5 ⼀PREGNANCY I (BREAST/REPRO) Flashcards

Question

inadequate control of gestational DM ➜ ⬜ and ⬜ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Tx for gestational DM? (4)

Answer 1

fetal macrosomia / shoulder dystocia \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ## Footnote 1st: diet 2nd: **INSULIN** --(alternative)--\> [glyburide vs metformin]

Answer 2

* occurring over years before [true menopause (51 yo)], * **[DECREASING** menstrual bleeding (amount and # of days)] * [Longer Intermenstrual intervals] * vasomotor sx \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *[INCREASED menstrual bleeding] or [shorter intermenstrual intervals] = [endometrial hyperplasia/CA] possible*

Answer 3

Bacterial Vaginosis 1. gray vaginal discharge 2. amine odor after KOH application 3. clue cells on wet mount 4. vaginal pH \>4.5

Answer 4

Bacterial Vaginosis 1. [metronidazole (PO or PV)] 2. [Clindamycin (PO or PV)]

Answer 5

YES - ONLY IF SYMPTOMATIC ; symptom relief \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *unclear if tx ⬇︎ obstetric complications (spontaneous abortion/preterm labor) from BV*

Answer 6

[influenza ***dead*** vaccine]^IM [anti-RhoD IG]

Answer 7

[3T≥28] *TDaP given [3rd trimester ≥28WG] enables [maternal TDaP Ab] transferance thru placenta to baby*

Answer 8

- [Migraine with aura (due to ⇪ stroke risk)] - [SEVERE HTN ≥160/100] - [SMOKING ≥15 cig/day] - [Female age ≥35] - Hypercoagulability (factor 5 leiden/antiphospholipid) - [ACTIVE BREAST CA] - [ACTIVE LIVER disease]

Answer 9

NO TX\<--(-PRG)--[**Female** **Asx bacteriuria**]--(+PRG)--\> [*CAF* abx] 1. [cephalexin x 5d] 2. fosfomycin x 1 3. [amox/clav x 7d] * repeat urine culture 1 week after abx completion to test for cure* * tx should be guided by culture susceptibility*

Answer 10

[⇪ iron demand] paired with inadvertent [*inadequate* maternal iron intake] —> [Pregnancy_IDA] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ microcytic hypOchromic RBC

Answer 11

★ [early pregnancy of undetermined location] occurs when βhCG is 0-3500 = [βhCG discriminatory zone **≤3500**] ★ ★ pregnancy cannot be located/visualized while in [βhCG discriminatory zone **≤3500**].. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ★ ★ ★ ➜{[repeat βhCG q48h] to determine if [INC of βhCG] is c/w normal pregnancy *(normal = ≥35% βhCG INC every 48h)*}

Answer 12

Detrusor hyperactivity 2/2 1. UTI 2. Estrogen deficiency (urethral closure --\> ⬆︎intrabladder pressure --\> urge) 3. Multiple Sclerosis 4. DM | *"Sudden urge to urinate all the time"*

Answer 13

1. DM neuropathy 2. mechanical obstruction | *"Overflow of urine e/b involuntary dribbling"* ## Footnote a.**"Overflow of urine evidenced by involuntary dribbling"** ⼀comes from *Overdistended bladder* b.{**Overdistended bladder** ⼀comes from *[incomplete emptying (⇪PVR)]*} c. -{**[incomplete emptying ( ⇪ PVR)]** comes from 1.⭐[DM ⬇︎Detrusor activity] vs 2.⭐[mechanical obstruction]}

Answer 14

**Menopause ➜ VulvoVaginal atrophy** ➜ pelvic organ prolapse / dyspareunia / [*Urge* Urinary Incontinence] | *"Sudden urge to urinate all the time"*

Answer 15

1st: [Timed Voiding bladder training] + [⬇︎ wt / smoking / etoh / caffeine] 2nd: [Oxybutynin vs Tolterodine (Anticholinergic)] 3rd: [BoTox vs perQ tibial nerve stimulation] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *detrusor HYPERactivity ➜ "Sudden urge to urinate all the time"*

Answer 16

[≤1.9L (or ≤64oz) /day]

Answer 17

Stress | *"Stress transabdominal causes urine leakage!"* ## Footnote 🧠*"Stress transabdomnal^{(cough, laugh, lift, sneeze)} causes urine leakage!" = [⊕Bladder Stress Test]*

Answer 18

1. [Pelvic Organ Prolapse^{*(c/s surgery if good candidate)*}] 2. [Stress urinary incontinence^{*"Stress transabdominal causes urine leakage!"*}]

Answer 19

1. **URETHRAL SLING** 2. **Kegel exercise physical therapy** 3. Vaginal pessary 4. Bladder neck Injectable bulking if etx is related to sphincter deficiency | *"Stress transabdominal causes urinary leakage!"*

Answer 20

1. **symmetrically enlarged TENDER uterus (\> 12 weeks in size)** 2. [^{menstrual and **INTERmenstrual**}Menorrhagia] 3. Dysmenorrhea eventually --\> Chronic Pelvic Pain ## Footnote *etx: glands invade uterine myometrium --\> blood deposition inside myometrium during cycle --\> dysmenorrhea from irregular contractions and menorrhagia from extra deposited blood*

Answer 21

1. Pregnancy/Childbirth 2. Obesity 3. Menopause | *"Stress transabdominal causes urinary leakage!"* ## Footnote *Diagnosed with* *Q-tip urethral hypermobility test*

Answer 22

*"Stress transabdomnal^{(cough, laugh, lift, sneeze)} causes Urine leakage!" = [⊕Bladder Stress Test]* due to: 1. [⇪ Urethral mobility]_{(injury that weakens pelvic floor muscles | urethral prolapse → [⇪ Urethral hypermobility]} 2. or [bladder cystocele] _{can --> bladder prolapse --> vaginal bulge and incontinence)} 3. [⬇︎Urethral tone*^(menopause)*] ## Footnote *Tx = Kegel excercises vs urethral sling*

Answer 23

1. Adenomyosis 2. Endometrial Polyps^{(nonpainful & light)} 3. Endometrial CA^{*(Hyperplasia vs ADC, Older Female)*} 4. Cervical PID 5. Cervical CA

Answer 24

In teen females, [**Upper/Outer SINGLE rubbery mobile breast mass]** that becomes PAINFUL PREMENSTRUATION but RELIEVED POSTMENSTRUATION

Answer 25

1. b/l Breast Fullness 2. b/l Breast Tenderness 3. b/l Breast warmth 4. No Fever Usually occurs 3 days postpartum when colostrum is replaced with milk, but can occur anytime during breastfeeding *Tx = BREASTFEED, Cool compress, APAP, NSAIDS*

Answer 26

* Breast Engorgement is BL without fever and Mastitis is uL WITH FEVER (Breast abscess is Mastitis with fluctuance) * Breast Engorgement is BL and Plugged Ducts is uL

Answer 27

1. NSAIDs for pain/inflammation 2. COMFORTABLE Bra that **avoids nipple stimulation** 3. Cool Compress to breast ## Footnote *Engorgement in and of itself eventually --\> Lactation suppresion on its own due to negative feedback! do NOT breast bind as this causes mastitis. Don't use drugs to treat this.*

Answer 28

1. **1st degree** relative with breast CA 2. Prolonged estrogen exposure (menstruating outside of 12-52 y/o range vs utero DES vs HRT) 3. Genetics (BRCA 1/2 mutation) 4. Alcoholic 5. Obesity 6. Radiation 7. Age 40-70 yo 8. White ## Footnote *Average Menopause onset = 51*

