4 ⼀PREGNANCY/BREAST/REPRO Z Flashcards

Question

describe the menopause transition (4) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ What s/s during menopause transition are c/f malignancy? (2)

Answer 1

occurring over years before true menopause (51 yo), involves **[DECREASING** menstrual bleeding (amount and # of days)] [Longer Intermenstrual intervals] vasomotor sx \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *[INCREASED menstrual bleeding] or [shorter intermenstrual intervals] = [endometrial hyperplasia/CA] possible*

Answer 2

Bacterial Vaginosis 1. gray vaginal discharge 2. amine odor after KOH application 3. clue cells on wet mount 4. vaginal pH \>4.5

Answer 3

Bacterial Vaginosis 1. [metronidazole (PO or PV)] 2. [Clindamycin (PO or PV)]

Answer 4

YES - ONLY IF SYMPTOMATIC ; symptom relief \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *unclear if tx ⬇︎ obstetric complications (spontaneous abortion/preterm labor) from BV*

Answer 5

[influenza *killed*] [anti-RhoD IG] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [3rd trimester ≥28WG] ## Footnote *TDaP given [3rd trimester ≥28WG] facilitates maternal ab immunity AND enables transfer of maternal ab thru placenta*

Answer 6

- [Migraine with aura (due to ⇪ stroke risk)] - [SEVERE HTN ≥160/100] - [SMOKING ≥15 cig/day] - [Female age ≥35] - Hypercoagulability (factor 5 leiden/antiphospholipid) - [ACTIVE BREAST CA] - [ACTIVE LIVER disease]

Answer 7

NO TX\<--(-PRG)--[**Female** **Asx bacteriuria**]--(+PRG)--\> [*CAF* abx] 1. [cephalexin x 5d] 2. fosfomycin x 1 3. [amox/clav x 7d] * repeat urine culture 1 week after abx completion to test for cure* * tx should be guided by culture susceptibility*

Answer 8

[⇪ iron demand] and [⬇︎ poor maternal iron intake] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ hypOchromic microcytic RBC

Answer 9

while [βhCG discriminatory zone **≤3500**] pregnancy cannot be located/visualized ➜ [repeat βhCG q48h] to determine if INC is c/w normal pregnancy (normal = ≥35% every 48h]

Answer 10

Detrusor hyperactivity 2/2 1. UTI 2. Estrogen deficiency (urethral closure --\> ⬆︎intrabladder pressure --\> urge) 3. Multiple Sclerosis 4. DM

Answer 11

1. DM neuropathy 2. mechanical obstruction ## Footnote *⬇︎Detrusor activity or mechanical outlet obstruction --\> Overdistended bladder --\> involuntary dribbling and incomplete empyting (⬆︎PVR)*

Answer 12

**Menopause ➜ VulvoVaginal atrophy** ➜ pelvic organ prolapse / dyspareunia / urinary incontinence

Answer 13

1st: [Timed Voiding bladder training] + [⬇︎ wt / smoking / etoh / caffeine] 2nd: [Oxybutynin vs Tolterodine (Anticholinergic)] 3rd: [BoTox vs perQ tibial nerve stimulation] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *detrusor hyperactivity ➜ sudden URGE to urinate*

Answer 14

[≤1.9L (or ≤64oz) /day]

Answer 15

Stress \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *will have positive bladder stress test (leakage of urine with coughing )*

Answer 16

1. Pelvic organ prolapse (can also do surgery if good candidate) 2. Stress urinary incontinence

Answer 17

1. **URETHRAL SLING** 2. **Kegel exercise physical therapy** 3. Vaginal pessary 4. Bladder neck Injectable bulking if etx is related to sphincter deficiency

Answer 18

1. **symmetrically enlarged TENDER uterus (\> 12 weeks in size)** 2. Menorrhagia 3. Dysmenorrhea eventually --\> Chronic Pelvic Pain ## Footnote *etx: glands invade uterine myometrium --\> blood deposition inside myometrium during cycle --\> dysmenorrhea from irregular contractions and menorrhagia from extra deposited blood*

Answer 19

1. Pregnancy/Childbirth 2. Obesity 3. Menopause ## Footnote *Diagnosed with* *Q-tip urethral hypermobility test*

Answer 20

*Incontinence with coughing/lifting/sneezing* 1. Urethral Hypermobility (injury to pelvic floor muscles and/or urethral prolapse --\> urethral hypermobility or bladder cystococele can --\> bladder prolapse and all of this --\> vaginal bulge and incontinence) 2. ⬇︎Urethral tone Tx = Kegel excercises vs urethral sling

Answer 21

1. Endometrial Polyps - Painless and light 2. Adenomyosis 3. Endometrial ADC/hyperplasia - Older women 4. PID - due to cervicitis 5. Cervical CA

Answer 22

In teen females, [**Upper/Outer SINGLE rubbery mobile breast mass]** that becomes PAINFUL PREMENSTRUATION but RELIEVED POSTMENSTRUATION

Answer 23

1. b/l Breast Fullness 2. b/l Breast Tenderness 3. b/l Breast warmth 4. No Fever Usually occurs 3 days postpartum when colostrum is replaced with milk, but can occur anytime during breastfeeding *Tx = BREASTFEED, Cool compress, APAP, NSAIDS*

Answer 24

* Breast Engorgement is BL without fever and Mastitis is uL WITH FEVER (Breast abscess is Mastitis with fluctuance) * Breast Engorgement is BL and Plugged Ducts is uL

Answer 25

1. NSAIDs for pain/inflammation 2. COMFORTABLE Bra that **avoids nipple stimulation** 3. Cool Compress to breast ## Footnote *Engorgement in and of itself eventually --\> Lactation suppresion on its own due to negative feedback! do NOT breast bind as this causes mastitis. Don't use drugs to treat this.*

Answer 26

1. **1st degree** relative with breast CA 2. Prolonged estrogen exposure (menstruating outside of 12-52 y/o range vs utero DES vs HRT) 3. Genetics (BRCA 1/2 mutation) 4. Alcoholic 5. Obesity 6. Radiation 7. Age 40-70 yo 8. White ## Footnote *Average Menopause onset = 51*

Answer 27

**CCAFF** 1. **C**A 2. **C**yst 3. **A**bscess 4. **F**ibroadenoma 5. **F**at necrosis

Answer 28

1. HTN 2. Breast Tenderness 3. ⬆︎TriAcylGlycerides 4. Bloating with Nausea 5. **Breakthrough bleeding** = **most common (usually with lower estrogen doses)** 6. Venous thromboembolism (Migraine w/aura is a ctd for Combined OCPs) ## Footnote *Wt Gain is NOT a side effect of combined OCPs and OCPS actually ⬇︎risk of Endometrial and Ovarian CA*

Answer 29

Elevated Prolactin (responsible for mammogenesis and galactogenesis) **inhibits GnRH release** --\> anovulation and amenorrhea for ≤ 6 months ## Footnote *after 6 months, even with breastfeeding women will start to ovulate again and even before then, this is not a reliable form of contraception*

Answer 30

**Hyperprolactinemia** **is most common cause of galactorrea** 1. PROLACTIN levels - Prolactinoma could --\> Hyperprolactinemia 2. TSH levels - hypOthyroidism could --\> ⬆︎TRH & TSH --\> Hyperprolactinemia since TRH stimuales prolactin release 3. PREGNANCY test - Pregnancy could --\> Hyperprolactinemia since TSH shares same α-subunit as bHCG 4. MED REVIEW - D2 blockers/Antidepressants/Opioids all --\> Hyperprolactinemia

Answer 31

1. ⬇︎Breast CA risk 2. adjuvant tx for Breast CA (Tamoxifen) 3. Postmenopausal Osteoporosis (Raloxifene) SIDE EFFECTS A: **Hot Flashes** B: Venous Thromboembolism (all estrogen agonist ⬆︎resistance to protein C) C: Endometrial Hyperplasia/ADC *note: SERMs not only modulate estrogen receptors but they actually block estrogen binding competitively*

Answer 32

Intraductal Papilloma

Answer 33

1. Firm mass after trauma 2. IRREGULAR SHAPED mass 3. overlying erythema ## Footnote *Mammogram: Oil cyst +/- calcifications that appear malignant but has fat globules and foamy macrophages on bx*

Answer 34

Tx = **KEEP BREASTFEEDING** + Dicloxacillin + Ibuprofen ## Footnote *drain via needle aspiration if abscess is present*

Answer 35

Bactrim Cipro suprapubic catherization (bladder decompression)

Answer 36

[UA/UCx before and after prostate massage] ➜ UA = [pyuria \> 20] + Urine Culture: [neg = CP/CPPS] vs [bacteriuria \> 10 fold increase = CBS] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ * [CP/CPPS = Chronic prostatitis chronic pelvic pain syndrome]* * [CBS = Chronic BACTERIAL prostatitis]*

Answer 37

[Chronic Prostatitis chronic pelvic pain syndrome] will have **NEGATIVE CULTURE** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *\> 3 month dysuria + pelvic/perineal pain*

Answer 38

UNKNOWN \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Prostate Enlargement Meds (alpha blockers)

Answer 39

EBRT \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *External Beam **Radiation** Therapy*

Answer 40

EBRT \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *External Beam **Radiation** Therapy*

Answer 41

UNKNOWN \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Prostate Enlargement Meds (alpha blockers)

Answer 42

[Chronic Prostatitis chronic pelvic pain syndrome] will have **NEGATIVE CULTURE** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *\> 3 month dysuria + pelvic/perineal pain*

Answer 43

[UA/UCx before and after prostate massage] ➜ UA = [pyuria \> 20] + Urine Culture: [neg = CP/CPPS] vs [bacteriuria \> 10 fold increase = CBS] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ * [CP/CPPS = Chronic prostatitis chronic pelvic pain syndrome]* * [CBS = Chronic BACTERIAL prostatitis]*

Answer 44

Bactrim Cipro suprapubic catherization (bladder decompression)

Answer 45

*24-8WG testing is performed due to [expanding RBC mass] and [insulin resistance from hPL secretion]*

Answer 46

**iPUB** ## Footnote {**I****D** [HIV|HBV|HCV|Syphilis|[chlamydia PCR (if risk factors)]} {**PX** [Rubella immunity|Varicella immunity|Pap (if indicated)]} {**URINE** [Cx | dipstick protein]} {**BLOOD** [Hgb|Hct|MCV|ferriTin|(RhoD type / Ab screen)]} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *[HBV=HepB Surface Antigen]* | [*HCV=anti-HCV Ab]* | *[Syphilis=VDRL/RPR]*

Answer 47

[2nd/3rd trimester] pregnancy, benign **asymptomatic** [thrombocytopenia\< 70K] that spontaneously resolves after delivery

