Case Files Notecards Flashcards
1
Q
Incontinence due to bladder neck falling out of normal intra-abdominal position
A
Genuine stress incontinence
2
Q
incontinence due to detrusor muscle overactivity
A
urge
3
Q
“I have to go the bathroom and can’t make it there in time”
A
urge
4
Q
what will cytometric exam show w/ urge incontinence
A
uninhibited contractions
5
Q
Tx for stress incontinence
A
kegal exercises
urethropexy
6
Q
Tx for urge incontinence
A
anticholinergic med
7
Q
tx for neurogenic bladder
A
intermittent self cath
8
Q
when can the HPV vaccine be given
A
ages 9-26
9
Q
most common cause of an inverted uterus
A
undue traction on the cord when the placenta hasn’t separated
10
Q
Signs of placental separation (4)
A
1- gush of blood
2- lengthening of the cord
3- globular shaped uterus
4- uterus rising to the anterior abdominal wall
11
Q
most common complication of an inverted uterus
A
hemorrhage
12
Q
ULN for the 3rd stage of labor
A
30 minutes
13
Q
what should be done if the placenta doesn’t deliver spontaneously after 30 minutes
A
manual extraction of the placenta should be attempted
14
Q
vasomotor change due to decreased estrogen levels associated with skin temp elevation and sweating lasting for 2-4 minutes
A
hot flash
15
Q
changes in the vagina during perimenopause
A
lwo estrogen causes a decrease in the epithelial thickness leading to atrophy and dryness
16
Q
what help confirm the diagnosis of menopause
A
elevated serum FSh and LH
17
Q
Tx for hot flashes
A
estrogen replacement therapy w/ progestin
18
Q
Why is it important to prescribe progestin in addition to estrogen replacement in a women who still has her uterus
A
helps prevent endometrial cancer
19
Q
how long does perimenopause last?
A
2-4 years
20
Q
the cessation of ovarian function due to atresia of follicles before age 40
A
premature ovarian failure
21
Q
benefits of hormone replacement therapy
A
decreases osteoporosis and lower incidence of colon cancer
22
Q
what is an alternative to estrogen therapy for vasomotor symptoms of menopause
A
clonidine
23
Q
what is a drug that helpful in preventing bone loss but doesn’t alter hot flashes
A
SERm- raloxifene
24
Q
what help maintains bone mass
A
weight bearign exercise
calcium
vitamin D
estrogen replacement
25
will FSH levels go down w/ estrogen replacement thearpy
No, FSH doesn't respond to estrogen
26
when the anterior pituitary suffers from hemorrhagic necrosis associated with postpartum hemorrhage
Sheehan syndrome
27
most common location of an osteoporosis associated fracture
thoracic spine compression fracture
28
A mean arterial pressure of what is needed to perfuse vital organs?
65
29
How do you calculate mean arterial pressure?
[(2 × Diastolic blood pressure) + (1 × Systolic blood pressure)]/3
30
what is a red flag for necrotizing fasciitis?
gas in the muscle or fascia tussieu
31
Abx for Staph aureus infection
IV nafcillin or methicillin
| if MRSA- vanco is used
32
during the active phase of labor in a nulliparous woman how many cm does the cervix dilate at?
1.2 cm/ hours
33
What phase of labor is where the cervix mainly efface (thins) rather than dilates
latent stage
34
what is the active phase of labor?
where dilation occurs more rapidly, usually when the cervix is >4 cm dilated
35
What is protraction of the active phase of labor?
<1.5 cm/hour in multiparous
36
what is no progress in the active phase of labor for 2 hours
arrest of active phase
37
what is the second stage of labor?
complete cervical dilation to delivery of infant
38
what is the third stage of labor?
delivery of the infant to delivery of the placenta
39
What are normal fetal heart rates
110-160
40
What are fetal heart rate episodic changes below the baseline
declerations
41
What type of decleration is a mirror image of the contraction?
early
42
what is a late decleration?
follow uterine contraction
43
what is an accleration?
episodes of fetal heart rate that increase above the baseline for at least 15 bpm and last for at least 15 seconds
44
how long does the latent phase (<4 cm dilated) typically alst in a nullpara women? a mulipara?q
n<14 hours
45
How long does the second stage of labor typically last in a nullpara women? a multipara?
n <2 w/ epidural
46
What is a clinically adequate uterine contraction
contraction every 2-3 minutes
firm on palpation
last 40-60 seconds
47
one main reason for fetal tachycardia
matrenal fever
48
what typically causes variable decelerations?
cord compression
49
are early decelerations concerning?
No, these are benign and are due to fetal head compression
50
What does late fetal contractions suggest?
fetal hypoxia
51
What are the 3 Ps?
