Pg 68 Flashcards
Blue Sclera
Osteogenesis Imperfecta
Orange Tears
Rifampin
ACE Inhibitors
Diabetes, chronic cough
OK for BF
Don’t give in pregnancy
Fever in PEC mimickers
HUS or TTP
HUS = renal failure, oliguria, creatinine high
TTP = AMS
Cocaine
Simple diffusion?
Fe Def
Microcytic anemia (MCV <80)
Ferritin is most Sn/Sp marker (low)
Total Fe needed for entire pregnancy is 1g
Facilitated diffusion
Sugars
Longest diameter of the fetal head
Supra-occipital mentum (12.5cm)
Most common cause of SAB
Trisomies/45 X (esp trisomy 16)
Pulmonary Fibrosis
Bleomycin
Most chemo is in what phase???
S phase
Low AFP is associated with
GTN and trisomies
Low Papp-a is associated with
FGR
DVT most common side is
LEFT (90%)
CMV
Paraventricular intracranial calcifications
do urine test to dx if sx
Syncytiotriphoblasts produce…
PAPP-A and HCG
Elevated Inhibin A
Bad (associated with T21)
Listeriosis, found in ..
Cantaloupe
see placental abscesses
Limiting dimension in pelvis
Mid pelvis (bi-spinous diameter)
OP position most associated with this kind of pelvis
AnthrOPoid pelvis
21-Hydroxylase Def (CAH) is inherited…
AR
elevated 17-OHP
PCKD is inherited…
AD
DMD is inherited…
X-linked
Dizygous is always
Di-Di
Split before 4d
Ventilator associated infection is…
Pseudomonas Pneumonia
Atypical Pneumonia is usually
Mycoplasma
PTU
Agranulocytosis
Hepatotoxicity
Give in 1st trimester only then Methimazole after 2nd
Alk Phos heat stability?
Normal placenta: heat STABLE alk phos
Cholestasis: heat labile alk phos
Factor V Leiden heterozygous
DO NOT TREAT
Most clotting seen in
AT III
Lewis LIVES because
IgM cant cross the placenta
HBV is what kind of virus?
DNA Can lead to hepatocellular cancer Vertical transmission is typically if mom has high viral load Treat with tenofovir in 3rd trimester OK for Vag del, BF, etc
Cardiomyopathy EF?
<45%
30-50% will fully recover after
If GFR after is >50%, recurrence risk is 20%
If GFR is <50%, recurrence risk is high and mortality is 16%
Lemon Sign
Spina Bifida (most associated with obesity)
Banana Sign
Chiari
Strawberry Cervix
Trichomonas (PO Flagyl only)
Blueberry muffin rash
CMV or rubella
Kernicterus
Sulfonamides
Cataracts, Cardiac defects, Deafness
Congenital Rubella
Microcephaly causes
Radiation (M phase)
Zika
CMV
13
Trisomy 13 = Patau, midline facial defects
Highest bishop score
Chromosome for BRCA 2
17
Chromosome for BRCA 1
Cerebral Palsy
Periventricular Leukomalacia
Tetracycline teratogenicity
Teeth staining
Avg age menarche
12.8yoa
BPAM
Breast (Thelarche)
Pubic hair
Axillary hair
Menarche
Primary amenorrhea
15yoa w/2nd sex characteristics
13yoa w/o 2nd sex characteristic
Kallman’s syndrome
Primary amenorrhea
Anosmia
5’6 or taller
Klinefelter Syndrome
47XXY
Azoospermia
Gynecomastia
Precocious puberty
Get a bone age
McCune Albright: fibrous dysplasia, precocious puberty, cafe au lait spots
Sheehan Syndrome
Necrosis of pituitary, 2nd amenorrhea, inability to lactate
Dysgerminoma
most common germ cell tumor (40%) most common germ cell tumor in pregnancy Associated with LDH elevation See large cyst, ascites, fevers Lymphocyte infiltrates on pathology
Cyclophosphamide
POF, hemorrhagic cystitis (give Mesna)
Vinblastine
Toxic to bone marrow (M phase)
Granulosa Cell
Sex cord stromal tumor
Call exner bodies, coffee been nuclei
Elevated inhibin B (can get high E, and concomitant endometrial cancer)
Krukenberg tumor
Gastric cancer
Signet ring cells
Brenner tumor
Walthard Rests?
