Repro Flashcards
Are losartan and spironolactone contraindicated in pregnancy
Yes
Is afp elevated in gastroschisis
Yes
What abdo defects is trisomy 21 associated with
Umbilical hernia and duodenal atresia
Gastroschisis is usually an ___ event
Isolated
You can hear fetal heart tones at how many weeks gestation
10-12
When can you feel fetal movement
17-18 weeks
When does bhcg peak
Ten weeks ga
Bhcg in range of ___ is diagnostic of pregnancy
1000-1500
Does renal blood flow and gfr increase in pregnancy
Yes
Should preggos be taking iron
Yes
Change over course of pregnancy: heart rate
Gradually increases 20%
Change over course of pregnancy: bp
Gradually decreases by 10% by week 34 then increases to prepreg values
Change over course of pregnancy: stroke volume
Increases to maximum at 19 weeks then plateaus
Change over course of pregnancy: cardiac output
Rises rapidly by 20% then gradually increases an additional 10% by 28 weeks
Change over course of pregnancy: peripheral venous distention
Progressive increase to term
Change over course of pregnancy: peripheral vascular resistance
Progressive decrease to term
Change over course of pregnancy: tidal volume
Increases by 30-40%
Change over course of pregnancy: respiratory minute volume
Increases by 40%
Change over course of pregnancy: blood volume
Increases by 50%
Change over course of pregnancy: hematocrit
Decreases slightly
Change over course of pregnancy: fibrinogen
Increases
Change over course of pregnancy: sphincter tone
Decreases
Change over course of pregnancy: gastric emptying time
Increases
Four elements of a quad screen
Afp
Inhibin a
Estriol
B-hcg
Elevated afp (>2.5 moms) is associated with
Nt defects Abdo wall defects Multiple gestation/incorrect gestational dating Fetal death Placental abnormalities
Reduced afp (0.5 mom) is associated with
Trisomy 21 and 18
Fetal demise
Incorrect dating
Afp, estriol, bhcg and inhibin a levels in trisomy 21
Low afp and estriol
High bhcg and inhibin
Afp, estriol, bhcg and inhibin a levels in trisomy 18
Low everything
Cvs is offered at how many weeks?
10-12
Amniocentesis is offered at how many weeks?
15-20
Cell free fetal dna is offered at how many weeks?
Ten
Cvs samples the
Placental tissue
Late congenital Syphillis sx
Saber shins
Saddle nose
Hutchinson triad: peg shaped central incisors, deafness, interstitial keratitis
Threatened abortion
Urine bleeding but no POc expulsion, closed os
Tx of threatened abortion
Pelvic rest for 24-48 hours and fu ultrasound
Tx of incomplete abortion
Manual uterine aspiration or d and c if <12 weeks
Incomplete abortion
Partial poc expulsion and bleeding, open os, visible tissue on exam
Inevitable abortion
Uterine bleeding, no poc expulsion, open os with possible rupture of membranes
Missed abortion
Baby dead inside but closed os
Intrauterine fetal demise
Absence of fetal cardiac activity >20 weeks ga
First stage of labor, latent: starts/ends?
Onset of labor to 3-4cm dilation
First stage of labor, active: starts/ends?
4cm-complete cervical dilation (10cm)
Latent first stage of labor takes how long in a primip?
6-11h
Latent first stage of labor takes how long in a multip?
4-8h
Active first stage of labor takes how long in a primip?
4-6h (1.2cm/hr)
Active first stage of labor takes how long in a multip?
