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Associations 6 Flashcards

1
Q

Precocious puberty

A

<9 (males)

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2
Q

Tanner level 5 (girls)

A

Breast: areola recedes to level of breast

Pubic hair: spreads to medial thighs

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3
Q

LH in menstrual cycle

A 
Midcycle surge (induced by estrogen) induces ovulation
Stimulates corpus luteum to secrete progesterone (luteal phase)
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4
Q

FSH in menstrual cycle

A

Stimulates development of ovarian follicle (follicular phase)

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5
Q

Estrogens in menstrual cycle

A

Stimulates endometrial proliferation (follicular phase)
Secreted by follicle, aids follicle growth
Induces LH surge
High levels inhibit FSH secretion

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6
Q

Progesterone in menstrual cycle

A

Secreted by corpus luteum (luteal phase); *decrease in levels leads to menstruation
Stimulates endometrial gland development
Inhibits uterine contraction, increases cervical mucus thickness
Increases basal body temperature
Inhibits LH and FSH secretion, maintains pregnancy

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7
Q

hCG in menstrual cycle

A

Acts like LH after implantation of fertilized egg

Maintains corpus luteum viability and progesterone secretion (no menstruation)

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8
Q

Causes of pseudoprecocious puberty

A

Exogenous hormones (estrogens)
Adrenal tumor
Other hormone-secreting tumor (eg ovarian)
CAH

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9
Q

Phase of menstrual cycle fixed at 14 days regardless of cycle length

A

Luteal phase

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10
Q

Diagnostic for menopause

A

Amenorrhea >1 year in woman

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11
Q

Premature menopause

A

< 40 years old

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12
Q

Hormones in perimenopause

A

+LH, +FSH

Estrogen fluctuates

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13
Q

Causes primary amenorrhea

A

HPO axis dysfunction
Anatomic abnormalities (absent uterus, vaginal septa, imperforate hyman, vaginal atresia)
Chromosome abnormalities
Pregnancy

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14
Q

Causes secondary amenorrhea

A

Pregnancy
Ovarian failure (menopause)
HPO axis dysfunction, uterine abnormalities, PCOS, thyroid disease
Anorexia, malnutrition

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15
Q

Hypogonadism + anosmia

A

Kallman syndrome

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16
Q

Initial tests for primary amenorrhea

A

Physical (anatomic abnl)
B-hCG, prolactin, TSH
Signs of hyperandrogenism -> DHEAS, testosterone

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17
Q

Primary amenorrhea + absent uterus on US

A

Karyotype + serum testosterone
(Androgen insensitivity syndrome = 46XY)
(Abnl mullerian development = 46XX)

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18
Q

Primary amenorrhea + uterus present

A

B-hCG + FSH
(Pregnancy = high B-hCG)
(Turner syndrome = high FSH)
(HPO axis disease = low FSH)

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19
Q

Secondary amenorrhea initial tests

A

B-hCG (always first test)
Prolactin, TSH, FSH
If hyperandrogenism signs -> DHEAS, testosterone

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20
Q

Secondary amenorrhea w/ normal initial tests

A 
Progesterone challenge (normal = anovulation) (abnl = low estrogen or outflow tract abnl)
If abnl, progesterone-estrogen challenge (normal = HPO axis abnl, menopause) (abnl = outflow tract obstruction eg Asherman syndrome)
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21
Q

Causes secondary dysmenorrhea

A

Endometriosis, PID, uterine fibroids, ovarian cysts, adenomyosis

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22
Q

Timing primary vs secondary dysmenorrhea

A

Primary - beginning of menstruation and resolve over several days
Secondary - midcycle before onset of menstruation and increase in severity until conclusion of menstruation

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23
Q

“Powder-burn” lesions or chocolate cysts on biopsy

A

Endometriosis

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24
Q

Common symptoms of endometriosis

A

3Ds - dysmenorrhea, deep dyspareunia, dyschezia

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25
Q

Common causes abnormal uterine bleeding

A 
PALM-COEIN
Polyps
Adenomyosis
Leiomyoma
Malignancy/hyperplasia
Coagulopathy
Ovulatory dysfunction
Endometrial
Idiopathic
Not yet classified
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26
Q

