UWorld Flashcards
All patients who take metronidazole (eg, for trichomonas infection) should abstain from drinking _______, as it is associated with a disulfiram-like reaction
All patients who take metronidazole (eg, for trichomonas infection) should abstain from drinking ALCOHOL, as it is associated with a disulfiram-like reaction
Cervical screening starts at age __ in most women (except those with HIV or SLE, and organ transplant or immunocompromised individuals) regardless of the age of onset of sexual activity
Routine testing for HPV is not indicated for women age
Cervical screening starts at age 21 in most women (except those with HIV or SLE, and organ transplant or immunocompromised individuals) regardless of the age of onset of sexual activity
Routine testing for HPV is not indicated for women age
Cervical cancer screening:
Immunocompromised (HIV, SLE/organ transplant pts on immunosuppressants):
Age
Cervical cancer screening:
Immunocompromised (HIV, SLE/organ transplant pts on immunosuppressants):
-Onset of sexual intercourse
-Every 6 months x 2 then annually
Age
- 23yo women, 26 weeks pregnant
- sudden onset severe SOB and inability to lie flat (pulmonary edema)
- emigrated from Eastern Europe
- h/o recurrent sore throats requiring tonsillectomy as a child
- EKG suggests a fib
Dx?
Mitral stenosis of pregnancy
- fever
- firm, red, tender, swollen quadrant of unilateral breast
- ± myalgia, chills, malaise
Dx?
MC offending organism?
Tx?
- fever
- firm, red, tender, swollen quadrant of unilateral breast
- ± myalgia, chills, malaise
Dx: Lactational mastitis
MC offending organism: Staph aureus
Tx: analgesia, frequent breastfeeding or pumping, Abx
Risk factors that increase the likelihood of osteoporosis include (9):
Risk factors that increase the likelihood of osteoporosis include (9):
advanced age thin body habitus cigarette smoking excessive alcohol consumption corticosteroid use menopause malnutrition family hx of osteoporosis Asian or Caucasian ethnicity
- variable presentation from no sx to light vaginal bleeding
- pregnancy sx may decrease
- cervix closed
- US findings: nonviable fetus
what type of abortion?
MISSED abortion
- vaginal bleeding, uterine cramps
- possible intrauterine fetus with heartbeat
- cervix open
- US findings: fetus with possible heartbeat
what type of abortion?
INEVITABLE abortion
- vaginal bleeding with passage of large clots or tissue
- uterine cramps
- products of conception often visualized in dilated cervical os
- cervix open
- US findings: products of conception often in cervix
what type of abortion?
INCOMPLETE abortion
- variable amount of vaginal bleeding
- pregnancy can proceed to viable birth
- cervix closed
- US findings: viable pregnancy
what type of abortion?
THREATENED abortion
- fever, malaise, signs of sepsis
- foul-smelling vaginal discharge, cervical motion & uterine tenderness
- rarely occurs after spontaneous abortion
- usually with induced abortions, can be life-threatening
- cervix usually open
- US findings: usually retained products of conception
what type of abortion?
SEPTIC abortion
management of threatened abortion:
expectant management until 1 of the following:
- sx resolution
- progression to inevitable, incomplete, or missed abortion
management of incomplete, inevitable, or missed abortion:
hemodynamically unstable, heavy bleeding:
hemodynamically stable, mild bleeding:
management of incomplete, inevitable, or missed abortion:
hemodynamically unstable, heavy bleeding:
-surgical evacuation (eg, D&C)
hemodynamically stable, mild bleeding:
- expectant mgmt
- prostaglandins
- surgical evacuation (eg, D&C)
management of septic abortion:
- blood & endometrial cultures
- broad-spectrum abx
- surgical evacuation of uterine contents (eg, D&C)
Anti-D immune globulin should be given at __-__ weeks gestation and again _____ ________ if the baby is Rh_
Anti-D immune globulin should be given at 28-32 weeks gestation and again AFTER DELIVERY if the baby is Rh+
Prenatal testing for fetal aneuploidy:
1st trimester combined test
- what is measured? (3)
- timing (weeks)?
- advantages?
- disadvantages?
Prenatal testing for fetal aneuploidy:
1st trimester combined test
- PAPP, ß-hCG, nuchal translucency
- 9-13 weeks
- advantages: noninvasive
- disadvantages: not diagnostic
Prenatal testing for fetal aneuploidy:
2nd trimester combined test
- what is measured? (4)
- timing (weeks)?
- advantages?
- disadvantages?