2-3h (1.5cm/hr)
Define second stage of labor
Complete cervical dilation to delivery of infant
second stage of labor takes how long in primip
0.5-3h
second stage of labor takes how long in multip
5-30min
Define third stage of labor
Delivery of infant to delivery of placenta
Fetal hr under ___ is bradycardia
110
Fetal hr above __ is tachycardia
160
Normal fetal heart rate variability
6-25 bpm
Sinusoidal fetal heart rate variability indicates
Serious fetal anemia
When to do a c section on mom with hsv
Whenever she has active lesions
Early fetal heart decels indicates
Head compression from uterine contraction (normal)
Late fetal heart decels indicates
Uteroplacental insufficiency and fetal hypoxemia
Variable fetal heart decels indicates
Umbilical cord compression
Normal nonstress test in pregnancy
Reactive-2 accelerations >15 bpm above baseline lasting for at least 15 seconds over a 20min period
A negative contraction stress test is __ and a positive one is ___
Good
Bad
Five parameters of biophysical profile
Fetal tone, breathing, movement, amniotic fluid volume, and nonstress test
Good score: 8-10
When do you use umbilical artery Doppler velocimetry
Only when iugr is suspected
Oligohydramnios is what level
Amniotic fluid index <5cm
First step in dx of hyperemesis gravidarum
Rule out molar preg with ultrasound plus minus B-hcg
Tx of hyperemesis gravidarum
Vit b6, doxylamine, promethazine, metoclopramide and ondansetron if severe
Three hour glucose tolerance test is positive at following levels: Fasting 1 h 2 h 3 h
Fasting >95
1 h >180
2 h >155
3 h >140
In diabetic Mom, maintain blood glucose at __ during labor with ___
80-100
Iv insulin drip
C section should be considered when fetus is > __ g
4500g (ten pounds)
Define gestational hypertension
Idiopathic htn without sig proteinuria (<300 mg/L) after 20 weeks ga
Common complication of gestational htn
Preeclampsia
What are three antihypertensives commonly used in pregnancy
Methyldopa
Labetalol
Nifedipine
Triad of preeclampsia
Hypertension
Proteinuria (>300mg/24h)
Edema
After 20 weeks
Hellp syndrome
Hemolysis
Elevated lfts
Low platelets
Bp in mild preeclampsia
> 140/90 on two occasions >6h apart
Bp in severe preeclampsia
Bp>160/110 on two separate occasions > 6h apart
Signs of severe preeclampsia
Persistent headache, visual disturbances, persistent epigastric pain, hyperreactive reflexes
How do you prevent intrapartum seizures in preeclampsia
Continuous magnesium sulfate drip
Signs of magnesium tox
Loss of dtrs
Resp paralysis
Coma
How long to continue mag after babe is born in preeclampsia
24h postpartum
Tx mag tox with
Iv calcium gluconate
Recurrent seizures in eclampsia , tx with
Iv diazepam
Tx of asymptomatic bacteriuria and uti in preggo
3-7 days nitrofurantoin, cephalexin, or augmentin
Tx of Pyelo in preggo
Iv fluids, iv third gen cephalosporin
Painful, dark vaginal bleeding that doesn’t stop and fetal distress before labor, think
Placental abruption
Painless, bright red bleeding that stops after 1-2 hours with or without uterine contractions. No fetal distress, think
Placenta previa
Painless bleeding at rom with bradycardia , think
Vasa previa
Tx of vasa previa before bleeding
Steroids at 28-32 weeks for fetal lung maturity, hospitalize at 30-32 weeks for close monitoring and schedule a c-section at 35 weeks
Planned c section for babes over ___g in moms without diabetes and over __g in moms with diabetes
5000g
4500g
Polyhydramnios is > __ on ultrasound
25
Etiologies of oligohydramnios
Fetal urinary tract abnormalities, chronic uteroplacental insufficiency, rom
Mechanism of and karyotype of complete mole
Sperm fertilization of an empty ovum
46,xx
Mechanism of and karyotype of incomplete mole
Normal ovum fertilized by two sperm
69,xxy
Does complete or incomplete mole contain fetal tissue
Incomplete
In molar pregnancies serum bhcg is usually
Really high (>100,000)
Ultrasound of molar pregnancy
Snowstorm appearance with no gestational sac or fetus present
D&c of molar pregnancy shows
Cluster of grapes tissue
Tx of molar pregnancy
Evacuate uterus and follow with weekly bhcg
Definition of failure to progress in latent first stage, primip
> 20h
Definition of failure to progress in active first stage, primip
> 2h
Definition of failure to progress in latent first stage, multip
> 14h
Definition of failure to progress in active first stage, multip
> 2h after reaching 3-4 cm
Arrest of fetal descent =>_h in primip
> 2h, >3h with epidural
Arrest of fetal descent =>_h in multip
> 1h or >2h with epidural
Define preterm premature rom
Rom occurring at <37 weeks
Define prolonged rom
Rom occurring >18h prior to delivery
Fever >38 deg within 36 h, uterine tenderness and malodorous lochia postpartum, think
Postpartum endometritis
Define postpartum hemorrhage
> 500ml for vaginal delivery
>1000ml for c section
Soft “boggy” uterus-most common cause of postpartum hemorrhage
Uterine atony
Tx of uterine atony
Uterine massage, oxytocin infusion, methergine/methylergonovine, pgf2a
Tx of postpartum infections
Broad spec empiric iv antibiotics (clinda, genta) until pts have been afebrile for 48h. Add amp in complicated cases.
