Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Step 2 Stuff > OBGYN > Flashcards

OBGYN Flashcards

1
Q

What is chorioamnionitis, risk factors, and how does it present?

A

Intra-amniotic infection.
Often a cx in patients with premature rupture of the membranes & prolonged rupture (>18hrs).
Pts have N/V and uterine fundal tenderness. Also may have abnorm contraction pattern d/t effect of IAI on uterine mm. contractility.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How to diagnose chorioamnionitis:

A

Diagnosis is based on presence of Maternal fever and 1+ of the following: fetal tachy (>160 bpm for 10+ min), maternal leukocytosis, maternal tachy, or purulent amniotic fluid.
Pts may have abnormal contraction pattern d/t effect of IAI on uterine mm. contractility.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is likely seen on FHR tracing in abruptio placentae?

A

Nonreassuring FHR w/minimal variability and decelerations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the mgmt. of Itraamniotic infection/Chorioamnionitis?

A

Broad spectrum abx and Delivery (augmentation of labor) to remove source of infection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What cxs are a/w chorioamnionitis?

A

Maternal – postpartum hemorrhage, endometritis

Neonatal – preterm birth, pneumonia, encephalopathy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What abx are used to tx IAI?

A

Broad spectrum: ampicillin, gentamicin, clindamycin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is ancef?

A

Cefazolin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What Rxs are contraindicated in pts w/IAI?

A

Tocolytics – nifedipine, indomethacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When is GBS screening done?

A

Universal screening = rectovaginal culture at 35-37 weeks gestation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

DoC for GBS pphx?

A

Penicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Who should be treated in labor for GBS pphx?

A

Those with +GBS screen
Women who missed GBS screening who are in labor and <37wks gestation, develop intrapartum fever, or have prolonged ROM (for 18+ hrs).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Risk factors of ovarian torsion:

A

Ovarian mass, women of reproductive age, infertility tx w/ovulation induction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What acid-base disturbance is a normal phenomenon of pregnancy? When is this seen?

A

Primary respiratory alkalosis – occurs d/t hypocapnia in late pregnancy that is caused by direct stimulatory effect of progesterone on the central respiratory center.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

HPV vaccine indications:

A

All females 11-26

Men 9-21 or 9-26 for MSM and HIV pts.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What causes the HoTN a/w epidurals?

A

The SNS nerve fibers responsible for vascular tone are blocked – vasodilation and venous pooling occur w/decreased return to the R heart and decreased CO.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does a uterus w/irregular enlargement on exam suggest?

A

Uterine leiomyomata.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the most common cause of prolonged or arrested 2nd stage?

A

Fetal malposition.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is considered arrest of the 2nd stage of labor?

A

When there is no fetal descent after pushing 3+ hrs in nulliparous or 2+ hrs in multiparous women.
Fetal malposition is the most common cause.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the optimal fetal position?

A

Occiput anterior.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Who should take a prenatal vitamin?

A

All women of childbearing age, especially those contemplating conception.
Recommendation is to start prenatal 3 months prior to conception.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How long should conception be delayed following rubella vaccination?

A

1 month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What disease should be tested for in every 1st-prenatal visit?

A

Syphilis by RPR or VDRL.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When should the US date be used to predict GA?

A

If less than 8+6 weeks and discrepancy is 5+ days
9+0 to 15+6 weeks w/discrepancy of 7+ days
16+0 to 21+6 weeks w/discrepancy of 10+ days
22+0 to 27+6 weeks w/discrepancy of 14+ days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the quadruple screen and when is it preformed?

A

Blood tests to measure: AFP, hCG, estriol and inhibin A.

Done during second trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What pattern on quadruple screen will suggest Trisomy 18?

A

Decreased AFP
Decreased BhCG
Decreased estriol
Normal or low inhibin A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What pattern on quadruple screen will suggest Trisomy 21?

A

Decreased AFP
Increased hCG
Decreased estriol
Increased inhibin A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What pattern on quadruple screen will suggest Trisomy 13?

A

Decreased hCG

very decreased PAPP-A (pregnancy-associated plasma protein A).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the best test to determine if a fetus has an aneuploidy?

A

10-13 weeks = Chorionic villus sampling.

15-20 weeks = Amniocentesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What should be administered to pts <32 weeks of gestation for neuroprotection?

A

Magnesium sulfate – decreases the risk of cerebral palsy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What should be given to patients with HELLP syndrome? When should this be given, and for how long?

A

Mag sulfate – given immediately on diagnosis and continued for 24hrs after delivery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is cervical insufficiency? How is it diagnosed?

A

Painless cervical dilation leading to recurrent pregnancy losses (norm in 2nd trimester)
Diagnosed based on hx of either 2+ consecutive prior 2nd trimester losses OR 3+ early (<34wks) preterm births.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Tx of cervical insufficiency:

A

Transvaginal cerclage at 12-14 weeks (early 2nd trimester) and weekly IM hydroxyprogesterone caproate injects from 16-36 weeks (2nd - 3rd trimester).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What should be done in patients who present w/only one prior 2nd trimester loss, or 1-2 preterm births?

A

This isn’t sufficient to diagnose cervical insufficiency, so serial measurements of cervical length should be performed from 14-24 weeks.
A cerclage should be placed if cervical length is <25mm before 24 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Most common form of abnormal placentation?

A

Placenta accreta – where the placenta attaches to the superficial myometrium (but does not penetrate it like increta) instead of the decidual layer of the endometrium.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is placenta increta?

A

Invasion of the placenta through the endometrium into the myometrium.
This can progress to placenta percreta.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is placenta accreta?

A

Where the placenta attaches to the myometrium but does NOT penetrate it (like w/increta).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is placenta percreta?

A

Where placenta perforates the myometrium and invades the serosa, or adjacent structures (like the bladder).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Risk factors for abnormal placentation:

A

Abnormal placentation = placenta accreta/increta/percreta.

Risks: prior C-section, inflammation, and placenta previa.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Most feared complication of an ectopic pregnancy:

A

Intraperitoneal hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Cxs of placental abruption:

A

DIC, maternal shock, fetal distress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What does an empty gestational sac suggest?

A

AKA a pseudogestational sac, suggests an early pregnancy or a failed pregnancy – an anembryonic gestation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Most common site of ectopic pregnancy:

A

Ampulla of the fallopian tube.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What should be administered to patients w/dehydration 2/2 hyperemesis gravidarum?

A

IV fluids and B1 (thiamine). Also possible electrolyte replacement dependent on labs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How is gestational HTN managed?

A

With dietary modification and normal activities w/avoidance of high-intensity exercise.
UA and BMP should be performed weekly to exclude organ damage and developing eclampsia.
If SBP is ever >160 or DBP > 110 then the patient should go straight to the ED for tx.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What should be given as HIV pphx during pregnancy and delivery?

A

Zidovudine aka AZT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

How are Rh- and ABO-HDFN differentiated?

A

Aka hemolytic disease of the fetus and newborn.
Both will have a positive direct Coombs test and direct hyperbilirubinemia w/in the first 24hrs.
ABO-HDFN will typically have spherocytosis (Rh will not)
Rh-HDFN will likely have severe anemia (ABO will not)
Rh-HDFN is more severe than ABO and can be life threatening, whereas ABO-HDFN can be completely asx.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What vaccine should be given to all mothers 27-36 weeks?

A

Tdap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is the timeline of different monozygotic twins?

A

0-4 days: dichorionic, diamniotic (25%)
4-8 days: monochorionic, diamniotic (most common – 75%)
8-12 days: monochorionic, monoamniotic (rare)
>13 days: conjoined monochorionic, monoamniotic (rare)
All types will have 2 cords

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are risks of all twin pregnancies?

A

IUGR
Increased risk of infant mortality
Preterm birth
Cerebral palsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is twin-twin transfusion syndrome a complication of?

A

Unique complication to monochorionic, diamniotic twins.

chorion = the cushion the fetus is attached to

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is PUPPP and its treatment?

A

Pruritic urticarial papules and plaques of pregnancy.
Self-limited derm condition commonly seen in primigravids during the peripartum period.
Initially present as pruritic, erythematous papules in the area of the abdominal striae – can spread to torso and extremities.
Typically spares face, palms and soles.
Tx: moisturizing creams and f/u. Typically resolves w/in 1-2 weeks post-partum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What are the clinical features of uterine leiomyomas?

A

Heavy, prolonged menses
Pressure sxs: Pelvic pain, constipation, urinary frequency
Obstetric cxs: impaired fertility, pregnancy loss, preterm labor
Enlarged, irregular uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What should be done to investigate fibroids?

A

Pelvic US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How does a uterus w/fibroids feel on PE?

A

Enlarged, firm and irregular. May feel a prominent mass.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What are the features and causative organism of granuloma inguinale ?

A

aka Donovanosis

Caused by Klebsiella granulomatis.

Features: extensive/progressive ulcerative lesions w/OUT lymphadenopathy; base may have granulation type tissue; deep staining G- intracytoplasmic cysts (Donovan bodies).