Power
passenger
pelvis
52
What type pelvis predisposes to persistent fetal occiput posterior position?
anthropoid pelvis
53
what is an anthropoid pelvis?
pelvis with an AP diameter greater than the transverse diametere w/ prominent ischial spines and narrow anterior segment.
54
What is 0 station?
the presenting part of the baby is right at the plane of the ischial spines
55
What is a C-section usually reserved for?
Cephalopelvic disproportion and arrest of active phase w/ adequate uterine contractions
56
Risk factor for ectopic pregnancy
hx of STDs
57
what is the hCG level whereby transvaginal sonography shoudl reveal an intrauterine pregnancy?
1500-2000
58
After 48 hours how much should hCG levels rise?
at least 66%
59
What are the best tools for evaluating a possible ectopic pregnancy?
hCG levels and a transvaginal US
60
what is HCG?
human chorionic gonadotropin
| glycoprotein secreted by the chorionic villi of a pregnancy
61
If an intrauterine pregnancy isn't seen on sonography and the hCG level is >1500-2000 then what is likely?
ectopic pregnancy
62
When the hCG level is below the threshold for sono- graphic visualization of an intrauterine gestational sac and an ectopic pregnancy is suspected what should be done?
repeat hCG levels in 48 hours
63
What progesterone level almost always indicates a normal intrauterine gestation?
greater than 25 ng/mL
64
what progesterone levels typically correlates w/ a nonviable gestation?
<5 ng/mL
65
If a nonviable pregnancy is diagnosed what is typically done?
Uterine curettage to assess whether the patient has had a miscarriage (histologic confirmation of chorionic villi)
66
What can be done w/ asymptomatic, small (<3.5 cm) ectopic pregnacies?
intramuscular methotrexate
67
what is another medical option for a nonviable pregnancy?
vaginal misoprostol
68
If hCG level is above the threshold and there is non sonographic evidence of intrauterine pregnancy what is done?
laparoscopy
69
If the patient presents w/ severe abdominal/ pelvic pain, HPOTN, volume depletion and ectopic is suspected what shoudl be done?
laparoscopy
70
what should Rh negative women w/ threatened abortions, spontaneous abortions or ectopic pregnancies recieve?
Rhogam
71
what increases the risks of placenta accreta?
```
previous uterine incisions
low-lying placentation
placenta previa
previous uterine curettage
prior myomectomy
fetal down syndrome
```
72
tx for placental accreta?
hysterectomy
73
what causes placenta acreta?
abnormality of the decidua basalis layer of the uterus leading to abnormal adherence of the placenta to the uterine wall
74
term for when the abnormally implanted placenta penetrates into the myometrium
placenta increta
75
where the abnormally implanted placenta penetrates entirely through the myometrium to the serosa. often invasion into the bladder is noted
placenta percreta
76
Gram-negative intracellular diplococci are highly suggestive of what?
Neisseria gonorrhoeae.
77
Tx for gonorrhoeae
Intramuscular ceftriaxone 125 to 250 mg for gonorrhea, and oral
azithromycin (or doxycycline) for chlamydial infection.
78
what is Yellow exudative discharge arising from the endocervix with 10 or more polymorphonucleocytes per high-power field on microscopy.
mucopurulent cervicitis
79
If the Gram stain of the cervical discharge is negative, then what condition is is probably?
Chlamydia
80
what can gonococcal cervicitis often cause?
salpingitis
| arthritis, usually involving the large joints, and classically is migratory.
81
what skin condition can gonorrheae cause
eruptions of painful pustules with an erythematous base on the skin.
82
wht can cause conjunctivitis and blindness in a newborn?
chlamydia and gonorrhea
83
when do gonococcal infections usually present in a newborn?
2-5 days of life
84
when do chlamydial infections usually present in a newborn?
5-14 day of life
85
what other condition can chlamydia trachomatis cause in newborns
infantile pneumonia- between 1-3 months of age
86
what signifies a completed spontaneous aboration
intense cramping, passage of tissue, closed cervical os
87
after a completed spontaneous abortion what should be done?
follow serum hCG levels to 0
| should halve every 48-72 hours
88
if HCG levels plateau instead of fall after a sponataneous abortion what has happened?
residual pregnancy tissue (incomplete abortion or ectopic pregnancy)
89
most common cause of a sponataneous abortion
chromosomal abnormality of the embryo
90
A pregnancy less than 20 weeks’ gestation asso- ciated with vaginal bleeding, generally without cervical dilation.
threatened abortion
91
pregnancy less than 20 weeks’ gestation asso- ciated with cramping, bleeding, and cervical dilation; there is no passage of tissue.
