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OB/Gyn Flashcards

1
Q

Criteria for discharge post surgery

A 
Alert
Ambulatory (to BL level)
Adequate po intake
Stable vitals
Satisfactory bowel/urinary fxn
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2
Q

What is footling breach?

A

Post membrane rupture, one single foot extending through the vaginal canal

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3
Q

What is lochia?

A

Normal shedding of endometrium after delivery of placenta
red (lochia rubra) -> pinkish/brown (lochia serosa) -> yellowish white (lochia alba)
Lasts 6-8 weeks post partum

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4
Q

Risk of vertical HIV transmission in a HIV + mom who declines ART delivery and c-section

A

25%
HIV + moms should receive ART and c-section
* 8% if ART alone and 2% or less in ART and c-section

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5
Q

Pt has bleeding, pain, and hCG in the 400’s. U/s negative. Now what?

A

Recheck BhCG in a couple of days. Pregnancy rarely visible on U/s when < 1500.
Visualize in a couple of days to identify if ectopic pregnancy

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6
Q

Mom at 27weeks is + for Syphillis. What next?

A

Confirm with MHA-TP (treponemal-specfic confirmatory test, more specific than RPR)
If this is also positive - tx mom for syphilis
Tx with penicillin. If allergic undergo penicillin desensitization

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7
Q

A pt presents with twins, one vertex one breech. What are the Method of delivery options?

A

Successful vaginal delivery is likely as long as the breeched twin is the same size or smaller than the vertex.

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8
Q

RhoGAM is indicated anytime mom is ___ and baby is ______

A

Mom is Rh- and baby is Rh+ regardless of blood type
Administer at 28wks and at delivery.
Failure = fetal hydrops

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9
Q

Pt has:
more than 5 contractions/10 min
Contraction lasting 2+ minutes
Contraction of normal duration within 1 minute of each other. dx?

A

Uterine hyperstimulation
d/c oxytocin (causes non reassuring fetal hr tracing)
half life = 3-5 min

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10
Q

Two malignant tumors that occur after abortion, ectopic pregnancy, or preterm/term pregnancy

A

Choriocarcinoma

Placental site trophoblastic dz

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11
Q

Management of hyperemesis gravidarum?

A

pyridoxine-doxylamine followed by promethazine and/or ondansetron

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12
Q

Pregnant woman AMS, RUQ pain, elevated LFTS, ABN coags. Dx?

A

Acute fatty liver of pregnancy
Microvesicular fatty infiltration usually occurring in late pregnancy.
presents with n/v, abd pain, jaundice

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13
Q

Why is vitamin A supplementation contraindicated in pregnancy?

A

Increased risk of cranial neural crest malformations.

Can be considered in strict vegans and immigrants

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14
Q

Mom presents in 3rd trimester for first prenatal visit also has HTN. Most likely finding on U/S?

A

Normal head and small abd circumference

Occurs due to diminished uteroplacental blood flow

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15
Q

Maternal hypothyroidism predisposes baby to?

A 
pregnancy loss
Pre-eclampsia
Placental abruption
Low birth weight
perinatal mortality
Neuropshyc impairment
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16
Q

Preggo with C-section history presents with bright red painless bleeding. Dx and at risk of?

A

Placenta previa
Massive hemorrhage
Usually plan a C-section at 35-36 weeks after confirmation of fetal lung maturity

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17
Q

Painless vaginal bleeding post sexual activity in a preggo. Dx and assessment?

A

Placenta previa
Do an abd U/S
Digital exam is contra -> worsens the bleeding
RF’s of previa are multiparity and C-sections

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18
Q

Cause of fetal deceleration during delivery?

A

Cord compression

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19
Q

What supplement should a woman take while she is trying to get pregnant?

A

Folic acid 0.4 mg QD

Prevents NTD

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20
Q

Preggo presents with painful vaginal bleeding following a trauma. Fetal heart rate 160. Dx?

A

Moderate placental abruption

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21
Q

What is an acceptable amount of radiation to expose a preggo to?

A

5 rad

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22
Q

Why do most preggo’s have a low HCT?

A

Decreased Serum:RBC ratio

Volume expanded

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23
Q

What should be measured following a spontaneous abortion that has been confirmed by U/S?

A

Serial BhCG to rule out ectopic preggo

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24
Q

Postpartum mom has little interest in her baby. Dx and Tx?

A

Post partum depression

Antidepressants and psychotherapy

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25
Q

When should a prophylactic cerclage be removed?

A

36-38 weeks gestation

This is when fetal lungs are considered mature

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26
Q

If a mother continues to bleed postpartum despite fundal massage, dx and tx?

A

uterine atony
Associated with late delivery, large baby, multiparity, long labor
Soft boggy bloody uterus
Tx - Oxytocine, IM methergine, carboprost, and misoprotol

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27
Q

Should you culture a pt that had a positive GBS urine in her first trimester and a previous baby that had GBS sepsis?

A

No. Just give intrapartum penicillin

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28
Q

When is the earliest you can karyotype a fetus?

A

10 weeks - chorionic villus sampling (CVS)
15 week - amniocentisis
Triple marker screening not considered definitive, just suggestive

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29
Q

Should a preggo be treated for aymptomatic UTI?

A

Yes. Nitrofurantonin. Do this to prevent pyelo

Untreated UTI also predisposes to low birth weight and prematurity

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30
Q

What should you do after D&C of a complete molar preggo?

A

Follow BhCG until it falls to zero

Then place pt on OCP and follow BhCG monthly to evaluate if there is a metastatic process

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31
Q

What do you do for a fetal demise?

A

Induce labor

Fetal demise = death in a fetus > 20weeks gestation. Usually from chromosomal anomaly but there are many causes

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32
Q

32 wk gestation with PPROM and lecithin:sphingoid of 1.5:1. Now what?

A

IM Betamethasone

PPROM with incomplete fetal maturity (ratio should be 2:1)

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33
Q

If a near term fetus does not have appropriate accelerations, what evaluation should you do?

A

Biophysical profile
Assess: fetal movement, fetal tone, fetal breathing, AF volume, and results of non-stress test
8-10 = baby is ok

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34
Q

Chorionic villous sampling increases risk of what?

A

Infant limb defects

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35
Q

Vaginal bleeding in the first trimester without fetal loss is?

A

Threatened abortion
Some bleeding, risk of miscarriage, but baby is still ok
About half will advance to complete abortion

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36
Q

Woman feels a gush of fluid. On PE no pooling of fluid in the vagina or ferning pattern. Dx?

