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OBGYN > Case Files > Flashcards

Case Files Flashcards

1
Q

First line of OBGYN presentation

A
  • age
  • GP
  • LMP
  • gestational age if relevant
  • chief complaint
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2
Q

Excessive menstrual flow is termed?

Excessive + irregular?

A
  • menorrhagia

- menometrorrhagia

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3
Q

When taking a gynecologic history, in addition to normal history sections (HPI, PMHx, PSHx, etc), what should be included?

A
  • menstrual hx
  • contraceptive hx
  • STDs
  • OB hx
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4
Q

Every pregnant patient greater than 20 weeks gestation should be asked about _____.

A

symptoms of PreE

headache, visual changes, dyspnea, epigastric pain, face/hand swelling

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5
Q

Murmur considered normal in pregnancy

A

systolic flow murmur

never diastolic

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6
Q

What is the grey turner sign?

A
  • discoloration at the flank

- indicates intra-abdominal/retroperitoneal hemorrhage

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7
Q

Ddx ulcers at vulva

A
  • HSV (painful)
  • syphilis (non-painful)
  • vulvar carcinoma
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8
Q

Location of bartholin gland cysts

A

5 & 7 oclock

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9
Q

Normal ovary size?

A

about the size of a walnut if palpated at all

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10
Q

Rectal exam finding suggestive of endometriosis

A

nodularity and tenderness in the uterosacral ligament

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11
Q

What do the vaginal and rectal exams inspect, respectively?

A
  • vaginal: anterior pelvis

- rectal: posterior pelvis

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12
Q

Routine initial prenatal labs

A
  • CBC, blood type
  • Urine Culture
  • Pap smear
  • G&C cultures
  • Hep B, HIV, Syphilis, Rubella Titer
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13
Q

When is testing for GDM usually performed in pregnancy? GBS?

A
  • GDM: 26-28 weeks

- GBS 35-37 weeks

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14
Q

Which of the initial prenatal labs are repeated in third trimester?

A
  • HIV in populations with prevalence above 1/1000
  • CBC for anemia
  • other STDs if indicated based on risk factors
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15
Q

Labs for: threatened abortion

A

-HCG and progesterone

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16
Q

Labs for: menorrhagia

A
  • CBC
  • endometrial biopsy
  • pap smear
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17
Q

Ovarian tumor markers (2)

A
  • CEA

- CA125

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18
Q

Thickened endometrial stripe significance:

A
  • premenopause: pregnancy

- postmenopause: endometrial cancer

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19
Q

Test that determines patency of fallopian tubes:

A

-HSG

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20
Q

Test that determines patency of ureters

A

-IVP

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21
Q

Test that best evaluates uterine anomalies

A

-MRI

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22
Q

Top two causes of post partum hemorrhage

A
  • uterine atony
  • genital tract laceration

**distinguish by looking for presence of “boggy” vs firm uterus

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23
Q

Multiparous woman with loss of urine when coughing:

  • diagnosis
  • PE finding
  • initial treatment, second treatment option
A
  • stress incontinence
  • hypermobile urethra +/- cystocele
  • kegel exercises, fix urethra above pelvic diaphragm (urethropexy)
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24
Q

What maintains continence in a healthy individual?

A

-urethral pressure exceeds bladder pressure (requires that both be located in the intraabdominal cavity)

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25
Q

MC cause overflow incontinence

A

diabetes/ neuropathy

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26
Q

MC cause stress incontinence

A

cystocele

hypermobile urethra

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27
Q

Describe mixed incontinence

A

-urge to void AND loss of urine with Valsalva

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28
Q

Treatments for stress incontinence

A

-kegels –> urehtropexy –> transvaginal fixation

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29
Q

Treatment of urge incontinence

A

anticholinergic medication to relax detrusor

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30
Q

Treatment of overflow incontinence

A

intermittent self cathetherization

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31
Q

What differentiates genuine and urge incontinence

A

-cystometric/ urodynamic evaluation

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32
Q

Three components of health maintenance

A

1) cancer screening
2) immunizations
3) addressing common disease in patient group

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33
Q

When are pap smears performed?

A

every three years 21-65

**may do every 5 years with co-testing ages 30-65

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34
Q

Requirement for stopping pap screening at age 65:

A

paps negative for CIN2 during last 20 years

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35
Q

What age groups receive HPV vaccine?

A

9-26

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36
Q

When should tetanus boosters be administered?

A

q10 years

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37
Q

What age groups receive varicella zoster + pneumonia vaccine?

A

60+

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38
Q

What two health maintenance screenings begin at age 45?

A

cholesterol q5 years
fasting blood sugar q3 years

(may start sooner if warranted)

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39
Q

When should TSH screening begin?

A

q5 years at age 50

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40
Q

When should DEXA scanning begin?

A

65+

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41
Q

For what age groups is cancer #1 COD? Heart DiseasE?

A

19-64: cancer
65+ heart disease
(younger = MVA… now probably Overdose is more accurate)

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42
Q

Mammography guidelines

A

q1 year starting age 40

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43
Q

Four major conditions in women 65+

A
  • depression
  • CVD
  • osteoporosis
  • breast cancer
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44
Q

Signs of placental separation

A

gush of blood + lengthening of the cord

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45
Q

What defines an abnormally retained placenta

A

third stage of labor longer than 30 minutes

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46
Q

Cause of uterine inversion

A

excessive force on the umbilical cord

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47
Q

Risk factors for uterine inversion

A

1) grand multiparous patient w/ placenta implanted at fundus
2) placenta accreta

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48
Q

1st step in management of uterine inversion

A

clinicians fist placed inside uterus to maintain structure until surgery can take place

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49
Q

If placenta is not delivered after 30 minutes, what is the next step in management?

