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OBGYN Flashcards

1
Q

VDRL +, miscarriages, thrombocytopenia, prolonged PTT

A

Anti-phospholipid anti-body syndrome –> LMW heparin

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2
Q

Vaginal bleeding 8wks after delivery

A

Gestational trophoblastic disease - Choriocarcinoma –> lungs

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3
Q

Dx Choriocarcinoma or GTD

A

HCG

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4
Q

Verrucous, papilliform lesions near anus, puritus

A

Condylomata acuminata –> Podophyllin, 5-FU, surgery. IF-a

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5
Q

Flat, velvety lesions near anus

A

Condyloma lata (2 syphilus) –> PCN

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6
Q

High fever, IVDU, prostatute, migratory arthralgias, pustules w/ central necrosis on arms, current menses, (-) culture

A

Disseminated gonococcal infection

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7
Q

Intense pruritis, extensive patches of erythema, vesicles and tense bullae on limbs > trunk

A

Herpes gestationis (IgG to BM) –> IUGR & stillbirth = steroids

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8
Q

Risk factor for endometrial CA

A

Anovulation, nulliparous, >35, tamoxifen, unopposed estrogen, OBESITY

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9
Q

Cis to uterine ablation

A

Polyp, leiomyoma, bicornate utrus

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10
Q

Complication of Tubo-ovarian abscess?

A

Rupture –> shock = surgery

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11
Q

Baseline fetal HR

A

110-160bpm

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12
Q

Early decelerations

A

mirror image of uterine contractions = fetal HEAD compressions

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13
Q

Late decelerations

A

Follow uterine contractions = HYPOXIA & >50% = Acidemia

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14
Q

Variable decelerations

A

Abrupt, jagged clips below baseline = most common = caused by CORD COMPRESSIONS

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15
Q

1 cause post-partum hemorhhage

A

Uterine atony

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16
Q

Post-partum bleeding with FIRM uterus

A

Gential tract lesion

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17
Q

Mechanism of acute dyspnea 2 days after tx for pyelopnephritis

A

Endotoxin mediated capillary leakage

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18
Q

Complication of PID or salpingitis

A

Ectopic pregnancy, sterility

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19
Q

Anthroipoid pelvis

A

Predisposes to occiput posterior - >AP diameter than Transverse

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20
Q

12h RLQ colicky pain w N/V, guarding, hx of ovarian cyst, 14 wks pregnant

A

Ovarian torsion —> laparotomy ovarian cystectomy d/t pregnancy

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21
Q

1 complication of benign ovarian cyst

A

Ovarian torsion

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22
Q

N/V, fever, anorexia, R abd/flank pain

A

Appendicitis —> surgery and IV antibiotics

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23
Q

Generalized pruritis, >palms, soles, worse at night, no rash or papules, inc bili, bile, LFTs

A

Intrahepatic cholestasis of pregnancy = INC circulating bile acids —> preme, fetal distress and death

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24
Q

Intense pruritis, erythematous papules surrounded by narrow pale halo on abd and butt

A

PUPPP = sx tx only

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25
Q

Tx cholestasis

A

Anti-histamines, cornstarch bath —> cholestyramine, UDA

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26
Q

RUQ pain, malaise, N/V, ARF, hypoglycemia, jaundice, coagulopathy

A

Acute fatty liver of pregnancy (LCHAD deficiency) = DELIVERY

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27
Q

Acute dyspnea, tachy, low O2, clear lungs

A

PE —> CTA, but D-dimer not helpful = heparin 5-7d for 3months to 6 wks post-partum

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28
Q

1 maternal mortality

A

PE (cause = stasis)

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29
Q

Grave’s, tachy, fever, diarrhea, tender thyroid, confused, leukocytosis

A

Thyroid storm = propanolol, steroids and PTU

During pregnancy –> PTU, surgery in 2nd trimester

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30
Q

Hypothyroid b4 pregnancy, changes with pregnancy?

