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UWise Flashcards

1
Q

Pt has a pap with ASUCS and + for high risk HPV. Now what?

A

Colposcopy is indicated

Repeat cytology in 1 year is acceptable with HPV testing was not done

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2
Q

What are the criteria for discontinuing Pap smears?

A
  1. If pt had a hysterectomy, unless the indication was for cervical cancer or high grade dysplasia
  2. Age 65-70 with 3 consecutive NL pap smears, or 2 negative in the last 10 years + no hx of abn cells
    Still need bimanual rectovaginal exam, mammograms
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3
Q

How frequently should women get a Pap smear?

A

Every 5 years if w/ HPV screening (cotesting)

Every 3 years if cytology along

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4
Q

Pap comes back with ASCUS. Now what?

A

Screen for HPV, or repeat cytology in a year

If + for high risk HPV -> colposcopy

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5
Q

Pt has lower abdominal pain, adnexal masses, CMT, Vaginal dyscharge

A 
Acute salpingitis (PID)
Chlamydia, gonorrhea
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6
Q

Pt with painless vaginal lesions and brown rash on palms needs a?

A

VDRL or RPR

Syphilis, confirm with treponemal testing

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7
Q

Pt presents with painful lesions on the vulva. How should you manage?

A

Herpes likely, offer a full screening for STD’s

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8
Q

Pt has a frothy yello-green vaginal discharge. PE erythematous patches on the cervix

A

Trichomonas

Strawberry cervix, protozoa on wet mount

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9
Q

Pt has syx suspicious for herpes, but culture is negative. Why?

A

Test is specific but not sensitive

10-20% false negatives

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10
Q

When is written Informed consent not required?

A

In a true emergency where the delay to consent could risk the pts life

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11
Q

Can a PI own stock in the company they do research for?

A

Yes, as long as it is disclosed

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12
Q

At what age should you start offering colonoscopies?

A

50
colonoscopy x 10 years
flex sigmoid x 5 years OR
FIT x 1 year

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13
Q

When is a DEXA scan offered?

A

Pts with RF’s prior to age 65

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14
Q

At what age should mammograms be offered?

A

40

Anual mammo

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15
Q

When would you recommend a colonoscopy early?

A

If pt has a first degree relative <60 with colon cancer.

Begin screening at age 40, or 10 years before the age of the relative at diagnosis. Repeat x 5 years

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16
Q

Which forms of contraception have <1% pregnancy rates?

A

Depo-Provera
Sterilization
Nexplanon
IUD

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17
Q

What vaccination should be avoided if a pt may become preg?

A

MMR

Avoid within 4 weeks prior to conception

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18
Q

Best way to prevent CVD in an otherwise healthy pt?

A

Start an aerobic exercise program

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19
Q

What is the strongest risk factor for osteoperosis?

A

Family Hx, age>50

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20
Q

Best way to lower risk of osteoperosis?

A

Weight bearing exercise 1-4x/wk

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21
Q

What supplement should be recommended to all women of child bearing age?

A

Folic acid

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22
Q

Preggo presents with dyspnea but no other findings

A

Physiologic dyspnea of pregnancy

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23
Q

What metabolic change is seen in pregnancy due to chronic hypoventilation?

A

Compensated respiratory alkalosis
preggos have increased minute ventilatin
Exacerbated by URI

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24
Q

What is the pathophys of preggo associated dyspnea

A

Inspiratory Capacity down by 15% due to decrease in TV and Inspiratory Reserve volume
FRC is reduced by 80%
Increased minute ventilation due to increased TV

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25
Q

Preggo presents with pulmonary edema. Why?

A

Decreased plasma osmolality, use of magnesium sulfate and nifedipine

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26
Q

Why do most women develop a diastolic murmur during pregnancy?

A

ABN
If Pulmonary vascular resistance > SVR causing R to L shunt if VSD is present
Develops cyanosis

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27
Q

Why do most women develop a systolic murmur during pregnancy?

A

Normal

CO increases by 33% due to increased hr and SV

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28
Q

Why do many women have syx consistent with hydronephrosis during pregnancy?

A

R ureter dilation and ovarian v. dilation

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29
Q

What can happen to thyroid hormone levels during pregnancy?

A

TBG increases due to increased estrogen -> increases total T3 while free T4 and T3 remain canstant

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30
Q

What study is needed in a pt with a molar pregnancy?

A

CXR -> lungs are most common site for metastatic dz in pts with gestational trophoblastic dz
Weekly BhCG will be required after

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31
Q

How much weight should a preggo gain if her BMI is < 18.5

A

28-40lb

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32
Q

How much weight should a preggo gain if her BMI is < 18.5-24.9

A

25-35 lb

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33
Q

How much weight should a preggo gain if her BMI is 25-29.9

A

15-25lb

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34
Q

How much weight should a preggo gain if her BMI is >30

A

11-20lb

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35
Q

How do you figure out risk of sickle cell?

A

Risk of being carrier in unaffected family = 1/10

Parent 1 chance of being carrier) x (parent 2 chance of being carrier) x (chance baby will be affected (1/4)

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36
Q

What screening would you recommend for a preggo AA woman?

A

CBC and Hgb electrophoresis

Detects Sickle cell, Hgb C, and thalassemia

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37
Q

Which ar disease have increased incidence in Ashkenazi jews?

A 
Fanconi Anemia
Tay-Sachs
Cystic Fibrosis
Niemann-Pick
Canavan
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38
Q

Valproic acid increases risk for?

A

Neural tube defects (hydrocephalus, craniofacial malformations)

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39
Q

Preggo with poorly controlled DM puts the fetus at increased risk of?

A

Structural anomalies - Neural tube defects, cardiovascular

G/U and limb defects are also reported but less common

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40
Q

What can be identified on chorionic villous sampling?

A

Chromosomal abnormalities, biochemical, or DNA based studies

CANNOT id neural tube defects

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41
Q

Which gestational screen is most sensitive for Trisomy 21 and trisomy 18

A

cell free DNA screen - 99%

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42
Q

What is the risk of miscarriage when a pt undergoes CVS?

A

Approx 1% regardless of previous hx of miscarriage

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43
Q

What is the most common form of inherited mental retardation?

A

Fragile X

Down syndrome is genetic, but not considered inherited

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44
Q

Non hispanic whites are at increased risk of having children with?

A

Cystic Fibrosis

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45
Q

What should you do if a patients LMP and fundal height are significantly different?

A

Fetal ultrasound

First trimester U/s is the most accurate estimate of gestational age

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46
Q

If a patient has multiple abn readings on a 3 hr glucose tolerance test, now what?

A

Educate on blood sugar monitoring and appropriate diet

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47
Q

Complications of gestational diabetes?

A 
Shoulder dystocia
Metabolic disturbances
Preeclampsia
Polyhydramnios
Fetal macrosomia
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48
Q

What dose of folic acid is recommended for a woman with a previous pregnancy complicated by fetal neural tube defect?

A

4mg folic acid QD

Recommended dose for a non-high risk pt is 0.6 mg/day

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49
Q

Pt has a negative cell free DNA screen but elevated alpha fetal protein. Why?

A

Most likely underestimation of gestation age

Could also be: fetal demise, multiple gestation, ventral wall defects, tumor, liver disease

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50
Q

If a pt is concerned from chromosomal anomaly following an increased nuchal translucency on U/s, their best option is?

A

Amniocentesis

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51
Q

Preggos can take ibuprofen up until?

A

32 weeks gestation - first risk of premature PDA closure

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52
Q

Preggos can take warfarin up until?

A

Never. Teratogenic. Switch to LMWH

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53
Q

Irregular, short contractions causing discomfort in the lower abdomen/groin

A

Braxton Hicks contractions

Less intense than true labor (strong regular contractions, cervical dilation, and effacement)

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54
Q

If a pt reports that her previous baby had neonatal sepsis, how do you manage her current preggo?

A

Do not culture

Give intrapartum abx

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55
Q

When do you normally screen for GBS?

A

35-37 weeks

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56
Q

What should you do if fetal heart rate cannot be measured through external methods during deliver?

A

Fetal scalp electrode

No epidural unless you can see the fetal hr

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57
Q

If a baby is at +2 station and heart tones drop to 60, what do you do?

A

Emergent outlet forceps or vacuum-assisted delivery

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58
Q

What should you do if frank blood is seen when inserting a intrauterine pressure catheter?

