Deck 1 Flashcards
1
Q
signs of ovarian torsion
A
intermittant pelvic pain that has periods of time that are symptom free and patient is in no distress
2
Q
what can cause ovarian torsion
A
masses such as or cysts, tumors, pregnancy, ovarian hyperstimulation syndrome, PID
3
Q
pathophys of ovarian torsion
A
Twisting of the ovary and the fallopian tube around the infundibulopelvic ligament and ovarian ligament
4
Q
management of ovarian torsion
A
diagnostic laporatomy
5
Q
what is candiduria
A
this is when you have yeast in the urine
6
Q
management of asymptomatic candiduria
A
nothing
7
Q
management of postpartum thyrotoxicosis hyperthyroid phase
A
add propanolol for symptom management
8
Q
management of postpartum thyrotoxicosis hypothyroid phase
A
levothyroxine
9
Q
what is shoulder dystocia
A
this is when the anterior shoulder fails to be delivered
10
Q
risk factors for shoulder dystocia
A
fetal macrosomia, maternal obesity, excessive pregnancy weight gain, gestational DM,
11
Q
why do solely lactating mothers get amenorrhea
A
due to prolactin inhibiting GnRH
12
Q
types of urinary incontinence
A
stress (decreased sphincter tone), urge (detrusor overactivity), overflow (impaired detrusor activity, bIadder outflow obstruction)
13
Q
what type of incontinence do fibroids cause
A
overflow due to bladder outflow obstruction
14
Q
significant signs of ovarian torsion
A
peritoneal fluid, low bp from blood loss
15
Q
what is considered secondary (late) postpartum hemorrhage
A
onset of bleeding >24 hours after delivery
16
Q
causes of secondary pp hemorrhage
A
retained products of conception, endometritis, placental site involution
17
Q
complications of polyhydramnios
A
fetal malpresentation, umbilical cord prolapse, preterm labor, P-PROM
18
Q
complications of oligohydramnios
A
meconium aspiration, preterm delivery, umbilcal cord compression
19
Q
accuracy of ultrasound use in pregnancy dating in third trimester
A
low
20
Q
signs of bupivocaine system toxicity
A
tinnitus, HTN, metallic taste in mouth, perioral numbness
21
Q
cervical dilation rate in second phase of labor
A
> 1cm every two hours
22
Q
causes of delayed second phase of labor
A
cephalopelvic disproportion, maternal gestational diabetes,
23
Q
which phase of labor can neuroaxial anesthesia lengthen
A
phase 2
24
Q
management of heavy uterine bleeding with fibroids
A
transexamic acid
25
migraines and OCPs
no go
26
patient population to not do an ablation in
people hoping to attempt pregnancy
27
most effective emergency contraception
IUDs
28
paresthesia of lateral thigh name
meralgia paresthetica
29
cause of meralgia paresthetica
entrapment of lateral femoral cutaneous nerve
30
signs of urethral diverticulum
dysuria, postvoid dribbling, dysparaneuria, anterior vaginal wall mass
31
is there an anterior vaginal wall mass in a urethral-vaginal fistula
no
32
what is HELLP sydrome
hemolysis, elevated liver enzymes, low platelets
33
why are liver enzymes elevated with HELLP
subcapsular thrombi causing RUQ pain
34
cause of acute dypsnea in a pre-eclamtic patient
pulmonary edema
35
causes of absent or minimal FHR variability
CNS depressants (like opioids), temorary fetal sleep, prematurity, fetal hypoxia
36
what is appropirate weight gain in pregnancy?
