UWorld 6+ Flashcards
treatment for different types of urinary incontinence
stress:
-lifestyle modifications, pelvic floor exercises, pessary, pelvic floor surgery
urgency:
-lifestyle modifications, bladder training, anti-MUSCARINIC drugs
mixed (stress and urgency)
-variable tx depending on predominant s/s
overflow:
-id and correct underlying causes, CHOLINERGIC agonists, intermittent self-catheterization
delivery planning for a nonviable fetus
fetal diagnosis
- anencephaly
- b/l renal agenesis
- holoprosencephaly
- acardia
- thanatophoric dwarfism
- intrauterine fetal demise
ob management (minimize mom m&m)
- vaginal delivery
- no fetal monitoring
neonatal management:
-palliative care if not stillborn
spontaneous abortion
pregnancy loss <20wks
CP: heavy vaginal bleeding, cramping, dilated cervix without passage of gestational tissue
RF
- advanced maternal age
- previous spontaneous abortion
- substance abuse
tx options:
- expectant
- medical induction (misoprostol)
- suction curettage if infection or hemodynamic instability
additional management:
- Rho(D) ig
- path exam
complications of a spontaneous abortion
- hemorrhage
- retained products of conception
- septic abortion
- uterine perforation
- intrauterine adhesions
RF for fetal macrosomia (weight >4kg)
maternal
- advanced age
- diabetes
- excessive weight gain d/r pregnancy or pre-existing obesity
- multiparity
fetal:
- AA or Hispanic
- male sex
- post-term pregnancy
Erg-Duchenne palsy
- mc type of brachial plexus injury
- 5th, 6th, and sometimes 7th CN
- weakness of the deltoid and infraspinatus muscles (C5), biceps (C6), and wrist/finger extensors (C7) leads to predominance of the opposing muscles=waiters tip
tx: gentle massage and physical therapy to prevent contractors
- up to 80% of its have spontaneous recovery in 3 mo
cervical ionization (excision of intact transformation zone) -cold knife vs LEEP
indications: CIN2 and 3 (RF: HPV and tobacco)
complications:
- cervical stenosis
- preterm birth
- preterm premature rupture of membranes
- 2T pregnancy loss
cervical stenosis
- abnml stricture of cervical canal
- may impede menstrual flow=secondary dysmenorrhea or amenorrhea
- block sperm=infertility
uterine rupture RF
- prior uterine surgery (cesarean, myomectomy)
- induction of labor/prolonged labor
- congenital uterine anomalies
- fetal macrosomia
Uterine rupture CP and management
CP:
- excruciating abdo pain
- vaginal bleeding
- intraabdo bleeding (hypoTN, tachy)
- fetal heart decals (d/t disruption of maternal-placental circulation)
- l/o fetal station
- palpable fetal parts on abdominal exam
- l/o intrauterine pressure
management: laparotomy for delivery and uterine repair
shoulder dystocia
-failure of usual ob maneuvers to deliver fetal shoulders
RF:
- fetal macrosomia** (>4.5kg/9.9lb)
- maternal obesity
- excessive pregnancy weight gain
- gestational diabetes
- post-term pregnancy (>42 wks)
warning signs:
- protracted labor
- retraction of fetal head into the perineum after delivery (turtle sign hehe. turtle turtle.)
what can shoulder dystocia cause
ob emergency d/t r/o:
- neonatal brachial plexus injury
- clavicular and humeral fracture
- if prolonged: hypoxic brain injury and death
rectovaginal fistula
-may occur after ob trauma
CP: incontinence of flatus and feces through the vagina
-red velvety rectal mouse may be seen on posterior vaginal wall
ovarian ca
- one of the leading causes of ca mortality
- typically diagnosed in advanced stages with widespread mets
- no screening tests exist to detect avg risk ppl in early, more treatable stages
granulosa cell tumor
path:
- sex cord-stomal tumor
- inc estradiol and inhibin
clinical features: complex ovarian mass juvenile subtype -precocious puberty adult subtype: -breast tenderness -abnml uterine bleeding -postmenopausal bleeding
histo: call-exner bodies (cells in rosette pattern)
management: endometrial bx (endometrial ca) or sx (tumor staging)
granulosa cells
convert T to estradiol (via aromatase) and secrete inhibit (which inhibits FSH)
labs for hyperemsis gravidarum
ketonuria
hypochloremic metabolic alkalosis
hypokalemia
hemoconcentration
SLE nephritis in pregnancy CP and Labs
CP: edema, malar rash, arthritis, hematuria
labs: nephritic range proteinuria, UA w/ RBC and WBC casts, dec complement, inc ANA titers
SLE nephritis in pregnancy diagnosis and ob complications
diagnosis: renal bx
ob complications:
- preterm birth
- cesarean
- preeclampsia
- fetal growth restriction
- fetal demise
engorgement
- may be caused by rapid cessation of breastfeeding
- if pt desires lactation suppression:
- wear a supportive bra
- avoid nipple stimulation and manipulation
- use ice packs and analgesics to relieve associated pain
breast abscess from untreated mastitis
- S. aureus
- localized erythema/pain, fever, malaise and fluctuant tender palpable mass
- needle aspiration of abscess under US guidance and Abc (dicloxacillin, cephalexin) for surrounding mastitis
- continue breastfeeding for continued milk drainage
menopause (absent menses for 12 mo)
CP:
- vasomotor s/s (hot flashes)-manage with HRT or SSRI
- oligomenorrhea/amenorrhea
- sleep disturbances
- dec libido
- depression
- cognitive decline
- vaginal atrophy