Answer 48

``` platelet dysfunction (thrombocytopenia | rapid ⬇︎ platelet) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ``` *this is because [ENA] in the setting of platelet dysfxn ⇪ risk for [Spinal Epidural Hematoma]*

Answer 49

lack of testicle enlargement **BY 14 Y/O** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *obtain bone radiograph / FSH, LH, testosterone*

Answer 50

1. Progesterone (vaginal or IM after 1st trimester) 2. Cerclage ## Footnote *Complications = Chorioamnionitis/Endometritis/Cord Prolapse/Placenta Abruptio*

Answer 51

1st best indicator: **PRIOR PRETERM DELIVERY = STRONGEST INDICATOR** 2nd best: Shortened cervix ≤ 2cm per transVaginal US (or 2.5 if preterm hx present) - hx of cold knife conization? 3rd best: + Fetal Fibronectin BUT ONLY BETWEEN 20-37WG 4th best: Circumstantial (Smoking, multiple gestation, IVF, obesity)

Answer 52

*Complications = Chorioamnionitis/Endometritis/Cord Prolapse/Placenta Abruptio*

Answer 53

**if baby not compromised, fetal surveillance until 34 WG and then deliver!** *Complications = Chorioamnionitis/Endometritis/Cord Prolapse/Placenta Abruptio*

Answer 54

***P**regnant **B**itches*

Answer 55

***P****regnant **B**itches **T**ake*

Answer 56

***P**regnant **B**itches **T**ake **M**oney*

Answer 57

1. observation if asx 2. NSAIDs **1st** 3. Contraceptive (OCP/IUD progesterone) 4. Leuprolide (GnRH agonist that ⬇︎Endometrial gland estrogen stimulation) 5. Hysterectomy with oophorectomy ## Footnote * Findings: Gun Powder Burn lesions, Adhesions, Chocolate fluid* * Dx = Laparoscopy to biopsy endometriotic lesions*

Answer 58

* PPROM patients are at ⇪ risk for* 1. [**UMBILICAL CORD PROLAPSE** = OBSTETRIC 911] : [tx = relieve cord compression ➜ Cesarean STAT] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 2. Chorioamnionitis 3. Endometritis 4. Placenta Abruptio

Answer 59

[1 - **18** hours after ROM] (no sooner ; no later) ## Footnote \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *labor starting ≥18H after ROM ➜ chorioamnionitis ➜ neonatal sepsis* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ * Do not confuse this with PPROM (Preterm Premature Rupture Of Membrane)* * Chorioamnionitis Tx = Abx --\> Delivery*

Answer 60

Prolactin inhibits GnRH secretion from hypothalamus ➜ [⬇︎FSH/LH] ➜ [⬇︎ secondary sex characteristics (testicle size/facial hair/libido)]

Answer 61

- [friable exophytic cervical mass] - [irregular vaginal bleeding +/- mucoid vaginal dischage] - postcoital bleeding - ulcerative cervical lesions \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ AIDS DEFINING ILLNESS

Answer 62

pelvic surgeray ; small vesicovaginal fistula from bladder to vagina ➜ [continuous PAINLESS malodorous urine leak from Bladder To vagina +/- red area of granulation (if small vv fistula)] ➜ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 63

for pts with βhCG \< 1500, **pregnancy of undetermined location** warrants [repeat βhCG in 48 hours]

Answer 64

Retrograde Ejaculation

Answer 65

underlying DM ; Balanitis is a/w high blood glucose

Answer 66

autoimmune disorder (involves anti-thyroid peroxidase Ab) that within a year of childbirth --\> brief **HYPER**thyroid phase --\> [brief **hypO**thyroid phase (*may require thyroid replacement if severe*)] --\> **Eu**thyroid back to normal Dx = tSH

Answer 67

*by trimesters* 1st = PropylThioUracil 2ND = METHIMAZOLE 3RD = METHIMAZOLE \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [*PTU = Hepatotoxic] // [Methimazole = teratogenic during 1st trimester]*

Answer 68

newborns born from gestational DM/maternal DM have ⇪ risk for transient HOCM (2/2 excess glycogen deposition in fetal myocardium ➜ thickened interventricular septum) ➜ [Tachypnea + Respiratory distress] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ even if newborn has transient HOCM sx... **MOST SPONTANEOUSLY RECOVER BY 3 WEEKS** ## Footnote (once natural insulin levels start to normalize ➜ ⬇︎myocardial glycogen deposition)

Answer 69

Exclusive breastfeeding **SHOULD BE ENCOURAGED TO ALL**. Within 1st week of life there is [*EXPECTED* *WEIGHT LOSS (*≤ 10% from birth)] -- so this should not stop breastfeeding!

Answer 70

[no menstruation by 13] OR [no menstruation by 15 with breast] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 71

PBP = Pregnant Bells Palsy * Pregnant/Postpartum Patients have INC risk for **PF7BP** * PBP tx = [CTS +/- acyclovir] * PBP pgn = [full recovery ≤3 mo] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *[PF7BP = Peripheral Facial CN7 Bells Palsy]*

Answer 72

[painful erection \> 4h] 2/2 impaired penile blood outflow (out of corpora cavernosa) ➜ irreversible ischemic injury = MEDICAL 911 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - PDE5 inhibitors - [intracavernosal alprostadil injection] - Trazodone - Sickle Cell Disease

Answer 73

[non-R_x( urination, cold compress)] \< (sx 4h) \< [{Corpora Cavernosa aspiration} --(if sx persist)-→ {intracavernosal phenylephrine}]

Answer 74

1. cystitis ≤ 15 yo 2. Spermicide use 3. New sexual partner 4. Postmenopause

Answer 75

postmenopausal woman with new pelvic pain uterine mass ascites metastatsis (pleural effusion) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *tx = hysterectomy*

Answer 76

SERM ; [endometrial hyperplasia/CA and uterine sarcoma CA] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (sx = *endometrial polyp* ?) NO = observation YES = [transvaginal US] ➜ [endometrial biopsy]

Answer 77

Unopposed estrogen --\> uncontrolled endometrial proliferation (CA). Progesterone can regulate proper endometrial differentiation ## Footnote *just remember, estrogen replacement therapy can --\> postmenopausal bleeding on its own*

Answer 78

autoimmune chronic inflammation of [vulva, perineum and anal region] that affects [**hypOestrogenic women (prepubertal and peri/postmenopausal)]** and--\> Vulva SQC \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ THIS DOES NOT AFFECT THE VAGINA! *dx = vulvar punch biopsy*

Answer 79

1. Pruritus SEVERE 2. Dyspareunia 3. White Grayish pale vulva (distinguishes from postmenopausal vaginal atrophitis) 4. Cigarette paper texture vulva (**thin**, crinkled) 5. loss of vulvar anatomy (introitus, labia minora, clitoral hood) ## Footnote *dx = vulvar punch biopsy*

Answer 80

atrophy; vaginal dryness / dyspareunia

Answer 81

menopause wreaks **HAVOC** 1. **H**ot flashes 2/2 vasomotor instability 2. **A**trophy of vagina --\> dyspareunia, urinary incontinence, paleness, narrowed introitus 3. **V**aginal Dryness --\> Pruritus 4. **O**steoporosis 5. **C**oronary artery disease *note: menopause can be 2/2 natural but also chemotherapy, radiation and oophorectomy*

Answer 82

1. **PERSONAL OR FAMILY HX OF OSTEOPOROTIC FX** 2. ⬇︎Estrogen (postmenopause) 3. LOW BMI (malnutrition/malabsorption) 4. Sedentary lifestyle 5. Poor Ca+ intake (body needs 1000mg/day premenopausal and 1200mg post) 6. Smoking 7. EtOH abuse 8. White race 9. CTS

Answer 83

1. natural Menopause 2. Chemotherapy - targets rapidly dividing granulosa/theca cells 3. Radiation - targets rapidly dividing granulosa/theca cells 4. oophorectomy

Answer 84

menopause wreaks **HAVOC** 1. **H**ot flashes 2/2 vasomotor instability 2. **A**trophy of vagina --\> dyspareunia, urinary incontinence, paleness, narrowed introitus 3. **V**aginal dryness --\> pruritus 4. **O**steoporosis 5. **C**oronary artery disease *note: menopause can be 2/2 natural but also chemotherapy, radiation and oophorectomy* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [≥45 yo **with anovulatory bleeding**] *c/f endometrial ADC/hyperplasia*

Answer 85

may cause [mild learning disability] **BUT DOES NOT AFFECT OVERALL INTELLIGENCE** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Most turner syndrome fetuses miscarry within 1st trimester*

Answer 86

1. [**EENT** ⼀(*Strabismus, OME, hearing loss*]^{=renal US} 2. [**CV** ⼀*Aorta_{(Coarctation/Dissection (WORST WITH PREGNANCY)/Dilatation)}, CHD_{(bicuspid aortic valve)}, Metabolic Syndrome X_DIVe]*^{= 4EBP, EKG, echo, GET AORTIC IMAGING} 3. [**Renal** ⼀*Horseshoe Kidney*]^{=renal US} 4. [**Bone** ⼀*Osteoporosis*]^{=DEXA, 25OHvitD} 5. [**autoimmune** ⼀*Celiac, hypOthyroid*]^{=antI-TED, TSH⼀free T4} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ * Most turner syndrome fetuses miscarry within 1st trimester* * 4EBP: 4-Extremity BP*

Answer 87

1. [Learning disability **WITH NORMAL INTELLIGENCE**] 2. [eye (nearsighted, strabismus)] 3. low set ears 4. webbed neck 5. hypOthyroidism 6. bicuspid aortic valve 7. aortic coarctation (*screen via 4-extremity BP and echo*) 8. aortic dissection ⼀*higher risk in pregnancy* 9. celiac disease 10. horseshoe kidney 11. scattered pigmented nevi 12. [Lymphedema congenitally of hands/feet from abnormal lymphatic system development] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Most turner syndrome fetuses miscarry within 1st trimester*

Answer 88

[Aortic **DISSECTION** or rupture]; [pregnancy hormones weakening aortic wall + hyperdynamic state of pregnancy can → Aortic **DISSECTION**]

Answer 89

DM/Obesity--\>Hyperinsulinemia which --\> ⬆︎⬆︎⬆︎LH secretion --\> ⬆︎ovarian theca Androgen secretion --\> 1. Androgen characteristics (acne, balding, hirsutism) 2. Follicular atresia ➜ Anovulation ➜ Infertility 3. PCOS on US from Follicular atresia 4. ⬆︎Estrogen (from Androgen conversion) --\> Endometrial ADC *tx = Wt loss ➜ **SOCK***

Answer 90

[Wt loss--\> **SOCK**] ## Footnote **S****OCK**:**S**pironolactone,**O**CP (1st line after wt loss),**C**lomiphene for infertility,**K**etoconazole \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *etx: DM/Obesity--\>Hyperinsulinemia which --\> ⬆︎⬆︎⬆︎LH secretion --\> ⬆︎ovarian theca Androgen secretion --\> Sx*

Answer 91

**⬇︎TONE** of Uterus \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [bimanual uterine massage] and [Oxytocin (causes uterine contraction)] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *2nd line uterotonics = methylergonovine/carboprost/misoprostol*

Answer 92

[**ANOVULATION** (up to 2 years post menarche)] 2/2 immature [hypothalamic-pituitary-ovarian axis] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Observation (since self-limited to up to 2 years post menarche)] ➜ [OCP if severe]

Answer 93

* MHT (_combined estrogen & progesterone)_* * BENEFICIAL✔︎ effects =* 1. ***HAVOC*** Menopause sx 2. Bone mass 3. Colon CA 4. T2DM 5. [All-Cause Mortality if \< 60 yo]

Answer 94

*MHT (_combined estrogen & progesterone)_* ***DETRIMENTAL❌**effects (with higher risk in Women GOE60yo) =* 1. **STROKE** 2. **Breast CA** 3. **CAD in GOE60yo** 4. **Gallbladder disease** 5. **Venous Thromboembolism**

Answer 95

*MHT (_combined estrogen & progesterone)_* ❌These MHT Detrimental effects are Higher /more clinically concerning in [Women GOE60yo]. ❌MHT Stroke risk in Women \< 60 yo is low = MHT can be used safely for short period in [Women \< 60 with low risk].

Answer 96

**GONOCOCCAL** conjunctivitis \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *does NOT treat chlamydia conjunctivitis*

Answer 97

*Annual Gonococcal and Chlamydia Screening (via vaginal/cervical NAAT) for:* ## Footnote Women: {IF SEXUAL \<-- **[24⼀*****AGE⼀*****25]** --\> ONLY IF *HIGH RISK* SEXUAL} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Men: Insufficient evidence :-(

Answer 98

▨ [Mucopurulent cervical discharge] + [Cervical Motion Tenderness] + [Abd Pain] + Fever \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ⊙ [ceFOXitin + doxy] *covers N.Gonorrhoeae, Chlamydia trachomatis, [Vaginal Flora =E.Coli/Mycoplasma]*