NON-painful lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Cause and presentation of lymphogranuloma venereum:

A

Caused by C. trachomatis

Features: small, and shallow, painLESS ulcers; large, painFUL coalesced inguinal LNs (buboes); intracytoplasmic chlamydial inclusion bodies in epithelial cells and leukocytes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What has the greatest sensitivity to diagnose syphilis in early infection?

A

Treponemal tests: FTA-ABS, TP-EIA (Enzyme immunoassay)

Nontreponemal (RPR, VDRL) may have negative results in early infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

When is laparoscopy indicated in patients with endometriosis?

A

If the patient has failed empiric therapy
If there are contraindications to Rx therapy
Need for definitive dx
Hx of infertility
Concern for malignancy or adnexal mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is often the only presenting sx of endometriosis?

A

Infertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What should be the first step in investigation of primary infertility?

A

Hysterosalpingogram – used to diagnose anatomic abnormalities

Primary infertility - refers to couples who have not become pregnant after at least 1 year having sex without using birth control methods.

Secondary infertility - refers to couples who have been able to get pregnant at least once, but now are unable.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is the management of abruptio placentae?

A

First step – aggressive fluid resuscitation w/crystalloids

Next – place pt in L lateral decubitus position to displace the uterus off the aortocaval vessels and maximize CO.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Infections to be tested for at all first prenatal visits:

A

HIV, HBV, Chlamydia, and syphilis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What patients are at increased risk for IAI?

A

Those with premature rupture of membranes or prolonged rupture (>18hrs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Clinical features of lichen sclerosus:

A

Thin, white, wrinkled skin over the labia
Atrophic changes extending over the perineum and around the anus
Excoriations, erosions, and fissures from severe pruritus
Dysuria, dyspareunia, painful defecation, constipation and anal fissures
May see changes in vulvar architecture – adherence of labia at the midline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Workup and treatment of lichen sclerosus:

A 
Punch biopsy (for adult lesions) to exclude malignancy
Tx: superpotent corticosteroid ointment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Who does lichen sclerosus affect?

A

People with decreased estrogen: Prepubertal girls and peri/postmenopausal women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Biochemical profile in a patient with PCOS:

A

Increased testosterone, Increased estrogen, LH/FSH imbalance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What are common signs/sxs of androgen-secreting tumors?

A

New-onset voice deepening (androgens lengthen and thicken the vocal cords – changing their acoustic freq. and changing the voice)
Frank virilization: male-pattern baldness, increased muscle bulk, clitoromegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What are the features of Bartholin gland cysts on PE?

A

Soft, mobile, nontender, cystic mass palpated behind the posterior labium majus w/possible extension into the vagina.
Pts may have pressure and discomfort with walking, exercise or sex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

How does uterine rupture present?

A

During labor of prior c-section pts. w/sudden onset of vaginal bleeding, intense abdominal pain, palpable fetal parts through the abdominal wall and FHR abnormalities.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What should be done in patients w/High-grade squamous itraepithelial lesions on pap?

A

Immediate colposcopy.

May be done even in pregnancy w/cervical bx for all pts.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What should be done in pts who have an “inadequate colposcopy”?

A

Endocervical curettage – invasive procedure and deferred during pregnancy d/t risk of miscarriage and preterm delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What screening tests can be done to asses for aneuploidy in the 1st trimester?

A

Cell-free fetal DNA – has high sensitivity and specificity.
If the results of this are abnormal then the more invasive chorionic villus sampling can be taken and confirm the diagnosis w/fetal karyotyping.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

When can amniocentesis be performed?

A

Second trimester (15-20 weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

When can chorionic villus sampling be performed?

A

First trimester (10-13 weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

When can cell-free fetal DNA be performed?

A

First trimester (10+ weeks) in patients at risk for aneuploidies (>35)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Diagnosis of ectopic pregnancy:

A

positive urine B-hCG test combined w/transvaginal US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What is pseudocyesis and how is it managed?

A

The belief that one is pregnant with the misinterpretation of bodily sxs (breast fullness, morning sickness, abdominal distention). The belief may be strong enough to misinterpret negative home pregnancy tests as positive.
Tx: psychiatric evaluation and tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

How does undiagnosed placenta accreta often present?

A

Difficulty w/placental delivery – placenta does not detach from the uterus and is extracted in pieces. Often also has severe maternal hemorrhage unresponsive to uterine massage and uterotonic Rxs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Why might pts undergoing chemo or radiation become infertile? What does it cause and treatment?

A

These txs target rapidly dividing cells – affect theca and granulosa cells in the ovary and cause primary ovarian failure.

Causes: Primary ovarian failure. Will decrease estrogen production and cause increased LH and FSH in return.

Tx:

  • HRT for menopausal sx relief and bone loss protection
  • Cryopreservation for fertility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What is thought to cause HELLP syndrome?

A

Abnormal placentation – triggers systemic inflammation and activation of the coag and complement cascades.
Have platelet consumption and microangiopathic hemolytic anemia which is v detrimental to the liver.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What causes the elevated liver enzymes in HELLP syndrome?

A

Microangiopathic hemolytic anemia causes hepatocellular necrosis and thrombi in the portal system.
Also causes liver swelling and distention of the hepatic (Glisson) capsule.
MAHA also increases BR production (indirect hyperBRemia), and blood cell fragments on PBS.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Tx of HELLP syndrome:

A

Delivery of fetus
Mag for seizure pphx
Anti-HTN Rxs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Clinical features of HELLP:

A

Preeclampsia (increased BP + urine proteins after 20 wks)
Nausea/vomiting
RUQ abdominal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What would HTN and hyperreflexia (clonus) in pregnancy be concerning for?

A

Preeclampsia w/severe features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What is the treatment of postpartum endometritis?

A

Clindamycin and Gentamicin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Definition of preeclampsia:

A

New-onset HTN (SBP 140+ and/or DBP 90+) at 20+ weeks gestation PLUS proteinuria &/or end-organ damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Severe features of preeclampsia (6):

A 
SBP >160 or DBP 110 (2x 4hrs apart)
Thrombocytopenia
Increased Creatinine
Increased Transaminases
Pulmonary edema
Visual or cerebral sxs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Mgmt of preeclampsia:

A

W/out severe features – delivery at 37+ weeks
W/severe features – delivery at 34+ weeks
Mag sulfate for seizure pphx
Anti-HTNs

C-section is not indicated unless there is a contraindication to labor, or there’s a non-reassuring FHR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What is primary ovarian insufficiency?

A

A form of hypergonadotropic hypogonadism.
Causes cessation of ovarian fxn age <40yr.
Characterized by amenorrhea or oligomenorrhea and sxs of decreased estrogen (hot flashes, fatigue).
Initial presentation = irregular menses or infertility.
Pts. often have hx of AI disorder – hypothyroidism etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What will be seen in the serum of pts. w/Primary ovarian insufficiency?

A

Increased GnRH, and FSH.

Decreased Estrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What are indications for an endometrial bx for women >35yrs?

A

Atypical glandular cells on pap test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What are indications for endometrial bx in women <45?

A

AUB plus:
Unopposed estrogen (obesity, anovulation)
Failed medical mgmt.
Lynch syndrome (HNPCC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What are indications for endometrial bx in women >45?

A

AUB or postmenopausal bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What is LEEP biopsy?

A

Loop electrosurgical excision procedure
A type of cone bx that removes the cervical transformation zone.
Does not evaluate the endometrium – not used to dx AGC on pap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What should be done to investigate ACG on pap?

A

Aka atypical glandular cells.
May be d/t either cervical or endometrial adenocarcinoma.
Investigated w/colposcopy, endocervical curettage and endometrial bx – allows evaluation of ecto- and endo cervix and endometrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What causes the AUB following initiation of menses?

A

Immaturity of the developing HPG axis – produces inadequate quantities and proportions of GnRH, and therefore FSH and LH, to induce ovulation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What are the signs and sxs of peripartum cardiomyopathy (PPCM)?

A

Causes rapid-onset systolic HF – fatigue, dyspnea, cough, pedal edema.
Occurs >36 weeks or in early puerperium.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What type of fibroids are a/w RPL?

A

Intracavity, intramural, and submucosal.

Subserosal fibroids are located outside of the uterine cavity and do not cause RPL.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

When is gHTN diagnosed?

A

After 20 weeks

If a patient presents w/HTN prior to 20 weeks then it is considered chronic HTN.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Maternal pregnancy-related risks d/t HTN (5):

A 
Superimposed preeclampsia
Postpartum hemorrhage
gDM
Abruptio placentae
C-section
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Fetal pregnancy-related risks d/t HTN (4):

A

IUGR
Perinatal mortality/Stillbirth
Preterm delivery
Oligohydramnios

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What will be seen on FHR tracing in fetal anemia?

A

Sinusoidal fetal heart tracing – smooth, undulating waveform w/no variability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What will be seen on FHR tracing in placental insufficiency?

