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OB/GYN > UWorld 7 > Flashcards

UWorld 7 Flashcards

1
Q

magnesium toxicity

A

CF:
mild-nausea, flushing, HA, hyporeflexia
moderate: areflexia, hypocalcemia, somnolence
severe: respiratory paralysis, cardiac arrest

Tx: stop mag therapy, give iv calcium gluconate bolus

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2
Q

endometrial hyperplasia/cancer

A

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

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3
Q

pseudocyesis

A
  • 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
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4
Q

pregnancy and exercise

A

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
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5
Q

Anti-D ig

A
  • 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
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6
Q

inflammatory breast carcinoma

A

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)
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7
Q

absolute contraindications to combined hormonal contraceptives

A
  • 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
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8
Q

PCOS CF and pathophys

A

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
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9
Q

PCOS comorbidities and tx

A

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
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10
Q

side effects and risks of combination oral contraceptives

A
  • 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)
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11
Q

acute cervicitis

A

cp: postcoital bleeding, mucopurulent d/c, friable cervix

- empiric tx: azithro and ceftriaxone for G/C (m/c pathogens)

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12
Q

oxytocin

A

indications: induction or augmentation of labor; prevention and management of PPH
se: hyponatremia, hypoTN, tachysystole

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13
Q

inactivated influenza vaccine

A

-safe in every trimester and d/r breastfeeding

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14
Q

postpartum endometritis

A

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

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15
Q

maternal serum-AFP

A

INC MSAFP: open NTD (anencephaly, open spina bifida); ventral wall defects (omphalocele, gastrochisis); multiple gestation

DEC MSAFP: aneuploidies (trisomy 18 and 21)

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16
Q

external cephalic version

A

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

17
Q

amniotic fluid embolism

A

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

18
Q

false labor versus latent labor

A 
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
19
Q

different types of labor

A
  • 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)
20
Q

hCG

A
  • 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

21
Q

Preventing neonatal GBS infection

A

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

22
Q

maternal thyroid testing in pregnancy, first trimester

A
  • 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

23
Q

Choriocarcinoma

A

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

24
Q

depot medroxyrogesterone acetate (DMPA)

A
  • 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
25
Q

functional hypothalamic amenorrhea

A
  • demonstrate s/s of hypoestrogenemia (infertility, breast atrophy)
  • decreased bone mineral density d/t low estrogen levels offsetting the bone-building effects of exercise
26
Q

ovarian torsion and dermoid cysts

A
  • 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

OB/GYN (7 decks)

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