Brainscape's Knowledge GenomeTM

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


See full index

Hematology > Peds and OB > Flashcards

Peds and OB Flashcards

1
Q

Peds Vitals (new borns)

A 
RR = 40-60 normal 
HR = 120-160 = normal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

APGAR

A

Color :
blue = 0 points
pink with blue extremities = 1
pink = 2

Pulse:
<60 = 0
60-110 = 1
>110 = 2

RR:
none =0
weak =1
crying =2

Grimace:
none=0
weak = 1
crying =2

activity:
none = 0
flexion =1
complete movement.. flailing arms and legs = 2 ponts

1st min apgar tells you inutero score

5min apgar tells you currently how baby is

most common apgar = 9,9

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

What do you do as soon as baby is born and you are in the deliver room?

A
  1. Eyes - Erythromycin drops
  2. Vitamin K injection –> to prevent hemolytic disease of newborn.. (babies have no E.coli in their intestines.. meaning they cant make vita k.. which means they cant make vita k dependent clotting factors - 2,7,9,10 or protein C and S
  3. New Born Screenings must do:
  4. G6PD testing (x-linked recessive)
  5. PKU testing (Autosomal recessive)
  6. Galactossemia testing
  7. Congenital Adrenal Hyperplasia testing
  8. Hypothyroidism in baby testing
  9. Cystic Fibrosis testing (BIT = sweat chlroide, most accurate = genetic testing)
  10. Hearing Screen
  11. HEP B vaccine! must do before they leave (if mom is HEP B surface antigen.. then the baby MUST get Hep B IG before leaving! If the mom is HEP B surface antibody Positive then the baby must get vaccine before leaving)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

conjunctivitis in new born

A

day 1 = chemical
day 2-7 = gohnnerhea –> treat with IM ceftriaxone one dose

Day 8-14 = chlamydia –> treat with ORAL Erythromycin

3 weeks + = Herpes – > tx with Acyclovir

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

If mom of newborn is HEP B antibody or antigen positive.. what must be done for the baby before DC

A

HEP B vaccine! must do before they leave (if mom is HEP B surface antigen.. then the baby MUST get Hep B IG before leaving! If the mom is HEP B surface antibody Positive then the baby must get vaccine before leaving)

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

Polycythemia of newborn

A

transient condition – goes away itself.

Hypoxia inutero causes polycythemia.. It goes away once the baby is born and breathing air

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

Is splenomegally normal in new born?

A

yes. Normal in new born

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

Transient tachypnea of newborn

A

normal vag delivered patients.. squeeze through birthing canal and get rid of the fluid in the lungs - these babies usually will not get transient thacypnea

babies with c-section.. dont get to have all the fluid squeezed out of their lungs –> transient tachypnea

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

hyperbilirubinemia in newborns

A

normal and transient

Spleen is removing all the HbF and making normal HbA.

Removing HbF –> hyperblilrubinemia

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

Caput Secumdarium vs Cephalo Hematoma

A

Caput Secundarium - Crosses suture lines

Cephalo Hematoma - does NOT cross suture lines.

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

Brachial plexus injury durring birth

A

Waiters tip

C5-C6

Treatment = immobilization and wait

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

Klumpke paralysis

A

Claw hand

C6-C8

Treatment = Immobilization and wait

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

Facial nerve paralysis during birth (using forceps to pull baby out)

A

Immobilize and wait.

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

New Born eye screening

A

Eyes - check RED reflex

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

WAGR

A

Willms tumor
Aniridia
GU tumor
Mental RETArdation

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

New born abnormal findings in the abdomen

A

Abdomen:
1. DIaphragmatic Hernia - Hole in diaphragm.. causes intestines to develop in chest.. This takes up space in the chest and results in HYPOpulmonary development –> Respiratroy distress in the nuewborn –> only way to fix is with SURGERY.

  1. Omphalocele –> INcreased alpha feto protein!!! Intestines in sac
  2. Gastrochisis –> NO sac covering –> must do surgery.. but first make sure you cover with something moist.
  3. Willms Tumor = most common palpable ABDOMINAL mass. Caused by HEMIhypertrophy of ONE kidney!! Assoicated with WAGR
  4. Neuroblastoma - tumor in the adrenal Medulla –> test with urinary VMA (just like a pheochromocytoma)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

New born abnormal findings in the GU system

A

Hydrocele - Reminant of the TUnica vaginalis, TRANSiluminates, PAINLESS swelling.
Treatment - Resolves on its own in 6 months

Varicocele - heaviness in scrotum.. BIT = physical exam – feel bag of veins
MAT = ultrasound or CT

Cryptoorchidism - Undescended testi.. If it doesnt descend in one year you must do surgery otherwise it can cause cancer.

Hypospadias = ventral surface opening

Episapdias = Dorsal surface of penis

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

Reflex testing in new borns

A

sucking
grasping
rooting - touch cheek they move face towards touching (shows baby is hungry)
Moro = make baby feel like they are falling they will put arms and legs out

Stepping reflex - hold baby up and they lift their feet

Babinski - Fanning of toes when touching the foot.. NORMAL in babies!!

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

What time frame defines prolonged labor?

A

First time mom - over 20 hours
Multigravid - over 14 hours

What are some causes?

  1. CLosed cervix
  2. Anesthesia

Treatment = wait.

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

Prolonged Dialation

A

1st time moms = dilating less than 1.2 CM / hour

Multi = dilating less than 1.5 Cm / Hour

Causes = 3 Ps
Power - Not enough uterine contractions –> treat with OXYTOCIN
Passenger - baby too big.. –> must do C-section
Passage - Birth canal too narrow, –> must do C-section

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

Known breech positioning of baby.. what do you do?

A

C-section

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

Post partum hemmhorage

A

More than 500mL blood after delivery

Treatment:

  1. Bi-manual exam (massaging uterus from inside and outside) this will cause blood vessels to constrict
  2. Oxytocin - This will cause contractions - constriction of vessels.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Mom had a postpartum hemmhorage.. and now she is having trouble breastfeeding.. what is the diagnosis?

A

sheehan syndrome –> atrophy of the pituitary because it didnt get enough blood –> endocrine abnormalities –> including Prolactin and Oxytocin

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

when can you do external cephalicversion?

A

AFTER 36 weeks.

meaning if baby is in breech position on ultrasound.. you can try and manuver the baby by pressing on the moms stomach into the right position.. but ONLY after 36 weeks.

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

What is the most common pediatric cyanotic lesion?

A

Tetralogy of fallot

  1. overriding aorta
  2. Pulmonary stenosis
  3. RVH
  4. VSD

Tet spells (squatting.. increases venous return) = Tetralogy

Causes: Genetic –> chromosome 22

Diagnosis =
BIT = CXR
MAT = ECHO

Treatment = surgery

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

In Transposition of Great Vessels what drugs are CONTRAINDICTED?

A

NSAIDS and INDOmethacin

In Transposition.. the aorta comes out of right heart and pulmonary vessels come out of left heart.. the ONLY WAY a baby survives if there is a VSD, ASD or PDA.. These MUST stay open.

To keep open - PGE1 analogues

Nsaids and indomethacin close these openings and are thus CONTRAINDICATED.

BIT = CXR –> Egg on string apperance.

MAT = ECHO!

Treatment = surgery

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

Hypoplastic Left Heart Syndrome

A

Tiny Left heart.

NO PULSE!!

single S2 sound

Right Ventricular HYPERTROPHy –> on PE you can feel the right side impulse NOT the left

CXR = GLobular heart (because right is bigger than the left)

These babies actually appear grey (not blue)

MAT = ECHO!!

Tx = Surgery

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

Truncus Arteriosis

A

only ONE vessele comming out of heart.. this one vessel supplies both the lungs and heart

THey will have SEVERE hypoxia and Dyspnea.

SINGLE S1

BOUNDING PULSES@!

MAT = ECHO

TX = SUrgery

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

VSD in infancy

A

a large VSD will result in pulmonary HTN.

Blood from normal route is already in lungs.. however in VSD extra blood is going from left to right heart pushing even more blood into the lungs–> pulmon HTN

This results in Dypnea.

If its little it will close on its own.

If its big –> pulmon HTN

VSD murmur = HIGH PITCHED HOLOsystolic Murmur

CXR = Increased pulmonary VASCULAR markings

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

ASD in Infancy

A

more common in females than males

Murmur = FIXED wide SPLIT S2

BIT and MAT = ECHO

Definitive diagnosis with CATH

Paradoxical EMboli –> these patients will have a DVT that becomes a STROKE. –> because in an ASD blood is going from Right atrium to Left atrium–> Left Ventricle and directly into circulation.. lots of the circulation goes to the brain directly.. this DVT goes straight to Brain rather than going from Right atrium to right ventricle to lungs and causing a PE.

