OBGYN Uworld Flashcards
tx of PID
3rd generation ceph (rocephin)
+ azithromycin OR doxycycline
hypotension after epidural due to ?
when to really worry
blood redistribution to LEs and venous pooling from sympathetic blockage
worry if hypotension, bradycardia, and respiratory difficulty, may be a sign of OD or intrathecal injection leading to depression of brainstem or cervical spinal cord activity (“high spinal” or “total spinal”)
intense vulvar pruritus with white atrophic plaques, “cigarette paper” skin (not involving vagina) think ?
what to do ?
lichen sclerosis
may have dyspareunia, dysuria, painful defecation
dx: punch biopsy to rull out vulvar squamous cell carcinoma, although it is a “premalignant” lesion
tx: topical steroid (clobetasol)
2/3 necessary for PCOS dx
abnormal/lack of ovulation
clinical/biochem hyperandrogenemia (hirsutism or testosterone)
polycystic ovaries on imaging
hirsutism, menstrual irregularities, ^17-OHP, ^androgens, ^LH/FSH, think ?
nonclassic CAH
in contrast to PCOS: both may have ^ LH/FSH, CAH will have ^17-hydroxyprogesterone (17-OHP) but PCOS will not
Erb-Duchenne palsy prognosis
most cases will resolve in a few months
irregular vaginal lesion + bloody malordorous discharge, think ?
vaginal cancer (SqCC)
commonly found in upper 1/3 of posterior vagina wall
risks: smoking, HPV
severe pre-E may lead to ? because of ^SVR, cap perm, ^pulm cap hydrostatic pressure, and decreased albumin
pulmonary edema
pathogenesis of HELLP
hepatic and systemic inflammation, activation of coag cascade, and platelet consumption
+ microangiopathic hemolytic anemia
cervical cancer risk factors
immunosuppressed (HIV), early sexual activity, muliple/high risk sexual partners, previous STI, hx of vulv/vag cancer, smoking
cervical cancer manifestations
may be asymptomatic
bleeding after sex or between menses, ^vaginal discharge, low back/pelvic pain
endometrial cancer risk factors
unopposed estrogen exposure: estrogen-only OCPs, prolonged menstrual timeline, nulliparity, anovulation, PCOS, obesity, tamoxifen (estrogen agonist in uterus)
ovarian cancer risk factors
endometriosis, family history, prolonged menstruation
when does mittelschmerz occur in contrast to endometriosis
middle of menstrual cycle (10-14) corresponding with ovulation
endometriosis typically causes pain before and during menses rather than mid cycle
chemo/radiation may cause amenorrhea due to what mechanism?
what hormone levels will be present?
ovarian failure
^FSH, ^LH, normal prolactin and TSH, estrogen deficiency
uterus in endometriosis vs adenomyosis vs fibroids
endometriosis: not enlarged
adenomyosis: bulky, tender, uniformly enlarged
leiomyomata uteri (fibroids): irregularly enlarged uterus, may present with anemia
fetal presentation vs position
presentation: what’s lowest i.e. vertex (good) or breech
position: OA (good), occiput transverse or OP (not good), may cause arrest of 2nd stage
C-section is indicated in arrested labor if cervix is dilated to ? and no cervical change for how long?
if cervix dilated +6cm and no cervical change for 4+ hrs with adequate contractions of +6hrs with inadequate contractions
neonate with facial hypoplasia, microcephaly, cleft lip/palat, digital hypoplasia, hirsutism, developmental delay, think ?
fetal hydantoin syndrome, caused by exposure to anticonvulsant meds in pregnancy
fetus with lethal abnormalities in breech position, how to deliver?
vaginal, C/S is not necessary as no need to protect fetus
CVS vs amniocentesis
CVS at 10-13 wks, amniocentesis at 15-20 wks
post-term complications (think fluid)
oligohydramnios: decreased fetal perfusion with aging placenta, decreased UOP of fetus
-indication for delivery
also: meconium aspiration, fetal convulsions/stillbirth
(not all complications)
week cutoff for C/S or expectant management vs. tocolytics in preterm contractions
34 weeks
multiple fetal fractures, hypoplastic thoracic cavity + intrauterine fetal demise, think ?
osteogenesis imperfecta type II (most severe)
mutation in type 1 collagen, autosomal dominant
vaccines contraindicated in pregnancy
HPV, MMR, live attenuated influenza, varicella
safe vaccines in pregnancy
inactivated influenza, Tdap, Rho(D) IgG
secondary amenorrhea in female athletes results from
hypothalamic amenorrhea (GnRH deficiency)
symmetric vs asymmetric IUGR and etiologies
symmetric (whole body): 1st trimester insults
-chromosomal anomalies, congenital infeciton
asymmetric (body smaller than head): 2/3 trimester
-maternal HTN, smoking (placental insufficiency), maternal malnutrition
pelvic mass and ascites, keep ? in mind?
what to do?
consider advanced ovarian cancer
exploratory laparotomy with cancer resection and staging
postpartum female (w.in 6 mos of delivery) with dyspnea, infiltrates on CXR, irregular vaginal bleeding, and enlarged uterus, think ?
choriocarcinoma
may metastasize to lung, vagina
46, XY with female external genitalia and no internal genitalia
androgen insensitivity syndrome
testicular secretion of anti-Mullerian hormone, resulting in primary amenorrhea
testosterone secreted from testes is converted to estrogen, so breast develop
atypical glandular cells on pap test in female +35 yo, do what next?
colposcopy, endocervical curettage, and EMB
only definitive way to dx endometriosis
laparoscopy with visualization and bx of endometrial implants
indicated with tx failure (NSAIDs, OCPs)
risk of infertility with endometriosis
infertility in PCOS due to ?
failure of follicle maturation (resulting in anovulation)
confusion, nystagmus, ataxia, ^LFTs in pregnant female, think?
