to increased GFR and renal plasma flow
Uterine tenderness, hyperactivity, and increased uterine tone
May be placental abruption, even without bleeding: can have concealed hemorrhage
Besides HTN and cocaine use, risk factors for abruption include
Short umbilical cord
Tobacco use
Folate deficiency
Cause of stress incontinence
Weak pelvic floor muscles --> urethral hypermobility with increased intraabdominal pressure --> ineffective sphincter closure
Rx for stress incontinence
Kegels and urethropexy
Cause of urge incontinence
Detrusor hyperactivity
Rx for urge incontinence
Rx for overflow incontinence
Bethanechol and alpha blockers
Dysmenorrhea and dyspareunia
Management of ovarian cyst seen on US in a postmenopausal pt
Exploratory surgery
2 first line options for endometriosis
Management of suspected hemorrhagic cyst
Repeat US in 2mo
Pathophys of interstitial cystitis
Disruption of glycosaminoglycan layer in bladder mucosa
Rx for interstitial cystitis
Dimethyl sulfoxide (DMSO), pentosan polysulfate, or anti-inflammatory and analgesics
How to aid fertility in women with endometriosis
Clomiphene citrate (+ IUI if needed)
Management of chronic pelvic pain if NSAIDs and OCPs have failed?
Diagnostic laparoscopy to look for endometriosis (can't use GnRH agonist until diagnosis confirmed)
2 non-gyne conditions associated with chronic pelvic pain
Interstitial cystitis
How do GnRH agonists work vs. danazol
GnRH agonists down-regulate HPA axis, decrease FSH/LH/estrogen

Danozol suppresses the mid-cycle surge in FSH/LH
50% of women with chronic pelvic pain have a history of
Physical or sexual abuse
Imaging study of choice for potential ovarian cancer
Transvaginal US
Surgical management of chronic pelvic pain due to past unilateral PID in pt hoping for future fertility
Laparoscopic unilateral salpingectomy (leave both ovaries if can)
Which 2 nerves are at risk of entrapment after LTCS
Loss of sensation in which distributions for iliohypogastric vs. ilioinguinal nerve entrapment
Iliohypogastric nerve: groin, skin overlying the pubis
Ilioinguinal nerve: groin, symphysis, labium and upper inner thigh
Breast nodule with normal mammogram
Still need cytology, e.g. FNA
This substance can increase the pain from fibrocystic breast changes
Management of bloody vs. clear fluid on breast lump FNA
Clear: f/u in 2mo if mass decreases in size after aspiration (if not, need excisional biopsy)
Bloody: excisional biopsy
Rx for mastitis
Abx and ibuprofen/tylenol
Bug and abx choice for mastitis
Dicloxacillin (erythro if pen-allergic)
Management of vulvar lesion unresponsive to trichloroacetic acid and imiquimod cream
Vulvar biopsy (if negative, then laser excision)
How does medroxyprogesterone acetate work to promote regular menses and how is it given
Switches endometrium from proliferative --> secretory
10mg for 10 days each month
LH:FSH ratio in PCOS
Androgen levels are ___ and estrogen levels are ___ in PCOS
Both increased
What is hyperthecosis?
Extreme PCOS; women experience virilization, usually refractory to OCPs
Elevated DHEAS, but normal testosterone
Adrenal tumor
2 tests for Cushing's
24hr urinary cortisol
Dexamethasone suppression test
Hyperinsulinemia may present as
Acanthosis nigricans; can actually do a fasting insulin level if think pre-diabetic
Cause of postpartum hair loss
High estrogen in pregnancy --> synchrony of hair growth
Signs of hyperthecosis
Temporal balding, deepening of the voice, clitoral enlargement
Rx for hirsutism (first and second line)
OCPs, then add spironolactone
(can also use Lupron or danazol in lieu of OCPs)
How do the bisphosphonates work
Inhibit osteoclast bone resorption
Oligospermia with low LH and normal testosterone
Exogenous steroid use
Recommended calcium supplementation for postmenopausal women
When to start treatment with bisphosphonates
Low BMD on DEXA scan, or with history of osteoporotic fracture
Most common reason women stop hormone replacement therapy
Vaginal bleeding from cycles after previous amenorrhea
Most effective treatment for hot flashes
Side effect of TCAs
Hyperprolactinemia, which can lead to infertility
Rx for infertility from functional hypothalamic amenorrhea
Weight gain; otherwise, LH and FSH (clomiphene citrate doesn't work as well for ovulation induction)
How to determine ovarian reserve in pt who may be perimenopausal and wants to conceive
Clomiphene challenge test
Basis for PMS/PMDD
Serotoninergic dysregulation (decreased serotonin in progesterone-dominant luteal phase)
What is entrainment?