inevitable abortion
92
A pregnancy less than 20 weeks’ gestation asso- ciated with cramping, vaginal bleeding, an open cervical os, and some passage of tissue per vagina, but also some retained tissue in utero. The cervix remains open due to the continued uterine contractions; the uterus continues to con- tract in an effort to expel the retained tissue.
incomplete abortion
93
A pregnancy less than 20 weeks’ gestation in which all the products of conception have passed; the cervix is generally closed. Because all the tissue has passed, the uterus no longer contracts, and the cervix closes.
completed abortion
94
A pregnancy less than 20 weeks’ gestation with embryonic or fetal demise but no symptoms such as bleeding or cramping.
missed abortion
95
women present with painless cervical dilation.
incompetent cervix
96
tx for incompetent cervix
ligature at the level of the internal cervical os (cerclage)
97
aginal spotting, absence of fetal heart tones, size greater than dates, and markedly elevated HCG levels.
molar pregnancy
98
diagnosis of molar pregnancy
US- "snow storm" pattern in uterus
99
tx for molar pregnancy
uterine suction curettage and follow w/ weekly hCG levels
100
2 most common causes of antepartum bleeding
placenta previa
| placental abruption
101
What is McRoberts maneuver?
hyperflexion of the maternal hips onto the maternal abdomen and/or suprapubic pressure
102
what maternal issues contribute to difficultly delivering the baby's shoulders (shoulder dytocia)?
gestational DM
multiparous
obesity
post-term
103
what is a sign of shoulder dystocia?
fetal head retracted back toward the maternal introitus "turtle sign"
104
A brachial plexus injury involving the C5-C6 nerve roots, which may result from the downward traction of the anterior shoulder; the baby usually has weakness of the deltoid and infraspinatus muscles as well as the flexor muscles of the forearm. The arm often hangs limply by the side and is internally rotated.
Erb palsy
105
what is wood's corkscrew manuver
progressively rotating the posterior shoulder in 180° in a corkscrew fashion), delivery of the posterior arm,
106
what is cephalic replacement with immediate cesarean section
Zavanelli maneuver
107
best test to determine ureteral injury post hysterectomy
intravenous pyelogram (IVP)
108
how does a ureteral injury post hysterectomy often present?
similar to pyelonephritis
109
what attaches the uterine cervix to the pelvic side walls (where the uterine arteries transverse)
cardinal ligament
110
Dilation of the renal collecting system, which gives evidence of urinary obstruction.
hydronephrosis
111
Placement of a stent into the renal pelvis through the skin under radiologic guidance to relieve a urinary obstruction.
percutaneous nephrostomy
112
if an IVP shows possible obstruction post hysterectomy what is the next step?
antibiotic administration and cystoscopy to attempt retrograde stent passage.
113
Risk factors for endometrial cancer
```
Obesity
DM
HTN
prior irregular menses
late menopause
nulliparity
unopposed estrogen replacement
```
114
initial test of choice for endometrial cancer
endometrial sampling or aspiration in office- place a thin, flexible catheter through the cervix
115
A growth of endometrial glands and stroma, which projects into the uterine cavity, usually on a stalk; it can cause postmenopausal bleeding.
endometrial polyp
116
what is the most common cause of postmenopausal bleeding?
friable tissue of the endometrium or vagina due to low estrogen levels
117
Transvaginal sonographic assessment of the endome- trial thickness; a thickness greater than 5 mm is abnormal in a postmenopausal woman.
endometrial stripe
118
what is the most common female genital tract malignancy
endometrial carcinoma
119
staging procedure for endometrial cancer
TAH B/L salpingo-oophorectomy
omentectomy
lymph node sampling
peritoneal washings
120
what may atypical glandular cells on pap smear indicate?
endocervical or endometrial cancer
121
next step after finding atypical glandular cells on pap smear?
colposcopic exam of the cervix
curettage of the endocervix
endometrial sampling
122
most common cause of painless vaginal bleeding after 20 weeks
placenta previa
123
management of placenta previa
C-section at 36-37 weeks
124
bleeding after 20 weeks associated w/ painful uterine contractions or excess uterine tone
placental abruption
125
Should vaginal manipulation be done w/ suspected placenta previa
no- it can induce bleeding
126
The edge of the placenta is within 2 to 3 cm of the internal cervical os.
low-lying placenta
127
Umbilical cord vessels that insert into the membranes with the vessels overlying the internal cervical os, thus being vulnerable to fetal exsanguination upon rupture of membranes.
vasa previa
128
risk factors for placenta previa
```
grand multiparity
prior C-section
prior uterine curettage
previous placenta previa
multiple gestation
```
129
risk factors for placental abruption
```
cocaine abuse
HTN
short umbilical cord
trauma
cigarette smoking
PPROM
```
130
Bleeding into the myometrium of the uterus giving a discolored appearance to the uterine surface.
couvelaire uterus
131
does a normal US r/o a placental abruption
No
132
usual management of placental abruption
delivery
133
who is the HPV vaccine approved for
female aged 9-26
| males 11-26
134
where do most cervical dysplasias arise
near the squamocolumnar junction of the cervix
135
when does cervical cytology begin?
