UWorld 2 Flashcards
28 yo G2P1 at 37 wks p/w hypotension and tachycardia
- h/o C-sxn
- PE: palpable, irregular protuberance in lower abdomen and moderate vaginal bleeding
- FHT: late decels
Rupture uterus
- increased risk given h/o C-sxn
- palpable fetal part
- late decels indicating uteroplacental insufficiency (b/c uterus is ruptured…)
Mechanism of acute postpartum urinary retention
Bladder atony 2/2 a decrease in detrusor tone
Screening test for ovarian cancer
There is none…
-so if person wants to be screened (concerned b/c friend has it etc) there is no good option
Best diagnostic test for primary syphilis
Dark field microscopy showing spirochetes
At the time of primary syphilis- often too early, antibodies aren’t made yet => RPR would give false negative
Differentiate the etiologies of symmetric vs. asymmetric fetal growth restriction
Symmetric (both head and body affected): 2/2 fetal factors
- chromosomal abnormalities
- early maternal infection (causing congenital infxns)
Asymmetric (only body affected, head intact), 2/2 fetal adaptation to suboptimal maternal factors
- ‘head sparing’ fetal growth restriction
- maternal HTN, DM, preeclampsia, smoking
78 yo w/ h/o Alzheimer’s p/w urinary incontinence x1 week
- less active
- afebrile
Next best step
UA and Cx-
UTI is a very common cause of acute urinary incontinence in the elderly
Clinical features of newborn clavicular fracture
Crepitus over the clavicle/palpable bony irregularity
-complication of macroscomia
36 yo F p/w lump in right breast found on self exam
- no other symptoms
- 1 cm firm, round mass in UOQ of right breast w/ no palpable LN
Next step?
Palpable breast mass, next step depends on age
Over 30: mammogram is first step
Under 30: Ultrasound in first step
So first use mammorgam (pt is 36) to further locate/characterize lump
45 yo G5P5 p/w involuntary loss of urine x5mo while jogging
- loses small amoung after coughing
- normal UA and low post-risidual volume
(a) Dx
(b) Mechanism
(a) Stress incontinence
(b) Urethral hypermobility
Define tachysystole
Tachysystole = abnormally frequent contractions defined as more than 5 contractions in 10 minutes averaged over 30 minutes
Main clinical feature of Sheehan syndrome
Sheehan syndrome = postpartum hypopituitarism 2/2 pituitary necrosis from hypovolemic shock/bloodloss after childbirth
Presents w/ lactation failure w/ hypotension and anorexia (2/2 adrenal insufficiency)
Clinical presentation of placental abruption
Biggest one = sudden-onset vaginal bleeding
- abdominal or back pain
- high-frequency (really close together), low-intensity contractions
ex: contractions q2 minutes - hypertonic, tender uterus
Diagnosed primarily by clinical presentation, then can use US to r/o placenta previa
Mechanism by which urinary incontinence risk increases in post-menopausal women
Estrogen deficiency
Hypoestrogenemia => atrophy of urethral mucosal epithelium and diminished urethral closure pressure => urinary frequency, urgency, UTI, incontinence
Tx = low-dose vaginal estrogen
23 yo F presents for infertility, irregular periods for past 2 yrs
- intense exerciser, lots of stress at work, BMI 18, negative pregnancy test
- labs: low FSH/LH, normal prolactin/TSH
(a) Dx
(b) Tx
(a) Hypogonadotropic hypogonadism
- problem is at the level of the hypothalamus not secreting proper GnRH
(b) Tx = pulsatile GnRH
Purpose if fetal fibronectin screening
Screening test for preterm labor-
-Best for negative predictive value (sensitive not specific): good predictor of spontaneous preterm labor before cervical dilation
-done as vaginal swab (preferably before manipulation by vaginal exam)
43 yo G6P5 at 39 wks w/ brief TC seizure
- BP 80/40, HR 110/min, RR 30, O2 75% on facemask
- PE: purpuric rash and bleeding from IV site
Dx
Mgmt
Respiratory failure 2/2 amniotic fluid embolism
-hypoxemia => seizures
Mgmt = intubation and mechanical ventilation
Common causes of fetal tachycardia
Maternal fever (ex: chorio)
Maternal hyperthyroid
Medication use (ex: terbutaline- tocolytic)
Placental aburption
Pt w/ hyperemesis gravidarum has pelvic US: enlarged ovaries w/ multilocular cystic appearance
Dx
Molar pregnancy
- b/l ovarian enlargement 2/2 hyperstimulation and ovarian cyst formation (theca lutein cysts)
- even more elevated beta-hCG puts these pts at higher risk for hyperemesis
When is external cephalic version performed
External cephalic version = convert breech into vertex for delivery
- performed btwn 37 weeks and onset of labor
- not before 37 wks: breech before can just move/convert to vertex
Thyroid hormone production during pregnancy
T4/T3/TSH
During pregnancy- total T4 is 1.5x greater than pre-pregnancy state, free T4 and T3 moderately increased
-slightly decreased TSH production b/c higher T3/T4 suppresses the TSH
beta-hCG stimulates thyroid hormone production, estrogen does increase TBG production but net effect is increase in T4
39 yo G4P0030 at 35 wks p/w intense constant lower abdominal pain
- h/o fibroids, s/p abdominal myomectomy where uterine cavity entered
- cervical dilation of 4cm, contractions q2-3 min
- FHR: persistent variable decels to the 90s
Next best step
Laparotomy and delivery
-aka C-section
Abdominal myomectomy- if uteirne cavity is entered then trial of labor is contraindicated 2/2 risk of uterine rupture
(if uterine cavity not entered you can do trial)
Cause of infertility:
37 yo w/ regular 28 day cycles, no other GU complaints
- no h/o STIs
- previous child w/ husband at age 31
- aeorbics instructor, normal vital
Decreased ovarian reserve
-significant drop in oocytes in 4th decade, one in 5 women are infertile btwn 35-39
What is hyperemesis gravidarum?
Such excessive/severe nausea/vomiting in pregnancy that it results in wt loss and dehydration
Causes of hypogonadotropic hypogonadism
Hypogonadotropic hypogonadism causes infertility 2/2 hypothalamic dysfunction: insufficient GnRH pulses from hypothalamus causes insufficient LH/FSH production
Causes: severe life stressors, eating d/o, excessive exercise
- anorexia
- marathon runners