Answer 99

① Spironolactone ⼀Medication Adverse Effect \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ② Spironolactone has 2 MOA 1. often used in HFrEF patients as an [aldosterone R blocker] 2. **it also is an [androgen R blocker]** ➜ [DEC androgen] ➜ pathologic gynecomastia in men *tx = switch to Eplerenone (has less androgen R blockade)*

Answer 100

① Spironolactone ⼀Medication Adverse Effect \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ② tx = switch to Eplerenone (has less androgen R blockade)

Answer 101

*especially in overweight/obese*, PG is a benign glandular proliferation of male breast tissue occurring 2/2 imbalanced [**DEC** testicular **testosterone** (*with normal aging*)] and [**INC** adipocyte (androgen → **estrogen**) (*with Obesity*)]

Answer 102

TRUE \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *physical exam is only required for _complicated_ cystitis (fever, chills, flank pain, CVA TTP = pyelonephritis) and urine cx if initial tx fails*

Answer 103

TRUE \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *physical exam is only required for _complicated_ cystitis (fever, chills, flank pain, CVA TTP = pyelonephritis)*

Answer 104

[**CAN** **F**osfomycin **C**ontrol] **B**asic **U**ncomplicated **C**ystitis ?? 1. **C**ephalexin (*Pregnancy*) 2. **A**moxicillin-clavulanate (*Pregnancy*) 3. **N**itrofurantoin (*Pregnancy*) 4. **F**osfomycin (*Pregnancy*) 5. **C**eftriaxone (*Pregnancy and PYELO*) * 6.*[**B**actrim (*2nd trimester only*) - *[1TM➜ NTD] & [3TM ➜ kernicterus]*] 7. ***U**rine Cx only if initial Tx fails* 8. **C**ipro *(fluoroquinolone if 1-6 can't be used)*

Answer 105

1st: PPP? ➜ [Complicated cystitis (obtain PEx, UCx before tx)] 2nd: Pregnant? ➜ [**CAN** **F**osfomycin **C**ontrol]^3-7d 3rd: Preference/NKDA?: [Uncomplicated cystitis ([**CAN** **F**osfomycin **C**ontrol] **B**asic **U**ncomplicated **C**ystitis) ] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PPP: Pyelo|Pervasive Systemic illness|Pelvic MALE pain

Answer 106

[empiric "**CAN F**osfomycin **C**ontrol" x 3-7d] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **CAN** **F**osfomycin **C**ontrol **B**ad **C**ystitis ??

Answer 107

[**CAN** **F**osfomycin **C**ontrol]^3-7d 1. **C**ephalexin (*Pregnancy*) 2. **A**moxicillin-clavulanate (*Pregnancy*) 3. **N**itrofurantoin (*Pregnancy*) 4. **F**osfomycin (*Pregnancy*) 5. **C**eftriaxone (*Pregnancy and PYELO*) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [**B**actrim (*2nd trimester only*) - *[1TM➜ NTD] & [3TM ➜ kernicterus]*] ***U**rine Cx only if initial Tx fails*

Answer 108

**PPP** **P**yelo? (Fever, Flank/CVA) **P**ervasive Systemic illness? **P**elvic MALE pain \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *_Complicated_ **_PPP_**➜ Obtain Physical Exam and UCx before tx*

Answer 109

**P**yelo? / **P**ervasive Systemic illness?/ **P**elvic MALE pain \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ALL: [PEx and UCx before tx ➜ tailor abx] Outpatient: [Cipro *Fluoroquinolone*] Inpatient: [Ceftriaxone or PipTazo or imipenem]

Answer 110

**SHORT** * * * [**AMENORRHEA**1º \> 2º] =Turner syndrome causes [streak ovaries gonadal dysgenesis] = 1º ovarian insufficiency → [DEC **PiE and T** (which DEC feed back on hypothalamus/ANT PIT)] → Elevated FSH & LH \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ***PiE\_T:** **P**rogesterone/**i**nhibin/**E**strogen _ **T**estosterone* * * * [**hyPOPUBERTAL** *(pubertal arrest I.e. Tanner³ instead of Tanner⁵at 18yo)*]

Answer 111

[uL painless ovoid testicular swelling] → [**BL scrotal US** : solid lesion]→ [Tumor markers^{(AFP, bHCG)} and CT staging] = [**CHEMO** + **RADICAL INGUINAL ORCHIECTOMY_Dx**_and**_Tx**]^{95% 5y Survival}

Answer 112

venous embolization *“bag of worms”*

Answer 113

1. Because Prostate CA is typically indolent = men with prostate CA usually die from other causes 2. Prostate CA screening with PSA can be used age 55-69 but absolute benefit is small 3. Screening NOT recommended [age to 55-69] *or* [life expectancy\<10y] 4. *\*\*1-3 does **NOT** apply to [HIGH RISK DEMOGRAPHICS^{Black, fam hx, symptomatic men}]*

Answer 114

▶Pelvic radiation (CA tx) commonly → Primary Ovarian Insufficiency = Amenorrhea \< 40 yo = premature menopause ▶Tx = ^{PO/Transdermal}[Estrogen (+progestin if uterus present)]*^{until 51 yo}* * * * ▶Estrogen DEC [hypOestrogen sx^{hot flashes/vaginal dryness} & bone loss] and should be replaced until [nml menopause age 50]. ▶We stop HRT at [nml menopause age 50] because *post*menopause estrogen HRT has INC risk for VTE *unopposed estrogen causes endometrial CA*

Answer 115

⼀[*post*menopause e^(p)HRT] has [INC vascular^{VTE & CAD} risk] = NOT RECOMMENDED * * * ⼀[(*pre*menopause POI) e^(p)HRT]\*\* DEC hypOestrogenic menopause sx but has substantially DEC vascular risk = RECOMMENDED * * * e^{(p) :}[estrogen (+ **P**rogestin in **P**resence of uterus)] [**E**strogen unopposed → **E**ndometrial CA] so.. [**P**rogestin added in **Presence of a Uterus**] \*\*

Answer 116

a. ⇪ Prolactin suppresses GnRH → ⬇︎LH → ⬇︎E2 . - No LH surge = no ovulation = amenorrhea and infertility * * * b. 📸

Answer 117

{[Cabergoline v Bromocriptine*_{(dopamine R agonist)}*] = inhibits prolactin secretion → ⬇︎Prolactinoma size} --*(if fails)*--\> Surgery

Answer 118

MOM = [TRIPLE ANTIRETROVIRAL THERAPY] THROUGHOUT PREGNANCY \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ newborn = Zidovudine ≥ 6 wks \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *viral load/CD4 count labs q 3 months*

Answer 119

Vaginal Delivery ≤ 1000 HIV copies \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *\> 1000 copies = C Section*

Answer 120

1. active TB 2. HIV (unless in poor country) 3. Herpes breast lesion 4. Active varicella 5. Chemoradiation 6. Active Substance Use Disorder (***but*** ***methadone regimen for tx is OK***) 7. Galactosemia

Answer 121

rare complication of ovulation induction. etx: hCG injections which artifically matures follicles for IVF ➜**BILATERAL OVARY ENLARGEMENT WITH TOO MANY FOLLICLES** PLUS ovaries **overexpress** [Vascular endothelial growth factor] = [INC Ovarian VEGF] ➜ INC capillary permeability ➜ abd 3rd spacing ➜ [ascites/effusions/electrolyte imbalance] ➜ eventually renal failure, hypOvolemic shock, hemoconcentration, hypercoagulability, DIC, death

Answer 122

***P****regnant **B**itches **T**ake*

Answer 123

***P**regnant **B**itches **T**ake **M**oney*

Answer 124

***P**regnant **B**itches* Maternal hypOtension with reflex tachycardia

Answer 125

***P**regnant **B**itches* Maternal hypOtension with reflex tachycardia

Answer 126

***P**regnant **B**itches* 1. Premature closure of ductus arteriosus 2. Oligohydramnios

Answer 127

***P**regnant **B**itches* It's a **weak tocolytic** so it doesn't actually help with slowing contractions down in preterm delivery

Answer 128

[PCN*or* ampicillin *or* ceFAZolin] ; ≥**4** **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

Answer 129

≥10WG ; [Advanced Maternal age \> 35 yof] ; higher risk of chromosomal abnormalities in this group \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. [Pateau trisomy 13] 2. [Edwards trisomy 18] 3. [Down syndrome trisomy 21] 4. Sex Chromosome aneuploidies

Answer 130

labor protraction 2/2 **inadequate uterine contractions \< every 3-5 min**

Answer 131

aneuploidy; [(**BNP** - (**β**HCG/**N**uchal translucency/[**P**regnancy associated plasma protein A]) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ confirmation by [chorionic villus sampling] or amniocentesis *to evaluate fetal karyotype*

Answer 132

endometrium or myometrium \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ RF = tamoxifen vs pelvic radiation

Answer 133

GnRH agonist ➜ temporary amenorrhea ➜ ⬇︎Leiomyoma size and ⬇︎vaginal bleeding

Answer 134

**A**ppearance, **P**ulse, **G**rimace(reflex irritability), **A**ctivity(tone), **R**espiration Performed at **1** and **5** min postpartum, All scaled from 0 to 2 and then added together [\< 3 = Critical] / [4-6 = fair: PPV] / [7-10 = normal: No intervention]

Answer 135

**A**ppearance, **P**ulse, **G**rimace(reflex irritability), **A**ctivity(tone), **R**espiration Performed at **1** and **5** min postpartum, All scaled from 0 to 2 and then added together [\< 3 = Critical] / [4-6 = fair: PPV] / [7-10 = normal: No intervention]

Answer 136

*same as non-pregnant asthma exacerbation = **BOC*** [**B**ronchoDilator (albuterol+ipratropium ➜ terbutaline ➜ Magnesium IV)] **C**TS PO **O**yxgen to SaO2 ≥95% (nonpregnant ≥90%) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ short term CTS benefit \> minor risk in pregnant patients

Answer 137

***C**an **M**om **F**eel **B**aby?* **C**ontractions? **M**ovement from Fetus? **F**luid leak vaginally? **B**lood leak vaginally?

Answer 138

**M**others **L**oathe **N**efarious **H**TN **M**ethyldopa / **L**abetalol \> **N**ifedipine / **H**ydralazine

Answer 139

1. **Amnisure** immunoassay (detects placental ⍺-microglublin1) 2. POOL test (there's pool of fluid in vaginal vault) 3. NITRAZINE test (fluid turns blue when placed on nitrazine paper since amniotic fluid is **alkaline**) 4. FERN test (fern-like estrogen crystals under microscopy) 5. US to determine fluid quantity (Normal = 6-23 cm AFI)

Answer 140

* SEVERE NVP = HYPEREMESIS GRAVIDARUM* * \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*

Answer 141

* SEVERE NVP = HYPEREMESIS GRAVIDARUM* * \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*

Answer 142

d/c antiHyperglycemic therapy after delivery ➜ At [6-12 wk postpartum] = [2h oral glucose tolerance test] (due to ⇪ DM2 risk)

Answer 143

1. **PRETERM DELIVERY** 2. low birth wt 3. perinatal Mortality 4. [Maternal anemia] 5. [Maternal Preeclampsia] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Inadequate nutrition and physiologic immaturity

Answer 144

[0.4 (or 4 IF HIGH RISK) mg daily] of **folic acid B9** ; ≥1 month \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *high risk = antiepileptics / prior NTD pregnancy*

Answer 145

[PRIOR UTERINE SURGERY (CSection/myomectomy)] Truama Macrosomia abnl placentation

Answer 146

**intermenstrual** vaginal bleeding

Answer 147

Pregnancy is a contraindication for pts with Eisenmenger syndrome (untreated VSD/HF) due to high maternal mortality rate and poor fetal pgn Pregnancy should be avoided/terminated

Answer 148

Healthy uncomplicated pregnant women are recommended to do [**Moderate exercise** **30 minutes daily - for most days of the week]** **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** *yoga/walking/running/light strength training/swimming*

Answer 149

Cervical CA (2/2 lower HPV vaccination rates than hetero) and Bacterial Vaginosis (2/2 greater exchange of vaginal secretions than hetero)

Answer 150

the fetus completely depends on maternal thyroid hormone for brain development up until 12WG when fetal thyroid gland forms

Answer 151

[⇪ baseline Levothyroxine dose] at time of pregnancy detection then [get TSH q4 wks ➜ Levothyroxine dose adjusted per trimester]

Answer 152

1. 1st trimester, fetal βhCG stimulate maternal TSH receptors ➜ [⇪ maternal T3/T4 **production**] (*but remember, this INC T3/T4 feed back on ANT Pit ➜ low TSH 1st trimester*) and 2. elevated maternal estrogen ➜ [⇪ thyroxine binding globulin] ➜ [⇪ binding sites for T4 to travel on] ➜ [⇪ TOTAL (not free) maternal T4 **available**] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *(hypOthyroid patients wont be able to INC maternal T3/T4 production ➜ requires INC exogenous dose/Levothyroxine )*

Answer 153