A

Placental seperation or uterine perforation
W/d cath, monitor for any signs of fetal compromise
If fetal status is reassuring - try to place cath again

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59
Q

What is the cause of late decels?

A

Uterine contractions, uteroplacental insufficiency

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60
Q

What is the cause of variable decels?

A

Umbilical cord compression

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61
Q

What is the cause of early decels?

A

Head compression

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62
Q

How do you manage umbilical cord prolapse in the setting of no fetal distress?

A

Elevate the fetal head to avoid compression of the cord and take to c-section

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63
Q

Is episiotomy ever the right answer?

A

No

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64
Q

Baby is born with flattened nasal bridge, small rotated ears, sandal gap toes, hypotonia, protruding tongue, simian creases, epicanthic folds, oblique palpebral fissures

A

Down syndrome

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65
Q

How do you manage a woman with meconium stained amniotic fluid?

A

intubate the trachea and suction meconium if the newborn is depressed
IF the newborn is vigorous

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66
Q

A T1DM mom is at risk of having a baby with?

A

Small and hypoglycemic

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67
Q

A mom with gestational diabetes is at risk of having a baby with?

A

Macrosomia, hypoglycemia, polycythemia, hyperbili, hypocalcemia, ARDS

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68
Q

Fetal tachycardia with minimal variability is a warning for?

A

Fetal spesis
Especially when mom is febrile (chorio)
Infant may be pale, lethargic, and febrile at birth

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69
Q

What is a common complication of twin-twin transfusion syndrome?

A

Plethoric twin - polycythemia, polyhydramnios, heart failure, hydrops
Donor twin - anemic, IUGR, oligohydramnios
Monochorionic pregnancy

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70
Q

How do you manage and infant born to a HIV + mom?

A

Start AZT immediately after delivery
test for HIV at 24 hours
Discourage breastfeeding

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71
Q

What are the recommendations for giving positive airway pressure in an infant?

A

Sniffing position
Secure mask
observe for initial chest rise
Oxygen flow at 10L/min

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72
Q

What is apgar scoring based on?

A 
Heart rate
Respiratory rate
reflex
activity
color
each is worth 2 pts at max
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73
Q

What is the most common cause of postpartum hemorrhage?

A

Uterine atony

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74
Q

1 year s/p delivery pt has slow mental function, weight gain, fatigue, amenorrhea, hypotension, and no milk production

A

Sheehan Syndrome
Occurs after a pt has significant blood loss causing pituitary necrosis -> loss of TSH, ACTH
Tx - estrogen, progesterone, thyroid and adrenal hormones

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75
Q

What increases risk of endometritis?

A

postpartum infection
increased by c-section, prolonged vaginal labor, PROM, multiple vaginal exams, internal fetal monitoring, manual placental removal

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76
Q

Most common cause of postpartum fever?

A

Endometritis

Commonly observed with fundal tenderness

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77
Q

Most common causative agent of endometritis?

A

polymicrobial, aerobes andanaerobes, Staph and Strep

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78
Q

Symptoms of post partum depression for less than two weeks?

A

Postpartum blues

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79
Q

What is a unique symptom in the post partum pt?

A

Ambivalence toward her infant

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80
Q

Strongest risk factor for postpartum depression?

A

Pt’s history of depression

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81
Q

Safest way to suppress lactation?

A

Breast binding, ice packs, analgesics. Avoid breast stimulation or milk expression (helps to prevent prolactin secretion)
hormones increase risk of HTN and strokes

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82
Q

Breast feeding can decrease the incidence of which cancer?

A

Ovarian. Maybe breast

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83
Q

s/p delivery day 2 pt has bleeding and cracked nipples.

A

Poor positioning of infant

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84
Q

Hormone required for breast milk synthesis?

A

Prolactin

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85
Q

Why do women begin lactating after birth?

A

Rapid decline in progesterone and estrogen
These inhibt milk release
Can take up to two days

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86
Q

Breast feeding mom presents with burning pain during feeds, Nipples are pink and shiny with peeling at the periphery

A

Candida
Treat mom with TOP antifungal
Treat baby with oral nystatin

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87
Q

How do you determine if baby is getting enough milk?

A

3-4 stools QD
6 wet diapers QD
Weight gain
Sounds of swallowing

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88
Q

How do you advise a pt that is complaining of breast engorgement?

A

Frequent nursing (1.5-3 hours), warm compress, massage the breast, good bra, analgesic 20 minutes before BF

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89
Q

Which hormone is required for milk ejection?

A

Oxytocin

Produced when the baby suckles (not as good with pumping)

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90
Q

How do you confirm an ectopic pregnancy when no fetal pole is visualized?

A

Repeat BhCG in 48 hours to see if the increase is consistent with pregnancy (usually >2000 before veing visualized on TVUS)

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91
Q

What is the greatest risk factor for ectopic pregnancy?

A

Previous ectopic,

followed by age >35

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92
Q

What do you do in a pt with a suspected ruptured ectopic?

A

exploratory lap

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93
Q

If a BhCG doubles in 24 hours what type of pregnancy does the pt have?

A

Intrauterine

BhCG should increase by at least 50% every 48 hours until the pregnancy reaches 48 hours

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94
Q

What is the diagnosis of ectopic pregnancy based on?

A
  1. Fetal pole outside of the uterus
  2. Bhcg > 2000 w/o intrauterine pregnancy on TVUS
  3. BhCG does not increase by 50% every 48 hours and these do not decrease after D&C
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95
Q

What criteria must a pt have in order to receive methotrexate?

A 
hemodynamically stable
non-ruptured mass <4cm w/o hr, or <3.5 with hr
Nl Liver enzymes
Nl renal fxn
Nl wBC
Ability for rapid follow up
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96
Q

What does endometrial stripe mean?

A

It excludes an intrauterine pregnancy

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97
Q

pt presents with cyclic midline abd cramping following a d&c. Scant bleeding. Dx?

A

Uterine perforation

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98
Q

Primary cause for 1st trimester spontaneous abortions?

A

genetic abnormalities

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99
Q

Most common karyotype causing spontaneous abortion?

A

Autosomal trisomy

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100
Q

What maternal RF’s contribute to spontaneous abortions?

A 
Chronic systemic dz (DM, CRD, SLE)
Genetic factors
Endocrine abnormalities
Reproductive tract abn
Immunologic factors
Environmental factors (cigarettes, EtOH)
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101
Q

How do you handle a 1st trimester mom that is profusely bleeding and H&H is dropping

A

Dilation and suction curettage

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102
Q

What do you do for a woman that has had two spontaneous abortions around 20 weeks and both fetuses were very normal?

A

Cervical cerclage at 14 weeks

Mom likely has an incompetent cervix

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103
Q

How do you evaluate a woman with 3 1st trimester losses?

A

Rule out systemic disease
Karyotyping
Hysterography

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104
Q

Does voluntary pregnancy termination increase risk of spontaneous abortion or infertility?

A

No

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105
Q

Risks to fetus in a mom with T1DM?

A

Spontaneous abortion
Major congenital malformations
Fetal growth restriction

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106
Q

Which HTN medication should be d/c after the 1st trimester?

A

ACEI

Oligohydramnios, growth retardation, neontal renal failure, hypotension, pulm hypoplasia, death

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107
Q

What should a HIV + preggo receive?

A

po zidoudine, IV zidovudine in labor and po z for baby

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108
Q

Most commone cause of sepsis during pergnancy?

A

Pyelonephritis

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109
Q

How do you manage asthma exacerbation in a preggo?

A

Continue beta agonists
Add INH corticosteroids or cromolyn sodium
SubQ terbutaline and corticosteroids in acute pts

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110
Q

What is thyroid storm?

A

Preggo in an acute life threatening hypermetabolic state.
Radioactive iodine is contra because it concentrates in the fetal thyroid and causes congenital hypothryoidism
Tx - PTU, propanolol, sodium iodide, dexamethasone

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111
Q

when do you do 50g OGTT in a preggo?

A

24-28 weeks

If they fail the 50 g, do the 100 g

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112
Q

What is the risk of mortality for a preggo with PHTN?

A

25-50%

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113
Q

Preggo has a systolic murmur with a click

A

Mitral valve prolapse

Tx - beta blockers (decrease sympathetic tone, relieve chest pain, palpitations)

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114
Q

Preggo has mild microcytic hypochromic anemia with a NL ferritin

A

Alpha thalassemia trait

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115
Q

What risks does a morbidly obese mom have?

