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A2 > Uworld Review 2 > Flashcards

Uworld Review 2 Flashcards

1
Q

What is the next step after US in the workup of an ovarian mass in a postmenopausal woman?

A

CA-125 levels

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2
Q

When is needle aspiration indicated for a suspected ovarian CA?

A

Never-might sead cancer

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3
Q

What is the treatment for comedonal acne?

A

Topical retinoids and lotions

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4
Q

What is the treatment for inflammatory acne?

A

Mild =topical retinoids and benzoyl peroxide
Moderate = Topical ABx
Severe = Oral abx

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5
Q

What is the treatment for nodular (cystic) acne?

A

topical retinoids and other topical stuff

If severe, oral abx. If that doesn’t work, oral isotretinoin

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6
Q

When is oral isotretinoin indicated the treatment of acne?

A

In severe cases of nodular (cystic) acne that is first unresponsive to oral abx

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7
Q

During a vaginal delivery, retraction of the head back into the perineum is called what sign? What does this suggest? What should be done?

A
  • Turtle sign
  • It is indicative of shoulder dystocia
  • Flexion of the mother’s thighs against her abdomen (McRoberts maneuver)
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8
Q

What is McRobert’s maneuver?

A

Flexion of the mother’s thighs during vaginal delivery to facilitate delivery of an infant at risk of shoulder dystocia

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9
Q

Why should excessive pressure be avoided in infants presenting at risk of shoulder dystocia?

A

May cause hyperextension of the neck, and lead to a brachial plexus injury

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10
Q

What is the Zavanelli maneuver? When is it used?

A

Pushing infant back into mother and preparing for cesarean delivery. Last step in cases of infants at risk of shoulder dystocia

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11
Q

What is the drug of choice for vaginal candidiasis?

A

Fluconazole

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12
Q

When is Rhogam first administered to a pregnant women?

A

28 weeks unless there is a risk of bleeding earlier

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13
Q

What neoplastic process is most associated with postcoital bleeding?

A

Cervical cancer

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14
Q

When is transmission of toxoplasma most likely in pregnancy? When is it most likely to be symptomatic?

A 
Transmit = increase as pregnancy progresses
Symptomatic = first trimester
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15
Q

True or false: immunocompetent women who have been infected with toxo prior to the pregnancy virtually never pass on the infection

A

True

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16
Q

What two organisms typically cause chorioamnionitis?

A

GBS

E.coli

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17
Q

How long after sex do diaphragms need to be left in?

A

6-8 hours

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18
Q

What is the next step after the McRobert’s maneuver, if that fails to deliver an infant?

A

Suprapubic pressure

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19
Q

When are forceps indicated in the delivery of an infant with possible shoulder dystocia?

A

never

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20
Q

When is fundal pressure indicated for the delivery of an infant at risk of shoulder dystocia?

A

never–may lead to uterine rupture

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21
Q

What is the role of inhaled anesthetics in labor?

A

Used to relax the uterus in an attempt to remove retained placenta

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22
Q

True or false: vaginal hygiene has not been associated with BV

A

True

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23
Q

What is danazol used for?

A

Synthetic androgen used to treat endometriosis

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24
Q

What are the components of the VACTERL syndrome? Is it associated with polyhydramnios , or oligohydramnios?

A 
Vertebral
Anal atresia
Cardiac
Tracheal
Esophageal
Renal
Limb

Poly

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25
Q

Why should TVUS be avoided in pts with suspected placenta previa?

A

May cause bleeding

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26
Q

When does GBS cause sepsis/pneumonia in a neonate? Chlamydia?

A 
GBS = with 48 hours
Chlamydia = 4-12 weeks
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27
Q

A difference of how many cm on fundal height is concerning for IUGR?

A

4 cm

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28
Q

What is the maximal interval post intercourse for which effective emergency contraception is available? What are the contraceptives that can be used at this point?

A

120 hours (Cu IUD or ulipristal)

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29
Q

What is the average return to menses with post-pill amenorrhea? Women who do not menstruate beyond what timeframe require further workup?

A

32 days

3 months + requires more workup

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30
Q

Primary amenorrhea is diagnosed as the absence of menses by what age?

A

16

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31
Q

If a mother has recurrent outbreaks of HSV infections, when should she begin prophylaxis to reduce the chances of transmission to the baby, and/or reduce chances of a cesarean section?

A

At 36 weeks onward.

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32
Q

True or false: if a woman becomes infected with HSV during the pregnancy, she should be managed expectantly, with a possible cesarean section

A

false-treat now to alcyclovir

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33
Q

What is the treatment for subacute thyroiditis in recently postpartum patients?

A

Same as not postpartum–NSAIDs and supportive therapy.

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34
Q

What is the likely etiology of urge incontinence in a young woman who has an over exaggerated response to bethancochol administration?

A

MS

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35
Q

What does a bethancol administration test assess for in the work up of urinary incontinence?

A

If overreactive, the suggests UMN lesion (MS)

If not reactive, then suggests Detrusor muscle problem

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36
Q

What is velamtous umbilical cord insertion? How is this managed?

