ob/gyn Flashcards

Question

standard of care for threatened abortion

Answer 1

- reassurance and outpatient follow-up | - can advise bed rest and avoidance of sexual intercourse, but there is no evidence that this is effective

Answer 2

- modifiable: low estrogen levels, malnutrition, decreased caclium, decreased vitamin D, use of certain meds like glucocorticoids or anticonvulsants, immobility, cigarette smoking, excessive alcohol consumption - non-modifiable: female gender, advanced age, small body size, late menarche/early menopause, caucasian and asian ethnicity, and family hx of osteoporosis

Answer 3

-weight bearing exercises, smoking cessation, and decreased alcohol consumption

Answer 4

BUN/Cr ratio of about 10:1

Answer 5

BUN/Cr ratio of greater than 20:1

Answer 6

Serum BUN and Cr are usually decreased in pregnant pts due to an increase in renal plasma flow and GFR -this increase in renal function begins early in the fist trimester, progresses gradually until reaching 40-50% above the non-pregnant state by mid-pregnancy, and remains unchanged until term

Answer 7

-estrogen analog that can be used to induce ovulation in anovulatory women who have some ovulatory reserve, such as pts w/ PCOS

Answer 8

-used in a pulsatile fashion to induce ovulation and as a chronic therapy to suppress ovulation

Answer 9

-used to correct luteal phase defect, which is characterized by failure of the corpus luteum to produce sufficient progesterone to maintain the endometrium and allow implantation of an embryo

Answer 10

- characterized by amenorrhea, hypoestrogenism, and elevated serum gonadotropin levels in women age < 40 years - the amenorrhea only needs to be of 3 months duration w/ FSH in menopausal range to meet diagnostic criteria - may be secondary to accelerated follicle atresia or a low initial number of primordial follicles - most commonly idiopathic, but may also be due to mumps, oophoritis, irradiation, or chemotherapy - can be associated w/ autoimmune disorders such as Hashimoto's thyroiditis, Addison's disease, type 1 diabetes mellitus, and pernicious anemia

Answer 11

in vitro fertilization w/ donor oocytes

Answer 12

- can be caused by diabetic neuropathy - characterized by loss of small amounts of urine from an over distended bladder, and a markedly increased residual volume - patients usually have a long hx of diabetes that is not well controlled

Answer 13

- common cause of incontinence in older women - high number of vaginal deliveries may lead to pelvic floor muscle weakness - proximal urethra prolapses outside pelvis due to pelvic relaxation, so rise in intraabdominal pressure (coughing, sneezing, laughing) causes rise in bladder pressure and urine is lost in small amounts - aggravating factors: morbid obesity, pregnancy, COPD, smoking - physical exam may show pelvic floor weakness such as uterine prolapse and/or cystocele - tx: Kegel exercises, pessaries, estrogen replacement if postmenopausal, Burch procedure, or sling procedures - urinalysis, cystometry, and postvoid residual volume are normal

Answer 14

-involves inserting a needle through the abdomen or cervix to extract fetal tissue for genetic analysis and assessing karyotype

Answer 15

- form of spontaneous abortion defined as intrauterine fetal death before 20 weeks gestational age w/ complete products of conception and a closed cervix - pts often develop loss of pregnancy symptoms and scant to light vaginal discharge - pelvic US is necessary for diagnosis

Answer 16

- hemodynamically UNSTABLE, heavy bleeding: surgical evacuation - hemodynamically STABLE, mild bleeding: expectant management, prostaglandins, or surgical evacuation - surgery achieves more complete evacuation than medical or expectant management - in the case of medical or expectant management, US is generally performed to confirm that there are no retained products of conception

Answer 17

- blood and endometrial cultures - broad spectrum antibiotics - surgical evacuation of uterine contents

Answer 18

- folic acid antagonist that disrupts rapidly dividing cells | - used to treat some cases of ectopic pregnancy but is not effective for spontaneous abortion

Answer 19

- can stimulate uterine contractions to expel retained fetus and POC - must be given IV in the hospital - often used to augment labor, treat postpartum hemorrhage, and expel a retained fetus following fetal demise in the late second or third trimester. However, it is not usually used in the first trimester

Answer 20

- all girls and women age 9-26 (including those w/ hx of genital warts, abnormal cytology, or positive HPV DNA test - boys and men age 9-21 (up to age 26 for men who have sex with men) - immunocompromised individuals (including HIV pts) age 9-26 - NOT indicated in pregnant women

Answer 21

- should start at age 21 in most women (except those w/ HIV or SLE, and organ transplant or immunocompromised individuals) regardless of the age of onset of sexual activity - Routine testing for HPV is not indicated for women age < 30 - HPV vaccine is recommended for all girls and women (except those who are pregnant) age 9-26 regardless of HPV status or sexual activity

Answer 22

- MSAFP: decreased - b-HCG: decreased - Estriol: decreased - Inhibin A: normal

Answer 23

- MSAFP: decreased - b-HCG: increased - Estriol: decreased - Inhibin A: increased

Answer 24

- MSAFP: increased - b-HCG: normal - Estriol: normal - Inhibin A: normal

Answer 25

- performed in the second trimester (15-20 weeks) and consists of maternal serum a-fetal protein (MSAFP), b-HCG, estriol, and inhibin A. - looks for trisomy 18, trisomy 21, and neural tube or abdominal wall defect - pts w/ abnormal quadruple screen results can be offered CELL-FREE FETAL DNA testing, which measures circulating, free maternal and fetal DNA in maternal plasma and has a sensitivity and specificity of up to 99% - an US should be performed to evaluate for fetal anomalies

Answer 26

- decreased MSAFP and estriol | - increased b-HCG and inhibin A

Answer 27

-normal inhibin A level and low MSAFP, estriol, and b-HCG

Answer 28

-elevated MSAFP; the rest of the markers are normal

Answer 29

- destroys the endometrium, including the basalis layer, to prevent endometrial regeneration - CONTRAINDICATED in pts w/ endometrial hyperplasia because it prevents future evaluation of the endometrium by biopsy

Answer 30

- if after endometrial biopsy (must always be done!) there is hyperplasia W/ ATYPIA, and the patient has completed childbearing or failed medical management - the risk of progression to endometrial adenocarcinoma is as high as 30%, and up to 50% of women with endometrial atypia have concomitant endometrial adenocarcinoma!

Answer 31

- should undergo endometrial biopsy to evaluate for hyperplasia versus cancer - progestin therapy is the tx of choice for those w/ NO ATYPIA - hysterectomy is the tx of choice for hyperplasia with atypia

Answer 32

- Hemolysis (microangiopathic hemolytic anemia): Schistocytes on peripheral smear, elevated bilirubin, and low serum haptoglobin - Elevated Liver enzymes: Aspartate aminotransferase or alanine aminotransferase twice the upper limit of normal - Low Platelet count: Platelets < 100,000 - Right upper quadrant or epigastric pain and nausea or vomiting (30-90% of pts)

Answer 33

- life-threatening complication that may occur in women w/ preeclampsia - thought to result from abnormal placentation, triggering systemic inflammation and activation of the coagulation system and complement cascade - circulating platelets are rapidly consumed, and microangiopathic hemolytic anemia is particularly detrimental to the liver - the resulting hepatocellular necrosis and thrombi in the portal system cause elevated liver enzymes, liver swelling, and distension of the hepatic (Glisson's) capsule - half of women w/ HELLP syndrome progress to DIC, which can lead to life-threatening multiorgan failure