A 
Chronic HTN
gestation DM
Preeclampsia
Fetal macrosomia
higher rate of cesarean
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116
Q

Which chemo is contra?

A

Radiotherapy

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117
Q

Which SSRI is contra in preggo?

A

Paroxetine (Paxil)

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118
Q

Preggo develops jaundice and pruritis

A

Pruritus gravidarum
Caused by retention of bile salt
Tx - Ursodeoxycholic acid, naltrexon

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119
Q

What imaging do you use to confirm appendicitis in a preggo?

A

compression U/s

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120
Q

Pre-eclampsia pt is having respiratory depression. Why?

A

Mag toxicity

d/c mag and give calcium gluconate

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121
Q

How do you manage preeclampsia in a pt at 39wks?

A

Just deliver the babe

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122
Q

Laboring preggo with preeclampsia, vag bleeding, and fetal hr is sinusoidal

A

Placental abruption

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123
Q

When preggo presents with preeclampsia, what is a goal diastolic pressure?

A

90-100 mmHg

Low enough to prevent maternal stroke or abruption without compromising uterine perfusion

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124
Q

What is the risk of Rh isoimmunization w/o rhogam?

A

Approx 60%

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125
Q

What is a noninvasive way to assess fetal anemia?

A

Doppler U/s of the middle cerebral a. peak systolic velocity

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126
Q

What can be seen on fetal u/s in a mom that has anti-D Ab’s

A

Fetal hydrops
Develops due to decreased hepatic protein production
Placental edema, pericardial effusion. and polyhydramnios on u/s

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127
Q

How do you decide how much rhogam to usse?

A

1:10. ie 30 cc of fetal blood requires 300 ug of Rhogam

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128
Q

When do you give Rho gam?

A

Give to Rh- women
Given after any event that could cause fetal-maternal hemorrhage
Give prophylactically at 28 weeks

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129
Q

Do Lewis Ab’s cause isosensitization?

A

No, they are IgM and can’t cross the placenta

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130
Q

If a preggo has evidence for hemolytic dz what would be found in the amnio?

A

Bilirubin

Amniotic fluid will be yellow

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131
Q

Which finding in the amniotic fluid is associated with spontaneous preterm delivery

A

Ferritin

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132
Q

If a preggo has severe hemolytic disease what s the best action?

A

Delivery baby depending on gestational age

Or fetal transfusion if the baby needs more time

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133
Q

Most likely reason a woman will be sensitized despite receiving Rhogam?

A

Underestimation of blood loss, therefore under dosed

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134
Q

Which u/s finding is suggestive a fraternal (dizygotic) twins?

A

2 placentas (dichorionic)
Dividing membrane >2mm
Twin peak (lambda sign)
Different fetal genders

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135
Q

What is a risk of having twins?

A 
Twin infant death is 5x higher than single babies
Risk of CP is 5-6x increased
Higher incidence of IUGR
58% premature (avg 35 wks)
Increased risk of congenital anomaly
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136
Q

What do you recommend for a preggo with twins that is worried about preterm delivery?

A

Recommend adequate weight gain in the first 20-24 weeks

Helps the placenta develop

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137
Q

Twin-twin transfusion syndrome involves which chorio amnio arrangement?

A

Monochorionic diamniotic twins

Twins need separate sack but share a placenta

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138
Q

What do you do with a preggo laboring with twins, one vertex and one breech?

A

C-section

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139
Q

Most common karyotype in spontaneous abortions?

A

Autosomal trisomy

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140
Q

When is a fetus at greatest risk of developing IDD due to radiation exposure?

A

8-15 wks

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141
Q

Pt has a thrombosis leading to a still birth due to IUGR. What might mom have?

A

Factor V Leiden

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142
Q

What should be checked in all women that have vaginal bleeding during pregnancy?

A

Maternal blood type

If Rh -, give Rhogam

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143
Q

What is the main reason that the C-section rate has been rising?

A

Rate of vaginal births after a c-section has decreased due to the risk of complications (esp uterine rupture)
Also fewer docs willing to do vaginal deliveries in a breech presentation

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144
Q

How to you start induction in a term patient with a closed cervix?

A

Give cytotec prior to pitocin

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145
Q

What are associated with breech presentations?

A 
Prematurity
multiple gestations
genetic disorder
polyhydramnios
Hydrocephaly
anecephaly
placenta previa
uterine anomalies
uterine fibroids
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146
Q

Largest risk factor for shoulder dystocia?

A

Gestational DM

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147
Q

How do you manage secondary arrest of dilation (ie no dilation after starting and epidural)

A

amniotomy

If still insufficient - add oxytocin

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148
Q

Fetus is at station 0 and category 3 heart tracing.

A

C-section

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149
Q

What is the most common type of breech?

A

Frank breech - presents with the buttocks

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150
Q

What is a RF for placental abruption?

A

Polyhydramnios

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151
Q

A pt with several previous C-sections is at risk of developing what in her future preggos?

A

Placenta accreta

Placenta grows into the myometrium

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152
Q

What is in FFP?

A

Finbrinogen
Factor V, Factor VIII
NO platelets

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153
Q

What is in cryoprecipitate

A

Fribinogen, Factor VIII, Von Willebrand

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154
Q

RF’s for placental abruption

A 
Smoking
Cocaine
Chronic HTN
Trauma
Prolonged PROM
Prior abruption
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155
Q

Totally normal labor but preggo bleeds easily from the cervix

A

Bloody show
Cervix is extremely vascular and will bleed during dilation (small or large)
Not clinically significant, normal

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156
Q

Preggo has small vaginal bleeding during gestation but everything else is NL

A

Cervicitis. Caused by STD and cervix is vascular during preggo

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157
Q

Preggo has a small amount of bleeding and a hard mass on the posterior lip of the cervix

A

Cervical cancer

Cervical polyps are soft

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158
Q

Most common cause of preterm labor?

A

idiopathic

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159
Q

What should be given to abort preterm labor?

A

Nifedipine - tocolytic
Betamethasone - promote pulmonary maturation
Ampicillin - if GBS status in unk
Terbutaline - no longer recommended due to AE’s

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160
Q

How do you manage pre term labor in a febrile preggo?

A

Deliver since there is concern for intra-amniotic infection

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161
Q

Which tocolytics are contra in DM preggos?

A

Terbutaline

Ritodrine

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162
Q

When is magnesium sulfate is contra in pts with?

A

Myasthinia gravis

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163
Q

Hoq does magnesium sulfate work?

A

Competes with Ca2+ for entry into the cells.

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164
Q

What is a side effect of terbutaline?

A

Tachycardia, hypotension, anxiety, chest tightening

Beta-adrenergic agonist

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165
Q

What syx would a magnesium toxicity pt exhibit before respiratory depression?

A

Areflexia
12-15 mg - respiratory depression
>15 mg - cardiac depression

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166
Q

Treating a preterm fetus with betamethasone at 24-34 wks reduces RDS, but also associated with?

A

Decreased risk of intracerebral hemorrhage and necrotizing enterocolitis
Increased risk of infection or enhanced growth

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167
Q

What is the use of fibronectin testing?

A

NL in the vaginal secretions in the first 20 weeks
Later in pregnancy thought to indicate injury to the maternal-fetal interface
Strong Negative predictive value

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168
Q

How do you confirm ROM?

A

Test vaginal fluid for ferning and nitazine testing

Do NOT test the cervical mucus, avoid digital exams

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169
Q

Why do you offer tocolytics to a preterm preggo with PROM?

A

Give time for steroids to have max benefit

48 hours of tocolytics

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170
Q

What is the main RF forpreterm ROM?

A

Genital tract infection, esp bacterial vaginosis

Smoking , cervical length, and prior PROM do too

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171
Q

Why can PPROm cause variable decels in the fetus?

A

Cord is compressed due to lack of amniotic fluid

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172
Q

What is recommended in the setting of PPROM that can extend the pregnancy 5-7 days?

A

Ampicillin + erythromycin, increases latency period and reduces risk of infection

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173
Q

How can you prevent PPROM in a preggo with a known history?

A

17 alpha hydroxyprogesterone
Reduces risk of premature labor
Administer weekly starting at 16-20 wks and d/c at 36 wks

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174
Q

At which gestational age are tocolytics contra?

