OB/GYN 8% Flashcards
1
Q
___ predominates in Phase 1 (a.k.a. ___)
Day:
A
Estrogen predominates
Follicular phase
Day 1-12
Follicular
2
Q
Causes follicle and egg maturation in ___phase
A
FSH
Follicular (phase 1)
3
Q
Stimulates maturing follicle ___ production
A
LH
Estrogen production
4
Q
___ causes a sudden ___ surge causes ovulation
Days:
A
Estrogen causes a sudden LH surge
Day 12-14
5
Q
Phase 3 (a.k.a. ___, a.k.a. ____)
___ surge causes ruptured follicle to become ___, which secretes ___ to ___.
A
Luteal, Secretory phase
LH
corpus luteum
progesterone
maintain endometrial lining and secretion
6
Q
If pregnancy occurs, ___ keeps the corpus luteum functional until placenta can support itself
A
blastocyst
7
Q
Estrogen is produced by ____
Provides (positive/negative) feedback on ___.
A
granulosa cells of follicle
Positive feedback on LH –> LH surge to cause ovulation
8
Q
Inhibins is produced by ___.
Provides (positive/negative) feedback on ____.
Inhibin B levels rise during ___, highest during ___. Increase again during ___.
Inhibin A levels decrease during ___.
A
granulosa cells of follicle
Negative feedback for FSH
- luteal-follicular transition
- highest during mid follicular phase
- LH peak
late luteal phase
9
Q
Chronic anovulation is caused by ___.
A
Unopposed estrogen, no corpus luteum –> no ovulation, no progesterone –> continuous estrogen production and stimulation of endometrium w/o progesterone stabilization/induced bleeding
10
Q
Ovulatory dysfunctional uterine bleeding caused by ___.
A
ovulation with prolonged progesterone secretion d/t low estrogen –> blood loss from endometrial vessel dilation and prostaglandins –> metrorrhagia
11
Q
Tx of acute severe uterine bleed
A
High dose IV estrogens
D&C if IV estrogen fails
12
Q
Tx of anovulatory dysfunctional uterine bleeding
A
OCPs
Medroxyprogesterone acetate
Leuprolide
13
Q
Tx of ovulatory dysfunctional uterine bleeding
A
OCPs
Medroxyprogesterone acetate
Leuprolide
NSAIDs*
14
Q
MC/most important diagnostic for DUB
A
Endometrial bx
15
Q
Primary amenorrhea = failure of onset of menarche by ___.
A
15 y/o
16
Q
High FSH in setting of primary amenorrhea suggests problem with ___
A
ovaries. FSH screaming at unresponsive ovaries
17
Q
Low FSH in setting of primary amenorrhea suggests problem with ___
A
H-P axis problem. Ovaries don’t know what to do without FSH.
18
Q
Breasts that are present, with absent uterus, 46, XX suggests ____
A
Mullerian agenesis = congenital absence of vagina, uterine agenesis
19
Q
Breasts that are present, with absent uterus, 46, XY suggests ____
A
Androgen insensitivity = female phenotype d/t testosterone resistance
20
Q
Kallmann’s Syndrome =
Hallmark symptom:
A
Hypogonadotropic hypogonadism –> pituitary secretion of FSH and LH VERY low
Anosmia (lack of smell)
21
Q
Low stature, webbed neck, edema, low hairline, low ears, widely set nipples =
Tx w/:
A
Turner Syndrome (45, XO)
Tx: estrogen
22
Q
Most common form of secondary amenorrhea
Induces a hypothalamic state in which reduced secretion of ___–> low ___ –> no stimulation of ____ –> ____ is not produced by follicles
A
Stress related
GnRH
LH and FSH
ovulation
estrogen
23
Q
Progesterone challenge test used for ____
Result interpretation:
A
determining ovarian disorders in secondary amenorrhea
If withdrawal bleeding = ovarian cause –> anovulatory. Estrogen present to build up the endometrial lining.
