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[2a] A ⼀ Step 2 OD USLME > ✅F3 (PEDS/PREGNANCY/REPRO/UROLOGY/BREAST) > Flashcards

✅F3 (PEDS/PREGNANCY/REPRO/UROLOGY/BREAST) Flashcards

1
Q

Give brief descriptions of each pediatric neoplasm

Neuroblastoma

________________

Rhabdomyosarcoma

________________

Wilms tumor

A

N: extracranial solid tumor of adrenal medulla p/w catecholamine sx: HTN, flushing sweating

___________________

R: malignant soft-tissue tumor of the head/neck

___________________

W: most common ped renal CA presenting < 5 yo with uL PAINFUL abd mass + Hematuria + HTN

N/W mass compresses renal artery ➜ activates renin-angiotensin system ➜ HTN

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2
Q

initial tx for Insomnia

A

CBT
_________________
sleep hygiene / sleep restriction / relaxation techniques

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3
Q

MDD and Grief have overlapping Symptoms

What are 3 factors of Grief that separate it from Major Depression Disorder?

A

grief (normal rxn to loss):

Intensity ⬇︎ over time

Suicidality NOT common

“waves” of grief at reminders

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4
Q

Clozapine’s SE is agranulocytosis

Name the Granulocytes - 3

A

BEN

Basophils

Eosinophils

Neutrophils

Clozapine also causes Metabolic Syndrome X, Seizures and Myocarditis

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5
Q

Diagnostic criteria for Persistent Depressive Dysthymia disorder - 3

A
  1. at least 2 / 6 of SIgeca
  2. CONSTANT ≥ 2 years (or 1 year in kids)
  3. No relief > 2 mo

Major Depressive Episodes may also occur with this

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6
Q

Vulvodynia cp

________________

tx -2

A

≥3 mo idiopathic raw burning vulvar pain

________________

Tx = [pelvic floor physiotherapy] and CBT

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7
Q

Exercise during pregnancy ⬇︎ risk of (⬜3)

A

gestational DM

PreEclampsia

Cesarean

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8
Q

What are the contraindications to Exercise during pregnancy? -3

A
  1. cervical insufficiency
  2. underlying comorbidity preventing exercise
  3. active vaginal bleeding
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9
Q

How do you manage Patient agitation when it’s escolated to violence? -2

A
  1. PHYSICAL RESTRAINTS
  2. INTRAMUSCULAR ANTIPSYCHOTIC
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10
Q

[Pyogenic granuloma telangiectaticum]

A

[dome shaped papule with recurrent bleeding] caused by capillary proliferation after trauma during pregnancy

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11
Q

Describe [Simple breast cyst]

________________

A

benign fluid filled mass 2/2 breast duct obstruction

________________

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12
Q

What are the risk factors for Cervical Insufficiency? -4

A
  1. Cervical Conization
  2. Uterine abnl
  3. Prior obstretric trauma
  4. congenital (intrauterine DES exposure, collagen abnl)
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13
Q

Rett syndrome sx -3

A
  1. [microcephaly with developmental regression]
  2. epilepsy
  3. unique hand gestures
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14
Q

patient is diagnosed with breast cyst

Describe your workup -5

A
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15
Q

What level of prolactin indicates a Prolactinoma

A

>200

Prolactin inhibits LH release

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16
Q

Name the factors of Schizophrenia a/w a good prognosis -6

A
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17
Q

Febrile seizures present day ⬜ of illness, are a common complication of high fever a/w ⬜, and onset between ⬜ y/o
_________________

What is the prognosis for children with febrile seizure

A

1 ; viral infection ; [3 months - 6 yo]
_________________
typically [benign course (does not require tx)] but 30% will have ≥1 recurrence and also have INC risk for Epilepsy

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18
Q

How do you treat Febrile Seizure? -3

A
  1. REASSURANCE
  2. [Abortive tx if ≥5 min]
  3. [Sx Tx (APAP)]
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19
Q 
A physician (⬜ can | cannot) unilterally terminate a patient solely for nonpayment
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
 When is a physician considered "abandoning" a patient? -2
A

CAN
_________________

Abandoning Patient if:

  1. Patient terminated whilst in immediate medical need
  2. Patient NOT given reasonable time to find alternate provider
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20
Q

AntiParkinson tx can cause psychosis due to ⬜

How do you manage this? -2

A

+ dopaminergic effects (activation of mesolimbic pathway)
_________________
[DEC AntiParkinson dosage (starting with least potent)]

–(if sx persist)–> [add D2 R Blocker (Quetiapine/Clozapine/PimaVanserin)]

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21
Q

What are 2 major signs of tooth decay?
_________________
Name 3 risk factors for a baby developing tooth decay?

A

white spots / discoloration
_________________

  1. sugary substances frequently
  2. nighttime bottle/feedings
  3. Inadequate fluoride
    * Dental Home must be established by 1 y/o*
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22
Q

What are the 4 major risk factors for [Spontaneous Abortion < 20WG]?

A

PREVIOUS SPONTANEOUS ABORTION

[Maternal Age > 35]

[Maternal Substance Use]

[BMI extremes]

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23
Q

Describe the following contraception:

a. Progestin-releasing IUD

_________________

b. Copper-containing IUD
_________________

c. BL tubal Ligation

A

a. long,reversible contraception used in pts with contraindication to estrogen. Also ⬇︎menstrual blood loss in anticoagulated pts

_________________
b. long, reversible contraception but ⇪ menestrual bleeding and dysmenorrhea

_________________
c. irreversible contraception indicated for pts finished with childbearing. Will NOT help menorrhagia

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24
Q

Ovarian torsion occurs in ⬜ women and presents with (⬜2 sx)

_________________

how do you diagnose this?

A

reproductive ; [uL pelvic pain + tender adnexal mass]
_________________

[Pelvic Ultrasound with color Doppler]

(will show enlarged edematous ovary with ⬇︎blood flow)

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25
Q

Main features of Becker Muscular Dystrophy - 4

A
  1. [Xp21 deletion] (X-link recessive deletion on Chromo Xp21)
  2. Scoliosis
  3. [peds onset at 5 yo]
  4. [cardiomyopathy ➜ 40-50 yo DEATH]
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26
Q

Main features of Duchenne Muscular Dystrophy - 5

A
  1. [CALF PSEUDOHYPERTROPHY requiring gower manuever + teenage wheelchair] = [⇪ Creatine Kinase]
  1. [Xp21 deletion] (X-link recessive deletion on Chromo Xp21)
  2. Scoliosis
  3. [peds onset at 2 yo]
  4. [cardiomyopathy ➜ 20-30 yo DEATH]
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27
Q

Why are the Negative symptoms of Schizophrenia treated differently?

and what are Negative Schizo sx treated with?

