Associations 6 Flashcards
(163 cards)
1
Q
Precocious puberty
A
<9 (males)
2
Q
Tanner level 5 (girls)
A
Breast: areola recedes to level of breast
Pubic hair: spreads to medial thighs
3
Q
LH in menstrual cycle
A
Midcycle surge (induced by estrogen) induces ovulation Stimulates corpus luteum to secrete progesterone (luteal phase)
4
Q
FSH in menstrual cycle
A
Stimulates development of ovarian follicle (follicular phase)
5
Q
Estrogens in menstrual cycle
A
Stimulates endometrial proliferation (follicular phase)
Secreted by follicle, aids follicle growth
Induces LH surge
High levels inhibit FSH secretion
6
Q
Progesterone in menstrual cycle
A
Secreted by corpus luteum (luteal phase); *decrease in levels leads to menstruation
Stimulates endometrial gland development
Inhibits uterine contraction, increases cervical mucus thickness
Increases basal body temperature
Inhibits LH and FSH secretion, maintains pregnancy
7
Q
hCG in menstrual cycle
A
Acts like LH after implantation of fertilized egg
Maintains corpus luteum viability and progesterone secretion (no menstruation)
8
Q
Causes of pseudoprecocious puberty
A
Exogenous hormones (estrogens)
Adrenal tumor
Other hormone-secreting tumor (eg ovarian)
CAH
9
Q
Phase of menstrual cycle fixed at 14 days regardless of cycle length
A
Luteal phase
10
Q
Diagnostic for menopause
A
Amenorrhea >1 year in woman
11
Q
Premature menopause
A
< 40 years old
12
Q
Hormones in perimenopause
A
+LH, +FSH
Estrogen fluctuates
13
Q
Causes primary amenorrhea
A
HPO axis dysfunction
Anatomic abnormalities (absent uterus, vaginal septa, imperforate hyman, vaginal atresia)
Chromosome abnormalities
Pregnancy
14
Q
Causes secondary amenorrhea
A
Pregnancy
Ovarian failure (menopause)
HPO axis dysfunction, uterine abnormalities, PCOS, thyroid disease
Anorexia, malnutrition
15
Q
Hypogonadism + anosmia
A
Kallman syndrome
16
Q
Initial tests for primary amenorrhea
A
Physical (anatomic abnl)
B-hCG, prolactin, TSH
Signs of hyperandrogenism -> DHEAS, testosterone
17
Q
Primary amenorrhea + absent uterus on US
A
Karyotype + serum testosterone
(Androgen insensitivity syndrome = 46XY)
(Abnl mullerian development = 46XX)
18
Q
Primary amenorrhea + uterus present
A
B-hCG + FSH
(Pregnancy = high B-hCG)
(Turner syndrome = high FSH)
(HPO axis disease = low FSH)
19
Q
Secondary amenorrhea initial tests
A
B-hCG (always first test)
Prolactin, TSH, FSH
If hyperandrogenism signs -> DHEAS, testosterone
20
Q
Secondary amenorrhea w/ normal initial tests
A
Progesterone challenge (normal = anovulation) (abnl = low estrogen or outflow tract abnl) If abnl, progesterone-estrogen challenge (normal = HPO axis abnl, menopause) (abnl = outflow tract obstruction eg Asherman syndrome)
21
Q
Causes secondary dysmenorrhea
A
Endometriosis, PID, uterine fibroids, ovarian cysts, adenomyosis
22
Q
Timing primary vs secondary dysmenorrhea
A
Primary - beginning of menstruation and resolve over several days
Secondary - midcycle before onset of menstruation and increase in severity until conclusion of menstruation
23
Q
“Powder-burn” lesions or chocolate cysts on biopsy
A
Endometriosis
24
Q
Common symptoms of endometriosis
A
3Ds - dysmenorrhea, deep dyspareunia, dyschezia
25
Common causes abnormal uterine bleeding
