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Ob-gyn case files > CF > Flashcards

CF Flashcards

1
Q

Nulliparous women dilate at what rate during active phase

A

1.2cm/hr

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2
Q

What features would suggest retained products of conception (i.e. after abortion)?

A

Open cervical os, lower abdominal cramping, vaginal bleeding, signs of infection

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3
Q

Why are we concerned about hemorrhage when performing curettage in an infected uterus?

A

Higher risk of perforation when infected

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4
Q

2 most common complications ass. with spontaneous abortion

A

Infection and Hemorrhage

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5
Q

Signs/sxs of septic abortion

A

Uterine bleeding and/or spotting in 1st Trimester + signs of infection. May see abdominal tenderness, cervical motion tenderness, foul-smelling vag discharge

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6
Q

In septic abortion, where does the infection come from/travel to?

A

Ascends from Vagina or Cervix. Goes to Endometrium –> Myometrium –> Perimetrium –> Peritoneum

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7
Q

Which organism causes septic abortion?

A

Polymicrobial –> Anaerobic strep, bacteroides, E coli, GBS are common

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8
Q

Bloody Show

A

A sign of impending labor that is often accompanied by the loss of the mucus plug. May present as bloody mucus in the vaginal vault.

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9
Q

What is the cutoff for ‘anemia in pregnancy’

A

10.5

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10
Q

Accelerations

A

> 15bpm above baseline for at least 15 seconds

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11
Q

Adequate Contractions

A

> 200 Montevideo Units in a 10min. window

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12
Q

Protracted Labor

A

Some progression but taking longer than normal (i.e. 0.5cm/hr)

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13
Q

Bloody Show

A

A sign of impending labor that is often accompanied by the loss of the mucus plug. May present as bloody mucus in the vaginal vault.

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14
Q

Combination of which 2 antibiotics works well for septic abortion tx 95% of the time

A

Gentamicin + Clindamycin (want broad spectrum with good anaerobic cover)

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15
Q

When do you begin uterine curettage for removal of retained products of conception/septic abortion?

A

4 hours after starting IV antibiotics

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16
Q

Why is urine output carefully observed in the setting of septic abortion?

A

because Oliguria = early sign of septic shock

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17
Q

Pelvic exam finding for Mullerian agenesis pt

A

blind vaginal pouch/vaginal dimple

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18
Q

Why does uterine inversion lead to PPH

A

Prevents adequate myometrial contraction

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19
Q

Absence of breast development points towards what hormonal state and condition?

A

Hypoestrogenic state –> Gonadal dysgenesis aka Turner syndrome

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20
Q

Next step in management after a shoulder dystocia has occurred

A

McRobert’s Maneuver - hyperflexion of maternal hips onto maternal abdomen and/or suprapubic pressure

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21
Q

Primary Amenorrhea = no menarche by age ____

A

16

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22
Q

Primary amenorrhea, normal breast, pubic, and axillary hair. Absent uterus

A

Mullerian agenesis

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23
Q

First dx test for any woman with primary or secondary amenorrhea?

A

Pregnancy test

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24
Q

T/F Fundal Pressure should be applied immediately following Dx of shoulder dystocia

A

False, it should be avoided due to increased risk of neonatal injury. McRoberts uses suprapubic pressure

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25
Q

+ whiff test

A

BV or Trich

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26
Q

Why do menses and intercourse exacerbate the fishy odor of BV?

A

Both introduce an alkaline substance

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27
Q

what are Amsel’s criteria?

A

3/4 indicate BV

  1. Homogenous, gray-white discharge
  2. vaginal pH>4.5
  3. Postive whiff test
  4. Clue cells on wet mount

(Gram stain is gold standard but rarely used clinically)

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28
Q

Strawberry cervix

A

Trichomonas

“Strawberries are trich-y to Cerve”

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29
Q

why does antibiotic use dispose to Candida vaginitis?

A

normal lactobacilli in vagina inhibit fungal growth (these are reduced by antibiotic)

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30
Q

which of the 3 vaginitis microscopic dx is assisted by KOH?

A

Candida: KOH lyses leukocytes and erythrocytes, can identify hypahae/pseudohyphae easier

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31
Q

Classic mammogram finding of breast cancer

A

A. Small cluster of calcifications around a small mass
or B. masses with ill-defined borders (spiculated/invasive)
or C. asymmetric increased tissue density

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32
Q

Next dx step if mammogram is suspicious for cancer

A

Stereotactic core biopsy

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33
Q

role of MRI in identifying breast cancer?

A

Can detect early breast cancers missed by mammography, especially in younger pts or BRCA pts

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34
Q

Name this method of breast cancer workup: Computerized,digital 3-D view of breast allows us to direct the needle to the biopsy site

A

Stereotactic Core Biopsy (needle localization is also acceptable)

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35
Q

Name this method of breast cancer workp: Multiple mammographic views of the breast allow us to localize the lesion with assistance of a sterile wire

A

Needle Localization

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36
Q

Digital mammogram has better sensitivity than film in which conditions:

A

Age<50, premenopausal, dense breasts

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37
Q

Define radical hysterectomy

A

removal of the Uterus, Cervix, and supportive ligaments (cardinal, uterosacral, and proximal vagina)

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38
Q

Who gets HPV vaccine?

A

M/F aged 9-26. Quadrivalent = 6, 11, 16, 18

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39
Q

What’s acetowhite change refer to?

A

(colposcopy) Addition of acetic acid to the cervix will turn cervical intraepithelial lesions white. Dysplastic lesions will often have vascular changes (punctuations, atypical, etc)

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40
Q

Next step to evaluate an abnormal Pap smear?

A

Colposcopic examinations with directed biopsies

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41
Q

T/F: When a woman presents with a cervical mass, Pap smear is appropriate

A

FALSE. Pap smear is a screening test, best used for asymptomatic women. BIOPSY OF MASS = best test for visible lesion

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42
Q

How is advanced cervical cancer (>4cm) best tx?

A

Radiotherapy: Brachytherapy (implants) with teletherapy (whole pelvis radiation) + chemo (cis-platinum) to sensitize the tissue to radiotherapy

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43
Q

Staging procedure for Cervical cancer (5)

A
  1. Exam under anesthesia
  2. IV Pyelogram
  3. Chest Xray
  4. Barium enema or proctoscopy
  5. Cystocopy
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44
Q

most common cause of death due to cervical cancer?

A

Bilateral ureteral obstruction leading to uremia

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45
Q

how can hydronephrosis be caused by cervical cancer?

A

Cancer often spreads to pelvic sidewalls (via cardinal) and obstruct one or both ureters

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46
Q

T/F: Pap smear is no longer needed after hysterectomy

A

False. In the case that hysterectomy was performed for cervical dysplasia, Pap smear of vaginal cuff is still needed

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47
Q

Whats the protocol if ASCUS (Atypical Squamous Cells of Uncertain Significance) is found?

A

May be observed instead of immediate colp/HPV testing

vs HSIL/LSIL req colp

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48
Q

Women younger than age 25 with biopsy proven CIN 1 or 2

A

may be observed with serial Pap since resolution rate is high

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49
Q

Atypical glandular cells (AGCs) on pap. Next steps?

A

Colp, endocervical curettage, and endometrial biopsy

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50
Q

What is radical trachelectomy?

A

Removal of cervix and upper vagina (leaves uterus). Newer option for cervical cancer tx in younger women who desire children

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51
Q

2 clinical signs that can indicate advanced cervical cancer

A

Flank tenderness

Leg swelling

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52
Q

T/F: Eye prophylaxis is effective for preventing gonoccoal and chlamydial conjunctivitis

A

False, its actually only effective against GC (even though chlamydia more common)

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53
Q

Which infection is late postpartum endometritis (2-3 weeks post) ass. with?

A

Chlamydia

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54
Q

Tx for chlamydia

A

Erythromycin, amoxicillin, or azithro

Tetra/doxy CI in preg

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55
Q

T/F: GC and Chlamydia are ass. with abortion, preterm labor, PPROM, chorio, neonatal sepsis, postpartum infection

A

False: Gonococcal cervicitis IS ASSOCIATED WITH ALL OF THESE. Links between these and chlamydia are unclear

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56
Q

T/F: Heterosexual spread of HIV is the most common mode of transmission

A

True

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57
Q

The goal in pregnancy is to maintain an HIV viral load under:

A

1000 RNA copies/mL (higher than this prior to labor/ROM, c-section reduces risk of vertical transmission)

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58
Q

What to give HIV infecte owmen who delivers vaginally?

A

IV Zidovudine during labor

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59
Q

Which HIV drug is associated with congenital anomalies?

A

Efavirenz (NNRTI) –> Neural tube defects

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60
Q

Tx for co-infection for HIV and HBV?

A

Tenofovir and lamivudine. Infants should get Hep B IG at birth and start vacc. within 12 hours.

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61
Q

Can women with Hep B or Hep C breastfeed?

A

Only if they don’t have co-infection with HIV

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62
Q

T/F: C/s does not affect the perinatal transmission of hep c

A

true

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63
Q

How is cervical cancer staged?

A

Clinically

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64
Q

2 key tests in assessment of extrauterine pregnancy

A

hCG (look for #s above 1500-2000 threshold–>should see pregnancy on US by this threshold, if not its likely ectopic)

Transvaginal US (look for IUP)

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65
Q

Most common reason for maternal mortality in the first 20 weeks gestation

A

Hemorrhage from ectopic gestation

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66
Q

If you suspect extrauterine pregnancy in a women, should you give methotrexate?

A

No, b/c you are not 100% sure and could destroy any intrauterine gestation. Do Laparoscopy instead

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67
Q

What is the most sensitivite way to detect IUP, as early as 5.5 weeks?

A

Transvaginal sonography>transabdominal

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68
Q

What finding demonstrates definite IUP?

A

Crown-rump length or yolk sac

ID of a gestational sac is sometimes misleading

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69
Q

How does a normal gestational sac appear?

