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med 5 > Gyn > Flashcards

Gyn Flashcards

1
Q

What is the pathophysiology of primary dysmenorrhea

A

increased endometrial prostaglandin (PGF2 alpha) production → vasoconstriction/ischemia and stronger, sustained uterine contractions

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2
Q

State 5 main causes of secondary dysmenorrhea

A 
Endometriosis 
Pelvic inflammatory disease (PID)
Intrauterine device (IUD)
Uterine leiomyoma
Adenomyosis
Psychological factors
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3
Q

Definition of primary and secondary amenorrhea

A
  1. Definition: the absence of menses (onset of menarche) at the age of 15 or older
  2. Absence of menses for more than 3 months (in women with previously regular cycles) or 6 months (in women with previously irregular cycles)
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4
Q

State some casues of primary amenorrhea

A

Patients with normal puberty
Anatomic anomalies: hymenal atresia, vaginal septum, Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome
Competitive sports

Patients with growth delay and developmental retardation
Hypogonadism
Hypergonadotropic hypogonadism
Hypogonadotropic hypogonadism

Patients with virilization
Congenital adrenal hyperplasia (CAH)
Polycystic ovary syndrome (PCOS)

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5
Q

What are the structural causes of AUB

A

Structural causes: polyps, adenomyosis, leiomyomas, malignancy/hyperplasia (PALM)

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6
Q

What are the functional causes of AUB

A

Non-structural causes: coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified (COEIN)

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7
Q

Define menorrhagia

A

Bleeding volume > 80 mL and/or length of menstruation > 7 days

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8
Q

State some causes of spotting

A
  1. After ovulation
  2. Breakthrough bleeding: mid-cycle bleeding caused by hormone imbalances (usually after starting new OCP therapy)
    - Estrogen breakthrough
    - Progesterone breakthrough
    - Estrogen withdrawal
  3. Endometriosis
  4. Myomas, polyps, carcinomas, contact bleeding (e.g., in patients with cervical carcinoma or during gynecological examination)
  5. During pregnancy: may indicate imminent abortion
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9
Q

Gyna term for intermenstrual bleeding

A

Metrorrhagia

Menometrorrhagia- Heavy and irregular bleeding

Don’t forget to rule out endometrial cancer/hyperplasia, cervical cancer
Ovarian insufficiency
Oral contraceptive use

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10
Q

What is the point of doing a pelvic USS

A

can be considered to rule out structural anomalies (e.g., leiomyoma, adnexal mass); allows evaluation of endometrial thickness

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11
Q

Endometrial biopsy/Pipelle is used for

A

The patient is > 45 years of age OR
The patient is at high risk for endometrial cancer (risk factors include: age > 35 years, obesity, polycystic ovary syndrome, diabetes mellitus, tamoxifen therapy) or has failed medical management OR
Endometrial thickness is ≥ 4 mm in a postmenopausal patient

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12
Q

Acute AUB with haemodynamically stable- bleeding alot out what would you give

A

High-dose conjugated estrogen(High levels of estrogen trigger rapid growth of the endometrium and thereby stop sudden, heavy bleeding from the uterine surface. Conjugated estrogen therapy is contraindicated in women with breast cancer and/or those at a high risk of thrombosis)

1st line
High-dose conjugated estrogen OR
multi-dose regimens of OCs or oral progestins

2nd line
Oral or IV tranexamic acid acts within 2–3 hours of administration and should not be used in women at a high risk for thrombosis.

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13
Q

Pharmacological treatment for menorrhagia

A

tranexamic acid
oral contraceptives
progestin (PO, IV, or as an IUD)

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14
Q

Surgical indications for AUB

A

Severe bleeding/patient hemodynamically unstable
Patient unresponsive to hormonal treatment
Hormonal treatment contraindicated (e.g., breast or endometrial cancer)
Underlying medical condition requiring surgical repair

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15
Q

4 surgical procedures for AUB are

A
  1. Dilation and uterine curettage (D&C) with concomitant hysteroscopy-preserve FERTILITY- it is both Diagnostic and therapeutic
  2. Endometrial ablation
  3. Transcatheter uterine artery embolization
  4. Hysterectomy: reserved for women who do not respond to any other treatment
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16
Q

Why do young girls(age 10-12) have irregular bleeding

A

In girls with acute abnormal uterine bleeding and onset of menarche within the last year, anovulatory bleeding due to immaturity of the hypothalamic-pituitary-gonadal axis should be considered.

