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UWORLD ABIM > Womens Health/Pregnancy > Flashcards

Womens Health/Pregnancy Flashcards

1
Q

What is gestational thrombocytopenia- clinical features, typical platelet range

A

benign

self-limiting

5-7% pregnancies

discovered late in gestation, usually at delivery. incidental, no symptoms

usually 100-150,000

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2
Q

Management of gestational thrombocytopenia

A

continue routine prenatal management

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3
Q

Management of ectopic pregnancy

A

In hemodynamically stable patients with:

  • BHCG <200 and no adnexal mass, can do expectant management
  • BHCG <5,000 (can use methotrexate in patients with no contraindications to therapy - immunodef, renal failure, active pulm disease)

hemodynamically unstable patients require surgery (ruptured ectopic –> intraabdo bleeding –> HD instability)

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4
Q

epidemiology and clinical pres of interstitial cystitis/bladder pain syndrome

A

more common in women

assoc with psychiatric and pain disorders (ex fibromyalgia)

clinical sx: bladder pain with filling, relief with voiding. increased urinary freq, urgency. dyspareunia

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5
Q

diagnosis of interstitial cystitis/bladder pain syndrome

A

bladder pain with no other cause for >6 weeks

normal urinalysis

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6
Q

management of interstitial cystitis/bladder pain syndrome

A

improve qual of life

amitriptyline or pentosan polysulfate sodium w/c repairs the urothelium

behav modification, avoid triggers, pt

analgesics

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7
Q

Definition of pre-eclampsia

A

new onset HTN at >20 wks gestation
PLUS
proteinuria and/or end-organ damage

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8
Q

Severe features of pre-eclampsia

A
  • SBP >=160 or DBP >= 110 (2 times >4 apart)
  • thrombocytopenia
  • elevated cr
  • elevated LFTs
  • pulm edema
  • visual or cerebral sx
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9
Q

Management of pre-eclampsia

A 
without severe features: delivery at >=37 wks
with severe fx: delivery at >=34 wks
Mag sulfate (seizure ppx)
antihypertensives
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10
Q

How do you treat pregnant women with anti-phospholipid syndrome?

A

aspirin and/or LMWH depending on prior pregnancy complications ex. fetal loss, pre-eclampsia

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11
Q

Is hydroxychloroquine (plaquenil) safe in pregnancy?

A

yes

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12
Q

is methotrexate safe in pregnancy?

A

no

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13
Q

What are anti-Ro/SSA and anti-La/SSB antibodies in pregnant women associated with in neonates?

A

neonatal lupus and congenital heart block

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14
Q

Treatment of mild menopausal symptoms

A

behavioral/lifestyle modifications

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15
Q

Treatment of mod/severe menopausal/vasomotor symptoms

A

In patients w/ contraindications to estrogen –> SSRI

if no contraindication to estrogen –>
intact uterus: estrogen and progestin
absent uterus: estrogen only
HRT is given for <5 years

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16
Q

Condyloma acuminata

A

HPV- types 6 and 11

non-friable, non-tender, fungating lesions

treatment: trichloroacetic acid, podophyllotoxin

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17
Q

What are examples of selective estrogen receptor modulators? When do you use each of them?

A

Tamoxifen- used in adjuvant breast ca therapy in patients with non-metastatic, estrogen positive br ca. first line in pre-menopausal pts. can also be used in post-menopausal pts who dont tolerate aromatase inhibitors

Raloxifene- used in post menopausal osteoporosis

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18
Q

How do selective estrogen receptor modulators work? What are their adverse effects?

A

They are competitive inhibitors of estrogen binding. Mixed agonist/antagonist activity

Adverse effects:
Hot flashes
VTE 
Endometrial hyperplasia and carcinoma- tamoxifen only
Uterine sarcoma- tamoxifen only
19
Q

UTI treatment in pregnancy:

abx for asymptomatic bacteriuria and cystitis

A 
Amox-clav
Fosfomycin
Cephalosporin (ex. cefpodoxime, keflex)
Nitrofurantoin- avoid in 1st trimester
TMP-SMX- avoid in 1st trimester and at term
20
Q

UTI tx in pregnancy

abx for mild-mod pyelo:

A
  • inpatient admission
  • 3rd or 4th gen cephalosporin- ceftriaxone or cefepime
  • aztreonam
  • ampicillin & gentamycin
21
Q

UTI tx in pregnancy:

abx for severe pyelo (immunocompromised, urinary retention):

A

zosyn

carbapenems

22
Q

complications associated w/ pyelonephritis in pregnancy

A

ARDS in mother, preterm labor

23
Q

How to manage hyperthyroidism in pregnancy; which drug to use in each trimester?

