UWise Flashcards
What is the sequential screen?
ComBines first trimester screen with quad screen - detects aneuploidies.
Asherman’s syndrome results from trauma to what?
Basal layer of endometrium
What blood pressures are needed for the diagnosis of preeclampsia with severe features?
SBP >160 or DBP >110
Early decelerations are thought to represent fetal response to what?
Head compression
What typically causes variable decelerations?
Cord compression
What is hyperthecosis?
More severe form of PCOS; associated with virilization due to the high androstenedione production and testosterone levels
Does a h/o SAB increase the risk of pre-E?
No
A baby born to a mother that is HIV + and has a positive PPD with a negative CXR is managed how?
Start zidovudine immediately and test for HIV at 24 hours; no need to isolate infant as CXR is negative
What is the risk of fetal loss associated with chorionic villus sampling?
1%
A patient presents with Mullerian agenesis, what other test should be completed?
Renal ultrasound - 25-35% of patients with Mullerian agenesis have renal anomalies
What are the risk factors for uterine atony?
Precipitous or prolonged labor, use of oxytocin, multiparity, general anesthesia, macrosomia, hydramnios, twins, chorioamnionitis
How does a neonate appear when septic from chorioamnionitis?
Tachycardic, minimal variability suggest sepsis; septic infant will appear pale, lethargic and have a high temp
What is the most effective screening test for Down syndrome?
Cell free DNA
What is the most common cause of elevated maternal serum alpha fetal protein?
Under estimation of gestational age
If a patient has an exposure to Hep B and has not get been vaccinated, what is the next steps for treatment of the patient?
Post-exposure prophylaxis should be initiated but no later than 7 days after blood contact and within 14 days after sexual exposure; should receive 1 dose of HBIG and the HBV series
What studies can be conducted using chorionic villus sampling?
Chromosomal abnormalities, biochemical or DNA-based
Patient presents in active labor with breech presentation, what should be done next?
C-section
Prolonged fetal tachycardia is seen when?
Maternal fever or chorioamnionitis
What is Chadwick’s sign?
Bluish color of cervix - seen in pregnancy
What is the definition of postpartum hemorrhage?
Vaginal - 500 cc; C-section - 1000 cc
G3P3 41 yo F presents with abnormal uterine bleeding, what test should be done first?
Ultra sound - less invasive than hysteroscopy
In what type of DM is associated with IUGR?
Pre-existing DM
What is Rokitansky-Kuster-Hauser syndrome?
Causes vaginal and uterine agenesis
What are the signs of magnesium toxicity?
Resp depression, nausea, muscle weakness and loss of DTRs; Mag in high doses can lead to cardiac arrest
What effect does estrogen have on the endometrium?
Stimulation of rapid endometrial growth, conversion of proliferative to secretory endometrium and regeneration of the functional layer
What is twin-twin transfusion syndrome?
Complication of monochorionic pregnancies - characterized by an imbalance in the blood flow through communicating vessels across a shared placenta leading to under perfusion of the donor twin
At what magnesium levels are there loss of DTRs?
7-10 mEq/L
Head compression typically causes what type of decelerations?
Early
What are potential neonatal complications of vacuum assisted delivery?
Lacerations to scalp, separation of fetal scalp from underlying structures, cephalohematoma, jaundice, transient lateral rectus paralysis (not of clinical importance apparently)
If CVS is performed before 10 weeks gestation there is an increased risk of what?
Limb abnormalities
What is the most common risk factor for uterine inversion?
Iatrogenic- excessive traction on the umbilical cord
What is the treatment for cervical insufficiency?
Prophylactic cerclage (transvaginal cerclage)
What defect can be seen in pregnancy with prenatal exposure to valproic acid?
Lots but most common is NEURAL TUBE DEFECT
What are the complications to each twin in twin-twin transfusion syndrome?
Donor twin becomes anemia, has IUGR, oligohydramnios; recipient has over perfusion and becomes polycythemic, experiences volume overload and polyhydramnios which may lead to heart failure and hydrops
What is the most common cause of inherited mental retardation?
Fragile X syndrome
What are the treatment options for vestibulodynia?