A

manual extraction attempt

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50
Q

What is climacteric?

A

perimenopausal state

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51
Q

What confirms the diagnosis of perimenopausal state?

A

FSH + LH levels (expected to be high)

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52
Q

Mean age of menopause

A

51

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53
Q

Age at which premature ovarian failure is diagnosed?

A

less than 40

At 30 or younger: consider AI disease or karotypal abnormality

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54
Q

Four risks associated with Estrogen+ Progestin therapy in menopause

A
  • breast cancer
  • stroke
  • PE
  • heart disease
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55
Q

Two diseases with decreased incidence when using E/P therapy in menopause

A

1) colon cancer

2) osteoporosis

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56
Q

In addition to estrogen, what drug may be used to treat hot flashses?

A

clonidine

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57
Q

How are estrogen levels changed in PCOS?

A

INCREASED

HIGH estrogen + testosterone and poor ovulation

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58
Q

How does hyperprolactinemia effect estrogen levels?

A

PRL —I GNRG —–I LH/FSH = low estrogen

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59
Q

MC location osteoporosis fracture

A

thoracic spine

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60
Q

Nectroizing fasciitis buzzword

A

crepitus

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61
Q

Bacteria responsible for nec fas

A

anaerobes

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62
Q

First sign of septic shock

A

decreased urine output –> tachy

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63
Q

Cause of hypotension in shock

A

vasodilation

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64
Q

Sepsis + sunburn like rash suggests what bacteria?

A

GAS

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65
Q

What dictates normalcy in labor?

A

change in the cervix, not contractions

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66
Q

Define: latent phase of labor

A

stage 1,
time when cervix effaces as opposed to dilating.
less than 4 cm

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67
Q

Define: active phase of labor

A

dilation occurs more rapidly

greater than 4 cm

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68
Q

Define adequate labor

A

primigravid: 1.2 cm/ hr
multip: 1.5 cm/hr

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69
Q

Contrast arrest and protaction of labor

A

arrest: no progress 2 hours
protraction: inadequate cervical dilation

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70
Q

Define the stages of labor:

A

first: onset to 10 cm dilation
second: complete dilation to delivery of infant
third: delivery of placenta

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71
Q

define adequate acceleration

A

15 bpm for at least 15 seconds

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72
Q

What should be first evaluated during labor abnormalities?

A

Three P’s
powers
passenger
pelvis

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73
Q

How long should stage one of labor last?

A

primi: 18-20
multip: 14

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74
Q

How long should stage two of labor last?

A

primi: 2, 3 with epidural
multip: 1, 2 with epidural

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75
Q

How long should stage three of labor last?

A

30 mins

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76
Q

Define clinically adequate contractions

A

q2-3 minutes lasting at least 40- 60 seconds

or 200 MVUs

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77
Q

How are Montevideo units calculated?

A

10 minute window, add each contractions rise above baseline

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78
Q

MC cause of early, late, and variable decelerations

A

early- head compression
variable- cord compression
late- hypoxia

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79
Q

How is normalcy of labor assessed?

A

cervical change IN ACTIVE STAGE

time in latent phase

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80
Q

When is cesarean delivery considered for abnormal labor?

A

CP disproportion

arrest of active phase w/ adequate contractions

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81
Q

When should a uterine pregnancy see visible on US

A

1500-2000 mIU/mL b HCG

25 ng/mL progesterone

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82
Q

What is a normal rise in b-HCG

A

66% over 48 hours

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83
Q

Who is a candidate for MTX?

A

women with small ectopics (less than 3.5 cm)

*reliable patient, no heart beat etc

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84
Q

Treatment for patient with suspected ectopic who is acutely symptomatic?

A

laparoscopy

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85
Q

Common ADR of MTX therapy

A

mild abdominal pain, can observe these patients with stable vitals

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86
Q

Best treatment for placenta accreta

A

hysterectomy

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87
Q

Cause of placenta accreta

A

defect of the decidua basalis layer

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88
Q

Treatment of placenta accreta in young patient who strongly desires further fertility

A

pack the uterus

excess mortality

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89
Q

Highest risk factors for placenta accreta

A

previous C-section/ D&C
placenta previa
fetal down syndrome

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90
Q

Placental position most commonly associated with placenta accreta

A

anterior placenta

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91
Q

Most common complication of placenta accreta treated with uterine artery ligation/ packing

A

hemorrhage

2nd most common infection

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92
Q

What procedures increase the risk of placenta accreta?

A

those that penetrate the uterine wall fully (ie cesarean not myomectomy)

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93
Q

Treatment for cervicitis (empiric)

A

gonococcal protection- ceftriaxone IM single dose

chlamydial protection- azithromycin oral single dose

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94
Q

Alternative to azithromycin for treatment of chlamydia

A

doxycycline

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95
Q

Where does the “lower genital tract” begin?

A

cervix and below

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96
Q

Two MC symptoms of cervicitis

A

post coital bleeding

mucopurulent discharge

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97
Q

What should be offered to patients with cervicitis?

A

counseling+ testing for other common STDs

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98
Q

MCC septic arthritis in young women?

A

gonorrhea

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99
Q

MC cause mucopurulent discharge in US women?

A

chlamydia

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100
Q

Presentation of disseminated gonococcal disease

A

multiple painful pustules on the skin

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101
Q

Treatment for complete spontaneous abortion

A

follow hcg levels to zero

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102
Q

How are inevitable abortion and cervical incompetence distinguished

A

presence or absence of contractions

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103
Q

MC risk factor for shoulder dystocia

A

maternal diabetes

multiparity, obesity

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104
Q

Sign of shoulder dystocia

A

turtle sign

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105
Q

Erb’s Palsy involves what nerve roots?

A

C5-6

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106
Q

What is the Zavanelli maneuver?

