OB/GYN Flashcards
maternal serum alpha-fetoprotein screening
incrased indicates what
decreased indicates what
increased: open neural tube defects, ventral wall defects, multipile gestation
decresased: aneuploidies
hypothyroidism FSH, LH, prolactin TSH
fsh and lh down
[prolactin and tsh up
bladder atony risk factors
when to suspect
prolonged labor, perineal injury, regional analgesia
suspect if cannot void by 6 hours after vaginal delivery
pseudocyesis
pt presents with what
risk factors
what can cause it
treatment
pt presents with sx of early pregnancy, and believes that she is pregnant
-office exam shows thin endometrial stripe, negative urine preg test
risk factors are hx of infertility and prior pregnancy loss
somatization of stress can affect HPO axis and cause early preg symtpoms or when bodily changes are misinterpreted
-psychaitric eval and tx
treatment for uterine leiomyomas (fibroids)
if asx
if sx
asx: observation
sx: hormonal contraception, embolization, or surery if sx
theca luteum cyst can cause ___ in pregnancy
maternal clincal features
fetal virilzation risk
hyperandrogenism
bilateral ovarian cyst on US
molar preganancy and multp gestation
regress spont
low risk fetal virilzation
initial diagnostic workup of suspected adenomyosis
tx
pelvic US and or MRI
definitive dx is histopathologic examination of a hysterectomy specimen
hysterectomy is the definitive tx if hormaonal methods do not work
management of cord compression and recurrent variable decelerations
maternal repositioning
next would be amnioinfusion
treatement for anovulatory cycles (AC causes prolonged heavy bleeds)
progesterone therapy
risks with combined estrogen-progestin contraceptives
VTE
HTN
hepatic adenoma
stroke or MI
treatment of chorioamnionitis
intraamnoiotic infection
broad spectrum antibiotics
delivery
disseminated gonococcal infection presents as what
pustular dermatitis, ensosynovitis and migratory asymmetric polyarthralgia
abnormal lab finding in intrahepatic cholestasis of pregnancy
serum total bile acids increased
sometimes increased alk phos and total and direct bilirubin increased
edemaatous, erythematous and painful cutanesous thickening of breast with superficial dimpling and fine pitting
may have ithing and retraction of nipples
what other feature common
inflammatoru breast carcinoma or peau d;orange
axillary LAD
medroxyprogesterone
systemic progestin contraceptive
stops GnrH but not emergency
management of intraductal papilloma
mammography and ultrasound
biopsy and excision
US or mam would show single dilated breast duct
painless genital ulcers without LAD, in india it is common
granuloma inguinale (klebsiella granulomatis)
what drug was used in pregnancy?
-fetal hydantoin syndrome: midfacial hypoplasia, microcepahly, cleft lip and palate, digital hypoplasia, hirsutism and developmental delay
phenytoin or carbamazepine
appearance of fetus in fetal growth restriction
large anterior fontanel
thin umbilical cord
loose peeling skin
minimal subcutaneous fat
management of ovarian torsion
laparoscpoic cystectomy and detorsion
pain to superficial touch on the vestibule
localized provoked vulvodynia
amniotic fluid embolism syndrome
risk factors
older mom, 5 births or more, c section, placenta previa or abruption, preeclampsia
what kind of breach has flexed hips and knees
complete
pathophysiology of functional hypothalamic amenorrhea: what causes it
excessive training low calorie diet weight loss chronic illness stress and depression anorexia nerovsa
chronic, inflammatory, skin dystrophy resulting in glazed, birghtly erythematous lesions on the vulva with erosive ulcerated areas
may have extragenital sites too
lichen planus
adenomyosis typically occurs in what women
leads to what
describe uterus
multiparous women over 40 with dysmenorrhea with heavy menstrual bleeding
leads to chronic pelvic pain
boggy, tender, uniformly enlarged uterus
complex multiloculated adnexal mass with thick walls and internal debris is what
tubo-ovarian abscess
atypical glandular cells on pap testing may be due to either what or what and whats the next step in management
cervical or endometrial adenocarcinoma
colposcopy, endocervical curettage, and endometrial biopsy
if you have an elevated AFP screen then what do you need to do to evaluate the fetus
ultrasound
what is the most accurate method of determining gestational age
first trimester US with crown rump length measurement
treatment of simple breast cyst in sx patients
follow up?
aspiration which should yield a clear fluid and make the mass disappear
-can reaccumulate so pt should return in 2-4 months for a follow up xam
intermenstrual spotting without uterine enlargement is hallmark of what
endometrial polyps
hypoxic brain injury in pregnancy to fetus in what
acute uteroplacental insufficiency like abruptio placentae
post term preg
42 weeks or more from LMP
underweight mom at risk for what in baby
intrauterine growth restriction
risk factors for vulvovaginal candidiasis
DM check for hemoglobin A1C immunosuppression pregnancy Ocs antibiotics
epithelial ovarian carcinoma
confirm cx diagnosis
__ should be drawn to correlate with cx findings and monitor treatment in future
___ should be done as definitive treatment with high clnical suspicion of EOC especially with acute presentation
pelvic US
CA-125
exploratory laparotomy with cancer resection, staging, and inspection of entire abdominal cavity
chemo after (paclitaxel)
how can oxytocin tox cause seizure
other AE of oxytocin tox
bc it acts like ADH and incrases water which decrases sodium level which can lead to seizureds
can also cause hypotension and tachysystole
is hpv cotesting recommended for ages 21-29
no
late term pregnancy length
41 weeks to 41 weeks and 6 days
antepartum hemorrhage from blunt abdominal trauma
in pregnant woman what happens and what is management
blood flow away from uterus and so no accelerations on fetal tracing
first step in management is AGGRESSIVE fluid resuscitation with crystalloids
place in left lateral decubitus position to displace uterus off aortocaval vessels and max out CO
only transfuse blood after fluid doesn’t work
bleeding and closed cervix, US reveals intrauterine gestation with normal heartbeat, increaseing b-hCG levels
what kind of abortion
threatened abortion
if pt has HIV and a partner that she does not want to inform what do you do
have to report her to the health department and encourage pt to tell her husband but you cannot tell husband if she does not want you to. The health department usually will make contact with all of pts sexual partners and inform them without IDing wife
biopsy of fat necrosis
mammography
from what causes this
fat globules and foamy histiocytes
often fixedd irregular mass with calcifications on mamm
post surgery or trauma
possible really bad effects with placental abruption
DIC
hypovolemic shock
hypoxia
preterm deliver
risk factors for preterm delivery
prior preterm delivery
multiple gestation
history of cervical surgery
-particularly cold knife conization for CIN
indication of raloxifene
postmenopausal osteoporosis
androgen insensitivity syndrome is also known as what
what doe these pts secrete
testicular feminization
AMH and testosterone
amh stimulates regression of the mullerian ducts
wolffian duct degenerates bc of androgen resistance
external femal genitalia and breast development
missed aboriton
bleeding?
os?
cardiac activity?
no vaginal bleed
closed os
no fetal cardiac activity or empty sac
postpartum fever is what temp
38 degrees celcius or greater or 100.4 F
fetal growth restriction risk factors
maternal HTN
pregestational DM
genetic abnormalities
congenital infection
lactation suppression with engorged breast from preg
wear supportive bra, avoid nipple stimulation, apply ice packs, and NSAIDs
-oral dopamine is no longer approved by FDA for lactation suppression due to side effects
treatment for women with engorgement of breast who want to breastfeed
involves frequent emptying of breasts for adequate milk drainage
premenstrual syndrome
sx
evaluation
tx
bloating, fatigue, HA, hot flash, breast tenderness, being a bitch too
eval: symptom/menstrual diary for 2 cycles
treatment: SSRI can give combined OCs but not in pt with migraines with aura
what kind of urinary incontinence
impaired detrusor contractility, bladder outlet obstruction
incomplete emptying emptying and persistent involunatary dribbling
overflow
can be from diabetes
markedly increased PVR
numbers for inadequate contractions
less than 3 in 10 mintues
oese or low body weight increases risk of osteoperosis
low body weight
intrauterine prenancy can be seen with a TVUS with a b-hcg of what and how often do these levels increase
1500-2000 every 2 days
neonatal thyrotoxicosis pathophys
tx
transplacental passage of maternal anti-TSH receptor antibodies that bind to infants TSH receptors
tx: self resolves witin 3 months or methimazole plus b blocker
pts with ambiguous external genitalia, normal uterus and ovaries and electrolye abnormalities (____) with 17-a hydroxylase deficiency
CAH
hyponatremia
normal preganancy pulmonary co2 and o2 change
chronic respiratory alkalosis with metabolic compensation
increased PaO2 and decrased PaCO2
progesterone directly stimulates Central resp centers to increase tidal volume and minute ventilation
breast cancer risk factors
nonmodifiable
genetic mutation or breast cancer in 1st degree relatives
white
increaseingage
early menarche or later menopause
what happens to the liver in HELLP syndrome
hepatocellular necrosis and thrombi elevate liver enzymes, liver swelling, and distension of the hepatic capsule
missed abortion
asx or decreased preg symptoms
embryo without cardiac activity or an empty gestations sac without a fetal pole (no embryo)
repeat US and seriel b-HcG to confirm
-decreased b-hCG indicate demise and exclude normal pregnancy
management of uterine inversion
fluid replace
manual replacement
placental removal and uterotonic drugs after uterine replacement
preeclampsia under 20 weeks gestation can be a complication of what
hydatidiform mole
abnormal trophoblastic tissue proliferation can result in preeclampsia and lead to enlarged uterus that is greater than expected for gestational age
diagnosing ectopic pregnancy
b-hcg and TVUS
sx with hemorrhage from a ruptured cyst
sudden acute ab pain with peritoneal signs
simple ovarian and CL cysts usually cause this
a failed progestin challenge test can indicate what?
