PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+, Exams of Nursing

Download PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ and more Exams Nursing in PDF only on Docsity! PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ Follicular Phase vs. Luteal phase - correct answers ✅1. Estrogen dominant (Day 1-14) 2. Progesterone dominant (Day 14-28) FSH vs. LH - correct answers ✅1. Causes follicle & egg maturation 2. Stimulate maturing follicle to produce estrogen Estrogen vs. Progesterone - correct answers ✅1. Thickens endometrium 2. Enhances lining of uterus to prepare for implantation In the follicular phase (days 1-14) of the menstrual cycle, FSH is increasing which causes a _______ to develop which produces ________ to help proliferate the lining of the endometrium; at the end of this phase _______ surges causing ovulation - correct answers ✅1. Primary ovarian follicle 2. Estrogen 3. LH PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ In the luteal phase (days 14-28), after ovulation, the leftover follicle becomes the _________ which produces _________ which maintains the endometrial lining for fertilization - correct answers ✅1. Corpus luteum 2. Progesterone In the luteal phase, the endometrial lining is prepared for fertilization from progesterone from the corpus luteum; the ________ degrades causing a drop in progesterone/estrogen and _________ begins - correct answers ✅1. Corpus luteum 2. Menstruation In the luteal phase, the endometrium is prepared for fertilization by progesterone from the corpus luteum; if fertilization does occur __________ gets released by the developing trophoblast/placenta which maintains the __________ to continue making progesterone/estrogen - correct answers ✅1. hCG 2. Corpus luteum Cryptomenorrhea - correct answers ✅Light flow or spotting PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ In a pt with primary amenorrhea who's uterus is absent but breasts are present, what may be the cause? (2) - correct answers ✅1. Mullerian agenesis (46XX) 2. Androgen Insensitivity (46XY) In a pt with primary amenorrhea who's uterus and breasts are absent, what may be the cause? - correct answers ✅*RARE* Defect in testosterone synthesis; presents like a phenotypic immature girl but will often have *intraabdominal testes* Secondary Amenorrhea Definition (2) - correct answers ✅1. No menstruation for *> 3 months* in a pt with previously normal menstruation 2. No menstruation for *> 6 months* in a oligomenorrheic pt Amenorrhea caused by Ovarian Disorders Sx + Dx - correct answers ✅Elevated FSH/LH, Decreased estradiol *Dx: Progesterone challange test* (10 mg for 10 days; if has withdrawal bleeding = ovarian; if no withdrawal bleeding = hypoestrogenic or uterine disorder PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ Amenorrhea caused by Hypothalamus Dysfunction Sx (3) + Tx (2) - correct answers ✅1. Normal or decreased FSH/LH 2. *Normal prolactin* 3. Low estradiol *Tx: Stimulate GnRH (Clomiphene, Menotropin)* Amenorrhea caused by Pituitary Dysfunction Sx (2) + Tx (2) - correct answers ✅1. Decreased FSH/LH 2. *Elevated prolactin* (Prolactin inhibits GnRH) *Tx: Tumor removal; Bromocriptine* Amenorrhea caused by Uterine Disorder Sx + Tx - correct answers ✅Asherman's Syndrome (scarring of the uterine cavity) *Tx: Estrogen* PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ Primary vs. Secondary Dysmenorrhea - correct answers ✅1. *NOT* due to pelvic pathology → due to *↑ prostaglandin* 2. Due to *pelvic pathology* (ex: endometriosis) Premenstrual Syndrome (PMS) Tx (5) - correct answers ✅1. Supportive 2. SSRI (for emotional symptoms) 3. OCP including *Drosperinone* 4. GnRH *(if no response to SSRI or OCP) 5. Spironolactone *(for bloating)* Premenstrual Dysphoric Disorder (PMDD) - correct answers ✅Severe PMS with functional impairment Menopause Sx (2) - correct answers ✅1. ↑ FSH, LH *(FSH > LH)* → *FSH > 30* 2. ↓ Estrogen *Premature menopause = <40 years old* PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ 2. Infertility 3. Ectopic pregnancy Fitz-Hugh Curtis Syndrome Sx (2) - correct answers ✅*Hepatic fibrosis and peritoneal involvement* 1. *Violin string* adhesion on anterior liver surface 2. RUQ pain, may radiate to right shoulder Bacterial Vaginosis Sx (3) + Tx (2) - correct answers ✅1. MCC of vaginitis 2. *(+) Whiff test* → fishy odor 3. *Clue cells* → epithelial cells covered with bacteria *Tx: Metronidazole, Clindamycin* Trichomoniasis Sx (5) + Tx (2) - correct answers ✅1. *Sexually transmitted* 2. Pruritus 3. Dysuria 4. *Frothy yellow-green discharge* PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ 5. *Strawberry cervix* *Tx: Metronidazole, Tinidazole* (MUST TREAT PARTNER) Candidiasis Sx (4) + Tx - correct answers ✅1. Swelling 