Qbank, Pretest, Uwise Flashcards
What is the most common cause of puerperal fever 2 or 3 days postpartum?
Endometritis- polymicrobial infection, treat with clindamycin and gentamicin
What is the cutoff to differentiate chronic HTN and HTN 2/2 pregnancy?
20 weeks
What is the most commonly identified risk factor for placenta abruption?
HTN
What is another treatment for Chlamydia besides doxycycline?
Single dose of azithromycin
A woman admitted for delivery has repetitive decreases in fetal heart rate at the same time as contractions and end before contractions stop- definition and likely diagnosis?
Early decelerations
Most likely fetal head compression
How is late deceleration different than early?
Late continues after contraction
How does clomiphene work?
Improves GnRH and FSH release thereby inducing ovulation
What is the name for plan B
Levonorgestrel
A mother @ 28 weeks gestation comes in and the baby has no heart sounds and no fetal movements. A dead fetus is evacuated- next step
Autopsy of fetus to look for cause of death- can treat possible recurrence in future pregnancy
Treatment for lactation suppression?
Tight fitting bra and ice packs
What should be done when placenta abruptio is diagnosied?
If in labor- vaginal delivery with augmentation of labor
If not in labor- no cervical changes- then C section
Why? Retroplacental hemorrhage is impetus for DIC
A 7 year old girl with precocious puberty and a pelvic mass has what type of tumor?
Granulosa cell tumor- secretes estrogen
A 36 year old woman presents with abnormal uterine bleeding, stable vital signs, and normal hemoglobin- next step?
Endometrial biopsy to r/o hyperplasia or carcinoma
Diagnostic test for fetal down’s syndrome?
Chronic villus sampling between 10-12 weeks
What happens to patients taking levothyroxine during pregnancy?
Must Increase dose- estrogen causes increased metabolism so increase dose
What happens to BUN and Cr during pregnancy?
Both decrease due to increase renal plasma flow
An antepartum hemorrhage with fetal heart changes from tachycardia to bradycardia with normal vital signs in mother is typical presentation of what?
Ruptured fetal umbilical vessel
What is the treatment of choice for endometrial hyperplasia WITHOUT atypia?
Cyclic progestins for 3-6 months then repeat biopsy
A patient with vaginal discharge has a vaginal pH of 5.5- what are two presenting symptom that can differentiate bacterial vaginosis from trichomonas- both present with pH > 4.5?
Trichomonas causes erythema and pruritus
What is the best test for syphilis diagnosis?
Dark-field micrscopy- RPR has a high false negative rate!
A patient at 42 weeks gestation is stable- what should she be monitored for? How?
Oligohydramnios is associated with prolonged pregnancy
Monitor with twice weekly US
A patient presents with virilization and undetectable estrogen with high FSH and LH- diagnosis?
Aromatase deficiency- cannot convert testosterone to estrogen
What are the three antibiotics used for treatment of UTIs in pregnancy?
Nitrofurantoin, Amoxicillin, Cephalexin
What is one way to convert a breech presentation to cephalic after 36 weeks?
External cephalic version- however must be prepared for emergent C section if fetal distress occurs
What is the treatment for lichen sclerosis?
Topical corticosteroids
Use topical estrogen for vaginal atrophy
A biophysical profile assesses fetal tone, fetal movements, breathing movements, amniotic fluid volume, and nonstress test- if the score is low what should be done and what does this show?
Immediate delivery due to fetal asphyxiation
What does placenta previa present as?
Painless 3rd trimester bleeding
What is the triad of hydatidiform mole? How can it be ruled out?
Enlarged uterus, hyperemesis, b-hcg > 100,000
Get b-hcg level
In the workup of primary amenorrhea, what is the next step if there is a uterus on US? What if there is no uterus?
Uterus- get FSH- increased indicates peripheral cause whereas decrease indicates central cause (get MRI)
No Uterus- get karyotpying
What disease presents with pruritis and increased serum bile acids during 2nd or 3rd trimester? Tx?
Intrahepatic cholestasis of pregnancy
Tx is symptomatic- ursodeoxycholic acid is first line
Condition will resolve after pregnancy, but increased risk of gallstones
A 75 year old tests + for blood on UA but is asymptomatic- next step?
Urine cultures for infection
Name the vaginal cyst by location:
Anterior vaginal wall
Posterior vaginal wall
Vulva
Anterior vaginal wall- Gartner’s duct
Posterior vaginal wall- Inclusion cyst
Vulva- Bartholins duct
What are 4 medications used to treat endometriosis?
OCPs, continuous progestins, danazole, and GnRH analogues
Adipose tissue changes andostenedione to what estrogen?
Estrone
What is the diagnostic test for luteal phase defect?
Endometrial biopsy
Name the day that the following procedures should be performed? Hysterosalpingogram Postcoital test Endometrial biopsy for infertility Progesterone level for ovulation
Hysterosalpingogram- day 8
Postcoital test- day 14
Endometrial biopsy for infertility- day 26
Progesterone level for ovulation- day 21
What are estrogens effects on lipid profile?
