Conditions Flashcards
Endometriosis: definition
Endometrial cells grow outside uterus
Hypospadias: definition
Urethral opening not located at tip of penis
Secondary amenorrhea: definition
Absence of periods for 3+ months in women who previously menstruated
Infertility: definition
Inability to conceive in 12 months for women <35
Begin evaluation at 6 mo for women >35
5-alpha reductase deficiency: presentation
Male internal genitalia, female external genitalia at birth Male external genitalia develop at puberty
Factor V Leiden: pathophysiology
Factor V Leiden is a mutant form of Factor V that Protein C (anticoagulatory factor) cannot bind to
Threatened spontaneous abortion
Cervical os closed, viable intrauterine pregnancy visible on ultrasound
Inevitable spontaneous abortion
Cervical os open, products of conception about to pass through
Incomplete spontaneous abortion
Cervical os open, products of conception partially passed through
Complete spontaneous abortion
Cervical os closed, products of conception fully expelled
Missed spontaneous abortion
Cervical os closed, nonviable intrauterine pregnancy visible on ultrasound
Ectopic pregnancy: risk factors
Prior ectopic pregnancy Hx of STI's Pelvic inflammatory disease Smoking Young age <18 IUD
Superficial thrombophlebitis: presentation? concerning?
Presentation: redness, tenderness, palpable veins
Usually does NOT lead to embolization but most common thrombotic disorder in pregnancy
Pulmonary embolism: presentation
Acute onset dyspnea
Tachypnea
Tachycardia
Pleuritic chest pain
Pulmonary embolism in pregnancy: diagnosis
Spiral CT is safe in pregnancy
Compression ultrasound: assess for DVT with PE
Diabetes: complications during pregnancy
Macrosomia
+Shoulder dystocia
+Brachial plexus palsy
Increased risk of spontaneous abortion
Infection
Pregestational diabetes: complications
Congenital cardiac anomalies
Sacral agenesis
Gestational diabetes: risk factors
Obesity
Maternal age
Gestational weight gain
Family history
Chronic hypertension in pregnancy: complications
Increased risk of preeclampsia (superimposed), placental abruption
Preeclampsia: risk factors
Things that lead to more placental mass:
- multiple gestation
Things that lead to abnormal vasculature:
- chronic HTN, diabetes, obesity
Extremes of age
Nulliparity
Preeclampsia: presentation
Neuro: severe headache, scotomata
Renal: oliguria
Pulm: pulmonary edema
GI: epigastric pain secondary to hepatic edema
HELLP: stands for?
Hemolytic anemia
Elevated Liver enzymes
Low Platelets
Eclampsia: presentation, PE warning signs
Seizures + preeclampsia, mostly occurring postpartum
Hyperreflexia, clonus = warning signs that seizures may be imminent
Caesarean section: indications
Malpresentation (breech)
Maternal HIV, HSV (if active lesions) infection
First or second stage arrest
Caesarean section: complications
Hemorrhage, infection
Neonatal microbome alteration (babies get gut flora from passing through birth canal)
Transient tachypnea of newborn (maternal hormones support fetal lung reabsorption; babies with C-section have extra fluid in lungs)
Maternal intra-abdominal adhesions
Neonatal resuscitation: indications
No crying, breathing
Poor tone
Neonatal resuscitation: steps
Position and clear airway
Warm, dry, stimulate for 30s
If HR<100, start positive pressure ventilation for 30s
If HR<100 continue PPV
If HR<60, begin chest compressions
Preeclampsia: pathophysiology
Not well understood
Vasospasm –> ischemia
Pyelonephritis in pregnancy: most common bugs
E. coli (75%)
Klebsiella, Enterobacter, Proteus
Meconium Aspiration Syndrome: pathophysiology
Meconium (fetal intestinal debris) can obstruct airways, cause pneumonitis, inactivate surfactant
In utero:
Fetal distress –> decreased anal sphincter tone –> meconium released into amniotic fluid and inhaled by fetus
After delivery:
Poor oxygenation –> pulmonary vasoconstriction –> pulmonary respiratory distress, possibly persistent pulmonary hypertension
Meconium Aspiration Syndrome: presentation
Meconium-stained fingernails and skin
Respiratory distress: tachypnea, use of accessory muscles, decreased O2 sat
Meconium Aspiration Syndrome: imaging
Hyperinflated lungs
Breast milk jaundice vs breastfeeding jaundice
Breast milk jaundice:
- BM itself may have beta-glucuronidase or . UDPGT inhibitors (unknown)
Breastfeeding jaundice:
- baby not feeding well, can’t produce enough output to excrete adequate bilirubin
Conjugated hyperbilirubinemia in neonates: definition?
