Miscellaneous - aa Flashcards
When do symptoms occur, in PMS?
~During the luteal phase/second half of menstrual cycle
~In fact, restriction of symptoms to the luteal phase is pathognomonic for PMS
Any patient experiencing any bleeding after menopause needs to be worked up for ____.
endometrial cancer
What is the primary risk factor for pelvic organ prolapse?
increasing parity
Name five treatments for pelvic organ prolapse.
- reassurance - benign condition that is mainly quality of life-affecting
- Kegels
- pessary
- estrogen
- surgery
PID = need to have IUD removed.
T/F
False
PID treatment?
ceftriaxone (for GC) + doxy (for CT) +/- metro (for BV)
GC treatment?
IM ceftriaxone + azithro (for CT)
Syphilis chancres are exquisitely painful.
T/F
False - painless
Counsel genital herpes patients to avoid sexual contact during lesion outbreak; ok if no lesions.
T/F
False - transmissible even in the absence of lesions
What two genital infections are not sexually transmitted?
BV, candidiasis
What is the risk of transmission of HSV from mother to fetus?
Depends on when in the pregnancy the mother becomes infected.
~30-50% transmission if mother is infected near time of delivery
~<1% transmission if mother has hx of recurrent herpes or is infected in the first half of the pregnancy
What are the characteristic features of congenital syphilis?
~Hutchinson teeth
~saddle nose
~deafness
~saber shins
Hepatitis C is or is not transmitted via breast milk?
Not transmitted through breast milk. Breastfeeding is not contraindicated in mothers with HCV infection.
What is the definition of infertility?
The inability of a couple to conceive within 1 year.
On what day of a woman’s cycle is infertility bloodwork and u/s done?
Cycle day 3
Your patient has a startle reaction and an extreme resistance to pelvic exam. What is this a red flag for?
hx of sexual assault/rape
Name two cardio and two pulm findings that would usually be considered pathologic but during pregnancy are pretty normal.
~temporary increase in heart size -> left axis shift on EKG
~90% of gravidas have systolic ejection murmur
~decreased total lung capacity
~slight respiratory alkalosis
Give me 4 teratogenic drugs, 3 teratogenic infections, and 2 teratogenic environmental factors.
- alcohol 2. warfarin 3. phenytoin 4. isotretinoin
- listeria 2. rubella 3. toxoplasmosis
- radiation 2. hyperthermia
What is DES and what are its effects in pregnancy?
~DES was a nonsteroidal synthetic estrogen used up until 1971 to prevent preterm birth and other problems.
~DES crosses the placental barrier and impacts reproductive tract development of the fetus -> the adult woman (daughter) has cervical abnormalities, infertility, miscarriage, ectopic pregnancy, premature infant, etc.
What are two specific reasons for fatigue in pregnancy? (besides carrying around a big load)
~anemia due to inability of erythropoiesis to keep up with demand
~early pregnancy progesterone spike causes sleepiness
All edema in pregnancy is normal.
T/F
False.
~lower extremity edema in late pregnancy is normal
~upper body edema is a first sign of preeclampsia
What percentage of chemically evident pregnancies end in spontaneous abortion (passing of a pregnancy less than 20 weeks)?
50%
80% of spontaneous abortion occur before __ weeks.
before 12 weeks
What is the difference between threatened abortion and inevitable abortion?
~cervical dilation
Both have uterine bleeding that occurs before 20 weeks without passage of products of conception, but in threatened abortion there is no cervical dilation and in inevitable abortion there is cervical dilation.
What is the fFN test used for? (fetal fibronectin)
When preterm labor is suspected.
POSITIVE vaginal swab fFN = inconclusive; labor may occur in days to weeks
NEGATIVE vaginal swab fFN = better predictor; 99% sure of no labor in the next 7-10 days
How can you test whether the watery discharge from mom’s vagina was amniotic fluid or not?
~nitrazine test: swab of fluid turns nitrazine paper blue (alkaline amniotic fluid)
~ferning: swab of fluid crystallizes in fern-like pattern on glass slide
Name two tests you could do to evaluate for multiple gestations.
~maternal serum alpha fetoprotein higher than normal levels indicates multiple gestations
~routine ultrasound is able to differentiate multiple gestations as early as 4-5 weeks (transvaginal)
What is the difference between pregnancy-induced hypertension and pre-eclampsia?
Proteinuria is present in pre-eclampsia.
~In both conditions the mother’s BP is over 140/90 on two occasions 6 hours apart.
What is HELLP?
A variant of pre-eclampsia with:
~hemolysis
~elevated liver enzymes
~low platelets
When is it ok to pull on the umbilical cord?
During stage 3, after a fresh show of blood appears, the cord lengthens outside the body, the fundus of the uterus rises up, and the uterus becomes firm and globular, it is safe to apply gentle traction to the cord.
What are three indications for caesarean section?
~transverse lie
~placenta previa
~active genital herpes infection
What are the Apgar score categories?
Appearance (color) Pulse (HR) Grimace Activity (muscle tone) Respiration (absent, slow/irreg, good/crying)
What 3 hormones are involved in breast milk production?
~estrogen - growth of ducts
~progesterone - maturation of glands
~prolactin - milk production
Estrogen antagonizes prolactin; lactation starts after the drop in circulating estrogen at birth
How long do nursing mothers generally have amenorrhea after giving birth?
25-30 weeks
Migraine with aura is a contraindication for what?
OCPs
