UWorld Flashcards
Tamoxifen and Raloxifen have what adverse effects?
- both may induce hot flushes and increase the risk of venous thromboembolism
- tamoxifen increases the risk of endometrial hyperplasia and carcinoma
What is the primary contraindication for Raloxifen?
history of venous thromboembolism
What is the primary risk factor for magnesium toxicity during pregnancy?
renal insufficiency
What descriptors are used to describe a mass secondary to fat necrosis in the breast?
firm and irregular, often with overlying skin or nipple retraction
What features of a breast mass are consistent with a fibroadenoma? What features are consistent with fibrocystic changes? How can the two be distinguished?
- fibroadenoma: a solitary, well-circumscribed, mobile mass with cyclic premenstrual tenderness
- fibrocystic change: multiple, diffuse nodulocystic masses with cyclic premenstrual tenderness
- fibroadenomas peak in incidence before age 30 and fibrocystic change peaks after age 30
Describe the appearance of a TOA on ultrasound along with it’s clinical presentation.
a complex, multilocular mass involving the tube and ovary, often in the setting of leukocytosis and fever
Describe the appearance of a mature teratoma on ultrasound.
- hyperechoic nodules and calcifications
- they may have solid components but rarely have septations
When should suppressive antivirals be started in pregnant patients with known HSV-2?
at 36 weeks
What is the first line therapy for premenstrual syndrome?
SSRIs
Describe oxytocin toxicity, including the pathogenesis and clinical features.
- oxytocin is analogous to ADH and high doses can result in water retention and a dilutional hyponatremia
- hyponatremia can then present as headaches, abdominal pain, n/v, lethargy, and tonic-clonic seizures
What treatment options are available for genital warts (condyloma acuminata)?
- podophyllin resin or trichloroacetic acid
- imiquimod
- cryotherapy, laser ablation, or excision
What is the treatment for BV, trichomoniasis, and vaginal candidiasis?
- BV: metronidazole or clindamycin
- trichomoniasis: metronidazole
- candidiasis: fluconazole
Which causes of vaginitis are associated with changes in pH and which are associated with inflammation?
- BV and trichomoniasis are associated with a rise in vaginal pH
- tichomoniasis and candida are associated with inflammation
Name two vaccines that are recommended during pregnancy.
Tdap and inactivated influenza
Name four vaccines that are contraindicated during pregnancy.
MMR, varicella, live attenuated influenza, HPV
What is the difference between symmetric and asymmetric IUGR?
- asymmetric is that which spares the head; it is typically the result of placental insufficiency or maternal malnutrition
- symmetric is more often caused by chromosomal abnormalities and congenital infections
How can uterine rupture be differentiated from placental abruption in clinical presentation?
both present with pain, bleeding, and fetal heart rate tracing abnormalities
- abruption often has low-amplitude, frequent contractions
- rupture is usually defined by diminishing contractions
How does diminished ovarian reserve impact fertility?
with age the quantity and quality of oocytes diminishes, so even though menstruation is normal, the woman’s fecundability (conception rate) is often lower
List severe features of pre-eclampsia.
- blood pressure greater than 160/110
- pulmonary edema
- elevated creatinine or liver enzymes
- thrombocytopenia
- CNS symptoms like headache or visual disturbances
At what point should patients with pre-eclampsia deliver?
as soon as they are no longer considered stable; otherwise, 34 weeks with severe features and 37 weeks without severe features
What is the mechanism of action of hydralazine? What is the mechanism of action of labetalol?
- hydralazine is a vasodilator
- labetalol is a beta blocker with alpha blocker activity as well
What is believed to cause HELLP?
abnormal placentation, inducing systemic inflammation and thereby activating the complement system and coagulation cascade
What are the obstetric complications associated with post-term delivery?
- fetal: macrosomia, oligohydramnios, dysmaturity, and demise
- maternal: severe obstetric laceration, c/s, postpartum hemorrhage
What is the preferred treatment for confirmed Chlamydial infection?
azithromycin alone
What would be an indication for suction curettage in a patient with an inevitable abortion?
patient preference or hemodynamic instability
When should the HPV vaccine no longer be offered?
- age 26 for women
- age 21 for men unless they are men who have sex with men or who have HIV
When should RhoGam be given during pregnancy?
at 28 weeks and then again within 3 days of delivery if the baby is found to be Rh+
Describe the typical presentation of a vaginal squamous cell carcinoma.
- most often seen in women over 60
- often have a history of smoking, in utero DES exposure, or HPV exposure
- presents with vaginal bleeding and/or malodorous vaginal
- visualized as an irregular vaginal lesion, typically a plaque or ulcer in the upper third of the posterior vagina
How is vaginal intraepithelial neoplasia treated?
wide local excision or topical therapy
Where are the bartholin glands of the vagina?
in the posterior wall of the introitus, draining into the 4 and 8 o’clock positions
Name three conditions associated with an elevated msAFP.
- ventral wall defects like gastroschisis or omphalocele
- multiple gestations
- neutral tube defects
What is carboprost?
a synthetic prostaglandin and uterotonic that is contraindicated in patients with asthma because it may cause bronchoconstriction
Methylergonovine is contraindicated in what group of patients suffering uterine atony?
those with a history of hypertension
What is a Gartner duct cyst and where can it be located?
it is a cyst that results from incomplete regression of the Wolffian duct during fetal development, and it can be found on the lateral aspect of the upper anterior vagina
How are Bartholin cysts treated?