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17
Q

AUB and the woman wants to preserve fertility, what is the best surgical options

A

Dilation and uterine curettage (D&C) with concomitant hysteroscopy-preserve–> Diagnostic and therapeutic

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18
Q

Endometrial ablation leads to increased risk of

A

Ectopics

Pregnancy may still occur following endometrial ablation but is associated with a higher risk of ectopic pregnancies, miscarriage, and fetal and maternal complications. Following ablation, use of contraceptives is recommended to prevent pregnancy.

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19
Q

Endometriosis

  • main clinical features
  • treatment options
A

Chronic pelvic pain that worsens before the onset of menses(cyclic pain)
Dyspareunia
Infertility–> many patients will only recognize they have endo when the doc tell them they have endometriosis
Rectovaginal tenderness and palpable adnexal masses (chocolate cysts) on palpation

Pharmacologic
Combination oral contraceptive pills (first-line)
GnRH analogs, danazol, NSAIDs, progestins

Surgical
Conservative: excision, cauterization, and ablation of lesions; removal of adhesions
Definitive: total abdominal hysterectomy (TAH)/bilateral salpingo-oophorectomy (BSO)

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20
Q

Why is endometriosis so concerning and must be treated early

A

Can lead to INFERTILITY

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21
Q

Adenomyosis

  • main clinical features
  • treatment options
A

Dysmenorrhea
Menorrhagia
Chronic pelvic pain
Uniformly enlarged uterus

Pharmacologic
NSAIDs (first-line)
Oral contraceptive pills, progestins

Surgical
Conservative: hysteroscopy → endometrial ablation/resection
Definitive: hysterectomy

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22
Q

Gyn term for fibroid/fibroma

A

Uterine leiomyoma Fibroid, Uterine fibromyoma

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23
Q

Treatment for uterine leiomyoma/fibroid

A

Treat only if symptomatic

Pharmacologic
GnRH agonists, progestins, levonorgestrel-releasing IUD
NSAIDs
Antifibrinolytics
Androgenic agonists (e.g., danazol)
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24
Q

What is the cut-off on USS for endometrial thickness, for you to be worried about cancer

A

4-5mm, then you should have a biopsy(hysteroscopy, D and C)

Diagnosis- pipelle(office procedure)
Hysteroscopy D&C

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25
Q

What are the 2 types of endometrial cancer, which one is most common

A

Type 1- 80-90% endometrial cancers

Type 2-clear cell, carcinosarcoma(MMMT)–> higher grade, worse prognosis–> No risk factors and healthy women get it–> VERY BAD luck

Genetic- Lynch Syndrome- HNPCC

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26
Q

Which hormone is protective against endometrial cancer

A

Progesterone–> Give Mirena(IUD) and pill is also protective

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27
Q

Risk factors for endometrial cancer are

COLDNUT

A

C-cancer(breast, bowel and ovarian)
O-Obesity
L-Late menopause
D-Diabetes Mellitus

Nulliparity
Unopposed estrogen
Tamoxifen use

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28
Q

Intermenstrual bleeding and post-coital bleeding must always rule out

A

Cervical cancer

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29
Q

Why is CST done every 5 years? are they trying to save money by not doing it every 2 years?

Does HPV equal cancer doc

A

Grows slowly
The body can get rid of the virus on its own
and looking at the virus itself no the cell changes
age of highest sexual encounters- 25
screening too early–> overtreatment

No having HPV means there is likely pre-cancerous changes that COULD/COULD NOT lead to cancer. Does that make sense?
HPV leads to pre-cancerous changes

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30
Q

Vulva itch in older woman, what should you rule out

A

Vulval cancer

lichen sclerosis-Lichen sclerosus is often mistaken for thrush so see your doctor if you are often itchy in the vulvar or anal area.