TCAs, pelvic floor rehabilitation, biofeedback, topical anesthetics. Surgery for patients who do not respond to standard therapies
Valproic acid exposure in utero is associated with an increased risk for what anatomical defects?
NTDs, hydrocephalus and craniofacial malformations
What is the treatment for Kallmann syndrome?
Pulsatile GnRH therapy
What are risk factors for uterine inversion?
Grand multiparity, multiple gestation, polyhydramnios, macrosomia
If a patient is exposed to Hep B but is a nonresponder to the vaccine, what is the course of treatment?
HBIG plus HBV or HBIG time two doses
What type of contraception should be used with caution in women with a history of depressoin?
Progestins
When is methergine contraindicated?
Hypertension
What weight is needed for menarche to occur?
85-106 lbs
What type of cancer has an increased incidence in patients with PCOS?
Endometrial and considered to increase the risk of ovarian
Prostaglandins are contraindicated in patients with what obstetrical history? Why?
C section - due to potential uterine rupture
What are the management options for endometrial polyps?
Observation, medical management with progestin, curettage, surgical removal and hysterectomy
Patient presents with anorexia nervosa and amenorrhea. You suspect hypothalamic-pituitary dysfunction. What hormone should be evaluated to confirm the diagnosis?
FSH level - would expect to be very low
What is the diagnostic criteria for PCOS?
Two of the following three criteria: chronic anovulation, hyperandrogenism (clinical or biological), polycystic ovaries on US
What does partial deletions of the long arm of the X chromosome cause?
Premature ovarian failure
What is the therapeutic range of magnesium?
4-7 mEq/L
A mother with a h/o substance abuse delivers a limp unresponsive infant with HR >90 bmp and no respiratory effort. What is the most appropriate next step?
Give positive pressure ventilation and prepare to intubate the infant
Newborns of mothers with T1DM are usually what size? Blood sugar levels?
Smaller in size and worry about hypoglycemia
What are initial measures to treat fetal hypoperfusion?
Maternal position to left lateral position - increases perfusion to uterus; maternal supplemental oxygen, treatment of maternal hypotension, d/c oxytocin
When is amnioinfusion used?
Repetitive variable decelerations
Late decelerations are associated with what?
Uteroplacental insuff.
What age are DEXA scans recommended?
65 for women, sooner if have risk factors
Why can anorexia nervosa result in amenorrhea?
Hypothalamic-pituitary dysfunction - lack of normal pulsatile secretion of GnRH
What is the normal and predictable sequence of sexual maturation?
Breast budding (thelarche) then adrenarche (hair growth), a growth spurt and then menarche
What is the recommended rate of oxygen flow for an infant needing positive pressure ventilation?
10 L/minute
What is the treatment for bacterial vaginosis?
Metronidazole 500 mg orally BID x7 days or vaginal metronidazole 0.75% gel QHS x 5 days
What is the recommended daily dose of folate for pregnancy with a h/o neural tube defect?
4 mg
When is an amniocentesis performed?
After 15 weeks
What is the treatment for uncomplicated vulvovaginal candidiasis?
Topical azoles (1-3 days)
During what weeks of gestation is chorionic villus sampling done?
Weeks 10-12
What organism is the likely cause of mucopurulent cervicitis with exacerbation in the symptoms during and after menstruation?
Gonorrhea
Infants born to diabetic mothers have an increased risk of developing what?
Hypoglycemia, polycythemia, hyperbilirubinemia, hypocalcemia, and respiratory distress
Acanthosis nigricans is associated with increased blood levels of what?
Elevated androgen levels and hyperinsulinemia
At what magnesium level does cardiac arrest occur?
15 mEq/L
When is hemabate contraindicated?
Asthmatics
Patient presents with thin, gray discharge with a fishy odor that is often worse after menses or intercourse. What is the likely cause? What is seen on wet prep? Vaginal pH?
Bacterial vaginosis; clue cells; pH >4.5
What is the most likely complication a patient will experience after postpartum tubal ligation?
Future pregnancy - failure rate of 1%
Patient presents with hirsutism, why can testing 17-hydroxyprogesterone be useful?
Evaluation for late onset 21-hydroxylase
When trying to place an IUPC, frank vaginal blood and amniotic fluid are noted. What is the next step to management?
Monitor fetus - worried about placenta separation or uterine perforation
What is Kallmann syndrome?
Arcuate nucleus does not secrete GnRH and there is olfactory tract hypoplasia; no sense of smell and do not develop secondary sexual characteristics
When is a B-lynch suture used for postpartum hemorrhage?
Recalcitrant cases of PPH - needs to be laparoscopic.
What is the recommended daily dose of folate in a non-high risk pregnancy?
0.6 mg
What uterotonic agent is contraindicated in asthmatics?
Prostaglandin F2 alpha (Hemabate) - smooth muscle constrictor and brochio-constrictive effect
Placental insuff is associated with what type of decelerations?
Late
At what size is observation of a polyp not recommended?
If the polyp is >1.5 cm observation is not recommended
What screening test can be done in the first trimester for downs syndrome?
Combined test - beta hcg, PAPP-A and nuchal translucency.
What is the pathophysiology behind postpartum telogen effluvium?
High levels of estrogen during pregnancy increase synchrony of hair growth. Therefore, hair grows in the same phase and is shed at the same time
What uterotonic agent is contraindicated in patients with hypertension?
Methergine - ergot alkaloid
Patient presents with features of PCOS, what is a the next lab tests for evaluation?
Fasting insulin
What phase of the menstrual cycle is inhibin increased?
Luteal phase
At what age does breast development begin?
Age 10
Uterine hyperstimulation may produce what on FHT?
Prolonged fetal bradycardia
Why is testosterone elevated in patients with PCOS?
It is elevagted because sex hormone binding globulin is decreased by elevated androgens
What needs to be given in magnesium toxicity?
Calcium gluconate
What is the most appropriate treatment for PCOS?
OCPs
What position should the head be in for an infant needing positive pressure ventilation?
Sniffing position - tilting he neonate’s head back and lifting the chin
What are the early skin changes seen with lichen sclerosis?
Polygonal ivory papules involving the vulva and perianal areas, waxy sheen on labia minora and clitoris
What is the loss rate of amniocentesis vs CVS?
Amniocentesis 0.5% vs CVS 1-3%
What is the MOA of medroxyprogesterone acetate for anovulatory bleeding?
Converts endometrium from proliferative to secretory endometrium
What are the risk factors for retained placenta?
Cesarean delivery, uterine leiomyomas, prior uterine curettage and succenturiate lobe of placenta
What age doe leiomyomas typically present?
30s and 40s
What urine protein levels are requires for the diagnosis of preeclampsia? Severe pre-elcampsia?
Preeclampsia = 300 mg; severe preeclampsia = 5000
Patient had an abortion and is now complaining of cyclic midline abdominal cramping pain. What is the likely diagnosis?
Hematometra
What complications might occur after suction and dilatation?
Anesthesia risk, bowel and bladder injury, cervical lacerations, and uterine perforations
What is the most common abnormal karyotype encountered in spontaneous abortions?
Autosomal trisomy
What systemic disease are associated with early pregnancy loss?
Diabetes mellitus, chronic renal disease and lupus
What is fetal fibronectin? How is it used?
Fetal fibronectin leaks into the vagin if a preterm delivery is likely to occur; +fFN is inconclusive but used as a negative predictor of preterm delivery
When should a cervical cerclage be done when a patient has an incompetent cervix?
14 weeks
Patient presents with recurrent (successive) first trimester losses. What tests should be performed?
Testing for lupus anticoagulant, diabetes mellitus and thyroid disease; can also obtain maternal and paternal karyotypes
What position is best for breast feeding?
Baby and mom belly to belly
What hospital policies promote breastfeeding?
Getting baby on breast within half hour of delivery and rooming-in for the baby to ensure frequent breastfeeding on demand
What hormone has an inhibitory influence on alpha-lactalbumin?
Progesterone; prolactin has a positive influence
How does candida of the nipple present?
Intense nipple pain
If mother has candida of the nipple, what else should you check for?
Check babies mouth
What are the signs that baby is getting enough milk?
3-4 stools in 24 hrs, 6 wet diapers in 24 hrs, weight gain and sounds of swallowing
What factors does fresh frozen plasma contain?
Fibrinogen, clotting factors V and VIII
What are the common presenting signs of placental abruption?
Abdominal pain, bleeding, uterine hypertonus and fetal distress
A patient presents with placental abruption and deteriorating fetal condition, what is the next best step?
Emergent cesarean delivery
Smoking increases the risk of what complications during pregnancy?
Placental abruption, placenta previa, fetal growth restriction, preeclampsia and infection
How does a cervical polyp appear on examination?
Bleeding and are typically soft (not hard)
What is the treatment protocol for pregnant women with HIV?
HAART therapy, IV zidovudine at time of delivery, zidovudine treatment for neonate, cesarean section prior to labor
What is the most common cause of sepsis in pregnancy?
Acute pyelonephritis
Why is radioactive iodine (I-131) contraindicated in pregnancy?
Concentrates in fetal thyroid and can cause congenital hypothyroidism
18 week pregnant woman presents with symptomatic mitral valve prolapse. What treatment should be used at this time?
Beta blockers; because she is symptomatic this should be treated
What is seen on hemoglobin electrophoresis in Beta thalassemia?
Hemoglobin F and hemoglobin A2
Women with obesity that are pregnant are at increased risk for developing what complications?
Chronic HTN, gestational DM, pre-E, fetal macrosomia
What SSRI is contraindicated in pregnancy? Why?
Paroxetine (Paxil); increased risk of fetal cardiac malformations and persistent pulmonary hypertension
What is pruritus gravidarum?
Pregnancy-related skin condition that is a mild variant of intrahepatic cholestasis of pregnancy; there is retention of bile salt which is deposited in the dermis which leads to pruritus
What is the treatment for gravidarum pruritus?
Antihistamines and topical emollients should be used initially; refractory cases ursodeoxycholic acid is helpful; naltrexone can also be used
Where is the appendix in pregnancy?
Enlarged uterus shifts the appendix upward and outward toward the flank (pain and tenderness may not be in RLQ)
What is the chance an Rh negative mom who refuses Rhogam will have isoimmunization if she gives birth to an Rh positive fetus?
2% antepartum, 7% after full term delivery and 7% with subsequent pregnancy; less than 20%
What test can be used to assess fetuses at risk for anemia?
Middle cerebral artery peak systolic velocity
Anti-D antibodies increase the risk of what complication for the fetus?
Hydrops fetalis - defined as fluid in two more more cavities
What amount of fetal blood is neutralized by 300 micrograms of rhogam?
30 cc of fetal blood is neutralized; this is equivalent to 15 cc of fetal red blood cells
When is Rhogam administered?
28 weeks gestation after testing for sensitization and given following amniocentesis, CVS, delivery, and abortion
What are Lewis antibodies?
IgM antibodies that do not cross the placenta
Amniotic fluid ferritin is associated with what?
Spontaneous preterm delivery
Patient’s amniotic fluid stains yellow, what does this indicate?
Yellow is bilirubin; this is due to erythroblastotic fetus - severe hemolysis
Fetus at 30 weeks EGA has severe hemolytic disease (zone 3 of the Liley curve); what can be done to help the fetus at this time?
Intrauterine Intravascular transfusion
What ultrasound markers are suggestive of dizygotic twins?
Dividing membrane thickness greater than 2 mm, twin peak (lambda) sign, different fetal genders and two separate placentas (posterior and anterior)
What is the twin infant death rate in comparison to singletons?
Five times higher
What is the risk for development of cerebral palsy in twin infants vs singletons?
5-6x higher
Twin-twin transfusion most comonly occurs in what type of twins?
Monochorionic, diamniotic twins
The surviving twin of a twin-twin transfusion syndrome has increased rates of what?
Neurological morbidity - including cerebral palsy
The recipient twin in twin-twin transfusion can have what complications?
Cardiomegaly, tricuspid regurgitation, ventricular hypertrophy, plethoric
What are the reasons for elevated alpha fetoprotein?
Twins, neural tube defects, pilonidal cysts, cystic hygroma, sacrococcygeal teratoma, fetal abdominal wall defects and fetal death
What is the most common chromosomal aneuploidy in abortuses?
Trisomy 16
At what gestational age is the greatest fetal risk for developing neurological deficits when exposed to radiation?
8-25 weeks (8-15 weeks)
Uncontrolled diabetes during organogenesis is associated with what?
High rate of birth defects - most common are spine and heart
Advanced maternal age is associated with what pregnancy complications?
Stillbirth, preeclampsia, gestation DM, IUGR
What is the ultrasound criteria for a missed abortion?
CRL >7mm with no cardiac activity
What conditions are associated with breech presentation of a fetus?
Prematurity, multiple gestation, genetic disorders, polyhydramnios, hydrocephaly, anencephaly, placenta previa, uterine anomalies, uterine fibroids
Whta is the definition of prolonged latent phase?
> 20 hours for nulliparous and >14 hours for multiparous
What is the typical presentation of cervical incompetence?
Usually diagnosed in early 2nd trimester and is associated with painless cervical dilation
Patient presents in preterm labor, what mediations are important for this patient?
Nifedipine - tocolytic; betamethasome - baby lungs; ampicillin (azithromycin + amoxicillin also)
By what MOA does Magnesium work as a tocolytic?
Competes with calcium entry into the cells
Indomethacin cannot be used as a tocolytic past what EGA?
32 weeks - premature closure of ductus arteriosus
What side effects does nifedipine have when used in pregnancy?
Fetal hypoxia and decreased uteroplacental blood flow
What is the statistical significant bullshit behind fetal fibronectin in a preterm labor lady?
Has a negative predictive value of 99.2% – MEANING…. 99/100 with a negative test result will not deliver in the next 14 days. HAS NOTHING TO DO WITH SENSITIVITY…. Also it has a low PPV.
What complications can occur with a bacterial vaginosis infection?
PPROM
What are the levels of glucose and IL-6 in chorioamnionitis?
Glucose levels are low and IL-6 would be increased
What medication can reduce the risk of premature labor?
17 alpha hydroxyprogesterone (administered between 16-20 weeks until 36 weeks)
What is the treatment for postpartum endometritis?
Clindamycin + gentamicin
How is septic pelvic thrombophlebitis diagnosed?
Diagnosis of exclusion - characterized by high fever not responsive to antibiotics
What is the treatment for septic thrombophlebitis in postpartum?
Anticoagulation and antibiotics;
What is the most common cause of fever on the first postpartum day?
Lungs - especially if patient had general anesthesia
Clindamycin covers what type of organisms?
Anaerobic organisms apparently…
Patient is 24 weeks pregnant and starts treatment with fluoxetine (Prozac), what is the most common side effects?
Insomnia and sexual dysfunction
Mother wishes to breastfeed her baby but is concerned about taking sertraline while breastfeeding. How do you counsel her?
Tell her its fine. She can take SSRIs if she wants. Its fine.
What side effects does a neonate experience when a mother uses fluoxetine during pregnancy?
It has been associated with abnormal muscle movements (EPS) and withdrawal sxs (decreased muscle tone, tremor, sleepiness, severe difficulty breathing)
At what time of the menstrual cycle do PMS and PMDD begin?
Luteal phase (second half) - resolves shortly after the onset of menses
A patient is postterm, what diseases are associated with postterm pregnancies?
Placental sulfatase def, fetal adrenal hypoplasia, anencephaly, inaccurate or unknown dates
Late term and postterm pregnancies are associated with what complications?
Macrosomia, oligohydramnios, meconium aspiration, uteroplacental insufficiency and dysmaturity; also increased risk preeclampsia
What is a reasonable approach to repetitive variable decelerations?
Amnioinfusion
How does an infant with dysmaturity appear?
Withered, meconium stained, long-nailed, fragile and have associated small placenta
What is most commonly used for cervical ripening?
Prostaglandins applied locally (tablet)
An increased systolic/diastolic ratio of the umbilical artery reflects what?
Increased vascular resistance
Fetal growth restriction is a significant risk factor for developing what diseases as an adult?
COPD, type II DM, CVD, CHTN, stroke, obesity
What are the characteristics of a threatened abortion?
Vaginal bleeding, positive pregnancy, positive pregnancy test and cervical os closed or uneffaced
What is the management of septic abortion?
Broad spectrum antibiotics and uterine evacuation
17-hydroxyprogesterone is indicated when?
