Casefiles Flashcards
1
Q
indications for c/s
A
fetal/maternal distress
cephalopelvic disproportion
arrest of active phase despite active contractions (>200MU by IUPC OR q2-3min x 40-60sec by toco)
2
Q
nl fetal heart rate
A
110-160
3
Q
microcytic anemia (<10.5)
A
Fe deficiency -> trial Fe x3wks
4
Q
elevated A2 hemoglobin
elevated F hemoglobin
A
beta-thal -> no intervention unless major, then transfusions
alpha thal
5
Q
megaloblastic anemia
A
folate def
6
Q
reddish mass bulging @ the introitus post partum -> dx? complication?
A
inverted uterus. Hemorrhage 2/2 uterine atony
7
Q
4 signs of placental seapration
A
- gush of blood
- cord lengthening
- globular shaped uterus
- uterus rising to anterior abd wall
8
Q
No placenta after 30 min
A
manual extraction -> abx
9
Q
shoulder dystocia -> do not use what?
A
fundal pressure
10
Q
workup for fetal bradycardia
A
- distinguish from maternal pulse
2. push cord back -> emergency c/s
11
Q
RF for cord prolapse
A
presentation
12
Q
most common finding w/ uterine rupture -> tx?
A
fetal heart rate abnormalities (deep variable decels or bradycardia) -> immediate c/s
13
Q
MCC of postpartum hemorrhage after 24hrs
A
subinvolution of uterus
14
Q
postpartum hemorrhage -> mgmt?
A
ABCs -> address source
15
Q
targeted US id's ?% of NTD triple screen (2nd semester) id's ?% of Down
A
95
60
16
Q
teratogen ?
teratogen between 15-60?
A
all or nothing
organogenesis problems
17
Q
monozygotic twins
A
more anomalies and maternal complications
18
Q
no dividing membrain -> complications?
A
stillbirth 2/2 cord entanglement
19
Q
dx and tx of vasa previa?
A
US w/ Doppler + stat c/s
20
Q
give acyclovir during pregnancy to HSV patient?
A
Yes -> decreases duration and viral shedding -> decreases transmission
21
Q
mgmt of stable placenta previa
A
US (do NOT examine) -> expectant and plan for c/s @ 34wks
22
Q
placental previa is a risk for?
A
placental accreta
23
Q
placental previa in early trimester?
A
repeat US for migration
24
Q
complications of abruption
A
hemorrhage w/ coagulopathy, fetal-maternal hemorrhage, PTL
25
RFs for abruption
HTN, trauma, cocaine
26
tx for accreta
hysterectomy
27
RFs for accreta
previa, C/S, defect in decidua basalis layer
28
location of appendix during pregnancy
out and up
29
character of ovarian torsion pain
colicky
30
what can mimic ecopic
ruptured corpus luteum cyst (more commonly in patients w/ bleeding tendencies)
31
if corpus luteum is excised in pregnancy mgmt?
progesterone supplementation
32
MCC of generalized pruritus in pregnancy w/o skin lesions
cholestasis -> adverse fetal outcomes (premature, fetal distress/loss)
33
lesion beginning on abd -> thighs and buttocks and arms
PUPP -> no adverse fetal outcomes
34
mgmt for AFLP
immediate delivery
35
MCC of maternal mortality
emoblism (thrombo or amniotic)
36
location for DVT in gyn
lower extremities and pelvic veins
37
O2 limit in pregnancy
80mmHg
38
hemo instability in pre-eclampsia patient post delivery
hepatic rupture -> stat ex lap + blood replacement
39
Tx of PET @ term
Mg and delivery
40
Mgmt of PET @ preterm
observe until severe/term
41
dyspnea in PTL w/ tocolysis
pulmonary edema
42
MCC of neonatal morbidity in preterm infant
RDS
43
mgmt of women w/ h/o PTL
progesterone @ 16 through 36 wks
44
PPROM
>34wks -> IOL
| expectant
45
earliest sign of chorio -> do not give?
fetal tachy -> steroids
46
mech of hydrops fetalis w/ parvovirus
parvo inhibits erythropoeisis -> anemia
47
earliest manifestation of hydrops
polyhydramnios
48
parvovirus in adult vs. child
myalgias + reticular rash vs. slapped cheek
49
ddx for hydramnios
GDM, isoimmunization, syphilis, cardiac arrhythmias, intestinal atresias
50
chlamydia tx in pregnancy
erythromycin/azithromycin or amoxicillin (avoid doxycycline; ophtho helps gonnorrhea but not CT)
51
mgmt of thyroid storm in pregnancy
propranolol, steroids, PTU (fx = agranulocytosis, rash, hepatotoxciity) (no methimazole b/c teratogen)
52
Grave's disease -> ? fetal hyperthyroidism?
yes 2/2 IgG crossing placenta
53
Pregnancy effects on thyroid labs
up total T3/4 but unchanged free T3/4 b/c up TBG -> TSH unchanged
54
antimicrosomal antibodies in hyperthyroidism 1-4 months post partum
postpartum thyroiditis -> hypothyroidism in several months
55
symmetric IUGR vs. asymmetric
chromosomal/infections vs. vascular
56
When to deliver IUGR?
when oligo, reverse doppler, HTN, absence of growth over 2-4 wks, non-reassuring testing
57
dreaded complication of pyelonephritis
ARDS (dyspnea) 2/2 endotoxin release upon abx
58
MCC of septic shock in pregnancy
pyelonephritis
59
ddx for unresponsive pyelonephritis (72 hrs)
resistance, stone, abscess
60
mgmt of septic shock
aggressive fluids (+/- pressor dopamine), debridement, abx
61
desquamation in septic shock -> organism? mgmt?
s. aureus -> IV nafcillin/methicillin unless MRSA then vanc
62
endometritis mgmt
genta + clinda
63
MCC of fever s/p c/s
endomyometritis abx + heparin
64
mgmt of mastitis
drain any abscess -> dicloxacillin -> continue breast feeding
65
mastitis vs. breast engorgement
high fevers >24hrs
66
how to confirm DKA w/ labs?