A

Involuntary loss of urine

PPROm would have pooled fluid in the vag and a ferning pattern on a dried slide

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37
Q

If a woman becomes preggo within a month of receiving the MMR vaccine, is this reason to terminate the pregnancy?

A

No. The risk is small and shouldn’t warrant termination by itself.

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38
Q

During induced delivery baby has late decelerations. Why?

A

Fetal academia, late decelerations are not reassuring.

Correct by d/cing uterotoning drugs (ie oxytocin), add IVF, add oxygen, or change mom’s position

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39
Q

During delivery baby has moderate to severe decels. Now what?

A

C-section

Baby appears to be in distress

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40
Q

Why is a classic C-section scar contra for trial of vaginal birth?

A

they have 10% risk of uterine rupture.

Perform an amnio at 36-37 weeks to confirm lung maturity prior to scheduling section.

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41
Q

How is arrest of active labor defined?

A

> 3cm dilation = active phase
no cervical change in >4 hours with adequate contractions or >6 hours with inadequate contractions = arrest of labor
Consider adding pitocin for augmentation

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42
Q

What should be monitored in a preggo for 24 hours post trauma (ie MVA)

A

Fetal heart tones
Vaginal bleeding
Uterine tenderness

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43
Q

RF’s and management of IUGR

A

RF’s - uncontrolled HTN, congenital kidney/lung dz, abn karyotype,
Management - Induce labor esp if mom has HTN

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44
Q

Preggo has anxiety, NL TSH but high total T4. What should you do?

A

Reassure her. She is euthyroid (NL TSH) and her T4 is elevated because of elevated estrogen of pregnancy.

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45
Q

A fetus over 4500 g is considered

A

Macrosomia

offer a C-section to prevent clavical and brachial plexus injury

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46
Q

Tx for mastitis?

A

Dicloxacillin

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47
Q

Female has dyschezia (painful defecation), dyspareunia (painful sex), and dysmenorrhea. Dx?

A

Endometriosis

Dx through direct obs during laparoscopy

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48
Q

Tx for dysfunctional uterine bleeding in a hemodynamically stable pt?

A

High dose estrogen and progesterone

Give IV estrogen if unstable

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49
Q

Most common cause of a vaginitis in a young girl (ie less than 10)

A

Foreign body

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50
Q

Most common site of endometriosis?

A

Ovaries

Can present with nodularity of the uterosacral ligaments

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51
Q

Management of high-grade squamous intraepithelial lesion (HGSIL) on Pap smear?

A

Colposcopy to get bx and stage the lesion.

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52
Q

Vaginal itching with thining and atrophy of the skin?

A

Lichen sclerosis

Tx - topical clobetasol or halobetasol

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53
Q

At what point in pregnancy does cervical insufficiency become concerning?

A

2nd trimester (16 weeks)

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54
Q

What are good prognostic factors in a bx of a breast lump?

A

less than 2 cm
No lymph nodes
estrogen and progesterone receptors (responds to tamoxifen)
Carcinoma in situ

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55
Q

When should GBS screening be performed?

A

between 35 and 37 weeks

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56
Q

Leak of urine due to involuntary bladder contraction?

A

Urge incontinence
Feel like they need to pee all the time because of detrusor overactivity
1st line tx - frequent voiding and kegals
2nd line - anticholinergics (tolterodine)

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57
Q

How do you treat breast cancer in a preggo?

A

Same as a non preggo but:
NO chemo in 1st trimester
NO radiation therapy

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58
Q

Appropriate chlamydia tx in a preggo?

A

Azithromycin
Essential to treat to prevent neonatal conjunctivitis and PPROM
retest 4-6 weeks later to confirm cure

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59
Q

Large uterus with endometrial glands within the myometrium

A

Adenomyosis

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60
Q

Following an endometrial bx, pt has severe abdominal pain. Why?

A

Uterine perforation
U/s will reveal fluid collection posterior to the uterus
More common side effects - cramping, vaso-vagal rxn

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61
Q

When is LEEP indicated?

A

For therapeutic removal and bx of cervical lesions
Outpatient with local anesthesia
Complications - minor bleeding, infection.
Later complications - cervical stenosis, cervical incompetence

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62
Q

How do you manage ovarian torsion?

A

Laproscopy to prevent necrosis

Pt presents with intermittent lower quadrent pain, large ovary on U/S

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63
Q

Two major RF’s for UTI

A

Sex

hypoestrogenism - give estrogen as a preventative

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64
Q

Abdominal pain/tenderness, Cervical motion tenderness, adnexal tenderness. Dx?

A

PID

Can also have fever, elevated ESR, leukocytosis

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65
Q

Breast mass that gets very large but does not involve skin, nodes, or chest wall.

A

Cystosarcoma phyllodes

Usually benign

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66
Q

Pt has amenorrhea and galactorrhea. What is this concerning for?

A

Pituitary adenoma
Order an MRI
Tx - DA agonist (bromocriptine, cabergoline)

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67
Q

How do you DVT prophylax a non preg pt that has cancer?

A

Cancer = Hypercoagulable

Enoxaparin and warfarin with INR goal of 2-3

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68
Q

What is physiologic leukorrhea?

A

Thin white discharge in a otherwise healthy female
Seen in neonates shortly after birth
Also seen in young girls months prior to menarche
Caused by increasing estrogen levels

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69
Q

Management for a fibroid pt that may still want to have children?

A

Myoectomy

Presents with pelvic pressure, menorrhagea, anemia

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70
Q

Pap smear reveals atypical squamous cells of undetermined significance (ASCUS). Now what?

A

2 options:

  1. Repeat cytology in 1 year - use this when HPV testing has not been done
  2. Do HPV-DNA testing - if + for 16, 18, 31, 33, 35 then colposcopy
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71
Q

What is premenstrual dysphoric disorder? (PMDD)

A

combo of physical and emotional syx within a week of starting menses
abd bloating, breast tenderness, HA, dizziness
Labile mood, food cravings, increased appetite

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72
Q

Fxn of tamoxifen

A

Estrogen receptor modulator (agonist in uterus, bones, and liver; antag in breast tissue)
If a pt develops atypical hyperplasia d/c tamoxifen

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73
Q

First sign of precocious puberty in a female?

A

Thelarche (boobs) -> adrenache (hair) -> growth spurt -> menarche
Occurs at < 8y/o in females

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74
Q

First sign of precocious puberty in a male?

A

Testicular growth -> penile growth -> adrenarche (hair) -> growth spurt
<9 y/o in males

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75
Q

What is the primary AE of tamoxifen?