A

NEGATIVE Schizo Sx respond poorly to Antipsychotics so…
_________________
➜ Negative Schizo symptom tx = [social skills training]

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28
Q

For Women who wish to preserve fertility:

What is the MOA for the 1st line tx of [Leiomyoma Fibroids]
_________________
Whats another tx for this?

A

[Progestin-releasing IUD] Reversibly induces endometrial atrophy ➜ [⬇︎ leiomyoma size and ⬇︎ uterine bleeding]

_________________
[Combined OCP]

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29
Q

What are the sx of [Leiomyoma Fibroids] -4

A

enlarged irregularly shaped uterus

regular menorrhagia

dysmenorrhea

mass effect (constipation/pelvic pressure/urinary sx)

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30
Q

In neonates, how might Cystic Fibrosis present? -4

A

Meconium iLeus = inspissated GI secretions obstruct meconium excretion in distal iLeum ➜

[DILATED SMALL BOWEL LOOPS with NARROW UNDERUSED MICROCOLON]

[Bilious emesis]

[R ground glass mass AXR (from iLeum air mixing with iLeum meconium)]

_________________
AXR = Abdominal XRay

ASK ABOUT FAM HX OF RECURRENT SINUS INFECTIONS

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31
Q

Diagnosis? ; Name the major risk factor for this

A

HIRSCHSPRUNG DISEASE ; [Mom ≥ 35 yo]

markedly dilated descending colon

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32
Q

[Advanced Maternal Age ≥35] is a risk factor for ⬜, which is a/w with what 2 neonatal conditions?

A

Down Syndrome Trisomy 21
_________________

Duodenal Atresia (double bubble)

Hirschsprung disease (dilated colon)

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33
Q

Maternal Macrolide use during pregnancy is a risk factor for ⬜ , which typically presents at age ⬜ with (⬜2)

A

[pyloric stenosis] ; 1 month old ;

NONBILIOUS PROJECTILE VOMITING + PALPABLE OLIVE SHAPED ABD MASS (target sign on XR)

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34
Q

What is the Doctrine of Implied Consent?

A

pts who LACK DECISION-MAKING CAPACITY

but REQUIRE 911 TX

may be given (wihout their explicit consent) same tx most reasonable people in a similar siutation would expect to receive

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35
Q

Physicians should screen for ⬜ in veterans reporting insomnia, substance use and interpersonal conflict

________________

Tx for this condition? -3

A

PTSD

________________

[Trauma Focused CBT]

[SSRI/SNRI]

[Prazosin for nightmares]

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36
Q

Physicians should screen for ⬜ in veterans reporting insomnia, substance use and interpersonal conflict longer than ⬜

________________

What is the diagnostic criteria -2

A

PTSD

> 1 month

________________

[LIFE THREATENING TRAUMA]

+

P.A.I.N. sx

________________

Pysch (sleep ∆ /hypervigilance/concentration ⬇︎)

Avoidance (avoids distressing thoughts/feelings/external reminds of the event)

Intrustion (nightmares/flashbacks)

Negative mood (guilt/ anhedonia/detachment/anger/self-esteem ⬇︎)

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37
Q

how does Nephrolithiasis present during pregnancy?
_________________
dx?

A

2nd or 3rd trimester

[Flank pain that radiates to labia + NV]
_________________
dx = renal/pelvic US

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38
Q

What are the recommendations regarding Bariatric Surgery and Pregnancy?

A

After Bariatric Surgery, Delay Pregnancy x 1 year to optimize wt loss and nutrition

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39
Q

BP Goal for Pregnant patients?

A

< 140/90

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40
Q

patients with fetal growth restriction (defined as ⬜ ) are at ⇪ risk for ⬜
_________________
How is this managed?

A

[estimated fetal wt < 10th%tile for gestational age]; STILLBIRTH
_________________
[Serial Antenatal testing]

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41
Q

What is the purpose of [Fetal Fibronectin test]?

A

determines risk of preterm delivery in patients with preterm contractions

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42
Q

Describe purpose of [Percutaneous Umbilical Sampling]

A

high risk procedure that samples fetal blood to confirm severe fatal anemia (hydrops fetalis)

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43
Q

What’s current recommendation regarding Lyme disease during Pregnancy?
_________________
Which 2 abx can be used to treat Lyme disease during Pregnancy?

A

If mother receive adequate abx (PO amoxicillin vs PO ceFUROxime) = NO ⇪ FETAL RISK

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44
Q

AFP is obtained in pregnant women at 15-20WG

________________

What does an elevated AFP indicate in a pregnant woman?-3

A
  1. Fetal Open Neural Tube Defects (open spina bifida, anencephaly)
  2. Fetal Abd Wall defect (Gastroschisis, Omphalocele)
  3. Multiple gestation (twins)

If ⬆︎AFP –> GET ANATOMY US!

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45
Q

What is the Prenatal Maternal Quad Serum screening? When is this obtained?

A

Measures 4 chemical markers for fetal anomalies and down syndrome- 81% accuracy (QUAD = BUAD):

  1. βHCG⬆︎
  2. Unconjugated EsTriol⬇︎
  3. AFP⬇︎
  4. Dimeric inhibin A⬆︎ - only in QUAD screen

Performed 15 -20WG

Be sure to f/u abnml results with cell free fetal DNA test and US

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46
Q

What are the Quad BUAD results (obtained 15-20WG) for Edward’s Trisomy 18?

A

⬇︎βHCG

⬇︎Unconjugated EsTriol

⬇︎AFP

NML Dimeric inhibin A

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47
Q

AFP (from Maternal serum) is a protein made by the (⬜3) It is obtained in pregnant women at ⬜ weeks gestation via ⬜
_________________

What constitutes as an elevated AFP?

A

[Fetal Yolk Sac]/GI/Liver

________________

15-20WG

________________

via Quad BUAD screen

if AFP > 2.5 ➜ get anatomical US!

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48
Q

What 2 contraceptives are the most ideal for adolescents teens? Why is this?

A

[IUD or subdermal implants] = RELIABLE, SAFE and REVERSIBLE

long acting reversible contraceptives

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49
Q

Pt on Valproate, incidentally found to be 14 WG

How do you manage this?

