Ob/Gyn - UWorld Flashcards
What should be avoided in patients with placental previa?
Coitus and requires pelvic rest
What is the cause of post epidural HoTN?
Vasodilation and venous pooling
How can you diagnose ovarian torsion?
Large edemamotous ovaries with decreases blood flow on ultrasound and Doppler velicometry studies
Complications from HTN during pregnancy?
Preterm labor and placental dysfunction
What is the most common cause of post partum hemorrhage?
Uterine Atony, resulting in decreased expulsion of contents and decreased myometrial contractions which leads to continued bleeding
What leads to the highest risk for clear cell adenocarcinoma of the vagina?
DES exposure in utero
What is the best first trimester test to rule out Down syndrome in pregnant. older women?
Cell free fetal DNA
Diagnostic criteria for preeclampsia?
New onset HTN at >20 wk gestation AND proteinuria (prot/cr ratio >=0.3) OR s/s of end organ damage
When should anti-HTN meds be given in PreE?
BP > or = 160/110
What are the risks of OCP therapy?
Venous thromboembolism, HTN, Hepatic adenoma, Rarely - stroke/MI
What is the appearance and progression of a syphilitic chancre?
Painless papule at site of inoculation -> ulceration occurs forming chancre (punched out base, raised indurated margins)
Which pathological marker in breast adenocarcinoma is most important for future management?
Oncogene amplication by FISH to identify HER2 overexpression
What should be done for a laboring patient with ROM whose preterm fetus shows bilateral renal agenesis?
Allow normal delivery because fetus will not be compatible with life (associated pulmonary hypoplasia)
What are late term and post term pregnancies at risk for?
Uteroplacental insufficiency
Which premenopausal patients with abnormal uterine bleeding require endometrial biopsy?
Any age >45, those with cancer risk factors like diabetes, obesity, unopposed estrogen tx, PCOS
What is the most effective post coital contraceptive?
Copper IUD (but make sure no PID hx)
What is eczematous rash on the breast suggestive of?
Mammary Paget’s disease, which is often associated with underlying adenocarcinoma
What are the features of aromatase deficiency?
Normal internal genitalia, ambiguous external genitalia, clitoral hyper trophy, high FSH/LH ratio and low estrogen
What is Klumpke’s palsy?
Complication of shoulder dystocia resulting from excessive traction on C8 and T1
Can cause claw hand, hand paralysis, and horner’s syndrome
What is the treatment of intramniotic infection?
Oxytocin to hasten delivery and antipyretics to control maternal fever
What is the treatment of intramniotic infection?
Oxytocin to hasten delivery and antipyretics to control maternal fever
What is the main role of beta hCG in pregnancy?
Maintains the corpus luteum to preserve progesterone secretion until placenta can produce on its own.
What provides the best coverage for polymicrobial infections like endometritis?
Clindamycin and gentamicin
When should all women have oral glucose tolerance test?
24-28 weeks, earlier if risk factors present
What should be done in postpartum patients who are unable to voide urine after a few attempts at intermittent catheterization?
Insert indwelling catheter to to decompress bladder and regain detrusor muscle function
What may be the cause of anovulation in a woman with normal LH/FSH levels?
morbid obesity
What is the effect of premature ovarian failure on LH and FSH levels?
Elevated levels with FSH >40 and LH > 25
What are the 3 key features of endometriosis?
3 D’s - dyspareunia, dysmenorrhia, and dyschezia
What are risk factors to ovarian torsion?
pregnancy, ovulation induction, ovarian masses (especially >=5 cm
What causes late deceleration in FHR?
Uteroplacental insufficiency
What is the cause of recurrent variable decelerations and what should be done?
LIkely cord compression, but now severe and can cause acidemia, reposition mother to left lateral side to relieve compression
Amnioinfusion if it persists
What is pseudocyesis?
psychiatric condition form of conversion disorder where women with great desire to be pregnant develop s/s of pregnancy -> breast fullness, amenorrhea, tympanic abdomen, amenorrhea (but negative bhcg and ultrasound
What is the risk for a child with O+ mother and Ab+ dad?
Child will be either A or B, likely will have mild hemolytic disease of newborn –> neonatal jaundice, which will recover with phototherapy
What are luteomas? What should be done?
benign condition mostly in AA women, which may cause hirsituism and acne
monitor for fetal virilization
What is lochia rubra? What may appear along with this?
Normal bleeding postpartum, patient may have high WBCs and low grade fever
reassure and monitor
What are the most common causes of secondary anemia? How do you check?
Pregnancy, beta-hcg
Hyperprolactinemia, prolactin
Thyroid abnl, TSH
Premature ovarian failure, FSH
What is the treatment of candida vaginitis?
Fluconazole
What is the gold standard for checking for cervical insufficiency?
Transvaginal ultrasound
What are contraindications to tamoxifen or raloxifene?
Venous thromboembolism and hot flashes
Endo and ovary cancer with tamox
How can you differentiate placenta previa from abruption?