Multiple Sexual Partners \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *other RF = [age 15-25], previous PID, inconsistent condom, partner with STI*

Answer 154

≥3 mo idiopathic raw burning vulvar pain \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Tx = [pelvic floor physiotherapy] and CBT

Answer 155

gestational DM PreEclampsia Cesarean

Answer 156

1. cervical insufficiency 2. underlying comorbidity preventing exercise 3. active vaginal bleeding

Answer 157

benign fluid filled mass 2/2 breast duct obstruction \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 158

1. Cervical Conization 2. Uterine abnl 3. Prior obstretric trauma 4. congenital (intrauterine DES exposure, collagen abnl)

Answer 159

1. [microcephaly with developmental regression] 2. epilepsy 3. unique hand gestures

Answer 160

**PREVIOUS SPONTANEOUS ABORTION** [Maternal Age \> 35] [Maternal Substance Use] [BMI extremes]

Answer 161

a. long,reversible contraception used in pts with contraindication to estrogen. Also ⬇︎menstrual blood loss in anticoagulated pts \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ b. long, reversible contraception *but ⇪ menestrual bleeding and dysmenorrhea* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ c. **irreversible** contraception indicated for pts finished with childbearing. Will NOT help menorrhagia

Answer 162

reproductive ; [uL pelvic pain + tender adnexal mass] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Pelvic Ultrasound with color Doppler] *(will show enlarged edematous ovary with ⬇︎blood flow)*

Answer 163

enlarged **irregularly** shaped uterus regular menorrhagia dysmenorrhea mass effect (constipation/pelvic pressure/urinary sx)

Answer 164

[**Progestin-releasing IUD**] *Reversibly* induces endometrial atrophy ➜ [⬇︎ leiomyoma size and ⬇︎ uterine bleeding] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Combined OCP]

Answer 165

2nd or 3rd trimester [Flank pain that radiates to labia + NV] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ dx = renal/pelvic US

Answer 166

After Bariatric Surgery, **Delay Pregnancy x 1 year** to optimize wt loss and nutrition

Answer 167

[estimated fetal **wt \< 10th%tile** for gestational age]; STILLBIRTH \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Serial Antenatal testing]

Answer 168

determines risk of preterm delivery in patients with preterm contractions

Answer 169

high risk procedure that samples fetal blood to confirm severe fatal anemia (hydrops fetalis)

Answer 170

If mother receive adequate abx (PO amoxicillin vs PO ceFUROxime) = NO ⇪ FETAL RISK

Answer 171

1. Fetal Open Neural Tube Defects (open spina bifida, anencephaly) 2. Fetal Abd Wall defect (Gastroschisis, Omphalocele) 3. Multiple gestation (twins) *If ⬆︎AFP --\> GET ANATOMY US!*

Answer 172

Measures 4 chemical markers for fetal anomalies and down syndrome- 81% accuracy (QUAD = **BUAD**): 1. **β**HCG⬆︎ 2. **U**nconjugated EsTriol⬇︎ 3. **A**FP⬇︎ 4. **D**imeric inhibin A⬆︎ - *only in QUAD screen* Performed 15 -20WG *Be sure to f/u abnml results with cell free fetal DNA test and US*

Answer 173

⬇︎βHCG ⬇︎**U**nconjugated EsTriol ⬇︎**A**FP NML **D**imeric inhibin A

Answer 174

[Fetal Yolk Sac]/GI/Liver \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 15-20WG \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ via Quad BUAD screen *if AFP \> 2.5 ➜ get anatomical US!*

Answer 175

[**IUD** or **subdermal implants**] = RELIABLE, SAFE and REVERSIBLE ## Footnote *long acting reversible contraceptives*

Answer 176

although [AntiEpileptics Drugs] (especially valproate) are INC risk for congenital anomalies DO NOT MAKE CHANGES TO AED **AFTER** CONFIRMATION OF PREGNANCY Instead ➜ start pt on [high dose folic acid] + [obtain AFP with anatomical US] to screen for congenital anomalies

Answer 177

FALSE \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ## Footnote *Moms CAN breastfeed while on [AntiEpileptic Drugs]*

Answer 178

**BITCHES** *can NOT breastfeed!* 1. [**B**reast has HSV lesions] 2. [**I**nfant has galactosemia] 3. **T**B untreated 4. **C**hemoradiation 5. **H**IV maternally 6. varic**E**lla actively 7. **S**ubstance abuse maternally * Hep B pts can breastfeed as long as baby receives HepB Immunoglobulin and vaccination*

Answer 179

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ * HDS*: [combined OCP with **HIGH DOSE ESTROGEN**] * NPO/Refractory*: [IV Estrogen] * HD**U**S*: [D&C (endometrium surgical removal)] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Estrogen proliferates and repairs Endometrium ➜ hemostasis*

Answer 180

endometrium builds 2/2 estrogen, however, without progesterone (common around menarche) the cue to slough endometrium is absent = Anovulation➜ estrogen breakthrough bleeding = *irregular heavy menstruation* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ## Footnote *Estrogen proliferates and repairs Endometrium ➜ Endometrial hemostasis*

Answer 181

**immaturity of hypothalamic-pituitary-gonadal axis** --\> inadequate amounts of GnRH --\> low FSH and LH --\> lack of ovulation --\> lack of Menses Menses normally occurs when corpus lutem (byproduct after ovulation) produces progesterone and this progesterone drops --\> Menses/shedding. **No ovulation --\> No menses** * Tx = Progestin-only or Combined OCPs* * this self-resovles 1-4 yrs after menarche*

Answer 182

syncytiotrophoblast ; **preserves corpus luteum** (which secretes progesterone) during early pregnancy until the placenta can take over ; 8 days after fertilization ## Footnote *hCG also stimulates maternal thyroid and promotes male sex differentiation*

Answer 183

**P**rogesterone **P**repares endometrium via decidualization

Answer 184

**E**strogen

Answer 185

**P**rogesterone

Answer 186

Physiological widening of pelvis by progesterone and relaxin to facilitate vaginal delivery ; **Postpartum** **suprapubic TTP pain that radiates to the Back and/or Hips** ## Footnote *worst with weight bearing, walking or position change and resolves by 4 weeks PostPartum*

Answer 187

The 3 Ds and **A**ll 1. **D**ysmenorrhea 2. **D**yspareunia deep pelvic - implants in posterior cul-de-sac 3. **D**yschezia (painful defecation) - implants in posterior cul-de-sac OR **(4) A**SX (tx not indicated if so) - otherwise tx = NSAIDs --\> Contraceptives (combined OCP/IUD progesterone) (5) Infertility of unknown origin * Findings: Gun Powder Burn lesions, ADHESIONS--\>immobile uterus, Chocolate fluid* * Dx = Laparoscopy to biopsy & remove endometriotic lesions*

Answer 188

Hyperinsulinemia and Elevated LH --\> ⬆︎ Androgen release from Ovarian Theca which is converted to Estrone--\> **Elevated Estrone** which feedbacks on the hypothalamus --\> ⬇︎GnRH --\> ⬇︎**FSH imbalance** --\> failure of follicle maturation and anovulation --\> No progesterone --\> Endometrial CA ## Footnote * tx = weight loss and clomiphene citrate* * Note: if pt has high levels of sex hormone binding globulin, total testosterone may be low. so clinical dx may be necessary*

Answer 189

Endometriosis

Answer 190

[Amoxicillin or Cephalexin **STAT**] + [PCN **intrapartum**] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *pregnant patients require abx STAT to prevent progression to upper UTI (like*

Answer 191

Clobetasol ointment (high potency topical CTS) ## Footnote *dx = vulvar punch biopsy*

Answer 192

DO THIS FOR ALL Rh NEGATIVE mothers 1. 50mcg 1st trimester **if uterine bleeding and/or spontaneous abortion occurs** 2. **300mcg at 28 WG** 3. **[300 mcg within 3 days after delivery** **(*if infant RhD+)*****]** 4. give with any episodes of vaginal bleeding (if indicated) 5. give with External Cephalic Version 6. give with Hydatidiform Mole dx 7. give if Ectopic Pregnancy occurs

Answer 193

folic acid blocker \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. liver disease (DEC MTX clearance) 2. renal disease (DEC MTX clearance) 3. ruptured ectopic (free fluid in posterior-cul-de-sac) 4. immunodeficiency 5. high failure probability (fetal cardiac activity, βhCG\>5000 )

Answer 194

positive UPT + HDuS hemoperitoneum \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 195

**Irregular breakthrough bleeding** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *2/2 thin atrophic endometrium that sheds UNEVENLY*

Answer 196

Oligohydraminos --\> **POTTER** Sequence **POSTERIOR URETHRAL VALVES** are the most common cause of obstructive uropathy in newborn **BOYS** (which causes renal damage --\> oligohydramnios during utero)

Answer 197

Oligohydraminos --\> **POTTER** Sequence **P**ulmonary hypOplasia **O**ligohydraminos from renal agenesis/damage (cause) [**T**wisted Face & Extremities] **T**wisted Skin **E**ars set low **R**enal Failure

Answer 198

Uterine Contractions... FALSE = irregular + weak + NO CERVICAL CHANGE True = [Regular with **increasing frequency**] + [**increasing in strength**] + cervical change

Answer 199

Intrapartum PCN to [(GBS+)] \_\_\_\_\_\_\_\_and\_\_\_\_\_\_\_\_ [(GBS unknown) + (≥1 risk factor)] *RF: [\<37WG] / [maternal intrapartum fever] / [Prolonged Rupture of Membrane ≥18H]*

Answer 200

**Head Compression** of Fetus ## Footnote *these occur WITH contractions and no tx is required*

Answer 201

abnml blood collection between [Uterus chorion] and gestational sac that presents as 1st trimester bleeding or incidental US finding \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Expectant (serial US for reassurance) *can result in placental dysfunction and ➜ spontaneous abortion/placenta abruptio/PPROM/preeclampsia/preterm labor/IUGR/IUFD*

Answer 202

spontaneous abortion/ placenta abruptio/ PPROM/ preeclampsia/ preterm labor/ IUGR/ IUFD \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *subchorionic hematoma result in placental dysfunction and ➜*

Answer 203

5 ; [**COPPER IUD**] ; [Ulipristal (AntiProgestin)]

Answer 204

[PSI (*r**3 year*)] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ progesterone 1. thickens cervical mucus and ⬇︎tubal motility ➜ inhibits sperm migration 2. ⬇︎ [FSH and LH secretion] ➜ stops ovulation [PSI-Progestin Subdermal Implant (long-acting + reversible)]

Answer 205

1. ≥300 mg protein on 24 hr urine OR 2. ≥ 30 mg/dL on dipstick OR 3. At least 1+ on dipstick **OR** 4. **Protein:Creatinine ratio \> 0.3** * Must occur at least 2 times at least 6 hours apart*

Answer 206

≥ 20WG! ; Preeclampsia is a complication of Hydatidiform mole which may occur \< 20WG

Answer 207

**PreEclampsia** --\> **SEVERE PreEclampsia** --\> **HELLP** and at anytime, **Eclampsia** is possible ANY **ONE** OF THE FOLLOWING: 1. Systolic \> 160 2. Diastolic \> 110 3. **refractory** HA 4. scotoma vision changes 5. Pulmonary Edema (from ⬇︎albumin) 6. RUQ OR Epigastric pain 7. Doubling of LFTs 8. Platelets \< 100K 9. Cr \> 1.1 or doubled from baseline *although not in criteria, can also include Hyperreflexia*

Answer 208

1. **HEAVY vaginal bleeding** 2. Hyperemesis Gravidarum 3. Severe Preeclampsia 4. Hyperthyroidism 5. Uterus larger than expected gestational age **but with regular countour** ## Footnote "Snowstorm with grapes" and/or [Theca lutein ovarian multiseptated cyst from excess bHCG] on ultrasound HHIIGH LEVELS OF bHCG (\> 100,000) *Most of the time this is caused by sperm implanting an EMPTY ovum*

Answer 209

**Ab complex mediated endovascular damage --\>** 1. Hemolytic Anemia 2. Platelet aggregation from ⬆︎Thromboxane 3. Vascular constriction pervasively from ⬆︎Thromboxane

Answer 210

can present up to 12 weeks postpartum \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ## Footnote **PreEclampsia** --\> **SEVERE PreEclampsia** --\> **HELLP** and at anytime, **Eclampsia** is possible

