Truelearn review 1 Flashcards
Most common initial presentation of DVT in pregnant women?
Leg pain
Bartholin gland cancer is most common in which group of women?
older women
Biopsy of bartholin gland is recommend in which group of women?
- women age 40 and greater
- any patient with solid components
- persistent or worsening mass despite marsupializaton or word catheter placement
What kind of hysterectomy has the greatest risk of vesicovaginal fistula?
Radical just ( upper 1/3rd of vagina is removed. Incidence is 1/81 cases)
What percent of shoulder dystocia is associated with brachial plexus injury ?
15 - 20%
What is the most common cause of death following uterine artery embolization?
Sepsis due to a necrotic fibroid
If paternity can be assured, what is the next step after identifying kell antibody in a prenatal screen?
Test the father for paternal antigen status
( If the father is kell antigen negative, then no need for additional surveillance with sonograms etc.)
If paternity is uncertain, what is the next step when finding kell antibody on prenatal testing?
MCA Doppler to screen for fetal anemia
What MCA Doppler level suggests fetal anemia?
> 1.5 MoM
What gyn onc etiology should be concerned in the case of AUB for more than 6 weeks following pregnancy ?
Gestational trophoblastic disease
What is the reported sensitivity of of ultrasound for ovarian torsion?
92%
Name the layers of the bladder from inside to outside (5)
Transitional epithelium ( urothelium)
Laminate propia
Submucosa
Detrusor muscle (muscular is propria)
Adventitious (Serosa)
How to manage vaginal hematoma ?
Small, non expanding - expectantly manage
Large, rapidly expanding - surgical exploration
Most common side effect leading to urge incontinence medication (oxybutynin) discontinuation reported by patients is _____
Xerostomia ( dry mouth) - 34%
Mechanism of oxybutynin
Anti muscarinic - competitively inhibits acetylcholine at muscarinic receptors to decrease involuntary detrusor muscle contractions
( other meds in this group include tolteridine and fesoterodine)
What are the three steps of implantation ?
Apposition - blastocyst hatches from zona and gets ready to get sticky to endometrium
Adhesion - adhesion molecules are expressed and endometrium and embryo express proteins for cell adhesion
Invasion - trophoblasts have differentiated into syncytiotrophoblast and cytotrophoblasts and spiral arteries are being invaded and destroyed
Increased NT (>3 mm) is most commonly associated with
Fetal cardiac anomalies, the most common of which is a septal defect
Most GYN malignancy staging systems classify invasion to adjacent structures as stage ______ and distant Mets as stage _____
What are the exceptions to this?
IV A
IV B
Exceptions are ovary and GTN
Vaginal cancer staging
** remember there are TWO types of labia, so 2cm is the differentiator in IA vs IB and IIA vs IIB
I - in vag wall only
II - invades into paravag tissues, nothing beyond pelvic sidewalls
III - either pelvic sidewalls involved AND/OR lower 1/3rd of vagina AND/OR hydronephrosis
- spread to pelvic or groin lymph nodes
IV - spread beyond true pelvis
Primary dysmenorrhea can be attributed to what chemicals
Prostaglandins ( F2 alpha and E2)
Stillbirth work up should include what (4 )
Fetal autopsy
Maternal lab work
Placenta examination
Fetal karyotype/microarray
What maternal lab work should be done in stillbirth work up
Screen for fetal- maternal hemorrhage with KB test
Syphilis
APLS work up - Lupus anticoagulant, anticardiolipin Ab , Beta 2 glycoprotein Abs [ performed in all cases]
Indirect Coombs test [ if not previously performed]
Glucose screening ( Oral GTT , A1C) - [ in case of LGA baby]
Toxicology screen [ in case of abruption or when drug uses suspected]
How is advanced paternal age defined by most organizations?
Age > 40 yrs
Advance paternal age is associated for what risk in a pregnancy ?
Increased risk of having a child with a single gene disorder
What common meds should be continued throughout perioperative period?
Beta blockers
Statins
SSRIs
Thyroid hormones
What common meds should be discontinued 24 hours before surgery?
ACE inhibitors, ARBs
When should a patient discontinue NSAIDs before surgery?
Several days before
Should corticosteroids be discontinued prior to surgery?
No!!
Continue and potentially stress dose during surgery
What common meds should be individualized before deciding to discontinue them before surgery ?
Aspirin
Antiplatelets ( clopidogrel)
What do you do about patient on oral anticoagulants like warfarin and DOACs before surgery?
Discontinue and bridge to short acting agents if necessary
When to discontinue herbal supplements before surgery ?
1 - 2 weeks
What is the most common karyotype of a complete mole ?
46 XX ( 80% of cases)
Can also be 46 XY
What percent of twins are born prematurely ?
60%
The most common site of urethral injury during gyn surgery is at ________
The level of the uterine arteries. Accounts for 80% of injuries
What is the most thrombogeneic inherited thrombophilia ?
Antithrombin deficiency
Ppl with this and no hx of VTE = 3 - 7% of getting VTE in pregnancy
Ppl with this and a hx of VTE = 40% chance of VTE in pregnancy
What level of antithrombin activity is abnormal ?
Is this reliable during pregnancy?
Anything < 60 is abnormal
Testing is reliable in pregnancy BUT
Testing is NOT reliable during acute thrombosis or with anti coagulation
What is the uterine anomaly with the highest risk for second trimester miscarriage
Septate uterus
How to diagnose adenomyosis
Histology via hysterectomy
What percent of women attend the postpartum visit
60%
What is the minimum time that has to pass between THERAPEUTIC LMWH and regional anesthesia
24 hours
What is the minimum time that needs to pass between PROPHYLACTIC dose of LMWH and regional anesthesia
12 hours
What are extrahepatic manifestations of chronic hepatitis C infxn
Essential mixed cryoglobulinemia ** MOST COMMON**
Porphyria cutanea Tarda
Sjogren syndrome
Membranoproliferative glomerulonephritis