A

although [AntiEpileptics Drugs] (especially valproate) are INC risk for congenital anomalies

DO NOT MAKE CHANGES TO AED AFTER CONFIRMATION OF PREGNANCY

Instead ➜ start pt on [high dose folic acid] + [obtain AFP with anatomical US] to screen for congenital anomalies

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50
Q

[T or F]

[AntiEpileptic Drugs] are relatively contraindicated with breastfeeding

A

FALSE
_________________

Moms CAN breastfeed while on [AntiEpileptic Drugs]

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51
Q

Name the absolute contraindications to breastfeeding? - 7

A

BITCHES can NOT breastfeed!

  1. [Breast has HSV lesions]
  2. [Infant has galactosemia]
  3. TB untreated
  4. Chemoradiation
  5. HIV maternally
  6. varicElla actively
  7. Substance abuse maternally
    * Hep B pts can breastfeed as long as baby receives HepB Immunoglobulin and vaccination*
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52
Q

Peds with untreated iron deficiency anemia are at INC risk for what 2 comorbidites?
___________________

How is this mitigated? -3

A

psychomotor delay

neurocognitive impairment
_________________
[universal screening starts age 1 yo]

–(if hgb <11)–> [PO ferrous sulfate]
_________________

IDA is the most common nutritional deficiency in kids

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53
Q

Explain why some females have irregular heavy menstruation around menarche
_________________

A

endometrium builds 2/2 estrogen, however, without progesterone (common around menarche) the cue to slough endometrium is absent = Anovulation➜ estrogen breakthrough bleeding = irregular heavy menstruation
_________________

Estrogen proliferates and repairs Endometrium ➜ Endometrial hemostasis

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54
Q

Name the causes of [Abnormal Uterine Bleeding] in nonpregnant women? -9
_________________

How do you treat ACUTE heavy [Abnormal Uterine Bleeding]?-3

A

__________________

  • HDS*: [combined OCP with HIGH DOSE ESTROGEN]
  • NPO/Refractory*: [IV Estrogen]
  • HDUS*: [D&C (endometrium surgical removal)]

_________________
Estrogen proliferates and repairs Endometrium ➜ hemostasis

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55
Q

What is Pubic Symphsis Diastasis? ; What is the clinical presentation of this after a traumatic delivery?

A

Physiological widening of pelvis by progesterone and relaxin to facilitate vaginal delivery ; Postpartum suprapubic TTP pain that radiates to the Back and/or Hips

worst with weight bearing, walking or position change and resolves by 4 weeks PostPartum

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56
Q

CP for Endometriosis - 5

A

The 3 Ds and All

  1. Dysmenorrhea
  2. Dyspareunia deep pelvic - implants in posterior cul-de-sac
  3. Dyschezia (painful defecation) - implants in posterior cul-de-sac

OR

(4) ASX (tx not indicated if so) - otherwise tx = NSAIDs –> Contraceptives (combined OCP/IUD progesterone)

(5) Infertility of unknown origin
* Findings: Gun Powder Burn lesions, ADHESIONS–>immobile uterus, Chocolate fluid*
* Dx = ​Laparoscopy to biopsy & remove endometriotic lesions*

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57
Q

Why is it common for adolescents to have irregular and anovulatory menstruation?

A

immaturity of hypothalamic-pituitary-gonadal axis –> inadequate amounts of GnRH –> low FSH and LH –> lack of ovulation –> lack of Menses

Menses normally occurs when corpus lutem (byproduct after ovulation) produces progesterone and this progesterone drops –> Menses/shedding. No ovulation –> No menses

  • Tx = Progestin-only or Combined OCPs*
  • this self-resovles 1-4 yrs after menarche*
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58
Q

hCG is secreted by _____ and responsible for what? ; When does hCG production begin?

A

syncytiotrophoblast ; preserves corpus luteum (which secretes progesterone) during early pregnancy until the placenta can take over ; 8 days after fertilization

hCG also stimulates maternal thyroid and promotes male sex differentiation

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59
Q

Which hormone prepares the endometrium for implantation of a fertilized egg?

A

Progesterone Prepares endometrium via decidualization

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60
Q

MOD for PCOS

A

Hyperinsulinemia and Elevated LH –> ⬆︎ Androgen release from Ovarian Theca which is converted to Estrone–> Elevated Estrone which feedbacks on the hypothalamus –> ⬇︎GnRH –> ⬇︎FSH imbalance –> failure of follicle maturation and anovulation –> No progesterone –> Endometrial CA

  • tx = weight loss and clomiphene citrate*
  • Note: if pt has high levels of sex hormone binding globulin, total testosterone may be low. so clinical dx may be necessary*
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61
Q

Tenderness along the uterosacral ligament should make you suspicious for what disorder?

A

Endometriosis

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62
Q

Which hormone induces prolactin production during pregnancy?

A

Estrogen

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63
Q

Which hormone is responsible for myometrium relaxation during pregnancy?

A

Progesterone

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64
Q

After giving abx

How do you manage UTI in peds less than 2 yo
_________________
what about peds > 2 yo?

A

after 1st febrile UTI,

in [peds < 2 yo]= renal/bladder US (to evaluate for anatomic abnl) –(if abnl)–>VCUG
_________________

[peds > 2 yo] = No imaging as long as abx tx ➜ resolution

VSUG = voiding cystourethrogram

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65
Q

How do you manage a pregnant patient who’s GBS positive at 14 WG? -2

A

[Amoxicillin or Cephalexin STAT] + [PCN intrapartum]
_________________
pregnant patients require abx STAT to prevent progression to upper UTI (like

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66
Q

Tx for Lichen Sclerosis

A

Clobetasol ointment (high potency topical CTS)

dx = vulvar punch biopsy

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67
Q

clinical presentation of [Genital wart condyloma acuminata]
_________________
Tx?

A

cauliflower-like, soft and raised lesions

_________________
TriChloroAcetic acid

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68
Q

Ectopic pregnancy can be managed medically with methotrexate (⬜MOA) unless its contraindicated which ➜ Surgery instead

________________

What are the contraindications for MTX in ectopic pregnancy? -5

A

folic acid blocker

________________

  1. liver disease (DEC MTX clearance)
  2. renal disease (DEC MTX clearance)
  3. ruptured ectopic (free fluid in posterior-cul-de-sac)
  4. immunodeficiency
  5. high failure probability (fetal cardiac activity, βhCG>5000 )
69
Q

When is [RhoGam AntiRhD] administered to Rh NEGATIVE pregnant women? - 7

A

DO THIS FOR ALL Rh NEGATIVE mothers

  1. 50mcg 1st trimester if uterine bleeding and/or spontaneous abortion occurs
  2. 300mcg at 28 WG
  3. [300 mcg within 3 days after delivery (if infant RhD+)]
  4. give with any episodes of vaginal bleeding (if indicated)
  5. give with External Cephalic Version
  6. give with Hydatidiform Mole dx
  7. give if Ectopic Pregnancy occurs
70
Q

the 2 diagnostic criteria for [ruptured ectopic pregnancy] are ⬜ and ⬜
_________________

How do you manage suspected ectopic pregnancy?

