Week 2 UWorld and Case Files 5-8 Flashcards
symptoms of ruptured ovarian cyst?
unilateral abdominal pain following activity
what is a complication of a ruptured ovarian cyst? when can this arise?
hemoperitoneum with patients on anti coags
what are signs, symptoms and way to diagnose hemoperitoneum from ovarian cyst rupture?
hemodynamic instability and peritoneal signs..dx with pelvic US
what is first line rx for dysmenorrhea in sexualy active female?
OCPs combined
what if fitz hugh curtis disease?
PID extension into liver capsule
what is classic symptom of fitz hugh curtis?
RUQ pleuritic pain in addition to fever and lower abdominal tenderness
following a c sxn a patient becomes hemodyamically unstable, what is best next step? what likely happened?
emergent laporotamy…likely injury to uterine artery in c sxn
how do you manage pregnant patient with pyelonephritis?
inpatient iv abx until afebrile for 24 hrs
complications of pyelonephritis in pregnancy 3
ARDS
sepsis
preterm labor
age cutoff for primary ovarian insufficiency
less than 40 years
what is often associated with primary ovarian insufficienc
autoimmune disease
three gyn issues that can raise ca125
ovarian cancer
fibroids
endometriosis
when is CA125 most specific for ovarian cancer?
in post menopausal women bc they wont have chance of fibroids and endometriosis
two treatment options for pelvic organ prolapse
surgical repair or pessary fitting
name the severe features of preeclampsia
elevated transaminases, thrombocytopenia, pulm edema, SBP over 160 or DBP over 110, increased creatinine
what is management of delivery with preeclampsia with severe featurs?
deliver at 34 weeks
what is management of delivery with preeclampsia without severe featurs?
deliver at 37 weeks
what is risk to fetus in preeclampsia?
uteroplacental insufficiency leading to fetal growth restriction and low birth weight
what are risks to mom in preeclampsia?
DIC, eclampsia and abruptio placenta
what is ICP? when do you get it?
intrahepatic cholestasis of pregnancy in 3rd tri
what are sx of ICP?
pruritis and RUQ pain
what are lab findings in ICP?
elevated liver enzymes and total bile acids
what is treatment for ICP?
ursodeoxycholic acid and antihistamine
what are fetal risk with ICP?
demise, preterm birth, neonatal RDS
define intrauterine fetal demis
no cardiac activity after 20 weeks gestation
what is management of intrauterine fetal demise?
20-23 wks can do DE
24+ need vaginal delivery induced when mom is ready
what causes peripheral edema in pregnancy?
plasma volume expansion
is shivering and chills and low fever common in post partum window of 24 hours?
yes..due to withdrawal of estrogen and progesterone
what trimester US is most accurate for dating? least?
1st is most and 3rd is least
what is etiology of primary dysmenorrhea?
increase in progesterone production
what is 1st and 2nd line rx of primary dysmenorrhea?
1st is NSAIDs to decrease progesteron
2nd is combo OCP
finding of androgen insensitivity syndrome
Xy genotypye with female phenotype…outer genitalia female with breast developed but no pubic hair…inner no female parts
four risks for abruptio placentae
HTN/preeclampsia, trauma, cocaine/smoking
aside from bleeding and pain, what are two other signs of abruptio placentae?
high frequency contractons and firm tender uterus
risks for having cervical insufficiency?
ehlers danlos, OB injury, conization
rx for cervical insufficincy?
cerclage
what happens with cervical insufficiency in pregnancy?
common to lose in 2nd tri…will have cervical dilation and increased vaginal discharge
what is rx of vaginosis and trichamonis?
metro 500mg bid 7 days
what are two look alikes of menopause?
hypothyroid and DM
what are two signs of placenta accreta?
postpartum hemorrhage, difficulty delivering placenta
how do you manage placenta accreta?
hysterectomy
what are two risk factors for placenta accreta?
placenta previa and prior uterine surgeries
when does septic pelvic thrombophlebitis occur?
post op or post partum
why does septic pelvic thrombophlebitis occur post op and post partum?
because there is endothelial injury, hypercoag state and venous stasis/dilation
what is management of septic pelvic thrombophlebitis?
broad spectrum abx with anticoagulation
what are signs of septic pelvic thrombophlebitis?
fever that is unresponsive to abx and no infxious sx
main symptoms of congenital Zika virus
microcephaly is number 1
thinned cortices and calcifications
in exam questions, positive leukocyte esterase means what?