A

Insertion of the umbilical cord between the chorion and the amnion, as opposed to the chorionic plates.

Expectantly with close monitoring for fetal anemia, which would suggest cord rupture. If this occurs, then immediate c-section is indicated, regardless of fetal maturity

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37
Q

What is a major hepatic complication in the postpartum mother with HELLP syndrome?

A

Hepatic hematoma rupture, resulting in severe internal bleeding

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38
Q

What are the components of the BECALM mnemonic for recalling the steps to take in cases of potential infant should dystocia?

A 
Breathe, do not push--lower head of bed
Elevate legs into McRobert's position
Call for help
Apply suprapubic pressure
enLarge opening with episiotomy
Maneuvers
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39
Q

What is the Gaskin maneuver for delivering an infant?

A

Mother on all fours

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40
Q

What is the classic triad of McCune albright syndrome?

A

Cafe au lait spots
Polyostotic fibrous dysplasia
autonomous endocrine hyperfunction

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41
Q

What is ovarian hyperthecosis?

A

Hyperplasia of the theca interna of the ovary causing virilization

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42
Q

What is the normal change in pulmonary status in pregnant women?

A

Chronic, mild respiratory alkalosis with metabolic compensation

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43
Q

What are the renal/urinary changes that occur in pregnancy?

A

Increased GFR
Decreased BUN
Mild hyponatremia

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44
Q

What causes the increased respiratory rate in pregnant women?

A

Increased progesterone stimulates the medullary respiratory center of the brain

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45
Q

Does acute cervicitis present with uterine tenderness?

A

No

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46
Q

Under what gestational age are corticosteroid indicated to hasten pulmonary maturity?

A

34 weeks

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47
Q

Is chorioamnionitis an indication for a c-section?

A

No

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48
Q

What is the pathophysiology of mittelschmerz?

A

Rupture of the follicle on day 14 causes concomitant release of a small amount of blood into the peritoneum, causing mild peritonitis

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49
Q

What are the point values of a BPP that are normal, equivocal, and abnormal respectively?

A 
Normal = 8+
Equivocal = 6
Abnormal = 4 or below
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50
Q

What are luteomas? Treatment?

A

Solid, Androgen producing ovarian masses found in pregnancy

Most will regress after pregnancy

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51
Q

When are luteomas operated on?

A

If torsion of ovary occurs

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52
Q

With what type of pregnancy are luteomas concerning?

A

If fetus is female–excess androgen exposure

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53
Q

Why are pregnant women more likely to get pyelonephritis?

A

Progesterone causes dilation of urethra

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54
Q

Untreated asymptomatic bacteriuria in pregnant women predisposes them to what conditions?

A

Pyelonephritis
Preterm labor
Low birth weight

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55
Q

What does osteogenesis imperfecta cause to a fetus?

A

broken bones

Hypoplastic thoracic cavity

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56
Q

What is amniotic band sequence?

A

Sequence associated with limb defects, Craniofacial defects, and/or abdominal wall defects

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57
Q

What is a major neonatal morbidity associated with preeclampsia?

A

Chronic placental insufficiency and low birth weight

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58
Q

What are cystic hygroma?

A

Congenital loculations of lymphatic tissue filled with lymph. They are benign, but can be disfiguring.

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59
Q

Women over what age with a breast mass should receive a mammography?

A

over 30

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60
Q

What is the treatment for syphilis in pregnant pts who are allergic to PCN?

A

Skin testing a PCH desensitization

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61
Q

True or false: OCP cause weight gain

A

False

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62
Q

After how many weeks gestation are tocolytics contraindicated?

A

34 weeks or above

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63
Q

If a fetus is in breech presentation and the mother goes into preterm labor, how should the infant be delivered?

A

C-section

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64
Q

What is the causative agent of lymphogranuloma venereum? S/sx?

A

Chlamydia trachomatis

Large and painful LAD

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65
Q

What is the most effective form of emergency contraception?

A

Cu IUD

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66
Q

How long after intercourse can the Cu IUD be used as emergency contraception?

A

0-120 hours

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67
Q

How long after intercourse can the Ulipristal pill be used as emergency contraception?

A

0-120 hours

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68
Q

How long after intercourse can the Levonorgestrel pill be used as emergency contraception?

A

0-72 hours

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69
Q

How long after intercourse can the OCPs be used as emergency contraception?

A

0-72 hours

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70
Q

How is hypothyroidism managed in pregnancy?

A

Increase dose of levothyroxine when becomes pregnant, and follow TSH according to pregnancy norms

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71
Q

What are the indications for inpatient admission for treatment of PID? (4)

A
  • Pregnant
  • cannot tolerate oral meds
  • Severe presentation (fever, vomiting)
  • Complications
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72
Q

What are the medications used to treat PID as an inpatient?

A

IV cefoxitin + PO doxycycline

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73
Q

What are the meds used to treat PID as an outpatient? What is added to this in cases of tubo ovarian abscess?

A

IM ceftriaxone + PO doxycycline

Metronidazole

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74
Q

When diagnosing preeclampsia, a BP should be taken twice, how far apart?

A

4 hours

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75
Q

How do OCPs cause HTN?