If no bleeding = Hypoestrogenic (Hypothalamus-Pituitary failure OR uterine disorder
24
Q
Hypothalamus dysfunction causing amenorrhea occurs when ____
Causes:
Tx:
A
disruption of pulsatile GnRH –> low FSH and/or LH from pituitary
Causes: Anorexia, weight loss, exercise**
Stress, nutritional deficiency, systemic disease
Tx:
Clomiphene = estrogen agonist/antagonist actions to stimulate gonadotropin release and ovulation
Menotropin = gonadotropin secretion
25
Ovarian disorders causing amenorrhea will show (high/low) FSH, (high/low) LH, (high/low) (Estradiol/Prolactin).
High FSH and LH
| Low Estradiol
26
Pituitary disorders causing amenorrhea will show (high/low) FSH, (high/low) LH, (high/low) (Estradiol/Prolactin).
Tx:
Low FSH and LH
High Prolactin
Tx:
OCP
Bromocriptine (Dopamine agonists to inhibit prolactin)
27
Asherman's Syndrome =
Dx:
Tx:
Acquired endometrial scarring (overaggressive D and C)
"A"dhesions + "A"menorrhea
Pelvic US showing absence of normal uterine stripe
Tx: Estrogen
28
Primary dysmenorrhea is caused by ___
High prostaglandins = painful uterine muscular wall
29
Premenstrual Syndrome diagnostic criteria:
Minimum of ___ symptoms need to begin ___.
Must be in ____ (prior/during/after) menstruation.
Must be symptom free for ____ in ____ of cycle.
Must occur in ___ cycles.
Minimum of FIVE symptoms need to begin THE WEEK PRIOR TO MENSES.
Must be in 2 WEEKS PRIOR menstruation.
Must be symptom free FOR 7 DAYS in FIRST HALF of cycle.
Must occur in 2 CONSECUTIVE cycles.
30
Severe PMS w/ FUNCTIONAL impairment
Premenstrual Dysphoric Disorder (PMDD)
31
Menopause: increased ___ levels, decreased ___ levels.
Increased FSH >25 (confirms dx)
| Decreased estradiol
32
Most effective tx for menopausal vasomotor symptoms (hot flashes/night sweats)
Tx of mood symptoms?
Estrogen
SSRI/SNRI
33
```
Which of the following is NOT a risk factor for uterine/endometrial polyps?
A. Obesity
B. Cervical polyps
C. HTN
D. Methotrexate
```
D. Tamoxifen (tx of breast cancer) is a RF
34
Medication tx of uterine/endometrial polyps
Progestins
| Leuprolide (GnRH inhibitor)
35
Polycystic Ovarian Syndrome has unknown etiology but possibly d/t ____, which results in ___
Elevated LH:FSH ratio
Suppression of pituitary FSH, constant LH stimulation, anovulation, multiple cysts, theca cell hyperplasia, excess androgens
36
LH stimulates ___ to produce ___, which are shunt to ___, which aromatize into ___.
- theca cells
- androstenedione and testosterone
- granulosa cells
- estrone and estradiol
37
Presentation of Polycystic Ovarian Syndrome
Hirsutism*
Obesity*
Amenorrhea*
Signs of hyperandrogenism (hair, deep voice)
38
"String of pearls" on TVUS
Other dx:
PCOS
LH:FSH > 2 or 3:1
39
Tx of PCOS
- Metformin: restore ovulatory menses
- Clomiphene: stimulate ovulation
- Low dose OCP or spironolactone: hirsutism and acne
- Weight loss
- Dexamethasone?
40
MC pathogen of bacterial vaginosis
Gardnerella
41
T/F: Candida vaginitis has acidic pH <4.5.
True. BV and Trichomonas have basic pH >4.5
42
Lymphogranuloma Venereum (LGV) is caused by ___.
Dx:
Tx:
Chlamydia Trachomatis
Dx:
- Complement fixation test >1:16
- Bubo aspiration and culture for chlamydia
Tx: Doxycycline, tetracycline or erythromycin
43
PAP smear for women age ___ Q ___.
PAP + HPV for age ___ Q ___.
21-65, Q 3 years
30-65, Q 5 years
44
What to do if PAP shows ASCUS?
