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OB/GYN UWorld Flashcards

1
Q

which contraceptive devices are contraindications in pts with breast cancer

A

hormone-containing methods of contraception should be avoided in pts with breast cancer,
as estrogen and progesterone may have a proliferative effect on breast tissue

esp concern hormone receptor-postivie breast cancer

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2
Q

what is the most effective non-hormonal contraceptive

A

copper IUD

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3
Q

what are absolute contraindications for combined hormonal contraceptives

A 
migraine with aura
>=15 cigarettes/day PLUS age >35
HTN >160/100
heart disease
DM with end-organ damage
h/o thromboembolic disease
antiphospholipid-antibody syndrome
h/o stroke
breast cancer
cirrhosis and liver cancer
major surgery with prolonged immobilization
use <3 weeks postpartum
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4
Q

what are you required to do if a pt is HIV positive

A

report positive HIV tests to the local health department

the local health department usually contacts the pt’s contacts (anonymously)

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5
Q

what is dx in pt with “3 D’s”:

dysmenorrhea, dyspareunia, and dyschezia

A

endometriosis

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6
Q

what is empiric tx for endometriosis

A

NSAIDs and/or combined oral contraceptives

OCPs are thought to reduce pain by ovulation suppression, which may result in atrophy of endometrial tissue

laparoscopy if treatment fails, adnexal mass, or acute symptoms

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7
Q

what is dx in female >20 weeks gestation with new-onset BP >140/90 + proteinuria and/or end-organ damage

A

preeclampsia

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8
Q

what are the 6 severe features of preeclampsia

A

systolic BP >160 or diastolic BP >110
(2x at least 4hrs apart)

thrombocytopenia

high Creatinine

high transaminases

pulmonary edema

visual or cerebral symptoms

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9
Q

how do you manage preeclampsia, depending on whether severe features are present

A 
Magnesium sulfate (seizure prophylaxis)
Antihypertensives

w/o severe features: delivery at >=37 weeks

w/ severe features: delivery at >= 34 weeks

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10
Q

what are 6 risk factors for preeclampsia

A 
multiple gestation
nulliparity
preexisting DM
advanced maternal age
CKD
prior preeclampsia
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11
Q

what are 3 treatment options for preeclampsia in a hypertensive crisis

A 
IV labetalol (beta blocker w/ alpha-blocking activity)
--avoid in bradycardia

IV hydralazine (vasodilator)

oral Nifedipine (CCB)
--avoid with emesis
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12
Q

which drug prevents/treats eclamptic seizures

A

IV or IM Magnesium sulfate

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13
Q

what are 2 indications for oxytocin use

A

induction or augmentation of labor

prevention and management of postpartum hemorrhage

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14
Q

what are 3 adverse effects in excessive oxytocin administration

A

hyponatremia (water intoxication)
–can cause generalized tonic-clonic seizure

hypotension

tachysystole

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15
Q

what has a similar structure to oxytocin that explains some of its action

A

ADH

prolonged doses of oxytocin can cause water retention and hyponatremia

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16
Q

how do you treat acute hyponatremia / water intoxication

A

hypertonic saline (3% saline) to normalize the Na levels

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17
Q

what are nl Mg levels, how does magnesium toxicity present and what serum level does it become toxic

A

normal serum levels: 1.5-2
therapeutic levels for pregnancy seizure prevention: 5-8
toxic Mg: >8

toxicity presents:
hyporeflexia
lethargy
headache
respiratory failure
ultimately cardiac arrest
(no seizures)
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18
Q

run through the 5 portions of the biophysical profile during pregnancy; and their normal findings

A
  1. Nonstress test:
    - -reactive fetal heart rate monitoring
  2. Amniotic fluid volume
    - -single fluid pocket >2x1 cm or amniotic fluid index >5
  3. Fetal movements
    - - >= 3 general body movements
  4. Fetal Tone
    - - >= 1 episode of flexion/extension of fetal limbs or spine
  5. Fetal breathing movements
    - - >= 1 breathing episode for >= 30 seconds

0 - 2 for each; max score of 10
8-10 is normal
6 is equivocal
<= 4 is an indication for delivery to prevent intrauterine fetal demise (fetal hypoxia 2/2 placental insufficiency)

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19
Q

what are late and post-term pregnancies at risk for

A

41-42 weeks’ gestation are at risk for

uteroplacental insufficiency

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20
Q

how long is the fetal sleep cycle, and how is it disrupted

A

fetal sleep cycle lasts for 20 minutes

usually disrupted by vibroacoustic stimulation

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21
Q

what is dx in pregnant F who presents with fetal tachycardia (>160), maternal fever, and uterine tenderness

A 
intraamniotic infection 
(chorioamnionitis)
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22
Q

what is dx in female with unilateral bloody nipple discharge w/o associated mass or Lymphadenopathy

A

intraductal papilloma

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23
Q

what is dx in female with well demarcated, round, firm, and mobile breast mass

A

fibroadenoma

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24
Q

what is dx in female with nipple discharge and mass / Lymphadenopathy

A

infiltrating ductal carcinoma

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25
Q

what does imaging show for infiltrating ductal carcinoa

A

a lesion with micro calcifications

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26
Q

what marks the second stage of labor

A

start:
when the cervix is dilated to 10cm

progression:
evaluated via fetal station, which measures the descent of the presenting part through the pelvis

ends:
fetal delivery

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27
Q

how is progression during the second stage of labor evalutated

A

by determining fetal station

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28
Q

what does fetal station measure

A

descent of the presenting part through the pelvis during the second stage of labor

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29
Q

what defines an arrested second stage

A

when there’s no fetal descent after pushing:
> 3 hrs if nulliparous
> 2 hrs if multiparous

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30
Q

what is optimal fetal position during second stage labor

A

occiput anterior (“occipital” part of head is anterior)

it facilitates the cardinal movements of labor

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31
Q

what are breech presentation types x 5

A

frank:
butt going through pelvis; both feet up by head

incomplete:
butt going through pelvis; 1 foot up by head

complete:
butt going through pelvis; no feet up by head

single footing:
1 leg through pelvis

double footing:
both legs through pelvis

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32
Q

what is the most common cause of second-stage arrest

A

fetal malposition

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33
Q

what is dx in pt with thin, off-white discharge with fishy odor; no inflammation

A

bacterial vaginosis

Gardnerella vaginalis

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34
Q

what are lab findings in gardnerella vaginalis

A

pH >4.5
clue cells
positive whiff test

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35
Q

what is tx for bacterial vaginosis

A

metronidazole or clindamycin

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36
Q

what is dx in pt with thin, yellow-green, malodorous, frothy discharge with vaginal inflammation

A

trichomoniasis

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37
Q

what are lab findings in trichomoniasis

A 
pH >4.5
motile trichomonads (pear-shaped)
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38
Q

what is tx for trichomoniasis

A

metronidazole for pt and sexual partner

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39
Q

what is dx in pt with thick, cottage-cheese discharge and vaginal inflammation

A

candida vaginitis

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40
Q

what are lab findings in vaginal candidiasis

A 
normal pH (3.8 - 4.5)
pseudohyphae
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41
Q

what is tx for candida vaginitis

A

fluconazole

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42
Q

what is dx in pt with low FSH and estradiol

A

hypogonadotropic hypogonadism

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43
Q

what causes hypogonadotropic hypogonadism

A

excessive weight loss
strenuous exercise
chronic illness
eating disorder

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44
Q

what sequence of labs occurs in hypogonadotropic hypogonadism

A

decrease in amplitude and frequency of GnRH pulses secreted by the hypothalamus,
decreasing LH and FSH production,
which also reduces ovarian estrogen production

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45
Q

what are lab values in PCOS

A

FSH and estradiol levels are normal to increased

high LH/FSH ratio

insulin resistance

elevated testosterone

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46
Q

what are possible fetal complications of late-term and post-term pregnancy

A 
oligohydramnios** (common)
meconium aspiration
stillbirth
macrosomia
convulsions
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47
Q

what are possible maternal complications of late-term and post-term pregnancy

A

Cesarean delivery
infection
postpartum hemorrhage
perineal trauma

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48
Q

why does oligohydramnios happen in late and post-term pregnancies

A

an aging placenta may have decreased fetal perfusion,
resulting in decreased renal perfusion,
and decreased urinary output from fetus

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49
Q

which trimester is the inactivated influenza vaccine safe during pregnancy

A

inactivated influenza vaccine is safe during every trimester,
and during breastfeeding

it should be given during the initial prenatal visit

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50
Q

which 3 routine prenatal lab tests should be done at the 24-28 week visit

A

Hemoglobin/Hct

Antibody screen if Rh(D) negative

50-g 1 hour Glucose challenge test (GCT)

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51
Q

which 1 routine prenatal lab test should be done at 35-37week visit

A

group B streptococcus culture

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52
Q

contrast symmetric vs asymmetric fetal growth restriction:
onset
etiology
clinical features

A

symmetric:
1st trimester onset
chromosome abnormality or congenital infection etiology
global growth lag

asymmetric:
2nd/3rd trimester onset
utero-placental insufficiency or maternal malnutrition etiology
“head sparing” growth lag

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53
Q

what is the definition of fetal growth restriction

A

ultrasound estimated fetal weight <10th percentile for gestational age

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54
Q

how do you manage fetal growth delay

A

weekly biophysical profiles

serial umbilical artery doppler sonography

serial growth ultrasounds

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55
Q

how can you treat atrophic vaginitis

A

topical vaginal estrogen therapy for moderate-severe cases

moisturizers and lubricants for mild cases

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56
Q

what signs and symptoms are indicative of menopause

A 
symptoms:
vulvovaginal dryness, irritation, pruritus
dyspareunia
vaginal bleeding
urinary incontinence, recent UTI
pelvic pressure
PE:
narrowed introitus
pale mucosa, decreased elasticity and rugae
petechiae, fissures
loss of labial volume
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57
Q

what is dx in pt with vulvar white plaque formation, “cigarette paper” skin changes, and loss of normal anatomical markers (obliteration of clitoris or labia minora, figure of 8 appearance)

