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OB/GYN > UWorld 4 > Flashcards

UWorld 4 Flashcards

1
Q

disorders of the active phase of labor

A

protraction
-clinical features: cervical change slower than expected +/- inadequate contractions. treat with oxytocin

arrest: no cervical change for >4 h with adequate contractions OR no cervical change for >6h with inadequate contractions. tx with cesarean

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2
Q

operative vaginal delivery (vacuum/forceps)

A

Indications

  • protracted second stage of labor
  • FHR abnormalities
  • maternal contraindications to pushing

Fetal complications:

  • laceration
  • cephalohematoma
  • facial nervy palsy
  • ICH
  • shoulder dystocia

maternal complications:

  • GU tract injury
  • urinary retention
  • hemorrhage
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3
Q

three types of thryoiditis

A
  1. chronic ai thyroiditis (hashimoto)
    - hypothyroid features, diffuse goiter, positive TPO ab, variable radioiodine uptake
  2. painless thyroiditis (silent thyroiditis)
    - small nontender goiter, mild brief hyperthyroid, positive TPO Ab, low radioiodine
  3. subacute thyroiditis (de Quervain thyroiditis)
    - prominent fever and hyperthyroid s/s, painful/tender goiter

-elevated ESR and CRP, low radioiodine uptake

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4
Q

common problems related to lactation

A
  • engorgement: b/l, symmetric fullness, tenderness and warmth
  • nipple injury: abrasion, bruising, cracking, and or blistering from poor latch
  • plugged duct: focal tenderness and firmness and or erythema no fever
  • galactocele: subareolar, mobile, well-circumscribed, nontender mass; no fever
  • mastitis: tenderness/erythema + fever
    abscess: s/s of mastitis + fluctuant mass
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5
Q

hemophilia

A
  • X-linked recessive d/o
  • on average carrier mothers and unaffected fathers have a 25% chance of having a son with hemophilia, a silent carrier daughter, an unaffected son, or an unaffected daughter
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6
Q

pelvic organ prolapse

A 
cystocele-bladder
rectocele-rectum
enterocele-small intestine
procidentia
apical prolapse-uterus, vaginal vault

Rf: obesity, multiparity, hsterectomy, postmenopausal

CP: pelvic pressure, obstructed voiding, urinary retention, urinary incontinence, constipation, fecal urgency/incontinence, sexual dysfunction

management: weight loss, pelvic floor exercises, vaginal pessary, surgical repair

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7
Q

nonstress test

A
  • external FHR monitoring for 20-40 mins
  • nml: reactive:>2 accels
  • abnml: nonrxv:<2 accels; reccurent variable or late decels
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8
Q

BPP

A
  • NST + US assessment of: amniotic fluid volume, fetal breathing movement, fetal movement, fetal tone
  • 2 pts per category if nml, 0 if abnnl (max: 10/10)
  • equivocal 6, abnml 0 2 4 or oligo
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9
Q

contraction stress test

A
  • external FHR monitoring d/r spontaneous or induced (eg oxytocin, nipple stim) uterine contractions
  • nml: no late or recurrent variable decels
  • abnml: late decels with >50% of contractions
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10
Q

doppler sonography of the umbilical artery

A
  • eval of umbilical artery flow in fetal intrauterine growth restriction only
  • nml: high velocity diastolic flow in umbilical artery
  • abnml: dec, absent, or reversed end-diastolic flow
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11
Q

BPP in depth (nml findings)

A
  • NST: rxv FHR monitoring
  • amniotic fluid vol: single fluid pocket >2cmx1cm or amniotic fluidindex>5 (otherwise its oligo)
  • fetal movements: >3 general body movements
  • fetal tone: >1 episode of flexion/extension of fetal limbs or spine
  • fetal breathing movements: >1 breathing episode for >30 seconds
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12
Q

RF for placental insufficiency

A
  • advanced maternal age
  • tobacco use
  • HTN
  • diabetes
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13
Q

abruptio placentae

A
  • concealed vs visible bleeding
  • separation of placenta from uterine wall prior to fetal delivery
  • CP: abdo and/or back pain, FHR abnormalities, variable amt of sudden-onset vag bleeding, high freq low intensity contractions, hypertonic/tender uterus

RF:

  • maternal HTN or preeclampsia/eclampsia
  • abdominal trauma
  • prior placental abruption
  • cocaine and tobacco use
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14
Q

oxytocin

A

indications: induction or augmentation of labor, prevention and management of PPH

Adverse effects: hyponatremia, hypoTN, tachsystole

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15
Q

s/s of GU syndrome of menopause

A
  • vulvovaginal dryness, irritation, pruritus
  • dyspareunia
  • vag bleeding
  • urinary incontinence, recurrent UTI
  • pelvic pressure
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16
Q

PE of GU syndrome of menopause and tx

A

PE: narrowed introitus, pale mucosa with dec elasticity and dec rugae; petechiae and fissues; loss of labial volume

Tx: vaginal moisturizer and lubricant, topical vaginal estrogen

17
Q

estrogen and stuff with its receptors

A

bladder trigone, urethra, pelvic floor muscles, and endopelvic fascia possess estrogen receptors and are maintained by adequate estrogen levels

18
Q

ectopic triad

A
  1. vaginal bleeding
  2. lower abdo pain
  3. adnexal tenderness

-diagnosis made by positive pregnancy test and TVUS showing gestational sac at an ectopic site, most commonly fallopian tube