Large ASD –> surgery

Small ASD = spontaneous closure

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

PDA is a connection between what vessels?

A

Pulmonary artery and AOrta

PDAs are normal part of embryo.. When baby is born and you breath oxygen and pO2 is above 50.. then the PDA shuts by itself.

Murmur = Continuous MACHINERY!

DIagnosis = BIT and MAT = Echo

and CATH = definitive

Treatment = INDOMETHACIN = closes PDA

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

Aortic Coarctation

A

associated strongly with turners

Narrowing of the AORTA after the DUCTUS

Low BP in legs
HIGH BP in arms

Notching of RIbs on CXR

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

Pathalogical Jaundice

A
  1. If it occurs in 1st day of life
  2. If it raises more than 5mg d/l in one day
  3. if its ever above 19.5
  4. If Direct is > 2 mg/dl
  5. If its elevated for more than 2 weeks.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is kernicturus?

A

Deposition of Bilirubin in the BASAL GANGLIA!

Symptoms:

  1. Hypotonia
  2. Seizures
  3. Hearing loss
  4. CHOREOathetosis

Kernictursu is IRREVERSABLE.. once its there you always have it!

DIagnosis =
Type and screen (looking for ABO incompatiblity)
Bilirubin levels

Pathological jaundice is treated how?
Photo-therapy
if its not working then do EXCHANGE TRANSFUSION!

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

Esophageal Atresia

A

Presents one of 3 ways in infants:

  1. Vomiting on first feeding
  2. choking when feeding
  3. recurrent aspiration pneumo

Prenatal history will show –> POLYHYDraminos

CXR –> esophageal bubble

Tx –> IVF, ABX (if there is pneumo) and surgery to fix atresia.

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

Pyloric Stenosis

A

Olive sign on CXR

NON-Billious Vomiting!!

PROJECTILE

Hypochloremic, hypokalemic, metabolic ALKAlosis

Diagnosis:
BIT = Abdominal US
MAT = Upper GI Series

Treatment = IV fluids, electrolytes
then do MYOtomey (cut the pylorus where there is hypertrophy)

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

Choanal Atresia

A

A MEMBRATE between NOSTRILS and PHARYNGEAL space.

Cant breathe while eating (drink milk) because of this membrane.

When they EAT = BLUE
CRY = PINK

Associated with CHARGE Syndrome

Diagnosis = CT
TX = Surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Hirshsprungs

A

NO nerves to DISTAL bowel

THis results in the muscle being CONTRACTED All the time.

THis causes no passage of feces.

NO MECONIUM Passage (or takes more than 48hrs) after birth.

Diagnosis:
Abdominal X-ray –> DIlated bowel.. and then very thin bowel (look up pic)

MAT = BIOPSY –> no nerves in distal bowel.

Tx = SURGERY

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

Imperforate ANUS

A

NO anal opening

related to Down Syndrome and VACTREL syndrome

No stool .. obviously

Diagnosis = clinical.. no anal opening on PE

Tx = Surgery

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

Duodenal Atreisa

A

Lack of APOPTOSIS –> thus lack of CANNALizatoin (no hole for everything to go through).. food will get THROUGH the duodenum.. but cant go PAST that.

Associated with: ANNULAR pancreas!

Symptoms: BILLIOUS vomiting within 12 hrs of life

CXR = DOuble Bubble sign

Tx = IVF / Electrolytes
then do SURGERY

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

Volvulus

A

Intestine twisted on itself –> vomiting, abdominal pain (colicky)

Abdominal X-ray –> FLuid AIR levels

Treatment - Try ENDOSCOPY if that doesn’t work then surgery

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

INtusucception

A

Telescoping of bowel

Colicky abodominal pain, vomiting

CURRANT JELLY stools

kids go into FETAL position.. because it feels better

PE = SAUSAGE like mass
US = Target lesion

Treatment = BARIUM ENEMA (diagnostic and treatment)

All of these can cause intussuception:

  1. meckels
  2. lymphomas
  3. hard stool
  4. viruses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Meckles Diverticulum

A

the ONLY true DIVerticulum

Caused by persistence of Viteline duct –> Ectopic (pancreatic or gastric) tissue!

PAINLESS rectal BLeeding (due to pancreatic or gastric enzymes)

Diagnosis: Tech 99 scan!

Treatment - SURGERY (remove diverticulum)

RUle of 2s:

  1. 2% of population
  2. 2 feet from illeocecal valve
  3. 2% of people that have it are symptomatic
  4. Usually at age 2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

whats the diff between diarrhea and gastro?

A

Gastro also causes INFLAMMATION in addition to the diarrhea.

Inflammatory - fever, pain, possible blood in stool

Non-inflammatory - watery, crapming pain, vomiting

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

GI Viruses

A

Rota = Seen more in winter, Watery, lasts less than 7 days.. no treatment. Patients are vaccinated by 6 months for this!

Adeno - Seen all year round, lasts less than 7 days

Norwalk - cruise ships, EXPLOSIVE diarrhea.. only lasts 1-2 days.

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

Necrotizing ENterocolitis

A

assoicatd with PREMATURE and LOW birthweight babies.

Basically causes BOWEL NECROSIS.

Fever, vomiting, abdominal distention

Diagnosis - ABdominal X-RAY –> will see PNEUMATOSIS INTESTINALIS (air in bowel wall) this is pathagnomonic!

Treatment = Stop feeding (to reduce blood flow.. and thus prevent further necrosis), Put in NG tube to decompress bowel, IVF fluids , maybe ABX

May need surgery to remove dead bowel.

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

Infants of Diabetic mothers

A

Macrosomia - organs are enlarged.. happens to all organs EXCEPT the BRAIN.

Patients also have increase in bone marrow –> polycythemia –> hyperbilirubinemia (when RBCs break down) –> can lead to kernictururs–> look out for that

Small left colon –> distention from constipation.. treat this with Small Frequent meals

Asymmetric Septal Hypertrophy (most common cardiac defect in diabetic mother infants) – Diagnose with EKG / ECHO
Treat with BB and IVF.

HYPOglycemia - Babies in utero are surrounded by all the glucose in the moms blood so they make tons of insulin.. then when they are born.. they have all the insulin.. but no sugar –> hypoglycemia –> leads to seizures

Hypocalcemia –> tetany.. lethargy

Hypomagnesemia –> tetany and Decreased PTH

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

Rickets

A

Rickets can be caused by a deficiency in any of the 3 components of bone:

  1. Vita D
  2. Calcium
  3. Phosphorous

Weak bones / softening of bones

  1. Vitamin D deficient –> replace vitamin D
  2. Vitamin D dependent (cant make active form of vitamin D2) –> replace with vitamin D2
  3. X-Linked Hypophosphatemia –> body cant retain phosphorous –> cant mineralize bones –> soft bones.

Symptoms:
Bowing of bones

Diagnostic test:
x-ray - Rosary like appearance and BOWING of bones on xray

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

If Mom is ONLY breastfeeding what must you supplement?

A

VITAMIN D!!!

starting at 2 months of age.

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

Neonatal sepsis

A

Two categories: Early and Late.

Early:

  1. E.coli
  2. GBS
  3. Listeria

Late:

  1. Staph
  2. E. coli
  3. GBS

Workup and treatment:

  1. IVF
  2. Cultures (urine and blood)
  3. LP if considering meni
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Scarlet Fever

A

Usually caused by StreP. PYOgenes

  1. Sand paper rash
  2. Fever
  3. STRAWBERRY tongue
  4. Cervical LYmph.

DIagnosis:
Clinical but labs will show: Elevated ASO, ESR, and CRP

Treatment:
Penicililin (just like any other strep infection), If allergic to penicillin –> azithromycin or cephalosporin

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

TORCH infections

A

Toxoplasmosis - Chorioretinitis, hydrocephalus and RING enhancing lesions on CT
BIT = IGM
MAT = PCR

SUlfadiazine and Pyridoximine = treatment

Syphilis = hutchinson teeth, rash, sniffling
BIT = VDRL
MAT = FTABS / Darkfield or PCR 
Treatment = Penicillin.. if allergic desensitize them

Rubella = Blueberry Muffin spots, Cataracts and Deafness
BIT = IgM titers
MAT- PCR
Treatment - supportive.. cant do much else.

