uworld Flashcards
3 risk factors for SCC of the vagina
HPV 16 or 18, smoking, h/o cervical dysplasia/ca.
MC risk factor for abruptio placentae? 2 others?
HTN; maternal trauma and cocaine use
Unilateral bloody nipple discharge is the hallmark symptom of?
an intraductal papilloma (a benign breast condition)
abnormal results of a nonstress test?
recurrent variabilty, loate decels or nonreactive= less than 2 acceleration
a strong predictor of preterm delivery is a short cervix on TVUS, what is considered short?
2cm or less w/o a h/o preterm birth or 2.5cm or less with a h/o preterm birth
Preeclampsia puts fetus at risk for chronic uteroplacental insuff which can cause
oligohydramnios and IUGR/ small for gestational age infants
name 2 recommended antihypertensives to use during preg, 2 acceptable alternatives?
beta-blockers esp Labetalol, methyldopa;
Hydralazine, Ca channel blockers (nifedipine)
Tx of an ASx Bartholin cyst?
if symptomatic?
Observation;
I and D then placement of a Word catheter
Late-term and postterm preg complications to the fetus? (5)
Oligo, meconium aspiration, stillbirth, macrosomia, convulsions
Late-term and postterm preg complications to the mom?
C-section, infection, PPH, perineal trauma
criteria of oligo: single deepest vertical pocket of… OR an AFI of… in transabdominal U/S
less than or equal to 2cm;
less than or equal to 5cm
first line therapy for vulvar lichen sclerosis ?
high potency topical corticosteroids (ie Clobetasol)
types of miscarriages that present with vaginal bleeding and dilated cervical os
incomplete and inevitable
preg pt. Pap test showed HGSIL, best next step?
immediate colposcopy and Bx of cervical abnormalities d/t high risk of progression to cancer
endometrial Bx is indicated in all pts 45yo or more with AUB, and in pts less than 45 with?
AUB plus any of these: unopposed estrogen exposure (obesity, chronic anovulation ie oliomenorrhea), failed med management, or lynch Sy
PCOS pts levels of FSH, LH and testosterone?
FSH and LH are nml to increased, elevated testosterone
classic signs of mag toxicity
m. weakness, loss of DTRs, nausea, resp depression
TOC for eclampsia?
mag sulfate
past history of what conditions increases risk of preeclampsia
preeclampsia, cHTN, multifetal and molar pregnancy
Lewis Abs are not assoc w isoimmunization or hemolytic disease of the newborn bc?
they are IgM Abs thus do not cross the placenta
causes of elevated maternal serum AFP?
multiple gestation, neural tube defects, fetal abdominal wall defect, fetal death, cystic hygroma…
common presenting signs of an abruption
abdominal pain, bleeding, uterine hypertonus and fetal distress
assoc w painless cervical dilation and typically Dxed early in 2nd trimester
cervical incompetece
this tocolytic should not be used due to its side effects and lack of efficacy
terbutaline
This tocolytic agent is CI in pts w myasthenia gravis
Mag sulfate
a low AF glucose is an indication of
intra-amniotic infection
in placenta previa, the first bleeding episode occurs MC at what gestational age?
29-30wks
this Dx is usually confirmed by dark red, velvety rectal mucosa on the post. vaginal wall? MC cause?
rectovaginal fistula ;
obstetric injury
MC type of brachial plexus injury from birth ? grasp reflex should remain intact, what nerves are involved?
erb-duchenne palsy (waiter’s tip posture);
5th and 6th CNs
Rare but potentially permanent complication of shoulder dystocia that results in hand paralysis/claw hand and ipsilateral Horner Sy? what nn are involved?
Klumpke palsy;
8th CN and 1st thoracic nerve
4 complications of cervical conization which is indicated for CIN grades 2 and 3?
cervical stenosis, preterm birth, PPROM, cervical insuff (2nd trimester loss)
2 causes of painful genital ulcers and a diff btwn them
HSV (small ulcers on red base, mild lymphadenopathy) and Haemophilus ducreyi (chancroid, larger deep ulcers w exudate, severe lymphadenopathy)
2 causes of painless genital ulcers?
Treponema pallidum (chancre, primary syphilis) and Chlamydia serovars L1-3 (lymphogranuloma venerum, small shallow ulcers often missed, can progress to painful buboes)
what quadruple screen results are assoc with Down Sy?
low MSAFP, low estriol, increased beta-hCG, and increased inhibin A
pathogenesis of HELLP Sy involves?
hepatic and systemic inflamm, activation of coag cascade and platelet consumption
intense itching, elevated bile acids and/or aminotransferases in pregnancy suggests?
Intrahepatic cholestasis of preg
this should be suspected in postpartum women with an enlarged uterus, irregular vaginal bleeding, pulmonary Sxs, and multiple infiltrates on chest x-ray? Dx confirmed by?
Choriocarcinoma;
elevated beta-hCG
arrest of the 2nd stage of labor is when there is no fetal descent after pushing for how many hrs in nulli-/multi-parous women?
MC cause of 2nd stage arrest?
3hrs in nulli, 2hrs in multi; fetal malposition (ie not occiput ant.)
routine prenatal lab tests for initial prenatal visit
Rh(D) type, Ab screen Hg/Hct, MCV HIV, VDRL/RPR, HBsAg Rubella and varicella immunity Pap test if needed chlamydia PCR Urine culture/urine protein
testing that should be done at 24-28wks
Hg/Hct
Ab screen if Rh (D) negative
50g 1hr glucose challenge test
management of preterm labor from 34wks to 36.6 weeks ?
PCN if GBS positive or unknown, can give betamethesone
management of preterm labor from 32 wks to 33.6 wks
betamethasone, tocolytics, PCN if GBS positive or unknown
management of preterm labor at less than 32 weeks ?
Betamethasone, tocolytics, PCN is GBS positive or unknown, Mag sulfate
typically presents w fever more than 24hrs postpartum, purulent lochia and uterine tenderness ? TOC?
Postpartum endometritis ;
Clindamycin plus gentamicin
3 first line ABXs used for ASx Bacteriuria in preg
Cephalexin, Amoxicillin-Clavulanate, Nitrofurantoin
2 MC SERMs?
Tamoxifen and Raloxifene
frequently used for osteoporosis management in postmenopausal women who cannot tolerate bisphosphonates or are at higher risk of invasive breast ca.
Raloxifene (a SERM)
Arrest of active labor occurs at a cervical dilation of…… when there is no cervical change for….
6cm or more;
4hrs or more w adequate contractions (atleast 200 MVUs) OR 6hrs or more w inadequate contractions
If arrest of active phase of labor occurs the next step in management should be ?
Cesarean delivery
Infants born to women w Graves disease are at risk for? affected infants have what Sxs?
Tx?
thyrotoxicosis;
irritable, tachycardic, gain weight poorly;
Methimazole and beta-blocker until it resolves over a few wks-months
mech of anovulation and amenorrhea in exclusively breastfeeding women?
elevated prolactin inhibits GnRH thereby suppressing LH and FSH
Pts w placenta previa should undergo cesarean delivery when?
36-37wks
inherited bleeding disorder that causes easy bruising, heavy menses, nosebleeds and excessive bleeding after surgery or delivery
Von Willebrand disease
In a young pt w recent menarche and an irregular cycle, heavy bleeding is likely due to?
anovulatory cycles
Adverse effects of Tamoxifen?
Hot flashes, Venous thromboembolism, endometrial hyperplasia and carcinoma
when should women w unknown GBS status be treated in labor?
if they are preterm,
develop an intrapartum fever, or
have rupture of membranes for 18hrs or more
3 adverse effects of Oxytocin
Hyponatremia, Hypotension, Tachysystole
Severe features of pre-eclampsia (6)
SBP 160 0r more, oe DBP 110 or more, thrombocytopenia, incr Cr, incr transaminases, pulm edema visual or cerebral Sxs
3 Tx options for PCOS
weight loss, OCPs for menstrual reg, Clomiphene citrate for ovulation induction
diffuse breast erythema, warmth, pain and edema w a peau d’orange(dimpling) appearance are hallmark features of
inflammatory breast carcinoma
the one type of fibroid that is not assoc w recurrent preg loss?
subserosal (located outside the uterine cavity)
this syndrome c/b midfacial hypoplasia, microcephaly, cleft lip/palate, digital hypoplasia, hirsutism, devel delay??
caused by?
Fetal hydantoin syndrome;
exposure to anticonvulsants during devel, MC- Phenytoin and carbamazepine
what is a nml post voidal residual volume in women?
LESS than 150mL
Greatest risk factor for epithelial ovarian ca.? others?
FH (even w/o BRCA mutations),
early menarche, late menopause, nulliparity, over 50yo, endometriosis
the nml hyperventilation of preg is c/b?
incr TV, ince minute ventilation, chronic resp alkalosis w metabolic compensation
what should initial evaluation be for a pt. with bilateral, guaiac-neg discharge w/o signs of malignancy (ie mass, lymphadenopathy, nipple changes)
serum prolactin, TSH, and preg test
then MRI in pts w elevated prolactin and/or Sxs of a pituitary mass
3 complications of PPROM ?
infection (chorioamnionitis/ endometritis), cord prolapse, abruptio placentae
postmenopausal bleeding w a thickened endometrium and a large ovarian mass is concerning for?
endometrial hyperplasia/cancer in the setting of a granulosa cell ovarian tumor (which secretes estrogen)
fetal fibronectin test use?
normally should be very low in vaginal secretions from 22-35 weeks, if detected it can help predict preterm delivery
majority of pts w pagets disease have an underlying breast ca., MC is?
adenocarcinoma (starts in glandular tissue)
