Ob/Gyn UWorld Flashcards
what should you be concerned about in a baby with shoulder dystocia
clavicular fractures may result in C8-T1 brachial plexus injury that may result in Horner syndrome, Erb-Duchenne palsy, or Klumpke palsy
-usually resolve spontaneously
cystocele
rectocele
enterocele
apical prolapse
bladder prolapse
rectum prolapse
small intestine prolapse
uterus or vaginal valt prolapse
what can cause sharp groin pain in a pregnant woman
round ligament pain
what increases risk of uterine rupture the most during pregnancy/labor
past uterine surgeries (like a classical/vertical c-section or a uterine myomectomy)
-if these pts are giving birth again do a laparotomy and delivery
what do amphetamines do to a baby in utero
fetal growth restriction
second line to oxytocin (ptosin) in a pt with postpartum hemorrhage and why would each of these be contraindicated
Methylergonovine (contraindicated in hypertension)
Carboprost (contraindicated in asthma)
risks of combined OCPs
- venous thromboembolism
- hypertension
- hepatic adenoma
- stroke/MI (both rare)
- cervical cancer
pt with breast dimpling, peau d’orange, edematous, erythematous, and painful breast with nipple flattening/retraction
inflammatory breast carcinoma
-if pt also has axillary lymphadenopathy you can assume its likely spread
unilateral bloody nipple discharge
intraductal papilloma
management of intrauterine fetal demise
20-23 weeks –> dilation and evacuation OR vaginal delivery
24+ weeks –> vaginal delivery (induce labor)
*Note: retention of the fetus for several weeks can lead to coagulopathy in the mom
cervical insufficiency and whatre the risk factors
painless dilation of the cervix that can lead to second trimester pregnancy loss
risk factors
- cervical conization or LEEP
- mechanical cervical dilation
- obstetric cervical laceration
- uterine anomalies
modifiable breast cancer risk factors
hormone replacement therapy
nulliparity
increased age at first live birth
alcohol consumption
lifetime risk of breast cancer for every woman
1/8
melasma
- acquired hyperpigmentation disorder that commonly occurs during pregnancy
- usually involves sun-exposed areas on the face
- diagnosed clinically and resolves postpartum
- tell pt to avoid sun exposure and use sunscreen
what is a major contraindication of any estrogen containing contraceptives
hypertension
what to lookout for when given pap smear data on a postmenopausal woman
endometrial cells seen after the age of 45 is an abnormal finding (this is normal on women less than 45yo)
- endometrial shedding may be due to endometrial hyperplasia/cancer
- do endometrial biopsy if this finding is seen
intermenstrual spotting without uterine enlargement (no prolonged menses)
endometrial polyps
pt seems like a girl then during puberty is more like a boy and you find clitoromegaly and bilateral labial masses
5-alpha reductase deficiency
-virilization during puberty due to increased levels of testosterone
how does androgen insensitivity present
normal female with no uterus or fallopian tubes, rudimentary vagina
–possibly with bilateral labial masses
patient postop from hysterectomy with unilateral nonradiating costovertebral angle pain, nausea, and vomiting
-normal renal function
hydronephrosis from ureteral injury during surgery
steps in dealing with a uterine inversion
- manual replacement of the uterus
- placental removal
- administer uterotonics
what is a leiomyoma
proliferation of smooth muscle cells within myometrium
what is the acid-base normal for a pregnant woman
respiratory alkalosis
what is a main cause of stress incontinence
weak pelvic floor muscles
-urethral hypermobility and reduced bladder support
delivery in pts with HIV
if they consistently take their meds and have a viral load less than 1000 you can do normal expectant management and delivery without any additional drugs
if they are inconsistent with meds and have a viral load more than 1000 you want to administer intrapartum zidovudine and do a c-section
Patient with colicky pain with an ultrasound seeing an ovarian cyst with calcifications and hyperechoic nodules
Mature dermoid cyst
how to manage a pt with a history of preterm birth
- intramuscular progesterone during the second and third trimesters
- cervical length measurements by transvaginal ultrasound during the second trimester
- cerlage placed if cervix is short
pagets disease of breast
extension of underlying DCIS/invasive breast cancer up the lactiferous ducts and into the contiguous skin of nipple –> eczematous patches over nipple and areolar skin
usually associated with intraepithelial adenocarcinoma cells
how to treat neonatal thyrotoxicosis
- maternal antibodies self-resolve in 3 months
- methimazole PLUS beta-blocker
ABO incompatibility b/w mother and baby
usually mother is O and baby is A or B