CMV - Periventricular CALCIFICAtions, microcephally, HEARINg loss, ChorioRETinitis
BIT = TItiers
MAT = PCR
Treatment = Gancyclovir

Herpes= Shock / DIC, Vesicular lesions, Encephalitis
BIT = Tzanck smear
Treatment = Acyclovir
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Croup

A

Caused by Parainfluenza virus

Can also be caused by RSV (especially in winter)

URI symptoms – caused by severe inflammation

BARKY cough with INSPIRATORY Stridor

COryza = inflammation of mucous membranes lining the nasal cavity

CXR - STEEPLE sign (narrowing trachea)

Mild Croup - steroids

Moderate to severe = RACEMIC EPINepherine

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

Epiglottiis

A

Caused by HIB!

Severe inflammation of the EPIglottis

HIB is normally vaccinated.. so kids that get this will have no vaccination or delayed vaccines.

TRIPOD positions, drooling, MUFFLED voice.

CXR = THumb Print Sign

INTUBATE these kids in the OR

Treatment - CEFTRIAXONE for 7-10 days

FOr close contacts –> RIfampin

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

Whooping Cough

A

caused by B. Pertussis.

TdaP and Dtap contain this vaccine.

There is 3 stages to whooping cough:
1. Catthareal stage - Nasal congestion and cough –> lasts 14 days. This is the ONLY TREATABLE stage.. the rest are NOT.
Treat with Azithromycin or Eryhtromycin!

  1. Paroxysmal Stage – With “whoop” at the end of it.. this stage lasts 14-30 days.. no treatment at this stage.
  2. Convalescent stage –> resolution with decreased cough

Make sure to ISOLATE the patient and give MACrolides to any close contacts!

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

whats the differenece between Tdap and DTAP?

A

Nothing. ITs the same thing.

TdaP given to ADULTS

Dtap = given to children!

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

Bronchitis

A

Inflammation of airways - caused by bacteria or viruses –> productive COUGH.. lasts 7-10 days.

CLINCAL diagnosis!

Treatment = supportive.

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

Pharyngitis

A

Inflammation of the NasoPharynx - caused by bacteria or viruses.–> sore throat, petechiae, FEVER, Cervical lymphadenopathy, URI symptoms.

MOST common cause = Group A strep

If this goes untreated what can it lead to?

GLomerulonephritis and Rheumatic fever

How do you diagnose?

  1. BIT = Rapid DNAase ANTIGEN testing!
  2. MAT = culture

Treatment = Penicillin (just like treatment for all strep).. if allergic to penicilin use MACROLIDES

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

Diphtheria

A

Corneobacterium DIphtherium

MEMBraneous Inflammation - Grey Pseudomembrane in the pharynx –> very VASCULAR so DO NOT SCRAPE!!!!!

No antibiotics for this

Must treat with ANti - toxin.

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

Congential Dysplasia of the HIP

A

found on NEWborn Exam (found in newborns.. age is big clue on exam)

Bortelani and Bartelow tests – Clicking or cluncking on exam –> positive for congentical dysplasia of hip.

Xray of HIP

Teatment = PAVILIC HArness

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

Legg - calve - perthes

A

Avascular Necrosis of Femoral Head.

Happens to kids 2-8 years old (BIG CLUE..on test is age bracet)

X-ray - Widening of Joint space, Painful Limb.

RX = Surgery of BOTH hips!! Not only the HIP with issues!!!… must do both!

Then do Rest and NSAIDS

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

Slipped Capital Femoral EPiphysis

A

OBESE ADOlescents (happens in adolescents.. age is big clue on exam)

Painful LIMP

X-ray = Widening of JOINT

Treatment - INTernal FIXATION with surgical PINNINg

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

Vitamin A deficiency or toxicity

A

Deficiency:

  1. poor NIGHt vision
  2. HYPOparathyroidism

Toxicity:

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

Vitamin B1 deficency or toxicity (thiamine)

A

Deficent:

  1. Berri Berri Syndrome
  2. Wernicke Encepholpathy

Toxicity:
its Water soluble.. no toxicity

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

B2 = Riboflavin

A

Deficency:

  1. Angular Chelosis
  2. Stomatitis
  3. Glossitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

B3 = Niacin

A

Pellagra

4 Ds.

DIarrhea, Dermatitis, Dementia, Death

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

B5 = Penthonic acid

A

Burning in FEET

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

B6 = Pyridoximine

A

Peripheral NEURO!

Must give with INH..

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

B9 = Folate

A

Deficency - Megaloblastic anemia
Hyper segmented neutrophils

No Periphreal neuro with this alone

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

B12

A

Megalobalstic anemia

Peripheral Neuro

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

Vitamin C deficency

A

Scurvy

Bleeding, petechiae, echymosis

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

Vita D

A

Rickets

Toxicicity – Increased Calcium –> polyuria and polydipsia

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

Vita K deficency

A

Bleeding, increased PT, PTT, INR

Give vita K in warfarin toxicity

Toxicity

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

PMS / PMDD

A

occurs in 20-30 y/o women

  1. headache
  2. moody
  3. breast tenderness
  4. pelvic pain
  5. cramping / bloating

Occurs in last 2 weeks of mesturation.

To get the diagnosis the patient must have charted these symptoms for 2 CONSECUTIVE cycles!!

PMDD = The above symptoms cause dysfunction in the patients life.

Treatment = Take away caffiene and chocolate.. decrease smoking and alcohol

Increase exercise

If severe + PMDD then give SSRI

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

Menopause

A

48-52 y/o

when it first starts - irrecular periods (because oocytes decrease estrogen and progesterone)

Lasts about 12 months.. symptoms are:

  1. Menstural irregularity
  2. irritability
  3. hot flashes
  4. DYSPARINURIA (caused by low estrogen leading to vaginal dryness and atrophy)
  5. decreased breast size
  6. atrophy of cervix

INCREASED risk of OSTEOperosis.

HRT = used to control the symptoms of Menopause and ONLY done for 1 year..

HRT is linked to Endometrial cancer and breast cancer… thus its used in limited amounts.

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

Menhorragia

A

HEavy and PROLONGed bleeding.

Causes:

  1. Fibroids = MCC
  2. Dysfuncitonal uterine bleeding
  3. Hyperplasia
  4. IUD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

HYPOmenhoragia

A

loss of bleeding

OCPs, Obstruction (present Hymen),

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

Metohoragia

A

irregular bleeding

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

METOMENOhragia

A

Irregular + Prolonged:

Cancers and polyps

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

Postcoital bleeding is a sign of what?

A

Cervical Cancer until proven otherwise!

also seen in atrophic vaginitis and cervical polyps

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

Dysfunctional Uterine bleeding

A

unexplained abnormal bleeding - MCC = anovulation

THe endometrium outgrows the blood supply and sheds –> bleeding

Diagnositc tests:
TSH levels
Prolactin Levels

Treatment = Combination OCPs (estrogen and progesterone pills)

Hysterectomy or endometrial ablation if very severe

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

Post Menopausal bleeding

A

AFTER all periods have stopped.. the patient comes in (6 months.. year later) with bleeding.

This is CANCER until proven otherwise

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

Simple Cysts

A

2 kinds - Luteal and Follicular cyts

These are the most common cysts in repo years.

Asymptomatic unless they become very large and compress adjacent tissues and burst.

B-hCG is negative

US will show fluid filled cystic Mass

Management - Follow up in 6-8 weeks.. generally resolve on their own.

Once they resolve give the patient STEROID Contraception to prevent new cysts from forming.

Laparoscopic removal must be done if the cyst is > 7cm Diameter.. or if STeroid contraception fails to resolve the cyst

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

Compelx Cysts

A

Benign Cystic Teratoma (DERMOID cyst)

COntains Cellular tissue from all 3 GERM LAYERS.

Rarely - SQUAMOUS CELL CARCINOMA develops.

US = COmplex MASS

Management = Laparascopic removal done in two ways:

  1. Cystectomy - just remove cyst and keep ovary
  2. OOPheroectomy - remove entire tube.. if fertility is no longer desired.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

31 yo woman in ED with severe, SUDDEN lower abdoinal pain that started 3 hours ago.

Exam = Abdomen tender, with no rebound tenderness present

Adnexal mass in the cul-de-sac area.

US 8cm left adnexal mass

beta-HcG negative!

What is next step?

A

b HcG is negative –> not ectopic.. and sign of a SIMPLE cyst.

However this is above 7cm.. and thus we must do a LAparascopic EVALUATION of the ovaries.

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

9 yo girl, right adnexal pain, complex cysts on US.

What is the most likely cause?

A

GERM CELL TUMOR!

Most common in young women

Most common malignant epithelial cell type is DYSGERMINOMA

Tumor Markers: LDH, B-hcG, AFP

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

67 yo woman with progressive weight loss, distended abdomen and left adnexal mass.. what is the most liekly cause?

A

Epithelial TUMOR

Most common ovarian cancer in post menopausal women.

Most commong malignant sub-type = SEROUS tumor.