When do you do colposcopy?
When do you redo pap in 1 year?
What do you do if negative HPV?
HPV reflex testing
If + HPV >24 y/o --> colposcopy
If + HPV and 21-24 y/o --> redo pap in 1 year
If - HPV --> back to routine schedule
45
Chancroid caused by what pathogen?
Co-infection?
Presentation?
Tx?
Haemophilus ducreyi
Co-infect: HSV, T. pallidum
Presentation: EXTREMELY painful ulcers w/ soft, ragged edges
Malaise, HA, anorexia
Tx: Azithromycin*
Cetriaxone, Cipro
46
Leading cause of infertility and ectopic pregnancy in young, Nulliparous, sexually active women
Tx:
Pelvic Inflammatory Disease (PID)
Broad spectrum abx, at least 2: Cetriaxone + doxycycline
47
Condyloma Acuminata caused by ____
Dx:
Tx:
HPV strain 6, 11
Dx: Acetic acid --> appear white raised plaques
Tx:
Cryotherapy
Podofilox (CI in pregnancy)
Imiquimod
48
Syphilis is caused by ____
Presentation of each stage:
Treponema pallidum
Initial (10-60 days):
Chancre
Secondary (1-3 months):
- Condylomata lata = soft, flat, moist papules scattered on perineum
- scattered discrete coppery papules on palms of hand/feet
Tertiary:
Gummas: granulomas of skin
49
Dx of Syphilis
Dark field microscopy
+
Direct fluoresecent antibody tests
- Screening: VDRL, RPR (rapid plasma reagent)
- Confirm: TPPA (Treponema pallidum particle agglutination assay), FTA-ABS (Fluorescent treponemal antibody absorption test )
50
Screening for syphilis during pregnancy with ___
RPR antibody
51
Tx of syphilis
Benzathine Penicillin G
PCN allergy: Doxycycline
F/u w/ VRDL titers at 3, 6, 12 months
52
Genital herpes most commonly caused by ___.
Viral shedding occurs for ___.
Time it takes to heal?
HSV-2
3 weeks
10-22 days
53
Dx of genital herpes
Tzanck smear*
| PCR testing
54
Precaution for pregnant women w/ active genital herpes lesions
Disseminated infection in neonates
Require C-section delivery
Encephalitis, eyes, skin, mucosa
55
Thinning of epidermis and fibrosis of dermis --> leukoplakia, thinning (parchment-like) vulvar skin
T/F: It causes increased risk for vulvar basal cell carcinoma.
Vulvar Lichen Sclerosus
False. Squamous carcinoma
56
Hyperplasia of vulvar squamous epithelium associated w/ chronic itching and irritation causing thicker, leathery skin
T/F: No risk of cancer development
Lichen Simplex Chronicus
True
57
Fetal complications of Erythema infectiosum (5th's dz)
Fetal loss
Fetal hydrops
Fetal viral myocarditis
58
Adults with 5th's dz present w/
Rash, fever, lymphadenopathy, arthritis
| Acute transient aplastic crisis*
59
```
All of the following are risks of Ovarian Neoplasms EXCEPT:
A. Early menarche
B. Nulliparity
C. Late menopause
D. OCPs
```
D. OCPs are protective.
Risk = uninterrupted ovulation. Infertility
Protective = multiparity, breastfeeding, hysterectomy, chronic anovulation
60
Tumor marker used to monitor Ovarian Neoplasms
CA-125
61
MC type of Ovarian neoplasm
Epithelial
62
Highest mortality of all gynecological cancers
Ovarian cancer
63
T/F:OCPs are protective against breast cancer.
FALSE: unopposed estrogen is a risk factor of breast cancer.
Other risk factors: AGE ***, nulliparity, early menarche, late menopause
OCP is protective in Ovarian Cancer.
64
MC type of breast cancer
Invasive ductal carinoma
65
Most common gynecological cancer
Endometrial cancer
66
Gynecological cancer that is ESTROGEN dependent
Endometrial cancer
Biggest risk factor = high estrogen exposure
67
MC site of metastasis in endometrial cancer
Lungs
| Do CXR
68
90% of vulvar cancers are ____.
