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OB/GYN > UWise > Flashcards

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
Q

Tx of septic thrombophlebitis

A

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
Q

Treating hyperthyroid during pregnancy

A

Use PTU (propylthiouracil)

27
Q

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?

A

Uncontrolled diabetes during organogenesis => 4-8x increased risk of having a fetus w/ structural anomaly- usually CNS (neural tube defects) and cardiac

28
Q

To confirm ROM, test cervical mucus or vaginal fluid

A

Important to test vaginal fluid (and not cervical mucus) b/c of false positive ferning patterns

29
Q

When would an elective C-section for pain be performed?

A

At 39 weeks gestation

  • NOT at 41 if labor has not already happened
  • totally a women’s choice to undergo elective C-section
30
Q

Benefit of vacuum delivery vs. forceps assisted delivery to the mother

A

Vacuum deliveries associated w/ less maternal lacerations/discomfort

31
Q

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?

A

Hypercoagulability- antiphospholipid syndrome

32
Q

33 yo at 29 wks presents w/ PPROM, next step?

A

Latency abx- ampicillin and erythromycin

-shown to prolong latency period for 5-7 days, and to reduce maternal amnioitis and neonatal sepsis

33
Q

2 signs of magnesium toxicity and levels at which they occur

A

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
Q

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

A

Hysteroscopic polypectomy

-Could do medical management w/ progestin but not if she wants to get pregnant

35
Q

Describe the discharge seen in

(a) Trichomonas
(b) Candida

A

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
Q

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

A

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
Q

60 yo p/w urinary frequency and urge incontinence

  • cystometrogram: uninhibited detrusor contractions upon filling
  • normal post void ridicual

Best tx

A

Best tx = oxybutynin (anticholinergic/antimuscarinic)

Mechanism of urge incontinence = detrusor instability, overactive bladder (doesn’t relax = uninhibited contractions)

38
Q

At what age does a F w/ a hysterectomy no longer need pap smear?

A

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
Q

Tx of baby born to HIV+ mother

A

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
Q

Contraindication to vacuum aspiration instead of D and C

A

Vacuum aspiration only for under 8 wks of gestation

41
Q

Which type of leiomyomas have the highest risk of infertility

A

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
Q

Postterm pregnancies association w/

(a) placental sulfatase
(b) fetal adrenal gland function

A

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
Q

Risk factors that would indicate DEXA before age 65

A
  • 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
Q

Type 1 diabetic w/ A1C of 9.2% is at highest risk for what fetal complication?

A

Fetal growth restriction

  • higher risk than macrosomia when this poorly controlled for this long
  • thought to be 2/2 placental microvasculature disease
45
Q

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

(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
Q

Describe classic presentation of gonorrhea induced PID

A

Lower abdominal pain, adnexal tenderness, fever, cervical motion tenderness

  • mucopurulent vaginal discharge
  • classically w/ exacerbation of symptoms during and after menstruation
47
Q

Risks of phenytoin and carbamazepine in pregnancy

A

Clinical syndrome called fetal hydantoin syndrome with group of findings:

  • microcephaly
  • hypoplasia of phalanges
  • excess hair, cleft palate
48
Q

What hormone is responsible for breastmilk production?

A

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
Q

28 yo G0 p/w severe endometriosis, failed conservative medical management

Best tx option?

A

Tx = laser ablation of adhesions- wouldn’t do hysterectomy/salpingo-oophorectomy in young nulliparous F

Sidebar: conservative management is OCPs and analgesia

50
Q

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

A

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
Q

Uterotonic agents: contraindications for methylergonovine vs. prostaglandin F2-alpha

A

Methylergonovine = methergine, can’t use in h/o HTN

Prostaglandin F2-alpha = hemabate, can’t use in h/o asthma

52
Q

Microscopic evaluation of discharge findings indicative of

(a) bacterial vaginosis
(b) trichomoniasis

A

(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
Q

Use of amitriptyline in pregnancy

A

Used in pregnancy to treat migraine headaches

54
Q

Associations with breech position

A
  • premature
  • multiple gestations
  • polyhydramnios
  • hydrocephaly
  • placenta previa
  • uterine anomalies and fibroids
55
Q

Which features of severe preeclampsia are contraindications to expectant management

A

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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