intrauterine adhesions (asherman syndrome) in a pt with a history of uterine instrucmentation or endometritis
maternal HTN and tobacco use during pregnancy are associated with ______ fetal growth restriction
asymettric
large fibroids can cause local compressive symptoms like what
constipation, urinary frequency/retention, and back/pelvic pain
PID treatment in pt
IV cefoxitin or cefotetan plus oral doxycycline
or IV clindamycin plus gentamicin
unsafe activites in pregnancy
contact sports
high fall risk
scuba diving
hot yoga
sx with acute fatty liver of pregnancy
in 3rd trimester or early postpartum period
prolonged PT and PTT, hypoglyemia, and encephalopathy
crampy lower abdomen and back pain during menses with a normal exam
what kind of dysmenorrhea
tx
primary
NSAIDs and hormonal contraception
if left untreated do recurrences of genital herpes increase or decrease with time
decrease bc of cell mediated immunity
US of breast shows posterior acoustic enhancement which is indicative of ____ and no echogenic debris or solid components, these features are consistent with a what
fluid
simple breast cyst
dysmenorrhea as well as noncyclic pain that can be exacerbated by exercise
endometriosis
uterine atony, if oxytocin and bimanual massage fail what is next step
administer other uterotonic agent like methylergonovine
causes SM constirction, uterine contraction, and vasoconstriction
history of HTN contraindicated bc causes this
in pts with negative syphillis serology but strong clinical evidence of primary syphillis should have what done
empiric treamtent with benzathine penicilin G
repeat nontreponemal serology in 2-4 weeks to establish baseline titers and 6-12 months later check again and 4 fold decrase in titer means adequate treatment
periumbillical pain that migrates to the RLQ with nausea, vomiting, and anorexia
appendiceal abscess
screening for ovarian cancer in a pt who has a cousin who died of the disease
no screening bc average risk pt and no test exist to detect ovarian cancer in its early more treatable stages
soft enlarged uterus after delivery with bleeding
uterine atony
preeclampsia severe features
160/110 2 times 4 hours apart
thrombocytopenia
incrased cretinine
increased transaminases
pulmonary edema
visual or cerebral symtpoms
medications that can cause galactorrhea due to _____ inhibtion
dopamine
antipsychoiitcs, antidepressnats, opiods, chronic histamine receptor blockers like cimetidine
what complication during pregnancy puts mom at risk for alloimmunization
these women need higher dose
what test used to determine dose?
placental abruption,
also after a delivery, or procedures
klaeihauer betke test
granulosa cell tumor of the ovary cx features child and postmenospausl woman
if find mass on US then what next
child: precocious puberty
postmenopause: bleed/endometrial hyperlplasia
increased estrogen
endometrial biopsy
biophysical profile scoring: 0-10 to 4-10
indicates fetal hypoxia due to placental dysfunction
risk factors: tobacco, HTN, diabetes
prolactinoma
fsh
lh
prolactin
tsh
fsh and lh down
prolactin up
tsh normal
which pop has most fibroids
black women
sudden onset, severe, unilateral lower abdominal pain immediately following strenuous or sexual activity and what see on US
ruptured ovarian cyst
see pelvic free fluid
_____ serves as a barrier to ascending infection during pregnancy, this brown red or yellow thick mucus typically is shed before or during labor
cervical mucus plug
anechoic, cystic spaces mass
snowstorm appearance
hydatidiform mole
placenta previa mom and fetus sx
fetus not affected bc materanal bleed
painless bleed 3rd trimester
magnesium toxicity
mild
mod
severe
tx
mild: nausea, flushing, HA, hyporeflexia
mod: areflexia, hypocalcemia, somnolence
severe: resp paralysis, cardiac arrest
txL calcium gluconate bolus
late term and postterm preg complications in fetus
MOMS Con
meconium aspiration oligohydramnios macrosomia stillbirth convulsions
ultrasound findings on epithelial ovarian carcinoma
and then management once this is found
solid mass
thick septations
ascites
manage: exploratory laparotomy
when should all pregnant women be screened for gestational DM
24-28 weeks
guaiac test in physiologic galactorrhea is what
negative
diagnosis/management of placenta previa once diagnosed
pelvic rest and abstinence from intercourse
no digital cervical exam by doctors
c section scheduled at 36-37 weeks
