Uworld OB Flashcards
should HIV positive use combination antiretrovirals in pregnancy
yes. immediately
what are the causes of fetal growth restriction if it is symmetric and in the first trimester
chromosomal abnormalities or congenital infection
global growth lag
what are the causes of fetal growth restriction if it is asymmetric and in the 2nd or 3rd trimester
uteroplacental insufficiency or maternal malnutrition
this is usually head sparing growth lag
very common cause is maternal hypertension
what is the management for intrauterine fetal demise between 20-23 weeks
dilation and evacuation
what is the management for intrauterine fetal demise between >24 weeks
vaginal delivery
what does gyn surgery put the patient at risk for
ureter damage due to close proximity f
what is a potential SE of bupivicaine epidural
systemic toxicity and seizrue
uterine procidentia is what and treated how
when the uterus prolaspes through the vagina. treated with pessary fitting and surgery
what is leiomyata uteri
uterine fibroids.
what is the presentation of uterine fibroids
heavy flow, globular mass in the abdomen and failure to conceive
what is pseudothrombocytopenia
a lab error
what is the presnetation of glanzman thrombocytopenia
bleeding due to platelet aggregation
what is a good test for risk of preterm labor
transvaginal ultrasound for cervical length
what is fetal fibronectin
fetaql fibronectin is a test for preterm labor, but after 20 weeks gestation
risks of preterm labor
previous preterm labor, multiple gestations, history of cervical surgery,
does colposcopy risk preterm labor
yes. cervical incompetence
if there is a risk for preterm labor what is given to ward off preterm labor
progesterone injections
if a mother is Rh negative and Coombs test is negative is baby at risk for hydrops
no. indirect test is negative.
what does tamoxifen put the patient at greatest risk of
hot flashes, venous thromboembolism and endometrial hyperplasia/carcinoma (this is tamoxifen only)
chancroid
H. ducreyi. multiple deep ulcers with yellow exudate, lesion is painful
granuloma inguinale
klebsiella granulomatis, extensive and progressive lesion without lymphadenopathy. base has granulation tissue. painless lesion
lymphogranuloma venerum
chlamydia. small and shallow ulcers. large and painful inguinal lymph nodes. not painful lesion to begin
syphillis
single ulcer, not painful, swollen inguinal nodes, clean base, single indurated well-circumscribed ulcer
what to do if clinically patient has syphillis but the blood tests are negative
empirically treat. syphillis tests have a high false negative rate
what are some other features of hypothyroidism
hyponatremia and high cholesterol
what is postpartum hypothyroidism
effects 7-8% of women within the first 6 months. brief phase of hyperthyroidism due to release of preformed hormone
what is the management of placenta previa
C section is indicated after 36-37 weeks
even with minimal bleeding and stable vital signs
what are the causes of 2nd and third trimester oligohydramnios
uteroplacental insufficiency (with fetal growth restriction), or maternal dehydration, or rupture of membranes (normal fetal growth).