```
PALM-COEIN
Polyps
Adenomyosis
Leiomyoma
Malignancy/hyperplasia
Coagulopathy
Ovulatory dysfunction
Endometrial
Idiopathic
Not yet classified
```
26
Regular, heavy abnl uterine bleeding
Think fibroid, adenomyosis, polyp
27
Irregular, heavy abnl uterine bleeding
Think anovulation
28
MCC abnormal uterine bleeding
Anovulation
29
Abnl uterine bleeding related to sex
Think cervical polyp/glandular tissue
30
Abnl uterine bleeding + positive B-hCG + intrauterine pregnancy + closed cervical os
Threatened abortion
31
Abnl uterine bleeding + enlarged uterus + menometrorrhagia for months
Fibroids, molar pregnancy, adenomyosis
32
Abnl uterine bleeding + severe menstrual pelvic pain
Endometriosis, adenomyosis
33
Menorrhagia + perimenopausal
R/o endometrial hyperplasia / cancer
34
Abnl uterine bleeding that started w/ menarch
R/o coagulopathy
35
MC coagulopathy associated w/ abnormal uterine bleeding
Von Willebrand disease
36
Abnl uterine bleeding + positive B-hCG + no fetus in uterus on US
Ectopic pregnancy
37
Abnl uterine bleeding + depression + constipation
Hypothyroidism
38
Diagnostic criteria for PCOS
2/3
Oligo or anovulation
Androgen excess
Polycystic ovaries ("string of pearls") by US
39
Labs for PCOS
+LH
LH:FSH ratio >2:1
+DHEA, androstenedione, testosterone
+progesterone challenge (anovulatory)
40
Complications of PCOS
Infertility
DM
Endometrial cancer (+unopposed estrogen)
Also HTN, ischemic heart disease, ovarian torsion
41
"Dew drops on rose petals" rash
Varicella zoster (chicken pox)
42
MCC postmenopausal bleeding
Atrophic vaginitis (but must r/o endometrial cancer)
43
Indications for endometrial biopsy
AUB >35 yo or <35 w/ risk factors
| Postmenopausal bleeding
44
Pap smear recommendations
Start at age 21
Every 3 years (21-29)
Every 3 years or every 5 years w/ HPV testing (>30)
Stop at age 65 if multiple normal results
45
ASCUS Pap - next step
21-24: repeat Pap in 12 months
25+: HPV testing
Colposcopy if either is positive
46
AGUS Pap - next step
Colposcopy + ECC +/- endometrial biopsy
47
ASC-H Pap - next step
Colposcopy
48
LSIL (CIN 1) Pap - next step
21-24: repeat Pap in 12 months
25-29: colposcopy
30+: HPV testing or colposcopy
49
HSIL (CIN 2 or 3) Pap - next step
21-24: colposcopy
| 25+: excision (LEEP, conozation or laser)
50
Thin anogenital skin w/ ivory or porcelain-white macules and plaques w/ pruritis or pain, usu postmenopausal
Lichen sclerosis (need to r/o SCC)
51
Functional benign ovarian tumors (physiological)
Follicular cyst, Corpus luteum cyst
| Often regress on their own
52
Psammoma bodies
Concentric calcifications
| Assoc w/ ovarian serous cystadenocarcinoma (or cystadenoma), papillary thyroid cancer, melanotic schwannoma
53
Benign ovarian tumor + chocolate cyst
Endometrioma
54
Benign ovarian tumor + multiple dermal tissues
Benign cystic teratoma (dermoid cyst)
55
Benign ovarian tumor + estrogen secretion (precocious puberty)
Granulosa theca cell tumor (stromal cell tumor)
56
Benign ovarian tumor + androgen secretion (virilization)
Sertoli-Leydig cell tumor (stromal cell tumor)
57
Characteristics of benign and malignant ovarian tumors on US
B - cystic, smooth edges, few septa
