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OB/GYN > UWorld 2 > Flashcards

UWorld 2 Flashcards

1
Q

Levonorgestrel intrauterine device (IUD) vs copper IUD

A
  • highly efficacious, long-acting, reversible contraception that works by thickening cervical mucus and impairing implantation
  • progestin-containing IUDs have added benefit of amenorrhea and minimal systemic side effects

—vs—

copper:

  • long -lasting reversible use for up to ten years
  • can cause heavy menstrual bleeding and shouldn’t be placed in women with hypermenorrhea or anemia
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2
Q

PID

A
  • lower abdo pain, abnml bleeding
  • cervical motion tenderness, fever, mucopurulent cervical d/c
  • third gen ceph and azithro or doxy
  • complications: tubo-ovarian abscess, infertility, ectopic pregnancy, perihepatitis
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3
Q

Leiomyomata

A
  • can cause irregularly enlarged uterus and size-date discrepancy d/r pregnancy
  • subserosal and pedunculated uterine leiomyomata can cause bulk-related s/s (pelvic pressure, sensation of incomplete voiding)
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4
Q

eclampsia=severe pre eclampsia plus seizures

A
  • most common cause on new-onset seizures in pregnant patients with HTN
  • associated with proteinuria and signs of CNS dysfunction (HA, vision changes), RUQ or epigastric pain, tonic-clonic sz (self-limited)
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5
Q

hyperemesis gravidum

A
  • significant volume depletion
  • loss of gastric acid
  • leading to primary metabolic alkalosis (vs diarrhea metabolic acidosis)
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6
Q

most common causes of hyperandrogenism in pregnancy

A
  • luteomas and theca luteum cysts
  • luteomas: appear as solid masses on US, can induce virilization in female fetuses, no maternal tx warranted
  • theca guys: unlikely to cause virilization in female offspring, suction curettage indicated if underlying cause is molar pregnancy
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7
Q

three liver disorder unique to pregnancy

A
  • intrahepatic cholestasis of pregnancy (ICP)
  • HELLP
  • AFLP: acute fatty liver of pregnancy
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8
Q

ICP intrahepatic cholestasis of pregnancy

A

cp: intense pruritus

labsL elevated bile acids, elevated AFT, diagnosis of exclusion

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9
Q

HELLP

A

cp: pre eclampsia, RUQ pain, n/v

labsL hemolysis, moderately elevated liver aminotransferases, thrombocytopenia

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10
Q

AFLP-acute fatty liver of pregnancy

A

cp: malaise, RUQ pain, n/v, sequelae of liver failure
labs: hypoglycemia, mildly elevated liver aminotransferases, elevated bilirubin, possible DIC

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11
Q

submucous fibroids

A
  • arise from myometrium immediately under endometrial lining and protrude into the uterine cavity
  • commonly cause heavy and prolonged menstrual bleeding and can prolaps through the cervical os presenting with a typical labor-like pain d/t cervical distension by the solid mass
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12
Q

gonococcal pharyngitis with PID

A

-pharyngitis with fever and lower abdo pain in young sexually active pt

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13
Q

HPV

A

dz associations: cervical ca, vulvar and vaginal cancers, anal cancer, penile ca, oropharyngeal ca, genital warts

vaccine indications: all girls and women* age 11-26, boys and men 9-21 (to 26 for MSM, indivs with HIV)
*includes those with h/o genital warts, abnml cytology, or positive HPV DNA test

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14
Q

2T quad screening

A

trisomy 21: beta hcg and inhibin A are increased
trisomy 18: everything down except for nml inhibin A
NT or abdo wall defect: all nml except for inc MSAFP

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15
Q

HIV management during pregnancy

A

maternal combo antiretroviral therapy during pregnancy and neonatal zidovudine (>6weeks) can dec perinatal HIV transmission to <1%

  • three drug regimen: 2 NRTIs and one nonNRTI or a protease inhibitor
  • NRTI with good placental transfer: Zidovudine, Tenofovir
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16
Q

Ectopic pregnancy

A
  • rf: previous ep, prev pelvic/tubal sx, PID
  • cp: abdo pain, amenorrhea, vag bleeding, hypovol shock 2/2 ruptured; cervical motion, adnexal or abdo tenderness
  • diagnosis: positive beta-hcg, TVUS adnexal mass, empty uterus
  • management: stable with MTX, unstable with sx
17
Q

neonatal complications of fetal growth restriction

A

-polycythemia, hypoglycemia, hypocalcemia, poor thermoregulation

18
Q

SERMS

A

-Tamoxifen and Raloxifene
moa for both: competitive inhibitor of estrogen binding, mixed agonist and antag action

indication both: prevention of breast ca in high risk pts
T: adjuvant tx of breast ca
R: postmenopausal osteoporosis

adverse effects: hot flashes, VTE, endometrial hyperplasia and carcinoma (T only)

