Brainscape's Knowledge GenomeTM

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


See full index

IPAP > OBGYN Reverse > Flashcards

OBGYN Reverse Flashcards

1
Q

Sexual expression is determined by ? five factors

Masters and Johnson describe ? four stage sexual response cycle in 1966

Basson proposed ? revised sexual response cycle in 2001

A

Psychological Learned Environment Spiritual Social

Excitement Plateau Orgasm Resolution

Intimacy Stimuli Arousal Desire Enhanced intimacy

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

? is the biological component of the Sexual Response Cycle and what control this component

? carries that most weight of the cycle

Desire Phase is driven by ? hormone while Arousal Phase is driven by ? hormone

A

Sexual Drive- influenced by neuroendocrine

Motivation
Emotional willingness

D: testosterone, excited- T, suppressed- Serotonin
A: E2 from parasympathetic

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

Menopause sexual dysfunction is d/t ?

What are the three phases of sexual response

? underlying Dxs are comorbid w/ sexual d/os

A

Hypo-estrogen
Inc FSH= hot flashes

Desire (Libido)
Excitement (Arousal)
Orgasm (Climax)

Anxiety/Depression

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

Excitement/arousal is a reflex controlled by ? nerves and controlled by ? system

The excitement/arousal phase is enhanced by ? hormone and the lack of this is the MC ?

Orgasmic phase reflex is controlled by ? nerves and modulated by ?

A

T11-L2, S2-4; Parasympathetic

Estrogen; MCC of dysfunction of excitement phase

T11-L2, S3-4; Sympathetic

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

What are the four RFs for developing dyspareunia

Difference between fe/male sexual assault in military

? are the RFs for violence against women and when are the RFs lowest

A

Hx of abuse/PID
Age <50
Depression/Anxiety

Unwanted touch: MC to men
More likely reported/investigated- MC to women

Age 16-24y/o
Witnessing violence as child
Lowest: 65/> y/o

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

What are the support structures of the pelvis

What are the pelvic organs

Define Chronic Pelvic Pain

A

Perineum
Urogenital diaphragm
Levator ani
Vagina

Rectum Uterus Bladder Vagina

Non-cyclic pain lasting 6mon+ severe enough for functional disability/medical intervention

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

What is used for first line Tx of Chronic Pelvic Pain

How are neuropathic Sxs Tx

How are dysmenorrhea/dyspareunia Sxs Tx

What surgical options are available

A

Acetaminophen and NSAIDs

SS/NRI TCA Gabapentin

CoCs Progestin GnRH agonist

Hysterectomy Neurolysis

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

Define Vulvodynia

What is used for Tx

When does Localized Provoked Vulvodynia become a DDx

A

Vulvar discomfort x3mon w/out identifiable cause

Topical Lidocain/Gabapentin
Antidepressant- TCA (max 200mg Amitriptyline)

New onset insertion pain x 3mon

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

What are the two sub-classifications of Dyspareunia and the causes

Exam for dyspareunia mirrors the exam for ?

How is this condition Tx

A

Insertion: d/t vulv-odynia/itis, poor lube
Deep: pain d/t endometriosis, adhesions or bulky leiomyomas

Chronic Pelvic Pain

Vaginismus- desensitization, counseling
Atrophy- estrogen cream
Poor lube- lube and arousal
Structural- surgery

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

Pudendal Neuralgia is Dx w/ ? criteria

Define Cystocele, Rectocele, Enterocele, Procidentia

? is the 3rd MC indication for hysterectomy

A 
Nantes:
Pain along pudendal nerve path
Worse w/ sitting
No sensory loss
Does not awaken
Relieved w/ nerve block

C: bladder prolapse
R: rectum prolapse
E: bowel prolapse
P: uterus prolapse

Pelvic organ prolapse

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

Define Splinting/Digitation associated w/ pelvic organ prolapses

Which type of prolapse presents w/ urinary retention

What are the RFs for prolapse

A

Splint: manual bolstering improves Sxs
Digit: manual pressure aids w/ BMs

Cystocele

Inc abdominal pressure
CT d/o
Age- risk double each decade
Vaginal delivery- 1.2x per delivery
Elective forcep delivery
Race: hispanic/white
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Although unknown, Interstitial Cystitis and/or Painful Bladder Syndrome is potentially d/t ? two etiologies

These two Dxs are considered when

Pts w/ this condition but Dx w/ UTIs will present w/ ? c/c

A

Mast cell activation; Defected mucin layer

Unexplained chronic pelvic pain w/ voiding Sxs

Cranberry juice exacerbates pain

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

Define Hunner Ulcer

Define Glomerulations

What is first and second line Txs for Interstitial Cystitis/Painful Bladder Syndrome

What is the only FDA approved medication for Tx Interstitial Cystitis/Painful Bladder Syndrome

A

Red/brown lesion w/ radiating vessel to central scar causing bladder stiffening- Dx for interstitial cystitis

More common; petechia/sub-mucosal hemorrhage (not unique to interstitial cystitis)

1st: Education, Behavior mod
2nd: PT Elmiron Amitriptyline Cimetidine Hydroxyzine

Elmiron- repairs bladder defects

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

What can be injected into bladder for Interstitial Cystitis/Painful Bladder Syndrome Txs

? MedHx makes females 2.5x more likely to be admitted to nursing homes than peers

What are the transient causes of incontinence

A

Lidocaine Heparin Dimethyl Sulfoxide

Incontinence

Delirium- MC in hospitalized Pts
Infections
Atrophic vaginitis/urethritis
Pharm: A-blockers (women) A-agonists (men)
Psych
Excess output/Endocrine dz
Restricted mobility
Stool impaction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the three degrees of Stress Incontinence Severity

How is the bladder controlled by the nervous system

? type of receptors are more predominant in the bladder dome and ? type of receptors are more predominant in the bladder neck

A

1: only w/ severe stress (cough, sneeze, jump)
2: moderate stress (movement, stairs)
3: mild stress (standing)

Peripheral, Autonomic:
Sympathetic: A/B receptors
Parasympathetic: Muscarinic/Nicotinic receptors

Dome: muscarinic, b-adrenergic receptors
Neck: a-adrenergic receptors

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

What meds do Pts w/ incomplete/overflow bladder emptying and stress incontinence need to avoid

? is the MC type of incontinence seen in women

How is urethral hypermobility assessed for during stress incontinence exams

A

Overflow: A-agonsits, CCBs
Stress: A-antagonists

Mixed

Q-tip test, angle changes >30* to horizontal= hypermobility and possible stress incontinence

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

Most cases of incontinence can be Tx conservatively w/ ?

What medication can be added to incontinence Tx to dec urgency/frequency

? medications can be used to work at detrusor muscle level

A

Kegels: 50-60 contractions/day

Calcium glycerosphate

Anticholinergics- inhibit muscarinic receptors to blunt contractions

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

? is a combo drug used for mixed incontinence Tx

? is a combo anti-spasmodic drug used for urge incontinence Tx

Botulinum injections can be used for Tx ? types of incontinence

A

Imipramine: TCA w/ a-adrenergic and anticholinergic effects

Mirabegron: relaxes detrusor, increases bladder capacity

Idiopathic detrusor overactivity
Urge

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

Urge Incontinence Tx methods

Stress Incontinence Tx methods

Overflow Incontinence Tx methods

A

Schedule
Anticholinergic: Detrol, Ditropan
Kegels

Pessary/kegel
Imipramine
Topical estrogen
Surgery
Duloxetine

Intermittent catheterizations
Surgery

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

Most breast dzs arise from ? structures

Because of their location these growths are very sensitive to ? hormones

When does breast epithelial cells proliferate and why

A

Terminal duct-acinar (lobules)

Est/Progest/Prolactin

Luteal- fullness week prior to menses d/t water content

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

? is the MC benign breast tumor and MC breast d/o

How does this MC appear on PE and what type of f/u is needed

? Pt populations are these more common in and what happens w/ age/menopause

A

Tumor: fibroadenoma
D/o: fibrocystic changes

Well circumscribed, rubbery and mobile;
No FamHx of breast Ca; f/u 3-6mon

Adolescent/pre-menopause;
Calcify and spontaneously involute

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

Simple Cysts appear as ? on US and need ? management for Tx

Complicated Cysts appear as ? on US

Complex Cysts appear as ? on US

A

Sololucent, smooth margins
No special management unless
Recurrent- consider excise

Internal echoes, proteinaceous debris
Consider aspiration, culture, cytology
Abnormality doesn’t resolve w/ aspiration- core needle

Septa/intracystic mass usually papillaoma
Core needle biopsy and/or excise

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

Define Fibrocystic Breast Changes

What causes these changes

These changes are characterized by ? that is d/t ?

A

Ropy, nodular tissue d/t dilated ducts and dense collagen

Collagen stromal response to hormones/GF

Hyperplasia- low progesterone compared to estrogen

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

How will Fibrocystic Breast Changes present to clinic

How are these Tx

What baseline order needs to be started if Pt is >25y/o

A

Bilateral cysts w/ pain worse pre-cycle (late luteal phase)

Aspiration for pain, Danazol but high androgen s/e
Bloody/residual= biopsy

Baseline mammogram (cut off age for US/Mamm- 30)

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

What is the preferred eval technique for the following exam/imaging findings:

Palpable cystic lesion

Recurrent cyst w/ bloody fluid

Non-Dx FNA

Solid palpable mass

Non-Dx core needle biopsy

A

PCL: needle drainage

Recurrent: excision

ND-FNA: core/excision biopsy

Solid: core needle biopsy

NDx CNBx: excision biopsy

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

What are the indications for breast biopsy

Mammography BIRADS Categories

A

Breast mass
Benign mass w/ personal/FamHx Ca
Equivocal mammograpy/cytology results

0- Incomplete: more/prior imaging needed for comparison
1- Negative: routine mammogram
2- Benign: routine mammogram
3- Probably benign: short interval f/u
4- Suspicious: biopsy
5- Highly suggestive of malignancy: biopsy
6- Biopsy proven malignancy: surgery

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

Pthirus Pubis

Sarcoptes Scabei

A

Crabs w/ contact transmission
Present: Adenopathy Itch Excoriation
Dx: exam/microscopy
Tx: Permethrin Pyrethrins Lindane- c/i in pregnancy/infancy

Scabies w/ contact transmission
Present: Dermatitis Itch
Dx: oil scrape and exam
Tx: Lindane Ivermectin- repeat at 2wks Permethrin

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

HSV is the most prevalent STI w/ more frequent recurrences of ? strain

What does the initial outbreak of the infection present as ? and holds the greatest risk to whom

How is it Dx

A

HSV-2 from saliva/contact transmission

HA Malaise Adenopathy Fever;
Neonate/fetus

Culture Abs PCR

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

Genital warts is d/t ? infection

What does this cause to develop

How is this Dx

How is it Tx by provider and Pt

A

HPV-6, 11

Condylomata acuminatum

Acetic acid
Biopsy if treatment failure

Provider: Podophyllin Chloroacetic acid Cryo
Pt: Podofilox Imiquimod

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

What microbe causes Syphilis and how is infection spread

How is this seen in clinic

How is this screened for and how is a Dx confirmed

A

Treponema pallidum- contact, transplacental

Painless chancre w/ hard, raised borders shedding spirochetes

Screen: RPR or VDRL
Confirm: FTA-Abs

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

How does Secondary Syphilis present

Time frame for Early or Late Latent Syphilis

What systems can Tertiary Syphilis infect differently between men and women

A 
Bacteremia
Condylomata lata- pink plaques in warm/moist areas
Adenopathy
Maculopapular rash on palm/sole
Exanthem- actively sheds spriochetes

Early: 1yr after secondary syphilis w/out Tx
Late: >1yr after initial infection

CV CNS MSK:
CV/Neuro less common in females

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

What is the reaction seen in Pts in response to Syphilis Tx and what causes this reaction to develop

How is Primary, Secondary and Early Late (<1yr) Syphilis Tx

How is Late Latent, Tertiary, or CV Syphilis Tx

When are Pts f/u with after Tx

A

Jarish Herxheimer- Fever Malaise HA d/t endotoxin release

Benzathine PCN G 2.4M units IM
PCN allergic and non-pregnant: Doxy x 14d
PCN allergy: Erythromycin

Benzathing PCN G 2.4M units IM weekly x 3wks
PCN allergic and non-pregnant: Doxy x 28d

Re-eval at 6mon;
Re-Tx w/ weekly PCN x 3wks

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

How does Chlamydia survive in the body

How is it Dx

How is it Tx

A

Intracellular bacteria

Culture Ag PCR*

Azith, Doxy w/ abstinence x 7d
Re-screen in 3mon

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

How is Gonorrhea Dx

What is used Primary, Secondary and Tertiary for Gonorrhea Tx

What class is no longer recommended for Tx

A

Gram stain
Culture- Thayer martin media
PCR- DNA/nucleic acid

Primary: IM 250mg Ceftriax+PO 1g Azith
Secondary: PO/IM Cephalosporin+PO 1g Azith
Tertiary: PO/IM Cephalosporin+Doxy 100mg x 7d
Abstinence x 7d
Re-screen at 3mon

Fluoroquinolones

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

PID is MCC by ?