A

lichen sclerosis

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58
Q

how do you treat lichen sclerosis

A

high-potency corticosteroid ointment

–clobetasol

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59
Q

what is the recommended initial treatment for dyspareunia

A

vaginal oil-based lubricants

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60
Q

what is dx in pt with fever, lower abdominal pain, purulent cervical discharge, cervical motion and adnexal tenderness

A

PID

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61
Q

what are possibilities if PID is left untreated

A

infection can progress to tube-ovarian abscess
abscess rupture
perihepatitis
sepsis

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62
Q

what two organisms usually precede PID

A

Neisseria gonorrhoeae and Chlamydia trachomatis

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63
Q

what is management for PID, depending on severity

A

indications for hospitalization:
pregnancy
failed outpatient tx
inability to tolerate oral medications
noncompliant with therapy
severe presentation (high fever, vomiting)
complications (tube-ovarian abscess, perihepatitis)
(also adolescents w/ risk of non-compliance)

inpatient:
these pts will receive IV cefoxitin or cefotetan plus oral doxycycline

outpatient:
intramuscular ceftriaxone plus oral doxycycline

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64
Q

what is dx in pt with chronic pelvic pain > 6 months, dysmenorrhea, non cyclical pain that can be exacerbated by exercise, and adnexal mass

A

endometriosis

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65
Q

what is the finding of a homogenous cystic ovarian mass highly suggestive of

A

endometrioma in endometriosis

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66
Q

what is dx in pt with endometrial glands in the myometrium;

typically F >40 w/ secondary dysmenorrhea and menorrhagia; symmetrically enlarged uterine size

A

adenomyosis

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67
Q

what does epithelial ovarian carcinoma look like

A

septated mass with solid components

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68
Q

what would give an ultrasound appearance of calcifications and hyper echoic nodules

A

mature teratoma (dermoid cyst)

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69
Q

what appears on ultrasound as a complex, thick-walled mass with air-fluid levels

A

tubo-ovarin abscess

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70
Q

what refers to rupture of membranes at <37 weeks gestation prior to onset of labor

A

preterm premature rupture of membranes PPROM

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71
Q

what is dx in pregnant pt with increased leakage frequency, nitrazine-positive vaginal fluid, and decreased amniotic fluid index

A

preterm premature rupture of membranes PPROM

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72
Q

how do you manage PPROM 34-37 weeks

A

Antibiotics
+/- corticosteroids
delivery (and intrapartum Penicillin for Strep B coverage)

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73
Q

how do you manage PPROM <34 weeks

A 
signs of infection or fetal compromise:
antibiotics 
corticosteroids
Magnesium if <32 weeks
delivery

no signs:
antibiotics
corticosteroids
fetal surveillance

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74
Q

how do you treat recurrent variable decelerations due to umbilical compression during labor

A

amniotransfusion

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75
Q

which exercises are unsafe in pregnancy

A

contact sports (basketball, hockey, soccer)

high fall risk (skiing, gymnastics, horseback riding)

scuba diving

hot yoga

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76
Q

what exercise regimen is recommended in pregancy

A

20-30min of moderate-intensity exercise on most/all days is recommended

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77
Q

how do thyroid values change in the first trimester of pregnancy

A

total T4 increases

free T4 unchanged or mild increase

TSH decreased

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78
Q

what is the mechanism of changing thyroid values in first trimester pregnancy

A

beta-hCG stimulates thyroid hormone production in first trimester

estrogen stimulates TBG

thyroid increases hormone production to maintain steady free T4 levels

increased beta-hCG and thyroid hormone suppress TSH secretion
(hCG has structural similarity to TSH and can directly stimulate TSH receptors)

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79
Q

what is dx in pt with low total and free T3 with a normal T4 and TSH

A

euthyroid sick syndrome

alteration in biochemical thyroid function tests in the setting of severe non thyroid illness

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80
Q 
what is dx in pt with increased total and free thyroid hormone levels
proptosis
diffuse goiter
HTN
tachycardia
A

graves disease

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81
Q

what is dx in pt with hyperthyroidism with suppressed TSH
following an acute viral illness
painful, tender goiter

A

subacute thyroiditis (granulomatous or De Quervain)

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82
Q

what is definition of spontaneous abortion

A

pregnancy loss <20 weeks

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83
Q

how do you manage a spontaneous abortion

A 
expectant
medical induction (misoprostol)

suction curettage if infection or hemodynamic instability

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84
Q

what signs/symptoms should raise suspicion for spontaneous abortion

A

<20 weeks gestation
heavy vaginal bleeding
cramping
dilated cervix
ultrasound that shows nonviable fetus (no heartbeat)
intrauterine gestation in the lower uterine segment

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85
Q

why is oxytocin not effective in stimulating uterine contractions or expelling retained products of conception during first or second trimesters

A

there are few oxytocin receptors in the uterus during early pregnancy

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86
Q

what is next step once Lichen Sclerosis is identified

A

vulvar punch biopsy

LS is pre-malignant lesion for squamous cell carcinoma

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87
Q

what commonly treats genital warts

A

cryotherapy

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88
Q

what treats genital herpes

A

acyclovir

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89
Q

what is dx in pt with an enlarged, irregular, firm uterus
pregnancy difficulties
heavy, prolonged menses with clots
urinary frequency, constipation, pelvic pressure/pain (compressive symptoms)

A

uterine leiomyomas (fibroids)

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90
Q

what is the workup when a uterine fibroid is suspected on H&E

A

pelvic ultrasound

higher sensitivity than CT for both uterine and ovarian pathology

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91
Q

what is treatment for uterine fibroids

A

observation if no significant symptoms

hormonal contraception, embolization, or surgery if symptomatic (usually the large fibroids causing compressive symptoms)

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92
Q

what is the most common pelvic tumor in reproductive-age women

A

uterine leiomyoma / fibroid

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93
Q

what is the next step when there’s clinical suspicion of endometrial hyperplasia or carcinoma

A

endometrial biopsy

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94
Q

what is dx in pt with cyclic lower abdominal pain in absence of menarche, with PE showing a blue bulging vaginal mass that swells with increased intraabdominal pressure (valsalva), and increasing pressure on surrounding pelvic organs (lower back pain, pelvic pressure, defecatory rectal pain)

A

imperforate hymen

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95
Q

what is treatment for imperforate hymen

A

incision of the hymen and drainage of the hematocolpos

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96
Q

what is dx in pt with amenorrhea and blind vaginal pouch

A

complete mullerian agenesis

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97
Q

what organs are missing in mullerian agenesis

A

uterus and cervix

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98
Q

what is dx in pt with pelvic pressure and vaginal bulge that increases with Valsalva, typically in postmenopausal Females

A

pelvic organ prolapse

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99
Q

what is dx in infant pt with polypoid or “grape like” mass protruding from the vagina with associated vaginal discharge and bleeding

A

sarcoma botryoides

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100
Q

when is a core biopsy indicated in a female pt <30yo

A

evidence of a complex cyst or complicated cyst (echogenic debris, thick septa, solid components)

or if mass recurs / does not disappear after aspiration

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101
Q

what are GnRH, FSH, and estrogen levels in:

A

hypothalamic hypogonadism:
low GnRH
low FSH
low estrogen

Primary ovarian insufficiency:
high GnRH
high FSH
low estrogen

PCOS:
high GnRH
normal FSH (LH/FSH ratio imbalance)
high estrogen

normal ovulation:
normal GnRH
normal FSH
normal estrogen

exogenous estrogen use:

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102
Q

what is the definition of primary ovarian insufficiency

A

cessation of ovarian function <40 yo

it’s a form of hypergonadotropic hypogonadism

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103
Q

what is pathogenesis of Sheehan syndrome

A

heavy permpartum blood loss complicated by hypotension and/or blood transfusion

postpartum pituitary infarction

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104
Q

what is dx in pt recently postpartum with lactation failure, hypotension, weight loss, fatigue, and postpartum hemorrhage

A

Sheehan syndrome-

ischemic necrosis of pituitary

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105
Q

what is dx in pregnant pt with HTN, thrombocytopenia, and proteinuria

A

HELLP syndrome
hemolysis
elevated liver enzymes
low plt count

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106
Q

what is dx in pt with acute renal injury, thrombocytopenia, and microangiopathic hemolytic anemia frequently 2/2 Gastroenteritis

A

HUS

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107
Q

how does SLE with nephritis present in pregnancy

A

pre-eclampsia + SLE signs (malar rash, etc)

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108
Q

what are appropriate maternal cardiopulmonary adaptations to pregnancy and their clinical manifestations

A

cardiac:

  • -increase cardiac output (inc SV early; inc HR late)
  • -increase plasma vol
  • -decrease SVR

respiratory:

  • -increase TV
  • -decrease FRC (elevation of diaphragm)

clinical manifestations:

  • -peripheral edema (plasma vol expansion)
  • -low BP
  • -high HR
  • -systolic ejection murmur (inc CO)
  • -dyspnea

–nocturnal leg pain (lactic and pyruvic acid)

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109
Q

what is RhoGAM

A

anti-D immune globulin

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110
Q

when is anti-D immune globulin (RhoGAM) indicated

A

unsensitized, Rh- females at 28 weeks gestation
or within 72 hours of any procedure/incident in which there is any possibility of feto-maternal blood mixing (incl delivery, abortion, ectopic, mole, villus sampling, trauma)

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111
Q 
what is dx in pregnant pt with:
low alpha-fetoprotein
low beta-hCG
low estriol
normal Inhibin A
A

Trisomy 18

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112
Q 
what is dx in pregnant pt with:
low alpha-fetoprotein
high beta-hCG
low estriol
high Inhibin A
A

Trisomy 21

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113
Q 
what is dx in pregnant pt with:
high alpha-fetoprotein
normal beta-hCG
normal estriol
normal Inhibin A
A

neural tube or abdominal wall defect

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114
Q

what are the 4 values included in quadruple screening

A

alpha-fetoprotein
beta-hCG
estriol
inhibin A

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115
Q

when is the quadruple screening test performed

A

second trimester 15-20 weeks

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116
Q

what is the next step after an abnormal quadruple screening

A

pts are offered cell-free fetal DNA testing

ultrasound

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117
Q

what is term for failure of primary neurulation

A

myelomeningocele

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118
Q

what is a paraumbilical bowel evisceration with no covering membrane

A

gastroischisis

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119
Q

what is a peritoneum-covered sac at the umbilicus

A

omphalocele

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120
Q

what is the most important direct role of hCG in pregnancy

A

maintenance of the corpus luteum

maintain progesterone secretion until the placenta is able to produce progesterone on its own

