Clinical Flashcards
How do you prevent or treat osetoporosis in a menopausal woman?
- Vitamin D and Calcium supplement
- Exercice
- Diet, alcohol, smoking…
- Selective estrogen-receptor modulators
What are the risk factors of Gestational Diabetes?
- Maternal obesity
- Ethnicity
- Previous gestational diabetes
- Family history of diabetes
- Excessive weight gain
- PCOS
What are the main causes of female infertility?
- 80-90% have polycystic ovary syndrome (PCOS)
- 5% ovarian failure
- 10% hypothalamic/pituitary disorders
- UNEXPLAINED
What are the indications for In vitro fertilization (IVF) ?
- Tubal disease
- Male factor infertility (ICSI)
- Endometriosis
- Unexplained infertility
- Anovulatory infertility (non-responsive)
- Congenital disease (PGD)
What are the non-hormonal contraceptive options?
- Sterilization
- Spermicides
- Withdrawal
- Vaginal sponge
- Diaphragm with spermicides
- Cervical cap
- Condom (male)
- Condom (female)
- Calendar
Is apnea of prematurity normal?
NOT ALWAYS –> NEED TO INVESTIGATE
You have a patient with Atypical Squamous Cells (ASC-H) pap test, what do you do?
A colposcopy
When do you recommend Rhogam (Anti-Rh D Antibodies) if Rh Neg for a pregnant woman?
28 weeks
What is the management of Post partum Hemorrhage (PPH)?
- Use of uterotonics:
Oxytocin 5 IU IV or 10 IU IM after delivery of anterior shoulder
Carbetocin 100 mcg IV after cord clamping at C/S
- Clamping of the umbilical cord
- Controlled traction of the cord
- Uterine compression (bimanual)
- Repair tears
What is the most common affective or behavioral symptom of PMS?
Mood swings
How do we manage preterm labor?
- Corticosteroids for lung maturation
- Antibiotics for GBS prophylaxis
- Tocolysis
- Calcium channel blocker
- MgSO4 for neuroprotection if <32 weeks
What is the BASIC investigation for infertility?
- Seminal analysis
- D21 (mid-luteal) serum progesterone
- Pelvic ultrasound
- Hysterosalpingogram
You have a patient with Atypical Squamous Cells of Unknown Significance (ASCUS) pap test, what do you do?
- < 30 yo: repeat pap at 6 and 12 months, refer if persists (have ASCUS repeatedly during that interval)
- > 30 yo: Do HPV, if + = colposcopy; if – = repeat pap test in 1 year
What can cause Primary Ovarian Failure (POF)?
- Fragile X syndrome
- Turner syndrome
- Mullerian Agenesis
What are the causes of Post partum Hemorrhage (PPH)?
- Tone: uterine atony, distended bladder
- Tissue: retained placenta and clots
- Trauma: vaginal, cervical, or uterine injury
- Thrombin: coagulopathy (pre-existing or acquired)
When do we investigate Amenorrhea or Oligomenorrhea?
- No onset of menses at age 13 and no other signs of pubertal development
- No onset of menses at age 15 with normal pubertal development
- No onset of menses within 3 years of completion of telarche (breast)
- Absence of menses for 3 months
- Less than 9 menstrual cycles per year
What is the treatment of Umbilical Cord Prolapse?
C-Section
What is the treatment of most placental abnormalities?
C-section
How do you treat PCOS?
IT DEPENDS IF WANNA GET PREGGY:
- Ovulation medication
- Anovulation medication
+ Weight loss and all that jazz
Production of surfactant in premature newborn lungs increases with which conditions?
Corticosteroid production (ex. labor)
What are the WHO 2010 criteria for seminal analysis?
- 15 x 106/ml
- 39 x 106 total per ejaculate
- 40% total motile (progessive 32%)
- 4% normal morphology (Kruger)
- Volume
- Leucocytospermia
- Antibodies
What is the treatment of Labor dystocia?
