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Med School Year 2 Flash Cards > Hinjke > Flashcards

Hinjke Flashcards

1
Q

What is a tier 1 contraceptives?

A

Progestin implants and IUD
Implanon
Copper IUD
Mirena

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2
Q

What are tier 2 contraceptives?

A

DMPA, rings, patches, OCP

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3
Q

What is a tier 3?

A

Condoms, diaphragms, caps, shield, spermicides, withdrawal, fertility awareness, natural family planning

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4
Q

What is the mechanism of action of implanon?

A

Negative feedback on hypothalamus decreasing GnRH
Thickens cervical mucus
Thins endometrium

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5
Q

What is a contraindication to using implanon?

A

Breast cancer

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6
Q

What drugs may decrease the efficacy of implanon?

A

Phenobarbital
Dilantin
St. John’s Wort

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7
Q

What are the emergency contraceptions?

A

Combo OCPs with 100 mcg of ethinyl estradiol and .5 mcg levonorgestrel twice 12 hours apart
Copper IUD
Plan B

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8
Q

How does a copper IUD work?

A

Immobilizes and kills sperm

Prevents implantation if fertilization

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9
Q

How long does a copper IUD last?

A

10-20 years

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10
Q

What is a contraindication in copper IUD?

A

Wilson’s disease and PID

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11
Q

How is a copper IUD used for contraception?

A

Can use for up to 5 days after

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12
Q

What do you worry about when your perforate laterally?

A

Bleeding through uterine artery

If patient feels pain immediately afterward - think perforation

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13
Q

How does levonorgestrel work?

A

Thickens cervical mucous
Thins endometrium
Does NOT prevent ovulation

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14
Q

How long does levonorgestrel work?

A

5 years

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15
Q

What are the contraindications to levonorgestrel?

A

Breast cancer

PID

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16
Q

How do tier 2 contraceptives work?

A

Thicken cervical mucous

Preventing ovulation by suppressing LH surge

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17
Q

What is a contraindication to OCPs?

A 
Aura or hx of migraines
Hx of uncontrolled HTN
Hx of TE, stroke, MI, breast cancer
Advanced DM 
Unexplained dysfunctional uterine bleeding - could have cancer
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18
Q

If someone on OCPs comes in with RUQ pain, what should you be thinking?

A

Cholelithiasis or benign hepatic tumor

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19
Q

What is the downside to ortho evra patch?

A

Skin irritation
Must be under 198 pounds
Higher risk of DVT!

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20
Q

What do you give to milking mothers for contraception?

A

The progesterone only pill - micronor

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21
Q

How does progestin only work as a contraceptive?

A

Thickens cervical mucous

Inhibits ovulation

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22
Q

Who cannot use progestin only?

A

Women who have had breast cancer in the last 5 years

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23
Q

What do progesterone and estrogen do to triglycerides?

A

They make them go up so don’t use for someone with hyperlipidemia

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24
Q

What is DMPA?