Complication of postpartum infection
Septic pelvic thrombophlebitis
How does postpartum septic pelvic thrombophlebitis present
Abdo and back pain and “picket-fence” fever (normal to as high as 105.8 deg)
Tx septic pelvic thrombophlebitis
Broad spec antibiotics and anticoagulation with heparin x 7-10 days
Order of puberty in girls
Growth accel—>thelarche—>pubarche—>menarche
Order of puberty in boys
Testicular growth—> penile growth—> pubarche —> facial hair
Dx of menopause
High fsh and lh, high cholesterol and low hdl
Tx for hot flashes
Ssris, clonidine and or gabapentin
Define primary amenorrhea
Absence of menses by age 16 with secondary sexual characeteristics, or absence of secondary sexual characteristics by age 14
Absence of secondary sexual characteristics indicates no production of
Estrogen
Ses of depo shot
Wt gain, irregular bleeding, delayed fertility after discontinuation (up to ten months)
How do ocps work
Inhibit fsh/lh, suppress ovulation, thicken cervical mucus, decidualize endometrium
Ocp risk for smokers
Thromboembolism in smokers >35 years
Mechanism of progestin only minipills
Thickens cervical mucus
Presence of secondary sexual characteristics + absence of 2/3 of the vagina and uterine abnormalities, what am I?
Mullerian agenesis.
Pt present with breast development but amenorrhea and lack of pubic hair
Complete androgen insensitivity
Workup of secondary amenorrhea
Preg test
Tsh
Prolactin
Progestin challenge
Tx of endometriosis
Inhibit ovulation (eg ocps) or surgically ablate
Causes of abnormal uterine bleeding
Palm coin Polyp Adenomyosis Leiomyoma Malignancy Coagulopathy Ovulatory dysfunction Iatrogenic Not known
First line tx of abnormal uterine bleeding
NSAIDs to decrease blood loss
When to do an endometrial biopsy
Abnormal uterine bleeding plus:
- endometrium is >4 mm in postmenopausal woman or
- if pt is >35 and has rfs for endometrial hyperplasia (obesity, diabetes)
Problem in 21-hydroxylase deficiency
Can’t convert 17-hydroxyprogesterone to 11-deoxycortisol leading to decreases cortisol synth, increased adrenal stimulation and increased acth and androgens
Etiology of 11B hydroxylase deficiency
Can’t convert 11 deoxycortisol to cortisol leading to increased acth and androgens
21 hydroxylase deficiency presents with __tension whereas 11B hydroxylase and 17-hydroxylase deficiencies present with __tension
Hypo
Hyper
Renin activity is ___ in 21 hydroxylase def but __ in 11B hydroxylase def
Increased
Decreased
Gold standard for dx of 21 hydroxylase deficiency
Cosynotropin stimulation test (not necessary if 17-0h progesterone levels are really high)
Ratio of lh to fsh in pcos
High
What is mittelschmerz
Pain at ovulation, unilateral but can switch sides
Tx of pcos in women who are not trying to get preg
Ocps, progestin and maybe metformin
Tx of pcos in women who are trying to get preg
Clomiphene and maybe metformin
Vaginal ph in B.V.
> 4.5
With metronidazole what should you be careful of
Stay away from alcohol it can cause
A disulfiram like reaction
What is the chandelier sign
Severe cervical motion tenderness that makes pt jump for the chandelier on examination
Toxic shock syndrome is caused by
Preformed s aureus toxin
Why are blood cultures negative in toxic shock syndrome
Because it’s caused by a preformed toxin
Tx of toxic shock syndrome
Rapid rehydration, get foreign objects in vaginal canal, empiric antibiotics clinda and vanco (narrow to clinda and oxacillin or nafcillin if methicillin sensitive)
Uterus is irregular and mobile think
Uterine myoma
75% of endometrial cancers are __ cancers
Endometrioid
25% of endometrial cancers are __ cancers
Serous
Etiology of endometrioid endometrial cancer
Unopposed estrogen stim
Etiology of serous endometrial cancer
Unrelated to estrogen; p53 mutation is present in most cases
Two major risk factors of vulvar cancer
Hpv types 16, 18, 31
Lichen sclerosis
Key words for lichen sclerosis
Atrophic
Paper-like skin
Dx of Vulvar cancer
Vulvar punch biopsy for any suspicious lesions or persistent vulvar pruritus
Vaginal cancer in postmenopausal women is usually due to what kind of cancer
Squamous cell carcinoma
Do ocps increase or decrease risk of ovarian cancer
Decrease
Radiation is effective for what kind of ovarian cancer
Dysgerminoma
Infectious vulvovaginitis in a pediatric patient can be caused by what three things
Gas
Candida
STDs typically from abuse
Bunches of grapes lesions in young girl in vagina
Sarcoma botryoides (rhabdomyosarcoma)
In precocious puberty, signs of estrogen excess (breast dev and possibly vag bleeding) suggests
Ovarian cysts or tumors
In precocious puberty, signs of androgen excess (pubic and or axillary hair, enlarged clitoris, and or acne) suggests
Adrenal tumors or cah
Workup of precocious puberty
Determine bone age and conduct gnrh stim test to distinguish central from peripheral precocious puberty
Causes f central precocious puberty
Cns tumor
Constitutional precocious puberty
Causes of peripheral precocious puberty
Ovarian cyst Adrenal tumor Gonadal tumor Exogenous estrogen Cah
Tx of cah
Steroids
Precocious puberty, cafe au lait spots, bony abnormalities (polyostotic fibrous dysphasia)
Mccune albright
Tx of mccune Albright
Tamoxifen or estrogen synthesis blockers (ketoconazole)
Differential of breast mass
CANdy’s Fat Flabby and Massive Boobs
Fibrocystic Fibroadenoma Fat necrosis Mastitis Abscess Breast cancer
How to dx discrete breast mass
Fine needle aspiration
Two common causes of bloody nipple discharge
Intraductal papilloma
Mammary duct ectasia
Define breast fibroadenoma
Proliferative breast lesion without atypia; benign slow growing breast tumor with epithelial and strolls components
Most common breast lesion in women under thirty
Fibroadenoma
Phyllodes breast tumor has a __ appearance
Leaf like
When do you use trastuzumab for breast cancer tx?
