Rosh (1/10) exam Flashcards
1
Q
Postpartum fever causes by day
A
0 atelectasis "wind" 1-2 UTI "water" 2-3 endometritis "womb" 4-5 "wound" 5-6 septic pelvic thrombophlebitis "walking" other: c. diff, drug fever
2
Q
Ovarian vein more likely affected by thrombosis
A
right (drains to IVC)
3
Q
Stages of alcohol withdrawal
A
0-12 hrs tremors
12-48 hrs hallucinations, then seizures
>48 hrs DTs
4
Q
Oxybutynin mechanism and a contraindication
A
Antimuscarinic (blocks acetylcholine)
Closed angle glaucoma
5
Q
Oligo and polyhydramnios definitions
A
<5 cm AFI or <2 cm DVP
>23 cm AFI or <8 cm DVP
6
Q
Traveler’s diarrhea ppx
A
Rifaximin
7
Q
Gestational ago for VAVD
A
34 wga
8
Q
Caput succadeneum
A
Bleeding in scalp at point of vacuum application, resolves in 48-72 hrs
9
Q
Cepalohematoma
A
Bleeding between skull and periosteum, does not cross suture lines, firm them fluctuant, resolved in 2-3 wks
10
Q
Subgaleal hemorrhage
A
Between scalp and periosteum
11
Q
Effect of pregnancy on CKD
A
Worsens kidney function
12
Q
Screening in BRCA carriers, age 25-29
A
Clinical breast exam q6-12mos + yearly MRI, annual pelvic exam
13
Q
Screening in BRCA carriers, age >29
A
Alternate mammogram and breast MRI q6mos, annual pelvic exam, TVUS, and CA-125
14
Q
Inheritance of BRCA
A
Autosomal dominant
15
Q
qSOFA
A
AMS, RR >22, SBP <100
16
Q
Changes to cardiac output during pregnancy
A
Increased (increased SV and HR)
17
Q
Changes to cardiac output 1 hour postpartum
A
Increased 50% (increased SV 70% and decreased HR)
18
Q
Berlin criteria for ARDS
A
- Begins within one week of a known insult
- CT / CXR with bilateral infiltrates not explained by another etiology
- Moderate to severe hypoxemia
- Respiratory failure cannot be explained by cardiac failure or fluid overload
19
Q
Best position for fitting a pessary
A
Lithotomy
20
Q
First-line pessary types
A
Ring and Gellhorn
21
Q
PID treatment with PCN allergy
A
Gent + clinda
22
Q
Varicella treatment
A
Supportive under age 12 y/o
Acyclovir > age 12 y/o and/or pregnant
23
Q
Varicella causes for hospitalization
A
Pneumonitis in adults
Super-imposed bacterial skin infections in kids
Encephalitis
24
Q
Associations with hypoplastic umbilical artery
A
Maternal DM, polyhydramnios, IUGR, congenital anomalies, abnormal insertion of umbilical cord, placental abnormalities
25
Why no OCPs with anti-epileptics or rifampin?
Increased hepatic clearances makes them less effective
26
Mechanism of heparin and LMWH
Enhance action of antithrombin III --> inhibits thrombin and factor Xa
27
Mechanism of coumadin
Inhibits synthesis of vitamin K - dependent clotting factors
28
Mechanism of debigatran
Direct thrombin inhibitor
29
Mechanism of rivaroxaban
Direct factor Xa inhibitor
30
MCA Doppler measurement that means anemia
1.5 MoM
| measures peak systolic velocity
31
How is hcg related to thyroid?
Alpha and beta subunits are similar to TSH so can induce hyperthyroidism
32
Symptoms of hyperthyroidism from a mole are due to...