A

Estrogen is converted to ANG II via hepatic first pass metabolism

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76
Q

In a pt with a h/o a conization for cervical CA, what should be done to assess the risk of preterm labor?

A

TVUS to determine remainder of cervical length

Done in second trimester

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77
Q

What medication is given to women with a short cervix to prevent preterm delivery?

A

Progesterone

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78
Q

What amount of urine is diagnostic or urinary retention?

A

Over 150 mL

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79
Q

What are the risk factors for urinary retention s/p vaginal delivery?

A

Perineal edema

Epidural anesthesia

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80
Q

What is the biggest risk factor for a preterm delivery?

A

h/o

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81
Q

Does a LEEP procedure increase the risk for preterm delivery? How about laser ablation?

A

LEEP maybe

Laser = no

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82
Q

True or false: gastric bypass increases the risk for preterm pregnancy?

A

False

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83
Q

Which ethnicity has the highest rates of breast CA?

A

Whites

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84
Q

What is the definition of tachysystole?

A

More than 5 contractions in 10 minutes, averaged over a 30 minute period

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85
Q

What hemodynamic changes occur with rapid oxytocin administration?

A

Hypotension

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86
Q

What electrolyte changes are associated with oxytocin administration? Why?

A

Normovolemic hyponatremia

Oxytocin is similar structurally to ADH

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87
Q

What is the pathophysiology behind HELLP syndrome?

A

Abnormal placentation triggers the immune system and complement cascade, causing platelet consumption, microangiopathic hemolytic anemia, and hepatocellular necrosis

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88
Q

What preterm gestational age is the turning point for deciding between delivery and delayed delivery?

A

34 weeks

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89
Q

Under what level of platelets should transfusion be administered prior to c-section and vaginal delivery respectively?

A

C section = under 40^3

Vaginal = under 20^3

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90
Q

What is the management for preterm labor under 32 weeks gestation?

A

Betamethasone
Tocolytics
MgSO4
PCN if GBS +

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91
Q

What is the management for preterm labor between 32-34 weeks gestation?

A
  • Betamethasone
  • Tocolytics
  • PCN
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92
Q

What is the management for preterm labor [34,37) weeks?

A

Betamethasone

PCN

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93
Q

What are the tocolytics of choice for preterm labor?

A

Nifedipine

Indomethacin

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94
Q

Why should MgSO4 be administered in preterm deliveries prior to 32 weeks gestation?

A

Protection against cerebral palsy

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95
Q

True or false: progesterone has tocolytic properties

A

False–Helps prevent preterm deliveries, but is not a tocolytic

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96
Q

What are the causes of a non-reactive stress test? What is the most common cause?

A
  1. Fetal sleep
    - placental insufficiency
    - fetal hypoxia
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97
Q

How long can fetal sleep last for?

A

40 minutes

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98
Q

When does fetal CNS develop? What does this mean for NST results?

A

26-28 weeks

If before this, then NST will not be reactive

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99
Q

What is the treatment for infertility associated with PCOS? MOA?

A

Clomiphene

Estrogen receptor modulator that blocks estrogen receptors at the pituitary

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100
Q

What electrolyte disturbances are common with hyperemesis gravidarum? (4)

A
  • Hypochloremic metabolic alkalosis
  • Hypokalemia
  • Hypoglycemia
  • Elevated LFTs
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101
Q

What vitamin deficiency, usually seen in alcoholics, can be seen with hyperemesis gravidarum?

A

Wernicke’s encephalopathy 2/2 thiamine deficiency

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102
Q

What are the classic s/sx of Wernicke’s encephalopathy? (3)

A
  • Encephalopathy
  • Oculomotor dysfunction
  • Gait ataxia
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103
Q

What are the s/sx of acute fatty liver of pregnancy? When in gestation does it usually occur?

A

N/v
Elevated LFTs
Hypoglycemia

Occurs in the third trimester

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104
Q

What is the usual presentation and treatment for ABO incompatibility between mother and fetus?

A

Mild anemia, maybe jaundice.

Phototherapy, or exchange transfusion if severe

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105
Q

In whom is CA-125 serum testing useful for evaluation of an ovarian mass?

A

Postmenopausal women

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106
Q

What is the treatment for a hemodynamically unstable pt with an incomplete/inevitable abortion?

A

Suction and curettage to evacuate fetus and stop bleeding

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107
Q

What are the treatment options for a hemodynamically stable pt with an incomplete/inevitable abortion?

A
  • Expectant
  • Misoprostol
  • Suction and curettage
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108
Q

When can oxytocin be used to evacuate a fetus from an inevitable abortion? Why?

A

In the third trimester, since earlier than this the uterus does not have enough oxytocin receptors for the medication to work

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109
Q

What are the effects of DES on male fetuses? (4)

A

Microphallus
cryptorchidism
Hypospadias
Testicular hypoplasia

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110
Q

What labs can distinguish between preeclampsia and SLE flare in pregnancy?

A

Decreased complement and increasing ANA with SLE flare

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111
Q

What are the three classic s/sx of HUS?

