Week 1 UWorld and Case Files 1-4 Flashcards
when does risk of MS onset increase in women? signs?
post partum period…fatigue and CNS symptoms
2 main signs on cerebral venous thrombosis in women
HA and papilledema
2 imaging modalities for CVT
CT first then MR venography
what is management of Ovarian torsion?
diagnostic laporoscopy
common cause of ovarian torsion?
ovarian mass
what is treatment of opioid dependent pregnant patients? why?
methadone throughout pregnancy…better than detox and medication withdrawal management because this has increased risk of relapse
signs of malignant hyperthermia
hypercapnea tachypnea tachycardia myoglobinuria muscle rigidity
symptom of uterine rupture? risk for? manage?
sudden abdominal pain in labor…risk is prior uterine surgery…manage with immediate c xsn
2 complications of uterine rupture in labor?
cord compression…decreased fetal HR
hypoxic placenta if placenta involved
three parts of initial eval of patient with AUB-O
CBC, preg test, coag studies
rx for AUB-O if patient is stable?
high dose estrogen will control bleeding…if contraindicated can give progesterone
when does peripartum cardiomyopathy occur? Signs? management?
happens in last month of preg or 5 mos after delivery
signs are those of HF, mitral regurg
manage with echo and follow…rx like HF
what is murmur associated with peripartum cardiomyopathy
mR
number one cardio contraindication to pregnancy
mitral stenosis that is symptomatic
5 cardio contraindications for pregnancy
symptomatis MS and AS
PAH
LVEF less than 30%
bicuspid AV with enlarged AA
what can often co occur with granulosa cell tumor? why? how to evaluate for it?
endometrial hyperplasia/cancer because of the increase inestrogen from the tumor…so do biopsy to rule in/out
what is AFLP?
acute fatty liver of pregnancy
when does AFLP occur?
in 3rd trimester
sx and management of AFLP
hypoglycemia, elevated liver enzymes and bilirubin
manage by immediate delivery
complication of AFLP?
DIC
Most common SE of tamoxifen?
hot flashes
what qualifies as recurrent cystitis in women?
2 infxns in 6 mos or 3 in a year
what is good way to treat recurrent cystitis in women if happening post intercourse?
postcoital abx
what is a urethral diverticulum?
urethral outpouching that can cause an anterior vaginal wall mass that is tender
what is a prolonged postoperative ileus?
greater than 72 hours after surgery the bowel still isnt moving…no flatus
signs of prolonged postoperative ileus
no flatus..abdominal distension on Xray and N/V
tubovarian abscess is from what? what does it look like?
from PID…is a complex multiloculated adnexal mass
what is prevention rx for preclampsia?
12 weeks gestation give low dose aspirin
what imaging is done for any unilateral spontaneous nipple discharge?
always US…if older than 30 then add on mammogram too
how does uterus feel in adenomyosis?
bulky and tender
how does uterus feel in fibroids?
irregularly enlarged
2 signs of uteroplacental insufficiency in late/post term pregnancies
fetal decelerations in non stress test and largest pocket of amniotic fluid on US is less than 2 cm
what is contraindicated in females with migraine history? why?
estrogen containing contraception because of increased risk of thrombotic stroke in patients with migraine…and estrogen increases that risk further
what is cutoff for fetal bradycardia/tachycardia?
110 and 160
when is non stress test done on fetus?
when there is concern for lack of fetal mvmnt, hypoxia and acidosis
what normally happens with non stress test in fetus?
when fetus moves…HR increase
if HR does not increase in non stress test, what is MC cause of this finding?
quiet sleep cycle in fetus…extend study
short interval between pregnancy is considered how long? what are risks?
6-18 mos
risk for PPROM, maternal anemia, pre term delivery and low birth weight
if corpus luteum is lost before week 10 of gestation what do you need to do?
give progesterone replacement
what is reason to check fetal heart rate patterns during delivery?
to be aware of brain hypoxia
what is category 1 of fetal heart rate patterns?
110-160 BPM
with variability and no late deceleration
what is category 2 of fetal heart rate patterns?
in between 1 and 3
what is category 3 of fetal heart rate patterns?
absent variability with late decels, variable decels or bradycardia
what is rx for cat III fetal heart pattern?
stop uterotonics…administer oxygen and reposition mom to see if that helps…if not go direct to c sxn
what is second stage of labor? when is it arrested?
second stage is after full cervical dilation and effacement and actively pushing…if actively pushing for 3 hrs with no fetal change then in second stage arrest
what is cause of gestational diabetes? when to screen?
human placental lactogen secretion
screen at 24-28 wks
what is first and second line rx for gestational diabetes?
1st is diet and exercise
2nd is insulin followed by metformin and glyburide
what is shoulder dystocia?
impaction of fetal anterior shoulder into moms pubic symphis…head is out
what is first thing to do for shoulder dystocia?
elevate legs and flex hips then apply suprapubic pressure
what are screenings at 12 weeks gestation?
HIV, syphilis, blood types, nuchal translucency and PAPP-a
what does nuchal translucency and PAPP- a test for at 12 weeks?