3 years after onset of sexual activity of by age 21
136
what are signs of advanced cervical cancer?
flank tenderness or leg swelling
137
when does cervical cytology no longer need to be performed
after age 65-70, after total hysterectomy for benign reasons w/ no hx of cervical dysplasia
138
anterior pituitary hemorrhagic necrosis caused by hypertrophy of prolactin-secreting cells in conjunction w/ a hypotensive episode usually in setting of postpartum hemorrhage
sheehan syndrome
139
what is postpartum hemorrhage
bleeding >500 mL for vaginal and >1000 mL for C-section
140
characterized by obesity, hirutism, glucose intolerance and estrogen excess w/o progesterone, oligomenorrhea
PCOS
141
treatment of sheehan syndrome
replacement of hormones governed by the anterior pituitary gland
142
what is fetal bradycardia
fetal heart rate <110 for greater than 10 minutes
143
how to confirm fetal bradychardia
internal fetal scalp electrode
| US (to distinguish from maternal pulse)
144
initial steps to improve cardiac output to uterus
place mom on her side to move the uterus from teh great vessels
IV bolus if possibly volume depelted
100% oxygen by face mask
stop oxytocin if it is being given
145
what drug often helps relax uterine musculature
terbutaline (beta agonist)
146
what is the most common finding in a uterine rupture
fetal heart rate abnormality (fetal bradycardia) deep variable decelerations, late decelerations
147
Tx for suspected uterine rupture
C-section
148
what is a cervical ripening agent that can be placed in the vaginal
misoprostol
149
prolonged fetal declerations associated with misoprostol cervical ripening are typically associated w/ what?
uterine hyperstimulation
150
a fetal scalp pH can only be done if what?
cervicx is at least 4 cm dilated
151
is atropine indicated for fetal bradycardia?
No
152
causes of galactorrhea
```
pituitary adenoma
pregnancy
breast stimulation
chest wall traum
ahypothyroidism
```
153
TRH acts as what what?
prolactin releasing hormone
154
Nonpuerperal watery or milky breast secretion that con- tains neither pus nor blood. The secretion can be manifested spontaneously or obtained only by breast examination.
galactorrhea
155
A tumor in the pituitary gland that produces prolactin; symptoms include galactorrhea, headache, and peripheral vision defect (bitemporal hemianopsia).
pituitary secreting adenoma
156
to determine if brast dx is truly galactorrhea what can you do?
smear under microscope- reveal multiple fat droplets
157
a pregnant patient with a symptomatic microadenoma can be treated w/ what?
bromocriptine
158
This 24-year-old woman, who is at 28 weeks’ gestational age, complains of gen- eralized pruritus. what is the most likely caused?
Cholestasis of pregnancy.
159
a condition causing intense itching but associated with erythematous blisters on the abdomen and extremities
herpes gestationis
160
when does cholestasis of pregnancy usually begin?
3rd trimester
161
a common skin condition of unknown etiology unique to preg- nancy characterized by intense pruritus and erythematous papules on the abdomen and extremities.
Pruritic urticarial papules and plaques of pregnancy (PUPPP)
162
what confirms the diagnosis of cholestasis of pregnancy
incrased levels of circulating bile acids
163
cholestasis of pregnancy + jaundice is associated with what?
increased incidence of prematurity, fetal distress and fetal loss
164
first line tx for cholestasis of pregnancy
antihistamines, cornstarch baths
vile salt binder (cholestyramine- associated w/ Vitamin K deficiency)
ursodeoxyholic acid- decreases puritis, better tolerated
165
when does herpes gestationis usually begin?
2nd trimester of pregnancy
| etiology is autoimmune
166
tx of herpes gestationis
oral corticosteroids
167
tx for PUPPP
topical steroids and anithistamines
168
usual location of PUPPP
abdomen
thighs
buttocks and arms
169
long term complications that can occur w/ PID
infertility or ectopic pregnancy
170
Extreme tenderness when the uterine cervix is manipulated digitally, which suggests salpingitis.
cervical motion tenderness
171
Collection of purulent material around the distal tube and ovary, which unlike the typical abscess is often treatable by antibiotic therapy rather than requiring surgical drainage.
