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OB Shelf Flashcards

1
Q

What are the screening recommendations for chlamydia?

A
  1. All sexually active non-pregnant women aged 24 and younger, or >25 if high risk
  2. All pregnant women aged 24 and younger, and >25 if high risk
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2
Q

What are the risk factors for chlamydial infection?

A
  • Hx of chlamydial or other STIs
  • New or multiple sex partners
  • Inconsistent condom use
  • Exchanging sex for money or drugs
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3
Q

What is Goodells sign?

A

Softening of the cervix during pregnancy

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4
Q

What is Hegars sign?

A

Softening of the uterus during pregnancy

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5
Q

What is Chadwicks sign?

A

bluish purple hue in the cervix and vaginal walls during pregnancy
- caused by hyperemia

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6
Q

How do you date pregnancies?

A

Naegle’s Rule:
minus 3 months, plus 7 days!
so if LMP was Sept 25th, 9-3 = 6, June 25th, Add 7 days = July 2nd

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7
Q

Triad of interstitial cystitis??

A
  1. Urinary urgency
  2. Urinary frequency
  3. Chronic pelvic pain
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8
Q

In interstitial cystitis, what exacerbates the pelvic pain?

relieves it?

A
  1. Sexual intercourse
  2. Filling of the bladder
  3. Exercise
  4. Spicy foods
  5. Certain beverages
    Relieved via voiding of bladder
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9
Q

What does cystoscopy classically demonstrate in interstitial cystitis?

A

submucosal petechiae or ulcerations

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10
Q

What is the triad of pelvic inflammatory disease?

A
  1. Pelvic pain
  2. Cervical motion tenderness
  3. fever
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11
Q

What is the single most useful parameter for predicting fetal weight by ultrasonogram in suspected FGR?

A

Abdominal circumference

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12
Q

What is fetal growth restriction? Describe the 2 types

A

2 types: symmetrical and asymmetrical

  1. Symmetrical: insult to fetus <28wks gestation and growth of head and body is deficient
    - usually the result of genetic anomalies or TORCH infections
  2. Asymmetric: insult to fetus after 28wks, normal head size and reduced abdominal circumference
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13
Q

When is FGR suspected?

A

when fundal height is at least 3cm less than the actual gestation age in weeks

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14
Q

What measurement can be used to differentiate between symmetric and asymmetric FGR?

A

head to abdomen circumference

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15
Q

When are serum progesterone measurement taken to detect ovulation?

A

Mid-luteal phease

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16
Q

What are the symptoms of severe preeclampsia?

A
  1. HTN (160/110)
  2. Proteinuria (>5g on 24hr urine)
  3. Oliguria
  4. Pulmonary edema
  5. Thrombocytopenia
  6. Elevated liver enzymes
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17
Q

What is HELLP syndrome?

A

Hemolysis
Elevated liver enzymes
low platelets

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18
Q

What causes RUQ pain in preeclampsia?

A

hematoma formation and formation of thrombi in the portal capillary system can cause swelling of the liver with distention of he hepatic (Glissons) capsule

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19
Q

Pt with eclampsia is given what to prevent further seizures?

A

magnesium sulfate

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20
Q

what screening test is performed in all pregnant women, regardless of risk factors?

A

RPR!

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21
Q

What is the difference between mild and severe eclampsia?

A

Mild: HTN >140/90, proteinuria >0.3g/24hr after the 20th week gestation
Severe: HTN >160/110, proteinuria >5g/24hrs, oliguria, elevated liver enzymes, thrombocytopenia, and possibly Pulmonary edema

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22
Q

when is transient HTN seen in pregnancy?

A

second half of pregnancy or during labor and delivery

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23
Q

What is the tx for the HTN seen in preeclampsia and eclampsia?

A

Methyldopa: centrally acting alpha agonist

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24
Q

What is the ideal range of maternal fasting glucose?

A

75-90mg/dL

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25
Q

What is the tx for gestational diabetes?

A

subcutaneous insulin (doesnt cross the palcenta)

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26
Q

What are the risks to the fetus associated with gestational diabetes?

A
  1. Macrosomia
  2. Hypocalcemia (from PTH suppression)
  3. Hypoglycemia
  4. Hyperviscosity due to polycythemia
  5. Respiratory difficulties
  6. Cardiomyopathy
  7. CHF
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27
Q

What is the mechanism behind the polycythemia in infants of a diabetic mother?

A
  • fetal hypoxia due to increased BMR incuded by hyperglycemia
  • this causes increased EPO production by the fetus -> increased red blood cell mass and O2 capacity of the blood
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28
Q

What causes early decelerations?

A

Fetal head compression leading to a vagal response

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29
Q

What causes variable decelerations?

A

Umbilical cord compression

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30
Q

What causes late decelerations?

A

Uteroplacental insufficiency -> fetal hypoxia -> fetal acidosis

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31
Q

What is ERT affect on metabolism of thyroid hormones?

A
  • incraesed due to induction of P450
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32
Q

What are the symptoms of neonatal thyrotoxicosis?

A
  1. Goiter
  2. Tachypnea and tachycardia
  3. Cardiomegaly
  4. Restlessness
  5. Diarrhea
  6. Poor weight gain
    - all within 1-2 days following delivery
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33
Q

What causes neonatal thyrotoxicosis?

A
  • Moms with Graves disease- circulating levels of thyroid stimulating immunoglobulin (IgG autoantibodies) cross the placenta and cause thyrotoxicosis via stimulating the thyroid gland
  • these levels can remain high even months after a thyroidectomy in a mother
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34
Q

What is the definition for arrest of descent during labor?

A

a lack of change (of descent in fetal presenting part) in 2 hours for primigravid patients or 1 hour for multigravid patients
- an extra hour for descent is allowed if an epidural is in place

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35
Q

What are the 5 categories of an Apgar score?

A
  1. Color
  2. Pulse
  3. Respirations
  4. Grimace
  5. Tone
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36
Q

What are the different degrees of perineal lacerations?

A
  • First: involve the fourchette, perineal skin and vaginal mucosa but not the underlying gascia and muscle (skid mark)
  • Second: first degree + fascia and muscle but NOT the anal sphincter
  • Third: second degree + anal sphincter
  • Fourth: Extend through the rectal mucosa to expose the lumen of the rectum
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37
Q

What are the two types of episiotomy?

A
  1. Midline: the incision is made in the midline from the posterior fourchette, most common
  2. Mediolateral: the incision is oblique starting from 5/7oclock position of the vagina, causes more bleeding and pain
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38
Q

A midline episiotomy increases the risk for what?

A

fourth degree laceration

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39
Q

what is the most common cause of postpartum hemorrhage?

A

uterine atony

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40
Q

Postpartum Hemorrhage causes what?

A

the 4 t’s:

  1. Tissue: retained placenta
  2. Trauma: instrumentation, lacerations, episiotomy
  3. Tone: uterine atony
  4. Thrombin: coagulation defects, DIC
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41
Q

How often should vaginal exams be performed during labor?

A

Every 4 hours in latent phase

Every 2 hours in active phase

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42
Q

What is the definition of arrest of labor?

A

lack of cervical change in active first stage for >2 hr with >200 montevideo units of uterine activity

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43
Q

How do you calculate a montevideo unit?