Answer 34

- can cause acute hepatic failure in the third trimester or early postpartum period - most pts will have a prolonged PT and PTT, hypoglycemia, and encephalopathy - may see acute microvesicular fatty infiltration of hepatocytes

Answer 35

- characterized by autoimmune platelet destruction - pts may have ecchymosis/petechiae and mucosal bleeding - peripheral smear would show megakaryocytes

Answer 36

-manifests as generalized pruritis, hyperbilirubinemia, and transaminitis due to elevation of serum bile acid concentration from impaired bile acid flow

Answer 37

- most commonly presents after infection w/ Shiga-toxin producing bacteria H5717 E. coli and causes thrombocytopenia and hemolytic anemia - typically have bloody diarrhea and renal failure

Answer 38

-110-160/min heart rate, long term variability >2 cycles/min, beat to beat variability 6-25/min

Answer 39

- at risk for lung immaturity and neonatal respiratory distress syndrome - if maternal and fetal status are both reassuring, pts <34 weeks can receive course of corticosteroids (eg, betamethasone) prior to delivery - however, delivery should not be delayed beyond 48 hours due to risk for rapid deterioration

Answer 40

ursodeoxycholic acid

Answer 41

plasmapheresis to remove pathogenic autoantibodies

Answer 42

- to prevent spontaneous bleeding in pts w/ platelets < 10,000 - exception to this rule is in asymptomatic children w/ idiopathic thrombocytopenic purpura, in which the condition usually recovers spontaneously

Answer 43

- associated w/ an increase in TBG, resulting in increased total T4 and T3, a normal free T4 and T3, and a normal TSH - increased estrogen leads to increase in circulating TBG and hCG mildly stimulates TSH receptor, however these values usually still remain within the normal range

Answer 44

- done at 9-13 weeks | - pregnancy associated plasma protein, b-HCG, nuchal translucency

Answer 45

-endocardial cushion defect, duodenal atresia, cystic hygroma

Answer 46

- indications: maternal age > 35, abnormal maternal serum screening test, sonographic findings associated with fetal aneuploidy, previous pregnancy w/ fetal aneuploidy, parental-balanced Robertsonian translocation - application: screening for trisomy 21, 18, 13 and sex-chromosome aneuploidies; fetal sex determination

Answer 47

- recommended for confirmation of abnormal quadruple screen results - Its invasive and should be guided by US to determine the best site for needle insertion. The needle must be positioned to draw adequate amniotic fluid without injuring the fetus, placenta, and maternal bowel and bladder - best performed at 16-20 weeks gestation, but US should be performed first to confirm gestational age and assess amniotic fluid

Answer 48

-indicated for early screening in women who desire fetal karyotyping at 10-13 weeks gestation

Answer 49

- can be used for fetal blood gas analysis, karyotyping, and blood culture - highly invasive and carries a risk of umbilical cord bleeding/hematoma, placenta injury, and fetal loss - reserved for cases when maternal blood testing, amniocentesis, and CVS fail to provide adequate or timely diagnostic information

Answer 50

- glycoprotein produced by the trophoblast - during the first trimester, PAPP-A can be measured w/ b-hCG and US nuchal translucency w/ a detection rate of about 85% for Down syndrome - fetuses w/ Down syndrome produce less PAPP-A - the marker is less accurate w/ increasing gestational age and is therefore not used in the second trimester

Answer 51

- genetic screening performed in the second trimester - low maternal serum a-fetoprotein, low estriol, increased b-hCG, and increased inhibin A are associated w/ trisomy 21 - a thorough transabdominal US should be performed to evaluate fetal anatomy and measure growth

Answer 52

- simple test that helps to identify male factor as the cause of infertility. Male factors are said to account for 20-30% of the infertility causes - Semen analysis should be performed early in the evaluation of the infertile couple, usually as the initial screening test

Answer 53

- the increased incidence of UTIs in women is due to the shorter length of the female urethra compared to males - other predisposing factors include: sexual intercourse, recent antibiotic use, the use of spermicidal contraceptives, and a close proximity of the urethra to the anus

Answer 54

- selective estrogen receptor modulator (SERM) that increases bone mineral density and is used to prevent osteoporosis, although it is somewhat less effective than bisphosphonates and estrogen for this purpose - important side effect is increased risk for venous thromboembolism! - may also cause hot flashes and leg cramps - unlike tamoxifen, raloxifene does NOT increase the risk for endometrial cancer - raloxifene decreases the risk for breast cancer - mixed agonist/antagonist of estrogen receptors - in breast and vaginal tissue, it is an antagonist, whereas in bone tissue, it is an agonist

Answer 55

-labor before 37 weeks gestation

Answer 56

- not proven to have a benefit after 34 weeks gestation; its use is limited to the period between 24 and 34 weeks - steroids require 24-48 hours to have a maximum benefit on fetal lung maturity

Answer 57

- Sheehan's syndrome and lymphocytic hypophysitis - Sheehan's syndrome develops due to ischemic necrosis of the pituitary gland (sometimes even the hypothalamic nuclei) because of peri-partum bleeding. - Lymphocytic hypophysitis is less common and is not related to peri-partum hemorrhage. Pts typically have headaches, visual disturbances, and pituitary failure - note that overt diabetes insipidus is uncommon in Sheehan's syndrome

Answer 58

- increases availability of GABA | - side effects include blood dyscrasias and liver toxicity

Answer 59

-partial agonist of dopamine D2 receptors; does NOT cause galactorrhea

Answer 60

-side effects: aplastic anemia and SIADH

Answer 61

-rash, Stevens-Johnson syndrome, toxic epidermal necrolysis

Answer 62

- atypical antipsychotic that is a dopamine and serotonin antagonist - inhibiting dopamine leads to elevated serum prolactin levels, which causes oligomenorrhea, amenorrhea, and galactorrhea; as well as weight gain - been found to increase prolactin levels to a greater extent than do many of the other antipsychotics

Answer 63

-stasis of urine from compression by the enlarging uterus, as well as smooth muscle relaxation caused by progesterone

Answer 64

-result of PROM, intrauterine instrumentation, STIs, and prolonged labor

Answer 65

-commonly seen as a result of PID due to STIs, infections such as TB, instrumentation of the genital tract, and after caesarean delivery

Answer 66

-1 hour glucose of less than 140 mg/dL

Answer 67

- occurs when the urine culture grows > 100,000 CFU per ml of a single organism in an asymptomatic patient - its important to promptly treat the infection to prevent progression to pyelonephritis in the pregnant patient, which can result in septicemia, preterm labor and low birth weight babies - amoxicillin, ampicillin, nitrofurantoin, and cephalexin are commonly used to treat the patients

Answer 68

- cannot convert testosterone to the more potent DHT - they have a 46 XY genotype, male internal genitalia, and female or undermasculinized external genitalia at birth - at puberty, they experience masculinization due to testosterone (ie. increase in phallus size, muscle growth, voice deepening) but lack breast development

Answer 69

- 46 XY karyotype and a defective androgen receptor that results in end-organ resistance to androgens - testicular secretion of anti-Mullerian hormone, which results in male internal genitalia. However, the testicular testosterone is converted to estrogen, resulting in breast development

Answer 70

- can result in an apparent amenorrhea due to vaginal obstruction - can be distinguished from Mullerian agenesis by cyclic abdominal pain, the presence of a uterus, and the visualization of an imperforate hymen and hematocolpos

Answer 71

- 45 XO genotype, short stature, small nonfunctional ovaries | - they do not typically develop secondary sexual characteristics