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121
Q

what is the timing of hCG levels during pregnancy

A

hCG production/secretion by the syncytiotrophoblast begins ~8 days after fertilization

hCG levels double every 48 hours until they peak at 6-8 weeks gestation

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122
Q

what is the structure of hCG

A

alpha subunit: common to hCG, TSH, LH, and FSH

beta subunit: unique to hCG, and is used as the basis of virtually pregnancy tests

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123
Q

what hormone inhibits uterine contractions

A

progesterone

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124
Q

which hormone is responsible for induction of prolactin production during pregnancy

A

estrogen

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125
Q

which hormone is responsible for preparing the endometrium for implantation of a fertilized ovum

A

progesterone

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126
Q

what is definition of preterm labor

A

regular contractions at <37 weeks gestation that cause cervical dilation and/or effaceent

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127
Q

which drugs postpone delivery

A

tocolytics:

indomethacin
nifedipine (CCB)
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128
Q

what drugs decrease risk of neonatal RDS in preterm delivery

A

corticosteroids (betamethasone)

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129
Q

which drug is administered <32 weeks gestation to lower the risk of neonatal neurological morbidities like cerebral palsy in pts who are expected to deliver within the next 24 horus

A

Magnesium sulfate

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130
Q

what does a positive fetal fibronectin test or a shortened cervix mean for pt

A

increased risk of preterm delivery

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131
Q

what is administered to pts with a h/o prior preterm delivery or a shortened cervix to prevent preterm delivery

A

progesterone

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132
Q

what is the medical management for preterm labor, depending on gestational age

A 
<32 weeks:
betamethasone
tocolytics
magnesium sulfate
Penicillin if GBS positive or unknown

32 - 33 weeks:
betamethasone
tocolytics
Penicillin if GBS positive or unknown

34 - 36 weeks:
+/- betamethasone
Penicillin if GBS positive or unknown

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133
Q

what is dx in female pt with normal internal genitalia, external virilization, and undetectable serum estrogen levels

A

aromatase deficiency

unable to convert androgens to estrogens

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134
Q

what may happen to mother if fetus has aromatase deficiency

A

transient masculinization of the mother that resolves after delivery

(inability of placental to convert androgens to estrogens)

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135
Q

what happens to patients with aromatase deficiency in adolesence

A

delayed puberty
osteoporosis
undetectable estrogen levels (no breast development)
high concentrations of gonadotropins, resulting in polycystic ovaries

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136
Q

what is generic dx in female pt with ambiguous external genitalia, normal uterus and ovaries, and electrolyte abnormalities

A

congenital adrenal hyperplasia

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137
Q

what is dx in pt with hypogonadotropic hypogonadism with anosmia, delayed puberty, and low/absent LH/FSH

A

Kallman syndrome

X-linked

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138
Q

what is dx in pt with triad of:
cafe au lait spots
polycystic fibrous dysplasia
autonomous endocrine hyperfunction

A

McCune-Albright syndrome

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139
Q

what is the most common endocrine feature of McCune-Albright syndrome

A

precocious puberty

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140
Q 
what is dx in pts with:
virilization
insulin resistance
low/normal LH and FSH
post-menopausal
ultrasound with solid-spearing, enlarged ovaries
A

ovarian hyperthecosis

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141
Q

what is the first-line management step in assessing a palpable breast mass in females >30yo

A

mammography

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142
Q

what is the “scenario” that puts one at risk for ABO incompatibility

A

infants with blood types A or B born to a mother with blood type O

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143
Q

what is the response when a type O mother is worried about ABO incompatibility

A

signs of hemolytic disease are typically mild and apparent only in ~1/3 infants

possible mild anemia at birth, may have jaundice

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144
Q

why can ABO incompatibility affect a first pregnancy

A

by the time a type O female becomes pregnant, she likely already has anti-A and anti-B IgG antibodies that can cross the placenta
–early A and B antigen exposure early in life from things like food, bacteria, and viruses

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145
Q

what is the next step if fetal movement decreases or becomes imperceptible by the mother

A

non-stress test NST

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146
Q

how is an NST test performed and what are possible results

A

record fetal HR while monitoring for spontaneous perceived fetal movements

reactive/normal if there are at least 2 accelerations of the fetal HR of at least 15 beats/min above baseline lasting at least 15 seconds each in 20 minutes

nonreactive/abnormal if <2 accelerations are noted in 20 min

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147
Q

what is the most common cause of a nonreactive NST and how is it managed

A

fetal sleep schedule

use vibroacoustic stimulation to awaken the fetus and allow a timely test

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148
Q

what is inheritance pattern for Hemophilia A

A

X linked recessive

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149
Q

what are the 2 etiologies of early decelerations of fetal HR

A

fetal head compression (stimulating vagal response which slows HR)

or can be normal fetal tracing

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150
Q

what are early deceleration findings

A

Nadir of deceleration corresponds to peak of contraction

gradual (>30 sec from onset to Nadir)

symmetric to contraction

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151
Q

what are late deceleration findings

A

Nadir of deceleration occurs after peak of contraction

gradual (>30 sec from onset to nadir)

delayed compared to contraction

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152
Q

what is the etiology of a late deceleration

A

uteroplacental insufficiency

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153
Q

what are variable deceleration findings

A

can be but not necessarily associated with contractions

abrupt (<30sec from onset to nadir)

decrease >15/min; duration >15 sec but <2 min

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154
Q

what are 3 etiologies of variable decelerations

A

cord compression

oligohydramnios

cord prolapse

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155
Q

which types o fetal HR decelerations are normal and which ones indicate fetal hypoxemia and acidosis

A

early decelerations do not indicate fetal distress

late and variable decelerations indicate risk for fetal hypoxemia and acidosis

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156
Q

at what beta-hCG level can a Transvaginal ultrasound be able to visualize an intrauterine pregnancy

A

hCG >1500

if hCG is lower than this, wait ~2 days, remeasure, and repeat TVUS
–hCG levels increase quickly

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157
Q

what is dx in pt with fever, firm, red, tender, swollen quadrant of 1 breast; +/- myalgia, chills, and malaise

A

mastitis

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158
Q

what is the most common cause of mastitis

A

staph aureus

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159
Q

how do you manage mastitis

A

continue breastfeeding
analgesics
Abx targeting staph aureus

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160
Q

what causes menopausal genitourinary syndrome

A

hypoestrogenism

  • -the bladder trigone, urethra, pelvic floor muscles, and endopelvic fascia possess estrogen receptors and are maintained by adequate estrogen levels
  • -hypoestrogenism results in atrophy of superficial and intermediate layers of the vagina and urethral mucosal epithelium
  • -diminished urethral closure pressure and loss of urethral compliance contribute to urgency, frequency, UTIs, and incontinence
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161
Q

what are 4 first-line treatment options in asymptomatic bacteriuria

A

cephalexin

amoxicillin-clavulanate

nitrofurantoin

fosfomycin

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162
Q

what is dx in pt with soft, mobile, well-circumscribed mass at base of labia majora; usually asymptomatic; <30 yo

A

bartholin duct cyst

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163
Q

what skin involvement results from infection by HPV 6 and 11

A

condylomata acuminata

exophytic or sessile growths that may be solitary or multiple but do not form cystic masses

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164
Q

what cyst results from incomplete regression of the Wolffian duct during fetal development

A

Gartner duct cyst

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165
Q

what cyst is described as single or multiple and are submucosal along the lateral (parallel) aspects of the upper anterior vagina; do not involve vulva

A

Gartner duct cyst

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166
Q

what presents as small, firm, painless bumps with central pits; usually asymptomatic or local itching

A

molluscum contagiosum

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167
Q

what presents with a chancre (round, painless ulcer)

A

primary syphillis

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168
Q

what is dx in pt with a raised and fleshy, often ulcerated, vulvar lump or mass; with long-standing vulvar pruritis

A

vulvar cancer

most are squamous cell carcinomas

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169
Q

how do you tx asymptomatic vs symptomatic Bartholin duct cyst

A

asymptomatic: observation
symptomatic: I&D, followed by placement of a Word catheter

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170
Q

what is dx in pt with prolonged menstruation, dysmenorrhea, miscarriages, and PE showing irregular uterine contour that may be palpable in the abdomen as a globular mass

A 
uterine leiomyomata (fibroids)
--most common pelvic tumor in females
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171
Q

what is dx when pt presents with dysmenorrhea, menorrhagia, and soft, boggy, uniformly enlarged uterus

A

adenomyosis

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172
Q

what is inter menstrual spotting without uterine enlargement hallmark for

A

endometrial polyps

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173
Q

what is dx in pt with adnexal mass and nonspecific GI symptoms (early satiety, constipation/diarrhea, anorexia, bloating, increased abdominal girth)

A

ovarian cancer

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174
Q

what is hallmark dx in painful, itchy, eczematous, and/or ulcerating rash on nipple that spreads to areola

A

Paget disease of the breast

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175
Q

what do 85% of pts with mammary Paget disease have

A

underlying breast adenocarcinoma

176
Q

what is dx in reproductive-age pt with acute lower abdominal pain, N/V, usually in setting of known adnexal mass

A

ovarian torison

177
Q

what is gold standard for dx of ovarian torsion

A

pelvic ultrasound showing an ovarian mass with absent Doppler flow

178
Q

what is the management of ovarian torsion

A

emergency laparoscopic detorsion and surgical restoration of anatomy with cystectomy

179
Q

what is the most common etiology of intrauterine fetal demise

A

can be maternal, placental, or fetal, but etiology is most often unknown

180
Q

what is most common cause of congenital adrenal hyperplasia

A

21-hydroxylase deficiency

181
Q

what is dx in female pt with hyperandrogenism (hirsutism, acne), elevated 17-hydroxyprogesterone, +/- hyponatremia, menstrual irregularities in adolescence/adulthood