Tumor Markers = CA-125, CEA

88
Q

58 yo Postmenopausal bleeding. Endometrial BIOPSy shows ENDOMETRIAL HYPERplasia. Pelvic US reveals RIGHT OVARIAN MASS

what is the most likely cause

A

Endometrial hyperplasia indicates an ESTROGEN secreting tumor.

Most likely mass = GRANULOSA - THECA cell tumor (STROMAL TUMOR)

Secretes estrogen and can cause ENDOMETRIAL hyperplasia

89
Q

48 yo woman with increased FACIAL hair and DEEPening voice. has ADNEXAL mass on exam..

what is most likely casue

A

Facial hair and deepining voice –> indicates TESTOSterone.

SERTOLI - LEYDIG cell TUMORs (STROMAL TUMOR) secrete Testosterone

Tumor marker = testosterone

90
Q

64 yo woman with Gastric ulcer and dyspepsia with WEIGHT loss and ABDominal pain. Adnexal mass on exam.

What is most likely cause?

A

gastric ulcers and dyspepsia is associated with the KRUKENBERG tumor.. which metastasizes from gastric cancer to the ovary.

MUCIN - producing ADENOcarcinoma

Metastasis from GAstriC Cancer.

Tumor Markers = CEA

91
Q

Management for ALL prepubertal or postmenopasual ovarian masses?

A

Management:
Sonogram

CT scan for postmenopausal women

Biopsy via laparoscopy for simple cysts
No septations or Solid Components

92
Q

Labial fusion

A

Fused Labia… caused by excess androgens

MCC = 21 B Hydroxylase Deficency

Treatment = Reconstructive surgery

93
Q

What are the 3 epidermal problems in OBgyn?

A
  1. Lichen Sclerosis
  2. Lichen Planus
  3. Squamous cell Hyperplasia
94
Q

Lichen Sclerosis

A

White, thin streak on the LABIA – In post menopausal women lichen sclerosis is a precursor to cancer

Treatment = TOpical steroids

95
Q

Lichen Planus

A

Purples flat lesions in the VULVA

Seen between 30-60 years of age

Treatment = Topical Steroids

96
Q

Squamous cell Hyperplasia

A

Chornic itchiness of vagina..excessive itching causes hyperKERATOSIS (thickenign and whitening of skin)

Treatment - Stiz Bath to stop the itchyness

97
Q

Bartholin Gland Cyst

A

Fluctuant mass in Vagina.

On the lateral sides of the vagina.

Normally they secret mucus.. if they got blocked or clogged –> now it starts forming a cyst / abscess –> pain, pain during sex, pain during walking

Treatment = Incision and Drainage. Make sure to culture the puss.. to see if it was ghonorrhea or chlamydia that caused the gland to clog.

98
Q

Vaginitis

A

Risk factors are anything that changes the pH balance of the vag –> ABX, diabetes.

Bacterial vaginosis - Gardenerella overgrowth (usually normal flora) –> fishy odor and copious vag discharge.
Wet mount - clue cells
Treatment = Metro

Candida - white thick cheese like vag discharge – > extreme itchyness / puritis… If you keep getting yeast infections check the patient for diabetes.
KOH prep - pseudo hyphate
Treatment - Fluconazole

Trichamonas - caused by T. Vaginalis
Green, forthy, copious amounts of vag discharge
Saline wet mount - motile organisms
Treatment - Metro.. MAKE SURE TO TREAT PARTNER!!!!

99
Q

Pagets disease

A

an INTRAepithelial lesion and is MALIGNANT

Occurs in POSTmenopasual women

SOre and itchiness of vagina

Redlesion with white on top

Definitive diagnosis –> biopsy

Treatment = vulvectomy

100
Q

Squamous Cell carcinoma of vagina

A

most common type of MALIGNANT cancer in vulva

Itchy, bloody vaginal discharge.

stage it with biopsy.

treatment - VULVectomy.. and if lymph nodes are involved.. do lymphectomy.

101
Q

Adenomyosis

A

Endometrial Glands inside the MYOmetrium - Occurs in patients between 35-50 years old

Pain
Menhoragia
Dysparenia

Risk factors - Endometreosis and Fibroids

Diagnosis – Clinical Diangosnis!.. when you do bimanual exam.. you will feel large, globular uterus.

MAT = MRI.

Treatment = Hysterectomy (only treatment)

102
Q

EndoMEtreosis

A

Endometrial tissue outside the Endometrium.

causes pain.. infertility

Pain occurs 1-2 weeks BEFORE menstruration and RESOLVES during menstruation.

Diagnosis - Laparoscopy –> choclate cyst on ovaries

On Ultra Sound - Ground Glass Appearance.

Treatment - NSAIDS for pain, OCPs to decrease ovulation.. Danazole = androgen analogue, Leupron = GNRH agonist.

103
Q

Fibroids

A

Benign Tumor in MYOmetrium.

They cause pain and menhoragia.

Diagnosis = US
Treatment = OCPs to decrease bleeding.
Can do Hysterectomy.

104
Q

Endometrial Cancer

A

Post menopausal women who suddenly have bleeding = endo ca until proven otherwise.

MUST DO BIOPSY in these patients!!!!

105
Q

PCOS

A

Amenhorrea, Irregular menstruation, Hirsutism, Acne, Diabetes

Bilateral ovarian cysts - “string of pearls”
Diagnosis - Pelvic US.. (if you dont see cysts that doesnt mean patient doesnt have PCOS)

Look at LH / FSH and TEstosterone (PCOS has elevated testosterone).

Treatment - Weight loss, OCPs,

Clompiphene and Metformin for women that want to coneive and PCOS

106
Q

Preterm Labor Risk factors and workup

A

The strongest risk factor for preterm labor = a PREVIOUS PREGNANCY with preterm labor.

Other risk factors are:

  1. Multiple gestation
  2. Cervical Surgery - in particular removal of part of the cervix by COLD KNIFE CONIZATION.

First step in evaluating the risk of preterm labor = TRANSVAGINAL ULTRASOUND for measurement of CERVICAL LENGTH.

A short cervical length is a strong predictor of PRETERM labor

107
Q

If on evaluation a pregnant patient is found to have a short cervix (less than 2cm).. then what is the next step?

A

Short cervix found on transvag US is a strong predictor of PRETERM LABOR.

Progesterone maintains UTERINE QUIESCENCE and protects the amniotic membranes against PREMATUre rupture.

Patients with short cervix and NO HISTORY OF preterm labor –> VAGINAL progesterone.

Patinets with a history of preterm labor –. INTRA MUSCULAR progesterone

May need to have CERCLAGE done in some patients to maintain cervix.

108
Q

Fetal Decelerations

A

Early Decelerations - Fetal Head Compression. Early decelerations are a benign physciologic finding and do not indicate fetal Hypoxia… These declerations DO NOT require intervention. NADIR at peak of contraction.

Late Declerations - Placental abruption and UTEROplacental insufficiency cuase FETAL HYPOXIA –> Late deceleration.
NADIR occurs AFTER peak of contraction.

Variable Deceleration - UMBILICAL CORD COMPRESSION.

109
Q

Tubo-Ovarian Abscess causes and workup

A

COmplication of PID - presents with:

  1. Fever
  2. Abdominal pain
  3. COMPLEX multiLOCULATED ADNEXal Mass with THICk walls and INTERNAL DEBRIS.
  4. Caused by a Polymicrobial infection of the upper Genital tract.

Infection Extends to fallopian tubes and creates an inflammatory exudate, purulent fluid and wall thinkening which conglomerate into a complex mass.

Lab findings:

  1. Leukocytosis
  2. C- Reactive Protein
  3. CA-125

these 3 along with fever suggest infection rather than malignancy.

TOA is diagnosed by imaging - Pelvic US or CT.

Treat with Broad spectrum ABx

110
Q

Abruptio Placentae

A

Placental seperation from the uterine wall

PAINFUL vaginal bleeding

Late decelerations! (uteroplacental insufficency)

HTN = Most common risk factor

COcaine / Tobacco use and trauma are other large risk factors.

Presents with ABDOMINAL and or BACK pain and Vaginal bleeding.

This is a clinical diagnosis.. US is not needed.. but is done to rule out Placenta Previa.

Associated with DIC and HYPOvolemic SHOCK.

Fetal complications include - Hypoxia and Preterm Delivery.

111
Q

Uterine Rupture symptoms

A

Abdominal PAIN, Vag bleeding, Fetal heart rate tracing abnormalities.

WIll present with LOSS of FETAL STATION, DIminishing CONTRACtions, and PALPABLE fetal parts

ABNORMAL CONTRACTION PATTERN.. (helps distinguish from placental abruption (which has normal contraction patterns)
will NOT have a smooth uterus.