A

positive UPT

+

HDuS hemoperitoneum
_________________

71
Q

What’s the most common side effect of combined OCP?

A

Irregular breakthrough bleeding
_________________
2/2 thin atrophic endometrium that sheds UNEVENLY

72
Q

Oligohydramnios –> ⬜ sequence.

Name the 3 most common causes of Oligohydramnios

A

Oligohydraminos –> POTTER Sequence

POSTERIOR URETHRAL VALVES are the most common cause of obstructive uropathy in newborn BOYS (which causes renal damage –> oligohydramnios during utero)

73
Q

Oligohydramnios –> ⬜ sequence.

Describe this clinical presentation for this Sequence

A

Oligohydraminos –> POTTER Sequence

Pulmonary hypOplasia

Oligohydraminos from renal agenesis/damage (cause)

[Twisted Face & Extremities]

Twisted Skin

Ears set low

Renal Failure

74
Q

False labor occurs as a result of Braxton Hicks contractions and causes NO CERVICAL CHANGE

Compare the Timing / Strength / Cervix status of contractions occuring in False Labor to True Labor

A

Uterine Contractions…

FALSE = irregular + weak + NO CERVICAL CHANGE

True = [Regular with increasing frequency] + [increasing in strength] + cervical change

75
Q

What is often the cause of Early Decelerations on Fetal Heart Tracing

A

Head Compression of Fetus

these occur WITH contractions and no tx is required

76
Q

which pregnant patients should receive ⬜ antibiotic prophylaxis for GBS prevention?

A

Intrapartum PCN to

[(GBS+)]

________and________

[(GBS unknown) + (≥1 risk factor)]

RF: [<37WG] / [maternal intrapartum fever] / [Prolonged Rupture of Membrane ≥18H]

77
Q

Diagnosis? | Tx?

A

[Actinic Solar Keratosis] | [topical 5-Fluoruracil]
_________________
diffuse scaly papules on photodamaged (telangiectasia/dyspigmentation/atrophy) background

can prorgress to SQC

78
Q

diagnosis?

A

Psoriasis

affects extensor surfaces

79
Q

What are the potential complications of Subchorionic Hematoma? (6)

A

spontaneous abortion/

placenta abruptio/

PPROM/

preeclampsia/

preterm labor/

IUGR/

IUFD
_________________
subchorionic hematoma result in placental dysfunction and ➜

80
Q

what is subchorionic hematoma ?
_________________
management?

A

abnml blood collection between [Uterus chorion] and gestational sac that presents as 1st trimester bleeding or incidental US finding
_________________
Expectant (serial US for reassurance)

can result in placental dysfunction and ➜ spontaneous abortion/placenta abruptio/PPROM/preeclampsia/preterm labor/IUGR/IUFD

81
Q

Treatment choices? (3)
_________________

What’s the prognosis of this condition after treatment?

A
  • treat SD with [topical CAC]*
    1. topical antifungal (ketoconazole / selenium sulfide)
    2. topical CTS
  1. topical calcineurin inhibitors (pimecrolimus)
    _________________

SD is a chronic RELAPSING condition so intermittent re-treatment may be necessary!
_________________

Seborrheic DERMATITIS ;

pruritic erythematous plaques with oily greasy scaling & flaking

82
Q

Emergency contraception should be offered within ⬜ days of unprotected intercourse.

⬜ is the most effective therapy and ⬜ is the most effective ORAL therapy.

_________________

Name all 5 options

A

5 ; [COPPER IUD] ; [Ulipristal (AntiProgestin)]

83
Q

describe Postexposure Px (PEP) management (5)

A
  1. Chlamydia = doxy
  2. Gonorrhea = Ceftriaxone
  3. Trichomoniasis = Metronidazole
  4. [HIV (if within 3 days of exposure)] = triple drug regimen
  5. [HBV (HBV vaccine if not immune [and IG if assailant HBV+])
84
Q

Most seizures in young children with fever are benign (febrile seizure)

When is Lumbar Puncture indicated? (4)

A
  1. Nuchal rigidity
  2. HA
  3. bulging fontanelle
  4. prolonged AMS
85
Q

Which contraception is the most effective?
_________________

MOA? (2)

A

[PSI (r**3 year)]
_________________
progesterone

  1. thickens cervical mucus and ⬇︎tubal motility ➜ inhibits sperm migration
  2. ⬇︎ [FSH and LH secretion] ➜ stops ovulation

[PSI-Progestin Subdermal Implant (long-acting + reversible)]

86
Q

[T or F]

Stimulant therapy for ADHD is associated with ⇪ risk for Substance Use Disorder

A

FALSE
_________________

Stimulant rx for ADHD does NOT increase risk of developing Substance abuse

87
Q

[Genu Varum] is normal during age ⬜ and presents as (⬜3) . When should this correct by?

A

0-2 yo ; [BL symmetric bow leg, normal stature, no lateral thrust]
_________________
should correct by 2 yo

obtain XR if > 2 yo, short stature or uL

88
Q

Criteria for PreEclampsia is Gestational HTN + [Proteinuria or End Organ Damage]

How do you clinically diagnose Proteinuria for pregnant women - 4

A
  1. ≥300 mg protein on 24 hr urine

OR

  1. ≥ 30 mg/dL on dipstick
    OR
  2. At least 1+ on dipstick

OR

  1. Protein:Creatinine ratio > 0.3
    * Must occur at least 2 times at least 6 hours apart*
89
Q

Preeclampsia is typically diagnosed ____ weeks gestation. What is the exception to the rule?

