uWise Facts Flashcards
1
Q
Contraindications to expectant management of Pre-E w/SF
A
- All deliver @ 34 weeks at latest
- contraindications to expectant management prior to 34 weeks
- thrombocytopenia
- pulmonary edema
- renal failure
- abruption- placentae
- disseminated intravascular coagulation
- persistent cerebral symptoms
- non-reassuring fetal testing
- fetal demise.
2
Q
- Dx?
- hirsutism, irregular menses and obesity
- patient’s hirsutism has worsened
- depressed
- She has also gained 20 pounds in the past two months and has noticed purple stretch marks
- terminal hair growth on her chin and hair growth on the back of her hands.
- Her cheeks appear flushed
A
Cushing’s syndrome likely
3
Q
Contraindications to using a patch
A
weight > 198 lbs
4
Q
Weight necc. for menses to begin
A
85 to 106 poinds
5
Q
Inpatient tx of PID
A
- options parenteral antibiotics covering both gonorrhea and chlamydia
- Cefotetan or cefoxitin PLUS doxycycline
- clindamycin PLUS gentamicin
6
Q
Outpatient tx of GC/CT
A
- For outpatient treatment, the 2010 CDC guidelines recommend:
- ceftriaxone, cefoxitin, or other third-generation cephalosporin (such as ceftizoxime or cefotaxime)
- PLUS doxycycline
- WITH or WITHOUT metronidazole.
7
Q
Criteria for PMDD
A
- PMDD is a psychiatric diagnosis, describing a severe form of premenstrual syndrome
- diagnostic criteria include five out of 11 clearly defined symptoms, functional impairment
- prospective charting of symptoms present during the last week of the luteal phase that begin to resolve with the beginning of the follicular phase
- All three areas of symptoms need to be represented for the diagnosis of PMDD.
8
Q
Menstrual cycle overview
A
- Days 0-14 = follicular phase
- Days 14-28 = luteal phase
9
Q
Tx of mastitis
A
- anti-staphylcoccal agent
- Dicloxacillin is used due to the large prevalence of penicillin resistant staphylococci
- Erythromycin may be used in penicillin allergic patients.
- Doxycycline, gentamicin, and cefotetan are not appropriate antibiotics for treatment of mastitis.
10
Q
Source of estrogen in postmenopausal women
A
- Estrogen production by the ovaries does not continue beyond menopause.
- estrogen levels in postmenopausal women can be significant due to the extraglandular conversion of androstenedione and testosterone to estrogen
- This conversion occurs in peripheral fat cells and, thus, body weight has been directly correlated with circulating levels of estrone and estradiol.
- Since menopausal ovaries are known to continue production of androgens, surgical removal of postmenopausal ovaries may result in the resurgence of menopausal symptoms from the abrupt drop in circulating androgens.
11
Q
Characteristifs of Postpartum telogen effluvium (hair loss)
A
- affects 40-50% of women postpartum
- High estrogen levels in pregnancy increase the synchrony of hair growth (hair growth normally asynchronous)
- ==> hair grows in the same phase and is shed at the same time.
- ==> significant postpartum hair loss at 1 to 5 months postpartum
12
Q
Tx of urge incontinence
A
- urge incontinence = detrusor instability
- acetylcholine is the transmitter that stimulates the bladder to contract through muscarinic receptors
- Thus, anticholinergics are the mainstay of pharmacologic treatment
- Oxybutynin is one example
13
Q
Control of prolactin production
A
- inhibited by dopamine
- dopamine antagonists ==> elevated prolactin
- antipsychotics, TCAs, MAOIs
- dopamine antagonists ==> elevated prolactin
- stimulated by TRH and serotonin
- hypothalamic and pituitary tumors ==> increased prolactin
14
Q
Cervical mucuous at various phases of menstrual cycle
A
- early follicular phase (just after menstruation) = thick, scant, acidic
- ovulatory phase = clear and thin
- stetches (to 6cm)
- more basic than other phases; pH>6.5
- mid-late luteal phase =
- ovulation already occured
- thicker, less stretching ability
- inhospitable to sperm
15
Q
Paget’s disease of breast associated with…
A
adenocarcinoma of the breast
16
Q
Management of preterm labor
A
- tocolytics x 48 hours
- to allow effects of steroids ==> increased fetal lung maturity and decreased interventricular hemorrhage
- steroids (betamethasone) < 34 weeks
- Mg-sulfate < 32 weeks
- for fetal neuroprotection
- Indomethicin < 32 weeks
- ABX - penicillin
- GBS prophylaxis
17
Q
Management of PROM (premature ROM)
A
- overall goal = prolong pregnancy
- sterile speculum exam
- confirm ROM
- est. cervical dilation
- r/o labor
- r/o infection
- Tx:
- Amoxicillin + Erythromycin
- minimize digital cervical exams
- admit and monitor for labor (?)
