UWorld Flashcards
what should be the first step after quad screen results suggestive of down syndrome?
U/S (confirm gestational age, assess amniotic fluid)
then can do amniocentesis after
when should women under 30 follow up for a simple cyst?
within 2-4 months for clinical breast exam
indications for RhoD ppx in pregnant pt?
- 28-32 wks gestation
- w/in 72 hrs delivery of Rh+ infant, spontaneous/threatened/induced abortion
- ectopic preg
- molar preg
- CVS, amniocentesis
- abdominal trauma
- 2nd and 3rd trimester bleeding
- external cephalic version
painless continuous leakage of fluid from vagina after surgery. dx?
vesicovaginal fistula
chronic pelvic pain, dyspareunia, urgency. dx?
interstitial cystitis (painful bladder syndrome)
common causes of hypogonadotropic hypogonadism?
excessive weight loss, strenuous exercise, chronic illness, eating disorder
what causes a dose dependent increase in risk of osteoporotic fx?
alcohol
how to first evaluate ovarian mass?
CA-125 with pelvic U/S
when is endometrial biopsy indicated?
AUB >45, postmenopausal bleeding, thickened endometrial stripe w. ovarian mass
what cancer is assoc w/ paget’s disease of the breast?
adenocarcinoma
midfacial hypoplasia, microcephaly, cleft lip/palate, digital hypoplasia, hirsutism, dev. delay. dx?
fetal hydantoin syndrome
MCC phenytoin, carbamezapine
early findings:
rhinitis (snuffles), HSM, skin lesions
congenital syphilis
late findings of congenital syphilis?
interstitial keratitis, Hutchinson teeth, saddle nose, saber shins, deafness, CNS involvement
midfacial hypoplasia, microcephaly, stunted growth, CNS damage (hyperactivity, MR, or learning disability)
fetal alcohol syndrome
what causes elevated 17-hydroxyprogesterone?
nonclassic CAH due to 21 hydroxylase deficiency -> hyperandrogenism in late childhood
homogenous cystic ovarian mass in young woman. dx?
ovarian endometrioma
risk factors for uterine inversion?
nulliparity
fetal macrosomia
placenta accreta
rapid L&D
What medications are common uterotonics?
oxytocin, misoprostol
What medications are common relaxants of the uterus (tocolytics)?
nitroglycerine, terbutaline, indomethacin, nifedipine
preferred endocrine drug for adjuvant tx of premenopausal women at low risk of breast cancer recurrence?
tamoxifen
what is mag sulfate usually used for?
(weak tocolytic)
used to lower risk of neuro complications in neonates born at <32 weeks
tx of symptomatic endometriosis options
conservative: NSAIDs, OCPs, progesterone IUD
definitive: surgical resection, hysterectomy w/ oophorectomy
management options for IUFD
20-23 wks: D&E or vaginal
>= 24 wks: vaginal delivery
- usually induce labor to prevent coagulopathy
what hormonal deficiency causes secondary amenorrhea in female atheletes?
estrogen
when does symmetric fetal growth restriction occur?
first trimester
what causes symmetric FGR?
chromosomal abnormalities, congenital infection
what causes asymmetric FGR?
2nd or 3rd trimester uteroplacental insufficiency or maternal malnutrition
(head size not as small as abdominal size)
what are common causes of asymmetric FGR?
hypertension, diabetes
what is the management of IUGR?
weekly BPP, serial U/S, serial umbilical artery sonography
characteristics of Bartholin duct cyst
occur in women <= 30
at 4 or 8 o’clock position on vulva
cause: dried mucoid glandular secretions or trauma or idiopathic
treatment of Bartholin duct cyst: asx vs sx
asx: observation
sx: I&D; placement of word catheter decreases risk of recurrence
treatment options for bacteriuria/acute cystitis in pregnancy
5-7 days nitrofurantoin;
3-7 days amox or amox/clauv
single dose fosfomycin
what tx to avoid for cystitis in preg?
avoid fluoruoquinolones always;
avoid bactrim in 1st and 3rd trimesters
tx for acute pyelo in preg?
hospitalize and IV abx (B lactams, metopenem)
avoid aminoglycosides if possible
change to 10-14 days course oral abx after afebrile 24 hrs
why is oxytocin not effective in stim uterine contraction/expelling retained pocs during T1 or T2?
there are few oxytocin receptors in the uterus during early pregnancy
how does atrophic vaginitis contribute to urinary urgency, frequency, incont and infection?
hypoestrogenemia -> atrophy of superficial and int. layers of vagina/mucosal epithelium; decreased urethral pressure and compliance -> sxs
define missed abortion
no vaginal bleeding, closed cervical os, no fetal HR or empty sac; asx
define threatened abortion
vaginal bleed, closed cervical os, fetal cardiac activity present
define inevitable abortion
vaginal bleed, dilated cervical os, poc may be seen or felt at/above cervical os
define incomplete abortion
vaginal bleed, dilated os, some pocs expelled, some remain
define complete abortion
vaginal bleed or non; closed cervical os; pocs completely expelled
late/posterm preg (>= 41 weeks/>=42 weeks) complications for FETUS
oligohydramnios meconium aspiration stillbirth macrosomia convulsions
late/postterm preg complications for MOM
Csection
infxn
PPH
perineal trauma
what does fetal heart tracing show with placenta previa?
usually unaffected. bleeding is maternal (even though it is painless)
what is pathognomonic for uterine rupture?
loss of fetal station; ability to feel fetal parts through abdominal wall
what does the fetal heart tracing look like with vasa previa?
rapid deterioration (bleeding is fetal)
define IUFD
fetal death at >= 20 wks
at what GA does IUFD need to be delivered vaginally?
24 or older
what are the absolute CI to combined hormonal contraceptives?
- migraine w aura
- > = 15 cigs/day & age >=35
- stage 2 HTN (>=160/100)
- hx stroke or ischemic heart dz
- hx of venous thromboembolism
- breast cancer
- cirrhosis & liver cancer
- major sx with prolonged immobilization
- <3 wks postpartum
what is recommended for dx of lichen sclerosus?
punch bx; rule out SCC
how do you distinguish lichen sclerosus from vulvovaginal atrophy?
LS: presence of white plaques, severe retraction/loss of normal anatomy of clitoral hood/labia minora/introitus, possible perianal involvement
LS tx?
high dose topical steroids
definition of AUB
prolonged menstruation (>5 days) and heavy (>1 pad every 2 hours) with irregular frequency
proliferation of SM cells in myometrium. dx and sx.
leiomyomata uteri (fibroids) can cause profuse menses and irregular uterine enlargement
work up for fibroids
U/S
what other conditions can elevate CA-125 in a premenopausal woman?
endometriosis, fibroids, lupus
locations of vaginal cancer and dx.
upper 1/3 of POSTERIOR vaginal wall = SCC
upper 1/3 of ANTERIOR vaginal wall = clear cell
clear elastic mucus with consistency similar to uncooked egg white. dx
cervical mucus (secreted close to ovulation - late follicular phase)
most important direct role of BhCG in pregnancy?
maintenance of corpus luteum
what cell secretes B-hcG?
syncytiotrophoblast
timeline of hCG in pregnancy?
produced beginning 3 days after fertilization. doubles every 48 hours. peaks at 6-8 weeks GA.
what does cystoscopy typically evaluate for?
bladder cancer
common cause of SUI in nulliparous woman?
fibroids
term for malignancy involving ovary, fallopian tube, and peritoneum?
epithelial ovarian carcinoma
hyperechoic nodules and calcifications in ovarian cyst. dx?
dermoid ovarian cyst (mature cystic teratoma)
what is the most effective emergency contraception? also MOA?
copper IUD
-> inflamm rxn toxic to sperm/ova & impairs implantation
what are the gestational DM target blood glucose levels?
fasting: <= 95 mg/dl
1 hour PP : <=140
2 hour PP: <= 120
management of shoulder dystocia?
BECALM
B: breathe, don’t push; lower head of bed
E: elevate legs into McRoberts position - sharp hip flexion
C: call for help
A: apply suprapubic pressure (down and lateral) to release anterior shoulder
L: enLarge with episiotomy
M: maneuvers; delivery of posterior arm; Woods corkscrew/Rubin (pressure against baby’s posterior shoulder anteriorly or posteriorly & anterior rotation); mom on “all fours” (Gaskin maneuver); replace head in vagina then emergent C section (Zavanelli maneuver)
maternal risks of shoulder dystocia?
4th degree perineal lacs, PPH
contraindications to CST?
CI to labor: previa, prior myomectomy
define preclampsia
new onset htn (sbp >=140/90) at >= 20 weeks GA AND proteinuria and/or end-organ damage
what are considered severe features of preclampsia?
- sbp >=160 or dbp >=110 (2 times, 4 hours apart)
- low platelets
- increased Cr
- increased transaminases
- pulm edema
- visual/cerebral symptoms
management of preclampsia?
without severe features: deliver at >= 37 wks
WITH severe features: deliver at >= 34 weeks
all: mag sulfate ppx, anti HTN
rf for preclampsia
- multiple gestation
- nulliparity
- preexisting DM
- advanced maternal age
- kidney dz
- prior preclampsia
when is mag sulfate given for neuroprotection?
24-32 weeks gestation when preterm birth is anticipated within the next 24 hours
SE of oxytocin?
hyponatremia, hypotension, uterine tachysystole (abnormally frequent contractions - >5 in 10 minutes on average over 30 min period)
U/S findings of irregularity/absence of placental-myometrial interface and intraplacental villous lakes. dx?
placenta accreta
fluctuant tender palpable mass while breastfeeding. dx? tx?
breast abscess from untreated mastitis
tx: needle bx and abx