Associated with INTRABDOMINAL HEMORRHAGE

Fetal parts may RETRACT upwards back into uterus.

Next step - EMERGENT LAPAROTOMY to confirm diagnosis and expedite delivery

112
Q

What is the most common complication with TWIN pregnancies?

A

PRETERM labor!

Uterine overdistension –> overstretching of the MYOmetrium –> increased PROSTAglandin production, number of OXYToCIN receptors, and CONTRACTILITY within the uterus –> PRETERM delivery.

over 50% of twin pregnancies occur before 37 weeks gestation

113
Q

Fetal DYsmaturity syndrome occurs in who?

A

POST term babies.. babies more than 42 weeks gestation!

Placental changes, loose skin, thin body, small for gestational age babies.

114
Q

Vaccines DURING pregnancy

A

Recommended:

  1. Tdap
  2. Inactivated Influenza
  3. Rho(D) Immunoglobulin

HIgh RIsk patients only:

  1. HEP B
  2. HEP A
  3. Pneumococcus
  4. H. Influenzae
  5. MEningococcus
  6. Varicella zoster Immunoglobulin

Contraindicated:

  1. HPV
  2. MMR - Give post partum if patients are not immune when testing during pregnancy.
  3. Live attenuated Influenza
  4. Varicella - Give POST PARTUM (if patients are not immune when testing durring pregnancy)
115
Q

What should you do for a mom who is NOT immune for Rubella and is pregnant?

A

Give MMR POST partum.

116
Q

When do you give RHOGAM (Rho(D) Immunoglobulin)

A

When Mom is Rh - and Baby is Rh +!

In these cases give Rho Immunoglobulin at 28 weeks gestation!!!

The ONLY TIME Rho Immunoglobulin is recommended in the 1st trimester is in the setting of UTERINE BLEEDING.

117
Q

Mullerian Agenesis

A

The Mullerian AKA PARAMESONEPHRIC Duct does not develop and thus patients dont have:

  1. Cervix
  2. Uterus
  3. Upper 1/3 of vagina (ends in blind pouch).

Primary Amenorrhea.. they will have ovaries bilaterally and normal secondary sexual characteristics (breast, normal stature, hair)

Must Do RENAL US –> paramesonephric duct has a lot of kidney organs the develop with it.. thus these patients need to be screened for any structural renal abnormaliteis via Ultra SOUND.

Treatment - dilate the vag for sexual intercourse.

118
Q

Androgen Insensitivity Syndrome

A

Genotypically MALE (46, XY)

DEFECTIVE androgen RECEPTOR function.

Appear PHENOTYPICALLY FEMALE and have Primary AMENORRHEA, tall stature, and an ABSENT UTERUS.

Minimal pubic / axillary hair (no peripheral effect of testosterone) and have MALE INTERNAL genitalia (testes)

119
Q

DIagnosis and treatment of chlamydia and ghonnerhea

A

ANNUAL SCREENING for CHlamydia and Ghonnerhea is recommended in all SEXUALLY ACTIVE WOMEN AGE 25 and OLDER!!

GOLD STAdARD = NAAT (nucleic acid amplification test) for both chlamydia and ghonnerhea.

the old testing method - culture and microscopy.. and had a high false negative rate.. thus if either chlamyida or gonnherea were positive you would have to treat for both.. that is NO LONGER THE CASE.

Treatment for CHlaymida = Azithromycin or DOXY

Treatment for Ghonnerea = BOTH Ceftiraxone and Azithromycin (need both drugs to fight gonnherea now because of resistance)

a positive NAAT test for either organism requires treatment REGARDLESS of if the patient doesnt have symptoms

120
Q

FOr a patient entering menopause.. how do you confirm the diagnosis?

A

get a SERUM TSH level and SERUM FSH level.

HYPERthryoidism has many features that overlap with menopasue.. and we must first rule out hyper thyroid.

Durring menopasue..the ciruclating estrogen decreases –> decreased in the feedback inhibition on the hypothalmaic-pituitary axis –> ELEVATED FSH –> helps confirm the diagnosis of MENOPAUSE.

121
Q

How can you tell the differnece between a lupus flare and preeclampisa in a prego patient?

A

BOTH will have:

  1. Proteinuria
  2. Edema
  3. HTN

However SLE flare will have other SLE findings:

  1. joint pain
  2. malar rash
  3. RBC casts on UA
  4. Decreased complement levels
  5. Increasing antinuclear antibody titers
122
Q

Gestational HTN definition

A

HTN at >20 weeks gestation with NO EVIDENCE of PRoteinuria or end organ damage..

If there is proteinuria or end organ damage –> Preeclampsia.

123
Q

HELLP syndrome

A

Hemolysis
Elevated Liver Enzymes
Low Platelet count

Patients will have:

  1. HTN
  2. Thrombocytopenia
  3. Proteinuria
124
Q

Oral COntraceptive Pills - types and side effects

A
  1. Combination (Estrogen - Progestin) OCPs.
    Most common side effect = BREAKTHROUGH BLEEDING (associated with lower estrogen doses).
    other side effects include nausea, bloating and breast tenderness –> improve with continued use.

Adverse effects - HTN, Increased risk of cervical cancer and VENOUS thromboembolisms.

Weight gain is NOT a side effect of Combo OCPs.

  1. MEDROxyPROGESTERONE - Increases body fat, decreases lean muscle and Causes WEIGHT GAIN. Not recommended for adolescents or young women due to significant risk of BONE Mineral density loss… only used if there is no other acceptable options.
  2. Progesterone ONLY pills - The side effects of comobination OCPs is mainly due to estrogen.. and thus this has much less side effects.. however its also less effective against contraception and dysmenorrhea treatment because it DOES Not inhibit ovulation.
125
Q

What is first line treatment for Primary Dysmenorrhea?

A

Primary Dysmenorrhea - defined as RECURRENT lower abdomonal pain associated with MENSTURATION.

FIRST line treatment = COMBINATION OCPs (estrogen - progestin).

They DECREASE PAIN by THINNING the ENDOMETRIAL LINING, REDUCING PROSTAGLANDIN RELEASE, and DECREASING uterine contractions.

126
Q

Granulosa Cell Tumor

A

Estradiol and Inhibin secreting tumor.

Inhibin suppreses pintuitary FSH release via negative feedback

Malignant proliferation of granulsa cells can cause high estradiol levels resulting in the following symptoms:

  1. Breast Tenderness and enlargment
  2. Endometrial proliferation (unopposed proliferatoin)
  3. Enlarged Uterus with thickened endometrial stripe on ultra sound.

manage surgically by removing tumor.

127
Q

what tumors secrete LACTATE DEHYDROGENASE?

A

DYSGERMINOMAS – these are malignant tumors that present as RAPIDLY ENLARGING, PAINFUL masses.

no breast tenderness or thickened endometrium

128
Q

Which tumors secrete TESTOSTERONE??

A

SERTOLI- LEYDIG cell tumors

they are sex cord-stromal ovarian tumors.

Patients have

  1. VIRILIZATION - Acne, Clitoromegaly
  2. HYPOESTROGENISM - Breast atrophy, Thin ENdometrium.
129
Q

IF there is a neonatal clavicular fracture durring birth what is the treatment?

A

X-ray to confirm the fracture.

Neonatal clavicular fractures HEAL RAPIDLY (7-10 days) and thus nothing is needed.

REASSURANCE and GENTLE HANDLING is given to parents.

130
Q

Uterine Inversion

A

Uncommon but Potentially FATAL cause of POSTPARTUM HEMORRHAGE.

Excessive FUNDAL PRESSURE and TRACTION ON THE UMBLICAL CORD before placental seperation can cause it.

SMOOTH, ROUND MASS, PROTRUDING through the CERVIX or VAG.

Uterine inversion is typically accompanies by HEMORRHAGIC SHOCK (BP drops) and LOWER AB PAIN.

Treatment =

  1. Aggressive fluid replacement
  2. MANUAL replacement of the UTERUS
  3. PLACENTAL removal and UTEROTONIC drugs AFTER uterine replacement.
131
Q

Pubic Symphysis Diastasis

A

Suprapubic pain that radiates to back, hips, thighs or legs and is EXACERBATED BY WALKING, weight bearing or position changes.

CLINICAL DIAGNOSIS.

POINT TENDERNESS TO PALPATION over the PUBIC SYMPHYSis, and sometimes have WADDLING GAIT.

Treatment - conservative management with supportive care

132
Q

When is quadruple screening done and what is included in it?

