Wall Flashcards
toxic shock syndrome sx
- hypotension, orthostatic syncope, macular erythoderma, fever, late skin desquaation
- treat vanc
elevated markers for IUFD
risk factors
- AFP
- AFP, cHTN, insulin dependent DM, FGR
% cHTN get PreE
25%
signs secondary HTN
- family hx
- renal disease
- labile
- resistant hypertension
- high creatinine
necrotizing fasciitis bug
- alpha hemolytic catalase neative, gram positive cooci
- strep pyrogenes
% uterine rupture kills the fetus
5%
EKG finding of HYPERkalemia
peaked T waves
- caused by angiotensin coverting eenzyme ACE inhibitors
- potassiume sparing diuretics
- NSIADS
- treat with calcium gluconate (antagonizes the K effect)
child labial adhesions
- topical estrogen
- steriod cream
- afterwards need to keep apart with jelly
- only bother with it if there are urinary symtpoms.
radiation effects and gestational age
- post conception:
- 0-2w: death (50-100mGy - 5-10 rads), organogensis/anomalies (200mGn-20 rads)
- 2-8w: FGR (200mGn - 25 rads)
- 8-15w: intellectual disability high risk (60-300 mGn)
- 16-25w intellectual disability low risk
*pelvic/adominal CT are the worst
HPV vaginal cancer
16
Call exner body
- granulosa cell tumor
- coffee bean nuclei
dysgerminoma cell marker
- LDH
gonadoblastoma
malignant only if dysgerminoma elemtns
serous tumors
- ciliated tubal epithelium, psammona bodies, tumor marker CA 125
lynch syndrome cancers
- gastric
- small bowel
- hepatobiliary
- renal pelvis
- ureteral
- breast
- brain
- colon, endo, ovarian
- associated genes MLH1, MLH2, MSH6, PMS2
normal TSH level
0.5-3
RA vs OA
- RA is close
- OA is outter appendage of hand
transobturator sling
TOT = obturator (more common groin pain) TVT = "retropubic" (more common all other inuries)
CAH
- autosomal recessive
live vaccines
- MMR
- rotavirus
contracting varicella in pregnancy
- 1-2% risk get neonatal infection : skin scarring, limb hypoplasia, eye defects, neuro abnormalities
- get varicella near dlelivery is wrose 30% death rate
max bone denisty
19 yo
vaginal hemotoma
- caused by uterine artery
- retroperitoneal hematomas usually by iliac artery including uterine and extension of paravaginal hematoma
androgen insensitivity syndrome
- testicular feminisation
- 46 XY
- x linked recessive
- short blind vagina, no uterus or fallopian tubes, no wolffian duct structures, no pubic hair, breast devo because LH are up and increase estrogen
osteoperosis treatment
- when 3% risk hip fracture or 20% risk of major osteoprotoc fracture (gotten from FRAX score)
- t-score less than -2.4
- tscore -1>-2.5 and frax >3% hip or FRAX greater than 20
urtheral mobility on stupid test
- point Aa
ayptical endometrial cells on pap
- endometrial/endocervical
- if those neg, then colpo
nerve injuries and surgery
- peroneal: foot drop
- obturator: adduction/hip rotation
- TAH: femoral from buckwalter retractor (feels liek sciatica)
treatment for EIN
- progesterones (includes megace) not including arm implant
worst contaceptive
spermacide – 28% failure rate
level of support and defect (POP)
- level 1: enterocele, vaginal prlapse
- level 2: pravaginal
- level 3: cystocele, rectocele
HPV vaccine allergy
yeast
cholesterol goals
- LDL: <100
- HDL >60
vACccum
3cm anterior to the posterior fontanelle
normocytic anemia
- acute blood loss
- sickle cell disease
- infection
- bone marrow disease
- chronic renal insufficiency
- hypothyroidism
- autoimmune hemolytic anemia
T score findings and screenign rates
- -1.5 > -1.99 (5 years)
- -2 > -2.49 (1 year)
unilateral breast bud
observe. jsut delveoping
treatment fr nocturnal vulvar and perinala itching
mebendazole
- pinworms, enterobius vermicularis
transgender male treatment begins with
giving testosterone
transgender female treatment
estrogen and androgen blockers (spironolactone)
beneftis of delayed cord clamping
- impromvent in blood count, decreased need transufusion, lower rates intrventitrucular hemorrheage, increasd iron stores, decreased nec enterocolitis
- helps premature the most
- at least 30-60seconds for term/preterm vigorous infants
- UNRELATED IS SEPSIS, this is not affected.