A

High estrogen –> inc thyroid-binding globulin, total T4/INC serum total thyroxine levels —-Free T3,4, TSH unchanged

Inc dose of Levo in pregnancy and menopause if receiving estrogen

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31
Q

Most common cause of post-partum hyperthyroidism

A

Lymphocytic (anti-microsomal abs) thyroiditis NOT Grave’s disease (overall and DURING pregnancy)

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32
Q

Smoker, underweight mother, small uterine size for gestation, 900g dx and next step?

A

IUGR = US - symmetric (head affected) or asymmetric, assess amniotic fluid, evaluate fetal well being (breathing, movement, tone)

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33
Q

IUGR complications & tx

A

Pre-term, fetal stress, death (esp reverse end-diastolic flow)

<34wks and ok = steroids
32-36wks - severe HTN, REDF, poor BPP, no growth
37wks = deliver

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34
Q

1 cause of asymmetric IUGR (<10 percentile)

A

Maternal vascular disorder - HTN, smoking, illicit drug use

Abd < head size & >20wks

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35
Q

Symmetric IGUR causes

A

Aneuploidy, early infection

<20wks

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36
Q

Morbidities in IUGR

A

INC meconium aspiration, necrotizing enterocolitis, hypoglycemia, thrombocytopenia

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37
Q

Neonatal tachy, restlessness, diarrhea, poor weight gain, goiter

A

Thyrotoxicosis - Mom tx for Graves w/ remaining TSI

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38
Q

Prolonged PT, PTT, 3rd tri or early PP, inc LFTs

A

Acute fatty liver of pregnancy (LCHAD deficiency) = DELIVERY (34+ wks)

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39
Q

1st step in young person (<30), pregnant or pain w/o evidence of mass

A

US

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40
Q

1st step in older person (>30) w/ breast mass

A

Mammo + US –> guided core Bx

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41
Q

Indication for breast Bx

A

Aspiration –> blood, reoccurance of mass, or mass doesn’t disappear, both cystic and solid parts

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42
Q

Risk factors for breast CA

A

1st degree relative esp pre-menopausal or B/L, BRCA, menarche 55, obese, etOH

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43
Q

Benign characteristics of breast masses

A

Soft, smooth, mobile, tender, <30

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44
Q

Malignant characteristics of breast masses

A

Firm/hard, fixed/immoble, painless, >50

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45
Q

Firm, hard, fixed mass, coarse calcifications, core bx shows fat globules and foamy histiocytes

A

Fat necrosis

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46
Q

Young woman, firm, rubbery mass, mobile

A

Fibroadenoma –> FNA or US

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47
Q

Very young adolescent, very rapid growth breast mass

A

Giant juvenile fibroadenoma

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48
Q

Late 20s, many yrs growth, very large, fixed, distorting breast mass

A

Cystosarcoma Phyllodes –> core bx and removal can become malignant

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49
Q

30-40s b/l, masses inc last 2 weeks of cycle

A

Fibrocystic - not persistent = Mammo, persistent = aspiration; recurrs –> bx

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50
Q

20-40s, bloody nipple discharge

A

Intraductal papilloma –> mammo

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51
Q

Standard form of breast CA, needs pre-op chemo and has worse prognosis if inflammatory

A

Infiltrating ductal CA

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52
Q

Breast CA type w/ inc risk for B/L CA?

A

Invasive Lobular CA

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53
Q

Rock hard, most invasive breast CA?

A

Invasive ductal CA

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54
Q

Tx ductal carcinoma in situ

A

Total mastectomy (recurrs w/ local excision), NO mets

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55
Q

When to suspect breast CA

A

Ill-defined mass, “orange peel,” nipple retraction, eczematous areola, palpable nodes

