UWise flash cards
What is the utility of an intrauterine pressure catheter in arrest of stage 1 of labor?
Determining whether contractions are adequate (if not, augment with oxytocin)
What liver-related problems indicate “severe features” of pre-eclampsia?
Severe URQ/epigastric pain not due to other causes Transaminases at least 2x normal
What total amount of calcium to postmenopausal women need to maintain bone density?
1200 mg
What part of the anatomy should nitrazine blue sampling sample from?
Vaginal fluid (NOT cervix)
When is it acceptable to directly proceed to LEEP following Pap test?
HSIL in a non-pregnant patient >24. (However, colposcopy also acceptable here). (If 21-24, perform colposcopy, not LEEP).
What are the most common fetal effects of poorly controlled maternal diabetes (non-gestational?) (2)
- Neural tube defects and other CNS defects 2. Cardiovascular defects
What is the most common cause of elevated maternal serum AFP?
Under-estimation of gestational age (if not properly calculated) (Also elevated with multiple gestations, neural tube defects, and abdominal wall defects) (Decreased levels seen in Down syndrome)
What is the relative risk of peripartum infection in vaginal deliveries and C-sections?
5-10x higher in C/S
What are restrictions on use of indomethecin as a tocolytic as a result of possibility of premature ductus arteriosus closure?
Do not use after 32 weeks (use from 24-32 weeks) Do not use more than 48-72 hours
What is the recommendation for antidepressents and breastfeeding?
Can continue normal regimen while breastfeeding
What should be done if cord prolapse is associated with a reassuring fetal heart rhythm?
Elevate fetal head with a hand in the vagina (to prevent cord compression) and deliver by C-section
What fetal endocrine abnormality is associated with post-term pregnancy?
Fetal adrenal hypoplasia
What endocrine abnormality may be seen in molar pregnancy?
Hyperthyroidism (high HCG levels mimic TSH)
What vaginal infection is assocaited with thick, curdish discharge?
Vulvoavaginal candidiasis
What is pelvic congestion syndrome, and how does it present?
Chronic dilation and stasis of pelvic veins leading to vascular congestion. Presents with pelvic pain and a sensation of “fullness” or “heaviness.” The uterus may be enlarged due to ovarian and uterine vein dilation. It may vary cyclically because estrogen vasodilates and worsens the congestion. It may worsen over the day. There may also be vaginal discharge, backache, and urinary frequency.
What medication has been shown to reduce the risk of premature labor in those with a history of premature later associated with PPROM?
17 alpha-hydroxyprogesterone (given from 16-20 weeks until 36 weeks)
How is pruriturus gravidarum treated if it is refractory to antihistamines and topical emollients?
Ursodeoxycholic acid (itching due to bile salt retension) (Can consider pruriturus gravidarum to be a mild form of intrahepatic cholestasis of pregnancy)
What old features of severe pre-eclampsia are no longer considered?
Total 24-hr urine protein >5 g Fetal growth restriction
What is suggested by mild fever and mild uterine fundal tenderness in the peripartum period?
Endometritis (seen after 2% of VD and 10-15% of C/S)
What is the treatment for a single vulvar intraepithelial neoplasia (VIN) III lesion?
Wide local excision
Other than fever, what physical exam finding can suggest intra-amniotic infection?
Uterine fundal tenderness
What tocolytic is myasthenia gravis a contraindication for?
Magnesium sulfate
How is syphilis treated in a pregnant woman with serious penicillin allergy?
Give Penicillin G, but “desensitive” by slowly building up dose over hours (There are no proven alternatives to penicillin for syphilis in pregnancy - doxycycline/tetracycline are normally second-line, but are CI in pregnancy) (I did find a paper that says ceftriaxone may work well)
What do you worry about with loss of fetal station?
Uterine rupture
What induction medications are contraindicated in patients with prior C/S?
Prostoglandins
What vaginal infection is associated with erythematous patches on the cervix?
Trichomonas (“strwaberry cervicitis”)
What is the pattern of the different biometry measurements in TORCH infection?
Symmetric IUGR: All measures decreased equally, normal HC/AC and FL/AC ratios
What is the next step in the workup of LSIL and in a 24 year old?
Repeat Pap + HPV in one year.
What is the pattern of the different biometry measurements in trisomy 13 and 18?
Symmetric IUGR: All measures decreased equally, normal HC/AC and FL/AC ratios
What vaginal infection is associated with yellow, frothy discharge?
Trichomonas vulvovaginitis
Other than abscess, what postpartum infection can persist despite appropriate antibiotics? What else is required in treatment?
Septic thrombophlebitis requires short-term anticoagulation (heparin) as well as antibiotics (Infection of thrombosis of venous system of pelvis)
What is the treatment for arrested dilation in the active phase with contractions every 2-3 minutes?
AROM if intact. Afterwards (or if already ruptured), may use pitocin.
What are three common conditions that can lead to increased risk of first trimester pregnancy loss?
