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Exama-vaginologists > Andrea Crunch Time > Flashcards

Andrea Crunch Time Flashcards

1
Q

Factors affecting placental transfer of drugs

A
  1. Molecular Weight
  2. Degree of ionization
  3. Lipid Solubility
  4. Protein binding
  5. Fetal and placental blood flow
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2
Q

Complications of Rad Tracheolectomy (Long Term)

A 
dysmenorrhea (most common)
AUB
recurrent candidiasis
cervical suture erosion
isthmic stenosis
prolonged amenorrhea
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3
Q

Benefits of Primary Surgery vs Primary chemo/rads in 2B1 cervical cancer.

A

Accurate Staging
Preserve the ovaries
Option to resect bulky nodes

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4
Q

Considerations when arranging patient transfer

A

Clarify who is calling, contact info in case disconnected
Where are they located/distance to travel
Weather conditions
Who can accompany the patient
land vs air transport
what pre transfer medications might be needed
What pre transfer investigations needed
Request records to be sent ahead/along with pt

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5
Q

CF:

  1. Carrier rate
  2. Protein affected, pathophys effect
  3. Best predictor of pregnancy outcome and longterm maternal outcomes
A
  1. 1/25 caucasian
  2. CFTR gene mutation (affects chloride channel causing altered epithelial cell membrane transport of electrolytes)
  3. Pulmonary function
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6
Q

CF:

  1. Predictors of poor outcome
  2. Maternal risks in pregnancy
A 
1. Predictors of poor outcome 
Pulmonary hypertension
Cyanosis
FEV 1 < 60
Poor nutrition
2. Maternal risks in pregnancy
- diabetes
- heart failure
- pulmonary infection
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7
Q

CF

  1. why might we recommend an assited 2nd stage?
  2. Can they breastfeed?
A
  1. risk of pheunothoraces a/w prolonged valsalva

2. yes, need inc caloric intake due to metabolic demands of BF and malnutrition from pancreatic dysfcn.

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8
Q

HDoP

  1. What is the maximum dose of Hydralazine?
  2. NNT to prevent a seizure in severe preeclampsia and mild preeclampsia
A
  1. 20mg IV

2. 50 and 100

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9
Q

Renal Transplant

1. Feto-Maternal risks

A

IUGR, PTD

HDoP, infection,

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10
Q

Renal Transplant

1. 2 most important predictors for pregnancy

A

kidney function

HTN

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11
Q

Renal Transplant

1. Pre-conceptual recommendations before proceeding with pregnancy (a/w 90% live birth rate)

A
  1. Stable for 1-2 years post transplant
  2. Optimal Graft function (Cr < 130, protein < 500mg/day)
  3. no evidence of rejection in 1 yr
  4. anti rejection meds have been stable and are not teratogenic
  5. HTN absent or well controlled
  6. normal graft US
    CMV infection excluded
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12
Q

Indications for elective CS in a patient with HIV (8)

A
  1. not on HAART
  2. monotherapy
  3. viral load > 1000
  4. unknown viral load, older than 1 month
  5. inadequate prenatal care
  6. Pt request
  7. High risk of a traumatic delivery
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13
Q

List 4 structural defects that would cause elevated MSAFP with a normal NIPT.

A 
Abdominal Wall Defect (omphalocele, gastroschisis)
Osteogenesis Imperfecta
Sacrococcygeal Teratoma
Bladder extrophy
Cystic Hygroma
renal anomalies
urinary or intestinal obstruction
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14
Q

When do you assess NT and what is normal?

A

CRL 45-84mm or BPD < 26mm

< 3mm

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15
Q

What are 3 causes of thickened NT

A 
Aneuploidy
Single gene disorders (Noonan's)
- Skeletal Dysplasia
- TTTS
- Structural anomalies (cardiac, cystic hygroma, diaphragmatic hernia)
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16
Q

In Cystic Hygroma what is the chance of structural anomalies elsewhere and what 2 systems are involded?