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56
Q

Irregular inc density and MICROcalcifications on mammo

A

Breast CA

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57
Q

Tx breast CA in pregnancy

A

Lumpectomy, mastectomy but NO radiation and NO chemo in 1st timester

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58
Q

HER2 breast CA tx

A

Trastuzumab —> cardiotoxic = get ECHO b4 starting

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59
Q

Pre-menopausal CA tx

A

Tamoxifen

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60
Q

Post-menopausal CA tx

A

Anastrozole

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61
Q

Persistent HA or back pain w/ local tenderness w/ hx breast CA

A

MRI of spine PEDICLES

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62
Q

Indication for surgical excision

A

atypical ductal hyperplasia

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63
Q

Tx for reducing breast pain

A

Primrose, red caffeine, topical NSAIDs, red stress, Danazol, Tamoxifen, Toremiphene, Bromocriptine

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64
Q

Physiologic nipple discharge

A

W/ stimulation, clear, yellow, green

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65
Q

Pathologic nipple discharge

A

Spontaneous, persistent, bloody, from single duct, w/ mass, >40 –> mammogram –> excision of terminal duct

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66
Q

Meds causing galactorrhea

A

SSRIs, TCAs, atenolol, verapamil, anti-psychotics, H2 blockers, opiates, estrogen

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67
Q

Work-up for galactorrhea w/ (-) pregnancy test

A

TSH, free T4, prolactin

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68
Q

Pathologic marker w/ impact on future Tx

A

Oncgoene/HER2 expression by FISH or IHC –> anthracyclines for overexpression

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69
Q

Negative prognostic indicator by flow cytometry in breast CA

A

DNA content - aneuploidy, higher % in s-phase = higher proliferation

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70
Q

Active phase of labor

A

4cm dilated –> full dilation

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71
Q

What predicts normalcy in labor?

A

Change in cervix per time

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72
Q

Nulliparous cervix dilation rate

A

1.2 cm/hr

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73
Q

Latent phase of labor

A

Cervical effacement (thins), <4cm

PGE2 breaks DISULFIDE bonds in collagen

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74
Q

Protraction of active phase

A

Dilation in active phase <1.2cm/hr NP or 1.5cm/hr MP

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75
Q

Arrest of active phase

A

No dilation for 2hrs
No descent for 1hr

Cephalopelvic disproportion –> C/S

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76
Q

Stage 1 of labor

A

Labor –> complete dilation

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77
Q

Stage 2 of labor

A

Complete dilation –> delivery of infant

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78
Q

Stage 3 of labor

A

Infant —> delivery of placenta

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79
Q

Adequate uterine contractions

A

q2-3 min, firm to palpations lasting 40-60 seconds; >200 Montevideo units

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80
Q

How to calculate Montevideo units

A

Sum of amplitudes above baseline of uterine contractions w/in 10minute window

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81
Q

Contractions 3-4 minutes, dilation 1-2cm over 3hrs next step?

A

Observation - still in latent phase

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82
Q

O’ Station

A

Head @ Ischial spines, NOT pelvic inlet

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83
Q

39 weeks, dark vaginal blood mixed w/ mucous cause?

A

Bloody show/mucous plug (vs. antepartum bleeding)

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84
Q

of weeks to deliver w/o inc risk of neonatal complications

A

39weeks

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85
Q

Pre-eclampsia, epigastric tenderness, high LFTs –> hypotension

A

Hepatic rupture (glissen capsule)

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86
Q

Complications of preeclampsia

A

ICH, coagulopathies, renal failure, hepatic hematoma/ruptures, uteroplacental insufficiency, IGUR

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87
Q

Risks for preeclampsia

A

Nulliparous, age extremes, AA, hx of preeclampsia or HTN, obesity, anti-phosphilopid ab

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88
Q

Severe vs. mild preeclampsia

A

Severe = >5g protein, 160/110, RUQ/epigastric pain, vision changes = delivery regardless of age

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89
Q

29 wks, contractions 3-5min, 2cm dilated, 80% efface, nulliparous, +fFN

A

Pre-term labor (>20 - < 37wks)

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90
Q

Manage preterm labor

A

Tocoylsis for cause (<34), GBS, fetal fibronectin, mag sulfate for neuroprotection

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91
Q

Risks of pre-term labor

A

PREVIOUS, PROM, multiple gest, cocaine, A.A, trauma, surgery in preg, hydramnios, pyelonephritis, gonococcal infections