A

Endometrial changes

Increases bone density

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76
Q

Hirtuism + oligomenorrhea + Infertility + Obesity

A

PCOS
Also IR (acanthosis nigricans)
Tx - weight loss, DM screening, BP and lipid control, metformin, and thiazolidinodiones

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77
Q

Morphology of chlamydia

A

GN Intracellular bacteria

Infect squamocolumnar epithelial cells

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78
Q

How do you tx a pt with gonorrhea?

A

Azithromycin + ceftriaxone
azithro for chlamydia
ceftriaxone for gonorrhea

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79
Q

Pt continues to bleed despite fundal massage. Now what?

A

Give oxytocin to stop uterine atony

Significant postpartum hemorrhage >500mL

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80
Q

Best way to evaluate vaginal bleeding in a preggo

A

Abd U/s

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81
Q

During labor baby hr falls to the 70s and the umbilical cord has prolapsed. management?

A

Prolapsed umbilical cord is an obstetric emergency.

STAT c-section

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82
Q

Mom has seizure at 32 weeks. Now what?

A

Infuse Mg sulfate 6g x 15min to stabilize mom

Then deliver baby

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83
Q

If a preggo fails the 1hr glucose tolerance test, what do you do?

A

Schedule a 3 hour test

Normal 1 hr test is <140

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84
Q

Some Asian moms get darkened skin after pregnancy. What is ti and management?

A

Melasma (chloasma)
Common in darker skinned individuals and worsens with subsequent pregnancies
Avoid sun and wear sun block
Tx- hydroquinone

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85
Q

Rh- mom received Rhogam at 28 weeks. Why would you give another dose during this pregnancy?

A

Exposure to fetal blood (perform E-rosette test)

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86
Q

Causes of DIC during pregnancy

A

abruptio placentae, saline-induced therapeutic abortion, retained fetus syndrome, and initial phase of amniotic emobolism

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87
Q

How does hypothyroidism affect menstration?

A

Anovulation and irregular bleeding

Anovulation is due to unopposed estrogen and this leads to an unstable endometrium with irregular bleeding

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88
Q

Ovarian enlargement due to cysts and third spacing

A

Ovarian hyperstimulation syndrome (OHHS)
Often seen in women needing fertility treatment
Tx - supportive care and prevent thromboembolic dz

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89
Q

MOA of acyclovir

A

Nucleoside analogue that inhibits viral DNA polymerase

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90
Q

What do you do if a preggo has an abn pap smear?

A

Get a colposcopy

Treat them the same as a non preggo

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91
Q

T2DM begins having involuntary loss of urine and incomplete emptying

A 
Hypotonic bladder (overflow incontinence)
Neuropathy -> loss of innervation to the bladder
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92
Q

Recommended outpt tx for uncomplicated UTI?

A

po Bactrim x 3 days

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93
Q

How do you manage PID in pregnancy?

A

Admit to the hospital

IV clindamycin and gentamicin

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94
Q

Pt has PID with severe leukocytosis and fever. Y/s reveals ovarian mass

A

Tubo-ovarian abscesses (TOA)
Caused by PID ascending to the ovary or after pelvic surgery
Tx - IV abx and possibly surgery

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95
Q

How do you rule out endometrial cancer in a post menopausal woman with vaginal bleeding?

A

Endometrial bx

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96
Q

Best tx for urge incontinence?

A

Urge incontinence = unexpected immediate need to void

1st line = pelvic flood exercises and bladder training (Kegel’s and timed voids throughout the day

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97
Q

Painless genital lesion caused by GN encapsulated bacteria

A 
Klebsiella granulomatis
Donovanosis
Usually found in the tropics
Painless papules that ulcerates over weeks
Tx - Bactrim, doxy x 3wks
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98
Q

Hormonal abnormalities in PCOS

A

Increased Test
Decreased Sex hormone binding globulin
Increased LH:FSH (>1)

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99
Q

1 yr after pregnancy a woman is yet to start her periods again. TSH and Prolactin WNL. Why?

A

Secondary amenorrhea
Can occur after pregnancy due to inadequate progesterone or estrogen
Challenge with IM progesterone, if no bleeding after a week give estrogen and progesterone

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100
Q

What causes dysfunctional uterine bleeding and how do you treat?

A

Cause - anovulation, unopposed estrogen -> endometrium becomes unstable and sloughes randomly
Tx - (if hemodynamically stable) po cyclic progestins on days 14-25 of cycle or OCPs

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101
Q

Struma ovarii are associated with what hormone change?

A

Decreased TSH
Ovarian teratoma
Unilateral
Predominantly thyroid tissue

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102
Q

What do you do if you dx bacterial vaginosis in a preggo?

A

Po metronidazol

top metro and not treating are both associated with preterm labor

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103
Q

Post menopausal woman has vaginal bleeding and bx + for endometrial adenoma. What do you do?

A

Hysterectomy
B/l adnexectomy
Lymph node sampling

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104
Q

Tx for premenstrual dysmorphic disorder?

A

SSRI’s (Fluoxetine)

QD or only when symptomatic

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105
Q

17 y/o has primary amenorrhea. On PE, normal external genitalia with short vagina, no uterus

A

Mullerian agenesis (Mayer-
rokitansky Kuster Hauser syndrome)
Lack of Mullerian stuctures - uterus, fallopian tubes, cervix, upper vagina

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106
Q

Use of OCP’s x 3 years reduces risk of?

A

Endometrial cancer

Reduces risk by 50%

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107
Q

How frequently should women 50-70 undergo mammography?

A

Yearly

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108
Q

How should you workup a girl that has long periods and gets anemic?

A

Get a coag panel

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109
Q

PCOS pt is able to conceive on clomiphene but loses the babies at ~20 weeks. Now what?

A

Examine with saline-infused sonohysterogram (SIS) to see the contours of the uterus

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110
Q

Breast with redness, fullness, peau d’orange

A

Inflammatory cancer of the breast

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111
Q

Malodorous greenish-gray vaginal discharge

A

Trichomonas
Flagellated protozoan
Strawberry cervix

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112
Q

COD in ovarian teratomas?

A

Torsion,

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113
Q

A couple struggling with infertility have an abn sperm count. Now what?

A

Repeat sperm count in a few weeks.

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114
Q

Tall female without pubic hair or menstration

A

Androgen insensitivity
46 XY
Blind-end vaginal pouch and breast development

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115
Q

Androgen insensitivity is at great risk for which malignancy?

A

Testicular
Intra-abdominal
Need a bilateral gonadectomy at puberty

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116
Q

What should you do following a pap with low-grade or high-grade squamous intrepithelial lesion?

