Miscellaneous - aa

Question 1

When do symptoms occur, in PMS?

Answer 1

~During the luteal phase/second half of menstrual cycle

~In fact, restriction of symptoms to the luteal phase is pathognomonic for PMS

Question 2

Any patient experiencing any bleeding after menopause needs to be worked up for ____.

Answer 2

endometrial cancer

Question 3

What is the primary risk factor for pelvic organ prolapse?

Answer 3

increasing parity

Question 4

Name five treatments for pelvic organ prolapse.

Answer 4

1. reassurance - benign condition that is mainly quality of life-affecting
2. Kegels
3. pessary
4. estrogen
5. surgery

Question 5

PID = need to have IUD removed.

T/F

Answer 5

False

Question 6

PID treatment?

Answer 6

ceftriaxone (for GC) + doxy (for CT) +/- metro (for BV)

Question 7

GC treatment?

Answer 7

IM ceftriaxone + azithro (for CT)

Question 8

Syphilis chancres are exquisitely painful.

T/F

Answer 8

False - painless

Question 9

Counsel genital herpes patients to avoid sexual contact during lesion outbreak; ok if no lesions.
T/F

Answer 9

False - transmissible even in the absence of lesions

Question 10

What two genital infections are not sexually transmitted?

Answer 10

BV, candidiasis

Question 11

What is the risk of transmission of HSV from mother to fetus?

Answer 11

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

Question 12

What are the characteristic features of congenital syphilis?

Answer 12

~Hutchinson teeth
~saddle nose
~deafness
~saber shins

Question 13

Hepatitis C is or is not transmitted via breast milk?

Answer 13

Not transmitted through breast milk. Breastfeeding is not contraindicated in mothers with HCV infection.

Question 14

What is the definition of infertility?

Answer 14

The inability of a couple to conceive within 1 year.

Question 15

On what day of a woman’s cycle is infertility bloodwork and u/s done?

Answer 15

Cycle day 3

Question 16

Your patient has a startle reaction and an extreme resistance to pelvic exam. What is this a red flag for?

Answer 16

hx of sexual assault/rape

Question 17

Name two cardio and two pulm findings that would usually be considered pathologic but during pregnancy are pretty normal.

Answer 17

~temporary increase in heart size -> left axis shift on EKG
~90% of gravidas have systolic ejection murmur
~decreased total lung capacity
~slight respiratory alkalosis

Question 18

Give me 4 teratogenic drugs, 3 teratogenic infections, and 2 teratogenic environmental factors.

Answer 18

1. alcohol 2. warfarin 3. phenytoin 4. isotretinoin
2. listeria 2. rubella 3. toxoplasmosis
3. radiation 2. hyperthermia

Question 19

What is DES and what are its effects in pregnancy?

Answer 19

~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.

Question 20

What are two specific reasons for fatigue in pregnancy? (besides carrying around a big load)

Answer 20

~anemia due to inability of erythropoiesis to keep up with demand
~early pregnancy progesterone spike causes sleepiness

Question 21

All edema in pregnancy is normal.

T/F

Answer 21

False.
~lower extremity edema in late pregnancy is normal
~upper body edema is a first sign of preeclampsia

Question 22

What percentage of chemically evident pregnancies end in spontaneous abortion (passing of a pregnancy less than 20 weeks)?

Answer 22

50%

Question 23

80% of spontaneous abortion occur before __ weeks.

Answer 23

before 12 weeks

Question 24

What is the difference between threatened abortion and inevitable abortion?

Answer 24

~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.

Question 25

What is the fFN test used for? (fetal fibronectin)

Answer 25

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

Question 26

How can you test whether the watery discharge from mom’s vagina was amniotic fluid or not?

Answer 26

~nitrazine test: swab of fluid turns nitrazine paper blue (alkaline amniotic fluid)
~ferning: swab of fluid crystallizes in fern-like pattern on glass slide

Question 27

Name two tests you could do to evaluate for multiple gestations.

Answer 27

~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)

Question 28

What is the difference between pregnancy-induced hypertension and pre-eclampsia?

Answer 28

Proteinuria is present in pre-eclampsia.

~In both conditions the mother’s BP is over 140/90 on two occasions 6 hours apart.

Question 29

What is HELLP?

Answer 29

A variant of pre-eclampsia with:
~hemolysis
~elevated liver enzymes
~low platelets

Question 30

When is it ok to pull on the umbilical cord?

Answer 30

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.

Question 31

What are three indications for caesarean section?

Answer 31

~transverse lie
~placenta previa
~active genital herpes infection

Question 32

What are the Apgar score categories?

Answer 32

Appearance (color)
Pulse (HR)
Grimace
Activity (muscle tone)
Respiration (absent, slow/irreg, good/crying)

Question 33

What 3 hormones are involved in breast milk production?

Answer 33

~estrogen - growth of ducts
~progesterone - maturation of glands
~prolactin - milk production
Estrogen antagonizes prolactin; lactation starts after the drop in circulating estrogen at birth

Question 34

How long do nursing mothers generally have amenorrhea after giving birth?

Answer 34

25-30 weeks

Question 35

Migraine with aura is a contraindication for what?

Answer 35

OCPs