A

Done in the second trimester (15-20 weeks)

Includes 4 things:

  1. MSAFP
  2. B-hCG
  3. Estriol
  4. Inhibin A

Trisomy 18:

  1. decreased MSAFP, B-hCH, Estriol and
  2. NORMAL inhibin A

Trisomy 21:

  1. Decreased MSAFP and Estrol
  2. ELEVATED B-hCG and Inhibin A

NTDs or Abdominal Wall Defects:

  1. Increased MSAFP
  2. Normal everything else (b-hcg, inhibin a and Estriol.)
133
Q

Late decelerations are a sign of uteroplacental insufficiency and impending fetal hypoxemia.

What is the only other event that can mimic late deceleration?

A

Uterine TACHYSYSTOLE = more than 5 UTERINE CONTRACTIONS / 10 mins.

For these patients.. DISCONTINUE all UTEROTONIC AGENTS (Oxytocin) untill the excessive uterine activity and resulting fetal decelerations resolve.

134
Q

Late Decelerations require what intervetion?

A

EMERGENT C-section.!!

If the late decelerations are not due to uterine tachysystole.. must do emergency c section.

In uterine tachysystole.. if discontinuation of uterotonic agents does not resolve the issue then must do emergency c sectoin.

135
Q

CMV in pregnancy - how is it diagnosed?

A

In mother via SEROLOGY

In baby via AMniocentesis.

INTRAcrainal and INTRAHEPATIC calcifications

There is no therapy.. if mom has it.. we dont give antiviral.. because it doesnt help prevent fetal infection.

Pregancy termination may be considred for fetuses that have severe congenital CMV identified early in prego.

136
Q

babies of mothers infected with ZIKA

A

transmited by Aedes mosquito bite

  1. SEVERE Microcephally
  2. THIN cerebral cortices
  3. MULTIPLE INTRACRANIAL Calcifications (due to tissue necrosis)
  4. Closed anterior fontanelle.
  5. Multiple contracctures and hypertonicity.

Diagnosis - Reverse transcriptase PCR

No treatment - avoid tropical areas with mosquitos when prego.

137
Q

acute cervicitis cause and symptoms

A

MCC - Chlaymd and gonorrhoeae

Presentation:

  1. Bleed after sex
  2. thick MUCOPURULENT Discharge
  3. Dysuria
  4. Dysparenuia

Diagnosed clinically - Pelvic exam –> MUCOPURURLENT DISCHARGE and a FRIABLE CERVIX (bleeds easy on contact).

Treatment = Empiric treatment with AZITHROMYCIN and CEFTRIAXONE

Do Nucleic Acid Amplification Testing to confirm. But start emperic treatment before confirming.. because if the infection ascends it can cause complications.

138
Q

Fetal Growth Restriction causes

A

Defined as UltraSOUND estimated fetal weight below 10th percentile for gestational age

Two Types:
Symmetric - 
1. Chormosomal abnormalities
2. Congenital infection
3. Global growth lag.. head is small with everything else
Asymmetric -
1. Utero-placental insufficiency
2 Maternal Malnutrition
3. Maternal HTN and Tobacco use
4. HEAD- SPARRING growth lag.. head will be normal.

Management for both:

  1. Weekly BIophysical profiles
  2. Serial Umbilical artery Doppler US
  3. Serial Growth USs
139
Q

HOw can Oxytocin cause a seizure?

A

Oxytocin is used to induce or augment labor. And also prevention and management of postpartum hemorrhage.

Adverse effects:

  1. HYPOnatremia
  2. HYPOtension
  3. Tachysystole - more than 5 contractions in 10 mins

The severe HYPOnatremia will cause seizures!

The severe hyponatremia is caused by Oxytocin.. oxytocin is similar in structure to ADH.. and thus causes water retention –> hyponatremia

140
Q

False Labor vs Latent Labor vs Labor

A

False Labor: Irregular, INFREQUENT, weak contractions with no pain. THey result in NO CERVICAL CHANGES - braxton hicks contractions.
In these cases reassure the patient and send them home.

Latent Labor: Regular contractions with INCREASING FREQUENCY and INTENSITY, and cause GRADUAL changes in CERVIX.

Labor: Regular, PAINFUL uterine contractions that cause CERVICAL CHANGES (dialtion and effacement)

141
Q

When do you give Penicillin for GBS prophylaxis?

A

DURING LABOR!!

if GBS culture comes back positive at ANY prentatal visit. Dont give pencilin UNTIL LABOR!!

if laboring before 37 weeks and patient GBS status is unknown –> give PENICILIIN to prevent vertical transmission.!!

It doesnt help to treat GBS before labor.. because of quick bacterial re-growth.. the mom woul dhave to get penicliin all over again during labor regardless.. so its pointless to give before.

142
Q

When is tocolysis contraindicated?

A

You DO NOT want to do TOcoysis AFTER 34 weeks gestation!

The risks of the therapies exceed those of preterm delivery.

Common tocolytics = Indomethacin and Mag sulfate –> both of these are actually contraindicated after 32 weeks (before 34 weeks).

143
Q

What kind of patients should be screened for illicit drug use at the initial prenatal visit?

A

all patients.

144
Q

Complications of Amphetamine abuse durring pregnancy

A

Fetal Growth Restriction

Preeclamisa

Abruptio Placentae

Preterm delivery

Intrauterine fetal demise

increased risk of maternal mortality

145
Q

Gastroschisis is associated with first trimester use of what substance?

A

NSAIDS

146
Q

NTDs are associated with deficiency of what?

A

FOLIC acid

147
Q

POLYhydraminos is associated with what?

A

Poorly controlled MATERNAL DIABETES

and anything preventing the fetus from swallowing (Esophageal Atresia)

148
Q

Vasa Previa is associated with what?

A

Low lying placenta or MUltiple Gestations

149
Q

What are the most common masses causing HYPERANDROGENISM in pregnancy?

A

Luteomas and Theca Lutein Cysts are the most common benging ovarian tumors causing hyperandrogenism.

Lutemoas - Solid, Bilateral or Unilateral masses on US. ELEVATED b-hcg levels stimulate the LUTEOMA (composed of large lutein ells) to rlease androgens, which may cause maternal VIRILIZATION.

Management = Observation and expectant management, as the masses and symptoms resolve spontaneously after delivery, due to falling of b-hcg levels.

150
Q

what is the 2 step approach for screening and diagnosing gestational diabetes?

A

Step 1: At 24-28 weeks administer 50g ORAL glucose load.. and check Glucose 1 hour later.

If it is <140.. no diabeetes.. no further testing

If it is >140 Must administer 100g ORal GLUcose load and check fasting serum glucose each hour after for 3 hours.

If there are 2 or more abnormal values you now have the diagnosis of gestational diabetes.

151
Q

What causes gestational diabetes?

A

INCREASed insulin RESISTANCE

hPL (Human placental lactogen) increases in production in the 3rd trimester resulting in Pancreatic B-cell Hyperplasia –> increased insulin resistance.

Gestational diabetes occurs when peripheral insulin resistance exceeds pancreatic insulin secretion.

152
Q

Which type of c-section incisions are a contraindication for vaginal delivery in the future?

A

Classic (vertical incision) - Contraindicated vaginal delivery due to high risk of uterine rupture

Low Transverse Cesarean - This has a low risk of rupture.. and thus patients who had this type of incision CAN HAVE A VAGINAL DELIVERY for subsequent pregos.

153
Q

pain that in lower pelvic area moves to legs and subsides within 2-3 days of menses.

includes nausea vomiting diarrhea

A

Primary dysmenorrhea.

Non sexyally active - NSAIDs
sexually active - Combination OCPS

154
Q

PMS / PMDD treatment?

A

SSRI is first line

155
Q

Child with lmitied upward gaze, upper eye lide retraction, pupils non-reactive to light, reactive to accomomdation.

Papilledema, headache, vmoiting, ataxia (all sysmtoms of obstructive hydrocephalus because the tuor blocks movement of CSF)

A

Pineal gland tumor

156
Q

suprasellar mass that can compress the optic chiasm and result in visual field deficits

A

Craniopharyngioma

157
Q

child (pediatric tumor) with ataxia, truncal instability (from hydrocephalus causing mass effect) and tumor in CEREBELLAR VERMIS

A

Medulloblastoma

158
Q

where is inhibin A released from and what would its level be in turners?

A

Low.

Released from ovaris.. turners dont have ovaries.

Decreased estrogen, inhibin and progesterone.

Increased FSH and LH

Turners patients require estorgne replacement therapy to induce sexual development, improve growth/ height and increase bone mineral density.

159
Q

what if you find High grade squamous intraepithelial lesions on pap testing (CIN2 or CIN3) in a pregnant patient?

what is next step?

A

IMMEDIATE COLPOSCOPY.

this is concernitng for cervical cancer sand shoudl be done rigta way.