A

Colpoxcopy with endocervical curettage in non preggo’s

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117
Q

Young sexually active woman with abdominal pain

A

Dds: appendicitis, pelvic inflammatory dz, ectopic pregnancy, ovarian torsion, corpus luteum cyst formation

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118
Q

How long is the copper IUD effective?

A

10 years

Contra’s: pelvic infection w/in last 3 months

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119
Q

Post surgery pt is febrile and unresponsive to multiple abx

A

Septic pelvic thrombophlebitis
Post op or post partum infected thrombosis of the deep pelvic or ovarian veins
Tx- anticoags and broad spectrum abx

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120
Q

Pre-eclampsia with migraine, visual changes, elevated LFTs, elevated Cr.

A

Pre-eclampsia with severe features (ie end organ damage)

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121
Q

What is the tx of choice in a preggo with BP>160

A

IV labetalol

However, if pt is HTN and bradycardic, hydralazine is a better choice

122
Q

How do you manage a pt with previous classic C-section or myomectomy that is laboring?

A

Laparotomy and delivery

Risk of uterine rupture is too high for vaginal delivery

123
Q

What prenatal labs should be ordered at the initial OB visit?

A 
RhD screen
CBC
HIV, VDRL/RPR, HBsAg
Rubella and Varicella titer
Pap (if needed)
Chlamydia PCR
Urine culture and protein
124
Q

What labs should be ordered at 24-28wks of pregnancy?

A

CBC
Ab screen if Rh-
1 hr OGT

125
Q

What labs should be ordered at 35-37 weeks of pregnancy?

A

GBS

126
Q

Why does gestational DM happen?

A

In 2nd and 3rd trimester the placenta secretes hormones to increase maternal IR to promote fetal growth/metabolism. If women have inadequate pancreatic function to overcome the IR, they develop GDM

127
Q

Preggo presents with HTN and RUQ pain

A

HELLP syndrome
Manifestation of severe preeclampsia
Hemolytic anemia, elevated LFTS, Low Platelet
Abdominal pain due to liver swelling with distension of the hepatic (Glisson’s) capsule

128
Q

Preeclamptic pt with lung crackles

A

Pulmonary edema is a life threatening complication of severe preeclampsia
Caused by increased vascular resistance, capillary permeability, pulmonary capillary hydrostatic pressure, and decreased albumin

129
Q

How do you manage preeclampsia?

A

Mg sulfate - seizure prevention
BP control
Expedient delivery

130
Q

How do you manage a laboring mom that has a nonviable fetus?

A

Goal of delivery is to minimize maternal morbidity and mortality
Vaginal delivery is the lowest risk

131
Q

Why does a mom become hypotensive and tachycardic after an epidural?

A

Vasodilation and venous pooling

Occurs in 10% of mom’s receiving epidurals

132
Q

How do you manage a breech baby at >37 wks in a laboring mom with no contra to SVD?

A

External cephalic version

Reduces rate of C-section

133
Q

Maternal fever + uterine tenderness

A

Chorioamnioitis
Dx’d clinically by presence of maternal fever + at least one of: uterine tenderness, maternal or fetal tachy, malodorous amniotic fluid, purulent vaginal discharge
RF: prolonged ROM

134
Q

How do you manage chorio?

A

Broad spec sbx
Oxytocin
Get that baby out

135
Q

Recommendations for exercise during a healthy pregnancy?

A

20-30 min of moderate exercise on most days

Avoid high contact sports

136
Q

Most common cause of primary postpartum hemorrhage?

A

Uterine atony
Caused by failure of the uterus to contract and compress the vessels at the insertion of the placenta.
Profuse vaginal bleeding and a soft boggy uterus
RF’s Prolonged labor, induction of labor, operative VD, and fetal weight over 4kg

137
Q

How do you manage uterine atony?

A

Infusion of oxytocin + bimanual uterine massage

138
Q

What is a fetus at risk of in the setting of preeclampsia

A

Oligohydramnios
Fetal growth restriction/ small for gestational age
Caused by chronic uteroplacental insufficiency

139
Q

Signs and risk factors of shoulder dystocia?

A

Signs: prolonged first or second stage of labor and turtle sign
RF’s: maternal obesity, fetal macrosomia, excessive weight gain in pregnancy, Gestational DM, post-term pregnancy

140
Q

> 24 hr Post partum, pt is febrile + purulent lochia + uterine tenderness

A

Postpartum endometritis
Polymicrobial
IV clindamycin + gentamicin for broad spectrum coverage

141
Q

How do you manage a fetus in traverse lie?

A

Most will spontaneously convert to vertex prior to term
Fetus is essentially perpendicular to the vagina
Can perform external cephalic version of c-section

142
Q

Contraindications to breast feeding?

A

Maternal: active TB, HIV, Herpetic breast lesions, Active varicella, chemo/radiation, active substance abuse (esp mj as it is lipophilic)
Infant: Galactosemia

143
Q

After delivery of placenta a smooth round mass protrudes through the vagina. Dx and management?

A

Uterine infversion
Fundus inverst and prolapses, not palpable transabdominally, severe pain, hemorrhage
Tx - manually replace the uterus and use utertonic drugs after replacement

144
Q

How do you manage fetal demise >24 weeks

A

Induce vaginal delivery
Can be delayed to allow time for the mom to accept the diagnosis however, if fetus is retained for several weeks it can lead to coagulopathy
Cause of demise is UNK in the majority of cases

145
Q

What are normal changes during the puerperium?

A 
Shivering
Uterine contaction and involution
Lochia
Peripheral edema
Breast engorgement
146
Q

Medroxyprogesterone is?

A

Depo shot
AE’s breast tenderness, weight gain fatigue
Get UPT in a pt with these syx and has been amenorrhic for >1 month

147
Q

How does the DEPO shot work?

A

Inhibits release of gonadotropin releasing hormone (GnRH) from the hypothalmus -> suppresses ovulation
Bleeding irregularities normal in 1st year and 50% will be amenorrhic after 1 yr

148
Q

Pt at >6cm dilation has no cervical change for >4hrs with adequate contractions. Now what?

A

C-section

Oxytocin won’t help because she already has sufficient contractions

149
Q

How do you manage a spontaneous abortion (fetal demise < 20 weeks) in a mom that is hemodynamically unstable (hypotensive, dizzy)

A

Suction curettage

150
Q

How do you manage a spontaneous abortion in a stable pt?