A

Late decelerations, smooth and subtle drops in the FHR occurring after contractions d/t transient fetal hypoxia caused by placental hypo-perfusion during contractions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

How does round ligament pain often present?

A

With sudden pain localized to the lower uterus and exacerbated by movement/improved with rest. Often lasts a few seconds with radiation to the groin.
Tx: reassurance, maternity support belt and acetaminophen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What are associated risk factors for uterine rupture (6)?

A

Previous scarring of the uterus – prior c-section or other surgery
Blunt abdominal trauma
Multiple gestation pregnancy
Grand multiparity
Inappropriate oxytocin admin
Excessive fundal pressure during delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

What is the best method for determining neural tube defects?

A

Amniocentesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What type of ovarian cysts are a/w hydatidiform moles?

A

Theca-lutein cysts – a/w choriocarcinoma and hydatidiform moles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What type of ovarian cysts are a/w teratomas?

A

Dermoid cysts – a/w cystic teratomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

What is the pathogenesis and clinical features of Granulosa cell tms?

A

Path: Sex cord-stromal tm. Have increased estradiol and inhibin
Complex ovarian mass
Juvenile features: Precocious puberty w/increased bone age
Adult features: breast tenderness, AUB, postmenopausal bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Histo and mgmt. of Granulosa cell tms:

A

Histo: call-exner bodies (cells in rosette pattern)
Mgmt: Endometrial bx (for ca screening) and surgery for staging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

What causes the sxs and lab values in Granulosa cell tms?

A

Granulosa cells convert testosterone to estradiol (via aromatase) and secrete inhibin which blocks FSH release.
Therefore, uncontrolled growth of these cells results in v. high estradiol and inhibin levels and low FSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What is secreted by dysgerminomas?

A

These are tumors of syncytiotrophoblast cells of the placenta – secrete LDH or B-hCG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

What type of ovarian tm may cause hyperthyroidism?

A

Struma ovarii – a type of mature teratoma/dermoid cyst.

These secrete TSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

What type of ovarian tms may cause virilization and what lab values will be seen?

A

Sertoli-Leydig cell tms – ovarian sex cord-stromal tms. that produce androgens.
Have increased testosterone and androstenedione; decreased estrogen; normal levels of DHEAS
Pts present w/amenorrhea, deepening voice, clitoromegaly
May also have signs of hypoestrogenism: vaginal dryness, breast atrophy, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

What ovarian tms produce high amounts of AFP?

A

Yolk sac tumors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

What is the first step in evaluating risk of preterm labor?

A

Measurement of cervical length by transvaginal US (TVUS) in the second trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

What is the mgmt. to reduce risk of preterm labor in pts w/short cervix?

A

Pts w/short cervices and no hx of preterm labor – vaginal progesterone
Pts w/hx of preterm labor – IM progesterone starting in 2nd tri and serial TVUS
Cerclage may be indicated then if TVUS shows short cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Risk factors of endometrial hyperplasia/ca (5):

A 
Anything w/xs estrogen
  OBESITY
  Chronic anovulation/PCOS
  Nulliparity
  Early menarche/late menopause
  Tamoxifen use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

What is in the BPP and what are abnormal results?

A

Biophysical profile = Nonstress test plus US to assess the following:
Amniotic fluid volume
Fetal breathing movement
Fetal movement
Fetal tone
Each category (including NST) gets 2 pts, normal is 8-10 points
6 points = equivocal
0-4 = abnormal – predictive of fetal acidemia
Oligohydramnios is also abnormal finding on US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

What are normal and abnormal results of NST?

A

NST = external FHR monitoring for 20-40 min
Normal: Reactive – 2+ accelerations
Abnormal: Nonreactive – <2 accelerations; recurrent variable or late decelerations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Risk factors for shoulder dystocia (5):

A 
Fetal macrosomia
Maternal obesity
Excessive pregnancy weight gain
gDM
Post-term pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

What effect on fetal growth does a short interpregnancy interval have?

A

Intervals <18mo are risks for IUGR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

What is seen on US in a septic abortion?

A

Retained POC and thick/echogenic endometrial stripe w/active blood flow.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

At what B-hCG level will a pregnancy be detectable by US?

A

> 1500

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

What is the mgmt. of HSV infection in pregnancy?

A

All pts w/prior HSV infection should receive antivirals from 36 weeks until delivery.
If lesions or prodromal sxs are present during labor – c-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

What is loss of fetal station pathognomonic for?

A

Uterine rupture – the presenting fetal part retracts back into the uterus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

How to dx gDM:

A 
First do glucose challenge test, if >140 then do 3-hr glucose tolerance test to confirm. Must have 2+ of the following to diagnose:
Fasting >95
1hr >180
2hr >155
3hr >140
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

Absolute contraindications to ECV:

A

Contraindications to vaginal delivery:
Prior classical cesarean
Prior extensive uterine myomectomy
Placenta previa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

Anti-HTN Rxs used in pregnancy:

A

First Line: BBs (labetalol) and methyldopa, then CCBs (nifedipine), and Hydralazine.
Second line: Clonidine, Thiazides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Anti-HTNs contraindicated in pregnancy (5):

A 
ACEIs
ARBs
Direct renin inhibitors
Nitroprusside
Spironolactone (mineralocorticoid R antags)
Furosemide (relative contraindication)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

What is the recommended antepartum mgmt. of HIV?

A

Get viral load at initial visit, every 2-4wks after initiation/change of tx, and then monthly until undetectable and every 3mos.
CD4 count every 3-6mos
Resistance testing
ART initiation
Avoid amniocentesis unless viral load <1000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

What is the recommended intrapartum mgmt. of HIV?

A

Avoid artificial ROM, scalp electrode or operative vaginal delivery
VL <1000 – ART + vaginal delivery
VL >1000 – ART + zidovudine + C-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

What is the postpartum mgmt. of HIV?

A

Cont. ART for mother
Zidovudine for infants of mothers w/VL <1000
Multi-drug ART for infants of mothers w/VL >1000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

What are the fetal risk factors for macrosomia (3)?

A

AfAm or Hispanic ethnicity
Male sex
Post-term pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

What is the mgmt. in a newborn w/shoulder dystocia?

A

Gentle massage and PT to prevent contractures – most spontaneously recover w/in 3 months
Surgery (nerve grafting) is considered when no improvement by 3-6mos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

How does lactation suppress ovulation?

A

High prolactin levels inhibit GnRH and thus LH and FSH.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

1st line tx to induce ovulation in PCOS pts:

A

WEIGHT LOSS

If this fails – Clomiphene citrate (a SERM; will restore pulsatile GnRH secretion).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

Factors, features and tx of Genito-pelvic pain/Penetration disorder:

A

Risks: Sexual trauma, lack of sexual knowledge, Hx of abuse
Features: pain w/penetration, distress/anxiety about sxs, no other cause of sxs
Tx: Desensitization tx, Kegels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

Risk factors for development of PPH (6):

A 
Prolonged or Induced labor
Chorioamnionitis
Multiple gestation
Polyhydramnios
Grand Multiparity
Operative delivery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

Causes of PPH (5):

A 
#1: Uterine atony
Retained placenta
Genital tract laceration
Uterine rupture
Coagulopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

What are uterotonics and what are they used for?

A

Oxytocin (DoC), Methylergonovine, Carboprost, Misoprostol

Used in the tx of PPH; cause the uterus to contract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

What is a contraindication to methylergonovine?

A

Hx of HTN

The rx causes sm. mm. constriction, uterine contraction and vasoconstriction which can cause/worsen HTN.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

What is a contraindication to Carboprost?

A

Asthma – it causes bronchoconstriction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

One differentiating factor of Lichen sclerosis v. GU syndrome of menopause:

A

Lichen Sclerosis DOES NOT affect the vagina – only the vulva/perineum
Menopause will affect all of these – pale vagina w/dryness and petechiae, discharge and atrophy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

What is a Category I FHR tracing?

A 
Requires all of the following:
  Baseline 110-160
  Moderate variability (6-25/min)
  No late/variable decelerations
  \+/- Early decelerations (the ones that mirror contractions)
  \+/- Accelerations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

What is a category III FHR tracing?

A

Requires 1+ of the following:
Absent variability + recurrent late decels
Absent variability + recurrent variable decels
Absent variability + bradycardia
Sinusoidal pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

What does a category III FHR tracing likely indicate?

A

Increased risk of severe fetal hypoxia (likely from uteroplacental insufficiency) – can easily lead to fetal acidemia, hypoxic brain injury and demise.

149
Q

What is the mgmt. of a category III FHR tracing?

A

Initial – maternal repositioning and intrauterine resuscitative interventions (O2, IVF, discont. Uterotonics).
Those who do not improve w/initial mgmt. and are <10cm dilated need immediate C-section

150
Q

What is the timeline for developing Sheehan syndrome?

A

May occur immediately postpartum or up to several years later.

151
Q

How is secondary amenorrhea defined and evaluated?