A

50%

cardiac, renal

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17
Q
  1. What is the likelyhood ratio of T21 with Thickened Nuchal Fold
  2. What is a normal nuchal fold at 16-18 weeks, 18-24 weeks
A
  1. 17
  2. 16-18 weeks: < 5mm
    18-24 weeks: < 6mm
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18
Q

What are the soft markers for T21 and their LRs (8)

What are 2 other US findings specific to T21?

A

Thickened NT (17)
Ventriculomegaly (9)
Echogenic Bowel (6)
EIF (2)

CPCs *(7 for T18)

Hypoplastic nasal bone (LR51)
AVSD ( 50% risk in T21)

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19
Q

What are 4 complications of doing amnio too early? When should it be done?

A
  • oligo
  • club feet
  • ROM
  • failed culture

15-20 weeks

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20
Q

DDx of a fetal neck mass

A

Fetal Goiter
Cervical Teratoma
Cervical hemangioma
Thyroid cyst

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21
Q

In Omphalocele what 2 investigations should be done?

A

Echo: cardiac anomalies 50-70%

karyotype - 30-70% a/w with aneuploidy, if liver in body

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22
Q

T18 findings

A

CPCs
Rocker Bottom Feet
Overlapping digits
AVSD

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23
Q

most common cause of Keyhole Bladder on US

- most common cause of mortality

A

Posterior Urethral valves
pulmonary hypoplaisa,

longterm renal failure

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24
Q

3 risks of single umbilical artery

A

renal anomaly
cardiac anomaly
IUGR

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25
Q

What causes cloverleaf skull

A
  • thanatophoric dysplasia, lethal skeletal dysplasia

- MTX

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26
Q

What can cause a FP Kleihaur Betke?

A

any of the hemaglobinopathies

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27
Q

What fraction of twins overall are monozygotic

What are the abn doppler findings in Quintero stage 3

A

1/3 vs 2/3

Donor: UAPI A or REDF
Recipient: DV a wave reversal

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28
Q

T13 findings (3)

A

Holoprosencephaly
Polydactyly
Cyclopia

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29
Q

What does a diaphragmatic hernia look like on US?

How do they stratify prognosis?

Other associated risks?

A
  • heart and lung in same pic, heart next to something echoic.
  • lung to head ratio
  • aneuploidy, cardiac anomalies, also renal
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30
Q
  1. Toxoplasmosis triad
  2. Diagnosis
  3. Treatment
A
  1. Hydrocephalus, IC calcifications, chorioretinitis
  2. T gondii present in amniotic fluid
  3. Prophylaxis: Spyramycin
    Mat/Fetal infection:
    - Pyrimethamine
    - Sulfadiazine
    - folinic acid rescue
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31
Q

Rubella

  1. What is the risk of CRS < 12 weeks and > 16 weeks?
  2. 3 manifestations of CRS at birth
A 
1. 
< 12 weeks 90%
> 16 weeks 0%
2. 
- Purpura (blueberry muffin rash)
- chorioretinitis
- sensorineural hearing loss
- cardiac defects
- microcephaly
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32
Q
  1. what is the most common cause of IU perinatal infection?
A
  1. CMV
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33
Q

CMV

  1. Whats the risk of transmission with primary infection and secondary infection?
  2. What percentage of congenitally infected infants have symptoms at birth? What are they?
  3. Of the Asymptomatic how many develop later sequelae?
  4. when do you do the Dx amnio?
A

30-40%
1%

2. 10-15%
chorioretinitis
sensorineural hearing loss
HSM
microcephaly
petechia

up to 15%

> 21 weeks GA, 7 weeks after maternal infection

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34
Q

HSV

  1. risk of transmission in recurrent HSV with and without lesions at time of delivery
  2. Benefits of suppressive Tx
A

2-5%
0.02-0.05% (< 1%)

  • less clinical lesions
  • less asymptomatic shedding
  • less need for CS
  • maybe dec risk neo HSV
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35
Q

HSV suppression in pregnancy?

A

Acyclovir 400mg PO TID starting at 36 weeks.