A
  • Thrombocytopenia
  • Renal dysfunction
  • Microangiopathic hemolytic anemia
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112
Q

What are the 6 P’s of lichen planus?

A 
Purple
Planar
Polygonal
Pruritic
Plaques
Papules
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113
Q

When should a pt with a likely simple breast cyst be seen again (assuming no malignant US features, clear fluid drained etc)?

A

2 months.

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114
Q

Over what age do breast masses require mammography, generally?

A

30

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115
Q

What is the role of lithotripsy in pregnancy?

A

Not used

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116
Q

True or false: HTN is a risk factor for PPROM

A

False

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117
Q

True or false: HTN is a risk factor for preterm labor

A

True

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118
Q

Premature ovarian failure is defined below what age?

A

40 years

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119
Q

What are the normal findings in the recently postpartum time that are easily mistaken for infection?

A
  • Chills/rigors
  • Enlarged fundus
  • Red/brown vaginal d/c from lining being shed (2-3 weeks)
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120
Q

What causes the urinary retention in the normal postpartum period?

A

Suppression of micturition reflex and/or a decrease in bladder tone after regional anesthesia

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121
Q

Breast abscesses that are larger than how many cm require I+D as opposed to needle drainage?

A

5 cm

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122
Q

What is the uterine cornua?

A

The interstitium around the uterus

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123
Q

Bicornuate uterus is a risk factor for what type of pregnancy pathology?

A

Ectopic

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124
Q

What is the treatment for stable vs unstable ectopic pregnancies?

A 
Stable = methotrexate
Unstable = surgery
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125
Q

What are the s/sx of breast engorgement? When does it commonly occur?

A
  • Breast fullness, TTP, and warmth

- 3-5 days after delivery when colostrum is replaced by milk

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126
Q

What is the treatment for breast engorgement?

A

Cool compresses

Acetaminophen /NSAIDs

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127
Q

What are the s/sx of mastitis?

A

Unilateral breast pain with isolated, firm, tender, erythematous area accompanied by a fever

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128
Q

How long does the brown/red lochia from pregnancy last for?

129
Q

What are the abx to treat postpartum endometritis?

A

Clindamycin and gentamicin

130
Q

What are the s/sx of postpartum endometritis? What bacteria cause(s) it?

A

Purulent lochia and uterine tenderness

Polymicrobial

131
Q

What is the abx of choice for pyelo in pregnancy?

A

Ceftriaxone

132
Q

What is the abx of choice for the treatment of lactational mastitis?

A

Dicloxacillin

133
Q

What is the treatment for a septic abortion?

A

D+S and broad spectrum Abx

134
Q

What are the s/sx of a septic abortion?

A

Malodorous d/c

Enlarged, boggy, Tender uterus

135
Q

When is a hysterectomy indicated for the treatment of a septic abortion?

A

If pelvic abscess develops or does not improve after D+S and 48 hours of abx

136
Q

Why isn’t misoprostol indicated for septic abortions?

137
Q

When can cephalic version by attempted?

A

from 37 weeks until onset of labor

138
Q

What are the contraindications for external cephalic version? (4)

A

Ruptured membranes
Hyperextended fetal head
fetal/uterine abnormalities
Non-reassuring fetal monitoring

139
Q

What should always be available when external cephalic version is attempted? Why?

A

C-section (can cause fetal distress)

140
Q

What are the four major options to treat endometriosis?

A
  • NSAIDs
  • OCPs
  • IUD (not Cu)
  • Leuprolide
141
Q

What is an aborting myoma?

A

Fibroid that is large and near the cervix, such that it causes dilation and occasionally prolapses through

142
Q

If PPROM happens what are the deciding factors to induce delivery?

A

If there are s/sx of infection or fetal compromise

143
Q

PPROM under how many weeks gestation is an indication for Mg? Why?

A

Under 32 weeks, since this will reduce incidence of cerebral palsy

144
Q

What is the first time a mother should receive Rhogam? Why this time?

A

At 28-32 weeks gestation

Abs last for 6 weeks, which would cover any exposure

145
Q

Within how many hours of delivery is rhogam given?

146
Q

What organism is most commonly associated with mastitis?

A

Staph Aureus

147
Q

What are the three major causes of increased afp in pregnancy?

A

NTDs
Ventral wall defects
Multiple gestation

148
Q

What disease results from a delta-508 mutation?

149
Q

What liver pathology can cause elevated afp?

A

hepatocellular carcinoma

150
Q

During what gestational weeks is the first trimester combined test ordered?

151
Q

During what gestational weeks is the cell free DNA test ordered?

A

Over 10 weeks

152
Q

During what gestational weeks is the quadruple screen ordered?

A

15-22 weeks

153
Q

During what gestational weeks is amniocentesis ordered?

A

15-20 weeks

154
Q

During what gestational weeks is anatomic US done?

A

18-20 weeks

155
Q

What are the usual US findings of ovarian epithelial cancers?

A

Solid mass with septations and ascites / free peritoneal fluid

156
Q

What are the US findings of cystic teratomas?

A

Hyperechoic nodules with calcifications

157
Q

What is the presentation of uterine Atony?