Prenatal testing for fetal aneuploidy:
2nd trimester combined test
- MSAFP, ß-hCG, estriol, inhibin A
- 15-20 weeks
- advantages: noninvasive
- disadvantages: not diagnostic
Prenatal testing for fetal aneuploidy:
Chorionic villus sampling (CVS)
- timing (weeks)?
- advantages?
- disadvantages?
Prenatal testing for fetal aneuploidy:
Chorionic villus sampling (CVS)
- 10-13 weeks
- advantages: definitive karyotype dx
- disadvantages: pain, vaginal spotting, risk of pregnancy loss
Prenatal testing for fetal aneuploidy:
Amniocentesis
- timing (weeks)?
- advantages?
- disadvantages?
Prenatal testing for fetal aneuploidy:
Amniocentesis
- 15-20 weeks
- advantages: definitive karyotype dx
- disadvantages: pain; risk of bleeding & amniotic fluid leak; risk of injury to fetus, placenta, maternal bowel/bladder
Prenatal testing for fetal aneuploidy:
2nd trimester ultrasound
- what is measured? (3)
- timing (weeks)?
- advantages?
- disadvantages?
Prenatal testing for fetal aneuploidy:
2nd trimester ultrasound
- fetal growth, fetal anatomy, confirms placenta position
- 18-20 weeks
- advantages: noninvasive
- disadvantages: cannot identify all abnormalities; soft markers are US findings of unknown significance
Prenatal testing for fetal aneuploidy:
Cell-free fetal DNA
- what is measured? (1)
- timing (weeks)?
- advantages?
- disadvantages?
Prenatal testing for fetal aneuploidy:
Cell-free fetal DNA
- aneuploidy (high sens & spec)
- ≥10 weeks
- advantages: noninvasive
- disadvantages: not diagnostic
Trastuzumab
-tx for ____+ breast cancer
-toxicity?
» what test should be performed before tx?
Trastuzumab
-tx for HER2+ breast cancer
-cardiotoxicity
» ECG
Asx women with pelvic masses should be evaluated initially by ____________ _______________ and then a __-___
Asx women with pelvic masses should be evaluated initially by TRANSVAGINAL ULTRASONOGRAPHY and then a CA-125
- any elevation of CA-125 in a postmenopausal woman raises suspicion for ovarian cancer
- if the US suggests a simple cyst and the CA-125 level is not elevated, masses
Acute pelvic pain
- recurrent mild & unilaterally midcycle pain due to normal follicular enlargement prior to ovulation
- pain lasts a few hours to couple of days
- US is frequently normal & not needed
Dx?
Mittelschmerz
Acute pelvic pain
- amenorrhea, crampy abd pain & vaginal bleeding
- no intrauterine pregnancy on transvaginal US
- (+) serum hCG
Dx?
Ectopic pregnancy
Acute pelvic pain
- acute onset of severe unilateral lower abd pain, N/V
- unilateral, tender adnexal mass on exam
- pelvic US with doppler shows enlarged ovary with decreased blood flow
Dx?
Ovarian torsion
Acute pelvic pain
- sudden-onset severe unilateral lower abd pain immediately following strenuous or sexual activity
- pelvic US shows free fluid near ovarian cyst
Dx?
Ruptured ovarian cyst
Acute pelvic pain
- fever/chills, new vaginal discharge, lower abd pain, dysuria, painful defecation & cervical motion tenderness
- transvaginal US to rule out tube-ovarian abscess
Dx?
Pelvic inflammatory disease
maternal fever and ≥1 of the following:
- uterine tenderness
- maternal or fetal tachycardia
- malodorous/purulent amniotic fluid or vaginal discharge
- WBCs ≥15,000/µL
Dx?
Important risk factor?
Tx? (2)
Dx: Chorioamnionitis (ie, intra-amniotic infection)
Important risk factor: prolonged rupture of membranes (PROM)
Tx:
- broad-spectrum abx
- delivery (» administer oxytocin!)
-chorioamnionitis is NOT an indication for c/s
- purulent or mucopurulent discharge
- friable cervix with easy bleeding (eg, inter-menstrual or post-coital)
Test?
Empiric tx?
Cervicitis (gonococcal or chlamydia)
Test: nucleic acid amplification
Empiric tx:
- 3rd gen cephalosporin (eg, ceftriaxone)
- azithromycin or doxycycline
- fever and uterine tenderness in postpartum period
- assoc with foul-smelling lochia
Dx?
Offending organism(s)?