Lupus, DM, thyroid disease
What enzyme deficiency leads to masculinization? What marker is used to test for this condition?
21-hydroxylase deficiency. 17-hydroxyprogesterone is elevated.
What drug with anti-androgen effects (but more commonly used for another purpose) can be used in conjunction with OCP to treat idiopathic hirsuitism?
Spiranolactone (aldosterone receptor antagonist that also has antiandrogen effects)
How does history suggestive of drug abuse affect the treatment of a newborn without respiratory effort?
Relative contraindication for naloxone as this can lead to fatal opioid withdrawal. (Instead, give positive pressure ventilation and prepare to ventilate).
What is the preferred management for severe hemolytic disease(e.g. in zone 3 of the Lilly curve)?
Delivery or intrauterine fetal transfusion (depending on gestational age)
What is the recommended time for avoiding pregnancy after D&C for molar pregnancy?
6 months after negative HCG levels
What is the biggest risk factor for peripartum infection after a vaginal delivery?
Protracted labor (others include prolonged ROM, multiple vaginal exams, internal fetal monitoring, manual placental removal, and low socio-economic status)
What is the gestational age cutoff at which manual vaccum aspiration abortion is no longer an option?
8 weeks
What is a noninvasive method for detecting fetal anemia?
Middle cerebral artery peak systolic velocity (increased in anemia)
What organism most commonly causes lactational mastitis?
Staph aureus
What is the the best predictor of chorioamnionitis on amniocentesis labs?
Low glucose (
What is the primary function restored by infusing cryprecipitate?
Coagulation (contains fibrinogen, vWF, Factors VIII and XIII)
In a patient under 24 who is having repeat Pap 12 months after ASC-US or LSIL, what are the potential next steps depending on findings?
ASC or higher: colposcopy Negative: repeat in 12 months, and then return to regular screening if that is negative.
Which out of these non-Rh(D) antibodies can be associated with hemolytic disease of the fetus and newborn (HDFN)? ABO, Duffy, I, Kell, Lewis, MNS, P, P1, Rh(c), Rh(E)
Associated with HDFN: ABO, Duffy, Kell, MNS, Rh(c), Rh(E) Not associated: I (not expressed on fetal/newborn RBC), Lewis (IgM), P1 (IgM) Clarification on P: Only associated with HDFN when the mother has the very-rare “p” phenotype, which has antibodies against P1+P+P(k). In contrast, women with P2 often produce anti-P1 antibodies, but these are IgM
What vulvar lesion presents with whitish, hyperkeratoric areas mottling over a fiery red background?
Paget’s disease of the vulva (reaction to SCC or internal carcinoma). (Analogous to Paget disease of breast)
What uterotonic is contraindicated in patients with significant asthma (especially if poorly controlled?
Prostoglandin F2alpha (Carboprost/Hemabate) (Smooth muscle constrictor that leads to bronchoconstriction)
What blood pressure levels require treatment in pregnancy? What is the blood pressure goal in pre-eclampsia?
Threshold for treatment: >150 or >160 systolic, >105 or >110 diastolic (recommendations differ) Target: 140-150 systolic, 90-100 diastolic (recommendations differ) Key take home: want to control, but don’t be too aggressive due to risk of fetal harm
What is the least invasive treatment for missed abortion?
Misoprostol (PGE1) to contract uterus to expel products of conception (Can also use manual vaccum aspiration or D&C)
How can cervicitis present in pregnancy?
Vaginal bleeding (cervix much more vascular in pregnancy)
What are the first three steps in evaluating postpartum hemorrhage?
Assess uterine tone Assess for retained placenta (examine delivered placenta for completeness) Assess for lacerations
What is given for prophylaxis in infants born to HIV-positive mothers? When does this begin? When does HIV testing begin?
Start AZT (Zidovudine) at birth HIV testing beginning at 24 hours of life (not birth)
What parenteral regimen for PID includes no beta-lactams?
Clindamycin + gentamicin
What is the treatment for vulvovaginal candidiasis?
A topical synthetic imidazole, or oral fluconazole
How does the use of chemotherapy and radiation change during pregnancy?
Chemotherapy: risk of birth defects or fetal loss in first trimester (especially antifolate drugs). In 2nd/3rd trimesters, some chemo regimens can be used, although there are still increased risks of stillbirth, IUGR,and fetal toxicities). Radiation generally avoided
What are the patterns of different biometry measuremens in the following causes of IUGR: Pre-eclampsia, Smoking/alcohol/heroin, TORCH infection, Trisomy 13/18, Uteroplacental insufficiency?
Asymmetric IUGR: Abdominal circumfrence decreased disproportionately to other measures (HC and BPD may be normal). High HC/AC ratio. Seen in pre-eclampsia and uteroplacental insufficiency Symmetric IUGR: All measures decreased equally, normal HC/AC and FL/AC ratios. Seen in Smoking/alcohol/heroin, TORCH, Trisomy 13/18
How is pregnancy with a large fibroid protruding into the lower uterine segment managed?