A

36 wks

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175
Q

How do you assess if contractions are adequate in a preggo that has arrest of labor?

A

Intrauterine pressure catheter

Helps you decide if oxytocin augmentation is appropriate

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176
Q

When are prostaglandins given?

A

Cervical ripening

Contra in pts with previous c-section due to risk of uterine rupture

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177
Q

How do you manage a fetus with persistant late decels?

A

c-section

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178
Q

What do you do if you see late decels but you are in the very early stages of labor?

A

Change maternal position to left lateral

Increases perfusion to the uterus

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179
Q

During labor, fetus has minimal variability and no accelerations

A

Fetal scalp stimulation
If hr increases by >15bpm x 15 sec, reassuring that the acid-base status is NL
If not responsive enough - fetal scalp pH, vibracuoustic stimulation, allis clamp test

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180
Q

Which utertonics can you use in uterine atony

A

Methergine
Prostaglandins
Misoprostol
Oxytocin

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181
Q

What is contra in a woman with HTN and uterine atony?

A

Methylergonovine
Potent smooth m. constrictor
Exacerbates HTN and pre eclampsia

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182
Q

Which utertonic agent should be avoided in asthmatic pts?

A

Prostaglanding F2-alpha (Hemabate)

Potent smooth muscle constriction with a bronchioconstrictive effect

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183
Q

Globular pale mass appears at the os during delivery of placenta

A

Uterine inversion

RF - excessive traction on the umbilical cord

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184
Q

How is post partum hemorrhage defined?

A

Vaginal delivery - >500 cc

C-section - >1000 cc

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185
Q

What is concerning for a woman with a low lying anterior placenta and hx of multiple c-sections?

A

Placenta accreta

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186
Q

What increases risk of retained placenta?

A

prior c-section
uterine leiomyoma
Prior uterine curettage
Succenturiate lobe of placenta

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187
Q

Uterine atony pt has already received all of the uterotonic agents. Now what?

A

Bakri balloon
Balloon placed into uterus with 500 cc of sterile fluid
Uterine a. ligation, B-lynch compression stitch, hysterectomy - laproscopic fixes
Uterine a. embolization - requiers IR

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188
Q

How do you tx endometritis after vaginal delivery?

A

Ampicillin (Gram +) + Gentamicin (Gram -)

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189
Q

Causes of acute cystitis after delivery?

A 
E. coli
P. mirabilis
K. pneumoniae
S. faecalis
S. agalactiae
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190
Q

Febrile mom struggling to breast feed 2 days after delivery

A

Breast engorgement

Low grade fever

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191
Q

How do you manage a pt having discharge from her c-section incision

A

Open the wound, check for fascial dehiscence, drain, assess the fluid.
Pack the wound
Give broad spectrum abx if you suspect cellulitis or abscess

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192
Q

Febrile patient 2 s/o c-section and you already ruled out endometritis, cystitis, and mastitis

A

Septic thrombophlebitis
thrombosis of the venous system of the pelvis
Diagnosis of exclusion
Tx- anticoags and abx

193
Q

Most common source of fever on postpartum day 1?

A

lungs

expecially if they received anesthesia (aspiration pneumonia_)

194
Q

grade 4 lack is not healing well and necrotic. Now what?

A

Debridement of the necrotic areas to prevent spread

195
Q

How do you treat endometritis following c-section

A

Gentamycin (Gram -) + Clindamycin (anaerobic)

196
Q

Epidural pt has a raging HA now what?

A

Spinal HA, can have meningitis syx
Dx with LP
Requires aggressive tx with abx

197
Q

Pt with a depression history is at greatest risk of developing?

A

post partum depression

not blues

198
Q

Most common AE of fluoxetine?

A

Insomnia

199
Q

Can you breast feed while on SSRI?

A

yes, at the regular dose

SSRI is secreted in the milk, but levels were not detected in the infant

200
Q

What is the risk of third trimester use of SSRI’s?

A

ABN muscle movements and w/d syx in the infant
agitation, inc/dec tone, tremor, sleepiness. difficulty breating/eating
Can subside in hours or days

201
Q

What testing is needed starting at 41 wks?

A

Bi-weekly non-stress testing

NL is two 15x15 accelerations over 20 min

202
Q

What is associated with postterm pregnancy?

A

Placental sulfatase deficiency
fetal adrenal hypoplasia
anecephaly
inaccurate dates

203
Q

What complications are associated with postterm?

A 
Macrosomia
Oligohydramnios
Meconium aspiration
Uteroplacental insufficiency
Dysmaturity
204
Q

What does amnioinfusion help to improve?

A

Tx of repetitive variable decels

205
Q

How do you manage at 42 weeks?

A

Favorable cervix - induce

Unfavorable cervix - biweekly stress tests

206
Q

Infant is born - withered, meconium stained, long-nails, fragile, small placenta

A

Infant with dysmaturity

Occurs in 10% of those when gestation age >43 wks

207
Q

What helps with cervical ripening in a 42wker?

A

Prostaglandins

208
Q

Greatest risk factor for a post term pregnancy?

A 
Previous post term pregnancy (#1)
Nulliparity
Advanced maternal age
obesity
Male fetus
Caucasian mom
209
Q

Most likely cause of IUGR in a woman with systemic disease?

A

Uteroplacental insufficiency

210
Q

How do yo work up a preterm preggo with IUGR?

A

Non stress tests
AFI (oligo is a frequent cause)
Dopple U/s (Sys/dys ratio of the umbilical artery) - increased = vascular resistance

211
Q

Once you detect IUGR, what do you do?

A

biweekly non stress testing

Weekly AFI

212
Q

Fetal growth restriction is a significant growth factor for?

A

Cardiovascular dz (HTN, stroke)
COPD
T2DM
Obesity

213
Q

Preterm fetus with IUGR and abn unbiliacl arter doppler studies

A

Deliver

Test is non reassuring so get baby out

214
Q

Best way to estimate fetal weight?

A

OB U/s

215
Q

Best way to estimate gestational age?

A

u/s measuring crown-rump length in the first trimester

216
Q

What should be done if fatty tissue is seen during a D&C

A

Turn the suction off and remove the tissue

Exp lap as this is most likely omental tissue and should look to see if there is bowel damage

217
Q

You see a preggo with a fibroid protruding from the cervix. Now what?

A

C-section

fribroid in the lower uterine segment can obstruct labor by preventing the fetal head to enter the pelvis

218
Q

At what fetal head diamete is c-section indicated?

A

> 12cm

219
Q

What is an advantage of vacuum assisted birth?

A

Decreased rate of maternal lacerations

Increased risk of fetal lateral rectus paralysis (transient)

220
Q

Can you do a c-section on a baby at +2 station?

A

Yes, apparently it is possible

221
Q

What is the most likely complication of a tubal ligation?

A

Future pregnancy

approx 1% failure rate

222
Q

Which type of cerclage is given to a woman that wants to get preg and has a hx of cervical insufficiency?

A 
Transvaginal cerclage (McDonald procedure)
Purse-string permanent suture at the cervicovaginal junction
If they fail the transvag, try transabdominal
223
Q

For how long do depo pts have unpredicatable bleeding?

A

2-3 months

50% amenorrhic at 1 yr

224
Q

How do you manage a pt that had unprotected sex x 24hrs ago?

A

Offer emergency contraception (levonorgestrel pills)

Start on OCP’s

225
Q

Indications for progesterone only OCP’s

A

Hx of clots
Lactating
>35 smoker
Severe nausea with OCP’s

226
Q

Contraception that decreases risk for gyn cancers?

A

OCP’s decrease risk of ovarian and endometrial cancer

227
Q

What is the best method of permanent sterilization for a pt with a morbidly obese woman with hx of multiple abdominal surgeries?

A

Hysteroscopic tubal occlusion (Essure)

228
Q

The number of yolk sacs corresponds to?

A

The number of placentas (chorios)

229
Q

AA pt has microcytic anemia and gel eceltrophoresis is 95% Hgb A

A

Iron deficiency anemia

230
Q

Amnio says the baby is 46XX, but the baby is male at birth. Why?

A

ACTH oversecretion

231
Q

Pt has chronic dyspareunia and dysmenorrhea. PE nodularity over the uterosacral area, uterus is retroverted, adnexa NL. Now what?

A

Laparoscopy

232
Q

Post menopausal woman with vulvar itching. Ulcerated lesion on the inner R labium majus surrounded by mild erythema. No adenopathy. Dx?

