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OB/GYN > UWorld 6+ > Flashcards

UWorld 6+ Flashcards

1
Q

treatment for different types of urinary incontinence

A

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

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2
Q

delivery planning for a nonviable fetus

A

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

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3
Q

spontaneous abortion

A

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
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4
Q

complications of a spontaneous abortion

A
  • hemorrhage
  • retained products of conception
  • septic abortion
  • uterine perforation
  • intrauterine adhesions
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5
Q

RF for fetal macrosomia (weight >4kg)

A

maternal

  • advanced age
  • diabetes
  • excessive weight gain d/r pregnancy or pre-existing obesity
  • multiparity

fetal:

  • AA or Hispanic
  • male sex
  • post-term pregnancy
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6
Q

Erg-Duchenne palsy

A
  • 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

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7
Q 
cervical ionization (excision of intact transformation zone)
-cold knife vs LEEP
A

indications: CIN2 and 3 (RF: HPV and tobacco)

complications:

  • cervical stenosis
  • preterm birth
  • preterm premature rupture of membranes
  • 2T pregnancy loss
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8
Q

cervical stenosis

A
  • abnml stricture of cervical canal
  • may impede menstrual flow=secondary dysmenorrhea or amenorrhea
  • block sperm=infertility
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9
Q

uterine rupture RF

A
  • prior uterine surgery (cesarean, myomectomy)
  • induction of labor/prolonged labor
  • congenital uterine anomalies
  • fetal macrosomia
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10
Q

Uterine rupture CP and management

A

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

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11
Q

shoulder dystocia

A

-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.)
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12
Q

what can shoulder dystocia cause

A

ob emergency d/t r/o:

  • neonatal brachial plexus injury
  • clavicular and humeral fracture
  • if prolonged: hypoxic brain injury and death
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13
Q

rectovaginal fistula

A

-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

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14
Q

ovarian ca

A
  • 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
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15
Q

granulosa cell tumor

A

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)

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16
Q

granulosa cells

A

convert T to estradiol (via aromatase) and secrete inhibit (which inhibits FSH)

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17
Q

labs for hyperemsis gravidarum

A

ketonuria
hypochloremic metabolic alkalosis
hypokalemia
hemoconcentration

18
Q

SLE nephritis in pregnancy CP and Labs

A

CP: edema, malar rash, arthritis, hematuria
labs: nephritic range proteinuria, UA w/ RBC and WBC casts, dec complement, inc ANA titers

19
Q

SLE nephritis in pregnancy diagnosis and ob complications

A

diagnosis: renal bx

ob complications:

  • preterm birth
  • cesarean
  • preeclampsia
  • fetal growth restriction
  • fetal demise
20
Q

engorgement

A
  • 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
21
Q

breast abscess from untreated mastitis

A
  • 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
22
Q

menopause (absent menses for 12 mo)

A

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

23
Q

gestational DM

A

target bg levels:

  • fasting <95
  • 1 hr postprandial <140
  • 2hr pp <120

tx: 1. dietary modifications 2. insulin, metformin

24
Q

mammary paget disease

A
  • painful, itchy, eczematous, and/or ulcerating rash on the nipple that spread to the areola
  • majority of its have underlying breast adenocarcinoma
25
Q

epidural anesthesia

A
  • se: hypoTN in 10% of patients

- hypotension is caused by blood redistribution to the LE and venous pooling from sympathetic blockade

26
Q

routine prenatal labs at initial visit

A 
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
27
Q

24-28wks lab tests

A
  • Hgb/HCt
  • Ab screen in Rh (D) negative
  • 50g 1hr GCT (for gestational DM)
28
Q

RF for lactational mastitis

A

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

29
Q

placenta accreta

A
  • 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
30
Q

syphilis in pregnancy

A

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

31
Q

fetal effects of syphilis in pregnancy

A
  • hepatic (hepatomegaly, jaundice)
  • heme (hemolytic anemia, dec platelets)
  • MSK (long bone abnormalities)
  • FTT
32
Q

Hep C in pregnancy potential complications and maternal management

A

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
33
Q

prevention of vertical transmission of Hep B

A
  • 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)
34
Q

postpartum period

A

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
35
Q

PMS/PMDD

A

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

36
Q

Rheumatic mitral stenosis

A
  • 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
37
Q

ovarian ca risk after menopause

A

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
38
Q

placenta previa

A

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

39
Q

neonatal thyrotoxicosis

A

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

40
Q

endometriosis

A
  • can have pelvic pain and/or infertility or be completely asymptomatic
  • tx: saids, ocp, progesterone IUD, leuprolide
41
Q

lactational amenorrhea

A
  • 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
42
Q

Bartholin cysts

A
  • soft, mobile, contender masses
  • located at the base of the labia major
  • symptomatic cysts require incision and drainage, followed by Word catheter placement

OB/GYN (7 decks)

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