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31
Q

Gestational trophoblastic disease/neoplasia

  • benign
  • malignant
A

benign–> complete and partial(incomplete) mole

incomplete mole–> has the fetus appearance(use its one egg and 2 sperms)

GTN malignant–> invasive mole or persistent GTN
Choriocarcinoma
Placental-site trophoblastic trauma

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32
Q

What is the most common cause of premature menopause

  • how do you diagnose the condition
  • what is the treatment
A

Menopause occurring before the age of 40 is considered premature. A common cause of premature menopause is ovarian insufficiency. The diagnosis is confirmed by increased FSH levels occurring after more than three months of amenorrhea in a woman under the age of 40. Treatment involves hormone replacement therapy.

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33
Q

How long do you have to stay without a period to confirm menopause

A

The official date of menopause is the last appearance of menstrual blood, which is determined retroactively after 12 months of amenorrhea

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34
Q

Why is obesity a risk factor for endometrial cancer

A

Causes unopposed oestrogen. Some estrogens are produced by peripheral aromatase conversion of adrenal androgens in adipose tissue.
Hence more oestrogen in the body increased risk of endometrial cancer

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35
Q

State some clinical features of menopause

A

Autonomic symptoms
Increased sweating, hot flashes, and heat intolerance
Vertigo
Headache

Mental symptoms
Impaired sleep (insomnia and/or night sweats)
Depressed mood or mood swings
Anxiety/irritability
Loss of libido

Atrophic features

  • Breast tenderness and reduced breast size
  • Vulvovaginal atrophy
  • Atrophy of the vulva, cervix, vagina (thin, pale, smooth epithelial layer, associated with vaginal dryness, pruritus, and dyspareunia; see atrophic vaginitis for details)
  • May present with features that mimic a urinary tract infection (i.e., dysuria, urinary frequency and urgency)

Weight gain and bloating

Increased risk of coronary artery disease

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36
Q

What happens to Estrogen, progesterone and FSH

A

↓ Estrogen, ↓ progesterone, ↑↑ FSH

Hyperthyroidism and menopause present similarly. For this reason, serum TSH should be checked in all suspected perimenopausal cases with heat intolerance and disturbed sleep to determine the cause!

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37
Q

What are some contraindications for HRT/ERT(estrogen replacement therapy)

A

Risks
Cancer
Unopposed estrogen can result in endometrial hyperplasia → increased risk of endometrial cancer
Estrogen plus progestin therapy → increased risk of breast cancer
Cardiovascular disease: coronary heart disease, deep vein thrombosis, pulmonary embolism, stroke
Gallbladder disease
Stress urinary incontinence

Contraindications
Undiagnosed vaginal bleeding
Pregnancy
Breast cancer/endometrial cancer
Chronic liver disease
Hyperlipidemia
Recent DVT/stroke
Coronary artery disease
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38
Q

Treatment for chlamydia

A

Azithromycin
doxycycline

or macrolides

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39
Q

What is the gold standard for chlamydia infection

A

NAAT

Nucleic acid amplification tests (NAAT): the gold standard

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40
Q

If the gonococcal infection is suspected with chlamydia, what is the treatment

A

If the gonococcal infection is suspected, combine azithromycin with ceftriaxone.

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41
Q

What are some complications of chlamydia infection

A

1) PID
2) Ectopic pregnancy
3) Infertility
4) Reactive arthritis
5) Perinatal transmission of infection to the newborn is a possible → risk of conjunctivitis, otitis media, and/or pneumonia

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42
Q

Intermenstrual bleeding can happen with PID- T/F

A

True

Fever, abdominal/pelvic pain, dyspareunia
Abnormal, intermenstrual bleeding
Fitz-Hugh-Curtis syndrome (perihepatitis with RUQ pain)

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43
Q

Extragenital manifestations of gonorrhea include

A

1) Pharyngitis (sore throat, pharyngeal exudate, cervical lymphadenitis)
2) Proctitis
3) Disseminated gonococcal infection–>

Clinical triad (arthritis-dermatitis syndrome)
Polyarthralgias: migratory, asymmetric arthritis that may become purulent

Tenosynovitis: simultaneous inflammation of several tendons (e.g., fingers, toes, wrist, ankle)

Dermatitis: vesicular, pustular, or maculopapular lesions, possibly with a necrotic or hemorrhagic centre

Purulent gonococcal arthritis
Abrupt inflammation in up to 4 joints (commonly knees, ankles, and wrists)

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44
Q

Yellow greenish discharge, purulent particularly in the morning

A

Gonorrheal infection

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45
Q

Is disseminated gonococcal infection= reactive arthritis

A

Nope

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46
Q

Two herpes conditions seen in children are

A

Herpetic gingivostomatitis and herpetic whitlow.