Nuclear Grooves
Granulosa Cell and Brenner tumors
Schiller Duval bodies
Endodermal Sinus/Yolk Sac tumor
Elevated AFP, can see hemorrhagic cysts
Hob Nail
Clear Cell Carcinoma
Psammoma Bodies
Serous tumors
Dilated pupils
Cocaine
Pinpoint pupils
Heroin, morphine, opioids
13-18 yoa primary cause of mortality
Accidents
Avg blood loss per period
30-50ml
Menorrhagia >80mL per cycle
TTP treatment
Plasmphoresis
ITP treatment
1) Steroids
2) IVIG
3) Platelet transfusion
BPD at term
9.3cm avg
Lithium
Ebstein’s Anamaly
Inhibin A is high in what part of menstrual cycle
AFTER ovulation (with progesterone)
Inhibin B is high at what stage of menstrual cycle
BEFORE ovulation (with estrogen)
Streptomycin on fetus
Fetal high tones hearing loss
Chloramphenicol on fetus
Gray baby syndrome
Femoral Nerve root
L2-4
Quads weakness, cant climb stairs, anterior leg numbness
Cause: self-retaining retractors
Obturator nerve root
L2-4
Adductor longus, inability to adduct, from direct injury in space of retzius or needle injury during TVT
Peroneal nerve root
L4-S2
Foot drop
Caused by dorsal lithotomy
Genitofemoral nerve root
L1-2
Loss of sensation of vulva/anterior medial thigh or burning, from skin incision location
Side effects of Cisplatin or Carboplatin
Ototoxicity
Nephrotoxicity
Doxorubicin
Cardiotoxic
Methotrexate and 5 FU
Myelosuppresion
Vinca Alkaloids
Peripheral Neuropathy M phase (all other chemos are basically M phase)
Reinke Crystalloids
Lipid (Hilus) cell tumors
hirsutism
CEA elevated in
Mucinous tumors
CRIST my nerves and BLAST my bones
Vincristine has HIGH neurotoxicity, low marrow tox
Vinblastine has HIGH marrow toxicity, low neuro
Treatment of Cervical Cancer: stage IA1
<3mm stromal invasion
Do CKC or simple hysterectomy if done with childbearing
Treatment of Cervical cancer IA2
Stromal invasion 3-5mm Radical Hysterectomy (can do trachelectomy) but need LND
Most common GYN malignancy
Endometrial Cancer
Most LETHAL GYN malignancy
Ovarian Cancer
Most diagnosed malignancy in pregnancy
Breast cancer
Most common malignancy during pregnancy
Cervical cancer
Rarest GYN malignancy
Fallopian tube cancer
Most common ovarian neoplasm in reproductive aged women
Dermoids
Most common ovarian neoplasm is all age groups
Serous cystadenoma
Septic Shock, SVR is…
LOW
Caused by sepsis, anaphylaxis, etc
Tx = IVF, Pressors (Epi), Abx
Cardiogenic shock, CO is
LOW
Hypovolemic shock, SVR is?
SVR is HIGH
PCWP is low (volume down)
CO is low (volume down)
Aortic insufficiency, dont give…
Nifedipine
Myasthenia gravis, dont give…
Magnesium!
Most common type of myoma degeneration
Hyaline (65%)
most common in pregnancy is Carneus
Most common type of fibroid degeneration IN PREGNANCY
Carneous (red, meaty, like carne asade)
BRCA 1 cancer risk
Breast 70%
Ovarian 40%
BRCA 2 cancer risk
Breast 70%
Ovarian 20%
PTEN mutation is seen in what familial cancer syndrome
Cowden
get those facial bumps
TP53 is associated with which familial cancer syndrome
Li-Fraumeni
Genes in Lynch Syndrome
MLH1 (promotor methylation) MSH2 MSH6 PMS2 Diagnosis = IMMUNOHISTOCHEMISTRY
CDKN is gene marker for what cancer?
Melanoma
2nd most common vulvar cancer
*If melanoma hx, always send placenta for path
CA 19-9 elevated in
Pancreatic and GI cancers
HE4 elevated in
Epithelial ovarian cancers
APC is marker for
Familial Adenomatous Polyps
STK 11 is cancer gene seen in…
Peutz Jeghers
see oro-facial freckling
Things than can be calcified on an xray of pelvis
Calcified fibroid Kidney stone Gallstone ileus Fetus (Lithopedian) Dermoid (teeth) Papillary ovarian cancer Appendolith Phlebolith
Most common malignant ovarian neoplasm
Dysgerminoma
Tx of orgasm disorder
Directed masturbation (!) - gasp
Lab findings in T2DM
A1c >6.5%
Microalbuminemia
Fasting >126
2hrs >200
Which of the following is the least likely indication for intubation in a 27wk gravida?