Answer 29

[**CCAFF**] 1. **C**A 2. **C**yst \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 3. **A**bscess \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 4. **F**at necrosis of breast 5. **F**ibroadenoma

Answer 30

1. HTN 2. Breast Tenderness 3. ⬆︎TriAcylGlycerides 4. Bloating with Nausea 5. **Breakthrough bleeding** = **most common (usually with lower estrogen doses)** 6. Venous thromboembolism (Migraine w/aura is a ctd for Combined OCPs) ## Footnote *Wt Gain is NOT a side effect of combined OCPs and OCPS actually ⬇︎risk of Endometrial and Ovarian CA*

Answer 31

Elevated Prolactin (responsible for mammogenesis and galactogenesis) **inhibits GnRH release** --\> anovulation and amenorrhea for ≤ 6 months ## Footnote *after 6 months, even with breastfeeding women will start to ovulate again and even before then, this is not a reliable form of contraception*

Answer 32

**Hyperprolactinemia** **is most common cause of galactorrhea** 1. PROLACTIN levels - Prolactinoma could --\> Hyperprolactinemia 2. TSH levels - hypOthyroidism could --\> ⬆︎TRH & TSH --\> Hyperprolactinemia since TRH stimuales prolactin release 3. PREGNANCY test - Pregnancy could --\> Hyperprolactinemia since TSH shares same α-subunit as bHCG 4. MED REVIEW - D2 blockers/Antidepressants/Opioids all --\> Hyperprolactinemia

Answer 33

1. ⬇︎Breast CA risk 2. adjuvant tx for Breast CA (Tamoxifen) 3. Postmenopausal Osteoporosis (Raloxifene) SIDE EFFECTS A: **Hot Flashes** B: Venous Thromboembolism (all estrogen agonist ⬆︎resistance to protein C) C: Endometrial Hyperplasia/ADC *note: SERMs not only modulate estrogen receptors but they actually block estrogen binding competitively*

Answer 34

Intraductal Papilloma

Answer 35

1. Firm mass after trauma 2. IRREGULAR SHAPED mass 3. overlying erythema ## Footnote *Mammogram: Oil cyst +/- calcifications that appear malignant but has fat globules and foamy macrophages on bx*

Answer 36

Tx =[**KEEP BREASTFEEDING**] + Dicloxacillin + Ibuprofen *drain via needle aspiration if abscess is present*

Answer 37

TMP-SMX Cipro [bladder decompression (via suprapubic catheterization)]

Answer 38

[UA/UCx before prostate massage] → *prostate massage* → [UA/UCx after prostate massage] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **UA** = [pyuria \> 20] + {[ _{(cp/cpps) ⬅︎ ⊝}} (**UCx**?) {^{⊕^{*(bacteriuria ≥10 fold INC after prostate massage)*} ➜ CBP} ] ## Footnote ✏️Urine Culture: [neg = cp/cpps] vs [bacteriuria \> 10 fold increase = CBP] *[cp/cpps = Chronic prostatitis chronic pelvic pain syndrome]* *[CBP = Chronic BACTERIAL Prostatitis]*

Answer 39

[Chronic Prostatitis chronic pelvic pain syndrome] will have **NEGATIVE CULTURE** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *\> 3 month dysuria + pelvic/perineal pain*

Answer 40

UNKNOWN \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Prostate Enlargement Meds (alpha blockers)

Answer 41

EBRT \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *External Beam **Radiation** Therapy*

Answer 42

*24-8WG testing is performed due to [expanding RBC mass] and [insulin resistance from hPL secretion]*

Answer 43

"Mom needs to [**BiPU**^{⑥-⑤- ₄③-②-₁}] before she can (Burp U)" ## Footnote {**BLOOD^⑥** [Hgb|Hct|MCV|ferriTin|(RhoD type / Ab screen)]} {**I****D^⑤** [HIV|HBV|HCV|Syphilis|[chlamydia PCR (if risk factors)]} *(4 Prenatal LAB GROUPS)* {**PX^③** [Rubella immunity|Varicella immunity|Pap (if indicated)]} {**URINE^②** [Cx | dipstick protein]} *(1st Prenatal Labs)* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_x\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *[HBV=HepB Surface Antigen]* | [*HCV=anti-HCV Ab]* | *[Syphilis=VDRL/RPR]*

Answer 44

[2nd/3rd trimester] pregnancy, benign **asymptomatic** [thrombocytopenia\< 70K] that spontaneously resolves after delivery