Hcg activation of TSH receptor (and symptoms will not include exophthalmos because in Graves, the anti-TSH receptor antibodies cause inflammation)
33
Treatment of septic pelvic thrombophlebitis
Gent + clinda and anticoagulation
34
Age to start DEXA screening
65 y/o
35
Risk factors that warrant early DEXA screen
Personal history of fragility fracture, weight <127 lbs, chronic glucocorticoid use, parental history of hip fracture, smoking, alcoholism, RA
36
Why increased risk of pyelonephritis in pregnancy
Progesterone causes dilation of ureters and renal pelvises, leading to stasis
37
Most common bacteria of pyelonephritis (4)
E. coli, proteus mirabilis, klebsiella pneumoniae, staph saprophyticus
38
What to do if LDL >190
Evaluate for familial hypercholesterolemia, start on high-intensity statin -- either atorvastatin or rosuvastatin
39
Rokitansky-Kuster-Hauser Syndrome
Normal ovaries and secondary sexual characteristics but no vagina, cervix, uterus
40
Transposition of the great arteries appearance on ultrasound
Normal 4-chamber view with parallel outflow tracts like normal
41
Truncus arteriosus appearance on ultrasound
Normal 4-chamber view with single outflow tract
42
Osteoporosis definition
T score
43
Erb palsy injury
Brachial plexus at C5-6
44
Categories of medications for osteoporosis
Bisphosphonates, calcitonin, SERM (raloxifene), monoclonal antibody (denosumab), parathyroid hormone (teriparatide)
45
Monitoring for treatment of osteoporosis
DEXA about q2yrs
46
Mechanism of bisphosphonate
Inhibit osteoclasts
47
Prolonged latent phase
>14 hrs in multipara
| >20 hrs in nullipara
48
Empiric treatment of UTI
TMP-SMX, cipro, or levofloxacin x 3 days OR nitrofurantoin x 7 days
49
Timing of pre-eclampsia
At least 20 wga
50
SERM used to treat dyspareunia associated with GU syndrome of menopause
Ospemifene
51
How to decrease infection rate in medical abortion
Buccal misoprostol (abx only for surgical abortion)
52
Most common bacteria in necrotizing fasciitis
Polymicrobial
| Group A strep
53
Most common medication error
Dosing error
54
When to do sentinel lymph nodes in breast cancer
If surgery will distort anatomy, ie. planned complete mastectomy or tumor >5 cm
55
What to do if a lymph node is detected on physical exam for breast cancer
Complete axillary node dissection (instead of sentinel nodes only)
56
First and second line treatment for dysmenorrhea
NSAIDs, OCPs
57
Normal breast development, abnormal pubic hair growth, absent uterus
Androgen insensitivity syndrome (46, XY); X-linked recessive
58
When to evaluate primary amenorrhea
13 y/o without secondary sex characteristics
| 15 y/o with secondary sex characteristics
59
Definition of secondary amenorrhea
No menses for 3 months with regular cycles
| OR for 6 months with irregular cycles
60
Work-up for amenorrhea
FSH, LH, prolactin, TFTs, testosterone, hcg
61
Changes in geriatric physiology that impact anesthesia
Increased adipose tissue, worsened renal clearance, decreased albumin (less binding), decreased hepatic function
62
Timeframe for Rhogam administration
Within 72 hours of delivery or other event
63
First step in care for Rh alloimmunization after titers
Determine fetal status, ie. paternity, amniocentesis, or cffDNA
64
Critical titer for alloimmunization
1:16 or 1:32
65
BPP criteria
In 30 minutes: fetal breathing >30 seconds, at least 3 gross movements, at least 1 flexion/extension, vertical pocket of at least 2 cm amniotic fluid
66
Positive CST
Late decelerations following at least 50% of contractions, even if less than 3 in 10 minutes (ideally at least 3 ctx lasting 40 sec in 10 min for a CST)
67
Mode of hysterectomy with most to least ureteral injury
1. Laparoscopic and robotic
2. Open
3. Vaginal
68
Most common vascular injury in laparoscopy and what to do about it
Inferior epigastric, place a Foley catheter for tamponade and consult vascular surgery
69
Which nerves can be injured with transverse abdominal incisions?