- Oxytocin
- Rupture the membrane artificially
- Instrumental delivery
What are the causes of postmenopausal bleeding?
- Vaginal atrophy >50%
- Polyps 20-30%
- Hormone replacement therapy
- Endometrial Hyperplasia 5-10%
- Endometrial Cancer 5-10%
- Other
You have a patient with Atypical glandular cells, not otherwise specified (AGC-NOS) or Atypical glandular cells, favour neoplasia (AGC-N), what do you do?
A colposcopy
What are the indications for Intra-Uterine Insemination (IUI)?
- Unexplained infertility
- Coital dysfunction
- Mild male factor infertility (over 5 million/ml)
- Donor sperm
What is the classic diagnosis triad of Amniotic Fluid Embolism?
- Abrupt hemodynamic compromise
- Abrupt respiratory compromise
- DIC
What is Metrorrhagia?
Irregular cycles or bleeding between periods
What are the structural causes of abdormal uterine bleeding?
- Polyp (AUB-P)
- Adenomyosis (AUB-A)
- Leiomyoma (AUB-L)
- Submucous myoma (AUB-LSM)
- Other myoma (AUB-LO)
- Malignancy and hyperplasia (AUB-M)
How do you diagnose ectopic pregnancy?
- Rule-out other causes of abdominal pain
- Serial bhgc: plateau or abnormal rise
- Transvaginal ultrasound
How is the diagnosis of adenomyosis made?
Usually pelvic MRI but definitivediagnosis is made by histologic findings in surgical specimens
What are the signs of respiratory distress in a newborn?
- Tachypnea
- Intercostal or subcostal retractions
- Nasal flaring
- Tracheal tugging
- Grunting
What is placenta abruptio?
Partial or complete separation of placenta from the inner wall of the uterus before delivery
What is the most common physical manifestations of PMS
Abdominal bloating and an extreme sense of fatigue
You have a patient with Adenocarcinoma in situ (AIS), what do you do?
A colposcopy
Other than cytologic abnormalities, what are the indications for colposcopy?
- Gross or palpable cervical ulcer, mass, or growth
- Concern for cancer on visual examination
- Unexplained lower genital tract bleeding
- History of in utero DES exposure
- Post-surgical follow-up examination
- Vulvar or vaginal HPV-associated lesion
What are the indications for Operative vaginal delivery?
- Fetal atypical/abnormal heart rate tracing
- Aftercoming head in breech delivery
- Maternal exhaustion
- Prolonged second stage
If a women going through menopause has no uterus, can you give hormonal therapy?
yes but ONLY ESTROGEN
How do you diagnose PCOS?
- WITH US:
- ≥12 follicles on one ovary (≥20)
- Ovarian volume >10 cc
- “pearl of strings” appearance
- Amenorrhea or Oligomenorrhea
- Hyperandrogenism
When do you recommend Group B strep screening for a pregnant woman?
36 weeks
What are the long term complications of amenorrhea?
- Endometrial hyperplasia/cancer (PCOS)
- Bone loss and cardiovascular disease (POF)
How do you treat Hyperprolactinoma?
- Dopamine agonists
- Transsphenoidal hypophysectomy/pituitary radiotherapy
What is Oligomenorrhea?
Infrequent cycles (<8 per year)
What is Placenta previa?
Placenta covers the cervical os + bleeding
What are the causes of poor response to resuscitation in a newborn?
- Hypovolemia
- Airway malformation
- Pneumothorax
- Congenital Diaphragmatic Hernia
- Congenital Heart Diseases
What is the single most important thing to assess in a patient with erectile dysfunction?
CVD risk
What are the risk factors of osteoporosis?
• Low calcium diet
- Lack of exercise
- Very high-protein diet
- High alcohol use
- Smoking
- Lack of vitamin D from sun, diet, or pills • High salt diet; High caffeine use
What is the single most important vital sign in infant resuscitation?
Heart Rate
What is Hypermenorrhea?
Regular cycles, normal duration, excessive flow
What are the pathologies associated with the postpartum period?