A

Vulvar carcinoma

233
Q

Preggo has a hx of a 10lb baby. What is she at risk for during this pregnancy?

A

Gestational DM

234
Q

What is the main RF for regretting sterilization in a female?

A

Age at time of procedure

235
Q

What is the best option for sterilization in a woman with chronic medical problems and morbid obesity?

A

Vasectomy

236
Q

What are the cons of the estrogen patch for contraception?

A

High failure rate in woman that weigh more than 198lb

Otherwise comparable efficacy to OCPs

237
Q

Febrile preggo presenting with vaginal bleeding and dilated cervix

A

Septic abortion

238
Q

How do you manage a septic abortion?

A

Uterine evacuation and broad spectrum abx

239
Q

What do you need to test in a woman with recurrent 1st trimester losses of karyotypically and anatomically normal fetuses

A

Antiphospholipid Ab’s

Cervical insuficiency are second trimester losses

240
Q

How do you tx a mom with a hx of APL that wants to conceive again?

A

Aspirin + heparin

241
Q

What is used to treat preterm delivery?

A

17-OH progesterone

242
Q

What is a risk of medical abortion?

A

More blood loss than surgical abortion
Medical abortion offered if pregnancy <49 days
Mifepristone + misoprotol

243
Q

Manual vacuum aspiration is an option for surgical abortion up until?

A

8 wks gestation

244
Q

Least invasive way to manage a missed abortion (fetal demise)

A

Misoprostol (prostaglandin E1)
Effective up to 9 wks gestation
Risks - hemorrhage, failure
Invasive procedures (D&C, manual vacuum)

245
Q

If pt has heavy bleeding after medical termination of preggo

A

D&C

retained products of conception

246
Q

Pt is febrile but not bleeding 2 days s/p D&C to terminate pregnancy

A

Post op endometritis - caused by bacteria that are introduced during the procedure
Start IV abx, u/s for retained products of conception

247
Q

Tx for bacterial vaginosis

A 
Metronidazole
Thin gray discharge with fishy odor
\+ whiff test
clue cells
pH>4.5
248
Q

Diffuse malodorous yellow green discharge

A

Trichomonas
Protozoa on wet prep
Tx - metronidazole

249
Q

Derm condition involving the scalp, oral mucosa, and vulva

A

Lichen planus

inflammatory dz with remissions and flares

250
Q

Healthy pt has severe pain with vaginal penetration

A

Vestibulodynia
Tx - TCA, pelvic floor exercises, biofeedback, top anesthetics
Surgery if they fail

251
Q

Healthy pt has chronic vulvar itching and scratching.

A

Lichen simplex chronicus
Common vulvar non-neoplastic disorder
Damaged skin due to scratching creates a protective barrier
Dx - bx
Tx - TOP corticosteroids + antihistamines

252
Q

Pt has copious yellow discharge from the cervix but pH is 4

A

Mucopurulent cervicitis
Chlamydia and gonorrhea
Tx - azithro + ceftriaxone

253
Q

Cause of recurrent genital herpes

A

HSV-2

Primary infection - includes systemic syx

254
Q

Pt has had a vulvar lesions x 1 yr

A

bx - suspicious for vulvar cancer

255
Q

Sexually active female with vaginal itching after a cold

A

Herpes

256
Q

Tx for a pt that had sex with a partner w/ acute Hep B

A

Initiate w/in 14 days of exposure
If unvax - HBIG + HBV vax series
If vax & responding - nothing
If vax & non resp - HBIG x 2

257
Q

What causes acute salpingitis w/ b/l tubo-ovarian abscess?

A

Most often gonorrhea/chlamydia

Also ascending infection from the GU or GI (polymicrobial)

258
Q

IV tx for gonorrhea/chlamydia

A

Cefotetan or cefoxitin
Plus either:
1. Doxycycline
2. Clindamycin + gentamycin

259
Q

Out pt tx for gonrrhea/chlamydia

A

Ceftriaxone or cefoxitin or 3rd gen cephalo
Plus doxycycline
w/ or w/o metronidazole

260
Q

How does PID decrease fertility?

A

Tubal infertility

261
Q

Main organism causing UTI in a young sexually active female

A 
E. coli
#2 Staph sapro
262
Q

Failure to empty the bladder adequately

A

Overflow incontinence
caused by underactive detrusor m. or obstruction
Post-void residual volume of 50-60cc is WNL

263
Q

What are the RF’s for pelvic organ proplapse?

A 
Fam Hx
Increasing: parity, age
Obesity
Connective tissue disorders
Chronic constipation
264
Q

Leakage of urine due to increased intra-abdominal pressure in the absence of a detrusor contraction

A

Genuine stress incontinence
Usually due to urethral hypermobility (angle >30)
Tx - if failed conservative measures, retropubic urethropexy (tape or sling procedure, 5 yr success rates for those with GSI due to hypermobility)
Urethral bulking for pts with intrinsic sphincteric deficiency

265
Q

Loss of urine due to unopposed detrusor activity

A

Detrusor instability

Tx - anticholinergics (oxybutynin)

266
Q

Prolapse requiring repair of defects in the pubocervical fascia or attaching it to the sidewall

A

Central and lateral cystoceles

267
Q

Defect in rectovaginal fascia

A

Rectocele

268
Q

Urine leakage due to overactivity of the detrusor m.

A

Urge incontinence
Causes an increase int he bladder pressure over urethral pressure causing leakage
No association with activity

269
Q

How do you manage asymptomatic prolapse?

A

Continue to monitor

Surgically repair is syx develop

270
Q

How do you manage a vaginal prolapse that is causing hydronephrosis?

A

Copocleisis

Vagina is surgically obliterated, does not require general anesthesia

271
Q

Initial tx for a symptomatic prolapse?

A

Pessary

272
Q

Dysmenorrhea + dyspareunia

A

Endometriosis
Presence of endometrial glands/stroma outside of the uterus
Nodularity at uterosacral ligaments

273
Q

Complex ovarian cyst in a endometriosis pt

A

Endometrioma (chocolate cyst)

274
Q

Surgical tx for endometriosis

A

Laser ablation - younger pts

Tots hys/BSO - older (done having babies)

275
Q

Good initial tx for endometriosis?

A

OCP’s

Negative feedback to pituitary/hypo thal -> ovarian suppression -> decreased estrogen

276
Q

Definitive way to dx endometriosis?

A

exp lap + bx’s

277
Q

Sudden onset of pain + nausea, ovarian cyst on u/s

A

Ovarian torsion

Tx - surgical exploration

278
Q

How do you manage a woman w/ endometriosis that is having difficult conceiving x 18 months

A

Clomiphene citrate
Stimulates the ovary
Can do w/ or w/o insemination

279
Q

Young female has dysmenorrhea and PE and u/s are WNL.

A

Exp lap

Ddx: endometriosis,

280
Q

Pt has pelvic pain, dyspareunia and recurrent syx of urgency and grequency

A 
Interstitial cystitis (IC)
Chronic inflammatory condition of the bladder
281
Q

Pt w/ pelvic pain reports improvement of syx with BM’s.

A

Irritable bowel syndrome

  1. Relief w/ defecation
  2. Associated with a change in stool frequency
  3. Onset associated with change in stool consistency
282
Q

How do GnRH agonists relieve endometriosis pain?

A

Down regulate the HPA production of LH and FSH -> decreases estradiol
Danazol - suppresses mid-cycle surges of LH:FSH

283
Q

What is a significant RF for pelvic pain?

A

Physical and Sexual abuse (40-50% of women w/ pelvic pain)

284
Q

Definitive tx for enometriosis in a multiparous woman?

A

Remove ovaries w/ or w/o hyserectomy

285
Q

Older pt with nonspecific pelvic fullness and postmenopausal bleeding. How do you dx?

A

TVUS

More sensitive that CT for gyn organs

286
Q

Pt with prior hys complicated by abscess has significant pain and fullness over the pelvic cuff

A

Pelvic adhesive dz

Adhesions on the tubes and ovaries that were retained

287
Q

Pt has chronic pelvic pain and lots of vessels in the broad ligament on doppler

A

Pelvic congestion syndrome
Caused by pelvic variscosities
Cause is fairly UNK

288
Q

Following surgery w/ a low transverse incision - pt has decreased sensation on medial thigh and across groin

A

Nerve entrapment of ilioinguinal
iliohypoastric would have loss of sensation in obliques
Nerve gets trapped in the suture during fascial closure

289
Q

Pt has axillary tenderness but no mass, on exam her skin is shaved

A

Folliculitis

290
Q

Woman with watery white nipple discharge has a mildly elevated prolactin immediately after PE. Now what?