Answer 72

- phenotypically and genotypically female - experience breast development and body hair growth at puberty but do not menstruate due to a congenitally absent or underdeveloped uterus, cervix, and upper vagina

Answer 73

- X-linked mutation of androgen receptor - breast development is present - absent uterus and upper vagina; cryptorchid testes - minimal to absent axillary and pubic hair - 46 XY

Answer 74

- Hypoplastic or absent mullerian ductal system - breast development is present - absent or rudimentary uterus and upper vagina; normal ovaries - normal axillary and pubic hair - 46 XX

Answer 75

- malformation of urogenital sinus and Mullerian ducts - breast development is present - normal uterus, abnormal vagina; normal ovaries - normal axillary and pubic hair - 46 XX

Answer 76

- Complete/partial absence of 1 X chromosome - Variable breast development depending on ovarian function - normal uterus and vagina; streak ovaries - normal axillary and pubic hair - 45 XO

Answer 77

- SRY gene mutation on Y chromosone - No breast development - normal uterus and vagina; streak gonads - minimal to absent axillary and pubic hair - 46 XY

Answer 78

- most effective emergency and long-term contraception - causes inflammatory reaction that is toxic to sperm and ova and impairs implantation - can be used up to 120 hours after intercourse - 99% efficacy

Answer 79

- antiprogestin that delays ovulation - can be used up to 120 hours after intercourse - >85% effective

Answer 80

- aka "Plan B" - most readily available emergency contraception; it works by delaying ovulation but is ineffective post-fertilization - efficacy decreases with time over the course of 72 hours in which its indicated - 85% effective - progestin that delays ovulation

Answer 81

- progestin that delays ovulation like Plan B - 0-72 hours after intercourse - 75% effective

Answer 82

-abortive medications

Answer 83

- common cause of sudden death in young people, particularly African Americans - a hypertrophic intraventricular septum obstructs the left ventricular outflow tract - hypovolemia and other conditions that decrease venous return worsen symptoms

Answer 84

-may result from rheumatic heart disease and can present with heart failure and atrial fibrillation, but it is less common than mitral stenosis in women of childbearing age

Answer 85

- classically presents during pregnancy due to physiologically increased total blood volume - its most often due to rheumatic fever and occurs much more often in countries with limited access to antibiotics - may present w/ atrial fibrillation and pulmonary edema - physical exam may reveal a diastolic rumble at the apex and/or an opening snap

Answer 86

- 2 to 3 weeks after infection w/ Treponema pallidum, pts develop a PAINLESS papule at the site of inoculation - this papule ulcerates, forming a chancre w/ puched-out base and raised, indurated margins - most lesions occur on the genitalia, and are accompanied by painless inguinal adenopathy - if left untreated, the chancre of primary syphilis heals spontaneously within one to three months

Answer 87

-PAINFUL ulcers with a deep, purulent base and painful lymphadenopathy

Answer 88

- PAINLESS genital ulcers that have a red, beefy base and there is NO associated adenopathy - the ulcer does NOT resolve without antibiotic treatment

Answer 89

- greatest risk factor is sun exposure - most common sites are face and trunk - lesions appear as pearly-colored papules covered with telangiectasias

Answer 90

- by dark field microscopy (identification of spirochete) - serologic testing like serum RPR is a nontreponemal test that should be avoided in suspected cases of PRIMARY syphilis due to the high rate of false negative results. This is because many patients with primary syphilis have yet to form antibodies against the organism

Answer 91

- used in diagnosis of Herpes simplex, Varicella, and Cytomegalovirus - Multinucleated giant cells on Tzank smear are characteristic of Herpes and Varicella

Answer 92

- used as a SCREENING test for syphilis, and treponemal serologic tests (FTA-ABS) are used for confirmation - note that darkfield microscopy is also an effective method of diagnosing syphilis, but requires proper equipment and clinical expertise. - in primary syphilis, there is a high rate of false-negative results to serologic testing, and therefore darkfield microscopy is necessary

Answer 93

-associated w/ congenital heart disease, classically Ebstein's anomaly, and should be weaned in pregnant women w/ stable bipolar disorder

Answer 94

- woman who is treated with isotretinoin should receive strict contraception - associated w/ craniofacial dysmorphism, heart defects, and deafness - women should have 2 effective forms of contraception in use for at least 1 month prior to initiating treatment. contraception must be continued during treatment, and for 1 month after isotretinoin is discontinued. In addition, patients must have a pregnancy test the week before beginning treatment, and should have periodic pregnancy tests during therapy

Answer 95

- presents w/ delayed/absent puberty and anosmia - the karyotype will be consistent with their male or female phenotype - FSH and LH levels are low, consistent w/ gonadotropin-releasing hormone deficiency - X-linked recessive disorder of migration of fetal gonadotropin-releasing hormone and olfactory neurons, resulting in hypogonadotropic hypogonadism and rhinencephalon hypoplasia - short stature, primary amenorrhea, absent breast development, eunuchoid appearance with small external genitalia and absent secondary sexual characteristics (pubic/axillary hair, voice deepening, libido)

Answer 96

- short stature - narrow, high arched palate - low hairline - webbed neck - broad chest w/ widely spaced nipples - cubitus valgus - horse shoe kidney - low set ears - coarctation of aorta - bicuspid aortic valve - streak ovaries, amenorrhea, and infertility - FSH levels are generally elevated due to primary ovarian failure - 45 XO

Answer 97

- 47 XXY - male phenotype - intellectual disability - sparse facial/body hair - gynecomastia - cryptorchidism - infertility - long legs

Answer 98

- may result in a ruptured appendix if the diagnosis is delayed beyond 24-36 hours - many of the symptoms including nausea and vomiting, mimic symptoms of pregnancy; most common symptom is right lower-quadrant pain - depending on the gestational age of the pregnancy, the location of pain and tenderness may be higher than expected due to displacement of the appendix upward by gravid uterus - pts may or may not have a fever; an elevated leukocyte count may be present in appendicitis as well as in normal pregnancy - US w/ a graded compression technique should be first test!!! Noncompression and dilation of the appendix are diagnostic of appendicitis. - nonvisualization of appendix on US does NOT exclude the diagnosis of acute appendicitis; if US is nondiagnositc, MRI can be performed

Answer 99

- mucopurulent discharge; friable cervix with easy bleeding - nucleic acid amplification testing for diagnosis - 3rd generation cephalosporin PLUS azithromycin or doxycycline for chlamydia coverage - second most common cause of cervicitis in US after Chlamydia trachomatis; also a major cause of urethritis and PID - more than 50% of women are ASYMPTOMATIC

Answer 100

metronidazole

Answer 101

-Clindamycin and gentamicin (used for polymicrobial infection w/ an anaerobic component)

Answer 102

- symmetric to contraction - nadir of deceleration corresponds to peak of contraction - gradual (>30s from onset to nadir) - can be due to fetal head compression - can be normal fetal tracing; if there is otherwise normal baseline rate, normal variability, and no late or variable decelerations, this pattern does not indicate fetal distress and no change in management is required - does NOT indicate fetal distress

Answer 103

- delayed compared to contraction - nadir of deceleration occurs after peak of contraction - gradual (> 30s from onset to nadir) - can be due to Uteroplacental insufficiency, fetal hypoxia, or fetal acidosis

Answer 104

- can be but not necessarily associated w/ contractions - abrupt onset (< 30s from onset to nadir) - decrease >15bpm; duration >15s but < 2 min - due to CORD COMPRESSION, OLIGOHYDRAMNIOS, CORD PROLAPSE - like late decelerations, recurrent variable decelerations also indicate fetal distress with risk of hypoxemia and acidosis

Answer 105

- often associated w/ ACCELERATIONS | - accelerations generally indicate normal fetal oxygenation

Answer 106

- Syphilis, HIV, and hepatitis B - note that screening for other infections in pregnancy (ie chlamydia, gonorrhea, hepatitis C) is based on the patient's risk factors - note that screening for syphilis is usually with the RPR or VDRL test; if test is positive, then diagnosis is confirmed w/ treponemal test such as FTA; treatment is with penicillin.