A

Amenorrhea for 3+ mos in women w/previously regular menses or 6+ in women w/irregular menses.
Evaluation is started w/B-hCG pregnancy test followed by serum FSH, TSH and prolactin levels.

152
Q

What does a fetal fibronectin test indicate?

A

Risk of preterm labor.
Fibronectin is produced from fetal cells and is found b/w decidua and uterine wall – starts to leak when labor is impending.

153
Q

What do decreasing B-hCG levels indicate?

A

Demise – automatically exclude normal pregnancy.

B-hCG should increase until end of 1st trimester

154
Q

What are the US findings in a missed abortion?

A

Embryo w/out cardiac activity or an empty gestational sac w/out a fetal pole (aka no embryo).
This can be seen in some early pregnancies, but if there is no continuation of embryonic development – missed abortion

155
Q

What are causes of increased AFP?

A

Open neural tube defects
Ventral wall defects
Multiple gestation

156
Q

Drugs used in maternal HTN crises:

A

IV Hydralazine, IV Labetalol, Oral Nifedipine.
If the pt. has bradycardia then labetalol can worsen this and shouldn’t be used.
If the pt. can’t tolerate PO then nifedipine cant be used
IV hydralazine is best

157
Q

What is the workup in suspected physiologic nipple discharge?

A

Pregnancy test
Guaiac test
Serum prolactin and TSH
Possible MRI of pituitary

158
Q

What is the workup in suspected pathologic nipple discharge?

A

Breast US and Mammography (if age 30+)

159
Q

What is Postpartum thyroiditis?

A

Occurs normally w/in the first 6mos postpartum but may be diagnosed up to a year.
Have brief hyperthyroid phase first (nonspecific sxs norm – anxiety, palpitations), then hypo phase which normally causes concern (fatigue, wt. gain, constipation, etc.)
Labs may show hyponatremia and hypercholesterolemia
Normally self-limited

160
Q

What are the common sxs of Aromatase deficiency in adolescents?

A

Delayed puberty
Osteoporosis – fractures easily
Undetectable estrogen – no breast development
High concentrations of gonadotropins – pubic and axillary hair, polycystic ovaries

161
Q

Most common cause of a nonreactive NST:

A

Quiet fetal sleep cycle – lasts <40min

162
Q

What is the pathogenesis of fibroids?

A

Proliferation of smooth muscle cells within the myometrium

163
Q

What is the cause and features of adenomyosis?

A

Proliferation of endometrial glands inside the uterine myometrium – causes bulky, tender uterus that is uniformly enlarged

164
Q

What is likely to be seen on FHR tracing in uterine rupture?

A

Fetal hypoxia – fetal tachycardia, minimal variability, and late decels.
May look like large accels + decels, but the “accelerations” may just be a high baseline (fetal tachy)

165
Q

What are cxs of cervical conization (4)?

A

Cervical stenosis
Preterm birth
Preterm PROM
2nd trimester pregnancy loss

166
Q

How do Theca lutein cysts present?

A

As multilocular, bilateral cysts (10-15cm) in the ovaries.
D/t ovarian hyperstimulation
Will resolve w/decreasing B-hCG levels

167
Q

How does a complete mole form?

A

Fertilization of an empty ovum by either 2 sperm or by 1 that duplicates its genome – all paternal parts.

168
Q

What is required to diagnose PMS and what is the tx?

A

Sx severity to a point of socioeconomic impact (missed work).
Tx: SSRIs (1st line) or combined OCs (2nd line)to induce anovulation
If both those txs fail can try Leuprolide

169
Q

When are women screened for gDM?

A

At 24-28 weeks

High risk pts can be screened earlier

170
Q

How to differentiate inflammatory breast ca. from infectious processes:

A

All commonly have warmth, pain and erythema.
Mastitis and abscesses often have fever and improve w/abx
IBC often have peau d’orange, itching, nipple changes, a palpable mass and lymphadenopathy

171
Q

What is the mgmt. of shoulder dystocia?

A

“BE CALM”
Breath, don’t push
Elevate legs & flex hips against the abdomen (McRoberts maneuver)
Call for help
Apply suprapubic pressure
enLarge vaginal opening w/episiotomy
Maneuvers – deliver post. arm, rotate shoulder, etc.

172
Q

What is the tx of ovarian torsion?

A

It is a gyn emergency!
Laparoscopy w/detorsion
Ovarian cystectomy
Oophorectomy if necrosis or malignancy

173
Q

What is the pathognomonic US finding in ovarian torsion?

A

Presence of an adnexal mass and lack of Doppler flow.

174
Q

When do we stop Pap testing?

A

At age 65 or hysterectomy plus no hx of CIN2 or higher
AND
3 consecutive neg. Paps OR 2 consecutive neg. co-testings

175
Q

When must pap testing continue past age 65?

A

If the pt. has a hx of CIN2 or more testing must continue for 20 years after that result (may extend past 65)
Or if a woman has risk factors for cervical ca (IMCP’d, high-risk activity, tobacco, DES exposure)

176
Q

What are the common US findings of epithelial ovarian carcinoma?

A

Solid mass w/thick septations and ascites (mod amount of peritoneal fluid)

177
Q

What type of ovarian tumor arises from ectodermal cells?

A

Dermoid cysts/Mature cystic teratomas – these will appear as hyperechoic nodules w/calcifications on US.

178
Q

What structures may be involved in epithelial ovarian carcinoma?

A

Can be malignancy involving the ovary, fallopian tube and peritoneum.
Abnormal proliferation in any of these will cause the hallmark large ovarian mass.

179
Q

What are the features of Asherman syndrome?

A 
Aka intrauterine adhesions.
Features: 
  AUB
  Secondary Amenorrhea (unresponsive to Progesterone challenge)
  Infertility
  Cyclic pelvic pain
  Recurrent pregnancy loss
Evaluated w/Hysteroscopy
180
Q

What are the current guidelines for Pap and HPV testing?

A

For women 21-29: Pap cytology alone every 3 years

Women 30-64: Pap w/HPV co-testing every 5 years

181
Q

What are the features of chancroid?

A

Caused by H. ducreyi – mostly found in tropical and subtropical regions.
Have erythematous papules that progress to pustules and then painful ulcers norm w/yellow or grey exudate covering the bases.
Also have buboes

182
Q

What serum abnormalities may be seen in AIS?

A

Typically will have increased testosterone, estrogen, and LH levels.

183
Q

What blood tests are recommended at time of dx of PCOS?

A

Fasting lipid panel

184
Q

What is 1st line tx for PCOS?

A

Metformin or other anti-DMs as well as OCs

185
Q

What tm marker is a/w endodermal sinus ovarian tms?

A

Aka Yolk sac tms.

AFP is typically elevated

186
Q

What is the maternal mgmt. of HCV in pregnancy?

A

Get HAV and HBV vaccinations if not already immune.
Otherwise nothing really – barrier contraception isn’t needed, can’t take ribavirin bc its teratogenic, and C-section is not protective.
Can still breastfeed

187
Q

What is 1st line mgmt. of recurrent variable decelerations?

A

Maternal repositioning.

If this fails can do an amnioinfusion to decrease cord compression.

188
Q

What needs to be investigated in Mullerian agenesis?

A

Renal abnormalities – all pts should get renal US
Mullerian anomalies may also occur and be a/w renal abnormalities (only 1/2 of the uterus forms and only 1 kidney and ovary etc.)
Type II will have renal and vertebral defects +/- auditory and cardiac defects.

189
Q

Risk factors of placenta previa:

A

1 is prior c-section

Prior previa
Multiple gestation
Advanced maternal age (>35)

190
Q

Contraindications to copper IUD:

A

Acute cervicitis and PID

191
Q

Where are the skene glands located?

A

Lateral to the urethral meatus

192
Q

What is size-dates discrepancy?

A

A >2cm difference in fundal height measurement from the gestational age.
Once ROM has occurred there will be a larger discrepancy – normal

193
Q

What are luteomas of pregnancy?

A

Solid uni- or bilateral ovarian masses
Cause increased release of androgens – maternal and possible fetal virilization.
May be asx or present w/sxs of virilization
Ovarian masses will spontaneously regress after delivery – no tx required

194
Q

How to differentiate Theca-lutein cysts from luteomas of pregnancy:

A

Both will present w/virilization of both mother and fetus and ovarian masses that regress after delivery.
Theca-lutein will be cystic and bilateral
Luteomas will be solid and unilateral or bilateral

195
Q

What type of cancer does DES exposure predispose to?

A

Clear cell adenocarcinoma of the vagina

aka not squamous cell

196
Q

Risk factors for vaginal ca.:

A

Age >60
HPV infection
Tobacco use
DES exposure in utero (clear cell adeno only)

197
Q

Causes of fetal tachycardia (4):

A

Maternal fever
Medication side effect (B-agonists)
Fetal hyperthyroidism
Fetal tachyarrhythmia

198
Q

Causes of fetal bradycardia (4):

A

Maternal hypothermia
Medication side effect (BBs)
Fetal hypothyroidism
Fetal heart block (anti-Ro/SSA, anti-La/SSB)

199
Q

Is MMR vax safe during breastfeeding?

