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OB Gyn > ob gyn shelf > Flashcards

ob gyn shelf Flashcards

1
Q

what bp meds in preg

A

hydralazine labetolol nifedipine methyldopa

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2
Q

which pregnant patients should get aspirin and when

A

pts at high risk of of pre-e: history of PreE, preterm delivery, multiple pregnancies, DM of any type, pre existing HTN, autoimmune disorders start 81mg aspirin 12-16 weeks ideally

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3
Q

magnesium sulfate adverse effects

A

flushing toxicity shows up first as decreased or absent DTRs, can lead to respiratory depression and cardiac arrest

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4
Q

tx for cholestasis of pregnancy

A

ursodeoxycholic acid cholestasis of pregnancy usually resolves a couple days after delivery

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5
Q

HELLP can lead to stretching of Glisson’s capsule and even subcapsular hematoma which can rupture and lead to exsanguination. What should you do for a HELLP patient with severe abdominal pain?

A

get Ultrasound

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6
Q

RUQ pain in gravida woman with pyuria, fever

A

appendicitis

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7
Q

acute fatty liver of pregnancy –> starts with vague symptoms like malaise, nausea, abdominal pain then leads to –>

A

hypoglycemia liver failure renal failure can also cause thrombocytop

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8
Q

most accurate test for age in early pregnancy

A

crown to rump length

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9
Q

most common cause of PROM

A

ascending infection

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10
Q

if AFI <5, then

A

oligohydramnios

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11
Q

potter sequence

A

oligohydramnios –> uterine compression –> funny faces, PULMONARY HYPOPLASIA, bowed legs, club feet

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12
Q

uti tx for preggars

A

amoxicillin (nitrofurantoin if penicillin allergic) remember repeat u/a after tx

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13
Q

pyelo in pregnant woman

A

admit to give ceftriaxone. if she improves, she gets 10 days abx. If she doesnt improve, worry about perinephric absecess: get US

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14
Q

hyperthyroidism in preg leads to ________ hypothyroidism in preg leads to________

A

hyperthyroid–> fetal demise hypothyroid–> cretinism

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15
Q

hypothyroid tx in preg

A

levothyroxine, test TSH every 4 weeks, will need higher levothyroxine dose!

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16
Q

hyperthyroid tx in preg

A

PTU, if sx only 2nd trimester

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17
Q

epilepsy tx in preg

A

L drugs! lamotrigene or leviteracetem Folic acid! if seizing, phenobarbital

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18
Q

consequences of poorly controlled blood sugars in preg

A

transposition of great vessles, macrosomia increasing risk for shoulder dystocia

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19
Q

tx for diabetes in pregnancy

A

insulin- basal bolus strategy. Increased insulin demand in pregnancy. Be sure to reduce after delivery so you dont crash her. Target *post* prandial sugars in preg.

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20
Q

“third trimester” labs

A

weeks 20-28 test for gestational dm (1 hr gtt , +/- 3 hr gtt) anemia Hgb<10 alloimmunization -Rh-ag - mom; screen for Rh-ab’s, have to be right type and titer to cause fetal anemia

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21
Q

risk factors for gestational diabetes

A

obesity (BMI>30), hx of gdm, pre-diabetic prior to pregnancy

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22
Q

how does glucose tolerance testing work in 20-28wk?

A

Give 1 hour GTT, should be less than 140. If positive, give 3 hour gtt (100g sugar): Fasting <95 1 hour<180 2 hour <155 3hr <140 (failing 2 of the above is positive test)

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23
Q

Antibodies in Rh- mom with first Rh+ baby are Ig__ and with second baby are Ig__.

A

IgM with first baby - cant cross placenta IgG with second baby - can most def cross placent

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24
Q

what titer levels with Rh- mom with rh+ baby make you worry?

A

greater than or equal to 1:8. Get transcranial doppler next

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25
Q

If Rh- mom has anti Rh antibodies >1:8, what do you do next?

A

get transcranial doppler to see if baby is compensating for anemia with increased cardiac output. If no increased flow – no worries! If flow is increased: delivery if 32w+, if younger than 32w do PUBS (test hemoglobin and transfuse)

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26
Q

what do you do with mom who is Rh ag and antibody negative with Rh+ baby…

A

delivery, hemorrhage, procedure, csection – any blood mixing…give Rh(D)Ig at 28 weeks and within 72hrs of mixing event

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27
Q

describe cardiovascular changes in pregnancy

A

bp drops because systemic vascular resistance goes way down.

there is compensatory increased cardiac output because HR goes up a bit and preload goes way up because RBC increase a ton

dont forget that even though there are more RBCs, HgB actually drops because there is also a bigger rise in plasma volume

anemia in preggars is <10

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28
Q

if mom with gestational DM refuses insulin, what can you use?

A

metformin

glyburide

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29
Q

signs of hyperemesis gravidum

A

weight loss

ketonuria

IVF, thiamine, electrolytes

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30
Q

antiemetic step ladder for pregnancy

A

pyridoxine, doxylamine

diphenhydramine

methylprednisolone (not first trimester)

people also use metoclopramide (reglan) and ondansetron (not first trimester), scopolamine (not first trimester)

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31
Q

criteria for diagnosis of cervical insufficiency

A

cervix <25mm before 24 weeks

AND

>2 mid trimester preg loss, >3 unexplained preterm deliveries , clinical diagnosis (a short cervix alone is not enough)

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32
Q

what’s the first thing you should do when mom has low BP

A

lay on left side. she might have her uterus compressing the IVC

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33
Q

fetal hydrops

A

generalized edema of the fetus, can be cause by fetal anemia, infections like parvovirus B19, chromosomal abnormalities, congenital heart defects

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34
Q

threatened abortion

A

vaginal bleeding, fetal activity, cervical os is closed. this is reversible

avoid strenuous activity, weekly pelvic ultrasound until it goes one way or the other, rule out treatable causes of vaginal bleed, give Rhogam if Rh- mom

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35
Q

inevitable abortion

A

cervical os is open. can’t do anything.

Option 1: expectant management if <14wks, Surgical evacuation is usually recommended if evacuation does not occur after 4 weeks

Option 2: medical management. Pretreat with mifepristone first (if available) and then 24 hrs later, misoprostal

Option 3: Dilation and curettage

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36
Q

missed abortion

A

baby is aborted but cervical os is closed –> no bleeding, no fetal activity, no expulsion of conception products.