BMI < 18.5 (underweight): 28–40 lb (12.7–18.1 kg)
BMI 18.5–24.9 (normal weight): 25–35 lb (11.3–15.9 kg)
BMI 25–29.9 (overweight): 15–25 lb (6.8–11.3 kg)
BMI ≥ 30 (obese): 11–20 lb (5–9.1 kg)
37
what foods should be avoided in pregnancy
fish with high mercury, caffeine, unpasteurized dairy, raw meats
38
highest risk cardiac defect to avoid pregnancy
mitral stenosis <1.5cm
39
PCOS hormone levels
elevated LH:FSH level, increased DHT, moderately increased testosterone
40
what is a sertoli leydig cell tumor
seminiferous lined tubules with sertoli or leydig cells
41
hormone markers in sertoli leydig tumors
very elevated testosterone, normal DHT
42
signs of a sertoli leydig tumor
rapid onset virulization, hirsutism, frontal balding, cliteromegaly, oligomenorrhea, unilateral ovarian mass
43
signs of sheehan syndrome
lactation failure, amenorrhea, anorexia, weight loss, hypotension
44
signs of placental abruption on exam
sudden onset vaginal bleeding, abdominal/back pain, high freq/low intensity contractions, rigid tender uterus
45
what causes placental abruption
Sudden decrease in intrauterine pressure ; decompression of an overdistended uterus (e.g., ruptured membranes in polyhydramnios)
46
risks for placental abruption
hypertension, abdominal trauma, prior occurance, tobacco and cocaine use
47
signs of uterine ruptures
ability to palpate fetal body parts on abdominal exam, no contractions, decreased rigidity in the uterus
48
clinical features of lichen planus
dyspareneuria, vulvar pain, vulvar pruritis, friable mucosa, serosanguious discharge, gingival erosions and plaques
49
obstetric complications of amphetamine uses
fetal growth restriction, spontaneous fetal demise, preeclampsia, placental abruption
50
when do you give rhogam
at 28 weeks, and 72 hours post delivery of an Rh+ baby
51
problems to the fetus due to septate uterus
growth restriction due to smaller cavity size, spontaneous abortion, decreased fetal perfusion, fetal malpresentation
52
what does the uterus feel like in fibroids (leiomyota uteri)
enlarged with irregular contour
53
what does the uterus look like in adenomyosis
painful and boggy
54
signs of congenital toxo in the mother
fevers, myalgias, lyphadenitis, maculopapular rash nonpruritic
55
signs of congenital toxo in the baby
intracranial calcifications, microcephaly, chorioretinitis, hydrocephalus
56
signs of congenital toxo
hydrocephalus, intraparenchymal calcifications, chorioretinitis, petechiae (blueberry muffin rash), lymphadenopathy
57
signs of congenital CMV
small for gestational age, petechiae (blueberry muffin rash), sensorineuronal hearing loss, chorioretinitis, seizures, hepatomegaly
58
signs of congenital syphilis
rhinorrhea, skeletal anomalies, desquamating rash on the palms and soles
59
signs of congenital HSV infection
chorioretinitis, skin vesicles or scars, microcephaly
60
signs of vesicovaginal fistula
continuous vaginal discharge with acidic pH, raised red granulation tissue,
61
how do you dx vesicovaginal fistula
bladder dye test
62
cause of vesicovaginal fistula
obstructed labor from delayed phase 2 which results in fetal head causing damage and necrosis to vaginal tissue, this can cause fistula
63
signs of compressed femoral nerve
impaired walking (knee extension), decreased anteromedial thigh sensation
64
what patients need STD testing at initial and 3rd trimester
<25yo, prior STD, high risk sexual activity
65
hyaditiform mole presentation
heavy vaginal bleeding, overt hyperthyroidism, elevated b-hcg, enlarged uterus, heterogeneous cystic structure
66
ultrasound of hyaditiform moles
heterogeneous mass of cystic spaces, snowstorm appearance
67
causes of magnesium toxicity
renal insufficiency
68
what is indicative of a tumor rather than worsening PCOS
virulization (androgen-secreting tumor)
69
initial tests for secondary amenorrhea
FSH, LH, prolactin
70
what to say to a patient that wants a home birth
allow them and discuss contingency plans
71
signs of peripartum cardiomyopathy
new onset mitral regurg and S3 heart sound, pitting edema, progressive dyspnea
72
onset of peripartum cardiomyopathy
>36 weeks or 5 months after delivery
73
management of peripartum cardiomyopathy
echo if stable, immediate delivery if unstable
74
fetal complications of late term delivery
