Rosh Material #1 Flashcards
usual age for menarch
11-15
work up amenorrhea if it has not occured by:
_ age if secondary sexual charcteristics present
_ age if no secondary sexual characteristics present
no secondary characteristics: 13 yo
secondary characteristics present: 15 yo
mc cause of primary amenorrhea
gonadal dysgenesis
name 4 tocolytics
Mg sulfate
indomethacin
terbutaline
nifedipine
endometrial stripe measurements in relation to hyperplasia in postmenopausal women
</= 4 mm -> low likelihood
>4 mm -> high likelihood
endometrial stripe in relation to hyperplasia in premenopausal women
< 5 mm -> exclude hyperplasia
stages of uterine prolapse
1: upper 1/2 of vagina, > 1 cm from introitus
2: nearly to opening -> >/= 1 cm from introitus
3: outside vagina -> < 1 cm
4: outside vagina -> >/= 1 cm
what med is used to induce labor
what is mc s.e
oxytocin
s.e: tachysystole
which level of cervical dilation is considered active labor
> /= 6 cm
sx of end organ damage with preeclampsia
CNS: photopsia, scotomata, HA
hepatic: severe RUQ pain, thrombocytopenia, pulmonary edema
renal: SCr > 1.1
new onset HTN < 20 weeks gestation should make you think
molar pregnancy
contraindication for labetalol for gestational HTN
asthma
IV meds used to acutely lower BP in pregnant pt
labetalol
hydralazine
with FHR monitoring, what does “variable deceleration” make you think of
umbilical cord compression
ovarian torsion is mc on which side
right
tx for breast abscess
- abx, continue bf’ing, needle aspiration
- surgical drainage if needle aspiration is unsuccessful
FIGO classification of abnormal uterine bleeding
PALM: polyp, adenomyosis, leiomyoma (submucosal vs other), malignancy/hyperplasia
COINE: coagulopathy, ovulatory dysfxn, iatrogenic, not yet classified, endometrial
FIGO staging of fibroids
SM (submucosal): pedunculated intracavitary
other: intramural, subserosal, cervical
contraindications for bf’ing
galactosemia
HIV/antiretroviral drugs
active TB
HTLV 1 or 2
active illicit drug use
active chemotherapy/xrt
what type of birth control is contraindicated in the first 6 weeks postpartum
combined OCP -> due to increased risk of VTE
t/f: progestin only contraceptives can be used immediately following birth
t!
lyte abnormalities assocaited w. hyperemesis gravidarum
hypochloremia -> metabolic alkalosis
hypokalemia
tx for hyperemesis gravidum
IVF w. 5% dex
antiemetics
what does this make you think of
giant multinucleated cells -> trichomoniasis
hCG concentration normally doubles every _ during the first 30 days of prenancy
29-53 hr (2 days)
hCG levels that rise slower than expected make you think (2)
ectopic
embryonic death
hCG levels decline after _ weeks gestation
and plateau _ weeks gestation
decline: 8-10 weeks
plateau: 20 weeks
hCG levels should remain constant at _ from 20 weeks gestation til term
2,000-50,000
hCG level used as discriminatory zone for when gestational sac should be visualized on transvaginal US
2,000
macrosomia is defined as infant weight >
4,500 g
what does a long, thin, malnourished newborn make you think of
restricted intrauterine growth
physical characteristics of macrosomic infant
-meconium staining
-decreased/absent vernix caseosa and lanugo hair
-dry/parchment-like peeling skin
-loose skin over thighs/buttocks
-increased scalp hair
-long nails
-alert/wide eyed appearance
mc symptom of menopause
hot flashes
1st line tx for infertility in PCOS
ovulation inducing agents:
clomiphene
letrozole
indications for leuprolide in pt struggling w. infertility
endometriosis
fibroids
common s.e of clomphene citrate
hot flashes
abd distension/pain
n/v
breast discomfort
tubo ovarian abscess is mc a complication of
PID
gs tx for PID
inpt: cefoxitin
PLUS
doxy
outpt: add metro
indications for abx alone for tubo-ovarian abscess
-hemodynamically stable
-abscess < 7 cm
-premenopausal
-abscess > 7 cm who meet all the above criteria
sx of ruptured/leaking tubo-ovarian abscess
acute abdomen:
involuntary guarding
rebound tenderness
+/- hemodynamic instability
management of premature labor < 34 weeks
ampicillin (until GBS culture comes back)
betamethasone
Mg sulfate
management of premature labor >/= 34 weeks
no meds
expectant management
degrees of perineal lacerations
1st: perineal skin only
2nd: perineal body and deeper tissues
3rd: extends into rectal sphincter
4th: into rectal mucosa
mc type of gonadal dysgenesis
turner syndrome (45, XO)
what do you think when you see: short stature, low set ears, low hairline, high arched palate, webbed neck, widely spaced nipples
turner syndrome
mc cause of infertility
PCOS
anatomic landmark used to measure fetal station
ischial spine
ground glass echogenicity