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37
Q

incomplete abortion

A

usually >12wks, stuff in uterus and cervical canal, cervical os open

Option 1: expectant management if <14wks, Surgical evacuation is usually recommended if evacuation does not occur after 4 weeks

Option 2: medical management. Pretreat with mifepristone first (if available) and then 24 hrs later, misoprostal

Option 3: Dilation and curettage. Preferred if hemorrhage or septic abortion

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38
Q

spontaneous abortion

A

<20wks

downtrending bHCG, no fetal cardiac motion

do a pelvic exam to make sure bleeding is coming from uterus/cervix. If no fetal heart beat or the bleed is definitely uterine, do transvaginal ultrasound

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39
Q

stillbirth

A

>20 wks

Spontaneous labor usually begins within 2 weeks of intrauterine fetal death. However, labor may be induced with oxytocin if maternal disease develops (e.g., coagulation abnormalities) or if the patient prefers induction.

Vaginal delivery is safer than cesarean section

Patients should be offered a fetal autopsy to determine the cause of death.

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40
Q

major complications of retained products of conception

A
  • septic abortion
  • release of thromboplastin into circulation leading to DIC
  • endometritis
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41
Q

normal level of fibrinogen in preggars can be a sign of…..

A

DIC

fibrinogen should be elevated in moms, also other clotting factors like vWF, factors 7, 8, 10

(moms are procoagulable because of this and also have less protein C, S)

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42
Q

which of the following hurt? placenta previa, placental abruption, vasa previa

A

placental abruption –> abdominal pain

placenta previa, vasa previa…painless vaginal bleed

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43
Q

how to tx GBS if penicillin allergy?

A

ampicillin if no allergy

cefazolin if mod allergy

clindamycin

vanc is last resort

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44
Q

risk factors for placental abruption

A

HTN! cocaine, smoking, previous abruption, trauma, PPROM

remember placental abruption causes pain, rigid uterus from hypertonic contractions. Some cases wont cause vaginal bleed because it retroplacental hemorrhage. +fetal distress

**vaginal exam contraindicated**

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45
Q

risk factors for placenta previa

A

hx C-section, previous previa, multiparity, multiple gestation, advanced maternal age, smoking

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46
Q

vasa previa

what is it?

risk factors?

A

fetal vessles are right over the cervical os with baby presenting above those. bleed after membranes rupture

risk factors: vilamentous cord insertion, placenta previa, IVF, multiple gestation

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47
Q

signs of uterine rupture

A

sudden severe pain, contractions stop, fetal distress, vaginal bleeding, hemodynamic instability

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48
Q

treatment of placental abruption

A

-get hemodynamically stable, give rhogam if mom is Rh-

if <34 weeks, try to give tocolytics. Give ANCS

34-36 weeks: if +ctx, do vaginal delivery. If you can hold off on labor, just manage expectantly

>36 weeks + acute abruption–> deliver

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49
Q

most common pathogens causing omphalitis

A

Staph, group A strep.

give ampicillin, gentamicin

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50
Q

most common pathogens of chorioamnionitis

A

E coli, ureaplasma, mycoplasma, GBS

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51
Q

IAI tx

A

ampicillin + gentimicin (add metronidazole or clinda if getting c-section)

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52
Q

rubella signs

A

rash that starts at head and moves down the body, sparing palms and soles

post auricular lymphadenopathy

flu like symptoms

polyartheritis

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53
Q

what do you do for mom with rubella?

A

if >20 weeks, congenital effects unlikely

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54
Q

congenital defect from lithium

A

epsteins anomaly

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55
Q

congenital effects of B19

A

hydrops, fetal death, fetal anemia

after exposure, test mom for infection/immunity

IgM+, IgG -/+ acute infection

IgM- IgG- susceptible

IgM- IgG+ immune

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56
Q

causes of fulminant liver failure in pregnancy

A

hep E v

fatty liver of pregnancy

HELLP

preeclampsia –> hepatic rupture

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57
Q

very toxic neonate with meningitis and visceral granulomas

A

listeria (unpasturized dairy products)

granulomas like swiss cheese

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58
Q

date range of pre term labor

A

20-37 wks

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59
Q

complications of pre term birth for neonate

A

intraventricular hemorrhage

necrotizing enterocolitis

respirtory distress syndrome

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60
Q

when and what do you do for fetal neuroprotection?

A

<32 weeks

mag sulfate

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61
Q

clinical signs of amniotic embolism

A

acute respiratory collapse, cardiovascular collapse, DIC, AMS, prolonged PT, respiratory acidosis

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62
Q

stages of labor

A

first: (latent) <6 cm
(active) 6-10cm
second: from when cervix is completely dilated until birth of infant
third: birth of infant until placenta expulsion
fourth: 2 hr postpartum period , monitor for hemorrhage, preeclampsia

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63
Q

early deceleration

A

gradual (>30s) onset to nadir

head compression causes vagal response

most often during active phase of labor

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64
Q

variable deceleration

A

abrupt to nadir (<30s), lasts at least 15seconds

cord compression, if >=50% of contractions then you need to start worrying–> intrauterine resuscitation

if that doesn’t work, then emergency c-section

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65
Q

late deceleration

A

placental insufficiency

gradual to nadir (>=30s)

–> fetal hypoxia, acidosis

give intrauterine resuscitations

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66
Q

intrauterine resuscitation measures

A

left lateral decubitus

amniotic infusion

maternal oxygen

maternal IVF

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67
Q

first maneuver for shoulder dystocia

A

McRoberts

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68
Q

foot drop after prolonged delivery

A

peroneal nerve compression

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69
Q

HIV treatment in pregnancy

A

2+1

Tenofovir, Emtricitabine (or zidovidene, lanividine)

+

Neviraprine or atazanivir/ritonavir

dont use combo pill of tenofovir, emtricitabine and efavirenz bc efavirenz is teratogen

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70
Q

when c-section for HIV+

A

viral load >1000 or no HART

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71
Q

if HIV status unknown in woman who presents for delivery, what do you do?

A

give her AZT

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72
Q

toxo

A

mono like illness in mom

baby: brain calcifications, ventriculomegaly, seizure

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73
Q

risk factors for meconium aspiration

A

obesity, older maternal age, postterm

look for yellow/green amniotic fluid

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74
Q

loss of fetal station is specific for

A

uterine rupture

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75
Q

what should you do first when there is variable decels in more than 50% of contractions

A

this is sign of umbilical cord compression. First reposition mom, give her oxygen and IVF.

if that doesnt work, give amnioinfusion

if uterus is contracting >5x/10min…you can give ternutaline

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76
Q

tocolytics

A

MINT

magnesium sulfate

indomethacin

nifedipine

terbutaline

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77
Q

No cervical change at >6cm dilation for 4 hours with adequate contractions (>200 Montevideo units)

A

arrested active phase –> c section

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78
Q

steroids for fetal lung maturity below ____ weeks

A

34

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79
Q

how long is a prolonged second stage of labor?