A

calculated by an increase in uterine pressure above baseline multiplied by contraction frequency over 10 min

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44
Q

What is the definition of a reactive strip?

A

15beats/min above baseline lasting at least 15 seconds, 2 time twithin 20 minutes

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45
Q

What age gestation is a fetus expected to be non reactive?

A

<28 weeks

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46
Q

What is the cause of early decelerations?

A

normal!!! due to head compression, usually between 4-7cm dilation

  • due to vagal nerve activation
  • no intervention is necessary
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47
Q

What causes late decelerations?

A
  • abnormal
  • due to uteroplacental insufficiency (blood without enough oxygen) during contractions
  • can follow epidural or uterine hyperstimulation
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48
Q

What position optimizes Cardiac output and uterine blood flow?

A

left lateral recumbent position

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49
Q

How do you manage a pt with decelerations?

A 
STOP
Sterile vaginal exam
Turn the pt to her left
Oxygen
Pitocin OFF!!!
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50
Q

When should you consider immediate delivery in a patient with late decelerations?

A

if repetitive and there are no other reassuring findings present

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51
Q

What is the cause of variable decelerations?

A
  • abnormal

- due to cord compression (oligohydramnios or a nuchal cord)

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52
Q

what are the classifications of variable decelerations?

A
  1. Mild = lasts 70-80beats/min
  2. Moderate=lasts 30-60 sec and depth 60sec and depth = 70-80 bpm
  3. Severe = lasts >60sec and depth <70bpm
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53
Q

How does one manage variable decels?

A
  • Amnioinfusion: infuse normal saline, mostly severe variable decels
  • change maternal position to side/ trendelenburg position
  • plan delivery of fetus soon if worsening or non reassuring
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54
Q

What are 4 causes of prolonged decelerations?

A
  1. Cervical examinations
  2. Uterine hyperactivity
  3. Maternal hypotension leading to transient fetal hypoxia
  4. umbilical cord compression
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55
Q

How are prolonged decelerations treatment?

A
  1. Stop oxytocin and prostaglandins
  2. Change maternal position
  3. Administer IV fluids and vasopressors if mom is hypotensive
  4. Administer maternal O2
  5. Sterile vaginal exam to exclude cord prolapse, sudden cervical dilation, or fetal descent
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56
Q

What are the causes of fetal tachycardia?

A
  1. Fetal hypoxia
  2. Intrauterine infection
  3. Maternal fever
  4. Drugs
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57
Q

What is the definition of fetal tachycardia?

A

Baseline HR >160bpm for >10minutes

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58
Q

What is used as the intital screening test for GDM?

A

1 hour 50g oral glucose tolerance test (OGTT)

if >140mg/dL, perform a three hour 100g OGTT

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59
Q

How is gestational diabetes diagnosed?

A
  • if two or more of the serum glucose values obtained during the 3hr OGTT are elevated above:
    1. Fasting glucose >95mg/dL
    2. One hour glucose >180
    3. Two hour glucose >155
    4. Three hour glucose >140
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60
Q
  • intense abdominal pain assoc with vaginal bleeding
  • hypovolemic vital signs
  • retraction of presenting parts on pelvic exam
  • palpability of fetal extremities
A

Uterine rupture (can be due to trauma like car accident)

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61
Q

In what instances do you see an increased AFP level?

A
  1. Neural tube defect
  2. Abdominal wall defect (gastroschisis, omphacele)
  3. Multiple gestation
  4. Inaccurate getsational age** most common
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62
Q

With neural tube defects, what two levels will be increased on amniocentesis?

A
  1. AFP

2. Acetylcholinesterase`

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63
Q

Tx of bacterial vaginosis?

A

Metronidazole

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64
Q

Primigravid pt at 6wks gestation has syphillis, but penicillin allergy, how do you treat?

A

Penicillin desensitization!

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65
Q

When can steroids be used to accelerate fetal lung maturity?

A

between 24-34 weeks!

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66
Q

what is a normal amniotic fluid index?

A

> 5 and <25

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67
Q

What are the management steps of septic abortion?

A
  1. Cervical and blood cultures
  2. Antibiotics
  3. Gentle suction curettage
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68
Q

when can chorionic villus sampling be performed?

A

10-12weeks of gestation

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69
Q

when can amniocentesis be performed?

A

16-18 weeks gestation

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70
Q

What are some complications of pyelonephritis in pregnancy?

A
  1. Septicemia
  2. Preterm labor
  3. low birth weight babies
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71
Q

Tx of pyelonephritis in pregnant women?

A
  1. Amoxicillin
  2. Ampicillin
  3. Nitrofurantoin
  4. Cephalexin
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72
Q

What causes chorioamnionitis?

A
  1. PROM
  2. Intrauterine instrumentation
  3. Sexually transmitted diseases
  4. Prolonged labor
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73
Q

How do you distinguish between central precocious puberty and peripheral?

A

Central have pubertal levels of basal LH that increase with GnRH stimulation
- Peripheral have low LH levels with no response to GnRH

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74
Q

What is central precocious puberty?

A
  • idiopathic premature activation of the hypothalamic-pituitary gonadal axis
  • have pubertal levels of basal LH that increase with GnRH stimulation
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75
Q

What is the workup that all pts with central precocious puberty should have??

A

should have brain imaging to rule out any underlying CNS lesion!!

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76
Q

Tx of central precocious puberty?

A

GnRH agonist therapy in order to prevent premature epiphyseal plate fusion

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77
Q

What organism most likely causes a yellow mucupurulent discharge seen at the cervical os?

A

Chlamydia trachomatis

- mucupurulent cervicitis (50% are asymptomatic)

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78
Q

What are the serious side effects of OCPs?

A
  • breast cancer
  • cervical cancer
  • MI, stroke, venous thromboembolism
  • HTN
  • Diabetes
  • Elevation of triglyceride levels
  • cholestasis
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79
Q

OCPs are protective against what?

A
  • ovarian cysts and cancer
  • endometrial cancer
  • benign breast disease
  • dysmenorrhea (anemia)
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80
Q

Which antipsychotic can cause amenorrhea, galactorrhea etc.?

A

Risperidone: DA antagonist, increases prolactin levels

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81
Q

Why do women with rheumatic heart disease become more symptomatic in pregnancy?

A
  • they have mitral stenosis and because of the physiologically increased total blood volume
  • causes pulmonary edema and atrial fibrillation due to left atrial overload and enlargement
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82
Q

What is a pregnancy luteoma?

A

bilateral multinodular solid masses on both ovaries

  • onset during pregnancy
  • most commonly seen in AA multiparous women in their 30s or 40s
  • can cause hirsutism and virilization
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83
Q

tx of pregnancy luteoma?

A

reassurance and follow up with ultrasonogram

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84
Q

What are the causes of symmetric intrauterine growth restriction?

A

Fetal Factors:

  1. Chromosomal abnormalities
  2. Congenital anomalies
  3. Congenital infections (TORCH)
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85
Q

What are the causes of asymmetric intrauterine growth restriction?

A

Maternal factors:

  1. Maternal hypertension
  2. Preeclampsia
  3. Uterine anomalies
  4. Maternal antiphospholipid syndrome
  5. Collagen vascular disease
  6. Maternal cigarette smoking
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86
Q

What are the risk factors for endometritis?