A

non classic congenital adrenal hyperplasia

182
Q

what are normal renal changes during pregnancy and the mechanisms

A

increase GFR and renal size, decrease BUN and serum Cr
–increase cardiac output and RBF 2/2 progesterone, with increase in renal excretion

urinary frequency, nocturia
–high urine output and Na excretion

mild hyponatremia
–hormones reset threshold to increase ADH release from pituitary

183
Q

what are normal heme changes during pregnancy and the mechanisms

A

dilutional anemia
–increased plasma volume and RBC mass

prothrombotic state
–hormone-mediated decrease in total protein S antigen activity; increase in fibrinogen and coagulation factors

184
Q

what are normal CVS changes during pregnancy and the mechanisms

A

increase cardiac output and HR

–increase blood volume, decrease SVR

185
Q

what are normal pulmonary changes during pregnancy and the mechanisms

A

chronic respiratory alkalosis with metabolic compensation
high PaO2 and low PaCO2
–progesterone directly stimulates central respiratory centers to increase Tidal Volume and minute ventilation

186
Q

what’s the strongest risk factor for a fragility fracture

A

prior history of a fragility fracture

187
Q 
what is dx in pt with presence of maternal fever and >= 1 of the following:
uterine tenderness
maternal or fetal tachy
malodorous amniotic fluid
purulent vaginal discharge
A

chorioamnionitis (intra-amniotic infection)

188
Q

what is an important risk factor for chorioamnionitis

A

prolonged rupture of the membranes PROM

189
Q

what is the most appropriate treatment of chorioamnionitis

A

prompt administration of broad-spectrum Abx followed by delivery to reduce the risk of life-threatening neonatal infection and maternal complications
–oxytocin accelerates labor

190
Q

what is dx in pregnant pt with sudden onset abdominal pain, recession of the presenting part during active labor, and fetal heart rate abnormalities

A

uterine rupture

191
Q

what is a major risk factor for uterine rupture

A

prior uterine surgery, such as a scar of prior cesarean delivery

192
Q

what is loss of fetal station pathognomonic for

193
Q

what is dx in pt with fever, abdominal pain, and complex multiloculated adnexal mass with thick walls and internal debris on ultrasound with h/o PID

A

tubo-ovarian abscess (TOA)

194
Q

what is the abdominal pain in HELLP syndrome due to

A

liver swelling with distension of the hepatic (Glisson’s) capsule

195
Q

what is dx in pt with secondary amenorrhea, negative pregnancy test, normal prolactin and normal TSH

A

functional hypothalamic amenorrhea (hypoestrogenemia)

196
Q

what does a challenge with medroxyprogesterone acetate do

A

it’s a progestin challenge test that can confirm low estrogen levels

the presence of estrogen causes proliferation the endometrium, with
sloughing after the progesterone is withdrawn
–pts with low estrogen will have little/no bleeding after progesterone withdrawal as there is no endometrial lining to shed

197
Q

what is a significant concern in pts with functional hypothalamic amenorrhea

A

decreased bone mineral density 2/2 estrogen deficiency

198
Q

what is the immediate management of uterine inversion

A

replacement of uterus

if placenta is still attached, wait to remove it until the uterus is replaced to reduce risk of massive hemorrhage

199
Q

what is first line imaging to assess fallopian tube patency

A

hysterosalpingogram

200
Q

what is gold standard for evaluating risk of preterm delivery

A

transvaginal ultrasound measurement of cervical length

201
Q

what hormone maintains uterine quiescence and protects amniotic membranes against premature rupture

A

progesterone

202
Q

what is the only way to definitively diagnose endometriosis

A

laparoscopy with visualization and biopsy of endometrial implants

indicated after NSAIDs and hormonal contraceptives have failed

203
Q

what is a major risk of endometriosis

A

infertility

cyclic accumulation of ectopic foci of hemorrhage and adhesions can distort pelvic anatomy and impair fertility by obstructing oocyte release or sperm entry

204
Q

what are first 2 steps when ovarian malignancy is suspected

A

pelvic ultrasound and CA-125

205
Q

what is dx in pt when uterine villi attach to the myometrium presenting w/ placental adherence and hemorrhage at time of attempted placental delivery

A

placenta accreta

206
Q

what is dx in pt with ultrasound showing irregularity or absence of the placental-myometrial interface and intraplacental villous lakes

A

placenta accreta

207
Q

what is dx in pt with premature detachment of placenta from uterus; presents w/ vaginal bleeding, sudden abdominal or back pain, tense distended uterus, and fetal HR abnormalities

A

placental abruption

208
Q

what is dx in pt whose placenta implants over the internal cervical os

A

placenta previa

209
Q

what is dx when uterus fails to contract after placental delivery

A

uterine atony

210
Q

what is dx when fetal vessels traverse the amniotic membranes over the internal cervical os; presents w/ painless antepartum bleeding and fetal HR abnormalities just after the rupture of membranes

A

vasa previa

211
Q

how do levothyroxine requirements change during pregnancy

A

increase

pts with hypothyroidism should increase their thyroid meds

212
Q

why are thyroid hormone requirements increased during pregnancy

A

estrogen induces an increase in serum TBG levels, requiring an increase in the amount of thyroid hormone needed to saturate the binding sites

213
Q

what are the vaccine indications for HPV

A

all females 11-26yo

males 9-21 yo (9-26 for those who have sex w/ men or have HIV)

214
Q

when does pap testing begin

A

pap testing begins at age 21 in immunocompetent pts regardless of age of onset of sexual activity or number of sexual partners

215
Q

what is dx in pt with proliferation of SM cells within the myometrium and irregular uterine enlargement

A

leiomyomata uteri (fibroids)

216
Q

what is dx in pt with cyclic bleeding of ectopic endometrial glands; presents as pelvic pain, heavy bleeding (no anemia), or an irregularly enlarged uterus

A

endometriosis

217
Q

what is dx in proliferation of endometrial glands inside the uterine myometrium; presents w/ bulky/boggy, tender uterus that is uniformly enlarged

A

adenomyosis

218
Q

what is concern in postmenopausal females with bleeding and normal-sized uterus

A

endometrial hyperplasia w/ atypia, progressing to endometrial carcinoma

219
Q

what is dx in pt with fever >24 hrs postpartum, uterine fundal tenderness, and purulent lochia

A

postpartum endometritis

220
Q

what is treatment for postpartum endometritis

A

clindamycin and gentamycin

polymicrobial infection requiring broad-spectrum Abx

221
Q

what are 3 liver disorders unique to pregnancy

A

intrahepatic cholestasis of pregnancy

HELLP

acute fatty liver of pregnancy

222
Q

what is dx in pregnant pt with intense pruritus;
diagnosis of exclusion w/ labs:
high bile acids
high aminotransferases

A

intrahepatic cholestasis of pregnancy

223
Q 
what is dx in pregnant pt with malaise, RUQ pain, N/V, sequelae of liver failure; labs:
hypoglycemia
mildly elevated liver aminotransferases
elevated bilirubin
possible DIC
A

acute fatty liver of pregnancy

224
Q

what is commonly prescribed in intrahepatic cholestasis of pregnancy for treatment, and its MOA

A

Ursodeoxycholic acid

increase bile acid flow and relieve itching

225
Q

what are maternal and fetal risk factors for fetal macrosomia

A 
maternal:
advanced age
DM
excessive weight gain during pregnancy, or pre-existing obesity
multiparity

fetal:
african american or Hispanic ethnicity
male
post-term pregnancy

226
Q

what is the most common type of brachial plexus injury during delivery, and what does it involve

A

Erg-Duchenne palsy

involves 5th, 6th, and sometimes 7th cervical nerves

227
Q

what is dx in pt with weakness of deltoid and infraspinatus muscles (C5), biceps (C6), and wrist/finger extensors (C7), leading to predominance of the opposing muscles

A

Erb-Duchenne palsy

“waiter’s tip” posture

228
Q

what is treatment for Erb Duchenne palsy

A

gentle massage and PT to prevent contractures

up to 80% pts have spontaneous recovery within 3 months; otherwise, surgical intervention is considered

229
Q

what is next step when evaluating renal colic in pregnant pts

A

ultrasound of kidneys and pelvis

low-dose CT urography may be considered only in 2nd and 3rd trimesters

230
Q

what is the HIV management protocol during pregnancy

A

antepartum:

  • -testing of HIV-1 viral load months until undetectable; then every 3 months
  • -CD4 cell count every 3 months
  • -Resistance testing if not previously performed
  • -Initiation or continuation of HAART
  • -Avoidance of amniocentesis if viral load is detectable

Intrapartum:

  • -avoidance of artificial ROM, fetal scalp electrode and operative delivery
  • -Viral load <1000 copies: continuation of HAART and vaginal delivery
  • -Viral load >1000 copies: Zidovudine and cesarean delivery

Postpartum:

  • -Mother: continuation of HAART
  • -Infant: Zidovudine for >6 weeks plus serial HIV testing
231
Q

what is recommended in pts at >37 weeks gestation with breech presentation

A

offer external cephalic version

Cesarean delivery is necessary if ECV fails

vaginal delivery of a singleton breech fetus is generally contraindicated due to increased his for birth asphyxia and trauma

232
Q

what is dx when fetal Doppler sonography fails to detect a fetal heart rate in pts with decreased or absent fetal movement >20 weeks

A

Intrauterine fetal demise

233
Q

what is management when intrauterine fetal demise is suspected

A

absence of fetal cardiac activity on ultrasound is necessary to confirm diagnosis

234
Q

what is gold standard method of diagnosing Cervical Intraepithelial Neoplasia (CIN)

A

colposcopy

235
Q

what is the recommendation for CIN 3

A

cervical conization (excision of the intact transformation zone)

CIN 3 is premalignant with high risk of progressing to SCC

236
Q

what are 3 potential complications of a cervical conization

A 
cervical stenosis (scar tissue)
cervical impotence
preterm delivery
237
Q

what is dx in pt with formation of intrauterine adhesions from infection or intrauterine surgical interventions (involving endometrium)

