Week 5 Uworld Flashcards
what are three risk factors for late PPH?
prolonged labor
intraamniotic infection
macrosomia
what can you give to patient with incidental short cervix that is pregnant and does not have documented cervical insufficiency?
vaginal progesterone
what does vaginal progesterone do to help with short cervix in pregnancy?
calms uterus down to prevent preterm birth
2 risk factors for having hyperemesis gravidum?
hydatiform mole and multifetal gestation
what is first line treatment of migraines in pregnancy?
acetaminophen
what is a postdural puncture headache?
headache that onsets after an LP or epidural anaesthesia
what is characteristic of postdural puncture headache?
positional…worse when upright. can have N/V and photophobia
what is a physical exam finding of a postdural puncture headache?
neck stiffness
what is rx for postdural puncture headache?
epidural blood patch if really bad…otherwise it self resolves
in the periods after menarche, is there ovulation?
no
why is there no ovulation in early periods after menarche?
no ovulation because the hypothalamic pituitary axis is immature and not putting out right quantities of hormones
since no ovulation, what are early periods like?
often irregular and heavy bleeding
what is the treatment for early periods being heavy
progestin only or combined OCP
two risk factors for developing a uterine sarcoma?
pelvic radiation and tamoxifen therapy
what are symptoms of uterine sarcoma
uterine mass that is palpable and irregular…post meno bleeding
what is the workup of intraductal papilloma?
US or mammogram depending on if patient less or more than 30 yrsold
what is MC cause of bloody discharge from nipple?
intraductal papilloma
lichen sclerosus involves what skin areas?
labia majora/minora and the perineum/rectal area
what is the work up of lichen sclerosis?
punch biopsy
what are the main sx of lichen sclerosis?
ITCHING, excoriations, dysuria
what is rx for lichen sclerosis?
high potency steroids
what are abnormal labs in acute fatty liver of pregnancy?
high ALT/AST, hyperbilirubinemia, thrombocytopenia, leukocytosis, LOW sugar
what is cutoff for fetal tachycardia?
160bpm
what is a common cause of fetal tachycardia?
intramaniotic infection
what nerve can get impinged during labor?
femoral nerve
what medication used in uterine atony is contraindicated in patients with asthma?
carboprost
what medication used in uterine atony is contraindicated in patients with HTN?
methylergonivine
what is a progestin challenge test? what does it inform you about?
give 10 days of progestin then stop to see if will bleed …informs about estrogen levels
if patient does not bleed after progestin challenge test, what does it mean?
they dont have enough estrogen
what is preferred contraception pill for breastfeeders?
progestin only
bilateral gray nipple discharge is likely what?
galactorhhea
what are two endocrine causes of galactorrhea?
hypothyroid and prolactinemia
if pregnant lady has HSV history but no active lesions, what is rx?
start acyclovir at 36 weeks
fever 24+ hrs after delivery and uterine tenderness mean what?
postpartum endometritis
what are risk factors for postpartum endometritis?
prolonged ROM
csxn
intraamniotic infxn
GBS+
what are sign sof postpartum endometritis?
uterine tender
fever
lochia discharge
what is rx for postpartum endometritis?
clinda and gentamicin
which of androgen insens syndrom and 5a reductase deficiency has breast bud development?
AIS does and 5a doesnt
what is management of intrahepatic cholestasis of pregnancy?
ursodeoxychoic acid and deliver at 36 weeks
normal female external organs, no uterus and cervix, but normal development should make you think what?
mullerian dysgeneis
what else should ppl with mullerian dysgenesis be evaluated for?
renal abnormalities
how long can discharge from vagina last after delivery?
8 weeks
what should be done for moms with gestational diabetes following delivery?
2hr glucose tolerance test at 6 weeks
what is management of placenta accreta?
hysterectomy
what med is used in PCOS to help with fertility?
letrozole
why do fibroids degenerate in pregnancy?
because they lose their blood
what are signs of fibroid degeneration?
leukocytosis, PAIN, tender mass, uterine contractions
what is rate of cervical dilation supposed to be in active phasE?
1cm every 2 hours
what is workup of fibroadenoma in adult less than 30?
ultrasound
how long till someone coming off OCP should have normal periods?
1-3 mos
what are three tests to workup secondary amenorrhea?
FSH, prolactin and TSH
what are the requirements of latent tb to meet criteria?
positive test without sx and good chest x ray
what is rx for latent tb in pregnancy?
isoniazid
what is most effective emergency contraception? when do you need it by?
copper IUD within five days
what age does HPV testing start
21
what is polymorphic eruption of pregnancy?
pruritic erythematous plaques in striae
when does polymorphic eruption of pregnancy occur
?