A
  1. Prolonged ROM (>24hrs)
  2. Prolonged labor (>12 hours)
  3. Cesarean section
  4. Use of intrauterine pressure catheters or fetal scalp elecrodes
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87
Q

What is the most likely organism responsible for postpartum endometritis?

A

Polymicrobial infection

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88
Q

What is the most common cause of puerperal fever o the 2nd and 3rd day postpartum?

A

endometritis!!

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89
Q

What is the treatment for endometritis?

A

Clindamycin and gentamycin

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90
Q

Why are initial menstrual cycles in pubertal females irregular and often anovulatory?

A
  • insufficient gonadotropin secretion due to immaturity of the developing hypothalamic-pituitary-gonadal axis
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91
Q

What is the definitive treatment of HELLP syndrome?

A

delivery in women beyond 34 weeks gestation

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92
Q

What is Kallmann’s syndrome?

A
  • congenital absence of GnRH secretion
  • associated with anosmia
  • normal XX genotype and normal internal female organs
  • absent secondary sex characteristics and amenorrhea
  • low FSH and LH
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93
Q

What is the possible complication of intrahepatic cholestasis of pregnancy?

A

Stillbirth

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94
Q

what is the treatment of intrahepatic cholestasis of pregnancy?

A
  • Antipruritics

- Ursodeoxycholic acid

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95
Q

What is the optimal time to screen for glucose tolerance?

A

26(24)-28 weeks

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96
Q

What causes insulin resistance in pregnancy?

A

Human placental lactogen causes gestational diabetes because it causes insulin resistance as it increases in pregnancy

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97
Q

What is the normal pregnancy metabolic state?

A
  1. Hyperlipemic
  2. Glycosuric
  3. Anabolic
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98
Q

What happens immunologically during T3? aka what increases and decreases

A

Increases:

  1. Granulocytes
  2. CD8 t lymphocytes

Decreases:

  1. CD4 t lymphocytes
  2. Monocytes
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99
Q

What increases/decreases to make pregnancy a hypercoagulable state?

A

Increases:

  1. Concentrations of all clotting factors, except XI and XIII
  2. Fibrinogen
  3. Resistance to activated protein C

Decreases:
1. Protein S

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100
Q

What is the normal acid base status in pregnancy?

A

respiratory alkalosis (due to blowing off more CO2), compensated (decrease in Bicarb)

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101
Q

What happens to kidney futction during pregnancy?

A

Increase in GFR, Cr clearance, and renal plasma flow (leads to decreased effectiveness of meds)
- Decrease in serum creatinine and BUN

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102
Q

What happens to renal tubules in pregnancy?

A
  • decreased resorptive capacity of Amino Acids, uric acid and glucose
  • Na is retained at higher levels
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103
Q

What are the effects of progesterone on GI tract?

A
  1. Decreased lower esophageal sphincter tone leading to heartburn
  2. Decreased bowel peristalsis causing constipation
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104
Q

What happens to systemic vascular resistance during pregnancy?

A

decreases! but maternal systemic vascular resistance is greater than pulmonary

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105
Q

When a pt is found to have a molar pregnancy on ultrasound, what is the next step in management?

A

Chest x-ray: lungs are the most common site of metastatic disease

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106
Q

What is peripartum cardiomyopathy?

A
  • an idiopathic cardiomyopathy that presents with heart failure secondary to left ventricular systolic functions towards the end of pregnancy or in the several months following delivery
  • sx: fatigue, shortness of breath, palpitations and edema
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107
Q

What effect does minute ventilation have on the mother’s metabolic state?

A

compensated resp alkalosis

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108
Q

what is one side effect of terbutaline or other beta agonists?

A
  • increased susceptibility to pulmonary edema (esp with the use of isotonic fluids)
  • plamsa osmolality is decreased during pregnancy during pregnancy, this increases the susceptability to pulmonary edema
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109
Q

which women are more likely to develop pulmonary edema?

A

those with chorioamnionitis! (but not main cause- unless pt is in septic shock)

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110
Q

What is the risk of fetal loss associated with CVS?

A

1%

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111
Q

What is the most common genetic disease among individuals of Eastern European Jewish descent?

A

Tay sachs! 1/30

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112
Q

Valproic acid causes what in the fetus?

A
  1. Neural tube defects
  2. Hydrocephalus
  3. Craniofacial malformations
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113
Q

What are the three components of the triple screen? and what else is added in the Quad screen?

A

Tri:

  1. AFP
  2. Beta-hCG
  3. Unconjugated estriol

Quad:
+ Inhibin A

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114
Q

What is the most common issue found in the fetus of women with poorly controlled diabetes immediately prior to conception?

A

Structural anomalies:

  1. CNS: neural tube defects
  2. Cardiovascular system
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115
Q

What blood tests should be performed on pregnant african american women?

A

Hemoglobin electrophoresis and CBC

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116
Q

What are the risks of gestational diabetes versus pre-existing diabetes?

A

Gestational:

  1. Shoulder dystocia
  2. Metabolic disturbances
  3. Preeclampsia
  4. Polyhydramnios
  5. Fetal macrosomia

Pre-existing:
- intra-uterine growth restriction

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117
Q

What are the risk factors for gestational diabetes?

A
  1. Previous large baby (greater than 9lb)
  2. Hx of abnormal glucose tolerance
  3. Pre-pregnancy weight of 110% or more of ideal body weight
  4. Ethnicity (american indian or hispanic descent)
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118
Q

What test is most effective in screening for Down Syndrome in the second trimester?

A

quad screen:

  1. Maternal serum AFP
  2. Unconjugated estriol
  3. HCG
  4. Inhibin A
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119
Q

How much folic acid would you give a women with a previous pregnancy complicated by a fetal neural tube defect?

A

4mg daily before conception and through the first trimester

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120
Q

What is the folic acid dose recommended for non-high risk patients?

A

0.4mg/day

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121
Q

Pts should report to the hospital for suspected labor if any of the following occur:

A
  1. Contractions every five minutes for one hour
  2. Rupture of membranes
  3. Fetal mvmnt less than 10 per 2 hours
  4. Vaginal bleeding
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122
Q

what are the most common cause of variable decelerations?

A

cord compression

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123
Q

What are the criteria to consider for medical treatment (versus surgical) on ectopic pregnancy?

A

tx w methotrexate:

  1. Hemodynamic stability
  2. Non ruptured ectopic pregnancy
  3. Size of ectopic mass <3.5cm in the presence of a fetal heart rate
  4. Normal liver enzymes and renal function
  5. Normal white cell count
  6. Ability of pt to f/u rapidly if condition changes (reliable transportation)
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124
Q

What is the appropriate time interval for repeating the initial level of B-HcG?

A

48 hours

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125
Q

B- HCG Levels should be increasing by approx 50% every 48 hours for how many days?

A

first 42 days of gestation

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126
Q

What are the signs of a ruptured ectopic pregnancy?

A
  1. Hypovolemia (tachycardia, hypotension)
  2. Peritoneal sings (rebound, guarding and severe abdominal tenderness)
  3. Positive pregnancy test
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127
Q

What is the management of ruptured ectopic pregnancy?

A

laparoscopy

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128
Q

What systemic diseases are associated with early pregnancy loss?