A

Asherman syndrome

238
Q

what are the 2 methods of cervical conization

A

cold knife conization

loop electrosurgical excision procedure (LEEP)

239
Q

what test is highly sensitive and specific screening for fetal aneuploidy, can be ordered at >=10 weeks gestation

A

plasma cell-free fetal DNA testing

240
Q

how can you confirm abnormal cell-free fetal DNA testing

A

confirmed by chorionic villus sampling at 10-12 weeks or amniocentesis at 15-20 weeks

241
Q

what is dx in pt with bilateral, symmetric fullness, tenderness and warmth of breasts 3-5 days after delivery

A

breast engorgement

242
Q

what causes breast engorgement

A

colostrum is replaced by milk

243
Q

what is dx in newborn with small body size, microcephaly, digital hypoplasia, nail hypoplasia, mid facial hypoplasia, hirsutism, cleft palate, and rib anomalies

A

fetal hydantoin syndrome

exposure to anticonvulsant meds during fetal development

244
Q

what 2 medications commonly cause fetal hydantoin syndrome

A

anticonvulsants, most notably phenytoin and carbamazepine

245
Q

what is dx in newborn with rhinitis, HSM, and skin lesions; later findings of interstitial keratitis, Hutchinson teeth, saddle nose, saber shins, deafness, and CNS involvement

A

congenital syphilis

246
Q

what is dx in newborn with mid facial hypoplasia, microcephaly, and stunted growth; also CNS damage (hyperactivity, intellectual disability, learning disability) is typical

A

fetal alcohol syndrome

247
Q

what are your 4 emergency contraception options, MOA, time after intercourse to use, and efficacy

A

copper IUD:

  • -copper causes inflammatory reaction that is toxic to sperm and ova; impairs implantation
  • -0-5 days
  • -99% efficacy

Ulipristal pill:

  • -antiprogestin; delays ovulation
  • -0-5 days
  • ->85% efficacy

Levonorgestrel pill:

  • -progestin; delays ovulation
  • -0-3 days
  • -85% efficacy

OCPs:

  • -Progestin; delays ovulation
  • -0-3 days
  • -75% efficacy
248
Q

what is dx in non psychotic F who present with signs and symptoms of early pregnancy (amenorrhea, morning sickness, abdominal distension, breast enlargement) and belief that she is pregnant, but evaluation excludes pregnancy (neg pregnancy test and ultrasound)

A

Pseudocyesis

249
Q

what is the management for pseudocyesis

A

pseudocyesis is a form of somatization, so management requires psych evaluation and tx

250
Q

what is dx in pt with androgen excess, oligo- or an-ovulation, obesity, and polycystic ovaries

251
Q

what malignancy is associated with PCOS

A

endometrial hyperplasia/cancer

due to unregulated endometrial proliferation from unopposed estrogen stimulation

252
Q

what is the treatment option for PCOS pt who wants to conceive

A

clomiphene citrate for ovulation induction

253
Q

how do you treat treponema pallidum

A

penicillin

254
Q

how do you screen and confirm syphilis

A

screen with either a nontreponemal test (VDRL) or a treponemal-specific test (fluorescent treponemal antibody absorption)

confirm with the other test type, as there’s a high false positive rate

255
Q

when should you screen for syphilis in a pregnant pt

A

first prenatal visit

256
Q

how do you treat syphilis in pregnant pt w/ penicillin allergy

A

penicillin skin test to evaluate for the presence of an IgE-mediated response

positive test = pts are desensitized to penicillin prior to receiving treatment with intramuscular penicillin G benzathine

257
Q

how do you manage chronic Hepatitis C in pregnancy

A

Hepatitis A and B vaccination with inactivated/killed vaccines

  • -Ribavirin is teratogenic and should be avoided
  • -no indication for barrier protection in serodiscordinant, monogamous couples
258
Q

how do you prevent vertical transmission of Hepatitis C in pregnancy

A

vertical transmission strongly associated with maternal viral load

Cesarean delivery is not protective

scalp electrodes should be avoided

breastfeeding should be encouraged unless maternal blood is present (nipple injury)

259
Q

how do you manage chronic hepatitis C in non-pregnant pts

A

combination of Interferon-alpha and Ribivirin

260
Q

what does primary HTN increase the risk of in pregnancy for mom and fetus?

A

maternal:

  • -superimposed preeclampsia
  • -postpartum hemorrhage
  • -gestational diabetes
  • -abruptio placentae
  • -Cesarean delivery

fetal:

  • -fetal growth restriction/small for gestational age
  • -perinatal mortality
  • -preterm delivery (not PPROM)
  • -oligohydramnios
261
Q

what is the initial management of blunt abdominal trauma (MVC) in pregnant pt (30 weeks)

A

aggressive fluid resuscitation and uterine displacement to optimize maternal circulation
–leave pt in LL decubitus position to displace uterus off aortocaval vessels to maximize CO

–BAT/MVC is a significant risk factor for severe hemorrhage from abrupt placenta

262
Q

what is the first-line treatment and second best long-term outcome treatment for stress urinary incontinence

A

pelvic floor exercises are first-line

urethral sling surgery provides the best long-term outcome

263
Q

what is stress incontinence due to

A

urethral hypermobility

264
Q

how do you diagnose urethral hypermobility

A

place pt in dorsal lithotomy position
insert cotton swab into urethral orifice
>=30 degree angle from horizontal to increase intraabdominal pressure (coughing) signifies urethral hypermobility

265
Q

what is treatment for urinary retention due to neurogenic bladder

A

intermittent self-catheterization

266
Q

what are alpha-blockers and cholinergics helpful in treating for urinary symptoms

A

help with bladder contraction

alpha blockers: urgency incontinence associated w/ BPH

bethanechol: tx overflow incontinence due to diabetic neuropathy

267
Q

what are antimuscarinics used for in urinary symptoms

A

treat urge incontinence

–sudden urge to urinate at any time

268
Q

what is dx in pt with crampy lower abdomen and/or back during menses; normal examination

A

primary dysmenorrhea

269
Q

how do you manage primary dysmenorrhea

A

NSAIDs and hormonal contraceptions for pain relief

270
Q

which dx has pain that peaks before menses

A

endometriosis

271
Q

what is the most accurate way to determine estimated gestational age (EGA)

A

ultrasound dating with fetal crown-rump measurement in the first trimester is most accurate

  • -accuracy varies from +/- 3 to 5 days between 7 - 14 weeks gestation
  • -EGA should not be changed based on measurement discrepancies on a 2nd/3rd trimester ultrasound; growth problems should be considered in this case
272
Q

what are daughters of mothers who took Diethylstilbestrol (DES) at risk for

A

40-fold increase clear cell adenocarcinoma of vagina and cervix

structural anomalies of the reproductive tract (hooded cervix, T-shaped cervix, small uterine cavity, vaginal septae, vaginal adenosis)

pregnancy problems (ectopic pregnancy, pre-term delivery)

infertility

273
Q

what is Diethylstilbestrol (DES)

A

synthetic estrogen used widely 1938-1971 for prevention of spontaneous abortion, premature delivery, and postpartum lactation suppression

banned in US due to adverse effects

274
Q

what is the major risk factor for CCA vs SCC in the vagina and cervix

A

CCA: daughter of DES mother

SCC: HPV and tobacco

275
Q

when are rectovaginal cultures obtained for GBS screening

A

35-37 weeks gestation

276
Q

who should receive GBS prophylaxis without testing

A

pregnant pts with a history of
GBS bacteriuria
UTI
infant w/ early-onset GBS disease

277
Q

how do you manage GBS prophylaxis

A

give Penicillin 4 hours before delivery

278
Q

what is dx in pt with diffuse breast erythema, warmth, pain, and edema w/ peau d’orange appearance

A

inflammatory breast carcinoma

279
Q

what does condylomata acuminata come from

A

HPV 6, 11

genital warts

280
Q

what is dx in pt with single or multiple pink or skin-colored lesions; lesions range from smooth, flattened papule to exophytic/cauliflower-like growth

A

genital warts
condylomata acuminata
HPV 6, 11

281
Q

how do you treat condyloma acuminata

A

small lesions may be treated with applications of trichloroacetic acid
or podophyllin resin

excisional therapy may be considered for larger lesions

recurrence rate is high, regardless of tx modality

282
Q

what is dx in pt with flat, velvety lesions; broad base and flat surface; lobulated and plaque-like

A

condyloma lata

secondary syphilis

283
Q

what is dx in pt with single/clustered blisters or superficial, tender ulcers

284
Q

what is dx in pt with pruritic, glassy, bright red erosions and ulceration involving the vulva and vagina

A

genital lichen planus

285
Q

what is dx in pt with poxvirus and single or multiple “pearly” (smooth, firm) painless nodules with central dimples/pits; no bleeding on contact

A

molluscum contagiosum

286
Q

what is the only current indication for hormone replacement therapy

A

vasomotor symptoms (severe hot flashes) in women <60 yo who have undergone menopause within the last 10 yrs

287
Q

what are contraindications to hormone replacement therapy

A 
history of:
CAD
thromboembolism
TIA/stroke
breast cancer
endometrial cancer
288
Q

how do you manage pts with severe vasomotor symptoms (hot flashes) with a contraindication to systemic HRT

289
Q

what is the concern with HRT in treating menopause symptoms

A

the estrogen component treats menopausal symptoms
but if unopposed (no progesterone),
can cause endometrial proliferation and hyperplasia

therefore, in pts with a uterus- HRT must contain a progestin component for endometrial protection

290
Q

what is dx in pt with h/o pelvic surgery and painless continuous loss of clear, watery fluid from the vagina

A

vesicovaginal fistula (urine leak)

291
Q

how can you diagnose a vesicovaginal fistula

A

PE
dye test
cystourethroscopy

292
Q

how can you prevent vesicovaginal fistula

A

bladder catheterization in the immediate postoperative period allows a small fistula to heal

otherwise, surgical correction is indicated

293
Q

what is the first sing of puberty in girls

A

breast development (thelarche)
age 8-12
in response to rising estrogen levels

294
Q

when is menarche expected during puberty

A

~Tanner stage 4
approximately 2-2.5 yrs after initial breast bud development
avg age 12.5