A 
Expectant management
Medical induction (misoprostol)
151
Q

Vaginal spotting + lower abdominal pain + adnexal tenderness

A

Ecotpic preggo

Get UPT and a transvaginal U/s

152
Q

28 wk gestation w/ no fetal movement and no heart tones on doppler. Now what?

A

Absence of fetal heart activity on Transabdominal U/S to confirm fetal demise

153
Q

Late term (41 wk) and post term (42 wk) pregnancies are at risk for?

A

Uteroplacental insufficiency
Biophysical profiles starting at 41wks
If <4 -> induce delivery to prevent intrauterine fetal demise

154
Q

Why do preggos hyperventilate?

A

Progesterone changes the homeostatic set points in the medullary respiratory centers (more sensitive to changes in PcO2)
On ABG -> Increased PaO2, (100-110), low PaCO2 (27-32) and alkalosis (7.4-7.45
Small decrease in serum bicarb to compensate

155
Q

Treatment for lichen sclerosis?

A

Topical steroid
Want an ultrapotent steroid (clobetasol)
UNK if this will prevent scarring and/or squamous cell carcinoma (SCC)

156
Q

When is bx indicated for abn uterine bleeding?

A

Pt is >45
Or Pt is < 45 + any one of:
1. unopposed estrogen (obesity, chronic anovulation)
2. Failed medical management
3. Lynch syndrome (hereditary nonpolyposis colorectal cancer)

157
Q

Complication of preeclampsia with thrombocytopenia, microangiopathic hemolytic anemia, RUQ pain, and elevated LFTs

A

HELLP syndrome
Caused by hepatic and systemic inflammation, activation of the coagulation cascade, and platelet consumption
Deliver if >34 weeks or if abn fetal testing

158
Q

Pharyngitis, fever, lower abdominal pain in sexually active female?

A

Gonococcal pharyngitis + PID

From oral sex

159
Q

Female teen presents with primary amenorrhea, breast development, minimal pubic hair, absent uterus & upper vagina. Dx?

A

Androgen insensitivity syndrome (46XY)
X-linked mutation of androgen receptor
Will have male levels or Serum testosterone and cryptorchid testes

160
Q

Female teen presents with primary amenorrhea, Tanner 4 breast and pubic hair. Absent or rudimentary uterus & upper vagina, ormal ovaries

A 
Mullerian agenesis (46 XX)
Hypoplastic or absent mullerian duct system
161
Q

Female teen with Tanner 4 breasts and pubic hair, Normal uterus, abn vagina, normal ovaries

A

Transverse vaginal septum (46XX)

malformation of urogenital sinus and Mullerian ducts

162
Q

Female teen with normal uterus, vagina, but streak ovaries?

A 
Turner syndrome (45X)
Absence of X chromosome
163
Q

What are the causes of abn uterine bleeding?

A

Fibroids
Adenomyosis
Endometrial hyperplasia/cancer

164
Q

Female with heavy menses, constipation, urinary frequincy, pelvic pain/heaviness, enlarged uterus

A

Fibroids

165
Q

Female with dysmenorrhea, pelvic pain, heavy menses, bulky globular tender uterus

A

Adenomyosis
“Boggy” uterus
Endometrial glands within the uterine m.

166
Q

Female with hx of obesity nulliparity or chronic anovulation w/ irregular intermenstrual or postmenopausal bleeding. Nontender uters

A

Endometrial hyperplasia or cancer

167
Q

Following a normal pregnancy mom has SOB, enlarged uterus, irregular vaginal bleeding, and infiltrates on CXR. Now what?

A

Choriocarcinoma likely
Get a quantitative BhCG
Chorio is a form of gestation trophoblastic neoplasia that arises from placental trophoblastic tissue that secretes BhCG
Can occur after a molar, normal preg, or spont abortion
Lung most frequent site of metastasis

168
Q

On Stress test, the most likely cause of lack of fetal acceleration with NL movements?

A

Fetal sleep cycle
Can lastup to 40 min
Confirm with biophysical profile or contraction stress test

169
Q

Irregular contractions, no cervical change

A

False labor (Braxoton- Hecks)

170
Q

How do you manage a preggo with a pap result of high-grade squamous intraepithelial lesion?

A

Immediate colposcopy

Risk of progression to cervial cancer is high enough that all pts need tx regardless of pregnancy status

171
Q

Cause of variable contractions?

A

Cord compression
Oligohydramnios
Cord prolapse

172
Q

During labor there are variable decelerations occur with >50% of contractions

A

Reposition the mom

173
Q

How do you manage a pt that just had a d&c for a hydatidiform mole

A

If b-hcg is increasing - dx of gestation trophoblastic neoplasia
If b-hcg is decreasing - check monthly until undetectable, Contraception x 6 months
Accidental pregnancy clouds GTN screening

174
Q

Tamoxifen tx for breast cancer increases the risk for?

A 
Hot Flashes (most common)
Endometrial cancer
Venous thromboembolism
175
Q

What type of adnexal mass is seen in endometriosis?

A

Endometrioma
Homogenous cystic ovarian mass
Pt is often also infertile

176
Q

dysmenorrhea + heavy menstrual bleeding progressing to chronic pelvic pain

A 
adenomyosis
endometrial glands burry in the myometrium
PE - Boggy, tender, enlarged uerus
Dx - pelvic u/s, and/or MRI
Tx - IUD, hysterectomy
177
Q

Postcoital bleeding + mucopurulent discharge in a preggo

A

Acute cervicitis
chlamydia, gonorrhea
Tx - azithro + ceftriaxone

178
Q

Healthy female teen presents with hirsutism, acne, and elevated 17-hydroxyprogesterone

A

Congenital adrenal hyperplasia
Partial deficincy of 21-hydroxylase
Low cortisol and and aldosterone stimulates ACTH to oversecrete causing an overall increase in adrogens (due to diversion away from cortisol production))

179
Q

Unilateral breast pain that is diffusely warm, erythematous and some dimpling

A

Inflammatory breast carcinoma
Aggressive form of cancer w/ rapid onset
Can have nipple retraction
Dx -mammo + u/s, confirm with bx

180
Q

How do you tx a preggo that has made diet modifications but postprandial blood glucose is >140

A

Insulin, metformin, or glyburide

Insulin does not cross the placenta

181
Q

How do you manage a laboring mom with shoulder dystocia

A 
Stop pushing
Elevate hips against abdomen
Apply suprapubic pressure
Episiotomy
Deliver posterior arm, rotate, 
If it fails -place fetal head back into pelvis for delivery
182
Q

Who receives zidovudine?