macrosomia, oligohydramnios, demise, dysmaturity syndrome
75
maternal complications of late term delivery
severe tears, c section, PPH
76
late term vs. post term timeline
late term is 41 weeks, post term is 42 weeks
77
complications of asymptomatic bacteruria
acute pyelo or preterm delivery
78
what do you do for asymtomatic bacteruria
treat it
79
management of a patient with mixed incontinence
urinary diary
80
can you give MMR vax during preg
nor
81
who gets rhogam
Rh negative mothers
82
signs of intraductal papilloma
breast discharge, no mass or lyphadenopathy
83
management of intraductal papilloma
ultrasound + mammogram then biopsy
84
what is rectus abdominus diastasis clinically
this is when there is palpation of the organs on straining not supine
85
incisional hernia signs
palpabel mass while supine and increases in size with straining
86
what is primary dysmenorrhea
this is when you have extreme pain and nausea during periods
87
etiology of primary dysmenorrhea
excessive prostaglandin production
88
bimanual exam findings of endometriosis
fixed immobile uterus or adnexal masses
89
signs of pseudocyesis
long standing challenges of getting pregnant, negative pregnancy test in office
90
management of a patient with chorioamneitis
delivery (if at term)
91
what test do you do to see if fluid is amniotic fluid
nitrazine test
92
signs of chorioamniotis in the mother
leukocytosis, fever, nausea/vomitting, fundal tenderness, tachy
93
what does premature rupture of membranes put you at risk of
chorioamniotis
94
clear vaginal non odorus discharge
normal discharge near delivery/ovulation
95
why do poeple get clear vaginal discharge with ovulation
increased amount of estrogen near time of ovulation
96
signs of gonorrhea infection
purulent dischrage and tender cervix
97
management of PPROM <34 weeks
antibiotics, steroids, NST
98
what to do if a mother has low bp from spinal
phenylephrine and fluids
99
signs of a fibroadenoma
mobile firm smooth breast mass
100
management of fibroadenoma
observation and reevaluation in 6 weeks
101
age group that gets fibroadenomas
<30yos
102
herpes vs. h ducreyi ulcers
herpes is grouped with erythematous base and h ducreyi is deep ulcers with well demarcated edges
103
occiput transverse head
face is facing the hip bone
104
coccydynia
pain localized to the tailbone
105
management of previous genital HSV in asymptompatic pregnant people
initiate suppressive acyclovir at 36 weeks
106
management of previous genital HSV in symptomatic pregnant people
c section at 39 weeks
107
what causes variable decels
cord compression
108
trichomonas clinical ID
odorous thin discharge with vaginal inflammation frothy
109
bacterial vaginosis clinical
odorous thin discharge with fishy odor no inflammation
110
which vaginosis have pH > 4.5
bacterial and trichomonas, candidal is normal pH
111
complications of inadequate weight gain during pregnancy
fetal growth restriction, preterm labor
112
management of firbroids in the uterus causing pregnancy loss
hysteroscopy with myomectomy
113
what tests are ran during weeks 24-28 of pregnancy
glucose test, blood type, Hb/hematocrit
114
initial tests for first prenatal visit
type and screen, RPR, syph, HIV, rubella, urine culture, urine dipstick protein, hemoglobin
115
what tests do you do if a patient has abnormal glandular cells on pap smear
you have to evaluate for both cervical ca and endometrial CA
116
when do you test for GBS
36-38 weeks gestation
117
evaulation of a mom with hyperemesis gravidum in ER
urine for ketones, hematocrit/electrolytes, ABG
118
features of a mass that are concerning
multiple irregular thickened internal separations, solid and complex mass
119
what is placenta accreta
placenta is adhered into the uterine wall
120
what to do about placenta accreta
hysterectomy
121
obstetric compilcations of acute pyelo
uterine irritation causing contractions early in pregnancy
122
what are the two types of uterine cancer
endometrial and sarcoma
123
risk factors for tamoxifen use
uterine CA (endometrial or sarcoma)
124
what medications cause renal hypoplasia
ACEs and ARBs
125
mag toxicity signs in mom
hypo or areflexia, somnolence, respiratory paralysis
126
management of a benign ovarian cyst
followup in 6 weeks
127
what do patients have to have to have mastitis
fever!