- if asymptomatic, treat with observation
- if symptomatic, incise and drain the cyst and place a word catheter to prevent recurrence
What are the cutoffs for 3-hour glucose tolerance testing during pregnancy?
- 95 fasting
- 180 at 1 hour
- 155 at 2 hour
- 140 at 3 hour
Apart from their size, describe neonates who suffered from IUGR while in utero.
they typically have loose skin, a thin umbilical cord, and an enlarged anterior fontanelle
How is IUGR evaluated in the postpartum period?
- the placenta should be sent to histopathology
- a urine toxicology screen and serology for applicable TORCH infections should be performed
- if there are suggestive traits, a karyotype should also be performed
Describe three contributors to normal low back pain during pregnancy?
- an enlarged uterus exaggerates lordosis
- progesterone and relaxin-induced laxity of joints and ligaments
- weak abdominal muscle lend less lumbar support
Describe benign back pain associated with pregnancy.
it is usually described as radiating down the legs in addition to being exacerbated by use and relieved by rest
What are the two most accurate means of dating a pregnancy?
- crown rump length during the first trimester is most reliable
- gestational sac diameter during the first trimester is second most
Who should receive an endometrial biopsy for abnormal uterine bleeding?
- those over 35 with a Pap finding fo AGC
- those less than 45 with AUB plus either an unopposed estrogen source, failed medical management, or lynch syndrome
- those over 45
What role does diazepam play in the treatment of eclampsia?
it is a second line agent, used only when magnesium sulfate is unable to control seizure activity
What is required to achieve a perfect score on BPP?
- a reactive fetal heart rate tracing
- amniotic fluid pocket measuring more than 2x1 or an AFI of greater than 5
- at least 3 general body movements
- at least 1 episode of flexion/extension
- at least 1 episode of breathing for at least thirty seconds
A BPP is used to exclude what?
fetal hypoxemia, a poor score is suggestive of chronic hypoxemia and an imminent risk of fetal demise
Describe the risk factors and appearance of a rectovaginal fistula.
- risk factors include a 3rd or 4th degree laceration, inadequate wound repair, or infection
- seen as dark red, velvety rectal mucosa on the posterior vaginal wall
How should uterine inversion be managed?
- replace the uterus first
- remove the placenta if still attached
- then administer fluids and uterotonics
What change is expect in the prolactin, FSH, and LH levels in a woman with a prolactinoma?
- elevated prolactin
- decreased FSH and LH
How is HIV+ pregnancy managed in the intrapartum period?
- avoid AROM, scalp electrodes, operative vaginal delivery
- ART + vaginal delivery if viral load < 1000
- ART + zidovudine + c/s if viral load > 1000
How is HIV+ pregnancy managed in the postpartum period?
- continue mother on ART
- start baby on zidovudine if maternal viral load < 1000
- start baby on multi-drug ART if maternal viral load > 1000
Asymptomatic bacteriuria is a risk factor for what obstetric complications?
acute pyelonephritis, low birth weight, and preterm delivery
Why is epidural-induced hypotension problematic during labor? How is it treated?
- it can lead to poor uterine profusion and fetal acidemia
- treat with IV fluids, pressors, and left lateral positioning to improve venous return
Pre-eclampsia is a risk factor for what neonatal and maternal problems?
- chronic placental insufficiency leading to IUGR and low birth weight
- abruption with maternal hemorrhage, DIC, or eclampsia
What are the first and second line therapies for cord compression?
- maternal repositioning
- amnioinfusion
Describe the typical presentation of adenomyosis.
- dysmenorrhea with heavy menstrual bleeding beginning later in the reproductive years with progression to chronic pelvic pain
- the uterus is typically soft/boggy, tender to palpation, and uniformly enlarged
Describe the typical presentation of a uterine rupture.
- patients almost always have a history of c-section
- presents with intense, abrupt, localized pain, relieved by the rupture but then returns in a more diffuse pattern
- often the fetal station regresses
How is hyperemesis gravidarum differentiated from normal n/v of pregnancy?
those with hyperemesis gravidarum typically have a risk factor associated with elevated B-hCG, weight loss from prepregnancy weight, and urinary ketones
In which population is CA-125 a more specific marker for epithelial ovarian cancer and why?
in postmenopausal women because the other things that may elevate CA-125 are more common in premenopausal women
What are the two most important modifiable risk factors for breast cancer?
- alcohol consumption
- use of hormone replacement therapy
Describe each of the following types of abortion:
- threatened
- inevitable
- incomplete
- threatened: closed cervix, vaginal bleeding, continued fetal cardiac activity
- inevitable: open cervix, vaginal bleeding, products of conception noted in the lower uterine segment
- incomplete: open cervix, vaginal bleeding, some products of conception expelled and some still retained
What are the risks associated with using cOCPs?
- venous thromboembolism
- stroke or MI
- cervical cancer risk
- hepatic adenoma
- hypertension
How does an amniotic fluid embolus present?
with cariogenic shock, hypoxemic respiratory failure, DIC, and seizures or coma
Paget’s disease of the nipple is almost always associated with what other condition?
adenocarcinoma
What action should be taken based on BPP score?
- 0-4: urgent delivery
- 6: repeat in 24 hours
- 8-10: rules out hypoxia