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47
Q

HSV gingivostomatitis vs herpetic whitlow

A

herpetic gingivostomatitis- painful lesions of the oral and pharyngeal mucosa

Herpetic whitlow causes blisters on the fingers with pronounced regional lymphadenopathy.

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48
Q

HSV most common in adults

A

HSV-1

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49
Q

HSV-1 happens in the

A

near the oral, lips

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50
Q

DDx for HSV-1

A 
Shingles (Herpes zoster)
Aphthous ulcers
Herpangina
Hand, foot, and mouth disease
Candidiasis
Syphilitic chancre or chancroid
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51
Q

Genital herpes is HSV

A

HSV2

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52
Q

What are some characteristics of genital herpes

A

-Most patients are asymptomatic
-Genitals: redness, swelling, tingling, pain, pruritus
-Unusual discharge
-Painful lymphadenopathy in the groin area
-After several days, “punched-out” lesions may appear that later ulcerate.
Lesions may appear as single or disseminated, painful red bumps or white vesicles.
They are typically located on or around the genitals and anus.

53
Q

Herpetic gingivostomatitis, who gets it

- what are some clinical features

A

Mainly in children (∼ 1–6 years), but also immunocompromised patients (e.g., agranulocytosis, HIV)
Prodrome (fever, malaise) often mistaken for teething in children.

Pharyngitis, cervical lymphadenopathy
Gingivitis; erythema and painful ulcerations on perioral skin and oral mucosa, especially on the inner cheek, soft palate, and tongue

54
Q

Primary syphilis presents as

A

Painless chancre(primary lesion)

55
Q

Which test offer screening for syphilis and which ones offer diagnosis

A

Nontreponemal tests are used for screening purposes, while treponemal tests confirm the diagnosis.

56
Q

What are the 2 non-treponemal tests

A

Rapid Plasma Reagin (RPR): generally the test of choice

Venereal Disease Research Laboratory (VDRL)

57
Q

What are the treponemal tests(2) and what do they detect

A

Detect specific antibodies to treponemal antigens

Treponema pallidum particle agglutination (TPPA)
Fluorescent treponemal antibody absorption test (FTA-ABS)

58
Q

What are 2 tests that can directly test for the antigen for syphilis

A

1) Darkfield microscopy, may be combined with immunofluorescence
2) Polymerase chain reaction (PCR)

59
Q

What is 1st line for treatment for syphilis

What if they are allergic to the mentioned 1st line drug

A

First-line therapy: benzathine penicillin G

Treat with doxycycline or ceftriaxone if allergic

60
Q

Jarisch-Herxheimer reaction-what is that?

A

an acute, transient, systemic reaction to bacterial endotoxins and pyrogens that are released after initiation of antibiotic therapy
-occurs within 24 hours

61
Q

If urethritis is suspected, what are the other infection you can think of

A

Acute cystitis
Epididymitis
Prostatiti

62
Q

What are the two types of urethritis

A

Gonococcal and non-gonococcal

63
Q

What are 3 of the most common causes of APH

A

Common causes of APH are bloody show associated with labor, miscarriage, placental previa, and placental abruption. Rare causes include vasa previa and uterine rupture.

64
Q

Define APH

A 
Antepartum haemorrhage (APH) is defined as bleeding from or in to the genital tract, occurring from 20+
weeks of pregnancy and prior to the birth of the baby

During 3rd trimester

65
Q

What are the most important causes of APH

A

The most important causes of APH are placenta praevia
and placental abruption, although these are not the most common.