- Puerperal infection
- Breast infection
- Obstetrical Neuropathies
- Post partum Depression
- Post partum Psychosis
What is the most common defect of the male genital tract?
Cryptorchidism: failure of normal descent of the testis
What are the contra-indications for Vaginal birth after caesarean section (VBAC)?
- Previous classical uterine incision
- Previous uterine rupture
- Contraindications to vaginal delivery
- Interdelivery interval <18 months
- Maternal refusal
What is the most important risk factor for urinary incontinence?
Childbirth
What are the PreMenstrual Dysphoric Disorder (PMDD) DSM-V criteria?
- Prospective documentation of physical and behavioral symptoms (using diaries) being present for most of the preceding year
- Five or more symptoms must have been present during the week prior to menses, resolving within a few days after menses starts.
- These criteria also specify that PMDD may be superimposed on other psychiatric disorders, provided it is not merely an exacerbation of those disorders.
- Symptoms must be associated with significant distress or interference with usual activities (eg, work, school, social life)
Can you give testosterone to people who have fertility issues and erectile dysfunction?
NONNNNN exogenous testosterone decreases spermatogenesis
What are the reasons for ineffective ventilation in newborn resuscitation?
- Inadequate mask seal
- Airway blocked (secretions)
- Not enough pressure
–> MRSOPA
What are the main causes of male infertility?
- 80-90% have oligo- astheno- teratozo- spermia
- 5-10% coital or ejaculatory failure
- 5% azoospermia
- UNEXPLAINED
What is the most common STI?
HPV
When is an endometrial biopsy required if there is a postmenopausal bleeding?
- Endometrial lining > 4 mm
- Endometrium shows diffuse of focal increased echogenicity (heterogeneity)
- Endometrium is not adequately visualized
- Patient has persistent bleeding
You have a patient with low-grade squamous intraepithelial lesion (LSIL) pap test, what do you do?
A colposcopy
What are the risk factors for cervical cancer?
- age
- low SES
- living in specific geographical regions (sub-Saharan Africa)
- lack of cytological screening
- multiple sexual partners
- history of STI
- oral contraceptives
- cigarette
- nutrition
- genetic
When do you recommend influenza immunization for a pregnant woman?
2-3rd trimester
What is the treatment of misscarriage?
- Expectant management
- Cytotec (misoprostol): Prostaglandin E1 analogue
- Suction curettage (Risks of infection and uterine damage)
What are the diagnosis criteria for PMS?
- >1 somatic and affective symptom 5 days prior to menses x 3 cycles
- Resolve within 4 days onset of menses and symptom free until day 12 of cycle
- Not due to medications, drugs or ETOH use
What is Vasa previa?
Cord implants in the membrane of placenta
- Amenorrhea
- Ipsilateral abdominal pain
- Vaginal bleeding
What is your diagnosis?
Ectopic pregnancy
- Obesity
- Insulin resistance/Diabetes
- Acanthosis nigricans
- Hirsuitism
- Acne
- Oligo/amenorrhea
What’s your dx?
PCOS
Which type of abortion has more risk of bleeding?
Medical
What is Sheehan’s Syndrome?
Pituitary apoplexy secondary to hypovolemic shock due to postpartum hemorrhage –> IS AN HYPOTHALAMIC CAUSE OF AMENORRHEA
Production of surfactant in premature newborn lungs decreases with which conditions?
Insulin (diabetes of mother)
Spalding sign and Robert’s sign on XRAY and signs of what?
Stillbirth
What are the causes of misscarriage?
- Chromosomal abnormalities (50%)
- Trisomies
- Monosomy X
- Polyploidy
- Foetal malformations
- Placental abnormalities
- Infection
- TORCH
- Listeria
- Syphilis
- Malaria
- HIV
- B19 parvo
- Maternal health/disease
- Alcohol and drugs
- Radio/Chemo
- Any health problem
- Intra-uterine abnormalities
What is Menometrorrhagia?