What are the three possible sequelae

How is the ultimate Dx of Silent PID given

A

Ascending lower tract infection;
BV (anaerobes) Chlamydia Gonorrhea
Mycoplasmas: Hominis Urealyticum Genitalium

Infertility CPP Ectopic

Tubal-factor infertility w/ Hx compatible for UTIs

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

When do Sxs of Acute PID tend to present

What are the criteria for Dx

What is the primary imaging tool for Pts w/ PID

A

During/After menses

Uterine/Adnexal/Cervical tenderness w/ 1 or more:
Fever > 101.6
WBCs on microscopy
Inc ESR/CRP
Chlamydia/Gonorrhea
Cervical d/c or friability

US

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

How is PID Tx outpatient

If one of the meds needs to be replaced, what is used instead

How is PID Tx inpatient

A

Ceftriaxone 250mg IM
Doxy 100mg PO x 14d
Metronidazole (if +Trich/BV) 500mg PO BID x 14d

If Ceftriax can’t be used: Cefoxitin w/ Probenecid or
3rd Gen Cephalosporins

Cefotetan or Cefoxitin w/ Doxy or,
Clinda w/ Gentamcin or
Amp/Sulbactam w/ Doxy

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

How does Tuboovarian Abscess present on PE

How is this Dx

What happens if rupture occurs

A

PID Sxs w/ adnexal mass Fever Leukocytosis

US or CT/MRI

Peritonitis

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

What causes Toxic Shock Syndrome

When/how does this appear on PE

What causes this to develop

A

Exotoxin from Staph A

Diffuse itching macular rash
OHOTN
Fever Malaise Diarrhea- 2d after surgery/mense onset

Absorbent tampon/contraceptive sponge

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

All major criteria must be met for a Dx of Toxic Shock Syndrome which include ?

Define Fecundity and Fecundability

Chances of fertility drops by half after ? age

A 
Temp >38.8*C
HOTN- SBP <90
Orthostatic syncope
Late desquamation
Diffuse macular erythema

Dity: probability of live birthper menstrual cycle
Ability: ability to conceive; pregnancy probability per month of exposure

37-45y/o

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

What is the conception window and how often should sex take place to maximize fertilization

What needs to be avoided during fertilization window

When is a fertility work up warranted

A

5 days prior through day of ovulation;
qDay or QoD x 10days

Oil based lubricants

Failure after 12mon w/out contraception
>35y/o after 6mon w/out contraception

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

What are the 5 etiologies of infertility in sequence

A 
Ovulatory
Male factor
Tubal/uterine
Unexplained
Other
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What type of menstrual Hx suggests ovulation is occurring

Define Mittelschmerz

What four other Sxs may present with this sign

A

Menses q25-35d lasting 3-7d

Unilateral mid-cycle pelvic pain w/ ovulation

Luteal phase Sxs:
Tenderness Acne Craving Moods

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

How does body temperature reflect ovulation

At home ovulation kits are testing for ?

? is a more direct/earlier predictor of ovulation than basal body temps

A

04-0.8* increase x 2 consecutive days d/t post-ovulatory progesterone

LH surge

Mid-Luteal serum progesterone- correlates to ovulation and corpus luteum

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

What labs are drawn for anovulation work up in Pts w/ Hx of irregular cycles

What is the miscarriage risk in women >40y/o

What 4 populations should fertility testing be conducted

A

Prolactin Testosterone DHEA-S TSH FSH

50-75%

35/> after 6mon of trying/just starting
<35y/o after 12mon of trying
Dec ovarian reserve risk
Considering egg freezing

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

? is used as initial Tx for anovulatory, infertile women

What is the MOA

When is this considered a failure

A

Clomiphene citrate- SERM and day 3-5 of cycle

Inc FSH levels to inc ovarian follicle activity

Max dose 100mg x 6mon- refer

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

Other then Clomid, what three classes of drugs are used for infertility Tx

Top three most effective contraceptions

What are the 3 leading causes of infant death

A

Metformin- dec insulin resistance, inc ovulation
Aromatase inhibitors
Gonadotropins

Implant, IUD, Sterilization

Congenital malformation
Low weight
SIDS

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

All women of reproductive age should be taking ? nutritional supplement and when should amount be increased

All women above and below ? BMI level should be counseled about risks of infertility/pregnancy

? Dx is 6x more likely for offspring if father is >40y/o at contraception

A 
Folic acid- dec neural tube defects
BMI >35
DMT1 
Med/FamHx NTD
Valproate/Carbamazepine

30kg or higher, <18.5kg

Autism

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

What are the failure rates of Tier 1-4 contraception

What are the criteria to be reasonably certain a woman is not pregnant

When are CoCs and Depo avoided as contraception

A

1: <1%
2: <10%
3: >10%
4: spermicide, sponge

7d or less after start of menses/abortion
No intercourse since start of last menses
Consistent, correct contraception use
<28d post-partum
Breast feeding 85% or more of the time

Uncontrolled HTN >160/100

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

What contraception considerations are taken for Pts w/ MedHx of migraines w/ or w/out aura

What contraception considerations are taken for Pts w/ diabetes

What contraception considerations are taken for Pts w/ SLE

A

No aura: CoCs w/ caution
W/ aura, any age: no CoCs, Depo ok

End organ dz/Vascular dz/>20yrs w/ DM: no CoC/Depo

Neg Ab syndrome: CoC use safe
Pos/Unknown Ab syndrome- avoid hormones

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

Depo needs to be use w/ caution or avoided in Pts w/ ? Dx

? contraception consideration is taken for Pts w/ breast Ca of Hx of DVT/embolisms

Pts breast feeding or Hx of DVT/emboli need to avoid ? methods

A

Osteoporosis, RA

Avoid hormones

CoCs

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

Copper IUDs are good for ? long

Mirenea/Kyleena are good for ? long

Liletta/Skyla are good for ? long

Generally, their MOA is ?

A

10yrs

5yrs

3yrs

Prevent fertilization

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

MOA of Copper IUD

Copper IUDs have no effect on ?

What are adverse effects of using this method

A

Local inflammatory response
Dec sperm/egg viability
Blastycyst inflammation reaction

Inhibit ovulation

Menstrual changes for first 3mon, Tx w/ NSAIDs
Immediate fertility return w/ d/c

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

MOA of Levonorgestrel IUDs

What will Pts commonly report as adverse effects of this method

What benefit can this offer to a certain population

A

Progestin atrophies endometrium, prevents implantation
Dec sperm mobility
Inconsistent ovulation suppression

Irregular bleeding x 6mon
Amenorrhea x after 2yrs

Improves dysmehorrhea

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

IUDs lost is most common during ? and is higher if ?

? is the next step if provider can’t see strings

What are the risks if pregnancy/miscarriage does occur

A

MC in first month;
Post partum or <25y/o

R/o pregnancy, cytology brush twirl, then US

More likely ectopic;
2nd trimester miscarriage- higher infection risk

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

Nexplanon may be the preferred contraceptive option for ? two populations

How much/often are Depo injections

What are the two benefits does Depo offer

A

Post-partum/abortion
Lactating mothers

Medroxyprogesterone- 150mg IM (shoulder/glut) q3mon

Improves menorrhagia, dysmenorrhea, endometrial pain
Dec risk for endometrial hyperplasia/Ca

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

What are the 4 relative c/i for Depo use

What is the only absolute c/i for Depo use

What are the adverse effects of Depo use especially in ? population

A

Recent breast Ca
Progestin pos Ca
Prior ectopic
Pregnant

Current breast Ca

Bleeding Bone loss HTN Anovulation Weight Functional cyst
Severe HTN- risk of stroke

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

What are the two absolute c/is for mini-pill use

Combined Hormone Contraceptives include ? forms

What is their MOA

A

Breast Ca, Pregnant

CoC- pills
Patches
Transvaginal rings

Suppress hypothalmic gonadotropic release to block LH/FSH from pituitary and inhibit ovulation
P: dec motility/implantation
E: cycle control, dec break through bleeds

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

Why do CHCs have <35mcg of estrogen and modified progestin

What are the pros/cons of 3rd Generation Progestins

What are the pros/cons of 4th Generation Progestins

A

E: Less risk for thromboembolism
P: Dec androgenic effects

Dec androgen/lipid profile effect
Inc risk of venous thrombosis

PMS Sxs- breast tenderness/bloat
HyperKa risk

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

? is the most popular reversible contraception method in US

What benefits do these most popular have

What risk do they carry

A

Oral CHC pills

Dec Ca risk w/out inc risk for breast Ca
Improve cycle irregularities
Dec PMDD Sxs

Blood clots

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

What are the 3 methods of initiating oral CHC pills

When are the embolism risks of CHCs the highest

What are the top 3 s/e reported when d/c oral contraceptives

A

First day: start on cycle day one w/out back up
Sunday: begin first Sunday after menses starts, no weekend withdrawal bleeding; back up x7d
Quick: start on day Rx is filled, back up x 7d

Inc 5x during pregnancy/post partum

Weight gain Irregular bleeding Nausea

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

Directions for use of Transdermal CHC

What risk do Transdermal CHCs have

What can cause this form to fail

A

Weekly application to arm, abdomen, torso (not breast)
1 patch x 3wks, one wk patch free w/ bleeding

Higher VTE risk than COCs

90kg or bigger

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

How is back up protection used when using transdermal CHCs

Directions for Transvaginal Rings

When is back up needed

A

Delayed in first week- reapply, back up x7d
Delayed in 2/3 week- <2d, no back up; >2d, back up x 7d
Detached <24hrs: replace same patch, no back up
Detached >24hrs: new patch on new day, back up x 7days

3wks in, 1wk out w/ refrigeration required

Day 1 start- no back up
Day 2-5 start- back up x7days
Falls out and replaced <3hrs- no back up
Falls out and replaced >3hrs- back up x 7d

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

? is the only requirement prior to starting CHCs

How are diaphragms used for contraception

? form of contraception has a higher failure rate than diaphragms

What risk do spermicides carry

A

Document BP

Insert 6hrs prior, left in place x 6hrs

Cervical caps

Inc risk for HIV/STI transmission

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

What are the three fertility awareness methods

A

Standard Day: avoid sex on day 8-19 of cycle; only effective if cycles q26-32 days

Cervical mucus:
Billings Method: no intercourse from menses-4d after slippery mucus identified
Two day Method: sex is safe if no mucus is noted on day of/prior to intercourse

Symptothermal: mucus and body temp measured; requires 12-17d of abstinence/month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Plan B emergency contraception needs to be taken within ? hrs

How long after vasectomy until father is “safe”

How long after miscarriage/abortion for ovulation to return

Medical options for early termination of pregnancy in non-surgical Pts

A

Progestin only/COC: <72hrs
Progestin receptor modulator/antagonist: <120hrs (most efficient oral regimen)
Copper IUD inserted <120hrs (most effective)

3 months/20 orgasms

2wks

Mifepristone, Methotrexate- day one
Misoprostol- day three

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

When are Leopolds maneuvers started

What are the four parts of the assessment

When is the fetus considered to be ‘engaged’ in labor

A

Can begin at 28wks,
Typically at 35-36wks

1st: What part occupies the fundus
2nd: What side is the back on
3rd: What is the presenting part
4th: Is it brow or occiput

Biparietal diameter (greatest transverse diameter in occiput presentation) passes through pelvic inlet

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

What are the 3 types of breech presentation

What pelvic diameters are suggested prior to attempting vaginal delivery

If fetus is found to be breech, ? maneuver can be attempted and w/ ? potential adverse outcomes

A

Frank: hip flexion, knee extension
Complete: hip flexion, knee flexed
Incomplete breech: one of both hips unflexed

AP 10.5cm or >
Inlet transverse 12cm or >
Midpelvic interspinous 10cm or >

External cephalic version, 36-37wks;
39wks w/ epidural; failure= C-section
ROM Abruption Delivery

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

What are the 4 phases of labor

What happens during each phase

The Three Stages of Labor occur during ? phase of labor

A

1: Quiescence, preludes parturition
2: Activation, preparation for labor
3: Stimulation, process of labor
4: Involution, parturient recovery

1: cervical softening
2: cervical ripening, uterus prepares for labor
3: contraction, dilation, expulsion
4: involution, repair, breast feeding

Phase 3- stimulation

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

Phase 1 of Labor

Phase 2 of Labor

Phase 3 of Labor

Phase 4 of Labor

A

Prelude to Parturition:
Changes at 36-38wks:
Myometrial relaxation, cervical softening

Preparation for Parturition:
Uterus activation/Cervical ripening/Isthmus formation
Head descends to pelvic inlet (baby dropped)

Parturition; Active Labor:
Stage 1: Effacement, Dilation
Stage 2: Descent
Stage 3: Placenta delivery

Recovery from Parturition/Puerperium:
Uterine involution/contractions
Lactogenesis

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

What is the sequence of labor onset

How does the timing between contractions help identify the stage of labor

Contractions normally last ? long and are every ? time

What are the hypotheses of why there pain associated w/ labor contractions

A

Prodromal/False to Latent to Active

Latent- 10min apart
Active: 3-5min apart

Avg: 60 sec long, 5/< in 10min averaged over 30min

Myometrium hypoxia
Nerve ganglia contractions
Cervical/peritoneum stretching

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

Stage 1 of Labor

Stage 2 of Labor

Stage 3 of Labor

A

Clinical onset:
Latent- dilation, not admitted unless 3-4cm dilated/ROM
Active- >5cm dilated, 4-6hrs until delivery

Fetal Descent: complete dilation until delivery

Placental delivery, usually <30min
>60min= problem

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

When are mothers at highest risk for developing post-partum hemorrhage

What are the names of the two labor curves

How much cervical dilation is expected for Pimips/Multips

What are the indications for administering oxytocin during labor

A

Most: first hour
Risk remains for 6hrs after delivery

Friedman and Zhang

Prim: 1.2cm/hr
Multi: 1.5cm/hr

No dilation at 1cm/hr in first stage or,
No descent for 1hr in second stage

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

What is assessed during a cervical check

Define Precipitous Labor and Delivery

What underlying Hx is seen w/ these types of deliveries

A

Dilation Effacement Station Position

Deliveries <3hrs

Cocaine abuse

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

Define Labor Dystocia

What are 4 potential components causing this issue

? is the MC cause of dystocia and subsequent c-section

A

Dysfunctional labor; too slow

Fetal abnormalities
Abnormal forces
Bony abnormalities
Soft tissue abnormalities

Cephalopelvic disproportion from malposition

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

What are the 4 P’s of Labor Dystocia causes

Average Latent Phase is ?hrs but factors affecting this time include ?

