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M3 - clinicals > OBGYN - General > Flashcards

OBGYN - General Flashcards

1
Q

Define early, variable, and late decels, sinusoidal, prolonged decels. Mechanism for each?

A

Early = head compression.
Variable = less than 30s from onset to nadir. Not correl w contractions. Cord compression
Late = Decel starts at max contraction. Placental insuff. Can be from tacchysystole
Sinusoidal = blood loss/fetal anemia. Hydrops fetalis risk
“VEAL CHOP”
Prolonged - >2min but less than 10min.

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2
Q

Woman vomiting - name, risk for, when?

A

Hyperemiss gravidarum. >5% weight loss. Hypoglycemia==ketoacidosis detected in urine. HEMOCONCENTRATION, HYPOCHLOREMIC MET ALK (VOMIT) HCL. HypoK via kidney excretion from to balance loss of OH- (Na/K atpase followed by ROMK).

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3
Q

Abnormal Uterine bleeding - definition and ddx

A

5 days more than 1pad/2hrs.
Fibroids - painful enlarged masses on uterus.
Endometriosis - menorrhagia
Adenomysosis - bulky tender enlarged uterus

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4
Q

Screenings for STIs. Who, when, tx if +? Some sxs?

A

Sexually active women <=25 or women w risk factors should have annual screening via PCR (NAAT). Chlam - azith. Gonn - cef AND azith (due to increasing resistance). Empiric = both.
Sxs: asymop (most common), cervicitis, urethritis, perihepatitis.
Risks: PID, ectopic, infert

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5
Q

Woman stops labor - name, definition

A

Active phase arrest - 6-10cm no change in size for 4hrs w 200unit contractions or 6hrs with inadequate contractions

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6
Q

Contraindicated in Breast Cancer?

A

Hormone replacement therapy. Also reduce ETOH intake to less than 1/day

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7
Q

Fetal heart rate tracing is called and when? Can work up more doing this test? What does it consist of and points?

A

Nonstress test - Contractions&FetalHR done if less than 10 kicks felt by mom in 2hrs.
Biophysical profile - NST + Amnoitic volume (oligohydromanios<=5=6/10 is normal

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8
Q

Skin conditions? Gyn/Ob

A

-Physiological leukoria….
-Lichen Planus - all mucous affected. Pruritic, glassy red-purple lesions with overlaying white lines.
-Lichen Sclerosis - no vaginal invovlemnt White labial lesions. Prepub and peri/postmenopausal women. r/o cancer then superpotent corticosteroids
-Candida intertrigo - think beefy red plaques, s/p steroids, tx clotrimazole oitment.
-Acanthosis nigricans vs melasma
-Hiradentisi suppurative - recurrent/chronic follicular inflam of intertriginous regions. Tx Doxy.
-Granuloatus inquinale = STI klebseilla - painless ulcers no lymph
-Cellulitis - bactrim (TMP-SMX
-Lymphogrnaulmoa vernirum = chlam, painful w/ lymph
-Condylomata acuminata (gen warts) - HPV6/11. Pink/skin colored leasions. VERRUCCOUS growths. Smooth to caulifolower-like gorwths. Tx: Resin, trichloroactic acid, Imiquiomd, cryotherapy/lase/excision.
Condylomata lata (2nd syph) - gray-white lesion on mucousal. SMOOTH.
HSV warts - ulcerative blisters/pustules

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9
Q

OCPs - side effects/risks

SERMs - tx, SEs, risks

A

HTN, Clots, breakthrough bleeding. Amenorrhea, breast tenderness, nausea/bloating.
Liver disorders - hepatic adenoma, chole & INCREASED triglycerides.
DECREASED risk of ovarian/endo.
INCREASED risk for cervical.
Not weight gain.

SERMs - Tamox, raloxifene. Comp inhibitor of estrogen (mixed antag/ag). Prevention of breast cancer.
Raloxifene - postmenopausal osteo.
SEs: Hot flashes, venous thromboembol, endo hyperplasia/cancer (tamox)

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10
Q

Fetal bradycardia and tachycardia - when?