A

Yes. All non-immune mothers should receive it immediately post-partum

200
Q

When should anti-D immune globulin be given?

A 
In uncomplicated pregnancies at 28-32 weeks gestation and then again w/in 72 hrs of delivery.
Other indications: 
  amniocentesis 
  chorionic villus sampling
  ECV
  Ectopic pregnancy
  <72hrs after spontaneous abortion
  Threatened abortion
  Hydatidiform mole
  Abdominal trauma/placental abruption
  2nd or 3rd trimester bleeding
201
Q

Tx of condylomata acuminata:

A

Chemical – podophyllin resin, trichloroacetic acid
Immunologic – imiquimod
Surgical – cryotherapy, laser therapy, excision

202
Q

How does vulvar lichen planus appear?

A

As pruritic, glassy, bright red-purple lesions w/overlying white reticular line (Wickham striae)

203
Q

What are the clinical features of intraductal papilloma?

A

Unilateral bloody nipple discharge w/o an associated mass or lymphadenopathy.
Benign dilation of breast duct.

204
Q

What is a boggy, tender uterus in a non-pregnant woman suggestive of?

A

Adenomyosis

205
Q

What kind of twins are at risk of cord entanglement?

A

Monochorionic monoamniotic (bc they’re in the same sac)

206
Q

What are the long-term consequences of exercise-induced hypothalamic amenorrhea?

A

Decreased bone mineral density

Increased total cholesterol and TGs

207
Q

What lab abnormalities are seen in Hyperemesis Gravidarum?

A 
Ketonuria
Hypochloremic metabolic alkalosis
Hypokalemia
Hemoconcentration
HG may also cause transient hyperthyroidism but levels are not typically measured unless there are overt signs of hyperthyroidism
208
Q

What is Intertrigo, and how is it txd?

A

A dermatitis caused by Candida (often in IMCP’d)
Features: Erythematous “beefy red” plaques w/in the inguinal folds. Typically in a symmetric mirror image pattern across skinfold w/satellite regions near primary infection.
May affect inguinal, axillary, gluteal, and inframammary folds.
Tx: Topical azoles – clotrimazole, ketoconazole

209
Q

What Rx can be used in the tx of Hidradenitis suppurativa?

A

Doxycycline

210
Q

Tx options of Spontaneous abortion:

A

Expectant and medical induction (Misoprostol) in stable pts.

Suction curettage in pts w/infection or hemodynamic instability

211
Q

Maternal cxs of Twin pregnancy:

A

Hyperemesis gravidarum
Preeclampsia
gDM
Fe-def anemia

212
Q

Fetal cxs of twin pregnancy:

A 
Congenital anomalies
IUGR
Preterm delivery
Malpresentation (breech)
Placenta previa
Abruptio placenta
Cerebral palsy
RDS
Transfusion syndrome (monochorionic)
Cord entanglement and conjoined (monoamniotic)
213
Q

What are the features, onset and etiology of Symmetric FGR?

A

Onset: 1st trimester
Etiology: Chromosomal abnormalities, congenital infections (less common)
Features: Global growth lag – all organs are uniformly affected

214
Q

What are the features, onset and etiology of assymmetric FGR?

A

Onset: 2nd or 3rd trimester
Etiology: Utero-placental insufficiency, maternal malnutrition, maternal vasculopathy (HTN, pre-gestational DM)
Features: “Head-sparing” growth lag – redistribution of blood flow spares brain, heart and placenta at the expense of less vital organs (abdominal viscera)

215
Q

Effect of maternal depression on fetus:

A

A/w increased risk for cognitive delay and psych illness – depression, ADHD.
SSRIs should be continued throughout pregnancy – not teratogenic

216
Q

Current guidelines for tx of Gonococcal infections:

A

Both azithromycin and ceftriaxone – both are active against N. gonorrhea and there is increasing resistance to cephalosporins, so monotx is not recommended

217
Q

What is the best initial step in evaluating an adnexal mass in a postmenopausal woman?

A

Measurement of CA-125 levels in conjunction w/pelvic US

218
Q

What procedure is contraindicated in a postmenopausal woman w/an ovarian mass?

A

Needle aspiration – high risk of spreading potential malignant cells

219
Q

What is the mgmt. and potential cx of Intrauterine fetal demise?

A

20-23 weeks: can have dilation & evacuation or vaginal delivery (induced by Oxytocin, Misoprostol or Prostoglandin E2)
24+ weeks: requires vaginal delivery – induced like above
Cx: Coagulopathy/DIC if fetus is retained for several weeks

220
Q

What is Mittelschmerz?

A

Unilateral pelvic pain occurring mid-cycle d/t ovulation/follicular cyst rupture.
Physiologic process – will be a simple, small, thin-walled cyst +/- free fluid

221
Q

Features and tx of Magnesium toxicity:

A

Features:
Mild – N/HA, flushing, diaphoresis, hyporeflexia
Moderate – areflexia, hypocalcemia, somnolence
Severe – resp. paralysis, cardiac arrest
Tx: Stop Mag therapy, give IV Ca-Gluconate bolus

222
Q

Biggest risk factor for Magnesium toxicity:

A

Renal insufficiency – mag is solely excreted by the kidneys

223
Q

Risk factors of placental abruption (4):

A

Maternal HTN or preeclampsia/eclampsia
Abdominal trauma
Prior abruption
Cocaine and tobacco use

224
Q

Risks for cornual/interstitial ectopic pregnancies:

A

Uterine anomalies – bicornuate uterus

IVF

225
Q

How often does the medroxyprogesterone acetate (DMPA) shot need to be admin’d?

A

Every 3 months to prevent pregnancy – inhibits GnRH and suppresses ovulation.

226
Q

Adverse effects of SERMs:

A

Both tamoxifen and raloxifene can cause hot flashes, and venous thromboembolisms.
Only tamoxifen can cause endometrial hyperplasia and ca.
Both also reduce risk of osteoporosis

227
Q

Tx of neonatal thyrotoxicosis:

A

Self-resolves w/in 3 mos (maternal Abs disappear)

Short-term tx w/Methimazole plus BB

228
Q

When is myomectomy a contraindication to vaginal delivery?

A

If it was extensive/the uterine cavity was entered

229
Q

When is amnioinfusion contraindicated?

A

In a pt. w/a hx of uterine surgery

230
Q

Tx of Stress incontinence:

A

Trial of conservative mgmt. – kegel exercises

Those who fail or request surgery – midurethral sling

231
Q

Tx of overflow incontinence in women:

A 
Cholinergic agonists (Bethanecol) and intermittent self-catheterization. 
Men are tx’d w/a-blockers (Tamsulosin)
232
Q

Tx of urge incontinence:

A

Oxybutynin (antimuscarinic)

233
Q

What is the purpose of hCG in pregnancy?

A

Responsible for maintaining the corpus luteum and adequate progesterone secretion until the placenta is able to produce it.
hCG production begins ~8 days after fertilization and doubles every 48hrs until it peaks at 6-8 weeks gestation.

234
Q

1st line tx for asx bacteriuria in pregnancy:

A

Cephalexin
Amoxicillin-clavulanate (Augmentin)
Nitrofurantoin
Fosfomycin

235
Q

Is TMP-SMX (Bactrim) safe during pregnancy?

A

Only during 2nd trimester.

Contraindicated in 1st d/t interference of folic acid metabolism, and in 3rd d/t increased risk of kernicterus

236
Q

What is pubic symphysis diastasis and how does it present?

A

Widening of the pubic symphysis during vaginal delivery.
Most pts don’t experience sxs of this physiologic phenomenon but some experience: suprapubic pain radiating to back, hips, thighs, exacerbated by walking, and position changes.

237
Q

What renal & urinary changes are seen in pregnancy?

A

Physiologic: Increased RBF, GFR, and BM permeability
Labs: Decreased BUN and Creatinine, Increased renal protein excretion (up to 300mg protein/1+ on dipstick)

238
Q

How should a simple breast cyst in a pt <30 be managed?

A

Repeat breast exam in 2-4mos.

If they are symptomatic can aspirate the fluid and if it is clear then f/u 2-4mos

239
Q

Cxs of inappropriate wt. gain in pregnancy:

A

Excessive – gDM, fetal macrosomia, C-section

Inadequate – FGR, preterm delivery

240
Q

How much should underweight pts gain for pregnancy?

A

Underweight (BMI <18.5) need to gain 28-40lbs during pregnancy.

241
Q

What is fetal organomegaly a potential cx of?

A

gDM and fetal hyperinsulinemia

242
Q

What causes of bacterial vaginitis will cause subsequent vaginal inflammation?

A

Thrichomonas and Candida

Gardenerella (bac vaginosis) will not cause inflammation

243
Q

What Rx is contra’d in Hydatidiform mole?

A

Misoprostol – high risk of incomplete uterine evacuation.