A. RR of 40 B. Respiratory fatigue C. PCO2 of 40 D. Blood pH of 7.35 E. PO2 of 60
D. Blood pH of 7.35
***pCO2 >40 is indication for INTUBATION
Meiosis begins at what GA? A. 8wks B. 12wks C. 16wks D. 24wks E. 32wks
B. 12 wks
During cystoscopy, you see multiple bladder contractions. What is the most likely diagnosis?
A. UTI
B. Genuine SUI
C. IC ("bladder pain syndrome"
D. Urethral syndrome
E. Urethral hypermobilityA. UTI (detrusor dyssynergia)
Patient has new diarrhea after going to a picnic. Most likely organism is: A. Salmonella B. Giardia C. Staph A D. Ecoli E. Listeria
C. Staph - common in MAYO, tx with LR
- Salmonella is more common in chicken, eggs
- Giardia is in ponds, creeks, untreated water
- Listeria is in cantaloupes, unpasteurized cheeses (queso), processed meats
You are performing a CS and the patient is actively bleeding but hemodynamically stable. All pharmacological methods fail. What is the least likely management? A. Hypogastric artery ligation B. Uterine artery ligation C. Uterine artery embolization D. Compression stitch E. B-lynch
C. UAE - would need to move to radiology and she is unstable
The least likely side-effect of MTX is: A. irreversible alopecia B. Pulmonary damage C. Myelosuppression D. Stomatitis E. Diarrhea
Least likely is A) alopecia
Most likely is GI symptoms and, from this list, D
What is the most important prognostic factor for a woman with endometrial adenocarcinoma? A. Age B. Grade C. Stage D. +peritoneal washings E. +aortic LN
C. STAGE
- least important is D. peritoneal washings, not used in staging
An infant you just delivered has ambiguous genitalia. There are fused labio-scrotal folds as well as an enlarged clitoris. No gonads are palpable. Most likely genotype is: A. 46 XX B. 46 XY C 45 X0 D. 47 XX +21 E 47 XYY
A. 46 XX - with CAH, 21 alpha hydroxylase def (AR)
Obesity is defined as a BMI of: A. 25 B. 30 C. 35 D. 40 E. 45
B. 30
BMI 25 is overweight
30-35 Class I
35-40 Class II
40+ Class III/”morbid”
26yo G1P1 presents to ER unconscious. Medical bracelet say panhypopituitarism. What is first step in her mgmt? A. MC B. ACTH C. ADH D. GCs E. Lasix
D. Glucocorticoids
- first treat w/hydrocortisone b/c thyroxine exacerbates GC depletion
In fetal-maternal circulation, where is the highest PaO2 found? A. Maternal uterine artery B. Umbilical artery C. umbilical vein D. fetal hypogastric artery E. maternal uterine vein
A. Maternal uterine artery (90-100%)
During gyn surgery, you dissect the broad ligament. Where is ureter found?
A. 3cm lateral to cervix
B. lateral leaf
C. 2cm superior to US ligament
D. Anterior aspect of the broad ligament
E. Medial leaf of the pelvic sidewall peritoneum
E. medial leaf
and 1-2cm from cervix at level of internal os
Of the following malformations, which is associated with the use of lithium during pregnancy? A. pulm B. GI C. CNS D. Renal E. Cardiac
E. Cardiac
-Ebsteins anomaly
Patient with endometriosis was treated with Luprolide acetate one week ago. She now has abdominal pain. This is most likely secondary to: A. increased progesterone level B. ischemia of surrounding tissue C. increase in endogenous estrogen D. infection E. inflammation
C. due to flare effect after gnRH therapy
Where would an abnormal finding be on neurological imaging after an eclamptic seizure? A. Occipital lobe B. Temporal love C. Cerebellum D. HT E. Pituitary gland
A.