A

Eccentrically located with a decidual sign (echogenic rim around sac)

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70
Q

A rise in hCG of at least ____% in ____hours is indicative of a normal pregnancy

A

53% in 48 hours

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71
Q

Progesterone level of > than _____ng/mL = always normal IUP

level < than ____ng/mL = always abnormal

A

25

5

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72
Q

Procedure used in a woman with ectopic pregnancy that can not be treated medically (ruptured/too large) but wants to preserve fertility

A

Salpingostomy

vs salpingectomy normally performed if not wanting to preserve fertility

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73
Q

Prinicipal form of medical therapy for ectopic

A

Methotrexate (one time, low dose, intramuscular injection)

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74
Q

What are the conditions in which methotrexate can be used to tx ectopic?

A
  1. less than 3.5cm diameter
  2. no fetal cardiac activity
  3. hCG<5000
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75
Q

Levels of hCG that plateau in the first 8 weeks of preg indicate:

A

Abnormal pregnancy (miscarriage or ectopic)

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76
Q

Classic triad of sxs of ectopic

A

Amenorrhea
Vaginal Spotting
Abdominal Pain

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77
Q

Tx of choice for all ovarian malignancies?

A

Surgical staging

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78
Q

Name for an androgen effect other than hair pattern (clitromegaly, male balding, deepening of voice, ACNE)

A

Virilism

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79
Q

Hirsutism is most commonly associated with:

A

Anovulation (PCOS)

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80
Q

Causes of Virilization

A
  1. Adrenal Hyperplasia or androgen-secreting tumor(high DHEA-S)
  2. Androgen-secreting tumors of the ovary (high Testosterone)
    (note: not really ass. with PCOS)
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81
Q

The rapid onset of hirsutism or virilization usually indicates:

A

Androgen-secreting tumor (NOT PCOS if its rapid, esp if not really related to menarche)

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82
Q

Hyperandrogenism + adnexal mass most commonly =

A

Sertoli-Leydig cell tumor of the ovary

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83
Q

5 basic factors to consider for infertility

A
  1. Ovulatory
  2. Uterine
  3. Tubal
  4. Male factor
  5. Peritoneal factor (endometriosis)
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84
Q

3 D’s of Endometriosis

A
  1. Dysmenorrhea
  2. Dyspareunia
  3. Dyschezia
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85
Q

Infertility = Inability to conceive after ___ of unprotected sex

A

1 year

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86
Q

Define fecundability and its estimated % for a normal couple

A

Probability of achieving a pregnancy within one menstrual cycle

20-25%

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87
Q

Easiest/cheapest method of detecting ovulation

A

Basal body temperature (rises 0.5F for 10-12 days after ovulation)

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88
Q

Ovulation occurs ___hours after onset of the LH surge

A

36 hours (measured by urine LH kit)

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89
Q

Do the majority of women with tubal factor infertility have hx of chlamydia or GC?

A

No, majority don’t have hx of STI (because asymptomatic)

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90
Q

Prevalence of endometrioitis in infertile women:

A

25-40%

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91
Q

Gold standard for dx tubal issues or endometriosis as causes infertility

A

Laparoscopy

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92
Q

Lesion of various appearances, from clear to red to the classic “powder burn” color are associated with:

A

Endometriosis

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93
Q

What is the choice tx for endometriosis

A

Laparoscopy or Laparotomy (so not DnC)

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94
Q

Technique used if male factor infertility

A

Intracytoplasmic spermatic injection (think of it like the sperm can’t make it on its own)

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95
Q

Pt has to use one’s fingers to apply pressure on vagina to achieve BM

A

One sign of Pelvic Organ Prolapse

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96
Q

Tx options for hot flushes

A
  1. Estrogen replacement therapy w/Progestin (most effective. If uterus gone, don’t need progestin)
  2. Clonidine
  3. Gabapentin
  4. SSRI

note: SERM does NOT work

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97
Q

Which hormones fall earliest in menopause?

A

Anti-Mullerian hormone is the earliest marker; Inhibin B is next; finally, E2 falls.

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98
Q

Inhibin and FSH levels during menopause

A

FSH is elevated, Inhibin is low (as is E2)

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99
Q

Is hormone replacement therapy to tx vasomotor sxs in menopausal woman continued forever?

A

No, it should be used in the lowest dose for the shortest duration feasible

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100
Q

What complications is a PCOS pt at risk for?

A
  1. DM
  2. Endometrial cancer
  3. Hyperlipidemia
  4. Metabolic syndrome
  5. CV disease
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101
Q

Dx for PCOS

A

Req 2/3:

  1. Oligo/amenorrhea
  2. Hyperandrogenism
  3. US evidence of small, multiple ovarian cysts

(LH:FSH ratio is unreliable)

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102
Q

Exclusion of these secondary causes of hyperandrogenism before labeling PCOS

A
  1. Congenital adrenal hyperplasia.
  2. Hyperprolactinemia, 3. Adrenal/ovarian tumor
  3. Cushing syndrome
  4. Thyroid disorders
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103
Q

PCOS tx

A

BMI<30: Clomiphene citrate (SERM)

BMI>30: Letrozole (aromatase inhibitor)

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104
Q

In female, testosterone is largely secreted by the ____ and DHEA-S by the _________

A

Ovary (T)

Adrenal Gland (DHEA)

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105
Q

Pts with PCOS should be screened for: (2)

A

Glucose intolerance

Lipid abnormalities

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106
Q

cHTN vs gHTN

A

Chronic: BP 140/90 before pregnancy or before 20 weeks, or persisting more than 12 weeks postpartum

Gest: HTN w/o proteinuria at >20weeks for at least 4 hours

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107
Q

Preeclampsia definition

A

140 or 90 measured 2x, 6 hours apart + new onset proteinuria (>300mg in 24hrs, or UP:C >0.3)

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108
Q

If there is HTN but no proteinuria, how else can you make dx of preeclampsia

A

HTN + one of the following “severe features”:

  1. Thrombocytopenia
  2. Impaired LFTs
  3. Renal insuff (Cr>1.1)
  4. Pulm Edema
  5. Cerebral disturb
  6. Visual impairment
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109
Q

What is cHTN pt at risk for?

A
  1. IUGR
  2. Fetal Demise
  3. Placental abruption
  4. Superimposed preeclampsia
  5. Eclampsia
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110
Q

Underlying pathophys of pre-E

A

tissue hypoxemia = heVasospasm and “leaky vessels” = serum leakage and molysis/necrosis/end-organ damage

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111
Q

What is the cure for Pre-E?

A

TERMINATION OF PREGNANCY = delivery

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112
Q

What is the effect of pre-E vasospasm on BP, Intravascular volume, and oncotic pressure?

A

Increased BP (increased systemic vascular resistance)

Decreased Intravascular Volume and Oncotic Pressure (leakage)

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113
Q

Complications of preeclampsia

A
  1. Placental abruption
  2. Eclampsia
  3. Coagulopathies
  4. Renal Failure
  5. Hepatic subcapsular hematoma
  6. Hepatic rupture
  7. Uteroplacental insufficiency

Fetal growth restriction, poor Apgar, and fetal acidosis also seen

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114
Q

Risk factors for Pre-E

A
  1. Nulliparity
  2. African american
  3. Extremes of age
  4. Previous pre-E
  5. cHTN
  6. chronic renal dx
  7. obesity
  8. antiphospholipid syndrome
  9. diabetes
  10. multifetal gest.
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115
Q

Lab tests for preE

A

CBC, UA and 24 hr urine protein, LFT, LDH (hemolysis), and Cr

Fetal testing (BPP) to check uteroplacental insuff

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116
Q

management of acutely elevated BP (160/110 for >15 min = HTN emergency)

A

Use IV labetolol or IV hydralazine or oral nifedipine immediately to avoid stroke. Recheck 20 minutes later

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117
Q

mgmt for preE with severe features

A

Over 34 weeks: give MgS04 and deliver

Less 34: corticosteriods, mag, and asses M/F stability. If stable, wait 48 hrs for steroids to work and deliver.

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118
Q

When is the greatest risk of Eclampsia occurrence?

A
  1. Just prior to delivery
  2. During labor (intrapartum) –>give preE pt mag
  3. w/in 1st 24 hours postpartum
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119
Q

1st sign of mag toxicity:

A

Hyporeflexia (loss of deep tendon reflexes).

Side effect of mag = pulmonary edema

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120
Q

Cystometric exam can differentiate between:

A

Urge and stress incontinence

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121
Q

No delay from cough to incontinence:

A

Genuine Stress Incontinence

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122
Q

From stress incontinence, where is the proximal urethra relative to the pelvic diaphragm

A

Falls below it.
Thus, when the patient coughs, intra-abdominal P is exerted to the bladder but not to the proximal urethra, and bladder pressure exceeds urethral = urinary flow

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123
Q

Delay between cough and void

A

Urge incontinence

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124
Q

Best tx’s for stress and urge incontinence

A

Stress: Surgical (sling)

Urge: Medical (kegel, lifestyle, antimuscarinics, Mirabegron)

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125
Q

Best tx for uncomplicated cystitis

A

3 day course of Bactrim

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126
Q

What are the classic sxs of cystitis?

A

Dysuria, urgency, frequency.

Note: Fever is NOT usually seen. Typically seen when upper tract involvement i.e. pyelo

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127
Q

Do we tx asymptomatic bacteriuria?

A

We always tx this in pregnant women (1/4 would go on to develop infection)

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128
Q

agens for urethritis

A

Chlamydia, Gonococcus, Trichomonas

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129
Q

Typical sxs of UTI but no growth in culture (so sterile pyuria) and no response to antibiotics

A

Suspect urethritis (chlamydia, gonorrhea, trichomonas)

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130
Q

Tx for urethritis

A

Typically do Doxy + ceftriaxone for the C/NG infection. In pregnant, substitute Azithromycin for doxy

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131
Q

between which weeks is considered ‘term’?

A

37-42

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132
Q

If a pt is rubella nonimmune, when do you immunize?

A

POSTPARTUM!

Rubella vaccine = live attenuated = do NOT give during pregnancy

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133
Q

Define Labor

A

Cervical change accompanied by regular uterine contractions

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134
Q

After how many cm dilation do we say active labor has begun?

A

6cm (not 4)

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135
Q

How do we define “arrest of active phase”?