92
Q

Hx of pre-term, medication to dec risk of pre-term

A

Progesterone weekly from 16-36wks

93
Q

37 weeks, breech position next step

A

External cephalic version

- can self-correct b4 37wks

94
Q

Convert second twin from transverse/oblique to breech

A

Internal podalic version

95
Q

Carpal tunnel management

A

Splint —> steroid injection —> surgery only w/ muscular atrophy

96
Q

Risks for placenta accreta (decidua basalis)

A

Previous uterine incisions (c-section), anterior > post. or low lying/previa, prior myomectomy, >35, Downs

97
Q

1st step in placenta accreta

A

Hysterectomy d/t hemorrhage and death

98
Q

Accreta - Increta - Percreta layers

A

decidua basalia - myometrium - serosa and bladder

99
Q

Dense blue tissue adherent to uterus and bladder, hematuria

A

Placenta precreta

100
Q

Accreta refuses hysterectomy next step and complication

A

Ligate cord, + IV MTX –> hemorrhage, infection

101
Q

Week when placenta is major progesterone source

102
Q

Mom has HBsAg, next step for baby?

A

HBIG and Hep B vaccine at birth

103
Q

How to tx syphilus in mom

A

PCN; w/ allergy, desensitize and give PCN

104
Q

When to give Rubella?

A

Post-partum b/c it’s a live vaccine

105
Q

When and how to screen for neural tube defects

A

B/W 16-20wks - preg assoc protein-A (PAPP-A), bhCG, nuchal translucency

106
Q

Screen for GBS

107
Q

Threatened abortion lab test

A

bHCG and/or progesterone levels

108
Q

Menorrhagia d/t uterine fibroids work-up

A

CBC, endometrial bx and papsmear

109
Q

Women >55 y/o w/ adnexal mass work-up

A

CA-125 & CEA markers

110
Q

Amenorrhea w/ some spotting, lower abd/pelvic pain, sharp/tearing, syncope

A

Ectopic pregnancy —> bHCG TVUS

  • IVFs if unstable
  • CBC, LFTs, b-hcg + MTX
  • surgery w/ <2cm w/ desire for fertility
111
Q

1 cause 1-2nd trimester maternal mortality & hemoperitoneum

A

Ectopic pregnancy

- risks = previous, IUD, PID, ovulation induction, ART, tubal

112
Q

Irregular menses, obese, inc body hair

113
Q

Benefits of sonohysterography

A

Saline injected into uterus + US to better ID polyps or submucosal myomata

114
Q

When to use CT?

A

Pelvic or abd mass to delineate LNs

115
Q

When to use MRI?

A

Mullerian defects - vaginal agenesis, double uterus, location or pregnancy

116
Q

Benefits of hysterosalpingogram

A

Submucosal fibroids, uterine adhesions, patency of fallopian tubes

117
Q

Fetal HR w/ sinus wave cycles 3-5/min

A

Severe anemia or asphyxia

118
Q

PPROM (gush, +nitrazine, ferning), fever, fetal tachy, tender uterus

A

Intra-amniotic infection (chorioamnionitis - + gram stain) –> amp or gent & deliver after 34wks

119
Q

Risks for PPROM

A

Poor, STDs, smoking, cervical cone, cerclage, abruption, hydramnios, multiple gestations

120
Q

Chorioamnionitis W/O PROM organism

A

Listeria (otherwise GBS and EC)

121
Q

Clear fluid, + PG, 33wks next step?

A

PG = fetal lung maturity = delivery

122
Q

Fetal heart tracing abnormality in PPROM

A

Variable decelerations

123
Q

Fever, myalgias, child w/ red cheeks, height > gestation, can’t palpate baby?

A

Hydramnios + Parvovirus in pregnancy –> severe anemia —> hydrops fetalis

124
Q

Fetal hydrops, inc middle cerebrl doppler flow cause?

A

Rh isoimmunization

125
Q

Parvovirus IgM and IgG (-) next step?