PP and PA

66
Q

Placenta and vasa previa which one occurs before rupturing of membranes and which one after

A

Placenta previa and vasa previa on the other hand typically manifest prior to rupture of membranes or after rupture of membranes respectively, with painless vaginal bleeding and fetal distress

PP- before
VP-after

67
Q

Any APH what questioned should be asked during in history

-any miscarriage as well

A

Domestic violence

68
Q

How can you classify APH

A

Spotting–> Stains, streaking, or spotting of blood
Minor Haemorrhage–> Less than 50mL
Major Haemorrhage–> 50-1000mL without signs of circulatory shock
Massive Haemorrhage–> Greater than 1000mL with or without signs of circulatory shock

69
Q

What are the upper genital tract causes(uterine/placental)

A

1) Placental abruption
2) Vasa previa
3) Placenta previa
4) Abnormal placentation- accreta, increta and percreta
5) Uterine rupture

70
Q

What are the upper genital tract causes(uterine/placental)

A

1) Placental abruption
2) Vasa previa
3) Placenta previa
4) Abnormal placentation- accreta, increta and percreta
5) Uterine rupture

71
Q

What are the lower genital tract causes

A

Cervical- Cervicitis, ectropion and cancer

Vagina and others

72
Q

Should we do a VE exam or a spec if APH is suspected

A

NOOOOO WE NEED TO RULE OUT PLACENTA PREVIA

73
Q

Kleihauer test- what are we looking for and why should I order it

A

is a blood test used to measure the amount of fetal hemoglobin transferred from a fetus to a mother’s bloodstream.

It is usually performed on Rh-negative mothers to determine the required dose of Rho(D) immune globulin (RhIg) to inhibit formation of Rh antibodies in the mother and prevent Rh disease in future Rh-positive childre

74
Q

Kleihauer test- what are we looking for and why should I order it

A

Not really worth it for Rh+ women but definitely worth it for Rh- women

is a blood test used to measure the amount of fetal hemoglobin transferred from a fetus to a mother’s bloodstream.

It is usually performed on Rh-negative mothers to determine the required dose of Rho(D) immune globulin (RhIg) to inhibit formation of Rh antibodies in the mother and prevent Rh disease in future Rh-positive childre

75
Q

Define placenta previa

A

Placental location below the presenting part of the fetus

76
Q

What is the hallmark for placenta previa bleeding

A

Painless

77
Q

What is the considered a clear placenta previa

A

2cm away from os

78
Q

What are the 3 P’s of cervical ectropion

A

1) Period
2) Pill
3) Pregnancy(a common cause of APH)

79
Q

Define placental abruption

A

Separation of the placenta with associated bleeding from exposed bleeding

80
Q

Hyperemesis gravidum- definition

A

Does not have a proper defintion, varies

1) Severe NV during pregnancy
2) Continued NVP despite oral anti-emetics
3) > 5% weight loss in the context of NV
4) Ketonuria
5) Electrolyte imbalance

81
Q

DDX for NVP in pregnancy

A

Multiple pregnancies and GTN should be considered

82
Q

Tell me some natural treatment for NVP

A

Ginger

Vitamin B6

83
Q

4 signs of the placenta are separating from the wall

A

Umbilical cord lengthens
Gush of blood
The uterus is firming up and uterus
The uterus is rising up to the anterior abdomen

84
Q

What is the cause of uterine inversion

A

Pulling on the umbilical cord prior to the 4 signs of placental separation

85
Q

What thing should you consider in cord prolapse

A

Is the cord pulsating or not?

86
Q

What are some risk factors of placental abruption

A 
Previous placental abruption
Hypertension
Trauma
Smoking
Cocaine use
Preterm premature rupture of the membranes
87
Q

Bright red vaginal bleeding in the 3rd trimester think

A

Placenta previa

88
Q

What is velamentous cord insertion in vasa previa

A

Abnormal cord insertion into chorioamniotic membranes, resulting in exposed vessels surrounded only by fetal membranes and not protective Wharton’s jelly.

89
Q

What is bloody show

A

Associated regular uterine contractions and cervical changes

A small amount of blood or blood-tinged mucus that is usually passed prior to labor or in early labor.