which imaging is worst for the fetus
CT pelvis
- itravenous pyleogram is okay, lumbar spine stuff xray okay, pulmonary angigram okay
whole exome seuqening of fetal DNA can be obtained by XX and not by YY
- can be from CVS, amnio, cord
- cannot from placenta
most common cause of cuff celulitis
- garderella vaginalis (BV)
- treat BV with metronidazole or clindamycin
carpel tunel in pregnant women
- treatment first line wrist splint
MCC duodenal ulcers in women >30 years?
- h pylori, give 14d amoxicillin 1000mg BID, with clarithromyicn or metro
pneumococcal vaccine given to
- elerly over 65 yo, or earlier if sick, sickel cell, immunosuppressed through chemo
least liekly lymph nodes involved in cervical cnacer
- inguinal
- spread through primary pelvic nodes (pericervical, presarcral, hypogastri/internal iliac, external iliac nodes, obturarotr ndes > paraaortic nodes
- rarely goes as far as inginal nodes
hyperandrogenism test
total testosterone
CAH
unresponsive pregnant lady with known hypopituitarism shoudl be given
- glucocorticoids
- thyroxine (T4/T3)
immature teratoma tumor markers
increased AFP, LDH, CA 125
dysgerminoma tumor markers
increased HCG, LDH
endodermal sinus tumor tumor markers
- increased AFP
embryonoal CA tumor marker
- increased HCG, AFP
chriocarinoma tumoar markers
- icnreased HCG, AFP
outflow obstruction dx best with
MRI
which antitumor metbolite is administreed carefuly cause it can cause skin necrosis with extravasation?
Doxorubicin
actinomycin D
- treat GTD
- G1 phase
- myleosuppression caused
bleomycin
- cuases DNA breaks
- causes pulmonary fibrosis and pneumonitis
etoposide
- topoisomerase 1 and II inhibitor
- myleosuppression
- germ cell tumor treatment
cisplatin/carboplatin
most comomon gyn malignancy treatment (ovarian, tubal, peritoneal, endometrial, cervical, vulvar cancers.
- cisplatin needs vigourous hydration , renal dependent
- carboplatin: myleosuppression
treatment STage 2B squamous cell cervical cancer
- stage 1: hysterectom
- stage 11B-IVA: radiation and brachtherapy and cisplatin
treatment for rhinosinusitis
- NSAIDs
- bacterial but doesnt’ usualyl require abx
- abx if sx more than 10 days and include fever/pain/swelling of face
sp svd 5 days prior, severe headache, focal neuro deficits, altered consciousness… caused by
- subarachnoid hemorrhage
pulmonary edema after hysteroscopy seen with what fluid
- normal saline
pumonary edema and CHF
down sydnrome soft markers on US
- hyperechoic bowel
- shortered femur
- fenal lyelectasis
- FGR
(not renal pylectasis)
osteoporsis casues
- loss of height
pupillary reaction to brbituates
- none, (weed and barbituates)
- amphetamines/LSD cause dilation, but reactive
- non-reactive puplis are anticholinergic agents
ARB fetal effects
- renal tublar dysplasia
- fetal limb contractures
- fetal skull ossification defects
0 hypplastic lung devo
(not cardiac anomalies)
blue vaginal lesion, head ache, increased blood pressure, sp NSD 5w ago…. waht do you do next?
CXR (GTN)
8w preg, IUD in place, what happens if you leave it in place?
- risk for spontaneous abortion, septic abortion, preterm delivery, spesis
- no risk for fetal limb issues
- remove prior to fetal viability, after feta viability unclear if shoudl be kept in
vaginal itching, white discharge, ph 3.4, KOH prep and wet mount negative . next step?