History of prior preterm birth
What is the treatment for antiphospholipid antibody syndrome in a patient that wants to become pregnant?
Heparin and aspirin
Prolonged diluted Russell viper venom time and 3 early pregnancy losses is suggestive of what?
Antiphospholipid antibody syndrome
What is mifepristone? Misoprostol?
Mifepristone - antiprogestin; misoprostol - prostaglandin
When can manual vacuum aspiration of a pregnancy be performed?
Less than eight weeks
What is the management for ovarian torsion?
Surgery
What is the first line treatment option for a woman with endometriosis trying to conceive?
Ovarian stimulation with clomiphene citrate
What can be used for pain relief in mastitis?
Acetaminophen and ibu
What is interstitial cystitis? What is the presenting complaint usually?
Chronic inflammatory condition of the bladder characterized by recurrent voiding symptoms of urgency and frequency; can also complain of pelvic pain and dyspareunia
What is the MOA of GnRH agonists in treatment of endometriosis?
Down-regulates hypothalamic-pituitary gland production and the release of LH and FSH leading to dramatic reduction in estradiol level
What is pelvic congestion syndrome?
Pelvic pain in the setting of pelvic varicosities
The iliohypogastric nerve provides cutaneous sensation to what?
The groin and skin overlying the pubis
The ilioinguinal nerve supplies sensation to what region?
Groin, symphysis, labium and upper inner thigh
What are the common complications of a LEEP procedure?
Infection, bleeding, cervical stenosis, persistent disease, possibility risk for preterm delivery
Hyperplastic overgrowth of endometrial glands/stroma is consistent with what disease?
Polyps
What effect can quetiapine have on fertility?
Can cause hyperprolactinemia, resulting in subfertility
What are the characteristic lab findings in exercise-induced hypothalamic amenorrhea?
Normal FSH with low estrogen levels
What lab test can be used to asses ovarian reserve?
Anti-mullerian hormone levels
What is a last resort treatment option for women with PMDD?
Bilateral oophorectomy
Prior to bilateral oophorectomy for patients with refractory PMDD, what treatment option can be done short-term to evaluate the success of the surgery?
Administer a course of GnRH agonist to initiate a menopause-like state
Who is at increased risk for molar pregnancies?
Asian women have a higher incidence, higher incidence in areas where people consume less beta-carotene and folic acid, increased risk in women with 2 or more miscarriages
What is the risk of recurrence for molar pregnancies?
1-2% which is a 20-fold increase from background risk; the risk of recurrence after two molar pregnancies is 10%
What is seen on ultrasound in a complete mole?
Snowstorm appearance; due to presence of multiple hydropic villi
What is the standard management for molar pregnancies?
Suction and curettage
What is the karyotype of a partial mole?
69XXY, 69XXX or 69XYY
What type of molar pregnancy shows marked villi swelling?
Partial moles
What needs to be done to evaluate a mass in the region of the Bartholin gland in a woman over the age of 40?
Should be biopsied; any finding of a new Bartholin gland cyst in a post-menopausal woman should be further investigated; worried about adenocarcinoma
What are the risk factors for vulvar cancer?
HPV expsoure, smoking, vulvar dystrophy (lichen sclerosis), immunocompromised
What are the follow-up guidelines for ASCUS?
Perform HPV DNA testing or repeat cytology in 12 months; if HPV testing was negative then routine screening can be resumed at 3 years; for women ages 21-24 with HPV positive - cytology should be repeated in 12 months
What is the major symptom associated with leiomyomas?
Heavy menstrual bleeding
What type of leiomyomas can cause infertility or miscarriages?
Submucosal (or intracavitary)
What are the risk factors for endometrial carcinoma? Which is the strongest risk factor?
Nulliparity, obesity, late menopause, HTN, exposure to unopposed estrogens, tamoxifen therapy, diabetes; obesity is the greatest risk factor
What is the recommended treatment to endometrial cancer?
TAH, BSO with pelvic and paraaortic lymphadenectomy
When is a theca lutein cyst usually seen?
Pregnancy (molar usually) and is often bilateral
What is a granulosa cell tumor?
An estrogen secreting tumor
What is the most common cause of postmenopausal bleeding?