When is latent phase of labor considered to be prolonged

A

Power: 200 Montevideo units per IUPC x2hrs
Passage
Passenger
Pysche- only applies to 2nd stage

6-8hrs

Nulli/Primipara: >20hrs
Multipara: >14hrs

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

What is protraction dystocia defined as

What is arrest defined as

What is the next step after inadequate cervical changes have occured x 2hrs and dystocia is suspected

A

Null: <1.2cm dilation, <1cm descent/hr
Multi: <1.5cm dilation, <2cm descent/hr

Dilatation: 2hrs w/out cervical changes
Descent: 1hr w/out fetal descent

AROM: amniotomy
Oxytocin augmentation if <200 MV units x10min
No/little change- place intrauterine monitor

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

What is the best method to document fetal maturity

Define Montevideo unit

Cervical ripening uses ? scoring system

A

First trimester US

Sum of contraction amplitudes in 10min period; 200 is enough for labor

Bishop;
4 or less: unfavorable, indication for ripening
9- high likelihood for successful induction

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

Define Labor Induction

Define Labor Augmentation

When can weekly membrane stripping be started for induction

A

Stimulation of contraction before spontaneous onset; includes ripening

Enhanced spontaneous contractions that are inadequate d/t failed dilation/descent

37wks

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

What prostaglandins can be used for cervical ripening

Ripening agents are only useful if ?

? is the only FDA approved drug for induction/augmentation

A

E1: Misoprostol
E2: Cervidil and Prepidil

Active labor is NOT underway

Oxytocin- normally released from posterior pituitary d/t response of canal distention/mammary stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Two precautions taken when performing amniotomy

Three indications for maternal induction

Two indications for maternal augmentation

A

Keep hand placed to r/o umbilical prolapse
No walking x 30min after to ensure head engagement

Pre-eclampsia DM Heart dz

Abnormal labor
Prolonged latent/active phase

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

? medication is the initial med used for un/favorable Bishop scores

NSAID MOA

ASA MOA

A

Un: Prostaglandins- initiate labor, maintain ductus
Fav: oxytocin

Inhibit phospholipase A2 converting ethanolamine into arachidonic acid

Inhibit arachidonic acid conversion to prostaglandins via cycloxygenase

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

Oxytocin can hyperstimulate the uterus which is defined as ?

This is also the first line drug for ?

When using Oxytocin and inc D-cels are noted, what are the next steps

A

Tachysystole: >5 contractions per 10min
Contractions w/in 1min of each other
Contraction lasting >2min

Post-partum hemorrhage

D/c med
Put mother on left side
Cervical exam r/o cord entrapment
O2 
Terbutaline- B-agonist tocolytic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Fetal HR is considered brady/tachy when

Define Minimal, Moderate and Marked variability

Definitions of Accelerations for <32 and >32wks EGA

A

Brady: <110, Tachy: >160

Min: 5 or less
Mod: 6-25bpm
Mark: >26 or more bpm

32wks: 15/15, <32wks: 10/10
>2min but <10min
10min or longer= baseline reset

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

Why are Fetal Scalp Electrodes and Intrauterine Pressure Catheters used and what requirement is needed prior to sue

What is the Tocodynamometer used for

? external fetal monitoring value is most reliable indicator of fetal well being

A

Must have ROM for use:
FSE: fetal HR based on R-R interval
IUPC: timing, duration and strength of contraction

Timing/duration of contraction via external monitors (no contraction strength measurement)

Variability, norm: 6-25bpm

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

Define VEAL CHOP

Which ones require intervention

? is the most frequent abnormal pattern seen w/ fetal monitoring and what is a severe classification of this MC

A

Variable decel: cord compression
Early decel: head compression
Accel: okay
Late decel: placental insufficiency

Variable, Late

Variable decels;
60 FHR decel x 60 sec

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

Absent/Minimal fetal variability can indicate ? issues are present

? lab result is reassuring after a fetal scalp blood sample is taken for HR tracing

How are non-reassuring FHR patterns managed

A

Acidosis, Hypoxemia

pH >7.25

D/c augmentation meds
Put mother on L-side/all fours
Cervical exam r/o cord entrapment
O2, Fluids
Elevate presenting part/Trendelenburg if pushing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Non-pharm pain management is most effective if used when

How long does Fentanyl, Morphine or Demerol last

What three sedatives can be used but only for ?

A

First stage

F: 20-60min
M: 1-2hrs
D: 4-6hrs

False labor;
Promethazine Hydroxyzine Zolpidem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Uterus is innervated by ? nerves

? is the procedure of choice for regional analgesia but w/ ? adverse reactions

What are two other forms of regional analgesia used

What is the risk of general anesthesia

A

T10-L1: body
S2-4: canal/cervix

Lumbar epidural: Bupivicaine w/ Fentanyl adjacent to canal; Prolonged 2nd stage, fever HA

Spinal: anesthesia into canal, causes HAs
Pudendal: only relieves perineal pain for 2nd stage

Uterine atony

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

What are the seven cardinal movements of labor

A

Every Darn Fool In Egypt EatsRaw Eggs

Engagement
Descent
Flexion- descending head meets resistance
Internal rotation- occiput moves to pubic symphisis
Extension- therwise posterior perineum would be impinged; uterine contraction exerts Posterior then Anterior force
External rotation (restitution)- occiput rotates to left ischial tuberosity (right to right)
Expulsion

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

Define Caput Succedaneum

Define Cephalohematoma

Define Subgaleal hemorrhage

A

Boggy head that crosses sutures

Boggy head that doesn’t cross sutures, associated w/ jaundice

Crosses sutures w/ jaundice/blood loss possibly requiring compression

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

Four indications for vaginal operative delivery w/ forcep/vacuum and w/ ? end benefit

Vacuum delivery systems attach to ? part of head

Normally how long for placental separation to occur

A

Prolonged 2nd stage
Breech- forcep only
Suspicion for fetal demise
Shortens 2nd stage for maternal benefit

Flexion point- 3cm anteriorly from posterior fontanelle, 6cm posterior from anterior fontanel

4-12min, longer in pre-terms

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

How is Chorioamnionitis Dx

How is this managed

? is a potential warning sign of fetal asphyxia

A 
Fever >100.4 and two of:
Foul/culture pos amniotic fluid
Leukocytosis >15K
Abdomen/fundal tenderness
Tachycardia (maternal >100, fetal >160)

Induction (not C-section)
Broad spectrum ABX
Monitor postpartum for atony/hemorrhage

Meconium- vasovagal process secondary to contraction

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

4 RFs for shoulder dystocia

Should Dystocia management in order mnemonic

Which step has the highest individual success rate

A

5- remove posterior shoulder

Macrosomia Obesity DM Prior dystocia

HELPERR
Help
Evaluate for episiotomy
Legs hyperflexed (McRoberts maneuver)
Pressure, suprapubic
Enter vagina for rotation (Rubin Reverse/Wood's Screw)
Remove posterior arm
Roll Pt onto all 4s (Gaskin maneuver)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Define Zavanelli Maneuver during shoulder dystocia

? is used only when surgical capabilities are not available

Two steps for managing cord prolapses

A

Replacing birthed head back into canal in anticipation for c-section

Symphysiotomy

Tocolytics, Stat C-section

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

What is the MCC of non-OB fetal demise

Mothers are observed for ? long after minor trauma to r/o abruptions and can only be d/c if ? criteria are met

? is the MCC of Abruptio Placentae and what is a common complication after this occurs

A

MVAs

4hrs;
Contracting less than once q10min
No vaginal bleeds
No abdominal pain/tenderness
Fetal HR reassuring
No visible bruising

HTN; DIC

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

How does Abruptio Placentae present

What happens if blastocytes implant too low in uterine wall and how would it present if not caught on US

Intact coag system is not necessary to post-partum hemostasis unless ?

A

Vaginal bleeding w/ contractions
Uterine tenderness
Non-reassuring fetal HRs

Placenta previa- avoid vaginal deliveries:
Painless vaginal bleeding

Laceration of Perineum Uterus Birth canal

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

Criteria for post-partum hemorrhage

What are the 4 etiologies

How is blood loss estimated

A

Vaginal: >500mL C-section: >1L or S/Sxs of hypovolemia <24hrs of delivery

Atony Tissue Trauma Thrombin

500mL loss for every 3% HCT drop

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

Post-partum hemorrhage is clinically worse if occurring at ? time frame and d/t ?

What uterotonic agents can be used

How long are these used for before moving to surgical interventions

A

1-2wks post-partum d/t abnormal involution of placental site

Oxytocin- first line
Methergine- first line/IM only; not for HTN/Pre-Ecl
Carboprost- not for asthma, Card/Renal/Liver dz, seizure
Misoprostol- used for asthmatics, HTN

30min

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

Name of balloon used for tampony and ? type of fluid is used during resuscitation

Rapid blood infusion is done if Hct drops below ?

How is maternal shock monitored for

A

Bakri; Crystalloids

<25%

Urine output >30mL/hr
Preferred >50mL/hr

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

? is the “classic” hemorrhage disaster

Define Sheehan Syndrome

How does this syndrome present

A

Uterine inversion

Pituitary failure after hemorrhage induced ischemia/necrosis

Failed lactation
Amenorrhea
Breast atrophy
Loss of secondary hair
Adrenal cortex insufficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Start episiotomy in ? location using ? tool

What are the 4 degrees of tears that occur during birth

What gestation factors/risks increases w/ age and what three factors place Pts more susceptible for this risk

A

Midline w/ scissors

1st: skin
2nd: skin, SQ
3rd: skin, SQ, sphincter
4th: skin SQ sphincter and rectal mucosa

Twins, parity;
Mother’s FamHx, Nutrition, FSH

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

Define Superfetation

Define Superfecundation

What happens during TTT

A

Second conception in already pregnant woman;
Two embryos of different ages in same uterus

Fertilization of two ova in same menstrual cycle but not same coitus/male

Donor twin- anemic, growth restriction, oligohydramnios
Recipient twin- polycythemic, overloaded, hydrops, polyhydramnios

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

Define Threatened Abortion

Define Incomplete Abortion

Define Complete Abortion

Define Missed Abortion

Define Inevitable Abortion

Define Recurrent Abortion

A

Bleeding w/ closed os during first 20wks

Tissue remains in uterus

All products have been expelled

Non-viable products retained in uterus

PROM w/ open cervix and bleeding

Three or more losses <20wks or fetus <500g

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

80% or more of early pregnancy losses occur prior to ? mile marker

How are Spontaneous Abortions managed if TV-US is unclear

Majority of ectopic pregnancies occur in what two locations

A

12wks

Serial hCG-
Inc w/out intrauterine pregnancy= ectopic
Dec w/out intrauterine pregnancy= complete abortion

Ampulla then Isthmic

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

What are the Triad Sxs of Ectopic pregnancy

What will be seen on PE

What time frame is an intrauterine sac, yolk sac and fetal pole detectable on US

A

Spotting/bleeding Amenorrhea Pain

PooP
Blood in Pouch of Douglas= posterior fornix bulge
Tender mass palpated next to uterus

Gestational sac: 4-5wks (1500hCG)
Yolk sac: 5-6wks (5200 hCG)
Fetal pole: 5.5-6wks (17500 hCG)

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

After Dx of unruptured extra-uterine pregnancy is made, what is the next step

Define Heterotopic Pregnancy

How are ectopic pregnancies medically managed and in ? populations

A

Laparotomy

IUP and ectopic pregnancy at same time

Methotrexate- targets rapidly proliferating tissue;
ASx Motivated Compliant

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

What are the three predictors of a good outcome of medical Tx of ectopic pregnancy w/ Methotrexate

What are 3 adverse effects of use

What is the difference between a Salpingostomy and Salpingectomy

A

Low hCG
Small pregnancy
No fetal cardiac activity

Marrow Mucosa Respiratory affected
Excreted in breast milk
Hepatotoxic

  • ostomy: removal of unruptured pregnancy
  • ectomy: removal of tube and pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Define Gestational Trophoblastic Dz and the two groups

? three populations are these higher in

What are the two RFs for development

A

Tumors of abnormal trophoblast proliferation;
Hydatidiform: +villi
Non-molar trophoblastic malignant neoplasm: -villi

Asian Hispanic American indian

Extreme age (>40= 10x risk)
Prior hydatidiform mole
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Define Complete Molar Pregnancy

What will hCG levels be at and w/ association to ?

