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UWise Flashcards

1
Q

Anticoag of preference in pregnancy

A

Lovenox (LMWH)

-warfain contraindicated b/c teratogenic

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2
Q

What is included in first trimester screening?

A

Chlamydia/gonorrhea, HIV, Hep B, syphilis

dont forget about HepB and syphilis…

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3
Q

17 yo at 32 wks presents w/ colicky right flank pain and CVAT

  • negative UA, normal white count
  • Renal US: moderate right hydronephrosis

Mechanism

A

Compression of the right ovarian vein by the uterus

-R more than L due to cushioning to the left ureter by the sigmoid colon

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4
Q

What is acute salpingitis?

A

Just another way of saying PID

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5
Q

Agent besides OCPs that can help in the tx of hirsuitism

A

Spironolactone = aldo antagonist diuretic

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6
Q

42 yo G2P2 p/w pelvic pain, dysmenorrhea, menorrhagia

  • pain used to be cyclic, now constant
  • regular menses
  • uterus soft and TTP
  • not sexually active in past 10 yrs

Dx
Physical exam findings

A

Adenomyosis- typically in multiparous F over 40 yo
-presents w/ dysmenorrhea and heavy menstrual bleeding that progresses to chronic pelvic pain

PE: boggy, tender, uniformly enlarged uterus

  • fibroids less likely to cause pelvic pain
  • lack of sexual activity makes PID less likely
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7
Q

Common complications in twin-twin transfusion syndrome

A

Death in utero for both twins iscommon

  • surviving infants: increased neurologic morbidity and CP
  • excessive volume => cardiomegaly, tricuspid regurg, ventricular hypertrophy, hydrops fetalis for recipient twin
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8
Q

19 yo G1P0 p/w vaginal spotting at 6 weeks past LMP

  • VS stable, PE unremarkable
  • initial beta-hCG 2000 w/ 48 hr repeat 2100
  • TVUS: empty uterus w/ thin endometrial stripe and no adnexal mass

(a) Dx
(b) Next step

A

(a) Ectopic
- insufficiently rising beta w/ thin endometrial stripe excludes intrauterine pregnancy

(b) Methotrexate
- ideal candidate: HDS, non-ruptured ectopic

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9
Q

22 yo G1P1 2 days s/p C-section, continually febrile since birth and despite broad spectrum abx

  • breasts: no erythema, nipples intact
  • abdomen: soft, NT, no adnexal masses or tenderness
  • incision c/d/i
  • normal lochia, unremarkable UA

Dx?

A

Septic thrombophlebitis = thrombosis of the venous system in the pelvis
-often dx of exclusion after r/o: mastitis, cystitis, endometriosis, ovarian abscess

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10
Q

Standard management for molar pregnancy

A

Suction curretage

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11
Q

Next step after pap smear w/ atypical squamous cells of undetermined significance

A

Next step- reflex HPV testing

If HPV+ for high risk serotypes => colposcopy

If HPV neg => cotest w/ cytology and HPV repeated in 3 years

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12
Q

24 yo at 39 wks presents in active labor w/ T 102, FHR 180 w/ minimal variability

(a) Dx
(b) Expected appearance of baby at delivery

A

(a) Chorioamnionitis

(b) Septic infant: lethargic, pale (minimal variability suggesting hypoxia) and high temperature

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13
Q

Treponemal vs. non-treponemal testing

A

For syphilis:

Non-treponemal tests (VDRL or RPR) are non-specific,
Treponemal tests- use when high pretest probability to confirm dx

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14
Q

36 yo at 32 wks

  • HTN and class F diabetes
  • IUGR with weight below 10th percentile

Most likely etiology of this IUGR?

A

Uteroplacental insufficiency 2/2 vascular disease (diabetes and HTN)

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15
Q

36 yo G0 w/ desire to get pregnant p/w spotting x6 mo
-TVUS: 2cm endometrial polyp

Best step in management?

A

Hysteroscopic polypectomy- remove the polyp and preserve further fertility

If didn’t want to get pregnant could try progestin or hysterecomy

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16
Q

Breastfeeding decreases risk of what cancer in mom?