2. Burning 3. Pruritus 4. *Thick cottage cheese discharge* *Tx: Fluconazole (1st line)* Atrophic Vaginitis - correct answers ✅Thinning, drying and inflammation of the vaginal walls due to less estrogen (MC after menopause) Chlamydia Sx (3) + Tx (2) - correct answers ✅1. MCC of cervicitis 2. Asymptomatic 3. *Lymphogranuloma venerum* in developing countries *(PAINLESS genital ulcer → PAINFUL inguinal LAD)* PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ *Tx: Azithromycin or Doxycycline* HPV Tx (6) + Dx - correct answers ✅In office: 1. Trichloroacetic acid 2. Podophyllin 3. Cryotherapy 4. Surgical removal Outpatient: 5. Imiquimod 6. Podofilox *Dx: Whitening with acetic acid application* What are the oncogenic strains of HPV? Genital warts? - correct answers ✅1. Oncogenic: *16, 18*, 31, 33, 35 2. Genital warts: 6, 11 PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ Breast Cancer Main Types (2) - correct answers ✅1. Ductal Carcinoma (associated with lymphatic METS, especially axillary) *MC* 2. Lobular Carcinoma (↑ risk of invasive breast CA in either breasts) Breast Cancer Sx (5) - correct answers ✅1. Painless, hard, fixed mass 2. *MC Upper outer quadrant* 3. Unilateral nipple discharge (purulent/green, +/- blood) 4. Paget's Disease of the nipple (eczematous itchy scalinng rash on nipple and areola) 5. Red, swollen, warm, itchy breast *(inflammatory breast CA)* Breast Cancer on Mammogram - correct answers ✅Microcalcifications and spiculated mass What neoadjuvant medication could be given to a 55yo w/ ER (+) breast cancer? (2) - correct answers ✅1. *Tamoxifen* (anti-estrogen) binds ER and blocks them 2. Aromatase inhibitors (*Letrozole, Anastrozole*) that reduce production of estrogen (best used in PMP women) PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ What neoadjuvant hormone therapy could you give to a pt with HER2 (human epidermal growth factor receptor) (+) breast cancer? - correct answers ✅monocloncal Ab treatment *(trastuzumab/Herceptin)* but s/e are *cardiotoxicity* How often should clinical breast exams, self breast exams, and screening MMGs take place? & in what age group? - correct answers ✅1. Clinical breast exam: q3y age 20-39, annually @ age ≥40 2. Self breast exam: monthly ≥20yo right after menstruation 3. Mammo: annually ≥40yo or 10y before 1st deg relative Dx Endometrial Cancer (5) - correct answers ✅1. MC GYN cancer in the US 2. 4th MC cancer in women overall (Breast → lung → colorectal) 3. MC PMP 4. *Estrogen dependent cancer* (Risk factor = ↑ estrogen exposure) 5. MC *adenocarcinoma* *Combination OCP are protective of endometrial and ovarian cancer* PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ Endometrial Cancer Sx (2) + Dx (2) - correct answers ✅1. PMP bleeding 2. Menorrhagia or metrorrhagia in pre or perimenopausal *Dx: Biopsy, US (endometrial stripe >4mm)* Endometrial Cancer Tx (3) - correct answers ✅1. Stage I = Hysterectomy +/- post op radiation 2. Stage II-III = Hysterectomy + lymph node excision +/- post-op radiation 3. Stage IV = Systemic chemotherapy What is the MC benign ovarian neoplasm? + Tx - correct answers ✅Dermoid cystic teratomas *Tx: Removal* (due to risk of torsion or malignancy development) *90% of ovarian neoplasms are benign in reproductive age women* PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ ≥30 w/ LSIL → *HPV testing* If (-) repeat pap in *1 yr* If (+) *colposcopy + Bx* *LSIL includes CIN1* 27 yo pt with HSIL (high grade squamous intraepithelial lesion) on pap; next step? - correct answers ✅Any age w/ HSIL = *colposcopy + Bx* *HSIL includes CIN2, CIN3, and carcinoma in situ* What region of the cervix has the highest risk for malignancy? - correct answers ✅*Transformation zone (squamocolumnar junction)* - junction of squamous cell of ectocervix and glandular columnar cells near end of endocervical canal CIN1 Sx + Tx (3) - correct answers ✅*Mild* dysplasia contained to the *basal 1/3 of the epithelium* PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ Tx: 1. *observation* (75% resolve in 1 yr; if <20 y/o) 2. *excision*- *LEEP* (loop electrical excision procedure) or *cold knife cervical conization* 3. *ablation* (energy assisted destruction of lesions via cryocautery, laser cautery, or electrocautery) CIN2 Sx + Tx (2) - correct answers ✅*Moderate dysplasia* including *2/3 thickness of basal epithelium* Tx: 1. *excision*- LEEP (loop electrical excision procedure) or *cold knife cervical conization* 2. *ablation* (energy assisted destruction of lesions via cryocautery, laser cautery, or electrocautery) CIN3 Sx + Tx (2) - correct answers ✅*Severe dysplasia* with *>2/3 up to full thickness of basal epithelium* (full thickness = Carcinoma in situ) PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ Tx: 1. *excision*- LEEP (loop electrical excision procedure) or *cold knife cervical conization* 2. *ablation* (energy assisted destruction of lesions via cryocautery, laser cautery, or electrocautery) What causes Cervical cancer? - correct answers ✅HPV especially strains *16, 18* (70%), *31, 33*, 45, 52, & 58 Types of cervical cancer? - correct answers ✅1. Squamous *(90%)* 2. Adenocarcinoma (10%) Cervical cancer Sx (3) + Dx - correct answers ✅*3rd MC GYN cancer* 1. *Post coital bleeding/spotting* (MC) 2. Metrorrhagia 3. Pelvic pain *Dx: Colposcopy + Bx* PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ Infective Mastitis vs. Breast Abscess - correct answers ✅1. Mastitis: usually redness, swelling, warmth, and tenderness in one quadrant of the breast 2. Breast abscess: more *localized induration* w/ fluctuance and is rare Congestive (5), Infective Mastitis (5) and Breast Abscess (2) Tx - correct answers ✅1. Congestive mastitis: If want to cont breast feeding then *manually empty breast* after each feed, *warm compress* If want to stop breast feeding then *ice packs*, tight-fitting bras, avoid breast stimulation 2. Infectious mastitis: warm compress, *cont pumping/nursing*, anti-staph abx *(Dicloxacillin, Nafcillin, Cephalosporin)* 3. Breast abscess: *I&D*, *d/c breastfeeding* from affected breast Fibroadenoma Sx (4) + Tx - correct answers ✅1. Nontender, freely mobile rubbery lump in the breast 2. Does not wax and wane with menstruation PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ 3. No axillary involvement or nipple discharge 4. Collagen arranged in *"swirls* *Tx: Observation; Excision not usually done* Fibrocystic Breast Disorder Sx (4) - correct answers ✅1. Due to exaggerated respond to *estrogen* 2. Multiple tender lumps 3. May change in size with menstruation 4. No axillary involvement or nipple discharge Fibrocystic Breast Disorder Dx + Tx (2) - correct answers ✅Fine needle aspiration → *straw-colored fluid* (no blood) *Tx: Spontaneously, FNA* Cystocele - correct answers ✅Prolapse of *posterior bladder* into *anterior vagina* PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ Enterocele - correct answers ✅Prolapse of pouch of Douglas *(small bowel)* into *upper vagina* Rectocele - correct answers ✅Prolapse of distal sigmoid colon into *posterior distal vagina* Uterine Prolapse Sx (4) - correct answers ✅1. Pelvic/vaginal fullness, heaviness, *"falling out"* sensation 2. Lower back pain 3. Vaginal bleeding/purulent discharge 4. *Urinary frequency/urgency/stress incontinence* Ovarian Torsion Sx (2) - correct answers ✅1. Acute unilateral pelvic pain 2. Adnexal mass Ovarian Torsion Tx (2) - correct answers ✅1. Detorsion and ovarian conservation 2. Salpingo-oopherectomy ONLY if PMP or necrotic ovary PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ Leiomyoma *(Uterine fibroids)* Sx (6) + Dx - correct answers ✅1. Benign uterus smooth muscle tumor *(MC benign gyn lesion)* 2. Due to ↑ *estrogen* (should regress after menopause, if not → think otherwise) *3. Menorrhagia* 4. Large irregular hard palpable mass in the abdomen or pelvis 5. Abd pain/pressure 6. Bladder frequency/urgency *Dx: Pelvic US* Leiomyoma Tx (4) - correct answers ✅*1. Observation* 2. Leuprolide (GnRH agonist → GnRH inhibition when given continuously → shrinks uterus) 3. Hysterectomy *(definitive)* 4. Myomectomy *(preserve fertility)* Ovarian Cysts Types - correct answers ✅1. Follicular cysts → follicles fail to rupture and continue to grow PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ 2. Corpus luteal cysts → fail to degenerate after ovulation 3. Theca lutein → excess b-hCG causes hyperplasia of theca interna cells Ovarian Cysts Sx (4) - correct answers ✅1. Asymptomatic 2. *Unilateral* lower quadrant pain 3. Menorrhagia 4. Mobile palpable adnexal mass Ovarian Cysts Dx - correct answers ✅*Pelvic US* Follicular → smooth, thin-walled Corpus luteal → complex, thicker-walled *MUST CHECK HCG* Ovarian Cysts Tx (4) - correct answers ✅1. *Spontaneously resolves if <8 cm* 2. Repeat US in 6 weeks 3. OCP 4. Laparoscopy or laparotomy *if >8 cm or persistent or in postmenopause* PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ What is natural family planning? - correct answers ✅Abstain from sex during fertile period What is coitus interruptus? - correct answers ✅Withdraws penis from vagina before ejaculation (20% failure because sperm in pre-ejaculatory fluid can lead to pregnancy) What is spermicide? (2) - correct answers ✅*1. Nonoxynol-9* *2. Slight ↑ risk of HIV* What barrier methods of contraception can ↑ risk for TSS? (3) - correct answers ✅1. Diaphragm 2. Fem cap 3. Contraceptive sponge What is a diaphragm? (5) - correct answers ✅1. Rubber cuplike device that holds spermicide against