What will Pt present w/ as c/c

A

Empty ovum w/ no maternal chromosomes, 46XX

> 100K, Theca Lutein cysts

1st trimester bleeding
Hyperemesis gravidum
Pre-Eclampsia

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

Define Partial Molar Pregnancy

What Pt education goes w/ Dx

Gestational Trophoblastic Neoplasias almost always develop after ?

A

Fertilized ovum by two sperm= 69XXX/XXY
Nonviable embryo present

Lower risk for subsequent trophoblastic neoplasias

Pregnancy: Hydatidiform > miscarriage

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

What are the four groups of Gestational Trophoblastic Neoplasias

A

Placental site trophoblastic tumor: chemo resistant

Invasive: MC after hydatidiform mole, less metastatic

Epitheloid: low hCG, chemo resistant and commonly mets

Choriocarcinoma: MC after SAB/term pregnancy; can mets and associated w/ ovarian theca lutein cysts

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

What is the MC presentation of Gestational Trophoblastic Neoplasia

? Dx/finding is pathognomonic for a molar pregnancy

How are Hydatidiform Moles Tx

How are Gestational Trophoblastic Neoplasia Tx

A

Irregular bleeding w/ uterine subinvolution

Pre-E/E developing <20wks w/out MedHx chronic HTN

Dnc
Serial hCG q1-2wks until undetectable
Then monthly surveillance x 6mon

Chemo alone, pregnancy avoidance x 12mon
Hysterectomy if chemo resistant

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

What f/u step is taken for pregnancies that follow Hydatidiform/GTN Tx

? affect do hydatidiform moles have on fertility

? is the MC fetal hematologic abnormality and three other causes

A

Serum hCG checked at 6wk PP f/u

None

MC: RBC alloimmunization
Parvovirus B19
Fetomaternal hemorrhage
a-Thalassemia

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

How fetal anemia abnormalities be detected on US

How does Rh-D alloimmunization occur

? fetal heart rate pattern suggest possible fetomaternal hemorrhage and needs ? further eval

A

Middle cerebral artery peak systolic velocity

Rh-D neg mother develops anti-D Abs from Rh-D pos fetus

Sinusoidal pattern;
Kleihauer Betke test: quant test for fetal RBCs in maternal circulation

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

Fetal transfusion is needed at ? Hct %

Hydrops has developed if Hct is under ? %

? is the target Hct for nonhydropic fetus

A

<30%

<15%

40-50%

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

? is the MCC of severe thrombocytopenia among term newborns

How will this MCC present in neonates

How is it Tx

A

Alloimmune thrombocytopenia: maternal alloimmunization to fetal platelet Ags, Abs cross placenta

Unexpected thrombocytopenia, petechiae or intracranial hemorrhage

IVIG steroids and C-section at/near term

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

What happens in RBC alloimmunization

What happens in Fetal Thrombocytopenia

Define Immune Thrombocytopenia and when is Tx indicated

A

Maternal ABs cross placenta to destroy fetal RBCs

Maternal antiplatelet Abs cross placenta into fetus

Maternal autoimmune d/o causing fetal thrombocytopenia but w/out hemorrhage risk at delivery

Maternal platelets <30K w/ CCS or IVIG
No response= splenectomy

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

What else will be present in cases of Hydrops Fetalis

What are the etiologies of this condition

How are Hydrops Fetalis evaluated

A

Placenta megaly, Polyhydramnios

RBC alloimmunization- immune
Aneuploidy (MC),
Infection (MC w/ P-B19),
Abnormalities >90% of cases: non-immune

Sonograph
Amniocentesis
Kleihauer Betke test if anemia suspected
Indirect Coombs for alloimmunization

120
Q

Tachy is considered any rate higher than ? and brady is anything below ?

MC Arrhythmia seen in fetus’

What is the risk in sustained tachy dysrhythmias

What can be administerred for convert fetal rhythms

A

> 180bpm, <110bpm

Premature Atrial Contractions; benign and resolve w/ time

Hydrops d/t impaired ventricular filling

Digoxin Sotalol Flecainide Procainamide

121
Q

? is the MCC of fetal bradycardia

Maternal use of ? med can be used to Tx fetal bradycardia

What are the three levels of severity of Polyhydramnios

A

Congenital heart block

Terbutaline if fetal HR <55bpm

Mild: 25-29.9
Mod: 30-34.9
Severe: >35cm

122
Q

What four infections can lead to Polyhydramnios

How is Oligohydramnios Dx

Maternal use of ? drugs can cause Oligohydramnios

? is the only factor that causes IUGR to Woman, Fetus and Placenta

A

Toxoplasmosis Parvovirus CMV Syphilis

AFI <5cm or, Deepest pocket <2cm

ACEI ARB NSAID

Infection

123
Q

What are the three phases of fetal growth

What is the difference between A/Symmetric Growth Restriction and what measurement is used to differ

What other fetal abnormality may be seen w/ placental abnormalities

A

Phase 1, 1-16: hyperplasia at 5g/day
Phase 2, 17-32: hyperplasia/trophy at 15-20g/day
Phase 3, 33+, hypertrophy w/ the most fetal fat/glycogen accumulation

Head/Abdomen circumference:
Symmetric: dec cell size and number
Asymmetric: maternal HTN causing ‘brain-sparing’ development

Accelerated lung maturation- inc stress causes inc adrenal glucocorticoid secretions

124
Q

IUGR can be suspected after ? PE finding

Define Macrosomia and what are the RFs for macrosomia

More than half of deliveries will occur as c-sections if baby weighs more than ?

A

Fundal growth lagging >3cm

> 90th percentile, >4500g or more at birth

DOPPLAR-M:
DM
Obesity
Post-term gestation
Previous macrosomic infant
Large parents
Adv age
Racial factors
Multi-parity

> 4000g

125
Q

How are macrosomia Pts managed

Why does pregnancy induce mild hyperthyroidism

MC form of Hyper/Hypo-thyroidism

A

Non-DM: prophylactic labor induction
DM: C-section

Placental production of hCG and hCT;
hCG resembles TSH

Hyper: Graves; dec TSH, inc free T4 (thyroxine)
Tx: PTU 1st T; inhibits T4 to T3 w/ less placental crossing
Methimazole 2nd T
Hypo: Hashimotos; inc TSH, dec free T4 (thyroxine)
Tx: Levothyroxine

126
Q

Both Hypo/Hyper-thyroidism have ? risks during pregnancy

What teratogenicitic risks do anti-epileptic meds have for pregnancy/lactation

How are these Pts managed

A

Both: pre-eclampsia, prematurity

Pregnant: neural tube defects
Lactation safe

Lowest dose of Rx monotherapy w/ folic acid and Vit K

127
Q

Seizing Pt w/ no MedHx of seizures needs ? Dx considered and Tx w/ ?

? liver enzyme increases w/ pregnancy

Define HELLP Syndrome

A

Eclampsia; Mg sulfate

Alkaline phosphate

Severe Pre-E w/ hepatocellular damage:
Hemolysis Elevated Liver enzyme, Low Platelets

128
Q

Intrahepatic Cholestasis in pregnancy can have ? onset and w/ ? risks to fetus

What will Pts present with and what will be seen on lab results

How is it Tx

A

Late/multi-fetal pregnancy;
Demise Preterm Resp-distress

Pruritus, Jaundice

Inc bile acids, bili, AlkPhos

Antihistamine and topical emolients
Ursodeoxycholic acid- dec pruritus and bile acid

129
Q

Acute Fatty Liver of Pregnancy is associated w/ ? conditions

What will be seen on lab results

What is Tx

A

Late pregnancy w/ pre-e or twin gestation

Inc- Ammonia Bili Uric acid Transaminase
Dec- Coags Glucose

Delivery, maternal support

130
Q

Half of pregnancy associated suicides are related to ? and w/ ? RF

Define PUPPP

How does this present

How is it Tx

A

Partner violence; previous psych admissions

Pruritic Urticarial Papule Plaque of Pregnancy;
AKA Polymorphic Eruption of Pregnancy

Urticarial plaques w/in striae on abdomen/upper thighs, sparing peri-umbilicus

PO Antihistamines Emollients Topical CCS

131
Q

Define Pemphigoid Gestationis

What complications can arise from this condition

What CV complications indicate need for C-section delivery

A

Papule, Plaques and Vesicles on abdomen/extremities w/ umbilical involvement

Pre-term birth, Growth restrictions, Transient natal lesions

Dilated aortic root >4cm/aneurysm
Recent MI
Acute CHF
Warfarin in past 14d
Emergency valve replacement after surgery
Severe aortic stenosis w/ Sxs
132
Q

When does ACOG recommend HTN medication use

What is a worse form of HTN

HELLP Syndrome is a more severe form of ? Dx and how is it monitored for

How is it Tx

A

Nothing for BP <160/105

Chronic HTN w/ superimposed proteinuria (>300mg/day) prior to 20wks

Pre-eclampsia;
LDH and maternal platelet count

Mg Sulfate, Antihypertensives

133
Q

Criteria for Gestational HTN

Criteria for Pre-Eclampsia

What four etiologies can cause this

A

New onset HTN >140/90 after 20wks EGA w/out proteinuria and resolves <12wks PP

HTN w/ proteinuria (or protein/Cr ratio >0.3) or end organ damage after 20wks; MC seen after 34weeks

Trophoblastic invasion into uterine vessels
Immune/Maternal intolerance
Genetics

134
Q

How is severe pre-eclampsia managed in order

What is definitive Tx

Pre-term labor/birth is anything in ? range

A

1st: seizure prophylaxis w/ Mg Sulfate/Diazepam
BP: hydralazine, labetalol
CCS for pulm maturity if <34wks

Deliver regardless of EGA, vaginal preferred

20-37wks

135
Q

How/why do infections induce preterm labor/birth

A decreased level in ? hormone can increase preterm labor risk

What PE finding is reassuring for determining true/false labor

A

Inc phospholipase A activity
Dec cervical length/changes

Progesterone

No cervical changes x2hrs

136
Q

What test has a high negative predictive value for preterm labor Dx

How does the cervical length correlate to risk for pre-term labor

Why is hydration so important during pregnancy

A

Fetal Fibronectin (Trophoblast glue)- basement membrane protein produced by fetal membranes

> 30mm: very low risk
20-30mm: check FFN
<20mm: significant risk

ADH looks like oxytocin to uterus

137
Q

Steroids can be used in pre-term labor for lung immaturity between ? weeks and what is used

What tocolytics can be used depending on the gestational age

Why is Mg Sulfate also used between 24-32wks

A

23-34wks, repeat at 34wks if first dose 7d or > ago
Betamethasone 12mg IM x 2
Dexamethasone 6mg IM x 4

48hr delay:
23-32wks: Indomethacin
32-34wks: Nifedipine (1st) Terbutaline (2nd)

Prevent cerebral palsy

138
Q

When using Mg Sulfate for preterm labor management, serum levels must be kept below ? to prevent ?

What is the antidote if too much is given

Mg Sulfate needs to be totally avoided in ? population

Dont use for longer than ? days to prevent ?

A

<10mg, dec DTRs signal early sign of resp distress

Ca gluconate, 10mL

Myasthenia gravis

<7days; dec fetal Ca levels

139
Q

What s/e can indomethacin use as preterm labor tocolytic cause

Fetal s/e of CCB usage

In most mammals, ? triggers onset of labor

A

Oligohydraminos

Dec uterine/umbilical blood flow

Progesterone withdrawal

140
Q

? is the only FDA approved drug for preventing recurrent pre-term births

What two populations is this med used in

How does Cervical Insufficiency present

When is a cerclage considered

A

17 OHP-C (17-a hydroxyprogesterone caproate; synthetic progesterone

Prior preterm birth
No prior preterm but US proven short cervix

Painless 2nd trimester dilation

Single pregnancy
Prior pre-term birth <34wks
Cervical length <25mm and
Gestational age <24wks

141
Q

How often is cervical insufficiency assessed w/ US and what are indications for cerclage placement

Define PROM

Define PPROM

Membrane rupture before 24wks carries ? risk to fetus

A

q2wks; <15mm or <25mm at 24wks

Rupture before onset of labor; single most identifiable factor of preterm delivery

Preterm Premature Rupture of Membranes- rupture <37wks

Lung hypoplasia

142
Q

BV infections are linked w/ ? adverse outcomes

? is the most reliable indicator for membrane rupture

How is this Dx confirmed

A

Preterm labor
PPROM
Chorioamnionitis
Spontaneous abortion

Pooling/Expulsion

Pt valsalvas w/ sterile speculum exam; +fluid= Dx

143
Q

Define Ferning Test w/ labor

Define Nitrazine test

Define Post-Term Pregnancy and what genetic issue can cause this

A

Vaginal fluid placed on slide and air dries; amniotic fluid crystalizes

Paper turns blue w/ alkaline fluid (pH >6.5)

Gestation of 42wks or more;
X-linked placental sulfatase deficiency

144
Q

What skin changes are seen w/ Post-Term Pregnancies

How are these Pts managed at 41wks

How are these Pts managed at 42wks

A

Loss of protective vernix caseosa

Prostaglandin E w/ membrane stripping

Labor induction

145
Q

Defect of ? nutrient causes neural tube defects and when should it be consumed

Hyperthermia can cause ? defect

Hyperglycemia can cause ? defect

Valproic acid can cause ? defect

A

Folic Acid;
Pre-conception through first trimester

Anencephaly- frog eye sign

Cranial, Cervical, Thoracic defects

Lumbosacral

146
Q

Neural tube defects are screened for in first and second trimesters by looking for ?