C-section
What is the gestational age cutoff at which medical abortion is no longer an option?
7 weeks (49 days)
What adverse events does terbutaline put the patient at risk for?
Maternal heart problems and resulting death
What is the risk of fetal loss with chorionic villus sampling?
1%
What is the biggest risk factor for post-partum depression?
Personal history of depression
What stragtegies does evidence support for preventing pre-term delivery in twins?
No clear best strategy. Ensuring good early maternal weight gain (first 20-24 weeks) may help, at least with preventing low birth weight. (Bed rest, cerclage, prophylactic tocolytics starting at 24 weeks, and home uterine monitoring have been shown to be ineffective)
What are the treatments for bacterial vaginosis and Trichomonas vulvovaginitis? What are alternate agents for each?
Both treated by metronidazole. Trichomonas can be treated by a single high dose, bacterial by multiple low doses. BV can also be treated by clindamycin, Trichomonas can also be treated by tinidazole.
What is classically associated with size > dates uterus and elevated HCG?
Molar pregnancy (especially complete mole)
Other than tocolytics, what drug likely needs to be given to a woman going into premature labor at 34 weeks?
Ampicillin (GBS status most likely unknown, since, testing occurs at 35-37 weeks)
What is indicated when a breast mass is reduced by fine needle aspiration, but the aspirate is bloody, and the mammogram is normal?
Excisional biopsy (normal mammogram does not rule out cancer)
What is the dilute Russel viper venom test a proxy test for?
Lupus anticoagulant (part of antiphospholipid syndrome workup for recurrent pregnancy loss)
In severe uterine atony requiring laporoscopic intervention, what is the first procedure to try?
B-Lynch suture (brace sutures that vertically wrap around the uterus itself)
What size babies are associated with type I diabetes, type II diabetes, and gestational diabetes? In each of these, are newborns are risk for hypoglycemia, hyperglycemia, or neither?
Type I: small Type II and GDM: large All: increased risk of hypoglycemia
For what malignancy is biopsy NOT the gold standard of diagnosis? How is the diagnosis made instead?
Choriocarcinoma (highly vascular, DO NOT biopsy) In a setting of recent pregnancy (term, miscarriage, termination, molar), elevated HCG when uterine and ectopic pregnancy ruled out is diagnostic for GTD
How is abnormal intrauterine pregnancy treated (slow HCG rise, low progesterone)?
Expectant management is sufficient. Misoprostone, vaccum aspiration, and D&C may be used.
On colposcopy, what do punctations and mosaicism represent?
New blood vessels on their ends (punctations) and sides (mosaicism)
How should preterm labor (
Induction of labor if reassuring FHR, otherwise C/S (Fever and tender fundus suggest intra-amniotic infection, so tocolysis and/or observation are not appropriate)
What rare complication of severe postpartum hemorrhage can lead to fatigue, prolonged amenorrhea, milk production failure, and hypotension?
Sheehan’s syndrome: Nectrosis of anti-pituitary leading to deficit of gonadotropins, TSH, and ACTH
What thresholds on 24-hr urine protein for pre-eclampsia? Pre-eclampsia with severe features in old guidelines?
Pre-eclampsia: >300 mg w/ severe features: >5 g (Note: latest guidelines do not include
What is the treatment for invasive SCC of the vulva?
Microinvasive SCC (lesion
What maternal genetic mutation is associated with maternal thrombosis as well as stillbirth, preeclampsia, placental abruption, and IUGR?
Factor V Leiden mutation (the most common inherited thrombophilic disorder, Factor V is resistant to activation by Protein C).
What cardiac conditions have maternal mortality of 25-50% in pregnancy? (3)
Pulmonary hypertension Aortic coarctation with valve involvement Marfan syndrome with aortic involvement
How do the rates of fetal death and cerebral palsy in twins compare to singletons?
Both are about 5x more likely
Vacuum vs forceps-assisted operative vaginal delivery: which has a greater risk of: Cephalohematoms? Hyperbilirubinemia? Maternal lacerations? Transient neonatal lateral rectus paralysis?
Vacuum has greater risk of cephalohematoma and therefore hyperbilirubinema, as well as transient neonatal lateral rectus paralysis (but the last resolves spontaneously and isn’t clinically important) Forceps has greater risk of maternal lacerations
How do cervical polyps compare to cervical cancer on examination?
Cervical polyps usually soft, cancer usually hard or nodular (Both can cause vaginal bleeding in pregnancy)
What adverse fetal effects are associated with maternal valproate use? (3)
- Neural tube defects 2. Hydrocephalis 3. Craniofacial malformations
What is the definite treatment for severe endometriosis in a patient who has failed medical management and does not desire fertility?
Hysterectomy with bilateral salpingo-oopherectomy
What surgical procedures have the best 5-year success rate in the treatment of genuine stress incontinence with urethral hypermobility?