A
  1. Diabetes
  2. Chronic renal disease
  3. Lupus
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129
Q

what is the most common abnormal karyotype encountered in spontaneous abortions?

A

Autosomal trisomy

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130
Q

What is the definition of a threatened abortion?

A

vaginal bleeding before 20weeks without the passage of any products

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131
Q

What is a missed abortion?

A
  • experienced fetal demise without cervical dilatation or passage of products of conception
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132
Q

What is the definition of a recurrent abortion?

A

refers to three successive spontaneous abortions

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133
Q

What is the etiologic factor that accounts for the majority of first trimester spontaneous abortions?

A

Conceptus genetic anomalies

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134
Q

What are a patient’s risks associated with a prior surgical abortion in the first trimester?

A

Does not predispose the patient subsequent spontaneous abortions
= no risk

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135
Q

What level is used as a negative predictor of preterm delivery?

A

Fetal fibronectin

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136
Q

In a pregnant patient, what is the next treatment of asthma after beta agonists and when do you decide to make the switch?

A
  • switch to inhaled corticosteroids

- switch when pt is using beta agonists more than twice a weeks

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137
Q

When should you screen a pregnant women with high risk for gestational diabetes?

A
  • pt has severe obesity and strong family history

- screening should be done as soon as feasible

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138
Q

What is the most common cause of sepsis in pregnancy?

A

acute pyelonephritis

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139
Q

what conditions put mom at highest risk for mortality during pregnancy??

A
  • Pulmonary hypertension (25-50% death)

- Cardiac disease

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140
Q

Why are ACE inhibitors contraindicated in pregnancy?

A
  1. Oligohydramnios
  2. Fetal growth retardation
  3. Neonatal renal failure
  4. Pulmonary hypoplasia
  5. Joint contractures
  6. Death
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141
Q

Mom is HIV positive and presents at 36wks, how do you proceed?

A

treatment with IV zidovudine at the time of delivery

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142
Q

How do you treat a severe SLE flair up in pregnancy?

A

Severe = corticosteroids

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143
Q

What SSRI cannot be used in pregnancy and why?

A

Paroxetine (Paxil)

- increased risk of fetal cardiac malformations and persistent pulmonary hypertension

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144
Q

What are risk factors for preeclampsia?

A
  1. Previous history of preeclampsia
  2. Chronic HTN
  3. Age
  4. Multifetal pregnancy
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145
Q

What is the contraindication to expectant management of severe preeclampsia remote from term (<32 weeks)?

A

thrombocytopenia

146
Q

What are the symptoms of abruptio placenta?

A
  • third trimester bleeding
  • tachysystole on tocometer
  • fetal anemia (tachycardia and sinusoidal heart rate pattern)
147
Q

300mcg of RhoGAM neutralizes what amount of fetal blood?

A

30mL of fetal whole blood or 15mL of Rh + RBCs

148
Q

What noninvasive test is used to detect severe fetal anemia?

A

Middle cerebral artery peak systolic velocity

149
Q

What test is used to assess fetal transplacental hemorrage?

A

The Kleihauer-Betke test

-using acid elution, the mother’s RBCs become very pale while the fetal cells (containing HbF) remain stained

150
Q

What are the classifications of variable decelerations?

A
  1. Mild: lasts 70-80 beats
  2. Moderate: lasts 30-60sec and depth 60sec and depth = 70-80bpm
  3. Severe: lats >60sec and depth <70 bpm
151
Q

BTBVariability decreases with?

A
  1. Fetal acidemia
  2. Fetal asphyxia
  3. Maternal acidemia
  4. Drugs (narcotics, MgSO4, barbs)
  5. Acquired or congenital neurologic abnormality
152
Q

What causes increases in BTBV?

A

mild fetal hypoxemia

153
Q

on a FHT, what is thought t be the most important predictor of fetal outcomes?

A

Short term variability

154
Q

what happens when theres no BTBV?

A

fetal acidosis!!

deliver immediately

155
Q

What are maternal contraindications to IOL?

A
  1. Placenta or vasa previa
  2. Prior uterine surgery/malpresentation
  3. Classical cesarean delivery
  4. Active genital herpes infection
  5. Previous myomectomy
156
Q

What are the fetal contraindications to IOL?

A
  1. Acute distress
  2. Transverse fetal lie
  3. Cord prolapse
157
Q

What are the complications of oxytocin/pitocin?

A
  1. Potent ADH effects -> hyponatremia (convulsions, coma, death)
  2. Risk of hyperstimulation
158
Q

What is misoprostol?

A

a synthetic PGE1 analong- used for cervical ripening and induction

159
Q

when would one perform a classical cesarean incision?

A
  1. lower uterine segment is not developed (prematurity)
  2. fetus is transverse lie with back down
  3. Placenta previa
160
Q

what is a contraindication for vacuum delivery?

A
  • prior scalp sampling
161
Q

what position must a baby be in for a vacuum delivery?

A

vertex

162
Q

what is cephalohemaoma?

A

collection of blood UNDER the periosteum of the skull of baby- it does NOT cross sutures
- due to rupture of vessels, resolves spontaneously over several weeks

163
Q

what is caput succedaneum?

A

temporary swelling of fetal head from prolonged engagement of the head

  • DOES cross the sutures
  • resolves in 1-2 weeks
164
Q

what are the nerve roots of the pudendal nerve?

A

S2-S4

165
Q

What is a paracervical block and whats its use?

A
  • anesthesia injected at 3 and 9 o’clock of cervix,
  • provides good relief of pain of uterine contractions during first stage of labor, requires additional analgesia bc pudendal nerves are not blocked
166
Q

Complication of paracervical block?

A

Fetal bradycardia (usually transient)

167
Q

What are the complications of a spinal (subarachnoid) block?

A
  • maternal hypotension (infusion w IL of solution to prevent)
  • total spinal blockade
  • spinal HA
  • seizures
  • bladder dysfunction
168
Q

Contraindications of spinal block?

A
  1. Severe preeclampsia (hypotension -> ischemic stroke)
  2. Coagulation/hemostasis disorder
  3. Neurologic disorders
  4. Infection
  5. Surgical emergency
169
Q

When is a spinal block used?

A

uncomplicated cesarean and vaginal deliveries

170
Q

in an epidural, qhere does the block begin and end in

a) abdominal delivery
b) vaginal delivery

A

Abdominal: begins at T8- S1 dermatome
Vaginal: T10 - S5 dermatome

171
Q

what is an epidural’s effects on labor?

A
  • longer duration of labor
  • increased incidence of:
    1. chorioamnionitis
    2. low forceps procedures
    3. Cesarean delivery
    4. maternal pyrexia
172
Q

how do you treat a postpartum hemorrhage due to atony?

A

Oxytocin- occurs when uterine involution is defective

173
Q

what are the risk factors for postpartum urinary retention?

A
  1. Instrument assisted delivery

2. Regional and general anesthesia

174
Q

for how long should iron supplementation be continued in the postpartum period?

A

3 months

175
Q

when is mom given anti-D immune globulin and how much?

A
  • within 72 hours of delivery, given 300ug (neutralizes 30mL of fetal whole blood or 15mL of Rh-positive RBCs)
176
Q

What are the postdelivery causes of fever?