- culture for yeast
donovan bodies
- related to granuloma inguinale chronic ulcerative bacterial infection on vulva
- intracelluluar gram negative non-motile encapsulated rod
- ulcers are painless
- given azithromycin 1gm weekly for at least 3 weeks until lesions are healed
MCC cancer death in women
lung
22 asymptomatic huge fibroid, first management optoin
- observatino, leave it alone
% cervical cancer diagnosed >65 years old
20%
largest diamtere fetal head is
- occiptial- mental
MCC adverse effect copper IUD
- bleeding or prolonged bleeding
oliguria prerenal azotemia is characterized by
- urine sodium excretion <20 mEq/L/24h
- urine plasma ratio greater than 40mEq/L/24h
progesterone efects on pregnacy
- increased body temp, increased nasal congestions, increased appetite, decreased esophageal tone, increased respiration
positive tilt test sp TAH with some signs low fluids… do what
give crystaloids 1-2 L
- hypovolumeic shock
- if it were hemorrhageic shock, get IVs, transfuse, etc
risk factors for wound dehiscence
- sepsis, malignancy, HTN, pumonary disease, advnaced age
- not related is a hx of infection.
invasive vulvar pagers disease
- wide local incision for <1mm invasions
- invasive diesaese needs radial vulvectomy
contraindications for robotic surgery
- acute glaucoma
- retinal detacment
- increased intracranial pressure
- ventri shunts
ARDS is associated wtih
- PCWP <12
- PO2 < 50
- Increased capillary permeability
- metabolic acidosisi
- decreased lung compliance
give what to stop vasomoto symtpoms
- gabapentin
- clonidien
- dang gui bu xu tang
- paroxitine
(not progeserones)
what is associated with abnormal AFP
- tri 18, 21, sacrococcyceal teratoma, congential hypothyroidism
(not associated with gastrocheisis)
caloric deficit needed to lose one pound total
- 3500 calories in a pound
- 500 calories in a week to lose a pound in that week
pod #5 with fever is most likely relate to
- wound infection
reason for POD#1 laparotomy sp LSC procedure
CT shwoign expanding hematmoa
most common retro mass reatled to the urinary tract is
pelvic kidney
which type of histological vulvar cacner is the most favorable prognosis
basal cell carcinoma
PCOS first line fertility treatment
aromatase inhibitor (letrozole) which is ovulation induction
normal seman analysis
volume 2> 1.5 concentration: 20 > 15 progressive motility: 50 > 32 % normal form: 14>4% *concentration and motility are the most important with coitus
16 to primary amonrrhea, +breast +pubic air, what is it and what tests
mullerian agenesis (mayer rokitansky kkuster hauser syndrome karyotype and testosterone
Vit D defeicience leads to
- hypocalcemia
- secondary HYPERparathyroidism
- increased bone turnover
- increased rate of bone loss
- decreased CA absroption
- decreased/poor bone mineralization
what hormone level changes the least compared pre/post menopause
testoserone changes barely any
preimplantation genetic diagnostics are helpful for:
- single gene disorders
- gender
- mutations
- HLA typeing (minor blood typing)
(not good for NTD)
hwo do you manage cholelithiasis ?
- fourty, fat, and fucking? these women have gallstones (cholelithiasis) and you can just ignore it if asymptomatic
- symptomatic: can give meds: oral bile acid therapy with urodeoxycholic acid and exracorporeal shock wav lithotripsy.
(note acute cholecystitis devleops when a gallstone blocks the duct adn the gallbladder gets inflammed. = pain, n/v, leukocytosis, anorexia
most common symptom in appendicitis in preg and outside preg
always RLQ pain
BRCA1 mutation carriers increased risk for which cancers:
- breast
- ovarian
- pancreatic
- melanoma
lynch syndrome cancer risk increased for
- brain
most likely neurological laparoscopic injury from a lateral trocar placement
- ilioinguinal nerve
HPV 16/18 positive serology and negaive pap smear 16 yo.
next step?