A

Brady <110 = tachysystole of uterus, hypothermia, beta-blockers, hypothyroid (fetal), heart-block (anti-RO/SSA, LA/SSB)
Tachycarida >160 = chorioamniotisis (think infection), beta-agonists, hypoerthyroid, fetal tachyarrhythmia

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11
Q

Fetal HR Accelerations - cause, definition, nl amount?
Contractions? - nl
Categories during labor?

A

From fetus moving around.
minimal<6 - moderate <=25 marked
<32wks = 10bpm inc for 10seconds 2 in 20min
>=32wks = 15bpm for 15, 2 in 20min.

Contractions - normal is 5/10mins.
Tachy = >5/10min

Type I: nl rate, moderate variability, with accels. Not late/variable decels. +/- early.
Type III: 
 1) Sinusiodal pattern. 
 2) Minimal variability with any of 
 -Recurrent late decels
 -Recurrent variable
 -Bradycardia
Type II: everything else
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12
Q

Def of PPH? Causes? Tx? Vignettes?

A

500ml in NSVD, 1000ml in C-section
1) Uterine Atony - boggy uterus - (most common) - Tx with pitocin. Methylergonivine is contraindicated in hx of ecclamp/HTN.
Carboprost - syn PG uterotonic, bronchoconstric & asthma***
2) If 48-72hrs postpartum think coagulopathy like vW disease (factor 5 is procoag).
3) Genital tract laceration
4) uterine rupture
5) retained placenta

Tx - massage, oxytocin, uterotonics, intrauterine balloon tamponade, uterine artery embolization hysterectomy.

RFs: Prolonged/induced labor, Chorioamn, Multip, polyhydramnios, operative delivery

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13
Q

HTN in pregnancy:
definitions? RFs? Tx? Risk for?

HTN crisis: drugs?

How long after preg can you have PreE?

A

Chronic HTN.
If AKI signs before 20 weeks it is likely nephropathy
——>20weeks—–
GestHTN = >140/90
PreE >140/90 [x2 4hrs apart] & proteinuria (300mg/ml)
PreE w Severe: >160/110 with
-Cerebral/visual disturbances
-2x nl LFTs
-Thrombocytopenia <100K platelets
-renal insuff: Cr>1.1 (or doubling from nl level)
-Pulm Edema
-*note that proteinuria isn’t needed
RFs: Nulliparity, previous PreE, HTN, DM, Coag, Smoking, CKD, BMI, PCOS, Autoimmune, Sickle cell, African american

Tx: Aspirin for high-risk patients. NSAIDs can INCREASE BP*. Labetolol, Hydralazine, Alpha-methyl-dopa, Nifedipine
HTN crisis: 1st line: IV Hydralazine (vasodil), IV labetalol (not in brady, <60bpm), Nifedipine (oral, not in emesis).
AMdopa - too slow acting. Nitro - last resort, avoid if possible dt cyanide byproduct.

Risk for: 
 Seizure
 HELLP (epigastric, nasuea, HA) ->DIC risk
 Abruption
 Stroke
 AKI
 ARDS

6weeks post-partum

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14
Q

Diabetes and Preggers

A

1hr 50g GLucose test <140

check this

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15
Q

Folate amount?

A

0.4g/day or if NT defect 4g/day

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16
Q

Poor growth - definition, measured,f/u, risk factors?

A

Fetal growth restriction <10th percentile (<3==severe).
Crown rump length most reliable.
F/u:
BPP getting amnio fluid volume and umbilical cord doppler. NST.
IUGR dx then twice weekly antenatal testing.
DM2 (not DM1), CVD, HTN, CVA, COPD, BMI. Polyhydramios w reverse doppler flow = deliver now

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17
Q 
Normal changes in preg:
Blood?
CV?
Pulm?
Renal?
Uterus?
Progesterone?
A

Blood: 36% volume (47% plasma, RBCs 17%)
CV: increase in CO (inc HR and SV)
Pulm: Physio dyspnea of preg. 15% insp cap from inc TV and insp reserve. Dec of FRC to 80% of nl
Renal: comp met alk
Uterus and R ovarian vein compress ureter causing hydronep (R more than L). Sigmoid colon protects L.
Progesterone is a smooth muscle relaxant - GERD.

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18
Q

Estrogens/OCPs effects?

