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Ob Gyn Ck

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mikenakhla's version from 2016-05-19 21:26

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Question Answer
• Gold standard for evaluating for cervical incompetence?transvaginal ultrasound
• Most effective emergency contraceptive method?Copper IUD
• Soft/boggy enlarged uterus and profuse vaginal bleeding after labor?Postpartum hemorrhage caused by uterine atony
• Treatment of uterine atony?bimanual uterine massage, IV fluids, oxytocin is first line.
• Shoulder dystocia can cause this defect with hand paralysis with possible ipsilateral miosis and ptosisKlumpke palsy - C8 and T1 nerve damage k
• Erb duchenne vs klumpke palsy?erb duchenne is the "waiter's tip" thing with decreased moro and biceps reflex and intact grasp. Klumpke is claw hand with intact moro and biceps but absent grasp. Basically opposites in terms of reflexes affected.
• Sexually active women less than or equal to this age get tested for chalmydia and gonorrhea24
• Treatment for primary syphilis if patient allergic to penicillin? What about if this person is pregnantdoxy, but if pregnant, desensitize then give penicillin
• Any bleeding prior to 20th week of gestation with a live fetus but closed cervixthreatened abortion
• First thing to do after threatened abortionultrasound to make sure baby is living
• How do you manage endomterial hyperplasia without atypia? What about if they have atypia but consider future pregnancy?progestin therapy for both. If they have no plans for pregnancy or fails progestin therapy, hysterectomy
• Why is endometrial ablation contraindicated in patients with endometrial hyerplasia?because it would destroy shit and you can't evaluate the endometrium by biopsy in the future
• Lab findings with premature ovarian failure?FSH and LH both increased, but FSH is cleared slower so the FSH/LH ratio is > 1
• Guideliens for ASGUS managementHPV testing, if positive, colposcopy, if negative, repeat pap and HPV in 3 years. If 21-24, repeat cytology in 1 year, if > 25 do what I just wrote up there
• Palpable breast mass, what do you do if < 30? > 30?if > 30 mamogram and ultrasonogram and if suspicious for cancer do a core biopsy. If under 30 do ultrasonogram and if it's a solid mass, core biopsy
• If mom has herpes eruption, what do you do for delivery?C section
• If NST is unreactive, what do you do next?contraction stress test or biphysical profile, CST can be done if there is no contraindication to labor
• Results of a normal contraction stress test?no late or recurrent variable decelerations
• Decreased AFP, decreased estriol, decreased B HCG normal inhibin ATrisomy 18
• Elevated inhibin A and B hcg, low estriol and AFPdown syndrome
• Elevated AFP, normal inhibin, estriol, B HCGneural tube or abdominal wall defect
• Genital warts treated with trichloroacetic acid or podophyllinHPV
• Treatment for trichomonal vaginitis?metro. Avoid alcohol b/c disulfram like reaction
• Hypotension, loss of sexual hair, lactation failure, lethargic, more after delivery with heavy peripartum bleedingsheehan syndrome - hypoperfusion of the pituitary
• Indications for hospitalization in patients with PID?high fever, failure to respond to oral abx, inability to take oral meds b/c n/v, pregnancy, and risk of noncompliance
• Treatment of PCOS?Weight loss and OCPs. Use spironolactone only if they can't tolerate OCPs
• Treatment of gestational diabetes?dietary modifications, if that fails, insulin or oral agents (metformin, glyburide).
• Heme abnormality in fetal macrosomia possiblepolycythemia b/c body is trying to ramp up RBC production. Get vicious blood
• When can you attempt external cephalic version if breech presentation?37 weeks. Before then, the baby can still flip a lot. If it fails, c section
• Definition of arrested labor?6cm dilation or more and no cervical change for at least 4 hours with good contractions or no change for at least 6 hours with no good contractions
• These genital ulcers are painful. This one is notchancroid and herpes are painful, syphilis is not.
• One painless genital ulcer vs multiple painful onessyphillis, herpes
• Multinucleated giant cells on Tzanck smear are characteristic of which two infections?Herpes and varicella. Tzanck smear also used to diagnose CMV
• Lecithin/sphingomyelin ratio?if it's over 2, their lungs are gucci
• Amniotic fluid index? What is it used for?if it's less than 5, oligohydramnios, do an amnioinfusion. If it's more than 25, polyhydramnios. You don't really do anything
• Treatment for BVmetro or clindamycin
• Treatment for itchy vagina, thin/yellow green frothy discharge with motile things under microscope?This is trichomoniasis. Treat with metronidazole and treat sexual partner
• Thick, cottage cheese discharge with vaginal inflammation and itchy? Treatment?Candida, flucanazole orally or nystatin intravaginally
• Presence of nitrates in dipstick mean what? What about esterase?nitrates is e coli, esterase signifies significant pyuria (wbcs/cloudy urine)
• Palpable fetal parts with sudden persistant abdominal pain and abnormal uterine contractions with vaginal bleeding and abnormal fetal heart tracingsuterine rupture
• Hypertonic uterus with pain and heavy vaginal bleedingplacenta abruptio
• C section prevents vertical transmission of what?HIV, GBS, and genital herpes.
