ObGyn Stuff

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Signs of chorioamnionitis: 1) Maternal fever
2) Uterine tenderness
3) Fetal tachycardia
4) Elevated WBC
What is definition of late pregnancy bleeding?: Bleeding after 20 weeks
What is the most common cause of late-trimester bleeding?: Placental abruption
Risk factors for placental abruption: 1) Previous abruption
2) Maternal trauma
3) Hypertension
4) Maternal cocaine abuse
5) Premature membrane rupture
Signs of mild abruption: Moderate vaginal bleeding with no fetal monitor abnormality. Localized uterine pain and tenderness.
Signs of moderate abruption: Pain and bleeding can be gradual or abrupt in onset.
FHT may show tachycardia, decreased variability or mild late decels
Signs of severe abruption: Abrupt pain that is continuous and knifelike. Greater than 50% separation.
FHT shows severe late decels, bradycardia or death.
DIC may occur
Why does DIC occur with abruption?: Release of tissue thromboplastin from placenta into maternal circulation.
What is couvelaire uterus?: Blood extravasating between myometrial fibers. Bruises appear on serosal surface.
What are complications of severe abruption?: Acute tubular necrosis from severe hypotension.
DIC from release of tissue thromboplastin.
What is characteristic of bleeding with abruption?: Painful bleeding
What is characteristic of bleeding with previa?: Painless bleeding
Which single dose oral regimens for gonorrhea should be avoided in pregnancy?: Ciprofloxacin and ofloxacin.
Single dose treatment for gonorrhea: Intramuscular ceftriaxone
Treatments for chlamydia: Single dose azithromycin
1 week regimen of doxycyline or erythromycin
Who should be routinely screened for gonorrhea and chlamydia?: All sexually active women who are young or have other risk factors.
What is the most common cause of septic arthritis in sexually active young adults?: Neisseria gonorrhea
What is the hormone imbalance in polycystic ovarian syndrome?: Too much LH
What are the origins of ovarian cancers?: Epithelial, germ cell and stromal
What is the most common type of ovarian cancer?: Serous cystadenocarcinoma
What do women over 35 with abnormal bleeding need to rule out?: Endometrial carcinoma
What prevents gonadal malignancy in Turner's syndrome?: Prophylactic removal of gonads.
What congenital anomalies are associated with Turner's syndrome?: 1) Coarctation of the aorta
2) Cystic hygroma
3) Renal anomalies
What is the most common cause of primary amenorrhea?: Turner's syndrome (45, X0)
What happens if a Turner patient is given progesterone?: Nothing, no bleeding because there was no estrogen to begin with.
What conditions has bacterial vaginosis been linked with?: Postpartum endometritis, pelvic infections, preterm labor.
What are three classical presentations of endometriosis?: Pain, abnormal bleeding and infertility
At what ages do most women present with endometreosis?: Between 20 and 35
What is medical therapy for endometriosis?: NSAIDS for pain; OCPs, danazol and GnRH agonists to induce "medical menopause" for relief of symptoms
What is normal pH of the vagina in a premenopausal woman?: Acidic (<4.5)
What is characteristic of the discharge produced by bacterial vaginosis?: Profuse, thin, foul smelling, "dirty-grey"
What is the treatment for BV?: Metronidazole for 7 days
What is the alternative treatment for BV?: Clindamycin
What time period during pregnancy should Metronidazole be avoided?: First trimester
Classic findings for endometriosis on physical exam: Fixed, retroverted uterus
Nodularity of uterosacral ligaments
Fixed ovaries
T or F: High parity is a risk factor for cervical cancer: True
What can vaginal discharge of cervical cancer look like?: Malodorous, purulent or clear
HPV serotypes that cause cancer: 16, 18, 33, 36 and others
Type of herpes that mostly causes genital warts: HSV Type II (90% of cases)
What is the treatment for herpes genitalis?: Acyclovir, valacyclovir or famcicyclovir for 7-10 days
In which eating disorder are severe electrolyte abnormalities and cardiac arrythmias seen?: Bulemia
What should be the antibiotic coverage for treatment of PID?: Chlamydia, gonorrhea, gram negative rods and anaerobes
What is the treatment for PID?: Cefotetan or cefoxitin and doxycyline
How long do you watch a tubo-ovarian abscess on antibiotics before resorting to surgery?: 72 hours
In what type of patient is and IUD a bad idea?: Women under 35, promiscuous women, those desiring future fertility
T or F: Patients with adenomyosis tend to present at a later age than patients with endometriosis: True (35-45 years)
Smooth symmetrically enlarged, boggy uterus that may be tender to palpation probably describes....: Adenomyosis
What is condyloma accuminata assiciated with?: Genital warts or HPV
Which conditions can cause genital warts to grow rapidly and larger?: Pregnancy, diabetes, immunosuppresion and taking OCPs.