18
Q
Indications for C/S
A
- Arrest of labor (maternal)
- Non-reassuring FHTs
- Malpresentation
- Placenta previa ==> schedule C/S @ 37
- Vasa previa ==> schedule C/S @ 37
19
Q
First & Second line antihypertensives in pregnancy
A
- first-line
- methyldopa
- beta-block (labetalol)
- hydralazine
- Ca-channel blockers
- second-line
- thiazide diuretics
- clonidine
20
Q
Anti-hypertensives contraindicated in preganacy
A
- ACE-i/ARBs
- aldosterone blockers
- direct renin inhibitors
- Furosemide
21
Q
Second trimester quad screen interpretations
A
- Trisomy 18
- aFP = low
- B-hCG = low
- estriol = low
- inhibin = normal
- Trisomy 21
- aFP = low
- B-hCG = high
- estriol = low
- inhibin = low
- NTD/abd wall defect
- aFP = high
- all others normal
22
Q
Causes of asymmetric fetal growth restriction
A
- generally, maternal factors ==> asymmetric
- vascular dz (hypertension, pre-e)
- antiphospholipid ab
- autoimmune dz
- cyanotic cardiac dz
- substance abuse (tobacco, alcohol, cocaine)
23
Q
Causes of symmetric fetal growth restriction
A
- generally, fetal factors:
- genetic disorder (aneuploidy)
- congenital heart dz
- intrauterine infection
- malaria, CMV, toxo, varicella, rubella
24
Q
AUB approach in older women/approaching menopause
A
- ==> endometrial biopsy to rule out endometrial carcinoma
- hyperplasia w/out atypia ==> progestin therapy
- hyperplasia w/atypia
- considering future pregnancy ==> progestin therapy
- no plans for future preg/fail of medical ==> hysterectomy
25
Q
Benefits and risks of combined estrogen-progesterone birth control
A
- benefits
- preg. prevent
- decreased endometrial and ovarian cancer
- menstrual regulation
- less benign breast disease
- risks
- venous thromboembolism
- HTN
- hepatic adenoma
- rarely ==> stroke and MI
26
Q
Thyroid changes in pregnancy
A
- Total T4 ++ (1.5x pre-preg)
- B-hCG stimulates thyroid
- increased TBG binds extra T4 ==>
- significant increase in total T4
- slight increase in free T4
- Free T4 +
- TSH -
- increased B-hCG and T4 suppresses TSH
27
Q
DDx of hyperandrogenism in females
A
- PCOS
- nonclassic CAH = oligo-ovulation, hyperandrogenemia, increased 17-OH-progesterone
- ovarian/adrenal tumors
- older, rapid sx, increased androgens
- hyperprolactinemia
- cushing’s
- cushing’s features, nonsuppressible dexamethasone, increased 24 hour urine cortisol
- acromegaly
- excessive growth, elevated GH and IGF-1
28
Q
Contraindications to breastfeeding
A
- active untreated TB
- maternal HIV infection
- herpetic breast lesions
- varicella infection <5 days before or 2 days after delivery
- chemotherapy or ongoing radiation therapy
- active abuse of alcohol or drugs
29
Q
Vaginismus presentation and tx
A
- vaginismus = pain with sex, related to penetration; tensing upon entry
- tx = kegel exercises and gradual dilation
30
Q
Congenital anomalies associated with valproic acid
A
- NTDs
- ASD (cardiac)
- cleft palate
- hypospadias
- polydactyly
- craniosynostosis
31
Q
Signs of fetal Rh disease on US
A
- Fetal hydrops
- develops in the presence of decreased hepatic protein production ==> collection of fluid in two or more body cavities, such as ascites, pericardial and/or pleural fluid and scalp edema.
- On occasion, when extramedullary hematopoiesis is extensive, there will be evidence of hepatosplenomegaly.
- Placentomegaly (placental edema) and polyhydramnios are also seen on ultrasound
32
Q
Management of patients with IUFD and DIC risk
A
- induction of labor
- cesearan section not indicated as can lead to complications
33
Q
Acid-base disorder causes in first trimester
A
- hyperemesis gravidum ==> metabolic alkalosis
- pH > 7.45
- HCO3 high (> 28)
- physiologic changes (over course of pregnancy) ==> respiratory alkalosis
- pH > 7.45
- pCO2 low (< 35)