A

3 hours in prima

2 hours in multiparous

add 1 hr for epidural

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80
Q

beta 2 receptor agonists like terbutaline can cause what electrolyte derangement?

A

hypokalemia (beta 2 agonists can cause intracellular potassium shift)

–> fatigue, proximal muscle weakness, decreased DTRs

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81
Q

tx for pregnant woman with pyelonephritis

A

in patient iv cefotaxime

get cx, can switch to oral when afebrile for 24-48hrs according to cx sensitie

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82
Q

what UTI-causing bacterium causes alkaline urine and is associated with catheters

A

Proteus mirabilis

(can lead to struvite, magnesium ammonium phosphate, stones)

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83
Q

chronic suprapubic pain, urgency and frequency. Often with dyspareunia. urinalysis, postvoid residual bladder scan are normal

A

interstitial cystitis

a diagnosis of exclusion

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84
Q

asymptomatic bacturia treatment in pregnancy

A

amoxicillin/calvulanate

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85
Q

recurrent uncomplicated UTI treatment

A

daily or postcoidal sulfamethoxazole-trimethoprim for 3 months

alternatives: ciprofloxicin

self-tx at first onset of symptoms

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86
Q

what are findings on colposcopy that are suspicious of neoplasia?

A

Typical findings that are suspicious of neoplasia are uptake of acetic acid (white discoloration), coarse or atypical vessels, and yellow discoloration after iodine staining.

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87
Q

what kind of epithelium on the endocervix? ectocervix?

A

endocervix: columnar epithelium
ectocervix: nonkeratinizing squamous epithelium

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88
Q

On colposcopy, you find white lesions under acetic acid application. What it is?

A

condylomata acuminata (HPV)

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89
Q

On colposcopy you find White membrane that cannot be scraped off

A

cervical leukoplakia

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90
Q

on colposcopy you find Punctate lesions or coarse mosaic pattern

A

cervical intraepithelial neoplasia

(precancerous)

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91
Q

if you find atypical vessels on colposcopy, you should think…

A

cervical cancer

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92
Q

vaginal pH greater than 4.5 should make you think…

A

bacterial vaginosis

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93
Q

Postmenopausal women with an endometrial thickness greater than ____ mm should undergo hysteroscopy and endometrial curettage to rule out endometrial carcinoma

A

10mm

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94
Q

human chorionic gonadotropin (hCG) is secreted by ___________ and does what action in first 6 or so weeks of pregnancy

A

human chorionic gonadotropin (hCG) is secreted by syncytiotrophoblasts (the cells that invade the endometrium)

maintains corpus luteum until placenta starts to make its own progesterone

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95
Q

describe hormone axis that is responsible for puberty in females

A
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96
Q

you have a girl with precocious puberty and her bone scan shows bone age >2 yrs above chronological age. What is your next step?

A

GnRH (leuprolide) stim test.

If LH is stimulated by leuprolide, then you know her hypothal–> pituitary axis is active and it’s a central condition. You need to look at brain with MRI. If tumor–> resect. If no tumor–> it’s constitutional; treat with continuous leuprolide which turns off the axis!

if stim test did not raise LH, it’s a peripheral lesion. Get US of adrenal glands, transvag US for ovaries, test DHEAS, testosterone levels, 17-hydroxyprogesterone in urine if considering congenital adrenal hyperplasia.

if cyst: reassure

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97
Q

congenital adrenal hyperplasia

A

can’t make glucocorticoids and mineralcorticoids, so everything gets shunted to androgens. Percocious puberty. Give exogenous glucocorticoids and mineral corticoids and the body will chill out.

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5
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98
Q

what tests do you do first for delayed puberty?

A

bone age scan, FSH, LH levels

if FSH/LH elevated: hypergonadotropic gonadotropism

if FSH/LH low, axis is still turned off. Look for pregnancy, prolactin, thyroid, CBC, LFT, ESR, MRI of brain

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99
Q

testosterone is made in the ….

A

ovaries

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100
Q

DHEA-S is made in the…

A

adrenal glands

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101
Q

PCOS is a problem of anovulation, leaving atretic follicles that cause…

A

excess in androgens.

modestly elevated testosterone –> hirsuitism

DHEAS is normal bc adrenal glands aren’t affected.

Dx: US shows bilateral cysts on ovaries or LH:FSH>3:1

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102
Q

PCOS treatment

A

diet, exercise

metformin

OCPs

clomiphine if she wants pregnancy

spironolactone for hirsuitism

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103
Q

sertoli leydig tumor

A

sex cord stromal tumor of ovaries

high testosterone, normal DHEAS

+hirsuitism

dx: transvaginal ultrasound.

resect (not malignant)

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104
Q

adrenal tumor

A

DHEA will be very high–> virilization

testosterone is normal (ovaries are fine)

get CT or MRI to look at adrenal glands.

**Do adrenal vein sampling to figue out which adrenal gland is hyperfunctioning because it can be the one without the mass

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105
Q

congenital adrenal hyperplasia

A

moderately elevated DHEAS, normal testosterone, hirsuitism

Get CT/MRI

Dx: 17-OH-Progesterone in urine

(high 17-OH-progesterone is a result of absent 21-beta-hydroxylase. All the cholesterol goes to DHEAS bc cant make aldosterone and cortisol. Body freaks out and sends even more cholesterol …even more DHEAS)

can be severe enough to cause virilization

tx: Give Cortisol +/- Fludrocortisone

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106
Q

Tx for CAH

A

cortisol +/- fludrocortisone

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107
Q

menopause avg age

A

51

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108
Q

premenarchal cancer risk factors

A

toxins

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109
Q

3 categories of ovarian cancer

A

germ cell, stromal or epithelia

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110
Q

cervical, vaginal, and vulvar cancer are most commonly _______________ carcinoma

A

squamous cell

all due to HPV exposure

precancer== carcinoma in situ

**black itchy lesions on vulva, post-coital bleeding from cervical cancer

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111
Q

endometrial cancer is caused by exposure to….

type of cancer….

common first symptom…

A

estrogen

adenocarcinoma

precursor = dysplasia, atypia

post-menopausal bleeding

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112
Q

ovarian epithelial cancer is caused by…..