Answer 107

- First trimester US w/ crown-rump length measurement - estimated gestational age should not be changed based on measurement discrepancies on a second or third trimester US - the accuracy varies from +/- 3 to 5 days between 7-14 weeks gestation - after the first trimester, fetal abdominal circumference, biparietal diameter, femur length, and head circumference are used to estimate gestational age; these are less accurate

Answer 108

- associated with an increased risk of ASYMMETRIC fetal growth restriction - pregnant women who stop smoking by the third trimester have similar fetal birth weights compared to pregnant women who do not smoke

Answer 109

- fetal weight < 10th percentile - can be SYMMETRIC or ASYMMETRIC - Symmetric: due to FETAL FACTORS; both the head and body are affected; includes: congenital anomalies, chromosomal abnormalities, and congenital infections (ie toxoplasmosis, CMV, rubella, malaria) - Asymmetric: due to MATERNAL FACTORS; the body is affected but the head is spared; any maternal disorder associated w/ vascular disease (HTN, DM, preeclampsia, and cigarette smoking) can lead to asymmetric growth restriction

Answer 110

- affects head and body | - caused by fetal anomalies, abnormal fetal karyotype, and early maternal viral infection

Answer 111

- affects body only - generally appears later in pregnancy and is caused by maternal vascular disease, including hypertension, diabetes, and smoking

Answer 112

- stillbirth is defined as fetal death at > 20 weeks gestation - risk factors: HTN, DM, smoking > 10 cigarettes per day, and advanced maternal age - most common presenting symptom is ABSENT FETAL MOVEMENT - 2nd trimester: D&C (up to 24 weeks), Induction of labor, spontaneous vaginal delivery - 3rd trimester: Induction of labor +/- cervical ripening agents, spontaneous vaginal delivery, repeat C-section upon maternal request if patient has a hx of prior cesarean delivery

Answer 113

- absence of menses for > 3 cycles or > 6 months in women who previously had menses - initial evaluation includes b-hCG to exclude pregnancy, followed by serum prolactin to exclude prolactinoma and TSH to rule out hypothyroidism; pts w/ normal TSH and prolactin require serum FSH and LH to evaluate for ovarian failure and hypothalamic pituitary disorders - can be due to pregnancy, hypothalamic (GnRH deficiency), functional (eating disorders, stress), uterine (Asherman's syndrome), pituitary (prolactinoma), and endocrine (hypothyroidism); and PCOS

Answer 114

-indicated for pts w/ amenorrhea and hx of uterine procedures, normal lab studies (TSH, prolactin, FSH), and no withdrawal bleeding on estrogen/progestin stimulation test

Answer 115

- can be due to significant stress, systemic illness w/ weight loss, eating disorders (ie anorexia nervosa), or strenuous daily exercise. - more common in women w/ BMI < 18.5

Answer 116

- progestin receptor antagonist - can be used as emergency contraception to prevent ovulation and blocks the action of progesterone which is needed to maintain pregnancy

Answer 117

made when: - a fetal pole is visualized outside the uterus on US - the patient has a b-hCG level over the discriminitory zone (1200-2000) and there is no intrauterine pregnancy seen on US - the patient has inappropriately rising b-hCG level (less than 50% increase in 48 hours) and has levels which do not fall following diagnositc D&C

Answer 118

these include: - hemodynamic stability - nonruptured ectopic pregnancy - size of ectopic mass < 3.5cm in the presence of a fetal heart rate - normal liver enzymes and renal function - normal WBC count - ability of the patient to follow up rapidly if her condition changes

Answer 119

-Thelarche, Adrenarche, Growth spurt, Menarche

Answer 120

- adequate body weight - sleep - optic exposure and sunlight

Answer 121

- eating disorders - excessive exercise - stress/depression

Answer 122

-can cause premature ovarian failure

Answer 123

- short stature - webbed neck - heart defects - abnormal faces - delayed puberty - normal karyotype

Answer 124

- olfactory tract hypoplasia and the arcuate nucleus does not secrete GnRH - females have no sense of smell and do not develop secondary sexual characteristics - diagnosis of exclusion in most cases during the workup of delayed puberty - anosmia w/ delayed puberty - Tx is pulsatile GnRH therapy

Answer 125

manifested by premature secretion of GnRH hormone in a pulsatile manner - generally a diagnosis of exclusion - tx is GnRH agonist to suppress pituitary production of FSH and LH - the process should be treated if the bone age or puberty is advanced by several years

Answer 126

-between nine and 17

Answer 127

- describes a severe form of PMS in which the diagnostic criteria include 5 out of 11 clearly defined symptoms, FUNCTIONAL IMPAIRMENT, and prospective charting of symptoms - all 3 areas need to be present for the diagnosis

Answer 128

- Vitamin A, E, and B6 | - replacement might improve symptoms

Answer 129

-Prospective symptom calendar

Answer 130

-Luteal phase

Answer 131

-PMS is characterized by mild to moderate symptoms, while PMDD is associated with severe symptoms that seriously impair usual daily functioning and personal relationships

Answer 132

- family history of PMS, vitamin B6, calcium, or magnesium deficiency - Note that previous anxiety, depression, or other mental health problems are significant risk factors for developing PMDD

Answer 133

Helps sustain the corpus Luteum during the first 7 weeks of pregnancy. After that the placenta takes over for the corpus Luteum in making progesterone to sustain pregnancy

Answer 134

66-100% every 48 hours

Answer 135

US before 12 weeks measuring the crown-rump length

Answer 136

- X linked mutation of androgen receptor - breast development present - absent uterus and upper vagina; cryptorchid testes - minimal to absent axillary and pubic hair - 46 XY

Answer 137

- Hypoplastic or absent mullerian ductal system - breast development present - absent or rudimentary uterus and upper vagina; normal ovaries - normal axillary and pubic hair - 46 XX

Answer 138

- malformation of urogenital sinus and mullerian ducts - breast development present - normal uterus, abnormal vagina; normal ovaries - normal axillary and pubic hair - 46 XX

Answer 139

- complete/partial absence of 1 X chromosome - breast development variable depending on ovarian function - normal uterus and vagina; streak ovaries - normal axillary and pubic hair - 45 X

Answer 140

-absence of menses by age 15 in someone who has normal growth and secondary sexual characteristics

Answer 141

- 46 XY - cannot convert testosterone to dihydrotestosterone - manifests as ambiguous genitalia at birth (undervirilization) and a male internal urogenital tract (due to AMH)

Answer 142

- diagnosed clinically be the presence of maternal fever and 1 or more of the following: uterine tenderness, maternal or fetal tachycardia, malodorous amniotic fluid, or purulent vaginal discharge - prolonged rupture of the membranes is an important risk factor - note that it can also occur in pts w/ intact membranes - usually a POLYMICROBIAL infection