cervix 2. Protects against pelvic infection and cervical dysplasia PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ *3. Helps with bloating during menses* *CI in liver, kidney, or adrenal disease* What are progestin only contraceptives? (5) - correct answers ✅1. Same as Combined OCP *2. Safe during lactation* (because postpartum are higher risk for thromboembolism, so avoid estrogen) 3. Slightly less effective than combo OCP 4. Slightly *higher risk of ectopic* *5. Menstrual irregularities* What is emergency contraceptive (Plan B)? (3) - correct answers ✅*1. Levonorgestrel - a progestin* (2 tabs of 0.75 mg 12 hrs apart or 1 tab of 1.5 mg single dose) 2. Best if taken *within 72 hours* of unprotected sex *3. Seek medical attention if no menses 21 days after tx* PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ What is Mirena? (4) - correct answers ✅*1. Levonorgestrel - long acting progestin IUD* (5 years) 2. Same effects of progestin *3. ↑ Risk of PID* *4. Spotting* *Most effective form of contraception (besides sterility and abstinence)* What is Paragard? (3) - correct answers ✅1. Copper IUD *2. 10 years of action* *3. ↑ Risk of PID* What is Implanon? (3) - correct answers ✅*1. Etonagestrel - long acting progestin implant (3 years)* 2. Same effects as progestin pills (menstrual irregularity) *3. Higher risk of osteoporosis* What is Depo Provera? (2) - correct answers ✅*1. Medroxyprogesterone - long acting injectable progestin (3 months)* PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ 2. Same effects as progestin pills (menstrual irregularity) What is Ortho Evra? (3) - correct answers ✅*1. Norelgestromin/ethinyl estradiol - combo transdermal patch* 2. Apply weekly x 3 weeks → 1 week off with withdrawal bleeding (period) 3. Less effective if underweight What is Nuvaring? (3) - correct answers ✅*1. Etonogestrel/estradiol - combo flexible plastic vaginal ring* 2. Applied 3 week → 1 week off with withdrawal bleeding (period) 3. *MUST* be removed during intercourse but *replaced* within 3 hours What is sterilization? (2) - correct answers ✅1. Tubal ligation (permanent, *↑ risk of ectopic*) 2. Essure (chemicals or coils to scar portion of fallopian tubes) *(difficult to reverse, ↑ risk of ectopic*) Infertility Definition - correct answers ✅Inability to conceive after 1 year PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ Urge Incontinence Sx (5) - correct answers ✅1. Urine leakage accompanied by or preceded by urge 2. Caused by *detrusor muscle overactivity* by muscarinic acetylcholine receptors *(overactive bladder)* 3. Urinary frequency 4. Small volume voids 5. Nocturia Urge Incontinence Tx (6) - correct answers ✅*1. Bladder training* (timed frequent voids and decrease fluid intake) *2. Anti-cholinergics* (*oxybutinin* or tolterodine) → blocks ACh receptors in bladder but s/e are can't see, can't spit, *can't pee*, can't shit *3. TCAs* (imipramine) central/peripheral anticholinergic effect and alpha adrenergic agonist *4. Mirabegron* (B3-agonist = bladder relaxant) *5. Surgical* (injection of botox or bladder augmentation) *6. Diet* (avoidance of spicy food, citrus fruits, chocolate and caffeine) PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ Overflow Incontinence Sx (5) + Dx - correct answers ✅1. Urinary retention (incomplete voiding) due to *decreased detrusor activity (atony or underactive bladder)* 2. Can be caused by DM, MS, autonomic dysfunction (spinal injury) or BPH outlet obstruction *Dx: Post void residual volume >200 mL* Overflow Incontinence Tx (2) - correct answers ✅1. Intermittent or indwelling *catheter* is *1st line* 2. Cholinergics *Bethanacol* → increase detrusor activity Gravida Para - correct answers ✅G_P_ _ _ _ G (# pregnancies) T (# term deliveries at 37+ weeks) P (# preterm deliveries at 20-37 weeks) A (abortions or miscarriages <20 weeks) L (# living children) PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ Ladin's Sign - correct answers ✅*Uterus softening* after 6 weeks Hegar's Sign - correct answers ✅*Uterine isthmus softening* after 6-8 weeks Piskacek's Sign - correct answers ✅*Palpable lateral bulge* or softening of uterine cornus after 7-8 weeks Goodell's Sign - correct answers ✅*Cervical softening* due to increased vascularization after 4-5 weeks Chadwick's Sign - correct answers ✅*Blue cervix and vulva* after 8-12 weeks Fetal Heart Tones (2) - correct answers ✅1. At 10-12 weeks 2. Normal 120-160 bpm When does fetal movement ("quickening") start? - correct answers ✅16-20 weeks PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ 4. Chorionic villus sampling (for abnormal screening results, maternal age >35 y/o, prior pregnancy abnormalities) → increases risk of spontaneous abortion How to test for Down