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USMLE Step 2 > Created 5/26/19 (red) > Flashcards

Created 5/26/19 (red) Flashcards

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USMLE® Step 1 flashcards
1
Q

Causes of hyperprolactinemia

A 
Pregnancy
Pituitary lesions
Hypothyroidism
Renal failure
Cirrhosis
Side effect of medications
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2
Q

Hematuria Differential

A

HITTERS (Hematologic or Coagulation DO, Infection, Trauma, Tumor, Exercise, Renal Disorders, Stones)

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3
Q

Renal Cell Carcinoma Symptom Triad

A

flank pain, hematuria, palpable mass

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4
Q

Dyspareunia (pain with intercourse)

A 
Pelvic Inflammatory Dz
Vestibulodynia
(Pain localized to vulvular vestibule)
Pelvic Tumor
Vaginismus
(Leading cause in premenopausal women
involuntary, painful reflex spasm of the paravaginal thigh adductor muscles
results from anxiety about sex or pelvic exam)
Domestic Violence
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5
Q

Premature ovarian failure

A

What? Primary hypogonadism before age 40

Path:
Autoimmunity against the ovary
Pelvic radiation therapy
Chemotherapy
Surgical bilateral oophrectomy
Familial factors
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6
Q

PCOS

A

What? Increased LH causing amenorrhea, hirsutism, and obesity

Why? Inc LH = Inc ovary and androgen stimulation = Inc estrogen and inc testosterone
Inc estrogen = insulin resistance (causing obesity) and FSH inhibition (amenorrhea)
Inc testosterone = hirsutism
Tests: LH, Testosterone
Comp: Inc risk for endometrial cancer 2/2 inc estrogen chronically

Tx:
OCPs - to suppress LH
If no OCPS => give progestin 7 days per month to induce bleeding and prevent endometrial hyperplasia
For hirsutism = spironolactone (antiandrogen effect)
For ovulation induction (If patient wants to get pregnant) = clomiphene citrate (antiestrogen- blocks est receptor at hypothalamus, causing follicle stimulation and maturation for pregnancy)

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7
Q

Theca Lutein Cysts

A

What? Multilocular, bilateral cysts on the ovaries. Causes ovaries to be enlarged.
Path: Ovarian Hyperstimulation 2/2…
Gestational trophoblastic disease (molar pregnancy)
Multifetal gestation OR
Infertility Treatment

Treatment: Tx the cause of the ovary hyperstimulation

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8
Q

Simple Cyst

A

Path: When follicle doesn’t rupture during ovulation

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9
Q

Placenta Accreta

A

What? When uterine willi attach to the myometrium (not the endometrium)

Who is at increased risk?
Prior C-section
History of D and C
Maternal age > 35

How to diagnose?
IF BEFORE BIRTH - antenatal ultrasound findings find irregularity of placental-myometrium interface
Tx: with C-section
IF AFTER BIRTH - difficulty with delivery of placenta, requiring manual extraction and can result in severe hemorrhage

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10
Q

Placenta Abruption

A

What? Premature detachment of placenta from the uterus

Clinical Features? Vaginal bleeding, abdominal pain, tense/distended uterus, fetal heart rate abnormalities

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11
Q

Placenta Previa

A

What? Placenta implants over the internal cervical os

Clinical Features? Hemorrhage with contractions

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12
Q

Ectopic Pregnancy

A

What? Pregnancy that implants outside the uterus

Clinical Features? Unilateral adnexal mass

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13
Q

Erythroblastosis Fetalis

A

When does it happen? RH- mom RH+ dad RH+ fetus
Path: fetal RBC which are RH+ spill into moms blood via placenta. Mom makes antibodies towards RH+ blood. During second pregnancy, if RH+ mom’s immune cells cross placenta and cause anemia and possible fetal death
Prevention? Rhogam given during 28 weeks of pregnancy and 72 hours after fetal expulsion (eiter via delivery or termination)