Retropubc urethropexy / suspension (tension-free tape or sutures from vaginal tissue around urethra, anchored to pubic bone) AND suberethral sling are both highly effective (Needle bladder neck suspension is less effective)
What is the treatment for mastitis during breastfeeding?
NSAIDs and antibiotics with SA coverage. Encourage to continue breastfeeding. (Antibiotics: Cephalexin or dicloxacillin if MRSA not suspected. Beta-lactam allergy: Clindamycin Severe disease: TMP-SMX (but not if breastfeeding newborn due to kernicterus risk) or vancomycin)
What should the response be to ASC-US with reflex HPV testing positive for a high-risk type?
Colposcopy
How is thyroid storm treated in pregancy?
Thiomide (propylthiouracil/PTU, carbimazole, or methimazole - inhibit thyroperoxidase) Propanolol Dexamethasone (decrease T4 conversion to T3) Sodium iodide (blocks thyroid hormone release) Radioactive iodine (I-131) is CI due to congenital hypothyroidism
What is the most common side effect of fluoxetine?
Insomnia
What complications does smoking put you at risk for? (5)
Placental abruption Placenta previa Fetal growth restriction Infection Preeclampsia
What provocative test can be used to determine ovarian reserve?
Clomiphene challenge test: give clomiphene citrate in mid-follicular phase (days 5 to 9), testing FSH before (day 3) and after (day 10). (If good ovarian reserve, FSH begins low and stays low (
How is hydrops fetalis defined?
Edema in at least 2 fetal components on ultrasound: Ascites, pleural effusion, pericardial effusion, and skin edema
How should decreased fetal growth with reassuring AFI and non-stress test be treated?
Weekly non-stress tests to ensure fetal wellbeing
What is the response to ASC-US in a patient 24 or under? Over 24?
ASC-US under 24: repeat screen in 12 months. Over 24: Reflex HPV testing. If positive, colposcopy. If negative, cotesting in 3 years (sooner than normal)
What is the antibiotic treatment for preterm premature ROM?
Ampicillin and erythromycin
What presents with a withered, thin newborn with long fingernails in the setting of post-term delivery?
Fetal dysmaturity (seen in 10% of deliveries past 43 weeks) (Significant risk of stillbirth)
What are risk factors for retained placenta?
Prior C/S Prior uterine curettage Fibroids Succenturiate lobe of placenta (accessory lobe)
What is the recommended dose for folate supplementation in women who may become pregnant?
Non-high risk: 0.6 mg/day Previous NT defect pregnancy: 4 mg/day
What malignancy is associated with PCOS?
Endometrial cancer (unopposed estrogen)
When is the screening glucose tolerance test performed in average-risk and in high-risk pregnant women?
Average risk: 24-28 weeks High risk (previous GDM, obesity, strong FHx): screen at initial prenatal visit, and if negative screen again st 24-28 weeks
What is the pattern of the different biometry measurements with exposure to smoking, alcohol, or heroin?
Symmetric IUGR: All measures decreased equally, normal HC/AC and FL/AC ratios
What part of pregnancy is bloody show associated with?
Cervical dilation
What should be done if “fatty appearing tissue” is removed during suction dilation and curettage?
Stop suction, gently remove tissuefrom currette, then perform laparoscopy or laparotomy, as this likely is omentum and may be associated with bowel
What test should be done following confirmed diagnosis of Mullerian agenesis?
Renal ultrasound (25-35% have associated renal defects)
What menstrual phase is associated with a dysphoric disorder?
Luteal phase (premenstrual dysphoric disorder)
What lab test is required following any maternal bleeding in pregnancy?
Blood type (to check if Rh negative), unless already documented
How is infertility secondary to antiphosphilipid antibody syndrome treated?
Combined aspirin + heparin
What is a common treatment for urge incontinence?
Oxybutynin, an anticholinergic.
What are indications for immediate delivery in pre-eclampsia remote from term (<32 weeks) (7)
Thrombocytopenia with platelets <100,000
Inability to control BP with maximum doses of two antihypertensives
Non-reassuring fetal surveillance
LFTs elevated more than 2x normal
Eclampsia
Persistent CNS Symptoms
Oliguria
What are risk factors for placental abruption (6)?
Smoking Cocaine use Chronic hypertension Abdominal trauma Multiparity Prolonged premature ROM
What nerves are at risk for entrapment in pelvic surgery performed through a low transverse incision? How are they distinguished on exam?
Iliohypogastric (T12-L1): loss of sensation of groin and skin overlying pubis Ilioinguinal (T12-L1): loss of sensation to groin, symphesis, labium, and upper inner thigh (a bit lower course) (Injury mainly occurs when incision goes lateral to lateral border of rectus abdominus, and can be due to entrapment of the nerve in suture or in scar tissue, or direct injury).
What uterotonic is contraindicted in patients with hypertension and/or preeclampsia?
Methylergonavine (smooth muscle constrictor that can increase BP)
What type of delivery is associated with increased risk of pelvic organ prolapse?
Vaginal
What are criteria for stopping Pap smears with old age?
