Gynecology

Question 1

Postpartum endometritis major risk factors

Answer 1

C-section (especially after onset of labor)
Prolonged labor and/or prolonged rupture of membranes
HIV
group B streptococcus colonization
Maternal diabetes.
C-section is still by far the most important, as the rate of endometritis following a C-section after onset of labor, even with antibiotic prophylaxis, is four times higher than with vaginal delivery!!

Question 2

Prolonged rupture of membranes is defined as?

Answer 2

18-24 hours passing between rupture and delivery.

Question 3

Acute fatty liver disease of pregnancy

Answer 3

3rd trimester
Acute liver failure secondary to extensive microvesicular fatty infiltration of the liver. It is due to failure of fatty acid beta-oxidation and presents with right upper quadrant pain, nausea, vomiting, and jaundice.
Elevated aminotransferases and a leukocytosis, hypoglycemia, thrombocytopenia.
Can decompensate quickly with multi-organ failure and fetal compromise.
Management is immediate delivery.

Question 4

A young woman with no family history of malignancy and a nonpalpable mass in the setting of unilateral painless bloody discharge is likely suffering from?

Answer 4

An intraductal papilloma.

Question 5

Letrozole

Answer 5

Aromatase inhibitor used to treat hormone receptor-positive breast cancer, also is the first-line treatment agent for restoring ovulation in women with PCOS and can cause decreased bone mineral density.

Question 6

Infants of women with Sjögren’s are at risk for perinatal complications?,

Answer 6

As circulating anti-Ro(SSA) and anti-La (SSB) autoantibodies can cross the placenta and result in heart block. A pacemaker may be required for the affected infant.

Question 7

Risk factors for placental abruption

Answer 7

Hypertension, previous placental abruption, abdominal trauma, cocaine use, smoking, premature rupture of membranes, blood-clotting disorders, multiple pregnancy, or age > 40.

Question 8

Menopause estrogen treatment indications

Answer 8

Estrogen alone for patients who do not have uterus.

Estrogen + progesterone for patients who have uterus avoiding dysplasia.

Question 9

Different types of decelerations

Answer 9

Early: are slowing of the fetal heart rate in a pattern that is exactly synchronous with the contraction. They indicate fetal head compression within the birth canal.

Late decelerations are slowing of the heart rate that occurs towards the end of the contraction cycle. They signify utero-placental insufficiency.

Variable decelerations vary in onset, duration, and depth. They may occur between or with contractions, and they have an abrupt onset and rapid recovery. Represents umbilical cord compression.