A

An IM injection every 3 months

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25
What is the biggest problem with the DMPA?
Weight gain | Return to fertility may be prolonged
26
What is a contraindication for using DMPA?
If the patient has asthma
27
What is the Yuzpe method?
Using OCPs for emergency contraception
28
What is plan B?
Progestin only .75 mg of levonorgestrel Can take up to 5 days after 89% effective
29
What female sterilization method is good for patients who aren't good with anesthesia?
Hysteroscopic - can be done in office. Put little stainless steel coils in the Fallopian tubes --- inflammatory reaction causes closure of the tubes. Do a hysterosalpingogram afterward to make sure the tubes closed
30
What is the Texas law in abortion?
Legal up to 20 weeks After 16 - must happen in a hospital Under 18 must have parental consent Info on alternatives must be provided 24 hours before Descriptions of US findings must be given Must offer to view US
31
What can be used for abortions before 7 weeks?
Mifepristone - anti progesterone | Misopristol - prostaglandin that causes uterine contractions
32
What is placental abruption?
Premature separation of normally implanted placenta
33
What are the risk factors for placental abruption?
HTN, hx of abruption, trauma, short umbilical cord (less than 30 cm), tobacco use, PROM
34
What is a succenturiate placenta?
An accessory placenta | Associated with postpartum hemorrhage or infection
35
What is velamentous cord insertion?
Vessels only surrounded by fetal membranes, no Wharton's jelly
36
What is vasa previa?
When vessels course over the cervical os. | Associated with perinatal mortality
37
What is a complication of velamentous cord insertion?
Fetal exsanguination
38
What is the Apt test?
When you are trying to figure out who is bleeding - mom or baby. Take blood from vag, put in water and add KOH. RBCS will lyse. Mom's Hb will be brown and baby's will be red
39
What is the greatest risk factor for velamentous cord insertion?
Multiples
40
What is the management for velamentous cord insertion?
Immediat abdominal delivery
41
Woman comes in at 30 weeks with painless vaginal bleeding and no contractions. Her vital signs are stable and is afebrile. What is the dx?
Placenta previa
42
A girl comes in with light vaginal bleeding after intercourse. Everything else is good. Cervix is friable. What is the dx?
Ectropion of pregnancy
43
What is cervical ectropion?
When the endocervical columnar epithelium is exposed to the vaginal milieu by eversion.
44
Preggers Patient comes in with heavy bleeding, ab pain, firm uterus. What is the dx?
Placental abruption
45
What does a normal placenta look like?
Diameter = 22 cm Thickness = 2-2.5 cm Cord length = 55-60 cm Gray wrinkled shiny and translucent
46
Pregger patient comes in with bright vag bleeding and no pain or contractions. How do you dx placenta previa?
Pelvic US
47
What is placenta accreta?
Deep attachment of the placenta through the endometrium and myometrium of the uterus due to defective desidual formation. Lots of hemorrhage and often leads to a hysterectomy Accreta - superior Increta - invades partially into the myometrium Percreta - extends to the serosa of uterus
48
What are the risk factors for placenta accreta?
Prior c-section!!!!! | Scar tissue - asherman's
49
What is a good method for determining the cause of third semester bleeding?
Pelvic US
50
What is a low lying placenta?
When the placenta is with 2 cm of the cervical os
51
What are the signs for placental abruption?
Painful vaginal bleeding Increased uterine tone and activity Uterine tenderness If fibrinogen is down
52
What are the risk factors for a ruptured placenta?
``` Maternal HTN Trauma Prior abruption PROM Short umbilical cord Tobacco use Folate deficiency ```
53
What is the most common cause of DIC in pregnancy?
Placental abruption
54
What is the best way to manage a placental abruption?
A vaginal delivery
55
What are the consequences of placental abruption?
Fetal demise Hypovolemic shock Acute renal failure Sheehan's syndrome
56
What are the signs of uterine rupture?
Sudden onset of intense abdominal pain and some vaginal bleeding No longer feel fetal parts Mother has hx of C-section
57
What is the most consistent clinical finding with a uterine rupture?
Abnormal fetal heart rate
58
What is the treatment for uterine rupture?
If you can't fix it - hysterectomy
59
What does uterine inversion cause?
HTN and postpartum hemorrhage
60
What is postpartum hemorrhage?
Blood loss of over 500 ml in vag delivery | Over 1000 ml in c-section
61
Patient with multiple different delivery attempts with fever and ok bp - had a c-section. what is dx?
Endometritis
62
What is uterine atony?
Loss of uterine muscle tone
63
What are the risk factors for uterine atony?
Multiples Macrosomia Prolonged labor Over distention
64
How does trichomonas present?
``` Itchy Odor White, greenish discharge that pools in the fornix and has bubbles in it. Strawberry cervix Will see WBCs ```
65
How do BV present?
``` Odorous discharge Milky white Fishy Usually just see in the walls Presence of clue cells = Gardernella No WBCs ```
66
How does Candida present?
Itching No odor Clumpy white Will see WBCs
67
What is the treatment for trich?
Metronidazole - 2 g
68
What is the treatment for candida?
Oral fluconazole Vaginal miconazole Boric acid suppositories
69
How do you diagnose a tuboovarian abscess?
US or CT
70
When do you hospitalize a patient when they have PID?
Pregnant Unsure about the dx Tuboovarian abscess Sepsis
71
What is the protocol for PID?
Test for all STDs | Broad spectrum antibiotics because PID is a polymicrobial infection
