U-World 2 Flashcards
Steps to dx suspected placenta previa
Transabdominal US followed by transvaginal sonography
No digital vaginal exam before US
Lectin/sphingomyelin ratio less than what to give steroids
2.0
Most important complication of PPROM
Pulmonary hypoplasia
Cataracts, PDA and purpura in newborn likely
Maternal rubella infection
Also look for hearing loss
Steps for patient with decreased fetal movement
NST followed by a contraction stress test of biophysical profile if NST is non-reactive
What does a normal contraction stress test mean
Suggests a low likelihood of stillbirth within 1 week of test –> So redo in 1 week
Septic abortion treatment
Broad spectrum Ab and surgical evacuation of the uterus
Acid base status of hyperemesis of pregnancy
Primary metabolic alkalosis
Exercise rec for pregnant women
> 30 min a day for 5 days week at low or moderate intensity
Paget’s path description
large cells surrounded by halo-like areas involving the epidermis
Increased risk of hyperemesis garvidarum from
Increased placental mass (twins, molar pregnancy)
What causes a complete mole?
When 2 sperm fertilize an ovum lacking genetic material
What causes a partial mole
When 2 sperm fertilize a haploid ovum (triploid karyotype)
Most common risk factor for placental abruption
Maternal hypertension
When does a placental abruption not blled
Retroplacental location of the hemorrhage
Fetal hydantoin syndrome features
Small body size, microcephaly, digital and nail hypoplasia, hirsutism and cleft palate
AE of COC
VTE, HTN, hepatic adenoma, rarely strokes and MI
How does hypothyroidism cause hyperprolactinemia
TRH stimulates prolactin production
Biggest risk factor for vaginal clear cell carcinoma
In utero DES exposure
HTN is a risk factor for what type of fetal growth restriction
Asymmetric 2/2 uteroplacental insufficiency
Who is the HPV vaccine recommended for
All women 9-26 regardless of HPV status or sexual activity
LH and FSH levels in anovulation
Normal
Women >35 should be offered what chromosomal abnormality screening test
Cell-free fetal DNA testing
Can be done in first trimester, quad screen not until 2nd
Most accurate way to determine gestational age
US dating w/ fetal crown-rump measurement in the first trimester
Gold standard for evaluating cervix for cervical incompetence in pregnancy
Transvaginal US
Tamoxifen MOA
ER antagonist on breast tissue, agonist on endometrium and bone
Amenorrhea most commonly associated with significant stressors, eating disorders, and excessive exercise
Acquired hypogonadotropic hypogonadism
Preferred initial imaging for suspected gynecological tumors
Pelvic US
Chorioamnionitis is diagnosed by
> 1 of the following: uterine tenderness, maternal or fetal tachycardia, malodorous amniotic fluid, or purulent vaginal discharge
Two tx for chorioamnionitis
Broad spectrum Ab and delivery
Why does mitral stenosis often present during pregnancy
Physiologically increased blood volume
What is an incomplete abortion
Involved evacuation of some fetal tissues while a remained is retained in the uterine cavity
Standard of care for threatened abortion
Reassurance and outpatient follow up (US exam one week later)
Copious white vaginal discharge that isn’t stinky
Physiologic leukorrhea
Lots of squamous cells and rare leukocytes
Tx regimen for PID
Inpatient management with cefotetan and doxy
Inhibin-a in trisomy 18
Normal
When is a NST considered normal
If in 20 min there are at least 2 accelerations of the fetal heart rate of at least 15 bpm above baseline lasting at least 15 seconds each
Primary risk factor for ovarian torsion
Ovarian enlargement (pregnancy, tumors)
Examples of end organ damage in pre-e w/ severe features
Severe headache, persistent RUQ or epigastric pain, renal insuff, pulm edema
Most appropriate test to confirm IUFD
Real-time US
When does the risk of coagulopathy in IUFD go away
When fetus is evacuated
What should be done after first episode of IUFD
Autopsy of fetus and placenta to determine cause
2 reasons why obesity prevents osteoporosis
Increased weight bearing and increase estrogen from adipose tissue
3 big placental abruption risk factors
Maternal hypertension, smoking, and cocaine use
Most common cause of decreased fertility in women in their 30s who still have regular periods
Decreased ovarian reserve
Hep management in pregnancy
Can give A and B vaccines if not already given`
Low grade fever in immediate post part period management
Normal –> reassurance
Also some leukocytosis and vaginal discharge
Failure lactate and other features of pituitary def post part likely
Sheehan’s syndrome
Test before starting trastuzumab
Echo due to risk of cardiotoxicity
FSH and LH in premature ovarian failure
FSH and LH increased
FSH/LH ratio > 1.0
Congenital toxo triad
Chorioretinitis, hydrocephalus, and intracranial calcifications
Serum BUN and creatinine in pregnancy
Usually decreased due to increase in renal plasma flow and GFR