A

Repeat prolactin

Can be flasly elevated after stimulation. Test prolactin when breast has rested at least 24hr

291
Q

What can aggrevate pain in fibrocystic breast disease

A

Caffeine

292
Q

How do you manage a breast lump that returns bloody fluid on FNA

A

excisional bx

If the mass had clear fluid and reduced - check back in 2 months

293
Q

How do you manage breast pain in a pt being treated for mastitis?

A

Acetaminophen + ibu

294
Q

Pt has a breast mass, -ve mammo and FNA and the mass persists

A

Reassure and observe

295
Q

When is a breast MRI indicated?

A

Pts with an increased risk of breast cancer (BRCA, 1st degree relatives of BRCA, Li-Fraumeni, hx of radiation to the chest 10-30)

296
Q

Find a solid breast mass on exam, -ve mammo, now what?

A

FNA

297
Q

Pt w/ b/l breast implants has diffuse breast pruritis

A

Chemical irritation (can also be caused by soaps/perfumes

298
Q

Colposcopy results show CNIII limited to the cervix

A

LEEP to remove the abn cells

299
Q

What test should you do for unexplained vaginal bleeding?

A

Endometrial bx (can id endometritis, endometrial polyps, endometrial carcinoma)

300
Q

What is a potential complication of LEEP?

A

Cervical stenosis

301
Q

What is Asherman’s syndrome?

A

Development of intrauterine adhesions

302
Q

What do you do with a vulvar lesion that has not responded to treatment?

A

Biopsy

This may be cancer, not a condyloma

303
Q

During an IUD removal, the strings are not visible but IUD is in the uterine cavity on u/s

A

Hysteroscopy

Can remove IUD under direct visualization

304
Q

What do you do for a breast mass similar to fibroadenoma in a pt with a recent mammo?

A

FNA

Gives definitive dx regardless of cystic or solid mass

305
Q

adnexal mass noted on PE. Now what?

A

Pelvic u/s

306
Q

What do you do w/ a cervical polyp?

A

Polypectomy

Common in women 40-50

307
Q

Definitive tx of endometriosis

A

Hysterectomy with b/l salpingo-oophorectomy

308
Q

First sign of puberty in a female?

A

Thelarche (boobs)

309
Q

What body weight is needed before menses can begin?

A

85-106lbs

Sleep and optic exposure to sunlight can also delay menarche

310
Q

How do you dx kallmann syndrome?

A

Olfactory challenge
Olfactory hypoplasia and the acrute nucleus do not secrete GnRH - females have no sense of smell or secondary sexual characteristics, including menstruation

311
Q

8 y/o female is tall, menstruating and has other sex characteristics. Dx?

A

True precocious puberty
Sex steroids are increased due to HPA with increased GnRH secretion
Caused by cNS abnormalitis, hypothalamic hamartomas, surgery, trauma, radiation, congenital

312
Q

Most likely cause of premature adenarche?

A

Congenital adrenal hyperplasia due to 21-hydroxylase deficiency
Insufficient cortisol -> accumulation of adrenal androgens -> precocious adenarche
Tx - steroid replacement

313
Q

Amenorrhic teen with NL breast and pubic hair w/ small vaginal opening w/ blind pouch. U/s - NL ovaries but absence of uterus and cervix

A 
Mullerian agenesis (46XX)
Do a renal u/s as anomalies are frequent
314
Q

Amenorrhic female with abd pain that is worse one week out of the month. PE - bluish mass parting the labia

A

Imperforate hyman

Tx - surgery

315
Q

Amenorrhic female with a bluish cervix

A

Chadwick’s sign
Increased blood flow to the cervix, indicative of pregnancy
Get a UPT

316
Q

How does anorexia cause amenorrhea?

A

Hypothalamic-pituitary dysfunction -> lack of GnRH pulsations -> no FSH/LH
Get an FSH level

317
Q

Tx for PCOS?

A

weight loss and OCPs

318
Q

Healthy adult w/ amenorrhea and -ve UPT w/ dyspareunia

A

Premature ovarian failure

dyspareunia due to vaginal dryness (hypoestrogen)

319
Q

Pt w/ hx of endometritis following D&C and is now amenorrhic

A

Asherman’s syndrome

Adhesions of the endometrium

320
Q

PCOS pts have a higher risk of which cancer?

A

endometrial

Ovarian

321
Q

Adult presents with hirsutism. NL testosterone but elevated DHEAS

A

adrenal tumor

322
Q

What should you do if you suspect Chushing’s?

A

Either:
24hr dexamethasone suppression test OR
24 hour urine for cortisol

323
Q

Irregular menses, hirtuism and acanthosis nigricans

A

Elevated androgens and insulin (DM, PCOS)

Get a fasting insulin

324
Q

Dx criteria for PCOS

A

At least 2 of:
Chronic anovulation
Hyperandrogenism (clinical or measured)
Polycystic ovaries on u/s

325
Q

Pt has syx of testosterone excess and enlarged adnexal mass

A

Sertoli-Leydig tumor
Secretes testosterone
Unilateral
Acne, hirsutism, amenorrhea, clitoral hypertrophy, voice deepening

326
Q

Severe form of PCOS

A

Hyperthecosis

Temporal balding, clitoral enlargment, deepening of the voice

327
Q

PCOS pt has improvement in menorrhea w/ OCPs but hirsutism persists. Tx?

A

Add Spironolactone

Aldosterone antagonist

328
Q

How does medroxyprogesterone acetate (MPA) produce regular menses?

A

anovulatory pt’s have endometrium proliferation due to unopposed estrogen
Progestin inhibits growth converting proliferative to secretory endometrium

329
Q

workup for heavy menstrual bleeding?

A

Pelvic u/s

330
Q

Most common cause of abn heavy bleeding in a teen?

A

Coag disorder

Von willeberand is most common

331
Q

At what size is polypectomy recommended?

A

> 1.5 cm

332
Q

ABN hormone levels in PCOS?

A

Testosterone - upper limit of NL or high

333
Q

Best fertility sparing tx for submucosal leiomyomas

A

Hysteroscopic myomectomy

Laproscopy can’t access submucosa

334
Q

Post transplant pt has post coital bleeding and a cervical mass

A

Colposcopy w/ cervical bx

Immunosuppresed at higher risk of cervical dysplasia or cancer

335
Q

Tx for dysmenorrhea

A

OCP’s

Supplemental progestin causes endometrial atrophy

336
Q

When do you start chlamydia, gonorrhea testing?

A

Sexually active pts <25

Can cause dysmenorrhea

337
Q

If dysmenorrhea pt does not respond to OCP’s?

A

Lap for endometriosis

338
Q

Woman >40 with irregular bleeding

A

Get endometrial bx to rule out endometrial carcinoma

339
Q

well-circumscribed, non-encapsulated myometrium

A

Fibroids

340
Q

Hyperplastic overgrowth of endometrial glands/stroma

A

Endometrial polyps

341
Q

How much calcium should post menopausal women take to maintain their bones (zero balance)

A

1200 mg

342
Q

Management of post menopausal woman with recent hip fx that has healed

A

Start bisphosphanates

Dexa (every 2 years)

343
Q

Recommended tx for severe menopausal syx (hot flashes, night sweats, vag dryness)

A

HRT (estrogen) at the smallest effective dose for the shortest amount of time

344
Q

Why can postmenopausal women have hotflashes after a hys w/ b/l SPO

A

Removing the post men ovaries causes an aburpt drop in circulating androgens -> w/o circulating androgens the periphral adipose cells cannot convert it to estrone and estradiol

345
Q

What are the cancer pros/cons of combo HRT (estrogen + progesterone)?

A

Increases risk of breask cancer
Reduces risk of colon cancer
NO increased risk of endometrial cancer as is seen in estrogen only HRT

346
Q

When is combo HRT recommended?

A

When the pt still has their uterus.

Estrogen only is safe when the uterus is gone and there is no risk of endometrial cancer

347
Q

How does HRT affect lipid profiles?

A

Reduces LDL

Increases HDL

348
Q

How is osteopenia defined?