A

≥ 20WG! ; Preeclampsia is a complication of Hydatidiform mole which may occur < 20WG

90
Q

Criteria for PreEclampsia is Gestational HTN + [Proteinuria or End Organ Damage]

Describe timeline for Postpartum preeclampsia

A

can present up to 12 weeks postpartum
_________________

PreEclampsia –> SEVERE PreEclampsia –> HELLP and at anytime, Eclampsia is possible

91
Q

PreEclampsia –> SEVERE PreEclampsia –> HELLP and at anytime, Eclampsia is possible
_________________

what is the treatment for HELLP? (3)

A

DELIVERY

MAGNESIUM SULFATE (SEIZURE PX)

[antiHTN (if ≥ 160/110)]- labetalol/hydralazine

92
Q

Criteria for PreEclampsia is Gestational HTN + [Proteinuria or End Organ Damage]

How do you clinically diagnose SEVERE PreEclampsia? - 9

A

PreEclampsia –> SEVERE PreEclampsia –> HELLP and at anytime, Eclampsia is possible

ANY ONE OF THE FOLLOWING:

  1. Systolic > 160
  2. Diastolic > 110
  3. refractory HA
  4. scotoma vision changes
  5. Pulmonary Edema (from ⬇︎albumin)
  6. RUQ OR Epigastric pain
  7. Doubling of LFTs
  8. Platelets < 100K
  9. Cr > 1.1 or doubled from baseline

although not in criteria, can also include Hyperreflexia

93
Q

What are the potential CP for Hydatidiform Mole? - 5

A
  1. HEAVY vaginal bleeding
  2. Hyperemesis Gravidarum
  3. Severe Preeclampsia
  4. Hyperthyroidism
  5. Uterus larger than expected gestational age but with regular countour

“Snowstorm with grapes” and/or [Theca lutein ovarian multiseptated cyst from excess bHCG] on ultrasound

HHIIGH LEVELS OF bHCG (> 100,000)

Most of the time this is caused by sperm implanting an EMPTY ovum

94
Q

What are the primary components for the Mechanisms of Disease in Preeclampsia? - 3

A

Ab complex mediated endovascular damage –>

  1. Hemolytic Anemia
  2. Platelet aggregation from ⬆︎Thromboxane
  3. Vascular constriction pervasively from ⬆︎Thromboxane
95
Q

Although tx for OSA in adults is ⬜ , what’s the first line tx for OSA in children?
_________________

OSA = Obstructive Sleep Apnea

A

CPAP ;

[Tonsillectomy and adenoidectomy] = 1st line for peds

96
Q

What are the recommendations regarding MD and teenager patients having sex.

Should MD discuss with parents?

A

MD should maintain confidentiality of sexually active teens and ensure teen access to healthcare and counseling

MD MUST BREAK CONFIDENTIALITY IF THERE’S RISK OF HARM TO SELF/OTHERS OR CHILD ABUSE

97
Q

What’s the single greatest indicator of a teenager being in an abusive or coercive sexual engagement

A

sexual partners who occupy POSITIONS OF POWER OR AUTHORITY over the teenager is s/f abuse/exploitation
_________________

MDs are obligated to notify CPS or law enforcement about abuse/exploitation

98
Q

Nipple discharge is pathologic if it is 1 of what 3 things?

________________

How do you workup breast nipple discharge?

A

spontaneous / uL / persistent

99
Q

The most common cause of pathologic breast nipple discharge is ⬜

________________

When is breast nipple discharge considered pathologic? -3

A

papilloma (from lining of the breast duct )

________________

spontaneous / uL / persistent

  • pathologic breast nipple discharge requires age-based imaging to r/o CA*
  • ________________*
  • Papillomas are usually benign but may have associated atypia, DCIS or invasive intraductal carcinoma within the lesion*
100
Q

Which contraception should be given to a patient with PCOS?
_________________

why?

A

Progesin-containing IUD
_________________
unoppossed estrogen in PCOS ➜ androgen excess, polycystic ovaries and anovulation (which ➜ irregular menses, endometrial hyperplasia/CA).

Progesterone protects the Endometrium

101
Q

What is 1st line tx for Dysmenorrhea in sexually active pts?

________________

What about non-sexually active pts?

A

Combined OCPs

_________________
NSAIDs

Combined OCPs treat dysmenorrhea by ⬇︎endometrial proliferation ➜ atrophy which –> ⬇︎prostaglandin release –> ⬇︎painful uterine contractions

102
Q

Diagnostic criteria for Primary Dysmenorrhea; etx

A

pelvic cramping during the first few days of menses in the context of a normal pelvic exam; prostaglandin release from endometrial sloughing during menses

103
Q

Hydatidiform Mole is a precursor to ⬜

How do you manage Hydatidiform Mole ? (5)

A

[Gestational Trophoblastic Neoplasia]
_________________

104
Q

What is a Hydatidiform Mole?
_________________

How is HM related to CA?

A

abnormal fertilization of [empty ovum] by either 2 sperm or [1 sperm whose genome ultimately duplicates] ➜ [hypertrophic and hydropic trophoblastic villi] that secretes βhCG > 100,000
_________________

HM can develop into [Gestational Trophoblastic Neoplasia]

_________________

tx = [D&C + contraception] ➜ [serial βhCG until undetectable x 6 mo]

105
Q

in newborns, bilirubin greater than ⬜ ➜ ⬜. Describe this condition

________________

management?

A

[20-25] ➜ [Kernicterus bilirubin encephalopathy] (mvmnt DO and hearing loss)

________________

Exchange Transfusion

exchanging [blood with SEVERE HYPERBILIRUBINEMIA and/or DAT+ maternal Ab] from baby and transfusing baby with replacement RBC

106
Q

Exchange Transfusion in neonates involves ⬜
_________________
When is this indicated? (3)

A

exchanging [blood with SEVERE HYPERBILIRUBINEMIA and/or DAT+ maternal Ab] from baby and transfusing baby with replacement RBC

_________________

  1. total bilirubin > 20-25
  2. worsening hyperbilirubinemia on phototherapy
  3. kernicterus encephalopathy
107
Q

MOD for this condition? | Management? (2)

A

Psuedofolliculitis barbae

shaving [“nappy” tightly curled hair] below skin surface➜ allows penetration of the resultant [angled tip hair shaft] into interfollicular skin ➜ [small painful papules in beard]

and possibly ➜ [hyperpigmentation / 2º bacterial infection / keloid]
_________________
D/C SHAVING (or use clippers that leave hair longer)

108
Q

Imiquimod indications (3)

A

actinic solar keratosis

anogenital warts

superficial Basal Cell Carcinoma

109
Q

Tx for Trichomoniasis is ⬜ . What are the precautions if female patient is breastfeeding?

A

[2 gm metronidazole PO x 1]
_________________

after taking, breast milk should be expressed and discarded x 24h

110
Q

Based on PECARN rule, name the [high risk Pediatric TBI features] for [2 -18 yo] (5)

A

high risk Ped TBI = [noncontrast head CT (or 5h obs if med risk)]

111
Q

Based on PECARN rule, name the [high risk Pediatric TBI features] for [0 -1y 11m] (5)

A
112
Q

Give brief descriptions that differentiate Postpartum

Blues vs Depression vs Psychosis

A
  • Blues = onsets PPD1, peaking at PPD5 and subsiding PPD14, worst w/lactation
  • Depression = onset between [1 month - 12 months after birth] Traditional s/s. Previous Depression hx is RF
  • Psychosis = RARE but onsets IMMEDIATELY after birth
113
Q

Why can’t Ceftriaxone be used during the 1st month of life?