Answer 143

-occurs before the onset of labor and is defined as prolonged when rupture lasts > 18 hours between the time of rupture and birth

Answer 144

- women w/ premature ROM are at increased risk - presents w/ PAINFUL vaginal bleeding - uterine tenderness, abnormal uterine contractions, and fetal distress due to poor placental perfusion may be evident

Answer 145

-manifests as purulent cervical discharge due to Trichomonas, Chlamydia, or Gonorrhea in the ABSENCE of uterine tenderness

Answer 146

-extremely rare after the first trimester

Answer 147

-prolonged ROM

Answer 148

- risk factors: prolonged rupture of membranes, prolonged labor, internal fetal or uterine monitoring devices, presence of genital tract pathogens - diagnosis: maternal fever > 100.4 PLUS 1 or more of the following: maternal tachycardia, uterine tenderness, malodorous/purulent amniotic fluid or vaginal discharge, WBC >15,000, fetal tachycardia - tx: broad spectrum antibiotics (ie ampicillin, gentamicin, clindamycin), delivery - complications: maternal uterine atony, postpartum hemorrhage, endometritis, premature birth, infection, encephalopathy, cerebral palsy, death of infant

Answer 149

- prompt administration of broad spectrum antibiotics followed by delivery to reduce the risk of life-threatening neonatal infection and maternal complications - chorioamnionitis is not an indication for cesarean delivery

Answer 150

- may lead to tubo-ovarian abscess, abscess rupture, pelvic peritonitis, and sepsis if left untreated - inability to take oral meds due to nausea and vomiting is an indication for inpatient tx of PID - diagnosis: fever > 38C, leukocytosis, elevated ESR, purulent cervical discharge, adnexal tenderness, cervical motion tenderness, lower abdominal tenderness - most common cause of infertility in women age < 30 w/ normal menstruation - regimes for inpatients: cefoxitin or cefotetan/doxycycline, and clindamycin/gentamicin (all IV) - regimens for outpatients: IM cefoxitin w/ oral probenecid and oral doxycycline, or IM ceftriaxone and oral doxycycline

Answer 151

- endometriosis - fibroids - adenomyosis - endometrial cancer/hyperplasia - endometritis

Answer 152

- pain w/ menses - dyspareunia - infertility

Answer 153

- heavy menses w/ clots - constipation, urinary frequency, pelvic pain/heaviness - enlarged uterus - frequently coexist w/ adenomyosis

Answer 154

- dysmenorrhea, pelvic pain - menorrhagia - bulky, globular and tender uterus - occurs most frequently in parous women age > 40 and typically presents w/ dysmenorrhea, menorrhagia, and pelvic pain. Uterus is symmetrically enlarged but < 12 weeks size - confirmation of the diagnosis requires surgical pathology after hysterectomy - other associations: early menarche, short menstrual cycles, prior uterine surgery, and preterm birth. More than 50 % of women w/ adenomyosis have concurrent fibroids or an adenomyoma (adenomyosis limited to one portion of the uterus)

Answer 155

- hx of obesity, nulliparity, or chronic anovulation - irregular, intermenstrual, or postmenopausal bleeding - small, nontender uterus - women age > 45 w/ irregular bleeding require an ENDOMETRIAL BIOPSY to exclude malignancy

Answer 156

- recent instrumentation of the uterus (ie abortion, uterine surgery, intrauterine device placement) - foul smelling discharge - fever - usually causes pelvic pain - presentation is typically acute (within 10 days of the procedure)

Answer 157

-inherited bleeding disorder that causes easy bruising, bleeding, heavy menses, nosebleeds, and excessive bleeding after surgery or delivery

Answer 158

- usually anovulatory due to immaturity of the developing hypothalamic-pituitary-gonadal axis that does not produce adequate quantities and proportions of the hormones (LH, FSH) required to induce ovulation - estrogen is present, but not progesterone

Answer 159

- occurs most commonly in women of reproductive age - primary risk factor is ovarian enlargement (ie pregnancy, tumors) - pts develop sudden onset of unilateral lower abdominal pain (usually right-sided), nausea, and vomiting - diagnosis is confirmed w/ US using color doppler - management includes laparoscopic surgery

Answer 160

- both often present similarly w/ sudden onset of lower abdominal pain, nausea, and vomiting - however, appendicitis usually begins as periumbilical pain that migrates to the right lower quadrant. Pts may also have anorexia and bowel complaints.

Answer 161

- serious complication of gonadotropin therapy for infertility - characterized by ovarian enlargement from multiple cysts w/ fluid shifts out of the intravascular space that results in ascites and hypovolemia

Answer 162

- presents w/ sudden onset of lower abdominal pain (at midcycle), often following strenuous physical activity or sexual intercourse - may be accompanied by light vaginal bleeding - in rare cases, significant hemorrhage from cyst rupture can lead to shock and hemoperitoneum

Answer 163

expected PaCO2 = (0.9 x bicarb) + 16 +/- 2

Answer 164

Winter's formula | PaCO2 = (1.5 x bicarb) + 8 +/- 2

Answer 165

- normal phenomenon of late pregnancy caused by a direct stimulatory effect of progesterone on the central respiratory center - this leads to increased respiratory drive, relative hyperventilation, and primary respiratory alkalosis

Answer 166

- Variable decelerations --> Cord compression/prolapse; oligohydramnios - Early decelerations --> Head compression - Accelerations --> Ok (normal fetal oxygenation) - Late decelerations --> Placental insufficiency

Answer 167

- surgical emergency that happens when the cord is the presenting part - can occur w/ rupture of the membranes - cord becomes compressed, compromising blood flow and oxygenation of the fetus - it is PAINLESS and may be diagnosed on fetal heart monitoring, w/ sudden changes frequently characterized by deep, recurring variable decelerations

Answer 168

- contractions and cervical change prior to 37 weeks gestation - pain associated w/ preterm labor is INTERMITTENT and the uterus relaxes w/ no pain between contractions

Answer 169

- include vaginal bleeding (80% of cases), abdominal pain, uterine tenderness, and uterine contractions w/ increased uterine tone - the absence of blood on pelvic exam does NOT rule out this condition

Answer 170

- should be evaluated initially by transvaginal US and then a cancer antigen (CA)-125 level - any elevation of CA-125 in a postmenopausal woman raises suspicion for ovarian cancer - If the US suggests a simple cyst and the CA-125 level is not elevated, masses < 10 cm can be followed conservatively

Answer 171

- generally occurs in a group O mother with a group A or B baby, but ABO incompatibility causes less severe hemolytic disease of the newborn than does Rh(D) incompatibility. - Affected infants are usually asymptomatic at birth w/ absent or mild anemia and develop neonatal jaundice, which is usually successfully treated w/ phototherapy

Answer 172

- typically presents w/ chronic pelvic pain (may be worse during menses), dyspareunia, infertility, and sometimes w/ bowel/bladder problems - pts w/ pelvic pain and no complications can be treated empirically w/ NSAIDs, COC's, progestins, or GnRH agonists - Laparoscopy is useful for diagnosis and tx of complicated endometriosis (ie bowel/bladder obstruction, rupture of endometrioma) and for pts refractory to medical therapy

Answer 173

10 points total; assign 0-2 for each of the following: - Color - Pulse - Respirations - Grimmace - Tone

Answer 174

The 4 T's: - retained Tissue - Trauma - uterine Tone - Thrombin (coagulation defects)

Answer 175

- recurrent mild and unilateral midcycle pain due to normal follicular enlargement prior to ovulation - pain lasts a few hours to couple of days - US is frequently normal and not needed