3rd trimester
what is rx for polymorphic eruption of pregnancy?
steroids topical
what is elevated in a granulosa cell tumor?
estradiol and inhibin
what is special about juvenile onset granulosa cell tumor?
can lead to precocious puberty
what are some signs of antiphospholipid syndrome?
thromboses, recurrent pregnancy losses
what is state of someone with antiphospholipid syndrome?
hypercoagulable
what can be a false positive in antiphospholipid syndrome?
syphilis VDRL
what is rx for antiphospholipid syndrome?
LMWH
four risk factors for preeclampsia
multiple gestation
T1DM
chronic HTN
SLE
what is screening for patient with increased risk of preeclampsia?
24 hour urine protein at first visit
what two bugs cause elevated vaginal pH?
trich and gardnerella
aside from hot flashes, what are other SEs of tamoxifen?
endometrial cancer, thromboembolism
three complications of asthma during pregnancy
preterm birth, low birth weight, antenatal hypoxia
what abx for cellulitis in post partum?
cephalexin
when do you give MG for CP?
32 weeks and less
what should you not give in PPROM? why?
dont give tocolytics because contractions can be sign of maternal issues
what is FHT seen in umbilical cord prolapse
bradycardia and prolonged decel
what are the signs of acute hemolytic transfusion reaction?
fever chills hypotension
hemoglobinuria and flankpain
purple mass in vagina and hemodynamic instability following delivery is what?
vaginal hematoma
can you live with anencephaly?
no
what is management of mom with non viable fetus who is in preterm labor?
allow labor to progress naturally
what is first step in retrieving foreign body in young girls vagina? second?
first is irrigation with warm water and second is exam under anesthesia
what mutation is common cause of primary ovarian insuff?
FMR1 fragile X
a thin intertwin membrane means what?
diamniotic
indomethacin can cause what in fetus if given to mom?
oligohydramnios
if you have bloody nipple discharge and a breast mass then what is most likely cause?
invasive ductal carcinoma
what lab abnormality can occur in amphetamine intox?
hyponatremia
what happens to pupils with amphetamine?
dilation
fetal heart block causes what issue on FHT?
bradycardia
dysuria and sterile pyuria should make you think what?
chlamydia infection
what is urethral hypermobility?
urethra abnormally moves with stress/valsalva and is not able to fully close
what type of incontinence with urethral hypermobility?
stress
what is rx for urethral hypermobility?
pelvic floor exercises
irregular menstrual bleeding and RUQ pain should make you think what?
fitz hugh curtis syndrome
a maculopapular rash in pregnancy that is on trunk and includes the palms and soles should make you think what?
secondary syphillis
patient with IUD in and found to have actinomyces and are symptomatic, what should you do?
further evaluation including IUD removal and penicillin
patient with IUD in and found to have actinomyces and are asymptomatic, what should you do?
nothing
can you have cervical motion tenderness in endometriosis?
yes
what is ideal head position for fetus?
occiput anterior
what should you evaluate if baby has fetal growth restriction?
placental function
how do you evaluate placental function in baby who has fetal growth restriction?
umbilical artery ultrasound
what is a contrindication to IUD placement that is related to menses?
irregular unexplained menstrual bleeding
what is management of patient with intra amniotic infection?
abx and labor augmentation
what is imaging modality for fecal incontinence after a laceration ?
endoanal US
define missed abortion
no bleeding, closed os, no cardiac activity or fetal pole
define threatened abortion
vaginal bleeding, closed os,positive fetal cardiac activity
define inevitable abortion
open os, bleeding, fetal parts still there
define incomplete abortion
bleeding, open os, some parts still there
define complete abortin
closed os, bleeding, no parts left
two tests to diagnose a vesicovaginal fistula
dye test and cystourethroscopy
patient under 45 yrs old with AUB intermenstrual bleeding should be treated how?
start on OCPs
patient under 45 yrs old with AUB intermenstrual bleeding who tried OCPs and didnt work, should be treated how?
endo biopsy
a persistent rise in hcg after a d/c is diagnostic for what?
ectopic pregnancy
what med is contrindicated with myasthenia gravis patients in pregnancy?
Mg
what is rectus abdominis stasis?
linea alba weakens and gut can protrude with vlsalve
what are risks for rectus abdominis stasis?
pregnancy and surgical weakening
what is a SE of epidural anasethesia?
hypotension
what is cause of hypotension in epidural?
leads to venodilation and venous pooling so low cardiac return
what is risk with hypotension from epidural?
fetal acidosis
what is management of hypotension from epidural?
left uterine displacement, fluids and pressors
which antiHTN should you not give to a mom with severe range pressures and bradycardia?
labetalol
name three antiHTN for severe range pressures in pregnancy
labetalol
hydralazine
nifedipine
cause of RUQ pain in HELLP?
distension of the liver capsule
what lung finding can occur in preeclampsia?
pulmonary edema