295
Q

what are contraindications to external cephalic version

A

indications for Cesarean delivery regardless of fetal lie (failure to progress during labor, non-reassuring fetal status)

placental abnormalities (placenta previa or abruption)

oligohydramnios

ruptured membranes

hyperextended fetal head

fetal or uterine anomaly

multiple gestation

296
Q

what is the most common cause of postpartum hemorrhage

A

uterine atony (failure to contract)

297
Q

what is initial management of postpartum hemorrhage 2/2 uterine atony

A

bimanual uterine massage and uterotonic agents

  • -oxytocin (first line)
  • -methylergonovine (risk of vasoconstriction/HTN)
  • -Carboprost (risk of bronchoconstriction/asthma)
298
Q

what is dx in pt with skin/nipple retraction, calcifications on mammography, and biopsy showing fat globules and foamy histiocytes

A

fat necrosis of the breast

–can mimic breast cancer; associated with breast surgery and trauma

299
Q

what ultrasound finding often correlates with benign breast etiology

A

hyperechoic mass

300
Q

how do pts with androgen insensitivity present

A

male karyotype
male testosterone levels
breast development (testosterone is aromatized into estrogen)
primary amenorrhea (absent ovaries, uterus, and cervix)
minimal pubic and axillary hair

301
Q

what is pathogenesis s of androgen insensitivity syndrome

A

end-organ resistance to androgens 2/2 mutated androgen receptor

pts have functioning testes and secrete AMH and testosterone
–AMH stimulates regression of Mullerian ducts (no uterus, cervix, or upper vagina)

no masculization 2/2 androgen resistance

  • -Wolffian duct degeneration
  • -fetal urogenital sinus does not differentiate into a penis and scrotum
  • -male 2ndary sex characteristics are minimal/absent (hair, voice)
302
Q

what is best next step in management with a high-grade squamous intraepithelial lesion Pap test result vs low-grade

A

high grade:
immediate colposcopic examination and biopsy of cervical abnormalities due to high risk of progression to cervical cancer

low grade or undetermined significance:
HPV co-testing

303
Q

what dx in pathogenesis that involves systemic inflammation, activation of the coagulation cascade, and platelet consumption

A

HELLP syndrome

304
Q

what are 2 maternal complications from abruptio placentae

A

hypovolemic shock

DIC

305
Q

what is the pathophysiology of neonatal thyrotoxicosis

A

transplacental passage of maternal anti-TSH receptor antibodies

antibodies bind to infant’s TSH receptors and cause excessive thyroid hormone release

306
Q

what is dx in newborn with warm, moist skin, tachy, poor feeding, irritability, poor weight gain, and low birth weight/preterm birth

A

neonatal thyrotoxicosis

307
Q

how do you dx neonatal thyrotoxicosis

A

maternal anti-TSH receptor antibodies >= 500% normal

308
Q

how do you treat neonatal thyrotoxicosis

A

self-resolves within 3 months (disappearance of maternal antibody)

methimazole PLUS beta-blocker

309
Q

when do you want to use Tamoxifen vs Raloxifene

A

Tamoxifen: adjuvant treatment of breast cancer
–endometrial hyperplasia and endometrial carcinoma

Raloxifene: postmenopausal osteoporosis

310
Q

what is management for placenta previa

A

Cesarean delivery

NO intercourse or digital vaginal examination

vaginal delivery is contraindicated

311
Q

who should be screened for chlamydia and gonorrhea

A

all sexually active women <25 yo should undergo annual screening for Chlamydia and gonorrhea due to high rates of asymptomatic infection that can lead to infertility

312
Q

what is the gold standard for screening/diagnosis of chlamydia and gonorrhea

A

nucleic acid amplification testing

313
Q

what is dx in pt with pain with vaginal penetration, distress/anxiety over symptoms, and no other medical cause

A

genitor-pelvic pain/penetration disorder

previously vaginismus

314
Q

what is dx in pt with insomnia, fatigue, weight gain, amenorrhea, and an enlarged uterus

315
Q

what are concerns for lithium exposure in pregnant women for fetuses?

A

first trimester: cardiac malformations
–septal defects; and possibly Epstein’s anomaly

2nd and 3rd:
goiter, transient neonatal neuromuscular dysfunction

316
Q

what is dx in pt in active phase of labor with cervical change slower than expected; +/- inadequate contractions

A

protraction to help with contraction strength

317
Q

how do you treat protraction during active phase of labor

318
Q

what is dx in pt in active phase of labor with no cervical change for >4hrs with adequate contractions
OR
no cervical change for >6hrs with inadequate contractions

319
Q

how do you treat arrest of the active phase of labor

A

cesarean delivery

320
Q

what is dx in post-op pelvic pt with persistent fever unresponsive to Abx and bilateral lower abdominal pain; no localizing signs/symptoms

A

septic pelvic thrombophlebitis

post-op/postpartum infected thrombosis of the deep pelvic or ovarian veins

321
Q

what is medroxyprogesterone’s MOA

A

Depot medroxyprogesterone acetate (DMPA) is administered intramuscularly every 3 months to prevent pregnancy by inhibiting the release of GnRH form the hypothalamus and suppressing ovulation

322
Q

what is dx in pt with postmenopausal bleeding, thickened endometrium, breast tenderness, and large pelvic/adnexal mass

A

granulosa cell tumor

–secretes estrogen and causes hormonal effects

323
Q

what is the major risk factor for shoulder dystocia

A

fetal macrosomia

post-term pregnancy
maternal obesity
gestational DM
excessive maternal weight gain during pregnancy

324
Q

when do you stop pap testing

A 
Age 65 or hysterectomy
PLUS
no h/o CIN 2 or higher
AND 
3 consecutive negative Pap tests
OR
2 consecutive negative co-testing results
325
Q

what is dx in pt with recurrent sudden mild and unilateral mid-cycle pain prior to ovulation lasting hours-days; may mimic appendicitis

A

Mittelscherz

326
Q

what is dx in pt with sudden-onset, severe, unilateral lower abdominal pain immediately following strenuous or sexual activity; ultrasound shows pelvic free fluid

A

ruptured ovarian cyst

327
Q

what is dx in pt with sudden-onset, severe, unilateral lower abdominal pain; N/V; unilateral, tender adnexal mass on examination; ultrasound shows enlarged ovary with decreased or absent flow

A

ovarian torsion

328
Q

what is the most significant risk factor for spontaneous preterm delivery

A

h/o spontaneous preterm delivery in a prior pregnancy

329
Q

what is dx in pt with Keratoconjunctivitis sicca, dry mouth, salivary hypertrophy, xerosis of skin, Raynaud phenomenon, cutaneous vasculitis, arthralgias/arthritis, interstitial lung disease

A

Sjogren syndrome

330
Q

what are diagnostic findings of Sjogren syndrome

A

objective signs of decreased lacrimation (Schirmer test)

postive anti-Ro (SSA) and/or anti-La (SSB)

salivary gland biopsy with focal lymphocytic sialoadenitis

331
Q

what is dx in pt with pain to superficial touch of the vaginal vestibule rather than dryness

A

vulvodynia

formerly vestibulodynia

332
Q

what is dx in pt with amenorrhea, lactational failure, and persistent hypotension

A

Sheehan syndrome,

a complication of massive obstetrical hemorrhage

333
Q

what is used for dx and treatment of postpartum urinary retention

A

urethral catheterization

334
Q

which 3 vaccines are recommended during pregnancy

A

Trap
Inactivated influenza
Rho(D) immunoglobulin

335
Q

which 6 vaccines are indicated for high-risk pts

A 
Hepatitis B
Hepatitis A
Pneumococcus
Haemophilus influenzae
Meningococcus
Varicella-zoster immunoglobulin
336
Q

which 4 vaccines are contraindicated in pregnancy

A

HPV
MMR
live attenuated influenza
Varicella

337
Q

what 4 labs/tests should you get to evaluate galactorrhea

A

serum pregnancy test
serum prolactin
TSH
possible MRI of brain

338
Q

what is dx in pt with PID complicated by perihepatitis

A

Fitz-Hugh-Curtis disease

339
Q

what is dx in pt with fever, lower abdominal tenderness, mucopurulent cervical discharge, and cervical motion and uterine tenderness; possible inter menstrual spotting,

340
Q

what are the 2 painful types of infectious genital ulcers

A

HSV (small vesicles or ulcers)

Haemophilus ducreyi (chancroid; larger, deep ulcers w/ gray/yellow exudate)

341
Q

what is the most sensitive test for HSV

A

PCR

viral culture can be used, but less sensitive

342
Q

what is the recurrence pattern of genital herpes if left untreated

A

it will resolve, with decreasingly frequent recurrences

343
Q

what is the management of shoulder dystocia

A

BE CALM

Breathe; do not push
Elevate hips against abdomen (McRoberts position)
Call for help
Apply suprapubic pressure
enLarge vaginal opening w/ episiotomy
Maneuvers:
–deliver posterior arm
–rotate 180 degrees (Woods corkscrew)
–collapse anterior shoulder (Rubin maneuver)
–replace fetal head into pelvis for cesarean delivery (Zavanelli maneuver)

344
Q

what causes the genitourinary syndrome of menopause (atrophic vaginitis)

A

due to loss of vaginal wall elasticity from lack of estrogen

345
Q

what is the best option for managing intrauterine fetal demise depending on weeks gestation?

A

20-23 weeks:
Dilation and evacuation
OR
vaginal delivery

> = 24 weeks:
induction of labor for vaginal delivery
–it can be delayed to allow time for parental acceptance of dx
–retention of fetus for several weeks can lead to coagulopathy

346
Q

what is dx in an immigrant pt with h/o recurrent sore throats and new onset AF w/ RVR

A

rheumatic mitral stenosis

may be brought on by pregnancy 2/2 physiologic increases in HR and blood volume that raise the transmittal gradient and LA pressure

347
Q

what causes infertility in PCOS pts

A

anovulation from failed follicular maturation and oocyte release

persistently elevate estrone levels due to peripheral androgen conversion in adipose tissue and decreased levels of SHBG.