72
What is Fitzhugh-Curtis syndrome?
Perihepatic adhesions presenting with RUQ pain
73
What are the clinical pearls for herpes?
Do not biopsy - too painful Start tx immediately Start suppressive tx at 36 weeks and consider c-section
74
What do you do for condyloma acuminatum?
``` Tx with TCA - chemical burn Surgical removal Antiviral - cidofovir Anti proliferation - podophyllotoxin Immunomodulatory - imiquimod ```
75
Is condyloma an indication for a c-section?
No, infection rate is low
76
What happens in lichen sclerosis?
You lose anatomical distinction between the labia minora and majora. Introitus is small
77
How does lichen sclerosis present?
Usually older woman with severe itching, especially at night who is not sexually active with husband because it is too painful
78
What is the tx for lichen sclerosis?
High dose steroids
79
When do you biopsy condyloma acuminatum?
If the lesions haven't gotten better
80
What do you do to confirm diagnosis of lichen sclerosis?
Office punch biopsy
81
How does lichen planus present?
Older woman with vulvar itching, not having sex, burning
82
What is lichen sclerosis a risk factor for?
Vulvar SCC
83
What is the most common form of mental retardation?
Down's syndrome
84
What are the sex-linked disorders mentioned?
Fragile X - triple repeat expansion on long arm of X | Duchenne's muscular dystrophy
85
What are some multifactorial disorders?
Cleft palate Spina bifida Anencephaly Pyloric stenosis
86
What is the recommendation is the patient has a history of babies with NT defects?
4mg of frolic acid daily
87
What is a triple marker screen?
Offered at 16-18 weeks | Tracks alpha fetoprotein, hCG, unconjugated estriol
88
What does an elevated MSAFP mean?
You need to do a sonogram because there are higher rates of NT defects associated with this Can also do amniocentesis
89
What problem is associated with low MSAFP, UE3, and hCG?
Trisomy 18
90
What problem is associated with low MSAFP, UE3, and high hCG?
Down's
91
When do you do a cordocentesis?
When there is rh factor problems to see how anemic the baby is and figure out when it's time to get the baby out
92
What are the screening tests in the first trimester?
Serum hCG Sono + Pregnancy associated plasma protein a Thickened nuchal translucency Chorionic villus sampling
93
What is the screening in the second trimester?
Quad screen: AFP, HCG UE3, inhibit a
94
When is the fetus most susceptible to teratogens?
3-8weeks
95
What does an FAH baby look like?
``` Low nasal bridge Thin upper lip Small chin Flat midface Short nose ```
96
What are the anxiolytics that can be teratogens?
Meprobamate and chlordiazepoxide
97
What are the anti neoplasticism agents?
MTX, amionopterin | Busulfan, chlorambucil, cyclophosphamide, nitrogen mustard
98
What is warfarin syndrome?
Stipples epiphysis Nasal hypoplasia Use heparin instead because it doesn't cross the placenta as readily
99
What are the anticonvulsants?
Dilantin Trimethadione Valproic acid - NT defects Carbamazepine - spina bifida
100
What is the problem with phenobarbital in pregnancy?
Low teratogenicity but baby goes through withdrawal
101
What do retinoids cause?
Ear defects, blindness,
102
What is preterm labor?
Contractions with cervical change prior to 37 weeks
103
What are the risk factors for preterm labor?
``` Infection Vascular problems (SLE) Placental problems Stress/strain Uterine stretch Hx of preterm Multiples ```
104
What are the two leading factors for preterm?
Multiples and hx
105
What is the most concerning diagnostic finding for preterm labor?
Cervical length less than 2.5 cm
106
What does the fetal fibronectin tell you?
If positive - you have a 50% chance of going into labor within the next 2 weeks
107
How do you treat preterm labor?
Give antibiotics Give steroids prior to 34 weeks Recommend hydration, bed rest
108
When do we use magnesium sulfate?
When they are having contractions - tocolytic
109
How does magnesium sulfate work?
It competes with calcium so it decreases contractions. | Makes you feel crummy
110
What else is mgso4 used for?
Neuroprotection
111
What is nifedipine?
It is a calcium channel blocker | Tocolytic and anti hypertensive
112
What is indomethacin?
Prostaglandin synthetics inhibitor - tocolytic
113
What is atosiban?
Oxytocin receptor antagonist | Tocolytic
114
What is PROM?
Rupture of membranes without other signs of labor. | Don't induce until after 34 weeks
115
How do you diagnose PROM?
Pooling - fluid in the vault Ferning - take liquid and dry it - if amniotic fluid, will see crystals Nitrazine - paper that turns blue Amnisure- detects alpha microtglobulin
116
What are the markers for fetal lung maturity?
Lecithin/sphingomyelin ratio is 2/1 Presence of phosphatidylglycerol with the ratio = great sign Lamellar body density count
117
What is IUGR?
When fetus is below 10th percentile
118
What is symmetrical IUGR?
When head to abdominal ratio is normal. The whole fetus is small
119
What is symmetrical IUGR due to?
Infection
120
What is asymmetrical IUGR?
When the head is larger than the rest of the body
121
What is asymmetrical IUGR due to?
Vascular problems - HTN, SLE, DM
122
What is the screening test for gestational growth?
Fundal height
123
What is used to diagnose fetal IUGR?
US
124
What is fetal post aridity syndrome?
When the placenta functions poorly, SC fat loss, long fingernails and dry peeling skin on baby
125
What do you worry about in a mother who has been carrying a dead fetus for several weeks?
DIC - check fibrinogen
126
What is IUFD?
Death of the fetus past 20 weeks and before th onset of labor

Med School Year 2 Flash Cards (18 decks)

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