A

Bone protective
Increase in TBG (inc in total T4 but not free).
Risk for blot clots, HTN

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19
Q

Molar pregnancy - presentation? Mets?

A

Snowstorm appearance on TransVUS.

Lungs are most common site - thus get CXR.

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20
Q

Methods to prolong pregnancy: when to use each? and what each does?

A

“MTS” - mag, tocolytic, steroids
<32wk - Mag & indometacin & Betamethasone
<34wk - Indomethacin & Betamethasone
<37wk - Betamethasone

Magnesium - develops nervous system, prevents CP.
Indometahcin - tocyltic - allows for you to get steroids on board. Renally excreted.
Steroids = lung maturation

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21
Q

Infertility - defintion? Tx?

A

1 year of trying.
PCOS - get testosterone levels.
Psych meds - anti-DOPA == inc ProLactin. Fix meds before bromocriptine
Ovarian insufficiency - look for antimullerian hormones
Tx - sex 18 days post-mences.

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22
Q

Prolapse thru vagina or incontince -tx?

Time for postpartum urinary retention?

A

1) Pelvic floor strengthening then 2) Pessary

Inability to void >=6hrs post NSVD

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23
Q

Endocrine disorders

A

Phenotympic female at birth, no upper ⅓ of vag or rest of female sex organs. With (androgen insensitivity syndrome->test to est. Androgen receptor cannot inhibit boob formation) vs without breasts (Alpha-5reductase, increase masculine features during puberty, )

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24
Q

“blue tinged vaginal protrusion”

A

Imperofate hymen

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25
Q

Post-menopausal bleeding?

A

Requires endometrial biopsy (less likely <=4mm

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26
Q

PALM COEIN

A

Compare end, firbroids [heavy menstrual bleeding, firm uterus], endometrioma[no affect on uterus - chronic pelvic pain 25-35yo, dysmenorrhia], cysts, adeno [boggy tender uterus**in multip 40+ women, chornic pelvic pain with increased bleeding, w symmetrically enlarge ut]…this is the most imporant

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27
Q

Primary ovarian insufficiency - definition and labs will show?

A

<=40yo. Increase in GnRH, FSH. Decreased Estrogen (ovarians cannot respond)

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28
Q

Bilateral lower quadrant pain & tenderness post c-section

A

Septic thrombophelbitis of pelvic/ovarian/uterine veins. T antibiotics and anticoag.

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29
Q

1) Unilateral breast inflammation?
2) Tender mobile breast mass?
3) When BRCA?

A

1) w/ fever - think mastitis, especially breast feeding. Give antibiotic and continue to feed
W/o fever - inflam breast carcinoma esp with dimpling/pitting (po’deorange). Possible axilliary lymph as well.

2) Likely benign. US shows simple echogenic likely cyst. FNA if clear monitor for 2-4 months. Then yearly survel.
3) 1 in 8 risk of breast cancer. BRCA if family dx before 50

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30
Q

Woman postpart with discharge and fever

A

Post-part endometriosis. Risks = csection, chorioamniotisi, Group B strep, Gonn/Chlam, Prolonged ROM. Tx with Cef/azith

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31
Q

Antibiotic combos?

A

Clind and gento = chalm and gonn

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32
Q

Annovoluation in a reproductive woman?

A

Give progesterone challenge to see if she bleeds.

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33
Q

Weight gain in pregnancy?

A

sadfasdfasdf?

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34
Q

Woman pregnant after 6months - at risk for?

A

Short interpreg interval (ideally >18mnths). Anemia, PPROM, preterm, low birthweight.

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35
Q

Fever, nausea vomitting in preg:

  • w right sided pain
  • unilateral pain
A
  • FHR inc and fever == infection generally
  • Acute appendicitis from uterus affecting anatomy. Sudden onset. Can have atypical right mid to upper quad w flank pain. Mild Leukocytosis. Psoas (hip extension) obturator (inernal hip rot pain), rovsing (RLQ with LLQ palp)
  • Ovarian torsion. Possible palpable mass. Absent doppler flow to ovary. Tx: Lap with detorsion.
  • Ruptured ectopic pregnancy: hCG, US (“RING of fire == increased doppler flow).
  • Nephrolithiasis - more flank pain but keep in ddx
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36
Q

Tired patient 5 months after pph. Other sxs?

