Practice Questions Flashcards
1
Q
what to do if ASCUS on pap smear
A
- -> HPV testing
a. If HPV testing positive –> Colposcopy
b. If HPV testing negative –> co-testing (cytology + HPV) repeated in 3 years
2
Q
Acute Salpingitis (PID)
A
abd pain, adnexal tenderness, fever, cervical motion tenderness, and vaginal discharge
3
Q
Mucopurulent cervicitis with exacerbation of symptoms during and after menstruation
A
–> Gonorrhea
4
Q
Primary herpes
A
painful genital ulcerations, fever, dysuria.
a. DX with culture of lesion (best to culture early in the course)
5
Q
- Trichomoniasis
A
erythematous patches on cervix, strawberry cervicitis, frothy yellow-green vaginal discharge
a. Unicellular protozoans with flagella
6
Q
- Pulmonary edema in pregnancy - why?
A
a. Decreased plasma osmolality during pregnancy –> increase susceptibility to pulmonary edema
b. Tocolytic use, cardiac disease, fluid overload, and preeclampsia, also all increase risk of pulm edema
7
Q
- Ureteral dilation during pregnancy
A
a. Right ovarian vein complex gets very dilated during pregnancy, and lies obliquely over R ureter –> contribute to R ureteral dilation
b. Often get dilation in R>L because sigmoid cushions L ureter
8
Q
- Molar pregnancy
A
US í heterogeneous cystic tissue in the uterus (snowstorm pattern)
a. Get CXR because lungs are most common site of metastatic disease
b. Repeat quantitative Beta-HCG Q week post-op
9
Q
- Increased minute ventilation during pregnancy causes a ________ __________ __________
A
compensated respiratory alkalosis
10
Q
- Gestational diabetes –> increases risk for…
A
shoulder dystocia metabolic disturbances (hypoglycemia) preeclampsia polyhydramnios fetal macrosomia
11
Q
previous pregnancy complicated by fetal neural tube defects…recommend how much folic acid supplementation?
A
4 mg
12
Q
_______ of fetal age can cause an elevated AFP
A
underestmation
13
Q
which anticoagulants are safe during pregnancy?
A
- LMW Heparin is safe during pregnancy, warfarin is teratogenic
14
Q
- Chorioamnionitis (sx of baby)
A
–> fetal tachycardia, minimal variability, pale, lethargic, high temperature
15
Q
- Twin-Twin transfusion syndrome: donor vs. recipient
A
complication of monochornionic pregnancies.
Under perfusion of DONOR twin –> becomes anemic + oligohydramnios + IUGR
over perfusion of RECIPIENT —> becomes polycythemic + polyhydramnios + volume overload, HF and hydrops)
16
Q
- APGAR
A
a. HR, RR, Reflex, Activity, Color (all 0-2)
17
Q
- Sheehan syndrome - presentation? pathology?
A
significant blood loss –> anterior pituitary necrosis –> loss of TSH, ACTH, LH/FSH.
a. SX = slow mental function, weight gain, fatigue, difficulty staying warm, no milk production, hypotension, and amenorrhea
18
Q
- Most common cause of post-partum fever is _______
A
endometritis (10-15% in C-section patients)
a. Most commonly caused by staph or strep, but can be a mixture of aerobes and anaerobes.
19
Q
Hormones of milk secretion
A
- Estrogen and progesterone inhibit the secretion of prolactin. After deliver, they decrease, and allow prolactin to act to stimulate milk synthesis.
a. Oxytocin is responsible for milk ejection and is stimulated by suckling
20
Q
- Candida of the nipple
A
is the only one that causes severe discomfort and pain
a. TX with topical clotrimazole or miconazole cream
21
Q
- Anovulation
LH? FSH? estrogen?
A
Normal LH and FSH, normal estrogen.
a. Caused by obesity
b. Progesterone is NOT being produced at normal post-ovulation levels, therefore progesterone withdrawal menses at the end of the cycle does not occur
22
Q
- Premature ovarian failure
LH? FSH? estrogen?
A
elevated FSH and LH (FSH > 40, LH > 25), decreased estrogen
a. Occurs in women aged < 40 yrs
23
Q
- External cephalic version (ECV)
A
maneuver to convert breech into vertex.
a. Can be performed between 37 weeks and onset of labor
b. Reduces rate of C/S
c. Contraindications: ruptured membranes, fetal/uterine abnormalities, non-reassuring fetal monitoring, oligohydramnios, placenta abnormalities, hyperextended fetal head
24
Q
- Granulosa cell tumor of the ovary
- sx in children? postmenopausal?