| M - irregular, nodular, multiple septa, pelvic extension or adhesions
58
Drugs that cause gynecomastia
```
STACKED
Spironolactone
THC (marijuana)
Alcohol (chronic)
Cimetidine
Ketoconazole
Estrogens
Digoxin
```
59
Multiple, bilateral small tender breast masses that vary in size with menstrual cycle
Fibrocystic changes
60
MC breast tumor <30 yo
Fibroadenoma
61
Bloody or nonbloody (serous) discharge with or without stimulation
Intraductal papilloma (nonbloody discharge only on stimulation is consistent w/ noncancerous)
62
Solitary, solid, mobile breast mass w/ well defined edges in young woman
Fibroadenoma
63
Large, bulky breast mass w/ leaf-like projections w/ patient in 50s
Phyllodes tumor
64
Embryonic age 1 week (3 weeks GA)
Implantation, B-hCG production starts
65
Embryonic age 2 weeks (4 wks GA)
Beginning of maternal-fetal circulation
B-hCG high enough to detect in urine (~30-40)
CNS starts to develop
66
Embryonic age 3 weeks (5 wks GA)
Heart starts to form
67
Embryonic age 4, 5 weeks (6, 7 wks GA)
GI tract start to form; lungs start to form
68
Embryonic age 6, 9 weeks (8, 11 wks GA)
Limbs, genitalia start to form; kidneys start to function
69
Embryonic age 15-20 weeks (17-22 wks GA)
Early detectable fetal movement
70
Embryonic age 24 weeks (26 wks GA)
Surfactant production begins
| Earliest chance of viable premature birth
71
Embryonic age 32 weeks (34 wks GA)
Fetus usually survives premature birth
72
Embryonic age 37 weeks (39 weeks)
CNS fully developed
73
Fetus considered full term
37-42 weeks GA (35-40 EA)
74
Biggest effect of teratogens on organ systems
2-12 weeks (esp 3-8 weeks) EA
75
CV effects of pregnancy
CO increases 40% (SV and HR)
| BP decreases slightly weeks 20-24, back to base by term
76
Respiratory effects of pregnancy
O2 consumption increases 20%
Tidal volume increases 40% w/ minute ventilation increase
PCO2 decreases to ~30 (respiratory alkalosis)
77
Endocrine effects of pregnancy
Nondiabetic hyperinsulinemia w/ mild glucose intolerance (HPL hormone contributes)
TG, cortisol increase
TSH decreases slightly; TBG and total T4 increase (free T4 stays the same)
78
Hematologic effects of pregnancy
Hypercoagulable
| Increased RBC production, increased blood volume = physiologic anemia of pregnancy (Hct still decreases)
79
GI effects of pregnancy
Increased salivation
| Decreased gastric motility (increased GERD)
80
Labs at initial prenatal visit
```
CBC
Blood type and cross
UA
Pap smear, G/C screening
RPR/VDRL, Rubella antibody titer, Hep B surface antigen, HIV screening (w/ permission)
```
81
Labs at 16-18 weeks GA
Quad screen
82
Labs at 18-20 weeks GA
US dating and anatomy screen
83
Labs at 24-28 weeks GA
1 hr glucose challenge (screen for gestational DM)
84
Labs at 32-37 weeks GA
```
Cervical culture for G/C in high risk
GBS screening (36 weeks)
```
85
Quad screen
```
Maternal serum aFP
Estriol
B-hCG
Inhibit
Must be done at 16-18 weeks (aFP requires this time)
Assesses for NTD, trisomy 18 and 21
```
86
Full integrated test
Nuchal translucency and PAPP-A in first trimester + quad screen in second trimester
Lowest false-positive rate for non-invasive tests
87
Amniocentesis
After 16 weeks
NTD and chromosomal abnormalities
0.5% miscarriage
88
Chorionic villi sampling