A

Sheehans - pit infarct

  • Dec prolactin: trouble breastfeeding
  • Amenorrhea: dec FSH/LH
  • Bradycardia: dec TSH.
  • Anorexia/weight loss, HoTN (dec ACTH)
  • Decreased lean body mass (dec grwoth hormone)
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37
Q

Fertile age woman with acute abdomen (guarding with decreased bowel sounds)

A

Hemopertineum from ruptured extopic preg. Dx/Tx: Ex lap. Get HCG if she were stable.

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38
Q

Causes of hirsuitism

A

PCOS, idiopathic, Nonclassic 21-hydroxy def, androgen-secreting ovarian tumors, ovarian hyperthecosis, cushing

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39
Q

Virilization - what is it? Compared with? Signs? Labs?

A

Severe Hyperandrogenism. Worse than hirsuitism. Voice deepening strong sign. Male pattern baldness, increased muscle, clitoromegaly. Get test, 17-hydroxygpreorgestorne and DHEAS.

If virulization: unlikely PCOS. more likely androgen secreting tumor( Sertoli-leydig or adrenal TUMOR.)

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40
Q

TransUV - bilateral fetal kidneys are enlarged with thin renal cortices? What else to expect? Name?

A

Posterior urethral valves. Potters sequence: expect oligohydramnois with increased FHR and hypoplastic lungs. Limb deformities/flat faces. Poor prog

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41
Q

Women cannot void >6 hrs post preg

A

Postpartum urinary retention due to pudenal nerve injury causing bladder atony.

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42
Q

White odorless discharge during cycle?

A

Physiologic leukorrhea - expect rare polymorphonuclear leukocytes.

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43
Q

Vaginal Infections/STIs?

Risk factors? Tx?

A

Bacterial Vaginosis Gardenerella vaginalis - malodorous discharge after mensces/intercourse. Clue cells >=20%. pH>4.5. Tx: metronidazole (even if preg; 500mg BID/7days) or clindamycin.

Candidiasis - white vaginal discharge, vulvur pruritis. Hyphae & +KOH test. RF: DM, Immunosupp, preg, OCP (increased Estrogen), antibiotics. Dx: nl pH, pseudohypahe. Tx: Flucanozole. pH 3.8-4.5

Acute cervicits - NAAT, Chlam/Gono. Spotting, mucopurlent cervical discharge. Abdundan polymorphs. NO organisms on microscopy.

Trich - vulvovaginal pruritus - malodorous green vag discharge. Protozoa. pH>4.5 Tx: metronidazole & partner

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44
Q

Still born male, short bent extremiities, limb fractures and hypoplastic thorax.

A

Osteogenisis imperfecta Type II. Auto dom, type I collagen defect.

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45
Q

Patient from india with cough, progressive dysnpea, orthopnea

A

Pulm Edema due to develop of new Atrial fib with rapid ventricular reposne (RVR) due to prior rheumatic heart disease. == mitral stenosis.

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46
Q

ONC CANCERS

A

Granulosa = estrogen
Sertoli-leydig = testo, ovarian mass
yolk-sac = AFP
Dysgerminous (placental tissue) = hCG.

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47
Q

Woman with multiple miscarriages? Dx? Tx?

A 
Antiphospholid syndrome.
Anti-cardiolipin
Lupus anticoag
Anti-beta2-glyocoprotein.
Tx: anticoag
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48
Q

Dysparunia, dymetria, dyschezia. Posssible met/Menorrahgia? Dx? Risk for?

A

Endometriosis. Risk for infertility.

Treat with NSAIDs & OCPs first. Then ex lap + removal.