A

No progress in the active phase of labor (>6cm) for:
-4 hours if adequate ctxs
-6 hours if inadequate ctxs
(assuming ROM)

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136
Q

Define adequate ctxs

A

every 2-3 minutes, firm on palpation, lasting at least 40-60 seconds (clinical) or at least 200 Montevideo units

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137
Q

how are Montevideo units calculated?

A

exaine a 10-min window; add each ctx’s rise above baseline (each mmHg is a Montevideo unit) –> 200 = normal ctxs

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138
Q

Late decels suggest fetal ____, and if recurrent or together with decreased variability, suggest fetal ____

A

hypoxemia; acidemia

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139
Q

reasons for C-section

A

(in order of freq)

  1. LABOR DYSTOCIA (does not include prolonged latent)
  2. ABNORMAL FHT
  3. fetal malpresentation
  4. multiple gestation
  5. macrosomia
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140
Q

How can we try to intervene after seeing many variable decels?

A

Amnioinfusion

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141
Q

What is a good way to asses fetal acid-base status when abnormal FHR patterns are present?

A

Scalp stimulation….if it induces an acceleration, highly correlates to a normal umbilical cord pH (>7.2)

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142
Q

when should external cephalic version be offered?

A

To women after 36 weeks with malpresentation

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143
Q

Intervention for pt that becomes hypotensive following epidural/spinal

A

IV fluid bolus OR admin Ephedrine (vasopressor)

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144
Q

Vaginal exam reveals cord through cervix

A

Umbilical cord prolapse –> Elevate presenting part and EMERGENCY C/S

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145
Q

Uterine tenderness + Vaginal bleeding

A

Placental abruption –> support BP and stabilize pt, consider c/s

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146
Q

what type of defect are the thalassemias?

A

Quantitative (vs sickle cell is qualitative)

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147
Q

Woman develops dark-colored urine after taking Nitrofurantoin for UTI. What does she likely have?

A

G6PD-Deficiency…hemolysis. Also consider HELLP if there is also thrombocytopenia

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148
Q

Elevated _____ = Beta-thal

Elevated _____ = Alpha-thal

A 
A2 hemoglobin (B)
HbF (A)
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149
Q

4 signs of placental separation

A
  1. Gush of blood
  2. Lengthening of cord
  3. Globular/firm shape of uterus
  4. uterus rises up to anterior ab. wall
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150
Q

Common complication of uterine inversion

A

Hemorrhage (due to atony)

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151
Q

Nerve injury related to shoulder dystocia

A

Erb Palsy = brachial plexus C5-C6. Arm hands limply by the side and is internally rotated.

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152
Q

Signs that a baby is getting sufficient milk

A
  1. 3-4 stools in 24 hrs
  2. 6 wet diapers in 24 hrs
  3. wt gain
  4. sounds of sucking
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153
Q

If you suspect ruptured ectopic, whats next step in mgmt?

A

EXPLORATORY SURGERY (lap). Not methotrexate or DnC.

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154
Q

Pt has inappropriate hcg levels (dont rise 50% in 48 hours) and levels that do not fall after dx’ic D and C

A

Ectopic

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155
Q

Mag toxicity and solution

A

Muscle weakness, loss of DTReflexes, Respiratory Depression!, nausea

–> Administer calcium gluconate if need to restore respiratory function

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156
Q

How to diff. preeclampsia with or without severe features based on protein level?

A

24-hr Protein>300 = mild preE (no severe features)

24-hr Protein>5000 = PreE with severe features

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157
Q

Initial steps after fetal bradycardia

A

Improve maternal oxygen and CO to uterus:
1. Put pt on her side (move uterus away from vessels)
2. IV fluid bolus if V depleted
3. 100% O2 by face mask
4. Stop Pit
Also MUST do vaginal exam to assess for cord prolapse

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158
Q

If fetal bradycardia is due to hyper stimulation with Pit, what can be done?

A

Give beta-agonist such as terbutaline to relax uterine musculature

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159
Q

Lack of myometrial ctxs, resulting in a boggy uterus

A

Uterine atony

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160
Q

An ergot that induces myometrial ctxs to tx Uterine atony

A

Methergine (CI in HTN pt)

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161
Q

3 agents that can be used for Atony

A
  1. Methergine (ergot. CI in HTN)
  2. PGF2-alpha (CI in asthma pt)
  3. Misoprostol (rectal. often preferred method)
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162
Q

Surgical therapy for atony if medical mgmt fails

A
  1. Exploratory lap + uterine artery or internal iliac artery ligation
  2. b lynch stitch
  3. hysterectomy
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163
Q

If uterus is firm contracted while bleeding persists, what is the likely etiology of PPH?

A

Genital tract laceration. Also, uterine inversion, placenta accreta, retained placenta, and coagulopathy (if no laceration).

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164
Q

PPH that doesnt start until 2 weeks postpartum (secondary PPH)

A

usually due to Subinvolution of the Placental Site…eschar of placenta falls off. Tx with oral ergot (methergine)

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165
Q

what are the steps involved in “active mgmt of 3rd stage of labor” and why perform it

A
  1. Pit immediately upon delivery
  2. Late cord clamping
  3. Gentle cord traction
    Decreases risk/severity of PPH
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166
Q

Define chorionicity

A

The # of placentas. In monozygotic, can be MC or DC. In dizygotic, always DC (same rule applies for amnion)

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167
Q

Complications ass. with twins

A
  1. Preterm delivery
  2. Congenital malformations
  3. Pre-E
  4. PPH
  5. Twin-Twin Transfusion
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168
Q

Link btwn OCPs and twins?

A

OCP slows tubal motility, which is a possible cause of twins (so increases incidence)

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169
Q

best imaging to detect vasa previa?

A

color Doppler ultrasound

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170
Q

mgmt if vasa previa is identified?

A

Planned c/s before ROM, around 35-36 wks gestation (note: digital vaginal exam is CI in vasa previa)

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171
Q

If fetal bleeding is uncertain, which two tests can differentiate btwn maternal and fetal bleeding?

A

Apt test and Kleihauer-Betke test

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172
Q

What to do if presence of prodromal sxs or genital lesions suspicious for HSV?

A

C/s to prevent neonatal infection

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173
Q

highest risk factor for neonatal HSV infection

A

acquisition of new maternal HSV infection near time of delivery

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174
Q

Painless antepartum (after 20 weeks) vaginal bleeding

A 
Placenta previa (vs abruption usually painful)
-->may have postcoital bleeding earlier in preg
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175
Q

Next steps after patient complains of antepartum (after 20 weeks) vaginal bleeding

A

Ultrasound to rule out placenta previa BEFORE doing a speculum or digital exam (because these can induce bleeding)

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176
Q

Placenta accreta is more common with placenta _____

A

previa

esp in presence of uterine scar i.e. prior c/s

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177
Q

Risk factors for Placental Abruption

A
  1. HTN! (chronic and preE)
  2. Cocaine use and Smoking
  3. Trauma (MVA)
  4. Uteroplacental insuff
  5. PPROM

PREVIOUS HX OF ABRUPT. = #1 though

“Abruptly had High Blood Pressure after getting into an MVA while Smoking Cocaine”]

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178
Q

Bleeding into the myometrium of the uterus, giving a discolored appearance to the uterine surface

A

Couvelaire Uterus

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179
Q

Why can placental abruption lead to coagulopathy (esp in cases severe enough to cause fetal death)?

A

Hypofibrinogenemia

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180
Q

Painful antepartum vaginal bleeding

A

abnormal adherence of placenta to uterine wall (abnormal decidua basalis layer of the uterus)

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181
Q

Accreta vs Increta vs Percreta

A

Accreta: placenta attaches to the myometrium
Increta: Penetrates into myometrium
Percreta: All the way through myometrium, possibly adjacent organs

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182
Q

Risk factors for accreta

A

Low lying placenta, previa, prior C/s or uterine curettage, or prior myomectomy

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183
Q

Usual mgmt. of placenta accrete/previa

A

Prelabor c/s + hysterectomy at 34-35 weeks + beta-methasone

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184
Q

Where is appendicitis located in a pregnant patient?

A

Superior and lateral to McBurney point (because enlarged uterus pushes on appendix)

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185
Q

Tx for appendicitis in pregnancy?

A

Surgical, regardless of gestational age. + IV antibiotic

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186
Q

Why is there a risk of gallstones in pregnant patient?

A

Increase in gallbladder volume and biliary sludge = common physiologic effect of preg.

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187
Q

Most frequent and serious complication of a benign ovarian cyst

A

Ovarian torsion

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188
Q

most common cause of septic shock in pregnancy

A

Pyelo

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189
Q

how can we detect fetal anemia in utero?

A

Fetal Doppler. Middle cerebral artery peak systolic velocity

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190
Q

How do corpus luteum cysts develop?

A

From mature Graafian follicles; ass. with normal endocrine f(x) or prolonged progesterone

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191
Q

If corpus luteum cyst is excised, does anything need to be supplemented?

A

If pregnancy is less than 10-12 weeks, supplement with progesterone (placenta takes over for the corpus luteum in making progesterone after this)

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192
Q

Mother and father of fetus are both Rh-. When do you admin Rhogham?

A

You don’t need to

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193
Q

Rh antibody screen comes back positive for Lewis antibodies. What are these and when do you give Rhogam?

A

They are IgM and thus don’t cross placenta, so no need to admin Rhogham

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194
Q

Which type of twins are most likely to undergo Twin-Twin transfusion?

A

Diamniotic, monochorionic

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195
Q

Most common trisomy in abortuses?

A

Trisomy 16

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196
Q

between which weeks is fetus most susceptible to developing intellectual disability and microcephaly i.e. after radiation exposure

A

8-15

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197
Q

What should be documented before initating HRT for menopause sxs?

A

tissue dx consistent with normal endometrium, or a pelvic ultrasound with an endometrial stripe of <4mm ought to be documented

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198
Q

Which hormone replacement should not be used in woman with intact uterus?

A

Do not use estrogen-only b/c increased risk of endometrial cancer

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199
Q

Which of the following levels do we assess for dx of menopause: FSH, LH, Estrogen?

A

FSH only

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200
Q

Which is more effective for treating hot flashes, Estrogen or SERM (i.e. raloxifene, clomiphene)?