128
for heart failure what ejection fraction is okay for pregnancy
>30%
129
treatment of atrophic vaginitis in menopause
estrogen cream
130
biophysical profile evaluation
2 points for breathing, movement, tone, and amniotic fluid volume, 10 is highest score,
131
physical exam of rectal prolapse
concentric erythematous mass with valsalva with fecal incontinence
132
nonclassic adrenal hyperplasia
21alpha-dehydroxyase def, causing only hyper androgenism
133
signs of nonclassic adrenal hyperplasia
increased facial hair, amenorrhea, severe acne, accelerated bone growth
134
fundal height correlation
fundal height equals weeks of gestation
135
treatment of fibroids in a patient who wants to become pregnant
hysteroscopy with myomectomy
136
when do you stop pap test
age 65
137
what do you do for a likely intraductal fibroadenoma
imaging
138
what is vasa previa
this is when the fetal vessels are not in the cord and instead are overlying the cervix
139
management of vasa previa
emergency c sectino
140
who needs screening for ovarian cancer
only women with significant family history
141
signs of menopause
night sweats, hypertension, difficulty concentrating/cognitive changes, behavioral changes too
142
what tests to run in a patient younger than 45yo with menopause sx
TSH, FSH, prolactin
143
what is hidradenitis suppurativa
this is recurrent infections of the hair follicles in the intertrigious areas which presents as a solitary painful nodule that can then progress to abscesses
144
next step in eval of infertility if the patient has normal anatomy and periods
midluteal phase (day 21) progesterone level
145
pH levels in HG
pH elevated, bicarb high, CO2 high (resp compensation)
146
risk factors for recurrent UTI
spermicide use, hx of cystitis <5yo, new sexual partner, post menopausal status
147
signs of aromatase deficiency
abnormal external genitalia, anovulation, external virulization, undetectable estrogen levels
148
postdural puncture headache signs
positional headache, neck stiffness, photophobia, hearing loss/tinnitius
149
next step after non reactive NST
biophysical profile
150
signs of amniotic fluid embolism
low bp, anxiety, pain, DIC, coma/seizures
151
what is concerning for persistent fevers after c section
septic pelvic thrombophlebitis
152
risk factors for HG
hyaditiform mole, multiple gestations, hx of previous HG
153
causes of asymmetric FGR
uteroplacental insufficiency, maternal HTN, pregestational diabetes melitus
154
causes of symmetric FGR
congenital infection, chromosomal abnormalities
155
complications of short interpregnancy interval
anemia, PPROM, preterm delivery, low birth weight
156
when do you begin pap testing
age 21
157
do you have to do HPV testing to give HPV vax
nor
158
benign apeearing endometrial cells on pap
normal for <45yo, >45yo concerning for a pathology
159
how to test for menopause
FSH level increased
160
inflammatory breat carcinoma
unilateral breath erythema with no lump and dimpIed skin
161
can fibroids cause heavy uterine bleeding
yace
162
pathophys of fibroids leimyomas
proliferation of myometrium smoothe muscle
163
fibrocystic change characteristics
multiple small cyclically tender masses
164
are fibroadenomas tender
no
165
unilateral nodular cystic mass nontender and mobile
fibroadenoma
166
intrahepatic cholestasis of pregnancy skin changes
itchy
167
premature ROM complications
premature labor, placental abruption, infection, cord prolapse
168
what does it mean if the fundus is not palpable after delivery
likely uterine inversion
169
immediate treatment of uterine inversion
fluids and immediate manual replacement of the unterus
170
signs of toxic shock
erythematous rash, diarrhea, vomiting, hypotension, fever
171
hx of patient with toxic shock
long flight, prolonged use of tampon, nose bleed with packing
172
what is chemical pneumonitis
this is aspiration of gastric contents causing irritation
173
clinical signs of chemical pneumonitis
acute onset dyspnea, low grade fever, hypoxemia, diffuse crackles in upper lobes,
174
dx of cyclic dysuria and hematuria
endometriosis with tissue implants in the bladder
175
which antibiotics are unsafe during pregnancy
TMP, fluoroquinolones
176
next steps for a newly discovered muellarian agenesis
renal ultrasoun