A

Mom’s requiring c-section

Baby for 6+weeks after birth

183
Q

New born has loose skin, thin umbilical card, wide anterior fontanel

A

Fetal growth restriction (<10%th)

Examine the placenta for infection and/or infarction

184
Q

Preggo hasn’t been gaining weight and presents with AMS, nystagmus, and gait ataxia

A 
Thiamine deficiency (wernicke)
Associated with hyperemesis gravidarum
185
Q

uterus and post/ant vaginal walls prolapse through the vagina

A 
Uterine procidentia (pelvic organ prolapse)
Can tx with pessary or surgery
186
Q

OCP pt has new onset HTN

A

D/c OCP as these can exacerbate HTN

187
Q

Management of PPROM w/o contraction in a preggo <37 wks

A

abx (GBS status unk)
steroids
delivery

188
Q

unilateral bloody nipple discharge

A

Intraductal papilloma (benign)
Get mammo + u/s
bx +/- excission

189
Q

You id a adnexal mass in a post menopausal woman.. Now what?

A

serum CA-125 level and pelvic u/s
Biomarker for epithelial ovarain cancer (specific in post menopausal women, because it is also elevated by endometriosis)

190
Q

Pt has n/v dizziness and a molar pregnancy

A

Theca lutein cst
b/l multiloculated ovarian cyst hyperstimulation from abn trophoblastic proliferation
Tx - monitoring, should resolve after D&C for the mole and as BhCG falls

191
Q

On quad screen:

Increased Bhcg and inhibin

A

Trisomy 21

192
Q

On quad screen:

everything is low but inhibin is NL

A

Trisomy 18

193
Q

On quad screen:

Alpha fetal protein is elevated but all else is NL

A

Neural tube

194
Q

Lithium use during pregnancy causes?

A

Congenital heart disease (Ebstein’s anomaly)

Wean preggo’s off

195
Q

Retenoids during preggo cause?

A

Serious tetragen
Craniofacial dysmorphism, heart defects, deafness
Women receiving this should be on strict contraception and d/c immeadiately if the become preggo

196
Q

Primary RF for breast cancer?

A

Age

197
Q

What is the most important direct role of hCG in pregnancy?

A

Maintenance of the corpus luteum

Maintains progesterone until the placenta is able to produce progesterone

198
Q

In normal pregnancy, hCG doubles every

A

48 hours
Peaks at 6-8 weeks
The alpha subunit is found in TSH, LH,and FSH
Beta is unique to hcg

199
Q

Unexplained painful vaginal penetration (no other medical issues)

A

Genito-pelvic pain/penetration disorder (vaginismus)
Usually have a hx of trauma
Tx- desensitization and Kegel’s

200
Q

Lower abdominal pain, on u/s adnexal mass w/o doppler flow

A

Ovarian torsion

Tx - laparoscopy w/ cystectomy

201
Q

Gold standard of evaluating a woman suspicious for pre-eclampsia

A

Urine protein:Cr for a 24 hour urine

Dipsticks have a high false -ve rate

202
Q

Healthy pre-menopausal women with hx of chemo presents w/ amenorrhea and vaginal dryness

A

Primary ovarian insufficiency (hypergonadotrophic hypogonadism)
TSH, Prolactin - WNL
FSH, LH - elevated (no negative feedback from estrogen)
Look for a hx of chemotherapy
Tx - HRT and freeze eggs

203
Q

Tx of asymptomatic UTI in a 1st trimester preggo?

A

Amox-clavulanate (augmentin)
Nitrofurntoin (macrobid)
Cephalexin
NOTE bactrim is contra in 1st trimester due to blocking folic acid metabolism

204
Q

Tx for vaginal cadida?

A

po -azole (fluconazole)
OR
Top nystatin (NOT po)

205
Q

Adolescent w/ unilateral abdominal pain around the time of ovulation

A

Mittelschmerz
Occurs when the follicle ruptures to release the egg -> this also leaks blood causing some peritoneum irritation
Tx - reassurance, lasts approx 1 day

206
Q

Primary RF’s for Squamous cell carcinoma of the vagina?

A

Smoking
HPV
Presents with vaginal bleeding and malodorous discharge in post menopausal female

207
Q

Gold standard of testing for acute cervicitis

A

Nucleic acid amplification

208
Q

If you suspect fibroids you should order a?

A

Pelvic u/s

209
Q

Healthy female presents with fever, hypotension, and diffuse red macular rash of the palms and soles

A

Toxic Shock syndrome
Staph aureus
IVF and bx neded

210
Q

3rd trimerster vaginal bleeding but Fetal heart rate is stable

A

Placenta previa

HR is stable, if it were abruption mom would report pain and the fetal heart tracing would be abn

211
Q

Elevated CA-125, cRP and febrile pt has a pelvic u/s revealing a large thick walled multiloculated mass filled with debris

A

Tubo-ovarian abscess

Found in reproducte aged women with a hx of infection in the upper genital tract

212
Q

Morbidly obese pt with amenorrhea but NL TSH, prolactin, FSH and LH

A

Anovulation secondary to morbid obesity

Ovaries are producing estrogen, but progesterone is not produced at the normal post ovulation levels

213
Q

Preggo has a large uterus and reports a long hx of incomplete voiding.

A

Fibroids

Bulk related symptoms

214
Q

Still born has short, bent extremities and XRay reveals multiple limb fx and hypoplastic thoracic cavity

A

Type II Osteogenesis imperfecta
Type II = fatal perinatal
AD, type 1 collagen defect -> decreased bone density, increased skeletal fragility

215
Q

If you suspect a ruptured ectopic, what do you do?

A

Surgical exploration

216
Q

Pt presents with guarding + decreased bowel sounds

A

Acute abdome

in a female with + UPT -> hemoperitoneum due to interstitial ectopic (implanted in uterine carnu)

217
Q

Incidental surgery finding of powder-burn lesions, nodules

A

Endometriosis

If asymptomatic, just observe

218
Q

Following induction of a delivery, mom has a seizure due to hyponatremia. Why?

A

Oxytocin toxicity causes hyponatremia, hypotension, tachysystole
Structure is similar to ADH causing excessive retention of water -> hyponatremia
Tx - gradual hypertonic saline

219
Q

Which vaccines are recommended in pregnancy?