A

Repeat in 1-2wks to ensure incubation period has elapsed

126
Q

(+) Chlamydia DNA assay, no sx next step?

A

Erythromycin or amox for 7d or 1dose Azithro —> WB or PCR confirmation

127
Q

Fetal sequela of Chlamydia infection

A

Conjunctivitis (NOT cured w/ erythromycin), PNA

128
Q

Most common neonatal conjunctivitis cause and tx?

A

Chlamydial = 14d oral erythromycin

129
Q

Complications of gonococcal cervicitis

A

abortion, pre-term, PPROM, sepsis, chorioamnionitis and post-partum infection

130
Q

Pustular skin lesions, arthralgias, septic arthritis in 3rd trimester

A

Disseminated gonococcal infection

131
Q

Tx and goal of HIV in pregnancy

A

<1000 RNA copies/ml, HAART therapy, IV ZDV during vaginal labor, no breast feeding, ZDV to neonate

132
Q

Organism is #1 cause of preventable blindness, propensity for columnar and transitional epithelium

A

Chlamydia –> LATE post-partum endometritis

133
Q

Pyelonephritis w/ EC (#1) sensitive to amp –> acute dyspnea

A

ARDS (Endotoxin release –> leaky capillaries) = supportive measures

134
Q

Most common cause of sepsis in pregnant women

A

Pyelonephritis = hospitalization, IV antibiotics (cephalosporins or amp + gent)

135
Q

No improvement in pyelonephritis/sepsis in 2-3d next step?

A

Look for urinary obstruction or perinephric abscess = CT scan

136
Q

Prevention of pyelonephritis

A

Urine culture @1st pre-natal and 1st trimester and tx early UTI/bacturia

137
Q

Post-c-section, hypotension, fever, lethagy, tender incision w/ crepitus, anemia, inc Cr

A

Necrotizing fasciitis —> isotonic IVFs, antibiotics, debridement

138
Q

Rapidly progressing infection of episiotomy or c-section, most common cause?

A

Group A strep

139
Q

C-section, fever, somewhat tender fundus, no other abnormalities

A

Endomyometritis (#1 fever followiing c-section)

140
Q

Cause and tx of endomyometritis

A

Ascending vaginal infection = Anaerobic (Bacteroides), some GNR (Polymycrobial) —> Gent & Clinda

141
Q

Post c-section fever after antibiotics persists after 48hrs? 72hrs cause?

A

> 48 = enterococcal –> amp; >72hrs = CT scan for abscess, hematoma, thrombophlebitis (antibiotics + heparin)

142
Q

Young, nulliparous, fever, abd pain near menses, dysparenunia, hyperemic cervix, uterine and adnexal tenderness

A

PID/Salpingitis –> infertility, ectopic; get US to R/O tubo-ovarian abscess

143
Q

Cause of PID/salpingitis

A

G/C, GNR, anaerobes (MULTIPLE) = test, antibiotics, US for abscess

144
Q

Salpingitis not improve after 48hrs

A

Laproscopy “GS for Dx,” & for abscess (anaerobes) –> clind or metronidzaole

145
Q

Risks for PID

A

Nulliparity, IUDs (OCPs, and depot DEC risk)

146
Q

Copious, white or yellow discharge, nonmalodorous, no other sx

A

Physiologic leukorrhea

147
Q

Thin-whitish/gray discharge from vagina, no CMT, pH 5, epithelial cells w/ adherent bacteria, no PMNs

A

BV = metronidazole

148
Q

Use of transcranial doppler

A

> 20wks

Fetal anemia w/ inc flow = has replaced PUBS

149
Q

Pseudocyesis

A 
Signs of pregnancy BUT
- normal endometrial stripe
- (-) hCG
- strong desire for child
= CONVERSION disorder
150
Q

1st sign of pregnancy

A

Goodell sign = softening of cervix @ 4wks

Ladin - midline uterus softening - 6wks
Chadwick - blue discoloration of vagina - 6-8wks