A

ovulation

present with late stage symptoms: small bowel obstruction, ureter obstruction, ascites

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113
Q

choriocarcinoma:

etiology?

symptoms?

A

comes from gestational trophoblastic disease (mole, incomplete mole, or even normal pregnancy)

follow beta HCG while pt on contraceptive

hyperemesis gravidarum, hyperthyroidism, size-date discrepancy

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114
Q

OCPs do not cause breast cancer

radiation for _________ can lead to breast cancer

A

chest radiation for example lymphoma

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115
Q

USPSTF recommendations for mammogram

A

mammogram every 2 years starting at 50

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116
Q

what do you do if mammogram +?

A

core biopsy to diagnose

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117
Q

someone under 30 comes in with breast lump. What do you do?

A

wait for a couple of menstral cycles and see if it goes away. If it doesnt, get ultrasound which will show mass or cyst. you need to find out if its a problem so get fine needle aspiration.

bloody = cancer

fluid = cyst :)

pus = abcess

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118
Q

what do you always do before axillary lymph node resection in breast cancer?

A

senteniel lymph node biopsy to see if you can spare axillary LN and avoid lymphedema

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119
Q

chemo for breast cancer

A

doxarubacin

cyclophosphamide

paclotaxil

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120
Q

side effect of doxarubacin, danorubacin?

A

CHF …dose dependent and irreversible. make sure you get ECHOs

121
Q

what’s difference between tamoxifen and raloxifen?

A

both are estrogen receptor modulators for breast cancer. Tamoxifen works better for breast cancer but risks DVT and endometrial carcinoma. Raloxifen doesnt work as well but also doesnt have these risks.

Tamoxifen causes endometrial cancer because it is a estrogen receptor antagonist in breast and a estrogen receptor agonist in the endometrium. go figure.

122
Q

What are targeted breast cancer therapies?

A

If Her2Neu positive, traztuzumab or bevacizumab. Her2neu has worse prognosis. Know that traztuzumab can cause CHF that is NOT does dependent but is Reversible.

If Her2neu negative, give tamoxifen or raloxifen if PREmenopausal. Give aromatase inhibitor if POST menopausal (anastrozole, letrozole)

123
Q

post partum hemorrhage = 500cc after vaginal birth or 1000cc (L) after C-section. What things can you do?

A

uterine massage

pitocin

methergen

if these fail, exploratory laparotomy. start by ligating uterine artery, then internal iliac, then total abdominal hysterectomy

124
Q

round ligament is made of….

broad ligament is made of…

A

round ligament = smooth muscle

broad ligament = loose aerolar tissue

don’t provide structural support

uterosacral and cardinal ligaments are responsible for support. prolapse happens when cardinal ligament gets floppy

125
Q

pubococcygeus, puborectalis, and iliococcygeus mm make up the…

A

levator ani

in constant contraction

126
Q

what artery are you trying to avoid for port placement in laparoscopy?

A

inferior epigastric arteries

127
Q

you can find pudendal nerve for nerve block at…

A

level of ischeal spine. palpate ischeal spine and inject 1 cm inferior and medial. be sure to aspirate so you avoid pudendal artery and inferior gluteal artery

remember that anterior to urethra, the innervation is not pudendal n but rather ileoinguinal nerve

128
Q

HPV strains that cause warts

A

6, 11

129
Q

hpv strains that cause cancer

A

16, 18, 30s

130
Q

procedure for endocervical cancer

A

cone biopsy

ecto: LEEP, cryo

131
Q

cervical cancer in upper 2/3 of vagina is stage____

cervical cancer in lower 1/3 of vagina is stage____

A

cervical cancer in upper 2/3 vagina is stage IIa, if it’s gone into cardinal ligament it’s IIb

lower i/3 vag = IIIa, if also abdominal wall IIIb. chemo is usually platinum based

IIa or better: local excision

IIb or worse, chemo and radiation

132
Q

ages for guardasil

A

girls 11-26

boys 11-21

133
Q

risk factors for endometrial cancer

A

obesity (peripheral conversion)

anovulation (think PCOS)

nulliparity

age

hormone replacement therapy

SERM like tamoxifen

134
Q

how do you assess for endometrial cancer

A

biopsy or D&C

if hyperplasia: treat with progesterone

if cancer: total abdominal hysterectomy and bilateral salpingooverectomy

135
Q

Germ cell ovarian tumor

A

nonmalignant, always stage 1 bc dont invade BM

teen girls

present as: weight gain, adnexal mass

dx: transvaginal ultrasound
tx: unilateral salpingooverectomy
types: dysgerminoma (track with LDH), endodermal sinus (track with AFP), teratoma (malignant in boys), choriocarcinoma (track with bHCG)

136
Q

types of epithelial

A
137
Q

types of epithelial cell ovarian tumors

A

**poor prognosis**usually present IIIb or worse**seed peritoneally

they are cystadenocarcinoma and arise from epithelial trauma (ovulation) (OCPs, preg will decrease risk)

serous

mucinous

endometroid

Brenners

138
Q
A
139
Q

presenting symptoms of epithelial ovarian cancer

A

ascites, small bowel obstruction, renal failure

get transvag US, then CT to stage. Track with Ca-125

total abdominal hysterectomy and bilateral salpingooverectomy

chemo with Paclitaxel

140
Q

screening for BRACA+ patients

A

yearly transvaginal US + Ca125

TAH+BSO at 35

141
Q

types of ovarian stromal cell tumors

A

granulosa-theca (produce estrogen)

sertoli-leydi (produce testosterone)

142
Q

workup for adnexal mass

A

Transvaginal US

(smooth small cyst WITHOUT septations, fluid is not loculated = simple cyst, normal)

otherwise: complex cyst. biopsy, think about what kind of tumor it is based on symptoms, history

143
Q

complete mole genetics

A

all sperm, 46 chromosomes

(empty egg, sperm haploid dublicates)

vaginal bleeding, very elevated bHCG (talking >100K) which can cross react and cause hyperthyroidism, hyperemesis gravidarum, size-date discrepancy

grape like mass that protrudes through cervix

dx: snowstorm on transvag us

144
Q

complete mole symptoms, dx, tx

A

vaginal bleeding, very elevated bHCG (talking >100K) which can cross react and cause hyperthyroidism, hyperemesis gravidarum, size-date discrepancy

grape like mass that protrudes through cervix

dx: snowstorm on transvag us
tx: suction curretage. only D&C if in 2nd trimester

contraception! Serial bHCG for a year to look for invasive disease

145
Q

Incomplete mole genetics

A

egg is fertilized by two sperms–> 69 chromosomes

there are fetal parts

symptoms: vaginal bleeding, very elevated bHCG (talking >100K) which can cross react and cause hyperthyroidism, hyperemesis gravidarum, size-date discrepancy

grape like mass that protrudes through cervix

dx: snowstorm on transvag us
tx: suction curretage, contraception and serial bHCG for a year to look for choriocarcinoma