A

ESTROGEN

We do NOT use SERMS…these may actually cause hot flashes

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201
Q

HRT effect on lipids (note: not rec for primary prevention CVD)

A

Increase HDL
Decreased LDL

(estrogen increases TG and LDL catabolism and #LDL-R = lower LDL)
(HRT blocks hepatic lipase = less conversion of HDL = more HDL)

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202
Q

Menopausal patient has DEXA of -1.7. What’s next step in mgmt. of pt?

A

Assess her risk factors for fracture
(prior fracture, FHx osteoporosis, race, dementia, hx of falls, nutrition, smoking, low BMI, E2 def, alcohol, physical activity)

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203
Q

Why does BSO in postmenopausal woman cause resurgence of menopausal sxs?

A

Abrupt drop in circulating androgens (which are peripherally converted to estrogen)
Note: Ovaries stop producing estrogen at menopause, but continue to produce androgen

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204
Q

Labs for Exercise-induced hypothalamic amenorrhea

A

Normal FSH

Low Estrogen

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205
Q

Tx for exercise-induced hypothalamic amenorrhea

A

Gain wt by less exercise and more calories

If menses fail to resume, can use exogenous gonadotropins (LH and FSH); clomiphene does NOT work

206
Q

What is a clomphene challenge test and what does it tell us?

A

Give clomid on days 5-9 of menstrual cycle; check FSH on day 3 and day 10

Determines Ovarian reserve

207
Q

What is better for maximizing chances of pregnancy, Ovulation predictor kits or basal body temperatures?

A

Ovulation predictor kits, because it tells you before you ovulate, versus BBT tells you after

208
Q

Premenstrual dysphoric disorder (PMDD) occurs during which phase of menstrual cycle?

A

functional impairment present during last week of luteal phase and begin to resolve with beginning of follicular phase

209
Q

Which vitamin deficiencies are associated with increased PMS?

A

Vitamin A, E, and B6

210
Q

T/F: SSRIs can be used to tx PMS

A

True

211
Q

Why does Exercise improve PMS sxs?

A

Release of endorphins (and NOT related to estrogen)

212
Q

Risk factors for developing PMS

A

Family Hx

Def of B6, Calcium, or Magnesium

213
Q

Describe the basic mechanism/defect causing cholestasis in pregnant patient

A

Intrahepatic Cholestasis of Pregnancy (ICP) –> bile salts are incompletely cleared by the liver, accumulate in the body, and deposit in the dermis

214
Q

Which trimester does cholestasis in a pregnant patient typically occur?

A

3rd

215
Q

Treatment of choice for ICP (cholestasis)

A

UDCA (Ursodeoxycholic acid)

Also, BPP or NST, and plan to deliver @37-38 weeks (increase risk of stillbirth)

216
Q

What’s the consideration for contraception in women with prior ICP?

A

Cholestasis and pruritis may recur with the use of OCP/estrogen containing meds, so alternative contraception should be recommended

217
Q

What’s the etiology of Herpes gestationis?

A

Autoimmune (No relation to HSV)

218
Q

What are the 5 components of BPP?

A
  1. NST
  2. Fetal breathing
  3. Fetal tone
  4. Fetal movement
  5. Amniotic fluid volume
    Each scored 0 or 2. Scores 8/10 with normal amniotic fluid, or 10/10 are reassuring.
219
Q

Pulse ox of less than 90% corresponds to an O2 of ____

A

less than 60 mmHg

220
Q

A clear chest radiograph in the face of hypoxemia

A

PE

221
Q

If fetus is breech, which body part is most likely palpable?

A

Buttocks.

So frank breech is most common. Incomplete (footling) is less so.

222
Q

Threatened abortion occurs during which trimester?

A

First (so before week 12ish)

223
Q

Cervicitis is caused by:

A

Chlamydia, Gonorrhea, Trichomonas, or other infections –>presents as vaginal bleeding

224
Q

What is the role of Nifedipine, Ampicillin, and Prostaglandin’s i.e. in preterm labor

A

Nifedipine: Tocolytic
Ampicillin: GBS prophylaxis for status unknown
Don’t use PG’s –>utertonic agents increase ctx rate

225
Q

What should be done prior to digital examination if you are suspecting preterm labor?

A

Fetal Fibronectin assay –>swab the posterior vaginal fornix for fetal fibronectin

226
Q

What do + and - results indicate on Fetal fibronectin assay

A

+: Risk of preterm birth

-: Strongly ass. with no delivery within 1 week

227
Q

A basement mem protein that helps bind placental membranes to the decidua of the uterus

A

Fetal Fibronectin Assay

228
Q

What is sufficient to make the dx of Preterm Labor?

A

Contractions + 2cm dilation and 80% effacement (btwn 20-37 weeks)

229
Q

4 commonly used Tocolytic agents

A
  1. Nifedipine
  2. Indomethacin
  3. Terbutaline
  4. Ritodrine
230
Q

If delivery is before ____ weeks, Mag should be given for neuroprotection (cerebral palsy)

A

32

231
Q

Cervical length of

A

25

232
Q

What is funneling (of cervix)?

A

Impinging of the amniotic cavity into the cervix –> Increases the risk of preterm delivery

233
Q

Biggest risk factor for preterm delivery?

A

Prior spontaneous preterm birth

234
Q

Side effect of Nifedipine

A

Pulmonary edema and respiratory depression

235
Q

What is the goal of Antenatal steroids (given btwn 23-37 weeks)?

A

<28 weeks: Lower risk fo Intraventricular hemorrhage

>28 weeks: Prevent respiratory distress syndrome

236
Q

What can you do between weeks 16-36 to prevent a high risk (prior hx) patient from preterm birth?

A

Weekly injection of 17 alpha-hydroxyprogesteronecaproate (blocks AP gonadotropin release; maintains pregnancy)

237
Q

Which infection is ass. with increased risk of Preterm labor?

A

Gonorrhea (more so than Chlamydia)

238
Q

What are the sequelae from Indomethacin closure of PDA?

A

Pulmonary hypertension and Oligohydramnios. May see variable decels (from cord compression from oligo)

239
Q

If a patient presents at 28weeks with preterm contractions and dilation to 1cm and 50% effaced, has a fever, tender fundus and elevated wbc count but category 1, what do you do?

A

She has intra-amniotic infection: Thi sis an indication for delivery. You INDUCE LABOR, instead of giving tocolytics.

240
Q

Side effects and CI of terbutaline and ritodrine (beta agonists)

A

Cause Pulm Edema, increase Pulse Pressure, Hyperglycemia, Hypokalemia, and Tachycardia.

CI in Diabetic pts, HTN, seizure, and arrhythmia

241
Q
  1. Drugs that prevent calcium entry into muscle cells by inhibiting calcium transport
  2. Drugs that compete with calcium entry into cells
  3. Drugs that increase cAMP in the cell = decrease free calcium
A
  1. CCB’s i.e. Nifedipine
  2. Mag sulfate
  3. Beta agonists (terbutaline/ritodrine)..also relax smooth muscle
242
Q

Side effects of mag sulfate (competitively inhibits calcium entry)

A

Areflexia first, then Pulmonary Edema, Respiratory Depression and Cardiac Depression

243
Q

When a patient is admitted with PPROM, what are indications for delivery ?

A

Infection
Abruption
Nonreassuring fetal status
–>Deliver these at 34 weeks.

PPROM>34 weeks, can also deliver

244
Q

How is dx of PPROM confirmed after a patient complains of a “gush of fluid”?

A
  1. Speculum exam showing pooling of amniotic fluid in the posterior vaginal vault
    • Nitrazine test (shows ALKALINE changes of vag fluid)
      and
  3. Ferning patern of fluid on microscopy
    –>speculum is neg but suspicion high, and US shoulding oligo is consistent with PPROM
  4. AmniSure immunoassay
245
Q

What is the AmniSure immunoassay?

A
  • Test for PPROM

- checks for Alpha Macroglobulin-1 = protein with 10,000x more conc. in amniotic fluid

246
Q

Common complications of preterm delivery

A

Respiratory distress syndrome
Chorio
Abruption
Necrotizing enterocolitis

247
Q

What type of decal would you expect after PPROM?

A

Variables due to cord compression due to Oligo

248
Q

What does presence of Phosphatidyl Glycerol (PG) in vaginal fluid?

A

Fetal Lung Maturity!! You may now deliver, and should not give steroids .

249
Q

Which organism can cause Chorio without rupture of membranes?

A

Listeria

250
Q

Which antibiotics do you give to PPROM patient?

A

Ampicillin and Erythromycin…prolongs latency period by 5-7 days (more so than tocolytics)

251
Q

Ruptured membranes and a tender fundus indicate:

A

Chorio

–>Proceed to delivery

252
Q

What are prostaglandins used for and when are they CI?

A

Used for cervical ripening (CERVIDIL)

CI if previous C/s

253
Q

what does fetal tachycardia typically indicate?

A

maternal fever/chorio

254
Q

T/F: BPP has no value during labor

A

True

255
Q

Initial measures to treat fetal hypo perfusion (late decals)

A
  • change mom to left lateral position
  • O2 supp
  • tx mom hypotension
  • DC Pit
  • maybe tocolytics/fluids

–>all are measures to improve uteroplacental blood flow (before jumping to c/s)

256
Q

Risk factors for Uterine Atony

A
  • Precipitous labor (<3hrs)
  • Multiparity
  • General anesth.
  • Pit
  • Prolonged Labor
  • Macrosomia
  • Hydramnios
  • Twins
  • Chorio
257
Q

Cytotec =

A

Cytotec = Misoprostol = Prostaglandin E1 (analog)

258
Q

Methergine =

A

Methylergonovine = Ergot

259
Q

Hemabate =

A

Prostaglandin F2-alpha = Carboprost

260
Q

3 drugs used as uterotonic agents to stop PPH

A
  1. Oxytocin (Pit)
  2. Prostaglandins (Hemabate = PG F2alpha; Cytotec - PGE aka misoprostol)
  3. Ergot(Methergine =Methylergonovine)
261
Q

Which uterotonic agent should not be used in Asthmatic?