244
Q

Most accurate method of determining GA:

A

First-trimester US w/crown-rump length measurement.
If later in the pregnancy there are discrepancies b/w US dating the 1st trimester US should be used and growth problems should be considered

245
Q

Hallmark of endometrial polyps:

A

Intermenstrual spotting w/out uterine enlargement.

The polyps are in the uterine cavity and will not be palpated on adominopelvic PE

246
Q

What affect will uteroplacental insufficiency have on amniotic fluid levels?

A

It causes chronic fetal hypoxemia and redistribution of blood flow sparing the brain at expense of other organs.
Will have decreased renal perfusion in fetal kidney – oligohydramnios

247
Q

What are nuchal cords a/w on FHR tracing?

A

Variable decelerations

248
Q

What effect will tamoxifen have on risk of ovarian cancer?

A

May decrease the risk

Increases the risk of endometrial ca. only

249
Q

What defines the arrest of active/1st stage labor and how is it managed?

A

No cervical change for 4+hrs w/adequate contractions
or 6+hrs w/inadequate contractions (adequate = contractions of 200+ MVUs in 10min)
Tx of any cause of arrest is C-section

250
Q

What is protraction of labor and its tx?

A

Cervical change slower than expected +/- inadequate contractions.
Tx w/oxytocin infusion

251
Q

Mgmt of Epithelia ovarian carcinoma:

A

Exploratory laparotomy, Bx of any sort is contra’d d/t high risk of spreading suspected malignant cells

252
Q

Mgmt of placenta previa:

A

When found early – no intercourse, no digital cervical exams, bedrest, and inpatient admission for bleeding episodes.
If in labor – c-section at 36-37 weeks

253
Q

What might be seen on US in congenital HSV infection?

A

Placental, umbilical cord, and temporal lobe calcifications

254
Q

Features and mgmt. of vaginal cancer:

A

Vaginal bleeding, malodorous vaginal discharge, irregular vaginal lesion (often in upper 1/3 of posterior vagina).
Dx w/vaginal bx and Tx w/surgery and chemo

255
Q

How is vaginal intraepithelial neoplasia tx’d?

A

It is non-invasive

Tx: topical therapy or wide local excision

256
Q

Mgmt of uterine inversion:

A

Aggressive fluid replacement
Manual replacement of the uterus
Placental removal & uterotonic Rxs after uterine replacement

257
Q

pH difference b/w causes of vaginitis:

A

Bacterial (gardnerella) and Trichomoniasis have increased pH >4.5
Candida has normal pH: 3.8-4.5

258
Q

What effect can estrogen have on the vaginal flora?

A

It can cause an imbalance and allow for candida proliferation.
So people at risk = pregnant women, postmeno on HRT, and those on OCs w/estrogen

259
Q

Mgmt. of preterm labor in women <32wks GA:

A

Betamethasone
Tocolytics (Indomethacin DoC)
Mag Sulfate (neuroprotection)
Penicillin if GBS + or unknown

260
Q

Risk factors for amniotic fluid embolism:

A 
Advanced maternal age
Gravida >5 (live or stillbirths)
C-section or instrumental delivery
Placenta previa or abruption
Preeclampsia
261
Q

What is vasa previa and how does it present?

A

Fetal vessels traverse the internal cervical os and are vulnerable to injury during amniotomy.
Presents as painless vaginal bleeding and FHR abnormalities (bradycardia d/t fetal exsanguiation) after amniotomy. Often see bright-red fluid w/ROM.
Normally need c-section right away

262
Q

What features would suggest secondary (pathologic) causes of dysmenorrhea?

A

Sx onset >25
Unilateral/non-midline pelvic pain
No systemic sxs during menses
AUB (intermenstrual or postcoital)

263
Q

Risk factors for cervical cancer:

A 
Infection w/high-risk HPV strains (16, 18)
Hx of STDs
Early onset sexual activity
Multiple or high-risk partners
IMCP’d
OC use
Low socioeconomic status
Tobacco use
264
Q

Features of Congenital Zika Syndrome:

A

Microcephaly and craniofacial disproportion
Neurologic abnormalities (spasticity, seizures, hypertonia)
Ocular abnormalities
Contractures, club foot and limb abnormalities
Closed anterior fontanelle (craniosynostosis) and collapsed skull
Thin cerebral cortices w/intracranial calcifications (d/t tissue necrosis)
Ventriculomegaly

265
Q

Tx of labial adhesions:

A

Topical estrogen for those w/sxs

Asx pts don’t need tx

266
Q

Breast cancer risk factors:

A 
HRT
Nulliparity
Increased age at first live birth
EtOH consumption
Fhx or genetic mutation
White race
Increasing age (>50)
Early menarche/late menopause
267
Q

Risks of and mgmt. for Intrahepatic cholestasis of pregnancy:

A 
Risks: 
  Fetal demise
  Preterm delivery
  Meconium-stained amniotic fluid
  Neonatal RDS
Mgmt:
  Delivery at 37wks
  Ursodeoxycholic acid
  Antihistamines
268
Q

Features and mgmt. of oxytocin toxicity:

A

Oxytocin is similar to ADH and cause water retention often leading to Hyponatremia.
Can present with: HA/AbdP/N/V, lethargy, HoTN, tachysystole and tonic-clonic seizures
Mgmt: correct hyponatremia w/hypertonic saline (3% NS)

269
Q

Appearance and evaluation of a neonate w/fetal growth restriction:

A

Appearance: wide/lg. anterior fontanelle, thin umbilical cord, loose/peeling skin, minimal subQ fat, and meconium-stained amniotic fluid.
Evaluate w/placental histopathology; may consider karyotype, urine tox, and serology

270
Q

Neonatal cxs of IUGR:

A

Polycythemia
Hypoglycemia
Hypocalcemia
Poor thermoregulation

271
Q

Lethal fetal anomalies that are non-viable:

A 
Acardia
Anencephaly
b/l renal agenesis
Holoprosencephaly
Fetal demise
Pulmonary hypoplasia
Thanatophoric dwarfism
These conditions require vaginal birth w/minimization of maternal cxs
272
Q

Features of Klumpke palsy:

A

Injury to C8 and T1
Presents w/claw hand (extended wrist, hyperextended mcp joints, flexed IP joints, and absent grasp reflex), Horner syndrome, Intact moro and biceps reflexes
Often caused by shoulder dystocia

273
Q

Features of Erb-duchenne palsy:

A

Injury to C5 and C6
Presents w/waiter’s tip (extended elbow, pronated forearm, flexed wrist and fingers), intact grasp reflex. May have absent or decreased Moro

274
Q

Absolute contraindications to exercise in pregnancy:

A 
Amniotic fluid leak
Cervical incompetence
Multiple gestation
Placenta abruption or previa
Premature labor
Preeclampsia/gHTN
Severe heart or lung disease
275
Q

Unsafe activities during pregnancy:

A

Contact sports
High fall risks (skiing, gymnastics, horseback riding)
Scuba
Hot yoga

276
Q

Major causes of Primary ovarian insufficiency:

A 
Turners
Fragile X (even carriers)
Autoimmune oophoritis
Anticancer Rxs
Pelvic radiation
Galactosemia
277
Q

Risk factors for vulvar cancer:

A 
Tobacco use
Vulvar lichen sclerosis
IMCP’d
Prior cervical ca.
Vulvar/cervical intraepithelial neoplasia
278
Q

Clinical features of vulvar cancer:

A

Vulvar pruritus, plaque/ulcer, abnorm bleeding

Need bx to dx

279
Q

How does hypothyroidism cause amenorrhea?

A

The low thyroid hormones cause increased TRH – increased TSH and prolactin from the anterior pituitary.
Increased prolactin inhibits FSH and LH production – anovulation and AUB.

280
Q

Features of Paget disease:

A

Paget disease – intraepithelial adenocarcinoma w/underlying DCIS or invasive breast ca.
Clinical features: Eczematous and/or ulcerating rash localized to the nipple and spreads to the areola, may have vesicles, scales, bloody discharge, and nipple retraction. Affected nipple may also have pain, itching and burning.

281
Q

How to differentiate 5-a Reductase deficiency from AIS:

A

Both will be phenotypically female at birth, and develop external female genitalia w/internal male (testes in labia).
AIS will develop breasts during puberty and continue to have feminine characteristics.
Will have increased testosterone, estrogen and LH.
5-aR deficiency will have no breast development and will have virilization at puberty: clitoromegaly, increased mm. mass, nodulocystic acne, etc.
Will have normal testosterone/estrogen and LH will be normal or increased.

282
Q

Risk factors for adenomyosis:

A

Age >40
Multiparity
Prior uterine surgery (myomectomy etc)

283
Q

How does septic pelvic thrombophlebitis present and how is it tx’d?

A

Presents w/fever unresponsive to abx, no localizing signs/sxs, negative infectious evaluation.
It’s a dx of exclusion.
Tx: anticoagulation and BSA

284
Q

What are risk factors for septic pelvic thrombophlebitis (6)?