Bilateral breast tenderness and swelling in first week post-partu
Breast engorgement
Resolves spontaneously
Why aren’t different blood types a problem in pregnancy
It only causes mild disease in the newborn
Appearance of aromatase def
Affected girls will have normal internal genitalia with ambiguous external genitalia
Labs of intrahepatic cholestasis of pregnancy
Elevated total bile acids and/or aminotransferases
Jaundice is uncommon
3 clinical features of endometriosis
- Pain peaks before menses
- Dyspareunia
- Infertility
Primary dysmenorrhea is characterized by
Crampy lower-abdominal pain during menses and normal physical examination
4 first line HTN medications in pregnancy
Methydopa, Labetalol, Hydrazine, Nifedipine
HTN drug classes contra in pregnancy
ACEi and ARBs
Tx for fungal vaginal infection
Oral Azole
Advice to newly pregnant patients on lithium
Wean the lithium
3 D’s of endometriosis*
Dyspareunia, dysmenorrhea, dyschezia (pain w/ defecation)
Goal of conservative endometriosis treatment
Prevention of ovulation
2 diff dx for night sweats, insomnia,and irregular menses in middle age women
Hyperthyroidism and menopause
Test of choice for suspected stone in pregnancy
US kidney/pelvis
Ruptured ovarian cysts description
Sudden-onset severe unilateral lower abdominal pain immediately following sex or strenuous activity
Pelvis US shows free fluid near ovarian cysts
Hypertonic uterus + bleeding
Placental abruption
What is seen in false labor
Irregular lower abdominal contractions that are received by sedation with absent cervical changes
Tx of fibrocystic changes after drainage of abscess
Observe for 4-6 weeks
First step for any breast ass
Mammography and US
Most effect emergency contraception
Copper insert
Primary vaginal cancer characterized by
Bloody, malodorous d/c and an irregular vaginal lesion
1st step is biopsy
Things that hemodynamically stable patient can do after sAb
Expectant mgmt, misoprostol, or dilation and evacuation (unstable pt’s)
Tx for endometrial hyperplasia w/out atypia
Progestin therapy
Androgen insensitivity syndrome features
46, Xy patients –> primary amenorrhea, normal breast development, blind vagina
How does elevated prolactin suppress levels of LH and FSH
Surpasses GnRH release
What to do to prevent hypotension with epidural? Tx if happens
Agressive fluids
To tx: Left uterine displacement (place pt on left side), addition IV fluid bolus, vasopressors
When can external cephalic version be attempted
After 37 weeks with no contraindications to vaginal delivery and fetal well being has been established
4 types of women whom endometrial biopsy is indicated for evaluation of abnormal uterine bleeding
- Women > 45 and all postmenopausal
2. Women age
Low back pain in the third trimester of pregnancy comes from
Increased lumbar lordosis and relaxation of ligaments supporting pelvic girdle
How does lichen sclerosis present
As white, think and wrinkled skin over the labia (itchy in older women)
Trichloroacetic acid treats
HPV caused warts
Painless vaginal bleeding the occurs on rupture of membranes likely to be
Vasa previa
Congenital issues with lithium use in 2nd and 3rd trimesters
Goiter and transient neontal neuromuscular defects
Abdominal pain in young female with the middle of her cycle with benign findings
Mittelschmerz (midcycle pain)
First step to help identify PMS
Menstrual diary
Injury to C8 and T1 during birth causes
Klumpke palsy - claw hand and extended wrist, hornet’s syndrome
Signs/symptoms of perinatal asphyxia
AMS (irritability, lethargy), respiratory or feeding disorders, poor tone, seizures
Hyperactive and tender uterus seen with
Placental abruption
How does a patient with a posterior shoulder dislocation hold their arm
Adducted and internally rotated
What does hGC do in early pregnancy
Maintains the corpus luteum
Tx to surpasses breast milk production
Wear tight-fitting bra, avoid nipple manipulation and use ice packs for pain
Amniotic fluid embolism risk factors
Advanced maternal age, G5 or greater, C section, previa or abruption, preeclampsia
Only option to allow pregnancy in patients with POV? Why?
In vitro fertilization with donor oocytes
These patients lack viable oocytes
What is clomiphene citrate
Estrogen analog that can be used to induce ovulation
All pregnant patients get screened for what diseases
Syphilis, HIV, and Hep B
5 things a BPP asseses
NST, amniotic fluid volume, fetal breathing movement, fetal tone, fetal movement
Stress incontinence likely from
Pelvic floor muscle weakness
Common complications of late-term pregnancies
Oligohydramnios, meconium aspiration, stillbirth, macrosomia, convulsions (fetal)
Why oligohydramnios in late term births
Aging placenta may have decreased fetal perfusion –> decreased renal perfusion and urinary output
Young woman with breast lump during period next step
Ask to return after period if no other obvious warning signs present