A
large adnexal mass
a. Child –> precocious puberty
b. Postmenopausal woman –> bleeding/endometrial hyperplasia
c. Tumor secretes estrogen –> breast tenderness
25
24. Menopausal genitourinary syndrome
due to estrogen deficiency
a. Bladder trigone, urethra, pelvic floor muscles, and endopelvic fascia have estrogen receptors and are maintained by adequate estrogen
b. --> atrophy of superficial and intermediate layers of the vagina and urethral mucosal epithelium --> diminished urethral closure pressure and loss of urethral compliance = urgency, frequency, UTIs, and incontinence (stress and urge)
c. Also will have vulvovaginal atrophy
TX: moisturizers and lubricants for mild atrophic vaginitis, if urinary symptoms are presents can treat with low-dose vaginal estrogen therapy
26
25. Postpartum urinary retention
a. Risks: primiparity, regional anesthesia, operative vaginal delivery, C/S
b. Sx: inability to void or small-volume voids w/incomplete bladder emptying or dribbling
c. Tx: self-limited, intermittent catheterization
27
26. Ovarian torsion
a. Sx: sudden-onset unilateral pelvic pain + N/V +/- palpable adnexal mass
- -> US with Doppler shows adnexal mass w/absent flow to ovary
b. TX: laparoscopy with detorsion, ovarian cystectomy, oophorectomy if necrosis or malignancy
28
27. Fibroids
| sx?
--> heavy menses, constipation, urinary frequency, pelvic pain/heaviness, enlarged uterus
29
28. Adenomyosis
--> endometrial glands in the myometrium --> dysmenorrhea, pelvic pain, heavy menses, bulky/globular/tender uterus
30
29. Dermoid ovarian cyst
mature cystic teratoma): common, benign germ cell tumor, occurs in premenopausal women
a. US --> hyperechoic nodules and calcifications
31
30. Mittelschmerz
recurrent mild and unilateral mid-cycle pain prior to ovulation.
a. Pain lasts hours to days
32
31. Ruptured ovarian cyst
sudden-onset, severe, unilateral lower abdominal pain immediately following strenuous or sexual activity --> pelvic free fluid on US
33
32. Tocolytics
help to prevent contractions and the progression of labor, allow for administration of Betamethasone steroids
34
33. Management of pPROM:
a. Abx (ampicillin) --> evidence that it prolongs onset of labor
b. Tocolytics --> controversial, may actually be harmful
c. Steroids --> use them
35
34. Causes of FHR decelerations
a. Preuterine: anything causing maternal hypotension or hypoxia
b. Uteroplacental: issues including placental abruption, infarction, and hemorrhaging previa, or uterine hyper stimulation
c. Post placental: cord prolapse, cord compression, rupture of a fetal vessel (e.g. vasa previa)
36
35. Shoulder dystocia
after delivery of head, impaction of anterior shoulder behind the pubic symphysis
a. Can cause erb palsy
37
36. Causes of small for gestational age (SGA) (2)
1) Decreased growth potential
| 2) Intrauterine growth restriction
38
Decreased growth potential (3 causes)
i. Congenital abnormalities
ii. Intrauterine infections (CMV, rubella)
iii. Exposure to teratogens, ETOH
39
b. Intrauterine growth restriction
i. Before 20 weeks (growth is primarily hyperplastic, increase # of cells)
- -> insult before 20 wks --> symmetric growth restriction
ii. After 20 weeks (growth primarily hypertrophic, increase cell size)
--> insult causes asymmetric growth
due to: Decreased nutrition, oxygen being transmitted across placenta, decreased placenta blood flow
40
How to differentiated SGA and IUGR?