Develop from 2 pathways:
squamous cell carcinoma
1. HPV 16 and 18
2. Long standing lichen sclerosus
69
T/F: You should stop breastfeeding if you have mastitis.
False. Stop breastfeeding w/ breast abscess. Continue breastfeeding in mastitis.
70
T/F: Fibroadenomas may fluctuate with menstrual cycle.
False. Fibroadenomas do NOT change. Fibrocystic breast changes fluctuate w/ menstrual cycle.
71
Cystocele presents with ____
Stress urinary incontinence
| Feeling of vaginal fullness
72
Procidentia
Cervix extends beyond vulva
73
Definitive dx of ovarian torsion
Laparoscopy
US can't r/o
74
```
All of the following are ABSOLUTE CI for estrogen EXCEPT:
A. DVT/PE
B. Stroke
C. CAD
D. Thromboembolic d/o
E. Breast/endometrial cancer
```
D. Thromboembolic d/o is a RELATIVE CI
75
1st line tx for endometriosis
Combination OCPs + NSAIDs
--> severe cases: Depot Leuprolide injections (GnRH agonist) --> decrease pituitary, no LH and FSH
76
Decreased pelvic organ mobility, endometrium proliferates outside of uterus and leads to pain, eventual scar tissue development in pelvis =
Endometriosis
77
Ectopic endometrial tissue within myometrium (muscle layer of uterine wall) =
Presentation:
Adenomyosis
Tender symmetrically, "boggy uterus"
78
Tx of Adenomyosis:
Total Abdominal Hysterectomy (TAH) = only effective treatment
79
#1 risk factor of Leiomyomas/fibroids:
#1 presentation symptom:
ESTROGEN:
multiparity, late/menopause/early menarche, oral estrogen
Menorrhagia
80
```
All of the following are charcteristics of Leiomyomas EXCEPT:
A. Nontender
B. Irregular
C. Firm
D. Symmetric
```
D. Asymmetric. Adenomyosis is symmetric, soft, tender.
81
Leiomyomas are differentiated from adenomyosis by ____ seen on MRI/US
pseudocapsule
82
Treatment of Leiomyomas
Definitive tx?
- Observation if asymptomatic other than menorrhagia
- Saline infusion sonohysterography
- Progestins, Leuprolide, Mifepristone
- NO estrogen
Definitive: Hypsterectomy
83
```
Causes of ovarian cysts include all EXCEPT:
A. Hyperthyroidism
B. Early Menarche
C. Use of Tamoxifen
D. Early menopause
```
A, D.
| HYPOthyroidism
84
Detrusor muscle is under ___ control.
Internal sphincter is under ___ control.
External sphincter is under ___ control.
Detrusor muscle is under PARAsympathetic (Beta-adrenergic) control.
Internal sphincter is under ALPHA-adrenergic control.
External sphincter is under ___ control.
85
History of Imipramine use for postpartum depression may cause ___
Hyperprolactinemia --> infertility
| and visual changes
86
Most common cause of infertility
Polycystic Ovarian Syndrome --> causes increased levels of estrogen production --> inhibit FSH and LH
87
Criteria for PCOS dx:
2 of 3:
- Oligo and/or anovulation
- Hyperandrogenism --> test Testosterone
- Polycystic ovaries on US --> "string of pearls"
88
Tx of Polycystic Ovarian Syndrome (PCOS)
- METFORMIN: lowers glucose, insulin, testosterone levels --> spontaneous ovulation
- Estrogen receptor modifiers
- Clomiphene (Clomid) --> inhibit negative feedback of estrogen on release of gonadotropin
89
Ladin's Sign =
Piscacek's Sign =
Goodell's or Hagar Sign =
Chadwick's Sign =
Ladin's Sign = uterus softening at 6 weeks
Piscacek's Sign = palpable uterus lateral bulge at 7-8 weeks
Goodell's or Hagar Sign = cervical softening at 4-5 weeks
Chadwick's Sign = Cervix/vulvar bluish at 8-12 weeks
90
G4P1123 =
```
G = # of times women has been pregnant
P = number of pregnancies that resulted in birth at or beyond 20 weeks
TPAL = Term, Preterm, Abortuses, Living children
```
Woman gave birth to set of preterm twins, 1 38 week infant, 2 miscarriages
91
Expected Due Date =
1st day of LMP - 3 months + 1 week, + 1 year
92
Fundal height:
___ weeks = pubic symphysis
___ weeks = umbilicus
___ weeks = elevates ~ 1 cm above umbilicus for each week of pregnancy
12 weeks = pubic symphysis
20 weeks = umbilicus
After 20 weeks = elevates ~ 1 cm above umbilicus for each week of pregnancy
93
Preterm =
Term =
24-37 weeks = preterm
37-42 weeks = term
94
Triple Screening at ___ weeks
What is tested?
15-20 weeks
alpha Fetoprotein (a-FP), b-HCG, Estradiol
95
low a-FP, HIGH b-HCG, low estradiol suggests ___
Trisomy 21
96
HIGH a-FP suggests ___
Open neural tube defect
OR
multiple gestation
97
low a-FP, low b-HCG, low estradiol suggests ___
Trisomy 18 --> stillborn or die w/i 1 year
98
Fetal imaging start at ____ weeks.
| GBS screening at ___.
18-22 weeks
32-37 weeks
99
Chorionic VIllus Sampling can be performed at ___.
Amniocentesis can be performed at ____.
9-12 weeks (earlier than amniocentesis)
> 15 weeks
100
Macrocytic anemia, tongue soreness, numbness/tingling of feet, impaired cognitive function suggests ___ deficiency
Cobalamin (B12) deficiency
101
Quad screen includes:
alpha Fetoprotein (a-FP), b-HCG, Estradiol AND Inhibin-A
Detects Down Syndrome 81%, 5% false positive
102
Gestational diabetes screen performed at ___ weeks with ____. If elevated > ____, f/u w/ ____. Diagnosis established when ___.
```
27 weeks
1 hr glucose tolerance test
>135
3 hr GTT
2 or more of 4 tests are abnormal
```
103
Sex of fetus determined at ___ weeks via US.
18 weeks
104
#1 tx of Hyperemesis gravidarum
Pyridoxine (vit B6) +/- doxylamine (Unisom)
105
hCG levels double every ____, peaks at ____ in normal pregnancy
48 hrs
| 10-12 weeks
106
PUPPP =
pruritic urticarial papules and plaques of pregnancy = papulovesicular lesions on trunk and extremities
107
T/F: Mother is considered G1P2 if she is pregnant with twins
False: Still G1P1
108
APGAR scoring evaluated at ____ after birth.
| Score and meaning:
```
7-10 = good
4-6 = assist, stimulate
<4 = resuscitate
```
109
APGAR stands for? How is each category scored?
Appearance: 2 = pink all over; 1 = pink w/ blue extremities; 0 = blue/pale
Pulse: 2 = > 100 bpm, 1 = <100 bpm, 0 = absent
Grimace: 2 = cough/sneeze/vigorous cry; 1 = grimace/slight cry, 0 = no response
Activity: 2= active movement, 1 = some movement/flexed extremities, 0 = limp
Respiration: 2 = slow/crying, 1 = slow, irregular, 0 = absent
110
What type of abortion?
| Bleeding before 20 weeks gestation
Threatened abortion. "Catch-all" dx
111
What type of abortion?
| Some but not all intrauterine contents expelled
Incomplete abortion
Tx: D and C
112
What type of abortion?
| Dilated cervical os, cramping, +/- bleeding
Inevitable abortion
113
What type of abortion?
| POCs have been completely expelled from uterus
Complete abortion
114
What type of abortion?
Fetal demise w/o cervical dilatation
Asymptomatic
Missed abortion
115
What type of abortion?
| With intrauterine infection
Septic abortion
116
Medical abortion most commonly use ____.
| Time limits?
Mifepristone + Misoprostol
24-48 hrs --> up to 9 weeks gestation
117
Spontaneous abortion = loss of pregnancy without outside intervention before ___.
20 weeks gestation
118
Placenta previa =
Tx:
PainLESS uterine bleeding 27-32 weeks
C section if 37 weeks OR unstable
Otherwise: observe, hgb checks, steroids
119
Premature placenta separation from uterine wall with hemorrhage =
Presentation:
Dx:
Risks:
Placental abruption (abruption placentae)
PainFUL bleeding**
US is NOT HELPFUL in dx. Pelvic exam and hx ONLY.
Risk: TRAUMA**
120
Toxoplasmosis during pregnancy can cause ___ in newborn.
hepatosplenomegaly
121
T/F: Rubella vaccine is administered at 16 weeks of pregnancy to prevent congenital disease.
FALSE: DO NOT give vaccine during pregnancy
122
Most common congenital infection =
Cytomegalovirus
123
Women with 1-2 prior second-trimester pregnancy losses or preterm births + cervical length < 25 mm on TVUS or advanced cervical changed on PE before 24 weeks =
Incompetent cervix
124
Tx of incompetent cervix for
Previable fetus:
Viable fetus:
Previable fetus:
elective termination OR
Cerclage placement (suture cervix to hold it closed)
Viable fetus:
Betamethasone (glucocorticoid to enhance fetal lung maturity) + strict bed rest
Tocolytics (Ritodrine) = prevent contractions and progression of labor if there is preterm labor contractions
125
Universal Gestational Diabetes screening is recommended for all pregnant women at ____ weeks.
Screening =
Definitive diagnosis =
24-28 weeks
Screening:
- Random blood sugar >200 OR fasting glucose >126 on 2 occasions = diagnostic
- Non-fasting 50 gm oral glucose challenge test > 140 = positive
Definitive:
3 hour glucose tolerance test
126
Tx of choice for gestational diabetes
If fasting blood glucose is high, use ___
If postprandial glucose is high, use ___
If both fasting and postprandial glucose are high, then ___
Insulin
Fasting: NPH insulin at bedtime
Postprandial: regular insulin before meals
Both: NPH before breakfast and bedtime + regular insulin before each meal
127
Gestational HTN = Persistent ___ mmHg, (with/without) proteinuria, at or after ___ weeks.
Tx:
>140/>90
WITHOUT
20 weeks
Tx: methyldopa
128
Preeclampsia = ___ mmHg + ____
Tx:
>140/>90
Porteinuria of 0.3 gm or greater in 24 hr urine
Tx: bedrest, Methyldopa
129
HELLP syndrome =
| Seen in ___
Hemolysis, Elevated Liver enzyme, Low Platelet
Severe preeclampsia (>160/110, >5 gm protein in 24 hrs)
130
Tx of severe preeclampsia
-Antihypertensive
-Mg sulfate = seizure prophylaxis
-Betamethasone x2 24 hrs apart = speed up lung development if under 33 weeks
Induce delivery
131
Occurrence of 1 or more conuslions in presence of preeclampsia =
Tx:
Eclampsia
Tx: Mg sulfate for seizures --> may cause hyporeflexia --> Ca gluconate
132
Painless, abnormal vaginal bleeding, preeclampsia, tachycardia, tachypnea is presentation of ___.
Molar pregnancy
133
Dx of molar pregnancy:
hCG =
US shows ___
hCG >100,000
| US: cluster of grapes, snowstorm appearance
134
Complete mole =
karyotype:
Partial mole =
karyotype:
Complete: 46XX
Fertilization of egg that had no chromosomes
Partial: 69XXY
Fertilization of ovum by 2 sperms
135
Complete moles have a 2 % chance of developing into ___.