Increase in HDL
What is the use of a cystometrogram?
Determine if patient has normal bladder sensation
If intraoperatively a ureteral injury is diagnosed what is the best treatment?
Reimplantation into the bladder
What is bladder dyssynergia?
Common cause of urge incontinence, treat with oxybutynin or TCAs
Kegel exercises work for which cause of incontinence?
Stress incontinence
What is the major cause of back pain in the third trimester?
Lumbar lordosis
A 25 year old presents with infertility and chronic pelvic pain- most likely diagnosis?
Endometriosis- can even have ovarian mass!
What is the most common cause of cervicitis?
Chlamydia
A woman @ 36 weeks gestation has sudden onset of severe abdominal pain- diagnosis? Typically will see bleeding as well
Abruptio placenta- most common risk factor? HTN
How are thyroid labs different during pregnancy?
Increased total T4 but normal TSH because bhcg stimulates TSH receptors
What is the most common cause of asymmetric intrauterine growth
Maternal causes- HTN very common
What is beta hcg most important direct role in pregnancy?
Maintenance of the corpus luteum
What neoplasm is associated with OCP use?
Hepatic adenoma
Name a couple of contraindications to IUDs?
Cancer, pregnancy, copper allergy, PID, acute cervicitis, postpartum endometritis
What is the most common immediate complication of a vasectomy?
Hematoma
How is fetal blood returned to the umbilical arteries and placenta?
Hypogastric arteries
A single umbilical artery is an indicator of increased fetal morbidity and mortality- what is one risk factor?
maternal diabetes
A velamentous insertion of the umbilical cord is associated with increased risk of what?
Fetal exsanguination before labor
Is bilateral hydronephrosis and hydroureter normal during pregnancy or require further work up?
Normal
What is the diagnosis when the placenta invades the superficial lining of the uterus and can result in difficulty removing the placenta and PPH
Placenta accreta
Uterine atony/ boggy uterus can be caused by what type of placenta?
Succenturiate placenta
Match the fetal heart rate with the diagnosis?
Sinusoidal
Saltatory
Sinusoidal- Rh isoimmunization
Saltatory- depressed fetuses and low APGAR scores
What is the best way to assess fetal heart action before 12 weeks?
Transvaginal sonogram
A fetal heart tracing with tachycardia, absent variability, and late decelerations is indicative of what? Treatment?
Fetal metabolic acidosis
C section
Most common complications of polyhydramnios (3)?
Uterine dysfunction, PPH, placental abruption
What is the most common infection following C section? Treatment?
Metritis
Tx- cephalosporins
Why should a breasteeding mother avoid OCPs?
Suppress lactation
A patient presents with chronic pelvic pain, typically worse premenstrually. Not pregnant, no fever or discharge. Diagnosis and confirmatory test?
Endometriosis, laparoscopy
What is the risk associated with endometriosis? (2)
Infertility, endometrial cancer
How can a mother with Graves disease cause thyrotoxicosis in her neonate?
Thyroid stimulating immunoglobulin crosses the placenta
A newborn has micocephaly, hypoplasia of the fingers and toes, excess hair, and a cleft lip and palate. Diagnosis?
Fetal hydantoin syndrome- mom was taking phenytoin
What neonatal GI complication is associated with gestational diabetes? Hematologic? Metabolic?
Small left colon syndrome
Polycythemia
Hypocalcemia, hypoglycemia
What is the most useful parameter for predicting fetal weight by ultrasound in suspected fetal growth retardation?
Abdominal circumference
What does the quad screen show in Down’s
Increased beta hcg, inhibin
Decreased estriol, MSAFP
What is the association between hypothyroid and hyperprolactinemia?
TRH stimulates prolactin
A G1P0 patient presents with bleeding and pain. Cervix is dilated- diagnosed with inevitable or incomplete abortion with stable vitals. What is the next step?
IV fluids, suction curretage, and RhoGAM
Why do female athletes have amenorrhea?
Estrogen deficiency
A patient with post-partum hemorrhage fails to lactate- why?
Sheehan’s syndrome leads to prolactin deficiency
A G4P4 patient has vaginal bleeding following a long labor. Uterus feels soft- diagnosis? Treatment?
Uterine atony
Oxytocin
What is a risk of the use of tocolytics?
Pulmonary edema, can lead to respiratory depression with toxic levels (>11)
A women at 16 weeks has a snowstorm appearance- what test must be ordered?
Chest X ray- common site of metastasis
A patient in active labor has umbilical cord prolapse, next step?
C section
A mother has type 1 diabetes- will her babies be large/small, hyper/hypoglycemic?
Small and hypoglycemic
A patient from OSH comes in with preterm premature rupture of membranes- first step?
Prophylactic penicillin due to unknown GBS status
A G1P0 @ 34 weeks comes in status post MVA with intense abdominal pain- what must be ruled out?
Uterine rupture
A patient is still menstruating but is experiencing hot flashes and insomnia- what is next step?
FSH and LH
A patient comes in febrile three days after an abortion at an outside clinic. US shows irregular and echogenic thick endometrial stripe, uterus is 6 weeks size- next step?