chocolate syrup material
endometrioma
hypoechoic
complex and heterogenous
corpus luteal cyst
heterogenous w. dots, fluid, acoustic shadowing
dermoid cyst
smooth, thin walled
completely fluid filled -> no internal echoes
follicular cyst
what cyst occurs from overstimulation of hCG and occurs during molar pregnancy, multiple gestation, or clomiphene therapy
theca lutein
mc type of breech
frank -> hips flexed, kneex extended
flagellated protozoa moving in corkscrew motions
trichomoniasis
punctuate macular hemorrhages on cervix
trichomoniasis
epithelial cells w. stippled borders
BV
APGAR scoring system
indications for workup for infertility (2)
< 35 yo w. 12 mo of infertility
>/= 35 yo w. 6 mo of infertility
male evaluation of infertility
semen analysis
imaging options to work up female infertility
US
hysterosalpingogram -> 1st line
hysteroscopy
endometrial bx
exploratory laparoscopy
mc type of breast ca
invasive ductal (IDC)
when is an infant considered full term
39 weeks
management of pregnancy if RhD incompatability is suspected due to parental genetics
- measure maternal anti-D titers until critical titer levels are reached
- doppler velocimetry of MCA of the fetus
- if fetal anemia is found -> cordocentesis to determine need for transfusion
1st line pharm for fibrocystic breast changes that have not responded to OTC/supportive care
tamoxifen
management of endometrial hyperplasia w. atypia
-considering pregnancy -> progestin (megestrol acetate)
-no plans for pregnancy/refractory/declines intervention -> hysterectomy
management of hyperplasia w.o atypia
progestin (megestrol acetate)
mc sx of fibroids
heavy menses
string of pearls sign
PCOS
normal NST finding
110-160 w. moderate variability
only factor significantly associated w. recurrant breast abscesses
cigs
t/f: bleeding w. placental abruption can be internal or external
t!
daily micronutrient recs for pregnant women
iron: 27 mg
Ca: 1,000 mg
vit D: 600 IU
folate: 600 mcg
idodine: 220 mcg
UTI tx in pregnant women
fosfomycin
augmentin
cefpodoxime
single most common identifiable rf for PPROM
gardnerella vaginalis infxn
the spectrum of complications where the placenta invades the myometrium
placenta accreta
spectrum of placenta accreta from least to most severe
placenta accreta
placenta increta
placenta percreta
black box warning for tamoxifen
increased risk for uterine malignancies and thromboembolic events
leading cause of cancer related deaths in women
lung
structures that can be visualized on US in 1st trimester of pregnancy
cardiac activity: 5 weeks
gestational sac: 5 weeks
yolk sac: 5.5 weeks
embryo/fetus: 6 weeks
postpartum women should wait a minimum of _ weeks before returning to sexual activity
2
mc cause of spontaneous abortion
fetal chromosomal abnormalities
well demarcated, slightly raised, erythematous vulvar lesion w. an eczematoid appearance
+/- small dotted pale islands
paget dz of the vulva
tx for paget dz of the vulva
- topical eczema therapy x 6 weeks
- if not resolved -> bx
- if paget -> wide local excision vs vulvectomy
rf for umbilical cord prolapse
hx of malpresentation
PROM
when must sx occur for dx of pmdd
luteal phase
when are fetal quickenings (movements) mc first felt
18-20 weeks
what gestational age does ectopic pregnancy mc occur
6-8 weeks
benefits of colostrum
immunity: immunoglobulins, lactoferrin, leukocytes, macrophages
-higher protein content than mature milk
types of leiomyomas with pics
name 2 GnRH agonists
leuprolide
goserelin
32 yo F 37 weeks gestation presents w. T 102.1, HR 115 - has fluid leaking from cervical os x 2 days - US shows baseline fetal tachy
what is her dx and what do you give her
chorioamnionitis
ampicillin PLUS gentamicin
2 mc rf for chorioamniocentesis
prolonged labor
prolonged rupture of membranes
3 causes of infxn for chorioamniocentesis
STI
GBS
BV
4 causes of fetal tachy
fetal movement
maternal factors
fetal factors
placental abruption
maternal factors that cause fetal tachy (6)
anemia
hyperthyroidism
hpoxia
dehydration
fever/sepsis
anxiety
lower than normal volume of amniotic fluid
oligohydraminos
mc cause of oligohydraminos
rupture of membrnes
dx criteria for oligohydraminos
amniotic fluid index </= 5 cm
OR
deepest vertical pocket < 2 cm
in 2nd or 3rd trimester
2 maternal conditions associated w. oligohydraminos
preeclampsia/chronic HTN
nephropathy
2 complications of endometritis that you should think of when endometritis is unresponsive to abx
ovarian vein thrombophlebitis
deep spontaneous pelvic thrombophlebitis
what PE finding makes you think of spontaneous pelvic thrombophlebitis
palpable cord like mass
mc cause of AUB in adolescent women
immature hypothalamic-pituitary axis