A

The 5 W’s + B:
1. Wind: atelectasis, 1-2 days postop
2. Water: UTI, 2-3 days ppm
3. Wound: cesarean vs episiotomy (5-7days ppm)
4. Walking: DVT -> pulmonary embolus
5. Wonder drugs: drug fever, 7-10 days ppm
Breast: engorgement, mastitis, abscess, 3d-4wks ppm

177
Q

what antibiotic is used as prophylaxis during cesarean deliveries?

A
  • IV cefazolin
178
Q

Lactational amenorrhea method of contraception can be used if:

A
  1. The mother is not menstruating
  2. Mom is nursing >2-3 times per night and more than every 4 hrs during the day without supplementation
  3. The baby is <6 months old
179
Q

what are COCPs effect on breastfeeding?

A

reduce the amount of breast milk, and very small quantities of the hormones are excreted in the milk
(progestin only OCPs are 95% effective without reducing breast milk)

180
Q

when does ovulation typically occur in moms who are:

a) nursing
b) non nursing

A

a. Nursing = >10wks ppm

b. Non nursing = 6-8 wks ppm

181
Q

what vitamin is NOT found in human breast milk?

A

vitamin K

182
Q

when is colostrum secreted? what’s in it?

A

usually starts by the 2nd day ppm and is secreted for 5 days ppm
- cotains protein, fat, carbs, secretory IgA, and minerals

183
Q

What is sheehan syndrome?

A

postpartum pituitary dysfunction possibly due to intrapartum ischemia
- pts cannot breast feed due to the absence of prolactin

184
Q

What hormones are involved with breast feeting?

A
  1. Prolactin = stimulates milk Production
  2. Oxytocin = stimulates milk letdown/ejection, via suckling stimulus causes contraction of myoepithelial cells and small milk ducts
185
Q

What organisms most commonly cause mastitis?

A
  1. Staph aureus from the infant’s nasopharynx

2. Staph coag negative and strep viridans

186
Q

treatment of mastitis?

A

dicloxacillin for 7-10days, continue breast feeding, usually resolves w/in 48 hours

187
Q

What viruses are excreted in breast milk?

A
  1. CMV (not contraindicated, both virus and Ab present)
  2. HBV (not contraindicated if baby receives hep B immune globulin
  3. HIV (contraindicated)
188
Q

What type of immunity is found in breast milk? (3)

A
  1. Secretorry IgA antibodies against e coli and other infections
  2. Memory T cells: gives baby maternal immunity
  3. Colostrum contains IL-6 stimulating increase in breast milk monocytes
189
Q

Can babies get Hepatitis C through breast milk?

A

4% risk of transmission (same as bottle fed babies)

190
Q

What medications are contraindicated in breast feeding? (8)

A
  1. Bromocriptine
  2. Cyclophosphamide
  3. Cyclosporine
  4. Doxorubicin
  5. Ergotamine
  6. Lithium
  7. Methotrexate
  8. Estrogen containing OCPs
191
Q

What is the time frame for classification of postpartum depression?

A
  • if it begins within 3-6 months after childbirth
192
Q

what are the two phases of postpartum thyroiditis? treatments?

A
  1. Thyrotoxicosis: 1-4 mos ppm,tx = Beta-blockers

2. Hypothyroidism: 4-8 months ppm, tx = thyroxine for 6-12 months

193
Q

What is the difference between A1 and A2 gestational diabetes?

A

A1: Fasting 105mg/dL, 2 hour >120mg/dL

194
Q

Diabetic ketoacidosis may be induced in type 1 diabetics by what? (4)

A
  1. Corticosteroids
  2. B mimetics (for tocolysis)
  3. Hyperemesis gravidarum
  4. Infections
195
Q

what are the complications of gestational diabetes versus pregestational diabetes?

A

Gestational -> macrosomia

Pregestational -> growth restriction due to concurrent maternal vascular disease

196
Q

What is the outcome of gestational diabetes versus pregestational dbm on the fetus?

A

Gestational = macrosomia, esp if fasting glucose is high

Pregestational dbm: growth restriction due to concurrent maternal vascular disease

197
Q

diabetic ketoacidosis may be induced in pregnant type 1 diabetics by what?

A
  1. Corticosteroids (for lung maturity)
  2. B mimetics (for tocolysis)
  3. Hyperemesis gravidarum
  4. Infections
198
Q

why do the insulin requirements increase during the first trimester in diabetic moms?

A

due to antagonistic effects of pregnancy

199
Q

why does uncontrolled diabetes cause neonatal hypoglycemia?

A

chronic maternal hyperglycemia -> hyperplasia of fetal B islet cells -> increased fetal insulin -> rapid decline in fetal plasma glucose after delivery

200
Q

what congenital anomalies are associated with maternal diabetes? and what increases risk of them?

A
  • caudal regression (rare but high assoc)
  • cardiac anomalies
  • Neural tube defects
  • increased risk with HbA1C > 10%
201
Q

what happens to thyroid hormones during normal pregnancy?

A
  • Total T3, T4 and TBG are increased

- free T4 and TSH do not change

202
Q

What is the tx of hyperthyroidism during pregnancy?

A

PTU (drug of choice): inhibits conversion to T4 to T3, small amount crosses placenta
- can cause fetal hypothyroid/goiter bc crosses placenta

203
Q

What is Methimazoles effect during pregnancy?

A
  • readily crosses placenta

- associated with aplasia cutis in fetus

204
Q

What tx of hyperthyroidism is contraindicated in pregnancy?

A

radioactive iodine!

205
Q

hyperthyroidism is noted in what two diseases?

A
  1. Hyperemesis gravidarum

2. Gestational trophoblastic disease

206
Q

how is overt hypothyroidism diagnosed in pregnancy? subclinical hypothyroidism?

A

Overt = increased TSH and decreased free T4
Subclinical = increased TSH and normal free T4
- ACOG recommends against routine screening for subclinical hypothyroidism

207
Q

Tx of hypothyroidism in pregnancy?

A

levothyroxine

208
Q

overt hypothyroidism is associated with what?

A

infertility and higher miscarriage rates

209
Q

how does blood pressure usually change during pregnancy?

A

normally decreases in T2

210
Q

What conditions are associated with a breech presentation? (6)

A
  1. uterine fibroids
  2. Prematurity
  3. Polyhydramnios
  4. Hydrocephaly
  5. Anencephaly
  6. Placenta previa
211
Q

smoking during pregnancy increases the risk of what? (5)

A
  1. Placental abruption
  2. Placental previa
  3. IUGR
  4. Preeclampsia
  5. Infection
212
Q

What is the difference in contents between FFP and cryoprecipitate?

A
  1. FFP = fibrinogen and factors V and VIII

2. Cryoprecipitate = fingrinogen, factor VIII, VWF

213
Q

What are the presenting signs of placental abruption?

A
  1. Abdominal pain
  2. Bleeding
  3. Uterine hypertonus
  4. Fetal distress
214
Q

What are the risk factors for placenta accreta?

A
  1. Prior history of surgery- like c sections

2. Low anterior placenta

215
Q

What are the contraindications for the following tocolytics?

  1. Terbutaline
  2. Ritodrine
  3. Magnesium sulfate
  4. Indomethacin
A
  1. Terbutaline = diabetics
  2. Ritodrine = diabetics
  3. Magnesium sulfate = magnesium sulfate
  4. Indomethacin = dont use prior to 34 weeks due to risk of premature closure of PDA
216
Q

What is a side effect of terbutaline?