A

1st: propylthiouracil b/c methimazole assoc w/ congenital defects
2nd/3rd: methimazole b/c PTU assoc with hepatotoxicity

can use beta blockers as well, and thyroidectomy also option

24
Q

how often do you monitor thyroid labs in hyperthyroid pregnant pt?

A

every 4 weeks

25
Q

goal for managing hyperthyroidism in pregnancy?

A

maintain slightly hyperthyroid state

26
Q

what hyperthyroid treatment is contraindicated in pregnancy?

A

radioactive iodine

27
Q

primary ovarian insufficiency clinical features

A

age <40

  • amenorrhea
  • menopausal sx: hot flashes, pain during sex
  • often idiopathic, however can be related to autoimmune disorders, previous chemo/rad, or genetic abnormalities - turners, fragile x
  • lab: elevated FSH, low estradiol
28
Q

most effective emergency contraceptive

A

copper IUD 99%

second most is levenogestrel pill / Plan B- 95% effective within 24h, then decreases to 85%

29
Q

treatment of urge incontinence

A

first line: bladder training and behavioral modifications like pelvic muscle exercises

if this fails, can try antimuscarinics- oxybutinin, tolterodine, and beta3 agonists ex. mirabegron

30
Q

when do you screen for GDM?

A

third-trimester for low risk pts

first-trimester for high risk/patients who had it previously

then repeat 2 weeks post partum if they had GDM to see if they have persistent T2DM

31
Q

PCOS diagnostic criteria

A

need 2 of 3:

  1. irregular or absent ovulation/menses
  2. clinical (hirsutism, acne) or biochemical (elevated testosterone) hyperandrogenism
  3. polycystic ovaries on ultrasound
32
Q

normal vaginal ph

A

3.8-4.5

33
Q

criteria for BV

A

3 out of 4 of the following:

thin,grey vaginal discharge

vaginal pH >4.5

odor after KOH whiff test

clue cells

34
Q

tx of BV (first and second line)

A

oral or vaginal metronidazole

alternatively, clindamycin

35
Q

glycemic targets during pregnancy:

  • fasting
  • 1 hour post-prandial
  • 2 hours post-prandial
A

fasting: <=95
1 hour post prandial <=140
2 hours <= 120

36
Q

second line treatment for GDM, after lifestyle/dietary changes (1st line)

A

basal bolus insulin

37
Q

new diagnosis of HIV in pregnant pt. when do you start HAART?

A

right away

38
Q

at what HIV viral load do you need to do a c-section and intrapartum zidovudine (AZT)?

A

> 1000

if viral load is optimal, <1000, can still deliver vaginally, without AZT

39
Q

can you do amniocentesis in a pregnant HIV pt?

A

yes if viral load is <1000

40
Q

postpartum, do you treat the infant born to a mother with HIV? with what?

A

if viral load <1000, zidovudine (AZT)

if viral load >1000, multi drug ART

41
Q

What do you do with thyroid replacement in hypothyroid pts during pregnancy?

A
  • at sign of positive pregnancy test, increase dose by 30%

- monitor every 4 weeks, adjust to trimester specific norms

42
Q

what vaccine do all pregnant pts need, in each pregnancy, regardless of vaccination history?

A

TDAP

if given in third trimester, it provides passive immunity to infant

43
Q

prolactinoma management

A

if causing hypogonadism/amenorrhea or neuro sx (headache, visual changes) due to mass effect, tx with dopamine agonists (cabergoline, bromocriptine) and follow with serial MRIs.

surgery (transsphenoidal resection) is only reserved for refractory cases

UWORLD ABIM (11 decks)

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