Regular, heavy abnl uterine bleeding

A

Think fibroid, adenomyosis, polyp

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27
Q

Irregular, heavy abnl uterine bleeding

A

Think anovulation

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28
Q

MCC abnormal uterine bleeding

A

Anovulation

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29
Q

Abnl uterine bleeding related to sex

A

Think cervical polyp/glandular tissue

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30
Q

Abnl uterine bleeding + positive B-hCG + intrauterine pregnancy + closed cervical os

A

Threatened abortion

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31
Q

Abnl uterine bleeding + enlarged uterus + menometrorrhagia for months

A

Fibroids, molar pregnancy, adenomyosis

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32
Q

Abnl uterine bleeding + severe menstrual pelvic pain

A

Endometriosis, adenomyosis

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33
Q

Menorrhagia + perimenopausal

A

R/o endometrial hyperplasia / cancer

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34
Q

Abnl uterine bleeding that started w/ menarch

A

R/o coagulopathy

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35
Q

MC coagulopathy associated w/ abnormal uterine bleeding

A

Von Willebrand disease

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36
Q

Abnl uterine bleeding + positive B-hCG + no fetus in uterus on US

A

Ectopic pregnancy

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37
Q

Abnl uterine bleeding + depression + constipation

A

Hypothyroidism

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38
Q

Diagnostic criteria for PCOS

A

2/3
Oligo or anovulation
Androgen excess
Polycystic ovaries (“string of pearls”) by US

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39
Q

Labs for PCOS

A

+LH
LH:FSH ratio >2:1
+DHEA, androstenedione, testosterone
+progesterone challenge (anovulatory)

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40
Q

Complications of PCOS

A

Infertility
DM
Endometrial cancer (+unopposed estrogen)
Also HTN, ischemic heart disease, ovarian torsion

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41
Q

“Dew drops on rose petals” rash

A

Varicella zoster (chicken pox)

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42
Q

MCC postmenopausal bleeding

A

Atrophic vaginitis (but must r/o endometrial cancer)

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43
Q

Indications for endometrial biopsy

A

AUB >35 yo or <35 w/ risk factors

Postmenopausal bleeding

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44
Q

Pap smear recommendations

A

Start at age 21
Every 3 years (21-29)
Every 3 years or every 5 years w/ HPV testing (>30)
Stop at age 65 if multiple normal results

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45
Q

ASCUS Pap - next step

A

21-24: repeat Pap in 12 months
25+: HPV testing
Colposcopy if either is positive

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46
Q

AGUS Pap - next step

A

Colposcopy + ECC +/- endometrial biopsy

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47
Q

ASC-H Pap - next step

A

Colposcopy

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48
Q

LSIL (CIN 1) Pap - next step

A

21-24: repeat Pap in 12 months
25-29: colposcopy
30+: HPV testing or colposcopy

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49
Q

HSIL (CIN 2 or 3) Pap - next step

A

21-24: colposcopy

25+: excision (LEEP, conozation or laser)

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50
Q

Thin anogenital skin w/ ivory or porcelain-white macules and plaques w/ pruritis or pain, usu postmenopausal

A

Lichen sclerosis (need to r/o SCC)

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51
Q

Functional benign ovarian tumors (physiological)

A

Follicular cyst, Corpus luteum cyst

Often regress on their own

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52
Q

Psammoma bodies

A

Concentric calcifications

Assoc w/ ovarian serous cystadenocarcinoma (or cystadenoma), papillary thyroid cancer, melanotic schwannoma

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53
Q

Benign ovarian tumor + chocolate cyst

A

Endometrioma

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54
Q

Benign ovarian tumor + multiple dermal tissues

A

Benign cystic teratoma (dermoid cyst)

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55
Q

Benign ovarian tumor + estrogen secretion (precocious puberty)

A

Granulosa theca cell tumor (stromal cell tumor)

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56
Q

Benign ovarian tumor + androgen secretion (virilization)

A

Sertoli-Leydig cell tumor (stromal cell tumor)

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57
Q

Characteristics of benign and malignant ovarian tumors on US

A

B - cystic, smooth edges, few septa

M - irregular, nodular, multiple septa, pelvic extension or adhesions

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58
Q

Drugs that cause gynecomastia

A 
STACKED
Spironolactone
THC (marijuana)
Alcohol (chronic)
Cimetidine
Ketoconazole
Estrogens
Digoxin
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59
Q

Multiple, bilateral small tender breast masses that vary in size with menstrual cycle