i. Differentiate with IUGR because SGA will start small and stay small, whereas IUGR will fall off the growth curve
41
37. Causes of large for gestational age (LGA)
a. Weight > 4,500 g
| b. Macrosomia
42
Macrosomia
increased risk shoulder dystocia
i. Increased risk with poorly controlled DM, increased maternal weight gain in pregnancy, maternal obesity, previous baby LGA, post term pregnancies, multiparity, advanced maternal age
43
a. Oligohydramnios
either decreased production (by fetal kidneys/lungs) or increased withdrawal (by placenta or swallowed) of amniotic fluid
- Causes:
1. Chronic uteroplacental insufficiency
2. GU tract abnormalities (potter syndrome ARPKD
-AFI <5
44
b. Polyhydramnios
i. AFI > 20-25
ii. Causes: obstruction of baby GI tract, increased blood glucose causing increased fetal urination
iii. Hydrops secondary to high output cardiac failure can result
45
39. Alloimmunization anemia
a. Erythroblastosis fetalis --> anemia causes increased extramedullary hematopoiesis
i. Can result in fetal hydrops, pericardial effusion, edema, heart failure, ascites
b. Will have increased bilirubin
c. Titers must be > 1:16, D type
46
40. Post term Pregnancy:
a. Increased risk of macrosomic infants, oligohydramnios, meconium aspiration, intrauterine fetal death, and dysmaturity syndrome, also greater risk to mom
47
41. Fetal growth restriction:
| MUST ASSES...
twice weekly NST + AFI + weekly umbilical artery doppler studies is indicated to monitor fetuses with IUGR
i. Amniotic fluid volume (often oligo),
ii. Systolic/diastolic (S/D) ratio of umbilical artery (increased = increased vascular resistance - eventually can get absent end-diastolic flow)
48
b. IUGR associated with:
increased risk of CV disease, chronic HTN, stroke, COPD, obesity, and T2DM
49
43. Chorionic villus sampling (CVS)
is used to detect genetic and chromosomal abnormalities
a. Can be performed at 10-12 wks (vs. amniocentesis, which is at 15 wks)
b. Higher risk of fetal loss than with amnio
c. More likely to require multiple attempts to get adequate sample
50
44. Hysteroscopic tubal occlusion
can be performed in office - place coils into the fallopian tubes that cause scarring that blocks the tubes.
a. Must use back up contraception for 3 months following procedure
51
a. Complete HM
abnormal fertilization of an empty ovum by 2 sperm or by 1 sperm that duplicates its DNA
i. --> very high HCG --> ovarian hyper-stimulation --> formation of theca lutein cysts (large BL, multilocular ovarian cysts)
1. Theca lutein cysts resolve after treatment of HM
ii. SNOW STORM
iii. More associated with high risk of malignancy
52
Mechanism of action of tamoxifen
i. Tamox --> selective estrogen receptor antagonist in the breast, and estrogen AGONIST in the uterus --> excess endometrial proliferation --> increased risk of carcinoma
NOT seen with raloxifene
53
47. Arrest of descent:
a. No cervical change for >4hrs with adequate contractions OR no cervical change for >6 hours with inadequate contractions
--> C/S
54
48. Intraductal papilloma
unilateral bloody discharge, no associated mass or lymphadenopathy
55
1. Congenital adrenal hyperplasia
a. 21-hydroxylase deficiency --> elevated 17a-hydroxyprogesterone
b. Ambiguous genitalia, hyperandrogenism with salt wasting, hypotension, hyperkalemia, and hypoglycemia
c. Can cause labial fusion
adrenal gland unable to produce adequate cortisol --> accumulation of adrenal androgens --> precocious adrenarche
a. TX: steroid replacement
56
2. Imperforate hymen
obstruction of outflow tract of the reproductive system
a. Presents at birth or in adolescents with primary amenorrhea with cyclic pelvic pain.
i. í tense bulging hymen
b. Tx w/ surgery
57
c. Transverse vaginal septum
presents similarly, but physical exam shows blind pouch w/ normal external genitalia
58
3. Vaginal agenesis
agenesis of all or part of the cervix, uterus, and fallopian tubes w/normal external genitalia
a. Phenotypically and genotypically female
59
4. Lichen sclerosis
typically in postmenopausal women
a. Atrophy w/resorption of labia minora, labial fusion, occlusion of the clitoris, contracture of vaginal introitus + increased risk vulvar cancer
60
5. Lichen planus
effects skin, nails, scalp, mucosa
| a. Papular/erosive vulvar lesions, purple papules, vaginal adhesions
61
6. Lichen simplex chronicus
thickened skin w/accentuated skin markings/excoriations
62
7. In utero DES exposure
linked with clear cell adenocarcinoma of the cervix and vagina
63
8. Normal sequence of sexual maturation:
breast budding/thelarch --> adrenarch (hair growth) --> growth spurt --> menarche
64
9. Kallman syndrome:
a. No sense of smell, females do not develop secondary sexual characteristics
b. TX: pulsatile GnRH therapy
65
11. Mullerian agenesis
uterus and cervix are absent, but ovaries function normally í normal secondary sexual characteristics w/46XX karyotype and normal testosterone