Answer 211

spontaneous / uL / persistent

Answer 212

papilloma (from lining of the breast duct ) ## Footnote \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ spontaneous / uL / persistent * pathologic breast nipple discharge requires age-based imaging to r/o CA* * \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_* * Papillomas are usually benign but may have associated atypia, DCIS or invasive intraductal carcinoma within the lesion*

Answer 213

Progesin-containing IUD \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ unoppossed estrogen in PCOS ➜ androgen excess, polycystic ovaries and anovulation (which ➜ irregular menses, endometrial hyperplasia/CA). Progesterone protects the Endometrium

Answer 214

Combined OCPs \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ NSAIDs ## Footnote *Combined OCPs treat dysmenorrhea by ⬇︎endometrial proliferation ➜ atrophy which --\> ⬇︎prostaglandin release --\> ⬇︎painful uterine contractions*

Answer 215

pelvic cramping during the first few days of menses in the context of a normal pelvic exam; prostaglandin release from endometrial sloughing during menses

Answer 216

DELIVERY MAGNESIUM SULFATE (SEIZURE PX) [antiHTN (if ≥ 160/110)]- *labetalol/hydralazine*

Answer 217

abnormal fertilization of [empty ovum] by either 2 sperm or [1 sperm whose genome ultimately duplicates] ➜ [hypertrophic and hydropic trophoblastic villi] that secretes **βhCG \> 100,000** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ HM can develop into [Gestational Trophoblastic Neoplasia] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *tx = [D&C + contraception] ➜ [serial βhCG until undetectable x 6 mo]*

Answer 218

[Gestational Trophoblastic Neoplasia] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 219

[2 gm metronidazole PO x 1] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ after taking, breast milk should be expressed and discarded x 24h

Answer 220

* Blues = onsets PPD1, peaking at PPD5 and subsiding PPD14, worst w/lactation * Depression = onset between [1 month - 12 months after birth] **Traditional s/s**. Previous Depression hx is RF * Psychosis = RARE but onsets IMMEDIATELY after birth

Answer 221

Breastfeeding only provides sufficient iron for **first 6 months of life**. [infants ≥6 months] MUST be introducted [iron-rich solid foods (pureed meats/cereals)] to prevent iron deficiency anemia \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *(thalassemia* \< *[Mentzer Index 13 (MCV/RBC)]\< IRON DEFICIENCY ANEMIA)*

Answer 222

urinary leakage with **INC INTRAABDOMINAL STRESS** (coughing / sneezing / laughing / lifting)

Answer 223

**URGE** to urinate Suddenly / Overwhelmingly / Frequently

Answer 224

**constant OVERFLOWING DRIBBLE OF URINE** and bladder distension 2/2 incomplete bladder emptying ## Footnote (either from mechanical outlet obstruction or DM Detrusor hypOactivity)

Answer 225

[⇪ post void residual] \> 150 cc + neuropathy \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [intermittent self catherterization] + [correct underlying etx for incomplete bladder emptying]

Answer 226

**COLPOSCOPY** = cervix magnified to identify and BIOPSY abnormal areas \_\_\_\_\_\_\_\_or\_\_\_\_\_\_\_\_ LEEP (loop electrosurgical excision procedure) = excision of cervical transformation zone and surrounding endocervix - [only if done with childbearing]

Answer 227

1. Spontaneous Abortion (inevitable vs threatened) 2. Acute cervicitis (postcoital bleeding, Friable cervix with discharge) 3. Molar Pregnancy

Answer 228

1. INEVITABLE = vaginal bleeding \< 20 WG **with cervical os dilated** --\>abortion will *inevitably* happen soon 2. THREATENED = early vaginal bleeding \< 20 WG **with cervical os closed** is clearly a threat to a STILL LIVING FETUS 3. MISSED = Fetal death **with cervical os closed**...which is why we *Missed* it - (pt will have pregnancy sx that just suddenly disappear out of nowhere) 4. COMPLETE = ALL PRODUCTS OF CONCEPTION COMPLETELY EXPEL AND THEN CERVIX CLOSES BACK UP ## Footnote *spontaneous = occurs \< 20 WG*

Answer 229

[*pp**:* ≥2 pain**LESS** 2nd trimester spontaneous abortions] ## Footnote OR [*C**p:* Ultrasound showing short cervix ≤25 mm] OR [*C**p:* (early \< 24WG ) pain**LESS** advanced cervical Dilation] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *pp = previous pregnancy* *Cp = Current pregnancy*

Answer 230

Cerclage; [Previable Prolapsing amniotic membrane]; POOR PROGNOSIS (PPAM a/w *imminent delivery/high risk preterm*)

Answer 231

[first 3 mo postpartum] ; ## Footnote ***(LIES) L****actational mastitis =*[**I**nduration / **E**rythema / **S**welling & Pain] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ([oral Dicloxacillin] or [oral Cephalexin]) + [frequent milk drainage] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *breastfeeding difficulties (can be improved with lactation consultant) ➜ prolonged engorgement ➜ inadequate milk drainage ➜ clogged milk ducts ➜ Bacteria from skin enters stagnant milk ➜ Lactational mastitis*

Answer 232

diffuse BL breast TTP \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ BREAST PUMPING / NSAID / Cold Compress

Answer 233

YES! (*Interrupting breastfeeding can ➜ ⬇︎maternal milk production*) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ breastfeeding difficulties (can be improved with lactation consultant) ➜ [prolonged engorgement (diffuse BL breast TTP)] ➜ inadequate milk drainage ➜ clogged milk ducts ➜ Bacteria from skin enters stagnant milk ➜ Lactational mastitis

Answer 234

[HPV 6 & 11] ; C-section does NOT prevent vertical transmission of HPV so Women with Condyloma Acuminata genital warts can proceed with vaginal delivery *(unless they're large/ obstructive)* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Podophyllum [contraindicated in pregnancy]

Answer 235

postpartum: [**uterine fundal tenderness**] , vaginal discharge, vaginal bleeding, fever \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Clindamycin + gentamicin ## Footnote *polymicrobial infection*

Answer 236

common benign condition = focal abd pruritus **without rash** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ tx = oatmeal baths | UV | [Histamine R Blocker] *Intrahepatic Cholestasis of Pregnancy = GENERALIZED PRURITUS INCLUDING PALMS/SOLES, NO RASH, A/W IUFD*

Answer 237

graded compression abd ultrasound ; [R abd pain **with NO peritoneal signs or McBurney TTP**]

Answer 238

1st: HPV typing, and if high risk (16 or 18) ---\> 2nd: Colposcopy and if abnml --\> 3rd: Cervical biopsy

Answer 239

eroded and bulging mass at introitus +/- incontinence, constipation, dyspareunia \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ exophytic cervical lesion \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ smooth vermiform appearance visibily protruding thru cervical os \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ uterine and cervical motion tenederness \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ enlaged **irregularly** shaped uterus

Answer 240

repeated infection and urethral trauma (vaginal delivery) ➜ distension of diverticulum with purulent fluid \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. ANT vaginal wall mass 2. postvoid dribbling 3. dysuria * diagnosis confirmed with pelvic MRI or TVUS*

Answer 241

1. [MisoPROstol (*PROstaglandin analogue*) 800 mcg vaginally] 2. MiFepristone (*antiprogestin*)

Answer 242

*Labor = (LA)PD* **1A: L**atent labor phase = Strong Contractions q3-5 min **(should be \<20 hrs for nulliparous pts and \<14 hrs for multiparous pts)** **1B:** **A**CTIVE labor phase = Cervix is now 6 cm Dilated, [growing @ \>1 cm /2 hr] and effacing \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **2** : **P**ushing Time! since Cervix is now 10 cm FULLY DILATED (should be ≤3 hrs for nulliparous and 2 hrs for multiparous) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **3 : D**elivery of Baby! and then Deliver Placenta

Answer 243

Deliver Placenta \< 30 min \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Labor = (LA)PD* **1A: L**atent phase = Strong Contractions q3-5 min (should be ≤20 hrs for nulliparous pts and 14 hrs for multiparous pts) **1B:** **A**CTIVE phase = Cervix is now 6 cm Dilated, [growing @ 1-2 cm/hr] and effacing **2** : **P**USH time! since Cervix is now 10 cm FULLY DILATED (\<3 hrs for nulliparous and \<2 hrs for multiparous (*add 1 hr if +epidural))*) **3 : D**elivery of Baby! and then Deliver Placenta **(\<30 min)**

Answer 244

**BREAST** --(2.5 years later)--\> Menarche by 15 yo

Answer 245

**girls with no menses by age 15** but who have normal growth and secondary sex characteristics ## Footnote If no breast --\> FSH (if FSH ⬇︎)--\> Pituitary MRI (if FSH ⬆︎) --\> karyotyping

Answer 246

[nulliparous \<3 hr] [MULTIPAROUS \<2 hr] (*add 1 hour if +epidural)* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ * Labor = (LA)**P**D* * 2 : PUSH time! since Cervix is now 10 cm FULLY DILATED (\<3 hrs for nulliparous and \<2 hrs for multiparous (add 1 hr if +epidural)))*

Answer 247

*Labor = (LA)PD* **1A: L**atent phase = Strong Contractions q3-5 min (should be \<20 hrs for nulliparous pts | \<14 hrs for multiparous) **1B:** **A**CTIVE phase = Cervix 6 cm Dilated, [growing @ 1-2 cm/hr] and effacing \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **2** : **P**ushing Time! since Cervix is now [**10** cm FULLY DILATED] (nulliparous \<3 hrs | MULTIparous \<2 hrs) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **3 : D**elivery of Baby! ➜ then [Deliver Placenta **(\<30 min)**] https://www.youtube.com/watch?annotation\_id=annotation\_563008&feature=iv&src\_vid=Xath6kOf0NE&v=ZDP\_ewMDxCo

Answer 248

* Labor = L**A**PD* 1. [**Strong** Contractions **every 3-5 min**] = LATENT + 2. [Cervix Dilation \> 6 cm] 3. [Cervix growing at 1-2 cm/hr] 4. [Cervix effaced] * Fetal Heart Tracing is IRRELEVANT to diagnosing active labor*

Answer 249

*Labor = (LA)PD* NORMAL: **1B:** **A**CTIVE labor phase = Cervix is now 6 cm Dilated, [growing @ \>1 cm /2 hr] and effacing PROTRACTED: 1B = [≤1 cm/2hr] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Oxytocin + Amniotomy *(since most common cause of [ACTIVE labor stage 1B] protraction = contraction inadequacy)*

Answer 250

GOE 3 consecutive spontaneous abortions

Answer 251

Migraines commonly start **2nd** **trimester** of Pregnancy ## Footnote *But also be suspicious of [Pseudotumor Cerebrii]*

Answer 252

**immaturity of hypothalamic-pituitary-gonadal axis** --\> inadequate amounts of GnRH --\> low FSH and LH --\> lack of ovulation --\> lack of Menses Menses normally occurs when corpus lutem (byproduct after ovulation) produces progesterone and this progesterone drops --\> Menses/shedding. **No ovulation --\> No menses** * Tx = Progestin-only or Combined OCPs* * this self-resovles 1-4 yrs after menarche*

Answer 253

Obesity --\> anovulation **without affecting LH/FSH levels** which--\> Amenorrhea

Answer 254

Hyperinsulinemia and Elevated LH --\> ⬆︎ Androgen release from Ovarian Theca which is converted to Estrone--\> **Elevated Estrone** which feedbacks on the hypothalamus --\> ⬇︎GnRH --\> ⬇︎**FSH imbalance** --\> failure of follicle maturation and anovulation --\> No progesterone --\> Endometrial CA ## Footnote * tx = weight loss and clomiphene citrate* * Note: if pt has high levels of sex hormone binding globulin, total testosterone may be low. so clinical dx may be necessary*

Answer 255

