F/M Repro, Pregnancy Flashcards
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?
placenta accreta. placental invasion into uterine myometrium. most likely from prior C-section.
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?
metaphase of meiosis II
meiosis I arrested in prOphase I until ovulation
meiosis II arrested in METaphase until fertilization= egg METs sperm
25yrM delayed puberty, small testes, small penis, hearing loss, ansomnia, cleft palate
GnRH deficiency (Kallman syndrome)
25yr M tall stature, small tests, gynecomastia, low sperm count, low T
Klinefelter syndrome (47, XXY) male hypogonadism
treatment for pelvic inflammatory disease
requires broad spectrum coverage for Neisseria & Chlymidia and vaginal flora–> cephalsporin (Ceftri), doxycycline, and Metro
is long term contraceptive use associated with infertility?
no. pts will resume menses and return to baseline fertility shortly after discontinuation.
BPH + HTN, treat both
doxazosin, terazosin, prazosin, (non-selective a1 blocker)> relaxation of SM
BPH only med
tamsulosin, alfuzosin, silodosin (selective urinary tract a1 blockers)> relax SM
5aR inhibitor (finasteride) can also decrease prostate size…but after several months.
levator ani complex
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.
fetal development wks
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
tertatogenics:
phenytoin
lithium
valproate
isotretinoin
methotrexate
ACE -
warfarin
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)
30yr obese F is infertile. cycles occur 2-3 times/yr, last 7-10days. mild acne, hair growth. pt is at greatest risk for?
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.
common presentation for PCOS
hyperinsilinemia, inc LH:FSH, inc androgens (T from theca cells), dec follicular rupture (creates cysts), anovulation, amenorrhea, acne. predisposed to endometrial carcinoma, DMII risk.
28yr 31wk gestation. incr SOB, what’s the ABG look like?
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)
ABG for resp acidosis
pH low, CO2 high, bicarb high
ABG for met acidosis
pH low, low CO2, low bicarb
ABG for met alk
pH high, bicarb high, high CO2
ABG for resp alk
pH high, low CO2, low bicarb
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?
“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.
prostate cancer is graded with ______, which identifies grading via _____.
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.
what are the contraindications to combined estrogen/progesterone pills?
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)
what does the bell clapper deformity indicate?
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.
anatomical location of the prostate
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.
renal physio changes in prego
inc kidney blood flow, urine output, GFR
inc ADH secretion
inc EPO production
dec BUN, serum creatinine, serum Na
major risk factors for placenta abrupto
maternal HTN, abd trauma, tobacco/cocaine (potent vasoconstriction), PMH