Ilioinguinal and iliohypogastric
70
Likelihood dermoid is bilateral
10%
71
Cell lines in a dermoid
Endoderm (lungs, GI)
Mesoderm (muscle, urinary)
Ectoderm (skin, hair, sebaceous glands)
72
Risk factors for multiple-drug resistant gram negative bacteria in pyelonephritis
Inpatient stay, isolated bacteria, travel to endemic areas, or prior treatment
73
How to treat possible multi-drug resistance gram negative bacteria
Imipenem, meropenem, doripenem
74
Timeline of sex differentiation in a fetus
3 weeks, no differentiation
6 weeks, no Sertoli cells in females
9 weeks, gonad differentiation has occurred
12 weeks, full phenotype has developed
13.5 weeks, ovarian primordial follicles start forming if female
75
Cause of male differentiation
SRY gene, which causes testes to develop and give off AMH, testosterone, and dihydrotestosterone
76
When to deliver ICP
36.0 to 36.6 wga
77
Active thyroid hormone
T3 (converted from T4)
78
Treatment for thyroid storm
1. Beta blocker (propanolol)
2. PTU
3. Iodine
4. Glucocorticoid
5. Bile acid sequestrant (cholestyramine)
79
What PTU does
Block synthesis of new thyroid hormone (like methimazole) AND blocks peripheral conversion of T4 to T3
80
Chemotherapy associated with premature ovarian insufficiency
Alkylating agents - cyclophosphamide and ifosphamide
81
Prevention of hemorrhagic cystitis
Mesna (given with alkylating agents)
82
Factors that could cause earlier menopause
Night shift work, smoking
83
Air-fluid levels
SBO, but not ileus
84
How to use peak flow during asthma exacerbation
80-100% of personal best is okay
50-80% of personal best is obstructive
<50% of personal best is severe
85
Anocutaneous reflex nerves
S2, 3, or 4
86
Rash, pharyngitis, soft tissue necrosis, sepsis a few days postpartum
Group A strep sepsis or TSSS
87
Elagolix mechanism
GnRH antagonist
88
What to do for bone density loss in leupron administration
Norethindrone "add-back"
89
Changes to renal excretion during pregnancy
Increased protein, amnio acids, and glucose in urine due to decreased reuptake
90
When to test for thrombophilias
At least 6 wks from acute event, not pregnant, not on anticoagulation
91
Thrombophilias to evaluate for...
1. Factor V Leiden
2. Prothrombin mutation
3. Protein C deficiency
4. Protein S deficiency
5. Antithrombin deficiency
92
Thrombophilia testing not reliable in pregnancy
Protein S functional assay
93
How to test for Factor V Leiden
Activated protein C assay, then DNA analysis if abnormal
94
Induction method for IUFD
Misoprostol until 28 wga, then routine methods for IOL
95
Mole more likely to be malignant
Complete
96
Gestational age safe for indomethacin
<32 wks (otherwise associated with premature closure of the ductus arteriosus)
97
Contraindication to magnesium sulfate
Myasthenia gravis
98
Alternative therapy in case of HIT
Direct Xa (thrombin) inhibitor like fondaparinux (safe in pregnancy)
99
HIT type 1 vs type 2
type 2: plts <100,000, likely to cause thrombosis, day 4-14 post-exposure (instead of immediate)
100
Hyperthyroidism treatment in pregnancy
PTU in first trimester (choanal atresia with MMI)
| Methimazole later in pregnancy (hepatoxicity with PTU)
101
Timing for ECV
37 wga
102
Ultrasound finding c/w malignant transformation of a dermoid cyst
Low-resistance Doppler flow inside the tumor
103
Treatment for...
A) Pre-malignant vulvar dysplasia
B) Cancer <2 cm diameter, >2cm from midline, no palpable lymph nodes
C) Cancer anything but above
A) Simple vulvectomy
B) Partial radical vulvectomy and unilateral lymph node dissection
C) Radical vulvectomy with bilateral lymph node dissection
104
Treatment of gonorrhea
Ceftriaxone alone
105
CMV vs toxo calcifications
Periventricular in CMV and intracranial in toxo
106
Postpartum depression diagnosis
At least 2 consecutive weeks with 5 or more depression symptoms, sometime within one year of delivery
107
Salpingitis isthmica nodosum
Acquired condition in which mucosal glands penetrate the myosalpinx with resultate hyperplasia and hypertrophy; cannot be fixed surgically; unknown etiology
108
Indication for lymph node dissection in surgery for endometrial cancer
Clear cell type, high-grade histology, myometrial invasion >50%, and tumors >2cm diameter or filling endometrial cavity