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49
Q

Menopause -
Sxs
Tx with contraindications

A

Vasomotor sxs
Oligo/ameno
Sleep disturbances, cognitive decline, Depression
Decreased libido.
GU: Vaginal bleeding, dysparenunia, dryness, atrophy, urinary incontence. UTIs

Tx: Topical estrogen or HRT. Contra=CAD, Thromboembolism, TIA/CVA, breast/endo cancer. SSRIs

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50
Q

1) Classical cong adrenal hyperplasia
2) Nonclassical cong adrenal hyperplasia
3) Adrenocortical carcinoma
4) Aromatse deficiency.
5) Kallman syndrome
6) McCune-Albright
7) PCOS

A

1) 21-hydrox def. Salt-wasting adrenal with hypohormone. inc in 17-h levels. NOT test.
2) 17-hydrox def. Hyperandrog. Inc 17-h levels. Not test.
3) DHEAS levels not test. Virulization.
4) No DHEAS to estradiol. Virulization
5) hypogonadotropic hypogonadism with anosmia
6) Traid: cafe au lait, polyostotic fibrous dysplasia, autonmous endo hyperfunctions
7) Hirsuit with Metabolic syndrome, OSA, NASH, endohyper. Tx: Weight loss, OCP/Clomiphene

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51
Q

PAP, Cerv, HPV

A

epithelial cells are common 45<= uncommon to have epithelial cells (meaning risk for endo cancer).

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52
Q 
PID: 
Sxs
PE
Tx
Risks
A

Lower abd pain with abnl bleeding.
Cervical motion tenderness, fever, discharge
Tx: Third-gen ceph with Azith or doxy
Risks: Tubo-ovarian abscess, infert, ectopic preg, perihepatisis (Fitz-hugh-curtis)* RUQ pain can present*

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53
Q

Edinburgh

A

10 or more suggest risk for depression, and further eval is needed

54
Q

Thyroid in preg

A

TSH dec due to hCGs similarity to TSH
Total T4 inc dt inc TBG
Free T4 unchanged.

55
Q

Patient with new onset gen tonic-clonic seizure one day after delivery with PPH. Likely cause? tx?

A

Oxytocin toxicity - causes hyponatremia, hypotension and tachysystole. Oxytocin has similarities to ADH == water retention and hyponat. Hypertonic (3%) saline.

Blood loss will cause shock - unlikely seizures.

56
Q

Types of spontaneous abortions? Causes? Tx? WHEN?

A

<20weeks*****
Threatened - vag bleeding, closed os, fetal cardiac act
Inevitable - vag bleeding, dilated os, products of conception at/above os
Incomplete - vag bleeding, dilated os, some products expelled, some present
Complete - vag bleeding, closed os, products completely expelled
MIssed - no vag, close os, no fetal activity or empty sac

RFs: Teratogens, chromo or anatomical abnormalities, substance abuse, AMA, previous ones

Tx: Expectant, PG admin (misoprostol), D&C.

57
Q

Risks for vag cancer

A

Age>60
HPV
Tobacco
In utero DES (only for clear cell adenoma)

58
Q

Retained placenta shows what on US?

A

Not a thin endometrial stripe

59
Q

Congenital infections? Sxs, Tx?

A

T - toxo. Undercooked meats/cats/unwashed produce. Bilateral ventriculomegaly. Intracranial calcifications. Chorioretnieis, hydrocephalus, seizures, FGR. Dx serology, PCR. Tx: Spiramycin.
O (varicella - limb abnormal)
R
C
H - erpes. Placental and umbilical calficitions. Anemia and hyrops fetalis (PlEffus, ascites).
E
S

60
Q

FHR - order

A

Important to do this on exams:

1) Contractions - regular? rate?
2) FHR - rate
3) Variability - mild/moderate/marked?
4) Accels present?
5) Decels?

61
Q

Fetal Fibronectin?

A

Initial Test for abruption now for preterm

62
Q

Preterm labor risk? w/u and tx?

A

TVUS - for length of cervix (<2.5cm, unless hx of preterm then <2.0 cm). If short (anatomy or dt procedure) - vaginal progesterone - if failed cerclage until 24 weeks

63
Q

Magnesium: when to give? Contradications?

A

Before or at 32 weeks.

Contra:
N
Hypocalcemia, renal dysfunction, myathenis gravis. No Mg for MG

64
Q

Breast feeding contraindications

A 
Untreated active TB
HIV
Herpetic breast lesions
Active Varicella
Chemo/radiation
Drugs. 
Do not breast feed is infant has galactosemia
65
Q

SERMs - drugs, mechanism, Indications, Adverse effects

A

Tamox/Ralox.
Inhibitor of Estrogen. Mixed anta/ago
Ralo=postmenopausla osteo
SEs: hot flahses , thromboemboli, endo carcinoma w tamox

66
Q

PPROM what to do and when?

