UWorld 7 Flashcards
magnesium toxicity
CF:
mild-nausea, flushing, HA, hyporeflexia
moderate: areflexia, hypocalcemia, somnolence
severe: respiratory paralysis, cardiac arrest
Tx: stop mag therapy, give iv calcium gluconate bolus
endometrial hyperplasia/cancer
RF: xs estrogen
-obesity, chronic an ovulation/PCOS, nulliparity, early menarche/late menopause, tamoxifen
CF: heavy, prolonged, inter menstrual and/or postmenopausal bleeding
eval: endometrial bx (gold standard) or pelvis US (postmenopausal women)
tx: hyperplasia: protesting therapy or hysterectomy; ca: straight to hysterectomy
pseudocyesis
- condition in which non psychotic woman presents with s/s of early pregnancy (amenorrhea, morning sickness, abode dissension, breast enlargement) and the belief that she is preggo
- eval excludes pregnancy
pregnancy and exercise
absolute contraindications:
- amniotic fluid leak
- cervical incompetence
- multiple gestation
- placenta abruption or previa
- premature labor
- preeclampsia/gestational HTN
- severe heart or lung dz
unsafe activities:
- contact sports
- high fat risk
- scuba diving
- hot yoga
Anti-D ig
- should be administered to any Rh D-negative mother who delivers an Rh D-positive baby (given at 28wks gestation and within 72hrs of delivery)
- standard dose is usually adequate at 28wks gestation
- after delivery or procedures, Kleihauer-Betke test is used to determine whether a higher dose is needed d/t the inc r/o fetal blood cells entering the maternal circulation
inflammatory breast carcinoma
CP: rapid-onset edematous cutaneous thickening with peau d’orange appearance (superficial dimpling, fine pitting)
- affected breast is edematous, erythematous, painful
- may also havee palpable breast mass and nipple changes
common: axillary LAD (=mets)
absolute contraindications to combined hormonal contraceptives
- migraine with aura
- > 15 cigs/day PLUS age>35
- HTM: >160/110
- heart disease
- DM with end-organ damage
- h/o thromboembolic dz
- antiphospholipid-Ab syndrome
- h/o stroke
- breast cancer
- cirrhosis and liver cancer
- major sx with prolonged immobilization
- use <3weeks postpartum
PCOS CF and pathophys
CF:
- androgen xs (acne, male pattern baldness, hirsutism)
- oligoovulation or an ovulation (menstrual irregularities)
- obesity
- polycystic ovaries on US
pathophys:
- INC T and E levels
- LH/FSH imbalance
PCOS comorbidities and tx
comorbidities:
- metabolic syndrome (diabetes, HTN)
- OSA
- NASH
- endometrial hyperplasia/cancer
tx options:
- weight loss (first line)
- OCP for menstrual regulation
- clomiphene citrate for ovulation induction
side effects and risks of combination oral contraceptives
- breakthrough bleeding
- breast tenderness, nausea, bloating
- amenorrhea
- HTN
- VTE dz
- dec r/o ovarian and endometrial ca
- inc r/o cervical ca
- liver d/o (hepatic adenoma)
- inc TG (d/t estrogen component)
acute cervicitis
cp: postcoital bleeding, mucopurulent d/c, friable cervix
- empiric tx: azithro and ceftriaxone for G/C (m/c pathogens)
oxytocin
indications: induction or augmentation of labor; prevention and management of PPH
se: hyponatremia, hypoTN, tachysystole
inactivated influenza vaccine
-safe in every trimester and d/r breastfeeding
postpartum endometritis
RF:
- cesarean
- chorioamnonitis
- GBS colonization
- PROM
- operative vaginal delivery
CF:
- fever >24hr postpartum
- uterine fundal tenderness
- purulent loch
etiology: polymicrobial infection
tx: clinda and gent
maternal serum-AFP
INC MSAFP: open NTD (anencephaly, open spina bifida); ventral wall defects (omphalocele, gastrochisis); multiple gestation
DEC MSAFP: aneuploidies (trisomy 18 and 21)
external cephalic version
procedure:
- manual rotation of fetus to cephalic presentation
- decreases cesarean delivery rate
indications: breech/transverse presentation; >37wk gestation
absolute contraindications=contraindications to vaginal delivery
- prior classical cesarean
- prior extensive uterine myomectomy
- placenta previa
complications: abrupt placentae, intrauterine fetal demise
amniotic fluid embolism
RF:
- advanced maternal age
- gravida >5 (live births or stillbirths)
- cesarean or instrumental delivery
- placenta previa or abruption
- preeclampsia
CP:
- cardiogenic shock
- hypoxemic rest failure
- SIC
- coma or seizures
tx: respiratory and hemodynamic support; +/- transfusion
false labor versus latent labor
false: timing-irregular, infrequent strength-weak pain-none to mild cervical change-no
latent: timing-regular, inc frequency strength-increasing intensity pain-yes cervical change-yes
different types of labor
- false labor: mild, irregular contractions that cause no cervical change (Braxton Hicks contractions)
- latent labor: regular contractions with increasing frequency and intensity that cause gradual cervical change
- labor: regular, painful uterine contractions that cause cervical change (dilation, effacement)
hCG
- secreted by syncytiotrophoblast
- mainly responsible for preservation of corpus lute in early pregnancy in order to maintain progesterone secretion until the placenta is able to make pro on its own
-hcg production starts 8d after fertilization, dbl every 48hr until they peak 6-8weeks gestation
Preventing neonatal GBS infection
universal screening: rectovaginal culture at 35-37 weeks gestation
indications:
- prior delivery complicated by neonatal GBS infection
- GBS bacteriuria or GBS UTI d/r current pregnancy (regardless of tx)
- GBS-positive rectovaginal culture
- unknown GBS status PLUS any of the following:
- -<37 week gestation
- -intrapartum fever
- -rupture of amniotic membranes for >18h
pix: first line tx-Penicillin
maternal thyroid testing in pregnancy, first trimester
- total T4 inc and free T4 unchanged or mildly increased
- -mech: beta-hCG stimulates thyroid hormone production in 1T; estrogen stimulates TBG; thyroid inc hormone production to maintain steady free T4 levels
-TSH dec; inc beta-hCG and thyroid hormone suppress TSH secretion
Choriocarcinoma
RF: advanced maternal age, prior complete hydatidiform mole
CP:
- amenorrhea or abnml uterine bleeding
- pelvic pain/pressure
- s/s from mets (lung, vagina)
- uterine mass
- elevated beta-hCG level
tx: chemo
depot medroxyrogesterone acetate (DMPA)
- IM every 3 months to prevent preggo by inhibiting the release of gonadotropin-releasing hormone from the hypothal and surpassing ovulation
- causes menstrual irregularities such as prolonged bleeding and/or spotting espies during first 6 months of use
- 50% of women have amenorrhea after one year of use
functional hypothalamic amenorrhea
- demonstrate s/s of hypoestrogenemia (infertility, breast atrophy)
- decreased bone mineral density d/t low estrogen levels offsetting the bone-building effects of exercise
ovarian torsion and dermoid cysts
- ot is a dangeroud complication of dc
- cp: acute-onset unlit lower abode pain that occurs d/t necrosis of the ovary from ischemia with lack of circulation