A

Uterus that is soft, boggy, above the umbilicus, and vaginal bleeding

158
Q

What are the risk factors for uterine atony?

A

prolonged labor
Induction of labor
Operative delivery

159
Q

What is the first line treatment for uterine atony?

A

Bimanual massage + oxytocin

160
Q

What is the second line treatment for uterine atony? What is the contraindication for this, and why?

A

Methylergonovine–HTN since this med causes vasoconstriction and will worsen it

161
Q

When is carboprost contraindicated for the treatment of uterine atony?

A

If h/o asthma

162
Q

What are four major risk factors for placenta previa?

A

h/o it
Prior c-section / surgery
Multiparity
Advanced maternal age

163
Q

How is placenta previa handled prior to delivery?

A

No sex

No digital vaginal exams

164
Q

A cervical length under what measurement is an indication for cerclage?

165
Q

What is the FSH:LH in premature ovarian failure? Why?

A

Over 1.0, with both components elevated

This is due to slower clearance of FSH from the circulation

166
Q

What are the main factors that determine the length of the second phase of labor?

A

Parity and neuraxial anesthesia

167
Q

What is the most common cause of failure of descent during the second stage of labor?

A

Fetal malposition

168
Q

What is the definition (in hours) of arrested second stage of labor for nulliparous and multiparous pts respectively?

A 
Nulliparous = More than 3 hours
Multi = more than 2 hours
169
Q

What is the fetal position?

A

The fetal presenting part in relation to the mother’s pelvis (OA, OP, OT, etc.)

170
Q

What are the six factors that determine if preeclampsia has severe features?

A
  • 160/110
  • Thrombocytopenia
  • Increased cr
  • Increased LFTs
  • Pulmonary edema
  • Visual/neuro symptoms
171
Q

When should pts with eclampsia deliver if they do and do not have severe features?

A 
severe = at/over 34 weeks
Not = at or over 37 weeks
172
Q

After how many gestational weeks can preeclampsia be diagnosed?

A

over 20 weeks

173
Q

What are the anti hypertensive medications of choice for the acute treatment of preeclampsia? Which is first line and why?

A
  1. Hydralazine since will not lower HR like:
    - labetalol
    - nifedipine
174
Q

Why isn’t methyldopa used to treat acute preeclampsia?

A

Slow onset and sedating effect at levels needed

175
Q

What are common US findings in pregnancy, besides the presence of a fetus?

A 
Ovarian cyst (corpus luteum cyst)
Fluids in the posterior cul-de-sac
176
Q

What are the three treatment options for inevitable abortions?

A
  • Expectant
  • Prostaglandins
  • Suction curettage
177
Q

What characterizes a normal, reactive NST?

A
  • two or more accelerations in 20 mins that are 15 beats above baseline and over 15 seconds long
  • No late/variable decels
178
Q

A BPP of what score indicates the need for repeat in 24 hours?

179
Q

When is doppler sonography of the umbilical artery indicated?

A

If less than 10th % weight

180
Q

What is the test that is used to determine the dose of Rhogam needed?

A

Kleihauer-Betke test

181
Q

What is done with the Kleihauer-Betke test?

A

Maternal RBCs gathered on a slide, and added to acid. Maternal cells lyse easier and leaves only fetal ones. % calculation is then used to determine dose of Rhogam needed

182
Q

What is the drug used to induce ovulation in a woman with PCOS?

A

Clomiphene

183
Q

What are the relative testosterone levels in PCOS? What may lead to false results?

A

Usually elevated, but may be normal if binding globulin is low

184
Q

True or false: severe nodulocystic acne is a sign of hyperandrogenism

185
Q

Why are women with PCOS at elevated risk of endometrial cancer?

A

Decreased progesterone secretion due to chronic anovulatory cycles. This leads to unbalanced estrogen, and chronic proliferation

186
Q

What hormone is responsible for maintaining the endometrium during pregnancy?

A

Progesterone

187
Q

What is the role of hCG in pregnancy?

A

Maintain the corpus luteum

188
Q

What cells produce hCG?

A

Syncytiotrophoblasts

189
Q

What other hormones share the same alpha subunit as hCG?

190
Q

What subunit is specific to hCG and forms the basis of pregnancy tests?

191
Q

Why are fluoroquinolones contraindicated in pregnancy?

A

Bone defects

192
Q

Why are tetracyclines contraindicated in pregnancy?

A

Bone and tooth defects

193
Q

When is TMP-SMX safe in pregnancy?

A

During the second trimester; it is contraindicated in the first d/t interference with folic acid metabolism, and increases the chances of kernicterus

194
Q

What four abx are first line to treat uncomplicated UTIs in pregnant women?

A

Macrobid
Augmentin
Cephalexin
Fosfomycin

195
Q

What age is an indication for endometrial bx in the presence of abnormal uterine bleeding?

196
Q

What are the three criteria the warrant an endometrial bx in a woman under 45 years in work up of aub?

A
  • Unopposed estrogen (obesity, PCOS)
  • Failed medical management
  • Lynch syndrome
197
Q

What are the genital findings of 5alpha-reductase deficiency pts?