A

PGF2 = Hemabate = potent smooth m constrictor and bronchio constrictor

262
Q

Who should methergine not be given to?

A

Its a vasoconstriction agent –> avoid in HTN and preE pts

263
Q

Factors ass. with retained placenta:

A
  1. Prior C/s
  2. Fibroids
  3. Prior curettage
  4. Succenturiate lobe of placenta
264
Q

Lack of gonadal f(x) is indicated by high ____ levels

A

FSH

265
Q

Lack of gonadal f(x) phenotype in XY vs XX

A

XY: Female genitalia, b/c MIF and testosterone not produced

XX: Ovarian failure -> Primary amenorrhea and incomplete breast dev.

266
Q

How to diff. btwn Mullerian agenesis and AIS?

A

AIS has high testosterone

267
Q

Patients with ovarian failure should be given:

A

Estrogen and progestin treatment (promote secondary sex characteristics, reduce risk osteoporosis)

268
Q

Prolactin concentrations are ____ in women with amenorrhea

A

Higher

269
Q

Thrombosis of the venous system and pelvis, leading to postpartum infection

A

Septic thrombophlebitis…treat with heparin anticoagulation + antibiotics (be careful, q stem may say theyre already on broad spectrum antibiotics)

270
Q

Patient has fever 20 hours after C-section…what’s most likely cause and what is your next step in mgmt.?

A

ATELECTASIS

Get a CXR!

271
Q

What is one of the earliest signs of fetal hydrous?

A

Hydramnios/excess amniotic fluid (uterine size greater than that predicted by dates + fetal parts difficult to palpate)

272
Q

“No evidence of harm to fetus in animal studies; however, therea are no adequate and well-controlled studies in pregnant woman or animal studies that have shown adverse effect”

A

Category B Drugs

273
Q

“Adverse effects have been shown in animal studies and there are no good studies in humans, but potential benefits may warrant use of drug”

A

Category C Drugs

274
Q

“Good studies in pregnant women have shown known risks to fetus”

A

Category D Drugs

275
Q

“Drugs that should not be used in pregnancy, because studies have shown positive evidence of fetal abnormalities”

A

Category X Drugs

276
Q

3rd trimester SSRI use side effects:

A
  • Agitation
  • Increased/decreased muscle tone
  • Tremor
  • Sleepiness
  • Severe difficulty breathing
  • Difficulty In feeding
    (note: Safe to use during breastfeeding though)
277
Q

this test assesses uteroplacental insufficiency and looks for persistent late decels after contractions

A

Contraction stress test (can usually just do NST though)

278
Q

Post term pregnancies can be caused by:

A
  1. Placental sulfatase deficiency
  2. Fetal adrenal hypoplasia
  3. Anencephaly
  4. Inaccurate dates
  5. Extrauterine pregnancy

(so NOT AFP def, adrenal hyperplasia, or renal/chromosomal abnormalities)

279
Q

Post term pregnancies can result in:

A
  1. Macrosomia
  2. Oligohydramnios
  3. Meconium aspiration
  4. Uteroplacental insuff
  5. Dysmaturity
280
Q

Infant that looks withered, meconium stained, long-nailed, fragile, and associated small placenta

A

Fetal Dysmaturity –> high risk when gest. age exceeds 43 weeks…great risk for stillbirth

281
Q

Ultrasound of ________ = best way to date a pregnancy in first trimester

A

Crown-rump length (as opposed to gestational sac)

282
Q

When thinking about PPROM, after which gestational age would treatment be to go ahead and deliver?

A

After 34-35 weeks

283
Q

Parvo infections in pregnancy may cause fetal infection, that can lead to suppression of :

A

erythrocyte precursors of bone marrow…severe aplastic anemia can result, leading to fetal hydrops

284
Q

What is one of the earliest signs of fetal hydrous?

A

Hydramnios/excess amniotic fluid (uterine size greater than that predicted by dates + fetal parts difficult to palpate)

285
Q

Classic triad of rubella sxs

A
  1. Cataracts
  2. Sensorineural deafness
  3. Cardiac defects (pulm artery stenosis + PDA)

-may also see microcephaly, IUGR, thrombocytopenia purpura

286
Q

Erythema infectiosum is caused by:

A

Parvo b19 (ss-DNA virus)

287
Q

Excess fluid in body cavities, such as ascites, skin edema, pericardial effusion, pleural effusion

A

Fetal hydrops

288
Q

What does a sinusoidal heart rate on FHT indicate?

A

Severe fetal anemia or asphyxia (can evaluate using Middle cerebral artery Doppler)

289
Q

Most common congenital infection in the US

A

CMV (DNA virus)

290
Q

CMV complications in infants

A
  • Microcephaly
  • Periventricular calcifications
  • Deafness
  • Chorioretinitis (blindness)
  • Seizures
  • Interstitial Pneumonia
291
Q

Transmission of CMV is highest in the ____ trimester; neonatal effects are worst in the ____ trimester

A

3rd

1st

292
Q

What’s the tx for CMV?

A

There is NONE

PREVENTION: Careful hand washing, avoid sharing utensils esp. with children

293
Q

Best method to dx Toxo?

A

PCR

294
Q

Classic triad of Toxoplasmosis sx’s

A
  1. Chorioretinitis (blindness)
  2. Hydrocephalus
  3. Intracranial calcifications
295
Q

Tx for Toxo

A
  • Pregnant women are tx with SPIRAMYCIN to reduce transplacental transfer
  • Fetal infection is tx w/pyrimethamine and sulfadiazine
296
Q

RNA Togavirus

A

Rubella

297
Q

Maternal infection with ____ in the 1st 8 weeks confers an 80% risk of major congenital defects; 50% btwn 9-12 weeks; no risk at 20+ weeks

A

Rubella

298
Q

Classic triad of rubella sxs

A
  1. Cataracts
  2. Sensorineural deafness
  3. Cardiac defects (pulm artery stenosis + PDA)

-may also see microcephaly, IUGR, thrombocytopenia purpura

299
Q

What is the tx for rubella?

A

None…prevention is by immunization of susceptible patients

300
Q

Most common cause of hyperthyroidism in pregnancy

A

Graves –>Tx = PTU

301
Q

Since Methimazole (MMI) and PTU both tx Graves and both can cross the placenta, which drug do you use?

A

1st Trimester: Use PTU…MMI has been linked to aplasia cutis (congenital skin or scalp defects)
2-3rd Trimester: Use MMI…PTU linked to hepatic toxicity
(radioactive iodine is always CI in preg)

302
Q

How is the fetus protected if maternal hypothyroidism is identified?

A

Maternal PTU or injection of intra-amniotic thyroxine (fetal hypothyroidism)

303
Q

What is the cause of Postpartum thyroiditis (Hyper->Hypo->Eu) (~5%)

A

Similar to Hashimotos…Anti-microsomal and Anti-Peroxidase antibodies

304
Q

Mgmt for thyroid storm in preg

A

Beta blocker (Propranolol), corticosteroids, and PTU/MMI

305
Q

What is the implication of maternal Graves on the fetus?

A

Can cause fetal hyperthyroidism due to IgG antibodies crossing the placenta

306
Q

Effect of pregnancy on thyroid proteins?

A

Total thyroxine: Increased
Free T4: no change
TSH: no change
Thyroid-binding globulin: Increased

307
Q

Kidney stones, lethargy, and pain that presents in pregnancy:

A

Hyperparathyroidism –>2nd trimester surgery = tx

308
Q

Factors affecting head growth (IUGR)

A

Chromosomal abnormalities

Severe and early intrauterine infections (TORCH)

309
Q

List TORCH infections

A

Toxoplasmosis
Rubella
CMV
Herpes

310
Q

Factors of IUGR that will preserve head size but affect rest of body (asymmetric)

A

Situations of relative hypoxia or decrease in nutrients provided to the fetus

311
Q

Most common cause of asymmetric IUGR

A

maternal vascular disorder: HTN, smoking, illicit drug use

312
Q

most common cause of symmetric IUGR

A

Simply a constitutionally small baby with no adverse problems.

313
Q

Maternal risk factors contributing to IUGR

A
  1. HTN disease (cHTN or preE)
  2. Renal disease
  3. Cardiac/respiratory distress
  4. Underweight/poor pregnancy wt gain
  5. Significant anemia
  6. Cocaine/Tobacco
314
Q

Uterine placental factors contributing to IUGR

A
  1. Placenta abruption
  2. Placenta previa
  3. Infection (toxo, HSV, Parvo)
    (placenta is important for nutrients and transportation btwn mother and fetus)
315
Q

What’s the difference btwn Small for gestational age and IUGR?

A

Both are <10th percentile weight

SGA is for infant, IUGR is for fetus

316
Q

Why do we repeat US for fetal growth in 3 weeks after suspecting IUGR?

A

to evaluate severity: No growth after 3 weeks = profound IUGR; normal interval growth = constitutionally small baby or dating error

317
Q

Asymmetric vs Symmetric IUGR

A

Asy: Preserved Head Circumference, but Abdominal Circumference and Femur Length lag behind
Symm: HC, AC, and FL are all small

318
Q

Combo of US criteria + NST to assess fetal well-being over 30 minutes; fetal breathing, movement, tone and amniotic fluid are assessed

A

BPP

319
Q

With IUGR, Doppler flow in the ____ is helpful

A

Umbilical artery

320
Q

When assessing flow through umbilical artery via Doppler US, what is the significant of “reverse end-diastolic flow”

A

Associated with a high stillbirth rate within 48 hours

“Absent end diastolic flow” has moderate high stillbirth risk”

321
Q

The pathophysiology of ______ = “leaky capillaries”

A

ARDS…fluid from intravascular space permeates into the alveolar areas

322
Q

Pyelonephritis can lead to: (3)

A
  1. Preterm labor
  2. Preterm delivery
  3. ARDS
323
Q

Which antibiotics can be used for pyelo?

A

Cephalosporins OR Amp-Gent

Give suppressive therapy for remainder of pregnancy after acute incident resolved (w/Nitrofurantoin 100mg daily)

324
Q

What should you suspect if peel is not improving clinically after antibiotics 48-72 hours later?