Answer 45

``` platelet❌ (thrombocytopenia | rapid ⬇︎ platelet) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ``` *this is because [SENA] in the setting of platelet dysfxn → ⇪ risk for [Spinal Epidural **Hematoma**]*

Answer 46

lack of [testicle enlargement to GOE 4cc] **BY 14 Y/O** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *obtain bone radiograph / FSH, LH, testosterone*

Answer 47

1. **Progesterone**^{{ PV ≤ [1st trimester] < IM }} 2. **Cerclage** ## Footnote *PPROM Complications = Chorioamnionitis/Endometritis/CORD PROLAPSE/Placenta Abruptio*

Answer 48

1st best indicator: **PRIOR PRETERM DELIVERY = STRONGEST INDICATOR** 2nd best: [Short cervical insufficiency ≤ 2cm] per transVaginal US (or 2.5 if preterm hx present) - hx of cold knife conization? 3rd best: + Fetal Fibronectin BUT ONLY BETWEEN 20-37WG 4th best: Circumstantial (Smoking, multiple gestation, IVF, obesity)

Answer 49

"***P**regnant **B**itches*" + ## Footnote {(*WW until 34WG delivery*)^{unless [fetal compromise | infxn] → DELIVER STAT}}

Answer 50

"***P**regnant **B**itches **T**ake*" ## Footnote 1. [PCN w/azithro] 2. [Betamethasone] 3. {Tocolytics {(to *WW until 34WG delivery*)^{unless [fetal compromise | infxn] → DELIVER STAT}}}

Answer 51

"***P**regnant **B**itches **T**ake **M**oney*" + ## Footnote {(*WW until 34WG delivery*)^{unless [fetal compromise | infxn] → DELIVER STAT}}

Answer 52

1. observation if asx 2. NSAIDs **1st** 3. Contraceptive (OCP/IUD progesterone) 4. Leuprolide (GnRH agonist that ⬇︎Endometrial gland estrogen stimulation) 5. Hysterectomy with oophorectomy ## Footnote *Findings: Gun Powder Burn lesions, Adhesions, Chocolate fluid* *Dx = Laparoscopy to biopsy endometriotic lesions*

Answer 53

*PPROM patients are at ⇪ risk for* 1. ⚠️[**UMBILICAL CORD PROLAPSE** = OBSTETRIC 911] : [tx = relieve cord compression ➜ Cesarean STAT] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 2.Chorioamnionitis 3.Endometritis 4.Placenta Abruptio

Answer 54

Prolactin inhibits GnRH secretion from hypothalamus ➜ [⬇︎FSH/LH] ➜ [⬇︎ secondary sex characteristics (testicle size/facial hair/libido)]

Answer 55

- [friable exophytic cervical mass] - [irregular vaginal bleeding +/- mucoid vaginal dischage] - postcoital bleeding - ulcerative cervical lesions \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ AIDS DEFINING ILLNESS

Answer 56

▶pelvic surgery ; ▶small vesicovaginal fistula from bladder to vagina ➜ {*continuous nonpainful malodorous* urine leak from Bladder To vagina ▶ [+/- red granulation^{(if small vv fistula)}]} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 57

1.**pregnancy of undetermined location** 2.{in pts with βhCG \< 1500} *(→ warrants [repeat βhCG in 48 hours])*

Answer 58

Retrograde Ejaculation

Answer 59

DM ; Balanitis is a/w high blood glucose

Answer 60

🔲 autoimmune disorder^{(involves anti-Thyroid PerOxidase Ab = variation of hCAT)} that 🔲 within a year of childbirth --\> [brief _nonpainful_ **HYPER**thyroid goiter] --\> 🔲 [brief _nonpainful_ **hypO**thyroid goiter (*may require thyroid replacement if severe*)] 🔲 --\> **Eu**thyroid back to normal | *[Nonpainful Subacute Lymphocytic Postpartum - hCAT]*

Answer 61

*by trimesters* 1st = PropylThioUracil 2ND = METHIMAZOLE 3RD = METHIMAZOLE \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [*PTU = Hepatotoxic] // [Methimazole = teratogenic during 1st trimester]*

Answer 62

🍼newborns born from [gestational DM/maternal DM] have ⇪ risk for excess glycogen deposition in [fetal myocardium] 🍼→ thickened [fetal interventricular septum] = transient HOCM 🍼➜ [Tachypnea + Respiratory distress] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (once natural insulin levels start to normalize ➜ ⬇︎myocardial glycogen deposition) even if newborn has transient HOCM sx... **MOST SPONTANEOUSLY RECOVER BY 3 WEEKS**

Answer 63

[**Exclusive** breastfeeding] **SHOULD BE ENCOURAGED TO ALL**. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Within 1st week of life there is [*EXPECTED* *WEIGHT LOSS (*≤ 10% from birth)] -- so this should not stop [**Exclusve** breastfeeding]!

Answer 64

*[1° amenorrhea] =* [(**13+** yof)_{with still} No❌menstruation] \_\_\_\_\_\_\_\_or\_\_\_\_\_\_\_\_\_ [(**15+** yof^{***with secondary sex ∆***})_{with still} No❌menstruation]

Answer 65

PBP = Pregnant Bells Palsy * Pregnant/Postpartum Patients have INC risk for **PF7BP** * PBP tx = [CTS +/- acyclovir] * PBP pgn = [full recovery ≤3 mo] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *[PF7BP = Peripheral Facial CN7 Bells Palsy]*

Answer 66

[painful erection \> 4h] 2/2 impaired penile blood outflow (out of corpora cavernosa) ➜ irreversible ischemic injury = MEDICAL 911 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - PDE5 inhibitors - [intracavernosal alprostadil injection] - Trazodone - Sickle Cell Disease

Answer 67

[non-R_x( urination, cold compress)] \< *sx 4h* \< [{Corpora Cavernosa aspiration} --(if sx persist)-→ {intracavernosal phenylephrine}]

Answer 68

1. cystitis ≤ 15 yo 2. Spermicide use 3. New sexual partner 4. Postmenopause

Answer 69

postmenopausal woman with new pelvic pain uterine mass ascites metastatsis (pleural effusion) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *tx = hysterectomy*

Answer 70

SERM ; [endometrial hyperplasia/CA and uterine sarcoma CA] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ sx? = (such as *endometrial polyp*?) NO = observation YES = [transvaginal US] ➜ [endometrial biopsy]

Answer 71

Unopposed estrogen --\> uncontrolled endometrial proliferation (CA). Progesterone can regulate proper endometrial differentiation ## Footnote *just remember, estrogen replacement therapy can --\> postmenopausal bleeding on its own*

Answer 72

autoimmune chronic inflammation of [vulva, perineum and anal region] that affects [**hypOestrogenic women (prepubertal and peri/postmenopausal)]** and--\> Vulva SQC \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ THIS DOES NOT AFFECT THE VAGINA! *dx = vulvar punch biopsy*

Answer 73

1. Pruritus SEVERE 2. Dyspareunia 3. White Grayish pale vulva (distinguishes from postmenopausal vaginal atrophitis) 4. Cigarette paper texture vulva (**thin**, crinkled) 5. loss of vulvar anatomy (introitus, labia minora, clitoral hood) ## Footnote *dx = vulvar punch biopsy*

Answer 74

atrophy; vaginal dryness / dyspareunia

Answer 75

menopause wreaks **HAVOC** 1. **H**ot flashes 2/2 vasomotor instability 2. **A**trophy of vagina --\> dyspareunia, urinary incontinence, paleness, narrowed introitus 3. **V**aginal Dryness --\> Pruritus 4. **O**steoporosis 5. **C**oronary artery disease *note: menopause can be 2/2 natural but also chemotherapy, radiation and oophorectomy*

Answer 76

1. **PERSONAL OR FAMILY HX OF OSTEOPOROTIC FX** 2. ⬇︎Estrogen (postmenopause) 3. LOW BMI (malnutrition/malabsorption) 4. Sedentary lifestyle 5. Poor Ca+ intake (body needs 1000mg/day premenopausal and 1200mg post) 6. Smoking 7. EtOH abuse 8. White race 9. CTS

Answer 77

1. natural Menopause 2. Chemotherapy - targets rapidly dividing granulosa/theca cells 3. Radiation - targets rapidly dividing granulosa/theca cells 4. oophorectomy

Answer 78

menopause wreaks **HAVOC** 1. **H**ot flashes 2/2 vasomotor instability 2. **A**trophy of vagina --\> dyspareunia, urinary incontinence, paleness, narrowed introitus 3. **V**aginal dryness --\> pruritus 4. **O**steoporosis 5. **C**oronary artery disease *note: menopause can be 2/2 natural but also chemotherapy, radiation and oophorectomy* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [≥45 yo **with anovulatory bleeding**] *c/f endometrial ADC/hyperplasia*

Answer 79

may cause [mild learning disability] **BUT DOES NOT AFFECT OVERALL INTELLIGENCE** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Most turner syndrome fetuses miscarry within 1st trimester*

Answer 80

1. [**EENT** ⼀(*Strabismus, OME, hearing loss*]^{=renal US} 2. [**CV** ⼀*Aorta_{(Coarctation/Dissection (WORST WITH PREGNANCY)/Dilatation)}, CHD_{(bicuspid aortic valve)}, Metabolic Syndrome X_DIVe]*^{= 4EBP, EKG, echo, GET AORTIC IMAGING} 3. [**Renal** ⼀*Horseshoe Kidney*]^{=renal US} 4. [**Bone** ⼀*Osteoporosis*]^{=DEXA, 25OHvitD} 5. [**autoimmune** ⼀*Celiac, hypOthyroid*]^{=antI-TED, TSH⼀free T4} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ * Most turner syndrome fetuses miscarry within 1st trimester* * 4EBP: 4-Extremity BP*