what nerves are involved in erb-duchene palsy
treatment
weakness of the deltoid and infraspinatus C5, biceps C6 and wrist and finger extensors C7. this is waiters tip hand
observation. most recover in 3 months
when can preeclampsia begin
fgreater than 20 weeks
what is the presentation of vulvar lichen planus
women 50-60, vulvar pain or pruritus, dyspareunia; if erosive patten then will present with oral lesions erosive glazed lesions with white border
what is the treatment for vulvar lichen planus
high dose corticosteroids
what do the oral lesions in lichen planus look like
lace like reticular lesions
what is the managment for someone with CIN3
if not pregnant then LEEP/cold knife conization/cryablation
PAP with HPV cotest 1 and 2 years postprocedure
what polyhydramnios complications
PPROM (more susceptible to rupture), preterm labor, umbilical cord collapse, fetal malposition
what are the causes of polyhydramnios
esophageal/duodenal atresia, diabetes, congenital infection, anencephaly, multiple gestation
when do we test for GBS
35-37 weeks
what tests are required at initial and 3rd trimester if <25 and high risk STI (prior STI/sex worker)
HIV, Syphillis, Hep B, gonorrhea, chlamydia
are OCPs associated with HTN
yes. they are actually recommended against in women with HTN
def of oligohydramnios
single pocket less than 2cm or AFI ≤ 5
what is placental insufficiency on BPP scoring
0-4/10. also could indicate hypoxia
what are the risk factors for placental insufficiency
advanced maternal age, tobacco use, hypertension, diabetes
what are the best steps to reduce vertical transmission of HIV
C section if viral load > 1000, zidovudine intrapartem, and continuation of daily antiretroviral regimen
is weight gain associated with OCPs
no. several studies have shown no gain especially in low dose formulations
what is aromatase def
normal internal anatomy, some external virilization such as clitoralmegaly, with undetectable estrogen levels and elevated testosterone. there will be high LH and FSH, ovarian cysts
what is the presentation of CAH
ambiguous genitalia and normal internal organs. they will have hyponatremia
why do androgen insensitive patients have breasts
because there is high testerosterone which is aromatized into estrogen which only effects the breast tissue
do you repeat a urine culture after treatment in pregnancy
yes. because it is hard to know the difference between the normal pregnancy symptoms and urinary tract symptoms. there is an increased risk for pyelonephritis and 1/3 patients do not resolve after treatment
management of shoulder dystocia
BE CALM breathe (do no push) elevate legs and flex hips against abdomen (McRoberts) CALL FOR HELP Apply suprapubic pressure enLarge Vaginal opening with episiotomy Manuveurs
what is the presentation of listeriosis in an immunocompetent host
febrile gastroenteritis
what is the most likely cause of painless bleeding in pregnancy
placenta previa or vasa previa
what is used for preeclampsia prevention
low dose aspirin at > 12 weeks gestation
what is the management of late decels
positioning and o2.
C-section
what is the etiology of late decelerations
placental insufficiency
when do you use amnioinfusion
when there is variable decelerations. because this may relieve umbilical cord compression
what does DES exposure in utero puts the patient at risk for
clear cell vagianl carcinoma
its clear what DES does
Can menopause change the vaginal pH
yes. can increase the pH.
how is the diagnosis of menopause made
clinical manifestations and increased FSH
what is the most common cause of active phase protraction
cephalopelvic disproportion
what is the management of uterine bleeding after labor
bimanual uterine massage, high dose oxytocin and tranexamic acid, then second line uterotonics such as carboprost tromethamine
what is the best indicator of uterine rupture
loss of fetal station
what does chemotherapy do to female hormone axis
it causes primary ovarian failure with decreased estrogen and high FSH LH
what do prolactin levels do in primary ovarian failure
nothing. normal
what is the treatment for lichen sclerosis
topical corticosteroids
what is the presentation of lichen sclerosis
thin white wrinkled skin over the labia with atrophic changes, excoriations erosions, fissures, and severe pruritus. dysuria, dyspareunia, painful defecation. punch biopsy to exclude malignancy
what is the management for PPROM
if there are no complications expectant management with latency antibiotics corticosteroids and fetal surveillance..
