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OB/GYN > UWorld 5 > Flashcards

UWorld 5 Flashcards

1
Q

intraductal papilloma

A

CF: u/l bloody nipple d/c and no associated mass or LAD
management: mammo and US, bx +/- excision

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2
Q

genital warts (condylomata acuminata)

A

etio: hpv 6 and 11
CF: multiple pink or skin colored lesions, lesions ranging from smooth, flattened papules to exophytics/cauliflower-like growths
tx: chemical podophyllin resin, trichloroacetic acid; immuno imiquimod; sx: cryotherapy, laser therapy, excision
prevention: vaccination, barrier contraception

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3
Q

Rf for (squamous cell) cervical ca

A
  • infection with high risk HPV (16,18)
  • h/o STD
  • early onset sexual activity
  • multiple or high-risk sexual partners
  • immunosuppresion
  • oral contraceptive use
  • low SES
  • tobacco use
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4
Q

Indications for prophylactic administration of anti-D Ig for Rh(D)-negative pts

A
  • at 28-32 weeks gestation
  • <72hr after delivery of Rh(D)-positive infant
  • <72 hr after spontaneous abortion
  • ectopic pregnancy
  • threatened abortion
  • hydatidiform mole
  • chorionic villus sampling, amniocentesis
  • abdominal trauma
  • 2T and 3T bleeding
  • external cephalic version
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5
Q

syphilis in pregnancy

A
  • treatment with penicillin is required for all pregnant pts with syphilis to prevent fetal complications (IUGR, fetal death, congenital infection)
  • pts with pen allergy receive skin testing, if positive desensitize them and give IM pen G benzathine
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6
Q

Lichen sclerosis

A
  • pale thin tissue and perianal thickening with fissures
  • causes intense pruritus and white atrophic plaques involving vulva and sometimes perianal skin but not the vagina; loss of minora
  • punch biopsy confirms the diagnosis and rules put vulvar SCC
  • tx: high potency topical steroids
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7
Q

atrophic vaginitis

A
  • vulvovaginal dryness
  • loss of vaginal elasticity/rugae
  • thinning vulvar skin/loss of minora
  • dec vaginal diameter
  • tx: low dose topical estrogen
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8
Q

nonreactive NST

A
  • should last 40-120 minutes to ensure that fetal activity outside of sleep is captured
  • should be followed with either a BPP or contraction stress test before concluding fetus may be hypoxic and needs intervention
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9
Q

lithium exposure in 1T

A
  • increases r/o cardiac malformations including septal defects and possibly Ebstein’s anomaly
  • 2T and 3T goiter and transient neonatal neuromuscular dysfunction are of concern
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10
Q

endometriosis

A

-ectopic implantation of endometrial glands

CF: dyspareunia, dysmenorrhea, chronic pelvic pain, infertility, dyschezia

PE: immobile uterus, cervical motion tenderness, adnexal mass, recto-vaginal septum, posterior cul-de-sac, uterosacral ligament nodules

diagnosis: direct visualization and surgical biopsy
tx: medical (oral contraceptives, NSAIDs), surgical resection

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11
Q

management of preeclampsia

A
  • w/ severe deliver at >34 wks

- sans severe deliver at >37wks

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12
Q

severe features

A
  • SBP >160 or dbp >110 (2 times >4 hours apart)
  • thrombocytopenia
  • inc cr
  • inc transaminases
  • pulm edema
  • visual or cerebral s/s
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13
Q

cone biopsy-CIN3

A

all nonpreggo pts >25 with CIN3 require excision of the transformation zone (cone biopsy) d/t high risk of progression to invasive SCCC

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14
Q

GnRH, FSH, Estrogen in the following

A
  • hypothalamic hypogonadism: all down
  • primary ovarian insufficiency (forms of hypergonadotrophic hypogonadism): e down, rest up
  • ->cp: irregular menses or infertility and h/o ai d/o or turner
  • PCOS: f nml others up
  • nml ovulation: all nml
  • exogenous estrogen use: e up rest down
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15
Q

BPP

A

performed in pts at risk for uteroplacental insufficiency (>41 wks gestation)
-chronic hypoxemia causes an abnml BPP and suggests imminent risk of fetal demise–delivery usually indicated in such cases