**Mittel**schmerz = "**Middle** of the cycle" uL pelvic pain that occurs when blood released from rupture of follicle during ovulation irritates peritoneum ## Footnote *order: LH surge --\> 36 hrs will pass --\> Ovulation*

Answer 256

1. Benign Abdominal pruritus during pregnancy 2. NO RASH associated

Answer 257

1. Oatmeal baths 2. UV light 3. Antihistamines

Answer 258

2nd OR 3rd ## Footnote [prodromal Pruritus] -\> [Periumbilical papules + plaques that spare mucus membranes] -\> [Bullae Eruption]

Answer 259

2nd OR 3rd Clinical , Biopsy Tx = Steroids, Antihistamines, Delivery

Answer 260

[PAP Cervical Screening starts at 21 yo] 1. [Age 21 - 65 PAP every 3 years (cytology only)] ≥ 3x consecutively before stopping after 65 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ OR 2. [Age 30-65 can PAP every 5 years if they add HPV testing] ≥ 2x consecutively before stopping after 65 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ BUT 3. Risk Groups (immunocompro/CIN2, 3 or CA hx) need more frequent PAP screening = voids out #1 and 2 if present

Answer 261

1. **Breast tenderness** 2. HA

Answer 262

* occurs GOE 42WG* 1. long fingernails 2. meconium-stained placenta 3. [wrinkled peeling skin] 4. small for gestational age

Answer 263

1. lung hyperinflation 2. cardiomegaly 3. [Interlobar fissure fluid] ➜ prominence 4. [Tachypnea (retractions/nasal flaring) **with clear breath sounds**]

Answer 264

**[CESAREAN/PREMATURITY/MATERNAL DM]** ➜ [Retained Fetal Lung Fluid]

Answer 265

SPONTANEOUSLY RESOLVES IN 1-3d

Answer 266

1. Cesarean 2. Maternal DM 3. Prematurity * caused by Retained fetal lung fluid*

Answer 267

PMS sx begin 1 week before menses (luteal phase) and resolves during week after menses (follicular phase) ## Footnote 1st: **Sx Diary** reveal PMS sx timing occured over ≥ 2 menstrual cycles 2nd: Order **TSH** to r/o hypOthyroidism as cause 3rd: **Exercise w/NSAIDs** 4th: **SSRI** 5th: **Combined OCP** if SSRI don't work and there's no ctd

Answer 268

*Functional hypOthalamic amenorrhea ; **these pts have low FSH** and therefore NO postmenopausal sx* 1. Excessive Exercise 2. Very low calorie diet/starvation 3. low BMI/Anorexia/Wt loss 4. Stress 5. Depression 6. Chronic illness ; Osteoporosis from lack of estrogen *note: these pts will NOT have normal mentrual cycles*

Answer 269

*Functional hypOthalamic amenorrhea ; **these pts have low FSH** and therefore NO postmenopausal sx* 1. Excessive Exercise 2. Very low calorie diet/starvation 3. low BMI/Anorexia/Wt loss 4. Stress 5. Depression 6. Chronic illness ; Osteoporosis from lack of estrogen *note: these pts will NOT have normal mentrual cycles*

Answer 270

*Functional hypOthalamic amenorrhea ; **these pts have low FSH** and therefore NO postmenopausal sx* 1. Excessive Exercise 2. Very low calorie diet/starvation 3. low BMI/Anorexia/Wt loss 4. Stress 5. Depression 6. Chronic illness ; Osteoporosis from lack of estrogen *note: these pts will NOT have normal mentrual cycles*

Answer 271

1. INEVITABLE = vaginal bleeding \< 20 WG **with cervical os dilated** --\>abortion will *inevitably* happen soon 2. THREATENED = early vaginal bleeding \< 20 WG **with cervical os closed** is clearly a threat to a STILL LIVING FETUS 3. MISSED = Fetal death **with cervical os closed**...which is why we *Missed* it - (pt will have pregnancy sx that just suddenly disappear out of nowhere) 4. COMPLETE = ALL PRODUCTS OF CONCEPTION COMPLETELY EXPEL AND THEN CERVIX CLOSES BACK UP ## Footnote *spontaneous = occurs \< 20 WG*

Answer 272

1. **Expectant**: Watchful Waiting for products of conception to expel naturally in 2-6 weeks 2. **Surgical**: [Dilitation & Curettage (D&C) (cant be done during infection)] or [Manual Vacuum Aspiration] 3. **Medical**: 800mcg Vaginal Misoprostol - takes up to 2 weeks for expel ## Footnote *ALL REQUIRE 1 WEEK FOLLOW UP*

Answer 273

\<1st trimester = [LMW Enoxaparin] \> \<2nd trimester = WARFARIN\> \<3rd trimester = WARFARIN\>

Answer 274

PMS sx begin 1 week before menses (luteal phase) and resolves during week after menses (follicular phase) for ≥ 2 menstrual cycles ## Footnote Sx: - Bloating - Fatigue - HA - Hot Flashes - Breast Tenderness - **Irritability/Mood Swings** - ⬇︎Concentration

Answer 275

PMS sx begin 1 week before menses (luteal phase) and resolves during week after menses (follicular phase) ## Footnote 1st: **Sx Diary** reveal PMS sx timing occured over ≥ 2 menstrual cycles 2nd: Order **TSH** to r/o hypOthyroidism as cause 3rd: **Exercise w/NSAIDs** 4th: **SSRI** 5th: **Combined OCP** if SSRI don't work and there's no ctd

Answer 276

1. Maternal DM - poorly controlled 2. swallowing fetal anomalieis (esophageal atresia)

Answer 277

≥ 24cm ## Footnote RF = Maternal DM, congenital swallowing malformation Polyhydramnios can --\> placenta Abruptio

Answer 278

1. Maternal DM - poorly controlled 2. swallowing fetal anomalieis (esophageal atresia)

Answer 279

≥ 24cm ## Footnote RF = Maternal DM, congenital swallowing malformation Polyhydramnios can --\> placenta Abruptio

Answer 280

[12 WG ASA low dose]

Answer 281

1. prior severe preeclampsia 2. chronic HTN 3. DM 4. CKD * px = [12 WG ASA low dose]*

Answer 282

reactive = appropriate [fetal cerebral oxygenation] 1. within a **20 min period** there are 2. at least **two HR acclerations** that are 3. **15 bpm over baseline** 4. **1.5 small boxes** **long** (15 sec) THIS IS NOT REQUIRED FOR PTS IN LABOR

Answer 283

1. NO previous HTN 2. ≥ 20 WG (2nd trimester) 3. **Systolic \> 140** 4. **Diastolic \> 90** 5. At least 2 readings taken \> 6 hrs apart 6. BP taken in seated or semi-reclined position ## Footnote *FYI: PreEclampsia can still occur superimposed on Chronic HTN*

Answer 284

1. ≥300 mg protein on 24 hr urine OR 2. ≥ 30 mg/dL on dipstick OR 3. At least 1+ on dipstick **OR** 4. **Protein:Creatinine ratio \> 0.3** * Must occur at least 2 times at least 6 hours apart*

Answer 285

**Ab complex mediated endovascular damage --\>** 1. Hemolytic Anemia 2. Platelet aggregation from ⬆︎Thromboxane 3. Vascular constriction pervasively from ⬆︎Thromboxane

Answer 286

***P**regnant **B**itches*

Answer 287

***P****regnant **B**itches **T**ake*

Answer 288

***P**regnant **B**itches **T**ake **M**oney*

Answer 289

upper uterine fundus ; implantation in outer "cornual" areas of uterus *dx = trans**Vaginal** US // tx = MTX or surgery if severe*

Answer 290

1. previous ectopic 2. previous Pelvic 3. previous Tubal surgery 4. PID 5. Bicornuate heart shaped uterus (causes cornual interstitial ectopic pregnancy) 6. In Vitro Fertilization (causes cornual intersitital ectopic pregnancy) ## Footnote *tx = MTX or surgery if severe*

Answer 291

1. Multiple Gestation 2. GERD hx 3. Hydatidiform Mole (note: elevated βHCG can stimulate thyroid and --\> thyrotoxicosis of hyperemesis!) ## Footnote *HG is usually unresponsive to PO antiemetics, and can cause Thiamine Deficiency*

Answer 292

1. 32-34WG in high risk pregnancies OR 2. ⬇︎fetal movements ## Footnote *the most common cause of NONreactive NST is fetal sleep cycle so be sure to allow at least 40 min testing and use vibroacoustic stimulation to wake them up!*

Answer 293

**FIRST** trimester US with crown to rump length (since there is minimal variability of fetuses when they first start off)

Answer 294

**Pelvic US** revealing adnexal mass with absent Doppler flow

Answer 295

**PRE**menopausal ## Footnote *Untreated ovarian torsion --\> sepsis, chronic pelvic pain and infertility*

Answer 296

centesis of intraperitoneal fluid thru the cul-de-sac via vaginal aspiration ; No longer used and has been replaced by US for identifying pelvic free fluid

Answer 297

**LAPORASCOPY** to biopsy & remove endometriotic lesions ## Footnote *1st, treat empirically with NSAIDs tho*

Answer 298

**Triple Antiretroviral therapy** (2 NRTI + 1 NNRTI or 1 PI) ## Footnote *Also, c/s if viral load is \> 1000 and Zidovudine given to neonate for ≥6 wks after birth are also good but not most important*

Answer 299

Mom's **Thyroid stimulating Ab** (anti-TSH R Ab) can cross the placenta and stimulate the baby's thyroid gland --\> Thyrotoxicosis ## Footnote Baby's tx = methimazole + Beta Blcoker

Answer 300

X-linked recessive

Answer 301

*Labor = (LA)PD* ## Footnote **1A: L**atent phase = Strong Contractions q3-5 min **(should be ≤20 hrs for nulliparous pts and 14 hrs for multiparous pts)** **1B:** **A**CTIVE phase = Cervix is now 6 cm Dilated, [growing @ 1-2 cm/hr] and effacing **2** : **P**ushing Time! since Cervix is now 10 cm FULLY DILATED (should be ≤3 hrs for nulliparous and 2 hrs for multiparous) **3 : D**elivery of Baby! and then Deliver Placenta

Answer 302

*Labor = (LA)PD* ## Footnote **1A: L**atent phase = Strong Contractions q3-5 min (should be ≤20 hrs for nulliparous pts and 14 hrs for multiparous pts) **1B:** **A**CTIVE phase = Cervix is now 6 cm Dilated, [growing @ 1-2 cm/hr] and effacing **2** : **P**ushing Time! since Cervix is now 10 cm FULLY DILATED **(should be ≤3 hrs for nulliparous and 2 hrs for multiparous)** **3 : D**elivery of Baby! and then Deliver Placenta

Answer 303

*Labor = (LA)PD* ## Footnote **1A: L**atent phase = Strong Contractions q3-5 min (should be ≤20 hrs for nulliparous pts and 14 hrs for multiparous pts) **1B:** **A**CTIVE phase = Cervix is now 6 cm Dilated, [growing @ 1-2 cm/hr] and effacing **2** : **P**ushing Time! since Cervix is now 10 cm FULLY DILATED (≤3 hrs for nulliparous and 2 hrs for multiparous) **3 : D**elivery of Baby! and then Deliver Placenta **(≤30 min)**

Answer 304

*Labor = (LA)PD* **1A: L**atent phase = Strong Contractions q3-5 min (should be ≤20 hrs for nulliparous pts and 14 hrs for multiparous pts) **1B:** **A**CTIVE phase = Cervix is now 6 cm Dilated, [growing @ 1-2 cm/hr] and effacing **2** : **P**ushing Time! since Cervix is now 10 cm FULLY DILATED (≤3 hrs for nulliparous and 2 hrs for multiparous) **3 : D**elivery of Baby! and then Deliver Placenta **(≤30 min)** https://www.youtube.com/watch?annotation\_id=annotation\_563008&feature=iv&src\_vid=Xath6kOf0NE&v=ZDP\_ewMDxCo

Answer 305

D-dimer is already **naturally elevated** in pregnant woman due to their physiological ⬆︎ fibrinogen

Answer 306

You have to take it every day **DOWN TO THE EXACT HOUR** or it will fail! = compliance issues

Answer 307

Intraductal Papilloma

Answer 308

1. Firm mass 2. IRREGULAR SHAPED mass 3. previous trauma ## Footnote *Mammogram: Oil cyst +/- calcifications that appear malignant but has fat globules and foamy macrophages on bx*

Answer 309

1. **painless mass** 2. firm mass 3. solitary mass 4. mobile 5. ~2 cm

Answer 310

**PRE**menopausal 1. cyclical bilateral breast pain 2. diffuse nodularity *This cyclical BL breast pain is exacerbated with caffeine!*

Answer 311

1. Peau d'orange appearance (superficial dimpling & pitting) 2. Diffuse breast erythema 3. breast edema 4. breast pain 5. nipple changes (retraction, flattening) 6. Axillary LAD 7. +/- nipple discharge ## Footnote *often confused with infectious process, **but difference is IBC has NO FEVER and DOESN'T RESPOND TO ABX***

Answer 312

1. **FIXED** palpable mass 2. Irregular borders 3. +/- Bilateral

Answer 313

Ductal **ADC** 1. **crusty eczematous or ulcerating nipple & areola** 2. +/- bloody nipple discharge 3. +/- nipple retraction *85% of Paget Disease of Breast is 2/2 underlying DCIS of glandular rissue which migrate thru mammary ducts to nipple surface. Dx = Mammogram and biopsy*

Answer 314

N. Gonorrhea = non-exudative pharyngitis, and has PID lower abd pain vs. Mono = **exudative** pharyngitis and has fatigue *otherwise, presentation is similar*

Answer 315

autoimmune chronic inflammatory condition of anogenital region that affects women **of any age** that --\> vulvar squamous cell carcinoma THIS DOES NOT AFFECT THE VAGINA! *dx = vulvar punch biopsy*

Answer 316

1. Pruritus SEVERE 2. Dyspareunia 3. White Grayish pale vulva (distinguishes from postmenopausal vaginal atrophitis) 4. Cigarette paper texture of vulva (**thin**, crinkled) 5. loss of vulvar anatomy (introitus, labia minora, clitoral hood) ## Footnote *dx = vulvar punch biopsy*

Answer 317

do not confuse with Inflammatory Breast CA **inadequate milk duct drainage** allows Staph Aureus from infant's nasopharynx or mother's nipple skin to multiply in stagnant milk --\> 1. Breast Erythema in quadrants 2. Breast Pain in quadrants 3. LAD 4. **FEVER** Tx = **KEEP BREASTFEEDING** + Dicloxacillin + Ibuprofen

Answer 318

1. **EEE** - Excess Estrogen Exposure (HRT, neoplasm, [menstruation *outside* of 12-52], Nulliparity, Anovulation/PCOS) 2. **Tamoxifen** 3. **Obesity** (excess insulin--\> ⬆︎androgen release from ovarian theca --\> excess androgen is converted into estrone --\> EEE) ## Footnote *Smoking and Progestin OCP ⬇︎Endometrial CA Risk*

Answer 319

1. Malodorous vaginal discharge 2. Vaginal irregularity aesthetically (mass, plaque, ulcer) 3. Postmenopausal bleeding 4. Postcoital bleeding Vaginal SQC = \> 60 yo Vaginal SQC = **POSTERIOR** Upper 1/3 of vaginal wall

Answer 320

same as **Cervical CA risk factors** ## Footnote (*cervical CA migrates to vagina*)

Answer 321

CA-125 can be elevated in younger women who have leiomyomata or endometriosis, so **elevated CA-125 is only associated w/ovarian CA in POSTmenopausal women**

Answer 322

*Postmenopausal women have ⬆︎risk of ovarian CA* 1. Monitors for recurrence after ovarian CA tx 2. used in initial w/u of an ovarian mass to determine if it is malignant or benign *DO NOT DO NEEDLE ASPIRATION ON OVARIAN MASS PTS SINCE CA STATUS IS UNKNOWN AND MAY BE IATROGENICALLY SPREAD DURING ASPIRATION*

Answer 323

**single** papule that turns into shallow, PAINLESS, **nonexudative ulcer** with indurated edges, accompanied with BL inguinal LAD ## Footnote THESE ARE EXTREMELY INFECTIOUS!

Answer 324

1. Multiple deep ulcers 2. Exudative Grayish yellow Base 3. **PAINFUL** inguinal coalesced bubo nodes ## Footnote Organisms clump in long strands like a "school of fish" **PAINFUL** *Haemophilus Ducreyi*

Answer 325

1. Multiple small shallow ulcers 2. Erythematous base 3. LAD ## Footnote **PAINFUL**

Answer 326

1. Multiple small shallow ulcers (similar to herpes) 2. Large PAINFUL coalesced inguinal lymph nodes = *Buboes* 3. Intracytoplasmic chlamydial inclusion bodies \*\* Initial lesion is NOT painful but Buboes are \*\* *Chlamydia Trachomatis*

Answer 327

Vasculitis-mediated Recurrent Multiple Ulcers (aphthous and genital)

Answer 328

Mostly in India 1. Extensive ulcers WITH NO LAD 2. Granulation like base 3. Deeply staining gram neg intracytoplasmic cyst = Donovan bodies No, not painful *Klebsiella Granulomatis*

Answer 329

Empiric **PCN G IM**! ## Footnote *RPR false negatives are a thing so you should repeat serology in 2 weeks to see if tx reduced titers. Also, Treponemal Pallidum can NOT be cultured so don't do it!* THESE ARE EXTREMELY INFECTIOUS!

Answer 330

*Incontinence with coughing/lifting/sneezing* 1. Urethral Hypermobility (injury to pelvic floor muscles and/or urethral prolapse --\> urethral hypermobility or bladder cystococele can --\> bladder prolapse and all of this --\> vaginal bulge and incontinence) 2. ⬇︎Urethral tone Tx = Kegel excercises vs urethral sling

Answer 331

1. DM neuropathy 2. mechanical obstruction ## Footnote *⬇︎Detrusor activity or mechanical outlet obstruction --\> Overdistended bladder --\> involuntary dribbling and incomplete empyting (⬆︎PVR)*

Answer 332

Since the NAAT (Nucleic Acid Amplification Test) is now so specific and sensitive that there is little chance of false negatives, empiric tx of both infections is no longer required if there is only 1 that actually has a positive result

Answer 333

1. **URETHRAL SLING** 2. **Kegel exercise physical therapy** 3. Vaginal pessary 4. Bladder neck Injectable bulking if etx is related to sphincter deficiency

Answer 334

1. **CLEAR** cervical mucus discharge (looks like uncooked egg white) - starts thin and then becomes thick after ovulation 2. ⬆︎temperature 3. Mittelschmerz mid-cycle (day 14) pelvic pain ## Footnote *order: LH surge --\> 36 hrs will pass --\> Ovulation*

Answer 335

high Androgen (such as PCOS) --\> ⬇︎GnRH release from feedback inhibition --\> ⬇︎FSH --\> ⬇︎ovarian maturation --\> 2°follicle atresia --\> 1. Anovulation chronically 2. Amenorrhea 3. Polycystic Ovaries

Answer 336

1. **symmetrically enlarged TENDER uterus (\> 12 weeks in size)** 2. Menorrhagia 3. Dysmenorrhea eventually --\> Chronic Pelvic Pain ## Footnote *etx: glands invade uterine myometrium --\> blood deposition inside myometrium during cycle --\> dysmenorrhea from irregular contractions and menorrhagia from extra deposited blood*

Answer 337

True dx = pathological exam of tissue after hysterectomy ## Footnote *etx: glands invade uterine myometrium --\> blood deposition inside myometrium during cycle --\> dysmenorrhea from irregular contractions and menorrhagia from extra deposited blood*

Answer 338

**PAINLESS** intermenstrual bleeding

Answer 339

1. Endometrial Polyps - Painless and light 2. Adenomyosis 3. Endometrial ADC/hyperplasia - Older women 4. PID - due to cervicitis 5. Cervical CA

Answer 340

1. Pelvic pressure --\> urinary incontinence/incomplete voiding/constipation 2. **irregularly enlarged NONTENDER uterus** 3. Menorrhagia (especially with submucosal) 4. Dysmenorrhea (especially with submucosal) 5. Progressively longer menses due to deformity of the uterus from fibroids ## Footnote *Submucosal and Pedunculated are the worst!*

Answer 341

**girls with no menses by age 15** but who have normal growth and secondary sex characteristics

Answer 342

they actually have functioning Testes that secrete **AntiMullerian Hormone** **& Testosterone** and this --\> regression of Mullerian ducts. Breast comes from the aromatization of testosterone into estrogen ## Footnote Wolffian ducts also degenerate and fetal urogenital sinus does not differentiate into a penis and scrotum --\> default of external female genitalia

Answer 343

ambiguous genitalia at birth 2/2 undervirilization ## Footnote *these pts can not convert Testosterone --\> DHT*

Answer 344

**AIS pts will have NO pubic or axillary hair** since they don't respond to testosterone (which is what causes axillary/pubic hair in both sexes!) but Mullerian agenesis pts have normal testosterone levels so will have pubic and axillary hair *Both obvi have no mullerian duct organs*

Answer 345

1. HTN 2. Breast Tenderness 3. ⬆︎TriAcylGlycerides 4. Bloating with Nausea 5. **Breakthrough bleeding** = **most common (usually with lower estrogen doses)** 6. Venous thromboembolism (Migraine w/aura is a ctd for Combined OCPs) ## Footnote *Wt Gain is NOT a side effect of combined OCPs and OCPS actually ⬇︎risk of Endometrial and Ovarian CA*

Answer 346

its uterine inflammatory rxn actually --\> ⬆︎pain

Answer 347

1. it causes ⬇︎ of bone mineral density 2. it ⬆︎body fat and ⬇︎lean muscle mass ## Footnote *in addition to Breast tenderness and bleeding for 1st 6 months*

Answer 348

uterine infxn extends from fallopian tubes (salpingitis) --\> diffuse abd --\> Liver capsule--\> RUQ pain exacerbated with deep inspiration = **Fitz Hugh Curtis perihepatitis** ## Footnote PID causes salpingitis and cervicitis

Answer 349

Colposcopy (**even if they're pregnant! - DO IT**) ; Cervical Conization (via cold knife conization or loop electrosurgical excision procedure) ## Footnote *conization inevitably --\> short cervix and cervical stenosis due to scar tissue*

Answer 350

**INTRAUTERINE ADHESIONS** (could be from infxn or uterine surgery) this can cause 2° Amenorrhea (normal ovulation and hormone levels but mechanical amenorrhea)

Answer 351

1. **4 or 8 oclock** position - base of labium majora 2. **egg shaped** 3. **CYSTIC mass** 4. Painless ; Duct obstruction *can develop into abscess which presents with flutuancy*

Answer 352

single or multiple submucosal cyst on the lateral aspects of the upper ANT vagina ; incomplete regression of Wolffian duct

Answer 353

**OBSERVATION** if asx since it will spontaneously drain :-) ## Footnote If symptoms are present --\> Incision and Drainage f/b word catheter ⬇︎ recurrence

Answer 354

**Mature dermoid cystic teratoma of ovary** mostly asx but sometimes with long standing lower abd/pelvic pain ; hyperechoic ovarian cyst with calcifications(from teeth and bone)

Answer 355

1. proximal Colorectal 2. Ovarian 3. Endometrial 4. Skin ## Footnote *Germline mutation in mismatch repair protein*

Answer 356

1st: **XLap** to remove pelvic mass, dissect pelvic and paraAortic lymph nodes, inspect entire abd cavity 2nd: **Platinum based Chemotherapy** * this comes from ovarian, tubal or peritoneal abnormal proliferation*

Answer 357

aggressive form of gestational trophoblastic neoplasia;metastasizes to **LUNGS** --\> cp/dyspnea/hemoptysis ## Footnote occurs after ANY TYPE OF PREGNANCY

Answer 358

**immaturity of hypothalamic-pituitary-gonadal axis** --\> inadequate amounts of GnRH --\> low FSH and LH --\> lack of ovulation --\> lack of Menses Menses normally occurs when corpus lutem (byproduct after ovulation) produces progesterone and this progesterone drops --\> Menses/shedding. **No ovulation --\> No menses** * Tx = Progestin-only or Combined OCPs* * this self-resovles 1-4 yrs after menarche*

Answer 359

1. **BL Salpingo-Oophorectomy** 2. OCP (only ⬇︎ovarian CA but actually ⬆︎breast CA risk) 3. 1st gestation \< 30 yo 4. Breastfeeding 5. Tubal ligation ## Footnote *Epithelial Ovarian Carcinoma comes from Ovarian, Tubal or Peritoneal abnormal proliferation*

Answer 360

**OVARIAN ISCHEMIA 2/2 TORSION** mass on the ovary --\> ⬆︎risk for torsion around its support ligaments which contain ovarian blood supply *It is not common for Mature dermoid cystic teratoma to rupture*

Answer 361

Inpatient: 1. CeFOXitin IV + Doxy PO 2. Cefotetan IV + Doxy PO 3. Clindamycin + Gentamicin IV *Remember: PID is actually POLYmicrobial*

Answer 362

CefTriaxone IM + Doxy PO ## Footnote *make sure these pts can tolerate and comply with PO abx*

Answer 363

1. Smoking (impairs immunity) 2. STI hx 3. Sexual activity early on or frequent (HPV 16/18 acquisition) 4. Immunosuppressed 5. Vaginal or Vulvar CA hx

Answer 364

1. Tampons 2. Surgery (**especially nasal/sinus**) 3. Burns/skin lesions

Answer 365

1. **Generalized macular rash INVOLVING palms & soles** 2. hypOtension 3. Fever 4. Vomiting 5. Diarrhea

Answer 366

HPV 6 & 11 Could Either be: 1. multiple exophytic (cauliflower-like growth) skin-colored lesion +/- friability OR 2. multiple sessile (broad & flat) & smooth papules that's skin-colored +/- friability

Answer 367

Treponema Pallidum **SECONDARY** syphillis 1. **FLAT** 2. **VELVETY**

Answer 368

*Functional hypOthalamic amenorrhea ; **these pts have low FSH** and therefore NO postmenopausal sx* 1. Excessive Exercise 2. Very low calorie diet/starvation 3. low BMI/Anorexia/Wt loss 4. Stress 5. Depression 6. Chronic illness ; Osteoporosis from lack of estrogen *note: these pts will NOT have normal mentrual cycles*

Answer 369

syncytiotrophoblast ; **preserves corpus luteum** (which secretes progesterone) during early pregnancy until the placenta can take over ; 8 days after fertilization ## Footnote *hCG also stimulates maternal thyroid and promotes male sex differentiation*

Answer 370