Tx? (2)
Dx: Endometritis
Offending organism(s): polymicrobial
Tx: clindamycin and gentamicin
MC causes of 2º amenorrhea: (3)
- hyperprolactinemia
- thyroid dysfunction
- premature ovarian failure
Renal plasma flow and GFR are (incr/decr) in pregnancy, which causes (incr/decr) in the serum BUN and creatinine from the pt’s pre-pregnancy baseline
Renal plasma flow and GFR are INCREASED in pregnancy, which causes DECREASED serum BUN and creatinine from the pt’s pre-pregnancy baseline
- hemolysis (microangiopathic hemolytic anemia):
- schistocytes on peripheral smear
- elevated bilirubin
- low serum haptoglobin
- elevated liver enzymes:
- AST or ALT 2x upper limit of normal
- low platelets (
HELLP syndrome
Abd pain in HELLP syndrome due to:
liver swelling with distension of the hepatic (Glisson’s) capsule
Pulmonary edema is a life-threatening complication of severe preeclampsia.
Caused by: (4)
Pulmonary edema is a life-threatening complication of severe preeclampsia.
Caused by: (4)
- INCR systemic vascular resistance
- capillary permeability
- pulmonary capillary hydrostatic pressure
- DECR albumin
recurrent pregnancy loss due to thrombus development within the placenta…
likely pathophysiology?
Antiphospholipid Abs
(eg, lupus anticoagulant and anticardiolipin Abs)
-sometimes seen in pts with SLE
Workup for uterine leiomyoma (fibroids):
Ultrasound
Tx for uterine leiomyoma (fibroids): (2)
- Observation if no sx present
- Hormonal contraception, embolization, or surgery if symptomatic
ABO incompatibility generally occurs in a group O mother with a group A or B baby, but ABO incompatibility causes (more/less) severe hemolytic disease of the newborn than does Rh(D) incompatibility.
LESS
Affected infants are usually asymptomatic at birth with absent or mild anemia and develop jaundice, which is usually successfully treated with phototherapy.
woman presents with many signs and symptoms of pregnancy:
-amenorrhea
-enlargement of breasts and abdomen
-morning sickness
-weight gain
-sensation of fetal movement
-"reported" (+)pregnancy test
However, ultrasound reveals normal endometrial stripe and (-)pregnancy test in office.
Dx?
pseudocyesis
form of conversion disorder, usually seen in women who have a strong desire to become pregnant
What is done to suppress breast milk production?
NO MEDS!
Pts are advised to wear a tight-fitting bra, avoid nipple manipulation and use ice packs and analgesics to relieve associated pain.
- skin/nipple retraction
- calcifications on mammography
- biopsy reveals fat globules and foamy macrophages (histiocytes)
Dx?
Tx?
Dx: fat necrosis
Tx: No treatment indicated - routine follow-up and no intervention. Condition is self-limited.
the most appropriate test to confirm the diagnosis of intrauterine fetal demise (IUFD) is:
real time ultrasonography
-demonstrates an absence of fetal movement and cardiac activity
- bilateral breast tenderness and swelling
- typically presents 24-72 hours postpartum, peaks 3 to 5 days after delivery
- resolves spontaneously
Breast engorgement
late-term and post-term pregnancy complications:
fetal: (5)
- oligohydramnios
- meconium aspiration
- stillbirth
- macrosomia
- convulsions
late-term and post-term pregnancy complications:
maternal: (4)
- cesarean delivery
- infection
- postpartum hemorrhage
- perineal trauma
clinical presentation:
- cardiogenic shock
- hypoxemic respiratory failure
- DIC
- coma or seizures
Dx?
Tx?
Dx: amniotic fluid embolism
Tx: respiratory and hemodynamic support (ie, intubation and mechanical ventilation) +/– transfusion
T/F
Most menstrual cycles in the first 1-2 years following menarche are anovulatory. These cycles may be irregular and may be complicated by menorrhagia.
TRUE
pathophysiology of neonatal thyrotoxicosis:
- transplacental passage of maternal anti-TSH receptor antibodies
- antibodies bind to infant’s TSH receptors and cause excessive thyroid hormone release
tx of neonatal thyrotoxicosis:
- methimazole + ß-blocker (symptomatic pts)
- self-resolves within 3 months (disappearance of maternal antibody)
direct role of hCG in pregnancy:
preservation of the corpus luteum in early pregnancy
secreted by the syncytiotrophoblast
- intense pruritus
- elevated bile acids
- elevated liver enzymes
- diagnosis of exclusion
Dx?
intrahepatic cholestasis of pregnancy (ICP)
presentation:
- preeclampsia
- RUQ pain
- N/V
labs:
- hemolysis
- moderately elevated liver enzymes
- thrombocytopenia
Dx?