A

Ovarian cancer

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17
Q

At what age should mammogram testing start

A

ACOG recommends that mammography start at age 40

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18
Q

List the normal and predictable sequence of female sexual maturation

A
  1. thelarche (breast buds)
    - average age 10
  2. adrenarche (hair growth)
  3. growth spurt
  4. menarche
    - average 12/13
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19
Q

30 yo desires removal of her IUD, pelvic exam shows no IUD string visible
-US: IUD in uterine cavity

Next step

A

Hysteroscopy to remove IUD under direct visualization

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20
Q

Which is the most concerning finding on colposcopy

-ectropion, acetowhite epithelium, disorderly atypical vessels

A

Most concerning = disorderly atypical vessels- indicating more angiogenesis (more irregular)
-ectropion = precursor to squamous metaplasia

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21
Q

Difference in complications btwn mothers w/ pre-existing vs. gestational diabetes

A

Pre-existing diabetes more likely to have IUGR

Gestational more associated w/ macrosomia, polyhydramnios, neonatal hypoglycemia, preeclampsia

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22
Q

Intervention to prevent risk of preterm, low birth weight infant in multigestation birth

A

Early, good weight gain
-aids in development and placenta

NOT: bed rest, cervical cerclage

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23
Q

Post-menopausal F undergoes THBSO, starts to re-experience hot flashes

Why?

A

2/2 Decreased circulating androgens
-ovaries produce androgens (androstenedione and testosterone) which peripherally get converted into estrogen
^also explains why obese F have fewer menopausal symptoms

24
Q

28 yo G0 pap test w/ high-grade squamous intraepithelial lesion

Next step?