**P**rogesterone **P**repares endometrium via decidualization

Answer 371

**E**strogen

Answer 372

**P**rogesterone

Answer 373

1st: **WEIGHT LOSS!** 2nd: Clomiphene citrate (GnRH agonist)

Answer 374

Elevated Prolactin (responsible for mammogenesis and galactogenesis) **inhibits GnRH release** --\> anovulation and amenorrhea for ≤ 6 months ## Footnote *after 6 months, even with breastfeeding women will start to ovulate again and even before then, this is not a reliable form of contraception*

Answer 375

Lichen Sclerosus does **NOT** affect the vagina Atrophic Vaginitis affects both and can be a result of menopause (2/2 natural, chemotherapy, radiation, surgical or lack of estrogen replacement therapy)

Answer 376

Glazed erythematous lesions on vulva with ulcerated areas

Answer 377

1. Women with Breast CA \< 50 yo 2. Women with Ovarian CA at any age 3. Women with first degree relatives with #1 or #2

Answer 378

1. early satiety (from ascities) 2. abd/pelvic pressure (from ascities) 3. GI sx (constipation/diarrhea/bloating/anorexia) - (from ascities)

Answer 379

Leiomyomata uterine fibroids ## Footnote *Submucosal and Pedunculated are the worst!*

Answer 380

**FALSE** ## Footnote (this is a normal finding for preggos along with corpus luteum ovarian cyst UNLESS IT'S IN THE SETTING OF ECTOPIC. THEN IT MEANS HEMOPERITONEUM FROM RUPTURE OR OVARIAN CYST RUPTURE)

Answer 381

1. Normal pregnancy change 2. Ruptured Ectopic --\> hemoperitoneum 3. Ruptured Ovarian cyst

Answer 382

FALSE ; **Combined** OCPs ⬇︎risk for Endometrial CA because the progestin differentiates endometrial cells

Answer 383

TRUE ; **Combined** OCPs ⬇︎risk for Ovarian CA because it suppresses chronic ovulation which causes chronic damage to surface

Answer 384

PMS sx begin 1 week before menses (luteal phase) and resolves during week after menses (follicular phase) for ≥ 2 menstrual cycles ## Footnote Sx: - Bloating - Fatigue - HA - Hot Flashes - Breast Tenderness - **Irritability/Mood Swings** - ⬇︎Concentration

Answer 385

PMS sx begin 1 week before menses (luteal phase) and resolves during week after menses (follicular phase) ## Footnote 1st: **Sx Diary** reveal PMS sx timing occured over ≥ 2 menstrual cycles 2nd: Order **TSH** to r/o hypOthyroidism as cause 3rd: **Exercise w/NSAIDs** 4th: **SSRI** 5th: **Combined OCP** if SSRI don't work and there's no ctd

Answer 386

There is a rare but serious **RISK OF STROKE** with use of combined OCs in women with migraine/HA hx, especially if they smoke or are \> 35 yo

Answer 387

**Hyperprolactinemia** **is most common cause of galactorrea** 1. PROLACTIN levels - Prolactinoma could --\> Hyperprolactinemia 2. TSH levels - hypOthyroidism could --\> ⬆︎TRH & TSH --\> Hyperprolactinemia since TRH stimuales prolactin release 3. PREGNANCY test - Pregnancy could --\> Hyperprolactinemia since TSH shares same α-subunit as bHCG 4. MED REVIEW - D2 blockers/Antidepressants/Opioids all --\> Hyperprolactinemia

Answer 388

Between 11-26 yo regardless of anything ## Footnote \*they receive 3 doses spread out\* **\*\*this INCLUDES women with genital warts, positive HPV and abnormal cytology hx!!!!\*\***

Answer 389

Between 9-21 (or 26 if HIV+ and/or gay) yo ## Footnote \*they receive 3 doses spread out\*

Answer 390

Intrauterine pregnancy is not detectable via transvaginal US until **1500-2000** bHCG. There should be SOMETHING on transvaginal US at that time (whether normal pregnancy or ectopic)

Answer 391

βhCG levels have to be **1500-2000** for conclusive pregnancy detection via transvaginal US and usually **\>5000** for transABDominal US to finally detect it A: Ectopic Preg/Miscarriage = low βhCG B: Molar Pregnancy = \> 100,000 βhCG!!! *βhCG should double every 2 days in normal pregnancy for first 7 weeks*

Answer 392

Obesity --\> anovulation **without affecting LH/FSH levels** which--\> Amenorrhea

Answer 393

1. ⬇︎Breast CA risk 2. adjuvant tx for Breast CA (Tamoxifen) 3. Postmenopausal Osteoporosis (Raloxifene) SIDE EFFECTS A: **Hot Flashes** B: Venous Thromboembolism (all estrogen agonist ⬆︎resistance to protein C) C: Endometrial Hyperplasia/ADC *note: SERMs not only modulate estrogen receptors but they actually block estrogen binding competitively*

Answer 394

⬇︎estrogen --\> Vulvovaginal and **URETHRAL ATROPHY** --\> Urethral closure --\> ⬆︎bladder pressure --\> URGE incontinence and ⬇︎urethral compliance --\>STRESS incontinence and UTI + Bladder trigone, urethra and pelvic floor muscles are maintained by estrogen *UTI can also cause urge incontinence so be sure to rule this out*

Answer 395

1. natural Menopause 2. Chemotherapy - targets rapidly dividing granulosa/theca cells 3. Radiation - targets rapidly dividing granulosa/theca cells 4. oophorectomy

Answer 396

1. Migraine with aura 2. Smokes ≥15 cig/day and ≥35 yo 3. HTN ≥160/100 4. Heart disease 5. DM with end organ damage 6. Breast CA (estrogen AND progesterone may have proliferative effects on breast tissue) 7. Liver Cirrhosis/CA 8. Thromboembolism hx 9. Prolonged immobilization 10. Antiphospholipid syndrome hx 11. ≤3 wks postpartum

Answer 397

pain with any vaginal penetration (penis, tampon, gyne exams) ## Footnote tx = Vaginal Dilators, Kegel exercises *this is AKA Vaginismus*

Answer 398

1. Vulva 2. Perineum 3. Rectum ## Footnote *these are the pudendal n distribution areas*

Answer 399

1. Adhesions (PID, surgery) 2. Tubal ligation

Answer 400

**WEIGHT LOSS** ; Combined OCPs ## Footnote HEY! HRT IS NO LONGER RECOMMENDED FOR CAD, DEMENTIA OR _OSTEOPOROSIS_ PX!!!!!!!

Answer 401

1. thickens cervical mucus 2. thins the endometrium when present outside of pregnancy which --\> implantation impairment AND ⬇︎menstrual bleeding 3. prevents withdrawal bleeding altogether --\> **amenorrhea**

Answer 402

Menorrhagia

Answer 403

Weight Gain

Answer 404

1. **Breast tenderness** 2. HA

Answer 405

Mature dermoid cystic teratoma

Answer 406

Endometriosis of ovary (endometrioma)

Answer 407

Tx = **KEEP BREASTFEEDING** + Dicloxacillin + Ibuprofen ## Footnote *drain via needle aspiration if abscess is present*

Answer 408

**POST**menopausal; ⬆︎Theca cell activity --\> ⬆︎androgen and ⬆︎insulin resistance --\> virilization, hyperglycemia, acanthosis nigricans ## Footnote this does NOT affect LH and FSH and ovaries are enlarged but not cystic

Answer 409

*Pregnancy, Structural, NonStructural, Meds* 1. Pregnancy 2. Leiomyomata fibroids 3. Adenomyosis 4. Endometrial Polyps 5. Endometrial hyperplasia/ADC (get bx if risk factors present) 6. Cervical CA 7. Vaginal CA 8. Coagulopathy 9. Ovulatory dsfxn 10. Copper IUD

Answer 410

oil cyst +/- calcifications that may appear to be malignant ## Footnote *ruled out from malignancy based on bx revealing fat globules and foamy macrophages*

Answer 411

fat globules and foamy macrophages

Answer 412

1. BRCA carrier 2. 1st degree reliative is BRCA carrier 3. eval of disease extent 4. eval of chemotherapy response 5. chest radiation exposure between 10-30 yo

Answer 413

diminished Ovarian reserve ## Footnote *oocytes are of number and quality*

Answer 414

sex cord-stromal tumor that secretes both but Estrogen \> testosterone

Answer 415

local trauma ; obstruction of sebaceous gland duct

Answer 416

**FAWN** 1. **F**atigue +/- insomnia 2. **A**menorrhea 3. **W**eight gain 4. **N**V *these sx can overlap with Perimenopausal sx so be careful not to quickly dismiss an older pt who's actually pregnant!*

Answer 417

HPV 6 & 11 1. **Trichloroacetic acid** 2. Cryotherapy c liquid nitrogen or cryoprobe 3. Podophyllin resin 4. Podofilox 0.5% gel - pt application 5. Imiquimod 5% cream - pt application

Answer 418

TRUE (**Colposcopy is indicated when pap is abnormal** **even if pt is pregnant! - DO IT**) ; So is Cervical bx if a lesion has high-grade features ## Footnote *Endocervical curettage is contraindicated*

Answer 419

TRUE - **after Colposcopy**, if lesion has high-grade features ## Footnote *Endocervical curettage is contraindicated*

Answer 420

cervical ; Endometrial (glands migrated to cervical area) 1. Colposcopy 2. Endocervical curettage 3. Endometrial biopsy *With AGC on Pap you need to evaluate Ectocervix, Endocervix and Endometrium*

Answer 421

**Mittel**schmerz = "**Middle** of the cycle" uL pelvic pain that occurs when blood released from rupture of follicle during ovulation irritates peritoneum ## Footnote *order: LH surge --\> 36 hrs will pass --\> Ovulation*

Answer 422

Ovulation inducing medications --\> excessive follicle development --\> ovarian enlargement, ascities, SOB and abd pain

Answer 423

Evaluate **F**LA**T** **P**iG for 2° Amenorrhea

Answer 424

**INCREASE** (with monitoring of T4); Estrogen from pregnancy usually ⬆︎Thyroid binding globulin AND bHCG stimulates thyroid which both --\> ⬆︎total thyroid hormone in mom for the baby. BUT hypOthyroid pts can't produce adequate thyroid hormone and this can --\> congenital hypOthyroidism. So **give them more Levothyroxine T4 when pregnant** *Levothyroxine = T4 / Liothyronine = T3*

Answer 425

**CAN** the UTI, CAN it 1. **C**iprofloxacin 2. **A**moxicillin-clavulanate 3. **N**itrofurantoin *but also can use Fosfomycin and CefTriaxone*

Answer 426

bleeds "crumbles" ; N. Gonorrhea

Answer 427

ALPHA; 1. FSH 2. LH 3. TSH--\> Prenant woman naturally have more T3 and T4 (also because Estrogen ⬆︎thyroid binding globulin which ⬆︎total thyroid levels) - these pts are still *clinically* euthyroid

Answer 428

urinary catheterization ≥150 cc ## Footnote *Bladder can hold up to 400 cc*

Answer 429

1. Pelvic organ prolapse 2. Stress urinary incontinence

Answer 430

1. **PERSONAL OR FAMILY HX OF OSTEOPOROTIC FX** 2. ⬇︎Estrogen (postmenopause) 3. LOW BMI (malnutrition/malabsorption) 4. Sedentary lifestyle 5. Poor Ca+ intake (body needs 1000mg/day premenopausal and 1200mg post) 6. Smoking 7. EtOH abuse 8. White race 9. CTS

Answer 431

1st: HPV typing, and if high risk (16 or 18) ---\> 2nd: Colposcopy and if abnml --\> 3rd: Cervical biopsy

Answer 432

1. **FAMILY HX OF PMS** 2. Vitamin B6 Pyrodixine deficiency 3. Ca+ deficiency 4. Mg deficiency 5. Age \> 30

Answer 433

Selective Estrogren R Modulator 1. Breast CA 2. Osteoporosis * SE = Venous Thromboemobolism*

Answer 434

Immune System in patients \< 21yo clears HPV on its own

Answer 435

* give me the TTP **TAN**!* 1. **T**hrombocytopenia ➜ Petechial Rash 2. **A**nemia hemolytic 3. **N**eurologic ∆ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ In pregnancy can occur [ANYTIME (even Postpartum)]

Answer 436

TTP = occurs 1st trimester - PostPartum vs HELLP (and Acute Fatty Liver) = 3rd Trimester

Answer 437

**3rd** trimester 1. NV 2. hypOglycemia 3. ⬆︎LFTs

Answer 438

upper uterine fundus

Answer 439

upper uterine fundus ; VAL had an ectopic the other day! 1. **V**aginal bleeding/spotting 2. **Adnexal Tenderness** **(if implanted in tube)** 3. **L**ower abd pain *dx = trans**Vaginal** US / tx = MTX or [surgery if severe]*

Answer 440

**GOE20WG**! ; Preeclampsia as a complication of Hydatidiform mole (which may occur \< 20WG)

Answer 441

1. STAT DELIVERY 2. IV Mg

Answer 442

1. **SSRI** 2. SNRI \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *50-70% f endorse sx reduction*

Answer 443

SEMEN ANALYSIS

Answer 444

[GOE12mo timely unprotected intercourse] ➜ still no conception

Answer 445

1. immobile uterus 2. pelvic nodules 3. chronic pelvic pain

Answer 446

1. Turner syndrome 2. Fragile X syndrome 3. hypOthyroidism 4. adrenal insufficiency 5. Chemoradiation

Answer 447

* ovarian insufficiency ➜* 1. [DEC estrogen] ➜ 2. [INC FSH] and 3. [amenorrhea LOE 40 y/o]

4 ⼀PREGNANCY/BREAST/REPRO Z Flashcards

(496 cards)