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