ABG, BS, electrolytes w/ AG and serum ketons
67
Maternal monitoring during preg if diabetic
retinopathy, nephropathy
68
50% of diabetic mothers will develop
preeclampsia
69
HgA1C 7% vs. 11%
general population risk vs. elevated risk
70
MCC anomalies associated w/ pre-GDM
cardiac and NTD
71
What's screened for at each prenatal visit?
HTN and proteinuria
72
most common location of osteoporosis fracture
thoracic spine compression
73
sequence of biochemical markers
AMH falls 1st -> inhibin B -> estradiol
74
mgmt of POP
pessary or surgical fixation
75
mgmt of stress incontinence
colporrhaphy / urethral sling
76
mgmt of enteroceles
resection of hernia sac + fixation of the vagina to secure ligaments
77
mgmt of rectoceles
colporrhaphy
78
mgmt of lacteral defects
reattachment of levator ani to its tendinous insertion
79
copious serosanguineous fluid post op -> concerning for?
fascial disruption -> stat surgical closure + abx
80
MC time for fascial disruption or evisceration?
5-14 postop
81
superficial wound separation mgmt? 2/2
2/2 infection or hematoma -> open the wound and dress
82
initial mgmt of stress incontinence
kegel + timed voiding -> slings & TVT & urethropexy
83
ddx for mucopurulent discharge
GC/CT, trichomonads, foreign body, irritation, allergic reaction
84
urine test of GC/CT
NAAT (nucleic acid amplification)
85
organisms of salpingitis
polymicrobial
86
PID triad
abd pain, CMT, adnexal tenderness
87
mgmt of ToA
IV abx (clinda, metro)
88
what diseases are associated w/ BV?
PTL, postpartum endometritis, PID
89
nontender ulcer w/ indurated edges
syphillis
90
dysuria + urgency + freq w/o fever / CVA / masses + normal pelvic exam
cystitis
91
uncomplicated vs. complicated cystitis
3 days vs. longer
92
cystitis picture but neg urine cx
urethritis from GC/CT
93
asymptomatic bacteriuria has a high incidence in?
women w/ sickle cell trait
94
outcomes of threatened abortion (vaginal spotting in the 1st half of pregnancy -> no implications for viability)
viable IUP, ectopic, SAB
95
mgmt of complete abortion
follow hCG to 0
96
painless cervical dilation during pregnancy
cerclage
97
molar pregnancy
size>date, snow storm on US, no fetal heart tones, vaginal spotting
98
mgmt of septic abortion
maintain perfusion and oxygenation, abx and evacuate
99
best initial imaging modality for younger patient w/ breast pathology
US
100
red inflamed breast in non-lactating woman
?inflammatory breast cancer
101
suspect familial breast cancer when?
2 1st degree relatives
102
35yo+ w/ family hx -> mammography guidelines?
35yo+ w/ family hx -> annual
103
MC histological type of breast cancer
infiltrating ductal carcinoma
104
breast mass that persists after aspiration
biopsy
105
suspiscious breast mass =? tx?
small cluster of calcifications w/ irregular bordered mass -> core needle or surgical bx
106
how to confirm dx of Asherman
HSG or SIS or hysterscopy
107
Galactorrhea 1st step in workup
pregnancy test -> PRL and TSH
108
galactorrhea + nml menses and nml PRL
observe
109
complication of hyper-PRL (pituitary adenoma <- MRI)
osteoporosis
110
Sheehan associates
anterior pituitary insufficiency -> replace thyroid and adrenocoroticoids
111
2 most common causes of secondary amenorrhea
Sheehan and intrauterine adhesions
112
secondary amenorrhea + monophasic basal body temp and hypothyroidism
Sheehan
113
PCOS: complications? dx? plan?
complications: DM, endometrial cancer, hyperlipidemia, metabolic syndrome, CV
dx: TSH/PRL, testosterone/DHEA, 17-OH, PUS
plan: OCP, metformin, diet and exercise; endometrial biopsy if long term
114
1st step of tumor management
surgical staging
115
MCC of infantile primary amenorrhea
| MCC of primary amenorrhea w/ secondary sex characteristics
gonadal dysgenesis -> test FSH
| Mullerian agenesis and androgen insensitivity -> testosterone and karyotype
116
tx for idiopathic precocious puberty
GnRH agonist
117
mulerian abnormalities are associated w/
renal anomalies
118
infertility in asymptomatic woman
endometriosis
119
how is endometrial cancer mg'd?
surgical staging and surgery
120
persistent postmenopausal bleeding after endometrial sampling -> mgmt?
hysteroscopy
121
flank tenderness or leg swelling can be a sign of what type of gyn cancer?
cervical
122
MCC ovarian tumor in young woman
dermoid -> cystectomy
123
When is CA-125 useful
epithelial tumor in post-menopausal women
124
mgmt after debulking of epithelial cancer?
combination chemo
125
tx for lichen sclerosis
corticosteroids
126
which derm condition can become squamous cell carcinoma of the vulva
lichen slcerosis
127
how to stage vulvar cancer
surgical including ipsilateral inguinal LN