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36
Q

3 ways to test for Syphilis

A
  1. non treponemal (screening, VDRL)
  2. direct visualization spirochetes (darkfield microscopy)
  3. treponemal antibody test (TPPA)
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37
Q

3 causes of FP VDRL

A

SLIMHART

  • SLE
  • Lyme Disease
  • Infectious mono
  • Malaria
  • HIV, Hep B
  • APLAS
  • Rheumatic Fever
  • Tropical Eosinophilia
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38
Q

Features of Congenital Syphilis

A 
Hepatic dysfcn:
- Jaundice
- HSM
- thrombocytopenia
- purpuric skin lesions
Placentomegaly
rhinitis
pneumonia
myocarditis
nephrosis

Late: hutchison’s teet, saddle nose, saber shins, mulberry molars

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39
Q

Treatment of Syphilis

alternative if allergy testing + and unable to desensitize

What reaction is caused by release of spirochetes systemic post treatment?

A
  • Pen G 2.4 mu IM x 1 (can do second dose 1 week later)
  • Doxycycline
  • Jarisch-Herxheimer
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40
Q

2 maternal indications for newborn treatment in Gestational Syphilis

A
  • untreated
  • serologic evidence relapse/infection
  • treatment was with erythromycin (as does not cross placenta)
  • treatment within 1 month of delivery
  • insufficient FU in pregnancy
  • baby gets aqueous Pen G
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41
Q

features of congenital varicella (3)

A
  • chorioretinitis
  • micropthalmia
  • cerebral cortical atrophy
  • IUGR
  • hydronephrosis
  • limb hypoplasia
  • cicatricial skin lesions
  • hydronephrosis
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42
Q

Treatment of varicella in pregnancy?

A
  • VZIG within 96h of exposure to 5 days

- IV Acyclovir if hospitalized with pneumonia

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43
Q
  • What is the risk of fetal loss in Parvovirus?

- What is the most common maternal symptom?

A

< 20 weeks 15%
> 20 weeks 2%

75% asymptomatic, Arthralgia most common symptom

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44
Q

3 ways to control for counfounders

A

Randomization
Matching
Restriction

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45
Q

Post vasectomy advice

A

Contracept until 3 month TOC, need min 20 ejaculations

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46
Q

Which chemos can cause extravasation?

A

paclitaxel
actinomycin
doxurubicin

47
Q

5 neonatal features indicative of an IP asphyxia

A

a. Sentinal hypoxic event intrapartum
b. Prolonged bradycardia or absence of variability and persistent late decelerations in a previously normal FHR tracing
c. Apgars 0-3 at greater than 5mins of life
d. Evidence of multi system involvement within 72 hours
e. Early imaging shows acute non focal cerebral anomaly

48
Q

3 acute complications of pelvic radiation

A

a. Acute radiation Cystitis
b. Acute Radiation Colitis
c. Acute vaginal mucositis

49
Q

4 mechanisms for drug to cross placenta

A

a. active transport
b. simple diffusion
c. facilitated diffusion
d. endocytosis

50
Q

Respiratory Changes in Pregnancy

A

Reduction in

  • functional residual capacity -
  • expiratory reserve volume (ERV)
  • residual volume (RV)

increases in

  • inspiratory capacity (IC)
  • tidal volume (VT).
51
Q

Indications for a cone biopsy

A

Biopsy proven

  • CIN 2
  • CIN 3
  • AIS
  • micro invasion

Cytology:

  • AGC-favor neoplasia
  • AIS
    • neg colpo/ECC

Cytology HSIL and histology normal or CIN 1

52
Q

Classification of renal insufficiency

A
  • Cr < 125 = mild chronic renal insufficiency
  • Cr 125-250 = moderate
  • Cr > 250 = severe
53
Q

Vaginal Cancer Staging

A 
I Vaginal wall
II Subvaginal Tissue
III Pelvic wall
IV 
- A extension out of true pelvis, bladder/rectum
- IB distant spread
54
Q

Stage I Cx Cancer

A

1A: microinvasive
1A1 - < 3mm in, < 7mm width
1B1 - 3-5mm, < 7mm

1B: early, clinically visible
1B1 - < 4cm
1B2 - > 4cm

55
Q

Stage II Cx Cancer

A

2A: no parametrial

  • A1 < 4 cm
  • A2 > 4cm

2B obvious parametrial invasion

56
Q

Stage III Cx Cancer

A

3A
lower 1/3 vag, no pelvic sidewall

3B
pelvic sidewall, hydronephrosis/bum kidney

57
Q

How does Heparin work?

