AMBOSS Concepts

Question 1

Most common cause of bloody nipple discharge

Answer 1

intraductal papilloma

Question 2

Patients with recurrent UTIs should be treated with….

Answer 2

prophylactic antibiotics for 3 months after eradication of their current UTI

This can be followed by continuous or post-coital-only antibiotics.

Most commonly TMP-SMX (Bactrim)

Alternative options include nitrofurantoin (Macrobid), cephalexin, and ciprofloxacin

Question 3

Criteria for the diagnosis of postpartum hemorrhage

Answer 3

blood loss >1000mL (1L)

or bleeding associated with symptoms of hypovolemia within 24 hours of delivery

Question 4

Most common cause of postpartum hemorrhage

Answer 4

uterine atony (70-80% of all cases)

Question 5

Initial management of post-partum hemorrhage d/t uterine atony

Answer 5

• bimanual uterine massage to induce uterine contraction and the constriction of blood vessels
• IV fluid resuscitation with crystalloid fluids

Question 6

Mainstays of treatment for PCOS in adolescent not desiring pregnancy (2)

Answer 6

• OCPs (regulate menstrual cycle, antiandrogenic effects, decrease endometrial hyperplasia and cancer risk)
• weight loss to reduce associated obesity and insulin resistance

Question 7

Why are you at increased risk for gallstones in pregnancy

Answer 7

Beginning in the third trimester of pregnancy, increased circulating estrogen levels result in an increased hepatic cholesterol synthesis and the formation of cholesterol-supersaturated bile. Moreover, higher progesterone levels cause smooth muscle relaxation, decreased and incomplete emptying of the gallbladder, and subsequent bile stasis. Together, cholesterol-rich lithogenic bile and gallbladder stasis predispose to gallstone formation. Similarly, hormone replacement therapy and oral contraceptive use also predispose to cholelithiasis.

Question 8

Relationship of estrogen to gallstones

Answer 8

Beginning in the third trimester of pregnancy, increased circulating estrogen levels result in an increased hepatic cholesterol synthesis and the formation of cholesterol-supersaturated bile. Similarly, hormone replacement therapy and oral contraceptive use also predispose to cholelithiasis.

Question 9

Possible adverse effects with the use of Terbutaline as a tocolytic in the treatment of PTL

Answer 9

Beta-2 receptor agonists, such as terbutaline, can cause hypokalemia by stimulating the Na+/K+-ATPase, which leads to an intracellular K+ shift. Symptoms of hypokalemia include fatigue, proximal muscle weakness, and decreased deep tendon reflexes, as seen in this patient. The diagnosis would be confirmed by a laboratory evaluation of serum potassium levels. Further adverse effects of beta-2 receptor agonists include tremor, headache, anxiety, tachycardia, and palpitations.

Question 10

Carpal tunnel syndrome refers to compression of the ________ nerve

Answer 10

median nerve

Question 11

With long-term compression of the median nerve, you can see atrophy of the _____ muscles

Answer 11

thenar

Question 12

Complications of cocaine use in pregnancy (4)

Answer 12

• preterm labor
• placental abruption
• IUGR
• low birth weight