A

Colposcopy

reflex HPV testing or repeat pap is not enough

25
Tx of septic thrombophlebitis
Transiently add anticoagulation to abx and fever should resolve quickly - suspect septic thrombophlebitis as dx of exclusion for persisting fever - sometimes CT scan will show thrombosed veins
26
Treating hyperthyroid during pregnancy
Use PTU (propylthiouracil)
27
30 yo w/ DM1 (Hgb A1C 9.7) presents at 10 wks, smokes 1/2 ppd What structural abnormality is the fetus at highest risk of developing?
Uncontrolled diabetes during organogenesis => 4-8x increased risk of having a fetus w/ structural anomaly- usually CNS (neural tube defects) and cardiac
28
To confirm ROM, test cervical mucus or vaginal fluid
Important to test vaginal fluid (and not cervical mucus) b/c of false positive ferning patterns
29
When would an elective C-section for pain be performed?
At 39 weeks gestation - NOT at 41 if labor has not already happened - totally a women's choice to undergo elective C-section
30
Benefit of vacuum delivery vs. forceps assisted delivery to the mother
Vacuum deliveries associated w/ less maternal lacerations/discomfort
31
35 yo G4P1021 at 7 wks p/w vaginal bleeding and cramping - 2 early first T losses - s/p stroke - US: empty uterus w/ slightly enlarged irregularly shaped uterus, beta-hCG 23 Most likely cause of this miscarriage?
Hypercoagulability- antiphospholipid syndrome
32
33 yo at 29 wks presents w/ PPROM, next step?
Latency abx- ampicillin and erythromycin | -shown to prolong latency period for 5-7 days, and to reduce maternal amnioitis and neonatal sepsis
33
2 signs of magnesium toxicity and levels at which they occur
High levels of magnesium sulfate can cause diminished or absent DTRS (around 10mg/dl) then respiratory depression (12-15) or cardiac depression (over 15)
34
35 yo G0 p/w 6 mo spotting btwn periods and desire for pregnancy - menorrhagia w/ increased blood loss w/ past 3 menses - TVUS: 2 cm endometrial polp Tx
Hysteroscopic polypectomy -Could do medical management w/ progestin but not if she wants to get pregnant
35
Describe the discharge seen in (a) Trichomonas (b) Candida
Vaginal discharge (a) Trichomonas- yellow-green 'frothy" discharge (b) Candida- thick white 'cottage-cheese' like discharge -neither would cause fever/abdominal pain => think PID if present
36
20 yo at 28 wks presents w/ contractions q4min - 101F, HR 120, BP 110/65, white count 18k - tender uterine fundus w/ otherwise normal exam - 1/50/-3, fetus in vertex - FHT: category I tracing Next step
Fever, tender fundus, white count- c/f intra-amniotic infection (chorio)- only thing is to get the baby out... Next step = labor induction -category I tracing => can induce labor instead of C-sxn
37
60 yo p/w urinary frequency and urge incontinence - cystometrogram: uninhibited detrusor contractions upon filling - normal post void ridicual Best tx
Best tx = oxybutynin (anticholinergic/antimuscarinic) Mechanism of urge incontinence = detrusor instability, overactive bladder (doesn't relax = uninhibited contractions)
38
At what age does a F w/ a hysterectomy no longer need pap smear?
Pap test screening is not indicated in pts who have had a hysterectomy, unless it was done for cervical cancer or a high-grade cervical dysplasia women w/ a uterus can d/c pap smears after 65 if have had 3 consecutive negative smears w/ no hx cervical neoplasia/cancer
39
Tx of baby born to HIV+ mother
Baby gets zidovudine (AZT) immediately after delivery -don't need to wait until 24 hrs of life, at 24 hrs of live HIV testing begins (not at time of delivery)
40
Contraindication to vacuum aspiration instead of D and C
Vacuum aspiration only for under 8 wks of gestation
41
Which type of leiomyomas have the highest risk of infertility
Submucosal and intracavitary -very unlikely for fibroids to cause infertility, but if they do it'll probably be a submucsal or intracavitary: tx w/ hysteroscopic resection then should be able to conceive
42
Postterm pregnancies association w/ (a) placental sulfatase (b) fetal adrenal gland function
Postterm pregnancies (a) placental sulfatase deficiency - placenta is the organ w/ an expiration date! not meant to last that long (b) postterm associated w/ fetal adrenal hypoplasia
43
Risk factors that would indicate DEXA before age 65
- early menopause - glucocorticoid therapy - sedentary lifestyle - EtOH - hyperthryoid, hypereparathryoid - anticonvulsant therapy - vit D deficiency - FHx for early or severe osteoporosis - chronic liver or renal disease
44
Type 1 diabetic w/ A1C of 9.2% is at highest risk for what fetal complication?
Fetal growth restriction - higher risk than macrosomia when this poorly controlled for this long - thought to be 2/2 placental microvasculature disease
45
25 yo G1P1 p/w left breast pain and fever, currently breastfeeding her 2 1/2 week old infant -erythema of the upper outer quadrant of left breast, TTP (a) Dx (b) Tx
(a) Puerperal (aka lactational- in a breastfeeding F) mastitis (b) Tx = abx (oral vs. IV depending on severity) and ibuprophen/acetaminophen for pain relief - don't have to stop breast feeding!!! encourage to keep breast feeding!!!
46
Describe classic presentation of gonorrhea induced PID
Lower abdominal pain, adnexal tenderness, fever, cervical motion tenderness - mucopurulent vaginal discharge - classically w/ exacerbation of symptoms during and after menstruation
47
Risks of phenytoin and carbamazepine in pregnancy
Clinical syndrome called fetal hydantoin syndrome with group of findings: - microcephaly - hypoplasia of phalanges - excess hair, cleft palate
48
What hormone is responsible for breastmilk production?
Prolactin Prolactin is made throughout the pregnancy but its fxn is inhibited by estrogen and progesterone. Post-partum, inhibition of estrogen/progesterone is lifted, prolactin continues to be secreted- and milk is produced
49
28 yo G0 p/w severe endometriosis, failed conservative medical management Best tx option?
Tx = laser ablation of adhesions- wouldn't do hysterectomy/salpingo-oophorectomy in young nulliparous F Sidebar: conservative management is OCPs and analgesia
50
36 yo G0 p/w severe abdominal pain x2-3 days w/ N/D - febrile to 102 - abdomen TTP w/ mild guarding and rebound, elevated white ct - pelvic US: b/l 3-4cm complex masses Dx
Dx = ascending infection causing salpingitis, ultrasound findings consistent w/ tubo-ovarian abscess -most often sexually transmitted: gonorrhea, chlamydia, or any other thing ascending from the GU or GI tract
51
Uterotonic agents: contraindications for methylergonovine vs. prostaglandin F2-alpha
Methylergonovine = methergine, can't use in h/o HTN Prostaglandin F2-alpha = hemabate, can't use in h/o asthma
52
Microscopic evaluation of discharge findings indicative of (a) bacterial vaginosis (b) trichomoniasis
(a) BV: clue cells on saline wet mount - drop of KOH releases amines from the cells => fishy odor (b) trichomoniasis = motile ovoid protozoa w/ flagella trichomonads = unicellular protozoans
53
Use of amitriptyline in pregnancy
Used in pregnancy to treat migraine headaches
54
Associations with breech position
- premature - multiple gestations - polyhydramnios - hydrocephaly - placenta previa - uterine anomalies and fibroids
55
Which features of severe preeclampsia are contraindications to expectant management
Need to deliver if: - thrombocytopenia (plt under 100k) - can't control BP on max doses of two antihypertensives - non-reassuring FHT - AST/ALT above 2x uln - eclampsia - persistent CNS symptoms Can wait if -elevated uric acid and hemoconcentration

OB/GYN (10 decks)

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