A

since no 5alpha-reductase to convert testosterone to DHT, ambiguous genitalia

198
Q

What hormone simulates the regression of the mullerian ducts? What is the significance of this?

A

Anti-Mullerian hormone (AMH)
-Pts with androgen insensitivity will still produce this, and thus not have a uterus. However, testosterone is needed to make boy bits, so rudimentary vag forms

199
Q

What is a common side effect of tamoxifen usage? Why?

A

Hot flashes-exhibits antiestrogenic activity in the CNS

200
Q

What is the most significant risk factor for the development of osteoporosis?

A

Fragility fracture

201
Q

What is the role of EtOH in osteoporosis?

A

Excessive drinking increases the risk

202
Q

True or false: being a vegetarian increases the risk for osteoporosis

203
Q

What is the effect of a hematoma/blood in the uterus 2/2 placental abruption?

A

Uterotonic effect, causing a firm, distended uterus and unusually low amplitude, but frequent contractions

204
Q

What is the usual presentation of placental abruption?

A

Sudden onset of LBP or abdominal pain, and vaginal bleeding

205
Q

What are the signs of uterine rupture?

A

Diminishing contractions
Palpable fetal parts
Loss of fetal station

206
Q

Sudden onset of abdominal pain, vaginal bleeding, and loss of fetal station = ?

A

Uterine rupture

207
Q

Is hep C transmissible by breast milk?

208
Q

What is the incidence of vertical transmission of Hep C? Does a c-section decrease this risk?

209
Q

What is the risk of transmitting Hep C in serodiscordant, monogamous couples?

A

Less than 0.1%

210
Q

What are the s/sx of intrahepatic cholestasis of pregnancy?

A

-Intolerable, generalized pruritus, especially on palms and soles, worse at night

211
Q

What is the treatment for intrahepatic cholestasis of pregnancy?

A

Ursodeoxycholic acid

Early delivery after fetal lung maturity

212
Q

What is the typical distribution of PUPPP?

A

Red papules within striae sparing around the umbilicus palms, soles, and face. May extend to extremities

213
Q

With what activities do bartholin gland cyst cause discomfort?

A

Sex
Walking
Sitting
Exercise

214
Q

True or false: cervical bx is still done during pregnancy

215
Q

True or false: Pts with HSIL on pap smear can be treated with immediate LOOP, even if pregnant

A

False–not if they’re pregnant, but otherwise true

216
Q

When is the HiB vaccine indicated for a pregnant woman?

A

Only if immunocompromised or asplenic

217
Q

What is the test to assess for ovarian reserve?

A

FSH levels on day 3 of cycle

218
Q

What are the s/sx of Mg toxicity?

A

Loss of DTRs
Respiratory depression
Somnolence

219
Q

How is Mg excreted? What is the significance of this?

A

100% by kidneys

Need to be careful when preeclamptic women have renal failure

220
Q

What may happen to calcium levels with administration of MgSO4?

221
Q

What is the risk of transmission of HIV to the fetus if the mother is on triple antiretroviral therapy with good CD4 and low viral titers?

A

Less than 1%

222
Q

If the mother has not been taking her triple antiretroviral therapy and the child is born, what should it be given?

A

Zidovudine

223
Q

When should the mother start receiving antiretroviral therapy for HIV in pregnancy?

224
Q

What should be avoided in a HIV+ mother during pregnancy?

A
  • Avoid amniocentesis until titers low

- Avoid artificial ROM, instrumentation

225
Q

When is a c-section indicated for HIV+ mothers?

A

If viral load over 1000 copies

226
Q

What is genito-pelvic pain/penetration disorder? Who is it seen in? What are the features and treatment?

A
  • Disorder characterized by pain on and an aversion to attempted vaginal penetration.
  • Common in women with a h/o of sexual abuse.
  • Pain w/ vaginal penetration + anxiety + no medical reason
  • Desensitization and kegels
227
Q

What is female sexual interest/arousal disorder?

A

Lack of interest

228
Q

What age does clear cell vaginal cancer develop?

A

UNder 20 years

229
Q

Where in the vagina is clear cell and squamous cell cancer found respectively?

A

Clear cell = Upper 1/3 of anterior wall

SCC = Upper 1/3 of posterior wall

230
Q

What are the two major risk factors for development of SCC of the vagina?

A

Smoking

HPV infx

231
Q

How does the arm appear with Klumpke’s palsy?

A
  • Extended wrist
  • Hyperextended MCPs
  • Flexed ICPs
  • Absent grasp reflex
232
Q

What nerve roots are affected with Klumpke’s palsy?

233
Q

What associated condition might be seen with Klumpke’s palsy?

A

Horner’s syndrome

234
Q

What nerve roots are affected with Erb Duchenne’s palsy?

235
Q

How is the arm held with Erb Duchenne’s palsy?

A
  • Extended elbow
  • Pronated forearm
  • Flexed wrist and fingers
236
Q

What is the treatment for brachial nerve plexus injury in babies?

A

PT and massages

237
Q

Which has an intact grasp reflex: Erb-duchenne palsy or Klumpke’s?

A

Erb-Duchenne (waiter’s tip can grasp)

238
Q

What are the clinical features of intraductal papilloma?