Answer 176

- amenorrhea, crampy abdominal pain and vaginal bleeding - no intrauterine pregnancy on transvaginal US - positive serum hCG

Answer 177

- acute onset of severe unilateral lower abdominal pain, nausea and vomiting - unilateral, tender adnexal mass on exam - pelvic US w/ Doppler shows enlarged ovary w/ decreased blood flow

Answer 178

- sudden onset severe unilateral lower abdominal pain immediately following strenuous or sexual activity - pelvic US shows free fluid near ovarian cyst

Answer 179

- fever/chills, new vaginal discharge, lower abdominal pain, dysuria, painful defecation and cervical motion tenderness - transvaginal US to rule out tubo-ovarian abscess

Answer 180

- presents w/ acute onset of unilateral pelvic pain immediately after strenuous activity or sexual intercourse - pelvic US can confirm the diagnosis by showing free fluid in the pelvis - supportive care (eg analgesics) is recommended for uncomplicated cyst rupture; complicated cyst rupture may require surgical intervention

Answer 181

- increases the risk of cystitis, pyelonephritis, preterm birth, low birth weight, and perinatal mortality - E. coli accounts for > 70% of cases - Accepted regimens include nitrofurantoin for 5-7 days, amoxicillin or amoxicillin-clavulanate for 3-7 days, or fosfomycin as a single dose - Fluroquinolones should be avoided during pregnancy, and TMP/Sulfa should be avoided in the 1st and 3rd trimesters

Answer 182

- used to determine ovulatory reserve | - will decrease in older women who have a decreased capacity to ovulate

Answer 183

- medical emergency that should be treated promptly w/ broad-spectrum antibiotics and surgical evacuation of the uterus - after the initial tx, the patient should be monitored closely for signs of systemic sepsis

Answer 184

- seen in fetal abnormalities such as open neural tube defects, gastroschisis, and omphalocele - also elevated in a multiple gestation pregnancy - an US should be performed to evaluate the fetal anatomy

Answer 185

- arise in younger women or in children, with an average incidence at the age of 20 - they are usually unilateral and occasionally undergo torsion - the tumor is neutral and does not secrete either male or female sex hormones

Answer 186

- produce androgens and cause defeminization followed by masculinization - women in the childbearing age may complain of an altered body contour, flattening of the breasts, and scanty, irregular menstruation, ultimately ending in amenorrhea - pts may develop hirsutism, coarsening of features, and enlargement of the clitoris

Answer 187

- aka dermoid cysts | - often benign and do not produce either estrogens or androgens

Answer 188

- most common cystic ovarian neoplasms, accounting for about 30% of all ovarian tumors - and 25% of all these are malignant, and about half of the cases are bilateral - they usually do not produce estrogen or androgen - ovarian mass and abdominal pain are the presenting features

Answer 189

- produce excessive amounts of estrogen, and can present w/ precocious puberty in younger children and postmenopausal bleeding in elderly pts - this has to be differentiated from heterosexual precocious puberty or virilizing symptoms which are usually produced by excessive androgens

Answer 190

- produced by the placenta, and serum levels quickly decrease after delivery of the placenta - insulin antagonist effect and plays an important role in nutrition of the fetus by causing maternal lipolysis and insulin resistance thus increasing delivery of fatty acids and glucose to the fetus

Answer 191

- Progestin-only oral contraceptives - note that sterilization, barrier methods, IUDs and progestin-only oral contraceptives can all be used in the postpartum period

Answer 192

- death of a fetus in utero that occurs after 20 weeks gestation and before the onset of labor - a coagulation profile should be drawn after diagnosis to detect incipient DIC - Fibrinogen levels in the low normal range may be an early sign of consumptive coagulopathy, esp. if there is an associated decrease in platelet count, increase in PT and PTT or the presence of fibrin split products - labor should be induced w/o delay in pts w/ intrauterine fetal demise who develop coagulation abnormalities

Answer 193

- risk factors: family history, early menarche - clinical features: urinary frequency, constipation (secondary to compression), heavy prolonged menses w/ clots, pelvic pressure or pain, pregnancy difficulties (impaired fertility, pregnancy loss, preterm labor) - workup: Ultrasound - Tx: observation if no significant symptoms, hormonal contraception, embolization, or surgery if symptomatic

Answer 194

- most commonly a benign problem - Preeclampsia and DVT should also be considered, but are unlikely in the absence of other classic symptoms of these conditions

Answer 195

- characterized by a phenotypic female w/ a 46 XY karyotype - BILATERAL GONADECTOMY is recommended after completion of puberty (ie attainment of adult height) to decrease risk of gonadal malignancy

Answer 196

- classic risk factors: female, fat, forty - gallstones may occur w/ rapid weight loss due to a very low calorie diet or bariatric surgery - unopposed estrogen use (hormonal therapy) and oral contraceptives also increase the risk of cholelithiasis

Answer 197

- male, diuretic use, alcohol consumption, obesity, and a diet rich in purines (organ meats, game, seafood) - starvation w/ rapid weight loss can precipitate an acute gout attack

Answer 198

- due to suppression of the hypothalamic pituitary ovarian axis by strenuous exercise, anorexia nervose, marijuana use, starvation, stress, depression, or chronic illness - pts are at risk for bone loss due to estrogen deficiency

Answer 199

- usually bilateral and can be milky (most common), yellow, brown, gray, or green. - hyperprolactinemia is the most common cause of physiologic galactorrhea - galactorrhea should be evaluated w/ serum prolactin, TSH, and possible brain MRI - Pts w/ unilateral or bloody (gross or occult) nipple discharge, palpable abnormalities, or skin changes should be evaluated for possible malignant causes

Answer 200

-most common cause of physiologic galactorrhea -can be due to pituitary prolactinoma, meds (antipsychotics, opioids), hypothyroidism, pregnancy, oral contraceptives, or chest wall/nipple stimulation (surgery, trauma, shingles). pts w/ prolactinoma often develop symptoms of hypogonadism (hot flashes, oligo/amenorrhea)

Answer 201

- usually occurs in the last 4-8 weeks of pregnancy - contractions are felt in the lower abdomen, are irregular, occur at an interval that does not shorten and do not increase in intensity - the the last month of pregnancy, pts may experience contractions that become rhythmic, occurring every 10-20 minutes, and contractions of greater intensity, mimicking more closely the contractions of actual labor - in all cases of false labor, however, contractions are NOT accompanied by progressive cervical changes and are usually RELIEVED BY SEDATION - all such patients need reassurance and discharge home

Answer 202

- contractions that occur at regular intervals w/ a progressively shortening interval and increasing intensity - the pain in true labor occurs in the back and upper abdomen and is NOT relieved by sedation - cervical changes are typically observed

Answer 203

- indicates poor preparation of the endometrium for implantation due to a progesterone deficiency - following ovulation, progesterone is produced in increased amounts by the corpus luteum

Answer 204

- in the fallopian tube is commonly the result of previous PID or endometriosis - other uncommon causes of ciliary dysmotility may also play a role

Answer 205

- characterized by anovulation or oligo-ovulation, signs of androgen excess, such as male-pattern hair growth and acne, and ovarian cysts - results from abnormal GnRH secretion that stimulates the pituitary to secrete excessive LH and insufficient FSH - excess LH stimulates excess androgen production by ovarian theca cells resulting in hirsutism, male escutcheon, acne and androgenic alopecia - anovulation is caused in part by imbalances in LH and FSH production and in part by insulin resistance in these pts