146
Q

choriocarcinoma

A

malignant

“gestational trophoblastic neoplasia”

elevated bHCG

transvag US –> curettage. Stage with CT.

surgical tx: TAH, debulking for more advanced disease

medical: MAC: methotrexate & actinomycin D +/- cyclophosphamide . advanced disease gets more chemo

147
Q

red pruritic lesion on vagina/vulva

A

Paget’s

good prognosis

148
Q

black itchy lesion on vulva

A

melanoma or SCC

149
Q

grape like mass in the vagina

A

look for DES exposure in mom that leads to adenocarcinoma

150
Q

menopause treatments

A

estrogen creme for vagina, dyspareunia

venlafaxine is bestlafaxine for hot flushes (fluoxetine and sertraline do not work)

151
Q

symptoms of menopause

A

hot flashes

vaginal atrophy/thinning mucosa

more UTIs

decreased libido

mood swings from estrogen withdrawal

cessation of menses for 12 consecutive cycles

152
Q

what screening should be done for menopausal/perimenopausal women

A

DEXA

LDL

don’t do FSH, follicle US unless it’s premature ovarian failure

153
Q

what is adnexal mass in premenarchal girl most likely to be

A

Germ cell tumor (sertoli leydig or granulosa theca)

154
Q

in postmenopausal woman, what is adnexal mass most likely to be

A

epithelial cancer

155
Q

in women, teratomas tend to be benign or malignant?

A

benign

asymptomatic but she’ll feel weight gain

usually teens/twenties. tx is conservative: remove cyst only and leave ovary if young.

they are likely to recur

156
Q

symptoms of endometriosis

A

dysmenorrhea

dyspareunia

dyschezia

infertility

157
Q

symptoms/signs of ectopic pregnancy

A

positive pregnancy test, bHCG>2000, empty uterus on US

amenorrhea, abdominal pain

158
Q

treatment for ectopic pregnancy

A

salpinostomy (remove ectopic preg only; if no rupture)

salpinjectomy (remove tube if rupture)

methotrexate + leucovorin rescue (most fertility preserving)

159
Q

what causes tubulovarian abscess

A

gonorrhea/chlamydia or vaginal flora

160
Q

treatment for tubulovarian abcess

A

there’s a good chance she’ll be toxic and need inpatient treatment: IV cefotoxine + doxycycline + metronidazole

second line: clinda + gentamycin

only need to drain abcess if not cleared with abx; ovary is so vascular that there is a good chance that abx will resolve the abcess!

161
Q

signs/symptoms of tubuloovarian abcess

A

abdominal pain, fever, +/- leukocytosis,

WBC on wet prep

162
Q

FSH stimulates conversion of …..by….

A

FSH stimulates conversion of androgens to estrogen by aromatase

tissues that have aromatase: adrenal glands, adipose, placenta, testicles, ovaries

163
Q

______ cells in ovaries make estrogen

A

granulosa cells

164
Q

________ cells in ovaries make androgens, stimulated by __________

A

LH stimulates theca cells to make androgens

165
Q

what is estrogen’s effect on blood vessles?

A

estrogen is protective against athersclerosis but increases clotting

166
Q

signs of low estrogen (can be due to menopause, ovarian failure, anatomic or genetic stuff like Turner’s or aromatase insufficiency (<–high androgens), hyperprolactinemia, GnRH agonists like leuprolide

A

Hot flashes

Headaches

Reduced libido

Breast atrophy

Decreased bone density and secondary osteoporosis

Urogenital atrophy

Dyspareunia

167
Q

menopause is confirmed by….

A

elevated FSH levels, 12 months without period

168
Q

pathophys of menopause

A

Numerical depletion of ovarian follicles with age → ↓ ovarian function → ↓ estrogen and progesterone levels → loss of negative feedback to the gonadotropic hormones → ↑ GnRH levels → ↑ levels of FSH and LH in blood (hypergonadotropic hypogonadism) → ↑ frequency of anovulatory cycles

169
Q

premature ovarian failure is before age….

A

40

170
Q

symptoms of endometriosis

A

dysmenorrhea, chronic pelvic pain, dyschezia, dyspareunia, abnormal uterine bleeding

do exam for rectovaginal tenderness, adnexal masses

*TVUS

laparoscopy is confirmative

171
Q

medical treatment options for endometriosis

A

NSAIDs

OCPs

danazol (steroid)

GnRH agonist (buserelin, goserelin)

172
Q

goserelin, buserelin

A

A gonadotropin-releasing hormone receptor agonist that can either be used to stimulate (via pulsatile administration) or suppress (via continuous administration, which downregulates GnRH receptors) LH and FSH secretion. Commonly used continuously to treat hormone-sensitive prostate cancer, precocious puberty, menorrhagia, and endometriosis. Used in pulsatile fashion to increase fertility

173
Q

symptoms of PCOS

A

acne

hirsuitism

obesity, insulin insensitivity

infertility

maybe virilization

174
Q

testing for PCOS

A

measure testosterone

LH:FSH ratio >2

can measure 17-hydroxyprogesterone to rule out non classical congenital hyperplasia

check for metabolic syndrome (HgA1c, BG, lipid panel )

+clinical diagnosis overrules blood tests+

175
Q

differential diagnosis for PCOS

A

pregnancy

cushings (too much cortisol)

androgen-secreting tumor

exogenous androgens

congenital adrenal hyperplasia

exogenous steroids

176
Q

treatment for PCOS

A

weight loss

OCPs

for fertility: clomiphene, letrozole

177
Q

Free fluid in the pouch of Douglas in a pregnant patient should raise concern for —–

A

ruptured ectopic pregnancy

178
Q

how does prolactinemia affect FSH, LH?

A

prolactin –> negative feedback on GnRH –> low FSH, low LH, low testosterone, low estrogen

179
Q

why can hypothyroidism lead to galactorrhea?