177
fetal complications of ulcerative colitis
small for gestational age, preterm delivery
178
description of lichen sclerosis
white plaques over vagina, dry, and severely itchy
179
treatment of lichen sclerosis
superpotent corticosteroids'
180
signs of androgen insensitivity syndrome
no axillary/pubic hair, breast development, high testosterone (in male range), no uterus/cervix and short vagina, cryptorchid testes
181
difference between preeclampsia with severe features and w/out
without is just hypertension, severe features is with HTN and >/= 1 of: severe HTN >160, elevated liver enzymes, platelets lower than 100, creatinine >1.1
182
antihypertensives in preeclampsia
1- labetolol (can cause bradycardia) 2- hydralazine (can cause tachycardia)
183
what does indomethcin for tocolysis create as a complication
oligohydramnios because fetal vasocontriction from decreased prostaglandins. this causes decraesed renal perfusion and therefore oligohydramnios
184
signs of sjogrens
dry vagina from inadequate secretions
185
what tests to run at initial visit for a patient with T1 DM
24hr protein collection
186
types of emergency contraception oral
levonogestrel, oral contraceptives
187
what position are bartholin cysts found
4 and 8 oclock positions
188
trtmt of intrahepatic cholecystis
ursodeoxycholic acid and antihistamines
189
appearance of endomitriomas on the adnexa via ultrasound
unilocular masses with low level echoes
190
what meds to administer for a late preterm patient
roids and antibios (if GBS unknown)
191
signs of cervical cancer
cervical lesion, postcoital bleeding, intermenstrual bleeding,
192
what is normal lochia
persistent bloody discharge up to 8 week pp
193
what should patients with gestational DM be tested for at their 6 wk appt
DM again because it can persisit
194
first step in eval of post menopausal bleeding
transvaginal ultrasound or endometrial biopsy
195
best route of delivery for fetuses with fatal anomolies
vaginal even if breech bc it doesnt matter if something traumatic happens bc the baby is already going to die
196
when can you dx preeclampsia
>20 weeks
197
what patients should do the cell free test
patients >35, prior chromosomal anomolies
198
signs of hydrops fetalis
ascites, skin edema, polyhydramnios, placental thickening
199
what things can cause hydrops fetalis
alpha thal major, Rh incombatiblity, parvo
200
what is considered polyhydramnios
single greatest pocket >8cm
201
what is cervical conozation
where you take out the ectocervix in a cone like maneuver
202
what defines fetal growth restriction
fetal growth <10th percentile
203
what to look for when a fetus is small for gestational age
look at the balance!! is it all the same or just the body is small and not head
204
causes of symmetric FGR
chromosomal abnormality or congenital infection
205
why doe moms get hypotensive with the epidural
vasodilation and venous pooling
206
what causes theca lutein cysts
hyaditiform mole from excess hCG stimulating the ovaries
207
presentation of theca lutein cysts
bilateral multilocular cysts
208
signs of pelvic symphysis diastasis
pain inferior to bladder, pain with ambulating, hx of operative delivery/fetal macrosomia
209
what med is contraindicated in pt with HTN for PPH
methergine or methylergonovine
210
what is the rash called thats limited to abdominal striae
polymorphic eruption
211
delivery method of a monoamniotic twin gestation
must be C section bc the cords can become entagled
212
braxton hicks type
irregular painful contractions with NO cervical change
213
tuberous sclerosis inheritance
auto D
214
does intraductal papilloma have a mass
nor,
215
if there is bloody discharge with a mass what is it
invasive ductal carcinoma
216
what type of birth control should patients with breast cancer use
copper IUD
217
serious AEs of oxytocin
hyponatremia (seizures)
218
treatment of stress incontinence
midurethral sling
219
treatment of urgency incontinence
antimuscarinic
220
treatment of overflow (neurogenic bladder) incontinence
alpha blockers
221
what does hemoglobin do during pregnancy
it goes down physiologically due to increase in plasma volume even though there is an increase in hemoglobin
222
renal lab findings during pregnancy