what latency antibiotics are given for PPROM
azithromycin and amipicilliin
def of gestational hypertension
new onset at greater than 20 weeks gestation
what are the risks of hypertension in pregnancy to the mothewr
superimposed preeclampsia. hemorrhage, gestational diabetes, C section, placental abruption
what risks does hypertension pose to the baby
fetal growth restriction, perinatal mortality, preterm delivery, oligohydramnios
what does an elevated AFP usually indicate for pregnancy
open neural tube defects, ventral wall defects, multiple gestations
what does a decreased AFP usually indicate
aneuploidy 18 or 21
what is the Down syndrome profile for prescreen
low AFP and estriol, increased beta-HCG and inhibin A
Are you DOWN with AFP, yeah you know E (estrogen). increased inhibin A
how can you tell the difference between vaginismus and another organic cause of pelvic pain
inserting the speculum will hurt vaginismus
urethral diverticulum
out pouching of the urethral mucosa that when pressed causes expression of bloody fluid from the meatus. can be palpated in the anterior vagina
what is the presentation of vasa previa
painless vaginal bleeding with ROM or contractions. fetal heart rate abnormalities, fetal exsanguination and demise
what is a culdocentesis
fluid removal from the pouch of douglas
boggy, tender, symmetrically enlarged uterus with painful menstruation. vitals normal
adenomyosis
what is the presentation of acute fatty liver
fulminant liver failure, epigastric/RUQ pain, scleral ictrerus/jaunice, DIC with hemolytic anemia and thrombocytopenia,
what is the management of acute fatty liver
immediate delivery regardless of gestational age
what are the indications to treat endometriosis
pelvic pain, dysmenorrhea worse throughout menses and not relieved by NSAIDs, dyspareunia, infertility
what are the unsafe exercise practices for pregnancy
hot yoga, fall risk, contact sports and scuba diving
what is the management of placenta previa
no iuntercouse, no digital cervical exam and inpatient admissions for bleeding episodes
what is the most common risk factor for placental abruption
hypertension
what are the findings of hyperandrogenism
hirsutism, nodulocystic acne, androgenic alopecia, increased testosterone.
what is the differential for hyperenadrogenism
PCOS, androgen secreting tumor, cushing, nonclassical CAH
what is the treatment for baratholin gland cyst
expectant management; if they are symptomatic cysts or abscesses then draining them is appropriate
what is the presentation of round ligament pain
sharp pain that radiates to the groin
what do women with SCD have more of in pregnancy
pain crises
when is a circlage placed fro cervical insufficiency
during the first trimester
what is klumke palsy
claw hand: brachial plexus injury that results in C8 and T1 nerve damage with a claw hand and horners syndrome
extended wrist, hyperextended metacarpophalengeal joints, flexed interphalangeal joints, absent grasp reflex
what is erb-duchenne
waiters tip hand:
extended elbow, pronated forearm, flexed wrist and fingers. intact grasp reflex
what is short inter pregnancy interval
less than 18 months between children
what are the risks of short interpregnancy interval
low birth weight, anemia, PPROM, preterm delivery
what are the risks of SCD to the baby
fetal growth restriction, oligohydramnios, preterm birth
do copper containing IUD cause amenorrhea
no. they usually increase flow
do we screen for hep C
no. unless high risk
do we perform wet mount testing during pregnancy
not unless indicateds
when do we screen for diabetes
24-28 weeks; unless high risk
what type of tumor in a young girl causes increased bone age and percocious puberty
granuloma cell tumor
how long do medroxyprogesterone shots last for
DEPO lasts for three months
what are the SE for DEPO
amenorrhea, weight gain, fatigue, nausea, breast tenderness. they typically last throughout usage and will not go away
do we give NSAIDs in pregnancy
generally avoided in the 1st and 3rd trimesters
how is back pain managed in pregnancy
conservatively. massage, heating pads, exercise, behavioral modification
what is pubic symphysis diaphysis
difficulty ambulating, radiating suprapubic pain, pubic symphysis pain, intact neurological exam.
what are the risk factor for pubic sym diaphysis
fetal macrosomia, multiparty, precipitous labor, operative delivery
pubic symphysis diaphysis treatment
conservative management. NSAIDs, physical therapy.
what are the risk factors for uterine sarcoma
tamoxifen, radiation, postmenopausal
can you use lamotrigine for bipolar in pregnancy
yes
what is the presentation of intrahepatic cholestasis of pregnancy
high bilirubin, pruritus, transaminitis
condyloma acuminata
this is HPV, usually caused by the low risk strains. 6, 11.