A

Ceftriaxone can displace albumin-bound bilirubin ➜ allows free bilirubin to cross blood brain barrier ➜ Kernicterus

114
Q

What microbes are the most common causes of serious bacterial infection in [neonates LOE 28 days]? -3

________________

Name abx for each -3

A
  1. GBS = Ampicillin
  2. Listeria = Ampicillin
  3. E Coli = [Gentamicin {or CefoTaxime/CefTazidime if meningitis suspected}]
115
Q

neonates > 28 days old

what organisms cause sepsis? -3

________________

Name the empiric abx -2

A
  1. [Ceftriaxone (Strep Pneumo + Neisseria meningitidis)]
  2. [+/- Vancomycin (MRSA or meningitis)]
116
Q

Explain why Breastfeeding is associated with iron deficiency
_________________

thalassemia< [MIX 13]< IDA

A

Breastfeeding only provides sufficient iron for first 6 months of life.

[infants ≥6 months] MUST be introducted [iron-rich solid foods (pureed meats/cereals)] to prevent iron deficiency anemia
_________________

(thalassemia < [Mentzer Index 13 (MCV/RBC)]< IRON DEFICIENCY ANEMIA)

117
Q

There are 3 types of female Urinary Incontinence

Describe [Stress Urinary Incontienence]

A

urinary leakage with INC INTRAABDOMINAL STRESS (coughing / sneezing / laughing / lifting)

118
Q

There are 3 types of female Urinary Incontinence

Describe [Urgency Urinary Incontienence Overactive Bladder]

A

URGE to urinate Suddenly / Overwhelmingly / Frequently

119
Q

There are 3 types of female Urinary Incontinence

Describe [Overflow Urinary Incontienence]

A

constant OVERFLOWING DRIBBLE OF URINE and bladder distension 2/2 incomplete bladder emptying

(either from mechanical outlet obstruction or DM Detrusor hypOactivity)

120
Q

There are 3 types of female Urinary Incontinence

dx for [Overflow Urinary Incontienence] -2

________________

tx for [Overflow Urinary Incontinence] -2

A

[⇪ post void residual] > 150 cc + neuropathy

________________

[intermittent self catherterization] + [correct underlying etx for incomplete bladder emptying]

121
Q

Congenital hypOthyroidism is a common and preventable cause of ⬜ in kids; but may be difficult to detect. Why is that?
_________________

how do you manage congenital hypOthyroidism?

sx: hypOtonia/poor feeding/lethargy/constipation

A

intellectual disability ; because maternal T4 crosses placenta most newborns lack clinical signs of congenital hypOthyroidism (hypOtonia, poor feeding, lethargy, constipation) at birth
_________________
give infant levothyroxine [by 2 WEEKS OF AGE]

T4 is important for neurodevelopment and myelination

122
Q

What are the complications of Cryptorchidism? -4

________________

How does Orchiopexy affect the incidence of all these?

A
  1. TESTICULAR CANCER (orchiopexy enables increased detection and ⬇︎ testicular CA but it will still remain higher than gen pop)

________________

  1. Testicular Torsion (orchiopexy ⬇︎)
  2. Inguinal hernia (orchiopexy ⬇︎)
  3. Subfertility (orchiopexy ⬇︎)
123
Q

by age ⬜ , full term infants should be able to sleep thru the night without overnight feeds

If they can’t, how do you change this?

A

6 months old
_________________

AVOID OVERNIGHT FEEDS

(do NOT offer feeding during nocturnal awakenings. Just check on baby)

124
Q

What is the normal age parameters for physiologic genu varum?
_________________

genu valgum?

A

varum “bow legged” = [onset birth - resolve by 2 year old]

_________________

valGus “Knock Kneed” = [onset 2y - resolve by 7y]

obtain imaging only if persist beyond upper age limit

125
Q

If Pap Smear testing reveals [High Grade Squamous intraepithelial lesion], what is the next step in management? -2

A

COLPOSCOPY = cervix magnified to identify and BIOPSY abnormal areas

________or________

LEEP (loop electrosurgical excision procedure) = excision of cervical transformation zone and surrounding endocervix - [only if done with childbearing]

126
Q

Your infant patient is due for the [Varicella Zoster Virus] Vaccine, but the patient lives with its immunocompromised grandmother

How do you manage this? (2)

A
  • VZV vaccine CAN be administered to immunocompetent patients with household contacts who are immunoCOMPROMISED as long as no RASH develops
  • monitor for pt rash –(if rash presents)–> isolate patient from household contact
127
Q

Major causes of 1st trimester bleeding - 3

A
  1. Spontaneous Abortion (inevitable vs threatened)
  2. Acute cervicitis (postcoital bleeding, Friable cervix with discharge)
  3. Molar Pregnancy
128
Q

Differentiate the following spontaneous abortions:

Inevitable abortion

Threatened abortion

Missed abortion

Complete abortion

spontaneous abortion = occurs < 20 WG

A
  1. INEVITABLE = vaginal bleeding < 20 WG with cervical os dilated –>abortion will inevitably happen soon
  2. THREATENED = early vaginal bleeding < 20 WG with cervical os closed is clearly a threat to a STILL LIVING FETUS
  3. MISSED = Fetal death with cervical os closed…which is why we Missed it - (pt will have pregnancy sx that just suddenly disappear out of nowhere)
  4. COMPLETE = ALL PRODUCTS OF CONCEPTION COMPLETELY EXPEL AND THEN CERVIX CLOSES BACK UP

spontaneous = occurs < 20 WG

129
Q

What are the 3 criteria options for diagnosing

Cervical insufficiency

A

[*pp:* ≥2 painLESS** 2nd trimester spontaneous abortions]

OR

[C**p: Ultrasound showing short cervix ≤25 mm]

OR

[*Cp:* (early < 24WG ) painLESS** advanced cervical Dilation]
_________________
pp = previous pregnancy

Cp = Current pregnancy

130
Q

⬜ placement ⬇︎ risk of 2nd trimester loss in pregnant patients with cervical insufficiency.

What is it called when [pregnancy with cervical insufficiency] fails and prolapses? and what’s the prognosis for this?