Answer 206

Nulliparous women 25-35

Answer 207

- risk factors: nulliparity, early menarche, shorter menstrual cycles, menstrual outflow obstruction - pathogenesis: ectopic endometrial tissue forms on or just beneath pelvic mucosa/serosal surfaces. Cyclic hyperplasia and degeneration occur in response to female sex hormones. Chronic hemorrhaging leads to formation of FIBROTIC PELVIC ADHESIONS. - clinical presentation: dyspareunia, dysmenorrhea, pelvic pain, infertility - diagnosis: direct visualization on laparoscopy +/- biopsy

Answer 208

-advancing age, hypertension, preeclampsia, renal disease, and cocaine or tobacco use

Answer 209

-positive family hx, genetic mutations (BRCA1, BRCA2, or p53), early menarche, late menopause, prolonged hormone replacement therapy, and nulliparity

Answer 210

-advancing age, unopposed estrogen or prolonged tamoxifen use, obesity, nulliparity, and anovulatory conditions

Answer 211

- mood swings, irritability, fatigue, bloating, and breast tenderness - symptoms occur in the 1-2 weeks prior to menses and resolve w/ onset of menstrual flow - the diagnosis is often readily apparent and can be confirmed w/ a menstrual diary - PMS can be differentiated from normal menstruation by the degree of distress and impaired functioning

Answer 212

- Depression of the deep tendon reflexes | - Tx requires stopping the magnesium sulfate infusion and administration of calcium gluconate

Answer 213

- indications for cesarean delivery regardless of fetal lie (ie failure to progress during labor, non-reassuring fetal status) - placental abnormalities (ie placenta previa or abruption) - oligohydramnios - ruptured membranes - hyperextended fetal head - fetal or uterine anomaly - multiple gestation

Answer 214

-performed in twin delivery to convert the second twin from a transverse/oblique presentation to a breech presentation for subsequent delivery

Answer 215

-can be attempted in women w/ breech pregnancies at >37 weeks gestational age if there are no contraindications to vaginal delivery, and fetal well-being has been established. These maneuvers can reduce the rate of cesarean section.

Answer 216

- administration of COMBINATION ANTIRETROVIRAL THERAPY to the mother throughout pregnancy. It should be administered as soon as possible during pregnancy, regardless of maternal CD4 count or viral load. - a 3 drug regimen of 2 nucleoside reverse transcriptase inhibitors (NRTIs) plus a non-nucleoside reverse transcriptase inhibitor or a protease inhibitor. - Zidovudine should be administered to the neonate for > 6 weeks

Answer 217

- Asymmetric (maternal factors): vascular disease, antiphospholipid antibody syndrome, autoimmune disease, cyanotic cardiac disease, substance abuse (tobacco, alcohol, cocaine) - Symmetric (fetal factors): genetic disorders, congenital heart disease, intrauterine infection (malaria, CMV, rubella, toxoplasmosis, varicella)

Answer 218

- maternal vascular disease, fetal anomalies, aneuploidy, intrauterine infection, and substance abuse - HTN is a risk factor for asymmetric fetal growth restriction secondary to uteroplacental insufficiency

Answer 219

- benefits: pregnancy prevention, endometrial and ovarian cancer risk reduction, menstrual regulation w/ reduction in iron deficiency anemia, reduction in risk of benign breast disease - risks: venous thromboembolism, HTN, hepatic adenoma, very rarely stroke and MI

Answer 220

ceftriaxone

Answer 221

Metronidazole

Answer 222

doxycycline

Answer 223

- may cause dysmenorrhea, typically in women age > 35 | - bulky, globular, and tender uterus

Answer 224

- tenderness along the uterosacral ligaments, nodularity in the cul-de-sac, and adnexal enlargement due to an endometrioma - pain from endometriosis usually precedes menses by a few days

Answer 225

- pelvic cramping during the first few days of menses in the context of a normal physical exam - caused by increased prostaglandin release from endometrial sloughing during menses

Answer 226

- high dose IV or oral estrogen - high dose combined oral contraceptive pills - high dose progestin pills - tranexamic acid

Answer 227

- usually a result of anovulatory cycles from an immature hypothalamic-pituitary-ovarian axis - evaluation for pregnancy and bleeding disorders is generally advised - high dose estrogen is the first line tx for pts w/ moderate to severe bleeding

Answer 228

- first trimester vaginal bleeding associated w/ expulsion of vesicles, excessive nausea and vomiting, and uterine size larger than dates - US shows a "snow storm" appearance, and b-hCG serum levels are increased beyond what would be expected in a normal pregnancy

Answer 229

- maternal smoking - advanced maternal age - previous spontaneous abortion

Answer 230

-placenta previa and abruptio placenta

Answer 231

- Prolactin production is STIMULATED by serotonin and TRH, and INHIBITED by dopamine (think about dopamine agonists such as bromocriptine) - Hypothyroidism may result in amenorrhea and galactorrhea!

Answer 232

- intense pruritis - elevated bile acids and levels of liver aminotransferases - diagnosis of exclusion - jaundice is uncommon in pts w/ ICP and warrant further workup

Answer 233

- preeclampsia, RUQ pain, Nausea/Vomiting | - Hemolysis, moderately elevated liver aminotransferases, thrombocytopenia

Answer 234

- malaise - RUQ pain - N/V - sequelae of liver failure - hypoglycemia, mildly elevated liver aminotransferases, elevated bilirubin, possible DIC

Answer 235

- diagnosed based on elevated blood pressure (>140 systolic or 90 diastolic), w/ new-onset proteinuria or end organ damage (thrombocytopenia, impaired liver function, pulmonary edema, and cerebral or visual symptoms) - lab abnormalities in a pre-eclamptic patient may raise suspicion for HELLP

Answer 236

- skin condition that develops in the third trimester - abdominal exam shows red papules within striae w/ sparing around the umbilicus, sometimes extending to the extremities - the palms, soles, and face are rarely involved, helping to distinguish it from Intrahepatic cholestasis of pregnancy (ICP) - there are no lab or liver abnormalities associated w/ PUPPP

Answer 237

- Screening by vaginal and rectal culture and PENICILLIN prophylaxis have drastically reduced the incidence of neonatal GBS infection - universal screening occurs at 35-37 weeks gestation as the result is most accurate within 5 weeks of the anticipated delivery date - Exceptions include a hx of GBS bacteriuria, UTI, or an infant w/ early onset GBS disease; these pts should receive antibiotic prophylaxis w/o testing

Answer 238

-initiate prophylaxis w/ penicillin if: | 18 hours

Answer 239

- normal bladder capacity: 400-600 mL | - PRV: < 50 mL

Answer 240

- Chlamydial cervicitis | - Tx is azithromycin

Answer 241

- Gonorrheal cervicitis | - Tx is Ceftriaxone

Answer 242

- Trichomonas vaginitis | - Tx is Metronidazole

Answer 243

- presents as white, thin, and wrinkled skin over the labia | - typically affects postmenopausal females and causes pruritus

Answer 244

- typically affects middle-aged women - lesions may be hyperkeratotic, erosive or papulosquamous in appearance - pruritis, soreness, and vaginal discharge are common

Answer 245

- caused by HPV and present as clusters of pink lesions on the genitalia. - small lesions can be treated in the office w/ trichloroacetic acid or podophyllin

Answer 246

- # of uterine contractions in 10 minutes x contraction strength - contraction strength = peak mmHg - baseline mmHg using internal pressure catheter - adequate labor = 200 montevideo unites