UTI
what is a urethral diverticulum? what can cause it?
a herniation of urethral tissue into surrounding tissue due to recurrent ant vaginal wall infxns
what are sx of urethral diverticulum?
post void dribblinf, infection, and dyspareunia
diagnosis and treatment of urethral diverticulum?
dx with MRI rx with surgery
what is adequate contraction units in labor?
200 montevido units in 10 minutes
2 definitions of arrest of active phase of labor
4 hours with no cervical change despite adequate contractions
6 hours with no cervical change and not adequate contractions
what is difference between idiopathic hirsutism and hypertrichosis?
hirsutism hair is coarse and only grows in androgen dependent areas
hypertrichosis is fine hair that can grow anywhere
what is treatment for chlamydia in pregnancy?
azithromycin
until what age do you screen yearly for chlamydia and gono?
25
What is interstitial cystitis?
chronic bladder pain not from another condition
what are sx of interstitial cystitis?
pain with filling, increased frequency and urgency and dyspareunia
what is rx for candida in vagina?
fluconazole
what is discharge like in candida in vagina?
thick cottage cheese like
what is the external cephalic version maneuver? when is it done?
at 37 weeks move transverse of breech bby to vertex
name contraindications to an external cephalic version?
prior classical c sxn
prior myomectomy
prior placenta previa
what is lichen sclerosus?
thin white areas on labias that can extend to rectal area
what are symptoms of lichen sclerosus?
ITCHY white area
what is rx for lichen sclerosus?
strong corticosteroids
who gets lichen sclerosus?
prepubertal and meno women
why do postmeno women have increased UTI risk?
because estrogen deficiency leads to higher vaginal pH so e coli can grow more
what is therapy to help prvent UTI occurrence in post meno women?
estrogen topical cream
6 risks to fetus with illicit drug use
preterm birth preeclampsia diminished fetal growth fetal demise spontaneous abortion abruptio placentae
signs of vulvar cancer?
pruritic vulvar plaque with AUB
what are some risks for vulvar cancer?
lichen sclerosus, immunodeficiency, cervical cancer, smoking
what is recurrence risk of preeclampsia?
10-20%
what is protein cutoff for preeclampsia on 24 hour protein?
300 mg
how long after delivery is magnesium continued with preeclampsia with severe features?
24 hours
what is treatment for confirmed gonorrhea and negatiive chalmydia?
both ceftriaxone and azithromycin
what is treatment for confirmed chlamydia and negative gono?
azithromycin only
what is a biophysicsl profile?
non stress test of fetus with ultrasound
what four things do you check in biophysical profile?
amniotic fluid volume fetal breathing fetal movement fetal tone non stress test result
4 risk factors for placental dysfunction or insufficiency?
smoking
HTN
diabetes
advanced maternal age
how do you score biophysical profile? what is normal?
2 for each category normal is 8 and up
what score on biophysical profile means placental insufficiency?
less than 4
what are three clinical signs of HELLP syndrome aside from hemolysis, elevated liver enzymes and low platelets?
RUQ pain, preeclampsia and N/V
what are two urinary symptoms of menopause?
recurrent UTIs and incontinence
what age should cell free DNA testing start being offered for women?
women over 35
3-4 days postpartum what is expected pospartum lochia?
dark or red blood with similar smell to menstrual blood, can have clots
4-14 days postpartum what is expected pospartum lochia?
pink or brownish old blood
14 days to 6 weeks postpartum what is expected pospartum lochia?
white/yellow creamy stuff
what is management of spontaneous abortion?
if hemodynamically stable without anemia give misoprostol, if not hemodynamically stable then do DC
what is management an sign of an unstable or ruptured ectopic pregnancy?
hemodynamic instability…surgery
how does a ureteral laceration present post op?
bloating and abdominal pain with vaginal leakage/discharge that is clear
preterm labor prior to 34 weeks gestation age, what is management?
give roids, penicilliin if + or unknown GBS, tocolytics like indomethacin or nifedipine
34+ week gestation age preterm labor what is management?
roids and penicillin if indicated…no tocolysis
what is a missed abortion?
no vaginal bleeding or cervical dilation, but no cardiac activity
what is an inevitable abortion?
vaginal bleeding and dilated cervix but fetal parts all still above internal os
what is a threatened abortion?
vaginal bleeding, no cervical dilation, fetal cardiac activity still there
what skin condition can you have in vagina?
vitiligo