Can stop at 65-70 if have had 3 consecutive negative Paps in 10 years, or 2 negative Paps with negative HPV cotesting. Also must have no history of HSIL or cervical cancer
What is the pattern of the different biometry measurements in pre-eclampsia?
Asymmetric IUGR: Abdominal circumfrence decreased disproportionately to other measures (HC and BPD may be normal). High HC/AC ratio.
What tocolytic is diabetes a contraindication for?
Terbutaline
What complication of D&C for abortion presents with profuse uterine bleeding?
Retained products of conception (may lead to septic abortion) (Cervical laceration could also present with heavy bleeding)
How much fetal blood is neutralized by a standard dose of 300 micrograms of RhoGAM?
30 mL
What organism causes infection presenting with painful, sensitive nipples and pink, shinny nipples with peripheral peeling?
Candida Bacteria cause mastitis instead, which generally does not cause intense nipple pain. However, nipple fissues can subsequently be infected by SA)
When is RhoGAM given to an Rh-negative pregnant woman? (5)
Routinely at 28 weeks Within 72 hours of delivery of an Rh+ baby Abortion (spontaneous or induced) Antepartum hemorrhage Amniocentesis or chorionic villus sampling (If father is confirmed Rh-negative, RhoGAM is not necessary)
What are infants of diabetic mothers are risk of in terms of: Glucose levels? RBC levels? Bilirubin? Lung development? Calcium?
Hypoglycemia Polycythemia (placental insufficiency leads to poor oxygen delivery and reactive erythropoiesis) Hyperbilirubinemia (Insulin opposes cortisol’s stimulation of bilirubin metabolism maturation) ARDS (Insulin opposes cortisol’s stimulation of lung maturation) Hypocalcemia (low PTH levels for unclear reasons)
What is the expected weight gain during pregnancy in someone who is initially:Underweight?Normal weight?Overweight?Obese?
•BMI less than 18.5 kg/m2 (underweight) – weight gain 28 to 40 lbs (12.5 to 18.0 kg) •BMI 18.5 to 24.9 kg/m2 (normal weight) – weight gain 25 to 35 lbs (11.5 to 16.0 kg) •BMI 25.0 to 29.9 kg/m2 (overweight) – weight gain 15 to 25 lbs (7.0 to 11.5 kg) •BMI greater than or equal to 30.0 kg/m2 (obese) – weight gain 11 to 20 lbs (5 to 9.0 kg)
How can a missed abortion be diagnosed by ultrasound alone?
Crown-rump length >7 mm with no cardiac activity
What is a last-ditch procedure for severe apical prolapse in a medically complicated patient for whom major surgery is very risky?
Colpocleisis: obliterate and close off vaginal cavity with permanent sutures
What can be used first for uterine atony after massage and uterotonics have failed?
Bakri balloon placement
What is the pattern of the different biometry measurements in uteroplacental insufficiency?
Asymmetric IUGR: Abdominal circumfrence decreased disproportionately to other measures (HC and BPD may be normal). High HC/AC ratio.
What is the dexamethasone suppression test used for?
Cushing’s syndrome (excess glucocorticoids) (Dexamethasone is a potend corticosteroid and should suppress ACTH via negative feedback. If ACTH remains high, then there is a pathologic ACTH source).
What is the physical exam finding uterine nodularity along the uterosacral ligament suggestive of?
Endometriosis
What is the antibiotic treatment for endometritis?
Ampicillin and gentamicin
What is the treatment for CIN III on colposcopy?
LEEP or cold knife cone
What should be done to induce labor with an entirely closed cervix?
Cytotec (misoprostol) (Foley balloon and AROM are other options for induction with an unfavorable cervix, but they require at least a small amount of dilation)
What is the most common cause (original infection) leading to sepsis in pregnant women?
Acute pyelonephritis
What is the first stage of pubertal development, and when does it begin? When does menarche occur, on average?
Telarche (breast bud development) is first, followed by adrenarche/pubarche, then menarche. Telarche typically occurs around 10 years. Menarche occurs around 12.5 years.
What could lead to a neural tube defect, polyhydramnios, and macrosomia?
Poorly controlled maternal diabetes (Associated with many birth defects, especially spine and heart defects)
What medicine can be used to treat elevated prolactin levels?
Bromocriptine (a D2 agonist. D2 stimulation inhibits prolactin release)
What complication of D&C presents with cyclic midline abdominal cramping pain?
Hematometra (scar tissue walls off a portion of endometrium so shed menses are trapped).
What is a common, easy suggestion to help many patients with pain from fibrocystic breast change?
Reduce/eliminate caffeine
In addition to breast firmness and tenderness, what can symptom can breast engorgement lead to?
Low-grade fever
What imaging is to be performed for gestational trophoblastic disease?
In addition to pelvic ultrasound, should perform a chest X-ray to show lung metastasis
What is the most common cause of primary genital herpes? Recurrent genital herpes?