A

Urinary tract obstruction (ureterolithiasis) or perinephric abscess

325
Q

Why do patients with identified Pyelo sometimes develop ARDS?

A

Antibiotic therapy causes release of endotoxins from cell wall to enter blood stream –>Endotoxinemia (also causes uterine contractions and preterm L and D)

326
Q

Risk factors for developing endomyometritis

A

Long labor, IUPC, numerous vag exams, low socioeconomic status, multiple gestations, young maternal age, GBS, chamydia, manual extraction of placenta

327
Q

When physical exam does not reveal a focus, including no dyspnea, what is most like cause of fever after c/s?

A

Endomyometritis –>usually polymicrobial and due to ascending vagina l organisms. May have foul-smelling lochia

328
Q

Tx for endomyometritis

A

IV Gentamicin + Clindamycin = good anaerobic coverage post c/s

if post vaginal, can just do Ampicillin + Gentamicin

“For c/s, us G&C; For V, remember that V stands for vAG”

329
Q

You tx endomyometritis with Gent/Clind but no improvement in 48 hours. What are you concerned about and how do you manage?

A

Concerned about enterococcal infection –> Add Ampicillin

Other possibility is wound infection (fever post op day 4)–> surgical debridement + antimicrobials

330
Q

Tx for mastitis

A

Dicloxacillin (anti-staph)

–>if fever still persists 48 hours later, suspect abscess

331
Q

Tx for breast engorgement

A

Breast binder, ice packs, and analgesics

332
Q

Fluctuance of the breast indicates:

A

Abscess

333
Q

Best tx of cracked nipples:

A

Air drying and avoidance of harsh soap

334
Q

How is DKA dx once suspected?

A

STAT arterial blood gas, blood sugar, electrolytes with anion gap, and serum ketones

335
Q

Most important initial tx if mother goes into DKA?

A

IV fluid infusion with 2 large bore IV’s using isotonic solution (normal saline)

336
Q

Fetus is showing late decels and mother is showing very high glucose and signs of DKA…why the late decels and how soon do you go to c/s?

A

Maternal acidosis translates to fetal acidosis. Acidosis causes late decels. Don’t need c/s because correction of maternal acidosis should correct fetal acidosis.

337
Q

Dx criteria for DKA in pregnancy

A
  1. pH<7.35
  2. glucose >200
  3. Ketones >5
  4. can also see bicarb <18 + ketonuria
338
Q

T/F: Pregestational diabetes and Gestational diabetes put fetus at risk of miscarriage and congenital anomalies, as well as ocular and renal disease

A

False…these risks are associated with Pre-gestational diabetes (due to exposure during conception and embryogenesis)

339
Q

Leading cause of blindness in reproductive age women

A

Diabetic retinopathy

340
Q

Fasting and 1 hour postprandial glucose targets in pregnancy

A

<105

<140 1 hour post prandial

341
Q

When do you want to deliver in diabetic patients?

A

If well controlled: 39 weeks

Poorly controlled: Before 39 weeks (after fetal lung maturity is confirmed)

342
Q

Elective c/s should be considered in diabetics with EFW of > ______g due to potential for _______

A

4500g

Shoulder dystocia

343
Q

Maternal hyperglycemia during L&D leads to neonatal ______

A

hypoglycemia –> increased risk of neurodevelopment delay

344
Q

DKA occurs more commonly in _____ trimester due to increased ___ levels and should be suspected with an arterial pH of < _____

A

2nd-3rd trimester b/c increased hPL

pH<7.35

345
Q

When is routine screening for gestational diabetes performed?

A

26-28 weeks. Can do early screen @16 for high risk pt

346
Q

Postpartum mgmt for GDM pts?

A

Screen for overt DM using 75g oral GTT @6 weeks postpartum

347
Q

Should GDM pts breastfeed?

A

Yes, because it can decrease maternal weight, as well as childhood obesity

348
Q

Fundal height at umbilicus corresponds to :

A

20 weeks

349
Q

Pt has prenatal Pap smear showing ASCUS, what’s next step in mgmt? What about LGSIL/HSIL?

A

ASCUS: Observe and repeat Pap postpartum

LGSIL/HSIL: Colposcopy

350
Q

Fundal ht in CM corresponds to gestational age from ___-____ weeks. If there is a discrepancy of more than ___cm, an US is needed

A

20-34

3cm

351
Q

T/F: Some abnormal findings will be normal in pregnancy, such as glycosuria (due to increase GFR); other seemingly normal findings are worrisome, i.e. PC02 level of 40 (indicates severe CO2 retention)

A

True

352
Q

When do you give rubella vaccine to a pregnant pt who is non-immunized?

A

Postpartum since its a Live attenuated; stay away from sick individuals.

353
Q

If pregnant pt has +RPR or VDRL, what is the mgmt?

A

if <1 year: Penicillin x1

>1 year: Penicillin IM each week x3

354
Q

Tx for chlamydia in pregnant

A

Azithromycin or Amoxicillin (no Doxy in preg)

355
Q

Preg pt has +HBsAG, how do you manage?

A

Check serology to see if chronic vs active; Baby needs HBIG + HBV vaccine

356
Q

T/F: Nuchal Translucency done @ 11-13 weeks;
Trisomy screen @16-18 weeks;
GBS culture @35-37 weeks

A

True

357
Q

T/F: Starting at age 45, screening includes Lipid profile q5 and Fasting blood glucose q3; @50, start TSH q5 years

A

True

358
Q

Screening in HIV-positive women

A
  1. Pap smears twice in first year after dx/entry of care, and then annually
  2. Usual immunizations EXCEPT varicella zoster (withheld)
  3. Pneumococcal 13 valent
359
Q

T/F: Most common cause of mortality in women <20 years = MVA; in woman >39 = Cardiovascular Disease

A

True

360
Q

Most common infections ID’d after sexual assault (4)

A

Trich, Gonno/Chlam, Hep B

–>common regimen = Ceftriaxone, Metronidazole, Azithromycin and HBIG + HBV vaccine if not immunized

361
Q

most effective form of emergency contraception

A

Copper IUD inserted within 120 hours postcoital

362
Q

If a patient has signs and sxs of pyelo after a laparoscopic procedure/hysterectomy, what should you be suspicious about?

A

Ureteral obstruction/injury –> do IV Pyelogram or CT abdomen w/contrast

363
Q

Procedure in which placement of a stent into the renal pelvis though the skin under a radiologic guidance to relieve a urinary obstruction

A

Percutaneous Nephrostomy

364
Q

Most common location for ureteral injury?

A

@the Cardinal Ligament (through which uterine arteries traverse…water under the bridge)

365
Q

Cervical motion tenderness suggests:

A

PID

366
Q

causes of Cervicitis (mucopurulent discharge)

A

GC, Chlamydia, OR TRICH (can cause both vaginitis and cervicitis)

367
Q

Most common cause of septic arthritis in females

A

GC

368
Q

T/F: IUD increases risk for PID, OCP decreases risk for PID

A

True

369
Q

Patient has PID and nan adnexal mass. Dx?

A

Tubo-ovarian abscess –>can be medically tx with IV antibiotics (include clinda or metro for anaerobic coverage

370
Q

pelvic pain + tender nodules of the uterosacral ligament or retroverted uterus

A

Endometriosis

371
Q

Woman has a vulvar ulcer, you do PCR for HSV, its negative. You do Darkfield microscopy for syphilis, its negative. What do you assess for next?

A

Candida, HIV, EBV

372
Q

most common sx of fibroids

A

Menorrhagia (excessive bleeding)

373
Q

few things to consider when intermenstrual bleeding

A

endometrial hyperplasia, endometrial polyp, cancer, fibroids

374
Q

what is the leading indication for hysterectomy in the US?

A

Fibroids

375
Q

Irregular, firm, midline nontender mass that moves contiguously with the cervix

A

Fibroid

376
Q

What is the medical tx for fibroids?

A
  • Start with NSAIDS or progestin
  • GnRH agonists lead to decrease in size within 3 months (only used prior to operation)
  • levongesterol IUD (for pts w/o distortion of uterine cavity)
377
Q

Most common cause of spontaneous abortion?

A

chromosomal abnormality of the embryo (karyotypic abnormality)

378
Q

Pregnancy w/vaginal spotting during 1st half of pregnancy; does not delineate viability of preg

A

Threatened abortion

379
Q

A pregnancy <20 weeks w/cramping, bleeding, and cervical dilation; no passage of tissue

A

Inevitable abortion

380
Q

A pregnancy <20 weeks w/cramping, bleeding, and open cervical os + some passage of tissue through vagina/some retained in utero

A

Incomplete abortion

381
Q

What is the state of cervix and uterine ctxs in an incomplete abortion?

A

Cervix remains open due to continued uterine ctxs –>ctxs b/c trying to expel the retained tissue

382
Q

A pregnancy <20 weeks in which all products of conception passed, cervix is closed

A

Completed abortion

383
Q

What is the state of cervix and uterine ctxs in a complete abortion?

A

Cervix closed, ctxs have stopped

384
Q

A pregnancy <20 weeks w/embryonic or fetal demise but no sxs such as bleeding or cramping

A

Missed abortion

385
Q

how is a noviable IUP managed?

A
  1. Expectantly
  2. D and C (surgical)
  3. Misoprostol (medical)
386
Q

T/F: Rh negative women with threatened abortion, spontaneous abortion, or ectopic pregnancy should receive RhoGAM to prevent isoimmunization

A

True

387
Q

Painless cervical dilation in 2nd trimester

A

Insufficient cervix (there will be no ctxs; vs in inevitable abortion, ctxs are what leads to cervical dilation)

388
Q

Vaginal spotting, absence of fetal heart tones, size greater than dates, and markedly elevated hCG levels

A

Molar pregnancy (trophoblastic tissue without a fetus) –>Snowstorm appearance on US –> do suction curettage

389
Q

What are the types of spontaneous abortion?

A

Threatened, Inevitable, Incomplete, Complete, and Missed

390
Q

Which types of abortion present with open cervical Os

A

Inevitable and Incomplete

so os is closed in Threatened, Complete, and Missed

391
Q

Which types of abortion present with passage of tissue

A

Incomplete (some), and Complete

so not seen in Threatened, Inevitable, or Missed

392
Q

Whats the DDx for patient with threatened abortion?