-affected infants are usually asymptomatic at birth or have mild anemia and may develop neonatal jaundice that typically responds to phototherapy
hemophilia A, B, and C… what are they and what are the inheritance patterns
A: factor 8 deficiency, X-linked recessive
B: factor 9 deficiency, X-linked recessive
C: factor 11 deficiency, autosomal recessive
fetal complications from preeclampsia
oligohydramnios and fetal growth restriction/small for gestational age infants due to chronic uteroplacental insufficiency
you see an ovarian torsion… WHAT DO YOU THINK
cystic teratoma (dermoid cyst)
pt has a cystic teratoma (dermoid cyst)… whatre you worried about
ovarian torsion
young pt with little prenatal care and long course of labor/obstructed labor is likely to experience what complication (especially in areas with limited resources)
vesicovaginal fistula
- continuous watery vaginal discharge
- area of raised red granulation tissue on the anterior vaginal wall
- higher pH of vagina
- diagnose via pelvic exam and bladder dye test
- treat with surgical repair
management of a shoulder dystocia
BE CALM
Breathe, do not push
Elevate legs, flex hips and thighs against abdomen (McRobers)
Call for help
Apply suprapubic pressure
enLarge vaginal opening with episiotomy
Maneuvers
diagnosis and treatment of ashermanns syndrome
formation of intrauterine adhesions (pt wont bleed during the progesterone challenge)
-hysteroscopy is used which can lyse the adhesions
maternal complications of placental abruption
hypovolemic shock
DIC
postcoital bleeding and thick mucopurulent discharge with a friable cervix
what is it and what do you do
acute cervicitis and you can give empiric treatment with azithromycin and ceftriaxone
crunching sound with breathing and retrosternal chest pain that radiates to the back after throwing up a ton
esophageal perforation/rupture (boerhaave syndrome)
nonspecfic symptoms of sti with vaginal pH of 3.8-4.5
candida
note: they dont have to say white cottage cheese discharge
HELLP syndrome is due to what
abnormal placentation triggering systemic inflammation and activation of the coagulation system and complement cascade
- platelets rapidly consumed
- MAHA
- hepatocellular necrosis (abdominal pain due to liver swelling with distension of the hepatic Glissons capsule)
sheehan syndrome
postpartum ischemic necrosis of anterior pituitary
PRESENTS WITH
-lactation failure (prolactin deficiency)
-hypotension
-anorexia (secondary adrenal insufficiency)
pt with sexually risky behavior (possible PID) presents with fever, abdominal pain, high white count, complex multiloculated adnexal mass with thick walls and internal debris on ultrasound
tubo-ovarian abscess
bilateral milky/green/brown//yellow/gray non-bloody nipple discharge
physiologic galactorrhea
- most common cause is hyperprolactinemia
- to work this up you should get a pregnancy test, measure prolactin and TSH, and get a possible MRI of the brain
multiparous woman in her 40s with…
- new onset dysmenorrhea
- symmetrically enlarged (globar) uterus thats boggy and tender but is smaller than 12 weeks in size
- heavy menstrual bleeding
adenomyosis
intrauterine fetal demise associated with growth restriction, bent limbs/limb deformities, hypoplastic thoracic cavity…
type II osteogenesis imperfecta
pseudocyesis
condition with nonpsychotic ladies that think they are pregnant and have all the signs except they are definitely not pregnant
what do you think of when you see a sinusoidal fetal tracing
fetal anemia
define and list the complications of oligohydramnios vs polyhydramnios
oligohydramnios (AFI< 5)
-meconium aspiration
-preterm delivery
umbilical cord compression
polyhydramnios (AFI > 24)
- fetal malposition
- umbilical cord prolapse
- preterm labor
- PPROM
vulvar irritation, intermittent bleeding, unifocal/friable mass commonly located on the labia majora
vulvar squamous cell carcinoma
patient with abnormal vaginal bleeding and hyperthyroidism
hydatidiform mole
list the three features of vasa previa
membrane rupture
painless vaginal bleeding
fetal bradycardia
pt with previous pelvic surgery has fever unresponsive to antibiotics, no localizing signs/symptoms, and a negative infectious evaluation
septic pelvic thrombophlebitis
-treat with anticoagulation and broad spectrum antibiotics
cholangitis
ascending infection due to biliary obstruction
-fever, jaundice, RUQ pain (charcot triad)
this + hypotension and altered mental status = reynolds pentad
how to manage a pregnant pt with HSV
antiviral prophylaxis from 36 weeks gestation until delivery to decrease risk of active lesions
- if no active lesions then vaginal delivery is ok
- if pt has active lesions then give them a c-section
Multiple glazed erythematous vulvar erosions bordered by white striae, vaginal and oral lesions