A

low thyroid hormones will lead to upregulation of TRH and thus TSH. TRH will cross react in anterior pituitary and lead to more prolactin release along with more TSH

180
Q

tx for bacterial vaginitis

A

metronidazole (topical, then oral)

181
Q

tx for trich

A
182
Q

treatment for chlamydia in pregnancy

A

NO DOXY

azithromycin

183
Q

PID tx for really toxic ppl

A

inpatient

cefoxitin + doxy

(clindamycin and gentamycin is alternative)

184
Q

outpt PID tx

A

metronidazole+IM ceftriaxone + doxy

(notice that those cover the most common bugs that cause PID - GC, CT, vaginal flora)

185
Q

true or false: hormone levels are the same between women with and without PMS or PMDD

A

true, the amount of estrogen, progesterone are not different between women who have PMS, PMDD and those that don’t. It seems that hormones play a role in PMS/PMDD but aren’t sufficient to explain it

186
Q

women with PMS/PMDD experience symptoms during the ______phase

A

luteal phase (second half, high progesterone)

187
Q

treatment options for PMDD, PMS

A

aerobic exercise

magnesium, calcium supplements

fresh, not processed food

NSAIDS

OCPs

SSRIs

last resorts: trial with leuprolide to see if “medical ovarectomy” helps; if so you can consider ovarectomy but remember this forced menopause can cause other probs like cardiovascular disease, hot flashes, osteoporeosis

188
Q

PMS criteria

A
189
Q
A
190
Q

PMDD critieria

A

CORE SYMPTOMS:

irritability

Depressed mood

Anhedonia

Anxiety/tension

191
Q
A
192
Q

risks and benefits of systemic hormone therapy for menopause sx

A

if they have uterus, they must get estrogen AND progesterone bc unoppossed estrogen –> endometrial cancer

taking E&P leads to increased breast cancer, coronary heart disease, stroke, VTE. decreased colon cancer and fractures

for women only taking estrogen, there was increased VTE but not cardiovascular disease

193
Q

contraindications for HRT for menopause

A

cardiovascular disease, stroke, breast cancer, DVT hx, liver disease

combined estorgen-progesterone HRT –> increased coronary heart disease, stroke, VTE. decreased colon cancer and fractures, decreased LDL and increased HDL

estrogen only HRT can only be given to ppl without uterurs. Only increased VTE

194
Q

nulliparous in active labor expected to dilate at —- per hour

A

1.2cm per hour

195
Q

multiparous woman in active labor expected to dilate at — per hour

A

1.5cm/hr

196
Q

how to measure montevideo and the normal labor montevideo units

A

with intrauterine tocometer, measure amplitude of ctx over ten minutes and add together. Normal is >200

197
Q

what parts of the baby head can you palpate on digital exam during labor?

A
198
Q

what’s ideal baby head position for deliver

A

occiput anterior

(occiput posterior (sunny side up) and occiput transverse mean a bigger diameter has to go through pelvis)

199
Q

what’s it called when baby head wont fit through pelvis

A

cephalopelvic disproportion

can be due to baby size, pelvic size/shape, adipose tissue

200
Q

two ways to augment labor

A

AROM, oxytocin

(with pitocin you want to avoid uterine tachysystole or 5 ctx/10 minutes over 30 min period

201
Q

what’s it called when mom is having 5 ctx per 10 minutes over 30 minute period

A

uterine tachysystole

202
Q

shoulder dystocia interventions

A

You have 5 minutes

  1. McRoberts manuever
  2. Suprapubic pressure
  3. Try to deliver posterior shoulder. you may need to do episiotomy

Other options:

  • woodscrew/rubin
  • get patient on hands and knees
  • clavicular fracture
  • zavenilli procedure
203
Q

risk factors of cord prolapse

A

fetus is not vertex

SROM or AROM before head engaged in pelvis

intervention: zavenelli + emergency c section

204
Q

breech delivery

A

Ideally do c-section

if not, don’t put traction on baby because you’ll extend the head and make it harder to deliver; put suprapubic pressure when mom’s pushing has delivered to umbilicus

205
Q

definition of labor

A

painful uterine ctx

&

cervical dilation

206
Q

when should a preggo go to hospital

A
207
Q

woman presents at weu and might be in labor. what will you do?

A
  1. Fetal heart tones
  2. Presentation (US or exam)
  3. Sterile vaginal exam: dilation/effacement/station
    - dilation of internal os
    - normally cervix is 4cm thick, 2cm thick is 50%, not thick is 100%
    - station: # cm above or below ischeal spine
208
Q

4 stages of labor

A
  1. latent phase - up to 4cm dilation; active phase - after 4 cm to 10cm and more brisk; visceral pain T10-L1
  2. complete dilation to delivery of infant; somatic pain S2-S4
  3. delivery of placenta
  4. 2hours postpartum
209
Q

interventions in stage 3 of labor to diminish risk of hemorrhage

A

(stage three is from delivery of infant to delivery of placenta)

  1. Fundal massage
  2. gentle cord traction
  3. IV/IM pitocin
210
Q

definition of pre-eclampsia

A

HTN after 20weeks with proteinuria or end organ dysfunction

211
Q

chronic hyptension in pregnancy vs. gestational hypertension

A

chronic hypertension is diagnosed before <20 weeks

gestational hypertension is diagnosed after >20 weeks without organ damage signs (which would be preeclampsia)

212
Q

anti hypertensives are for severe range bp in pregnancy which are…

A

160 systolic or 110 diastolic

213
Q

when should you ideally deliver preE babes

A

37 weeks

if severe features: 34 weeks

don’t forget betamenthasone for under 34 weeks

may have to deliver earlier if things go downhill

214
Q

ssris for pms pdd

A

sertraline,

citalopram, escitalopram (new)

215
Q

nonhormonal treatment for hot flashes

A

venlafaxine (SNRI)

clonidine

ssris

gabapentin (esp. for sleeping prob)

black coash and soy

216
Q

menopause –> vaginal atrophy and dryness

–> higher pH and more bacterial vaginosis

–>dysparenuia bc vagina can’t expand without rugae

–> more UTIs because distance between vagina and urethra shortens

A

you can do vaginal estrogen cream, rings, tablets

217
Q

what do you do for chorioamnioitis

A
  • tylenol
  • IVF
  • abx
  • delivery
218
Q

abx choices for GBS

A
  1. ampicillin
  2. if penicillin allergy, cefazolin
  3. if life-threatening penicillin allergy, there’s enough cross reaction between penicillin and cephalosporin, so give Clindamycin
  4. vancomycin
219
Q

when to give GBS abx

A
  • history of GBS
  • positive 36wk screen
  • intrapartum fever
  • prolonged rupture of membranes