Syndrome? (3) - correct answers ✅1. *Abnormal high/low* free b-hCG 2. *Low* PAPP-A (Pregnancy associated plasma protein A) 3. *Thick* nuchal translucency (at 10-13 weeks) Second Trimester Screening (5) - correct answers ✅1. Triple Screening (AFP, b-hCG, Estradiol) 2. Inhibin A *(High = abnormal chromosome)* 3. US (amniotic fluid level, fetal viability, and growth for gestational age) 4. Amniocentesis (same indications as CVS) 5. Gestational DM screening *(24-28 weeks)* What is Quad Screening? - correct answers ✅Triple screening + Inhibin A testing *For Trisomy 21, Trisomy 18, and NTD* PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ Triple Screening Results (3) - correct answers ✅1. Low AFP, High b-hCG, Low Estradiol = *Down syndrome (Trisomy 21)* 2. High AFP, N/A b-hCG, N/A Estradiol = *open neural tube defects or multiple gestation* 3. Low AFP, Low b-hCG, low Estradiol = *Trisomy 18* (often stillborn or die within 1 year) Third Trimester Screening (7) - correct answers ✅1. Gestational DM Screening *(24-28 weeks)* 2. Repeat antibody titers 3. *RhoGAM* for Rh- mothers *at 28 weeks* and *within 72 hours after childbirth* 4. Group B Strep Screening *(32-37 weeks)* via vaginal-rectal culture (if +, give *IV PCN* when presenting in labor) 5. H/H *(35 weeks) 6. Biophysical profile (fetal breathing, fetal tones, amniotic fluid levels, Non- stress test, gross fetal movement) 7. Non-Stress Testing PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ What other tests should be done for high risk individuals in the third trimester? (3) - correct answers ✅1. G/C Chlamydia 2. HSV (if +, give Acyclovir at 36 weeks) 3. GBS (if +, give *IV PCN* when presenting in labor) Reactive Non-Stress Testing (3) - correct answers ✅1. 2 or more accelerations in 20 mins 2. ↑ Fetal HR of 15 or more bpm from baseline, lasting 15 or more secs 3. Repeat weekly or biweekly *Fetal well being* Nonreactive Non-Stress Testing (4) - correct answers ✅1. No fetal HR accelerations or <15 bpm, lasting <15 secs 2. Fetus can be sleeping, immature, or compromised 3. Try vibratory stimulation 4. Try contraction stress test PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ 4. Human placental lactogen is produced by placenta and responsible for nutrient supply to fetus but can cause a diabetogenic state (bc insulin antagonist) 5. Prolactin greatly increases 6. ↑ in T3/4 while fT4 and TSH remain minimally changed What are the effects of pregnany on the msk system? (2) - correct answers ✅1. Change in center of gravity = low back strain 2. Carpal tunnel syndrome is common What are the effects of pregnancy on the dermatologic system? (3) - correct answers ✅1. Spider angiomatas 2. Palmar erythema 3. Hyperpigmentation of nipples, umbilicus, abdominal midline (linea nigra), perineum, face (melasma) What is the cal/day recommendation in normal BMI pregnant women? - correct answers ✅300 cal/day (500 cal/day when breastfeeding) PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ What amount of weight gain is recommended in underweight, normal, and overweight patients? - correct answers ✅1. Underweight: 28-40 lb 2. Normal: 20-30 lb 3. Overweight: 15-25 lb Morning Sickness and Hyperemesis Gravidarum (HEG) Tx (5) - correct answers ✅1. High protein foods 2. Avoid spicy/fatty foods 3. Total parenteral nutrition if severe 4. *Pyridoxine (Vit B6) +/- Doxylamine* (1st line) 5. Promethazine Ectopic Pregnancy Sx (6) - correct answers ✅1. *MC ampulla of fallopian tube* 2. Unilateral pelvic/abd pain 3. Vaginal bleeding 4. Amenorrhea (pregnancy) 5. CMT 6. Adnexal mass PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ *2-4 is a triad* Ectopic Pregnancy Tx (3) - correct answers ✅*1. Methotrexate* (only if hemodynamically stable, early gestation <4 cm, b-hCG <5000, no fetal tones) 2. Surgery (1st line if ruptured) 3. RhoGAM (if mother is Rh-) Severe unilateral abdominal pain, dizziness, N/V, signs of shock (syncope, tachycardia, hypotension), vaginal bleeding, cervical motion tenderness, adnexal mass, US showing absence of gestational sac, hCG that isn't doubling q1-2 days. What is the dx and tx? - correct answers ✅1. Ruptured ectopic pregnancy -Tx: laparoscopic salpingostomy to remove ectopic gestation- may need salingectomy; RhoGAM if Rh- Spontaneous Abortion (2) - correct answers ✅*1. <20 weeks* 2. MCC chromosomal abnormalities PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ *Tx: D&C in 1st trimester, D&E after 1st trimester; Misoprostol* Septic Abortion Sx (7) + Tx (3) - correct answers ✅1. Retained POC becomes infected 2. Some POC retained 3. Os closed *4. CMT* *5. Foul brown discharge* 6. Fever, chills 7. Spotting → heavy bleeding *Tx: D&E to remove POC + Broad spectrum Abx; hysterectomy if refractory* Methods for Elective Abortion (4) - correct answers ✅1. Mifepristone → Misoprostol 1-3 days after (safe up to 9 weeks) 2. Methotrexate → Misoprostol 3-7 days after (safe up to 7 weeks) 3. D&C during 4-12 weeks 4. D&E during 12-24 weeks PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ *Surgery can be performed up to 24 weeks after LMP* A pregnant woman comes in at 8 wks GA c/o foul, brownish d/c, F/C, spotting that lead to heavy bleeding; on PE she has cervical motion tenderness; US shows no fetal heart beat. What is the dx and tx? - correct answers ✅Septic spontaneous abortion Tx: D&E + broad spectrum abx +/- RhoGAM Gestational HTN Sx (2) + Tx (3) - correct answers ✅1. Occurs after 20 weeks of gestation and resolves 12 weeks postpartum 2. HTN with *NO* proteinuria *Tx: Supportive; Labetalol; Hydralazine Preeclampsia Sx (3) - correct answers ✅1. Occurs after 20 weeks of gestation (earlier if multiple gestation or molar pregnancy) 2. HTN *WITH* proteinuria PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ 3. Edema Preeclampsia Dx (7) - correct answers ✅*Mild*: - BP >/= 140/90 in 2 separate occasions at least 6 hours apart but no more than 1 week apart - Proteinuria >/= 300 mg/24 hour or >+1 on dipstick *Severe*: - BP >/= 160/110 - Proteinuria >/= 5 g/24 hour or >+3 on dipstick - Oliguria (small amount of urine) <500 mL/24 hour - Thrombocytopenia +/- DIC - *HELLP Syndrome* (Hemolytic anemia, elevated liver enzymes, low platelets) Preeclampsia Tx (9) - correct answers ✅*Mild*: - Delivery if 37 or more weeks - Conservative if <37 weeks PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ Gestational DM Tx (4) - correct answers ✅1. Insulin *(TOC)* → doesn't cross placenta - 2/3 in AM 1/3 in PM - 0.8 IU/kg in 1st trimester; 1.0 IU/kg in 2nd trimester; 1.2 IU/kg in 3rd trimester - Goal is fasting sugar <95 2. Glyburide (doesn't cross placenta but ↑ risk of eclampsia) 3. Metformin 4. Screening for mothers 6 weeks postpartum and yearly after Placenta Previa Sx (3) + Dx - correct answers ✅1. Abnormal placenta placement on or close to cervical os 2. 3rd trimester *PAINLESS bright red bleeding* 3. No fetal distress *Dx: US; DO NOT PERFORM PELVIC EXAM* Placenta Previa Tx (4) - correct answers ✅1. Hospitalization and stabilize PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ 2. Magnesium sulfate 3. Steroids at *24-34 weeks* for fetal lung maturity 4. Delivery when stable (if 36 weeks, blood loss >500 mL); vaginal if partial/marginal, c-section if complete Placental Abruption Sx (4) + Dx - correct answers ✅1. Premature separation of placental from uterine wall *after 20 weeks* 2. 3rd trimester *PAINFUL dark red bleeding* 3. Fetal bradycardia 4. MCC is maternal HTN *Dx: US; DO NOT PERFORM PELVIC EXAM* Placental Abruption Tx (3) - correct answers ✅1. Hospitalization and stabilize *2. IMMEDIATE delivery* *3. May lead to DIC* What are the 4 types of gestational trophoblastic disease? - correct answers ✅1. Molar pregnancy (benign) 80% PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ 2. Invasive mole 10-15% 3. Choriocarcinoma 2-5% 4. Placental site trophoblastic tumor <1% *ALL ARE CAUSED BY ABNORMAL PLACENTAL DEVELOPMENT* Complete Molar Pregnancy (3) - correct answers ✅1. Egg *with no DNA* fertilized by 1 or 2 sperms 2. 46XX with all paternal chromosomes 3. Higher risk of malignant development into *choriocarcinoma* Partial Molar Pregnancy (2) - correct answers ✅1. Egg is fertilized by 2 sperm (or 1 sperm that duplicates its chromosomes) 2. May develop fetus but it is always *malformed* and never viable Gestational Trophoblastic Disease Sx (7) - correct answers ✅1. *Painless* vaginal bleeding 2. +/- *Brownish discharge* 3. *Large* uterine size than expected PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ What will happen to the fetus of an Rh- mother untreated with RhoGAM in a previous pregnancy? - correct answers ✅Mother's antibodies may cross placenta and attack fetal RBCs resulting in *hemolysis of fetal RBC* If subsequent newborn is Rh+ Sx (6) - correct answers ✅1. Hemolytic anemia 2. Jaundice 3. Kernicterus 4. Hepatosplenomegaly 5. Fetal hydrops (fluid accumulation in 2 places: pericardial effusion, ascites, pleural effusion, subQ edema) 6. CHF If Rh incompatibility occurs and the fetus suffers erythroblastosis fetalis with mod-severe anemia what is the tx? - correct answers ✅Antigen negative RBCs through US guided umbilical vein transfusion Fraternal twins vs Identical twins - correct answers ✅Dizygotic (2 ova by 2 sperm) vs. Monozygotic (1 ova by 1 sperm) PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ MC fetal position in the womb during the third trimester? - correct answers ✅*MC Cephalic* (vertex) Fetal position (4) during first stage of labor and how can you tell? - correct answers ✅1. OA best (face down) 2. LOA, ROA 3. OT and OP are considered malpositioned Palpate the anterior and posterior fontanelles (anterior is bigger and more central) When is APGAR score performed? (3) What is the normal score? - correct answers ✅1. 