19
Q

what are three causes of abnml menstrual bleeding

A
  1. fibroids
    - heavy prolonged menses
    - pressure s/s: constipation, urinary freq, pelvic pain/heaviness
    - ob complications: impaired fertility, pregnancy loss, preterm labor
    - enlarged irregular uterus
    - asx: observe, symptomatic: combined hormonal contraception, sx
  2. adenomyosis
    - dysmenorrhea, pelvic pain
    - heavy menses
    - bulky globular and tender uterus
  3. endometrial ca/hyperplasia
    - h/o obesity, nulliparity, or chronic anovulation
    - irregular, intermenstrual, or postmenopausal bleeding
    - nontender uterus
20
Q

high grade squamous intraepithelial lesions pap test requires…

A

colposcopic exam and biopsy of cervical abnormalities d/t high risk of progression to cervical ca

21
Q

colposcopy

A

evaluautes cervix and vagina under magnification and id abnml (acetowhite changes) from nml cells in addition to abnml vessels

-cervical neoplasia occurs at transformation zone or squamocolumnar jxn

22
Q

vesicovaginal fistula

A

RF: pelvic sx, pelvic irradiation, prolonged labor/childbirth trauma, GU malignancy

CF: painless, continuous urine leakage from the vagina

diagnostic studies: PE (clear watery fluid in the vagina), dye test, cystourethroscopy

23
Q

DDx of urinary incontinence

A
  1. stress-2/2 obesity, multiparity, pelvic sx
    - dec urethral sphincter tone, urethral hypermobility (tx with kegel exercises, or urethral sling sx)
    - s/s: leakage with coughing, lifting, sneezing
  2. urge
    - detrusor hyoeractivity
    - s/s: sudden, overwhelming urge to urinate
  3. overflow
    - impaired detrusor contractility, BOO
    - s/s: incomplete emptying and persistent involuntary dribbling
24
Q

US assessment of gestational age

A
  • gestational sac diameter at 4.5-6wk, +/-5-7d accuracy
  • crown-rump length at 7-10d +/-3, at 11-14 +/- 5
  • biparietal diameter, head circumference, femur length less accuracy as the gestational age increases
25
Q

urinary stress incontinence

A
  • can be a presenting symptom of leiomyomata uteri (fibroids) d/t direct pressure on the bladder from an irregularly enlarged uterus
  • best imaging modality to diagnose fibroids: US of pelvis
26
Q

uterine inversion

A
  • uterine fundus that inverts and prolapses through the cervix or vagina
  • results in smooth, round mass protruding through the cervix or vagina, a uterine fundus that in nonpalpable transabdominally, severe pain, and PPH

CP: hemorrhagic shock, lower abdo pain

pathophys: xs fundal pressure, xs umbilical cord traction

RF: nulliparity, fetal macrosomia, placenta accreta, rapid L&D

management: aggressive fluid replacement, manual replacement of the uterus, placental removal and uterotonic drugs after uterine replacement

27
Q

intrauterine fetal demise

A
  • fetal death at >20 wks
    diagnosis: absence of fetal cardiac activity on US

management: 20-23 wks do D&E or vag delivery
24 wks: vag delivery

complication: coagulopathy after several weeks of fetal retention

28
Q

different causes of amenorrhea

A
  • ovarian failure-FSH and LH inc
  • functional hypothalamic amenorrhea-FSH and LH dec
  • asherman syndrome (FSH, LH, prolactin, TSh are nml)
  • prolactinoma-fsh and lh down, prolactin up, tsh nml
  • hypothyroidism-fsh and lh down, prolactin and tsh up
29
Q

type 2 oi

A

pathophys: AD, Type 1 collagen defect

US: mulitple fractures, short femur, hypoplastic thoracic cavity, fetal growth restriction, intrauterine demise

prognosis: lethal

30
Q

dermoid ovarian cyst (mature cystic teratoma)

A
  • cmmon benign ovarian tumor in premenopausal women
  • can be found incidentally d/r PE
  • typical US: calcifications and hyperechoic nodules
  • dangerous complication: ovarian torsion
31
Q

initial menstrual cycles in adolescents

A

-irregular and anovulatory d/t hypothalamic-pituitary-gonadal axis immaturity and insufficient secretion of gonadotropin-releasing hormone

32
Q

intraamniotic infection (chorioamnionitis) RF

A
  • prom (>18h)
  • preterm premature rupture of membranes
  • prolonged labor
  • internal fetal/uterine monitoring devices
  • repetitive vaginale examinations
  • presence of genital tract pathogens
33
Q

intraamniotic infection (chorioamnionitis) diagnosis

A

maternal fevel PLUS >1 of the following:

  • fetal tachy (>160/min)
  • maternal leukocytosis
  • purulent amniotic fluid
  • maternal tachy (>100/min)
  • uterine fundal tenderness
34
Q

intraamniotic infection (chorioamnionitis) management and complications

A

management: broad spec Abx and delivery

complications for mom: PPH, endometritis
for neonatal: preterm birth, PNA, encephalopathy

35
Q

non-classic (late onset) CAH

A

pathophys: ar, dec 21, nml gc and mineralcort, inc androgens

CF: early pubic/axillary hair growth, severe acne, hirsutism, and oligomenorrhea in girls; inc growth velocity and bone age; inc 17 hydroxyprogesterone level

tx: hydrocortisone

36
Q

order of puberty in girls

A
  1. breast development (thelarche) 8-12 in resp to rising estrogen
  2. pubic hair (pubarche)
  3. six mo before menses get growth spurt
  4. menarche at tanner stage 4 2-2.5 yr after initial breast bud (avg age 12.5 for menses onset)
    - considered nml at age <15 if development of secondary sex characteristics has been appropriate

OB/GYN (7 decks)

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