Suction curettage to remove products of conception- this is septic abortion
What is the treatment for idiopathic precocious puberty and why?
GnRH agonists to prevent premature epiphyseal plate fusion
What public health measure would be the best way to decrease the amount of fetal growth retardation?
Smoking cessation- #1 cause of FGR in USA
Trichloroacetic acid is used for the treatment of which disease?
HPV lesions
A teenager girl has irregular periods following menarche. She bleeds 3 days after progesterone treatment. Diagnosis?
Immaturity of hypothalamic pituitary access- probably low GnRH, FSH, or LH
What is indicated following repetitive late decelerations?
Emergent C section- late decels a sign of fetal distress
A patient has a family history of thalassemia- first test?
CBC is first
hgb electrophoresis is best
A patient has a HGSIL on Pap smear during pregnancy with negative colposcopy as follow up- next step?
Repeat cytology and colposcopy after pregnancy
What is the size cutoff for surgical resection of vaginal cancer?
2 cm- anything larger should get radiation
Is the uterus enlarged in endometriosis?
NO
Enlarged uterus–> think adenomyosis, fibroids, cancer
What is the treatment for mild preeclampsia at 32 weeks? When to use mg?
Bed rest and frequent follow up
Use Mg for prevention of ecclamptic seizures. Always give within 24 hours of pregnancy and in severe cases up to 24 hours after pregnancy- look for pulmonary edema and areflexia as side effects
PCOS increases the risk for which cancer?
Endometrial cancer- anovulation increases risk of endometrial cancer
A post-menopausal woman presents with an adenexal mass confirmed on ultrasound- next step?
CA-125 levels are helpful to differentiate benign from malignant lesions
What fibroids are most likely to cause sub fertility?
Sub mucosal
A 50 year old comes in with a uterus at 14 weeks, most likely fibroids what is the next step?
Get biopsy to rule out malignancy
What is the most common presenting symptom of endometrial cancer?
Post menopausal vaginal bleeding
A post menopausal patient has bleeding and endometrial hyperplasia without atypia. A adenexal mass is seen on ultrasound- most likely diagnosis.
Estrogen secreting tumor such as granulosa theca tumor
A 23 yo patient presents asymptomatic with an ovarian mass on ultrasound- most likely diagnosis?
Functional ovarian cyst
When do you give zidovudine during pregnancy for someone with HIV and viral load.?
At time of delivery to mom and baby after delivery
A patient comes in at 8 weeks gestation for prenatal care. She has strong family history of diabetes and is obese- when should she be screened with 1 hr GTT?
ASAP due to string family history or personal history
A woman has symptomatic mitral valve prolapse during pregnancy- treatment?
Beta blockers
Which SSRI is contraindicated in pregnancy?
Paroxetine
What imaging is used to diagnose appendicitis during pregnancy?
Graded compression ultrasound
What on fetal ultrasound is explained by Rh disease?
Pericardial or pleural effusion
Where on the uterus can a fibroid be an indication to primary c section?
Lower uterine segment
Twin-twin transfusion most commonly occurs in what type of twins?
Mono chorionic diamniotic
What is the treatment for twins if one is breech and one is vertex?
C section both
A patient at 23 weeks with twins is discovered to have had a fetal demise for one of the twins at 21 weeks- next step?
Maternal fibrinogen levels
What is the treatment for arrest of the active phase of labor
Oxytocin, placement of IUPC. C section only if everything else fails or baby looks in trouble
What is the treatment of an unfavorable cervix prior to use of oxytocin?
Cytotec (misoprostol)
When are the following tocolytics contraindicated? Terbutaline Ritodrine Indomethacin Mag sulfate
Terbutaline- dM
Ritodrine-DM
Indomethacin-after 33 weeks due to closure of PDA
Mag sulfate- myasthenia gravis
A patient at 28 weeks has a fever, tender uterus, and elevated WBC. next step?
Induction of delivery
What reduces the risk of preterm PROM?
17-alpha-hydroxyprogesterone
What part of reproductive tract should be tested for nitrazine and fern testing?
Vagina- not cervix
A patient has a 2000mL post partum hemorrhage- IV is in place, uterus is boggy, no lacerations present. Next step? (3)
IM prostaglandin F2, oral misoprostol, IV oxytocin are your options
A patient with PpH has failed conservative and medical management. First step in OR
B-Lynch suture to compress uterus to conserve fertility
What are some associated risks with postterm pregnancy (5)
Macrosomia, oligohydramnios, meconium aspiration, uteroplacental insufficiency, dysmaturity
What is one benefit of amino infusion?
Decrease variable decelerations
What is the most commonly used cervical ripening agent?
Prostaglandins
Hirtuism- significantly elevated DHEAS, short onset, normal testosterone
Adrenal tumor
A patient has hair growth, deepening of her voice, and an adenexal mass- diagnosis?
Sertoli-Leydig cell tumor secreting testosterone
A patient who desires children needs a fibroid removed. If it is sub mucosal what approach should the surgeon use?
Hysteroscopic removal if submucosal