  • -high estrone levels provide negative feedback to hypothalamus, which inhibits GnRH secretion
  • -imbalance in LH and FSH release from anterior pituitary
  • -LH/FSH imbalance results in a lack of LH surge
  • -failure of follicle maturation
348
Q

what are 4 benefits and 4 risks of Combined estrogen-progestin contraceptives

A

Benefits:

  • -pregnancy prevention
  • -endometrial and ovarian cancer risk reduction
  • -menstrual regulation with reduction in iron deficiency anemia
  • -reduction in risk of benign disease

Risks:

  • -Venous thromboembolism
  • -HTN
  • -Hepatic adenoma
  • -Very rarely, stroke and MI
349
Q

what test is used to determine appropriate dose of anti-D immune globulin

A

Kleihauer-Betke (KB) test

maternal RBCs fixed on a slide
slide is exposed to acidic soln
adult Hb lyses
leaves "ghost" cells
dose of anti-D immune globulin is calculated from the % of remaining fetal hemoglobin
350
Q

what is the standard dose of anti-D immune globulin given, and when?

A

300 micrograms at 28 weeks gestation usually prevents alloimmunization

  • -~50% of Rh- women will need higher dose after delivery, placental abruption, or procedures
  • -do KB test to determine dosage
351
Q

what is helpful to dx PMS

A

symptom diary

352
Q

what is an effective tx option for PMS

353
Q

when do PMS symptoms typically occur

A

1-2 weeks prior to menses during the luteal phase

–resolve with menses

354
Q

what is management for pts with active genital herpes lesions at the time of delivery

A

Cesarean delivery to reduce risk for neonatal HSV

355
Q

what should management be for pregnant women w/ h/o genital HSV infection

A

prophylactic acyclovir or valacyclovir beginning at 36 weeks gestation

356
Q

distinguish between placenta previa and placental abruption

A

placenta previa:

  • -placenta implants over internal cervical os
  • -painless antepartum vaginal bleeding
  • -normal fetal HR tracings

placental abruption:

  • -premature separation of placenta from uterus
  • -vaginal bleeding
  • -distended and very tender uterus
  • -fetal HR tracing abnormalities
357
Q

what is the work-up process of secondary amenorrhea

A

amenorrhea for >=3 cycles or >=6 months:

beta-hCG
–positive = pregnancy

prior uterine procedure/infection?
–hysteroscopy

check prolactin, TSH, FSH

  • -high prolactin = brain MRI
  • -high TSH = hypothyroidism
  • -high FSH = premature ovarian failure
358
Q

how should you manage pts with uncomplicated preterm premature rupture of membranes (PROM) at <34 weeks gestation?

A

manage conservatively with antenatal corticosteroids and antibiotics (betamethasone) to decrease risk of neonatal RDS

delivery should occur at 34 weeks or in the setting of intrauterine infection or deteriorating fetal/maternal status

359
Q

what is the next step in pregnancy management if first-trimester screen is abnormal

A

diagnostic testing with either:

amniocentesis

  • -15-20 weeks
  • -definitive karyotype dx
  • -invasive; risk of membrane rupture, fetal injury, and pregnancy loss

chorionic villus sampling

  • -10-13 weeks
  • -definitive karyotype dx
  • -invasive; risk of spontaneous abortion

(quadruple test is not indicated if the first-trimester screen is already abnormal, as they have similar sensitivity/specificity)

360
Q

what are indications for endometrial biopsy, depending on age of pt
>=35
<45
>= 45

A

> = 35:
atypical glandular cells on Pap test

<45:
abnormal uterine bleeding PLUS:
--unopposed estrogen (obesity, anovulation)
--failed medical management
--lynch syndrome (HNPCC)

> =45:
abnormal uterine bleeding
postmenopausal bleeding

361
Q

how do you manage persistent variable decelerations (occurring with >50% of contractions)

A

may be alleviated by maternal repositioning

362
Q

how do you manage intermittent variable decelerations (occurring with <50% of contractions)

A

well-tolerated by fetus

363
Q

what is fetal scalp stimulation used for

A

an attempt to induce accelerations when they are absent
–does not treat variable decelerations and could exacerbate decelerations if parasympathetic tone increases in response to the stimulus

364
Q

what are the 2 indications for oxytocin and 3 adverse effects

A

indications:

  • -induction or augmentation of labor
  • -prevention and management of postpartum hemorrhage

adverse effects:

  • -hyponatremia
  • -hypotension
  • -tachysystole
365
Q

what is the most significant risk factor for precipitous labor

A

multiparity

366
Q

what is likely dx in pt with preeclampsia at <20 weeks gestation, and what causes the preeclampsia

A

hydatidiform mole

preeclampsia is likely due to abnormal placental spiral artery development,
which causes placental hypo perfusion, placental ischemia, and maternal hypertension

367
Q

what are 5 modifications that can be done ro reduce risk of ovarian cancer in a pt with BRCA mutation

A

bilateral salpingo-oophrectomy
(recommended as soon as child-bearing is complete)

oral contraceptive use

age <30 at first live birth

breastfeeding

tubal ligation

368
Q

what does the workup for a pt with decreased fetal movement

A

pt should undergo antenatal fetal testing with a non stress test (NST)
followed by a biophysical profile or contraction stress test if the NST is nonreactive

369
Q

which lab value is helpful for monitoring growth-restricted fetuses (estimated fetal weight <10th percentile)

A

umbilical artery flow velocimetry

370
Q

what is the screening test for ovarian cancer in an asymptomatic, average-risk pt without an adnexal mass?

A

no screening test for these pts

ovarian cancer is most commonly dx in advanced stages and therefore has high mortality rates

371
Q

what is the cause of initial irregular and anovulatory cycles in adolescents, aka “abnormal uterine bleeding” following menarche

A

hypothalamic-pituitary-gonadal axis immaturity and insufficient secretion of GnRH

372
Q

what is dx in pt with painless lesion that begins as a papule and converts to a nonexudative ulcer with indurated borders; may have mild-moderate bilateral lymphadenopathy

A

primary syphilis

373
Q

what is dx in intrauterine fetal demise associated with growth restriction, multiple limb fractures, and a hypo plastic thoracic cavity

A

type 2 osteogenesis imperfecta

  • -auto dominant
  • -defective type 1 collagen synthesis
  • -decreased bone density and increased fragility
374
Q

what is dx in intrauterine fatality that presents with pulmonary hypoplasia, limb deformities (clubfoot, hip dislocation, but not limb fractures) and oligohydramnios

A

potter sequence

375
Q

what is the most common cause of Potter sequence

A

urinary tract abnormalities (bilateral urinary agenesis, PKD)

376
Q

what causes amenorrhea in a breastfeeding female

A

elevated prolactin levels inhibit GnRH release, thereby suppressing LH and FSH production
–anovulation and amenorrhea

377
Q

what is hypotension 2/2 epidural anesthesia caused by

A

blood redistribution to the LE and venous pooling from sympathetic blockade of nerves responsible for vascular tone

  • -decreased venous return to the R heart
  • -decreasded cardiac output
378
Q

how can you prevent hypotension 2/2 epidural anesthesia? treat it?

A

prevent:
aggressive IV volume expansion prior to epidural placenta

treat:

  • -left uterine displacement (pt positioning) to improve venous return from the IVC
  • -additional IV fluid bolus
  • -vasopressor administration
379
Q

what is dx in post-abortion pt with fever, chills, abdominal pain, sanguinopurulent vaginal discharge, boggy, tender uterus w/ dilated cervix, and pelvic ultrasound showing retained parts of conception, thick endometrial stripe

A

septic abortion

380
Q

what are the 3 things to manage septic abortion

A

IV fluids
broad-spectrum Abx
suction curettage

381
Q

what should you do after dx and removal (suction curettage) of hydatidiform mole

A

serial beta-hCG monitoring to ensure it’s decreasing/undetectable for at least 6 months
–this also means contraception for 6 months so a pregnancy does not interfere with beta-hCG levels

you need to monitor the pt because they’re at risk for gestational trophoblastic neoplasia

382
Q

what is the term for the longitudinal axis of the fetus is perpendicular to the longitudinal axis of the uterus

A

transverse lie

–can be either back up (with the spine toward the maternal head) or back down (with the spine toward the cervix)

383
Q

what is the management of a transverse lie

A

it’s typically transient prior to term

  • -most fetuses spontaneously convert to breech or vertex presentation
  • -ultrasound at 37 weeks to determine delivery management
384
Q

how close does the placenta have to be to the cervical os to be considered placenta previa

A

<2 cm from the cervical os

> 2cm from the cervical os is not considered placenta previa and does not require Cesarean delivery

385
Q

what is dx in postpartum pt with difficulty ambulating, radiating suprapubic pain, pubic symphysis tenderness, and intact neuro exam with a traumatic delivery

A

pubic symphysis diastasis

386
Q

what is management for pubic symphysis diastasis

A

conservative:
NSAIDs
physical therapy
pelvic support

–most pts recover within 4 weeks postpartum

387
Q

what is dx in pt with adhesions and powder-burn lesions/nodules

A

endometriosis (AKA “chocolate cysts”)

388
Q

what is management of asymptomatic vs symptomatic endometriosis (incidental finding)

A

asymptomatic:
observation

symptomatic:

  • -conservative management includes NSADs, OCPs, a progesterone IUD
  • -definitive tx includes surgical resection and hysterectomy with oophorectomy
389
Q

what is MOA of leuprolide

A

GnRH agonist

  • -suppresses estrogen stimulation of endometrial tissue
  • -poorly tolerated due to menopausal symptoms
390
Q

what is dx in pt with amenorrhea, diffuse abdominal pain, and hemodynamic instability, possible bleeding

A

ruptured ectopic pregnancy

391
Q

what symptoms accompany blood in abdomen and pelvis (ex ruptured ectopic pregnancy)

A

syncope, hypotension, tatty

irritation of nearby structures:

  • -diffuse abdominal pain
  • -cervical motion tenderness
  • -shoulder pain (referred from diaphragm)
  • -urge to defecate (blood in posterior cul-de-sac)
392
Q

what 5 conditions can minors (<18yo) be medically emancipated for

A

emergency care

STD

substance abuse (most states)

pregnancy care (most states)

contraception

393
Q

what are 4 first-line, 2 second-line, and 5 contraindicated antihypertensives in pregnancy

A

First line (safe):

  • -methyldopa (alpha-2 agonist)
  • -beta blocker (labetalol)
  • -Hydralazine (arterial vasodilator)
  • -CCB (nifedipine)

Second line:

  • -Thiazide diuretics
  • -Clonidine

Contraindicated:

  • -ACE inhibitors
  • -ARBs
  • -Aldosterone blockers
  • -Direct renin inhibitors
  • -Furosemide
394
Q

describe the contractions in a false labor vs latent labor in terms of timing, strength, pain, and cervical change

A

false labor:

  • -irregular, infrequent timing
  • -weak strength
  • -no/mild pain
  • -no cervical change

latent labor:

  • -regular, increasing frequency timing
  • -increasing intensity strength
  • -painful
  • -cervical change
395
Q

what is dx in pt postpartum (mole, normal pregnancy, or spontaneous abortion) with enlarged uterus, irregular vaginal bleeding, pulmonary symptoms, and multiple pulmonary infiltrates on CXR

A

choriocarcinoma

  • -metastatic form of gestational trophoblastic neoplasia
  • -dx confirmed w/ elevated beta-hCG
396
Q

what is dx in pt with rapid cessation of breastfeeding, bilateral fullness and tenderness, no erythema, and afebrile

A

engorgement

–milk production exceeds release

397
Q

how do you manage a pt’s desire for lactation suppression 2/2 engorgement

A

NSAIDs, supportive bra, avoid nipple stimulation/manipulation, and ice packs

–Dopamine agonists (bromocriptine) inhibits prolactin secretion from anterior pituitary to suppress lactation, but is no longer approved by the USFDA for lactation suppression due to side effects

398
Q

what is dx in pt with recurrent pregnancy loss, prior TIA

A

thrombophilia/hypercoagulability

–Antiphospholipid syndrome is an autoimmune disorder that presents w/ pregnancy complications or VTE/arterial thrombosis due to membrane antiphospholipid antibodies

399
Q

what is the next step in management after pt presents with signs/symptoms of ectopic pregnancy

A

dx is made by a positive pregnancy test and transvaginal ultrasound showing the gestational sac at an ectopic site

400
Q

when do you use laparoscopy vs laparotomy

A

laparoscopy:
gold standard tx for ruptured ectopic pregnancy which presents with diffuse abdominal pain and eventually hemodynamic instability

laparotomy:
may be considered in pts with acute bleeding

401
Q

what is the first-line treatment for Candida vaginitis

A 
oral azole (fluconazole)
--intravaginal agents are equally efficacious, but pts prefer oral over intravaginal

(oral nystatin is only used for oral candidiasis; intravaginal nystatin would treat Candida vaginitis though)

402
Q

what is the best way to diagnose uterine fibroids

A

ultrasound of pelvis

403
Q

what is best management for uterine procidentia (a form of pelvic organ prolapse) in a poor surgical candidate

404
Q

what are 3 causes of hyperandrogegism in pregnancy

A

luteoma

theca luteum cyst

Krukenberg tumro

405
Q

what is dx in pregnant pt wth hyerandrogenism, bilateral solid ovarian masses on ultrasound, and metastasis from primary GI tract cancer; fetal virilization risk?

A

Krukenberg tumor

–high fetal virilization risk

406
Q

what is dx in pregnant pt with hyperandrogegism, bilateral solid ovarian cysts on ultrasound; associated with molar pregnancy and multiple gestation; and regress spontaneously after delivery; fetal virilization risk?

A

Theca luteum cyst

–low fetal virilization risk

407
Q

what is dx in pregnant pt with hyperandrogegism, yellow-yellow/brown masses (often w/ areas of hemorrhage) of large lutein cells; solid ovarian masses on ultrasound (50% bilateral); and regress spontaneously after delivery; fetal virilization risk?

A

Luteoma

–high fetal virilization risk

408
Q

what is proper tx for asymptomatic pt who tests positive for chlamydia but negative for gonorrhea using nucleic acid amplification testing?
gonorrhea only?

A

Chlamydia only:
Azithromycin only

Gonorrhea only:
Azithromycin + ceftriaxone

409
Q

how should a pt deliver if they have a history of a classical Cesarean delivery or extensive myomectomy for leiomyoma removal

A

delivery requires laparotomy and delivery

–labor and vaginal delivery are contraindicated due to significant risk of uterine rupture

410
Q

what is dx in pt with decreased urethral sphincter tone; urethral hypermobility

A

stress incontinence

411
Q

what is dx in pt with detrusor hyperactivity

A

urge incontinence

412
Q

what is dx in pt with impaired detrusor contractility (bladder atony); bladder outlet obstruction

A

overflow incontinence

413
Q 
distinguish between vaginal squamous cell carcinoma vs clear cell adenocarcinoma with:
epidemiology
risk factors
location 
clinical features
dx
A

Squamous cell:

  • ->60yo
  • -Risk factors: HPV 16 or 18; h/o cervical dysplasia or cancer; smoking
  • -Located: upper 1/3 of posterior vaginal wall

Clear cell adenocarcinoma:

  • -<20yo
  • -Risk factors: in utero exposure to diethylstilbestrol
  • -LocateD: upper 1/3 of anterior vaginal wall

clinical features are the same:

  • -malodorous vaginal discharge
  • -postmenopausal or postcoital vaginal bleeding
  • -irregular mass, plaque, or ulcer in vagina

Dx:
–biopsy

414
Q

what is the rule for pregnant women making decisions for their unborn children

A

a woman who has mental capacity has the right to refuse treatment, even if it places her unborn child at risk
–maternal autonomy supersedes the rights of the unborn child while it is still physically attached to her

415
Q

what is the best way to evaluate proteinuria when testing for preeclampsia

A

urine protein-to-creatinine ratio or a 24-hour urine collection for total protein (gold standard)

416
Q

what is dx in pt with ultrasound findings of a solid mass with thick sepations, ascites/peritoneal fluid

A

epithelial ovarian carcinoma

–presents with bloating and pelvic pain

417
Q

what is dx in pt with confusion/encephalopathy, ataxia, and horizontal nystagmus and bilateral abducens palsy

A

Wernicke Encephalopathy

418
Q

what is the etiology and 3 associated conditions of wernicke encephalopathy

A

Thiamine deficiency

chronic alcoholism (most common)
malnutrition (anorexia nervosa)
Hyperemesis gravidarum

419
Q

what is dx in pt with hyperemesis gravidarum, enlarged uterus, and bilaterally enlarged ovaries

A

complete hydatidiform mole, a type of gestational trophoblastic disease

420
Q

what causes the enlarged ovaries in a hydatidiform mole

A

the gestation is composed of proliferative trophoblastic tissue that secretes high levels of beta-hCG

the markedly elevated beta-hCG levels cause hyper stimulation of the ovaries and formation of theca lutein cysts, which are large, bilateral, multilocular ovarian cysts

421
Q

what is dx in pt with pharyngitis with fever and lower abdominal pain in a young, sexually active female

A

gonococcal pharyngitis with PID
–Neisseria gonorrhea is common STD that can cause cervicitis leading to PID; and pharyngitis occurs during urogenital contact

422
Q

what is dx in newborn with large anterior fontanel, thin umbilical cord, loose skin, and minimal subcutaneous fat

A

fetal growth restriction

423
Q

what evaluation step is included when a growth-restricted fetus is born

A

evaluation includes histopathologic examination of the placenta to asses for infection and/or infarction

424
Q

what dx should you consider/suspect in a pt with recurrent candidiasis in an otherwise “normal” pt

A

diabetes mellitus

–candidiasis risk factors are DM, immunosuppression, and Abx

425
Q

what is dx in pt with a pregnancy loss at <20 weeks gestation prior to expulsion of products of conception; typically asymptomatic, or light vaginal bleeding; findings of closed cervix, decreasing beta-hCG; no fetal cardiac activity or empty sac

A

missed abortion

426
Q

what is dx in pregnant pt with pain, bleeding, dilated cervix, and passage of some products of conception and some remain

A

incomplete abortion

427
Q

what is dx in pregnant pt with vaginal bleeding, closed cervical os, and fetal cardiac activity

A

threatened abortion

428
Q

what is dx in pregnant pt with vaginal bleeding, dilated cervical os, products of conception may be seen or felt at/above cervical os

A

inevitable abortion

429
Q

what is surgical removal of uterine fibroids called

A

myomectomy

430
Q

how do you manage epithelial ovarian carcinoma

A

exploratory laparotomy and resection of cancer with inspection of entire abdominal cavity

–a biopsy of the pelvic mass is contraindicated due to risk of spreading cancerous cells throughout the abdomen

431
Q

what is smoking a cancer risk factor for

A

cervical cancer

432
Q

what is dx in shoulder dystocia pt with:
clavicular crepitus/bony irregularity
decreased Moro reflex due to pain on affected side
intact biceps and grasp reflexes

A

Fractured clavicle

433
Q

upper-arm crepitus/bony irregularity
decreased Moro reflex due to pain on affected side
intact biceps and grasp reflexes

A

Fractured humerus

434
Q

decreased Moro and biceps reflexes on affected side
“waiter’s tip” w/ extended elbow, pronated forearm, and fleeced wrist and fingers
intact grasp reflex

A

Erg-Duchenne palsy

damage to nerves C5-C6

435
Q

“claw hand” with extended wrist, hyperextended metacarpophalangeal joints, flexed interphalangeal joints, and absent grasp reflex
Ipsilateral Horner syndrome (ptosis, miosis)
intact Moro and biceps reflexes

A

Klumpke palsy

damage to nerves C8 and T1 (hand paralysis and IL Horner syndrome)

436
Q

variable presentation depending on duration of hypoxia
altered mental status (irritability, lethargy)
respiratory or feeding difficulties
poor tone
seizure

A

perinatal asphyxia

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