A

-1 to -2.5 on DEXA plus RF’s for fx (hx of falls, poor nutrition, smoking, low BMI, estrogen deficiency, alcoholism, insufficient exercise)

349
Q

When is a couple considered infertile?

A

A year w/o contraception and not conceiving

350
Q

You suspect infertility is due to PID.

A

Get a hysterosalpingogram

Evaluates the uterus and tubes for adhesions

351
Q

Pt being treated for bipolar and is infertile due to elevated prolactin

A

Switch bipolar meds

Antidopaminergic effect of psychotropic medication (quetiapine)

352
Q

What study do you order for infertiity in a heavy exerciser

A 
estrogen level (low)
exercise-induced hypothalamic amenorrhea
tx - encourage decreased exercise and increased caloric intake
353
Q

pt in her 40’s still getting periods but infertile

A

Get an anti-mullerian hormone level to determine ovarian reserve

354
Q

How do you counsel a woman w/ irregular cycles (26-30 days) of when is the best day to have sex?

A

Use an ovulation predictor kit
Most women ovulate on day 14 in a 28 day cycle, but hers vary.
Sperm can live up to 3 days

355
Q

IF female has NL periods, TSH, and prolactin but no reason to be infertile

A

Order a semen analysis

Cause of about 30% of infertility

356
Q

Hypothyroidism can cause what other hormone abnormality?

A

Hyperprolactinemia

357
Q

What condition can mimic PMS? (weight gain, fatigue, bloating)

A

Hypothyroidism

358
Q

What is a last resort for women with severe PDD?

A

B/l oophorectomy
Risks - CVD, hot flashes, bone loss
Do a trial of GnRH agonist first, if syx improve she is likely to benefit from surgery

359
Q

What can be effective in PMS that has not responded to other tx?

A

SSRI’s

360
Q

Why does exercise help PMS?

A

Endorphins

361
Q

RF’s for PMS?

A

Family Hx

B6, Calcium, or Magnesium deficiency

362
Q

What is a RF for molar pregnancy?

A

Being asian

<20 or >40

363
Q

Once a woman has a mole, what is the risk of having another?

A

1-2%

20x higher than other people

364
Q

Characteristics of a partial mole?

A

69XXY, 69XXX, or 69XYY
Caused when egg is fertilized by dispermy
Can have fetal parts

365
Q

Characteristics of a complete mole?

A

46XX (empty egg) or 46 (XY) empty egg fertilized by 2 sperm

Usually presents with large uterus, preeclampsia, and higher risk of GTD

366
Q

Molar pregnancy has a vaginal nodule. What needs to be done sTAT?

A

CT of the chest, andomen, and pelvis. Brain MRI also likely

Evacuation is likely to be necessary but need to id if the nodule suggests metastasis

367
Q

What confirms a dx of choriocarcinoma?

A

Beta-hcg
Pt presents with dyspnea months after delivery andno intrauterine preg
NEVER bx as these are highly vascular

368
Q

Bx of a lichen sclerosis pt reveals SCC. Now what?

A

Radical vulvectomy and groin node dissection

369
Q

Pigmented lesion on vulva

A

High grade vulvar intraepithelial neoplasia or

Melanoma

370
Q

Painless mass at the Bartholian gland

A

Bartholian gland malignancy
Needs excision/bx
Adenocarcinoma most common

371
Q

How do you manage a Vulvar intraepithelial neoplasia III (VIN III)?

A

Local superficial excision

Close surveillance

372
Q

Pt with vulvar itching has a diffusely erythematous labia with a thin white film. Many focal flat whitish lesions

A

HPV related condition (condyloma or vulvar dysplasia)
Suspect this in the immunosuppressed
Get a bx

373
Q

Pt has multifocal VIN II. Tx?

A

Laser ablation

374
Q

Breast cancer survivor has vaginal pruritis. On exam - vulva fiery red mottled background with whitish hyperkaeratotic areas

A

Paget’s disease of the vulva

375
Q

RF’s for cervical cancer

A

HPV exposure (early onset of sexual activity, multip partners, etc)
Smoking
Lack of pap smears

376
Q

Female < 25 w/ ASCUS but NL HPV

A

Repeat Pap in 3 yrs

377
Q

Female < 25 w/ ASCUS

A

Repeat pap in 1 year

378
Q

Post coital bleeding in post menopausal?

A

Cervical bx

Depending on result, may also need a CT

379
Q

What should you do if you see a white plaque on the cervix?

A

Bx for leukoplakia regardless of pap status

380
Q

What can make a cervical lesion more concerning?

A

Atypical vessels/angiogensis

381
Q

Entire lesion cannot be seen on colposcopy and endocervical curettage is negative. Now what?

A

Cervical conization to obtain a pathologic specimen

382
Q

Can you get cervical cancer w/o HPV exposure?

A

No

383
Q

Cervical dysplasia extending below the basement membrane

A

Carinoma in situ (CIS)
abn cells involving the entrire epithelium to the basement membrane
Microinvasive cancer - invades <3mm

384
Q

Major syx of fibroids

A

Heavy menstrual bleeding

385
Q

Which type of fibroid can cause miscarriage?

A

Submucosal or intracavitary
Cause lower pregnancy and implantation rates
Tx - hysteroscopic resection

386
Q

What do you do with a new dx of fibroids on PE/U/s

A

Endometrial sampling to rule out hyperplasia
especially if pt is post menopausal or late in reproductive age
Surgery not indicated unless pt is anemic

387
Q

Anemic fibroid pt wants a little time to decide if she wants a hysterectomy, what can you offer for short term tx?

A

GnRH agonist
3-6 months max
can also decrease size of fibroid if trying to do a hysteroscopic removal

388
Q

1 RF for endometrial carcinoma?

A

Obesity

Unless pt has complex atypical hyperplasia

389
Q

Post menopausal with endometrial bx + for endometriod adenocarcinoma

A

TAH + BSO

390
Q

Perimenopausal woman with intermenstrual bleeding, endometrial bx + and adnexal masses

A

Granulosa cell tumor

Secretes estrogen

391
Q

Elderly woman has spiral fx of the arm

A

Suspect abuse, spirals rarely occur w/o violence

392
Q

Greatest FR for ovarian cancer

A

Family Hx

393
Q

What can be protective for developing ovarian cancer

A

Long term suppression of ovulation (OCPs)

394
Q

Healthy female has a unilocular simple cyst on pelvic u/s. Shes on day 21 of her menstrual cycle

A

Functional ovarian cyst

NL part of ovulatory cycle

395
Q

Post me female has abn vaginal bleeding, endometrial hyperplasia, and adnexal mass. Which ovarian tumor can cause this?

A

Granulosa cell tumor (sex-cord stromal tumor)
Fxnal tumor secreting high levels of estrogen
Can lead to endometrial cancer

396
Q

Following debulking of a stage III ovarian tumor, all patients should receive?

A

Chemo

397
Q

Most common ovarian tumor in women of all ages?

A

Dermoid (termatoma)
Mean age is 30
u/s - cystic and solid components

398
Q

Vaginal atrophy can lead to which type of female sexual dysfunction

A

Insertional dyspareunia

Women with regular sexual activity are less likely to develop this

399
Q

Important source of lubrication during sexual arousal?

A

Vaginal mucosa/transudate

400
Q

Define sexual behavior

A

How a person chooses to act sexually

independent of orientation

401
Q

Best therapy for vaginismus?

A

Vaginal dilators

402
Q

At what age is a girl able to give consent?

A

16

may not apply to relationships of similar age

403
Q

What medications should be offered to rape victims?

A

Abx
Antiretroviral
plan B

404
Q

Where is the best place to put fliers about a hotline for intimate partner violence?

A

Office restroom

405
Q

Up until which gestational age is medical abortion approved?

A

Misprestone
63 days (9wks)
* recent data up until 10 wks

406
Q

Mom is febrile during delivery. suspcious for?

A

Chorioamnionitis
Newborn at risk for sepsis
May appear pale lethargic and febrile at the time of birth

407
Q

Babies born the GDM mothers are at risk of

A 
Hypoglycemia
polycythemia
hyperbili
hypocalcemia
ARDS
408
Q

What lab needs to be ordered in the event of fetal demise?

A

Maternal blood type

409
Q

5 stages of grief

A 
Denial
Anger 
Bargaining
Depression
Acceptance
410
Q

What is the primary reason for increasing rate of c sections?

