UWorld 5 Flashcards
intraductal papilloma
CF: u/l bloody nipple d/c and no associated mass or LAD
management: mammo and US, bx +/- excision
genital warts (condylomata acuminata)
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
Rf for (squamous cell) cervical ca
- 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
Indications for prophylactic administration of anti-D Ig for Rh(D)-negative pts
- 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
syphilis in pregnancy
- 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
Lichen sclerosis
- 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
atrophic vaginitis
- vulvovaginal dryness
- loss of vaginal elasticity/rugae
- thinning vulvar skin/loss of minora
- dec vaginal diameter
- tx: low dose topical estrogen
nonreactive NST
- 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
lithium exposure in 1T
- 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
endometriosis
-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
management of preeclampsia
- w/ severe deliver at >34 wks
- sans severe deliver at >37wks
severe features
- SBP >160 or dbp >110 (2 times >4 hours apart)
- thrombocytopenia
- inc cr
- inc transaminases
- pulm edema
- visual or cerebral s/s
cone biopsy-CIN3
all nonpreggo pts >25 with CIN3 require excision of the transformation zone (cone biopsy) d/t high risk of progression to invasive SCCC
GnRH, FSH, Estrogen in the following
- 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
BPP
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
epithelial ovarian carcinoma
- 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
exercise-induced hypothalamic amenorrhea
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
secondary amenorrhea
- 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
placenta previa
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
ABO hemolytic dz
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
primary vaginal ca
- 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
Infertility
- 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)
PPROM
pts at >34 wks gestation should be delivered
-intrapartum iv penicillin should be given for unknown or positive GBS status
risks and benefits of estrogen-progestin contraceptives
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
underweight and preggo
inc r/o fetal growth restriction and preterm delivery
uterine rupture
- 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
blunt abdominal trauma
-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
resp to hemorrhagic shock,
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!
septic abortion
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)
renal colic in preggo pts
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
preterm labor
- 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
preterm birth prevention
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
