True learn questions Flashcards
How to diagnose maternal vs fetal parvovirus B19 in pregnancy? What does it cause to fetus?
Maternal: serum IgG and IgM
Fetal: amniocentesis + PCR
Hydrops fetalis d/t aplastic anemia
Best way to obtain fetal karyotype in a demise?
fetal cells via amniocentesis
TXA administered for PPH (as in WOMAN trial) reduces maternal morbidity or mortality?
Reduced MORTALITY if given within 3hrs of delivery (1g IV or PO)
Most likely karyotype for neonate with ambiguous genitalia and no labial masses?
What do you do for next pregnancy?
46XX - CAH
Administer dexamethasone beginning at 4-5wks GA, and then confirm karyotype at 9wks by CVS. If XX –> continue dex throughout pregnancy.
BEST management of a fever in a 12 hour post op patient?
expectant management
Indications for cerclage
History indicated - at 13-14wks, clear history of cervical insufficiency
Exam indicated - painless cervical dilation, mid second trimester
US indicated - short cervix, prior PTB <34wks
All of the following are contraction-associated proteins expected to be increased at delivery EXCEPT
- calcium receptors
- connexin 43
- nuclear factor kappa B
- oxytocin receptors
- PGF2-alpha receptors
nuclear factor kappa B
Which cardiac lesion is most associated with maternal mortality secondary to epidural placement and subsequent cardiovascular changes?
Aortic stenosis - preload dependent
Epidural –> decreased SVR –> decreased preload –> CV collapse
Recommended max viral load in HIV to proceed with vaginal delivery?
1000 copies/ml
Vulvar dermatoses matching
Vaginal atrophy, lichen simplex chronicus, contact dermatitis, lichen sclerosus, lichen planus
a- white reticulate lacy striae with purple papules
b- thick leathery, hyper and hypo pigmented, erosions, ulcers
c- poorly demarcated, pruritic, scaling, swelling, erythema
d- pale mucosa, thin dry skin, decreased secretions
e- white cigarette paper crinkled skin, ecchymoses or purpura, hour glassing perianal involvement
a lichen planus b lichen simplex chronicus c contact dermatitis d vaginal atrophy e lichen sclerosus
ovarian cancer histology
hobnail cells call-exner bodies psammoma bodies sheets of lymphocytes schiller-duval bodies walthard nests immature neuroepithelium malignant cytotrophoblast/syncitiotrophoblast signet ring
hobnail - clear cell
call-exner - granulosa cell tumor
sheets of lymphocytes - dysgerminoma
schiller duval - endodermal sinus tumor
psammoma bodies (onion) - serous
walthard nests, bladder epithelium - brenner tumor
immature neuroepithelium - immature teratoma
malignant cytotrophoblast/syncitiotrophoblast - choriocarcinoma OR embryonal carcinoma
signet ring - krukenberg tumor (GI met to ovary)
Tumor markers
AFP, HCG, CEA, Inhibin B, LDH
AFP - yolk sac tumor or embryonal carcinoma
HCG - choriocarcinoma, mixed germ cell, embryonal
CEA - mutinous (also CA19-9)
Inhibin B - granulosa cell tumor
LDH - dysgerminoma
blood flow to uterus at term?
500ml/min
Metabolic syndrome
Must have 3/5:
- abdominal obesity, waist circumference >88cm
- triglycerides >150 (or on meds)
- HDL <50 (or on meds)
- BP >130/85 (or on meds)
- fasting glucose >100 (or on meds)
identifying patients with metabolic syndrome helps target them for lifestyle interventions/modifications to decrease risk of developing DM and CV disease
Postmenopausal calcium and vitamin D supplementation dose?
1200mg / 800mg
5-alpha-reductase deficiency
46XY karyotype, autosomal recessive, abnormal external genitalia (fused labia, clitoromegaly, abnormal urethra), normal internal male organs, male chest development . Defective T to DHT conversion, impaired virilization.
Complete mole vs partial mole
complete - no fetal parts, diffuse hydropic villi, diffuse trophoblastic hyperplasia, 46xx/46xy
partial - fetal parts, focal hydropic villi, focal trophoblastic hyperplasia, 69xxy/69xyy
Most likely malignant component in a mature dermoid cyst?
squamous cell carcinoma
Antidote for transfusion associated citrate toxicity
calcium chloride
Which lymph nodes drain lower 1/3 vagina? upper 2/3?
Lower 1/3 - deep inguinal
Upper 2/3 - pelvic
Type 1 vs Type 2 vulvar carcinoma
Type 1 - age 35-65, high association with cervical neoplasia, hx STDs, HPV, VIN, condyloma, cigarette smoking
Type 2 - age 55-85, associated with vulvar inflammation, lichen sclerosis, squamous cell hyperplasia
Side effect unique to presacral neurectomy
urinary retention and constipation - usually resolve 1-2, and 6 weeks, respectively, post procedure
What are the 3 ACOG recommendations for active management of third stage of labor?
1) oxytocin administration (prophylactic uterotonics)
2) uterine massage
3) umbilical cord traction
FDA approved treatment for hirsutism?
eflornithine
Medications to treat alcohol dependence
Naltrexone - opioid receptor antagonist
Acamprosate - modulation of glutamate neurotransmission
Disulfiram - inhibits aldehyde dehydogenase (causing fatigue, nausea, headache)
What do theca and granulosa cells produce?
Theca interna - androstenedione
Theca externa - progesterone
Granulosa - estradiol