Frequent menstrual bleeding that is excessive and irregular in amount and duration
What are the 3 first important question in infant resuscitation?
- Term gestation?
- Breathing or crying?
- Good tone?
When is it appropriate to give estrogen + progesterone therapy to a women going through menopause?
- < 60 y/o
- < 10 years of menopause onset
- Intact uterus
- No contraindication
What is the work-up for someone with reproduction problems with an endocrine suspected cause?
- Androgen (testosterone, DHEA)
- Estrogen
- LH, FSH and Prolactin
- Fasting insulin
- Scan pituitary if suspected lesion
What is the treatment of respiratory distress syndrome?
Supportive:
- IV fluids
- Oxygen
- CPAP (Continuous positive airway pressure)
Definitive
- Mechanical ventilation
- Exogenous surfactant administration
You have a patient with high-grade squamous intraepithelial lesion (HSIL) pap test, what do you do?
A colposcopy
Is abortion risky?
No, complications are RARE
What are the causes of secondary Amenorrhea?
- PCOS
- POF
- Hyperprolactinaemia
- Weight-related
- Hypo-hypogonadism
- Exercise-induced
What are the non-structural causes of abdormal uterine bleeding?
- Coagulopathy (AUB-C)
- Ovulatory Dysfunction (AUB-O)
- Endometrial (AUB-E)
- Iatrogenic (AUB-I)
- Not yet classified (AUB-N)
What advices do you give to a mother asking you about prevention of SIDS?
- PRONE SLEEPING POSITION (also sleeping on the side)
- CO-SLEEPING WITH PARENTS BEFORE 3 MONTHS
- SLEEPING ON A SOFT SURFACE
- HYPERTHERMIA-OVERNIGHT HEATING
- POSTNATAL PASSIVE SMOKING
What is the management of shoulder dystocia?
- Manual maneuvers
- Fracture of the clavicula (upward direction)
- Symphysiotomy
- Zavanelli Maneuver: put the fetal head into the vagina and cesarean section
When do we screen women for HPV?
We screen SEXUALY ACTIVE women every 2-3 years from 21 (or 3 years after onset of sexual activity) until 65 AND after 2 negative pap test in last 10 years
What are the causes of stillbirth?
- Foetal: abnormalities
- Placental: abruption, cord accidents
- Maternal: antiphospholipid antibody, DM, hypertension/pre-eclampsia, trauma
- Unexplained (25-30%)
Which type of abortion only needs 1 visit?
Surgical
When do you recommend gestational diabetes screening for a pregnant woman?
24-26 weeks
When do you recommend pertussis (dTAP) vaccination for a pregnant woman?
26-32 weeks
What are the causes of primary Amenorrhea?
- Primary Ovarian Failure (POF)
- Hypo-hypogonadism
- PCOS
- Hyperprolactinaemia
- Weight-related
What are the risk factors for pre eclampsia?
- SLE
- Nulliparity
- > 35 y/o
- Prior stillbirth
- CKD
- ART
- BMI > 30
- Multiferal
- Prior abruption
- Diabetes
- CHTH
- APA
What is the most common defect of the penis?
Hypospadias: abnormal ventral openings of the urethra along the ventral surface of the penis
IT IS A RESULT OF INCOMPLETE URETHRAL FOLDS
What are some normal post-partum changes?
- Afterpains
- Lochia: vaginal discharge containing sloughing of decidual
- Abdominal wall: soft and flaccid
- Glomerular hyperfiltration
- Bladder trauma
- Hypervolemina
- Diuresis
- Weight loss
What is Menorrhagia?
Regular cycles, prolonged duration and excessive flow
(> 7 days, ≥ 80 mL of blood)
- Vaginal bleeding
- Uterine cramps or back pain
What is your diagnosis?
Misscarriage
You have a patient with a negative for intraepithelial lesion (normal) pap test, what do you do?
You repeat pap test in 2-3 years
What is Polymenorrhea?
Frequent menstrual bleeding (≤ 21 days)