A

In patient management <34wks. Proph latency antiboiotics, steriods, survel

67
Q

AFLP - acute fatty liver of preg

A

RUQ, Mildly elevated Aminotrans and possible leuko.
Nausea, vom, abd, jaundice

Share features of preEcclam (HTN, you can hemolysis). But cue in on the LFTs and hypogyclemia and (can have) bili, Thromboytopenia and DIC

Risk for Fulminant liver failure - hypoglyc, hyperbili, thrombocytopenia, and DIC. DDx this from panc via lipase and Amylase needing to be elevated.

68
Q

ETOh is a risk factor for? and not for

A

RF for boobs, not for uterus (RFs - esrogen exposure - and BMI)

69
Q

Cut off for gestational vs nongest diseases?

A

20 weeks**

70
Q

When no contraction stress testing?

A

Contraindications to preg - risk for uterine rupture, placental previa.

71
Q

Degenerating uterine leiomyoma?

A

Fundal tenderness, preg, acute-R sided pain. As preg increases blood shifts from pan-uterus to placenta causing fibroids to outgrow their blood supply. Conservative management.

72
Q

Sexually transmitted ulcers

A

1) HSV - small vessicles/ulcers erythematous base, mild lymph
2) H Ducreyi - large deep ulcers w gray/yellow exu. Well demar borders, soft friable base. Severe lymph that may suppurate.
3) T pall - single chancre***** regular borders hard base
4) C trach - small shallow ulcers, can progress to painful fluctunant adenitis (buboes)

73
Q

Late & post-term preg:

1) Def
2) RFs
3) Complications
4) Managment

A

Late >=41, post>=42

2) Prior post-terms, Nullip, BMI, >fetal anom
3) Macrosomia, dysmat syndrome, oligo, demise (all things related to placental insuf). Obstetrics laceration, c-delivery, pph
4) Freq fetal monitor, delivery prior to 43hr

74
Q

Ovarian hyperstim - dt? Sxs?

A

From clomiphene == increased VEGF in ovaries. Bilaterally enlarged cystic ovarise with increased casc perm (inc dopple flow) == t`hrid spacing (ascites and PEdema).

75
Q

Intrahepatic cholestasis of pregnancy (ICP) - Sxs, dx, Tx

A

3rd trimester. Increased est&prog. Elevated total bile acids (>10umol/L) and intractable pruritus (WORST ON PALMS AND SOLES). can have RUQ and elevated LFTs. Alk phos can be from this or placenta.

Tx: Ursodeoxycholic acid. If irreg fetal assess deliveray at 37 weeks (esp >40umol/L)

76
Q

Vulvar cancer - sx? RFs? Dx

A

RFs: HPV, Inflamm, tobacco, Vulv lichen sclerosis, immunodef, prior cervical cancer, VIN/CIN.

Pruritus, plaque/ulcer, bleeding.

Biopsy

77
Q

Condylomata accuminata

A

HPV -gen warts you “keep accumuliating them”

78
Q

Lichen Planus vs sclerosis

A

Planus - autoimmune, mucosa. Labia&vulvualr purple plaques w white stripes
Sclerosis - old and young women. Benign inflam. Perianal involvement. Itching, around vagina

79
Q

CA-125 maker for

A

Epithelial ovarian cancer (also in leiomyomata, endometriosis but more in permenopaus).

80
Q

Primary amenorrhea - tx

A

Nsaids then OCPs

81
Q

HELLP - sxs, findings, tx

A

PreEcalmp, Nause/vom, RUQ
Microangiopathic hemo anemia, inc LFTs, Low plate
Tx - delivery (>=34wks), mag for seizure proph, antiHTN (predelivery platelets given if <20k Vag or <40K c/s)

82
Q

Kleihauer-betke test

A

Lyse maternal hg and leave fetal rbcs. Give number of fetal in m blood - then use to calc suf dose of Anti-D

83
Q

Vaccines can give and not give during preg?

A

NO: MMR, Varicella, HPV, Live influe
YES: Tdap, inact influe, RhoD.
Highrisk only: Hep A, B, pneumo, H influ, Mening, Varicella-zoster

84
Q

HCG - where does it come from what does it do for preggers?