> 10% direct (conjugated)
Prematurity: complications
PULM
Neonatal Respiratory Distress Syndrome
CARDIO
Patent ductus arteriosus, heart failure
GI
Necrotizing enterocolitis
HEENT
Retinopathy of prematurity
HEME
Anemia
ENDOCRINE
Hypoglycemia
NEURO/PSYCH
Developmental delays
Intraventricular bleeding
Neonatal respiratory distress syndrome: prevention
Give betamethasone 48hrs (and up to 7 days) prior to delivery
Neonatal respiratory distress syndrome: pathophysiology
Absence/lack of surfactant keeps pulmonary vasculature resistance high - cannot get oxygenated blood
Neonatal respiratory distress syndrome: imaging
Ground glass appearance due to microatelectasis (alveolar collapse)
Air bronchograms due to air unable to enter alveoli
Hypoinflation
Necrotizing enterocolitis: pathophysiology
Neonates don’t have normal gut flora + have weaker intestinal walls - certain bacteria can overgrow, increases risk of infection
Hypoglycemia in premature babies: pathophysiology
Decreased fat = fewer glucose stores; liver hasn’t yet started gluconeogenesis
Retinopathy of prematurity: pathophysiology
Newly developed blood vessels grow out and then regress -
in premature babies, vessels haven’t regressed and are still friable –> risk of rupture
Interventricular hemorrhage in prematurity: pathophysiology
Friable vessels can rupture
Small for gestational age (SGA): definition
<10th percentile for birth weight
Small for gestational age: pathophysiology
Either IUGR or constitutionally small
Small for gestational age: complications
Increased risk of hypoglycemia, hypothermia (decreased glycogen stores, impaired gluconeogenesis)
Large for gestational age: definition
> 90th percentile for birth weight
Short stature: definition
> = 2 SD’s below mean, or <3rd percentile for height
OR growth line crosses 2+ major percentile lines
Failure to thrive: definition
> = 2 SD’s below mean, or 3rd percentile for weight
OR growth line crosses 2+ major percentile lines
GH deficiency: presentation
Initially presents as failure to thrive, then decreased height velocity
Developmental delay: patterns of onset
Inborn errors of metabolism: good health followed by decline in developmental milestones (metabolites take time to build up, or child recently added new foods into diet)
Prenatal/perinatal causes: present early in life
Delayed puberty: definition
No breast development by 13
No testicular development by 14
Kallman Syndrome: pathophysiology
Defective migration of GnRH-releasing neurons from olfactory placode to hypothalamus
Kallman Syndrome: presentation
Hyposmia/anomsia (reduced or lack of smell)
McCune-Albright Syndrome: pathophysiology
Increased hormone levels (estrogen, GH, thyroid, etc)
McCune-Albright Syndrome: presentation
Cafe-au-lait macules
Polyostotic fibrous dysplasia (affecting more than one bone)
Primary ovarian insufficiency: definition
Cessation of ovarian function before age 40
Asherman Syndrome: definition
Endometrial scarring due to surgery (e.g. curettage) or infection
Benign prostatic hyperplasia: presentation
Increased urinary frequency, nocturia
Difficulty initiating stream, fully emptying bladder
Fibroadenoma: presentation
Palpable, smooth, mobile mass, often in a young and otherwise healthy woman
Ductal carcinoma in situ: presentation
Most women with mammography findings were asymptomatic (no palpable masses)