Tubo-ovarian abscess (TOA)
172
diagnosis of acute salpingitis
abdominal tenderness
cervical motion tenderness
adnexal tenderness
173
Criteria for outpatient treatment of acute salpingitis
low grade fever
can take meds PO
absence of peritoneal signs
174
outpatient tx of acute salpingitis
IM ceftriaxone
oral doxycycline BID for 10-14 days
evaluated in 48 hours for improvement
175
gold standard for diagnosing salpingitis
laparoscopy
176
Risks for PID
IUD use
| nulliparity
177
sulfur granules are classic for what?
actinomyces (gram positive anaerobe)
178
treatment of actinomyces
penicillin
179
Diagnostic test of choice for PE in pregnancy
spinal CT or MR angiography
| V?Q scan exposes fetus to more radiation
180
why does pregnancy cause venous stasis?
mechanical effect of teh uterus on the vena cava and high estrogen levels induces a hypercoagulable state
181
normal ABG levels in pregnancy
pH 7.45
Po2 95-100
PCo2- 28
HCO3- 19
182
TX for PE in pregnancy
anticoagulation with LWMH
183
most common cause for maternal morality
thromboembolism
184
most common presenting symptom of PE
dyspnea
185
What can herpes simplex virus cause in neonates?
Neonatal encephalitis
186
what are prodromal symptoms of an HSV outbreak
burning, itching, tingling
187
when do you recommend a C-section with HSV?
genital lesions suspicious for HSV or prodromal syndromes
188
STD caused by the gram- negative bacterium Haemophilus ducreyi, and causes painful genital lesions
Chancroid
189
what is the most common reason for hysterectomy in the US?
Uterine fibroids
190
what is the most common symptoms of a uterine leiomyomata?
Menorrhagia
191
how does leiomyomata present on PE?
enlarged midline mass that is irregular and contiguous with the cervix
192
When is the maximum shrinkage of fibroids seen after introducing a GnRH agonist?
3 months and fibroids will regrow if it is stopped
193
Malignant, smooth muscle tumor, with numerous mitoses in the uterus
Leiomyosarcoma
194
Changes of the leiomyomata due to rapid growth; the center of the fibroid becomes red, causing pain. This is synony- mous with red degeneration.
Carneous degeneration
195
what is a sign of a potential leiomyosarcoma?
Rapid growth- increase of more than 6 weeks' gestational size in 1 year
196
initial treatment for fibroids
NSAIDs, progestin
197
What is a GnRH agonist typically used for w/ uterine fibroids?
correct anemia and shrink the fibroid before surgery
198
Tx for a symptomatic uterine leiomyomata in women who desire pregnancy
myomectomy
199
Risk factors for preeclampsia
```
primigravida
African american
family hx
chronic HTN
chronic renal dz
antiphospholipid syndrome
DM
multifetal gestation
```
200
Hypertension with proteinuria (> 300 mg over 24 hour) at a gestational age greater than 20 weeks, caused by vasospasm.
preeclampsia
201
Development of preeclampsia in a patient with chronic hypertension.
Superimposed preeclampsia
202
what is chronic HTN?
HTN before the pregnancy or that develops before 20 weeks
203
what is needed for the dx of preeclampsia
2 BP readings 6 horus apart of >140 or >90
| proteinuria >300 mg in 24 hours
204
what is the underlying pathophys of preeclampsia
vasosparsm and "leaky vessels"
205
Cure for preeclampsia
delivery
206
complications of preeclampsia
```
placenta abruption
eclampsia (w/ possible intracerebral hemorrhage)
coagulopathies
renal failure
hepatic subcapsular hematoma
hepatic rupture
uteroplacental insufficiency
```
207
when is the risk of eclampsia the greatest?
just prior to delivery, intrapartum, w/i the first 24 hours postpartum
208
During labor what should the preeclamptic patient be started on
```
magnesium sulfate (must monitor urine output, respirtaory depression, hyporeflexia)
this is used to prevent surgeries
```
209
Tx for severe HTN w/ preeclampsia
hydralazine
| labetalol
210
when should a patient w/ preeclampsia be seen postpartum
1-2 weeks to check BP and for proteinuria
211
what is the most common cause of maternal death due to eclampsia
intracerebral hemorrhage
212
what is the first sign of magnesium toxicity
loss of deep tendon reflexes
213
Do fibroadenomas change with the menstrual cycle?
