Uworld Ob/Gyn Flashcards
primary syphilis sx, dx
- painless ulcer (usually on genitalia) = chancre
- painless inguinal lymphadenopathy
- dx non-serologic: dark field microscopy (preferred in primary)
- dx serologic: FTS-ABS (treponemal; confirmation); RPR & VDRL (nontreponemal; screening)
- puerperal
- lochia
- postpartum
- vaginal discharge after giving birth; lasts 4-6 weeks
endometritis px, tx
- fever + uterine tenderness + foul-smelling lochia + leukocytosis
- broad spectrum abx for gram +/-, anaerobes, and aerobes (polymicrobial infection)
In eclampsia, what do you use if 2 doses of magnesium sulfate have not worked to control the seizures?
diazepam or phenytoin
drug of choice for preeclamptic hypertensive emergency?
- labetalol or hydralazine
- methyldopa used for general HTN; slower onset
- ultimately tx with delivery
reasons to do a C-section
- breech presentation
- fetal distress
- maternal hemodynamic instability
- history of c-sections
before performing a pelvic what must you rule out in a pregnant female presenting with vaginal bleeding?
placenta previa
-pelvic exam increases risk of separating the placenta from the uterus
placenta previa tx
- stable mom and baby at term
- stable mom and baby preterm
- scheduled c-section
- expectant management + close monitoring
pathologic vs physiologic vaginal discharge
- pruritus, burning, malodorous, green/ curd-like vaginal discharge, erythema, edema, friable
- copious white/yellow, non-malodorous = physiologic leukorrhea
Amsel Criteria
-need 3 of 4 to diagnose bacterial vaginosis
1) thin, gray-white vaginal discharge
2) pH>4.5
3) positive whiff test upon adding KOH to the vaginal discharge
4) clue cells = vaginal epithelial cells with adherent coccobacilli on wet mount
-tx: metronidazole
preeclampsia-eclampsia syndrome pathophysiology
abnormal placental vasculature development –> endothelial cell dysfunction or vasospasm
-delivery is the only definitive tx
metronidazole + alcohol intake –>
disulfiram-like reaction
-acetaldehyde accumulates in the blood stream –> flushing, n/v, hypotension
HELLP syndrome pathophysiology
abnormal placentation –>
systemic inflammation & activation of coagulation system –>
circulating plts are consumed & microangiopathic hemolytic anemia –>
hepatocellular necrosis –>
elevated liver enzymes, liver swelling, dissension of hepatic/Glisson’s capsule –> RUQ pain
when do you screen for GBS?
35-37 weeks
indications to tx for GBS with penicillin?
- GBS(+) swab
- hx of GBS bacteruria/ UTI
- prior birth to GBS(+) infant
- unknown GBS + maternal fever/ prolonged rupture of membranes/ <37 weeks
ovarian vs adnexal torsion
- which side is more common?
- causes?
twisting of the ovary vs ovary+Fallopian tube over the suspensory ligament of the ovary & utero-ovarian ligament
- more common on the right side
- ovarian enlargement (mass, tumor, pregnancy, infertility tx)
what is midcycle pain called? what causes it?
- mittleschmerz
- caused by ovulation
ovarian hyperstimulation syndrome
iatrogenic complication of ovulation-inducing drugs –> pain due to ovarian enlargement
+/- ascites, dyspnea, other systemic findings
cause of urge incontinence?
cause of stress incontinence?
- detrusor hyperactivity
- pelvic floor muscle weakness –> ineffective urethral sphincter control
ABO vs Rh incompatibility
- when it occurs
- what causes it
- what blood type moms it occurs in
- level of hemolytic disease of the newborn
- 1st vs 2nd pregnancy
- A&B antigens in food/environment vs Rh antigen from 1st pregnancy
- Group O vs Rh(-) moms
- low vs high
risk factors for placental abruption
- maternal HTN
- smoking
- cocaine use
marker for ovulatory reserve?
inhibin A
-decreases in older women
periods of amenorrhea indicate unopposed _______
estrogen
endometrial biopsy indications
abnormal bleeding +
- postmenopausal women/ 45+
- <45 with persistent sx
- unopposed estrogen exposure (obesity, PCOS)
- prolonged amenorrhea with anovulation
types of antiphospholipid antibodies?
effects in pregnancy? pathophys?
-lupus anticoagulant and anticardiolipin antibodies (in SLE)
- abortion
- thrombus development within the placenta
adenomyosis vs leiomyomas (uterine fibroids) on exam
-symmetrically enlarged, globular, and boggy; constipation, urinary frequency
routine vaccines during pregnancy
-special circumstances
- Tdap
- influenza vaccine (inactivated)
-HBV, HAV, pneumococcus, h flu, meningococcus, Rhogam
vaccines to avoid in pregnancy
- HPV
- MMR
- varicella
- smallpox
- live attenuated flu vaccine
*all are live vaccines
when is Rhogam administered?
- 28-32 weeks
- again postpartum if baby is Rh(+) within 72 hours
what causes fetal virilization?
- leutoma (high risk; yellow-brown ovarian masses)
- theca luteum cyst (low risk; bilateral ovarian cysts)
- Krukenberg tumor (solid ovarian metastases from primary GI tract cancer; high risk)
Fetal fibronectin
- measure of preterm labor if found in vagina
- protein released by fetal cells
- found in interface b/t chorion and decidua
FSH level in Turner syndrome? Why?
high because estrogen is not produced by the “streak ovaries” so there is no negative feedback to the pituitary
MCC of antepartum hemorrhage?
- placenta previa
- placental abruption
can a copper IUD be used as “emergency” postcoital contraception?
yes - as long as it is placed within 5 days
what is the association between hypothyroidism and hyperprolactinemia?
- low TH –> inc TRH and TSH
- TRH stimulates prolactin production
magnesium sulfate toxicity tx?
discontinue + calcium gluconate
when taking what drug would you monitor cyanide levels?
nitroprusside
next step after an abnormal NST?
- BPP
- contraction stress test (CST) –as long as there is no contraindication to labor (previa)
-abnormal NST has a high false-positive rate, thus further testing is needed
tx options for intrauterine fetal demise?
after 20 weeks gestation
- watchful waiting for natural delivery
- induction of labor (especially if signs of DIC or chorioamnionitis)
gonadectomy after puberty in what disorder?
androgen insensitivity syndrome: cryptorchid gonads have a risk of developing dysgerminoma or gonadoblastoma
uterine fibroid (leiomyoma) sx
local compressive sx:
- urinary frequency/ retntion
- constipation
- pelvic/back pain
effects of high exercise regimen
-suppression of HPO (hypothalamic-pituitary-ovarian) axis:
low GnRH –> low FSH, LH –> low estrogen, amenorrhea, osteoporosis risk
-will fail progestin challenge test (no withdrawal bleeding)
role of HCG in pregnancy?
to main the corpus luteum –so that it can continue to produce progesterone before placenta becomes the sole source of progesterone
condyloma accuminata definition, cause, px, tx
= genital warts
- cause: HPV
- px: smooth tear drop appearance; pink or skin color
- tx: trichloroacetic acid, podophylin, excision, fulguration
granulosa cell tumor px
(pre vs postmenopausal), why?
- pre: precocious puberty
- post: postmenopausal bleeding
-tumor produces excessive amount of estrogen
acceptable postpartum contraception? (4)
- tubal ligation
- IUD
- progestin-only OCPs
- condoms