A

cephalic replacement –> cesarean delivery

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107
Q

How might bony diameter from shoulder to axilla be decreased in the case of shoulder dystocia?

A

delivery of posterior arm

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108
Q

How can anterior rotation of the pubic symphysis be achieved in the case of shoulder dystocia?

A

mcroberts maneuver

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109
Q

How might fetal shoulder axis switch from AP –> oblique?

A

suprapubic pressure

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110
Q

What should be avoided in the case of shoulder dystocia?

A

fundal pressure

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111
Q

Symptoms of pyelonephritis post op suggest _____

A

ureteral injury –> need IVP or CT

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112
Q

Through which ligament do the uterine arteries traverse?

A

cardinal

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113
Q

IVP images what structures?

A

KUB

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114
Q

MC surgery injuring the ureter

A

abdominal hysterectomy

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115
Q

When the ureter is “dissected” during surgery, what risk is posed to the patient?

A

ureteral ischemia

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116
Q

In addition to surgery, what may cause a fistula leading to incontinence?

A

radiation therapy

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117
Q

Postmenopausal bleeding always warrants a __________

A

endometrial biopsy

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118
Q

risk factors for endometrial cancer

A
  • late menopause, nulliparity, early menarche

- obesity, diabetes, htn, pcos

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119
Q

In the case of negative biopsy in the face of PM bleeding and many risk factors, the next best step in management is?

A

direct visualization, hysteroscopy vs hysterectomy

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120
Q

MC cause post menopausal bleeding

A

friable tissue, only 20% will have endometrial cancer

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121
Q

Normal thickness of the endometrial stripe

A

5 mm

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122
Q

When do we worry about endometrial cancer in a 30 year old patient

A

history of anovulation (ie PCOS= unopposed estrogen)

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123
Q

MC female genital tract malignancy

A

endometrial cancer

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124
Q

Endometrial cancer in thin patients is _____

A

more aggressive

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125
Q

When is a patient with placenta previa delivered?

A

cesarean at 36-37 weeks with stable vitals

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126
Q

Three types of placenta previa

A

complete, partial, marginal

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127
Q

Placenta previa causes a risk of placenta _____

A

accreta

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128
Q

Risk factors for placenta previa

A

multips
surgeries
history

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129
Q

Order of appropriate examinations in case of placenta previa

A

U/S –> speculum –> digital

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130
Q

Treatment of stable placenta previa diagnosed early in pregnancy?

A

repeat US at second trimester

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131
Q

Three major risk factors for placental abruption

A

cocaine
trauma
HTN

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132
Q

Bleeding that occurs behind the placenta in an abruption

A

concealed abruption

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133
Q

What is couvelaire uterus?

A

bleeding into the myometrium that discolors the uterus

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134
Q

How is placental abruption diagnosed?

A

clinical picture, not US

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135
Q

What lab is critical in case of suspected coagulopathy secondary to abruption?

A

fibrinogen levels (less than 150)

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136
Q

What tests for fetal-maternal hemorrhage in case of abruption?

A

kleihauer betke test

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137
Q

Desried hematocrit and urine output in placental abruption?

A

hct 25-30%

urine 30 ml/hour

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138
Q

post cotial bleeding
odorous discharge
suggestive of….

A

cervical cancer

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139
Q

Mean age of presentation for cervical cancer

A

51

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140
Q

Risk factors for cervical cancer

A

STDs
early sex/ many partners
cigarettes
multiparity

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141
Q

Ages during which HPV vaccine is given

A

9-26

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142
Q

Which strains of HPV cause cervical cancer? warts?

A

cancer: 16,18
warts: 6,11

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143
Q

1 location cervical cancer

A

squamocolumnar junction

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144
Q

Appearance of CIN lesions on colposcopy

A

aceto-white changes

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145
Q

Best test for visible cervical lesion

A

biopsy, not pap smear

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146
Q

Treatment of early versus late cervical cancer

A

early: surgical vs chemo/radiation
late: radiation + chemo gold standard

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147
Q

Contrast brachytherapy and teletherapy

A

brachy: implants
tele: full pelvic radiation

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148
Q

MC chemo drug used in cervical cancer

A

cisplatin

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149
Q

Most common cause of death in cervical cancer

A

bilateral ureteral obstruction leading to uremia

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150
Q

Followup post hysterectomy for cervical cancer

A

hysterectomies of the vaginal cuff

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151
Q

What populations with ASCUS may be observed?

A

adolescents and pregnant women

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152
Q

Sheehan syndrome is _______ pituitary necrosis

A

anterior

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153
Q

Symptoms of Sheehan

A

amenorrhea
failure to breast feed
hypothyroid
adrenocortical insufficiency

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154
Q

Asherman syndrome is caused by damage to _____

A

the decidua basalis layer

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155
Q

How are Sheehan and Asherman distinguished?

A

determine whether the uterus is responsive to hormonal therapy

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156
Q

How is Ashermans definitively diagnosed?

A

hysterosalpingogram

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157
Q

Amenorrhea is formally defined as

A

lack of cycles for 6 months

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158
Q

Definition of PPH

A

500+ mL vaginal

1000+ mL cesarean

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159
Q

MCC amenorrhea in reproductive years

A

pregnancy

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160
Q

What hormones need to be replaced in Sheehan syndrome?

A
  • thyroxine
  • cortisol
  • mineralocorticoids
  • estrogen, progestin
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161
Q

Treatment asherman syndrome

A

hyperoscopic resection

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162
Q

Temperature chart associated with PCOS

A

monophasic

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163
Q

Treatment of cord prolapse

A

immediate cesarean delivery

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164
Q

Risk factors for cord prolapse

A

rupture of membranes with transverse fetal lie or unengaged presenting part

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165
Q

AROM should be avoided without ______

A

engagement of the presenting part ! `

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166
Q

Position that must be maintained while preparing patient for cesarean delivery in case of cord prolapse

A

trendelenburg + physicians hand maintains cord inside

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167
Q

Define engagement

A

largest diameter of the head has negotiated the fetal pelvic inlet

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168
Q

Initial triage steps in case of fetal bradycardia

A

1) patient on side
2) fluid bolus
3) 100% O2 by face mask
4) stopping oxytocin

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169
Q

How does hyperstimulated labor present?