9-12 weeks
Chromosomal abnormalities
1% miscarriage
89
PUBS
After 18 weeks
| Fetal anemia, Rh sensitization, possible transfusion
90
Increased nuchal translucency
Trisomy 21, 18, 13
Turner syndrome
Congenital heart defects (+fluid)
91
Maternal serum aFP
High in NTD and multiple gestations
| Low in trisomy 21, 18
92
Quad screen, trisomy 21 vs 18 (doesn't see trisomy 13)
```
21 = low aFP, estriol; high hCG, inhibin-A
18 = low aFP, estriol, hCG
```
93
B-hCG levels during pregnancy
Double every 48 hours until ~10 weeks, ~100K
| Slowly return down to ~10K, stay there til end of pregnancy
94
Timing of diagnosis for gestational diabetes, preeclampsia vs pre-existing conditions
Diabetes >24 weeks
| HTN >20 weeks
95
Pre-gestational diabetes early fetal complications
Sacral and renal agenesis, cardiac (TGA, tetralogy of Fallot), neural tube defects
96
HTN + edema in hands or face + proteinuria (>300 g/24 hrs) in pregnancy >20 wks
Preeclampsia
97
HELLP syndrome
Hemolysis
Elevated Liver enzymes
Low Platelets
98
Maternal N&V timing
Worst in first trimester, usu resolves by 12-16 weeks
99
Congenital infection w/ hydrocephalus, intracranial calcifications, chorioretinitis
Toxoplasmosis or CMV
100
Congenital infection w/ blueberry muffin rash
Rubella
101
Congenital infection w/ high rate of neonatal death
Rubeola, HSV
102
Congenital infection w/ rash w/ hand and foot desquamation
Syphilis
103
Congenital infection w/ progressive unilateral hearing loss + neuro abnl
CMV
104
Congenital infection w/ halo sign on CT of brain
Toxoplasmosis
105
Congenital infection w/ IUGR, deafness, cataracts/glaucoma
Rubella
106
Congenital rubella cardiovascular problems
PDA
| Pulmonary artery stenosis
107
Congenital infection w/ temporal lobe encephalitis
HSV
108
Congenital infection w/ dermatomal skin scarring, chorioretinitis, microcephaly, intellectual disability, hypoplasia of hands and feet, early death
VZV (new infection)
109
Leading cause of congenital blindness
Chlamydia
110
Congenital infection w/ PNA, sepsis (early) or meningitis (late)
GBS
111
Congenital infection w/ decreased RBC production + hemolytic anemia = hydrops fetalis, high output cardiac failure
Parvovirus B19
112
MC site of ectopic pregnancy
Ampulla of fallopian tube (95%)
113
US can see intrauterine pregnancy
Intraabdominal: B-hCG >6500
Intravaginal: B-hCG >1500
114
<20 weeks + uterine bleeding + closed cervical os + viable IUP
Threatened spontaneous abortion
115
<20 weeks +/- uterine bleeding or pain + closed cervical os + non-viable IUP
Missed spontaneous abortion
116
<20 weeks + uterine bleeding + pain + open cervical os +/- viable IUP
Inevitable spontaneous abortion
117
<20 weeks + uterine bleeding + open cervical os + some uterine contents expelled
Incomplete spontaneous abortion
118
<20 weeks + uterine bleeding + open or closed cervical os + all uterine contents expelled
Complete spontaneous abortion
119
>20 weeks + nonviable IUP w/o fetal movement or heart activity
Intrauterine fetal demise
120
Cause of 1st trimester spontaneous abortion
Chromosomal abnl (usu trisomies, trisomy 16 is common)
121
Cause of 2nd trimester spontaneous abortion
Infection, cervical incompetence, uterine abnl, drug use...