A 
Tachycardia
hypotension
anxiety
chest tightening or pain
- terbutaline is a beta adrenergic agent
217
Q

What are the risk factors for placental abruption?

A
  1. Smoking
  2. Cocaine use
  3. Abdominal trauma
  4. Chronic hypertension
  5. Multiparity
  6. prolonged, premature rupture of membranes
218
Q

Smoking during pregnancy increases the risk of what?

A
  1. Placental abruption
  2. Placenta previa
  3. fetal growth restriction
  4. Preeclampsia
  5. Infection
219
Q

What are the possible adverse fetal affects of indomethacin?

A
  1. Premature constriction of the ductus arteriosus (esp before 34 weeks)
  2. Oligohydramnios
220
Q

What are the possible adverse fetal affects of calcium channel blockers?

A
  1. Fetal hypoxia

2. Decreased uteroplacental blood flow

221
Q

What are the most common causes of preterm labor?

A
  1. Idiopathic most common!
  2. Dehydration
  3. Uterine distortion (from fibroids or structural malformations)
222
Q

What is betamethasone’s effect on the newborn?

A

Decreased risk of intracerebral hemorrhage, RDS, and necrotizing enterocolitis

223
Q

What is magnesium sulfate’s MOA?

A

competes with calcium for entry into cells

224
Q

Unexplained fever + increased WBC count makes you worried of…? how do you rule it out?

A

intra-amniotic infection

- amniocentesis`

225
Q

What is the first line treatment for hyperemesis gravidarum?

A

Vitamin B6 with doxylamine

226
Q

how long to anti-D immunoglobulin last for and when is the highest risk of sensitization?

A

lasts for 12 weeks and highest risk is during T3

227
Q

What is the critical antibody titer?

A

1:16, follow titer every 4 weeks

228
Q

if rh- mom is pregnant with a rh+ baby and has an antibody titer of 1:32, what are the next steps of management

A
  1. Do an amniocentesis
  2. Serial US monitoring for anatomy scan for hydrops, MCA doppler for presence of severe anemia
  3. Delivery:
    Mild anemia = Induce at 37-38weeks
    Severe anemia= deliver at 32-34 weels
229
Q

What are the symptoms of hemolytic disease of the newborn?

A
  1. Fetal hyperbilirubinemia + kernicterus
  2. Heart failure
  3. Edema
  4. Ascites
  5. Pericardial effusion
    - DEATH
230
Q

What is fetal hydrops?

A

collection of fluid in two or more body cavities:

  1. Scalp edema
  2. Pleural effusion
  3. Pericardial effuion
  4. Ascites
231
Q

what is a predictor of preterm labor?

A

transvaginal cervical length measurement:
>35mm: low risk of preterm delivery
<25mm: high risk of preterm delivery
OR
Fetal fibronectin assay: negative = 99%for no preterm

232
Q

Magnesium sulfate as a tocolytic:

MOA:

A

suppresses uterine contractions

  • competes with calcium, inhibits myosin light chain
  • shown to decrease chance of hypoxic brain injury in babies
233
Q

Magnesium sulfate as a tocolytic:

Maternal side effects

A
  1. Flushing
  2. Lethargy
  3. MM weakness
  4. Diplopia
  5. Pulmonary edema
  6. Cardiac arrest
234
Q

how do you treat magnesium toxicity?

A

calcoium gluconate

235
Q

Magnesium sulfate as a tocolytic:

fetal side effects

A
  1. Lethargy
  2. Hypotension
  3. Respiratory depression
236
Q

Magnesium sulfate as a tocolytic:

contraindications

A

Myasthenia gravis

237
Q

Nifedipine as a tocolytic:

Maternal side effects

A
  1. Flushing
  2. HA
  3. Dizziness
  4. Transient hypotension
238
Q

Nifedipine as a tocolytic:

contraindications

A
  1. Maternal hypotension
  2. Cardiac disease
  3. Caution w renal disease
    - DO NOT USE W MAGNESIUM
239
Q

Ritodrine, terbutaline: MOA

A

Beta 2 receptor stimulation on myometrial cells -> increase in cAMP -> decrease in intracellular Ca -> decreased contractions

240
Q

Ritodrine, terbutaline: maternal side effects

A
  1. Pulmonary edema
  2. Tachycardia
  3. HAs
241
Q

Ritodrine, terbutaline: fetal side effects

A

tachycardia

242
Q

Ritodrine, terbutaline: contraindications

A
  1. cardiovascular disease
  2. Hyperthyroidism
  3. Uncontrolled diabetes
243
Q

Indomethacin: MOA

A

prostaglandin inhibitors for <32 weeks

244
Q

Indomethacin: maternal side effects

A

Nausea & heartburn

245
Q

Indomethacin: fetal side effects

A
  1. Premature constriction of ductus arteriousus
  2. Pulmonary HTN
  3. Reversible decrease in amniotic fluid
246
Q

Indomethacin: contraindications

A
  1. Renal or hepatic impairment

2. PUD

247
Q

Overall contraindications to tocolysis?

A 
BAD CHU
Bleeding, severe
Abruptio placentae, severe
Death: fetal
Chorioamnionitis
Hypertension: severe pregnancy induced
Unstable maternal hemodynamics
248
Q

What is 17alpha-hydroxyprogesterone used for and when?

A
  • a weekly IM injection at 16-20 weeks to women with risk factors or history of preterm labor
  • prevents preterm laborvia relaxing the myometrium
  • prevents rejection of the fetus by suppressing lymphocyte production of cytokines
249
Q

What is an apt test?

A

determines whether or not blood is maternal or fetal
- put blood from vagina into tube w KOH
Brown = maternal
Pink = fetus

250
Q

two most common causes of T3 bleeding

A
  1. PLacenta previa

2. Placenta abruptio

251
Q

pregnant woman + vaginal bleeding + pain =

A

placental abruption until proven otherwise

252
Q

what is the clinical presentation of placenta previa?

A
  1. Painless profuse bleeding in 2nd or 3rd trimester
  2. Postcoital bleeding
  3. Spotting during first and second trimester that subsides then recurs later in pregnancy
253
Q

what two conditions cause third trimester bleeding resulting from fetal vessel rupture?

A
  1. Vasa previa

2. Velamentous cord insertion

254
Q

what do you give for uterine atony and what are their contraindications?

A
  1. Dilute oxytocin
  2. Methergine: contraindicated in HTN
  3. Prostaglandin F2a: contraindicated in asthma
  4. Misoprostol
255
Q

What are the 3 different types of placental attachment disorders?

A
  1. Placenta accreta: attaches directly to the myometrium
  2. Placenta increta: invades into the myometrium
  3. Placenta percreta: penetrates through the myometrium, could invade the bladder
256
Q

what is the tx of choice for placenta problems?

A

hysterectomy

257
Q

what do you think when a mass is palpated in the vaginal canal immediately after the placental delivery?

A

uterine inversion

258
Q

what does varicella infection cause in pregnant moms?

A

pneumonia

259
Q

what are the fetal effects of early pregnancy varicella infection?