No
214
multiple, irregular, "lumpiness of the breast"
| most common benign breast condition
fibrocystic changes
215
Tx for fibrocystic breast changes
NSAIds
decrease caffeine
tight fitting bras
OCPs or oral progestin
216
With severe cases of fibrocystic breast changes what can be done
danazol (weak antiestrogen and androgenic compound)
| mastectomy
217
Most common of a breast mass in an adolescent or in 20s
fibroadenoma
218
how are fibroadenomas described
firm, rubbery, mobile, and solid
219
what should be done for a fibroadenoma
biopsy
220
what will a fibroadenoma look like on histology
mature smooth muscle cells
221
what are the five basic factors of infertility?
```
1-ovulatory
2-uterine
3-tubal
4-male factor
5- peritoneal factor (endo)
```
222
what are the 3 Ds of endometriosis
dysmenorrhea
dyspareunia
dyschezia
223
what is infertility?
inability to conceive after 1 year of unprotected intercourse
224
what is the easiest and cheapest way of detecting ovulation?
basal body temperature
225
when shoudl BBT temp be taken?
before patient arises out of bed, eats or drinks. should be taken orally
226
why does body temp rise 0.5 F after ovulation?
release of progesterone by the ovary
227
when does ovulation occur?
36 hours after the onset of the LH surge
228
when should a hysterosalpingogram be performed?
between days 6-10 of the cycle
229
gold standard for diagnosing tubal and peritoneal disease?
hysteroslapingogram
230
what is a treatment for anovulation
clompiphene citrate
231
when is ovarian torsion most common?
14 weeks gestation (when uterus rises above the pelvic brim) or immediately postpartum
232
what is the most serious and frequent complication of a benign ovarian cyst?
ovarian torsion
233
with what hCG level should an intrauterine gestational sac be seen on TVUS?
1500-2000 mIU/ML
234
A progesterone level greater than what refelects a normal IUP
25
235
2 most common causes of microcytic anemia
iron def and thalassemia
236
An X-linked condition whereby the red blood cells may have a decreased capacity for anaerobic glucose metabolism. Certain oxidizing agents, such as nitrofuran- toin, can lead to hemolysis.
Glucose-6-phosphate dehydrogenase deficiency
237
what Hb is consistant w/ anemia?
<10.6
238
an elevation in what type of hemoglobin is suggestive of Beta thalassemia?
A2 hemoglobin
239
an elevated what hemoglobin level is suggestive of alpha thalassemia?
hemoglobin F
240
what can trigger glucose-6-phosphate dehydrogenase deficiency?
sulfonamides, nitrofurantoin, antimalarial agents
241
in a nulliparous women, a dilation of what and effacement of what indicate preterm labor?
2 cm and 80% effacement
242
What can you swab the posterior vaginal fornix for to indicate possible preterm birth
fetal fibronectin (ffn)
243
A negative fetal fibronectin is strongly associated with what?
No delivery within 1 week
244
what should be given to a women who is in labor before 34 weeks
Intramuscular antenatal steroids (for fetal pulmonary maturity)
245
Preterm labor is before how many weeks?
37 weeks
246
most common tocolystics
indomethacin
nifedipine
terbutaline
ritodrine
247
what are names of antenatal steroids?
bethamethasone, dexamethasone
248
a basement membrane protein that helps bind placental membranes to the decidua of the uterus. Vaginal swab is used to detect its presence
fetal fibronectin assay
249
A cervical length less than what is an increased risk of preterm delivery?
25 mm
250
weekly shots of what from 20-36 weeks have been shown to help prevent preterm labor
17 α-hydroxyprogesterone caproate
251
what infection is most stonrgly associated w/ pre-term labor
gonococcal cervicitis
252
what is a contraindication for tocolysis?
suspected uterine abruption
253
what is indomethacin associated with?
associated with decreased amni- otic fluid and oligohydramnios,
254
organism that most often causes a UTI
e coli
255
abx for e. coli
sulfa agents
cephalosporins
quinolones
nitrofurantoin
256
what organism typically cuases urethritis
C trachomatis
257
most common symptoms of cystitis
dysuria
urgency
urinary frequency
258
gross hematuria raises the suspicion of what?
nephrolithiasis
259
what should be suspected in a woman with typical symptoms of UTI yet with sterile culture and no response to the standard antibiotics.
urethritis
260
next step w/ urethritis
cultures of the urethra for gonococcus and chlamydia
261
contraindications to an IUD
STDs
behavior that increases risk for STD
abnormal size/ shape of uterus
262
what can depot medroxyprogesterone acetate cause?
decrease in bone density
263
common side effects of Yuzpe regimen for EC
N/V (due to increased estrogen)
264
most common cause of septic shock in pregnancy
pyelonephritis
265
when dyspnea occurs in a pregnant women being treated for pyelo what should be considered
ARDS
266
preferred anticoag in pregnancy
heparin
267
what does heparin block?