19
Q

ovarian torsion

A

rf: ovarian mass, repro age women, infertility tx with ovulation induction
cp: sudden onset unilat pelvic pain, n/v, palpable adnexal mass
us: adnexal mass with absent doppler flow to ovary
tx: laproscopy with detorsion, ovarian cystectomy, oophorectomy for necrosis or malignancy

20
Q

when to stop pap testing

A 
-age 65 or hysterectomy
PLUS
-no h/o CIN2 or higher
AND
-3 consec negative pap tests
OR
2 consec negative co-testing results
21
Q

epithelial ovarian carcinoma

A

cp:

  • acute: sob, obstipation/costipation with v, abdo distention
  • subacute: pelvic/abdo pain, bloating early satiety
  • asymptomatic advexal mass

lab finding: inc ca-125

US: solid mass, thick septations, ascites

management: ex lap

22
Q

Antihypertensive during pregnancy-first line

A
  • beta blockers (Labetalol)
  • CCB (nifedipine)
  • hydralazine
  • methydopa

contraindicated: ace-i, ARB, direct renin inhibitors, nitroprusside, mineralcort receptor antagonists (spironolactone)

23
Q

recommended vaccines during pregnancy

A

-Tdap, inactivated influenza, Rho(D) Ig

24
Q

contraindicated vaccines during pregnancy

A

-HPV, MMR, live attenuated influenza, varicella

25
Q

vaccines d/r pregnancy indicated for high-risk pts

A

-Hep A and B; Penumococcus, H. influenzae, meningococcus, varicella-zoster Ig

26
Q

asymptomatic bacteriuria

A

->100k CFU/mL bacteria

RF:

  • pre gestational diabetes mellitus
  • h/o UTI
  • multiparity

common bugs: E coli (m/c), Klebsiella, Enterobacter, GBS

first-line tx: cephalexin, augmentin (amox clav), nitrofurantoin, Fosfomycin

if untreated=r/o pyelonephritis, preterm birth and low birth weight

27
Q

G/C in women

A

RF: age<25, high risk sexual behavior

manifestations: asymptomatic (m/c), cervicitis, urethritis, perihepatitis (Fitz-Hugh-Curtis syndrome)
diagnosis: NAAT

tx empiric: azithro and ceftriaxone

complications: PID, ectopic pregnancy, infertility

28
Q

HELLP labs

A
  • microangiopathic hemolytic anemia
  • elevated liver enzymes
  • low platelet count

(abdominal pain d/t liver swelling with distension of the hepatic (Glisson’s) capsule

29
Q

pathophys of pulm edema in preeclampsia/eclampsia

A
  • generalized arterial vasospasm (systemic HTN) leads to
  • INC afterload against which heart is pumping leads to
  • INC pulm capillary pressure leads to
  • PULM EDEMA
  • other things leading to pulm edema: dec albumin, inc vascular permeability, dec renal fxn
30
Q

Sheehan syndrome Path

A
  • massive ob hemorrhage complicated by hypoTN

- postpartum pituitary infarction

31
Q

Sheehan syndrome clinical features

A
  • lactation failure (dec prolactin)
  • amenorrhea, hot flashes, vaginal atrophy (dec FSH, LH)
  • fatigue, bradycardia (dec TSH)
  • anorexia, weight loss, hypoTN (Dec ACTH)
  • dec lean body mass (dec growth hormone)
32
Q

Pre-term labor

A
  • 34 0/7 to 36 6/7:
  • -+/- Betamethasone
  • -pen if GBS positive/unknown

32 0/7 to 33 6/7:

  • -betamethasone
  • -tocolytics
  • -penicillin if GBS positive or unknown

<32:

  • -betamethasone
  • -tocolytics
  • -Magnesium sulfate (fetal neuroprotection)
  • -Penicillin if GBS positive or unknown
33
Q

acute cervicitis

A
  • most commonly caused by G/C
  • inflamm of cervix=abnml vag d/c and post-coital bleeding d/t contact irritation of the cervix

findings: mucopurulent cervical d/c and edematous, friable cervix that bleeds with manipulation

OB/GYN (7 decks)

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