151
Q

Physiologic changes of pregnancy

A

Inc CO –> murmur
Lower BP
Dec SVR
Inc TV & minute ventilation –> resp alkalosis
GERD, constipation
INC GFR
Estrogen –> INC TBG –> INC total T4, T3
Anemia, inc WBC
Hypercoagulable - no change in PT, PTT, INR but dec platelets and inc fibrinogen

152
Q

How to do DM testing

A

50g –> >140 at 1 hr do 100g glucose tolerance test

100g –> 180, 155, 140

153
Q

Risk with chorionic villus sampling

A

In high risk pts, advances maternal age or known genetic disorder

b4 9-10 wks —> limb defects

154
Q

Type of abortion

  1. “liver passed”
  2. some products + dilation
  3. some products intact + bleeding + dilation
  4. products intact + bleeding + NO dilation
  5. 2nd trimester dilation w/o cramps
A
  1. Complete
  2. Incomplete –> D&C
  3. Inevitable –> D&C
  4. Threatened –> bed rest, no sex, reassurance
  5. Incompetent cervix (hx LEEP) –> cerclage
155
Q

Work-up for threatened abortion

A

bhcg should rise 66% inn 48hrs, progesterone >25

Otherwise get TVUS to assess pregnancy and viability

156
Q

Twins same gender + 2 placentas

A

Monozygotic
Dichorionic
Diamniotic
0-72 hr split, tubal

157
Q

Twins same gender + 1 placenta + 1 sac/no septums

A 
Monzygotic
Monochorionic
Monoamniotic
8-12d split
conjoining, cord entanglement
158
Q

Deliver vs. delay pre-term labor

A

Deliver
- Pre-eclampsia, fetal demise, pROM, abruption/DIC, 34-37wks, >2500g

Delay
- 24-33 wks, 600-2500g –> Mag sulfate, terbutaline, or CCBs + steroids (48hrs)

159
Q

3rd timester painless bright red bleeding, NO contractions, NON tender uterus

A

Placenta previa –> abd US

  • never do digital exam or TVUS
  • strict pelvic rest, no sex
160
Q

Work-up for vasa previa

A

TVUS

  • steroids if 28-32 wks
  • NST 2-3x daily
  • C/S w/ PROM, variable decel, bleeding + tachy
161
Q

3rd rimester dark bleeding + pain + contractions

A

Placental abruption –> abd US

- C/S w/ hemorrhage, fundal tenderness, fetal distress

162
Q

Risks for abruption

A

HTN
cocaine
trauma
smoking

163
Q

Post-partum bleeding, shaggy mass, placental extraction from funds >30min

A

Uterine inversion –> halothane, terbutaline or mag sulfate

164
Q

Gush of blood, lengthening of cord, globular, firm uterus

A

Placental separation

165
Q

Baby tacky –> brady + vaginal bleeding

A

Apt test = rupture of fetal umbilical vessels

166
Q

Extremem abd pain, HYPERVENTILATION + TACHY, regression of fetus, variable decels seen in MVA pt

A

Uterine rupture –> laparotomy for delivery

167
Q

Rh work-up

A

1st prenatal + 24-28wks

  • Unsensitized = RHOgam@28wks
  • Sensitized >1:16 w/ Rh+ baby –> amniocentesis for bilirubin and anemia –> possible PUBS
168
Q

Management of Eclampsia and HELLP

A

Mag & deliver

169
Q

Fetal acidosis, late decels, ph<7.35, BG 200

170
Q

Sequlae of neonatal hyperglycemia

A

hyperglycemia –> hypoxia –> polycythemia & hyperviscosity, hypoCa

171
Q

Management of GDM

A

Diet & exercise –> post-patrum 75g test at 6wks
Breast feed
>4500g = c/s
NPH at hs + aspart b4 meals