conversion of fibringoen to fibrin
268
reason for a hypercoaguable state in pregnancy
venous stasis due to uterus compressing the vena cava
269
what type transmission does the BRCA gene have?
autosomal dominant
270
what is the most common cause of unilateral serosanguineous nipple discharge from a single duct?
intraductal papilloma
271
most common histological type of breast cancer
infiltrating intraductal carcinoma
272
most common ovarian tumor in women under 30
benign cystic teratomas (dermoid cysts)
273
why can dermoid cysts cause hyperthyroidism
they may contain thyroid tissue
274
most common ovarian tumor in women over 30
epithelial origin, serous subtype and often B/L
275
any adenxal mass greater than what size is likely to be a tumor
8 cm
276
any adnexal mass less than __ cm suggests a functional cyst
5
277
rotrusion of bowel or omentum through the incision, which connotes complete separation of all layers of the wound
Evisceration
278
what type of SSI should be immediately repaired?
one with fascial disruption or evisceration
279
A physiologic ovarian cyst formed from mature graafian follicles following ovulation, which secretes progesterone.
corpus luteum
280
what is the earliest indicator of hypovolemia
decreased urine output
281
allows for direct visualization of the uterine cavity and is considered the “gold standard” for the establishment of the diagnosis and extent of the IUA.
hysteroscopy
282
2 most common causes of primary amenorrhea when there is normal breast development
mullerian agenesis
| androgen insensitivity
283
a significant number of individuals with Mullerian agenesis will also ahve what?
a urinary tract abnormality
284
with androgen insensitivity what will be lacking
axillary and pubic hair
285
how to confirm the diagnosis of androgen insensitivity
serum testosterone (will be elevated)
286
what is missing with mullerian agensis
absence of uterus, cervix and fallopian tubes
287
what karyotype are people w/ androgen insensitivity
46 XY
288
why is there no formation of male internal or external genitalia with androgen insensitivity
no androgen receptor synthesis or action
289
what must be done w/ androgen insensitivity
gonadectomy after puberty (around 16-18)
290
hypogonadotropic hypogonadism, or hypothalamic hypogonadism, disorder caused by a deficiency in the gonadotropin-releasing hormone (GnRH) secreted by the hypothalamus (and therefore, decreased LH and FSH produc- tion). Also don't have the ability to smell
Kallmann syndrome
291
treatment for a septic abortion
abx and uterine curettage
292
abx for spetic abortion
gentamicin and clindamycin
293
what is an early sign of septic shock
oliguria
294
what bacteria can be acquired through unpasturized milk products?
Listeria (gram positive rod)
295
tx for listeria
IV ampicillin
296
Tx for uterine atony
uterine massage, dilute IV oxytocin then prostaglandin F2 alpha or rectal misoprostol
297
what is uterine atony
myometrium hasn't contracted to cut off the uterine spiral arteries that are supplying the placental bed
298
If the uterus is palpated and foudn to be firm, yet there is vaginal bleeding still what should be suspected?
a laceration to the genital tract
299
Risk factors for uterine atony
```
preeclampsia
magnesium sulfate
oxytocin use udring labor
rapid labor and/or delivery
overdistention of uterus (macrosomia, multifetal preg, hydramnios)
chorioamniotitis
prolonged labor
high parity
```
300
What is an ergot alkyloid agent that induces myometrial contraction as a treatment of uterine atony, contraindicated in HTN
methylergonovine maleate (methergine)
301
who is prostagladin F2-alpha contraindicated in?
asthmatic patients
302
what are the 4 stages of puberty
therlarche
pubarche/ adrenarche
growth spurt
menarche
303
what is the first sign of puberty
thelarche (around 10)
304
What is the most commonc ause of delayed puberty that has high FSH and low estrogen
gonadal deficiency (Turner syndrome)
305
karyotype w/ turner syndrome
45X
306
what do women w/ turner syndroem lack?
ovaries and ovarian estrogen so they don't have seoncary sexual characteristics
307
most common etiology in postpartum mastitis?
staph aureus
308
when does mastitis usually present
3rd or 4th week postpartum
309
babies who are exclusively breast fed need supplementation of what at 2 months of age
vitamin D
310
best tx for postpartum mastittis
oral antistphylococcal abx (dicloxacillin) and continue to breast feed/ pump
311
best tx for a cracked nipple
air-drying and avoidance of using a harsh soap
312
most commonly used medication for hyperthyroidism in pregnancy
PTU
313
tx for thyroid storm in pregnancy
Beta blockers
corticosteroids
additionall PTU
314
Extreme thyrotoxicosis leading to central nervous system dysfunction (coma or delirium) and autonomic instability (hyperthermia, hypertension, or hypotension).