T21
is weight gain common with OCPS?
NO…just depo
when do you need backup for OCPs?
if you start more than 7 days after last period
what are some dietary changes to help with first tri N/V?
small frequent meals low in fat with ginger root and ale
what are two supplements for N/V in 1st tri?
B6 and doxylamine
what are anti emetics for N/V in 1st tri?
metocloprmaide and pomethazine
what abx decrease OCP effectiveness?
rifamipin, rifabutin and rifamixin
patient in labor develops fever and has prolonged membrane rupture, what is diagnosis?
chorioamnionitis
what is rx for chorioamnionitis?
continue labor and give broad spectrum abx
a fever in immediate post partum setting should be considered as what?
endometritis
what is the bishop score?
score to determine need for cervical ripening agents…takes dilation, effacement and position into account
what are some ways to induce labor without medication?
nipple stimulation
amniotomy
membran stripping
what is most effective labor analgesia agent?
epidural, pudendal nerve blocks are useful in second stage of labor
name the four risks of assisted vaginal delivery
shoulder dystocia, facial nerve palsy, cephalohematoma and brachial plexus injury
4 drugs for postpartum hem
oxytocin
carboprost
methylergonivine
misoprostol
what is contraindication to carboprost?
asthma
what is contraindication to methylergonivine
HTn
what does fetal fibronectin test for?
it is a test to determine likelihood of preterm delivery…if negative then good
what are tocolytic meds used for?
prevention of pre term labor
name the tocolytics
nifedipine
magnesium sulfate
prostaglandin inhibitors
effects of magnesium toxicity?
somnolence, loss of DTRs and respiratory depression
risk for magnesium toxicity?
renal insufficiency `
wht age for significant fertility decline?
35…minimal ovarian reserve
what is infertility at 35 or older likely from ?
diminshed ovarian reserve
what do you do if patient has seizure from eclampsia in labor?
prompt delivery
what two things elevated in T21? what is low?
hcg and inhibin a
afp is low
what are levels of afp, hcg and estriol in T18?
all low
what is rx of uterine inversion?
manual replacement of uterus
what causes uterine inversion?
excess fundal massage and traction on umbilical cord
most common cause of term oligohydrmnios?
rupture of membranes
what are signs and symptoms of chorioamnionitis?
fever, tachycardia, leukocytosis, N/V and uterine tenderness
what are two risks for chorioamnionitis?
PPROM and prolonged rupture of membranes
what is rx for chorioamnionitis?
abx and delivery
Define pprom
preterm prelabor rupture of membranes before week 37
three risks for PPROM
GU infxn, antepartum bleeding and prior PPROM
how do you manage PPROM?
if less than 34 wks give abx and steroids if more then deliver
risk factors for cervical cancer?
immunosupression, HPV, lot of sex partners, early sex, tobacco
risk factors for ovarian cancer?
family history, emdometriosis, early menarche and later menopause
risk factors for endometrial cancer
annovulation and obesity
what four things to give in preterm labor?
ampicillin
steroids
magnesium sulfate
tocolytics
why is magnesium sulfate given in pre term labor?
because it is neuroprotective against CP
what is rx for labial adhesion?
estrogen cream
who gets labial adhesions? sx?
2-3 yo girls
usually asymptomatic but can cause GU infxn and be itchy
symptoms of inflammatory breast cancer?
peau de orange, edema, erythema and lymphadenopathy
classic finding in inflammatory breast cancer?
peau de orange…dimpling of skin with edema
what is rx for inflammatory breast cancer?
mastectomy and chemo
how to dx inflammatory breast cancer?
punch or core biopsy
three common reasons for elevated AFP?
NTD,
gastric wall defect like omphalocele and multiple gestations
what is TTTS?
twin twin tranfusion syndrome
explain what happens in TTTS?
anastomosis btw umbilical artery of one twin and vein of other twin so one twin loses blood and gets anemic and oligohydramnios while other gets polycythemia and polyhydramnios
what must be present to have TTTS?
monochorionic twins
what is treatment for endometrial hyperplasia if patient desired future preg?
IUD with progesterone
what is treatment for endometrial hyperplasia if patient does not desiree future preg?
hysterectomy
what is common bleeding sign for endometrial polyps?
regular menses with intermenstrual light bleeding
what is rx for endometrial polyps?
hysteroscopic polypectomy
what is uterine exam like for endometrial polyps?
normal usually because polyps are within the uterine cavity
what is goal of giving combined OCP to patient with AUB who is less than 45yo?
estrogen will help build endometrium the progesterone will help shed it
if a patient with AUB less than 45yo is started on OCP for control of AUB but it does not improve, what should be done? why?
they should have endometrial biopsy because the progesterone in the combines OCP likely isnt able to completely shed endometrium so they may be having hyperplasia
what are some contraindications to IUD placement?
unexplained vaginal bleeding pregnancy wilson disease (copper0 liver disease (progestin) pelvic infection endometrial and cervical cancer
main sx of vesicovaginal fistula?
continuous urinary leakage
what are three common causes of vesicovaginal fistulas?
post radiation, surgery and childbirth