they are fleshy colored, verrucous nontender, friable and bleed on manipulation
condyloma lata
this is syphilis. these are raised grey white lesions they are smooth and have a broader base.
what is indicated for a late term pregnancy that is complicated by oligohydramnios
induction of labor
what is a common cause of magnesium toxicity
renal insufficiency
what are the symptoms of hypermagnesemia
nausea, flushing, headache, hyporeflexia, areflexia, hypocalcemia, somnolence, respiratory paralysis, cardiac arrest
what is the treatment for toxic shock syndrome
vancomycin and clindamycin. Vanco provides coverage of the bacterial while clindamycin is highly effective at reducing toxin production
what cells cause fibroids
smooth muscle cells in the myometrium
lichen sclerosis management
biopsy first and if benign then topical steroids
what is the etiology of HELLP
thought to be systemic inflammation
cure for HELLP
delivery
what does elevated testosterone with normal DHEAS indicate
ovarian source of tumor
most likely a sertoli leydig
what is the typical presentation of CAH
infancy. salt wasting crises
what is rapid onset virilization with constitutional symptoms of weight loss with elevated DHEAS
adrenal tumor
what is the best next step after maternal sensation of reduced fetal movement
NST.
what is a hysterosalpingogram
a study to look at the anatomy of the Fallopian tubes and the uterus for the purposes of infertility
which vaccines are recommended in pregnancy
Tdap, inactivated influenza, RhoD immunoglobulin.
which vaccines are contraindicated in pregnancy
varicella, live flu, MMR, HPV
which vaccines are indicated for high risk pregnancy
hep A, B, C, pneumococcus, H flu, minigococcus, varicella zoster immunoglobulin
clinical features of sheehan
lactation failure, amenorrhea, vaginal atrophy, fatigue, bradycardia, anorexia, weight loss, hypotension, decreased lean body mass
does malnutrition effect the quality or quantity of breast milk
not usually
what are the risk factors for vulvovaginal candidiasis
DM, immunosuppression, pregnancy, OCPs, antibiotic use
what is the presentation of candidiasis
pseudohyphae and normal pH
what is the treatment for vulvocandida
fluconazole
what is the presentation of herpes simplex
round ulcerations or vesicles that are painful. mild lymphadenopathy.
what are the painful genital lesions
herpes or chancroid.
what is the presentation of chancroid
larger deep ulcers with gray/yellow exudate. well-demarcated border and soft friable tissue. severe lymphadenopathy that may be suppurative.
what are the painless genital lesions
syphillis and lymphogranuloma venereum (C. trachoma’s servars L1-3
what is the presentation of von willebrands
increased bleeding time. other parameters normal
what is a clue cell indicative of
bacterial vaginosis. the pH will be >4.5 with clue cells and a positive whiff test. thin off-white discharge with a fishy odor.
malodorous green and frothy discharge is indicative of what
this is trichomoniasis. this is green frothy, vaginal inflammation with pH >4.5. motile trichomonads
what is the treatment for bacterial vaginosis
metro or clindamycin.
what is the treatment for trichromatis
metro for patient and partner
what is the treatment for trichromatis
metro for patient and partner
what is the presentation of candida
vulvar and vaginal erythema/itching and discharge. pH 3.5-4.5
what is the management for a breech presentation pregnancy
contraindication to vaginal delivery
what is the presentation of acute fatty liver of preganncy
nausea, vomiting, abdominal pain, jaundice.
what is preeclampsia with severe features
Sup > 160 or DBP>110. thrombocytopenia, elevated creatinine or transaminases, pulmonary edema, visual or cerebral symptoms
what is the most appropriate med for BP control in a severely hypertensive pregnant patient
hydralazine
first line drugs for maternal hypertensive crisis are
hydralazine, labetalol, nifedipine
can you use estrogen containing OCPs in migraine
NO. risk of stroke
what birth control is easy, lasts up to three years and can reduce or cause amenorrhea
implantable. progestin releasing subdermal