Answer 81

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Learning disability **WITH NORMAL INTELLIGENCE**] [Lymphedema congenitally of hands/feet from abnormal lymphatic system development] *Most turner syndrome fetuses miscarry within 1st trimester*

Answer 82

a. [Aortic **DISSECTION**^{or rupture}]; b. [pregnancy hormones weaken aortic wall + hyperdynamic state of pregnancy can → Aortic **DISSECTION**]

Answer 83

DM/Obesity--\> Hyperinsulinemia which --\> ⬆︎⬆︎⬆︎LH secretion --\> [⬆︎⬆︎⬆︎ovarian theca Androgen secretion] = **HAG** ➜ _PCOS***APES*** 🔎 1.[**A**ndrogen characteristics^{*(acne, balding, hirsutism)*}] 2.[**P**olycystic Ovaries_{*on US*}] 3.[**E**ndometrial ADC] 4.[**S**terile (infertiity)] ## Footnote 🔎 [ **HAG** *(**HYPERandrogenemia**)*] → \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1.[**A**ndrogen characteristcs^{*(acne, hirsutism, balding)*}] 2.{[**P**olycystic Ovaries_{*on US*}] ^{2/2 [⬆︎Estrone _{*(from ⇪ conversion of Androgen)*}] →*(estrone neg feedback on hypOthalamus)*--\> ⬇︎GnRH → ⬇︎FSH → ⬇︎follicle maturation → (FOLLICLE ATRESIA) → Polycystic Ovaries and Ovarian enlargement}} 3.[**E**ndometrial ADC_{(FOLLICLE ATRESIA) also → ⬇︎progesterone → (io\unopposed Estrone) → endometrial ADC)}] 4.[**S**terile (infertility)_{(FOLLICLE ATRESIA → Anovulation = Amenorrhea = Sterile_Infertile)}] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_x\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *tx = Wt loss ➜ **SOCK*** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Note: if pt has high levels of sex hormone binding globulin, total testosterone may be low. so clinical dx may be necessary*

Answer 84

[Wt loss--\> **SOCK**] ## Footnote **S****OCK**:**S**pironolactone,**O**CP (1st line after wt loss),**C**lomiphene for infertility,**K**etoconazole \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *etx: DM/Obesity--\>Hyperinsulinemia which --\> ⬆︎⬆︎⬆︎LH secretion --\> ⬆︎ovarian theca Androgen secretion --\> **APES**

Answer 85

**⬇︎TONE** of Uterus \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [bimanual uterine massage] and [Oxytocin (causes uterine contraction)] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *2nd line uterotonics = methylergonovine/carboprost/misoprostol*

Answer 86

[**ANOVULATION**^{*(self-limited up to 2 years post menarche)*} ] 2/2 immature [hypothalamic-pituitary-ovarian axis] ## Footnote [Observation^{*since (self-limited up to 2 years post menarche)*} ] ➜ [OCP if severe]

Answer 87

*(_combined estrogen & progesterone)_* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *BENEFICIAL✔︎ effects =* [DEC 🔲] 1. [***HAVOC***_{Menopause sx}] 2. Osteoporosis 3. Colon CA 4. T2DM 5. [All-Cause Mortality if \< 60 yo]

Answer 88

*(_combined estrogen & progesterone_)* ***DETRIMENTAL❌**effects (with higher risk in Women GOE60yo) =* 1. **STROKE**⭐ 2. **CAD**⭐ 3. **Breast CA** 4. **Gallbladder disease** 5. **Venous Thromboembolism** | ⭐= emphasized ^{{ low✔︎risk < [60 yo] ≤ HIGH⚠️RISK }}* ## Footnote ^{*(Stroke is low risk for Women < 60 yo → MHT relatively safe for Women < 60 yo)*}

Answer 89

*MHT (_combined estrogen & progesterone)_* ❌These MHT Detrimental effects are Higher /more clinically concerning in [Women GOE60yo]. ❌MHT Stroke risk in Women \< 60 yo is low = MHT can be used safely for short period in [Women \< 60 with low risk].

Answer 90

**GONOCOCCAL** conjunctivitis \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *does NOT treat chlamydia conjunctivitis*

Answer 91

*Annual Gonococcal and Chlamydia Screening (via vaginal/cervical NAAT) for:* ## Footnote Women: {_{*AGC* ONLY IF}SEXUAL \<-- **[AGE 25]**==> _{*AGC* ONLY IF}***HIGH RISK*** SEXUAL} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Men: Insufficient evidence :-(

Answer 92

▨ [Mucopurulent cervical discharge] + [Cervical Motion Tenderness] + [Abd Pain] + Fever \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ⊙ [ceFOXitin + DOXy] *covers N.Gonorrhoeae, Chlamydia trachomatis, [Vaginal Flora =E.Coli/Mycoplasma]*

Answer 93

## Footnote ✳^{*(either via ⇪ estrogen production or ⇪peripheral conversion of androgen to estrogen)**}

Answer 94

1.GnRH🟢*^{(⬇︎androgen production )}* 2. Ketoconazole*^{( ⬇︎androgen production )}* 3. [5α reductase-inhibitor*^{( ⬇︎peripheral conversion to DHT)}*] 4. Spironolactone*^{( androgen 🟥)}* 5. Bialutamide*^{( androgen🟥)}* | Rx = medication effect

Answer 95

① _Rx⼀Spironolactone \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ② Spironolactone has 2 MOA 1. [aldosterone🟥] for HFrEF 2. **[androgen🟥]** *also, which ➜ [⬇︎androgen effect] ➜ pathologic gynecomastia in men* | Rx = med effect ## Footnote _{*[spironolactone-induced pathologic gynecomastia] tx = switch to Eplerenone (has less androgen R blockade)*}

Answer 96

① _Rx⼀Spironolactone^{*(Spironolactone is an [Aldosterone🟥 & Androgen🟥]*} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ② tx = switch to Eplerenone^{*(has less [testosterone androgen] R blockade)*} | *Ketoconazole inhibit testes from secreting [testosterone androgen])*

Answer 97

-P _hG is a benign glandular proliferation of male breast tissue occurring 2/2 _[2 ⼀component hormone imbalance_] -*especially in overweight/obese*, -1st component = [**DEC** testicular **testosterone** (*with normal aging*)] and -2nd component = [**INC** adipocyte (androgen → **estrogen**) (*with Obesity*)]

Answer 98

TRUE \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *physical exam is only required for _complicated_ cystitis (fever, chills, flank pain, CVA TTP = pyelonephritis) and urine cx if initial tx fails* ## Footnote _{{[**CAN** **F**osfomycin **C**ontrol] **B**asic **U**ncomplicated **C**ystitis ??}}

Answer 99

[**CAN** **F**osfomycin **C**ontrol] **B**asic **U**ncomplicated **C**ystitis ?? 1. **C**ephalexin (*Pregnancy*) 2. **A**moxicillin-clavulanate (*Pregnancy*) 3. **N**itrofurantoin (*Pregnancy*) 4. **F**osfomycin (*Pregnancy*) 5. **C**eftriaxone (*Pregnancy and PYELO*) 6.[**B**actrim (*2nd trimester only*) - *[1TM➜ NTD] & [3TM ➜ kernicterus]*] 7.**U**rine Cx *only if initial Tx fails* 8.**C**ipro *(fluoroquinolone if 1-6 can't be used)*

Answer 100

1st: PPP? ➜ = [Complicated cystitis (obtain PEx, & UCx before tx)] 2nd: Pregnant? ➜ [**CAN** **F**osfomycin **C**ontrol]^3-7d 3rd: [Pills: ^{Preferred abx? NKDA?}]: [Uncomplicated cystitis ([**CAN** **F**osfomycin **C**ontrol] **B**asic **U**ncomplicated **C**ystitis) ] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PPP: Pyelo|Pervasive Systemic illness|Pelvic MALE pain

Answer 101

*empiric* ["**CAN F**osfomycin **C**ontrol]^3-7d \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 102

[**CAN** **F**osfomycin **C**ontrol]^3-7d 1. **C**ephalexin (*Pregnancy*) 2. **A**moxicillin-clavulanate (*Pregnancy*) 3. **N**itrofurantoin (*Pregnancy*) 4. **F**osfomycin (*Pregnancy*) 5. **C**eftriaxone (*Pregnancy and PYELO*) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [**B**actrim (*2nd trimester only*) - *[1TM➜ NTD] & [3TM ➜ kernicterus]*] ***U**rine Cx only if initial Tx fails*

Answer 103

**[_PPP**Complicated Cystitis**]** **P**yelo? (Fever, Flank/CVA) **P**ervasive Systemic illness? **P**elvic MALE pain \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *_[**__PPP_**Complicated Cystitis]_ ➜ [Obtain (Physical Exam) and (UCx before tx)]*

Answer 104

**P**yelo? | **P**ervasive Systemic illness?| **P**elvic MALE pain \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ▶*_empiric*Outpatient: [Cipro*_{Fluoroquinolone}*] ▶*_empiric*Inpatient: [Ceftriaxone | PipTazo | imipenem] ▶PEx ▶[UCX before empiric tx → tailored abx]

Answer 105

**SHORT** * * * [**AMENORRHEA**1º \> 2º] =Turner syndrome causes [streak ovaries gonadal dysgenesis] = 1º ovarian insufficiency → [DEC **PiE and T** (which DEC feed back on hypothalamus/ANT PIT)] → Elevated FSH & LH \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ***PiE\_T:** **P**rogesterone/**i**nhibin/**E**strogen _ **T**estosterone* * * * [**hyPOPUBERTAL** *(pubertal arrest I.e. Tanner³ instead of Tanner⁵at 18yo)*]

Answer 106