For locally advanced cancer that is her2+ or her2/neu+
When do you use tamoxifen for breast cancer tx?
All er/pr+ pts and premenopausal
If pt is under thirty and identifies a breast mass what should you do
Us to distinguish a solid mass from a cyst
Dexa screening for osteoporosis should start for women at age
65
Do direct inguinal hernias enter the scrotum
No
Hydrocele is painful or painless?
Painless
Varicocele is painful or painless?
Painless
Can you use oral nystatin for vaginal candidiasis
No only intravaginal nystatin, oral is only for thrush
If a lady isn’t pregnant and has amenorrhea (no hx of prior uterine procedure) what’s next in workup
Prolactin, tsh, fsh
What kind of medication is plan b
Oral levonorgestrel
If you have gonorrhea what should you also test for? (4)
Chlamydia
Hiv
Syphillis
Hep b
GnRH independent precocious puberty, irregular cafe au lait macules, polyostotic fibrous dysplasia (frequent bone fractures)
Mccune Albright
Precocious puberty, long bone dysplasia, numerous cafe au lait macules, axillary freckling
Nf1
Gi hamartomatous polyposis, small perioral pigmented macules
What am I?
Peutz-jeghers
Intellectual disability, seizures, visual impairment, port wine stain over trigeminal nerve area
What am I?
Sturge Weber
Define placenta accreta
Villi attached directly to myometrium instead of decidua. See villous lakes.
Tx of placenta accreta if you identify it before delivery
Cesarean hysterectomy
If placenta accreta isn’t diagnosed before delivery, what could happen in delivery
Cord evulsion necessitating manual extraction, complicated by placental adherence and severe hemorrhage
Pde5 inhibitors are contraindicated in pp using what med
Nitrates
Most effective emergency contraception
Copper iud
Would a femoral hernia protrude into the scrotum?
No
Femoral hernias occurs most commonly in what demographic
Older women
Path of varicocele
Dilation of the pampiniform plexus
Does varicocele increase in size with valsalva
Yes
What do you see on urinanalysis in hyperemesis gravidarum
Ketones
Is tb screening recommended in pregnancy?
Only if pt is at risk for tb
Non sexual nocturnal erections are associated with what kind of erectile dysfunction?
Psychogenic
In intraamniotic infections, what do you do after abx? Assuming pt is near term
C section if babe is unstable
Induction of labor if babe is stable
Easy way to tell placenta previa from placental abruption
Previa has no pain; abruption is very painful
Treatment of postpartum endometritis
Clinda + genta
Gnrh agonists eg leuprolide are used for
Creating a hypoestrogenic state, used to suppress sx of endometriosis and uterine leiomyoma
Untreated herpes infections will resolve and then recur with increasing or decreasing frequency?
Decreasing
What happens to hemoglobin, pa02 and paco2 in pregnancy?
Hemoglobin- decreases due to dilutional anemia (increased plasma vol and rbc mass)
Pa02 increases
Paco2 decreases
Acid base status in pregnancy
Chronic respiratory alkalosis with metabolic compensation
Fetal tachycardia is defined as >__ bpm
160
When pt displays signs of overt intraamniotic infection (chorioamnionitis), what should you do
Deliver the baby regardless of gestational age
Give cell free dna test to what women at what weeks?
Women over 35
Week ten and beyond
What is a myelomeningocele
Spina bifida