The marker screened for in 2nd Trimester is made ?

What will be seen if defected levels are present

A

1st: nuchal translucency on US
2nd: Maternal Serum Alpha Feto-Protein at 16-18wks

Yolk sack,
GI tract/liver

Defected integument system= inc AFP in amniotic fluid;
Eval w/ sonography/US (DxTOC for NTDs)

147
Q

? abnormality accounts for half of all fetal chromosomal anomalies

When is this screened for

How is CF inherited

A

Trisomy 21

All women presenting for prenatal care <20wks
1st trimester- nuchal skin US
2nd trimester- Triple/Quad screen

Autosomal recessive on CFTR number 7, encodes Cl channel protein

148
Q

Define Tay Sachs

How are high/low risk populations tested for this

How does this present to clinic and how is it Dx

A

Autosomal recessive mutation causing progessive neurodegeneration/early death

High: DNA base mutation analysis
Low: hexosaminidase A serum level

Galactosemic infant’s unmetabolized milk builds and damages liver, eye, kidney, brain
Chorionic villus sample/Amniocentesis

149
Q

Four indications to perform amniocentesis

What is used to separate samples if multiple gestational sacs

What two populations have increased risk of fetal loss d/t amniocentesis procedures

A

Congenital Fetal lung maturity Alloimmunization Genetics

Indigo carmine dye

Class 3 obesity, Twin pregnancies

150
Q

Two indications to perform Chorionic Villus Sampling

What is the benefit of doing this tests

What are the adverse risks

A

Fetal karyotype
Genetic analysis

Earlier results than amniocentesis (done at 10-13wks vx 15-20wks)

Higher loss rate, especially fetus w/ inc nuchal translucency

151
Q

Define Cordocentesis

MC indication to perform this test

What other benefit does this test have

How can the complications of this procedure be grouped together

A

Percutaneous Umbilical Blood Sample (PUBS):
Fetal blood sample taken via US guidance from vein

Fetal anemia assessment

Fetal karyotype 48hrs sooner than amniocentesis/CVS

More transitory

152
Q

Using amenorrhea to Dx pregnancy is not reliable until ? long

Why is there bleeding associated w/ first month of pregnancy

? is the common early sign

A

x 10days or more after expected menses

Implantation

Fatigue

153
Q

What is the role of hCG in early pregnancy

How quickly does it increase

What is the difference between the Qualitative and Quantitative tests

A

Prevents corpus luteum involution

Doubles q2.2 days
Peaks levels at day 60-70

Qual: urine test, detects + 8-9 days after ovulation
Quant: blood draw to follow doubling time

154
Q

What are the three possible causes of False Positive pregnancy tests

TVUS can Dx pregnancy by identifying ? structures at ? weeks

End of pregnancy uterus is ? many times bigger than normal and holds average ? much fluid

A

Exogenous hCG/tumor
Renal failure

Sac: 4.5-5wks Pole: 6wks Heart: 6-7wks

500-1000x bigger w/ avg 5L

155
Q

Uterus is too big to fit in pelvis by ? week and as it ascends it rotates ? direction

Placental perfusion requires uterine blood to perfuse ? area

Braxton hicks intensity measures ? much and these early contractions are d/t ? stimulation

A

13wks or >; Right

Placental intervillous space

5-25mmHg; Estradiol

156
Q

What does the mucus plug contain to prevent infection and why is this mucus usually thick

How long does corpus luteum maintain progesterone levels

Define Theca Lutein Cysts

A

Immunoglobulins, Cytokines;
Progesterone

At least week 7

Exaggerated physiological follicle stimulation

157
Q

Where is relaxin secreted from

What does it do

What does it NOT do

A

Corpus luteum Decidua Placenta

Remodels CT
Initiates renal vasculature augmentation
Dec serum osmolality
Inc arterial compliance

Peripheral joint laxity

158
Q

Define Glands of Montgomery

Estrogen/Progesterone effect on breasts

Why is there an increase in striae

A

Hypertrophic sebaceous glands appearing as scattered elevations on areolae

E: adipose deposition, ductal growth, proliferation
P: alveola/ampulla hypertrophy, secretory

Inc cortisol d/t estrogen causing insulin resistance/striae

159
Q

? female gland enlarges by 135% during pregnancy

When is the peak size seen

When does it return to normal size

A

Pituitary d/t prolactin levels

First few days

6mon post-partum

160
Q

? naturally produced tocolytic is produced during pregnancy to relax uterus

How do ventral hernias form

What two skin changes can be seen other than striae

These skin changes can be causes by ? non-pregnancy factor

A

Progesterone

Diastasis recti d/t expansion

Linea nigra- dark pigments
Chloasma/Melasma- irregular patches on neck/face

OCPs

161
Q

Why do pregnant Pts have increased incidences of angioma/telangiectasias and palmar erythema

What is considered average weight gain during pregnancy

Why do Pts retain water easier/more

A

Inc estrogen increases cutaneous blood flow

27.5lbs (12.5kgs)

Dec osmolality/colloid pressure
Inc venous pressure d/t partial vena cava occlusion

162
Q

Protein metabolism increases by ? x during pregnancy

What is considered normal carbohydrate metabolism during pregnancy

When does maternal fat accumulation stop or decrease

A

1000g

Mild fasting hypo
Post prandial hyperglycemia and hyperinsulinemia

3rd trimester

163
Q

When do leptin levels peak along w/ ? other food hormone

What inflammatory marker can be used as marker for bacterial inflammation after delivery

What type of EKG change will be seen during pregnancy and what sound will be heard

A

2nd trimester w/ ghrelin

Inc procalcitonin

LAD;
Exaggerated splitting of S1 w/ loud S1 and S2, possibly S3 w/ 90% of Pts having systolic murmurs;
10% will have continuous murmur d/t breast vasculature

164
Q

What CV system constrictor helps regulate vasoconstriction and is seen at pathological levels in pre-eclampsia

? urine/blood ratio is a suspected pathogenesis behind pre-eclampsia

How is Morning Sickness Tx

A

Endothelin

PGI2 : thromboxane

Pyridoxine B6 w/ Doxylamine (unisom), Phenothiazine

165
Q

What are the risks of using serotonin antagonists for Tx of N/V in pregnancy

Define Epulis Gravidarum

What is the MC form of Pica seen in pregnancy and what can cuase this to set in

A

Long Qtc >440

Pyogenic granuloma of gums, resolve w/ delivery

Amylophagia, starch;
Fe deficiency

166
Q

What is first line medication Tx for GERD

What is safe for use in pregnancy for constipation and what needs to be avoided for Tx

When does round ligament pain set in

A

TUMS then endoscopy if no relief

Colace, Fiber, Bulk formers;
Stimulants- risk for megacolon

2nd trimester w/ R > L

167
Q

Define Intrauterine Demise

Define Preterm labor

Define Macrosomia

Define Low birth weight

Define Extremely Low birth weight

A

Death >20wks

Labor prior to 37wks

Weight >4kg

  1. 5-2.5kg
  2. 5-0.99kg
168
Q

Define IUGR

Define advance maternal age

Define Adolescent Pregnancy

A

Weight <10th percentile

35y/o or > at delivery

<20y/o at delivery

169
Q

? obesity factor help contribute and lead to insulin resistance

What is the recommended weight gain for Pts depending on starting BMI

How is asthma managed during pregnancy

A

Adipokines

BMI 25-29.9: 15-25lbs
BMI 30/>: 11-20lbs

SABA and inhaled CCS
Steroid use >3wks, consider stress dose during L/D to prevent adrenal crisis

170
Q

? is the leading cause of pregnancy related deaths and when is this risk the highest

What sign would be seen on PE and what two stratifies are not valid

How are PEs during pregnancy manged

A

PE; 1-3wks post-partum

+homans;
D-dimer and Wells criteria

LMWH- Lovenox
Avoid Coumadin

171
Q

? is the leading cause of septic shock in pregnancy

When is DM screened for in pregnancy and how is this done

What is used medicinally for first line management and when is insulin indicated

A

Pyelonephritis

24-28wks w/ US at 20wks if +DM Dx
Step 1: 50g glucose challenge; 140/>, order Step 2
Step 2: 100g after over night fast;
Fasting: 95mg 1hr: 180mg 2hr: 155mg 3hr: 140mg

PO Sulfonylureas: Glyburide, Metformin;
Fasting glucose persistently >95

172
Q

Definition of embryo timeline

Definition of Fetus time line

Fetal viability is defined as ?

Define Previable

Define Periviable Birth

A

Fertilization to 8wks; 10 wks gestational age

> 8wks until birth (>10wks gestational age)

20-24wks

Infant delivered <24wks

Delivery occurring between 20 +0 through 25 +6

173
Q

Define Preterm

Define Term

Define Post-Term

Define Abortus

A

Delivery 24-37wks, <259 days

Delivery between 37-41 +6

Delivery at/> 42wks; 294 days or more

Fetus weighs <500g or <20 wks EGA

174
Q

Define Placenta Previa

How does this present if unknown

What are the three types

A

Placenta develops in lower segment/zone of dilation

Painless 3rd trimester bleeding/8th month

Marginalis- placenta touches margin of os
Partialis- placenta covers part of os
Centralis- placenta covers entire os

175
Q

Define Placenta Accreta

Define Placenta Increta

Define Placenta Percreta

A

Abnormal adherence of placenta to uterine wall w/ defected decidua basalis

Accreta w/ penetration into myometrium

Myometrium invasion and into surrounding structures

176
Q

Define Velamentous Placenta

Define Vasa Previa

Define G_P_TPAL

A

Umbilical cord attached to adjoining membranes w/ vessels entering separately

Umbilical vessels between head and os; C-section 35-37wks

Gravids- number of pregnancies, twins/+ count as 1
Parity- number of births after 20wks w/ twins/+ count as 1
Term Preterm Abortus Live

177
Q

Define Primigravida

Define Nullipara

Define Primipara

Define Grand Multipara

A

Currently in first pregnancy

No prior births prior to 20wks

One prior birth >20wks EGA

Five or more births after 20wks

178
Q

Normal duration of pregnancy is called ? and is calculated as ?

How long is a pregnancy and starting from ? day

New OB appointments start at ? and then f/u how often as long as they’re uncomplicated

A

Gestational age; Menstrual age

1st day of LMP;
280 days/40wks divided into epochs

10-12wks;
1st/2nd Trimester: q4wks
28-36wks: q2wks
36wks+: q7d

179
Q

? pelvic angle can be measured directly

Most favorable pelvic shape for delivery

Female mid-pelvis is measured at ? land mark and how do these land marks help w/ labor

A

OB conjugate: diagonal - 1.5-2cm= XX, Should be 10cm/>

Gynecoid > Anthropoid

Ischial spine;
Stations, ischial spine= 0 station

180
Q

How is EDD determined by Naegele’s Rule

? is the most accurate method to predict gestational age

When do EDD need to be adjusted to US dates

A

1st day LMP
Subtract 3mon
Add 7 days
Adjust year forward

Crown Rump length during first trimester

<9wks EGA w/ >5d difference in days
>9wk - <14wks w/ >7d difference in days

181
Q

What perinatal infections are mothers screened for

What type of virus is HIV and when are screenings done for this

How are HIV+ mothers managed

A

TORCH+:
Toxoplasmosis Other Rubella CMV HSV

RNA retrovirus
New OB, Repeat 3rd trimester for high risk

Antiretroviral therapy; viral load <1000 can do vaginal delivery; >1000= C-section w/ no breast feeding

182
Q

Risk of Toxoplasmosis in pregnancy

How is this Tx depending on who is infected

What are late signs of congenital syphilis

A

1st trimester: low infective, severe sequelae
3rd trimester: high infective, less sequelae

Spiramycin- maternal infection only
Pyrimethamine-Sulfadizine w/ folinic acid for maternal and fetal infection

Hutchinson teeth
Saber shins
Saddle nose deformity
FTT/Deaf

183
Q

How is syphillis Tx in pregnancy

What is the risk

? IgG titer is conducted on all pregnant Pts

A

Benzathine PCN G 2.4M units w/ 2nd dose 7d later

Jarisch- Herxheimer: Tx w/ antipyretic, O2, hydrate
Contraction Fever Dec movement/FHR decels

Rubella- RNA virus
Live virus= not during pregnancy, ok for breastfeeding

184
Q

? is the MC congenital viral infection

How does it present in clinic

When is HSV prophylaxis started

A

CMV- DNA herpes virus

Mental retardation, delayed development, vision/hearing issues

Acyclovir at 36wks

185
Q

How is varicella Tx after pregnancy w/ exposure

Why is there this risk

How is Hep B screened for and what maternal carrier has a higher transmission risk

A

Baby: VZIG w/in 96hrs and contact isolation
Mother: VZIG if w/in 6d of exposure

No vaccination during pregnancy

HBsAg;
+HbAg w/ risk for fetus to be chronic carrier

186
Q

How is a new born of HBsAG mother w/ Hep B Tx

What risks do chlamydia and gonorrhea have for infants

How are these Tx during pregnancy

A

HBIG w/ vaccine <12hrs of birth w/ +breast feeding

C: conjunctivitis, pneumonia
G: conjunctivitis

C: Amox TID x 7d or Azith x 1dose
G: Ceftriax or Cefixime

187
Q

Define Strep Agalactiee and this is the MCC of ?