[uL nonpainful ovoid testicular swelling] → [**BL scrotal US** : solid lesion]→ [Tumor markers^{(AFP, bHCG)} and CT staging] = [**CHEMO** + **RADICAL INGUINAL ORCHIECTOMY_Dx**_and**_Tx**]^{95% 5y Survival}

Answer 107

venous embolization *“bag of worms”*

Answer 108

1. Because Prostate CA is typically indolent = men with prostate CA usually die from other causes 2. Prostate CA screening with PSA can be used [age 55-69] but absolute benefit is small 3. Screening _NOT_ recommended _external to [age 55-69]_ 4. Screening _NOT_ recommended _[life expectancy\<10y]_ 5. *\*\*1-3 does **NOT** apply to [HIGH RISK DEMOGRAPHICS^{Black, fam hx, symptomatic men}]*

Answer 109

▶[Pelvic radiation (CA tx)] commonly → Primary Ovarian Insufficiency = Amenorrhea \< 40 yo = premature menopause ▶Tx = ^{PO/Transdermal}[Estrogen (+progestin if uterus present) HRT]*^{until 51 yo}* * * * ▶[Estrogen HRT] ⬇︎ [hypOestrogen sx^{hot flashes/vaginal dryness} & bone loss] and should be used until [nml menopause age 50]. ▶We stop HRT at [nml menopause age 50] because *post*menopause estrogen HRT has INC risk for VTE *unopposed estrogen causes endometrial CA*

Answer 110

⼀[*post*menopause e^(p)HRT] has [INC vascular^{VTE & CAD} risk] = NOT RECOMMENDED * * * ⼀[(*pre*menopause POI) e^(p)HRT]\*\* DEC hypOestrogenic menopause sx but has substantially DEC vascular risk = RECOMMENDED * * * e^{(p) :}[estrogen (+ **P**rogestin in **P**resence of uterus)] [**E**strogen unopposed → **E**ndometrial CA] so.. [**P**rogestin added in **Presence of a Uterus**] \*\*

Answer 111

a. ⇪ Prolactin suppresses GnRH → ⬇︎LH → ⬇︎E2 . - No LH surge = no ovulation = amenorrhea and infertility * * * b. 📸

Answer 112

{[Cabergoline v Bromocriptine*_{(dopamine R agonist)}*] = inhibits prolactin secretion → ⬇︎Prolactinoma size} --*(if fails)*--\> Surgery

Answer 113

MOM = [TRIPLE ANTIRETROVIRAL THERAPY] THROUGHOUT PREGNANCY \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ newborn = Zidovudine ≥ 6 wks \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *viral load/CD4 count labs q 3 months*

Answer 114

Vaginal Delivery ≤ 1000 HIV copies \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *\> 1000 copies = C Section*

Answer 115

a. ▩**rare** complication of ovulation induction. * * * b. ▩: hCG injections ^{(which artificially mature follicles in IVF)} can sometimes ➜**BILATERAL OVARY ENLARGEMENT FROM TOO MANY MATURED FOLLICLES** * * * c. ▩ACCOMPANIED with ovaries **overexpressing** [Vascular Endothelial Growth Factor] = [INC Ovarian VEGF] ➜ INC capillary permeability ➜ abd 3rd spacing ➜ [ascites/effusions/electrolyte imbalance] * * * d. ▩➜ eventually hypOvolemic shock, renal failure, hemoconcentration, hypercoagulability, DIC, death

Answer 116

[(***P**regnant^{(+azithromycin)}*) ***B**itches **T**ake **M**oney*] + [*Watchful Wait until 34WG Delivery* \*] ## Footnote **Watchful Wait^{fetal surveillance} until 34WG Delivery*^{(unless fetal compromise|infxn → STAT DELIVERY)}

Answer 117

[(***P**regnant^{(+azithromycin)}*) ***B**itches*] * * * 1. Premature closure of ductus arteriosus 2. Oligohydramnios

Answer 118

[(***P**regnant^{(+azithromycin)}*) ***B**itches*] * * * Maternal hypOtension with reflex tachycardia

Answer 119

[(***P**regnant^{(+azithromycin)}*) ***B**itches*] * * * Magnesium is a **weak tocolytic** so it doesn't actually help with slowing contractions down in preterm delivery

Answer 120

[**p**|**a**|**c**] ; ≥**4** ## Footnote **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** [**p**|**a**|**c**]= [**p**CN *_or ***a**mpicillin *_or* **c**eFAZolin]

Answer 121

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ***PRE**partum**:** must give* [**p**|**a**|**c**] *abx [intrapartum ≥4h before delivery]* ## Footnote **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** [**p**|**a**|**c**]= [**p**CN *_or***a**mpicillin *_or* **c**eFAZolin]

Answer 122

≥10WG ; [Advanced Maternal age \> 35 yof] ; [higher risk of chromosomal abnormalities in this group] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **PEDS** 1. [**P**ateau trisomy 13] 2. [**E**dwards trisomy 18] 3. [**D**own syndrome trisomy 21] 4. [**S**ex Chromosome aneuploidies*^{(Klinefelter, XXX)}*]

Answer 123

[Cesarean^{*(1a.if _NPT_ too small ( < 1500 g ) or 1b.NPT too big ( wt ≥ 20% PT wt ) → Csxn)*}] vs 2.{[Vaginal]- *if (⊝CSxn criteria) and (⊕MDexperience)*} * * * ## Footnote ***NPT:N**on**P**resenting**T**win | **PT**: **P**resenting**T**win*

Answer 124

**inadequate uterine contractions \< every 3-5 min** *labor protraction*

Answer 125

aneuploidy; [(**BNP** - (**β**HCG/**N**uchal translucency/[**P**regnancy associated plasma protein A]) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ confirmation by [chorionic villus sampling] or amniocentesis *to evaluate fetal karyotype*

Answer 126

endometrium or myometrium \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ RF = tamoxifen vs pelvic radiation

Answer 127

GnRH agonist ➜ temporary amenorrhea ➜ ⬇︎Leiomyoma size and ⬇︎vaginal bleeding

Answer 128

**A**ppearance, **P**ulse, [**G**rimace^{(reflex irritability})], [**A**ctivity^(tone)], **R**espiration * * * **1** and **5** min postpartum, [score 0 to 2 pts] each [0-2 = Critical] | [3-6 = fair: PPV] | [7-10 = normal: No intervention]

Answer 129

**A**ppearance, **P**ulse, [**G**rimace^{(reflex irritability})], [**A**ctivity^(tone)], **R**espiration Performed at **1** and **5** min postpartum, All scaled from 0 to 2 and then added together [0-2 = Critical] | [3-6 = fair: PPV] | [7-10 = normal: No intervention]

Answer 130

*same as non-pregnant asthma exacerbation except:* **O**yxgen to SaO2 ≥95%^{(nonpregnant ≥90%)} ## Footnote *short term CTS benefit \> minor risk in pregnant patients*

Answer 131

***C**an **M**om **F**eel **B**aby?* **C**ontractions? **M**ovement from Fetus? **F**luid leaking vaginally? **B**lood leaking vaginally?

Answer 132

**M**others **L**oathe **N**efarious **H**TN **M**ethyldopa | **L**abetalol \> **N**iFedipine | **H**ydralazine

Answer 133

1. **Amnisure** immunoassay (detects placental ⍺-microglublin1) 2. POOL test (there's pool of fluid in vaginal vault) 3. NITRAZINE test (fluid turns blue when placed on nitrazine paper since amniotic fluid is **alkaline**) 4. FERN test (fern-like estrogen crystals under microscopy) 5. US to determine fluid quantity (Normal = 6-23 cm AFI)

Answer 134

*SEVERE NVP = HYPEREMESIS GRAVIDARUM* *\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*

Answer 135

* SEVERE NVP = HYPEREMESIS GRAVIDARUM* * \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*

Answer 136

d/c antiHyperglycemic therapy after delivery ➜ At [6-12 wk postpartum] = [**2**H oral glucose tolerance test] (due to ⇪ DM2 risk) ## Footnote _{💡 2H^{*(instead of 1H)*} is used during [*gestational* DM] POSTpartum course --- to ensure resolution of *gestational* DM}

Answer 137

1. **PRETERM DELIVERY** 2. low birth wt 3. perinatal Mortality 4. [Maternal anemia] 5. [Maternal Preeclampsia] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Inadequate nutrition and physiologic immaturity

Answer 138

≥3 | [**≥3** consecutive *< 20WG* spontaneous abortions]

Answer 139

[0.4 (or 4 IF HIGH RISK) mg daily] of [**folic acid B9**] ; ≥1 month \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *high risk = antiepileptics / prior NTD pregnancy*

Answer 140

[PRIOR UTERINE SURGERY (CSection/myomectomy)] Trauma Macrosomia abnl placentation

Answer 141

**intermenstrual** vaginal bleeding ## Footnote _{*🧠other causes of intermenstrual bleeding= Adenomyosis, Endometrial CA, Cervical PID, Cervical CA*}

Answer 142

❌ **[Eisenmenger syndrome] is a contraindication for Pregnancy** since VSD/HF→ high maternal mortality rate and poor fetal pgn ❌[_{Eisenmenger syndrome}] pregnancy should be avoided/terminated

Answer 143

{**Moderate exercise [**(**30**_min **qd**) x **≥4d/w**]}^{*([Healthy Uncomplicated Pregnancy] only)*} | *yoga/walking/running/light strength training/swimming*

Answer 144