A

Tdap
Flu
Rhogam
NO: HPV, MMR, nasal flu, Varicella

220
Q

Irregular menses and infertility. Low LH, FSH and estradiol

A

Hypogonadotropic hypogonadism
Loss of pulsatile GnRH due to weight loss, stress, or chronic illness
Tx - remove underlying stressor

221
Q

Pt presents for first prenatal (amenorrhea, breast enlargement, morning sickness). On u/s, thin endometrial stripe

A

pseudocyesis
RF - infertility and previous pregnancy loss
Occurs when stress afftects the HPO axis

222
Q

Obese Pt with abn uterine bleeding has a bx showing complex endometrial hyperplasia

A

Endometrial hyperlasia due to uncontrolled proliferation of the endometrium due to unopposed estrogen from the peripheral adipose

223
Q

Laboring pt has moderate vaginal bleeding and baby has receded away from the pelvis

A

Uterine rupture
RF - csection
Loss of fetal station is pathognomonic
Tx - emergency laprotomy

224
Q

AA preggo with hirstuism and b/l ovarian masses

A

Luteoma
Hyperandrogenism
Caused by ovarain mass, benign, AA

225
Q

What is a renal change that is normal in preggo?

A

Decreased serum Cr

Increased renal blood flow -> increased GFR -> increased GBM permeability

226
Q

Modifiable RF’s for breast cancer

A

HRT
Nulliparity
Age at 1st live birth
Alcohol consumption

227
Q

How do you assess risk for preterm delivery in a preggo with a hx of cold knife bx?

A

TVUS

Measure the cervical length

228
Q

If a preggo has a short cervix (<2cm) at <24 wks give?

A

progesterone to maintain uterine quiescence

229
Q

Preggo <20 wks presents with preeclampsia with end organ damage

A

Hydatidiform mole
Pt presents with - HA, HTN, Hyperreflexia and + UPT
Caused by abn trophoblastic tissue proliferation

230
Q

Hormone levels in primary ovarian insufficiency

A 
Cessation of ovarian function at <40
High FnRH, FSH (hypothal and pit activity)
Low estrogen (ovary)
231
Q

Pt with irregular menses has a w/d bleed after progesterone challenge. what causes the irregularity?

A

Insufficient GnRH from the hypothalamus
Bleeding after progesterone challenge suggests nl estrogen production and endometerial proliferation (so ovaries are working)
HPO axis takes a while to mature in adolescents

232
Q

preggo presents with syx suspicious of hyperemis gravidarum. How do you confirm?

A

RF’s: Mole, multifetal gestation, hx of hyperemesis gravidarum
Signs: n/v, weight loss, dehydration
U/A ketones
Tx - antiemetics of IVF
Normal pregnancy associated nausea does not have ketones

233
Q

When is ROM PPROM?

A

<37 weeks

234
Q

Ovarian mass with calcifications and hyperechoic nodules

A

Cystic teratoma (dermoid ovarian cyst)
Benign ovarian tumor in premenopausal women
Tx - surgery
At risk of torsion

235
Q

Initial screening for a women with a palpable breast mass

A

> 30 Mammo

<30 U/s

236
Q

Risk of leaving asymptomatic cystitis untreated in a preggo

A

Pyelo

237
Q

Wat can cause magnessium toxicity in a preeclamptic?

A

Renal insufficiency

Mag is renally excreted

238
Q

Newborn has small body size, microcephaly, hypoplasia of distant phalanges and nails, excess hair, and cleft palate and rib anomalies.

A

Phenytoin exposure

239
Q

Newborn has rhinitis, hepatosplenomegaly, skin changes

A

Syphilis exposure

240
Q

Newborn has midfacial hypoplasia, microcephaly, stunted growth, hyperactivity, IDD

A

Fetal alcohol syndrom

241
Q

at <20 wks pt has spotting, decreasing bhcg, but closed cervix. Yolk sac but no fetal pole

A

Missed abortion

242
Q

<20wks vaginal bleeding, closed os, fetal cardiac activity present

A

Threated abortion

243
Q

<20 weeks, vaginal bleeding, dilated os, POC is felt/seen in the uterus

A

Inevitable abortion

244
Q

<20 wks, vaginal bleeding, closed os, PO outside of the uterus

A

Complete abortion

245
Q

What is the 1st step in managing a mom suspicious for a traumatic placental abruption

A

Resuscitate with fluids and crystalloids
Position mom in Left later decubitus position
Need to optimize maternal circulation

246
Q

Initial workup for a pt suspicious for meopause

A

hCG
TSH
FSH

247
Q

All sexually active women <25 should be screened for?

A

G/c

248
Q

Women with endometriosis are at greatest risk of developing?

A

Infertility

249
Q

Female <30 presents with an aysmptomatic soft, mobile, wel-circumscribed mass aprox the size of an egg at the base of the labia majora

A

Bartholin cyst
Caused by duct obstruction (dried glandular secretions, local trauma, idiopathic)
Gland distends due to accumulated fluid
Typically at 4 or 8 oclock position on labia majora

250
Q

How do you tx an asymptomatic Bartholin cyst?

A

Observation, generally drain on their own

251
Q

How do you tx a symptomatic Bartholin cyst?

A

I&D
Same as a Bartholin abscess
Word catheter prevents reoccurence

252
Q

Tx for stress incontinence that fails medical management?

A

Urinary sling

253
Q

Immigrant develops dyspnea during pregnancy. EKG id’s new a fib

A

Rhemuatic mitral stenosis

Can present during pregnancy due to extra stress on the heart

254
Q

Shortly after delivery pt develops hyperthyroid syx of anxiety

A

Postpartum thyroiditis
Occurs w/in 6 months of birth
Caused by release of T3/T4 that had been sequestered by TBH
Followed by a hypothyroid phase (fatigue, weight gain) until T3/T4 production catches up

255
Q

In placenta accreta the vili attach to?

A

Myometrium
NL placenta attaches to the decidua
Presents with difficulty delivering placenta and hemorrhage

256
Q

Tx for breast abscess?

A

Needle aspiration and abx (dicloxacillin, cephalexin)

Occurs due to untreated mastitis (presents similar but has a fluctuant mass)

257
Q

What is absolutely contra in all breast cancer pts?

A

Hormonal contraception (copper IUD is ok)

258
Q

Infetility pt presents with clear vaginal discharge and clear mucus over the cervical os

A

Ovulation
This clear thin cervical mucus corresponds with the LH surge (transition from follicular into into luteal phase)
Ovulation kits detect LH

259
Q

Most common cause of second stage arrest of labor (no fetal descent in >3 hrs in nulli’s and >2hrs in multi)

A 
Fetal malposition (ie anything not occiput anterior
Optimal: occiput anterior
260
Q

Fetal presentation refers to?

A

Presenting fetal part into the maternal pelvis (ie vertx vs breech)

261
Q

Amphetamine abuse during pregnancy is associated with?