A

Cerclage;

[Previable Prolapsing amniotic membrane];

POOR PROGNOSIS (PPAM a/w imminent delivery/high risk preterm)

131
Q

Is it safe to direct breastfeed if Lactational mastitis is present?

_________________

etx for Lactational mastitis

A

YES!

(Interrupting breastfeeding can ➜ ⬇︎maternal milk production)

_________________

breastfeeding difficulties (can be improved with lactation consultant) ➜ [prolonged engorgement (diffuse BL breast TTP)] ➜ inadequate milk drainage ➜ clogged milk ducts ➜ Bacteria from skin enters stagnant milk ➜ Lactational mastitis

132
Q

Lactational mastitis occurs ⬜ and presents with (⬜:3). What’s treatment for it? (3)

A

[first 3 mo postpartum] ;

(LIES) Lactational mastitis =[Induration / Erythema / Swelling & Pain]
_________________

([oral Dicloxacillin] or [oral Cephalexin]) + [frequent milk drainage]
_________________

breastfeeding difficulties (can be improved with lactation consultant) ➜ prolonged engorgement ➜ inadequate milk drainage ➜ clogged milk ducts ➜ Bacteria from skin enters stagnant milk ➜ Lactational mastitis

133
Q

Breast engorgement presents as ⬜

Tx? (3)

A

diffuse BL breast TTP
_________________
BREAST PUMPING / NSAID / Cold Compress

134
Q

[Condyloma acuminata genital warts] is caused by ⬜. How is delivery managed in patients who are pregnant?
_________________

What topical medication is typically used to treat CAGW?

A

[HPV 6 & 11] ; C-section does NOT prevent vertical transmission of HPV so Women with Condyloma Acuminata genital warts can proceed with vaginal delivery (unless they’re large/ obstructive)
_________________
Podophyllum [contraindicated in pregnancy]

135
Q

What are the guidelines for Breast Cancer Screening? (2)

A
136
Q

Postpartum endometritis cp -4
_________________
tx (2)

RF: CESAREAN / GBS+ / prolonged ROM / protracted labor / operative vaginal delivery

A

postpartum: [uterine fundal tenderness] , vaginal discharge, vaginal bleeding, fever
_________________
Clindamycin + gentamicin

polymicrobial infection

137
Q

What is Pregnancy induced pruritus?
_________________
tx? (3)

A

common benign condition = focal abd pruritus without rash
_________________
tx = oatmeal baths | UV | [Histamine R Blocker]

Intrahepatic Cholestasis of Pregnancy = GENERALIZED PRURITUS INCLUDING PALMS/SOLES, NO RASH, A/W IUFD

138
Q

pregnant patient

Diagnosis?

Tx?

A

pemphigoid gestationis ; topical Triamcinolone

  • [Pregnancy Induced Pruritus (abd pruritus without rash)] ➜ gzd urticarial papular RASH starting umbilicus and trunk ➜ eventually tense bullae*
  • Pemphigoid gestationis is autoimmune*
139
Q

Pt with severe mania is treated with ⬜. If this patient does not respond to monotherapy, what should you do?

A

[mood stabilizer (Lithium/Valproate)]

; add ANTIPSYCHOTIC

140
Q

What regimen is considered in Bipolar pts who DON’T respond to [mood stabilizer monotherapy] ?

A

ADD [Antipsychotic 2ND GEN]
_________________

Treat Bipolar pts b4 they go B(AL)D!

A + L

[Antipsychotic 2ND GEN] + [Lithium or Valproate]

141
Q

S/S of Amphetamine and Cocaine withdrawal - 4

A

Coke/Meth withdrawal hits HARD

  1. Hungry
  2. Angry irritable
  3. Rest a lot w/unpleasant dreams
  4. Depressed (can mimic MDD vs Bipolar)

can last several days

142
Q

For Bipolar I dx, you need at least [__ mania sx +/- ___] that last for ___ duration.

________________

What are the mania sx? (7)

A

[3 sx +/- major depression]; 1 week duration;

BIPOLAR

Buying excessively (⬆︎ in pleasurable activity)

Inflated self-esteem

Psychomotor agitation (pacing)

awOke - won’t sleep

Lots of Language

ADD distractability

Racing thoughts

143
Q

Diagnostic criteria for Bipolar II ? - 3

A
  1. Major Depressive Episodes +
  2. hypOmanic episode +
  3. NOT functionally impaired
144
Q

Diagnostic criteria for Bipolar I ? - 3

A
  1. Major Depressive Episodes +
  2. Manic episode +
  3. Functionally impairing
145
Q

Tx for Acute Bipolar Mania -3

A

ALV

[AntiPsychotics (1st or 2nd gen)] > Lithium > Valproate

NO ANTIDEPRESSANTS

146
Q

Tx for Bipolar I and II - 6

A

Treat Bipolar pts b4 they go BALLD!

-Benzos adjunct prn

-AntiPsychotics (Only use 2nd gen for Depressive phase)

-Lamotrigine (depression phase only)

-Lithium or Valproate **

-DepakOte **

147
Q

When is it ok for Bipolar pts to discontinue their Rx therapy?

________________

Explain

A

NEVER!!

________________

It is a lifelong illness requiring maintenance tx for years (and forever in severe bipolar pts)

148
Q

Antipsychotics (___ generation) can be used to treat the depressive phase of Bipolar disorder

Which 2 are the best to be used?

A

Treat Bipolar pts b4 they go BALLD!

2nd generation Antipsychotics for Bipolar Depression =

Quetiapine and Lurasidone

149
Q

What is the clinical criteria for Mania-2

A
  1. ≥3 [BIPOLAR] sx PLUS
  2. Elevated or irritable mood > 7 days
150
Q

What is the clinical criteria for hypOmania -2

A
  1. ≥3 [BIPOLAR] sx PLUS
  2. Elevated or irritable mood 4< x <7 days
151
Q

Adolescent Depression has different cp than Adult MDD

________________

Name 4 main features
_________________

ALL DEPRESSED ADOLESCENTS MUST BE SUICIDE SCREENED!

A
  1. irritability
  2. somatic sx (tension HA)
  3. socioeducational decline
  4. anhedonia

ALL DEPRESSED ADOLESCENTS MUST BE SUICIDE SCREENED!

152
Q

Patient presents with Suicidal Ideation

What 2 factors determine if this patient should receive inpatient tx or outpatient tx?

A

+Ideation

[+PLAN and +INTENT] = Inpatient Tx

[No Plan and No Intent] = Outpatient tx

________________

153
Q

How should you manage a nonsuicidal teen who cuts themself ?

