UWise - Objectives 3-11 Flashcards
When is a colposcopy indicated during Pap Smear testing?
All abnormal Pap test results (including ASC-US) WHEN HPV IS POSITIVE
In the setting of an abnormal Pap test and negative HPV, what should be done?
Co-testing with cytology and HPV can be repeated in three years; repeat cytology in 1 year is also acceptable if HPV testing cannot be done
In the setting of an HSIL result, what is recommended?
Colposcopy, regardless of HPV result (diagnostic excisional procedure when colpo is inadequate)
Mucopurulent cervicitis with exacerbation in the symptoms during and after menstruation is classically ___.
Gonorrhea
In a patient with high suspicion for syphilis ___ can confirm infection.
Specific testing with treponemal antibody
What is a characteristic skin finding of syphilis?
Macular rash on the palms and soles (copper penny lesions)
What is the preferred drug for treating all stages of syphilis?
Penicillin G
True or false - given the presence of on STI, screening should be offered for other STIs.
True
Erythematous patches on the cervix (strawberry cervicitis) are characteristic of what disease?
Trichomoniasis
Multinucleate giant cells and inflammation are microscopic findings in a patient with ___.
Herpes
What is the gold standard diagnosis of herpes? Discuss the sensitivity and specificity.
Culture; highly specific, but sensitivity is limited
What is the only exception to obtaining informed consent for all procedures?
Emergency situations that would risk the patient’s life
Elective delivery should not be scheduled prior to ___ weeks due to risks associated with prematurity.
39
True or false - it is acceptable for pharmaceutical companies to support conferences in which physicians receive CME credit.
True (Physician participation in those activities should not be contingent upon physician use or advocacy of the product.)
True or false - an investigator may own stock in a company if h/e she does research for that company.
True, as long as he/she declares the conflict of interest and the conflict of interest is addressed
ACOG recommends that women aged ___ and older be offered a screening mammogram annually.
40
A combination of first and second-degree relatives on the same side of the family diagnosed with ___ and ___ cancer (one cancer type per person) increases the risk of BRCA mutation.
Breast; ovarian
When should colonoscopy screening occur before age 50, and how should it be done?
If there is a history of a first-degree relative with colon cancer before age 60, then begin screening with colonoscopy at age 40, or 10 years before the youngest relative diagnosis, and repeat every 5 years
List the contraceptive methods with <1% pregnancy rates (typical use).
- Depo-Provera (depot medroxyprogesterone acetate)
- Sterilization (male or female)
- LARC (Nexplanon and IUD)
OC’s have a ___ pregnancy rate with typical use.
3-5%
The male condom has a ___ pregnancy rate with typical use.
12%
The contraceptive ring has a ___ pregnancy rate with typical use.
8%
Pregnancy or the possibility of pregnancy within 4 weeks is a contraindication to the ___ and ___ vaccinations.
MMR; varicella
What is the number one killer of women?
Heart disease
List risk factors for osteoporosis.
- Age>50
- Family history of fracture
- Gender (4:1 - F vs. M)
- Small-framed, petite, and thin women (less bone to lose than women with more body weight and larger frames)
- Heavy alcohol consumption
What is the best way to prevent osteoporosis?
Exercise regularly (weight-bearing 3-4x/week)
What are the pre-menopausal recommended intake values of Calcium and Vitamin D?
- Calcium - 1,000 mg
2. Vitamin D - 600 IU (if not in the sun at least 20 minutes/day)
Folate lowers ___ levels.
Homocysteine
How does maternal blood volume, plasma volume, and RBC mass change in pregnancy?
Blood volume - 36% increase; maximum reached around 34 weeks
Plasma volume - 47% increase
RBC mass - 17% increase
What are the effects of the change sin blood and plasma volume, and RBC mass?
Relative dilutional effect lowers hemoglobin, but causes no change in the MCV
Physiologic dyspnea of pregnancy is present in up to ___% of women by the third trimester.
75
What is peripartum cardiomyopathy?
Idiopathic cardiomyopathy that presents with heart failure secondary to left ventricular systolic function towards the end of pregnancy or in the several months following delivery; symptoms include fatigue, SOB, palpitations, and edema
The increased minute ventilation during pregnancy causes a ___ (metabolic state?).
Compensated respiratory alkalosis
What happens to inspiratory capacity in pregnancy and why?
Increases by 15% during the third trimester because of increases in tidal volume and inspiratory reserve volume
What happens to minute ventilation in pregnancy?