Atrophy of the endometrium
A spiral fracture is indicative of what?
Abuse/violence associated with the Fx
What are the risk factors for ovarian cancer?
Nulliparity, family history, early menarche, late menopause, white race, increasing age, residence in north America or northern europe
How does a functional ovarian cyst appear on ultra sound?
As a simple cyst - unilocular simple cyst without evidence of blood, soft tissue elements or excrescences
How does a dermoid tumor appear on ultrasound?
Echogenic, may contain teeth, cartilage, bone, fat and hair
What type of ovarian tumor can produce estrogen and therefore cause endometrial hyperplasia/cancer?
Granulosa cell tumor
What is the most common subtype of ovarian tumors?
Epithelial tumors
Prognosis of ovarian cancer is based on what?
Tumor stage
What is the standard of care for advanced ovarian cancer?
Tumor debulk followed by post-operative chemotherapy with combination of taxane and platinum adjunct
What chemotherapeutic agents are used for ovarian cancers?
Taxane and platinum
What is the most common ovarian tumor found in women of all ages?
Dermoid
75 yo F presents with dyspareunia. Atrophic vaginal mucosa is noted on exam. What is a good treatment option for her?
Topical estrogen cream
How can a female help prevent vaginal atrophy?
By staying sexually active
What is the most important source of lubrication during intercourse for a female?
Transudate of the fluid across the vaginal mucosa
What prescriptions should be offered to a rape victim?
Ceftriaxone, doxycycline, and anti-retrovirals; emergency contraception if desired
What is peripartum cardiomyopathy? What are the presenting s/sx?
Heart failure secondary to left ventricular systolic function; fatigue, SOB, palpitations and edema
What does peripartum cardiomyopathy usually present?
Towards the end of pregnancy or in the several months following delivery
Why is there a compensated respiratory alkalosis during pregnancy?
Pregnancy increases minute ventilation - blow off more CO2, excrete by HCO3
What happens to the inspiratory capacity during pregnancy?
It increases by 15% due to increases in TV and IRV
How is the minute ventilation increased in pregnancy?
Increase in tidal volume, no change in RR
What happens to the functional residual capacity in pregnancy?
Reduced to 80% of non-pregnant volume
What ureter and renal pelvis becomes more dilated in pregnancy? Why?
R>L; the left is cushioned by the sigmoid colon
What is the recommended weight gain in pregnancy for a woman with a pre-pregnancy BMI of <18.5?
28-40 lbs
What is the recommended weight gain in pregnancy for a woman with a pre-pregnancy BMI of 18.5-24.9?
25-35 lbs
What is the recommended weight gain in pregnancy for a woman with a pre-pregnancy BMI of 25-29.9?
15-25 lbs
What is the recommended weight gain in pregnancy for a woman with a pre-pregnancy BMI of >30?
11-20 lbs
Beta thalassemia anemia is seen in populations from what region?
Mediterranean
In chorionic villus sampling, what region of the chorion is the sampling done from?
Chorionic frondosum
What is the most common cause of inherited mental retardation?
Fragile X syndrome
Women with poorly controlled diabetes prior to conception have an increased risk for having a fetus with what structural anomalies?
Lesions of the CNS (neural tube defects) and the cardiovascular system
What is the risk of fetal loss with CVS?
1%
Prior history of ectopic pregnancy increases the risk of ectopic pregnancy by how much?
10 fold
Age between 35-44 increases the risk of ectopic pregnancy by how much?
3 fold
What progesterone level suggests a healthy pregnancy?
Progesterone >25 ng/ml
What criteria must be met for use of methotrexate?
Hemodynamically stable, non-ruptured ectopic pregnancy, size of ectopic mass <4 cm without a fetal heart rate or <3.5 cm in the presence of fetal hear rate, normal liver enzymes and renal function, normal white cell count, reliable to follow up
What should be rule out and documented prior to starting HRT for menopause?
R/o endometrial hyperplasia/cancer; normal endometrial bx or US with endometrial stripe < or equal to 4 mm
How often should bone mineral density testing be done in a patient with an osteoporotic fracture?
Repeated every two years
HRT increases the risk for what cancer? And decreases the risk of what other cancer?