172
Q

Movements of baby through birth canal

A

Flex - IR - Extension - ER

173
Q

Contractions in lower abdomen, irregular, equal in intervals and intensity

A

False labor

  • better w/ sedation
  • -> reassurance
174
Q

Latent stage >14-20hrs

A

Prolonged latent stage –> rest & wait for resolution in 6-12hrs

Balloon —> stim engagement and dilation
Pitocin

175
Q

Stage 2 3hr w/ epidural, >2hrs w/o

A

Prolonged stage 2 –> oxytocin & re-asses in 2hrs
+1/+2 station = vacuum forceps
0 station = c/s

176
Q

Delivery w/ shoulder dystocia

A

McRoberts
- flex knees + suprapubic pressure

Delivery of posterior arm –> humerus fx

177
Q

Post-partum bleeding management

A

1 uterine atony

Palpate

  • Firm/normal uterus = laceration
  • Very firm = retained placenta –> D&C, follow hcg
  • Boggy = Atony
  • Absent = inversion –> tac fornices, pitocin

Massage –> oxytocin –> PGF or misoprostol –> uterine a. ligation or hysterectomy

PGF2a CI in asthmatics
Methergine CI w/ HTN d/t stroke risk

178
Q

Post-partum fever tender uterus, foul lochia, prolonged PROM, C/S

A

Endometritis –> Gent + clinda

- normal to have low fever, leukocytosis in 1st 24hrs

179
Q

Hyperemesis

A

bhcg to r/o mole
US to r/o mole

IVFs
Anti-emetics - doxylamine > promethazine > reglan > zofran

180
Q

Seizures in pregnancy tx

A

Phenobarbital + FOLATE

181
Q

Dx menopause

A

Inc FSH
Dec estrogen –> thoracic spine fx, dryness, atrophy

Estrogen replacement –> endometrial hyperplasia

182
Q

Work-up for AUB/DUB

A

Post-coital = CA

D&C –> ablation or hysterectomy

183
Q

Contraceptive for breastfeeding

A

Progestin mini-pill or Depo

184
Q

Risks of OCPs

A

Inc stroke, MI, cholelithiasis, liver adenomas, breast CA

185
Q

Contraceptive for sickle-cell, epilepsy

A

Depo –> DEPRESSION, weight gain

186
Q

Vaginal ring left in & patch left on for how long?

A

3 weeks

Patch Norelgestin + EE –> 2X INC IN DVT

187
Q

CIs to IUDs

A

STDs, abnormal shape uterus, cancer, fibroids, PID

188
Q

Labial fusion cause

A

21B-OH deficiency - Excess androgens

189
Q

White, thin labial skin, dysuria, dysparenuina

A

Lichen sclerosis –> steroids –> punch bx for SCC

190
Q

Sticky, white, adherent discharge w/ PRURITIS, recent abc, pH 4

A

Candida –> oral fluconazole

191
Q

Grey-white spilled milk, homogenous discharge, pH 6

A

BV –> metronidazole

192
Q

Yellow-green, profuse discharge, ERYTHEMA

A

Trichomonas –> metronidazole + partner

193
Q

HEAVY bleeding, midline uterine mass irregularly shaped

A

Uterine fibroid/leiomyoma

—> NSAIDs, progestin –> myomectomy –> uterine rupture –> Hysterectomy

194
Q

PAINFUL heavy bleeding, large, globular, boggy uterus

A

Adenomyosis –> hysterectomy

195
Q

Cyclical pelvic pain 1-2 wks b4 menses + dysparenunia + dysmenorrhea + DYSCHEZIA w/ nodular uterus and adnexal mass

A

Endometriosis

dx - laparoscopy w/ chocolate cysts
tx - NSAIDs, OCPs –> danazol and leuprolide

196
Q

LH:FSH >3:1, amenorrhea, obesity

A

PCOS –> OCPs, weight loss, metformin, clomiphene

197
Q

Post-menopausal adnexal mass work-up

A

TVUS & CA-125

198
Q

3 wks post-partum fever, breast pain, redness, induration

A

Mastitis

  • I&D, docloxacillin
  • Continue feeding

w/o fever or tenderness = galactocele –> aspiration

199
Q

Normal vaginal secretion thick, scant, acidic = which phase

A

Pre & post-ovulatory = Follicular & mid –> late luteal

200
Q

Resolution w/ TCAA

A

HPV –> TCAA, podophyllin

201
Q

PainLESS papule –> ulcer, painLESS B/L LAD + flat, velvety lesion w/ raised margin