It increases due to increased tidal volume (no change in RR)
What happens to functional residual capacity in pregnancy?
Reduced to 80% of the non-pregnant volume by term
What happens to plasma osmolality in pregnancy?
It is decreased (increasing susceptibility to pulmonary edema)
What are common causes of acute pulmonary edema in pregnancy?
Tocolytic use (especially multiple)
Cardiac disease
Fluid overload
Preeclampsia
What happens to systemic vascular resistance in pregnancy?
It is decreased
What happens to cardiac output in pregnancy and why?
It increases up to 33% due to increases in both the HR and SV.
Up to 95% of women will have a ___ murmur in pregnancy due to the increased volume.
Systolic
What type of murmur is always abnormal?
Diastolic
SVR is normally > than pulmonary vascular resistance in pregnancy. What happens of this flips in the setting of a VSD?
R to L shunt will develop
What happens to the ureters and renal pelvis in pregnancy and why?
Some degree of dilation; it is unequal (R>L) due to cushioning provided by the sigmoid colon to the left ureter and from greater compression of the right ureter due to dextrorotation of the uterus. The right ovarian vein complex, which is dilated during pregnancy, lies obliquely over the R ureter and may contribute significantly to R ureteral dilation.
What happens to thyroid hormone levels in pregnancy and why?
Thyroid binding globulin is increased due to increased circulating estrogens with a concomitant increase in the total thyroxine. Free T4 remains relatively constant. Total T3 also increases in pregnancy, while free T3 does not change. In a patient without idoine deficiency, the gland may increase in size up to 10%.
What are the weight gain recommendations during pregnancy for various BMIs?
Underweight (BMI <18.5) - 28-40 lb
Normal weight (BMI 18.5-24.9) - 25-35 lb
Overweight (25-29.9) - 15-25 lb
Obese (>31) - 11-20 lb
Sickle cell anemia is an autosomal ___ condition.
Recessive
Sickle cell anemia occurs in 1/___ births in the black population.
500
The carrier state (sickle-cell trait) is found in 1/___ blacks.
10
Screening for carriers of both alpha and beta thalassemia is possible by evaluation of ___.
Red cell indices
What is the preferred test for Hg S or sickle cell anemia?
Hemoglobin electrophoresis (can detect Hg C trait and thalassemia minor as well)
List 4 autosomal recessive conditions that occur at an increased incidence in Ashkenazi descent.
- Fanconi anemia
- Tay-Sachs disease
- Cystic fibrosis
- Niemann-Pick disease
Beta thalassemia is mainly seen in ___ populations.
Mediterranean
Non-Hispanic white individuals are at increased risk for being carriers for ___. What is the carrier frequency?
CF; 1/25
Carrier frequency for Tay-Sachs disease for Ashkenazi Jews vs. general population?
1/30 vs. 1/300
Carrier frequency for Canavan disease for Ashkenazi Jews?
1/55
Carrier frequency for Bloom disease for Ashkenazi Jews?
1/134
Carrier frequency for Gaucher disease for Ashkenazi Jews?
1/15
Valproic acid is associated with an increased risk for ___, ___, and ___.
Neural tube defects (most common); hydrocephalus; craniofacial malformations (also ASDs, cleft palate, hypospadias, and polydactyly)
Women with poorly controlled diabetes immediately prior to conception and during organogenesis have a 4-8x risk of having a fetus with what type of anomaly? The majority of lesions involve what systems?
Structural anomaly; CNS (neural tube defects), CV system
Chorionic villus sampling is generally performed at ___ weeks.
10-12
CVS involves sampling of the chorionic frondosum - why?
Contains the most mitotically active villi in the placenta
What can CVS be used for?
Fetal chromosomal abnormalities, biochemical, or DNA-based studies
How are omphaloceles and neural tube defects diagnosed?
Prenatal U/S (also associated with increased MSAFP)
What screening test has a detection rate of over 99% at a 0.2% false-positive rate for Trisomy 21?
Cell-free DNA screening
What is included in the first trimester combined test for trisomy 21 and what is the detection rate?
First trimester nuchal translucency, PAPP-A, and beta-hCG; 85% detection rate
What is included in the triple screen for trisomy 21 and what is the detection rate?
Second trimester AFP, beta-hCG, uE3 (unconjugated estriol); 69% detection rate
What is included in the quad screen for trisomy 21 and what is the detection rate?