Wernicke encephalopathy
may also be caused by hyperemesis gravidarum and anorexia (in addition to chronic alcoholism)
1st w/u in amenorrhea (after HCG)
prolactin, TSH, FSH
OR if prior uterine procedure or infection perform hysteroscopy
secondary amenorrhea defined as ?
absences of menses for 3+ cycles or 6+ months in women who menstruated previously
adnexal fullness and u/s findings of hyper echoic nodules and calcifications in premenopausal female
mature cystic teratoma (dermoid ovarian cyst)
tx for PID
inpatient: IV cefoxitin or cefotetan + doxycycline
OR IV clindamycin + gentamicin
outpatient: IM ceftriaxone + PO doxycycline
pelvic pain, bloating + u/s findings of solid mass with thick septations and peritoneal free fluid in mass (ascities)
epithelial ovarian carcinoma
when would ABO incompatibility occur in pregnancy and what symptoms would occur?
mom: O and infant: A, B, or AB
mild hemolytic disease of newborn: asymptomatic but may have mild anemia, jaundice
Down’s quad screen
low ms-AFP, low estriol, ^B-hCG, ^Inhibin-A
if ^ms-AFP, think?
NTDs, ventral wall defects, multiple gestation
when to give RhoGAM?
when to screen for asymptomatic bacteriuria?
when to screen for rubella and HIV?
when to screen for GBS?
RhoGAM: 28-32 wks and delivery/exposure
asym. bac: 1st trimester, rescreen if risk factors
rubella: prenatal visit
HIV: prenatal visit and 3rd trim if high risk
GBS: rectovaginal culture at 35-37 wks
hormone roles:
inhibits uterine contractions and promotes/maintains implantation
induces prolactin production from pituitary
maintains corpus luteum
induces early embryonic division and differentiation
inhibits uterine contractions and promotes/maintains implantation: PROGESTERONE
induces prolactin production from pituitary: ESTROGEN
maintains corpus luteum: HCG (before placenta produces progesterone on its own)
induces early embryonic division and differentiation: trick question, occurs before implantation and days before hormone secretion
breast cancer risk factors
mod: HRT, nulliparity, ^age at 1st birth, etOH
non-mod: genetics, white, ^age, prolonged lifetime menstruation
female pt less than 35 yo with amenorrhea:
+menopausal symps (hot flashes, fatigue) think ?
+calorie deficiency or strenuous exercise think ?
menopausal symps (hot flashes, fatigue): primary ovarian insufficiency (^GnRH, ^FSH, low estrogen) (often hx of autoimmune (hypothyroidism) or Turner's) calorie deficiency or strenuous exercise: hypothalamic hypogonadism (low GnRH, low FSH, low estrogen)
vaginal bleeding and B-hCG is 1000 IU/L with no intra or extra uterine pregnancy found out TVUS, what to do next?
repeat B-hCG in 2 days
do not expect to see uterine pregnancy until B-hCG reaches 1500 IU/L, once it does, repeat TVUS
management of intrauterine fetal demise
20-23 wks: Dilation and evacuation or vaginal delivery
+24 wks: vaginal delivery at mother’s discretion
(however, ^risk coagulopathy longer fetus stays in)
best anti-hypertensives for acute maternal HTN crisis
hydralazine IV, labetelol IV (not if bradycardic), nifedipine PO
methyldopa for chronic
fetal tachycardia in setting of prolonged ROM think
chorioamnionitis
if want to inquire risk of Downs at 10 wga
best test: plasma cell-free fetal DNA (99% sn)
PAPP-A has 85% sn
indications that labor is false
irregular, infrequent, weak contractions with no/mild pain and no cervical change
reassure and discharge
inevitable vs incomplete abortion
both have vaginal bleeding and cervical dilation
inevitable: POCs are at or above os (“it’s coming”)
incomplete: some POCS already out, some still in (“it started to happen already”)
tx for vaginal candidiasis
oral fluconazole
intravaginal nystatin may be used, but oral nystatin is only used to tx oral candidiasis, not vaginal
indications and risks of cervical conization
CIN 2/3
complications: cervical stenosis, preterm birth, p-PROM, 2nd trimester pregnancy loss
what to do if Hepatitis C+ during pregnancy
vaccinate for hep A and B
vertical transmission is 2-5%, C-section is not indicated/does not decrease risk
u/l reddish-brown nipple discharge with no masses
intraductal papilloma
infiltrating ductal carcinoma will have mass + LAD
when to give what in preterm labor (less than 37 wks)
always betamethasone and PCN if GBS+/unknown
+tocolytics if less than 34 wks
+Mg+ if less than 32 wks (neuroprotective)
tocolytics
nifedipine, indomethacin
progesterone is not a tocolytic but can be used to prevent preterm delivery in pt with shortened cervix
low sodium after induction think
oxytocin toxicity: similar to ADH and can cause H2O retention, low Na, and seizures
therapeutic Mg range
tox presents how?
5-8 mg/dL
hyporeflexia, lethargy, HA, resp failure, cardiac arrest (NOT seizures)
cause of hyperandrogenism in pregnancy
luteomas and theca luteum cysts
painful, itchy, ezcematous/ulcerating breast rash think?
Paget’s, associated with adenocarcinoma
1st step in working up infertility if hx of PID
hysterosalpingogram