labs in hyperemesis gravidarum
(often have hypochloremic met acidosis, hypokalemia, hypoglycemia, and elevated aminotransferases
bulky tender uterus that is uniformly enlarged
adenomyosis
fetal heart tracing shows tachy, what are possible etiologies
maternal infection
poor maternal hyperthyroidism control
terbutaline
abruptio placentae
how much exercise in pregnancy is recommended
20-30 mintues of mod-intensity exercise on most or all days of the week
intrauterine fetal demise associated with growth restriction, multiple limb fractures and a hyoplastic thoracic cavity is consistent with what
genetics
collagen
prognosis
type II osteogenesis imperfecta
AD
type 1 collagen
lethal
after the first trimester what is used to estimate gestational age
fetal abdominal circumference, biparietal diameter, femur length
what is fetal scalp stimulation used for
to perform an attempt to induce accelerations when they are absent
evaluating fetal growth restriction
placenta histopathology
consider karyotype, urine to, serology
if doesn’t look like infant has syndromic etiology don’t get karyotype
a BPP of 6/10 is equivocal and should be repeated when
in 24 hours
luteoma can cause ___ in pregnancy
maternal clinical features
fetal virilization risk
hyperandrogenism
yello or Y-brown mass
solid ovarian masses on US
regress spontaneously after delivery
high risk
uterine inversion what do you see when pull out too quick
other physical findings
smooth, round mass protruding through the cervix or vagina
uterine fundus no longer palpable transabdominally
accompanied by hemorrhagic shock and lower abdominal pain
evaluation of amenorrhea (missed 3 cycles or none for 6 months
if b-hcg negative
- check prolactin, TSH, FSH
- if prolcatin is increased then get brain MRI
if had prior uterine procedure or infection then do hysteroscopy
diagnosis of chorioamnionitis
maternal fever plus any of the following
fetal tachy maternal leukocytosis purulent amniotic fluid maternal tachy uterine fundal tenderness
with intrauterine fetal demise what is the best way to deliver baby
vaginally induced when pt is ready
hyperemesis gravidarum is what and causes what
severe vomiting during the first to early second trimesters and is associated with weight loss, volume depletion and ketonuria
metabolic alkalosis is often present due to loss of gastric acid
renal changes and urinary in normal pregnancy
RBF,
GFR
renal basement memrbane perm
BUN, Cr, renal protein excretion
think about what
1) all increase
-BUN, Cr decrease
renal protein excretion increase
renal excreted drugs monitored
infiltrating ductal carcinoma or lobular breast carcinoma may cause dimpling or breast contour changes but is diff from inflammatory breast carcinoma how
no diffuse breast erythema, edma and peau d orange appearance
violetn muscle contractions as seen in a seizure or electrocution injury are a common cause of what dislocation
position
posterior shoulder
shoulder held in adduction and internal rotation with visible flattening of anterior aspect of shoulder
light bulb sign on radiograph
GU syndrome of menopause
sx:
PE
treatment
sx: dryness, irritation, pruritius, dysparenunia, bleeding, urinary incontinence, recurrent UTI, pelvic pressure
PE: narrowed introitus, pale mucosa, desecreased elasticity and rugae, petechiae and fissures
treat with lube or topical vaginal estrogen
the only current indication for HRT in menopause is what
not for what anymore
vasomotor symptoms in women under 60 who have undergone menopause wihtin past 10 yrs and have severe hot flashes
no longer for heart disease, dementia, or osteoporosis
are persistent variable decelerations normal?
no
concern for uterine rupture
pubic symphysis diastasis
after traumatic delivery pts can develop this
risk factors are big baby or forceps and multiparity
suprapubic pain that radiates to the back or hips, worse with weight bearing, walking or position changes
tenderness ofver pubic symphissis
initial menstrual cycles in adolescents are usually what
irregular and anovulatory due to HPGonadal axis immaturity and insufficient secretion of GnRH
vesicovaginal fistula presents with
clear watery vaginal discharge (urine) with a fistulous tract on the anterior rather than posterior, vaginal wall
if mom gets varicella in pregnancy then do what
mom doesn’t have varicella immunity, neg IgG antibody, no history of childhood infection
postexposure prophylaxis
VCZ Ig administration