A

Inhibits thrombin

58
Q

First line tx for OAB

name 2 other options

A

Oxybutynin 5mg BID

  • Tolterodine
  • Trospium
  • Solifenacin
59
Q

CI to anticholinergic treatment of OAB

A

Absolute:

  • urinary retention
  • gastric retention
  • uncontrolled narrow angle glaucoma
  • known hypersensitivity

Relative:

  • high PVR
  • controlled NAG
  • impaired cognition
  • reduced renal or hepatic function
  • ETOH abuse
  • constipation
  • Myasthenia Gravis
60
Q

Treatment VVC

A

Uncomplicated:

  • Clotrimazole 1% x 7 days or 2% x 3 days
  • Fluconazole 150mg X 1
Recurrent:
- Induction: 
Clotrimazole x 14 days
Fluconazole 3 doses 72h apart
Boric acid 300 mg 14 days
  • Maintenance
    Monthly Clomitrazole 500mg
    Weekly Fluconazole 150 mg
    Boric acid Day 1-5 of cycle
  • Non Albicans
    Boric Acid 300mg nightly x 14 days
61
Q

3 causes of non albicans VVC

A

Glabrata, parapsolosis,

Tropicalis

62
Q

Most common benign, persistent adnexal mass in pregnancy?

A

Mature Teratoma

63
Q

Non pharmacologic causes of hyperprolactinemia

A

a. Pregnancy and Breastfeeding
b. Pituitary adenoma
c. Chest Wall trauma
d. Hypothyroidism
e. Renal Failure
f. Stress

64
Q

Most common causes secondary amenorrhea

A 
PREGNANCY
Hypothalamic - tumor or functional
Pituitary - tumour, Shehan's
Hypothyroidism
Ovarian - PCOS, POI
Asherman's
65
Q

Hill’s Criteria for Causation

A

a. Reproducibility
b. Plausibility
c. Temporality
d. Specificity
e. Strength of association
f. Dose response relationship
g. Experiment
h. Coherence

66
Q

3 structures not susceptible to teratogens after the embryonic period.

A

a. Spine
b. Heart
c. Palate

67
Q

Risk Factors for endometrial cancer

A

a. Obesity
b. Infertility
c. Anovulation
d. Exogenous estrogen
e. Nulliparity
f. Age > 60
g. Family history of BRCA or Lynch syndrome

68
Q

Plan in fertility sparing treatment of FIGO Gr I endo Ca

A

a. MRI to assess depth of invasion
b. Consider D & C due to 30% risk higher grade disease than indicated on biopsy

Couselling

i. 30% risk disease is more aggressive than indicated on biopsy
ii. Chance the disease will progress on progestin treatment
iii. If it does respond, 25% chance of recurrence

Treatment

i. High dose progestins (Megace 160 mg daily) x 3 months
ii. Pelvic US and endometrial biopsy q3months
e. Definitive management post childbearing (Hysterectomy BSO)

69
Q

Risk Factors for Placenta Previa

A 
Previous Placenta Previa
Previous CS
Previous myomectomy
Age > 35
Multiparity
Multiples
Smoking IVF
70
Q

Risk Factors for Placenta Accretta

A 
Previous Placenta previa
Previous CS
Previous myomectomy
Age > 35
Submucosal Fibroid
Asherman's Syndrome
71
Q

Wickham striae
mucous membrane involved
VV

A

Lichen Planus

72
Q

Treatment of vulvodynia

A 
Treat underlying cause
Pelvic floor physio
Meds:
- Topical xylocaine
- tricyclic antidepressants
- Gabapentin
- SSRIs
Surgery if refractory
73
Q

Most common cancers in pregnancy

A

Breast
Thyroid
Cervix

74
Q

Medical complications of a Dermoid

A

Struma ovarii
Carcinoid Syndrome
NMDA-receptor encephalitis

75
Q

How to diagnose maternal Rubella

A
  • 4-fold increased in IgG titres between acute and convalescent serum
    o titres best done within 7-10d of rash and repeated 2-3 weeks later
  • positive rubella-specific IgM
  • positive rubella culture (viral)
    o nasal, throat, urine, CSF
    o may be positive from 1 week before to 2 weeks after rash
76
Q

Risk of transmission to fetus with HSV

A

Primary infection in T3: 30-50%
Recurrent, with lesion 2-5% (SVD)
Recurrent, without lesion 0.02-0.05% (SVD)

77
Q

Treatment for Placental Site Trophoblastic Tumor

A

Hyst only unless mets

78
Q

Dose of epinephrine in acute anaphalactic reaction

A

Epinephrine 0.3-0.5ml of 1:1000 (1mg/ml) IM or SC

79
Q

Causes of total hair loss

A 
Alopecia areata (universalis)
Telogen effluvium
Chemotherapy
Radiation therapy
Thyroid disease
Lupus
80
Q

In hyst for CPP and no identifiable pelvic pahtology, what percentage of women will have ongoing pelvic pain?

A

40%

81
Q

Mullerian Agenesis - other anomalies

A

a. renal anomalies (double collecting system)
b. skeletal anomalies (cervical vertebral anomalies)
c. unilateral hearing loss
d. cardiac anomalies (VSD)

82
Q

3 causes of CAH

A
  • 21 hydroxylase deficiency
  • 11B hydroxylase deficiency
  • 3B hydroxysteroid dehydrogenase Type 2 deficiency
83
Q

3 causes 46XX DSD

A
  • CAH
  • gestational hyperandrogenism (maternal luteoma, placental aromatase enzyme deficiency)
  • ovotesticular DSD (formerly true hemaphrodism)
84
Q

3 causes 46XY DSD

A
  • Partial gonadal dysgenesis (Incomplete/Partial AIS)
  • Ovotesticular DSD (formerly true hemaprhodism)
  • uncommon forms of CAH
  • 5 alpha reductase deficiency
85
Q

4 histologic criteria for diagnosis of endometriosis?

A

a. Endometrial glands and stroma found outside the uterus
b. Need >2 for diagnosis:
i. Endometrial epithelium
ii. Endometrial glands
iii. Endometrial stoma
iv. Hemosiderin laden macrophages

86
Q

Management of PSTT

A

GO
Hyst
(not chemosensitive)

87
Q

Maximum dose of bupivicaine

A

2mg/kg no EPI

3mg/kg w/ EPI

88
Q

Common Chemo’s by MOA

A 
Alkylating agents
- cyclophosphamide
Antitumor antibiotics
- D'actinomycin
- Doxorubicin
Antimicrotubule agents
- Taxels
Topoisomerase inhibitors
- Etoposide
89
Q

Trade name of Diane 35

A

Cyproterone acetate

90
Q

3 chemos that cause extravasation injury

A

Paclitaxel
Actinomycin D
Doxorubicin

91
Q

4 pelvic shapes

A

Gynecoid (OA)
Anthropoid (OP)
Platypelloid (OT)
Android (heart)

92
Q

Rate of malignant transformation in dermoid

A

0.2-2%

93
Q

The blood test used to test vaginal bleeding to see if fetal or maternal (in setting of ?vasa previa)

A

APT test

94
Q

Indications for RT in endometrial Ca (5)

A

a. FIGO Grade 3 endometriod Cancer (adjuvant brachy)
b. Stage II endometrioid Cancer (adjuvant brachy)
c. Recurrence at the vaginal vault (salvage radiation)
d. Lymphovascular space invasion
e. Outer 1/3 myometrial invasion

95
Q

RF for endometritis (4)

A

a. Ceserean Section (#1 risk)
b. IP chorioamnionitis
c. Prolonged ROM
d. Manual removal of the placenta

96
Q

CI to regional anesthesia

A

a. refractory maternal hypotension
b. maternal coagulopathy
c. Thrombocytopenia Plt < 70
d. LMWH within 12 hours
e. Untreated maternal bacteremia
f. Skin infection over site of needle placement
g. Increased IC pressure s/t mass lesion

97
Q

High Spinal Management

A

b. Support blood pressure with vasopressors and/or inotropes as needed (anesthesiologist should be involved)
c. Left uterine displacement to minimize aorto-caval compression
d. Ventilation and O2, consider need for intubation

98
Q

1 investigation needed before starting ocp

A

BP

99
Q

4 types of meds which affect OCP effectiveness

A

Anticonvulsants
Antiretrovirals
Rifampicin
Griseofulvin

100
Q

DDX of AUB on ocp

A 
irregular pill taking
concomittant medication use
malabsorption
uterine or cervical pathology
pregnancy
chlamydia
101
Q

Advice if missed pill

A

< 24h no problem

During week 1:

  • back up 7 days
  • consider EC

During week 2/3

  • skip the hormone free interval that pack
  • *if 3+ pills missed you need to also back up 7 days, consider EC
102
Q

Category 4 CI to OCP

A

CV Stuff:

  • Hx Stroke
  • Migraine with Aura
  • Hx Ischemic heart disease
  • Complicated Valvular disease (pulm htn, a fib)
  • Peripartum cardiomyopathy
  • HTN (> 160/100)
  • Vascular disease

Clot Stuff:

  • Acute DVT/PE or Hx VTE
  • known thrombophilia
  • SLE with + APLAS abd

Active breast Ca

Liver Stuff:

  • severe cirrhosis
  • hepatocellular carcinoma
  • malignant hepatoma

Complicated solid organ transplantation (graft failure)

Breastfeeding:

  • < 4 weeks PP (BF)
  • < 21 days PP (not BF)

Smoking > 35 y/o, > 15 ciggs/day

Major Sx with prolonged immobilization

103
Q

ER contraception options

A

Cu-IUD (7d)
UPA-EC 30mg (5d)
LNG-EI 1.5mg (5d)
Yuzpe - target 100mcg ethinyl estradiol

104
Q

Risk Factors for Cx Insufficiency

A

a. Recurrent T2 loss
b. Prior PTB
c. Prior PPROM < 32 weeks
d. Prior short cervix < 25mm before 27 weeks
e. Cx procedures
f. Mullerian anomalies
g. DES exposure in utero
h. Maternal connective tissue d/o

105
Q

Components of a systematic review

A

a. Focused Clinical Question
b. Comprehensive search strategy
c. Clear inclusion/exclusion criteria
d. Quality assessment of studies
e. Systematic Synthesis

106
Q

Teratogenic effects of ACE (3)

A

a. Cardiac defects (ASD)
b. CNS malformations (hypocalvaria)
c. Renal tubular dysplasia

107
Q

3 risks of advanced paternal age

A

Autosomal dominant conditions

  • achodroplaisa
  • Pfeiffer syndrome
  • Crouzo syndrome
  • Apert syndrome
108
Q

Criteria for CPP

A

a. Duration > 6 months
b. Incomplete relief from most treatments
c. Interferes with activities of daily living
d. Altered family roles
e. Signs of depression

109
Q

Treatment of NVP

A

Non Rx:

  • ginger
  • acupuncture
  • psychotherapy

Rx:

  • 1st line: Diclectin
  • 2nd line: dimenhydrinate
  • 3rd line: Metoclopramide or Prochlorperazine 5-10mg q6-8h

IVF if needed

110
Q

Minimal safe rad dose

A

5 rads / 0.05 Gy

111
Q

VTE risk in OCP

A

healthy pop age 24: 5 /10 000

  • cOCP: 10 /10 000
  • Pregnancy: 30 /10 000
  • Post: 300 /10 000
112
Q

Reasons to test for BRCA

A

a. Female Breast CA < 50
b. 2 or more primary breast cancers
c. Male breast ca
d. 1 or more first degree relatives with breast ca diagnosed at < 50

113
Q

Conservative management Accretta

A
  • IAL
  • uterine embolization
  • oversew placental bed if localized
  • utero-vaginal packing
  • leave placenta in place and follow
114
Q

3 accepted indication for HRT in menopausal patient

A

1) Vasomotor symptoms
2) Osteoporosis
3) Urogenital Atrophy

Exama-vaginologists (7 decks)

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