Choriocarcinoma
136
Sheets of anaplastic cytotrophoblasts and syncytiotrophoblasts w/o chorionic villi =
Choriocarcinoma
137
Choriocarcinoma tx
Methotrexate
| Actinomycin D
138
Tx of Rh-Incompatibility
300 mg Rh immunoglobulin given to Rh - mother at 28 weeks and within 72 hours of delivery
139
Erb palsy
Fetal brachial plexus injury
Complication d/t shoulder dystocia
140
Tocolytics =
Examples:
medication that suppresses premature labor
- Betaminmetics* (ritodrine, terbutaline)
- Magnesium sulfate
- Nifedipine (CCB)
- Indomethacin (anti-prostaglandins)
- Oxytocin ANTAgonists
141
Tx of preterm labor =
- Tocolytics
- Dexamethasone/betamethasone (stimulate fetal lung development)
- GBS prophylaxis: PCN
142
Prenatal screening for vaginal and rectal GBS at ____ weeks.
32-37
143
MC cause of life-threatening infections in newborns.
GBS
Sepsis, meningitis, newborn pneumonia
144
Prolapsed umbilical cord will cause ____ after membrane rupture
severe variable deceleration or bradycardia
145
Abnormal accumulation of fluid in fetal tissue =
Hydrops fetalis (fetal hydrops)
146
All of the following are reassuring fetal status EXCEPT:
A. Minimal variability
B. Active fetal movement
C. 2 accelerations in 20 minute period
A. Moderate variability (6-20 bpm) is good. Minimal (<5 bpm), marked (>20 bpm) or absent variability is bad.
Reactive strip = 2 accelerations of >15 seconds w/ peak of >15 bpm in 20 min period
147
Uterine myometrium fails to contract following delivery =
Tx:
Uterine atony
```
Tx:
- Bimanual uterine massage*
- Uterotonic agents =
IV oxytocin*
Prostaglandins (CI in asthma)
Methylergonovine (CI HTN/pre-eclampsia)
Bakri Balloon (good for HTN)
```
148
Bloody mass seen near introitus after delivery =
Tx:
Uterine inversion
Tx: ** Steps
1. Uterine relaxants/tocolytics (Mg sulfate, terbutaline)
2. Replace proper position (place fist inside uterus)
3. Uterotonics agents (oxytocin)
149
Sheehan Syndrome
Tx:
Pituitary infarct d/t hypovolemia and hypotension
--> absence of lactation d/t loss of prolactin OR no restart of menstruation d/t loss of gonadotropins
Tx: find cause, fluid resuscitation, blood transfusion
150
Tx of endometritis
Prophylaxis:
W/ C-section:
W/ vaginal delivery:
Prophylaxis: 1st gen cephalosporin during C-section
W/ C-section: Clindamycin + gentamicin
W/ vaginal delivery: Ampicillin + gentamicin
151
What congenital disorder?
| Rocker bottom feet
Trisomy 18
152
Klinefelter syndrome = ___ karyotype
(high/low) testosterone, (high/low) FSH/LH
Phenotype:
47, XXY
low testosterone, high FSH/LH
Male, hypogonadism
Long extremities
Decreased intelligence, behavioral problems
153
Low birth weight, poor muscle tone, microcephaly, language difficulties, profound retardation =
Results from ___.
Cri Du Chat
Deletion of long arm of chromosome 5
154
Diagnosis of Premature Rupture of Membranes (PROM)
Direct visualization
| Fern test OR nitrazine paper: pH >6.5
155
MC cause of infertility
Endometriosis
156
Classic triad presentation of Endometriosis
Premenstrual pelvic pain
Dysmenorrhea
Dyspareunia (pain w/ sex)
157
Definitive diagnosis of Endometriosis
Laparoscopy
158
Premature labor = Regular uterine contractions w/ progressive cervical changes before ___ weeks gestation.
Cervical dilation =
Effacement =
37 weeks
>3 cm cervical dilation
> 80% effacement
159
Tx of choice of chronic HTN in pregnancy
What meds should be avoided?
Methyldopa if BP > 150/100
Avoid ACEI** and diuretics
160
BP med should be started if BP > ____ in preeclampsia
> 180/110
Hydralazine**, Labetalol, Nifedipine
161
Schiller Test
Evaluates cervix after abnormal Pap smear. Iodine staining highlights areas of rapid cell turnover.