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16
Q

epithelial ovarian carcinoma

A
  • malignancy involving ovary, fallop tube, and peritoneum
  • cp: hallmark large ovarian mass and widespread pelvic and abdo mets regardless of primary origin
  • US: investigate pelvic pain and/or adnexal mass
  • ->will see large ovarian mass with thick septations, solid components, and peritoneal free fluid (ascites)
  • s/s: bloating, pain, early satiety/anorexia, abdo distension
17
Q

exercise-induced hypothalamic amenorrhea

A

CP: strenuous exercise, relative caloric deficiency, stress fractures, amenorrhea, infertility

hormone levels: GnRH, LH/FSH and estrogen all DEC

long-term consequences: dec bone mineral density, inc total cholesterol and tg

tx: inc caloric intake, estrogen, calcium and vit D

18
Q

secondary amenorrhea

A
  • absence of menses for >3 cycles or >6 months in women who menstruated previously
  • initial eval is beta hcg to exclude preggo then serum prolactin, TSH, and FSH
19
Q

placenta previa

A

RF: multiparity, advanced maternal age >35

  • at r/o antepartum bleeding (painless) with or sans contractions on toco
  • placenta implants over internal cervical os
  • contraindication to labor and vaginal delivery
  • cesarean at 36-37 weeks
20
Q

ABO hemolytic dz

A

RF: infants with bloodtypes A or B born to a mother with blood type O

clinical features: jaundice within 24hr of birth, anemia, inc retic ct, hyperbilirubinemia, positive coombs

management: serial bili levels, oral hydration and phototherapy for most neonates, exchange transfusion for severe anemia/hyperbili

21
Q

primary vaginal ca

A
  • bloody, malodorous d/c and irregular vaginal lesion
  • RF for SCC of va are similar to cervical ca (smoking, HPV)
  • diagnosis: by bx and treatment is determined after staging
22
Q

Infertility

A
  • failure to achieve pregnancy after 12 mo of unprotected sex with woman <35
  • for women >35 infertility eval can begin after 6 mo without conception
  • 25% of cases due to male factor-test with semen analysis (sperm concentration motility, morphology)
23
Q

PPROM

A

pts at >34 wks gestation should be delivered

-intrapartum iv penicillin should be given for unknown or positive GBS status

24
Q

risks and benefits of estrogen-progestin contraceptives

A

benefits:

  • pregnancy prevention
  • endometrial and ovarian ca reduction
  • menstrual regulation (anovulation, dysmenorrhea, anemia)
  • hyperandrogenism tx (hirsuitism, acne)

risks:

  • VTE
  • HTN
  • hepatic adenoma
  • stroke, MI (both very rare)
  • cervical ca
25
Q

underweight and preggo

A

inc r/o fetal growth restriction and preterm delivery

26
Q

uterine rupture

A
  • usually occurs in pts with prior uterine sx
  • CP: focal, intense abdo pain; hyperventilation, agitation, tachy; vaginal and/or intra abdo bleeding
  • pathognomonic: fetal part may retract (loss of fetal station)
  • ->fetal limbs may be palpable on abdominal exam and FHT are usually abnml (fetal tachy, recurrent decels)
  • to prevent maternal and/or fetal exsanguination, suspected uterine rupture necessitates emergency laparotomy to confirm diagnosis and expedite delivery
27
Q

blunt abdominal trauma

A

-can cause antepartum hemorrhage and significant fetal and maternal M&M
…abruptio placentae
-aggressive fluid resuscitation with crystalloids
-place pt in left lateral decubitus (if spine stable) to displace uterus off aortocaval vessels and maximize cardiac output

28
Q

resp to hemorrhagic shock,

A

peripheral vasoconstriction and blood redistribution to the heart and brain and kidneys reduce blood flow to the extremities (cool extremities) and uterus (no accels on fetal tracing)
-due to physiologic hypervolemia of pregnancy, pregoo pt may appear hemodynamically stable until up to 20% of blood volume has been lost!

29
Q

septic abortion

A

RF: retained poc from elective abortion with nonsterile technique, missed or incomplete abortion (rare)

CP: f/c, abdo pain; sanguinopurulent, vaginal d/c; enlarged boggy tender uterus, dilated cervix; pelvic US: retained POC, thick endometrial stripe

management: iv fluids, broad-spec abx, suction curettage (surgical evacuation)

30
Q

renal colic in preggo pts

A

cp: flank pain that radiates to the groin with microscopic hematuria
- renal and pelvic US is recommended to eval
- low dose CT urography maybe in 2T and 3T
- need to distinguish physiologic hydronephrosis in pregnancy vs pathological hydronephrosis 2/2 obstruction

31
Q

preterm labor

A
  • strongest RF is preterm labor in a prior pregnancy
  • other rf: multiple gestation and h/o cervical sx in particular removal of pt of cervix by cold knife conization for CIN can cause cervical scarring/stenosis and incompetence
  • eval r/o preterm labor with TVUS and measure cervical length in 2T…short cervical length is bad news bears
32
Q

preterm birth prevention

A

h/o preterm labor
NO: do TVUS-CL (for cervical length); if nml routine prenatal care, if short cervix do vaginal progesterone

YES: do progesterone injections and TVUS-CL; if nml do serial TVUS-CL until 24 wks; if short do cerclage and serial TVUS-CL until 24 wks

OB/GYN (7 decks)

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