Lichen planus
Treat with topical corticosteroids
pregnant pt presents with RUQ pain, leukocytosis, and mildly elevated liver enzymes, profound hypoglycemia
acute fatty liver of pregnancy
-manage with immediate delivery
how to manage a pt with PPROM
before 34 weeks do expectant management with prophylactic antibiotics, corticosteroids, and inpatient monitoring
at or after 34 weeks deliver the baby (or sooner if there are complications)
encephalopathy, oculomotor dysfunction, and gait ataxia in a pregnant patient
wernicke encephalopathy is a complication of hyperemesis gravidarum that results from thiamine deficiency
unilateral nipple discharge
intraductal papilloma (benign)
when a pt with hypothyroidism gets pregnant what do you do to their levothyroxine dose
increase the dose when they get pregnant
newborn with thin cerebral cortices and multiple intracranial calcifications
congenital zika
patient just gave birth to a macrosomic baby and a day or so later is having trouble ambulating, radiating suprapubic pain, pubic symphysis tenderness, and an intact neurological exam
-symptoms get worse with walking
pubic symphysis diastasis
-conservative management with NSAIDs, physical therapy, and pelvic support
pregnant woman suddenly gets shortness of breath, atrial fibrillation, pulmonary edema, and pulmonary congestion… what is this
rheumatic mitral stenosis
biggest risk factor for vaginal cancer (squamous cell metaplastic changes)
age >60
HPV infection
tobacco use
in utero DES exposure (clear cell adenocarcinoma only)
super heavy periods in woman in her 40s + boggy uterus
adenomyosis leads to symmetrically enlarged uterus
brenner tumor
benign epithelial ovarian tumor in asymptomatic woman
what levels will be high in a pt with an embryonal carcinoma
alpha-fetoprotein
hCG
how does a yolk sac tumor present
- young woman with high alpha-fetoprotein
- grow rapidly
- acute onset pelvic pain
large ovarian tumor in woman with post menopausal bleeding
granulosa cell tumor
single most important risk factor for pts with placental abruption
hypertension
if a patient has endometrial adenocarcinoma what are the two biggest risk factors and whats the basis of both of them
unopposed estrogen!!!
- obesity
- chronic anovulation
postpartum urinary retention
inability to void >6hrs after vaginal delivery
bladder atony –> usually causes an overdistended bladder
pudendal nerve injury –> you will see a perineal laceration
physiologic leukorrhea
white odorless mucoid cervical discharge that typically occurs midcycle due to increasing estrogen levels prior to ovulation
-lots of discharge and squamous cells/leukocytes seen
complications of a short pregnancy interval
maternal anemia
PPROM
preterm delivery
low birth weight
mittelschmerz
physiologic cause of unilateral abdominal pain in young women
-usually occurs in the middle of a womans cycle around the time of ovulation
what is apt testing and why would it be done
most commonly used testing in cases of vaginal bleeding late during pregnancy (antepartum hemorrhage) to determine if bleeding is from mother or fetus
-positive = fetal blood (think vasa previa)
how to treat magnesium toxicity
stop magnesium and give IV calcium gluconate bolus (reverses neuromuscular paralysis, stabilizes cardiac membranes, and prevents cardiac arrest)
OB question that mentions mid-epigastric pain. what do yo think of
that suggests fundal placenta
why are cocaine and tobacco bad in pregnancy
they are potent vasoconstrictors that readily cross the placenta and cause placental vasoconstriction and ischemia
first line treatment for migraine prevention in pregnant ladies
beta-blockers
-propranolol or metoprolol
how to treat pyelo in pregnancy
inpatient abx cause of the severe maternal and fetal complications
-empiric ceftriaxone
delusional disorder
delusions lasting >1 month in the absence of other psychotic or mood symptoms
how to treat a labial adhesion (fused labia minora)
first-line: topical estrogen cream for symptomatic lesions
-usually on prepubertal girls due to low estrogen production
what is the most serious complication of pregnant pts with lupus or sojgrens
fetal AV block
-due to passive placental transfer of anti-SSA and SSB antibodies
how does AV block look on fetal hr tracing
fetal bradycardia
how to deal with pts with ruptured ovarian cyst
hemodynamically stable- observe and reassure
hemodynamically unstable- may have continued bleeding so surgical intervention
dysuria and sterile pyuria
chlamydia trachomatis urethritis
pt has sickle cell and shes pregnant… what do you think of
possible risk of uteroplacental insufficiency
woman gets hyperthyroid within 1 year of having a baby
postpartum thyroiditis
- painless autoimmune thyroiditis
- hyperthyroid pt with low uptake on radioactive iodine uptake scan
