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USMLE Reproductive > Pathology - Gestational > Flashcards

Pathology - Gestational Flashcards

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USMLE® Step 1 flashcards
1
Q

What is spontaneous abortion?

A

Miscarriage of fetus (20 weeks before gestation)

- Vaginal bleeding, cramp like pain and passage of fetal tissues

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2
Q

How common is spontaneous abortion?

A

Up to 1/4 pregnancies

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3
Q

What can spontaneous abortions be due to?

A
  • Chromosomal anomalies
  • Hypercoagulable states (SLE)
  • Congenital infection
  • Exposure to teratogens
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4
Q

What is placenta previa?

A
  • Implantation of placenta in lower uterine segment

- Overlies cervical os

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5
Q

What does placenta previa present with?

A
  • 3rd trimester bleeding
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6
Q

What does placenta previa require (what intervention needed)?

A

C-section

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7
Q

How can placenta previa cause fetal distress?

A

As the baby is being delivered it can compress the placenta - blood source compromised

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8
Q

What is abruptio placentae?

A
  • Seperation of placenta from decidua prior to delivery
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9
Q

What does abruptio placentae present with?

A
  • 3rd trimester bleeding and fetal insufficiency

- Still birth possibility

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10
Q

What can be seen on the placenta after delivery in abruptio placentae?

A

Blood and clots on the surface of the placenta

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11
Q

What is placenta accreta?

A
  • Improper implantation of placenta into myometrium with little or no intervening decidua
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12
Q

What are the layers of the endometrium?

A
  • Functional layer

- Basal layer

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13
Q

How does placenta accreta present?

A

Difficulty delivering placenta and post-partum bleeding

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14
Q

What is required often in placenta accreta?

A

Hysterectomy

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15
Q

What is preeclampsia due to?

A

Abnormality of maternal-fetal interface in placenta

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16
Q

What does preeclampsia involve?

A
  • Hypertension after 20 weeks

- Proteinuria or end-organ dysfunction

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17
Q

What is eclampsia?

A

Preeclampsia + seizures

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18
Q

What hypertension drugs are recommended in pregnancy?

A
  • Hydralazine
  • alpha-methyldopa
  • Labetalol
  • Nifedipine
    Hypertensive moms love Nifedipine
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19
Q

How is gestational hypertension defined?

A

> 140/90 mmHg after 20 weeks

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20
Q

What medications may be used in Preeclampsia?

A

Antihypertensives
- Hydralazine, alpha-methyldopa, labetalol, nifedipine

  • IV magnesium sulfate (seizures)
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21
Q

When should babies be delivered in gestational diabetes?

A

37-39 weeks

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22
Q

What is the definitive treatment for preeclampsia, eclampsia and HELLP syndrome?

A

Delivery

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23
Q

How is HELLP syndrome defined?

A
  • Preeclampsia with thrombotic microangiopathy of the liver

- Hemolysis, Elevated liver enzymes, Low platelets

24
Q

What will a blood smear reveal in a patient with HELLP syndrome?

A

Schistocytes

25
Q

What are the 2 major complications of HELLP syndrome?

A
  • Hepatic subscapular hematomas (rupture - severe hypertension)
  • DIC (due to release of TF)
26
Q

What is placenta increta?

A

When the placenta penetrates into the myometrium

27
Q

What is placenta percreta?

A

Placenta perforates through myometrium and into uterine serosa (invades entire uterine wall)
- Placenta may attach to rectum or bladder (hematuria)

28
Q

How does placenta percreta present?

A
  • Detected on US prior to delivery

- No separation of placenta after delivery -> PPH

29
Q

What can PPH cause as a complication?

A

Sheehan syndrome (hypopituitarism -> O2 cannot reach the gland)

30
Q

What is a hydatidiform mole?

A
  • Abnormal conception characterised by swollen and edematous villi with proliferation of trophoblasts
  • Uterus expands as if normal pregnancy is present
31
Q

What are the hCG levels like in a hydatidiform mole?

A

Higher than usual for the time

32
Q

What is associated with hydatidiform mole?

A
  • Early preeclampsia (<20 wks)
  • Theca-lutein cysts
  • Hyperemesis gravidarum
  • Hyperthyroidism
33
Q

What is the classical presentation of a hydatidiform mole?

A
  • Passage of grape-like masses through vaginal canal in 2nd trimester
    (edematous villi)
  • US in 1st trimester would reveal absent heart sounds and snow storm appearance
34
Q

What appearance would hydatidiform moles give on US?

A

Snow-storm

35
Q

What type of mole involves an enucleated egg?

A

Complete mole (single sperm which duplicates)

36
Q

Which type of mole has diffuse trophoblastic proliferation?

A

Complete mole

37
Q

Which type of mole has fetal parts?

A

Partial

38
Q

Which type of mole is P57 positive?

A

Partial

39
Q

Which type of mole cuases an increased uterine size?

A

complete

40
Q

Which type of mole causes a larger increase in hCG complete or partial?

A

Complete

41
Q

Which type of mole has an increased eisk of invasiveness?

A

Complete (15-20%)

Partial (<5%)

42
Q

Which type of mole has a larger risk of choriocarcinoma?

A

Complete (2% risk)

43
Q

What is a choriocarcinoma a malignancy of?

A

trophoblastic (cyto and syncyto) tissue (no chorionic villi present)

44
Q

What can choriocarcinoma increase the chances of?

A

Theca-lutein cysts

45
Q

What does choriocarcinoma present with?

A
  • Abnormal increased hCG
  • SOB
  • Hemoptysis
  • Cannonball metastases on lungs on X-ray
46
Q

What is choriocarcinoma treated with?

A

Methotrexate

47
Q

How is molar pregnancy treated?

A

Dilation and curettage

48
Q

What is vasa previa?

A

Fetal vessels run over or in close proximity to cervical os

- Triad of membrane rupture, painless vaginal bleeding and fetal bradycardia

49
Q

How is vasa previa treated?

A

C-section

50
Q

What is vasa previa associated with?

A
  • Velamentous umbilical cord insertion (inserts in chorioamniotic membrane rather than placenta)
  • Vessels then travel unprotected by whartons jelly
51
Q

What can postpartum hemorrhage be due to?

A

4Ts

  • Tone (uterine atony -> soft boggy uterus)
  • Trauma (lacerations, incisions, uterine rupture)
  • Thrombin (coagulaopathy)
  • Tissue (retained products of conception)
52
Q

What is the treatment of PPH?

A
  • Uterine massage
  • Oxytocin
  • Surgery
53
Q

What vessels may be ligated in surgery of PPH?

A

Uterine or internal iliac artery (will preserve fertility since ovarian arteries provide collateral circulation)

54
Q

What is supine hypotensive syndrome (aortocaval compression syndrome)?

A
  • Seen at > 20 weeks gestation
  • Supine compression of patients abdominal aorta and IVC by gravid uterus -> decreased placental perfusion and decreased venous return (hypotension)
55
Q

What gynae cancers are more common?

A

Endometrial most then ovarian then cervical (US)

- Cervical is more common worldwide

56
Q

What type of gynae cancers have the best vs worst prognosis?

A
  • Cervical (best) (<45 yrs)
  • Endometrial (~55 yrs)
  • Ovarian (worst) (>65 yrs)
    CEOs often go best to worst as they get older

USMLE Reproductive (14 decks)

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