A 
C-section
Pelvic surgery
Endometritis
PID
Pregnancy
Malignancy
285
Q

What causes septic pelvic thrombophlebitis?

A

Caused by thrombosis of deep pelvic or ovarian veins (get b/l LQ tenderness) that becomes infected.
Predisposing factors: hypercoagulability of pregnancy, pelvic venous stasis and dilation, endothelial damage from infection and/or trauma during surgery

286
Q

What is considered excessive alcohol consumption?

A

> 2drinks/day

287
Q

What will be elevated in CAH?

A

Both classic and non-classic types will have 21-hydroxylase deficiency causing elevated 17-hydroxyprogesterone levels, normal DHEA and elevated testosterone

288
Q

How to differentiate ovarian from adrenal androgen-secreting tumors:

A

Ovarian androgen-secreting tumors will have very high testosterone levels with normal DHEAS.
Adrenal will have very high DHEAS as well as increased testosterone.

289
Q

What are the maternal cxs of an operative vaginal delivery (vacuum/forceps)?

A

GU tract injury
Urinary retention
Hemorrhage

290
Q

What are the fetal cxs of an operative vaginal delivery (5)?

A 
Laceration
Cephalohematoma
Facial n. palsy
Intracranial hemorrhage
Shoulder dystocia
291
Q

What is a common cause of infertility in women >35?

A

Diminished ovarian reserve – decreased oocyte number and quality.
Ovulation and regular menses occur but conception rates decrease d/t diminished oocyte quality.

292
Q

How will patients with acute fatty liver of pregnancy present?

A

Often have sxs of fulminant hepatic failure – scleral icterus, encephalopathy, leukocytosis and thrombocytopenia.
May present w/RUQ pain, elevated transaminases and IUFD

293
Q

How does onset of decelerations differ?

A

Early decels a/w head compression are slow and have >30sec from onset to nadir
Variable have quick onset and are <30sec from onset to nadir
Late are gradual and have >/= 30 sec from onset to nadir

294
Q

What pharmacotherapy can be used to tx stress incontinence?

A

Trick question – NONE

295
Q

What are risk factors a/w uterine inversion and how will it present?

A

Risks – nulliparity, fetal macrosomia, placenta accreta, and rapid L&D
May result from xs fundal pressure and traction on umbilical cord before placental separation.
Presents w/smooth, round mass protruding through cervix/vagina, lower abdominal pain, hemorrhagic shock, and a uterus no longer palpable transabdominally

296
Q

What can exclude endometrial ca. in postmenopausal women w/AUB?

A

An endometrial stripe = 4 mm.

This cannot exclude endometrial ca. in premenopausal women

297
Q

How should suspected ectopic pregnancy in hemodynamically stable patients be managed?

A

Do TVUS – if non-diagnostic then measure serum B-hCG.
If B-hCG >1500 – repeat hCG and TVUS in 2d
If B-hCG <1500 – repeat hCG in 2d, once >1500 TVUS should be repeated

298
Q

What effect does hPL have in the third trimester?

A

Human placental lactogen (a placental somatomammotropin) increases in the 3rd trimester and causes pancreatic B-cell hyperplasia causing increased peripheral insulin resistance – gDM

299
Q

Risk factors for HG:

A

Multiple gestation
Hydatidiform mole
Hx of GERD

300
Q

What is the only indication for HRT?

A

Vasomotor sxs in women <60 who have undergone menopause w/in the last 10yrs

301
Q

How is placenta accreta diagnosed antenatally?

A

With US – see irregularity/absence of the placental-myometrial interface and intra-placental villous lakes

302
Q

What is a Gartner duct cyst?

A

Results from incomplete regression of the Wolffian duct during fetal development.
Appear along lateral aspects of upper anterior vagina.
DO NOT INVOLVE VULVA (in contrast to Bartholin)

303
Q

Cxs of ECV:

A

Abruptio placentae

IUFD

304
Q

Risk factors for developing 2nd stage arrest of labor and its mgmt.:

A

Risks: Maternal obesity, xs pregnancy wt. gain, DM
Mgmt: operative vaginal delivery, c-section

305
Q

What is the definition of the 2nd stage of labor?

A

Begins when cervix is 10cm dilated – ends w/fetal delivery.

306
Q

What is the pathogenesis of congenital Zika syndrome?

A

ssRNA flavivirus targets neural progenitor cells.

Transplacental transmission to the fetus

307
Q

What lab values are likely seen in acute fatty liver of pregnancy?

A

Prolonged PT, aPTT, and hypoglycemia w/encephalopathy

d/t acute microvesicular fatty infiltration of hepatocytes

308
Q

Causes of Hyperandrogenism in pregnancy:

A

Placental aromatase deficiency – no ovarian mass
Luteoma – solid uni or bilateral masses
Theca lutein cysts – cystic bilateral masses
Sertoli-leydig tumor – solid unilateral mass (only one that needs sx)

309
Q

What is the definition of primary amenorrhea?

A

Absence of menses w/normal secondary sex characteristics at age 15
or absence of both at age 13

310
Q

How is primary amenorrhea evaluated?

A

First step – B-hCG to exclude pregnancy
If hCG is negative get FSH levels and Pelvic US
High FSH – karyotype
Normal FSH – Pelvic US or MRI to look for presence of uterus/ovaries
Prolactin and TSH can be obtained after FSH

311
Q

Most important step in evaluating amenorrhea?

A

B-HCG!!

Regardless if they deny sexual activity or if its primary or secondary

312
Q

What is suggested by a lack of uterine bleeding w/an estrogen-progesterone challenge?

A

Asherman syndrome

313
Q

What are the current criteria to suggest genetic testing to assess hereditary cancer risk (6)?

A

Female breast cancer dx’d age 50 or less
Triple-negative breast cancer dx’d age 60 or younger
2+ primary breast cancers
Invasive ovarian or fallopian tube ca. or primary peritoneal ca.
Male breast ca.
1st, 2nd, or 3rd degree relatives w/breast ca. dx’d age 50 or younger

314
Q

What is Meig’s syndrome?

A

Triad of pleural effusion and ascites in combo w/a benign ovarian tm. (norm. a fibroma)

315
Q

What is the most common epithelial ovarian cancer and what are its common histo features?

A

Serous cystadenocarcinoma – malignant
Commonly bilateral
Histo: Will be lined w/ciliated, cuboidal, fallopian-like cells w/Psammoma bodies

316
Q

What are the features of Mucinous cystadenocarcinoma?

A

2nd most common epithelial ovarian tm. (after serous cystadenocarcinoma)
Causes pseudomyxoma peritonei – aka Jelly Belly; Intraperitoneal accumulation of mucinous material from ovarian or appendiceal tm.
Will be multi-loculated and can become very large (up to 50lbs)
Will resemble GI cells on histo

317
Q

What are the features and origins of immature teratomas?

A

These are aggressive, containing fetal tissue, arising from the neuroectoderm.
Most common postmenopausally
Will have immature/embryonic-like neural tissue

318
Q

How is leuprolide beneficial in the tx of Endometriosis?

A

It reduces sxs by inducing a state of pseudo-menopause – decreases FSH and LH, and therefore estrogen which is needed to promote growth of the foreign tissue.
This causes infertility while being taken.

319
Q

What is required for the dx of PID?

A

Aka Salpingitis
Pelvic pain
Tenderness of the cervix, OR uterus, OR adnexa on PE
Absence of an alternative explanation

320
Q

How are PID and cervicitis distinguished from each other?

A

Pelvic pain and cervical motion tenderness are more consistent w/PID
Cervicitis often has no pain, but a friable cervix, postcoital bleeding, and an abnormal discharge

321
Q

What are the palpable nodules in fibrocystic breast disease?

A

Inflamed and swollen breast lobules – d/t spikes in estrogen levels during the menstrual cycle.

322
Q

How is fibrocystic breast disease tx’d?

A

NSAIDs
Ice packs
OCs

323
Q

Characterisitcs of FBD—Sclerosing Adenosis:

A

Increased acini and intralobular/stromal fibrosis
a/w calcifications
Slight increase risk for cancer

324
Q

Characteristics of FBD—Fibrosis subtype:

A

Hyperplasia of the breast stroma

325
Q

Characterisitcs of FBD—Cystic subtype:

A

Cysts filled w/fluid

“blue dome cysts”

326
Q

Characterisitcs of FBD—Epithelial/Ductal hyperplasia subtype:

A

Increased number of cell layers in the terminal ductal or lobular epithelium.
Increased risk of cancer

327
Q

How is the 1st stage of labor defined?

A

Begins w/the onset of regular contractions and ends when the patient is 10cm dilated.
Has 2 phases:
Latent – gradual cervical dilation
Active – rapid cervical dilation
Transition b/w latent and active norm. occurs around 6cm dilation.

328
Q

What defines the 3rd stage of labor?

A

Time b/w delivery of infant to delivery of placenta – should be 30min or less

329
Q

What is the tx of congenital toxoplasmosis?

A

Spiramycin

330
Q

How is the dx of Preeclampsia confirmed?