A

Fibrocystic changes

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60
Q

MC breast tumor <30 yo

A

Fibroadenoma

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61
Q

Bloody or nonbloody (serous) discharge with or without stimulation

A

Intraductal papilloma (nonbloody discharge only on stimulation is consistent w/ noncancerous)

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62
Q

Solitary, solid, mobile breast mass w/ well defined edges in young woman

A

Fibroadenoma

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63
Q

Large, bulky breast mass w/ leaf-like projections w/ patient in 50s

A

Phyllodes tumor

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64
Q

Embryonic age 1 week (3 weeks GA)

A

Implantation, B-hCG production starts

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65
Q

Embryonic age 2 weeks (4 wks GA)

A

Beginning of maternal-fetal circulation
B-hCG high enough to detect in urine (~30-40)
CNS starts to develop

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66
Q

Embryonic age 3 weeks (5 wks GA)

A

Heart starts to form

67
Q

Embryonic age 4, 5 weeks (6, 7 wks GA)

A

GI tract start to form; lungs start to form

68
Q

Embryonic age 6, 9 weeks (8, 11 wks GA)

A

Limbs, genitalia start to form; kidneys start to function

69
Q

Embryonic age 15-20 weeks (17-22 wks GA)

A

Early detectable fetal movement

70
Q

Embryonic age 24 weeks (26 wks GA)

A

Surfactant production begins

Earliest chance of viable premature birth

71
Q

Embryonic age 32 weeks (34 wks GA)

A

Fetus usually survives premature birth

72
Q

Embryonic age 37 weeks (39 weeks)

A

CNS fully developed

73
Q

Fetus considered full term

A

37-42 weeks GA (35-40 EA)

74
Q

Biggest effect of teratogens on organ systems

A

2-12 weeks (esp 3-8 weeks) EA

75
Q

CV effects of pregnancy

A

CO increases 40% (SV and HR)

BP decreases slightly weeks 20-24, back to base by term

76
Q

Respiratory effects of pregnancy

A

O2 consumption increases 20%
Tidal volume increases 40% w/ minute ventilation increase
PCO2 decreases to ~30 (respiratory alkalosis)

77
Q

Endocrine effects of pregnancy

A

Nondiabetic hyperinsulinemia w/ mild glucose intolerance (HPL hormone contributes)
TG, cortisol increase
TSH decreases slightly; TBG and total T4 increase (free T4 stays the same)

78
Q

Hematologic effects of pregnancy

A

Hypercoagulable

Increased RBC production, increased blood volume = physiologic anemia of pregnancy (Hct still decreases)

79
Q

GI effects of pregnancy

A

Increased salivation

Decreased gastric motility (increased GERD)

80
Q

Labs at initial prenatal visit

A 
CBC
Blood type and cross
UA
Pap smear, G/C screening
RPR/VDRL, Rubella antibody titer, Hep B surface antigen, HIV screening (w/ permission)
81
Q

Labs at 16-18 weeks GA

A

Quad screen

82
Q

Labs at 18-20 weeks GA

A

US dating and anatomy screen

83
Q

Labs at 24-28 weeks GA

A

1 hr glucose challenge (screen for gestational DM)

84
Q

Labs at 32-37 weeks GA

A 
Cervical culture for G/C in high risk
GBS screening (36 weeks)
85
Q

Quad screen

A 
Maternal serum aFP
Estriol
B-hCG
Inhibit
Must be done at 16-18 weeks (aFP requires this time)
Assesses for NTD, trisomy 18 and 21
86
Q

Full integrated test

A

Nuchal translucency and PAPP-A in first trimester + quad screen in second trimester
Lowest false-positive rate for non-invasive tests

87
Q

Amniocentesis

A

After 16 weeks
NTD and chromosomal abnormalities
0.5% miscarriage

88
Q

Chorionic villi sampling

A

9-12 weeks
Chromosomal abnormalities
1% miscarriage

89
Q

PUBS

A

After 18 weeks

Fetal anemia, Rh sensitization, possible transfusion

90
Q

Increased nuchal translucency

A

Trisomy 21, 18, 13
Turner syndrome
Congenital heart defects (+fluid)

91
Q

Maternal serum aFP

A

High in NTD and multiple gestations

Low in trisomy 21, 18

92
Q

Quad screen, trisomy 21 vs 18 (doesn’t see trisomy 13)