diagnosis: clinical and inc FSH
tx: topical vaginal estrogen, systemic HRT
gestational DM
target bg levels:
- fasting <95
- 1 hr postprandial <140
- 2hr pp <120
tx: 1. dietary modifications 2. insulin, metformin
mammary paget disease
- painful, itchy, eczematous, and/or ulcerating rash on the nipple that spread to the areola
- majority of its have underlying breast adenocarcinoma
epidural anesthesia
- se: hypoTN in 10% of patients
- hypotension is caused by blood redistribution to the LE and venous pooling from sympathetic blockade
routine prenatal labs at initial visit
Rh (D) type, Ab screen Hgb/HCt, MCV HIV, VDRL/RPR, HBsAg Rubella and varicella immunity pap test (if screening indicated) chlamydia PCR urine culture urine protein
24-28wks lab tests
- Hgb/HCt
- Ab screen in Rh (D) negative
- 50g 1hr GCT (for gestational DM)
RF for lactational mastitis
h/o mastitis
engorgement and inadequate milk drainage d/t:
-sudden increase in sleep duration
-replacing nursing with formula or pumped breast milk
-weaning
-pressure on the duct (tight bra or clothing, prone sleeping)
-cracked or clogged nipple pore
-poor latch
placenta accreta
- occurs when uterine villi attach directly to the myometrium
- CP: placental adherence and hemorrhage at the time of attempted placental delivery
- RF: prior cesarean, h/o d&c, advanced maternal age
syphilis in pregnancy
screening: universal at 1st prenatal visit, 3T and delivery (if high risk)
serologic tests: nontreponemal (RPR, VDRL), treponema (FTA-ABS)
tx: intramuscular benzathine pen G
pregnancy effects: intrauterine fetal semis and preterm labor
fetal effects of syphilis in pregnancy
- hepatic (hepatomegaly, jaundice)
- heme (hemolytic anemia, dec platelets)
- MSK (long bone abnormalities)
- FTT
Hep C in pregnancy potential complications and maternal management
potential complications:
- gestational diabetes
- cholestasis of pregnancy
- preterm delivery
maternal management:
- ribavirin is teratogenic, avoid it
- no indication for barrier protection in serodiscordant, monogamous couples
- Hep A and B vaccination
prevention of vertical transmission of Hep B
- vertical transmission strongly associated with maternal viral load
- cesarean delivery not protective
- scalp electrodes should be avoided
- breastfeeding should be encourage unless maternal blood present (nipple injury)
postpartum period
nml:
- transient rigors/chills
- peripheral edema
- lochia rubra (reddish brown vaginal dc-the nil shedding of the uterine decidua and blood)
- uterine contraction and involution
- breast engorgement
routine care:
- rooming-in/lactation support
- serial examination for uterine atony/bleeding
- perineal care
- voiding trial
- pain management
PMS/PMDD
Clinical features (occurring d/r luteal phase aka 1-2 wks prior to menses…resolve during follicular phase aka onset of menses):
- Physical: bloating, fatigue, HA, hot flashes, breast tenderness
- Behavioral: anxiety, irritability, mood swings, dec interest
Evaluation: symptom/menstrual diary
Treatment: SSRI
Rheumatic mitral stenosis
- insidious progressive disease
- physiologic and hemodynamic changes during pregnancy can precipitate symptoms in previously asymptomatic its
- development of new fib can further increase transmitral gradient and LA pressure with dramatic worsening of pulmonary congestion and pulmonary edema
ovarian ca risk after menopause
INCREASES
- an ovarian mass in postmenopausal pt is highly concerning for malignancy
- investigation by pelvic US and CA-125 measurement is necessary
- even if the mass has no malignant features on US an elevated CA-125 is concerning, requires further imaging and possible surgical exploration
placenta previa
RF: prior pp, prior cs, multiple gestation
CF: painless vaginal bleeding for >20wk gestation
diagnosis: transabdo followed by transvaginal sonogram
management: no intercourse, no digital cervical examination, input admission for bleeding episodes
neonatal thyrotoxicosis
pathophys:
- transplacental passage of maternal anti-TSH R Ab
- Ab bind to infants TSH R and cause excessive thyroid hormone release
CF:
- warm, moist skin; tachy
- poor feeding, irritability, poor weight gain
- low birth weight or preterm birth
diagnosis: maternal anti-TSH R Ab >500% nml
tx: self resolves within three months (disappearance of maternal Ab); methimazole PLUS beta blocker
endometriosis
- can have pelvic pain and/or infertility or be completely asymptomatic
- tx: saids, ocp, progesterone IUD, leuprolide
lactational amenorrhea
- result of high levels of prolactin which has inhibitory effect on the production of the hypothalamic gonadotropin-releasing hormone (GnRH)
- pulsatile GnRH release from hypothalamus is necessary for the production and release of LH and FSH by the ant pit
- LH and FSH stimulate the ovary to induce ovulation
- by inhibiting GnRH (and thus l and f) prolactin prevents ovulation and menstruation
- because lactation suppresses ovulation it is a natural form of contraception for the first six months postpartum is om is exclusively breastfeeding
Bartholin cysts
- soft, mobile, contender masses
- located at the base of the labia major
- symptomatic cysts require incision and drainage, followed by Word catheter placement