COlposcopy evaluates the CERVIX and VAGINA under maginfication after application of acedtic acid to contrast and identify abnormal ACETO - WHITE changes from normal cells.

Cervical neoplasia typically occurs at the TRANSFORMSTION ZONE (squamo-columnar junction).

If a high grade lesion is found.. do a CERVICAL BIOPSY.. even in pregnancy.!

Endocervical curettage is an invasive procedure.. and is differed to after pregnancy…due to risks of miscarage and preterm delivery.

Cervical incision via LOOP electrosurgical cexcision procedure is ONLY done AFTER confirming high grade neoplasia in the pregnant female.

160
Q

if mom had varicella zoster 2 days before or 5 dfays after delivery what should the post exposure prophylaxis be for the neonate?

A

VZIG. (passive immunity.. Varicella zoster immunoglobulin).

VZIG is given to neonates, pregnant women and immunocompromised patients.

Varicella live faccine (VZV vaccine) is given to all immunocopentent indivisuals for post exposure prophylaxis.

161
Q

What sould be done for someone who has a uterine prolapse thorugh vag.. and is a poor surgical candidate?

A

Pessary fiting.

For good surgical candidates - do surgery.

Pelvic floor muscle exercises can be done for mild prolapse. For complete prolapse must do a pessary or surgery.

162
Q

retraction of the superior portion of the TM and a pearly white mass in a patient with chornic middle ear infectiosn is what?

A

Cholesteatoma.

Tympanic membrane epithelium and KERATIN debris accumulation.

163
Q

what is the most common potential side effect of the first line medication to prevent sickle cell flares?

A

Hydroxyurea.

Myelosupression is the most common potential side effect.

164
Q

severe nodulocystic acne on the arms and upper back of a woman is a sign of what?

A

Hyperandrogenism.

A common cause of hyperandrogenism in young women, particularly in conjunciton with obesity is PCOS!

PCOS - high testosterone (hirstuitsm), Polycisystic ovaris on ULTRA SOUND, and a history of IRREGULSR MENSES.

165
Q

Androstenedione produced by the adrenal glands and Ovaries goes to the Fat cells and is converted to ESTERONE by which enzyme?

A

AROMATASE

166
Q

what increases the chance of endometrial cancer more? obesity or OCPS?

A

OBESITY.

unapposed estrogen creation leading to endometrial hyperplasia.

OCPS actually reduce the risk of endometrial cancer by causing cyclic shedding of the endometrium (never hyperplasias).

167
Q

Bilateral hydronephrosis, oligohydramions inuntero, flattened facies, abdominal distension and club feet.

what is the diagnosis. and what is causing the bilateralhydronephrosis?

A

Potters syndrome.

Posterior urethral valves are causing the bilateral hydronephrosis.

168
Q

what is the role of hCG in pregnancy?

A

maintainece of the corpus luteum.

secreted by the synctiotrophoblast its responsible for preserving the copus luteum durring pregnancy in order to maintiant progesterone secreion until the placenta is able to produce progesterone on its own.

169
Q

when is GBS screening done?

A

35-37 weeks gestation.

results are valid for 5 weeks after the screening.

170
Q

Unifocal, firm, white vulvar plaque is concenring for what?

A

Vulvar Squamous Cell Canccer.

Diagnosis is done via biopsy.

Chronic inflammation from lichen sclerousus, and persistent HPV infection are risk factors.

171
Q

When should PAP and HPV testing begin?

what if a woman is sexually active before 21?

A

Done starting age 21 in women.

REGARDLESS Of when sexual activity began or number of partners.

172
Q

Who should receive the HPV vaccine?

what if the patient already had HPV?

A

Even if they had previous HPV you MUST GIVE the vaccination if they are in the age group.

All girls and women age 11-26

All boys and men 9-21 or (9-26 for gays)

173
Q

Sudden onset unilateral pelvic pain, nausea and vomiting, palpable adnexal mass and Absent doppler flow to ovary (first line imaging modality is US).

A

Ovarian torsion.

Treatment - LAPAROSCOPY with DETORSION.

Do oophorectomy if there is necrosis or malignancy.

untreated torsion will lead to infertility, hemorrhage or periotnitis and spesis.

174
Q

what is treatment for scabies?

A

Topical 5% permethrin or Oral Ivermectin

175
Q

what is seen in primary ovarian insufficiency and what is the treatment?

A

Amenorrhea at age less than 40.

Hypoestrogenic symptoms (hot flashes)

Decreased estrogen and INCREASED FSH.

Major causes - turners, Fragile x, Autoimmune oophoritis, cancer drugs, pelvic ratiation, glactosemia.

Treatment - estrogen therapy.

176
Q

Heavy menses, abnormal menstrual bleeding, constipation, urinary frequency, pelvic pain / heaveness and enlarged uterus are all signs of what?

A

UTERINE FIBROIDS

177
Q

Dysmenorrhea, pelvic pain, heavy menses, bulky, globular and tender uterus.

A

Adenomyosis

178
Q

what is the gold standard for diagnosis of endometrial hyperplasia and malignancy?

A

Endometrial biopsy.

179
Q

how do you treat patients with bartholin duct cysts?

A

Asymptomatic patients are treated with expected managment and observation.

symptomatic or patients with an absces are treated via Incision and drainage with either a WORD catheter or MARSUPIALZATION procedure

180
Q

Stridor, barky cough, Para influenza is caused by what?

and what causes the inspiratory stridor?

A

edema and narrowing of the proximal trachea?

Treatment - corticosteroids and nebulized epinephrine

181
Q

what is the mOA of HIB causing epiglottitis?

A

Inflamation of the epiglottis and aryepiglottic folds.

these patients will also have stridor amontst all the other symptoms

182
Q

Child with thromobocytopenia (bleeding, brusing gums), leukpenia (infections), Anemia (fatigue), Short stature, Hyper or Hypopigmentation, and Absent or HYPOplastic THUMBS.

A

Fanconi syndrome.

This is the most common cause of congenital APLASTIC ANEMIA (bone marrow failure, pancytopenia).

Caused by a DNA repair defect.

Treatment - Hematopoietic stem cell transplant.

183
Q

women with multiple candidal infections and nocturia / urinary frequency should be screened for what?

A

diabetees.

check the HbA1c

184
Q

Scarlet fever vs Kawasaki disease.

A

Kawasaki disease: - medium vesel vasuclits
Fever for 5 or more days plus 4 of the following:
1. conjunctivitis - bilateral, nonexudative
2. Mucositis - Erythematous, fissured lips (strawberry tongue)
3. Rash - Polymorphous
4. Extremity changes - erythema, edema, desquamation of the HANDS and FEET
5. Cervical Lymphadenopathy - >1.5 cm
treatment - aspirin

Scarlet fever (caused by strep pyogenes)
pharyngitis, fever and sandpaper like rash that usually desquamates.  Strawberry toungque and cervical lymphadeonopathy.  However, the rash in scarlet fever is most prominent ofver SKIN FOLDS and patients DO NOT have CONJUNCTIVAL INJECTION or EXTREMITY swelling.
185
Q

fine pink, maculopapular rash that spreads cephalocudally. Low grade fever and lymphadeonopahty

A

rubella - german measels

186
Q

Fever, cough, coryza, conjunctivitis, Koplik spots.

pink rash that spreads cephalocaudally

A

Rubeola ( measels)

187
Q

Nitrazine positive vaginal fluid (amniotic fluid) before 37 weeks is called what?

A

Premature rupture of membranes.. is rupture of membranes before 37 weeks.

If after 34 weeks DELIVER THE BABY! there is increased morbidity and mortality associated with prmeature delivery decrease and the incidence of chorioaminiotis is decreased after 34 weeks so deliver.

Patients with PROM at less than 34 weeks with signs of infection (maternal fever, fetal tachyshould also be delivered.

ALL patients, beofre or afer 34 weeks with PROM should receive IV ANTIBIOTICS!

188
Q

How can hypothyroidism cause abnormal uterine bleeding?

A

In hypothyrodism the increased release of TRH (thyrotropin releasing hormone) from the hypothalamus causes increased PROLACTIN levels.

Elevated prolactin level INHIBITS FSH and LH release from the pitutiary —> ANOVULATION and ABNORMAL uterine bleeding.

189
Q

WHy is C3 decreased in PSGN

A

Because PSGN causes a Type 3 Hypersensitivity reaction.

Immune complexes deposit in the GBM and MESANGIUM. This causes Complement system activation and ACCUMULATION of C3 in the glomerular deposits. This resltuls in Decreased C3 with elevation in creatinine.

190
Q

Child with Microscopic or gross hematuria + Sensorinueural hearing loss + occular defects.

A

Alports syndrome.