How is it managed?

A

fetal bradycardia

B-agonists (terbutaline)

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170
Q

What most commonly causes fetal bradycardia during labor?

A

epidural, give fluids, it will resolve

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171
Q

Position that most strongly predisposes to cord prolapse

A

footling breech presentation

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172
Q

Ddx for bradycardia

A

1) epidural
2) hyperstimulation of labor
3) cord prolapse
4) uterine rupture

173
Q

FIRST step in assessing fetal bradycardia

A

distinguish maternal and fetal pulse + look for cord prolapse

174
Q

MC finding assc with uterine rupture

A

fetal HR abnormality

175
Q

Treatment for uterine rupture

A

STAT cesarean

176
Q

How do thyroid hormone levels alter prolactin levels?

A

TRH increases PRL levels

177
Q

How does elevated PRL cause amenorrhea?

A

^^ PRL –I GnRH

178
Q

How is galactorrhea definitively diagnosed

A

fat droplets under the microscope

179
Q

Differential diagnosis of pruritis in pregnancy

A

cholestasis
herpes gestationalis
PUPPP

180
Q

what does PUPPP stand for?

A

pruritic urticarial papule and plaques of pregnancy

181
Q

Cholestasis of pregnancy:

  • most common location of pruritis
  • most common time of onset
A
  • extremities

- third trimester, at night

182
Q

What confirms the dx of cholestasis in pregnancy?

A

increased bile acids

183
Q

Treatment of cholestasis of pregnancy?

A

antihistamines

184
Q

Cause of herpes gestationis

A

IgG autoantibodies against basement membrane (not virus”)

185
Q

dx and Treatment of herpes gestationis

A

IgG levels, corticosteroids

186
Q

Where does PUPPP typical start?

A

abdomen –> thighs and buttocks

187
Q

Treatment of PUPPP

A

topical steroids and antihistamines

188
Q

Effect of cholestatis, PUPPP, and HG on pregnancy

A
  • cholestatis: increased neonatal mortality
  • PUPPP: none
  • HG: will see transients neonatal lesions
189
Q

Pelvic inflammatory disease is AKA

A

acute salpingitis

190
Q

2 longterm sequelae of PID

A

infertility

ectopics

191
Q

The best method for diagnosing PID is?

A

laparoscopy

192
Q

Perihepatic lesions in the presence of PID is termed:

A

Fitz-Hugh Curtis syndrome

193
Q

What is required to manage PID outpatient?

A

absence of peritoneal signs
low fever
tolerance of oral meds
not pregnant or at extremes of age

194
Q

Most common cause and treatment of tuboovarian abscess

A

anaerobes

metronidazole/clinda

195
Q

Most common culture findings in PID

A

multiple organisms

gonorrhea, chlamydia, anaerobes, gram -

196
Q

Sulfur granules are classic for infection with what bacteria?

A

actinomyces

197
Q

Is multiparity or nulliparity assc with higher PID risk?

A

nulliparity

198
Q

vital sign changes assc with PE

A

tachycardia

tachypnea

199
Q

classic test for PE

A

Spiral CT or MRA

200
Q

What predisposes pregnant women to DVT?

A

venous stasis (vena cava) + hypercoagulable state (estrogen) of pregnancy

201
Q

How does estrogen cause hypercoagulable state?

A

increases fibrinogen levels

202
Q

“Rales” on exam in a patient woman are suggestive of:

A

1) pneumonia
2) CHF
3) ARDS
4) atelectasis

203
Q

Normal pH, pCO2, HCO3 in a pregnant woman?

A 
7.45
28 CO2 (higher tidal volume)
19 bicarb (higher renal excretion to compensate for respiratory changes)
204
Q

How is peripartum cardiomyopathy treated in pregnancy?

A

diuretics

ionotropic therapy

205
Q

How is PE treated?

A

IV heparin 5-7 days followed by subQ therapy to maintain PTT 1.5-2.5 for at least 3 months

206
Q

What tests should be done to detect clotting disorders?

A
  • Protein S/C levels
  • Factor V levels
  • AT levels
  • homocysteinuria/ APL syndrome
207
Q

MCC maternal mortality

A

PE

208
Q

What PO2 is concerning in a pregnant woman?

A

less than 80 mmHg

209
Q

Painful vaginal lesions + inguinal adenopathy =

A

chancroid (haemophilus ducreyi)

210
Q

MC symptom of leiomyomata

A

heavy bleeding/ anemia

211
Q

what medication is used to shrink the size of fibroids?

A

GnRH agonist

212
Q

Change seen in leiomyoma during pregnancy?

A

red degeneration

213
Q

What types of leiomyomata exist?

A
  • subserosal
  • submucosal
  • intramural
  • pedunculated
214
Q

MC reason for hysterectomy

A

fibroids (30%)

215
Q

Risk factor for leiomyosarcoma

A

pelvic radiation

216
Q

When should an asymptomatic leiomyomata be removed?

A

rapid growth

ureteral compression

217
Q

How might pre-eclampsia lead to blood loss/ severe hypotension?

A

hepatic rupture

218
Q

Proteinuria + BP diagnostic for PreE

A

300+ mg over 24 hour period

140/90+

219
Q

Underlying pathogenesis of PreE

A

vasospasm and leaky vessels

220
Q

What labs are included in the PIH panel?