A

Syphilis –> IM PCN G

202
Q

Deep purulent base/necrotic, ragged, SCHOOL OF FISH, painful ulcer and LAD

A

Chancroid –> Azithro or IM ceftriaxone

203
Q

Red, beefy base, painless, NO LAD

A

Granuloma inguinale

204
Q

Tx HSV during pregnancy

A

Active = C/S
No Sx = SVD
Acyclovir @ 3wks

205
Q

Blindess 5-14 post delivery

A

Chlamydia (GC is 2-5d)

206
Q

NST < 15/15 2 in 20 and no rxn to vibroacoustic stim next step

A

BPP

  • 8-10 = good
  • 4-8 >36 wks = deliver
  • 4-8 CST

CST brady or late decal = deliver now
CST reassuring –> steroid and wait

207
Q

Risk of CA in endometrial hyperplasia

  1. Simple
  2. Complex
  3. Simple atypia
  4. Complex atypia
A

“Penny, nickel, dime, quarter”

1
3
8
29%

208
Q

S/P hsyterectomy, fever, flank pain

A

Ureteral injury = CARDINAL ligament

  • -> CT w/ contrast, abx, stent
  • -> dissection –> ischemia ascities
209
Q

Which SERM stimulates endometrium –> CA?

210
Q

ASCUS work-up

A

25 –> HPV + = colpo or repeat 3yrs if -

211
Q

HSIL work-up

A

Colpo + bx

Repeat 6-8 wks after delivery if pregnant

212
Q

Cough, sneeze –> urine leak

A

Stress incontinence –> kegel

213
Q

Urge, frequency, nocturia, delay from cough urine leak

A

Urge –> oxybuntin or ditropan

- spastic bladder or instability

214
Q

DM, epidural, NO urge but dribbling throughout day, inc RV

A

Overflow –> bethanachol, a-blockers, intermittent cath

215
Q

Continuous urine leak but normal function, hx crohns or radiation

216
Q

Chronic pelvic pain + urgency, frequency, worse w/ spicy food

A

Interstitial cystitis

- submucosal petechiae & ulcers

217
Q

Never had menses
+ breasts
- uterus
Normal testosterone + hair

A

46XX - Mullerian agenesis

- No vagina or uterus but normal ovaries –> hair

218
Q

Never had menses
+ breasts
- uterus
INC testosterone + scant hair + inguinal buldge + normal female genetalia

A

46XY - Androgen insensitivity

- gonadectomy of testes AFTER puberty

219
Q

Never had menses
- breasts
+ uterus
LH, FSH HIGH

A

Turner

  • no secondary characteristics
  • give E +P
  • –> osteoporosis and coarctation
220
Q

Never had menses
- breasts
+ uterus
LH, FSH low

A

Craniopharygioma
Kallman syndrome
- No GnRH, anosmia, no pubic hair

221
Q

Amenorrhea
- hcg
Progestin –> bleed

222
Q

Amenorrhea
- hcg
Progestin - bleed
+ estrogen –> inc FSH, LH

A

Menopause
Ovarian failure - FSH/LH <1, Turner, auto-immune
Aromatase deficiency - LOW estrogen, clitoromegaly
Pituitary apoplexy, adenoma or sheehan

223
Q

Virilization - rapid onset
VERY HIGH TESTOSTERONE
U/L adnexal mass

A

Sertoli-Leydid tumor

224
Q

Virilization

HIGH DHEAS

A

Adrenal tumor

- sample vein

225
Q

Hirsuitism in pregnancy 1st step

A

US
no mass = check adrenal w/ CT

B/L cystic = THECA-LUTEIN
B/L solid = luteoma

U/L solid –> laparoscopy to r/o CA

Step 2 (20 decks)

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