A

From Syncytiotropho and preserves coprus lut during early preg (maintains prog secretion) until placenta can produce its own. Doubles every 48hrs from 8 days to 6-8wks

85
Q

Cholecystis vs choleangitis

A

Cystis - elevated bili but below <4.

Acute choleagnitis - Jaundice and Altered mental status. and bili more than 4. And ALT/AST more than 1000

86
Q

Hydrops fetalis causes?

Patho?

A

Parvo B19 most common (no other major structural findings in fetus, nl limbs, face, etc)

Alpha thal major (all four hb are fetal -> HgBarts too much O2 affinity), Thalassemias, Rh alloimmune, Achondroplasia (limb abnl too), Turners (FEMALE and cystic hydrogramo off of neck). Fetal aneuploidy. CV abnormalities.
Decreased CO == third spacing.

87
Q

Uterine Adhesions?

A

THink endoemtriosis - infertility is thought to be from adeheisons blcoking tubes. Lots of bleeding as well

88
Q

Placental abruption tx in hemodynamically unstable pnt?

A

Two large bore IV fluids, place on left lateral side (to max CO), and if not responsive packedRBCs

89
Q

Baby born to mom with Graves?

A

Neonatal thryoidtoxiosis - dt transplacental anti-TSH receptor abs (>=500% nl) causing excessive thyroid release. Leads to tachy, warm, poor feeding, low weight gain, irritable baby
Tx - self resolves in about 3months (since it’s placentaL) but if symptomatic methimazole (TPOxidase inhibitor) and beta blocker.

90
Q

Traumatic delivery to large baby. Woman now has ambulatory pain radiating to back and legs.

A

Pubic symphasis diastasis.

91
Q

suspected PPH in unstable patient? Tx?

A

retroperitoneal hemotoma–Emergent Ex Lap

92
Q

Risk for PPROM? Tx?

A

Untreated Assymoptomatic bacteruia. Antepartum bleeding, prior PPROM.

Tx:
<34 - antiobiot, cortico,
<34 - nonreassuring ==delivery
>=34 - delivery

93
Q

When choriovillis vs amnoi?

AFP vs Quad when?

A

Chorio is 9-13 (less invasize)
AFP - 9-13
Amnio: 15-20
Quad: 15 - 22

94
Q

Cervical conation risk?

A

Cervical stensosis from scar.
PPROM
Preterm birth
Loss in 2nd tri

95
Q

Definition of labor

A

Painful contractions WITH cervical change. If reassuring reactive NST and no cervical dilation with woman presenting with contractions, send them home as they are just having false labor (brax hicks) contractions?

96
Q

Labor stages and phases?

Active phase protraction? Caused by?

A

Stage 1: Phase 1dilation to 6cm
Stage 1: phase 2 6-10cm (1cm/2hrs). Protraction usually caused by cephalopelvic disproportion, BMI, nullip.
Stage 2: baby delivered. Epidural can lenghten this***
Stage 3: placenta

97
Q

Assymptomatic bact in preg - risk for, tx with?

A

Risk for pylonephr.

NAC (nitro, amox, ceftri)

98
Q

Cuase of infert in aging woman?

A

Decreased ovarian reserve

99
Q

Pseudocyesis

A

“Phantom” preg. Essentially psychosomatic induced pregnancy symptoms. Tx via psych eval

100
Q

TX for a hyatidaform mole?

A

Suction curattage. Then HCG to ensure removal. Birth control for 6months

101
Q

Older woman with PE supect for epithelial ovar carcinoma - what next? Tx?

A

If Pelvic US confirms - then EX LAP. Biopsy risks spreading the mass****. Chemo w platinum agents

102
Q

Transverse baby at 35wks - mangagement? Contra?

A

Contra: classical c-section, myomectomy, placenta previa.

If not External cephalic version.

103
Q

Why do high BMI ppl have increased risk for endometrial hyperplasia?

A

Unopposed estrogen from aromatse conversion of androgens into estradiol in peripheral fat tissue

104
Q

GBS workup

A

35-37 weeks in Rectovag test. If + or in urine tx OR ROM >18hrs or prior infant with GBS:
IV Peniccilin if allergic cef (if non anaphalaxissi).