HRT increases the risk for breast cancer but decreases the risk for colon cancer
HRT has what effect on lipid levels?
Increases HDL and decreases LDL
What race increases the risk for osteoporotic fracture?
White/Asian
What is the size and blood sugar levels of neonates of a type 1 diabetic with moderately controlled sugars during pregnancy?
Small and watch for hypoglycemia
Infants born to diabetic mothers are at increased risk for what?
Hypoglycemia, polycythemia, hyperbilirubinemia, hypocalcemia, and respiratory distress
What is overflow incontinence?
Failure to empty the bladder adequately - due to underactive detrusor muscle
What is a normal post-void residual? What is considered elevated?
Normal is 50-60 cc; elevated is >300 cc
Family history of pelvic organ prolapse increases the risk of POP by how much?
2.5 fold increase
How is urethral hypermobility genuine stress incontinence diagnosed?
Straining Q-tip angle >30 degrees for horizontal
What is the best surgical treatment option for genuine stress incontinence?
Retropubic urethropexy
What is the best surgical treatment option for intrinsic sphincter deficiency?
Urethral bulking procedures
What neurotransmitter stimulates the bladder to contract?
Ach through muscarinic receptors
How is vaginal vault prolapse treated?
Supporting the vaginal cuff to the uterosacral or sacrospinous ligaments or by sacrocolpopexy
How are central and lateral cystoceles repaired?
Repaired by fixing defects in the pubocervical fascia or reattaching it to the sidewall if separated from the white line (arcus tendineus fascia)
How are rectoceles repaired?
Repairing defects in the rectovaginal fascia
What is the cause of urge incontinence?
Overactivity of the detrusor muscle
What is Sheehan syndrome?
Patient experiences significant blood loss (eg PPH) resulting in anterior pituitary necrosis
What factors are related to increased rates of infection with a vaginal birth?
Prolonged labor, prolonged ROM, multiple vaginal examinations, internal fetal monitoring, removal of the placenta manually and low SES
What is the most common cause of postpartum fever?
Endometritis; DDx includes UTI, lower genital tract infection, wound infections, pulmonary infection, thrombophlebitis, and mastitis
What bacteria are responsible for endometritis?
Bacterial isolates related to postpartum endometritis are usually polymicrobial resulting in a mix of aerobes and anaerobes in the genital tract. The most causative agents are Staphylococcus aureus and Streptococcus.
What is the safest method to suppress lactation?
Breast binding, ice packs and analgesics
Why are prostaglandins inhibited for cervical ripening in a patient with a prior cesarean section?
Risk of uterine rupture
What is the first initial step for fetal stimulation?
Digital scalp stimulation with the goal to elicit acceleration of 15x15
Fetal head with measurements great than what diameter would benefit from a cesarean?
Diameter >12cm
When is a patient a candidate for prophylactic cerclage?
Cervical insuff. - painless cervical dilation before 24 weeks with expulsion of pregnancy in second trimester, in absence of labor or other clear pathology such as infection or ROM
What is the MOA of medroxyprogesterone acetate?
Inhibits endometrial growth converting the proliferative to secretory endometrium
A polyp of what size or greater is an indication for polypectomy in a woman trying to conceive.
Polyp >1.5 cm in a woman with infertility a polypectomy is a treatment of choice
Which non-invasive test can detect severe fetal anemia?
Doppler study of middle cerebral artery peak systolic velocity
What about of fetal blood is neutralized by a dose of 300 micrograms of rhogam?
30 cc of fetal blood = 15 cc of fetal RBCs
What is the definition of prolonged latent phase labor?
> 20 hours for nullips; >14 hours for multips
What is the most common type of breech presentation?
Frank breech - buttocks is presenting part
What is the most common cause of preterm labor?
Idiopathic
What tocolytics are contraindicated in diabetic patients?
Terbutaline and ritodrine
What tocolytic is contraindicated in myasthenia gravis?
Mag
What treatment option is first line for a woman presenting with infertility secondary to endometriosis?
Ovarian stimulation with clomiphene citrate
Preterm rupture of membranes is especially associated with what genital tract infection?
Bacterial vaginosis
What findings are seen on amniocentesis in triple I?
Chorioamnionitis - increased IL-6, low glucose, leukocytes