a. Renal anomalies occur in 25-35% of females with this
66
12. For abnormal anovulatory bleeding, mostly due to...
mostly due to proliferative endometrium from unopposed stimulation by estrogen
a. Progestins inhibit further endometrial growth --> convert proliferative to secretory endometrium --> withdrawal of progestins then mimics the effect of inovulation on corpus luteum, creating a normal sloughing of the endometrium
67
13. Leiomyomas:
a. Submucosal
b. Intramural:
c. Subserosal:
a. Submucosal: beneath endometrium
- Associated with heavy/prolonged bleeding and can affect fertility
b. Intramural: in muscular wall of uterus
i. Most common
c. Subserosal: beneath uterine serosa
68
13. Leiomyomas - tx?
i. NSAIDS, transexamic acid (for dysmenorrhea and heavy bleeding)
ii. OCPs, Progestins, Mifepristone, androgenic steroids, GnRH agonists
1. GnRH agonists can shrink fibroids and decrease bleeding by decreasing circulating estrogen levels. (growth resumes after cessation)
69
a. Functional cysts: (4)
i. Follicular cysts
ii. Corpus luteum cysts:
iii. Theca Lutein cysts:
iv. Endometrioma:
70
i. Follicular cysts
most common, due to failure of follicle to rupture during follicular maturation phase of the menstrual cycle
1. Can increase risk of ovarian torsion
2. Usually resolve spontaneously in 60-90 days
71
ii. Corpus luteum cysts:
1. Occur in the luteal phase of the menstrual cycle
| 2. Can cause pain if hemorrhagic
72
iii. Theca Lutein cysts:
1. Large, bilateral cysts filled with clear, straw-colored fluid
2. Due to abnormally high B-HCG stimulation (moles, multiple gestations, Gnrh infertility tx)
-secrete an excess of androgens into circulation
73
iv. Endometrioma:
growth of ectopic endometrial ovary
| 1. "Chocolate cysts"
74
15. Septic pelvic thrombophlebitis
complication associated with either pelvic surgery or the postpartum period
a. Thrombosis of the deep pelvic or ovarian veins (e.g. bilateral lower abdominal tenderness)
b. Persistent fever, unresponsive to broad-spectrum abx with a negative infectious evaluation í dx of exclusion
75
16. Neonatal thyrotoxicosis:
a. Transplacental passage of maternal anti-TSH receptor antibodies --> ab binds to infant's TSH receptors and cause excessive thyroid hormone release.
b. Baby--> warm, moist skin, tachycardia, poor feeding, poor weight gain, irritability, low birth weight
c. TX: self-resolves within 3 months or methimazole + B-blocker
76
which ssri contraindicated in pregnancy?
a. Paroxetine is contraindicated in pregnancy - CLASS D
77
FFP contains....
a. FFP contains factor V and VIII, fibrinogen
78
hair loss during pregnancy caused by....
estrogen surge
79
estrogen effect on lipid panel?
a. Estrogen --> increase LDL, decrease HDL
80
Pathophysiology of HELLP
Results from abnormal placentation, triggering systemic inflammation and activation of the coagulation system and complement cascade
-circulating platelets are consumed, and microangiopathic hemolytic anemia occurs --> hepatocellular necrosis and thrombi in the portal system --> elevated liver enzymes, liver swelling, and distension of the hepatic capsule
81
Acute fatty liver of pregnancy
can cause acute hepatic failure in the third trimester or early postpartum period
- -> prolonged PT and PTT
- -> hypoglycemia, encephalopathy
82
Breastfeeding contraindications
- active untreated TB
- maternal HIV (in developed countries only, where formula is available)
- Herpetic breast lesions
- Active varicella infection
- chemotherapy or radiation therapy
- active substance abuse
- infant with galactosemia
83
MVP in pregnancy: palpitations, intermittent chest pain, systolic ejection murmur with click
treatment?
For women who are symptomatic, b-blocking drugs are given to decrease sympathetic tone, relieve chest pain and palpitations, and reduce the risk of life-threatening arrhythmias