X linked inherited disorder of type 4 COLLAGEN

191
Q

Hematuria / Proteinuria + Dyspnea, cough, Hempotysis.

A

Good pastures.

Renal and pulmonary disease.

IgG autoantibodies against the GLOMERULAR and ALVEOLAR basement membranes.

192
Q

Sudden onset unilateral pelvic pain, Nausea and vomiting +/- adnexal mass?

A

Ovarian torsion.

Caused by partial or complete rotation of the ovary aroudn the infundibulopelvic (suspensory ligament of the ovary) and/or utero ovarian ligaments –> these cause obstructed blood supply.

Diagnosis –> US will show absent doppler flow to ovary and a pelvic mass.

RIsk factors = Ovarian Mass, Women of repro age, Women receiving Infertility treatment with ovulation induction

Treatment - Laparoscopy with DETORSION, Ovarian cystectomy or oopherectomy if necrosis or malignancy.

193
Q

Athlete with Low BMI develops amenorrhea.

A

This is called HYPOTHALAMIC amenorrhea –> secondary amenorrhea.

Low GnRH –> Low FSH / LH –> Low estrogen

Long term consequences –> Low bone mineral density, Increased cholesterol and triglycerides.
They also will get vag and breast atrophy and infertility (all signs of decreased estrogen)

Treatment = Increase caloric intake, ESTROGEN and Calcium and Vita D.

194
Q

Patient under 30 years old comes in with a single, unilateral, mobile, well-circumscribed mass. What is next step?

A

This is likely a fibroadenoma.

breast cancer is VERY RARE in patients under 30. This patients mass should be checked again after the next menstrual cycle.

Fibroadenomas increase in size during menses (due to elevated estrogen and progesterone) and go away after that. They are usually rubbery and mobile.

If the mass is still there after do a US.

If the patient is above 30 do an US

Mammogram is not helpful in patients under 30 due to dense breast tissue.

195
Q

An adolescent had unprotected sex. What do you give them for abortion?

A

Most steates allow you to give contraception, pregnancy care and STD treatment confidentially to adolescents (dont need to notify parents)

Plan B - Oral Levonorgesterl –> works by DELAYING OVULATION. Can be take upto 72 hours after.

Ulipristal –> Antiprogestin –> DELAYS FOLLICULAR RUPTURE, inhibits ovulation and IMPAIRS IMPLANTATION –> can be taken up to 5 days after.

Copper IUD –> the MOST EFFECTIVE emergency contraception –> creates an inflammatory response that is TOXIC TO SPERM AND OVA –> no fertilization.

196
Q

what is the most readily available form of emergency contraception?

what is the most effective form of emergency contraception?

A

Readily available - Plan B (oral Levonorgestrel).

Most Effective - Copper IUD

197
Q

Phenotypically female + Breast development + minaimal or absent axillary and pubic hair + Female external genitalia + absent uterus, cervix and upper 1/3 of vag (blind pouch).

What is diagnosis and what should be done next?

A

Androgen insensitivity syndrome (x-linked mutaiton in androgen receptor)

Genotpyically male 46xy

Must treat with:

  1. Gender identity / assignment counseling
  2. Elective Gonadectomy –> the testis inside aere normal but are CRYPTORCHID / UNDESCENDed (testicular descent is an androgen dependent process).

These testies need to be removed because they are a risk for testicular cancer (elevated intrabodominal pressures –> abnormal spermatogenesis and aberrant germ cell differentiation)

ELECTIVE GONADECTOMY.

198
Q

Is SPF 100 better than SPF 50?

A

no.

SPF 50 filters 98% of UVB.

SPF 100 does 99%.. a NEGLIGBLE AMount.

199
Q

what is the best method of photo protection to prevent sunburn?

A

SUN AVOIDANCE!!!

If its not possible to avoid the sun use SPF 15-30 or higher and apply it 15-30 minutes BEFORE sun exposure.

Make sure to REAPPLY ATLEAST EVERY 2 HOURS.

Cloud coverage does NOT block UVB rays.

200
Q

which bleeding disorder is the most common cause of heavy menstural bleeding in adolescents?

A

Von Willebrand disease.

Deficency of VwF –> IMPAIRED PLATELED ADHESION –> vWF acts as a bridging glycoprotein between platelets and endothelial factors at site of injury.

Platelet count and PT are NORMAL.
PTT can be normal in mild disease.. or elevated in severe disease.

Confimr diagnosis with Ristocetin cofactor activity.

Treatment - Desmopressin or vWF replacement therapy.

201
Q

heavy painful menses + IMMOBILE UTERUS

A

endometriosis.

MUST HAVE IMMOBILE UTERUS.

202
Q

Cows milk vs breast milk

A

cows milk - low iron. Give iron. Can cuase IDA.

breast milk - low vitamin D supplement with vita d

203
Q

What are treatments for primary nocturnal enuresis?

A

Urinary incontinece after age 5.

Do UA to rule out secondary causes.

1st. Lifestyle mods
2nd. Enuresis alarm
3rd. DESMOPRESSIN (ADH analogue)

Imipramien used if desmopressin fails

if desmopressin used as monotherapy.. it has a high rate of relapse after stopping.

204
Q

what is usually the first sign in infant botulism?

A

constipation from bowel hypoactivity.

Inhibits presynaptic AcH release

Treatment = Botulism immune globulin

Diagnosis =
resp - spores from dust
Honey - toxin in stool

205
Q

9 year old boy with oozing skin lesions on his leg. Causing pain an puritis. lesions appear wet and others have thin, crusted coating. VESICLES in a LINEAR ARRANGEMENT. what is the diagnosis?

A

Poison Ivy.

This is ALLERGIC CONTACT DEMRATITIS - Type 4 Hypersensitivity. Cell mediated.

Treatment.. reduce exposure.. remove clothes and if needed topical / oral glucocorticoids.

206
Q

Neonate with vaginal bleeding and discharge. what is the most likely cause?

A

Maternal withdrawal of estrogen.

Maternal estrogen crosses the placenta during pregnancy and causes growth of the fetal endometrial lining (just like the follicular phase of menstruation).

Following delivery the neonatal endometrium may slough off –> mucoid vaginal bleeding.

Usually occurs in the first 2 weeks of life.

The maternal hormones may also cause breast bud and genitalia engorgement during the first month of life.

Neither of these require any treatment.

207
Q

what are risk factors for hyperemesis gravidarum?

A

Twin pregnancies (multiple gestational)
previous prego with hyperemeis
Hydatiform mole

The elevated bHCG in these conditions causes the emesis.

208
Q

Miosis + Ptosis + claw hand –> injury to what nerves?

A

C8-T1

209
Q

pink / flesh colored, verrucous papules and plaques. puritic and friable lesions in a child. what is the next step?

A

this is HPV.

they can be asymptomatic (not bleeding) or bleed.

If seen in a child - do a sexual abuse investigation.

210
Q

Persistent, ECZEMATOUS, and / or ulcerating RASH, localized to the NIPPLE and spreads to the areola.

A

Pages disease of breast.

Patients can have vesicles, scales, bloody discharge and nipple retraction. Patients experience pain, itching, and burning of the affected nipple and NO resolution with topical steroids.

85% of patients with Pagets disease of breast will have an underlying breast cancer.

Adenocarcinoma is the most common type of breast cancer.

211
Q

How do you diagnose wilms tumor?

A

after palpating an abdominal mass the first step is Abdominal US.

that should be followed up with CT with contrast of the abdomen. also CT with contrast of chest to identify any pulmonary mets.

212
Q

what is the imaging study in a patient below 30 with a breast mass?

A

US.

If US shows simple cyst then do an FNA (if the patient wants).
“Posterior acoustic enhancement” on US means its FLUID and no debris / solid components –> simple breast mass

If the US shows a solid mass (complex cyst / mass) then do an Image guided CORE BIOPSY

213
Q

What is the imaging study in a patient 30 or older with breast mass?

A

Mammogram.

If its suspicious for malignancy do a CORE BIOPSY.

214
Q

after removal (drainage) of a simple cyst in breast (clear fluid).. when should the patient come back next?

A

the follow up breast exam shold be done in 2 months.

If this is normal then the patient can move to annual screening.

215
Q

variable decelerations are a sign of cord compression. what is something that can be done to reduce cord compression?

A

AMNIO INFUSION!

216
Q

12 weeks Post delivery patient has amenorrhea. what is teh cause?

A

Lactational Amenorrhea.

The high prolactin inhibits the production of Hypothalamic GnRH.

Low GnRH = Low FSH and LH.

Thus lactation prevents ovulation –> natural form of contraception for the first 6 months postpartum.

after 6 months over 50% of women resume ovulation and another form of contraception should be considered.

Hematology (13 decks)

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