F/M Repro, Pregnancy

Question 1

36yr F 38wks active labor. BP 132/84, 94/min. Delivers a 9lb baby vaginally. Small placental fragments are removed in pieces via manual extraction. Profuse bleeding, uterus is firm, massage + meds performed. Pt had previous C-section. Why bleeding?

Answer 1

placenta accreta. placental invasion into uterine myometrium. most likely from prior C-section.

Question 2

Healthy 29yr F comes for fertility eval. Pt tracks cycle. Urine preg test +, couple had intercourse every other day from cycle day 8 thru LH surge. The oocyte most likely arrested in which stage of meiosis immediately prior to fertilization?

Answer 2

metaphase of meiosis II

meiosis I arrested in prOphase I until ovulation
meiosis II arrested in METaphase until fertilization= egg METs sperm

Question 3

25yrM delayed puberty, small testes, small penis, hearing loss, ansomnia, cleft palate

Answer 3

GnRH deficiency (Kallman syndrome)

Question 4

25yr M tall stature, small tests, gynecomastia, low sperm count, low T

Answer 4

Klinefelter syndrome (47, XXY) male hypogonadism

Question 5

treatment for pelvic inflammatory disease

Answer 5

requires broad spectrum coverage for Neisseria & Chlymidia and vaginal flora–> cephalsporin (Ceftri), doxycycline, and Metro

Question 6

is long term contraceptive use associated with infertility?

Answer 6

no. pts will resume menses and return to baseline fertility shortly after discontinuation.

Question 7

BPH + HTN, treat both

Answer 7

doxazosin, terazosin, prazosin, (non-selective a1 blocker)> relaxation of SM

Question 8

BPH only med

Answer 8

tamsulosin, alfuzosin, silodosin (selective urinary tract a1 blockers)> relax SM
5aR inhibitor (finasteride) can also decrease prostate size…but after several months.

Question 9

levator ani complex

Answer 9

puborectalis, pubococcygeus, iliococcygeus. important for urinary voiding, defecation, sexual fxn—> commonly damaged in pregnancy–> posterior pelvic organ prolapse of elderly lady. sensation intact. splinting to help hold contents with pooping helps.

Question 10

fetal development wks

Answer 10

implantation= day 6 (end of wk 1)
bilaminar disc= wk2
gastrulation= wk 3
neurulation= wk 4
neural crest migration= wk 5
GI tract fixation= wk10
primitive alveoli= wk 24ish

Question 11

tertatogenics:
phenytoin
lithium
valproate
isotretinoin
methotrexate
ACE -
warfarin

Answer 11

phenytoin> neural tube, facial, digit hypoplasia
lithium> Ebstein anomaly, nephrogenic DI
valproate> neural tube maternal folate change
isotretinoin> small ears, small head, hydroceph
methotrexate> limb & craniofacial/, abortion, neural tube
ACE -/ARBs > renal dysgenesis= olgiohydram
warfarin> nasal hypoplasia, stippled epiphysis (pinpoint calcifications)

Question 12

30yr obese F is infertile. cycles occur 2-3 times/yr, last 7-10days. mild acne, hair growth. pt is at greatest risk for?

Answer 12

endometrial carcinoma. pt has hella increased amounts of estrogen; aromatase @ ovary to estradiol, and @ fat to estrone. PCOS has low progresterone–> chronic anvoluation, but +estrogen= endometrial hyperplasia, which can undergo dysplasia sequence to become endometrioid endometrial carcinoma. loss of PTEN.

Question 13

common presentation for PCOS

Answer 13

hyperinsilinemia, inc LH:FSH, inc androgens (T from theca cells), dec follicular rupture (creates cysts), anovulation, amenorrhea, acne. predisposed to endometrial carcinoma, DMII risk.

Question 14

28yr 31wk gestation. incr SOB, what’s the ABG look like?

Answer 14

chronic hyperventilation from progesterone stimulated resp drive> resp alk w/ inc renal dumb of bicarb at 31wk gestation, will be fully compensated, so increased bicarb in urine
(high pH, high urine bicarb, low CO2, high PaO2 vs. normal resp alk: high pH, low CO2, low bicarb)

Question 15

ABG for resp acidosis

Answer 15

pH low, CO2 high, bicarb high

Question 16

ABG for met acidosis

Answer 16

pH low, low CO2, low bicarb

Question 17

ABG for met alk

Answer 17

pH high, bicarb high, high CO2

Question 18

ABG for resp alk

Answer 18

pH high, low CO2, low bicarb

Question 19

53yr F with itchy rash on L breast for 1 month. LMP 2yrs ago. PMH HTN. eczematous plaque on L nipple and areola. histology most likely to show?

Answer 19

“eczematous rash”, “scaling and ulceration” “pruritic”
Paget Disease of the nipple> underlying ductal carcinoma in situ. lymphatic obstruction.
*unlike Paget Disease of vulva, no underlying carcinoma.

Question 20

prostate cancer is graded with ______, which identifies grading via _____.

Answer 20

Gleason grade, via glandular structure= poorly (high grade)/well-differentiated (low grade) cells; not taking into consideration cellular atypia.
staging is still degree of spread with nodes.

Question 21

what are the contraindications to combined estrogen/progesterone pills?

Answer 21

venous embolism risks: tobacco use, prolonged immobilization, PMH, antiphospholipid antibodies SLE, <3 wk postpatrum
CVD risk: migraines w/ aura, uncontrolled HTN, ischemic heart disease, prior stroke
medical conditions: active breast cancer, active liver disease (acute hepatitis, liver cancer)

Question 22

what does the bell clapper deformity indicate?

Answer 22

congenital horizontal positioning of testes> making testicular torsion (acute, severe pain, absent cremasteric reflex, -Prehn sign, hemorrhagic infarction) much more likely with incr mobility of testes.

Question 23

anatomical location of the prostate

Answer 23

ant to anal canal
post to pubic symphysis.

*locate the anal canal (dark=air) inferior, and bladder is superior on CT. find spine for cranio-caudal orientation.

Question 24

renal physio changes in prego

Answer 24

inc kidney blood flow, urine output, GFR
inc ADH secretion
inc EPO production

dec BUN, serum creatinine, serum Na

Question 25

major risk factors for placenta abrupto

Answer 25

maternal HTN, abd trauma, tobacco/cocaine (potent vasoconstriction), PMH