OBGYN End of Rotation (EOR) Study Materials - Rosh & Hippo

What are the components needed to diagnose preeclampsia?

new-onset HTN (≥ 140/90 mm Hg) with either proteinuria (≥ 300 mg/24 hr or urine protein: creatinine ratio ≥ 0.3) OR significant end-organ dysfunction

What are the RF for an ectopic pregnancy?

previous PID, prior ectopic, prior tubal ligation, IVF, infertility, smoking, vaginal douching, conception with an IUD, prior spontaneous abortion, and older maternal age

What are buboes and what are they associated with?

unilateral painful inguinal lymph nodes associated with lymphogranuloma venereum (genital ulcer dz caused by chlamydia)

APGAR definiton

appearance (skin color), pulse (heart rate), grimace (response to irritable stimuli, reflex irritability), activity (extremity movement, muscle tone), and respiratory effort

What is an excellent APGAR score?

7-10

What indicates an early deceleration of the fetal HR caused by compression of the fetal head but are benign?

the fetal heart rate gradually decreases at the start of the uterine contraction, reaches a nadir at the peak of the contraction, and returns to baseline as the contraction ends

Which stage of uterine prolapse is defined by the uterus located at the level of the hymen?

stage 2

What are the 7 cardinal movements of fetal descent during labor?

engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion

What is the most common symptom of uterine fibroids (leiomyomas)?

heavy or prolonged menses

What does two fetuses and the presence of a T sign on US indicate?

monochorionic, diamniotic gestation

What is the treatment for gonorrhea in a pregnant patient?

ceftriaxone (500 mg intramuscularly) and azithromycin (1 g orally)

What is the diagnostic criteria for preterm labor?

regular and painful uterine contractions approximately 5 min apart for an hour accompanied by cervical change (cervical dilation ≥ 3 cm, cervical length < 20 mm on transvaginal ultrasound, or cervical length between 20 and 30 mm with a positive fetal fibronectin) prior to 37 weeks

When should anti-D immune globulin be administered to an Rh negative mother?

28 weeks gestation (and again after delivery if infant is Rh positive)

What stage of syphilis involves condyloma latum (wart like lesions on the genitals)?

secondary

What HPV types cause condyloma acuminata (skin colored cauliflower genital lesions)?

HPV 6 and 11

Which human papillomavirus (HPV) serotypes are most associated with cervical cancer?

HPV 16 and 18

What is first line tocolytic therapy for women between 32-34 weeks gestation?

nifedipine

What lab findings determine the diagnosis of menopause?

estradiol <20 and FSH of 21-100

What is the primary difference between premenstrual disorders and mood disorders?

there is a symptom-free interval in the follicular phase with premenstrual disorders

What is the strongest risk factor for placental abruption?

history of a previous placental abruption (along with trauma, cocaine use, and eclampsia)

What daily micronutrient supplements are recommended during pregnancy?

iron 27 mg, calcium 1,000 mg, vitamin D 600 IU, folate 600 mcg, and iodine 220 mcg

What is first line treatment for hyperemesis gravidarum?

doxylamine + pyridoxine, then add diphenhydramine

What station is when the baby's head is at the level of the maternal ischial spines?

0 station

What triad suggests placental abruption?

severe abdominal pain, fetal distress, and third-trimester bleeding of sudden onset

What is the MC type of vulvar cancer?

squamous cell carcinoma usu d/t HPV 16 or 18 infection

Presentation of squamous cell vulvar carcinomas vs melanoma

squamous: plaques, ulcerations, or warty masses that are red or white and pruritic usu on the labia majora

melanoma: black nodules with irregular borders that evolve rapidly

What 3 meds can be used to treat cystitis during the first trimester of pregnancy instead of Nitrofurantoin?

Fosfomycin, amoxicillin-clavulanate (Augmentin), and cefpodoxime

What are risk factors for placenta previa?

previous placenta previa, previous cesarean delivery, smoking, increased maternal age, and multiple gestation pregnancy

What cancer risk increases when using combined menopausal hormone therapy?

breast cancer

At what gestational age can you start to feel fetal movements?

18-20 weeks if first pregnancy, but as early as 14 weeks in following pregnancies

What type of cancer risk will be significantly increased with long term use of OCPs?

breast and cervical cancer

When should screening for cervical cancer begin?

women between the ages of 21 and 29 years should undergo screening for cervical cancer every 3 years with cervical cytology alone

When should a pregnant patient be treated for genital herpes?

acyclovir or valacyclovir for 7-10 days after primary infection and from 36 weeks to delivery

What is the greatest risk factor for postpartum endometritis?

a c-section delivery

What skin surgical incision is the preferred approach for most cesarean section deliveries?