1 min after birth 2. 5 min after birth 3. 10 min after birth *if abnormal* Normal = 7 or more Fairly low = 4-6 Critically low = 3 or less PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ APGAR Score - correct answers ✅From 0, 1, 2 1. Appearance (blue-gray and pale all over; Acrocyanosis - body pink but blue extremities; Pink) 2. Pulse (0; <100; 100 or more) 3. Grimace reflex irritability (No response to stimulation; Grimaces feebly; pulls away, sneezes, or coughs) 4. Activity muscle tone (none; some flexion; flexes arm and legs, resists extension) 5. Respiration (absent; weak, irregular; strong, crying) A baby is born crying with a pink body but blue extremities, HR of 157, grimaces feebly on stimulation, flexes arms/legs and resists extension; what is the APGAR score? - correct answers ✅8 What is the difference between contractions of pregnancy and Braxton-Hicks contractions? - correct answers ✅Braxton-Hicks are not associated with cervical dilation PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ What are the positions of complete, footling and frank breech? What are the tx options? (3) - correct answers ✅1. External version after 37 weeks +/- anesthesia 2. Trial of breech vaginal delivery (rare) 3. Elective cesarean delivery What are the 3 etiologies of a dystocia in labor? - correct answers ✅1. *P*ower - uterine contractions aren't strong enough 2. *P*assenger - too big or position not cephalic 3. *P*assage - pelvis, uterus or soft tissue abnormalities What can shoulder dystocia lead to? (2) - correct answers ✅*1. Erb's palsy (brachial plexus injury) - C5/C6 roots* 2. Umbilical cord compression or fetal asphyxiation Shoulder Dystocia Management (3) - correct answers ✅*1. McRobert's Maneuver* (nonmanipulative) *1st line* 2. Woods "corkscrew" maneuver 180 shoulder rotation(manipulative) PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ 3. C-section if cannot fix with maneuvers Induction vs. Augmentation of labor - correct answers ✅1. Induction = attempt to begin labor in a nonlaboring pt 2. Augmentation = intervening to increase the already present contractions How do you induce labor? (3) - correct answers ✅1. *Prostaglandin gel* directly on cervix (early induction in women with unfavorable cervix to promote cervical ripening) 2. *Oxytocin* (later induction when cervix is dilated <1 cm with some effacement → *NEED TO MONITOR UTERINE ACTIVITY AND FHR* 3. *Amniotomy* (artifical ROM with a small hook if cervix is partially dilated and there is effacement) An external tocometer is placed on the pt's abdomen near the fundus and is used to measure... - correct answers ✅*Contractions* by sensing pressure when abdomen gets firmer - best for measuring frequency of contractions and to *monitor fetal heart rate accels/decels* PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ What degree of fetal heart rate variability is reassuring? - correct answers ✅*Moderate* (little variability may mean fetus is asleep or inactive and absent variability may mean fetal death) aka lines will appear squiggly What is considered a reactive fetal heart tracing? - correct answers ✅2 accelerations, at least 15 bpm above baseline, for at least 15 seconds in 20 minutes What kind of fetal heart deceleration is a result of fetal head compression during a contraction? - correct answers ✅*Early deceleration* (begins and ends with contraction) What kind of fetal heart deceleration is a result of umbilical cord compression? - correct answers ✅*Variable deceleration* (can occur at any time and drops more precipitously than early or late decels) What type of fetal heart deceleration is a result of uteroplacental insufficiency and are the most worrisome type? - correct answers ✅*Late deceleration* (begin at peak of contraction and slowly return back to baseline after contraction has finished) they may degrade into bradycardias as labor progresses PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ What is given during stage 3 of labor to strengthen uterine contractions to decrease placental delivery time and blood loss? - correct answers ✅Oxytocin (pitocin) Retained placenta is defined as placental delivery/stage 3 lasting >___ minutes; it is common in preterm deliveries but can also be a sign of _________; how is it removed? - correct answers ✅>30 minutes -sign of placenta accreta (placenta invaded into or byond endometrial stroma) -manual extraction (hand placed in intrauterine cavity and fingers used to shear placenta off surface of uterus) VBAC (vaginal