UWorld 3 Flashcards
Complications of post-term pregnancies
- meconium aspiration
- stillbirth
- macrosomia
- oligohydramnios: aging placenta => decreased fetal perfusion => decreased urine output
Clinical presentation of Kallmann’s syndrome
Amenorrhea or delayed puberty w/ low or absent LH and FSH (2/2 no GnRH)
Kallmann’s = hypogonadotropic hypogonadism + anosmia
Signs of congenital adrenal hyperplasia
Verilization (b/c of high androgens) and salt wasting (b/c high aldo)
Differentiate cervical secretions during
(a) Pre-ovaulatory / early follciular
(b) Ovulatory
(c) Post-ovulatory . late follicular
Vaginal mucus secretions
Pre and post-ovulatory: mucus is scant, opaque, thick, acidic
-incompatible w/ penetration by spermatozoa
During ovulatory phase: clear cervical secretion that extends in a long thread (6 cm) when lifted vertically, pH of 6.5 (more basic)
SSRI safety during pregnancy
SSRIs except Paxil (paroxetine) are ok during pregnancy
Define menorrhagia
Technically: period lasting longer than 7 days or greater than 80 mls
How does hypothyroidism affect prolactin secretion
Hypothyroidism => hyperprolactinemia
b/c TRH (high when no negative feedback from low thyroid hormone) stimulates prolactin production
-explains how hypothyroidism can => amenorrhea and galactorrhea
When to suspect McCune Albright syndrome
Early puberty w/ some bony abnormalities and cafe au lait spots
17 yo G1P0 at 37 wks p/w HA
Preeclampsia (after 20 wks) w/ severe features
14 yo p/w excessive menstrual bleeding
-menarche at 13
Cause of the excessive bleeding?
Anovulation
-W/ recent menarche, menorrhagia (longer than 7 days or greater than 80 ml) is 2/2 anovulatory cycles due to an immature/irregular HPA axis
First step if F of reproductive age presents w/ amenorrhea and negative beta-hCG
Depends on if she’s had a prior uterine procedure or infection
No prior procedure/infection => check prolactin, TSH, FSH
Prior uterine procedure or infection => hysteroscopy (camera up vagina to look inside uterus)
Genitalia of fetus w/ congenital aromase deficiency
Normal internal w/ ambiguous external genitalia
-virilization
G2P1 at 29 wks w/ fetus in transverse lie and low lying placenta at 3cm away from the cervical os
Next step?
Reassure and wait
-don’t have to do C-sex: transverse lie is typically transient and will spontaneously convert to cephalic
How to differentiate intraductal papilloma and infiltrating ductal carcinoma on physical exam
Both can present w/ pathologic nipple discharge (unilateral bloody discharge)
Intraductal papilloma = benign
Infiltrating ductal carcinoma as accompanying breast mass and lymphadenopathy
What is Kallmann’s syndrome?
Hypogonadotropic hypogonadism (failure of hypothalamus to release GnRH) + anosmia (no sense of smell) => delayed puberty w/ low or absent LH/FSH
Mechanism = failure of GnRH secreting hypothalamic neurons to migrate to the correct place during embryonic development
Most common side effect of Tamoxifen
Hot flashes
-Tamoxifen blocks estrogen from its receptor => similar to estrogen withdrawal in menopause
Tamoxifen increases risk of which 2 dangerous conditions
- endometrial hyperplasia
- VTE
Traid of McCune-Albright syndrome
- hyperfunctioning endocrine disease => gonadotropin-independent precocious puberty
- progressive fibrous dysplasia => polyostic (bony abnormalities)
- cafe au lait macules (coast of Maine appearance)
Imaging finding on intraductal papilloma
Normal on imaging, potentially a single dilated breast duct
Unilteral bloody nipple discharge
Hallmark finding of intraductal papilloma (tis benign)
Lab findings: pseudohyphae
Dx
Dx = candida
-normal pH of secretions (3.8-4.5), not over 4.5 like BV and trich
Is oligo or poly hydramnios more assocaited w/ post-term pregnancies?
Oligo b/c aging/calcified placenta => decreased perfusion => decreased fetal urine output
Post-term induced neonates are at higher risk for which two fetal complications?
SGA and oligohydramnios
Placenta ages/calcifies => chronic uteroplacental insufficiency
-SGA b/c lack of nutrients in last bit
-oligo b/c decreased fetal perfusion => decreased fetal urine output
24 yo obese F w/ hirsuitism, acne, and menstrual irregularity
-greatest risk of which gynecologic malignancy?
Endometrial carcinoma 2/2 unbalanced estrogen secretion
-insufficiency estrogen + peripheral conversion of estrogen
Unopposed estrogen secretion => endometrial hyperplasia