HELLP syndrome
presentation:
- malaise
- RUQ pain
- N/V
- sequelae of liver failure
labs:
- hypoglycemia
- mildly elevated liver enzymes
- elevated bilirubin
- possible DIC
Dx?
acute fatty liver of pregnancy
abdominal pain in a young female in the middle of her cycle with a benign hx and clinical exam is most likely:
mittelschmerz (midcycle pain)
T/F
Pts with multifetal gestation or molar pregnancy are at increased risk for hyperemesis gravidarum; therefore, an ultrasound should be performed in pregnant pts with severe vomiting and weight loss.
TRUE
tx to prevent recurrent seizures:
magnesium sulfate
T/F
In stable pts with pregnancies close to term, induction of labor is appropriate if there are no standard obstetrical contraindications.
TRUE
indications for GBS prophylaxis when GBS status is unknown: (4)
-delivery at
maternal contraindications to breast feeding: (6)
- active untreated TB
- maternal HIV infection
- herpetic breast lesions
- varicella infection
prolactin production:
- (stimulated/inhibited) by serotonin
- (stimulated/inhibited) by TRH
- (stimulated/inhibited) by dopamine
prolactin production:
- STIMULATED by serotonin
- STIMULATED by TRH
- INHIBITED by dopamine
mgmt of ASC-US in women age ≥ 25:
HPV testing –>
(+) HPV –> colposcopy
(–) HPV –> repeat pap AND HPV test in 3 years
indications for prophylactic anti-D immune globulin administration for an unsensitized Rh(–) pregnant pt: (8)
- at 28-32 weeks gestation
- within 72 hours of delivery of an Rh(+) infant or a spontaneous, threatened, or induced abortion
- ectopic pregnancy
- molar pregnancy
- chorionic villus sampling, amniocentesis
- abdominal trauma
- 2nd and 3rd trimester bleeding
- external cephalic version
pathogenesis of HELLP syndrome:
- systemic inflammation, especially the liver
- activation of the coagulation cascade
- platelet consumption
T/F
Women who are inadvertently given rubella vaccination before or during pregnancy do not require additional intervention and may proceed with routine prenatal care.
TRUE
oral glucose testing should be performed in all pregnant women at __-__ weeks gestation
oral glucose testing should be performed in all pregnant women at 24-28 weeks gestation
UTI abx in pregnancy
recommended: (4)
contraindicated: (3)
UTI abx in pregnancy
recommended:
- nitrofurantoin
- amoxicillin
- amoxicillin-clavulanate
- cephalexin
contraindicated:
- tetracyclines
- fluoroquinolones
- TMP-SMX
- small body size
- microcephaly
- digital/nail hypoplasia
- midfacial hypoplasia
- hirsutism
- cleft palate
- rib anomalies
fetal hydantoin syndrome
assoc meds include phenytoin and carbamazepine
T/F
Labor should be allowed to proceed in pts where the fetus has been diagnosed with a severe congenital anomaly incompatible with life.
TRUE
- 38yo Caucasian female presents to office c/o lethargy, weight and fatigue
- denies HAs, pruritus or urine discoloration
- gave birth 2 months ago; delivery complicated by vaginal bleeding requiring transfusion and postpartum endometritis that responded rapidly to abx
- has not had menstrual periods following delivery
- CPE: sparse pubic hair, dry skin and delayed tendon reflexes
most likely dx?
Sheehan’s syndrome (ischemic necrosis of anterior pituitary)
-present in the postpartum period with failure to lactate and other features of pituitary hormonal deficiency
T/F
Breech presentation diagnosed before the 37th week of gestation requires intervention.
FALSE!
- breech presentations often convert to vertex before the 37th week
- external cephalic version is indicated if breech presentation is persistent after 37 weeks (and if this fails –> planned cesarean delivery)
STIs screened for in all pregnant women regardless of their risk factors: (3)
- syphilis (rapid plasma reagin (RPR) test)
- HIV
- hep B
-age
mgmt: biopsy
Dx: clear cell adenocarcinoma
- age >60
- risk factors: HPV 16 or 18, h/o cervical dysplasia or cancer, cigarette use
- location: upper 1/3 of posterior vaginal wall
- malodorous vaginal discharge
- postmenopausal or postcoital vaginal bleeding
- irregular mass, plaque, or ulcer on vagina
mgmt?
Dx?
mgmt: biopsy
Dx: squamous cell carcinoma
T/F
Lithium is assoc with congenital heart dz (Ebstein’s anomaly) and should be weaned in pregnant women with stable bipolar disorder.