122
MCC symmetric IUGR
Congenial infection, chromosomal abnormalities
| Familial
123
MCC asymmetric IUGR
Poor maternal health, placental insufficiency, multiple gestations
124
MC initial finding in IUGR
Abdominal circumference <10% for GA
125
AFI in oligohydramnios
2 cm
126
AFI in polyhydramnios
>25 cm or one pocket >8 cm
127
MCC first trimester oligohydramnios
Often results in spontaneous abortion
128
MCC second trimester oligohydramnios
Fetal renal abnl
Maternal HTN/CVD
Placental thrombosis
129
MCC third trimester oligohydramnios
PROM, abruption
Preeclampsia
Idiopathic
130
MCC polyhydramnios
```
Insufficient fetal swallowing (GI abnl)
Increased fetal urination (maternal DM)
Multiple gestation
Fetal anemia
Chromosomal abnl
```
131
Complications oligohydramnios
Spontaneous abortion / IUFD
| Abnl limb/face/lung/abdomen from compression
132
PROM vs PPROM
Spontaneous ROM before onset of labor (PPROM = before 37 weeks)
133
Labs for PROM
"Ferning" on slide
| Nitrazine paper turns blue (non-specific)
134
Signs of fetal lung maturity
L:S ratio >2 + presence of phosphatidylglycerol (PG) in amniotic fluid
135
Signs of chorioamnionitis
Fever +
| Maternal HR >100, fetal HR >160, maternal WBC >15K, uterine tenderness or foul smelling discharge
136
2 OB complications that can lead to DIC
IUFD (if fetus remains for extended time)
| Abruptio placenta
137
Preterm labor
<37 weeks
138
MCC vaginal bleeding after 20 weeks
Placenta previa (painless) and abruptio (painful)
139
Higher B-hCG than expected
Molar pregnancy
| Multiple gestations
140
Painless heavy or irregular vaginal bleeding during first or second trimester + hyperemesis gravidarum
R/o molar pregnancy
141
Preeclampsia <20 weeks gestation
Molar pregnancy
142
Expulsion of "grape-like" vesicles from vagina
Molar pregnancy
143
"Snow-storm" appearance on US w/o gestational sac
Molar pregnancy
144
Uterine mass on US w/ mix of hemorrhagic and necrotic areas and possible parametrial invasion
Choriocarcinoma
145
MC sites of mets for hydatidiform mole or choriocarcinoma
Lungs
Liver and brain = worse prognoses
Kidney, GI for choriocarcinoma
146
Workup for infertile couple
1) Semen analysis (30-40%)
2) Anovulation workup (20%)
3) Hysterosalpingogram to r/o anatomic issue (30%)
147
Normal non-stress test
15 bpm accelerations x 15 sec x 2 in 20 min
148
BPP scoring
```
NST
AFI
Fetal movement
Fetal breathing
Fetal tone
8-10 is reassuring, under that suggests fetal distress
```
149
Decelerations that begin and end w/ uterine contractions, rounded
Early (usu head compression)
150
Decelerations that begin any time and last different amounts of time, v-shaped
Variable (usu cord compression)
151
Decelerations that begin after uterine contraction starts and end after it finishes, check mark-shaped
Late (possible sign of uteroplacental insufficiency and fetal hypoxia)
152
Stage 1 of labor, latent phase
Start until 4 cm dilation and complete effacement
| Stops and starts, gradual, variable
153
Stage 1 of labor, active phase
4 cm to complete 10 cm dilation w/ constant progression
| >1.2 cm/hr (null) or >1.5 cm/hr (multi)
154
Stage 2 of labor
Fetal descent through birth canal
| <1 hr (multi) (add 1 hr for epidural)
155
Stage 3 of labor
Neonatal delivery until placental delivery, <30 min
156
Stage 4 of labor
1 hr after lab, monitor mom hemodynamically
157
Induction of labor, Bishop score
3 has 15%
| Fetal station, cervical dilation, effacement, consistency and position
158
Apgar scores
1 and 5 minutes, 0/1/2 points each
>7 (1 min) and >9 (5 min) reassuring
Appearance (blue/pink + blue extremities/pink)
Pulse (none/100)
Grimace (none/grimace/strong cry to pain)
Activity (none/some/active)
Respirations (none/poor weak cry/good strong cry)
159
Small, red, tender area on breast during breastfeeding
Galactocele
160
Larger, circumscribed area of redness and warmth on breast during breastfeeding + fever and +WBC
Mastitits
161
Uterine tenderness postpartum day 1-7 w/ fever, foul lochia
Postpartum endometritis
162
Immediately postpartum or during labor sudden-onset hypoxia, cardiogenic shock, DIC
Amniotic fluid embolism
163
Postpartum bleeding >500 cc + anemia + lack of breast milk when attempting to breastfeed
Sheehan syndrome