Previa is usually painless bleeding
Abruption has rigid distended uterus and painful contractions
What are the maternal and fetal complications of placental abruption?
Mom - DIC and hypovolemic shock
Baby - hypoxia and preterm delivery
What is the preferred contraception in women with breast cancer?
Copper IUD, OCPs may cause breast tissue proliferation
What is the gold standard for checking for cervical insufficiency?
Transvaginal ultrasound
What should be done for breech presentation at 34 weeks?
Reassurance and followup, most self correct after 37 weeks, external cephalic version should be attempted only after this time
What is the most common cause of postpartum hemorrhage?
Uterine atony
When is the best time to measure prolactin levels?
During fasting to ensure accuracy (postpartum may have elevated prolactin up to 2 years)
What is septic thrombophlebitis in pregnancy?
postoperative thrombi in pelvic venous system, leading to infection
treat with IV abx and heparin anticoagulation
What is ruptured membranes and tender fundus of uterus indicative of?
Chorioamnionitis
What is the biggest fetal risk in mom’s with type 1 insulin dependent diabetes?
Spontaneous abortion, congenital anomalies, and fetal growth restriction
What is the cause of urge incontinence and what are the symptoms?
overactivity of the detrusor muscle -> uninhibited contractions -> increased bladder pressure over urethral pressure -> urine leakage
urinary incontinence, urgency, nocturia
What are the symptoms of candidiasis of the nipple?
Severe discomfort and pain, pink/shiny nipples with peeling at periphery
What are the s/s of acute salpingitis?
lower abdominal pain, adnexal tenderness, fever, cervical motion tenderness, and vaginal discharge
What puts patients at risk for placenta accreta?
Multiple prior C-sxns
What is pelvic congestion syndrome?
chronic pelvic pain (fullness/heaviness radiating down) occurring in the setting of pelvic varicosities
What should be done if frank blood and fluid is seen coming from the cervical os after placement of IUPC?
withdraw, monitor fetal/maternal vital signs, if FHT reassuring re-attempt placement of IUPC
Which patient’s are at the highest risk for maternal mortality during pregnancy?
pulmonary hypertension (25-50%) - and other cardiopulmonary disease
What should be done for category 3 FHT?
emergent cesarean delivery
What are the potential causes of elevated maternal serum AFP levels?
under-estimation of gestational age, fetal demise, multiple gestation, ventral wall defects and a tumor or liver disease in the patient, and in 5-10% of cases-> Neural tube defects
What finding on aspiration of breast mass necessitates excisional biopsy?
bloody fluid
What does irregular menses and hirsituism (of short duration) with elevated testosterone and significantly elevated DHEAS suggest?
Adrenal tumor
What is the optimal mode of delivery for twins when one is in breech presentation?
c-section
When is the best time to take herpes cultures and why?
Take early in the course, false negative rate can be 10-20% (poor sensitivity)
What is the most effective therapy for hot flashes?
estrogen
What is the preferred management for IUGR at 36 weeks gestation with oligohydramnios and abnormal umbilical artery Doppler studies?
induction of labor
What can occur from treatment with imipramine in women?
hyperprolactinemia
What uterotonic agent should be withheld in women with chronic HTN or preeclampsia/
Methylergonovine which is a potent smooth muscle vasoconstrictor
Patients taking tamoxifen therapy are at greatest risk for developing what? What risk may it decrease?
Hot flashes
decreased risk for ovarian ca
What is the typical presentation for adenomyosis?
Multiparous woman >40 with dysmenorrhea, menorrhagia, and progressive chornic pelvic pain
exam: boggy, tender, uniformly enlarged uterus
What are indications for penicillin ppx in women with missed/unknown GBS screening?
18hrs
What are s/s of neonatal thyrotoxicosis and how may it occur?
warm/moist skin, tachycardia, poor feeding, irritability, low birth weight or preterm
transplacental transfer of TSH-R abs
What should be checked in patients who are to receive adjuvant herceptin (trastuzumab) therapy for breast cancer?
Echocardiography, as combo of Herceptin+chemo can cause cardiac toxicity
Irregularly enlarged uterus with heavy menstrual bleeding?
FIBROIDS
What are the fetal signs indicating uterine rupture?
loss of fetal station (effaced and dilated, but no fetal parts), fetal heart deccelerations,
What is the usual cause of fetomaternal hemorrhage, and what are the associated s/s?
May occur after trauma
decreased fetal movement, sinusoidal FHT, and hydrops
When should oxytocin not be administered in a laboring woman?
When adequate contractions are present, as additional oxy may cause tachysystole
What is the effect of pregnancy on free T4?
Increases free t4
What is the management of lactational mastitis?
Administer PO Abx and continue breastfeeding
What are the signs and symptoms of uterine rupture? How can you differentiate from abruption?
Sudden vag bleeding, constant abd pain, cessation of contractions, loss of station and fetal deterioration
Abruption has frequent uterine contractions, hypertonicity, and tachysystole