A

ULAC PP

  • uric acid
  • ldh
  • AST/ALT
  • Creatinine
  • Platelet
  • Protein/creatinine ratio
221
Q

How is magnesium sulfate excreted?

A

kidneys, monitor urine output +reflexes

222
Q

Treatment for severe PreE

A

deliver, regardless of gestational age

223
Q

When are platelets transfused?

A

50,000 or less

224
Q

How do ecclamptic seizures lead to maternal mortality?

A

intracranial hemorrhage

225
Q

Treatment for mild pre-eclampsia:

A 
expectant management before term
at term (37 weeks) deliver
226
Q

When are monochorionic twins delivered?

A

35 weeks

227
Q

When are PPROM patients delivered?

A

34 weeks

228
Q

HTN that persists beyond 12 weeks postpartum is deemed

A

chronic HTN

229
Q

Difference between fine and core needle biopsies

A

core needle biopsies preserve cellular architecture

230
Q

What is a “triple assessment” of a breast mass?

A

clinical exam
imaging
FNA/CNB

231
Q

What are the five main causes of infertility?

A

1) ovarian
2) uterine
3) tubal factor
4) semen
5) peritoneal factor (endometriosis)

232
Q

Define fecundability

A

probability of achieving viable pregnancy during one menstrual cycle (20-25% is normal)

233
Q

Ovulation occurs _____ hours after the LH surge

A

36

234
Q

Gold standard for diagnosis of endometriosis

A

laparoscopy

235
Q

When is temperature highest during the menstrual cycles?

A

after LH surge (luteal phase)

236
Q

HSG revealing blocked tubes should be followed up with ______

A

laparoscopy

237
Q

Most common time of ovarian torsion during pregnancy?

A

14 weeks when uterus rises or immediately post partum

238
Q

What distinguishes ovarian torsion from appendicitis and cholecystitis?

A

absence of fever/ anorexia/ leukocytosis

239
Q

Timing of appendicitis vs cholecystitis in pregnancy ?

A

appy: any trimester
cholecystitis: after first trimester

240
Q

What predisposes women to gall stones?

A

increases size of gallbladder

increased biliary sludge

241
Q

Ddx of abdominal pain in pregnancy

A 
cholecystitis 
appendicitis 
placental abruption 
ectopic 
torsion
242
Q

MCC pancreatitis in pregnancy

A

gallstones

243
Q

Labs assc with pancreatitis:

A

amylase

lipase

244
Q

How is cholelithiasis/ cholecystitis treated in pregnancy?

A

lowfat diet
observe until post partum

**not to be confused with choleCYSTITIS (treat with cholecystectomy)

245
Q

1 cause maternal mortality in the first twenty weeks of pregnancy

A

ruptured ectopic

246
Q

Gold standard for diagnosis of ectopic

A

laparoscopy

247
Q

After giving MTX, what should raise suspicion of rupture?

A

hypotension and low Hct

*abdominal pain is normal

248
Q

What progesterone level denotes a normal IUP

A

25 ng/mL

249
Q

Most common cause of anemia in pregnancy women

A

iron deficiency, fetus has increased need for iron

250
Q

Sickle Cell anemia mutation

A

glutamic acid –> valine on B globin chain

251
Q

B-thal presentation at birth

A

normal, until Hb F falls

life expectancy in third decade

252
Q

Which is more common in pregnancy: folic acid or B12 deficiency?

A

folic acid, B12 stored for years

253
Q

Three common causes of hemolysis in patients with G6Pd deficiency?

A

nitrofurantoin
antimalarials
sulfa drugs

254
Q

Elevated A2 Hb suggests ______.

Elevated Hb F suggests ______.

A

A2: B thal
F: A thal

255
Q

What test of vaginal fluid determines risk of preterm delivery?

A

fetal fibronectin assay

256
Q

What steps should be taken to manage preterm labor?

A
  • abx for GBS px
  • steroids
  • tocolysis
  • cause of labor?
257
Q

What is needed to diagnose preterm labor in a nulligravida

A

2cm dilated, 80% effaced

258
Q

At what week gestational age are steroids/tocolytics no longer necessary in face of preterm delivery

A

34

259
Q

What are common tocolytic agents?

A

CCBs
terbutaline
indomethacin

260
Q

How does MgSO4 work to maintain a pregnancy?

A

competitively inhibits calcium

261
Q

How does 17 a hydroxyprogesterone caproate work to stop labor?

A

(progesterone) inhibits pituitary gonadotropin release; maintains pregnancy

262
Q

Nifedipine should never be combined with _____

A

MgSO4

263
Q

Terbutaline/ Ritodrine ADRs

A

pulmonary edema
hyperglycemia
hypokalemia
tachy

264
Q

MgSO4 ADRs

A

pulmonary edema and respiratory distress

265
Q

How often are steroids given when mother is at risk of preterm delivery?
17aOHprogesterone caproate?

A

steroids: once
17aOHPC: weekly to maintain pregnancy

266
Q

What infection is strongly linked to preterm delivery?

A

gonorrhea

267
Q

What is a contraindication to tocolytic therapy?

A

suspected abruption

268
Q

Dyspnea in a woman given tocolysis is generally caused by ______

A

pulmonary edema, give furosemide

269
Q

E .coli = MC etiology of simple UTI.

What abx are known to treat e coli?

A 
SCQN 
super cocks never quit 
sulfa 
cephalosporins 
quinolones 
nitrofurantoin
270
Q

1 cause urethritis

A

chlamydia

271
Q

Why does female sex predispose to UTIs?

Why do pregnant women have high risk UTIs?

A

women- shorter urethra

pregnancy- incomplete emptying of bladder

272
Q

What abx is e coli commonly resistant to?