Answer 247

- diagnosed when dilation is 6 cm or more with ruptured membranes in the setting of no cervical change for 4 or more hours despite ADEQUATE contractions (> 200 montevideo units for >2 hours) OR when there is no cervical change for >6 hours w/ INADEQUATE contractions. - Pts who do not meet criteria should be observed if there is no fetal distress

Answer 248

- average age 51 - can be diagnosed clinically in women over the age of 45 w/ a 12 month hx of amenorrhea without other physiologic causes

Answer 249

- women 45 or older and all postmenopausal women - women less than 45 w/ persistent symptoms or risk factor for endometrial cancer (obesity, diabetes, unopposed estrogen exposure, PCOS, early menarche, etc.) - unopposed estrogen exposure (eg obesity, PCOS) - prolonged amenorrhea w/ anovulation

Answer 250

- risk factors: heavy blood loss during or after delivery with hypotension &/or need for large volume blood transfusion - can occasionally occur after normal delivery - loss of anterior pituitary hormones (GH, prolactin, FSH, LH, TSH, ACTH) - inability to lactate, amenorrhea - loss of sexual hair, anorexia, weight loss, lethargy - hyponatremia

Answer 251

-made by the granulosa cells of ovarian follicles and causes feedback inhibition of pituitary FSH release

Answer 252

- typically presents w/ rapid onset of respiratory failure, severe hypotension, and DIC during labor or the immediate postpartum period - the diagnosis is made clinically, and management is supportive - it is rare, unpredictable, and associated w/ poor maternal and fetal outcomes - risk factors: advanced maternal age, gravida >5 (live births or stillbirths), cesarean or instrumental delivery, placenta previa or abruption, preeclampsia - presentation: cardiogenic shock, hypoxemic respiratry failure, DIC, coma or seizures

Answer 253

- usually suggest umbilical cord compression - intermittent or recurrent - intermittent: require no specific interventions - recurrent: require maternal intrauterine resuscitative measures - most cases can be managed w/ oxygen administration and change in maternal position

Answer 254

- FSH measurement should be ordered if there is no breast development - pituitary MRI is the next step if FSH is decreased - Karyotyping is the next step if FSH is increased

Answer 255

- mother is given IV oxytocin sufficient to result in 3 contractions every 10 minutes, and the effect these contractions have on fetal heart activity is recorded - if a late deceleration is noted at each contraction, the test is positive and delivery is usually recommended

Answer 256

- reactive (normal) if in 20 minutes there are at least 2 accelerations of the fetal heart rate of at least 15 beats/min above the baseline and lasting at least 15 seconds each - if < 2 accelerations are noted in 20 minutes, the test is considered nonreactive (abnormal) and further assessment is required

Answer 257

- FETAL: oligohydramnios, meconium aspiration, stillbirth, macrosomia, convulsions - MATERNAL: cesarean delivery, infection, postpartum hemorrhage, perineal trauma

Answer 258

- single deepest vertical pocket of amniotic fluid < 5 cm on transabdominal US - common complication of prolonged pregnancies

Answer 259

-between 5.5-9.9 lbs

Answer 260

- deepest vertical pocket > 8 cm or an amniotic fluid index of > 24 cm - associated w/ congenital fetal malformations or maternal diabetes

Answer 261

-extremes of maternal age ( 40), nulliparity, chronic hypertension, hx of preeclampsia, diabetes mellitus, and renal disease

Answer 262

-Hgb < 11 g/dL in the 1st and 3rd trimesters and < 10.5 g/dL in the second

Answer 263

-usually occurs EARLY in pregnancy (not in the 3rd trimester) and presents w/ significant vomiting leading to volume depletion and a hypochloremic metabolic alkalosis

Answer 264

- commonly presents after 20 weeks gestation w/ proteinuria or evidence of end organ damage - pts typically develop severe hypertension, headaches, nausea/vomiting, and vision problems (ie blurry vision) - lab studies usually show thrombocytopenia, elevated liver enzymes, microangiopathic hemolytic anemia, and elevated creatinine > 1.1 mg/dL

Answer 265

- LABETALOL and METHYLDOPA - calcium channel blockers and hydralazine are acceptable alternate therapies - ACE-inhibitors and angiotensin receptor blockers are contraindicated in pregnancy!

Answer 266

- breastfeeding women are at risk if missed nursing sessions leading to inadequate milk drainage - tx consists of analgesics, frequent BREASTFEEDING (not pumping), and antibiotics directed at Staphylococcal aureus

Answer 267

- bloody, malodorous discharge, and an irregular vaginal lesion - risk factors for squamous cell carcinoma of the vagina are similar to cervical cancer (ie smoking, HPV infection) - diagnosis is by biopsy and tx is determined after staging

Answer 268

- defined as primary hypogonadism in a woman under age 40 - causes: chemotherapy, radiation, autoimmune ovarian failure, Turner's syndrome, and fragile X syndrome - decreased estrogen levels, and increased FSH and LH levels. Developing follicles are the main source of estrogen, and since impaired follicular development is the cause, there is depressed estrogen levels. This results in loss of feedback inhibition of estrogen on FSH and LH, causing both to become elevated. The elevated of FSH is generally greater than that of LH due to slower clearance of FSH from the circulation - FSH elevation in the setting of > 3 months of amenorrhea in a woman under age 40 confirms the diagnosis - all pts w/ secondary amenorrhea should receive a pregnancy test, prolactin level, and FSH level

Answer 269

- only beneficial in monitoring growth-restricted fetuses (< 10th percentile) - normal test would show high velocity diastolic flow in umbilical artery

Answer 270

-estrogen analog that can be used to induce ovulation in anovulatory women who have some ovulatory reserve, such as pts w/ PCOS

Answer 271

- UNILATERAL discharge - SEROUS or BLOODY (gross or occult) rather than milky discharge - Palpable breast abnormalities - skin changes (eg Paget disease of the breast) - These pts require mammography and possible US

Answer 272

- occurs most frequently in parous women age > 40 and typically presents w/ dysmenorrhea, menorrhagia, and pelvic pain. - on physical exam, the uterus is symmetrically enlarged, globular, and boggy but is usually < 12 weeks size - confirmation of the diagnosis requires surgical pathology

Answer 273

- arise in younger women or in children, w/ an average incidence at the age of 20. - they are usually UNILATERAL and occasionally undergo TORSION - the tumor is NEUTRAL and does not secrete either male or female sex hormones

Answer 274

- produce ANDROGENS and cause defeminization followed by masculinization - women in the childbearing age may complain of an altered body contour, flattening of the breasts, and scanty, irregular menstruation, ultimately ending in amenorrhea - pts may develop hirsutism, coarsening of features, and enlargement of the clitoris

Answer 275

- aka dermoid cysts | - often benign and do not produce either estrogens or androgens

Answer 276

- most common cystic ovarian neoplasm, accounting for about 30% of all ovarian tumors - about 25% of these are malignant, and about half of cases are BILATERAL - they usually do NOT produce estrogen or androgen - ovarian mass and abdominal pain are the presenting features

Answer 277

- produce excessive amounts of estrogen, and can present with precocious puberty in younger children and postmenopausal bleeding in elderly patients - this has to be differentiated from heterosexual precocious puberty or virilizing symptoms which are usually produced by excessive androgens

Answer 278

antibiotics should be given if: - labor starting at less than 37 weeks (preterm labor) - prolonged membrane rupture (water breaking 18 or more hours before delivery) - fever during labor