Pfannenstiel

What is the treatment for an intra amniotic infection (chorioamnionitis)?

ampicillin and gentamicin

What indicates the suspected diagnosis of chorioamnionitis (intrauterine infection or inflammation)?

maternal fever of > 100.4°F, maternal leukocytosis (> 15,000 cells/μL in the absence of corticosteroids), purulent fluid from the cervical os, and baseline fetal tachycardia

What is the Rotterdam criteria used for PCOS?

in order to make the diagnosis of PCOS, there must be at least two out of three of the following: oligo- or anovulation or both, evidence of hyperandrogenism, and the presence of polycystic ovaries on ultrasound

What are RF for a cystocele?

pregnancy, vaginal delivery, advanced age, obesity, multiparity, menopause, and diabetes mellitus

What fetal heart rate is considered reactive?

two accelerations of 15 bpm above baseline for 15 seconds to 2 min each in a 20-minute period

What are the major complications of PID?

tubo-ovarian abscess, chronic pelvic pain, infertility, and ectopic pregnancy

What is the most common RF for preterm pre labor rupture of membranes?

a genital tract infection such as Gardnerella vaginalis infection

What is the treatment for gestational trophoblastic disease that is invasive but confined to the uterus and has not spread?

single-agent chemotherapy, such as methotrexate

What type of contraception is contraindicated for the first 6 weeks postpartum?

combined hormonal contraceptives (pills, patch, or ring) d/t increased risk of VTE

What is seen on a wet mount with BV?

epithelial cells with stippled borders (clue cells)

When should breast cancer screening be done?

initiated at age 50 and done every 2 years with a mammogram

What complications are associated with gestational diabetes?

preeclampsia, gestational hypertension, polyhydramnios, large for gestational age infant, maternal and infant birth trauma, perinatal mortality, and neonatal complications

What is the MC type of cervical cancer?

squamous cell carcinoma

What is the recommended treatment for vulvovaginal candidiasis in pregnant women?

topical miconazole or clotrimazole applied vaginally for 7 days

How will an endometrioma appear on ultrasound?

smooth-walled with homogeneous internal echoes that have the appearance of ground-glass- fluid inside endometriomas is old blood and appears chocolate-colored on biopsy

What is seen on a pelvic US with a tubo-ovarian abscess?

complex, heterogenous adnexal mass with septations and thickened walls

What is the tumor marker for ovarian cancer?

CA-125

What are the major risk factors for ovarian cancer?

Lynch syndrome, BRCA1 and BRCA2 mutations, infertility, endometriosis, and cigarette smoking

What type of incision is made when an episiotomy is indicated?

a mediolateral incision is preferred over a posterior midline incision to reduce the risk of anal sphincter laceration

What is the definition of a shortened cervix?

less than 25 mm before 24 weeks gestation

What labs are significant for PCOS?

elevated testosterone and increased LH:FSH ratio >3:1

What causes dilutional anemia during pregnancy?

a greater increase in plasma volume relative to the red blood cell mass (both increase though)

How do you treat chlamydia in a pregnant patient and when do you do a test of cure?

azithromycin 1 g PO and test of cure 3 to 4 weeks after treatment is completed (then 3 months after that)

How long does puerperium last?

4-6 weeks

What are theca cells stimulated by and what do they produce?

theca cells are stimulated by LH to produce progesterone and androstenedione

What are granulosa cells stimulated by and what do they produce?

the granulosa cells are stimulated by FSH to convert androstenedione to 17-beta-estradiol (form of estrogen)

What contraceptive method has a BBW of increased risk of thromboembolism/blood clots?

ethinyl estradiol and norelgestromin patch

What diuretic can be used to treat symptoms of PMS?

spironolactone

What should initially be used to treat nausea during pregnancy?

pyridoxine (vitB6) alone or in combination with doxylamine

What is the most important RF for postpartum endometritis?

a cesarean section

What US findings indicate oligohydramnios?

amniotic fluid index < 5 cm or a single deepest pocket that is < 2 cm in depth in the second or third trimester

What are the 5 components of the biophysical profile (BPP)?

fetal breathing, fetal movement, fetal tone, amniotic fluid volume, and nonstress test to measure FHR

How does a chancroid caused by haemophilus ducreyi present?

a painful genital ulcer that has a ragged border and a purulent base; starts initially as a papule that progresses into a pustule and then into an ulcer within a few weeks

What is the MC SE of oxytocin and how is it treated?

tachysystole is the MC SE of oxytocin administration (an average of more than 5 contractions per 10 min for ≥ 30 min) tx is reduction or d/c in the dose

What glu challenge results indicate gestational diabetes after the >130-140 after 1 hr 50g glucose load?