How is this Tx during labor

How is Bacteriuria Tx

A

GBS- number one cause of neonatal sepsis

Recommended: PCN G
Alternate: Ampicillin
Allergy: Clinda, Vanc

Empirically w/ test of cure: Nitrofurantoin, Amox, Ampicillin

188
Q

How is TB tested for if Pt received Bacille Calmette Guerin vaccine

How is TB Tx

How is Zika prevented during pregnancy

A

Interferon gamma release assay- TB Gold/Spot

Latent: INH w/ Pyridoxine x 9mon
Active: RIPE x 2mon, RI x 4mon

No travel, Condoms

189
Q

? vaccine is recommended at any gestational age

When is MMR administered

How long into pregnancy can air travel be done and how much exercise is recommended

A

Influenza

Post-partum w/out breast feeding c/i

36wks; 150min/wk

190
Q

Low mercury containing seafood/shellfish should be limited to ? amount

? sweetener needs to be avoided

Keep ASA ingestion below ? amount

Caffeine intake limit

Smoking causes dec birth weight by an average of ?

? is the leading cause of preventable developmental disabilities world wide

A

8-12oz/wk
6oz/wk of white tuna/albacore

Saccharin

<100mg

<200mg= no risk

200g less than non-smokers

Alcohol

191
Q

? does Fetal Alcohol Syndrome appear

Limit x-ray exposure to ? amount

When are domestic violence screenings conducted

A 
Micrognathia
Flat midface
Indistinct philtrum
Thin upper lip
Short palpebral fissure/nose

<5 rads

First prenatal
Once per trimester
Post-partum visit

192
Q

Recommended time to screen for depression/behavioral health

4 known c/i for breast feeding

Criteria for elective delivery

A

Once during perinatal period

Lithium
Active TB
Chemical dependency
HIV

Initial hCG 36wks prior
FHTs documented x30wks
Dating US prior to 20wks GA

193
Q

What is done at 10wks

What is done at 18wks

What is done at 18-20wks

What is done at 20wks

What is done at 24-28wks

What is done at 28wks

What is done at 36wks

A

FHT w/ doppler

Quickening (Primi- 18-20wks; Multi- 16-18wks)

Anatomy scan

Fundal height at umbilicus

GTT

Rhogam

GBS screening

194
Q

Fetus is at risk from maternal stress until ?

How much weight gain is expected per trimester

How much of a calorie increase is needed

A

22wks

1st: 3-6lbs
After 20wks: 1 lb/wk
25-35lbs overall if normal BMI 18.5-24.9

300-400/day; 500/day during breast feeding

195
Q

When is the lowest maternal BP expected at ? week and beware of BPs over ? level

How is edema defined in pregnancy

How long is a fetal sleep cycle

A

26wks; >140/90

> 1+ after 12hrs bed rest or
Gain of 5lbs in 1wk

20-75min, avg 23min

196
Q

What is the Qualitative/Screening test of fetal-maternal hemorrhage

What is the quant test done

How much is a standard dose of Rhogam and how much coverage is given

A

Erythrocyte rosette screen- maternal serum mixed w/ IgM

Kleihauer Betke test- citric acid ghosts mom’s cells

300mcg- covers 30cc

197
Q

Fetal Aneuploidy tests for ? MC

What is included in a Triple Screen during second trimester

What is included in a Quad Screening and better at IDing the MC w/ less false-pos rates

A

Downs Syndrome

13-16wks:
MSAFP Unconjugated estriol Total hCG

15-20wks: Inhibin A

198
Q

US view of ? structure correlates to dec risk for Downs

What are the Quad Screening results seen in Trisomy 21

What are the Quad Screening results seen in Trisomy 18

A

Nasal bone

Dec MSAF/Estriol
Inc b-hCG/Inhibin

All four decreased

199
Q

When are Amniocentesis/CVS offered to Pts

When is antenatal testing started

Amniotic fluid is similar to ?

A

> 35y/o at delivery
32y/o at delivery w/ twins
Pos previous pregnancy/serum markers
Known translocation abnormalities

Uncomp: 32-34wks
High risk: 26-28wks

Extracellular fluid

200
Q

Fetal urine production begins at ? and is the main contributor by ?

Define Biophysical Profile and the BPP scoring system

A

Begins 8-11; Primary: 18wks

Done if demise is suspected/delivery would benefit:
Fetal breathing, movement, tone
NST accelerations
AFI
Modified: AFI w/ vibroacoustic NST x10min

10: 
Norm- rpt q7d unless DM/post-term then twice/wk
8: 
Normal AFI- repeat per protocol
Dec AFI- asphyxia risk= delivery
6:
Dec AFI- deliver
Normal AFI and >36wks w/ favorable cervix- deliver
Repeat test 6 or less: deliver
4:
Repeat same day, 6/< is delivery
0-2:
Almost certain asphyxia, deliver
201
Q

When are BPPs done for diabetic mothers

Doppler of umbillical artery is especially useful in cases of ?

What are the four types of uterine growths and what three are estrogen dependent

A 
Class A:
37-40wks: qWk
40+wks: 2x/wk
Class B/worse:
Twice weekly starting at 34wks
Post-term:
Start at 42wks and twice weekly

IUGR- quantified w/ Sys/Dias ratio

LAE:
Leiomyomata
Endometrial hyperplasia
Aenomyosis
Polyps
202
Q

Structural causes of uterine bleeding

Non-structural causes of uterine bleeding

A

Polyp
Adenomyosis
Leiomyoma
Malignancy

Coagulopathy
Ovulatory
Endometrial
Iatrogenic
Not classified
203
Q

? is the MC pelvic tumor in women

How is this MC distinctly ID’d in surgery

This MC often leads to ? sequelae

A

Leiomyomas- benign, smooth muscle tumor

Distinct autonomy from surrounding myometrium d/t CT layer

Hysterectomy

204
Q

? type of Leiomyomas are associated w/ infertility

How are these viewed w/ imaging

How are they managed

A

Submucosal

US, not CT
MRI differentiates fibroid vs adenomyosis

COCs/Mirena- dec bleeding
Uterine artery ablation
Hysterectomy

205
Q

Define Adenomyosis

How does it present to clinic

How are Adenomyosis Dx

How is it Tx

A

Endometrial glands and stroma in uterine muscle wall; Endometriosis in myometrium

Heavy, abnormal bleeding/dysmenorrhea in parous women 40-50y/o

US- hetergeonous w/ echotexture then MRI

Manage: Progestin IUD, GnRH agonists, COC, Danazol
Tx: Hysterectomy

206
Q

Define Endometrial Polyp

Incidence peaks at ? age w/ ? MC Sx

How are they Tx

A

Hyperplastic over growth of endometrium on stalks

50y/o w/ metrorrhagia

Sx/Large= hysterscopic polypectomy

207
Q

Define Endometrial Hyperplasia and what is the MC presentation

Why does this occur

How is this Dx

This condition is the only known direct precursor to ?

A

Endometrial overgrowth during proliferative phase;
AUB in post-menopausal women

Recurrent/Chronic annovulation (unopposed estrogen)

Endometrial biopsy (gold standard) then DnC
Post-Menopause: TVUS equivalent to first Dx step
Invasive Dz

208
Q

What type of endometrial hyperplasia has the most/least malignancy potential

How is endometrial hyperplasia w/ atypia managed depending on Pts pregnancy wishes

How is endometrial hyperplasia w/out atypica Tx regardless of menopause status

A

Most: complex w/ nuclear atypia
Least: simple w/out nuclear atypia

Postmenopause: hysterectomy w/ BSO
Premenopause, done: hysterectomy w/ salpingectomy
Pre-menopause, wants: Progestins w/ endometrial biopsy q3mon

Low progestin/COC x 3-6mon w/ endometrial biopsy

209
Q

What is the MC Gyn cancer in the USA and what is the MC presentation

What is the primary Tx for this MC

? syndrome has an increased risk for endometrial cancer

A

Endometrial; vaginal bleeding

Hysterectomy w/ BSO and node staging

Lynch Syndrome- hereditary non-polyposis colorectal cancer
Endometrial cancer presents as sentinel cancer, prophylactic hysterectomy at 40y/o

210
Q

Post-menopausal women w/ TVUS endometrial stripe larger than ? need biopsy to eval for hyperplasia Ca

Elevation in ? tumor marker indicates a more advanced endometrial cancer process and need ? f/u radiological images ordered

Endometrial cancer will respond to ? hormone

A

5mm/>

Ca-125:
CXR, CT scan

Progestin- Tamoxifen upregulates progesterone receptor expression

211
Q

What are the two types of functional ovarian masses

What are the two types of inflammatory ovarian masses

When is a follicle considered to be a functional cyst

A

Follicular, Lutein cysts

Neisserian salp/oo-itis
Pyogenic oophoritis

> 3cm in reproductive age woman, Dx on US

212
Q

? type of functional cyst is more symptomatic

What is the MC benign ovarian neoplasm

What is the largest, benign ovarian neoplasm

A

Hemorrhagic

Serous cystadenoma (epithelial)

Mucinous cystadenoma (epithelial)

213
Q

Stromal ovarian neoplasms are d/t ? and include ? three types

? is the MC ovarian neoplasm and what do they contain

What risk do these MC types carry

A

Estrogen/Androgen excess:
Granulosa Thecal: estrogen (resemble ovaries)
Sertoli Leydig- testosterone (resemble testis)
Fibroma- non-functional, non-hormonal

Germ cell- benign cystic teratoma w/ rapid growth;
Mature forms of all three germ cells: exto/meso/endo-derm

Ovarian torsion

214
Q

? US finding is reassuring for ovarian masses

Ovarian tumor marker is only beneficial in ? population though

What causes the highest rates of ovarian torsions to occur

A

Unilocular

Post-menopausal only

Right sided adnexa (ovary and tube) 6-10cm

215
Q

? are the four steroid hormones that can cause “maleness” and ? tissue do they affect

Define Hypertrichosis and the three types of hairs seen w/ this condition

Define Hirsutism caused by androgens

A

DHEA- adrenal
Androstenedione- adrenal, ovary
Testosterone- adrenal, ovary, adipose
Dihydrotestosterone- most potent; follicles, genital skin

Non-sexual hairs NOT d/t androgens:
Vellus Lanugo Variants

Terminal, thick hair in male patterns d/t androgens

216
Q

Define Virilization caused by androgens

What three deficiencies are androgen related and can cause hyperandrogenemia

Define PCOS and what is required for a Dx

A 
Male pattern baldness
Acne
Inc labido
Deep voice 
Clitomegaly

21 hydroxylase- MC
11b hydroxylase
3b hydroxysteroid dehydrogenase

Inc androgen/estrogen levels;
Hyperandrogenism
Oligo/annovulation
Polycystic ovaries

217
Q

What are the five MC clinical presentations of PCOS in order

Androgens circulate through body attached to ?