A

No mass

Unilateral bloody nipple discharge

239
Q

What are the clinical features of fibroadenomas of the breast?

A

Solitary, painless, firm, and mobile mass averaging 2 cm size

240
Q

What is the classic presentation of fibrocystic changes of the breast?

A

Cyclical mastalgia and diffuse nodularity on breast examination
-Usually no d/c, but if present, serous

241
Q

How does lobular breast cancer usually present?

A

(Bilateral) fixed irregular mass

242
Q

What are the first three labs that should be obtained in the evaluation of secondary amenorrhea, after a pregnancy test? What test/diagnosis should follow if the respective lab is elevated?

A
  • TSH-hypothyroidism
  • Prolactin-brain MRI
  • FSH-premature ovarian failure
243
Q

What is the technical definition of secondary amenorrhea?

A

Absence of menses for more than / = to 6 months or 3 cycles

244
Q

When is a hysteroscopy indicated in the workup of secondary amenorrhea?

A

If woman has a h/o uterine procedure or infx

245
Q

What is the drug of choice to treat gonorrhea?

A

Ceftriaxone

246
Q

What is the drug of choice to treat chlamydia?

A

Doxycycline

247
Q

What topical therapy may be used on condyloma acuminata?

A

Trichloroacetic acid

248
Q

What are the warning signs of shoulder dystocia?

A

Prolonged first/second stage of labor

Turtle sign

249
Q

True or false: adenomyosis usually presents with symptoms of mass effect

A

False–much more common with leiomyomas

250
Q

What result from the Q-tip test indicates stress urinary incontinence 2/2 urethral hypermobility?

A

Deviation 30 degrees or more from the horizontal

251
Q

What is oxybutynin used for? MOA?

A

Urge incontinence

Anticholinergic

252
Q

What is the classic presentation of inflammatory breast CA?

A 
Edematous
Erythematous
Painful
Pruritic
Dimpling
253
Q

What causes worsening of rheumatic heart disease in pregnant women?

A

Physiologic increases in HR and blood volume raise the transmitral pressure gradient an LA pressure

254
Q

What is peripartum cardiomyopathy?

A

Rapid onset cardiomyopathy seen at over 36 weeks gestation

255
Q

True or false: A-frib is common with peripartum cardiomyopathy

A

False–relatively rare

256
Q

What type of chemo is indicated for the treatment of ovarian cancer?

A

Platinum compounds

257
Q

What degree of vaginal lacerations are risk factors for rectovaginal fistula?

A

3rd or 4th degree

258
Q

Over what weight is fetal macrosomia diagnosed?

259
Q

What is the main cervical nerve innervating: the biceps

260
Q

What is the main cervical nerve innervating: infraspinatus

261
Q

What is the main cervical nerve innervating: wrist/finger extenders

262
Q

What is the prognosis for brachial plexus injuries in infants?

A

Usually self limiting

263
Q

What is the presentation and prognosis for cephalohematoma?

A

Hematoma that does not cross suture lines

Self limiting

264
Q

What is the test to assess for PMS? Treatment?

A
  • Symptom diary for two menstrual cycles that results in socioeconomic impact
  • SSRIs
265
Q

What will the symptom diary of a pt with PMS demonstrate?

A

REcurrence of s/sx during the luteal phase (1-2 weeks prior to menses) and resolution during the follicular phase

266
Q

What common neurological pathology is a contraindication to OCPs?

267
Q

What is the major absolute contraindication to raloxifene or tamoxifen treatment?

A

h/o venous thrombosis

268
Q

What non-malignant disease is raloxifene used to treat?

A

Osteoporosis

269
Q

True or false: a h/o CAD is a contraindication to raloxifene use

270
Q

Does raloxifene increase or decrease the risk for endometrial cancer?

A

Decrease (antagonist here, unlike tamoxifen)

271
Q

True or false: SERMs are associated with an increase in ovarian cancer

272
Q

What lab abnormality is often seen with Turner’s syndrome?

A

Increase FSH levels

273
Q

What is the treatment for neonatal hyperthyroidism?

A

Beta blockers and methimazole

274
Q

How much does T3/T4 cross the placenta?

275
Q

What are the teratogenic effects of valproic acid and carbamazepine?

A

NTDs

Craniofacial abnormalities

276
Q

What are the US findings of endometriosis of the ovary?

A

Homogenous, Cystic like mass

277
Q

True or false: surgical resection of endometriosis usually improves fertility

278
Q

What are the typical US characteristics of tubo-ovarian abscesses?

A

Complex, thick walled mass with air-fluid levels

279
Q

Atypical glandular cells on pap smear warrants colp + endometrial bx if what criteria are met?

A
  • Age 35 or more

- Less than 35 with risk factors (e.g. obesity, anovulation)

280
Q

What is the treatment for breast engorgement in a woman that is not /does not plan breastfeeding?

A

NSAIDs + supportive bra + no nipple stimulation

281
Q

Over what age is mammography preferred over US for evaluation of nipple discharge?