A
  1. Chorioretinitis
  2. Cerebral cortical atrophy
  3. Hydronephrosis
  4. Cutaneous and bony leg defects
260
Q

what are the fetal effects of parvovirus (b19) during pregnancy?

A
  1. Fetal death

2. Nonimmune hydrops: due to fetal aplastic anemia

261
Q

what are the fetal effects of rubella (german measles)?

A
  1. Cataracts, congenital glaucome (blindness)
  2. Deafness: most common single defect
  3. CNS defects: MR, microcephaly
262
Q

what is the congenital infection found with CMV?

A
  1. Intracranial calcifications
  2. Chorioretinitis
  3. Microcephaly
  4. Mental and motor retardation
263
Q

what is the triad of toxo infection in newborns?

A
  1. Chorioretinitis
  2. Intracranial calcifications
  3. Hydrocephalus
    - similar to CMV, look at hx
264
Q

tx of toxo in pregnancy?

A

sulfonamides + pyrimethamine, sulfonamides

- spiramycin

265
Q

BV increases the risk of what antepartum complications?

A
  1. Preterm birth
  2. PROM
  3. Preterm labor
  4. Chorioamnionitis
266
Q

what is jarisch-herxheimer reaction?

A
  • occurs with penicillin treatment
  • involves uterine contractions and late decels in the fetal heart rate as the dead spirochetes (and their endotoxins) affect the placental circulation
267
Q

what infections are associated with preterm delivery?

A
  1. Gonorrhea
  2. Trichomoniasis
  3. Bacterial vaginosis
268
Q

how do you treat a gonorrhea infection in pregnancy?

A

ceftriaxone

269
Q

what is the most common cause of ophthalmia neonatorum?

A

chlamydia trachomatis

270
Q

how do you treat a chlamydia infection in pregnacy?

A

erythromycin, amoxicillin, azithromycin

271
Q

pt has a hx of herpes, suppression with what and when is recommended?

A

acyclovir at 36 wks

272
Q

is it possible for infant to breast feed when mom has hep B?

A

yes- but only when infant givent prophylaxis (HBIG at birth and first of three hepatitis B vaccines upon delivery)

273
Q

what is given during antepartum/intrapartum/neonate to reduce risk of vertical transmission of HIV?

A

zidovudine or HAART

- cesarean delivery

274
Q

what can HPV cause in the fetus?

A

laryngeal papillomatosis: rare benign neoplasm of the larynx

- HPV 6 and 11

275
Q

what is the recommended weight gain for multiple gestation pregnancy?

A

24lbs in 24 weeks, 35-45 total lbs

276
Q

twins: division of ovum between 0-3 days:

A

dichorionic, diamniotic, monozygotic

277
Q

twins: division of ovum 4-8days:

A

monochorionic, diamniotic, monozygotic

278
Q

twins: division between 9-12 days:

A

monochorionic, monoamniotic, monozygotic

279
Q

twins: division >13 days:

A

conjoined twins

280
Q

which type of twins are at risk for twin-twin transfusion syndrome?

A

monochorionic

281
Q

IOL should be considered when in multiple gestations?

A

38wks

282
Q

what is the tx of twin-twin transfusion syndrome?

A

laser coagulation of the anastomoses

283
Q

top 5 etiologies of spontaneous abortion

A
  1. Chromosomal abnormalities (trisomy 16)
  2. Unknown
  3. Infection (toxo, herpes)
  4. Anatomic defects (bicornate, cervical incomp)
  5. Endocrine (PCOS, DBM)
284
Q

what is the management of an inevitable abortion?

A
  1. surgical evacuation of the uterus if fetal cardiac activity is absent
  2. expectant management if fetal cardiac activity it present
285
Q

what kind of abortions have a dilated cervical os?

A

Inevitable and Incomplete

286
Q

what is a missed abortion?

A

fetal demise before 20wks of gestation without expulsion of any POC

287
Q

what is an uncommon but serious complication of septic abortion?

A

DIC

288
Q

what is the most common parental chromosomal abnormality that causes recurrent abortions?

A

balanced translocation

289
Q

What is the differential diagnosis for T1 bleeding?

A
  1. Spontaneous abortion
  2. Ectopic pregnancy
  3. Molar pregnancy
  4. Vaginal/cervical lesions/lacerations
290
Q

Differential diagnosis for T3 bleeding?

A
  1. Abruptio placenta
  2. Placenta previa
  3. Rupture of vasa previa
  4. Uterine rupture
291
Q

Contraindications to PGF2a?

A

asthamatics! bc it induces smooth muscle contraction

292
Q

most common reason for T2 abortions?

A

congenital anomalies

293
Q

Biggest risk factor for ectopic pregnancy?

A

prior ectopic pregnancy

294
Q

what are the signs of ruptured ectopic pregnancy?

A

1, Hypotension

  1. Tachycardia
  2. Abdominal exam with rebound and guarding
295
Q

what is the threshold of B-hCG that you should expect an ectopic pregnancy?

A

> 1200mIU/mL and theres no evidence of an IUP

296
Q

Significance of these B-hCG values:

  1. > 25
  2. 1200-2000
  3. > 5000
A
  1. > 25 = positive urine pregnancy test
  2. 1200-2000 = IUP detectable with TVUS
  3. > 5000 = IUP detectable with abdominal US
297
Q

when can you give methotrexate for an ectopic pregnancy?

A

if:

  1. It’s early in the pregnancy
  2. Unruptured
  3. Mom is hemodynamically stable
  4. Pregnancy is <3.5cm
298
Q

what are the relative contraindications for using methotrexate in an ectopic pregnancy?

A
  1. Fetal cardiac activity present
  2. Quantitative B-hCG >15,000mIU/mL
  3. Ectopic pregnancy >3.5cm
299
Q

what are the absolute contraindications for using methotrexate in an ectopic pregnancy? (6)

A
  1. Hemodynamically unstable pt
  2. Leukopenia
  3. Renal/hepatic disease
  4. Thrombocytopenia
  5. Active PUD
  6. Breastfeeding
300
Q

what type of birth control is best for patients with sickle cell disease?

A

injectables

301
Q

what type of birth control is best for patients with epilepsy?

A

injectables

302
Q

what are some side effects of injectables?

A
  1. Depression
  2. Weight gain
  3. Osteoporosis/osteopenia
303
Q

what are the p450 induces that will decrease the effectiveness of OCPs?

A
  1. Phenytoin
  2. Rifampin
  3. Griseofulvin
  4. Carbamazepine
  5. Alcohol
  6. Barbs
304
Q

what are the types of estrogens and when do you see them?

A
  1. Estradiol: reproductive life
  2. Estriol: Pregnancy
  3. Estrone: Menopause
305
Q

mechanism of action of estrogen in combined OCPs?

A

suppresses FSH preventing follicular emergence

- maintains stability of endometrium

306
Q

MOA of progesterone in combined OCPs?

A
  1. Prevents LH surge, inhibiting ovulation
  2. Thickens crevical mucus to pase as a barrier for sperm
  3. Alters motility of fallopian tube and uterus
  4. Caues endometrial atrophy
307
Q

why is estrogen a procoagulant?

A

it increases factors VII and X and decreases antithrombin III

308
Q

what is a contraindication for IUD placement?

A
  1. Multiple sexual partners
  2. Recent hx of PID
  3. Immunocompromised
309
Q

What are the two options for emergency contraceptions?