Primary: HSV-1 Recurrent: HSV-2
What is the most common risk factor for uterine inversion?
Iatrogenic - excessive cord traction (Factors that lead to increase uterine distension also increase risk - multiple gestation, polyhydramnios, macrosomia, and grand multiparity)
What type of drug can lead to elevated prolactin levels?
Tricyclic antidepressants, such as imipramine (D2 receptor blocker, and D2 receptors inhibit prolactin release). (This is why bromocriptine can treat elevated prolactin - it is a D2 agonist)
What CBC changes indicate “severe features” of pre-eclampsia?
Thrombocytopenia
What test should be perform in a young person with severe chronic menstrual pain that is not responsive to NSAIDs and OCPs, in a woman with a normal pelvic exam and ultrasound?
Exploratory laporoscopy (primarily for endometriosis)
What is the response to ASC-US with positive HPV test in a patient over 24? 21-24?
Over 24: Colposcopy Under 24: Repeat Pap in 1 year
What is the most common form of breech presentation?
Frank (buttocks first) - seen in 48-73% of breech.
What is the treatment for diffuse vulvar intraepithelial neoplasie (VIN) II?
Laser ablation (preserve sexual function) vs. complete skinning vulvectomy (aggressive treatment)
What is the next step in the workup of a suspicious breast mass with a normal mammogram and negative fine needle aspiration but persistent mass?
Excisional biopsy
What FHR pattern results from cord compression? Cord prolapse? Uteroplacental insufficiency?
Compression: Variable decels Prolapse: Sustained bradycardia Uteroplacental insufficiency: Late decels
What can cause hair loss 1-5 months postpartum?
Postpartum telogen effluvium: during pregnancy, high estrogen syncrhonizes hair growth, so follicles turnover synchronously as well. (Most commonly atbout 3 months postpartum, can be 1-5 months)
What are the BP thresholds for pre-eclampsia? With severe features?
Pre-eclampsia: >140/>90 Severe features: >160/>100 (Both require 2 reads 4 hours apart, in a previously normotensive patient with new-onset HTN after 20 wks gestation)
What condition has the classic finding of sharp, burning, raw sensation with vestibular touch or entry? How can it be treated?
Vestibulodynia syndrome Tricyclics work (“block sympathetic afferents.”) Can also use biofeedback or pelvic floor rehabilitation. Topical anesthetics too.
What is a normal post-void residual urine volume? What values are typical for overflow incontinence?
Normal: 50-60 mL Overflow incontinence: often >300 mL
What are the effects of the following hormones on milk in the breast: Estrogen, progesterone, prolactin, oxytocin?
Estrogen and progesterone: suppress milk production during pregnancy Prolactin: drives milk production after inhibition by estrogen and prgesterone released Oxytocin: stimulates milk letdown
What is the most common form of peripartum infection?
Endometritis (seen after 2% of VD and 10-15% of C/S)
How are postpartum depression and postpartum blues differentiated in terms of 1) duration and 2) symptoms?
Duration: Blues last less than 2 weeks Symptomas: PPD has ambivalence to newborn and sense of inability of loving her family
What demographics are associated with higher rates of molar pregnancy?
Asian race. Age 40 (extremes of childbearing years)
What is the next step after molar pregnancy has been diagnosed in association with a fleshy, friable legion on the vaginal wall?
Chest/abdomen/pelvis for staging of likely metastatic GTD. (Likely highly vascular, DO NOT biopsy due to risk of severe bleed).
When can cell-free DNA screening be performed?
From 9 weeks’ gestation until delivery
What is empiric therapy for cervicitis? (Remember an option_)
GC coverage: cephalosporin (e.g. ceftriaxone) Chlamydia coverage: azithromycin OR doxycycline
What respiratory problem indicates “severe features” of pre-eclampsia?
Pulmonary edema
What hormones do menopausal ovaries produce?
Androgens (which are peripherally converted to estrogens) (Postmenopausal ovaries do not directly produce estrogen).
What should be done for C/S incision tenderness before establishing a diagnosis of surgical cite infection?
Opening wound and draining it, then assessing the drained fluid. (Also look for wound dehiscence at the same time)
How are chest palpatations and intermittent chest pain accompanied by a systolic click treated in pregnancy?
Symptomatic MVP treated with beta-blockers (Asymptomatic needs no treatment)
What is the safety of NSAIDs in pregnancy?
Unsafe after 30-32 weeks due to potential ductus arteriosus closure (and other problems). Safe before then
What magnesium levels are therapeutic? When are DTRs lost? When is respiratory depression seen? When Is cardiac arrest seen?
Therapeutic: 4-6 mEq/L Loss of DTRs: 7-10 mEq/L Respiratory depression: >11 mEq/L Cardiac arrest: >15 mEq/L
How is significantly precocious puberty managed?
GnRH agonist (Leuprolide) to shut down HPO axis
What treatments are given to prevent vertical transmission of HIV in an HIV-positive woman?