282
Q

What type of nipple discharge is concerning for CA, and warrants US/Mammogram as the first step? (3)

A

Unilateral
Bloody
Serous

283
Q

True or false: any breast mass that is palpable with abnormal discharge needs US/Mammogram

284
Q

What type of nipple discharge does NOT require mammography/US in diagnosis? (3)

A
  • Bilateral
  • Non-bloody, milky
  • No lump associated
285
Q

How can chronic use of antihistamines lead to galactorrhea?

A

inhibits estradiol metabolism and increase prolactin levels

286
Q

What causes the RUQ pain with HELLP syndrome?

A

Distention of the liver capsule

287
Q

What are the s/sx of acute fatty liver of pregnancy?

A
  • n/v
  • Abdominal pain
  • Elevated LFTs
  • Leukocytosis
  • hypoglycemia
  • AKI
288
Q

How can you differentiate acute fatty liver of pregnancy and HELLP syndrome?

A

AFLP is characterized by AKI, leukocytosis, hypoglycemia

289
Q

What is the pathophysiology of pulmonary edema in preeclampsia?

A
  • Generalized arterial vasospasm leads to increased systemic vascular resistance and high cardiac afterload. The heart becomes hyperdynamic to overcome systemic resistance
  • Decreased renal function
  • Decreased serum albumin
290
Q

What are the five major fetal problems that can occur with late term pregnancies?

A
  • Macrosomia
  • Oligohydramnios
  • Meconium aspiration
  • Stillbirth
  • Convulsion
291
Q

What are the five major maternal problems that can occur with late term pregnancies?

A
  • Cesarian section
  • Infx
  • Postpartum hemorrhage
  • Perineal trauma
292
Q

Prolonged pregnancies are at risk for polyhydramnios or oligohydramnios? Why?

A

Oligo

Aging placenta may have decreased fetal perfusion, resulting in decreased renal perfusion and decrease urinary output

293
Q

What is the definition of oligohydramnios?

A

Single deepest pocket 2 cm or less or fluid index 5 cm or less

294
Q

What is the precursor to estrone?

A

Androstenedione

295
Q

What is the role of progesterone in the treatment of endometrial hyperplasia?

A

Causes differentiation of endometrium

296
Q

When (in gestational weeks) is external cephalic version offered?

A

37 weeks and over

297
Q

What are the complications of marijuana use while breastfeeding for the infant?

A
  • Decreased muscle tone
  • Sedation
  • Delayed motor development
298
Q

What are the six major contraindications to breast feedings? (4 infectious, 2 environmental)

A
  • Untreated, active TB
  • HIV
  • Herpetic lesions
  • Active varicella infx
  • Chemo
  • Substance abuse
299
Q

Why is the fetus largely unaffected by bleeding from placenta previa?

A

Maternal blood loss, not fetal

300
Q

What is the treatment for confirmed chlamydia infx? Confirmed Gonorrhea infx?

A 
Chlamydia = z-pack
Gonorrhea = z pack + ceftraiaxone
301
Q

When does co testing for HPV start with pap smears?

302
Q

All sexually active women under what age should be tested for gonorrhea and chlamydia?

303
Q

Gestational age over how many weeks is a contraindication to cerclage?

304
Q

What is the relationship between EtOH consumption and breast cancer?

A

Dose dependent increase in risk

305
Q

When is PID pain the worst, usually?

A

Menstruation

306
Q

True or false: Gonorrhea and chlamydia are not screened for in initial pregnancies if pts are over 25 and are not high risk

307
Q

True or false: hep C is screened for at every initial prenatal visit for all pts

A

False-only for at risk pts

308
Q

What are the absolute contraindications to exercise in pregnancy? (7)

A
  • Amniotic fluid leak
  • Cervical incompetence
  • Multiple gestation
  • Placental abruption or previa
  • Premature labor
  • Preeclampsia
  • Severe heart or lung disease
309
Q

What exercise activities are not safe for pregnant women? (4)

A
  • Contact sports
  • High fall risk
  • Scuba diving
  • Hot yoga
310
Q

What is the recommended amount of exercise for pregnant women?

A

20-30 minutes most or all days

311
Q

Why should pregnant pts avoid dehydration?

A

Chance for preterm labor

312
Q

Why should pregnant pts avoid lying supine for long periods?

A

Decreases venous return and thus placental perfusion

313
Q

What are the characteristics of false labor in terms of:

  • Timing
  • Strength
  • Pain
  • Cervical change
A
  • irregular, infrequent contractions
  • Weak strength
  • None to mild pain
  • No cervical changes
314
Q

What are the characteristics of latent labor in terms of:

  • Timing
  • Strength
  • Pain
  • Cervical change
A
  • Regular, increasing in frequency
  • Increasing intensity
  • Painful
  • Cervical changes
315
Q

What are the indications for the HPV vaccine?

A

All women ages 11-26

Males 9-21 (until 26 if MSM or HIV+)

316
Q

When does pap testing begin?

317
Q

What are the US findings of placenta accreta?

A

Intraplacental villous lakes

318
Q

How do you differentiate uterine atony and placenta accreta on exam?

A

Placenta accreta will have a firm uterus, as opposed to a soft one

A2 (26 decks)

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