Cervical CA (2/2 lower HPV vaccination rates than hetero) and Bacterial Vaginosis (2/2 greater exchange of vaginal secretions than hetero)

Answer 145

1. Asx 2. Mucopurulent discharge 3. Postcoital bleeding 4. intermenstrual bleeding 5. Friable cervix

Answer 146

the fetus completely depends on maternal thyroid hormone for brain development up until 12WG when fetal thyroid gland forms

Answer 147

[⇪ baseline Levothyroxine dose] at time of pregnancy detection then [get TSH q4 wks ➜ Levothyroxine dose adjusted per trimester]

Answer 148

1. 1st trimester, fetal βhCG stimulate maternal TSH receptors ➜ [⇪ maternal T3/T4 **production**] (*but remember, this INC T3/T4 feed back on ANT Pit ➜ low TSH 1st trimester*) and 2. elevated maternal estrogen ➜ [⇪ thyroxine binding globulin] ➜ [⇪ binding sites for T4 to travel on] ➜ [⇪ TOTAL (not free) maternal T4 **available**] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *(hypOthyroid patients wont be able to INC maternal T3/T4 production ➜ requires INC exogenous dose/Levothyroxine )*

Answer 149

**MULTIPLE SEX PARTNERS** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *other RF = [age 15-25], previous PID, inconsistent condom, partner with STI*

Answer 150

≥3 mo idiopathic raw burning vulvar pain \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Tx = [pelvic floor physiotherapy] and CBT

Answer 151

gestational DM PreEclampsia Cesarean ## Footnote _{{*Moderate* Exercise = ^{*(yoga/walk/run/ lite🏋/swim)*}[(**30**_min **qd**) x **≥4d/w**]}^{*([in Healthy Preg only] )*}}

Answer 152

1. [short cervical insufficiency ≤2cm] 2. underlying comorbidity preventing exercise 3. active vaginal bleeding

Answer 153

benign fluid filled mass 2/2 breast duct obstruction \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 154

1. Cervical Conization 2. Uterine abnl 3. Prior obstetric trauma 4. congenital (intrauterine DES exposure, collagen abnl) | [*Short* cervical insufficiency ≤ 2cm]

Answer 155

1. [unique **hand** gestures] 2. [**micro**cephaly with developmental regression] 3. [**seizure** DO (epilepsy)] *"can't fux with Rett's _hands_... theyll give you _micro_ _seizures_"*

Answer 156

**PREVIOUS SPONTANEOUS ABORTION** [Maternal Age \> 35] [Maternal Substance Use] [BMI extremes]

Answer 157

1.[long & reversible] 2.Thickens cervical mucus^{( → blocks sperm entry)} 3.[⬇︎menstrual bleeding^{(nml and anticoagulated pts)} by thinning uterine lining] 4.used in pts with contraindication to estrogen OCP

Answer 158

✔︎ [long & reversible] ✔︎ [toxic to sperm and ova^{(endometrial inflammation)}] ✔︎ [Most effective **Emergency** Contraception^{(administer ≤5d from sexual intercourse)}] *❗️⇪ menstrual bleeding* *❗️ ⇪ dysmenorrhea*

Answer 159

**▶NOT reversible** ^{(only indicated in pts finished with childbearing)} ▶does NOT help menorrhagia

Answer 160

reproductive ; [uL pelvic pain + tender adnexal mass] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Pelvic Ultrasound with color Doppler] *(will show enlarged edematous ovary with ⬇︎blood flow)*

Answer 161

enlarged **irregularly** shaped uterus menorrhagia dysmenorrhea mass effect (constipation/pelvic pressure/urinary sx)

Answer 162

[Levonorgestrel_ProgestinIUD] *Reversibly* induces endometrial atrophy ➜ thins uterine lining = [⬇︎ (leiomyoma fibroid) size] and [⬇︎ uterine bleeding] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Combined OCP]

Answer 163

2nd or 3rd trimester [Flank pain that radiates to labia + NV] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ dx = renal/pelvic US

Answer 164

After Bariatric Surgery, **Delay Pregnancy x 1 year** to optimize wt loss and nutrition

Answer 165

[estimated fetal **wt \< 10th%tile** for gestational age]; STILLBIRTH \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Serial Antenatal testing]

Answer 166

determines risk of preterm delivery in patients with preterm contractions

Answer 167

high risk procedure that samples fetal blood to confirm severe fatal anemia (hydrops fetalis)

Answer 168

If mother receive adequate abx (PO amoxicillin | PO ceFUROxime) = NO ⇪ FETAL RISK

Answer 169

1. Fetal Open Neural Tube Defects (open spina bifida, anencephaly) 2. Fetal Abd Wall defect (Gastroschisis, Omphalocele) 3. Multiple gestation (twins) *If ⬆︎AFP --\> GET ANATOMY US!*

Answer 170

Measures 4 chemical markers for fetal anomalies and down syndrome- 81% accuracy (QUAD = **BUAD**): 1. **β**HCG⇪ 2. **U**nconjugated EsTriol⬇︎ 3. **A**FP⬇︎ 4. **D**imeric inhibin A⇪ - *only in QUAD screen* Performed 15 -20WG *Be sure to f/u abnml results with [Cell-free fetal DNA test^(PEDS)] and US*

Answer 171

⬇︎βHCG ⬇︎**U**nconjugated EsTriol ⬇︎**A**FP NML **D**imeric inhibin A

Answer 172

Maternal; [Fetal Yolk Sac] / GI /Liver \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 15-20 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Quad BUAD screen *if AFP \> 2.5 ➜ get anatomical US!*

Answer 173

[**IUD** or **subdermal implants**] = RELIABLE, RISK-LOW , REVERSIBLE ## Footnote *long acting reversible contraceptives*

Answer 174

although [AntiEpileptics Drugs] (especially valproate) are INC risk for congenital anomalies DO NOT MAKE CHANGES TO AED **AFTER** CONFIRMATION OF PREGNANCY Instead ➜ start pt on [high dose folic acid] + [obtain AFP with anatomical US] to screen for congenital anomalies

Answer 175

FALSE \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ## Footnote *Moms CAN breastfeed while on [AntiEpileptic Drugs]*

Answer 176

**BITCHES** *can NOT breastfeed!* 1. [**B**reast has HSV lesions] 2. [**I**nfant has galactosemia] 3. **T**B untreated 4. **C**hemoradiation 5. [(**H**IV^⊕) | (*HBV*^⊕^*⚠️*)]_maternal 6. _varic**E**_lla active 7. **S**ubstance abuse_maternal ## Footnote ⚠️*HBV^⊕ mom **can NOT** breastfeed unless newborn receives _both_ HBV Immunoglobulin and HBV vaccine*

Answer 177

(**PALM COINE**)_{(see image)} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ * HDS*: [**HIGH DOSE ESTROGEN** combined OCP] * NPO|Refractory*: [Estrogen IV] * HD**U**S*: [D&C (surgical endometrial removal)] | *🄴strogen ["_e_nlarges" (builds/fixes)] EMT* ➜ hemostasis

Answer 178

▩a1. Menses normally occurs when corpus lutem^{*(a byproduct after ovulation)*} produces 🄿rogesterone and when this 🄿 drops --\> [Menses shedding]. ▩a2. **immaturity of [hypothalamic-pituitary-gonadal axis**^{(common around menarche)}] --\> inadequate GnRH --\> low FSH ^{*(although enough to stimulate 🅴strogen secretion)*} and low LH^{⭐**( →anovulation)**⭐} ▩a3. **NO ovulation --\> No** [**_{corpus luteum}🄿rogesterone**] to (rise and fall) **→ [NO menses shedding]** ▩a4. [NO menses shedding] io\ *unopposed* [EMT 🅴 "enlargement"] .. ➜ accumulated EMT (eventually) ➜ breakthrough bleeding = ⭐**irregular heavy menstruation**⭐ | 🔎EMT = Endometrum ## Footnote *"🄴strogen (**_e_**nlarges) EMT"*^{(= proliferates and repairs EMT ➜ EMT growth & hemostasis)} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *"🄿rogesterone (**_p_**repares, **_p_**rotects, **_p_**eels) EMT"* ^{=

🄿Rise ➜ **_p_**repares EMT⼀for fertilized egg implantation via decidualization

🄿Level ➜ **_p_**rotects EMT ⼀from error during [estrogen-based enlargement]

🄿Fall ➜ **_p_**eels EMT⼀ via sloughing ➜ [menses shedding]} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Tx = 1. [Progestin-only|Combined OCPs]^{to supplement deficient 🄿} 2. self-limited to 1-4y post menarche* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_x\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ _{**immaturity of hypothalamic-pituitary-gonadal axis** --\> inadequate amounts of GnRH --\> low FSH and LH --\> lack of ovulation --\>No [**_{corpus luteum}progesterone**] for shedding = [No Menses = _Anovulation_] → eventually *(because estrogen still proliferates/repairs Endometrium)* [accumulated cycle-anovulation] eventually → estrogen breakthrough bleeding = _irregular heavy_}

Answer 179

syncytiotrophoblast ; [8 days after fertilization] 1. βhCG **preserves corpus luteum**^{(which secretes progesterone during early pregnancy until placenta takes over)} 2. _{*(because βhCG shares same α subunit as TSH)*}[βhCG stimulates maternal thyroid^{(→ ⇪ TOTAL T4/T3 secretion)}] 3. βhCG promotes male sex differentiation

Answer 180