What causes the major transporter to increase

A 
Hirsutism
AUB
Polycystic ovaries
Infertility
Obesity

Sex Hormone Binding Globulin > Albumin, only the 1-2% that are free are bioactive

SHBG-
Inc by estrogen
Dec by androgen/insulin

218
Q

Define Ovarian Hyperthecosis

What three forms of virilization will be seen

What two PE/lab results will be seen

A

Nests of luteinized theca cells in ovarian stroma

Temporal balding
Clitomegaly
Deep voice

Greater insulin resistance, Acanthosis nigrans

219
Q

Define HAIRAN Syndrome

What three criteria are needed to Dx Idiopathic Hirsutism

What is the believed pathogenesis behind this condition

A

Hyper Androgenic Insulin Resistant Acanthosis Nigricans

Normal serum androgen level
No menstrual irregulars
No identifiable cause

Milder form of PCOS w/ inc 5-a reductase activity

220
Q

How is PCOS Anovulation Tx

How is PCOS Hirsutism Tx

When do Pts need to be f/u w/ and what can be added but w/ ? s/e

What medication can be used to slow hair growth but no permanently remove it

A

COCs or Progestin only
Clomiphene/Metformin if attempting pregnancy

COCs- inhibit LH secretion

6mon, add anti-adrogenic agent
Spironolactone: inc K levels, especially if w/ NSAID/ACEI
Flutamide: hepatotoxicity
Finasteride: male fetal teratogenicity

Eflornithine- inhibits enzyme needed for hair follicle growth

221
Q

Difference between Depilation and Epilation

Average age of Dx for ovarian cancer is ? and claims ? dangerous fact

What is the MC type of ovarian cancer and when are these seen in ages

A

De: hair removal above skin
Epi: shaft and root removed from below skin

Early 60s, more deaths than any other Gyn malignancy

Epithelial- >50y/o
Germ cell- 15-29y/o
Stromal- any age

222
Q

What are ovarian cancer protective factors

What genetic markers make Pts predisposed to ovarian cancer

These carriers have ? option to prevent cancer formation

A 
Hysterectomy
Diet w/ high fiber, low fat
Breast feeding***
Long term OCP use w/ anovulation
Tubal ligation

BRCA 1 and 2: tumor suppressor gene repair protein to preserve chromosomal structure

Prophylactic ovary removal at end of child bearing or 40y/o= 90% ovarian prevention, dec breast Ca risk

223
Q

What are four common lab results seen in ovarian cancer screenings

? is the most useful initial and follow up test for imaging ovarian cancer

What imaging results suggest malignancy

A

Thrombocytosis
HypoNa
CA-125
Human epididymal protein 4 tumor marker

TVUS then CT

Muliloculated, solid, echo
Papillary projection
Neovascularization
Thick septa
Size >5cm
224
Q

What makes ovarian cancer Pts have a better prognosis

What are the four types of benign cervical dz

Cervical os must be ? size for sufficient flow

A

BRCA mutations- more susceptible to chemo

Nabothian Polyp Cervicitis Stenosis

5mm, <2mm= retrograde flow

225
Q

How is cervical stenosis caused and what are the Tx for pre/post-menopause PTs

Define Nabothian Cyst

Cervical polyps usually arise during ? time and are usually ? size

A

LEEP/Cold Knife
Hypoestrogen
Pre: dilators, Post: estrogen x 4wks

Trapped columnar cells continue secreting mucus

Endocervical canal during reproductive years;
<3cm

226
Q

How ae Cervical Polyps Tx based on size

Endocervix contains ? cells while ectocervix contains ? cells

What causes the SC junction to move location

A

Small, pedunculated: grasp and twist w/ forceps
Sessile: forcep removal w/ cauterize

Endo: glandular columnar
Ecto: squamous

Extend/evert: young and hormones
Regress: low estrogen, long lactation, long term progestin

227
Q

What three RFs place Pts at increased risk for cervical Ca

HPV virus causes nearly all cervical neoplasms, ? is a ‘surrogate’ for cervical cancer

Fetal exposure to ? chemical increases risk for adenocarcinoma

A

Early age first intercourse/pregnancy
Inc parity

Cervical Intraepithelial Neoplasia 3- squamous epithelial lesions

Diethylstilbestrol- used to prevent miscarriages 1938-71

228
Q

? is the MC STI in the US

? type of microbe is this STI

What are the four categories of CIN

A

HPV, > 150 types hides in basal cell/basement membrane

Double stranded DNA virus

Mild Mod Sev Adenocarcinoma in Situ- full thickness

229
Q

What are the high and low risk forms of HPV

How are these prevented

Define Pap Testing

A

Low: 6, 11
High: 16*, 18
16- most oncogenic world wide

Gardasil between 9-45y/o:
6 11 16 18 31 33 45 42 58

Cervical cytology test q3yrs

230
Q

Define Primary HPV testing

Define Co-Testing

Define Reflex HPV Testing

A

HPV DNA test q5yrs

Pap and HPV test q5yrs

+ ASCUS cytology reflexes for HPV test

231
Q

Define HPV-Based testing

How often are Paps conducted based on age

A

Primary HPV test alone or co-test

<21y/o: none

21-29: Pap q3yrs

30-54:
Primary HPV or Co-testing q5yrs
Pap q3yrs

232
Q

When can Pap tests be d/c after 65y/o

A

No Hx of CIN2 or higher in past 20 yrs and:

Two consecutive negative Primary HPVs w/in 10yrs, most recent in 5yrs or

Two consecutive negative Co-tests w/ past 10yrs, most recent in 5yrs or

Three consecutive negative Pap tests in past 10yrs, most recent 5yrs

233
Q

If inadequate/unknown screening has been done for Pts >65, how often are they scheduled for cervical pap/screening

Cervical dysplasia screenings posthysterectomy

A

Annual Co-test x 3yrs then q5yrs

No CIN2 or higher x 20yrs:
+cervix: age appropriate screening
- cervix: no screening

Pos CIN2 or higher x 20yrs:
Vaginal cuff cytology even after total hysterectomy
Continue for 20yrs past CIN2 Dx/Tx date, even if extends beyond 65y/o

234
Q

What is the non-standard strategy for HPV screening

Pap results use ? system and what are the 5 sections of the result report

A

HPV HR DNA screen is pos and cytology is negative and Pt is 30/> y/o

Bethesda:

Specimen type
Adequacy
Interpretation
Description
Notes/recs
235
Q

? are the 5 cervical dysplastic types

A

ASCUS- atypical SC of undertermined significance (MC abnormal cytology, preceded CIN2,3)

LSIL- low grade squamoud intraepithelial lesion

ASC-H- atypical squamous, cannot exclude HSIL

HSIL- high grade squamous intraepithelial lesion

AGC- atypical glandular cells

236
Q

ASCUS results management

A

> 30y/o:
+HPV: colpo
-HPV: HPV based testing in 3yrs

25-29y/o:
+HPV: colpo
-HPV: HPV based testing in 3yrs
No HPV test: Pap in 12mon, then colpo if abnormal

<25y/o:
Repeat pap in 12mon
If reflex HPV is Pos, repeat pap in 12mon
If reflex HPV is neg, routine screen

237
Q

What is the down side to +LSIL cervical dysplasia results

How are these results managed by age

A

No HPV reflex tests

> 25y/o:
+HPV: colpo
-HPV: repeat HPV 12mon
Unknown HPV: colpo

<25y/o:
Repeat pap in 12mon
If reflex HPV is Pos, repeat pap in 12mon
If reflex HPV is neg, routine screen

238
Q

How are ASC-H results managed

How are HSIL results managed

How are +AGC results managed

A

Doesn’t matter, Colpo

> 25y/o:
Colpo or LEEp
<25y/o:
Colpo

Atypical endometrial: endo-metrial/cervical sample and colpo
Other: Colpo w/ endocervical sample unless pregnant
>35y/o:colpo and endocervical/metrial samples

239
Q

Define Colposcopy and what is needed prior to all procedures

What are the steps of this procedure

A

Screening for cervical cancer to assist w/ Dx visualization/biopsy

Qualitative pregnancy test

Cleansed w/ acetic acid- neoplasm of cervical dysplasia turns white (sample and curettage)

Green filter accentuates CIN lesions

Schiller test w/ Lugol iodine- failure to fully stain= dys/neo-plasia

240
Q

What is the next step for Coplos where the entire T-zone can’t be visualized on exam

? population is less likely to have successful pre-cervical cancer treatments

MC Gyn Ca in world is

A

LEEP, Cold Knife Cone

HIV Pts

Cervical Ca

241
Q

? is a poor prognosis finding in Pts w/ cervical Ca

? form of cervical Ca has a worse prognosis than squamous cell and why is this prognosis worse

? is the MC type of cervical cancer and it’s location

A

Lymphovascular spread

Mucinous adenocarcinoma;
Occult d/t location allows for later detection

SCC from ectocervix

242
Q

How can cervical cancer bleeding be managed

How can cervical cancer be Tx during pregnancy

How often d/ Pts need f/u

What medical hormone therapy is not c/i for cervical Ca Tx

A

Monsel paste- ferric subsulfate w/ packing

Cisplatin w/ vincristine/paclitaxel after first trimester

q3mon x 2yrs then,
q6mon x 5yrs post-tx then
Annual w/ full body lymph node check

Estrogen

243
Q

What microbe causes erythrasma and how is it Dx on PE

How is it Tx

Normal vaginal flora is ? pH and responds to ?

A

Corynebacterium, Red on Woods lamp

Wide: erythromycin
Local: topical clinda

4-4.5, estrogen

244
Q

? is the predominant microbe found within the vagina and how does this microbe help protect the vagina

Of the two categories of vaginitis, what are the two non-inlfammatory causes

Which one appears in both non/inflammatory categories

A

Lactobacilli;
Lactic acid, H2O2

BV, Candidiasis

Candidiasis

245
Q

? is the MCC of vaginal d/c and vaginitis

Dx criteria for BV

What result would be seen w/ nitrazine paper

A

BV- grey d/c w/ fishy odor e/t overgrowth of anaerobes/ loss of lactobacilli

Amsels:
Clue cells Odor whiff test pH >4.5 D/c

Blue= pos if pH >4.5

246
Q

How is recurrent BV w/ no prior extended treatment managed

How is BV w/ prior extended Tx managed

What is two differences done w/ recurrent BV Tx

A

Vaginal Metrogel/Clindamycin x 2wks
PO Metronidazole/Tinidazole x 2wks

Same as acute but acutely x 2wks then,
Suppression w/ weekly Metronidazole gel/twice weekly PO metronidazole/Tinidazole x 6mon

Tx of male partner offers no benefit
Probiotics help recurrent/chronic

247
Q

2nd MCC of vaginitis

What are the two MC forms of this MC microbe

How is this Dx

A

Candidiasis- itch, burn, irritation, nonodorous cottage cheese

Albicans > Glabrata (resistant to -azoles)
Glabrata > in DMT2 population

pH <4.5
Erythema
KOH w/ budding yeast, pseudohyphae

248
Q

What factors contribute to chronic candidiasis

How are recurrent cases Tx acutely and for suppression

What is used to Tx non-albicans induced recurrent VVC

A

Dec mannose binding lectin
Inc IL-4

Acute: 
PO Fluconazole on day 1,4,7
Suppression: 
PO Fluconazole wkly x6mon
External Sxs: mid-potency steroid

Boric acid > Fluconazole

249
Q

? is the 3rd MCC of vaginal d/c and ? is the gold standard for Dx

How is the MC Tx

If another Dz is present, which needs to be Tx more aggressively

A

Trichomoniasis- frothy yellow d/c w/ musty odor and strawberry cervix;
NAAT

Metronidazole, Tinidazole w/ test of cure at 1 and 6mon

BV > Trich

250
Q

How does Lichen Sclerosis present on PE

How are Lichen Sclerosis cases managed

What medical Txs are available

A

Cellophane/cigarette paper w/ pruritus, irritation

Inc risk of vulvar malignancy, biopsy and f/u q12mon

Topical Clobetasol
Retinoids if severe/unremitting
Phototherapy and 5-Amino Avid if severe

251
Q

Lichen sclerosis MC affects ? site while Lichen Simple Chronicus MC affects ? site

How are cases of LSC managed

How would Atopic Dermatitis be managed

A

LS: perenium
LSC: majora

Sitz bath w/ PO antihistamine
Cotton glove wear at night w/ topical steroids
Unresolved in 3wks- biopsy

Tacrolimus w/ topical steroid/dry skin Tx

252
Q

What causes Inverse Psoriasis

What causes Inverse Psoriasis in vulva area

How are these cases managed and what is used once control is obtained

A

T-cell mediated autoimmune response

Trauma, koebnerization

Emollient, Steroids
Calcipotriene once controlled

253
Q

What 5 drugs can induce Lichen Planus

What does Lichen Planus look like on PE

Of the 3 variants, which one is MC and most difficult to Tx

? syndrome can develop that is also Tx resistant but ? can be used

A

NSAID BB Methyldopa PCN Quinine

Red erosion w/ white border

Erosive > Papulosquamous, Hypertrophic

Vulvovaginal- vagina and gingiva
Clobetasol, vaginal hydrocortisone

254
Q

What causes Intertrigo

? is the MCC of vaginal irritation after menopause

When do bartholin cysts become concerning for cancer but if they occur in ? location have no pain

A

Friction in warm, moist skin folds

Atrophic vaginitis

> 40y/o= biopsy; In ducts= painless

255
Q

How are Bartholin Cysts managed

? is a sequelae of the cyst that can develop w/ ? correlation

What are the indications to use ABX after cath placement

A

ASx- none, unless >40y/o
Word catheter
Cath failure/after two caths= marsupilization

Abscess, G/C

Pregnancy, Cellulitis, Systemic, ImmComp;
Fqnln Augmentin TMP-SMX Second gen Cephalospor.