(don’t have to if planned c-section and membranes are intact)

220
Q

what to do if preggo is HepB positive

A

c-section

1st day of life: HepB vaccine and IgG

*ideally mom is vaccinated before pregnancy*

221
Q

how to make HIV dx

A
  1. ELISA
  2. confirm with Western Blot
222
Q

treating HIV in pregnancy

A

goal: is to bring viral load down
tx: 2+1

2 nucleotide reverse transcriptase inhibitor +( 1 non nrti or 1 protease inhibitor&ritonovir)

2NRTI: [tenofovir +emtracitabine ($$)][B] + neviraprine (C) or atazanovir/ritonovir

223
Q

can you give Atripla ( Efavirenz/emtricitabine/tenofovir combo pill) in pregg

A

this HIV HARRT combo pill can NOT be given in pregnancy because efavirenz is teratogen

224
Q

how do you deliver HIV+ mom

A

low viral load, <1000: vag

high viral load, >1000: c-section

if you don’t know her status, give AZT

225
Q

what are the TORCH infections

A

T oxo

Other (Syphilis)

Rubella

Cytomegalovirus

HSV

226
Q

where do you get T. gondii

A

cysts in soil, cat feces, undercooked meat

227
Q

what are Toxo symptoms for mom?

A

mono like illness

228
Q

infant with brain calcifications

ventriculomegaly

seizure

A

toxo

229
Q

what are signs/symptoms of congenital toxo?

A
  • ventriculomegaly
  • brain calcifications
  • seizure
230
Q

symptoms of primary syphilis

A

painless chancre

231
Q

symptoms of secondary lesions

A

targetoid lesions that include palms, soles

snail track oral lesions

cranial nerve defects, condyloma lata

RPR and confirm with FTP-Abs

232
Q

signs of latent syphilis

A

+RPR, VRDL but no symptoms

233
Q

signs of tertiary syphilis

A

neuro symptoms, like not being able to feel feet

tabes dorsalis, gumma (ulcerating granulomas), coronary arterities, aortic aneurysm

**Diagnose with CSF via RDR

neurosyphilis–> IV penacillin

234
Q

congenital syphillis

A

Snuffles

Saber shins

Saddle nose

HutchinsonS teeth

235
Q

blueberry muffin

cataract

congenital cardiac defect

deafness

if first trimester, IUGR

A

congenital rubella

236
Q

dsDNA virus that causes mono like disease

A

cmv

237
Q

painful burning on vulva

A

hsv prodrome

238
Q

confirmatory test for HSV

A

not necessary

PCR

239
Q

IUGR

preterm delivery

blindness

A

congenital HSV

240
Q

bilateral cataracts, sensorineural hearing loss (secondary to a cochlear dysfunction), and a heart defect – typically patent ductus arteriosus or pulmonary artery stenosis

A

congenital rubella

241
Q
A
242
Q

in setting of post partum hemorrhage from uterine atony, a mom has been given bimanual uterine massage and oxytocin. she’s still bleeding. what do you do next?

A

tranexamic acid

methylergonovine

carboprost tromethamine

misoprostol

243
Q

carboprost can’t be given to patients with what underlying condition?

A

asthma

244
Q

methylergonovine can’t be given to patients with underlying….

A

cardiovascular problems

245
Q

side effects of misoprostol, carbopost

A

hypertension

bronchospasm

fever

246
Q

most common pathogen that causes bacterial vaginosis

A

Gardnerella vaginalis

247
Q

painless genital nodules that eventually ulcerate to form large, beefy-red lesions that bleed easily

A

Granuloma inguinale

caused by Klebsiella granulomatis

248
Q

mom presents with virilization and baby is at high risk of virilization; there are no ovarian masses. what is it?

A

probably placental aromatase deficiency

mom’s symptoms resolve after delivery

249
Q

in setting of post partum hemorrhage, you’ve tried bimanual massage and oxytocin without success. What’s your next step?

A

tranexamic acid

250
Q

In setting of postpartum hemorrhage, you’ve tried massage, oxytocin and tranexamic acid and she’s still bleeding. You can try second line utertonic agents now like carboprost tromethamine. What’s a contraindication of carboprost tromethamine?

A

don’t use carboprost tromethamine in pts with asthma as it can cause bronchospasm

251
Q

In setting of postpartum hemorrhage, you’ve tried massage, oxytocin and tranexamic acid and she’s still bleeding. You can try second line utertonic agents now like methylergonovine, carboprost tromethamine or misoprostal. What’s a contraindication of methylergonovine?.

A

Dont use methylergonovine in pts with hypertension (regardless of current BP) bc it can cause stroke.

If these dont work, the next step is balloon tamponade then laparotomy

252
Q

how do you manage preggos with HSV?

A

start suppression at 36weeks with acyclovir

if they have lesions or prodome during labor, they must have c-section. otherwise, vaginal delivery if possible

253
Q

solid unilateral or bilateral ovarian masses, lead to moderate virilization of mom and high risk of virilization of baby; resolve after delivery

A

luteoma

254
Q

cystic bilateral ovarian masses; mom might get virilization; low fetal virilization risk; spontaneously resolve after delivery

A

theca lutein cyst

255
Q

solid unilateral ovarian mass with high risk of both maternal and fetal virilization; requires surgery in either second trimester or postpartum

A

sertoli leydig tumor

256
Q
A
257
Q

Retention of a dead fetus for > 2 weeks increases the risk of systemic absorption of _____________produced by the placenta and dead fetus. This activates the coagulation cascade and causes disseminated intravascular coagulation (DIC).

A

thromboplastin

258
Q

sudden painless vaginal bleeding after rupture of membranes and fetal distress

A

ruptured vasa previa. **occurs with ROM because the vasa previa are located in the membranes

259
Q

if a breast mass is highly suspicious for cancer, what kind of biopsy?

A

core needle biopsy (cancer will shake you to your core)

use fine needle aspiration for less suspicious masses

260
Q

Irregularly defined and dense periareolar breast mass with erythyma, ecchymosis, and skin retraction after a trauma to the breast. US/Mammography shows fluid filled cyst with course rim calcification

A

fat necrosis of breast

261
Q

Solitary, well-defined, non-tender, rubbery and mobile mass with popcorn calcifications

A

fibroadenoma

262
Q

Painless, smooth, multinodular lump in the breast in women 40-50 years old. On core needle biopsy, Leaf-like architecture with papillary projection of epithelium-lined stroma

A

phylloides tumor (benign)

263
Q

benign tumor behind the nipple that is most common cause of bloody nipple discharge

A

intraductal papilloma

264
Q

what do you do for a pt less than 30 with a palpable breast mass? what about a patient over 30yo?