• Reduce vertical transmission of GBS viaintrapartum abx
• When is anti-D immune globluin given to O negative moms (indicating Rh negative)28 weeks and repeated within 72 hours of delivery
• When can you diagnose gestational hypertension?20 weeks, before that it's primary hypertension
• Treatment for vaginismuskegel exercises to relax vagina and gradual dilatation with objects to encourage desensitization
• Late term pregnancies are at risk ofuteroplacental insufficiency. Fetal compromise would be suggested by abnormal heart rate and oligohydramnios
• Treat UTI in pregnant women with these 3 optionsnitrofurantoin, amoxicillin, cephalexin
• Patients in preterm labor <34 weeks should receive what?tocolytic (calcium channel blocker), magnesium sulfate for neuroprotection (decreased risk of cerebral palsy) and steroids for baby's lungs to mature
• Abnormal uterine bleeding - who gets endometrial biopsy?anyone over 46 or anyone under with persistent symptoms or risk factors for endometrial cancer, or those with obesity/PCOS
• Symmetric fetal growth restriction vs asymmetric?symmetric would be fetal factors (genetic disorders, heart disease, intrauterine infection eg malaria CMV rubella toxo varicella). Head and body are smaller. Asymmetric would be maternal factors (hypertension, diabetes, Antiphospholipid antibody syndrome, autoimmune issues, substance abuse). Body is smaller, head is normal
• First line treatment for moderate to severe abnormal uterine bleeding in an adolescent?high dose estrogen
• Painless vaginal bleeding that occurs with rupture of membranes then fetal deterioration. Maternal vital signs are unchanged usuallyvasa previa
• 46 XY karyotype, minimal axillary and pubic hair. Boobs present. Absent uterus and upper vagina. Cryptorchid testes. What is this and what do you do about the testes?complete androgen insensitivity syndrome. Defective androgen receptors. Wait till after puberty then take them out
• In postmenopausal women, what is a workup of an adnexal mass?transvaginal ultrasonography then CA-125 level if suspicious for malignancy
• Treatment for essential hypertension during pregnancy? Acceptable alternatives?beta blockers and methyldopa. Hydralazine and calcium channel blockers are acceptable alternatives
• What is fitz-hugh curtis syndrome?perihepatitis in the setting of PID. Inflammation of hepatic capsule
• Macrosomia is a risk factor forshoulder dystocia.
• Erb-Duchenne palsy prognosis?good, most recover arm function spontaneously, so just reassure
• Can't feel fetal parts, palpable protuberance in the lower abodmen with vaginal bleeding. Usually history of c section in momuterine rupture
• This is a complication of prolonged rupture of membranes? Fever, uterine tenderness, maternal or fetal tachy, malodours amniotic fluidchorioamnionitis.
• Treatment of chorioamnionitis?broad spectrum antibiotics and oxytocin to accelerate labor. Not an indication for a c section
• How to suppress milk production?tight bra and ice packs for pain, no medications
• Changes to BUN and creatinine in pregnancy? Why?decreased because increased renal plasma flow and GFR
• Mucpurulent discharge and erythematous/friable cervix? Most common causes?cervicitis. Most common is chlamydia trachomatis. Followed by gonorrhoeae. Most women are asymptomatic.