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14
Q

Vasa Previa

A

What? Fetal vessels cross over internal cervical os

Clinical Features? Abnormal fetal heart rate after rupture of membrane, painless antepartum bleed

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15
Q

Hydatidiform Mole

A

What? Neoplasm of the cells that make the placenta (trophoblastic cells)

Who is at risk? Infertility and extremes of maternal age (younger than 15, older than 35)
History: LARGE FUNDAL HEIGHT FOR GEST AGE. B-HCG LARGE FOR GEST AGE. grape like vesicles being expelled from the vagina.
CF: abnormal vaginal bleeding, hyperemesis gravidarum, preeclampsia int he first half oc pregnancy, theca l
Dx: US = “snowstorm pattern” or heterogenous mass composed of cystic structures within the uterus
Tx: D&C + follow-up B-HcGs
Comp: (1) If the neoplasm becomes malignacny or (2) choriocarcinoma or (3) theca lutein cysts 2/2 overtimualtion of the ovary by beta hcg
Types:
Complete = empty ovum + 2 sperm
Incomplete = 1 ovum + 2 sperm
Who is at risk? Infertility and extremes of maternal age (younger than 15, older than 35)
History: LARGE FUNDAL HEIGHT FOR GEST AGE. B-HCG LARGE FOR GEST AGE. grape like vesicles being expelled from the vagina.
CF: abnormal vaginal bleeding, hyperemesis gravidarum, preeclampsia int he first half oc pregnancy, theca l
Dx: US = “snowstorm pattern” or heterogenous mass composed of cystic structures within the uterus
Tx: D&C + follow-up B-HcGs
Comp: (1) If the neoplasm becomes malignacny or (2) choriocarcinoma or (3) theca lutein cysts 2/2 overtimualtion of the ovary by beta hcg
Types:
Complete = empty ovum + 2 sperm
Incomplete = 1 ovum + 2 sperm

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16
Q

Uterine Atony

A

What? Uterus fails to contract after placental delivery

17
Q

Uterine Inversion

A

What? Prolapse of the uterine fundus
Path? Forceful traction on the umbilical cord and abnormally adherent placenta
Symptoms? Abdominal pain, hemorrhage, and mass protruding from the vagina

18
Q

Operative Vaginal Delivery (eg. delivery requiring vacuum or forceps)

A

When is it needed?
Protracted second stage of labor
Fetal heart rate problems
Maternal contraindications to pushing
Problems with valsalva (cerebrovascular disease, cardiovascular disease)
Ineffective pushing (neuromuscular disease)

What are the complications to baby?
Lacerations
Cephalohematoma
Facial nerve palsy
Intracranial hemorrhage
Shoulder dystocia

What are the complications to mom?
Genitourinary tract injury
Urinary retention
hemorrhage

19
Q

Postpartum Hemorrhage

A 
Why? The 4 T’s
Tone (uterine atony)
Trauma (pelvic/cervical laceration, uterine inversion)
Tissue (Retained placental tissue)
Thrombin (Bleeding disorder)
20
Q

Breast Cancer

A

Risk Factors? Modifiable vs non-modifiable

Modifiable? 
Hormone replacement therapy
Nulliparity
Increased age at first live birth
Alcohol consumption - even if low intake, will have inc risk of cancer

Non-modifiable?
Genetic mutations
Increased age
Early menarche

21
Q

Human Papilloma virus

A

Why? Persistent infection with HPV strains 6 and 11

What? Clusters of skin-colored fleshy lesions in the vaginal, vulvar, or anal regions in women. Lesions are dry and verrucous (cauliflower-like). Non-tender. Pruritic and friable (bleed with manipulation)

Who is at inc risk? Chronic tobacco use, immunosuppression

Tx: topical agents that chemically injure lesion (trichloroacetic acid, podophyllin resin) OR stimulate immune response (imiquimod)

USMLE Step 2 (1 decks)

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