A 
Preterm delivery
Preeclampsia
Abuptio placentae
Fetal growth restriction
Intrauterine fetal demise
262
Q

Sexually active female has grouped, tender, shallow labial ulcers w/ mildly enlarged tender lymph nodes

A

HSV

263
Q

Large deep painful vulvar ulcers with gray/yellow exudate and severe lymphadenopathy

A

chancroid

H. ducreyi

264
Q

Causes of painless genital ulcers

A

Trepenoma (syphillis)

Chlamydia trachomatis L1-L3 - shallow ulcers and

265
Q

Post partum pt had 3rd degree lac now presents with smelly vag discharge. PE small, red, velvety area on posterior vaginal wall w/ foul smelling brown discharge

A

Rectovaginal fistula
Usually present about 2wks postpartum
RF’s: 3rd, 4th degree lacs
Can present with flatus or fecal incontinance

266
Q

Shoulder dystocia produces claw hand

A

Klumpke palsy
Extended wrist, Hyperextended MCP’s, Flexed IPS, absent grasp reflex
Damage to c8 and T1
Can also have eye findings of Horner syndrome
Tx - PT to prevent contractures, usually improve by 9 months

267
Q

Shoulder dystocia produces waiter’s tip

A 
Erb-Duchenne palsy
Decreased moro and bicep reflex
Extended elbox, pronatoed forearm, flexed wrist, fingers
Intact grasp reflex
Damage to C5/6
268
Q

Most common cause of unilateral bloody nipple discharge

A

Intraductal papilloma

269
Q

Female with unilateral pelvic pain and free fluid on pelvic u/s, - UPT

A

Ruptured ovarian cyst

270
Q

Best test to dx HSV?

A

PCR

271
Q

Postpartum pt that received epidural is having continuous leaking of urine

A

Bladder atony (Post partum urinary retention and overflow incontinence)
RF’s: epidural and perineal swellin
Cath her for dx (urinary retention >150mL) and tx
Most pts regain fxn after a few hours off of anesthesia

272
Q

Pt has a resolved breast cyst after a FNA. When do you see her again?

A

2 months for repeat CBE.

If all good -> 1 yr

273
Q

STI with vag pH >5

A

Trichomonis

274
Q

How do you manage a HCV preggo that has not been vaccinated for any heps?

A

Order HAV and HBV now (acute hep is life threatening for these guys)
Ribavririn - teratogenic
Vertical transmission risk is low - c-section not protective, encourage BF

275
Q

What are complications of inadequate weight gain in a preggo?

A

Fetal growth restriction

Preterm delivery

276
Q

Preggo post partum has tachy cardia, DIC and poor O2 sat. Management

A

PE of amniotic fluid
prepare to intubate her and give supportive care
RF’s for amniotic emobolism: advanced maternal age, multigravada
Amniotic fluid enters vasculature through placental insertion site or other uterine trauma

277
Q

Post term preg is at risk for

A

oligo hydramnios

278
Q

Neonate born to mom w/ hx of Graves dz is tachycardic. Why?

A

Transplacental TSH receptor ab
Causes neonatal thyrotoxicosis
Self resolves in 3 months
In mena time - methimazole + BBlocker

279
Q

Primary amenorrhea with virilization, ambig ext genitalia at birth, but female internal organs

A

Congenital aromatase deficiency
Loss of conversion of androgens to estrogens
Virilized female with undetectable serum estrogen

280
Q

Genital warts w/ multiple pink or skin colored lesions that range from smooth flat papules to cauliflower like

A

Condylomata acuminata
HPV 6, 11
Tx - trichloroacetic acid

281
Q

amenorrhic postpartum that is able to breast feed

A

Lactational amenorrhea
Breastfeeding -> elevated prolactin -> inhibits GnRH -> LH/FSH production decreased
Exclusive breastfeeding often leads to anovulation and amenorrhea

282
Q

Painful, itchy, eczematous, ulcerating rash on the nipple and areola

A

Paget disease of the breast
type of adenocarcinoma
Can also present with bloody discharge and nipple retraction

283
Q

Why is mag sulfate given in preterm labore <32 wks?

A

Fetal Neuroprotection

Given regardless if mom is preeclamptic

284
Q

Pt with dysmenorrhea has cervical dilation and small firm mass within the uterus

A

Submucosal fibroid
can cause dilation when it prolapses through the os
Can be described as a labor like pain

285
Q

What do you recommend for a hypothyroidism pt that wants to get pregnant?

A

Increase levothyroxine when the pt becomes preg

Approx 30%

286
Q

What happens if a pt declines tx for HSV?

A

Flare will resolve, and then they’ll have decreasingly frequent recurrences

287
Q

Pt has stress incontinence and irregularly enlarged uterus

A

Fibroids
Get a u/s
irregularly enlarged uterus

288
Q

Premenopausal woman has dyspareunia, dry eyes, and decreased vaginal moisture

A

Sjogren’s
anti-Ro/La
Bx - salivary gland

289
Q

Management of CIN3 confirmed on colposcopy

A

If > 25

Cervical conization or LEEP

290
Q

What do you do if you really suspect syphillis but RPR is negative?

A

Tx with penicillin now and get a FTAA

291
Q

post seizure, prego has arm in adduction and loss of external rotation

A

Posterior shoulder dislocation

292
Q

Risks of untreated PID?

A

tubo-ovarian abscess, sepsis

293
Q

Pt presents somewhat toxic with a ovarian mass.

A

Exp lap

Advanced ovarian cancer can present with pelvic mass and ascites

294
Q

Why are women infertile in PCOS?

A

Failure of follicle maturation due to imbalance in LH/FSH

295
Q

b/l brownish gray nipple discharge

A

Non bloody discharge should be worked up for: pregnancy, guaiac, prolactin, TSH
Most likley physiologic galactorrhea

296
Q

Post delivering a large baby mom has radiating suprapubic pain exacerbated by weight bearing

A

Pubic symphisis
Occurs after traumatic deliveries
Tx - supportive

297
Q

Following pelvic surgery pt has painless loss of urine into the vagina

A

Vesicovaginal fistulas
PE pooling of clear watery fluid in the vagina
Dx - cysturoethroscopy

298
Q

What should be checked in an obese pt with candida?

A

A1C

299
Q

Contraindication for raloxifene?

A

Hx of DVT

Used for osteoperosis in post menopausal

300
Q

Ovarian mass w/ thick septations and solid components

A

Ovarian epithelial carcinoma

abn proliferation of tubal epithelium

301
Q

Greatest risk of chronic HTN in preggo?

A

Preterm labor

Shelves (25 decks)

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