Test for clinda and erythro. Since erythro is associated with inducible clinda resistance. If resistant to both then Vancomycin

105
Q

Emergency contraception

A

COPPER IUD (copper causes toxic rxn for sperm and impairs implantation)

106
Q

Delay in labor: types? tx?

A

Protraction - slower or inadequate contractions = Oxy

Arrest (no change in 4hrs w adequate or no change in 6 hrs inadequate) - c/section

107
Q

Risk factors for breech presentation?

A

AMA (>35), Multip, uterine anatomical issues, fetal anomalies, Preterm, Oligo/poly, placenta previa.

108
Q

gDM - when to screen how to interpret resutls?

A

GDMA1 (diet controlled) and GDMA2 (insulin/met controlled). Needs to be found after 20 weeks (or else chronic DM) - thats why screening occurs at 24-28.

50g -> <140. If not less then 2 of 4 of 150 (90, 180, 155, 140)

109
Q

Ulipristal acetate - when to use? MOA?

A

Emergency contraception, immediately before myomectomy. Selective progesterone modulatory (essential blcoks prog).

110
Q

Sxs and TOLACs?

A

Low Transverse and abdmonial myomectomy where cavity was not entered: TOLAC OK.
Classical c-section and abd myo where cavity entered: TOLAC contraindicated

111
Q

When to test for syph in preg?

A

First prenatal visit (if high risk also third)

112
Q

Uteroplacental insufficiency in late term

A

Delivery/c-secion. Signs like Oligo, macrosomia.

113
Q

When to amnioinfuse?

A

Variable decels - 2/2 oligo from rupture of membranes and cord compression.

114
Q

Painless vaginal bleeding >20wks

A

Placenta previa. Fetal heart tracing will likely remain normal since it is from mom

115
Q

RhoD when to give? when to test?

A

28-32wks gest, <72hrs after delivery or abortion, ectopic, threatened, mole, CV/amnio sampling, trauma, 2/3rd bleeding, External cephalic version

116
Q

Def of secondary amen

A

> 3 months in previously reg or >6 for irreg

117
Q

light post-menopausal bleeding?

A

cancer until proven othrwise. PAP & TVUS (>4mm->biopsy) or biopsy

118
Q

First prenatal testing blodo work

A

RhD, Anemia (HgB, MCV), HIV, Syph, HepB** (not C), Rub and Varicella, Pap, Chlam PCR, Urine culture and dipstick.

119
Q

Diamn, monochorion at risk for?

Monoamn, monochorio?

A

Twin-twin transfusion. Smaller does better long term. Laser ablation of anostomasis.

Cord entanglement and fetal demise

120
Q

Fibroadenoma vs fibrocystic changes

A

FA - <30yo. Benign Painless. SINGLE

FC - 30-50yo. Painful benign. Rubbery breast mass. Typically MULTIPLE

121
Q

Ground class appearing mass on ultrasound

A

endometrioma - endometriosis with blood inside a cyst

122
Q

Women with endometriosis who wants to get preggers?

A

Ovarian stimulation w/ or w/o intrauterine inseminnation

123
Q

Chronic dysuria in absence of other disease

A

Interstital cystitis

124
Q

Ovarian cyst suspect for cancer - what DON’T you do?

A

Drain it - risk for seeding peritoneum

125
Q

What to check before implanon or IUD?

A

Pregnancy test

126
Q

Lichen:

1) Sclerosis
2) Planus
3) Simplex chronicus

A

1) Benign chronic, marked inflammation, epithelial thinning and dermal changes. Vulvar itching/burning. Tx top corticosteriods. RF squamous cell carcinoma. VULVA only (no vag)
2) Inflamm affecting skin, oral, vulvar and vagina. Buring/itching/dysprunia (VULVA AND VAG)
3) Itchy/scratch cycle -> epidermal thickening and inflam infiltrate

127
Q

Tx for PID?

A

Cefoxitin and doxycyclin. “Foxy doxy”

128
Q

Pain vulvar symptoms and urinary retention

A

Primary Herpes outbreak

129
Q

Size of endometrial polyp requiring removal?

A

1.5 cm or more

130
Q

Most severe virulization sign?

A

Deepening of voice

M3 - clinicals (7 decks)

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