OB/gyn Flashcards
how do you manage GBS in pregnant women with history of previous GBS+ pregnancy?
prophylactic IV penacillin
when do you give anti-D Ig?
screen at 24-28 weeks –> if negative, give at 28 weeks and within 72 hours of delivery of Rh+ baby
rubella in pregnancy
rash the spreads face down, spares palms and soles
postauricular LAD
arthralgias
**sx tx after 18 weeks
risks for endometritis? treatment?
prolonged labor and/or C section after onset of labor
tx with IV clinda/gent (polymicrobial infx)
t/f: active maternal HSV infx is an indication for csection?
yes
approach to meconium ileus?
gastrograffin enema= diagnostic and therapuetic
signs/sx of chorio?
maternal tachy WBC >15k uterine tenderness malodorous discharge fetal tach >150
***give IV amp/gent and deliver!
c section or NSVD in chorio?
csection if hemodynamically unstable or other pathology
add CLINDA to amp/gent
nerve injury moms at risk for (especially from prolonged labor)
common peroneal –> footdrop
hepatic adenoma vs focal nodular hyperplasia on imaging
FNH has stella scar (central area of fibrosis)
-FNH is less risk of bleeding than Hepatic adenoma
-If on OCPs and hepatic adenoma found, you should dc OCP
cut off ages for HPV vax?
girls <26
boys <21
character of variable decels?
differ in amplitude, duration and form
**indication of cord compression –> reposition and administer O2 —> amnioinfusoin if previous attemps are unsuccessful
hyperkeratotic exophytic papules that turn white with acetic acid?
HPV
vaginismus
severe pain/ anticipatroy anxiety on insertion of anything into the vagina
if complaints are due to pain: pelvic floor PT
if complaints are due to anxiety and stress: sex psychotherapy
preterm infants exclusively breast fed are at greater risk for….
Fe deficiency anemia
how does clomiphene induce ovulation?
SERM –>blocks hypothalamic endogenous estrogen receptors therefore blocking negative feedback inhibition –> this increases pulsatory GnRH –> inc FSH/LH –> ovulation
tx for ectopic (After its out)// contraindications
methotrexate –> check after 7 days, expect to see >15% drop in Hcg
CI:
- immunodeficiency
- non compliant patients
- hepatotoxicity
- ectopic > 3.5 cm (high failure rate)
- fetal heart beat (high failure rate)
HPO immaturity
cycles in girl with recent menarche that are heavy and occur >45 days apart
*lack progesterone signal
non stress test
20 minutes on the montior looking for >2 accels for at least 15 seconds
-indicated after 32 weeks in high risk pregnancies or when mom stops feeling movement
3 D’s of entrometriosis
dsymennorrhea
dysperuenia
dyschezia (painful poops)
*rectovaginal nodularity in the posterior cul-de-sac
management of stable PPROM < 35 weeks
steroids
antibiotics
mag if <32 weeks
delivery
BP lowering meds for preE
IV hydral
IV labetalol –> look at HR
PO nifedipine –> is patient able to take PO?
*methyldopa is for chronic HTN
treating syphillis in pregnancy with reported hx of allergy?
there are no alternatives. Do a skin test. Do a sensitization if you need to.
(if someone is not pregnant, you can use IV ceftriaxone)
how to treat vulvovaginal candadiasis
pregnant= intravaginal clomitrazole
not pregnant= oral fluconazole
BV
- clue cells = epithelial cells covered in coccobacili (gram indeterminate)
- alkali pH
- treat with oral metro
when to use FNA vs core needle in breast mass?
FNA is not definitive, jsut shows abnormal cells. Use this to evaluate non suspicious cystic lesions in women under 30
Core needle used in suspicious mass in older women
up until what age do you screen for GC/CT?
25
physiologic nipple discharge
BILATERAL, can be milky or greenish, in young women with normal endo fx is physiological. Avoid nipple stimulation
large, rapidly growing breast mass, that appears sharply demarcated from normal tissue on imaging?
phyllodes –> benign!
however, treat like a cancer because they can rarely become malignant
distinguish pagets of the breast from inflammatory breast CA?
paget’s generally involves/ is limited to the areola
how to treat breast cancer in pregnancy
chemo can be given after the first tri?
trich
pH> 4.5
burning with urination
strawberry cervix
5a-reductase deficiency
X,Y but maintain female external genitalia because they lack testosterone to convert from default
-increasing levels of T at puberty cause adrenarche and virilization but no secondary sex characteristics
aromatase deficiency
ambiguous genitalia at birth -decrease est, increased T ---> virilization of mom during pregnancy as androgens cross placenta tall stature osteoporosis
function of aromatase
converst androgens to estrogens
endometrial tissue within the uterine wall. associated with pelvic pain in a woman closer to menopause
adenmyosis
**uniformly enlarged uterus but assymetrical thickening, wahtever that means
what factor, generally, has greatest impact on prognosis of breast cancer
nodal status
endometrial thickness >5mm, with no atypia, in postmenopausal woman?