> 95 mg/dL fasting, > 180 mg/dL at 1 hour, > 155 mg/dL at 2 hours, or > 140 mg/dL at 3 hours

What are the sx of an intra-amniotic infection (chorioamnionitis)?

fever, uterine tenderness, purulent or malodorous amniotic fluid, maternal tachycardia, and fetal tachycardia

What is AFP a marker for in prenatal screening?

neural tube defects

What is the MC type of cervical carcinoma?

squamous cell carcinoma (70-75%) followed by adenocarcinoma (25%)

ENDOMET: endometrial CA RF

Older age, Nulliparity, Diabetes, Obesity, Menstrual Irregularity, Estrogen mono therapy, HTN

What is Sheehan Syndrome?

Postpartum hypopituitarism (pituitary gland enlarges in pregnancy-> postpartum hemorrhage-> necrosis of pituitary gland)

What are some common sx of Sheehan Syndrome?

failure to lactate after delivery, amenorrhea or oligomenorrhea, hypotension, hyponatremia, hypothyroidism

What is the most significant risk factor for breast cancer?

age (highest in 70s)

What is the BBW for Tamoxifen (single agent therapeutic agent)?

uterine malignancy

What is the MC type of endometrial cancer?

adenocarcinoma

Patients with PCOS have an increased risk of developing which type of cancer?

endometrial

An obese 30 y/o with a hx of abdominal bloating, pelvic pressure, LBP, urinary frequency, and dysmenorrhea with a firm, contender, irregularly enlarged uterus on PE most likely has what dx?

Leiomyoma

What medication is indicated for use in those with PCOS that may induce ovulation?

Metformin (Glucophage)

What is a risk factor for the development of gestational diabetes?

history of macrosomia

What is the procedure of choice for differentiating a benign from a malignant breast mass in a 40 y/o patient with a palpable mass?

needle aspiration

RF for developing primary dysmenorrhea

age <30, menarche before age 12, tobacco use, low BMI, longer or irregular menstrual cycles, and history of sexual assault

How do you treat lymphogranuloma venereum?

doxycycline 100 mg twice daily for 21 days (erythromycin second line)

What are the risk factors for endometritis?

c-section is number one, others include prolonged rupture of membranes, long labor with multiple vaginal examinations, manual placenta removal, maternal DM, GBS, chorioamnionitis, and low SES

What antibiotic therapy is used to treat tubo-ovarian abscesses?

IV doxy and cefotetan

What antifibrinolytic agent can be used to treat heavy menstrual bleeding?

tranexamic acid (can preserve fertility)

What is the MOA of Tamoxifen and what is it used for?

it is an estrogen agonist on the endometrium and antagonist on the breast that is used as adjuvant treatment in patients with breast cancer, treatment of metastatic breast cancer, and prophylaxis to reduce the incidence of breast cancer in high-risk patients

What is needed to make the diagnosis of polyhydramnios?

an amniotic fluid index of more than 24 cm or a single pocket of fluid that is greater than 8 cm in depth

What is the treatment for polyhydramnios?

Indomethacin unless they are 32-32 weeks d/t possible closure of the PDA; other treatment is reductive amniocentesis

Where specifically are the red blood cells of a D-positive fetus phagocytized by macrophages in the presence of anti-D IgG antibodies in a Rh(D) alloimmunized mother?

spleen

What is the most appropriate additional workup for a patient who is > 35 years old, not pregnant, and has a Pap smear positive for atypical glandular cells?

colposcopy, endocervical curettage, and endometrial biopsy

Which component of tissue sampling during a colposcopy should be avoided in a pregnant patient?

endocervical curettage

What risk factors are associated with PROM?

low socioeconomic status, low body mass index, tobacco use, history of preterm labor, urinary tract infections, vaginal bleeding, cerclage, and amniocentesis

What can be used to treat acute onset severe HTN in pregnancy?

IV lebetalol, IV hydralazine, and immediate release oral nifedipine

What shows up on a gram stain with gonorrhea?

gram-negative diplococci and many polymorphonuclear lymphocytes

What is compound fetal presentation?

an extremity (most commonly, a hand) presents alongside the part of the fetus closest to the birth canal

What type of virus is HSV?

double stranded DNA