A 
21 = low aFP, estriol; high hCG, inhibin-A
18 = low aFP, estriol, hCG
93
Q

B-hCG levels during pregnancy

A

Double every 48 hours until ~10 weeks, ~100K

Slowly return down to ~10K, stay there til end of pregnancy

94
Q

Timing of diagnosis for gestational diabetes, preeclampsia vs pre-existing conditions

A

Diabetes >24 weeks

HTN >20 weeks

95
Q

Pre-gestational diabetes early fetal complications

A

Sacral and renal agenesis, cardiac (TGA, tetralogy of Fallot), neural tube defects

96
Q

HTN + edema in hands or face + proteinuria (>300 g/24 hrs) in pregnancy >20 wks

A

Preeclampsia

97
Q

HELLP syndrome

A

Hemolysis
Elevated Liver enzymes
Low Platelets

98
Q

Maternal N&V timing

A

Worst in first trimester, usu resolves by 12-16 weeks

99
Q

Congenital infection w/ hydrocephalus, intracranial calcifications, chorioretinitis

A

Toxoplasmosis or CMV

100
Q

Congenital infection w/ blueberry muffin rash

A

Rubella

101
Q

Congenital infection w/ high rate of neonatal death

A

Rubeola, HSV

102
Q

Congenital infection w/ rash w/ hand and foot desquamation

A

Syphilis

103
Q

Congenital infection w/ progressive unilateral hearing loss + neuro abnl

A

CMV

104
Q

Congenital infection w/ halo sign on CT of brain

A

Toxoplasmosis

105
Q

Congenital infection w/ IUGR, deafness, cataracts/glaucoma

A

Rubella

106
Q

Congenital rubella cardiovascular problems

A

PDA

Pulmonary artery stenosis

107
Q

Congenital infection w/ temporal lobe encephalitis

A

HSV

108
Q

Congenital infection w/ dermatomal skin scarring, chorioretinitis, microcephaly, intellectual disability, hypoplasia of hands and feet, early death

A

VZV (new infection)

109
Q

Leading cause of congenital blindness

A

Chlamydia

110
Q

Congenital infection w/ PNA, sepsis (early) or meningitis (late)

A

GBS

111
Q

Congenital infection w/ decreased RBC production + hemolytic anemia = hydrops fetalis, high output cardiac failure

A

Parvovirus B19

112
Q

MC site of ectopic pregnancy

A

Ampulla of fallopian tube (95%)

113
Q

US can see intrauterine pregnancy

A

Intraabdominal: B-hCG >6500
Intravaginal: B-hCG >1500

114
Q

<20 weeks + uterine bleeding + closed cervical os + viable IUP

A

Threatened spontaneous abortion

115
Q

<20 weeks +/- uterine bleeding or pain + closed cervical os + non-viable IUP

A

Missed spontaneous abortion

116
Q

<20 weeks + uterine bleeding + pain + open cervical os +/- viable IUP

A

Inevitable spontaneous abortion

117
Q

<20 weeks + uterine bleeding + open cervical os + some uterine contents expelled

A

Incomplete spontaneous abortion

118
Q

<20 weeks + uterine bleeding + open or closed cervical os + all uterine contents expelled

A

Complete spontaneous abortion

119
Q

> 20 weeks + nonviable IUP w/o fetal movement or heart activity

A

Intrauterine fetal demise

120
Q

Cause of 1st trimester spontaneous abortion

A

Chromosomal abnl (usu trisomies, trisomy 16 is common)

121
Q

Cause of 2nd trimester spontaneous abortion

A

Infection, cervical incompetence, uterine abnl, drug use…

122
Q

MCC symmetric IUGR

A

Congenial infection, chromosomal abnormalities

Familial

123
Q

MCC asymmetric IUGR

A

Poor maternal health, placental insufficiency, multiple gestations

124
Q

MC initial finding in IUGR

A

Abdominal circumference <10% for GA

125
Q

AFI in oligohydramnios

A

2 cm

126
Q

AFI in polyhydramnios

A

> 25 cm or one pocket >8 cm

127
Q

MCC first trimester oligohydramnios

A

Often results in spontaneous abortion

128
Q

MCC second trimester oligohydramnios

A

Fetal renal abnl
Maternal HTN/CVD
Placental thrombosis

129
Q

MCC third trimester oligohydramnios

A

PROM, abruption
Preeclampsia
Idiopathic

130
Q

MCC polyhydramnios

A 
Insufficient fetal swallowing (GI abnl)
Increased fetal urination (maternal DM)
Multiple gestation
Fetal anemia
Chromosomal abnl
131
Q