Luteal phase worsening of underlying medical/psychiatric disorder (e.g. IBS, MDD)
How do OCPs help with dysmenorrhea?
Induce endometrial atrophy; with less endometrium, less prostaglandins released
When is chlamydia and gonorrhea testing indicated?
In ALL sexually active women under 25
Menorrhagia with severe dysmenorrhea
Definitive Rx for adenomyosis
Hysterectomy (can also use Mirena)
When do you need an EMB with diagnosis of fibroids?
Woman >40 with AUB
Which vitamins can reduce PMS symptoms?
Vitamin A, E, and B6
When do pts need a symptom diary for PMS/PMDD diagnosis?
Strongest risk factor for PMS
Family history (other than vitamin deficiencies)
Karyotype of complete vs. partial moles
Complete: 46XX (entirely paternal)
Partial: 69XXY (one materanl and two paternal)
Which has a higher likelihood of malignant transformation, and which is more common
Complete mole for both
Second trimester bleeding, no fetal heart tones, exaggerated pregnancy symptoms
Molar pregnancy (exaggerated symptoms due to high beta-hcg)
Ovarian appearance with hyaditiform moles and why
Multicystic from theca lutein cysts due to follicular stimulation from high levels of circulating hCG
Choriocarcinomas can follow which types of pregnancies?
Molar, normal, abortion, ectopic
Form of metastases in choriocarcinoma
Hematogenous embolization
Why should metastatic sites in GTD not be biopsied?
Bleeding complications
Risk factors for molar pregnancy
Asian, extremes of age, Hx of 2+ miscarriages, low beta carotene or folic acid
Uterine size greater than dates can indicate
Molar pregnancy, esp complete mole
Rx for molar pregnancy
Suction curettage
Contraception length recommendation after molar pregnancy
For 6mo after negative hCG values
Risk factor of prolonged lichen sclerosis
Extensive irritation can --> vulvar SCC
Significant lifestyle risk factor for vulvar cancer
Multiple white plaquelike lesions
Paget disease of the vulva
Thin, inelastic, white vulvar skin with "tissue paper" appearance
Lichen sclerosis
Multicentric brown-pigmented papules on the perineum, perianal area, and labia minora
HPV-associated VIN (vulvar intraepithelial neoplasia)
Rx for VIN III
Wide local excision
Rx for diffuse lesions from VIN II
Laser therapy
Vulva w/ fiery red background mottled with whitish hyperkeratotic areas without a distinct lesion
Paget disease of the vulva
Areas involved in lichen planus
Hair-bearing skin and scalp, nails, oral mucous membranes and vulva
Severe pain on attempted vaginal entry
Vulvar vestibulitis
Rx for vulvar vestibulitis
TCAs, topical anesthetics, pelvic floor exercises; radical vestibulectomy if refractory
Persistent itching and scratching --> thick, lichenified, enlarged labia
Lichen simplex chronicus
Cause of mucopurulent cervicitis
Chlamydia or gonorrhea
Name and management of white lesion on cervix
Leukoplakia; always must biopsy
Management of insufficient colpo
CKC biopsy
Management of HSIL but negative colpo/biopsy
Cervical conization, given discrepancy in results
Definition of microinvasive cancer
Cells that extend <3mm beyond the basement membrane
Why should myomectomy at the time of C-section be avoided?
Increased blood loss
Which fibroid pts are good candidates for GnRH agonist Rx?
Pts close to menopause, or pts receiving hysterectomy in 6mo (to reduce size prior to surgery)
Pregnant pts with myomas >3cm are at increase risk for?
Preterm labor, placental abruption, pelvic pain, C-section
Management of EMB with scant tissue and rare atypical cells
Best scan to look for mets in pt with stage 1 endometrial cancer
CXR (more invasive scans not needed)
How often do pts on tamoxifen need EMB?
Never, unless symptomatic; still just regular annual exams
Yellow-brown discharge and foul odor on a young girl
Foreign body
Management of vaginal foreign body in a young girl
Removal under anesthesia