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