What has to be included in the investigation of vaginal bleeding in postmenopausal woman?: Pap smear, endocervical curettage, endometrial biopsy
What is benign cystic teratoma known as?: Mature teratoma or dermoid cyst
What are the most common ovarian neoplasms?: Benign cystic teratoma
What is struma ovarii?: Fuctioning thyroid tissue in a benign teratoma causing hyperthyroidism
What are the screening tests for syphilis?: VDRL and RPR
Nonspecific, false positives, become negative after treatment
What are confirmatory tests for syphilis?: FTA-Abs, MHT-TP
More specific, stay positive for life
What is Jarish-Herxheimer?: It is a reaction that occurs in patients with syphilis on the first day of treatment.
Fever, sweating, malaise.
Not an allergic reaction!
What might a false positive syphilis screening test mean?: Lupus or some collagen vascular disorder (anti-phospholipid syndrome)
How early can pregnancy be detected by transvaginal ultrasound?: 5 weeks
T or F: Mild glucosruia and proteinuria is normal in pregnancy: True
What LFT value is normally elevated in pregnancy?: Alkaline phosphatase
When in pregnancy is the "triple screen" done?: 16-20 weeks
When in pregnancy is diabetes screening done?: 24-28 weeks
What are normal pregnancy levels of beta-HCG?: <100,000
What is another name for molar pregnancy?: Gestational trophoblastic neoplasia (GTN)
What is the next step in a molar pregnancy if beta-HCG levels continue to rise after a D&C?: Chemotherapy with methotrexate or actinomycin D
Describe complete molar pregnancy: 46, XX; no fetal tissue present
Describe incomplete molar pregnancy: 47, XXY; some fetal tissue present
Date of delivery based on LMP: subtract 3 months and add 7 days
What is the definition of spontaneous abortion?: Expulsion of fetus at <20 weeks or <500 grams
In which trimester does Pregnancy Induced Hypertension classically occur?: Third trimester
Second trimester + signs of pre-eclampsia = ?: Possible molar pregnancy
What are classic complaints of PIH?: Dec. urine output, headache, visual changes, altered mental status, RUQ pain, face, hand or leg swelling
What defines pre-eclampsia?: Hypertension + PROTEINURIA + edema
What distinguishes pre-eclampsia from eclampsia?: SEIZURES
What is in the HELLP syndrome?: Hemolysis, elevated liver enzymes, low platelets +/- RUQ pain
What can occur with magnesium sulfate toxicity?: Dec. deep tendon reflexes
Hypotension
Respiratory depression
Which PIH is okay to treat with BP control and observation?: Those with mild disease:
BP < 160/110, 1-2+ proteinuria and no symptoms besides edema
What is symmetric IUGR a result of?: Fetal anomalies and infections
What is asymmetric IUGR a result of?: Maternal or placental factors
More common
What are the three most common presenting complaints for an ectopic pregnancy?: Amenorrhea, abdominal pain and vaginal bleeding.
24 year old, RLQ pain, spotting, LMP 5 weeks ago: first test?: beta-HCG
Name three initial lab values to check in a pre-menopausal woman presenting with amenorrhea.: beta-HCG, TSH, prolactin
Which metabolic disorders are women with PCOS at risk for?: Diabetes mellitus type 2 and dyslipidemia

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