A 16yo Tanner stage II with hypoplastic breasts and sparse pubic hair has FSH 4 and LH 3. Most likely dx is: A. Testicular feminization B. Hypogonadotropic hypogonadism C. CAH D. Mullerian Agenesis E. Turner syndrome
B. look at CNS causes
D - have normal FSH/LH usually
E - have elevated FSH
Which of the following is a late complication following a SSLF: A. Anterior vaginal wall prolapse B. Uterine prolapse C. Dyspareunia D. medial thigh pain E. enterocele
A. SSLF fixes apical and then can have anterior prolapse after
Which of the following can cause IUGR prior to 26wks? A. Cocaine B. Tobacco C. EtOH D. gHTN E. Class C DM
E. DM (class C = dx btw 10-19yoa)
What is the strongest sonographic sign of an ovarian malignancy? A. multiloculations B. Papillary excrescences C. Neovascularization D. Solid components E. hyperechoic areas
B. nodularity and papillary shit is the worst
Refer to Onc also if PMP, CA125 >35 (>200 in pre-MP), size >10, ascites, septations >3mm (thick)
49yo with renal impairment is scheduled for pelvic CT scan w/contrast, which of the following medications should be given prior to the procedure? A. Diphenhydramine B. BMZ C. DMZ D. Acetylcysteine E. Observation
D. Mucomyst helps protect kidney and ureters from contrast dye (also given prior to cardiac cath)
- can also pre-hydrate with IVF
The most likely cause of a SBO in a 55yo female is: A. Malignancy B. Constipation C. Adhesions D. Diverticulitis E. IBS
C. Adhesions - or extraluminal causes (adhesions > hernias > cancer > infection)
The most common cause of peptic ulcer disease in a reproductive age female is: A. Infection B. Stress C. Anti-inflammatory medications D. Alcohol E. Tobacco use
A. Infection with H, Pylori
- other causes do include NSAIDs, alcohol, and less common - stress
Which of the following muscles is responsible for maintaining anal continence? A. EAS B. IAS C. Coccygeous D. Bulbocavernosis E. Levator Ani
B. Internal Anal Sphincter - provides resting anal tone
A patient with infertility is undergoing induction of ovulation with HMG/hcg. What is the best test to follow her progress? A. FSH B. LH C. Progesterone D. Estradiol E. Endometrial thickness
D. Estradiol
HMG is LH/FSH, so can only measure estrogen
A 19yo is dx with AIS, what is the least likely finding? A. Breast development B. Blind vaginal pouch C. Clitoromegaly D. Elevated T E. Male pseudohermaphrodite
C. Clitoromegaly (think 17,20 desmolase def with this one)
Under what circumstance is giving Rhogam LEAST indicated? A. ECV B. Missed AB at 6wks w/o YS/FP C. 2nd trimester amnio D. Abd trauma E. 1st trimester SAB
B.
Which of the following is a maternal physiological change associated with sPEC? A. hemodilution B. Occipital vasocongestion C. increased renal blood flow D. Placental infarction E. Decrease in GFR
E. Decrease in GFR –> vasospasm (not vasocongestion), hemoconcentration (no dilution), decreased oncotic pressure, increase PCWP, pulmonary edema
Oral contraceptives are associated with an increased risk of: A. Chlamydia B. Endometrial Cancer C. HSV D. Ovarian cancer E. uterine fibroids
A. Increased risk of CT, decreased risk of GC and Ov cancer
WHY? WTF knows
if an AD disorder is transmitted from parent to child, which of the following is the recurrence risk? A. 1 B. 25 C. 33 D. 50 E. 100
D. 50%
Metastases to which organ system poses the worst risk to the patient with GTD? A. Lung B. Spleen C. Vagina D. Brain E. Bone
D. Brain and liver are the worst –> need EMA-CO
Lowest risk is lung (A)
What are the 5 red cell antigens???
C, c, D, E, e
There is no d
Most common D > E > c > C
Titer threshold is >1:16 to do cordocentesis, etc (>1:8 in anti-Kell)
Which of the following urogyn procedures has the highest rate of bladder perforation? A. MMK B. Burch C. TVT D. TOT E. Kelly plication
C. TVT (3-9% rate of bladder perf)
All of the following are seen with OHSS except: A. ascites B. changes in CVP C. Tachycardia D. HyperK E. Hypervolemia
E. Hypervolemia –> actually see volume depletion, hemoconcentration
Tx is fluid hydration and electrolyte repletion, albumin, possible tap, anticoag
Which type of sexual practice is most likely to transmit the HIV virus? A. receptive anal sex B. Receptive vaginal sex C. Receptive oral sex D. insertive vaginal sex E. insertive oral sex
A. its the anal