A

Fewer women having trial of labor after a previous c section

411
Q

What are RF’s for breech presentation?

A

Prematurity
Multiple gestation
Polyhydramnios
Uterine anomalies/fibroids

412
Q

Latent phase is <4cm dilated. When is a pt considered latent?

A

nullipapras >20hrs

multi >14 hours

413
Q

Fetal hr is category 3 racing

A

Get baby out stat

414
Q

Preggo with vaginal bleeding has a a hard xcmass on their cervix that readily bleeds

A

cervical cancer

415
Q

Variable decels

A

Cord compression

416
Q

What indicates delivery in a PPROM?

A

signs of chorio (febrile, uterine tenderness)

417
Q

In PPROM, which amnio finding would suggest chorioamnioitis?

A

Increased IL-6

418
Q

At what time point does admin of steroids become controversial?

A

> 32 wks

419
Q

Most common source of fever on post partum day 1?

A

Lungs

Especially if they had a c section

420
Q

Baby is in breech at 2+ station

A

c-section

All breech babies are at high risk of complication in vaginal delivery

421
Q

Which contraceptive should be offered to a woman that is concerned about gyn cancer?

A

OCP’s

Decrease ovarian and endometrial

422
Q

Failure to empty the bladder completely

A

Overflow incontinence
underactive detrusor m. (DM, MS) or obstruction (prolapse)
Residual volum >400cc

423
Q

Tx of stress incontinence that fails conservative management

A

Retropubic urethrophexy (vaginal taping)

424
Q

Tx for intrinsic sphincteric deficiency?

A

Urethral bulking

“drain pipe” urethra on cystourethroscopy, q-tip test reveals fixed immobile urethra

425
Q

Tx for detrusor instability

A

oxybutynin

anticholinergics

426
Q

Fixing defect in pubocervical fascia

A

Cystocele

427
Q

Pt has frequency and nocturia but post voiding volume is 50cc

A

Urge incontinence

Overactivity of detrusor m. causes no urge to pee

428
Q

Why are colpocleisis preferred in older woman with multiple morbidities?

A

the vaginal ablation is done without general anesthesia

429
Q

Pt about to start menses has b/l ovarain cysts (one complex, one simple)

A

Hemorrhagic cyst

Repeat u/s in 2 months - most self resolve

430
Q

post op hysterectomy pt had an abscess that was treated. Years later, non specific pelvic pain is suspicious for?

A

Pelvic adhesive dz. Infection likely involved her tubes and ovaries

431
Q

What are 3 critical factors for starting menses?

A

> 85 lbs
adequate sleep
Optic exposure to sunlight

432
Q

Why do females with Kallmann syndrome have primary amenorrhea?

A

Their arcuate nucleus does not secrete GnRH
Do not develop secondary sexual characteristics
Dx: anosmia
Tx - pulsatile GnRH

433
Q

Pt develops menses before breast and pubic hair development

A

McCune Albright

434
Q

Pt having precocious puberty syx w/ LOW LH/FSH and high DHEA, DHEAS

A

Congenital adrenal hyperplasis
21-hydoxylase deficincy causes accumulation of adrenal androens
Tx - steroid replacement

435
Q

Visibly female teen - NL ovaries, no uterus and cervix

A

Mullerian agenesis
Associated with renal anomalies
NL ovaries - 2ndary characteristics

436
Q

For what ages should HPV vaccine be offered?

A

9-26

437
Q

How do you manage a pt with a fx consistent with osteoperosis?

A

Get a DEXA and start bisphosphanates

DEXA in 2 yr intervals

438
Q

Mot effective tx for hot flashes?

A

Estrogen

Only give if they dont have a uterus

439
Q

Risk of initiating combo HRT?

A

Increased breast cancer

This is not seen in estrogen only HRT

440
Q

Pt with molar pregnancy has a vaginal lesion

A

Get CT of the chest/abdomen/pelvis

CXR is not sufficient because she already has metastasis to the vagina

441
Q

Untreated lichen sclerosus can progress to?

A

Squamous cell carcinoma

442
Q

Abartholin mass in a post menopausaul woman is suspicious for?

A

Malignancy

Needs bx/excision in any woman >40

443
Q

Management of VIN III?

A

Local superficial excision

Radical vulvectomy not appropriate since cancer has not been diagnosed

444
Q

RF’s for vulvar cancer

A

HPV
Smoking
Vulvar dystrophy (lichen sclerosis)
Immunocompromised (HIV, Autoimmune)

445
Q

How far can micrinvasive cancer invade beyond the basement membrane

A

Up to 3mm

Over this is carcinoma in situ

446
Q

How do you manage a asymptomatic fibroid in pregnancy?

A

Just observe, unless it’s lower in the uterus which would indicate a c-section

447
Q

First step in a workup for a pelvic mass?

A

Pelvic u/s

448
Q

Preggo w/ b/l ovarain cyst

A

theca lutein cyst

seen in molar preg

449
Q

Most helpful scoring to determine prognosis in a tumor?

A

Tumor stage

450
Q

What is not associated with GDM?

A

Intrauterine growth restricition (this is associated with classic DM)

451
Q

If quad screen is suspicious for trisomy 21 get a?

A

amnio

452
Q

Baby is at 2+ and hr is dropping

A

Vacuum assisted vag delivery

453
Q

T1 DM preggo has a fetus with IUGR. Now what?

A

NST 1 or 2/wk

454
Q

How do you surgically remove a submucosal fibroid in a pt that wants to protect her fertility?

A

Hysteroscopic myomectomy

Cant get a submucosal on lap

455
Q

Best study for a woman w/ infertility suspicious for PCOS?

A

Testosterone

LH:FSH also helpful

456
Q

If a healthy preggo fails the 3hr OTT, what do you do?

A

Diet and blood sugar monitoring (90 fasting and <120 post prandial)

457
Q

Fetal risk of being exposed to intrauterine valproic acid?

A

NTD

458
Q

Most common reason for elevated alpha fetal protein?

A

Under estimation of gestational age

NTD is possible, but not the most common

459
Q

What is normal output for a baby?

A

3-4 stools

6 wet diapers

460
Q

Suckling increases which hormone?

A

Oxytocin

Actual suckling is better than a breast pump for stimulating the secretion of milk

461
Q

Preggo with MVP should be treated with?

A

If asymptomatic - monitor

IF symptomatic - Beta block - relieves chest pains, paliptations, anxiety

462
Q

Mild microcytic hypochromic anemia, with NL ferritin and NL electrophoresis

A

Alpha thalassemia

463
Q

Severe anemia with Hgb F and Hgb A2 on electrophoresis

A

Beta thalassemia

464
Q

Obesity in pregnancy increases the risk of?

A

Preeclampsia and HTN

465
Q

2 most common causes of anemia in pregnancy?

A

Iron deficiency

Acute blood loss

466
Q

SLE pt at 22 weeks has a flair.

A

NSAIDS

467
Q

Why is Paxial contra in pregnancy?

A

Cat D drug
Risk of cardiac malformations and PHTN
Other SSRI’s ok

468
Q

Most common reasons for abdominal surgery during pregnancy?

A

Appendicitis

Get a compression u/s if you’re suspicious

469
Q

What do you do if pt has mag toxicity during labor?

A

d/c mag and give calcium gluconate

470
Q

How do you manage a preeclampsia pt at 39 weeks?

A

Induce her

471
Q

Therapeutic range of magnesium?

A

4-7

Over that areflexia> respiratory depression > cardiac arrest

472
Q

Approximatre risk of isoimmunization w/o rhogam?

A

< 20%

473
Q

How is fetal hydrops dx’d on u/s?

A

collection of fluid in two or more body cavities

474
Q

Key complication of twin-twin transfusion syndrome

A

Neurologic sequelae of the surviving twin
Hydrops fetalis in either twin
Recipient - cardiomegaly, Tricuspid regurg, VH, plethoric, hypervolemic
Donor - anemic, hypovolemic, growth retarded

475
Q

What makes fibronectin a good screening tool for preterm labor?

A 
High NPV (99.2%)
- 99 of 100 women will not deliver w/in 10-14 days
476
Q

PPROM + tender uterus

A

Deliver

Chorioamnionitis

477
Q

Other than elevated IL6 would suggest chorioamnioitis on an amnio?

A

Low amniotic glucose

478
Q

Uterotonics

A

Methylergonovine, prostaglandins, oxytocin

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