A

full psych eval (if suicidal ideation ➜ inpatient)

154
Q

s/s of Anorexia Nervosa (3)
_________________

Tx for Anorexia Nervosa typically includes ⬜ and ⬜ but When should these patients be hospitalized?(4)

A
  1. knuckle calluses (indicates self-induced vomiting)
  2. [BMI <15]
  3. distorted body image

_________________

Tx = [CBT + Nutritional Rehab] –(BESO sx)–> HOSPITALIZATION
_________________

BESO

Bradycardia / [Electrolyte ∆] / Syncope / [Orthostatic hypOtension]

155
Q

In pregnancy, c/f appendicitis can be ruled out using ⬜ and presents atypically with ⬜

A

graded compression abd ultrasound ; [R abd pain with NO peritoneal signs or McBurney TTP]

156
Q

Name the 6 body systems potentially associated with Erectile dysfunction?

A
157
Q

Pt’s Pap Smear reveals Atypical Squamous Cells of Undetermined Significance

Mngmt? - 3

A

1st: HPV typing, and if high risk (16 or 18) —>
2nd: Colposcopy and if abnml –>
3rd: Cervical biopsy

158
Q

There are several causes of abnormal uterine bleeding. give differentiating factors for each:

Pelvic organ Prolapse
_________________

Cervical CA

_________________

endocervical polyp

_________________
endometritits

_________________
leiomyoma

A

eroded and bulging mass at introitus +/- incontinence, constipation, dyspareunia
_________________
exophytic cervical lesion

_________________
smooth vermiform appearance visibily protruding thru cervical os

_________________
uterine and cervical motion tenederness

_________________
enlaged irregularly shaped uterus

159
Q

Urethral diverticula etx
_________________

s/s (3)

A

repeated infection and urethral trauma (vaginal delivery) ➜ distension of diverticulum with purulent fluid
_________________

  1. ANT vaginal wall mass
  2. postvoid dribbling
  3. dysuria
    * diagnosis confirmed with pelvic MRI or TVUS*
160
Q

⬜ (caused by hyperactive cremasteric reflex) may present very similarly to Cryptorchidism. How are they differentiated? (2)
_________________

How is this condition managed?

A

Retractile Testes;

  1. RT (caused by hyperactive cremasteric reflex) ReTains ability to manually manipulate testicle into the scrotal base
    * (In cryptorchidism, testicles can not be manipulated back down)*
  2. RT ReTains scrotal rugae

_________________
Monitor annually

161
Q

What are the 2 medical managements for elective spontaneous abortion

A
  1. [MisoPROstol (PROstaglandin analogue) 800 mcg vaginally]
  2. MiFepristone (antiprogestin)
162
Q

For pregnant women in [ACTIVE labor stage 1B], when is the patient considered to be in labor protraction?

________________

How do you treat this? (2)

A

Labor = (LA)PD

NORMAL: 1B: ACTIVE labor phase = Cervix is now 6 cm Dilated, [growing @ >1 cm /2 hr] and effacing

PROTRACTED: 1B = [≤1 cm/2hr]

________________

Oxytocin + Amniotomy

(since most common cause of [ACTIVE labor stage 1B] protraction = contraction inadequacy)

163
Q

What’s the time limit for pregnant women in [Latent labor Stage 1A] if they’re nulliparous?

________________

What about if they’re multiparous?

A

Labor = (LA)PD

1A: Latent labor phase = Strong Contractions q3-5 min (should be <20 hrs for nulliparous pts and <14 hrs for multiparous pts)

1B: ACTIVE labor phase = Cervix is now 6 cm Dilated, [growing @ >1 cm /2 hr] and effacing

________________

2 : Pushing Time! since Cervix is now 10 cm FULLY DILATED (should be ≤3 hrs for nulliparous and 2 hrs for multiparous)

________________

3 : Delivery of Baby! and then Deliver Placenta

164
Q

What’s the time limit for pregnant women in [Labor Stage 2] if they’re nulliparous?

________________

What about if they’re multiparous?

A

[nulliparous <3 hr]

[MULTIPAROUS <2 hr]

(add 1 hour if +epidural)

________________

  • Labor = (LA)PD*
  • 2 : PUSH time! since Cervix is now 10 cm FULLY DILATED (<3 hrs for nulliparous and <2 hrs for multiparous (add 1 hr if +epidural)))*
165
Q

What are the stages of Labor?

A

Labor = (LA)PD

1A: Latent phase = Strong Contractions q3-5 min (should be <20 hrs for nulliparous pts | <14 hrs for multiparous)

1B: ACTIVE phase = Cervix 6 cm Dilated, [growing @ 1-2 cm/hr] and effacing

________________

2 : Pushing Time! since Cervix is now [10 cm FULLY DILATED] (nulliparous <3 hrs | MULTIparous <2 hrs)

________________

3 : Delivery of Baby! ➜ then [Deliver Placenta (<30 min)]

https://www.youtube.com/watch?annotation_id=annotation_563008&feature=iv&src_vid=Xath6kOf0NE&v=ZDP_ewMDxCo

166
Q

What’s the time limit for pregnant women to deliver the Placenta?

A

Deliver Placenta < 30 min

________________

Labor = (LA)PD

1A: Latent phase = Strong Contractions q3-5 min (should be ≤20 hrs for nulliparous pts and 14 hrs for multiparous pts)

1B: ACTIVE phase = Cervix is now 6 cm Dilated, [growing @ 1-2 cm/hr] and effacing

2 : PUSH time! since Cervix is now 10 cm FULLY DILATED (<3 hrs for nulliparous and <2 hrs for multiparous (add 1 hr if +epidural)))

3 : Delivery of Baby! and then Deliver Placenta (<30 min)

167
Q

What are the 4 clinical features for diagnosing [ACTIVE labor stage 1B]?

A
  • Labor = LAPD*
    1. [Strong Contractions every 3-5 min] = LATENT

+

  1. [Cervix Dilation > 6 cm]
  2. [Cervix growing at 1-2 cm/hr]
  3. [Cervix effaced]
    * Fetal Heart Tracing is IRRELEVANT to diagnosing active labor*
168
Q

What is the first manifestation of pubety for females?

A

BREAST –(2.5 years later)–> Menarche by 15 yo

169
Q

What is the workup for Primary Amenorhhea?-3

A

girls with no menses by age 15 but who have normal growth and secondary sex characteristics

If no breast –> FSH

(if FSH ⬇︎)–> Pituitary MRI

(if FSH ⬆︎) –> karyotyping

[2a] A ⼀ Step 2 OD USLME (21 decks)

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