• How do you differentiate between gonorrheae and chlamydia infection?nucleic acid amplification testing. Treatment for both anyway because coinfection is common (azithromycin and ceftriaxone)
• Yolk sac tumor finding?increased AFP
• Teratoma increased what?AFP and B HCG
• Choriocarcinoma characterized by increasedB HCG
• Leydig cell tumors, increased levels oftestosterone and estrogen, inhibit LH and FSH. Cause precocious puberty or gynecomastia in older males
• History of IUD use then PID?think Actinomyces israelii
• Gold standard for diagnosis of endometriosis? Treatment options for someone who doesn't want to have children right now?laparoscopy. Treat with birth control pills. Second line is danazol (suppresses gonadotropin production) GNRH agonists (eg leuprolide)
• Treatment of chlamydia if patient is pregnant? IF not?if pregnant, erythromycin, if not azithro or doxy. Patients with gonorrhea should be treated for chlamydia, but not the other way around
• Stage II syphilis?condylomata lata, maculopapular rash on palms. Treat with penicillin still
• Pedculosis aka ____. How do you treat this?"crabs", itching, lice on pubic hairs possible. Treat with permethrin cream (or malathion)
• Treat sexual partners if infection is STD, but not these two because they're not STDscandida and gardnerlla
If you suspect adenomyosis, what do you do first to rule out cancer?adenomyosis, do a D&C to rule out endometrial cancer. Consider hystrectomy or Leuprolide to relieve symptoms
• Treatment for leiomyomas (Fibroids)myomectomy or hysterectomy if fertility not desired
• Dysfunctional uterine bleeding - what test do you do on all women?hemoglobin/hematocrit to make sure not anemic. Over 35 do a D&C to rule out endometrial cancer
• Treatment for dysfunctional uterine bleeding in the absence of treatable pathology?NSAIDs for pain, OCPs for heavy menses. Severe bleeding give progesterone
• Treatment for PCOS if patient desires pregnancy? If not?clomiphene, otherwise OCPs. Spironolactone for hirsutism. Clomiphene increases endometrial risk
• First step in evaluating couple infertility?semen analysis
• First test after pregnancy test if secondary amenorrhea cause isn't obvious?progesterone. If vaginal bleeding develops within 2 weeks, patient has sufficient estrogen. In this case check LH level, if high, consider PCOS, if low or normal, check prolactin and TSH. If no bleeding, estrogen levels inadequate. Check FSH levels. If high, premature ovarian failure. If low or normal, MRI because brain tumor possible, clomiphene is ineffective in these patients.
• Phenotypical female with normal breasts but no axillary or pubic hair and amenorrhea, what do you think?androgen insensitivity syndrome, no uterus
• Most common benign tumor of breast? What do you do for it?Fibroadenoma, wait one to two cycles and see if it goes away
• Treatment for mastitis?keep breastfeeding, acetaminophen or NSAIDs for pain. If symptoms are more severe, use an antistaph antibiotic (eg dixcloxacillin or cephalexin). If MRSA risk, bactrim or clindamycin.
• History of trauma to breast then a mass, think thisfat necrosis
• After 35, for any breast mass that's not obviously benign, do thisbiopsy and mammography
• Increased risks with IUDs?ectopic pregnancies and PID (actinomyces)
• Treat 21 hydroxylase deficiency with ___ to prevent death?steroids and IV fluids
• Malignant type of embryonal rhabodmyosarcoma presenting as a bunch of grapes coming out of vagina?sarcoma botryoides
• Treatment for idiopathic precocious puberty? Why?GnRH analog to stop the axis because you don't want premature closure of epiphyseal plates
• Vaginal discharge in a young girl, think thisforeign object. Warm water flush to get it out
• Vaginal bleeding in neonates?maternal estrogen withdrawal, no treatment needed
• OCPS and ovarian cancer?decrease risk of ovarian and endometrial cancer too
• BV, Trich, candida, which have pH > 4.5?BV and trich.
• Treatment of uncomplicated UTI? Complicated? Pyelo?Nitrofurantoin or bactrim or fosfomycin. Complicated is fluoroquinolones, Pyelo is fluroquinolines outpatient or IV fluoroquinolon, aminoglycoside +/- ampicillin if inpatient
• Patients with history of C section or an extensive myomectomy should be delivered viac section because of risk of uterine rupture
• Patients who arrive at the hospital in labor with a history of prior C section or extensive myomectomy, what do you do?Laparotomy and delivery. They have a high risk of uterine rupture
• All patients with hep C infections, including pregnant woman, should getHep A and B vaccines
• What is the Kleihauer-Betke test?quantifies how much RhD immunoglobulin needed to give to Rh negative mother (if fetus is Rh positive). Not indicated in Rh positive mother
• Management of abnormal paps in pregnancy?Pap shows ASGUS, HSIL etc, then you get initial colposcopy, and if negative, repeat pap and colposcopy after delivery. Don't do a biopsy unless invasive cancer found on colposcopy
• PAINLESS (to mom), with recurring deep variable decelerationsumbilical cord prolapse. Emergency
• Abdominal pain, uterine tenderness, and uterine contractions with increased uterine tone. May or may not have blood on pelvic examplacental abruption
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