A

For patient less than 30, if you think probability of malignancy is low you recheck 3-10 days after menses. If you think probability of malignancy is high in pt over 30, then you do US and/or fine need aspiration.

For patient over thirty, always get a mammogram. a suspicious mass gets a core needle biopsy.

265
Q

hormone therapy for post menopausal women with ER or PR+ breast cancer

A

aromatase inhibitor (anastrozole, letrozole, exemestane) plus tamoxifen (or raloxifen)

aromatase inhibitors increase risk of osteoporesis

266
Q

what is letrozole and what are its side effects?

A

letrozole is aromatase inhibitor. Used for postmenopausal ER+ breast cancer.

raises risk of OSTEOPOREOSIS! side effects are basically menopause symptoms

267
Q

what is anastrozole and what are major side effects?

A

anastrozole is aromatase inhibitor. Used for postmenopausal ER+ breast cancer.

raises risk of OSTEOPOREOSIS! side effects are basically menopause symptoms

268
Q

drug for HER2+ breast cancer

A

trastuzamab

**cardiotoxic** get ECHO

269
Q

Trastuzamab is used to target HER2+ breast cancer. What’s its major risk?

A

cardiotoxicity. Get ECHOs.

270
Q

Most vulvar cancers are sqaumous cell carcinoma. Paget disease of the vulva is ….

A

Adenocarcinoma

Low risk of underlying invasive Paget disease/invasive adenocarcinoma (unlike Paget disease of the breast which is always associated with underlying carcinoma)

271
Q
A

lichen sclerosis

get punch biopsy

treatment = topical steroids (clobetasol or betamethasone) or tacrolismus (calcineurin inhibitor)

can also do oral steroids, oral retinoids, phototherapy (these are all second line)

272
Q

In-utero exposure to diethylstilbestrol (DES) is associated with…

A

cervical cancer

273
Q

symptoms of uterine leiomyoma

A
  • abnormal menstration (dysmenorrhea, menorrhagia, metorrhagia (bleeding between periods)
  • mass effect (e.g. back, pelvic pain, pressing on bladder)
  • infertility , dyspareunia
274
Q

what pretreatment do you give before surgical removal of uterine fibroids?

A

leuprolide or goserelin (GnRH analogues) to shrink the tumors and reduce tumor vascularization

275
Q
A
276
Q

cancers associated with Lynch syndrome (hereditary nonpolyposis colorectal cancer)

A
  • colorectal cancer
  • gastric cancer
  • endometrial cancer

(also increased risk of ovarian cancer)

277
Q

struma ovarii (mature teratoma) is an ovarian germ cell tumor that contains what type of tissue?

A

thyroid

can cause hyperthyroidism

278
Q

a rapidly growing ovarian mass in teen girl that has fried egg cells on histology

A

dysgerminoma . malignant.

279
Q

malignant and aggressive ovarian tumor in child or teen that has schillar duval bodies

A

yolk sac tumor (endodermal sinus tumor)

280
Q

dont use trimethoprim sulfate in pregnancy because it can cause

A

cardiac defects, neonatal jaundice/kernicterus

281
Q

birth defect caused by aminoglycosides

A

ototoxicity/deafness

A Mean Guy stepped on a babys ear

282
Q

congenital effects of intrapartum tetracycline use

A

discoloration of teeth, bone growth restriction

teethracycline discolors teeth

283
Q

risks of intrapartum NSAID use

A

pulmonary hypertension in fetus and premature closure of ductus arteriosus; also inhibits uterine contractility

284
Q

what medications for hyperthyroidism in pregnancy? First trimester? Second and third trimester?

A

First trimester: propylthiouracil

2nd&3rd: methimazole

285
Q

why don’t we use methimazole in first trimester for hyperthyroidism?

A

methimazole in first trimester can cause aplasia cutis (missing portion of skin), craniofacial and GI malformations in fetus

286
Q

what medication do we use for hyperthyroidism in first trimester?

A

propylthiouracil

287
Q

what congenital defects are caused by phenytoin and carbamazepine?

A

Fetal hydantoin syndrome

Characterized by cleft palate, phalanx/fingernail hypoplasia, excessive hair growth, and intrauterine growth restriction

Due to impaired absorption of folate

Neural tube defects (carbamazepine only)

288
Q

what congenital defects are caused by valproate?

A

neural tube defects

289
Q

congenital defects caused by intrapartum steroids?

A

Reduced birth weight

Increased risk of preeclampsia

Increased risk of oral and lip clefts

290
Q

risks of isotretinoin or excessive vitamin A

A

High risk of miscarriage

Multiple congenital malformations, including cardiac anomalies, facial cleft, and skeletal abnormalities

291
Q

Meigs syndrome

A

Benign ovarian fibroma + ascites + right pleural effusion

292
Q

what sort of tests might you run for bleeding in early pregnancy

A

bHCG - confirm pregnancy, look for elevations consistent with molar preg, doubling q48hrs consistent with viable pregnancy

US - look for intrauterine preg, fetal heart tones

CBC to look at blood loss

Blood typing to see if mom is Rh- and needs rhogam

group, save, cross match if worried will need transfusion

histology: look at expelled products; might not be anything trophoblast indicating ectopic preg

293
Q

medical management of incomplete abortion

A

mifepristone + misoprostol

294
Q

previous surgery like appendectomy, PID, and conception after infertility/assisted conception, IUDs are risk factors for…

A

ectopic pregnancy

always suspect ectopic preg for early preg bleeding

295
Q

medical management of ectopic preg

A

methotrexate and serial bHCG levels

only if hemodynamically stable

296
Q

surgical management of ectopic pregnancy

A

laparoscopy with serial bHCGs

297
Q

medical treatment for hyperemesis gravidarum

A

admit

IVF

IM metoclopramide, IV ondansetron, prochlorperazine (compezine), B6, steroids in severe cases

298
Q

3 miscarriages = recurrent miscarriage. What tests would you do?

A
  • karyotype of parents
  • chromosomal analysis of products of conception
  • check mom for lupus anticoagulent, anticardiolipin antibodies (both antiphospholipid)
299
Q
A

OB Gyn (2 decks)

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