90
Q

What is the most common cause of placental abruption

A

HTN

91
Q

Continuous, dark, vaginal bleeding in the 3rd trimester think

A

Placental abruption

92
Q

If its placenta previa can you delivery vaginally

A

Vaginal delivery should never be attempted outside the operating room in a patient with placenta previa

93
Q

A woman infected with choro will present as, what are the symptoms and what are the signs

A

Infected women typically present with

1) fever
2) purulent vaginal discharge
3) and malodorous amniotic fluid

The combination of maternal (> 120/min) and fetal tachycardia (> 160/min) is highly indicative of intrauterine infection

94
Q

What are some symptoms of choro

  • maternal-5
  • fetal-1
A 
Maternal
Fever (> 38 °C or > 100°F)
Tachycardia > 120/min
Uterine tenderness, pelvic pain
Malodorous and purulent amniotic fluid, vaginal discharge
Premature contractions, PROM

Fetal tachycardia > 160/min in cardiotocography

95
Q

What is a common cause of neonatal infection

A

GBS

96
Q

What are the 2 most common cause of neonatal infections

A

Streptococcus agalactiae (GBS) and Escherichia coli are the most common causes of both early- and late-onset neonatal sepsis!

97
Q

Congenital infections are caused by pathogens transmitted from mother to child during pregnancy (transplacentally) or delivery (peripartum). What are they?

A

TORCH infections

98
Q

What does TORCH stand for

A 
Toxoplasmosis
Others (e.g., syphilis, varicella, parvovirus B19 infection, listeriosis)
Rubella
Cytomegaly (CMV)
Herpes simplex virus (HSV) infection
99
Q

Hemolytic disease of the newborn has to 2 conditions within it to cause HDFN what are they

-which one is worse

A

Rh incompatibility –> won’t affect the current pregnancy, but second one is worse
ABO incompatibility–> will affect the current pregnancy, however, will have a milder course of the disease progression

ABO incomp - Newborn infants may present with pallor, jaundice, and hepatosplenomegaly.

100
Q

What is hydrops fetails

A

A fetal condition characterized by generalized edema and accumulation of fluid in serous cavities (e.g., pleural effusion, pericardial effusion, ascites).

Hydrops fetalis (only expected in cases of Rh incompatibility)

101
Q

erythroblastosis fetalis is

A

HDFN

Hemolytic disease of the newborn, also known as hemolytic disease of the fetus and newborn, HDN, HDFN, or erythroblastosis fetalis,

102
Q

Which HDFN is milder

A

ABO incompatibility usually has a significantly milder course of disease than Rhesus incompatibility!

103
Q

Which coombs test will show positively in HDFN

A

Rh incompatibility

104
Q

Which HDFN happens in the 1st trimester

A

ABO incompatibility

105
Q

What diagnostic test can be pre-natal and post-natal to determine HDFN

A

Prenatal diagnosis

Imaging
Ultrasound: to determine hydrops fetalis

Doppler sonography of fetal blood vessels → increased flow rate indicates fetal anemia

Postnatal diagnosis
If newborn has signs of hemolysis, conduct Coombs test (either direct or indirect)
In Rh incompatibility: positive
In ABO incompatibility: weak-positive or negative

106
Q

What is the treatment for HDFN prenatally and postnatally

A

Prenatal
Intrauterine blood transfusion

Postnatal
Anemia: iron supplementation and, if necessary, RBC transfusion
Hyperbilirubinemia: phototherapy; if necessary, exchange transfusion with red blood cells (→ see the treatment of neonatal jaundice)
In severe cases, IV immunoglobulin (IVIG) may be administered

107
Q

What are the indications for Anti-D immunoglobulin (RhoGAM)

A

Further indications (in Rh negativity)
After miscarriage, ectopic pregnancy, or termination of pregnancy
Bleeding during pregnancy
Following invasive procedures (e.g., amniocentesis, chorionic villus sampling

108
Q

What is the life-threatening progression of pre-eclampsia

A

HELLP syndrome

109
Q

What is the pathophysiology of HTN in pregnancy

A

Arterial hypertension with systemic vasoconstriction causes placental hypoperfusion → release of vasoactive substances → ↑ maternal blood pressure to ensure sufficient blood supply of the fetus

110
Q

Why is there an increased risk of DVT in HTN in pregnancy

A

Systemic endothelial dysfunction causes placental hypoperfusion → ↑ placental release of factors → endothelial lesions that lead to microthrombosis

111
Q

What are the consequences of vasoconstriction and microthrombosis in HTN pregnancy

A

Organ ischemia and damage

1) Preeclampsia: multiorgan involvement (primarily renal)
2) Eclampsia: predominantly cerebral involvement
3) HELLP syndrome: severe systemic inflammation with multiorgan hemorrhage and necrosis (particularly liver involvement)