A

With a urine protein:creatinine ratio >= 0.3 or a 24-hr urine collection (gold standard) showing total protein >300mg.
Anyone w/HTN dx’d >20wks and a urine dipstick 1+ or below needs one of these tests.

331
Q

How often do HIV+ pts need pap smears?

A

Need pap smear at initial evaluation, then 6mos later, and then yearly after that.
If hx of HPV, CIN or symptomatic HIV dx then go back to every 6mos.

332
Q

What type of incontinence can fibroids lead to?

A

Overflow from urinary tract outlet obstruction

333
Q

How is fetal growth restriction defined?

A

As estimated fetal weight <10th percentile for GA

334
Q

Features of inevitable abortion:

A

Dilated cervix, w/viable fetus.
Pain and vaginal bleeding.
No PoC have been expelled – in contrast to incomplete where there’s a non-viable fetus and some PoC have been passed.

335
Q

What cancers are a/w Lynch syndrome?

A

Early-onset colorectal ca.
Female genital tract, skin, stomach, pancreas, brain, breast and biliary tract.
Pts. dx’d w/CRC and have a 1st degree relative w/a Lynch assoc. ca. at <50yrs, or 2+ relatives dx’d w/Lynch assoc. cas. at any age should be tested for Lynch syndrome

336
Q

What does a positive nitrazine test indicate?

A

Vaginal pH of 4.5-7.5, aka high

Will be positive in Bacterial vaginosis and trichomoniasis

337
Q

Mgmt of tubo-ovarian abscess:

A

Admit and give IV abx for 48-72hrs

If hemodynamically unstable/signs of sepsis then need surgery

338
Q

What are the features of Lichen simplex chronicus?

A

Chronic skin condition – caused by trigger/irritant or infection which leads to pruritus and scratching.
Scratching leads to skin damage – further itching – ongoing cycle damages the skin and causes thickened/rough skin.
Commonly on the vulva

339
Q

What is the target BP range in pregnant pts?

A

140-150/90-100
This is mild HTN and shouldn’t be treated w/Rxs
If it ever rises to 150+/95+ then anti-HTNs should be started to meet target above

340
Q

What is the most effective form of contraception?

A

Etonogestrel implant – aka implanon (99.95% effective)

A progestin-only hormonal contraceptive

341
Q

What is the recommended tx of TSS?

A

IV vancomycin (covers MRSA) + Clindamycin (suppresses protein/toxin synthesis)

342
Q

What will be seen on CT in Pseudomyoxoma peritonei?

A

Mucin-containing cysts w/calcified rims (calcifications can spread throughout the peritoneum).
Copious amounts of mucin in the abdomen can lead to SBO

343
Q

What defines oligohydramnios?

A

AFI less than or equal to 5cm, or DVP <2cm

344
Q

How can ovulation be confirmed?

A

With serum progesterone levels >3 – should be measured 1wk prior to expected menses

345
Q

How is assessment of ovarian reserve done?

A

With measurement of FSH on day 3 of menses – elevated FSH means decreased number of follicles and oocytes.

346
Q

What maneuver is performed in conjunction w/c-section in the setting of shoulder dystocia?

A

Zavanelli maneuver – involves admin of Terbutaline or NO to relax the uterus, then the baby head is shoved back in and c-section is performed.
Only done after all other maneuvers have failed

347
Q

How would increased activity of 5-aR present?

A

In females with increased hair/hirsutism with absence of lab abnormalities.
Idiopathic increase causes more conversion of testosterone to DHT
DHT is more potent than testosterone and will cause the increased hair growth

348
Q

Difference in sxs depending on location of fibroid:

A

Submucosal – very heavy and prolonged bleeding and infertility. Least common.

Subserosal – pelvic pain and abdominal pressure

Intramural – most common type and can cause increased menstrual bleeding, pain and infertility depending on the size, but likely to be asx. Will make the uterus feel larger than normal

349
Q

How will CAH present at birth?

A

21 & 11-hydroxylase deficiencies will cause virilization of XX females (may be told its a girl from karyotype and then pops out w/a penis) or have ambiguous genies

All types of CAH will have b/l enlarged adrenal glands from xs ACTH stimulation in response to decreased cortisol

11 will have decreased renin, 21 will have increased renin and 17-hydroxyprogesterone.

350
Q

Phases of the menstrual cycle:

A

Day 1-5: Menstrual phase – both progesterone and estradiol are low. Get bleeding and shedding of the endometrium.
Day 6-13: Proliferative phase – large peak of estradiol from mid-to end of this phase
Day 14: Ovulation
Day 15- 26: Secretory phase – Large peak and then plateau of progesterone throughout this entire phase
Day 27-28+: Premenstrual phase – progesterone and estradiol both drop right at the beginning

351
Q

What are the features and tx of Thyroid storm in pregnancy?

A

Autonomic instability is the hallmark – HTN, fever/increased T, nervousness, palpitations, AMS, V/D, arrhythmias.
Tx: BB (propranolol), corticosteroids, and an anti-thyroid.
PTU is typically DoC in thyrotoxicosis bc of its quicker onset of axn.
In very ill pts. potassium iodide oral drops may be used instead of PTU but this may affect the fetal thyroid gland.

352
Q

Tx of Hyperthyroidism in pregnancy:

A

PTU is DoC in 1st trimester, bc MMI is a/w cutis aplasia (congenital skin and scalp defects)
MMI is preferred in the 2nd and 3rd trimesters bc of the hepatotoxicity a/w PTU
PTU is preferred in thyroid storm bc of the quicker onset
RAI is contraindicated

353
Q

What is the fetal cx associated w/untreated Thyroid storm?

A

Nonimmune hydrops and IUFD.

354
Q

What effects does pregnancy have on thyroid hormone levels?

A

Increased estrogen causes increased TIBG and total T4 (thyroxine), but the active/free T4 and TSH levels remain unchanged.

355
Q

What is likely the cause of hyperthyroidism postpartum?

A

Destructive lymphocytic thyroiditis.
High corticosteroid levels in pregnancy suppress AI response and then lead to flare in post-partum
Often + for anti-microsomal and anti-peroxidase Abs

356
Q

Most consistent lab findings of HoThyroidism in pregnancy:

A

Decreased free T4
Unchanged total T4
Increased TSH and TIBG

357
Q

What are the upper limits of normal for latent phase of labor?

A

20 hrs for nulliparous

14 hrs for multiparous

358
Q

What is considered xs contractions/tachysystole?

A

Uterine contractions >5/10min.

Need to relax uterus – stop oxytocin or uterotonics and give Terbutaline/Beta-mimetic

359
Q

What should be done when a FHR tracing shows lack of accelerations and minimal variability?

A

This would be a cat-II FHR tracing.
Should do scalp stimulation and try to induce an acceleration
If no accelerations can be induced, likely there’s fetal hypoxia

360
Q

When should the cord be clamped for preterm infants?

A

Should be delayed and clamped b/w 30-60 sec.
This increased total Fe stores, Hb levels and decreases the risk of intraventricular hemorrhage.
Delayed clamping also improves Fe stores in term infants but increases risk of hyperbilirubinemia so should be clamped right away.

361
Q

Prenatal risk factors of shoulder dystocia in order of significance:

A

Prior dystocia
Fetal macrosomia
gDM

362
Q

When should amniotomy be avoided?

A

If there is an unengaged fetal part – it is higher than 0 station.
This commonly predisposes to umbilical cord prolapse bc the head is not taking up the space and blocking the cord.

363
Q

What is the most common cause of late postpartum hemorrhage?

A

Subinvolution of the uterus – the placental implantation site doesn’t decrease in size like it should, and when the eschar falls off (7-10d postpartum) there is more bleeding than expected.
Tx is w/uterotonics

364
Q

What should be done to investigate a high msAFP and what values are considered normal?

A

Normal msAFP during pregnancy is defined as levels 2.0-2.5 multiples of the median, anything greater is concern for neural tube defect.
First step in investigation is US to assess for incorrect dates and multiples
If <20 weeks may repeat msAFP
If >20 weeks may refer for genetic counseling and amniocentesis

365
Q

1st step in mgmt. of an abnormal triple screen:

A

Basic US to determine correct GA, identify multiples and exclude fetal demise
Most common cause of abnormal screen = wrong dating

366
Q

What is the rationale for giving acyclovir in a primary HSV outbreak?

A

It reduces viral shedding and the duration of infection – does not have any effect on future occurrences

367
Q

What are some cxs of pyelonephritis in pregnancy?

A 
Preterm labor
Preterm delivery
ARDS
Urinary tract obstruction (ureterolithiasis)
Perinephric abscess
368
Q

How should pyelonephritis in pregnancy be managed?

A

With IV abx: Cefotetan, ceftriaxone, or amp+gent combo
Recurrence rate is very high, so suppressive tx w/nitrofurantoin should be continued throughout the rest of the pregnancy.

369
Q

Most common cause of septic shock in pregnancy:

A

Pyelonephritis

Step 2 Stuff (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions