OB/GYN Flashcards
1
Q
maternal serum alpha-fetoprotein screening
incrased indicates what
decreased indicates what
A
increased: open neural tube defects, ventral wall defects, multipile gestation
decresased: aneuploidies
2
Q
hypothyroidism FSH, LH, prolactin TSH
A
fsh and lh down
[prolactin and tsh up
3
Q
bladder atony risk factors
when to suspect
A
prolonged labor, perineal injury, regional analgesia
suspect if cannot void by 6 hours after vaginal delivery
4
Q
pseudocyesis
pt presents with what
risk factors
what can cause it
treatment
A
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
5
Q
treatment for uterine leiomyomas (fibroids)
if asx
if sx
A
asx: observation
sx: hormonal contraception, embolization, or surery if sx
6
Q
theca luteum cyst can cause ___ in pregnancy
maternal clincal features
fetal virilzation risk
A
hyperandrogenism
bilateral ovarian cyst on US
molar preganancy and multp gestation
regress spont
low risk fetal virilzation
7
Q
initial diagnostic workup of suspected adenomyosis
tx
A
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
8
Q
management of cord compression and recurrent variable decelerations
A
maternal repositioning
next would be amnioinfusion
9
Q
treatement for anovulatory cycles (AC causes prolonged heavy bleeds)
A
progesterone therapy
10
Q
risks with combined estrogen-progestin contraceptives
A
VTE
HTN
hepatic adenoma
stroke or MI
11
Q
treatment of chorioamnionitis
A
intraamnoiotic infection
broad spectrum antibiotics
delivery
12
Q
disseminated gonococcal infection presents as what
A
pustular dermatitis, ensosynovitis and migratory asymmetric polyarthralgia
13
Q
abnormal lab finding in intrahepatic cholestasis of pregnancy
A
serum total bile acids increased
sometimes increased alk phos and total and direct bilirubin increased
14
Q
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
A
inflammatoru breast carcinoma or peau d;orange
axillary LAD
15
Q
medroxyprogesterone
A
systemic progestin contraceptive
stops GnrH but not emergency
16
Q
management of intraductal papilloma
A
mammography and ultrasound
biopsy and excision
US or mam would show single dilated breast duct
17
Q
painless genital ulcers without LAD, in india it is common
A
granuloma inguinale (klebsiella granulomatis)
18
Q
what drug was used in pregnancy?
-fetal hydantoin syndrome: midfacial hypoplasia, microcepahly, cleft lip and palate, digital hypoplasia, hirsutism and developmental delay
A
phenytoin or carbamazepine
19
Q
appearance of fetus in fetal growth restriction
A
large anterior fontanel
thin umbilical cord
loose peeling skin
minimal subcutaneous fat
20
Q
management of ovarian torsion
A
laparoscpoic cystectomy and detorsion
21
Q
pain to superficial touch on the vestibule
A
localized provoked vulvodynia
22
Q
amniotic fluid embolism syndrome
risk factors
A
older mom, 5 births or more, c section, placenta previa or abruption, preeclampsia
23
Q
what kind of breach has flexed hips and knees
A
complete
24
Q
pathophysiology of functional hypothalamic amenorrhea: what causes it
A
excessive training low calorie diet weight loss chronic illness stress and depression anorexia nerovsa
25
chronic, inflammatory, skin dystrophy resulting in glazed, birghtly erythematous lesions on the vulva with erosive ulcerated areas
may have extragenital sites too
lichen planus
26
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
27
complex multiloculated adnexal mass with thick walls and internal debris is what
tubo-ovarian abscess
28
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
29
if you have an elevated AFP screen then what do you need to do to evaluate the fetus
ultrasound
30
what is the most accurate method of determining gestational age
first trimester US with crown rump length measurement
31
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
32
intermenstrual spotting without uterine enlargement is hallmark of what
endometrial polyps
33
hypoxic brain injury in pregnancy to fetus in what
acute uteroplacental insufficiency like abruptio placentae
34
post term preg
42 weeks or more from LMP
35
underweight mom at risk for what in baby
intrauterine growth restriction
36
risk factors for vulvovaginal candidiasis
```
DM check for hemoglobin A1C
immunosuppression
pregnancy
Ocs
antibiotics
```
37
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)
38
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
39
is hpv cotesting recommended for ages 21-29
no
40
late term pregnancy length
41 weeks to 41 weeks and 6 days
41
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
42
bleeding and closed cervix, US reveals intrauterine gestation with normal heartbeat, increaseing b-hCG levels
what kind of abortion
threatened abortion
43
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
44
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
45
possible really bad effects with placental abruption
DIC
hypovolemic shock
hypoxia
preterm deliver
46
risk factors for preterm delivery
prior preterm delivery
multiple gestation
history of cervical surgery
-particularly cold knife conization for CIN
47
indication of raloxifene
postmenopausal osteoporosis
48
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
49
missed aboriton
bleeding?
os?
cardiac activity?
no vaginal bleed
closed os
no fetal cardiac activity or empty sac
50
postpartum fever is what temp
38 degrees celcius or greater or 100.4 F
51
fetal growth restriction risk factors
maternal HTN
pregestational DM
genetic abnormalities
congenital infection
52
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
53
treatment for women with engorgement of breast who want to breastfeed
involves frequent emptying of breasts for adequate milk drainage
54
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
55
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
56
numbers for inadequate contractions
less than 3 in 10 mintues
57
oese or low body weight increases risk of osteoperosis
low body weight
58
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
59
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
60
pts with ambiguous external genitalia, normal uterus and ovaries and electrolye abnormalities (____) with 17-a hydroxylase deficiency
CAH
hyponatremia
61
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
62
breast cancer risk factors
nonmodifiable
genetic mutation or breast cancer in 1st degree relatives
white
increaseingage
early menarche or later menopause
63
what happens to the liver in HELLP syndrome
hepatocellular necrosis and thrombi elevate liver enzymes, liver swelling, and distension of the hepatic capsule
64
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
65
management of uterine inversion
fluid replace
manual replacement
placental removal and uterotonic drugs after uterine replacement
66
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
67
diagnosing ectopic pregnancy
b-hcg and TVUS
68
sx with hemorrhage from a ruptured cyst
sudden acute ab pain with peritoneal signs
simple ovarian and CL cysts usually cause this
69
a failed progestin challenge test can indicate what?
intrauterine adhesions (asherman syndrome) in a pt with a history of uterine instrucmentation or endometritis
70
maternal HTN and tobacco use during pregnancy are associated with ______ fetal growth restriction
asymettric
71
large fibroids can cause local compressive symptoms like what
constipation, urinary frequency/retention, and back/pelvic pain
72
PID treatment in pt
IV cefoxitin or cefotetan plus oral doxycycline
or IV clindamycin plus gentamicin
73
unsafe activites in pregnancy
contact sports
high fall risk
scuba diving
hot yoga
74
sx with acute fatty liver of pregnancy
in 3rd trimester or early postpartum period
prolonged PT and PTT, hypoglyemia, and encephalopathy
75
crampy lower abdomen and back pain during menses with a normal exam
what kind of dysmenorrhea
tx
primary
NSAIDs and hormonal contraception
76
if left untreated do recurrences of genital herpes increase or decrease with time
decrease bc of cell mediated immunity
77
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
78
dysmenorrhea as well as noncyclic pain that can be exacerbated by exercise
endometriosis
79
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
80
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
81
periumbillical pain that migrates to the RLQ with nausea, vomiting, and anorexia
appendiceal abscess
82
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
83
soft enlarged uterus after delivery with bleeding
uterine atony
84
preeclampsia severe features
160/110 2 times 4 hours apart
thrombocytopenia
incrased cretinine
increased transaminases
pulmonary edema
visual or cerebral symtpoms
85
medications that can cause galactorrhea due to _____ inhibtion
dopamine
antipsychoiitcs, antidepressnats, opiods, chronic histamine receptor blockers like cimetidine
86
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
87
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
88
biophysical profile scoring: 0-10 to 4-10
indicates fetal hypoxia due to placental dysfunction
risk factors: tobacco, HTN, diabetes
89
prolactinoma
fsh
lh
prolactin
tsh
fsh and lh down
prolactin up
tsh normal
90
which pop has most fibroids
black women
91
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
92
_____ 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
93
anechoic, cystic spaces mass
snowstorm appearance
hydatidiform mole
94
placenta previa mom and fetus sx
fetus not affected bc materanal bleed
| painless bleed 3rd trimester
95
magnesium toxicity
mild
mod
severe
tx
mild: nausea, flushing, HA, hyporeflexia
mod: areflexia, hypocalcemia, somnolence
severe: resp paralysis, cardiac arrest
txL calcium gluconate bolus
96
late term and postterm preg complications in fetus
MOMS Con
```
meconium aspiration
oligohydramnios
macrosomia
stillbirth
convulsions
```
97
ultrasound findings on epithelial ovarian carcinoma
and then management once this is found
solid mass
thick septations
ascites
manage: exploratory laparotomy
98
when should all pregnant women be screened for gestational DM
24-28 weeks
99
guaiac test in physiologic galactorrhea is what
negative
100
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
101
labs in hyperemesis gravidarum
(often have hypochloremic met acidosis, hypokalemia, hypoglycemia, and elevated aminotransferases
102
bulky tender uterus that is uniformly enlarged
adenomyosis
103
fetal heart tracing shows tachy, what are possible etiologies
maternal infection
poor maternal hyperthyroidism control
terbutaline
abruptio placentae
104
how much exercise in pregnancy is recommended
20-30 mintues of mod-intensity exercise on most or all days of the week
105
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
106
after the first trimester what is used to estimate gestational age
fetal abdominal circumference, biparietal diameter, femur length
107
what is fetal scalp stimulation used for
to perform an attempt to induce accelerations when they are absent
108
evaluating fetal growth restriction
placenta histopathology
consider karyotype, urine to, serology
if doesn't look like infant has syndromic etiology don't get karyotype
109
a BPP of 6/10 is equivocal and should be repeated when
in 24 hours
110
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
111
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
112
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
113
diagnosis of chorioamnionitis
maternal fever plus any of the following
```
fetal tachy
maternal leukocytosis
purulent amniotic fluid
maternal tachy
uterine fundal tenderness
```
114
with intrauterine fetal demise what is the best way to deliver baby
vaginally induced when pt is ready
115
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
116
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
117
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
118
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
119
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
120
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
121
are persistent variable decelerations normal?
no
concern for uterine rupture
122
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
123
initial menstrual cycles in adolescents are usually what
irregular and anovulatory due to HPGonadal axis immaturity and insufficient secretion of GnRH
124
vesicovaginal fistula presents with
clear watery vaginal discharge (urine) with a fistulous tract on the anterior rather than posterior, vaginal wall
125
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
126
_____ is a common anatomic cause of primary amenorrhea
imperforate hymen
127
dry vagina after chemo and ammenorhea
ovarian failure secdonary to chemo
hypogonadotropic hypogonadism in women under 40 is Primary ovarian insufficiency
-no developing follicles, so decreased estrogen
chemo affects prolfierating granulosa and theca cells of ovary
128
all patients with chronic hep C infection including pregnant women whould be immunized with what
against hepatitis A and B if not already immune
129
variable decelerations
abrupt drops in fetal HR of varying depth and duration likely due to compression of the umbillical cord causing transient fetal HTN
130
when to stop pap testing
age 65 or hysterectomy plus
no history of CIN 2 or higher and
3 consecutive negative pap test
or
2 consecutive negative co testing results
131
HELLP and tranfusion before delivery platelet count
prophylactic transufion if platelets under 20,000 and for c section can do if under 40,000
132
breaast cancer risk factors
modifiable
HRT
nulliparty
increased age at first live birth
alcohol
133
risk factor of PPROM
genital tract infection and history of prior PPROM
134
how to treat postpartum endometritis
clinamycin + gentamicin
135
management of shoulder dystocia
BE CALM
breath, do not push
elevate legs and flex hips, thighs aginast abdomen (mcroberts)
call for help
apply suprapubic pressure
enLarge vaginal opening with episiotomy
Maneuvers
-deliver post arm, rotate post shoulder, adduct post shoulder, mother on all fours, replace fetal head into pelvis for c section delivery (if all else fails)
136
flank pain that radiates to the groin with microscopic hematuria
renal colic
stones
pelvic ultrasound is diagnositc
137
____ is suspected when a persistent, eczematous and or ulcerating rash is localized to the nipple and spreads to the areola
what is associated with it
mammary paget disease
adeoncarcinoma is often found in pagets disesae
138
gonococcal pharyngitis
LAD?
N gonorrhoeae
pharyngitis with fever and lower abdominal pain (PID) in young, sexual active pt
from sucking off an infected dude or cunnilinging an infected female
nontender cervical LAD
139
mom in pregnancy
protein S
fibrinogen
decrease protein S activity
| increase in fibrinogen
140
positive TPO antibody in what
hashimoto thyroiditis
141
complications of cervical conization
cervical stenosis
preterm birth
PPROM
2nd trimester preg loss
142
RUQ pain with PID
other symptoms
increased pain during inspiration
perihepatitis or ritz hugh curtis disease
intermenstrual spotting
lower abdominal tenderness
fever
CMT
143
adolescent pts with an imperforate hymen present with
cyclic lower abdominal pain in absence of apparent vaginal bleeding
blood collects behind hymenal membrane (hematocolpos)
pelvic exam typically reveals a blue, bulging vaginal mass or membrane that swells with valsalva
144
pathophysiology of preeclampsia likely involves what which can lead to what
chronic uteroplacental insufficiency which can lead to fetal growth restriciton/low birth weight
145
in pts with AUB, bleeding after exogenous progesterone administrations confirms what
normal endogenous estrogen production and proliferative endometrium
eliminates cuases of
estrogen deficiency
endometrial abnormalities
outlet tract abnormalities
146
risk factors of hyperemesis gravidarum
hydatidiform mole
multifetal gestation
history of it
history of GERD
147
when should pregnant women undergo oral glucose challenge test
24-28 weeks at end of 2nd trimester
1 hr 50 g GCT
confirm with 3 hr 100 g glucose test
148
risk factors of placenta previa
multiparity, smoking, and previous uterine surgery
149
normal internal genitalia, external virilization (clitoromegaly) and undetectable serum estrogen levels in a female pt dx
what happens to mom in pregnancy
aromatase deficiency
leads to transient masculinzation in mother that resolves with birth
150
breast feeding contraininidcations
```
active untreated TB
maternal HIV infection
herpetic breast lesion
active varicella
chemo or radiation therapy
active substance abuse
```
infant: galctosemia
151
risk factors uterine atony
pronlonged labor, induction of labor, operative vaginal delivery and
fetal weight over 4000 grams (8.8 lbs) ***
152
choriocarcinoma presnetation
amenorrhea or AUB, pelvic pain
SYMPTOMS from metastases (LUNGS and vagina)***
elevated b-HCG
-sx of metast to lung = chest pain, hemoptysis, and dyspnea
can occur after normal gestation or SPONTANEOUS abortion and usually presents <6 months after pregnancy
153
can uterine fibroids cause stress incontinence
yes
154
intra-amniotic infection (chorioamnionitis) risk factors
```
prolonged ROM over 18 hours
prolonged labor
internal fetal unterine monitors
repetitive vaginal exams
presence of genital tract pathogens
```
155
endometrial biopsy indications
45 and up
-AUB, postmenopausal bleed
under 45
- AUB + unopposed estrogen (obesity, anovulation)
- failed medical management
- lynch syndrome
35 and up
-atypical glandular cells on pap test
156
cafe au lait spots, polyostotic fibrous dysplasia, and autonomous endocrine hyperfunction (gonadotropin independent precocious puberty)
mcune albright syndrome
157
sjogren syndrome can cause what ob gyn problem
sicca syndrome
dyspareunia from dry vaginal mucosa
sicca is impaired fnct of salivary and other exocrine glands
158
pruritic utricarial papules and plaques of pregnancy PUPP is what
classical finding
spares what
skin condition that develops in third trimester of pregnancy
classic finding on abdominal exam is redpapules within striae with sparing around umbillicus sometimes goes to extremeties
palms soles and face not usually involved
159
postpartum endometritis presents as
polymicrobial infection with fever >24 hours postpartum, purulent lochia, and uterine tenderness
160
syphilis diagnostic serology
nontreponemal (RPR and VDRL)
Ab to cardiolipin cholest-lechithin antigen
-possible negative result early in infection
-decrease in tgiters confirms treatment
treponemal
antibody to trep antigens
greater sensitivity in early infecion, positive even after treament
161
can hep c be transmitted through breast milk
no
162
what lab finding can distinguished on UA SLE flare up from preeclampsia
presence of RBC casts on urinalysis is SLE
163
woman with blood type O and baby stuff
in pts with blood type O they produce antibodies to antigen A and B early on in life and already have IgG antibodies when pregnant to these. ABO compatability can occur in first pregnancy
most of these newborns will have only mild hemolytic disease
164
symptoms of pelvic organ prolapse
urinary retention
difficulty intitiaing stream
incontinence
bowel dysfunction
165
target blood glucose levels in pregnant woman
fasting, 1 hr post prand, 2 hour postprand
fasting: under 95
1 hr post prand under 140
2 hr post prand under 120
166
treatment of hydati mole
suction curettage
167
what is pathologic for ovarian cancer
peritoneal fluid in postmenopausal women with bloating and pain and abdominal distension
168
when use vibroacoustic stimulation
to awaken fetus for a NST
169
acute appendicitis in pregnancy managment
get US with graded compression technique
| if US not diagnositc then MRI can be performed in pregnant pts
170
managmetn of suspected ectopic pregnancy
hemodynamically unstable
immediate surgery consult
171
etiology of second stage arrest of labor
tx
cephalopelvic disproportion
malposition
inadequate contractions
maternal exhaustion
operative vag delivery or c section
172
bilateral, symmetric fullness, tenderness and warmth of breast
breast engorgment cx features
173
is methyldopa used to treat HTN emergencies in pregnancy
no, chronic HTN only
174
how to try to R/O fibroids vs adenomysosis
fibroids: dysmenorrhea is less common and does not typically progress to chronic pelvic pain
also nontender, firm, and irregulary enlarged
175
septic pelvic thrombophlebitis cause and sx
postoperative or postpartum infected thrombosis of the deep pelvic or ovarian veins
pts have persistent fevere urepsonsive to antibiotics
tx with anticoags and broad spectrum antibiotics
176
cocaine abuse can increase the risk of what in pregnancy
placental abruption
177
the most common symptoms of vaginal cancer are ____ and _____ a SCC lesion is generally seen where
managment
risk factors
vaginal bleeding and malodorous vaginal discharge
upper third of the posterior vagina
get biopsy
risk factors are hpv and smoking etc
178
bilateral, gray, nonbloody nipple discharge,
physiologic glactorrhea
179
treatment for PCOS
weight loss is first line to reestablish ovulation
180
AE and risks with combined oral contraceptives
```
breakthrough bleed
breast tenderness, nausea, bloating
amenorrhea
htn
vte
increased risk cervical cancer
hepatic adenoma
increased TGs
```
181
uterine rupture cx presentation
```
vaginal bleed
intraabdominal bleed (hypotension and tachy)
fetal heart decels
loss fetal station
loss intrauterine pressure
```
182
HIV treatment in pregnancy
drugs
```
2 NRTIs (zidovudine, tenofovir) +
1 NNRTI or a protease inhbitor
```
183
q tip test
an angle of at or greater than ___ degrees from horizontal on increase on intra abdominal pressure signifies urethral hypermobility
30 degrees
184
how is mg excreted and why does this matter
excreted by the kidneys and a common risk factor for mg tox is renal insufficiency
185
emergency contraception options
copper IUD 99% effective, 0-120
ulipristal pill (antiprogestin, delay ovulation) 85% or more, 0-120
levonorgestrel (progestin, delay ovul) 85%, 0-72 hrs
OCPs 75%, 0-72 hrs
CULO
186
when is a breast MRI done
in pts with known cancer to evaluate for disesae recurrence and to screen for breast cancer in high risk pts with known BRCA or first degree relatives with breast cancer
187
which type of masson ovary has highest chance of causing ovarian torsion
dermoid cyst
188
krukenberg tumorcan cause what in pregnancy
maternal clincial features
fetal virilization risk
hyperandrogenism
bilateral solid ovarian masses on US
high risk
189
management of CIN3 in pt over 25 and not pregnant
LEEP
cold knife conization
cryoablation
then pap test with HPV 1 and 2 years postprocedure
190
fundal height and gestation age
can be measured after 20 weeks gestation
+/- 3 weeks
not as accurate
191
what do you use to test for PID
hysterosalpingogram
192
etiololgy of variable decelerations
cord compression, oligohydramnios, cord prolapse
193
is weight gain associated with OCs
no
194
risk of fracture with osteoperosis is highest in what population
people with prior history of fragility fracture
195
first line treatment for asx bacteruria in pregnancy
why treat in pregnancy?
fosfomycin
amoxicillin-clavulanate
nitrofurantoin
Cephalexin
dat ask bacteruria is FANC
treat bc can lead to pyelonephritis and preterm delivery, low birth weight
196
tutle sign
retratction of the fetal head into the perineum after delivery
in macrosomic baby
197
false labor
timing
strength
pain
cervical change
irregular, infrequent
weak
none to mild
no change
braxton hicks contractions
198
medically emancipated minor situations
```
STI
emergency care
substance abuse
pregnancy care
contraception
```
minors need to Control their PESS
199
what kind of dysmenorrhea
dull and ill defined pelvic ache that worsens with standing
dyspareunia
pelvic congesion
200
ebstein anomaly with lithium use in pregnancy
malformed and inferiorly attached tricuspid valve so atrialized RV
also ASD
201
management of breast abscess frommastitis
needle aspiration and antibiotics (dicloxacillin, cephalexin)
continued breast feeding for continued milk drainage
202
soft mobile nontender asx mass on labium majorum
bartholin duct cyst
| usually 4 or 8 o clock position
203
pt with a palpable breast mass then what for algorhytm
pt under 30
if pt over 30 and suspicious for malignancy
ultrasound
if shows simple cyst = needle aspirations if pt wants
if shows complex cyst/mass then core biopsy
over 30 and suspicious = core biopsy
204
only ____ can confirm a diagnosis of a palpable breast mass
biopsy
205
pathophysiology of functional hypothalamic amenorrhea: what causes it on the physiological level
increased ghrelin, NPY, CRH, gaba, and beta endorph, decreased leptin
decreased GnRH, decreased FSH and LH and decreased Estrogen
206
tenderness over anterior vaginal wall occurs with _____
presents with discomfort upon bladder filing, dysuria, and urinary frequency
bladder pain syndrome
207
order of puberty in females
BAG Me
Breast 8
axillary hair growth 9
growth spurt 10 (beofre menarche)
menarche 12.5 (within 2 to 2.5 yrs of breast development)
208
has does prolactin stop ovulation
negative inhibition of GnRH
209
is a hyperechoic mass on US mean benign or malignant?
benign
210
HTN in pregnancy incrases risk of what in pregnancy
superimposed preeclampsia, abruptio placentae, fetal growth restriction, preterm labor, stillbirth
211
side effect of epidural anesthesia in 10% of pts
hypotension by vasodilation and venous pooling
212
acute cervicitis
caused by what
sx
dx
chlamydia, gonn
mucopurulent cervical discharge and edematous friable cervix that bleeds with manipulation
dx: NAAT
- wont see anything on light microscopy
213
risk of uterine rupture is greatest in laboring pts with what
tx
prior uterine surgery, (c section or myomectomy with uterine cavity entry to remove fibroids)
tx: uregent laparotomy and delivery
214
lab abnormalities of hyperemesis gravidarum
acid base and electrolytes and heme and sugar
```
ketonuria
hypochloremic metabolic alkalosis
hypokalemia
hypoglycemia
hemoconcentration
```
215
all sexually active women under age 25 are recommended to get tested for what along with routine pap screen and why
chlamydia and gonorrhea bc can be asx
216
breast feeding effect on breast cancer
protective effect
217
_____ causes variable decelerations
umbilical cord compression
218
what is internal podalic version used for
breech extraction of a malpresenting second twin
219
how does levonorgestrel stop pregnancy
releases progestin which creates a physical barrier by thickening cervical mucus and impairing implantation
-SE is amenorrhea
220
most common urinary incontinence in pregnancy
stress urinary incontinence
221
postpartum urinary retention with overflow incontinence
risk factors
dx
managment
RF: analgesia, nulliparity, prolonged labor
dx: uretrhal cath and urinary drainage of 150 ml or more confirms retention
tx: urethral catheterization to decompress bladder
222
high secretion of b-Hcg in a Hyd mole causes what
hyperstimulation of the ovaries and formation of theca lutein cysts which are large, bilateral and multilocular
223
management of uterine rupture
laparotomy for delivery and uterine repair
224
misoprostol in abortions
used to treat incomplete or missed abortion
causes cervical dilation and myometrial contraction to expel intrauterine contents
225
history of preterm labor and short cervix
management of preg
cerclage and progesterone
if history of preterm labor offer progest injections
226
pelvic pain in a pt with a known ovarian mass should be suspected as what until proven otherwise
ovarian torsion
227
persistent fever unresponsive to broad spectrum antibiotic therapy and a negative infectious evaluation after birth or pelvic surgery sgugests what
septic pelvic thrombophlebitis
(endometritis would usually respond to antibiotics
228
treatment for lichen sclerosus
coritcosteroids (clobetasol) ointment
229
lack of menses is considered normal at age of less than what if 2ndary sex characteristic development has been appropriate
15 yrs old
230
biophysical profile results
what are the things assessed
abormal = 0,2,4
equivocal = 6
normal = 8 or 10
fetal: breathing, movement, tone, and amniotic fluid
231
Preeclampsia managment
without severe features
with severe fetures
mg sulfate and anti HTN
severe then deliver at 34 weeks or greater
without severe deliever at 37 weeks or greater
232
wernicke encephalopathy can be caused by what in pregnancy
sx
tx
hyperemesis gravidarum
encepth
oculomotor dysfunction (horiz nystagmus and bilateral abducens palsy)
postural and gait ataxia
tx: IV thiamine then glucose
233
tx for placenta previa
C section at 36-37 weeks
234
modifiable risk factors for osteoporosis
smoking
excessie alcohol intake (over 2 drinks a day)
sednetary lifestyle
235
anovulation secondary to morbid obesity
obesity is a common cause of amenorrhea
in anovulation, the FSH and LH levels are normal
ovaries still produces estrogen but no progesterone being produced at normal post ovulation levels, so pregeterone withdrawal menses does not occur
236
routine administrations of the hpv vaccine series begins at age _____ and catch up vaccination should be offered until age ___
11-12
26
237
definition of preterm labor
regular contractions at <37 weeks that cause cervical dilation and or effacement
238
antibodies in antiphospholipid syndrome
management
anti-cardiolipin antibody
lupus anticoagulant
anti-beta2-glycoprotein antibody
management: anticoagulation with hep or warfarin
239
focal tenderness and firmness and or erythema and no fever of breast
plugged duct
240
if pap shows HSIL or CIN 2 or 3 then what next
immediate colposcopy
if not visualized during colposcopy then endocervical curettage is performed to evaluate endocervical canal (don't do during pregnancy)
cervical biopsy is performed even in pregnancy if lesion has high grade features
241
how does clomiphene work
estrogen receptor antagonist on hypothalamus so stops negative inhibition of GnRH
242
mom has 1:32 titer after getting standard anti d at 28 weeks in first preg and 1 day postpartum, what happened
inadequate dose of anti d immune globulin after her first delivery
standard dose is usually adequate at 28 weeks gestation, after delivery or procedures ned to use kleihauer betke test to determine dose for post delivery dose
243
biophysical profile what is normal fetal movement
tone
breathing
```
movement = 3 or more
tone = 1 or more flex extension
```
breating 1 or more in 30 seconds
244
cx presentation of amniotic fluid embolism syndomre
cardiogenic shock
hypoxemic resp failure
DIC
coma or seizure
245
concentration of what increases close to ovulation and can be perceived as discharge from vagina in pts
cervical mucus
246
management of lichen sclerosus
punch biopsy recommended bc it is a vulvar premalignant lesion of SCC
247
subareolar, mobile, well-circumscribed, nontender mass; no fever breast
galactocele
248
what patients does placenta accreta usually occur in
pts with prior c section, myomectomy, or D and C
-surgery
249
management of suspected ruptured ovarian cyst
blood count for anemia, and pregnancy test to exclude ectopic, US to see pelvic free fluid
250
what is the most important direct role of hCG in pregnancy
maintenance of the corpus luteum from syncytiotrophoblast
251
what population does a dermoid ovarian cyst (mature cystic teratoma) most commonly occur in
premonpausal women
hyperchoic nodules and calcifcations
252
if pt has GBS positive when do you give penicillin
during labor
253
gold standard treatment for a ruptured ectopic pregnancy is what
laparoscopy
254
if known placental accreta then management
planned c section
255
pain on and an aversion to attempted vaginal penetration
tx
genito pelvic pain/penetration disorder
tx: desensitization and kegal exercises
256
diagnostic workup for urethral hypermobility
test
PVR
tx
Q tip test
determines whether pt has abnormal urethrovesical angle
urinalysis and postvoid residual volume should be normal
( <150 in women and <50 in men)
kegel exercises first then urethral sling surgery if that does not work
257
If moms anti-D antibody titer is less than what it cannot harm baby
1:8
if over 1:8 not good
258
proliferation of smooth muscle cells within the myometrium that causes irregular uterine enlargement
leiomyomata uteri (fibroids)
259
___ ___ can cause heavy and prolonged menstrual bleeding and can prolapse through the cervical os presenting with a typical labor like pain due to cervical distension by the solid mass
submucous fibroids
260
when should external cephalic version be done
at or over 37 weeks
261
outpt regimen for PUD
intramuscular ceftriaxone plus oral doxycycline
262
tenderness/erythema and fever with breast
above plus fluctuant mas
mastitis
abscess
263
submucosal along lateral aspects of the upper anterior vagina that don't involve vuvlva
cyst
gartner duct cyst
from incomplete regression of wolffian duct during fetal development
264
a typical NST will last ___ minutes but a nonreactive NST should be extended ___ minutes to ensure what
20, 40-120 to ensure not from fetal sleep cycle
265
beclomethasone, isotretinoin and lithium in pregnancy
beclo okay
stop iso
wean lithium (ebstein anomaly)
266
preterm labor management
if >34 to <37 weeks then do what
if >32 to <34 then what
if under 32 then what
1) betamethasone and penicllin if GBS + or unknown
2) betamethasone, tocolytics, penicillin if needed
3) betamethasone, tocolytics, Mg sulfate, pencilin if needed
- can add indomethacin with mg sulfate too
add one every time gets lower
267
treatment of hpv warts
small lesions can be treated with trichloroacetic acid or podophyllin resin
cryotherapy, laser therapy, excision of larger ones
268
when does routine screening for breast cancer start in women and with what
mammography at age 50 or older
269
contraindicated vaccines in pregnancy
HPV
MMR
live attenuated influenza
varicella
270
PE with GU syndrome of menopause
urinary incontinence, reccurent UTI
narrowed introitus
pale mucosa, decrased rugae
petechiae, fissures
271
are transient rigors/chills in postpartum period normal
how about peripheral edema
yes
yes
272
abruptio placentae
risk factor
sx
uterus texture
contraction amplitude and frequency
HTN, cocaine
abdominal and or back pain and vaginal bleeding (can be concealed behind placenta)
-blood can cause a firm uterus and low amplittude but frequent contractions
fetal brady
273
breast engorement occurs when and how
tx
3-5 days after delivery when colostrum is replaced by milk
cool compresses, tyleonl, nsaids
breastfeeding and pumping should help
274
fetal fibronectin and preterm delivery
FFN are high until 20 weeks gestation, low after that then increase at term
elevated levels prior to term are used as indicator for increased risk of preterm delivery
275
hydrosalpinx is caused by what
fluid accumulation in fallopian tube due to blockage by either adhesions (PID) or surgery (bilat tubal ligation)
mass would be seperate from ovary on US
276
ectopic pregnancy tx
stable
unstable
stable: methotrexate
unstable: surgery
277
management of suspected ectopic pregnancy
positve urine hcg, lower abdom pain, and or vag bleeding and stable next step
TVUS
- adenexal mass = treat ectopic
- intrauterine = nothing else to do
- nondiagnostic = get B-hcg
- if over 1500 = repeat b-hcg and TVUS in 2 days
- if under 1500 repeat b hcg in 2 days
278
epithelial ovarian carcinioma refers to malignancy involving what sites and can present at any of these sites
ovary, fallopian tube and peritoneum
279
intrauterine fetal demise pathophysiology and figuring out cause
maternal, fetal, or placental
fetus undergo autopsy, karyotype studies, placenta evealuated for disesae
labs for mom as well like antiphospholipid antibody syndrome
280
management if have no history of preterm labor and short cervix
progesterone
281
symptoms of mass effect like pelvic pressure in fibroids or adenomyosis?
only fibroids
282
tx of HELLP syndrome
timeline
stablize (mg and anti-HTN) then
delivery
at 34 weeks or greater
or at any age with abnormal fetal testing or severe or worsening maternal status
283
pt presents with hyperemesis gravidarum, an enlarged uterus, and bilaterally enlarged ovaries which is a presentation concerning for a
complete hydatidiform mole (gestatinoal trohoblastic disease)
284
tuboovarian abscess is a complication of what disease and presents with what
from what infection
labs
dx
PID
presents with fever, ab pain and mass
polymicrobial infection
labs: leukocytosis, CRP, and CA-125 elevated and fever
dx: US, CT scan
285
FSH LH prolactin and TSH in asherman syndrome
normal all
286
most common cause of fetal demise
frequently unknown
287
what is lochia rubra and is it normal in postpartum period
red or reddish-brown vaginal discharge (normal shedding of ther uterine decidua and blood)
normal
runs pink or brown then yellow eventually
288
in PID what do you see on US
tubo-ovarian abscess
289
assessing for syphillis in pregnancy when
universal at first prenatal visit
third trimester and delivery if high risk
non treponemal RPR and VDRL
treponemal FTA-ABS
290
tx for gestational diabetes
1st line: dietary mod
| 2nd line: insulin, metformin, glyburide
291
ursodeoxycholic acid used to treat what in pregnancy
intrahepatic cholestasis
292
early decelerations are caused by what
fetal head compression
not alarming
293
vaccines recommended during pregnancy
Tdap
inactivated influenza
rho(D) gam
294
Adverse effects of tamoxifen and raloxifene
hot flashes
venous thromboembolism
endometrial hyperplasia and carcinoma (tamoxifen only) (estrogen antagonist in breast)
295
clinical features of a vesicovaginal fistula and dx
painless, continuous urine leakage from the vagina following surgery
dx: dye tests or cystourethroscopy
296
carboprost in delivery
synthetc prostaglandin that stimulates uterine contraction
causes bronchoconstriction and asthma is a contraindication
297
contraindications of HRT therapy
histroy of coronary heart disease, thromboembolism, TIA, breast cancer, endometrial cancer
298
progesterone and preterm delivery treatment
it is administered to pts with history of preterm delivery or a shortened cervix to prevent preterm delivery
299
smooth undulating waveform with no variablilty or sinusoidal fetal heart tracing on fetal monitor suggests what
fetal anemia
300
rist step in evaluating risk of preterm delivery is what
TVUS measuring cervical length in second trimester
301
when c section with HIV
if mom viral load over 1,000
302
maternal thyroid in pregnancy first trimester
total t4 increased bc b-hcg stimulates thyroid hormone produciton in 1st semester
fre t4 same or mild increase
tsh decrased
estrgoen stimulates syn of TBG which leads to increased pool of bound thyroid hormone
303
septic abortion presents with what
usually from what
uterus description
tx
fever lower abdominal pain and heavey vag bleeding and malodorous purulent vaginal discharge
usually after unsterile abortion
enlarged boggy tender uterus with echogenic material
tx: broad spectrum antibiotics and suction curettage
304
normal amniotic fluid volume
single fluid pocket equal to or greater than 2X1 cm or amniotic fluid index over 5
305
comorbidities with PCOS
diabetes, HTN
obstructive sleep apnea
nonalcoholic steatohepatitis
endometrial hyperplasia/cancer
306
risk factors of preterm labor
multiple gestation
history of preterm delivery
history of cervical surgery (conization)
307
preeclampsia is likely due to abnormal what
placental spiral artery development
308
preeclampsia at <20 weeks gestation can be a complication of what
hydatidiform mole
309
breast engorgement tx for pt who does not want to breast feed
comfortablebra, avoid nipple stimulation, ice and NSAIDs
310
breast engorgement tx for pt who wants to breast feed
frequent emptying of breasts
311
difference from LS and menopausal atrophy
menopausal atrophy does not affect the perianal skin like LS
312
how old do you have to be to get an endometrial biopsy when you get atypical glandular cells on a pap test
35 or older
313
thickening of the uterosacral ligaments
endometiosis
314
cervical cancer upper 2/3 of vagina
stage IIa