endometrial hyperplasia
- risk: estrogen replacement without P, obesity, PCOS
- ***at risk for malignant transformation
- tx= progestin
endmetrial hyperplasia with atypia, tx?
hyst +bso
confirmation of fat necrosis of the breast?
oil cysts
multinucleated giant cells
approach to primary dysmennorrhea
nsaids
OCPs
mastitis
caused by over production of milk or insufficient drainage –> staph infection
- occurs 2-4 weeks after birth
- tx with a pcn of sorts and continue breast feeding
linchen sclerosis
- vaginal pruritis in post menopausal women
- figure 8 pattern
- do punch to r/o SCC
- treat with high dose steroids
GnRH ago 3 months before definitive surgery for leiyomyomas
decreases size, decreases surgical time/ complications
-decreases dysmennorrhea/mennorhagia in the mean time
first line tx for PMDD
SSRIs
should also advise to stop smoking
pharmacological tx of acute AUB in hemodynamically stable patient
high dose conjugated estrogen therapy –> triggers rapid growth of endometrium, stops bleeding from endometrial surface
age of endometrial cancer
> 45
>35 with risk factors (ie obesity, nulliparity)
t/f: isolated precocious adrenarche in an obese (probably african america feamle) can be caused by insulin resistance?
true.
It’s a complicated mechanism that bascially leads to increased free T
most common vaginal forein body in a young girl and easy office procedure to get it out?
TP –> warm saline irrigation
how to manage delivery in HIV positive mom
cART during pregnancy, C/S, zidovudine for baby at birth for prophylaxis PEP
brings vert transmission risk down to ~2%
contraindication to breast feeding:
MOM
- maternal HIV
- active TB
- drug abuse (MARIJUANA!)
- meds: tetracyclines, chemo, chloramphenicol
BABY
-active galactosemia
quickie on physiologic change in pregnancy:
- acid base?
- hgb?
- renal fx?
acid base= chronic compensated respiratory alkalosis (bicarb will be up)
hgb= dec by 2mg/dL due to increase in plasma volume by 40-50%
renal= 50% decrease in GFR due to inc blood flow= increase filtration –> dec Cr, BUN, uric acid
oral glucose challnege should occur when?
24 weeks (24-28)
risk factors for intrauterine hypoxia? sequelae of this in baby?
- maternal smoking, MGD, SGA, LGA
- polycythemia
safe managment of preE with severe features
if stable, >34 weeks, induce labor. Vaginal > CS
if stable <34 weeks, give IV mag, steroids and BP meds
you admin IV Mag to prevent progression of pre-E, and then patient looses DTRs. What do you do?
d/c Mag and start Ca-gluc.
loss of reflexes is earliest sign of Mg toxicity
what is the CONFIRMATORY test for Downs?
chorionic villous sampling, between 10-15 weeks.
amnio at 15-17 weeks
whats a way to distinguish abruption from rupture when presentation is looking very similar?
abruption = rigid uterus with hypertonic contractions
rupture= cessation of previously adequate contractions (they’ll give you a hx of a previously scarred uterus)
GBS test timing?
35-37
Rh antibody testing
28-29 weeks
“chronic” hypertension in pregnancy
before 20 weeks, or persisting after 42 weeks
ruptured vasa previa
presents with antepartum hemorrhage and signs of FETAL distress/ blood loss. There will be no signs of maternal blood loss.
management of threatened abortion:
reassurance –> f/u ultra sounds –> limit physical activity/ sex
***intact IUP + closed os + intrauterine bleeding
management of APLA in pregnancy
ASA + heparin
**d/c ASA in third trimester to prevent premature closure of ductus
anti epileptics in pregnancy
they are all bad, so choose one that best controls moms seizures at lowest dose possible
placental thrombosis causing abortion in first/second tri?
think APLS/ SLE –> look for prolonged PTT!
rosette test
tests for fetal/maternal hem
gestational hypertension causes:
IUGR.
hypotension and increased HR after spinal epidural?
sympathetic blockadge
incomplete abortion? management?
retained products, dilated os
d/c! give abx for retained products
genetic contraindication to copper IUD?
wilson’s
breast imaging modality in pt under 30?
US!
whats a good lab to check in someone presenting with menopause like sx?
TSH!!!!!!!