A

ampicillin

273
Q

DOC for chlamydia? gonorrhea?

A

chlamydia- azithromycin, doxy

gonorrhea- ceftriaxone

274
Q

Which two drug classes cover e coli AND penetrate kidney for treatment of pyelo?

A

FQs

TMP-SMX

275
Q

Most simple difference in presentation of lower UTI vs pyelo?

A

fever

276
Q

What are contraindications to IUD placement?

A 
recent infection (STD)
scandalous sexual behavior. give them condoms.
abnormal size/shape uterus
277
Q

Does hormonal IUD increase risk of DVT/PE?

A

no. its progesterone, not estrogen.

278
Q

ADR assc with hormonal patch for contraception

A

nausea and vomiting

279
Q

How does the levonorgestrel IUD work?

A

thickens cervical mucus, thins endometrium

**doesn’t prevent ovulation

280
Q

How does the copper IUD work?

A

inhibits sperm migration/viability

damages ovum

281
Q

What patients cant have copper IUD?

A

wilsons disease

282
Q

How long should a diaphragm be left in?

A

put in 1-2 hours before sex and leave in for 8 hours after

must also use spermicide

283
Q

MOA compination OCPs

A

progresterone inhibits ovulation and thickens cervical mucus

estrogen stabilizes endometrium to prevent breakthrough bleeding

284
Q

Three risks OCPs

A

1) clotting (stroke, MI, PE)
2) benign hepatic tumors
3) cholelithiasis

285
Q

What is the preferred method of oral emergency contraception and why?

A

progestin only, as opposed to combination…..

less nausea

286
Q

when must emergency contraception be initiated?

A

within 72 hours of intercourse

287
Q

For what conditions is contraception with IMPA indicated?

A

SCA, epilepsy

288
Q

What may occur after initiation of abx therapy for treatment of gram negative infection?

A

ARDS

endotoxin release after bacteria are lysed

289
Q

What is the pathogenesis of ARDS?

A

leaky capillaries

290
Q

CT finding in case of ARDs

A

patchy infiltrates

291
Q

MC cause septic shock in pregnancy

A

pyelo

292
Q

Proper evaluation test for DVT

A

Doppler ultrasound

293
Q

How common is PE in untreated DVT?

A

40%

294
Q

Which anticoagulant leads to osteoporosis?

A

heparin

295
Q

What chromosomes are assc with the BRCA genes?
What types of genes are they?
What is the inheritance pattern?

A
  • BRCA1 17
  • BRCA2 13
  • tumor supressors
  • AD
296
Q

Any palpable dominant mass requires _____

A

histologic diagnosis regardless of imaging findings
FNA for young women
Excisional biopsy for women 50+

297
Q

MC type of breast cancer

A

intraductal carcinoma

298
Q

Tumor producing TH

A

struma ovarii

299
Q

MC type ovarian neoplasm + type assc with CA 125

A

epithelial tumor in ages 30+

younger than 30 dermoid more common

300
Q

U/S features of mature/benign cystic teratoma

A

hypoechoic area, cystic structures, fat fluid level

301
Q

What are the five types of epithelial ovarian neoplasms?

A

1) serous
2) mucinous
3) endometroid
4) brenner
5) clear cell

302
Q

What epithelial tumor is most rapidly growing?

A

mucinous, assc with pseudomyxoma peritonei

303
Q

What size ovarian cyst warrants operation in:

  • prepubertal girls
  • reproductive age girls
  • menopausal girls
A
  • prepuberty: 2+ cm
  • reproductive 8+
  • menopausal: 4+
304
Q

Appearance of ovarian neoplasms on US:

  • granulosa cell
  • dermoid
  • follicular
A
  • granulosa cell: solid
  • dermoid: complex
  • follicular: simple cyst
305
Q

Treatment of surgical site infection

A

immediate surgical closure and abx

306
Q

Contrast wound dehiscence, fascial disruption, and evisceration

A

dehiscence: separation of surgical incision
fascial disruption: communication of the perionteal cavity with the skin
evisceration: disruption of all layers, bowel protruding through

307
Q

MCC post op fascial breakdown

A

suture tearing through fascia

308
Q

How can urine vs lymphatic drainage be distinguished?

A

creatinine

309
Q

Copious amounts of serosanguinous fluid from abdominal incision suggest _____

A

fascial disruption

310
Q

Risk factors for fascial disruption

A
  • obesity
  • malnutrition
  • chronic cough
311
Q

Endometrial tissue floating with a frond pattern is diagnostic of _____

A

IUP

312
Q

Hemoperitoneum in the presence of a viable IUP is likely caused by

A

ruptured corpus luteum cyst, less commonly co-existing ruptured ectopic + IUP

313
Q

Symptoms of hemoperitoneum:

A 
hypovolemic symptoms 
peritoneal signs (pain)
314
Q

What part of pregnancy requires progesterone from the corpus luteum

A

first 10 weeks

315
Q

Symptoms of degenerating leiomyomata in pregnancy:

A

localized tenderness over the site of the mass

316
Q

What percentage of blood volume must be lost before hypotension is seen?

A

30-40%

317
Q

How is ashermans syndrome diagnosed?

A

HSG, trial of progesterone withdrawl bleeding

318
Q

Treatment for ashermans

A

operative hysteroscopy

319
Q

Classic finding suggestive of breast cancer on mammography

A

Small cluster of calcifications around a mass.

Mass with spiculated borders

320
Q

Annual mammograms age 40-90 exposes patients to how many rads?

A

10; safe.

321
Q

Tx for palpable breast mass with normal imaging

A

Biopsy; false negative up to 10% of cases

322
Q

Lesion caused by trauma to breast + it’s mammogram appearance

A

Fat necrosis
Mimics breast cancer

** Still must excise lesion to confirm

323
Q

At what age is primary amenorrhea diagnosed?