``` 🄿rogesterone ``` **_P_**repares EMT^{⼀for fertilized egg implantation via decidualization} | *🔎EMT = endometrium* ## Footnote _{"🄿_rogesterone (**_p_**repares, **_p_**rotects, **_p_**eels) EMT" =

🄿Rise ➜ **_p_**repares EMT⼀for fertilized egg implantation via decidualization

🄿Level ➜ **_p_**rotects" EMT ⼀from error during [estrogen-based enlargement]

🄿Fall ➜ **_p_**eels EMT⼀ via sloughing ➜ [menses shedding]}

Answer 181

🅴_strogen | *🔎EMT = endometrium* ## Footnote *"🅴strogen (**_e_**nlarges) EMT"*^{(= proliferates but repairs EMT ➜ EMT growth & hemostasis)}

Answer 182

🄿_rogesterone

Answer 183

Physiological widening of pelvis by [🄿_rogesterone and relaxin]^{*(to facilitate vaginal delivery)*} ## Footnote ✔︎ [**POSTPartum suprapubic TTP]** _that a.*radiates to Back and/or Hips* b.*worst with weight bearing, walking or position change* c.*self-limited to 4 weeks POSTPartum*

Answer 184

*"**T**he **3D**s **I**sn't **A**ll endometriosis"* 1. **T**TP along UteroSacral ligament 2. **D**ysmenorrhea^💊 3. [**D**yspareunia deep pelvis^{*posterior cul-de-sac implants*}]^💊 4. [**D**yschezia (painful defecation)^{*posterior cul-de-sac implants*}]^💊 OR 5.**I**nfertility of unknown origin OR 6.**A**SX^🚫💊 | *"**T**he **3D**s **I**sn **A**ll endometriosis"* ## Footnote *Findings: [*Gun Powder Burn* lesions], ADHESIONS--\>immobile uterus, Chocolate fluid* *Dx = Laparoscopy to biopsy & remove endometriotic lesions* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_x\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ▶{[🚫💊_*tx*🚫] = no tx indicated} ▶{💊_*tx* = [NSAIDs --\> (combined OCP|IUD progesterone)]}

