pregnancy care, amenorrhea

Question 1

Gonadal dysgenesis

Answer 1

ovaries are replaced by tissue called gonadal streak, no produciton of ovarian steroids ie estrogen, so no breasts, but internal and extern al gentialia are phenotypically female FSH LH elevted due to lack of negative feedback,

Question 2

Primary amenorrhea, breast present, but uterus absent

Answer 2

1. mullerian agenesis ( 46,xx) mullerian structures just don’t form, normal testosterone 2. Androgen insensitivity syndrome (46, xy) male but no androgen receptor so will see no pubic hair

Question 3

primary amenorrhea: no breasts, uterus present

Answer 3

1. no ovarian follicle top produce sex steroid, estrogen ( FSH high) GT17 Gonadal Dysgenesis, Turner Syndrome 17alpha-Hydroxylase deficiency 46(,XX) 2. HPA Axis disorder, low (FSH from lack of GnRh secretion) Kallman Syndrome, lesion in brain

Question 4

primary amenorrhea: no breasts, no uterus

Answer 4

17 alpha hydroxylase 46,XY

Question 5

normal semen analysis: sperm count, motility, morphology, volume

Answer 5

sperm count >15 million/mL; motility (>40%); morphology >4%; >1.5mL

Question 6

Infertility diagosis

Answer 6

<35yo - no concepiton after 12 months of trying’ >35 yo 6 months of trying

Question 7

When should hysterosalpingogram be performed and why?

Answer 7

day 6-11 of cycle to avoid contrast injection when patient is pregnant

Question 8

To assess ovulation, what hormone level, when, cutoff?

Answer 8

day 21 (mid liteal phase) progestrone >3ng/mL means pt is ovulatory

Question 9

single lab to assess ovarian reserve

Answer 9

anti-mullerian hormone

Question 10

McCune Allbirght Syndrome 3 P’s

Answer 10

1. precocious puberty 2. polyostotic fibrous dysplasia 3. pigmentation Café-au-lait spots

Question 11

virilization

Answer 11

female developing characteristics associated with male hormones

Question 12

OB visit frequency when GA <28 weeks

Answer 12

every 4-6 weeks

Question 13

OB visit frequency when GA 28-36 weeks

Answer 13

every 2-3 weeks

Question 14

OB visit frequency when GA 36-41 weeks

Answer 14

weekly

Question 15

OB visit frequency when GA 41-42 weeks

Answer 15

2x/week

Question 16

modified biophysical profile (mBPP)

Answer 16

NST and AFI

Question 17

Subsequent OB Physical Exams

Answer 17

BUFF: BP, Urine dip( glucose, leukocytes, protein), Fundal Height, Fetal Heart Rate

Question 18

Postpartum endometritis antibiotic

Why?

Answer 18

Gentamicin and clindamycin

Covers gram + cocci, anaerobes (clindamycin)

Covers gram - bacilli (gentamicin)

Question 19

diabetes is screened at

Answer 19

26-28 weeks

Question 20

Rhogam is given

Answer 20

after amniocentesis, at 28 weeks, and after delivery \

• hangs around system for 12 weeks hence given at 28 to cover delivery

Question 21

Abruptio placentae occurs

Answer 21

after 20 weeks gestation ,

• premature placental separation , characterized by pain, abnormal bleeding, and contractions

Question 22

GA from fundal height at:
- pubic symphysis
- between pubic symphysis and umblilicus
-at umbilicus

Answer 22

12 weeks
16 weeks
20 weeks

Question 23

cortisol and gnrh relationship

Answer 23

high cortisol would suppress the release of gnRh and cause amenorrhea due to negative feedback

Question 24

thalessemia presents as ________anemia

Answer 24

microcytic

Question 25

Vasa previa management

Answer 25

• schedule c-section at 34-35 weeks, unless ROM then emergency c-section

Question 26

post party urinary retention

Answer 26

-bladder atony from neural injury

Question 27

In pregnancy, influenza vaccine should be given

Answer 27

prior to the influenza season

Question 28

In the setting of prelabor rupture of membrane what should be done?

Answer 28

> 37 weeks, induction of labor
34- <37 weeks : steroids and induction, delivery
24-<34 weeks: Mg( <32 weeks), latency antibiotics, steroids

Deliver if there is infectionm fetal or mternal compromise