A

16

324
Q

Ddx of painless primary amenorrhea with normal breast development

A

Androgen insensitivity vs mullerian agenesis

325
Q

Treatment of androgen insensitivity

A

Removal of intra-abdominal gonads after puberty

326
Q

Anomaly commonly assc with mullerian anomalies

A

Renal anomalies

327
Q

What explains breast development in androgen insensitivity syndrome?

A

Peripheral conversion of androgens

328
Q

Treatment for septic abortion:

A

IV broad spectrum abx
D&C
Also monitor BP/O2/urine output

329
Q

MC etiology of septic abortion

A

Usually polymicrobial

330
Q

Pockets of gas on pelvic CT suggest what diagnosis?

What was the treatment?

A

Metritis

Treatment = urgent hysterectomy

331
Q

Ergot alkyloid used to treat atony

A

Methergine

332
Q

What vessels are ligated to treat uterine atony?

A

Uterine artery

Internal iliac artery

333
Q

Late post partum hemorrhage cause

A

Subinvolution of the placenta

334
Q

MCC sexually infantile delayed puberty

A

gonadal dysgenesis, chromosomal abnormality

kallman v turners

335
Q

Contrast Kallman and Turners

A

FSH, LH increased in Turners

336
Q

Four stages puberty

A

thelarche –> adrenarche –> growth spurt –> menarche

337
Q

MC health concern in Turners Syndrome

A

osteoporosis

338
Q

No menses at age 15 is diagnosed as?

A

delayed puberty (no sex characteristics at 14-15) –> primary amenorrhea not diagnosed until 16 years

339
Q

______ determines gonadotropic state, _____ determines gonadal state.

A

FSH-gonadotropic

estrogen- gonadal

340
Q

breast fluctuating lesion:
dx:
tx:
etiology:

A

abscess
drain
staph aureus, from infants nose and throat

**continue breast feeding

341
Q

What vitamin is absent in breast milk?

A

Vitamin D, supplement by 2 months

342
Q

What proteins are in breast milk?>

A

whey + casein

343
Q

What immunogenic compounds are found in breast milk?

A

lactoferin
secretory IgA
lysozyme

344
Q

Treatment of thyroid storm in pregnancy

A
  • Bber
  • corticosteroids
  • PTU
345
Q

Rare but serious ADR of PTU

A

bone marrow aplasia

check white cell count before giving

346
Q

Changes to thyroid panel in pregnancy

A
  • normal free T4/TSH

- increased TBG, total T4

347
Q

MC cause hyperthyroidism in the postpartum patient

A

destructive lymphocytic thyroiditis

antimicrosomal antibodies

348
Q

Manifestations of chlamydial infection in pregnancy

A
  • neonatal conjunctivitis and pneumonia
  • late postpartum endometritis
  • mucopurulent urethritis/cervicitis
349
Q

MCC neonatal conjuncitivits

A

chlamydial

erythromycin given at birth prevents gonococcal conjunctivitis

350
Q

Manifestations of gonococcal infection in pregnancy

A
  • PPROM/premature labor/SAB/chorio
  • disseminated gonococcal disease
  • postpartum endometritis
  • neonatal sepsis, conjuncitivits
351
Q

MC mode of transmission of HIV

A

heterosexual intercourse

352
Q

How long after infection are HIV ab’s detectable

A

by three months

353
Q

How should delivery be handled in HIV+ patient?

A

scheduled cesarean prior to rupture of membranes

**If PPROM just go ahead and deliver vaginally, baby already exposed

354
Q

Chlamydia prefers what tissue type?

A

transitional and columnar epithelium

355
Q

Treatment of chlamydia in pregnancy

A

ORAL azithro/amox

356
Q

How does parvovirus B19 lead to hydrops?

A

inhibits bone marrow erythrocyte production –> anemia –> hydrops

(aplastic anemia)

357
Q

Describe adult rash associated with parvo

A

“lacy”/reticular

358
Q

What ab is assc with past parvo infection? current?

How long after infection might it take for ab’s to become evident?

A

IgG-past
IgM- current

20+ days after infection

359
Q

Describe fetal hydrops

A

fluid in multiple body cavities

360
Q

What fetal heart tracing is assc with fetal hydrops?

A

sine wave with cycles of 3-5/minute

361
Q

Describe the viral structure of parvo

A

small single stranded DNA

362
Q

What are some causes of fetal hydraminos?

A
  • CNS, GI, chromosomal anomalies
  • maternal DM, multiple gestation
  • syphilis, parvo
  • Rh isoimmunization
363
Q

Fetal findings assc with ITP

A

thrombocytopenia

IUGR

364
Q

Abx for postpartum endometritis should cover what bugs?

A
  • anaerobic, gram -
    cesarean: clinda +gent
    vaginal: amp + gent
365
Q

Ddx of postpartum fever, most common causes (4)

A
  • mastitis
  • wound infection
  • endometritis
  • pyelo
366
Q

Postpartum fever persisting beyond 72 hours after abx treatment warrants _____

A

CT of abdomen

367
Q

Best treatment of wound infection

A

open the wound.

368
Q

Greatest risk factor for endometritis?

A

cesarean

369
Q

MC bacteria assc with endometritis

A

bacteroides (anaerobes)

370
Q

Treatment for septic thrombophlebitis

A

heparin + abx

371
Q

Exam finding assc with syphilis

A

nontender lesion + lymphadenopathy

372
Q

What test is more specific that RPR/ VDRL for syphilis?

A

FTA-ABS

373
Q

2 MC infectious causes of ulcers in the US

A

syphilis + herpes

374
Q

What are the stages of syphilis infection?