Answer 185

Endometriosis | **T**TP along UteroSacral ligament ## Footnote *"**T**he **3D**s **I**sn't **A**ll Endometriosis"*

Answer 186

[Amoxicillin or Cephalexin **STAT**] + [**p**|**a**|**c**] *abx [intrapartum ≥4h before delivery]* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | *pregnant patients require abx STAT to stop progression to upper UTI* ## Footnote [[**p**|**a**|**c**]= [**p**CN *_or ***a**mpicillin *_or* **c**eFAZolin] **intrapartum**]

Answer 187

Clobetasol ointment (high potency topical CTS) ## Footnote *dx = vulvar punch biopsy*

Answer 188

DO THIS FOR ALL Rh NEGATIVE mothers 1. 50mcg 1st trimester **if uterine bleeding and/or spontaneous abortion occurs** 2. **300mcg at 28 WG** 3. **[300 mcg within 3 days after delivery** **(*if infant RhD+)*****]** 4. give with any episodes of vaginal bleeding (if indicated) 5. give with External Cephalic Version 6. give with Hydatidiform Mole dx 7. give if Ectopic Pregnancy occurs

Answer 189

folic acid blocker \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. liver disease (DEC MTX clearance) 2. renal disease (DEC MTX clearance) 3. ruptured ectopic (free fluid in posterior-cul-de-sac) 4. immunodeficiency 5. high failure probability (fetal cardiac activity, βhCG\>5000 )

Answer 190

positive UPT + HDuS hemoperitoneum \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 191

**Irregular breakthrough bleeding** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *2/2 thin atrophic endometrium that sheds UNEVENLY*

Answer 192

Oligohydramnios --\> **POTTER** Sequence 1. ARPKD 2. BL Renal agenesis 3. Obstructive Uropathy**^{POSTERIOR URETHRAL VALVES}**^{are the most common cause of obstructive uropathy in newborn}**^BOYS**^{(which causes renal damage --> oligohydramnios during utero)}

Answer 193

Oligohydraminos --\> **POTTER** Sequence **P**ulmonary hypOplasia [**O**ligohydraminos ^{*2/2 RENAL FAILURE 2/2 RENAL AGENESIS/ARPKD/Obstructive Uropathy*}]^{ultimately → POTTER} [**T**wisted Face & Extremities] **T**wisted Skin **E**ars set low **R**ENAL FAILURE^{*2/2 Renal AGENESIS/ARPKD/Obstructive Uropathy*}

Answer 194

For *Uterine Contractions*... FALSE = 🅵irregular^*timing* + 🅵weak^*strength* + 🅵 [NO ∆]^*cervix* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ True = 🅃[Regular with **INC frequency**]^*timing* + 🅃[**INCREASING** ^*strength*] 🅃[ [✅∆]^*cervix* | [False *"Braxton Hicks"* Labor] produces NO CERVICAL CHANGE

Answer 195

|[**p**cn|**a**MPicillin|**c**eFAZolin] ❗️Must give [**PRE**partum ***p|a|c***] abx [intrapartum ≥4h before delivery] to ## Footnote [(GBS**+**)] \_\_\_\_\_\_\_\_and/or\_\_\_\_\_\_\_\_ [(GBS_**unknown**) *and has (GOE1 risk factor^{{[ <37WG] | [maternal intrapartum fever] | [Prolonged Rupture of Membrane ≥18H]}*})]

Answer 196

**Head Compression** of Fetus ## Footnote *these occur WITH contractions and no tx is required*

Answer 197

abnml blood collection between [Uterus chorion] and gestational sac that presents as 1st trimester bleeding or incidental US finding \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Expectant (serial US for reassurance) ## Footnote 📝*can result in placental dysfunction ➜ sPontaneous abortion/placenta abruptio/PPROM/preeclampsia/preterm labor/IUGR/IUFD*

Answer 198

sPontaneous abortion/ placenta abruptio/ PPROM/ preeclampsia/ preterm labor/ IUGR/ IUFD \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *subchorionic hematoma can result in placental dysfunction and ➜ (above)*

Answer 199

5 ; [**COPPER IUD**] ; [Ulipristal_{AntiProgestin}]

Answer 200

[PSI_{(Progestin Subdermal Implant)}^{*r3 year*}] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ progesterone 1. thickens cervical mucus and ⬇︎tubal motility ➜ inhibits sperm migration 2. ⬇︎ [FSH and LH secretion] ➜ stops ovulation | [PSI-Progestin Subdermal Implant (long-acting + reversible)]

Answer 201

1. ≥300 mg protein on 24 hr urine OR 2. ≥ 30 mg/dL on dipstick OR 3. At least 1+ on dipstick **OR** 4. **Protein:Creatinine ratio \> 0.3** | *Must occur at least 2 times at least 6 hours apart*

Answer 202

GOE 20WG! ; \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Since Preeclampsia is a possible complication of Hydatidiform mole ⼀and Hydatidiform mole may occur < 20WG ➲ *Preeclampsia can be diagnosed < 20WG **only** when that Preeclampsia is a complication of Hydatidiform mole* | "_{*Hydatidiform Mole is*} **HEAVY**!"

Answer 203

^{*PreEclampsia plus*}ANY **ONE** OF THE FOLLOWING: 1. Systolic \> 160 2. Diastolic \> 110 3. [**refractory** HA]^{*+/- HYPERreflexia*} 4. [scotoma vision ∆] 5. [Pulmonary Edema (from ⬇︎albumin)] 6. [RUQ OR Epigastric pain] 7. [Doubling of LFTs] 8. [Platelets \< 100K] 9. [Cr \> 1.1 or doubled from baseline] | *although not criteria, [SEVERE PreE] may also p/w HYPERreflexia* ## Footnote _{**PreEclampsia** --\> **SEVERE PreEclampsia** --\> **HELLP** and at anytime, **Eclampsia** is possible}

Answer 204

"_{*Hydatidiform Mole is*} **HEAVY**!" 5._**HEAVY**Preeclampsia^{(***Severe Preeclampsia***)} 4._**HEAVY**Thyroid^{(***HYPERthyrodism***)} 3._**HEAVY**Vomiting^{(***Hyperemesis Gravidarum***)} 2._**HEAVY**Uterus ^{(*Uterus larger than expected gestational age **but with regular countour***)} ⭐1. [_**HEAVY****VAGINAL BLEEDING.** ]⭐ ## Footnote HHIIGH LEVELS OF bHCG (\> 100,000) *Most of the time this is caused by sperm implanting an EMPTY ovum*

Answer 205

*🄿_rogesterone* functions include: 1.**[Endometrial decidualization]**^{(prepares endometrium for implantation of fertilized egg)}] 2.[**Endometrial differentiation *protection***] (from error) ^{(unopposed estrogen → ⇪ risk endometrial ADC)}*(which thins Uterine lining)*during Menses**]^{(once progesterone level falls)}] 4.relaxes myometrium 5.[thickens cervical mucus^{(prevents sperm entry into cervix)} ] 6.[Pubic Symphysis *diastasis* ^{(widens pelvis for delivery)}]