birth after cesarean)/ TOLAC (trial of labor after cesarean) are common but have a slight risk ~1% of _________ - correct answers ✅Uterine rupture *1% after 1 c/s, 2% after 2 c/s, but after 3 risk goes way up so do a c/s How can you diagnose PROM? (4) Tx? (2) - correct answers ✅1. Pooling test on speculum exam PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ 2. Nitrazine paper (will turn *blue if pH>6.5* aka amniotic fluid) 3. Ferning appearance of amniotic fluid on a microscopic slide 4. US to check the amniotic fluid index (AMI) or fluid levels *Tx: await spontaneous labor and monitor for infection (chorioamnionitis or endometritis)* After water has broken or amniotomy performed it is important not to do what that may cause the umbilical cord to prolapse past the head - correct answers ✅do not elevate fetal head from pelvis to release more amniotic fluid Preterm labor is defined as... - correct answers ✅*Regular uterine contractions* (>4-5/hr) with progressive cervical changes (effacement/dilation) *before 37 wks of gestation* *MCC of perinatal mortality* PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ What degree of dilation & effacement is preterm labor likely? - correct answers ✅2-3cm dilation 80% effacement Besides, nitrazine/pooling/ferning tests what other test can be performed between 20-34 weeks to determine if ROM has occured? - correct answers ✅*Fetal fibronectin* (a protein that keeps amniotic sac "glued" to uterine lining- if found means it *STRONGLY SUGGESTS PRETERM LABOR*) If preterm labor is suspected what tests/tx should be started? (3) - correct answers ✅1. Abx prophylaxis *(Ampicillin → PO Amoxicillin or Azithromycin)* 2. *Betamethasone* (enhance fetal lung maturity if L:S ration <2:1 or <34 wks) 3. Tocolytics: to suppress uterine contraction (given for 48h delay so steroids can take effect on fetal lungs) What tocolytic (supresses uterine contraction in PTL) is 1st & 2nd line in 24- 32 weeks? what about in 32-34 weeks? - correct answers ✅-24-32: 1st line: PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ 4. +/- Abx ________ is diagnosed clinically in postpartum patients with *2 fevers and uterine tenderness* and is mostly seen s/p *c-section* but can also be present s/p vaginal delivery or postabortus - correct answers ✅Postpartum endometritis (polymicrobial infection of the endometrium due to exposure during childbirth) What is the ddx (4)/tx for postpartum endometritis? - correct answers ✅DDx: surgical site infxn, UTI, mastitis, PNA Tx: broad spectrum abx (*clindamycin + gentamicin* OR ampicillin- sulbactam in clinda resistance or if GBS (+)); add ampicillin or vancomycin if fever doesn't resolve in 48-72 hrs -*ampicillin + gentamicin* if after vaginal delivery what are the differences between 1st-4th degree lacerations postpartum? - correct answers ✅-1st deg: skin/mucosa only -2nd deg: extend into perineal body but do not involve anal sphincter -3rd deg: extend into or completely through anal sphincter PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ -4th deg: through anal mucosa (may be a button hole laceration so perform rectal exam) How are 1st-4th degree tears repaired? - correct answers ✅-1st deg: interrupted suture -2nd deg: suture anchored at apex of lac, then through hymenal ring and used to bring together the perineal body; then skin closed with subcuticular sutures -3rd deg: repair anal sphincter w/ severel interrupted sutures, then the rest same as above for 2nd deg -4th deg: repair anal mucosa meticulously to prevent fistula formation, repair rectum, and repair the rest as above w/ 3rd deg *all w/ dissolvable sutures What is the size of the uterus postpartum/puerperium after delivery? After 2 weeks? After 6 weeks? - correct answers ✅-after delivery: @ umbilicus -2 weeks: into pelvic cavity -6 weeks: nml size PAEA OBGYN EOR Topics Study Guide (Latest Update 2024) RATED A+ What is normal discharge/bleeding in the postpartum/puerperium period? - correct answers ✅Especially days 4-10, pinkish brown vaginal bleeding called *lochia serosa* that should cease by *3-4 weeks* postpartum T/F: lactating/breast feeding mothers remain anovulatory - correct answers ✅*true* but still use back up contraception just in case When do regular menses return postpartum? - correct answers ✅6-8 weeks (if not breastfeeding) the pathophysiology of PCOS is from excess/unopposed estrogen which is driven by? - correct answers ✅*increased LH levels* which are driven by *increased insulin levels* what lab/radiology results will a pt with PCOS have? - correct answers ✅-*inc testosterone*, ≥3:1 LH:FSH ratio (nml is 1.5:1), inc lipid panel, in blood glucose, pelvic US with bilateral enlarged ovaries with peripheral cysts aka *"string of pearls"* appearance