decreased creatinine, decreased BUN, increased protein excretion in the urine
223
what type of stroke can occur during preeclampsia
acute ischemic from increased HTN either due to microthrombi or from ruptured vessels
224
complications of functional hypothalamic amenorrhea
amenorrhea, low estrogen state, decrease in bone density
225
first step in therapy for pelvic organ prolapse
pessary fitting, surgical repair second line
226
should a patient with unexplaned vaginal bIeeding get an IUD
nor
227
changes to TSH and T4 during pregnancy
TSH goes down bc of HCG, T4 increases
228
procedures in which a trial of labor is contradinicated
myomectomy with uterine cavity entry, vertical incision csection
229
hormone therapy for patients with turners
progestin and estrogen
230
cholelithiasis sx
RUQ and midepigastric pain, vomiting and nausea
231
cause of AUB in a 14yo recent onset menarche
physiologic immature HPA axis
232
what should patients who had a cervical conization get during pregnancy
US to estimate cervical length
233
uniformly dilated loops of bowel management and dx
this is ileus and just bowel rest
234
stress urinary incontinence in pregnancy presentation
leakage when standing or coughing, pool of clear fluid
235
description of condylomata accuminata
nontender, fleshy, verracuous growths, friable and bleed with manipulation
236
can you chest xray a pregnant person
yace as long as you shield the fetus
237
management of PPROM with purulent discharge
immediate induction
238
management of GDM
preprandial glucometer check and post prandial 1-2 hrs later
239
pathophys of sheehan
pituitary ischemic necrosis
240
contraindications to exercise in pregnancy
PPROM, cervical insufficiency, preeclampsia etc
241
causes of stillbirth
congenital syphilis, hemoglobinopathy, antiphospholipid syndromes, severe GDM
242
treatment of HG
pyridoxine and doxylamine succinate and then odansetron
243
risks for placenta previa
smoking, prior csection, multiparity
244
can you do colposcopy on a pregnant person
yace for high grade lesions ID'd via pap
245
ureter changes in pregnancy
hydronephrosis and dilation of the ureter
246
if a patient has dysparenia but not pain with speculum whats the dx
endometriosis
247
trtment of endometriosis
OCPs
248
signs of postpartum urinary retention
lower abdominal pain/pressure (overdistention of bladder), small volumes/inability to void, constant dribbling
249
what do you do for a septic abortion
suction curretage
250
management in following months after a complete hyaditiform mole
contraception bc pregnancy would make it hard to tell what the real b-HCG is
251
US findings of placenta previa
numerous lacunae and myometrial thickening
252
HELLP syndrome
hemolysis, elevated liver enzymes, low platelets
253
what age is the cutoff for HPV vax
26yo
254
risks factors for osteoporosis
white race, smoking, late menarche
255
typical time of onset of an amniotic fluid embolism
during delivery or shortly thereafter, rare up to 48 hours later
256
uterus exam findings of ectopic pregnancy
still firm and consistent in size with the gestational age
257
when is platelet infusion indicated
<10k
258
what receptors caus the uterus to contract
sympathetic, parasympathetic causes it to relax
259
what kind of fluid is serosanguinous
bloody liquidy discharge
260
what is succenturiate placenta
this is an accessory lobe of the placenta and you often see miscellaneous vessels coming off the main pole
261
do you see anything on US of pyelonephritis
nor
262
what antibiotic for mastitis
dicloxacillin
263
can you still have breast cancer without findings on mastectomy
yace
264
do you need a hysterosalpingogram to dx PID
nor
265
what is a hysterosalpingogram
this is where you inject dye to make sure the fallopian tubes are patent
266
treatment of condyloma accuminata
lazer or podophyllum resin
267
should ovaries be palpable after menopause
nor
268
risk factors for endometrial CA
unopposed estrogen from chronic anovulation, obesity, nulliparity, early menarche/late menopause, PCOS
269
do functional ovarian cysts have echogenicity on US
no
270
contraindications for an IUD
recent STI, PID, anotomical abnormalities, gestational trophoblastic disease, active breast cancer
271
dx for a patient with dysparenia/dysmenorrhea and infertility
endometriosis