A

primary (painless ulcer)
secondary (rash on hands and feet)
latent (1+ year)
tertiary (ocular, CNS,CV findings)

375
Q

How is neurosyphillis diagnosed?

What are the manifestations of neurosyphilis?

A

LP

-argyl Robertson pupil, unsteady balance

376
Q

Gram stain finding of chancroid

A

“school of fish”

377
Q

What causes false + RPR

A

SLE

378
Q

T pallidum:

-organism type

A

Thin spirochete

379
Q

Alternatives to penicillin in the treatment of syphilis

A

erythromycin, doxycycline

380
Q

How long after PPROM does labor occur?

A

50% within 48 hours

90% within a week

381
Q

Risk factors for PPROM

A
  • cigarettes, STDs, low SES
  • multiple gestation
  • cone
  • cerclage
382
Q

MC acute complication of PROM

A

labor

383
Q

How to definitively diagnose infection during PPROM

A

gram stain of amniotic fluid (amniocentesis)

384
Q

Cause of intra-amniotic infection WITHOUT PROM

A

listeria via transplacental spread

385
Q

Treatment for trich resistant to metronidazole

A

tinidazole

386
Q

What vaginal bug may be isolated from a wet surface up to 6 hours after inoculation?

A

trich

387
Q

Both BV and trich are assc with ____ and ____

A

alkaline pH and + whiff test

388
Q

What are the three phases of hair growth and which determines length/ stability of hair?

A

anagen- length
catagen
telogen- strength

389
Q

Diagnostic test for cushings

A

dexamethasone suppression test

390
Q

Molecule elevated in adrenal tumor? sertoli leydig?

A

adrenal: DHEA
sertoli: testosterone

391
Q

Molecule elevated in CAH

A

17 OH progesterone

392
Q

Treatment of CAH

A

replace cortisol/ mineralocorticoid

393
Q

Changes in LH/FSH assc with PCOS

A

^^ LH:FSH ratio (ie 2:1)

394
Q

Cause of high AFP? low?

A

high- multifetal gestation, open defect
low- downs

*or incorrect dating

395
Q

PAPPA/hcg/NT assc with downs in early pregnancy?

A

low hcg/papp-a thick NT

396
Q

Trisomy 18 vs Downs findings 2nd trimester

A

all markers low in trisomy 18

hcg,inhibin high/afp, estriol low in downs

397
Q

First step in management of abnormal triple screen

A

ultrasound

398
Q

Risks assc with amnio

A

death, chorio, prom

399
Q

When does window for serum screening end?

A

21 weeks

400
Q

Cystic masses in left + right abdominal region suggests

A

duodenal atresia- assc with downs

401
Q

Unexplained elevated AFP puts babies at risk of what conditions?

A
  • stillbirth
  • IUGR
  • preE
  • abruption
402
Q

Definition of PCOS

A

hyperandrogenic chronic anovulation + excess estrogen

403
Q

Define BMI

A

kg/height in m2

404
Q

Treatment of young patients with endometrial cancer (stage 1)

A

hysterectomy and surgical staging …or high dose progesterone + repeat sampling if child bearing is desired. Hysterectomy indicated after childbirth

405
Q

Patient with PCOS should be screened for ____ and ____.

A

glucose intolerance

lipid abnormalities

406
Q

What organs prolapse anteriorly through vagina? posteriorly? centrally?

A

anterior: cystocele
posterior: rectocele
central: enterocele

407
Q

The vagina may be fixed to ______ to prevent prolapse

A

sacrospinous ligament

408
Q

What muscles make up the pelvic diaphragm?

A
  • pubococcygeus
  • puborectalis
  • levator ani
409
Q

What organ sits on the pelvic diaphragm?

A

bladder

410
Q

Define procidentia

A

uterus prolapses beyond the introitus

411
Q

To what structure should the vaginal cuff be fixed after a hysterectomy?

A

cardinal or uterosacral ligament

412
Q

How might prolapse be prevented in patient with deep culdesac?

A

culdoplasty

413
Q

Bleeding with ROM suggests what diagnosis? treatment?

A

vasa previa

stat cesarean

414
Q

What is vasa previa?

A

fetal vessel overlies the os

415
Q

Risks assc with twin pregnancies

A

1) congenital anomalies
2) preterm labor
3) preE
4) PPH
5) maternal death

416
Q

How are OCPs related to twinning?

A

slow tubal motility

417
Q

Best treatment of twin twin transfusion syndrome

A

laser ablation of shared vessels

418
Q

Why are tocolytics relatively contraindicated in multifetal gestations?

A

^^ pulmonary edema risk

419
Q

What screenings should be offered early for women over age 30?

A

cell free DNA

glucose tolerance

420
Q

PCO2 and bicarb are both _____ in pregnancy

A

decreased, increased tidal volume + urinary output

421
Q

In patient with a history of unexplained abruption, how might future pregnancies be managed?

A

induce slightly before GA of previous abruption

422
Q

What are the consequences of anti-Lewis and anti-Kell ab’s in pregnancy?

A

Lewis Lives
Kell Kills
Duffy Dies
(Lewis is IgM and doesn’t cross placenta)

423
Q

Treatment of neonate after birth from HbS+ mom

A

HBIG

HB vaccine

424
Q

Three infectious diseases in which fetal well being can be dramatically improved

A

HIV
syphilis
HepB

425
Q

Biopsy findings assc with lichen sclerosis (3)

A

thinned epidermis
hyperkeratosis
elongation of the rete pegs

426
Q

Second most common type of vulvar cancer

A

melanoma

427
Q

Treatment of Bartholin gland abscess

A

marsupialization

428
Q

Lichen sclerosis shows predilection for _____

A

anus and vulva

429
Q

Uncontrolled vaginal candidiasis may lead to

A

fissures in the labial folds = pain on urination

OBGYN (3 decks)

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