thyroid storms
315
women in the postpartum period w/ hyperthyroidism are liekly to have what?
destructive lymphocytic thyroiditis due to high corticosteroid levels in pregnancy
316
what can chlamydia cause in a neonate
conjunctivitis or pneumonia
317
why should doxycycline not be taken by pregnant women
can lead to staining of the fetal teeth
318
is eye prophylaxis w/ erythromycin effective against chalmydial conjunctivitis?
no, only gonococcal
319
why is ciprofloxacin C/I in pregnancy
can lead to neontal MSK problems
320
best treatments for chlamydial cervicitis in pregnancy
erythromycin
azithromycin
amoxicillin
321
what does parovirus in pregnancy cause
hydramnios from fetal anemia which inhibits bone marrow erythrocyte production
322
how does parovirus B19 present in children?
red cheeks and high fever
323
How does parovirus B19 present in adults?
malaise, arthralgias, maylgias and lacy int rash
324
Illness caused by a single-stranded DNA virus, parvovirus B19, also known as erythema infectiosum.
fifth disease
325
A fetal heart rate pattern that resembles a sine wave with cycles of 3 to 5 per minute, indicative of severe fetal anemia or fetal asphyxia.
sinusoidal heart rate pattern
326
most common cause of fever for a woman who has undergone C-section
endomyometritis
327
what is the mechanism of endomyometritis?
Ascending infection of polymicrobial vaginal organisms
328
Ddx for a women who has had C-section
mastitis
wound infection
pyelonephritis
329
abx tx for endomyometritis
IV gentamicin and cindamycin
330
are bacterial infection affecting thrombosed pelvic veins, usually the ovarian vessels.
septic pelvic thrombophlebitis (SPT)
331
most commonly isolated organism in endomyometritis
anaerobic bacteria (most common species is bacteroides)
332
Tx for spetic pelvic thrombophlebitis
antibiotic therapy and heparin
333
if RPR or VDRL tests are negative and syphilis is suspected still what is the next diagnostic
scraping of lesion for darkfield microscopy
334
best dx test for herpes
viral culture `
335
what causes syphilis
T pallidum
336
typical incubation of syphilis
10-90 days
337
tx for syphilis
Pen G
338
what physical sign indicates secondary syphillis
conyloma lata
339
with penicillin allergy what can be used to tx syphili
erythromycin or doxycycline
340
how long must a nontreponemal test be followed w/ syphillis
every three months for at least a year
341
what type of organism is t. pallidum
spirochete
342
what should pregnant women w/ syphillis be given
Pen G (desnesnitize them is they are allergic)
343
Rupture of membranes prior to the onset of labor.
PROM
344
Rupture of mem- branes in a gestation less than 37 weeks, prior to onset of labor.
PPROM
345
what is an early sign of chorioamniotitis
maternal fever
346
what can induce chioramnionitis w/o rupture of membranes
listeria
347
c/i to corticosteroid use
clinical infection
348
cell tumor of the ovary is a solid stromal type of tumor, the androgen counterpart of granulosa-theca cell tumor. These tumors are usually of low malignant potential and slow growing, but nevertheless may metastasize and often recur. Hence, surgical staging is the treatment of choice.
Sertoli-Leydig cell tumor
349
Androgen effect other than hair pattern, such as cliteromegaly,
male balding, deepening of the voice, and acne.
virilism
350
Excessive male pattern hair in a female.
hirsutism
351
screen is used in pregnant women between 15 and 21 weeks’ gestation to identify those pregnancies that may be complicated by neural tube defects, Down syndrome, or trisomy 18.
triple screen
352
what is used in the triple screen
alpha feto protein (AFP)
human chorionic gonadotropic (hCG)
unconjugated estriol
353
what level os AFP are suspicious for neural tube defects?
>2.0-2.5
354
what does an elevated AFP raise suspicion for?
neural tube defects
355
what does a low maternal serum of AFP raise suspicions for?
Down syndrome
356
if unconjugated estriol elevated or decreased w/ trisomy 21
decrease
357
what leve lis elevated in trisomy 21?
HCG
358
how are the markers w/ trisomy 18?
all are low
359
what does first trimester trisomy 21 screening use?
PAPP-A (pregnancy associated plama protein)
free beta hCG
sonographic measurement of nuchal translucency
(will have decreases PAPP-A and free beta-hcg with thickened nuchal translucency)
360
most common cause of an abnormal triple screen?
wrong dates
361
primary management of PCOS
combined oral contraceptives
362
for PCOS patients desiring pregnancy what can be given
clomiphene citrate