Second semester triple screen + inhibin A; 81% detection rate
What is included in the sequential screen for trisomy 21 and what is the detection rate?
First trimester NT and PAPP-A + second trimester quad screen; 93%
What is included int he serum integrated screen, when unable to obtain nuchal translucency and what is the detection rate?
First trimester PAPP-A + second trimester quad screen; 85-88% detection rate
What is the most common form of inherited mental retardation?
Fragile X syndrome (1/3600 males, 1/4000-6000 females)
What is the most common genetic cause of mental retardation?
Down syndrome (genetic, but the majority are not inherited)
When can cell-free DNA screening be performed?
As early as 9 weeks and until delivery
Down syndrome occurs in about 1/___ births in the absence of prenatal intervention.
800
What are goals for blood sugar management in pregnancy?
Fasting - below 90
One-hour post-meal - below 135
Two-hour post-meal - below 120
List 4 risk factors for gestational diabetes.
- Previous large baby (>9 lb)
- History of abnormal glucose tolerance
- Pre-pregnancy weight of 110+% of ideal body weight
- Member of an ethnic group with a higher than normal rate of DM2 (American Indian, Hispanic, etc.)
___ is typically seen in women with pre-existing diabetes and NOT with gestational diabetes.
IUGR
List 5 risks of gestational diabetes.
- Shoulder dystocia
- Metabolic disturbances
- Preeclampsia
- Polyhydramnios
- Fetal macrosomia
The CDC recommends that all women with a previous pregnancy complicated by a fetal neural tube defect ingest ___mg of folic acid daily before conception and through the first trimester.
4
Fetal U/S exam at approximately ___ weeks is recommended to detect neural tube defects.
16-18
Caudal regression syndrome is a rare syndrome observed in offspring of people with ___.
Poorly controlled diabetes
___% of cases of elevated MSAFP are caused by conditions other than neural tube defects, including what?
90-95; under-estimation of gestational age (most common explanation), fetal demise, multiple gestation, ventral wall defects, tumor or liver disease in the patient
___ is a diagnostic test that may detect Down syndrome and other chromosomal abnormalities.
Amniocentesis
What is nuchal translucency a measurement of?
Fluid collection at the back of the fetal neck (thickened NT may be associated with fetal chromosomal and structural abnormalities as well as a number of genetic syndromes)
In the setting of a thickened NT, what should be done?
Detailed fetal U/S and echocardiogram at 18-20 weeks to rule out anomalies
Ibuprofen is safe to take in pregnancy until around 32 weeks - why?
Risk of premature closure of the doctus arteriosus
If continued anticoagulation is necessary in pregnancy, what should be used?
LMWH
When is the quad screen done?
16-20 weeks
When is an amniocentesis offered to women?
Women over 35 and in the setting of an abnormal screening test
Generally, when should cell free fetal DNA screening be offered?
Women at increased risk for fetal aneuploidy
What are Braxton-Hicks contractions?
Short and less intense contractions than those of true labor with the discomfort occurring in the lower abdomen and groin areas
What defines true labor?
Strong, regular uterine contractions that result in progressive cervical dilation and effacement
How do pregnant patients with dehydration present?
Frequently present with maternal tachycardia and ketonuria
In a woman who has previously given birth to a neonate with early-onset GBS disease or who had GBS bacteriuria during the current pregnancy, what should be done regarding prophylaxis?
Treat with intrapartum antibiotic prophylaxis; no screening needed
All women with positive cultures for GBS should receive intrapartum antibiotics in labor unless…
…a Cesarean delivery is performed before onset of labor in a woman with intact amniotic membranes.
The initial evaluation of patients presenting to the hospital for labor includes what?
- Review of the prenatal records with a focus on the antenatal complications and dating criteria
- Focused history
- Targeted physical exam to include maternal vitals and FHR, and abdominal and pelvic exam
If the FHR cannot be confirmed using external methods, the most reliable way to document fetal well-being is to…?
Apply a fetal scalp electrode
If an IUPC is placed and a significant amount of vaginal bleeding is noted, what should be considered and what should be done?
Possibility of placental separation or uterine perforation; withdraw the catheter, monitor the fetus, and observe for any signs of fetal compromise
What should be done in the setting of umbilical cord prolapse?
Elevate the fetal head with a hand in the patient’s vagina and call for assistance to perform a Cesarean delivery
When is pitocin augmentation indicated?
If the patient is protracted with documented insufficient power of contractions (<240 MV units)