HAART during pregancy IV Zidovudine (AZT) during delivery C-section Zidovudine (AZT) to infant beginning at birth
What screening test is performed specifically for African American couples preparing to conceive?
Hemoglobin electrophoresis and CBC
How do OCPs and hormonal IUD affect ovarian and endometrial cancer risks?
OCP reduces risk of both, IUD reduces risk of endometrial cancer only.
Which lichen is often associated with extra-genital lesions?
Lichen planus (e.g. oral lesions, alopecia, extragenital rashes)
What vaginal infection is associated with thin grey discharge from the vagina?
Bacterial vaginosis
What is the next step in the workup of LSIL and negative HPV test in a 30 year old?
Repeat Pap + HPV in one year.
What is cervical ectroprion?
Mucinous columnar epithelium that is present on the vaginal ectocervix (in communication with the endocervix).
What is suggesed by multicenteric brown-pigmented papules on the perineum, perianal region, and labia majora?
Vulvar intraepithelial neoplasia
What is the safest method of lactation suppression?
Breast binding and ice packs with analgesics (OCP and bromocriptine have increased risk of thromboembolic events)
What can lead to a falsely elevated prolactin level in the workup for breast discharge?
Stimulation of breast exam can lead to elevated levels. Meals can also elevate prolactin levels, so fasting levels are best. (If true positive, work up for pituitary pathology with TSH and MRI)
What can result from severe fetal anemia?
Hydrops fetalis (essentially a form of prenatal high-output heart failure)
What is suggested by blue-black powder burn lesions in the pelvis? What would they show histologically?
Endometriosis. Pathology would show endometrial glands/stroma with hemosiderin-laden macrophages
What ultrasound tests should be performed with fetal growth restriction?
Amniotic fluid volume Doppler umbilical cord systolic:diastolic ratio Non-stress test
What is suggested by a firm, non-tender mass in the Bartholin’s gland?
Bartholin gland malignancy
What should be done in cases of meconium-stained aspiration?
Depressed newborn: Intubate trachea and suction meconium from behind glottis Vigorous newborn: No need for intubation Routine suction at the peritoneum not recommended.
What is the role of tocolysis in the setting of premature ROM?
Potentially used to delay delivery to allow steroids to take maximal effect. But do not delay beyond 48 hours due to risk of chorioamnionitis.
What vitamins may be deficient in PMS, and can be supplemented back as part of therapy?
A, E, and B6/pyridoxine
What does amnioinfusion prevent?
Cord compression / repetitive variables 2/2 oligohydramnios (Does not appear to reduce the rate of meconium aspiration syndrome with meconium-stained amniotic fluid)
What are the two biggest risk factors for placenta accreta?
Uterine scarring (e.g. Asherman’s syndrome, multiple C-sections, multiple D&Cs, myomectomy) Placenta previa (especially overlying a scar, such as a C/S scar, but it is also an independent risk factor)
How should missed abortion be treated?
Induction with misoprostol vs. surgical evacuation.
What antidepressant is Category D in pregnancy?
Paroxetine (Paxil) (Heart defects and persistent pulmonary HTN)
Why does hypothyroidism lead to hyperprolactinemia?
TRH (the hypothalamic hormone that stimulates the AP to release TSH) also stimulates the AP to release prolactin. Hypothyroidism leads to elevated TRH due to loss of negative feedback.
At what gestational age is the risk of mental retardation in response to significant imaging radation greatest?
8-15 weeks
What is the risk of isoimmunization in an Rh-negative mother who gives a normal vaginal delivery of an Rh-postive infant?
About 16%
What should be avoided in premature ROM?
Digital exam (risk of introducing bacteria and choriomanionitis)
How is spontaneous abortion in a hemodynamically unstable patient treated?
Dilation and suction curettage
What benefits are associated with betamethasone treatment prior to preterm delivery?
Lung maturation and prevention of ARDS Decreased intracerebral hemorrhage Decreased necrotizing enterocolitis (Does NOT lead to increased growth)
What lab test(s) can be useful to confirm the diagnosis of exercise-induced hypothalamic amenorrhea?
Estrogen (low) with FSH not elevated (but may be normal)
What creatinine changes indicate “severe features” of pre-eclampsia?
Creatinine >1.1 or double baseline
At what BPD threshold is it reasonable to consider C-section based on that alone?
12 cm
How should pregnancies after 41 weeks be monitored?
Monitor AFI and NST twice weekly to assess for oligohydramnios and fetal well being
What are CNS symptoms that indicate “severe features” of pre-eclampsia?
Visual changes AMS Severe headache
What can lead to cord compression in the absence of issues such as nuchal cord, cord knots, and cord prolapse?
Oligohydramnios, e.g. secondary to premature ROM (lack of cushioning effect of amniotic fluid makes cord vulnerable to compression)
What surgical procedure is useful in the treatment of genuine stress incontinence without urethral hypermobility?
Urethral bulking agent injections (especially useful for intrinsic sphincter deficiency)
What complication of D&C presents with lower abdominal pain, tenderness, and guarding, with nausea, scant bleeding, and fever?