colposcopy
16 and 18 are hte most likely to cuase cervical cancer so maybe your screen just missed it
MCC problem with TPN
catheter tip infection
TTTS recipient twin associated with
- kernicterus
- heart failure from too much volume
- thrombosis
- polythycemia
- polyhydramnios (donor has oliohydramnios, poly/oli)
risk factor of HIT
- use of unfractionated heparin
- female gender
- surgery
- longer durations of heparin
- LWMH is lower risk
UAE has to go through which vessel
- common iliac beacuse can’ maek the sharp turn
diagnostic test for pre E oncludes:
- CBC
- liver transaminases
- serum creatinine
- p/c ratio
which feature with PE increases mortality rate
- treatment
- right ventriucular dysfunction
- treatment: O2, trachael intubation, mechanical intubation, need thrombolysis/filter pracelemnt/embolectomy
what progestin in NOT derived from 19-nortestonsterone
- drospirenone (unusual)
in pregnancy what happens to facto 8 and vWF levels>
- Factor 8 increases clotting
- vWF increases clotting
— both increase (therefore both
consanguinity increases the risk for
autosomoam recessive diosroders
MCC famililal mental retardation
fragile X syndrom
irregualr vaginal bleeding, first step in work up
b-hcg
sudden, strong sensation to void, large volume loss, nocturia
urgency incontinence
- due to detrusor overactivity
best way to examine a enterocele
- standing
amenorrhea, galactorrhea, prolactin 68
- first test
- b -hcg test
urogenital sinus gives rise to all the following structures
- urinary bladder
- hymen
- lower vagina
- paraurethral glands
it does NOT give rise to gartner’s duct (or upper vagina)
improve labido
testerosterone
androgen insensitivity syndrome
- female phenotype
- short blind vagina
- xy
- X linked autosomal resessive
- no ovaries or uterus or fallopian tubes
what are the iron requremients in pregnancy daily
- 1000 mg
-
which tumor is associated with amneohrea
- craniopharygniomas
maylard incision causes whch vascualr injury
- inferior epigastric (deep in the muscle bed)
granulosa cell aromstase enzyme allows conversion of androstenedione to which of the following:
estrogen
(they also make inhibin)
conidiotns that affect estrogen production in pregnancy
- fetal demise
- anencephaly
- adreanl hypoplasia
- trimsomy 21
- featl ethryroblastosis
(gastrochisis does not effect estrogn)
ovary makes the following androgens:
testostoerone
dihydrotestosterone
dehydroepiandrosterone
androstenedione
- also estrogen (but it’s not an androgen)
water transfered across the placenta
bulk flow (a lot)
what cannot be assessed using “simple cystometrics”
intrinsic spinchter deficiency
what phase of the cell cycles does proteins synthesis, RNA synthesis and DNA repair occur>
G1: protein synthesis, RNA synthesis, DNA repair
S: copies DNA two times
G2: nothing really
M: division into two cells
VIN 3 lesions
- wide local excision
- margins clear, SSC noted in specimen, invading 0.9mm = observation
- no risk for metasisis for invasion <1mm
VAIN 3 management
- wide local excision
(VAIN 1 obersvation after biopsy)
tumor suppressor does HPV E6 AND E7 USE
E6: p53
E7: retinobastoma
what is used for staging of cervical cnacer
- cystospcy
- proctospcy
- intravenous pyleogram
(CT not used)
typical findings of complete hydraform mole
- abnormal uterine bleeding
- hihg HCG
- large uterus
- increased thyroxine
(hyerpemesis is sometimes seen)
26 yo secondary amenorrhea, increased hair gwroth, cliteromegaly causes by….
androgen secreting tumor
sertoli leygid tumor
(breast atrophy, deepening of voice)
secondary hone loss is worked up with
- CBC
- serum chemistry
- TSH
- 24h urine calcium excretion
(celiac panel is second line workup)
bone formation markers
- osteocalcin
- bone specific alk phos
- procollagen type 1
N-terminal pro-petide
(turn over markers: N-telopetides, c-telpetides, deoxypyridinoine)
- proliferative breast lesions
- non-proliferatinve breast lesions
- proliferative breast lesions (increase your risk for cancer)
- —- fibrocystic changes
- non-proliferative breast lesions
- —- cysts
- —- fat necrosis
- —- fibroadenoma
- —- microcalicifations
nerve injury
1-2 buckle my shoe (S1-2, ankle)
3-4 kick the door (L3-4 knee extension)
5-6 pick up sticks (C5-6 biceps brachialis)
7-8 lay then straight (C7-8 triceps)
transeint causes of urinary incontinence
DIAPPERS Diabetes (DKA), infection, atrophy, Pregnancy, excess urine output, restricted mobility, stool impaction
acute onset young child gentil itcing
- mor elikely single organism – strep or shigella (repsiratory)
- intermittent problamems then multi organism
PE CXR findings
- enlarged pulmopnary artery
- pleural effusion possible
- airspace opacity (lung infarcation)
- elevated hemi-diaphragm
pain more common with what version of sling
TOT (puncture muscular pelvic wall and pain over all)
EIN treatment
medical, surgical
megace, progestin therapy (want retain fert or poor surgical candidate)
surgical: total hysterecomty with out other staging
(dx wth D&C hysteroscopy)