256
Q

MC type of vulvar cancer is ? type and develop on ? landmark

? is the 2nd MC etiology of vulvar cancer

What are the 5 other types of vulvar cancers seen

A

SCC on Hart line

Malignant melanoma- poor prognosis

Verrucous: cauliflower w/ pruritus; radiation resistant

BCC: older Pt’s majora w/ poor pigmentation and pruritus

Vulvar Sarcoma: rare, affects broader age range

Barthlin Gland: peak occurrence mid 60s

Vulvar Paget: eczematous, red neoplasia

257
Q

What are the RF for vulvar cancer in Pts <55y/o

How do these RFs change for Pts >55y/o

What is the f/u schedule post-vulvar Ca Tx

A

HPV, smoking

Non-smokers w/out STD Hx but long history lichen sclerosis

q3mon x 3yrs
q6mon x 5yrs
Annually

258
Q

Vulvar Ca w/ ? recurrence is almost always fatal

Most cancers found in vagina are ?

What is the MC vaginal Ca, c/c and location

A

Inguinal node

Mets to vagina

SCC d/t HPV, presents MC as bleeding in MC site of upper third wall

259
Q

What causes Clear Cell vaginal Ca

What are the two types of mesenchyma tumors

Why are there increased incidence of vulvovaginal candidiasis during pregnancy

A

Diethystillbestrol exposure

Rhabdo: MC vaginal malignancy <5y/o
Leiomyosarcoma: 140 cases ever

Inc lactic acid production- more acidic
Inc vaginal glycogen stores

260
Q

Wash fruits/veggies d/t ? risk

Avoid raw eggs d/t ? risk

? herbal teas can induce labor

Avoid raw/undercooked seafood d/t ? risk

A

Toxo/Listeria

Salmonella

Raspberry leaf tear

Norovirus

261
Q

What single gene d/os are screened for during pregnancy

Trisomy 18 and 13 are called ?

CVS testing offers no info about ? but carries ? risk if done too early

A

CF Sickle Tay-Sachs Hgbnopathies

18: Edwards
13: Patau

NTDs; jaw/limb abnormalities

262
Q

Kick counts start on ? week

First line tool for fetal surveillance

? BPP score is associated w/ normal fetal pH, poor predictor

Done w/

A

28wks

NST

8-10: normal
6: retest in 12-24hrs

Deck 4

263
Q

Leiomyomas are AKA ?

Ovarian androgen production in ? cells occurs d/t ?

Peripheral conversion of these products occurs ?

A

Fibroids

Theca, d/t LH- cholesterol+cAMP= androstedione/testosterone

Granulosa, d/t FSH- androstedione/testosterone+cAMP (aromatization)= estrone/estradiol

Adipocyte: androstenedion into estrone/testosterone/estradiol
Hair follicle/genital skin: testoterone via 5-a reductase into dihydrotestosterone/estradiol-17

264
Q

Pap Co-Testing and Reflex testing determine ?

Vulvar cancer Tx w/ wide, local excision is only appropriate for ? stage Ca

Define Puberty

A

HPV presence, not genotype

Microinvasive, IA

Development of secondary characteristics w/ reproductive capabilities

265
Q

Why does puberty not start during toddler years

What is the sequence of changes seen in order

What is the proposed puberty initiator hormone

A

HPO axis suppressed by estradiol
CNS inhibition of GnRH

TAPuP Me
Thelarche Adrenarche Pubarche Peak growth Menarche
Pubarche can be normal variant

Leptin produced in adipocytes

266
Q

What marks the onset of puberty

Tanner Staging

A

Pulsatile GnRH release from anterior pituitary triggering FSH/LH

No Budy Elevates 2 Mountains in Adulthood:

1: no glandular tissue
2: buds form
3: breast elevated
4: secondary mounds
5: adult size

No Small Cat Sparing Thighs

1: no hair
2: small amount of hair
3: coarse hair
4: adult like sparing thighs
5: adult like encompassing thighs

267
Q

Define Precocious Puberty

What are the two types and Txs

A

Secondary characteristics <8y/o or <2.5SD

Central: gonadotropin dependent;
Isosexual: same characteristics as phenotype
Tx: GnRH agonist- inhibits LH/FSH

Peripheral: gonadotropin independent;
Hetersexual or Isosexual

268
Q

Define Delayed Puberty

What is the MCC

Menstrual cycles usually occur ? often, last ? long and have ? much blood loss

A

Lack of thelarche by 13y/o
No menses by 16y/o

Constitutional/physiologic delay

q28d +/-7d
x3-7d
20-60ml

269
Q

When are menses most erratic

Why is the follicular phase the one most focused on

How much estrogen is required for ovulation to occur

A

2yrs after menarche
3yrs before menopause

Variable- dependent on estradiol reaching threshold level

200pg x 50hrs for LH surge to occur

270
Q

Events of Follicular phase

Events of Luteal Phase

A

First day of menses to ovulation
Inc FSH develops primary follicle
Follicle increases estrogen to proliferate endometrium
Day 14- LH surge after estrogen surge, stimulates ovulation 36-40hrs later

Begins 1-2d after LH surge, ends w/ first day of menses
Define duration
Corpus luteum produces E/P to make endometrium ready for implantation
Corpus luteum dissolves after 14 days w/out fertilization
Progesterone withdrawl= menses

271
Q

? hormone is similar to LH

Follicular Phase is AKA

What occurs during an Anovulatory Menstrual Cycle

A

hCG

Proliferative phase

Ovary fails to produce mature follicle
Proliferative phase occurs in endometrium, does not progress into luteal phase
Break through bleeds occur

272
Q

Define Primary Amenorrhea

Define Secondary Amenorrhea

MCC of Secondary Amenorrhea

A

No menses by 16y/o w/ normal 2* characteristics
No menses or 2* characteristics by 14y/o
No menses w/in 3yrs of thelarche

No menses x3mon after previous menses

Pregnancy

273
Q

Secondary Amenorrhea evaluation flow chart

A

Pregnancy test, TSH, Prolactin

Progesterone challenge test:
+ bleed: anovulatory, PCOS
- bleed- conduct E/P challenge test

+ bleed: check FSH
>40: menopause/premature ovary failure
<5: stress, CNS tumor, Sheehans

  • bleed: outflow obstruction, Ashermans
274
Q

DDxs for AUB

How is acute menorrhagia managed

How is chronic/recurrent menorrhagia managed

A

PALM-25% COEIN-75%:
Poly Adenomyosis Leiomyoma Malignancy/Hyperplasia
Coagulopathy Ovulatory Endometrial Iatrogenic Not class.

Stable:
COC/Medroxypred
Unstable or no response x24hrs:
Dnc, Tamponade, Artery embolization, Hysterecomy

Normalize prostaglandins- NSAIDs
Coordinate sloughing x 1 cycle: MedroxyPred, COCs
Endometrial suppression: Progestin only, Levo IUD
Anti-fibrinolytic therapy- TXA

275
Q

More severe dysmenorrhea Pts will have higher levels of ? in menstrual fluid

Initial dysmenorrhea Tx is ?

MC site for endometriosis glands to be found

A

Prostaglandins- highest in first 2 days of menstruation

NSAIDs COCs Progestin only

Estrogen dependent in right sided peritoneum

276
Q

What are the four pathogenesis of endometriosis

What are the 3-Ds of this condition

Preferred imaging for work up and only method to definitively Dx

A

Retrograde menstruation
Mullerian dysplasia
Lympatic spread
Stem cell

Dysmenorrhea Dyspareunia Dyschezia

CT, laparoscopy

277
Q

What type of cysts are seen on adnexal masses of endometriosis

How is this Tx

Define PMS/PMDD

A

Chocolate cysts
Barbed uterosacral ligament

NSAID, OCPs- if ineffective, refer to OBGYN for definitive Dx
Danaols- androgen analog that inhibits FSH/LH
Leuprolide- GnRH agonist induces pseudomenopause

PMS: Sxs w/out impairement
PMDD: five Sxs w/ impairement

278
Q

Sxs of PMS/PMDD occur during ? part of cycle

Why does bloat/weight gain occur

How are these conditions Tx

A

Luteal d/t dec serotonin activity

Progesterone w/ anti-mineralcorticoid properties
Estrogen w/ RAAS activatio
Altered E+/fluid balance

Exercise/Stress/Diet
SSRI
COC, GnRH agonist, Danazol
NSAIDs, Diuretics

279
Q

? dietary adjunct can help w/ PMS/PMDD Sxs

Define Menopause

Define Premature Ovarian Failure

A

Pyridoxine B6- serotonin production cofactor

12mon since last menses

Menses stop <40y/o d/t high FSH

280
Q

What hormone changes are seen in menopause

What are the Sxs of Menopause

A

High FSH/LH
Low E/P

FSHIUL
Flash flush forgetful
Sad skin sweat
HA Heart dz
Insomnia
Urinary Sxs
Libido decrease
281
Q

? is the leading cause of death in women >50y/o

Why is this

When is the risk between wo/men the same

A

CVDz

Estrogen is cardio-protective

70y/o

282
Q

Why do we never give unopposed estrogen to woman w/ uterus

? med is used prophylactically to lower risk of Pre-E

What is a key part of Dx PMS and ? lab is recommended to be ordered

A

Inc risk of endometrial hyperplasia/Ca/neoplasia

ASA

No Sxs during follicular phase; TSH

283
Q

ABX for non-surgical Tx of tubo-ovarian abscesses

How are abscesses associated w/ mastitis Tx

? type of breast Ca presents as eczematous lesion on nipple

A

Cephalosporin w/ Doxy or,
PCN Allergy: Clindamycin w/ Gentamycin

ABX w/ drainage- Diclox Cephalex Clinda TMP Vanc
Continue feeding/emptying affected side

Paget’s Dz

284
Q

? microbe causes BV

Why do Pts need to avoid alcohol during Tx w/ Metronidazole

RF for Vulvar Ca

A

Gardnerella vaginalis d/t inc coccobacilli numbers

Disulfiram reaction

Vulvar LS
ImmDef syndrome
Smoking
Hx of cervical Ca
Intraepithelial neoplasia
285
Q

MC microbe causing Barthlin cysts

How is pregnancy Dx w/ TVUS

Post-coital bleeding can suggest ? issue

A

E Coli

Gestational sac w/ yolk sac

Cervical Ca

286
Q

Define Oligomenorrhea

Define Polymenorrhea

Define Hypomenorrhea

Define Amenorrhea

Define Menorrhagia

Define Metrorrhagia

A

Oligo: cycle >35d long

Poly: cycle <21d long

Hypo: scant menstruation

Amen: absent x 6mon

Men: regular cycle w/ excessive flow/duration

Metro: irregular cycle

287
Q

First and Second line medical therapy for Primary Dysmenorrhea Tx

How is AUB managed

MCC of uterine bleeding in post-menopause women

A

1st: NSAID
2nd: estrogen-progestin

Hormones DnC/Ablation Hysterectomy

Atrophy of mucosa/endothelium

288
Q

MC non-viral STD in the world

? microbe can hematogenous spread and cause Chorioamnionitis

Gestational diabetes Dx w/ ? fasting level or ? A1c

A

Trichomonas vaginalis

Listeria

> 95, 6.5%

289
Q

What time during menstrual cycle offers most reliable exam for fibrocystic breast dz

How is trichomoniasis Tx

What medication can be used for endometrial hyperplasia Tx in women attempting to preserve fertility

A

Directly after menstruation

Metronidazole 500mg BID x 7d
Tinidazole

Megestrol acetate w/ biopsy q3mon

290
Q

? is the MCC of AUB in pre-menopause women that are obese

What tocolytics are used in pre-term labor

? hormones are high in the follicular phase and ? hormones are high in the luteal phase

A

Endometrial hyperplasia

It's Not My Time:
Indomethacin
Nifedipine
Mg sulfate
Terbutaline

Follicular: LH, Estradiol
Luteal: FSH, Progesterone

291
Q

Hormone shift seen in menopause

? RF puts women at high risk for developing pre-eclampsia and how can this be avoided

MCC of PID

A

Inc FSH, dec E/P

Autoimmune d/o; ASA

Chlamydia trachomatis

292
Q

MCC of menorrhagia

? is the preferred initial Dx test of choice for painless, vaginal bleeding in post-menopausal woman

? is the MC type of endometrial carcinoma

A

Fibroids- leiomyoma

TVUS

Adenocarcinoma

293
Q

? medication is used for hot flash/menopause Sxs if estrogen is c/i

? causes anovulatory bleeding

First, Second and Third line Tx for PMS/PMDD

A

Gabapentin

Failed corpus luteum development= no progesterone
Unopposed estrogen stimulation

Exercise/stress reduction
SSRI
GNR agonist

294
Q

Most concerning outcome to newborn born to diabetic mother

Estrogen receptor positive breast cancer can be Tx w/ ? medication

MC type of GYN cancer

A

Hypoglycemia

Tamoxifen

Uterine

295
Q

? is the longest phase of labor and what marks the start/end

Stages of labor

MC vulvar cancer and the MCC

A

First stage- true contractions, ending w/ fully dilated cervix

First-
Early: 0-3cm, 8-12hrs
Active: 3-7cm, 3-5hrs
Transition: 7-10cm, 30-120min

Second: end of dilation to delivery

Third: fetal delivery to placental delivery

SCC d/t HPV

296
Q

Why do ovarian torsions rarely have complete blood supply cut off on US images

Leading cause of GYN death

A

Dual supply from uterine and ovarian artery

Ovarian Ca

IPAP (212 decks)

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