A

Viable IUP, Spontaneous abortion, or Ectopic pregnancy

393
Q

Hx of DVT makes which type of contraception CI?

A

Estrogen-containing (OCP, Patch, or Ring)

394
Q

In a pt with heavy menses and hx of DVT, which contraception would you recommend?

A

Mirena (levonorgesterol IUD), Nexplanon (progestin implant), or Depo (Depot medroxyprogesterone acetate) –> the progestin helps thin the endometrial lining and reduce bleeding; anything w/E2 is CI b/c DVT

395
Q

T/F: IUD protects against STI

A

False

396
Q

How is diaphragm used?

A

Must be fitted by a physician. Placed 1-2 hours before sex, use with spermicide, leave inside for at least 8 hours after

397
Q

How is a cervical cap used?

A

Fitted by a physician. Can be left in place for up to 48 hours and is more comfortable. Only for use in women with normal cervical cytology

398
Q

Most common side effects of OCPs

A

Nausea, breast tenderness, fluid retention

399
Q

main risks of OCPs

A

Venous Thromboembolism, Stroke (in pt w/migraine and aura), MI (women who are smokers)

400
Q

non-contraceptive benefits of OCPs

A
  1. increase risk of ovarian, colon, or endometrial cancer
  2. Shorter duration of periods
  3. Less blood loss during periods
  4. Improving pain from dysmenorrhea/endometriosis
  5. Less AUB
  6. Improves acne
401
Q

CI’s to estrogen

A
  • hx of thromboembolic disease
  • age>35 that smoke
  • women who develop N/V on OCPs
  • women who are lactating
402
Q

T/F: OCPs decrease risk for ovarian and endometrial cancer

A

TRUE

403
Q

T/F: Hysterectomy is the choice procedure for permanent sterilization

A

False…not done for this. Do Essure coils

404
Q

T/F: Obesity and having chronic problems increase risks during general anesthesia and surgery

A

True. Therefore, this patient would benefit more from partner vasectomy than personal tubal ligation

405
Q

Who should not use the patch for contraception?

A

Pts who weigh >200 lbs

406
Q

T/F: In a septic abortion, the cervix is closed

A

FALSE: CERVIX IS DILATED

407
Q

Tx with 17-hydroxyprogesterone (17-OH progesterone) is indicated in a patient with:

A

Prior hx of preterm birth

408
Q

Antiphospholipid antibodies are associated with:

A

recurrent pregnancy loss

409
Q

Hx of dvt or recurrent pregnancy loss, +anti-cardiolipin, prolonged dilute Russel Viper = _______, tx with _____

A

antiphospholipid syndrome; tx with HEPARIN + aspirin (NOT corticosteroids)

410
Q

Medical abortion is ass. with higher _____ than surgical

A

higher blood loss

411
Q

Pt has a missed abortion @ 10 weeks gestation; whats best medical mgmt?

A

Misoprostol (PG) –> will induce uterine cramping with expulsion.
(vs Mifepristone is for termination; Oxytocin is not effective @ this gestational age)

412
Q

CI to IUD placement

A
  1. Current pregnancy
  2. Current STI
  3. PID: Current or w/in 3 months
  4. Unexplained vaginal bleeding
  5. Malignant gest. trophoblastic disease
  6. Untreated Cervical or Endometrial cancer
  7. Fibroids distorting endometrial cavity
  8. Curent breast cancer (no Mirena)
  9. Pelvic TB
413
Q

main side effect of emergency contraception pills:

A

nausea and vomiting (GI)

414
Q

Firm, contender, rubbery breast mass, typically mobile and occurring in young women

A

Fibroadenoma –> confirm dx w/biopsy

415
Q

Best breast imaging for younger patients

A

Ultrasound > mammography due to dense breast tissue

416
Q

Cyclic, painful, engorged breasts, more pronounced just before menstruation, occasionally w/serious or green breast discharge

A

Fibrocystic changes

417
Q

Breast changes described as multiple, regular, with lumpiness of the breast

A

Fibrocystic changes (benign)

418
Q

Tx for fibrocystic breast changes

A

Decrease caffeine ingestion, add SNAID, a tight-fitting bra, OCP, or oral progesterone

419
Q

A mass that feels separate from the remainder of the breast tissue

A

Dominant breast mass

420
Q

BRCA1 is located on chromosome ___, BRCA2 on ___

A

BRCA1 on 17

BRCA2 on 13

421
Q

Most important risk factor for developing breast cancer

A

AGE

422
Q

Clinical breast exam should be preferred every ____ years in women aged _____

A

every 3 years in women 20-39

every year if over 40 + mammogram

423
Q

Mammogram guidelines

A

ACOG says year CBE and mammo after 40; USPSTF says biennial mammo in ages 50-74

424
Q

Pt has dominant breast mass and negative mammogram. Next steps?

A

Can’t fully trust the mammogram (10% FN’s) –> proceed w/histologic diagnosis

425
Q

What’s the recommended imaging for screening women with 20% or higher lifetime breast cancer risk (i.e. BRCA)

A

its actually MRI…

426
Q

Why does hypothyroidism cause galactorrhea?

A

Hypothyroid = elevated TRH –> acts like a prolactin-releasing hormone

427
Q

causes of galactorrhea

A
  1. Pregnancy
  2. Pituitary adenoma
  3. Breast stimulation
  4. hypothyroidism
  5. chest wall trauma
  6. meds (TCA, anti-HTN, OCP, narcotics)
428
Q

physiology of irregular menses due to hypothyroidism

A

Elevated TRH and TSH; hyperprolactinemia (from TRH) = increase dopamine…this produces GnRH = disrupt pulsatile GnRH release = follicle development disrupted = E2 decreases and menstrual cycles become irregular/cease

429
Q

When patient has irregular menses due to hypothyroidism, what will be the response to a progestin challenge?

A

There will be no bleeding in response, since there will be insufficient endometrium

430
Q

What should you keep in mind when measuring Prolactin levels?

A

Prolactin should be measured in the morning (b/c it is @ lowest physiologic level)

431
Q

What’s the risk of a patient with galactorrhea and regular menses for having prolactinemia?

A

relatively low, because hyperprolactinemia = common cause of menstrual disturbances

432
Q

What causes sheehan syndrome?

A

Hypotension in the setting of PPH –> hypertrophy of prolactin-secreting cells –>hemorrhagic necrosis of the AP gland

433
Q

Asherman syndrome (intrauterine adhesions) due to:

A

curettage that damages decidua basalts layer *so endometrium is unresponsive)

434
Q

When a women is hypoestrogenic, what are the 2 main general causes and how can you diff. them?

A 
Hypothalamic/Pituitary diseases
Ovarian failure (Elevated FSH Level)
435
Q

2 most common causes of secondary amenorrhea after PPH: Sheehan syndrome vs Asherman (intrauterine Adhesions: LH surge, cortisol/ prolactin (ability to breastfeed), bleeding when given E2/P

A

Sheehan: No LH surge, low cortisol and prolactin, Yes bleed
Asherman: Normal LH surge, cortisol, and prolactin; no bleed

436
Q

Define delayed puberty

A

Lack of secondary sex characteristics by age 14

437
Q

Most common cause of precocious puberty in women?

A

Idiopathic –> tx w/GnRH agonist

438
Q

What’s the first sign of puberty?

A

Breast budding (thelarche), avg age = 10.8 (next is pubic/axillary hair @ 11).

439
Q

When does growth spurt and menarche occur (relatively)?

A

Growth spurt 1 year after thelarche, around 12 years.

Menarche = 2.3 years post thelarce = 12.9

440
Q

What is hypergonadotropic hypogonadism?

A

High FSH, Low Estrogen –> due to gonadal def. Most common cause of this type of delayed puberty = TURNER’S

441
Q

mgmt goals for patient with delayed puberty

A
  1. Initiate and sustain sexual maturation
  2. Prevent osteoporosis from hypoestrogenemia
  3. Promote full height potential
442
Q

Tx for Hypergonadotropic Hypogonadism (i.e. turners)

A

Since its a High FSH, Low E2 state…give unopposed E2 for 2-3 years before progestin is added –>E2 will promote growth of bones and breasts. Can then give OCP (E protects against osteo; p against endometrial cancer)

443
Q

How is precocious puberty defined clinically

A

breast development before 7 (whites) or 6 (blacks)

444
Q

Dx of precocious puberty (LH and FSH levels)

A

LH and FSH barely detectable: Peripheral cause= Granulosa cell tumor, McCune Albright, Adrenal tumor

LH and FSH in reproductive range: Central cause = brain tumor, meningitis, hydrocephalus, head trauma

445
Q

Height of child with untreated precocious puberty

A

Initial taller than peers, but early long bone epiphyseal closure = eventual height shorter

446
Q

Acceptable initial testing for endometrial cancer

A
  1. Endometrial biopsy

2. Transvaginal ultrasound

447
Q

T/F: A blind sampling of the endometrium, with biopsy device, is not very good for detecting cancer

A

False, it has a 90-95% sensitivity so its a good test. If negative, can do hysteroscopy for direct visualization

448
Q

Most common cause of postmenopausal bleeding

A

Atrophic endometrium –> friable tissue of endometrium/vagina due to low estrogen levels

449
Q

What’s the usefulness of identifying endometrial stripe

A

Tells us thickness on transvag ultrasound.

Thickness >4mm = abnormal in postmenopausal woman

450
Q

Endometrioid, estrogen-dependent cancer in perimenopausal/early menopause pt with classic risk factors of unopposed estrogen. Low grade

A

Type 1 Endometrial Cancer (ESTROGEN DEPENDENT)

451
Q

Aggressive disease w/cell types of papillary serous or clear cell, estrogen independent. Late menopausal women, thin patients, or having regular menses.

A

Type 2 Endometrial Cancer (ER NEGATIVE)

–>more likely to have thin endometrial stripe

452
Q

Endometrial hyperplasia + atypia strongly associated with:

A

Endometrial Cancer

453
Q

Presence of ascites + weight loss

A

ovarian cancer

454
Q

Gyn cancer presentation in order of prevalence:

  1. Postmenopausal vag bleeding
  2. Abnormal vag bleeding/friability/mass
  3. leading cause of gynecologic cancer death
  4. itching/ulcer/mass
A
  1. Endometrial
  2. Cervical
  3. Ovarian
  4. Vulvar
455
Q

benign cystic teratoma containing thyroid tissue = hyperthyroid sxs

A

Struma ovarii

456
Q

Germ cell tumors

A

Ovarian tumors presenting in younger women (20-30s)

  • Dysgerminoma
  • Endodermal sinus tumor
  • Embryonal carcinoma
  • Choriocarcinoma
  • Teratoma (mainly mature/benign cystic teratoma)
  • Polyembryoma
457
Q

Hypo echoic area, or echoic band-like strand in a hypo echoic medium, or appearance of a cystic structure with a fat fluid level

A

Ultrasound appearance of Demoid cysts aka mature benign cystic teratomas

458
Q

MRI of ovary shows complex multilobulated massed with thick septa

A

Struma ovarii (thyroid tissue)

459
Q

secondary amenorrhea, Progestin challenge tests results in bleeding:

A

Probably PCOS

460
Q

Secondary amenorrhea, no bleeding in response to Progestin challenge and no abnormality in prolactin or tsh

A
  1. Outflow tract problem (normal E2)
  2. Premature Ovarian failure (low E2, high FSH/LH)
  3. Hypothalamic/Pituitary prob (Low E2, low FSH/LH)
461
Q

Tx of choice for Asherman (intrauterine adhesions)

A

Operative hysteroscopy –> allows direct transection of adhesions

462
Q

What is the post-op mgmt after operative hysteroscopy for Ashermans?

A

IUD or a pediatric Foley catheter for 7 days to prevent the recently lysed adhesions from reforming
–> also, consider Depo/E+P admin

463
Q

When is 1st trimester screen performed?

A

10-13 weeks

–>PAPP-A and b-hCG or transvag US for nuchal translucency = risk of Downs and Trisomy 18

464
Q

When is trisomy (triple) screen done?

look for Downs, tri 18, or neural tube defects

A

15-21 weeks (second trimester)
–>Maternal AFP, hCG, inhibin-A, and unconjugated E2
(remember, 21 and 18 also looked at during 1st tri screen)

465
Q

Where is AFP made?

A

Alpha-fetoprotein first made by fetal yolk sac, and later by fetal GI tract and Liver
–>Increases if there is a neural tube opening

466
Q

What levels of maternal AFP are suspicious for neural tube defects?

A

> 2.0-2.5 MOM

467
Q

causes of elevated maternal serum AFP?

A
  1. Neural tube defects
  2. underestimation of GA
  3. Oligo
  4. Decreased maternal weight
  5. Multiple Gestations
  6. Cystic hygroma/fetal skin defects
468
Q

causes of decreased maternal serum AFP ?

A
  1. Overestimation of GA
  2. Increased maternal weight
  3. Chromosomal trisomies
  4. Fetal death
  5. Molar pregnancy
469
Q

Levels of AFP, estriol, and and hcg in downs

A

AFP: low
Estriol: low
hcg: high
(in trisomy 18, all markers are low)

470
Q

When are teratogens most dangerous?

A

Day 15-60 (organogenesis)

–>1st 2 weeks = all or none effect…either fetus dies or recovers

471
Q

Drug used to tx endometriosis that inhibit mid-cycle FSH and LH surge

A

Danazol (17 alpha etinyl testosterone deriv)

472
Q

What are some risk factors for molar pregnancy?

A
  • ASIAN RACE
  • Age below 20 or above 35 (though incidence is higher in btwn b/c thats who gets pregnant)
  • low carotene and vitA deficiency
473
Q

T/F: Complete and partial moles are ass. with a hx of infertility and SAB

A

False…PARTIAL moles are ass. with hx of infertility and SAB

474
Q

A hytadiform mole (complete and partial) has replacement of normal placental trophoblastic tissue by:

A

hydropic placental villi

especially found diffusely in complete

475
Q

Which has identifiable fetal or embryonic structures: partial or complete mole?

A

Partial only

476
Q

The karyotype of a complete mole is ____, and partial mole is ____

A

Complete: Diploid (46XX)

Partial: Triploid

477
Q

What kind of mole is more common and also more likely to undergo malignant transformation?

A

Complete>partial

478
Q

How can you recognize molar pregnancy clinically?

A
  • findings consistent w/confirmed pregnancy
  • uterine size>date discrepancy
  • exaggerated subjective sxs of pregnancy
  • painless 2nd trimester bleeding
  • hCG levels excessively elevated
479
Q

What should you suspect in any woman who presents with findings suggestive of severe HTN prior to 20 weeks in pregnancy?

A

MOLAR PREGNANCY

–>the high hCG can cause marked gHTN, proteinuria, hyperthyroidism, tachycardia, SOB, and hyperreflexia

480
Q

How does partial mole typically present?

A

As a missed abortion (vaginal bleeding is less common in partial than in complete)

481
Q

Why are theca lutein cysts ass. with moles?

A

Because they are multi cystic ovaries resulting from follicular stimulation by high hCG…are not malignant…will regress spontaneously within few months of mole evacuation (don’t need surgical removal)

482
Q

Tumor with a red, granular appearance; is intermingled syncytiotrophoblastic and cytotrophoblastic elements w/abnormal cellular forms

A

Choriocarcinoma

483
Q

Rapid myometrial and uterine vessel invasion and systemic metastases from hematogenous embolization to lung, vaagina, CNS, kidney, and liver

A

Choriocarcinoma

484
Q

Choriocarcinoma may occur after:

A
  1. molar pregnancy
  2. normal pregnancy
  3. abortion
  4. ectopic pregnancy
485
Q

Is chemotherapy effect for gestational trophoblastic neoplasia, including malignant forms?

A

Yes, highly; and allows for future reproduction

486
Q

How is nonmetastatic persistent GTN tx?

A

Single-agent chemotherapy: Methotrexate or Actinomycin D

487
Q

Whats the combination tx regimen for high risk metastatic GTN?

A 
Etoposide
Methotrexate
Actinomycin D
Cyclophosphamide
(O)Vincristine

EMACO

488
Q

What two types of epithelium meet at the SCJ junction in cervix?

A

Squamo-Columnar J(X)

  • ->columnar cells
  • ->stratified, nonkeratinizing squamous
489
Q

How do you define the transformation zone in the cervix?

A

Area between the original SCJ (childhood, inside external os) and active SCJ (rolls out to cervical surface)

490
Q

Where are Nabothian cysts (they are non-pathological)?

A

Glands w/in the columnar epithelium on the cervical surface become trapped by squamous epithelium metaplastic activity

491
Q

Why does acetic acid help visualize abnormal cervical cells on colposcopy?

A

Dehydrates cells, causing those with large nuclei to appear white

492
Q

Next steps for pt with ASCUS (on pap)?

A
  1. Reflex HPV DNA testing
    or
  2. Repeat cytology @ 6 and 12 months
493
Q

Next steps for pt with +ASCUS and +HPV DNA?

A

Manage same way as LSIL woman: COLPOSCOPY

494
Q

What is a common outpatient procedure used to tx CIN 1?

A

Cryotherapy

495
Q

T/F: Cold knife cone and LEEP are ass. with increased risk of 2nd tri pregnancy loss secondary to cervical incompetence, PTL, PPROM, and cervical stenosis

A

True

496
Q

How many doses is the HPV vaccine and when do you give them?

A

1st: @ elected date (9-26 recommended time)
2nd: 1 month later
3rd: 6 months later
Safe when breastfeeding, not given during pregnancy

497
Q

most common indication for hysterectomy

A

Fibroids

498
Q

What is tranexamic acid?

A

An Anti-fibrinolytic agent used to tx menorrhagia

499
Q

What are the common sxs of a corpus luteum cysts (corpus luteum thats greater than 3cm)?

A
  1. Pain: dull, ipsilateral, lower quadrant

2. Missed periods

500
Q

Why do patients with corpus luteum cysts miss periods

A

Produces progesterone for longer than usual 14 days; menstruation typically delayed a few days to several weeks, usually occurs w/in few weeks

501
Q

Patient not using OCPS, has regular periods, presents with acute pain late in the luteal phase

A

Hemorrhagic/ruptured luteal phase cyst

–>if no hemoperitoneum or hypoveolemia (surgical intervention), can give analgesics and reassure

502
Q

What is “quickening” and when is it reported?

A

Patients initial perception of fetal movement

–>16-20 weeks

503
Q

When should urine pregnancy tests be performed (in the day)?

A

Early-morning, because highest concentration of hCG

504
Q

Are urine or serum pregnancy tests more specific and sensitive?

A

Serum –> test for the unique beta subunit of hCG, can even detect before the patient has missed a period (versus urine typically 4 weeks after LMP)

505
Q

Gestational age = number of weeks that have elapsed between:

A

First day of LMP (not the presumed time of conception)….and date of delivery

506
Q

Fetal Bradycardia vs prolonged decel

A

Prolonged decel: under 100-110bpm for >2min

Brady: ““>10 min

507
Q

Fetal bradycardia etiology: +maternal respiratory compromise/mental status change

A
  1. Seizures
  2. PE
  3. Amniotic Fluid Embolism
508
Q

Fetal bradycardia etiology: +hypotension

A

Commonly after Epidural placement

509
Q

Fetal bradycardia etiology: +increased vaginal bleding

A
  1. Uterine rupture (fetal station will be higher than expected)
  2. Placental Abruption
510
Q

Fetal bradycardia etiology: manual vaginal inspection

A

Check for cervical dilation, fetal station, prolapsed umbilical cord, uterine hyperstimulation, fetal parts outside the uterus. If station very low, decels could be from rapid descent (vagal response)

511
Q

Tx of Fetal bradycarida: initial mgmt

A
  1. Patient moved to left/right lateral decubitus position(resolve IVC compression, decreased preload, or uncompress umbilical cord by fetus)
  2. Oxygen - face mask
512
Q

post mortem finding of fetal cells in the maternal pulmonary vasculature

A

Amniotic Fluid Embolism

Ob-gyn case files (1 decks)

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