A
  1. Levonorgestrel up to 72 hours after intercourse

2. Copper IUD up to 5 days after intercourse

310
Q

what is the motto about pregnancies after tubal ligation reversals?

A

theyre ectopic until proven otherwise

311
Q

what are the pubertal landmarks?

A
  1. Thelarche: breast budding, around age 10, due to estradiol
  2. Pubarche: axillary and pubic hair growth, age 11, due to adrenal hormones
  3. Menarche: first menses, age 12. increase in estradiol
312
Q

which follicle is the one chosen to be released during ovulation?

A

the follicle that secretes more estrogen than androgen

313
Q

what causes dysmenorrhea during menstruation?

A

prostaglandins released from endometrium

314
Q

what is the average blood loss during menstruation?

A

30-50mL

315
Q

what two medications can impair sperm number and function?

A
  1. Calcium channel blockers

2. Furantoins

316
Q

what two medications can impair sperm number and function?

A
  1. Calcium channel blockers

2. Furantoins

317
Q

normal values for semen analysis:

  1. Volume:
  2. Semen count:
  3. Motility:
  4. Morphology:
A
  1. Volume: >2mL
  2. Semen count: >20 million/mL
  3. Motility: >50% with forward movement
  4. Morphology: >40%
318
Q

Primary amenorrhea + elevated plasma FSH?

A

gonadal dysgenesis (hypergonadotropic hypogonadism), most common cause of primary amenorrhea

319
Q

what is the pathophys behind gonadal dysgenesis?

A

absence of ovarian follicles, no synthesis of ovarian steroids

320
Q

17alpha hydroxylase deficiency:
46 XX =
46 XY=

A

46 XX= breast absent, uterus present

46 XY = breast absent, uterus absent

321
Q

normal breast and pubic hair + no menses + cyclic pelvic pain + bulging blue mass at the introitus

A

hematocolpos from imperforate hymen

322
Q

what are the most common non-prolactin secreting pituitary tumor?

A

chromophobe adenomas

323
Q

what is sheehan syndrome?

A

pituitary cell destruction occurs due to hypotensive episode during pregnancy
- replace pituitary hormones

324
Q

Simmonds disease?

A

pituitary disease unrelated tp pregnancy?

325
Q

what is the drug of choice for women with PRL-secreting microadenomas who want to conceive?

A

Bromocriptine

326
Q

what is the drug of choice for reducing prolactin levels and shrinking tumors?

A

Cabergoline (more effective and better tolerated than bromocriptine)

327
Q

what is the management of a molar pregnancy?

A

suction curretage (even if person doesnt want any more children)

328
Q

how do partial moles differ from complete moles?

A
  1. Partial are triploidy, complete are diploid
  2. Partial tend to have lower B-hCG levels
  3. Partials affect older patients
  4. Partials have longer gestations
  5. Partials are often diagnosed as missed or incomplete abortions
  6. Partials are less likely to develop into post molar GTD
329
Q

how long after a partial molar pregnancy should one wait before getting pregnant again?

A

6 months

330
Q

what is a downside to the patch for contraception?

A

it has a higher failure rate when used in women who weigh more than 198 pounds

331
Q

what is increased in a woman undergoing a medical abortion compared to a surgical abortion?

A

blood loss!!

332
Q

at what gestational age can you perform manual vacuum aspiration?

A

<8weeks

333
Q

treatment of antiphospholipid antibody syndrome?

A

heparin plus aspirin

334
Q

What is the treatment for vulvar vestibulitis syndrome?

A
  1. TCAs to block sympathetic afferents
  2. Pelvic flood rehab
  3. Biofeedback
  4. topical anesthetics
  • surgery w vestibulectomy in refractory
335
Q

erythematous vagina + frothy yellow discharge and multiple petechiae on cervix, vaginal pH is 7

A

trichomonas (tx w metronidazole)

336
Q

polygonal ivory papules involving the vulva and perianal areas + waxy sheen on the labia minora and clitoris, and hypopigmentation

A

lichen sclerosus

tx: high potency topical steroids

337
Q

lacy reticulated pattern of labia and perineum, oral lesions, alopecia, extragenital rahes

A

lichen planus

- supportive therapy + topical superpotent corticosteroids

338
Q

gray homogenous vaginal discharge + positive whiff test + vaginal pH >4.5

A

BV!

tx w metronidazole

339
Q

most common organism causing acute cystitis in a healthy non-pregnant woman?

A

e coli

340
Q

What is colpocleisis?

A

a procedure where the vagina is surgically obliterated and can be performed under local anesthesia
- used to tx vaginal prolapse

341
Q

tx of stress incontinence??

A

retropubic urethropexies

342
Q

what medication is used for detrusor instability?

A

oxybutynin- anticholinergics (bc ach is used in bladder emptying (contraction)

343
Q

what is used for definitive diagnosis of endometriosis?

A

exploratory laparoscopy

344
Q

nodularity at the back of the uterus is suggestive of what?

A

endometriosis

345
Q

What nerves are at risk during low transverse surgical procedures?

A
  1. Iliohypogastric (T12-L1): cutaneous sensation to the groin and skin overlying pubis
  2. Ilioinguinal (T12-L1): cutaneous sensation to to the groin, labium, and upper inner thigh
346
Q

WHat is pelvic congestion syndrome?

A
  • pelvic pain occurring in the setting of pelvic varicosities
  • pain exacerbated by standing, fatigue, and coitus
  • hormonal factors contribute to vasodilation when pelvic veins exposed to high estradiol
347
Q

what are the three critical elements for secondary sexual characteristics?

A
  1. Body weight
  2. Sleep
  3. Optic exposure to sunlight
348
Q

What is Noonan’s syndrome?

A
  • short stature, webbed neck, heart defects, abnormal faces, and delayed puberty
  • normal genital tract
  • partial deletions of the long arm of the X chromosome
349
Q

tx for precocious puberty?

A

GnRH agonist to suppress potuitary production of FSH and LH unless theyre within months of the expected

350
Q

in a pt with mullerian agenesis, what is the most appropriate next study after physical exam and pelvis us?

A

renal ultrasound!

351
Q

when is observation okay management for an endometrial polyp?

A

when it’s less than 1.5 cm

352
Q

when do you do a polypectomy for an endometrial polyp?

A

when its causing infertility

353
Q

what is mid cycle bleeding at the time of ovulation due to?

A

the drop in esrogen

354
Q

what is the tx of choice for a pt with a leiomyoma who desires pegnancy?

A

hysteroscopic myomectomy (preserves the uterus)

355
Q

premature ovarian failure occurs before what age?

A

35

356
Q

what is the optimal daily calcium intake for a postmenopausal woman?

A

1000-1200 mg

357
Q

HRT has what affect on lipid/cholesterol profile?

A

HDL levels increase and LDL levels decrease

358
Q

what is the first line tx for ovulatory dysfunction in PCOS patients?

A

metformin and ovulation induction agnets

359
Q

what is a side effect of imipramine that concerns us?

A

hyperprolactinemia

360
Q

what is the clomiphene citrate challenge?

A
  • giving clomiphene citrate days 5-9 of the menstrual cycle and checking FSH levels on day 3 and 10
361
Q

what vitamins help with PMS?

A

Vitamins A, E, and B6

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