Adenomyosis: presentation
Enlarged, rounded uterus OR asymptomatic
Acute endometritis: presentation
Soft uterus
Uterine tenderness
+systemic signs of infection
Fibroids/leiomyomas: presentation by type
Submucosa: heavy bleeding, can be intermenstrual bleeding if endometrial lining is unstable
Intramural: heavy bleeding
Subserosal: NO bleeding! Bulk symptoms
+dyspareunia (pain during intercourse)
Leiomyosarcoma: gross presentation
Single lesion with areas of necrosis and hemorrhage
Does NOT arise from leiomyoma
Endometrial cancer: presentation
Post-menopausal bleeding
Ovarian cancers: presentation
Super non-specific, vague symptoms: abdominal distension/bloating, abd pain, urinary frequency, constipation, nausea
Presents late clinically b/c masses have so much space to grow within peritoneal cavity
Types of ovarian cancers
Serous (most common), mucinous, endometroid, Brenner (bladder-like epithelium)
Stages of ovarian cancers
Benign, BORDERLINE, malignant
Difference between Type I and Type II ovarian cancers
Type I:
- low grade, likely progressed from benign cystadenoma –> borderline serous carcinoma –> low grade serous carcinoma
- associated with KRAS and BRAF mutations
Type II:
- higher grade, NOT derived from low grade tumors
- likely of fallopian tube origin (serous tubal intraepithelial carcinoma)
- associated with p53 mutations and BRCA1 carriers
Endometriosis: presentation
Usually asymptomatic but 3 D’s:
- Dysmenorrhea: cyclic pelvic pain around time of period
- Dyschemiza: pain w/ bowel movements - endometrial implants near bowel
- Dyspareunia: pain w/ intercourse - implants near uterosacral ligaments or vagina
Urge urinary incontinence: presentation
Involuntary leakage accompanied by or preceded by urgency, due to overactive bladder
Stress incontinence: presentation
Involuntary leakage on effort or exertion, or on sneezing or coughing, due to underactive outlet
PCOS: diagnostic criteria
Rotterdam Criteria (2 out of 3):
- Clinical or biochemical hyperandrogenism
- Oligoamenorrhea (<8 menses/year)
- Polycystic-appearing ovaries on ultrasound
Need to exclude:
- Cushing’s (24 hr urine cortisol)
- Testosterone producing tumor (testosterone, DHEA)
- Nonclassical (late-onset) adrenal hyperplasia (21-hydroxylase deficiency)
Virchow’s Triad
Prothrombic states:
- Hypercoagulability
- Venous stasis
- Endothelial damage
Preeclampsia: diagnosis
BP: 2 measurements of >140/90 four hours apart AND one of the following:
- proteinuria (24 hr urine >300mg or spot protein/creatinine ratio >0.3)
- thrombocytopenia <100K
- impaired liver function: LFT’s 2x normal
- renal insufficiency (creatinine >= 1.1)
- pulmonary edema
- cerebral disturbances (severe headache)
- visual impairment (blurry vision)
Delirium: diagnosis
Acute onset
AND inattention that fluctuates
AND EITHER:
Disorganized thinking OR altered level of consciousness (reduced awareness of environment)
Conductive hearing loss: definition
Hearing loss due to conducting sound waves anywhere along the route through the outer ear, tympanic membrane (eardrum), or middle ear (ossicles)
Sensorineural hearing loss (SNHL): definition
Hearing loss due to issues with
- inner ear or sensory organ (cochlea and associated structures) OR
- vestibulocochlear nerve (cranial nerve VIII)
[90% of hearing loss reported]