T/F
When a woman is treated with isotretinoin, she should receive strict contraception.
T/F
Inhaled steroids can be used during pregnancy.
TRUE x 3
describe cervical mucus during the ovulatory phase
profuse, clear, thin, stretches to approx 6 cm when lifted vertically, pH ≥ 6.5 (more basic than at other phases), demonstrates “ferning” when smeared on slide
elevated prolactin levels suppress ____ release thereby suppressing __ and ___ production and ovulation
(this is the reason for anovulation and amenorrhea in lactating mothers)
elevated prolactin levels suppress GnRH release thereby suppressing LH and FSH production and ovulation
(this is the reason for anovulation and amenorrhea in lactating mothers)
- sudden-onset lower abdominal pain (at midcycle)
- often following strenuous exercise or sexual intercourse
- may be accompanied by light vaginal bleeding
- does NOT cause significant N/V
Dx?
ruptured ovarian cyst
pregnant women with a current or previous diagnosis of anorexia nervosa are at risk for numerous complications, including: (6)
- miscarriage
- IUGR
- hyperemesis gravidarum
- premature birth
- cesarean delivery
- postpartum depression
causes of fetal growth restriction (weight
- vascular dz (HTN, preeclampsia, diabetes)
- antiphospholipid antibody syndrome
- autoimmune dz (SLE)
- cyanotic cardiac dz
- substance abuse (tobacco, EtOH, cocaine)
causes of fetal growth restriction (weight
- genetic disorders (aneuploidy)
- congenital heart dz
- intrauterine infection (malaria, CMV, rubella, toxo, varicella)
- virilized XX child with normal internal genitalia but ambiguous external genitalia
- clitoromegaly often seen when excessive androgens are present in utero
- high FSH/LH with low estrogen
Dx?
aromatase deficiency
An intrauterine pregnancy should be seen with transvaginal ultrasonography at ß-hCG levels of 1,500-2,000. If the level is
both ß-hCG and transvaginal ultrasound should be repeated in 2-3 days
increased MSAFP levels assoc with: (3)
- open neural tube defects (eg, anencephaly, open spina bifida)
- ventral wall defects (eg, omphalocele, gastroschisis)
- multiple gestation
decreased MSAFP levels assoc with: (1)
aneuploidies (eg, trisomies 18 & 21)
small lesions of HPV can be treated in the office with: (2)
- trichloroacetic acid
- podophyllin
most accurate way to determine estimated gestational age:
1st trimester ultrasound with crown-rump measurement
the first priority in evaluating abnormal uterine bleeding in premenopausal women is to:
exclude pregnancy (serum ß-hCG)
secondary amenorrhea is relatively common in elite female athletes and results from:
estrogen deficiency
serologic testing (VDRL, RPR) for syphilis results in many false-negatives, therefore which diagnostic test is necessary in primary syphilis?
dark field microscopy
ovulation can be induced in pts with PCOS with: (2)
clomiphene citrate
metformin
the majority of pts with Paget’s dz have an underlying breast (adenoCA/SCC)
the majority of pts with Paget’s dz have an underlying breast ADENOCARCINOMA
mgmt of a pregnant pt with syphilis who is allergic to penicillin:
penicillin desensitization
pts in preterm labor at
- tocolytic agent (eg, CCB, terbutaline)
- magnesium sulfate (neuroprotective)
- corticosteroids (fetal lung maturity)
raloxifene increases the risk for:
thromboembolism
common SE of epidural anesthesia:
what is the cause of the this SE?
hypotension
cause: blood redistribution to the lower extremities and venous pooling from sympathetic blockade
overexpression of the oncogene HER2 can be detected by:
FISH
fluorescence in situ hybridization
Important side effects of oral contraceptive pills include: (3)
- breakthrough bleeding
- HTN
- incr risk of thromboembolism
tx of magnesium sulfate toxicity (earliest sign being depressed DTRs):
stop the mag sulfate and give calcium gluconate
preferred form of hormonal contraception for lactating mothers:
progestin-only oral contraceptives
- dyspareunia
- dysmenorrhea
- pelvic pain
- infertility
Dx?
how diagnosed?
Dx: endometriosis
diagnosed via direct visualization on laparoscopy ± biopsy
classic triad of congenital toxoplasmosis:
chorioretinitis
hydrocephalus
intracranial calcifications
class triad of congenital rubella:
deafness
cataracts
cardiac defects
(anterior/posterior) dislocation of the shoulder commonly occurs after tonic-clonic seizure
POSTERIOR dislocation of the shoulder commonly occurs after tonic-clonic seizure