112
Q

Chronic hypoperfusion of the placenta leads to

A

Chronic hypoperfusion of the placenta → insufficiency of the uteroplacental unit and fetal growth restriction

113
Q

When we pre-eclampsia most likely occur

A

34 weeks

114
Q

What will you expect from HELLP syndrome, like what are the signs

A

Rapid clinical deterioration (DIC, pulmonary edema, acute renal failure, stroke, abruptio placentae)

115
Q

Preeclampsia with severe features includes

A

Severe hypertension (systolic ≥ 160 mmHg or diastolic BP ≥ 110 mmHg)
Proteinuria, oliguria
Headache
Visual disturbances (e.g., blurred vision, scotoma)
RUQ or epigastric pain
Pulmonary edema
Cerebral symptoms (e.g., altered mental state, nausea, vomiting, hyperreflexia, clonus)

116
Q

What is ddx for eclampsia/ Seizure disorder in pregnancy-4

A

1) Epilepsy
2) Encephalitis
3) Metabolic disorders (e.g., hypoglycemia, hyponatremia)
4) Hemorrhagic stroke
5) Ischemic stroke
6) Withdrawal syndromes

117
Q

Differential diagnosis of HELLP syndrome-3

A

Causes of thrombocytopenia and liver impairment during pregnancy

Thrombotic microangiopathy (TTP, HUS)
Fulminant viral hepatitis
Acute fatty liver of pregnancy
Intrahepatic cholestasis of pregnancy

118
Q

Intrahepatic cholestasis of pregnancy- treatment

A

First-line medication: ursodeoxycholic acid PO(UDCA)

An early therapy with ursodeoxycholic acid reduces the risk of preterm birth and stillbirth.

119
Q

Position patient on left lateral decubitus position why in eclampsia patients

A

Prevent placental hypoperfusion through compression of the inferior vena cava and reduce the risk of aspiration in the mother

120
Q

Cure for eclampsia

A

Delivery

121
Q

Most common cause of IUGR

A

Placental insufficiency

122
Q

What are some fetal signs and maternal signs of IUGR

A

Fetal signs

1) Small for gestational age (or with a birth weight below 10th percentile)
2) Decreased or absent fetal movements
Asymmetrical IUGR: disproportionate growth restriction
The dimensions of the head are normal while the body and limbs are thin and small.
Symmetrical IUGR: global growth restriction
The entire body is proportionally small.
The circumference of the head is proportional to the rest of the fetal body.
↑ Risk of neurologic sequelae

Maternal signs
Mostly asymptomatic
Small uterus (e.g., a smaller abdomen than in previous pregnancies)
Possible vaginal bleeding (e.g., placental abruption); preterm labor
Your notes

123
Q

Methyldopa is

A

Methyldopa is a central alpha-2 agonist.

124
Q

Antithyroid drugs for 1st trimester and then on?

A

First trimester: propylthiouracil

Second and third trimester: methimazole

125
Q

Single most important test to perform in a woman who states she has amenorrhea now

A

Beta-hCG

Main cause of secondary amenorrhea

126
Q

What are the 4 types of secondary amenorrhea and state an example for each

A

1) Pregnancy
2) Endocrine–> Hypothyroidism
3) Ovarian disorder(PCOS)
4) Central–>
- hypergonadotrophic hypogonadism
- hypogoandotropic hypogonadism

127
Q

Hypergonadotropic hypogonadism (primary hypogonadism)- causes

A

insufficient sex steroid production in the gonads

Turner syndrome (females), Klinefelter syndrome (males),

128
Q

Hypogonadotropic hypogonadism (secondary hypogonadism)- causes

A

Definition: insufficient gonadotropin-releasing hormone (GnRH) and/or gonadotropin release at the hypothalamic-pituitary axis
Kallmann syndrome
Eating disorders (functional hypothalamic amenorrhea)
Trauma to head
Infection
Genetic syndromes- Prader Willi

129
Q

With AUB state your 1st line investigations

and what other 3 additionally test can be requested

A

CBC → rules out anemia
Platelet count, PT, PTT → rule out bleeding disorders
Beta-HCG → rules out pregnancy

Additional testing if required (e.g.,

1) thyroid function tests,
2) prolactin
3) serum iron)

med 5 (23 decks)

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