Complications oligohydramnios

A

Spontaneous abortion / IUFD

Abnl limb/face/lung/abdomen from compression

132
Q

PROM vs PPROM

A

Spontaneous ROM before onset of labor (PPROM = before 37 weeks)

133
Q

Labs for PROM

A

“Ferning” on slide

Nitrazine paper turns blue (non-specific)

134
Q

Signs of fetal lung maturity

A

L:S ratio >2 + presence of phosphatidylglycerol (PG) in amniotic fluid

135
Q

Signs of chorioamnionitis

A

Fever +

Maternal HR >100, fetal HR >160, maternal WBC >15K, uterine tenderness or foul smelling discharge

136
Q

2 OB complications that can lead to DIC

A

IUFD (if fetus remains for extended time)

Abruptio placenta

137
Q

Preterm labor

A

<37 weeks

138
Q

MCC vaginal bleeding after 20 weeks

A

Placenta previa (painless) and abruptio (painful)

139
Q

Higher B-hCG than expected

A

Molar pregnancy

Multiple gestations

140
Q

Painless heavy or irregular vaginal bleeding during first or second trimester + hyperemesis gravidarum

A

R/o molar pregnancy

141
Q

Preeclampsia <20 weeks gestation

A

Molar pregnancy

142
Q

Expulsion of “grape-like” vesicles from vagina

A

Molar pregnancy

143
Q

“Snow-storm” appearance on US w/o gestational sac

A

Molar pregnancy

144
Q

Uterine mass on US w/ mix of hemorrhagic and necrotic areas and possible parametrial invasion

A

Choriocarcinoma

145
Q

MC sites of mets for hydatidiform mole or choriocarcinoma

A

Lungs
Liver and brain = worse prognoses
Kidney, GI for choriocarcinoma

146
Q

Workup for infertile couple

A

1) Semen analysis (30-40%)
2) Anovulation workup (20%)
3) Hysterosalpingogram to r/o anatomic issue (30%)

147
Q

Normal non-stress test

A

15 bpm accelerations x 15 sec x 2 in 20 min

148
Q

BPP scoring

A 
NST
AFI
Fetal movement
Fetal breathing
Fetal tone
8-10 is reassuring, under that suggests fetal distress
149
Q

Decelerations that begin and end w/ uterine contractions, rounded

A

Early (usu head compression)

150
Q

Decelerations that begin any time and last different amounts of time, v-shaped

A

Variable (usu cord compression)

151
Q

Decelerations that begin after uterine contraction starts and end after it finishes, check mark-shaped

A

Late (possible sign of uteroplacental insufficiency and fetal hypoxia)

152
Q

Stage 1 of labor, latent phase

A

Start until 4 cm dilation and complete effacement

Stops and starts, gradual, variable

153
Q

Stage 1 of labor, active phase

A

4 cm to complete 10 cm dilation w/ constant progression

>1.2 cm/hr (null) or >1.5 cm/hr (multi)

154
Q

Stage 2 of labor

A

Fetal descent through birth canal

<1 hr (multi) (add 1 hr for epidural)

155
Q

Stage 3 of labor

A

Neonatal delivery until placental delivery, <30 min

156
Q

Stage 4 of labor

A

1 hr after lab, monitor mom hemodynamically

157
Q

Induction of labor, Bishop score

A

3 has 15%

Fetal station, cervical dilation, effacement, consistency and position

158
Q

Apgar scores

A

1 and 5 minutes, 0/1/2 points each
>7 (1 min) and >9 (5 min) reassuring
Appearance (blue/pink + blue extremities/pink)
Pulse (none/100)
Grimace (none/grimace/strong cry to pain)
Activity (none/some/active)
Respirations (none/poor weak cry/good strong cry)

159
Q

Small, red, tender area on breast during breastfeeding

A

Galactocele

160
Q

Larger, circumscribed area of redness and warmth on breast during breastfeeding + fever and +WBC

A

Mastitits

161
Q

Uterine tenderness postpartum day 1-7 w/ fever, foul lochia

A

Postpartum endometritis

162
Q

Immediately postpartum or during labor sudden-onset hypoxia, cardiogenic shock, DIC

A

Amniotic fluid embolism

163
Q

Postpartum bleeding >500 cc + anemia + lack of breast milk when attempting to breastfeed

A

Sheehan syndrome

Step 2 DIT (23 decks)

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