Uterine perforation
What androgens are elevated in Cushing’s syndrome?
DHEAS is elevated, Testosterone is normal.
What can present with pelvic pain and dyspareunia as well as urinary frequency and urgency, in the absence of pelvic floor defects?
Interstitial cystitis
What are three options for the surgical treatment of apical prolapse of vaginal cuff after hysterectomy? What is a major risk of each?
Uterosacral ligament suspension: risk of ureter obstruction Sacrospinous ligament suspension: pudendal/sciatic nerve injury Sacral colpopexy (suspend to anterior longitudinal ligament using mesh to vaginal walls): mesh exposure/erosion (as well as bowel injury/obstruction or iliac/middle sacral vessel injury)
What is the response to ASC-H?
Colposcopy (regardless of HPV status)
What is the next step in the workup of LSIL and positive HPV test in a 30 year old?
Colposcopy (20% of LSIL on Pap smear finds HSIL on colposcopy) (If HPV test cannot be done, need to do colposcopy) (If under 25, can f/u LSIL w/ repeat Pap in 1 yr)
What patient factor interferes with the birth control patch more than other combined oral contraceptives?
Obesity (weight >198 lb)
What is the recommended first treatment for breach presentation during active labor?
C-section due to greater risk of neonatal complications with vaginal delivery of breech baby (External and internal versions are CI in active labor)
In addition to maintaining oncotic pressure, what is a primary function restored by infusing fresh frozen plasma?
Coagulation (contains fibrinogen and factors including V and VIII) (Also contains factors for fibrinolysis and complement, as well as ions, carbohydrates, and fats)
What should be done first if placing the IUPC leads to flow of frank blood and amniotic fluid out of the vagina?
Remove IUPC and monitor fetus. (If re-assuring, can try to re-place catheter) (Want to rule out iatrogenic placental separation or uterine rupture).
What is the prognosis for lateral rectus paralysis following vacuum delivery?
Resolves spontaneously, no clinical importance
What inborn error of metabolism is associated with post-term pregnancy?
Placental sulfatase deficiency
How should women age 30 to 65 be routinely screened?
Pap + HPC Co-testing every 5 years is recommended. Pap alone every 3 years is “acceptable”
What non-hormonal medication class can be use to treat PMS and PMDD?
SSRIs
What are the two drugs most commonly used in combination to induce abortion, and what are their mechanisms?
Mifepristone (RU486): antiprogestin Misoprostol: prostoglandin E1 (induces uterine contraction)
What is the absolute and relative risk of a second molar pregnancy in someone who has already had one?
Absolute risk: 1-2%. About 20x the baseline risk.
How are gonadotropin levels changed in PCOS?
Increased LH / FSH ratio
What is the treatment for advanced ovarian cancer?
Surgical cystoreduction with taxene / platinum adjunct chemotherapy
What is a succenturiate lobe of the placenta, and what does it increase the risk for?
Smaller accessory lobe of placenta separate from main placenta Risk of retained placenta
At what point in pregnancy is a cerclage placed based on past history?
Around 14 weeks (after the first trimester ends)
What is the best indicator of Rh hemolytic disease on amniocentesis?
Elevated bilirubin (gives amniotic fluid yellow color) (Quantified by the OD450, which is a spectrographic measurement of the yellowness of the fluid)
What is the first-line treatment for eclampsia?
Magnesium sulfate
What are possible effects of magnesium toxicity? How are they treated?
Muscle weakness, loss of DTRs, respiratory depression, nausea. Cardiac arrest may be seen in very high doses. Treatment: Stop magnesium sulfate, give calcium gluconate to restore respiratory function.
What imaging is indicated following a biopsy-confirmed diagnosis of low-grade endometroid adenocarcinoma?
Chest X-ray (lungs are the most common site of metastasis)
What will the uterine tone be like in placental abruption?
Hypertonic (tense and very tender)
What is the next step in the workup of a suspicious breast mass with a normal mammogram?
Fine needle aspiration
What is associated with a lacy, reticulated pattern of the labia and perineum?
Lichen planus
What is suggested by fetal tachycardia and minimal FHR variability in the setting of likely chorioamnonitis? How will the newborn present in terms of color, HR, and temperature?
Suggests septic infant Presentation: Tachycardic, pale, febrile
What vulvar lesion can involve erosive changes to labia and clitoris, but spares the vagina?
Lichen sclerosis
What type of lesion should never be biopsied?
Lesions suspicious for GTD (highly vascular)
What is the primary risk factor for premature ROM?
Genital tract infections, especially bacterial vaginosis (Others include smoking, short cervix, and prior preterm ROM)
What previously commonly-used tocolytic is now relatively discouraged by the FDA?
Terbutaline (Oral terbutaline is not to be used. Injected terbutaline should not be used to prevent preterm labor, and should only be used as a tocolytic in active preterm labor for 48-72 hours)
