Case Files Flashcards
(429 cards)
1
Q
First line of OBGYN presentation
A
- age
- GP
- LMP
- gestational age if relevant
- chief complaint
2
Q
Excessive menstrual flow is termed?
Excessive + irregular?
A
- menorrhagia
- menometrorrhagia
3
Q
When taking a gynecologic history, in addition to normal history sections (HPI, PMHx, PSHx, etc), what should be included?
A
- menstrual hx
- contraceptive hx
- STDs
- OB hx
4
Q
Every pregnant patient greater than 20 weeks gestation should be asked about _____.
A
symptoms of PreE
headache, visual changes, dyspnea, epigastric pain, face/hand swelling
5
Q
Murmur considered normal in pregnancy
A
systolic flow murmur
never diastolic
6
Q
What is the grey turner sign?
A
- discoloration at the flank
- indicates intra-abdominal/retroperitoneal hemorrhage
7
Q
Ddx ulcers at vulva
A
- HSV (painful)
- syphilis (non-painful)
- vulvar carcinoma
8
Q
Location of bartholin gland cysts
A
5 & 7 oclock
9
Q
Normal ovary size?
A
about the size of a walnut if palpated at all
10
Q
Rectal exam finding suggestive of endometriosis
A
nodularity and tenderness in the uterosacral ligament
11
Q
What do the vaginal and rectal exams inspect, respectively?
A
- vaginal: anterior pelvis
- rectal: posterior pelvis
12
Q
Routine initial prenatal labs
A
- CBC, blood type
- Urine Culture
- Pap smear
- G&C cultures
- Hep B, HIV, Syphilis, Rubella Titer
13
Q
When is testing for GDM usually performed in pregnancy? GBS?
A
- GDM: 26-28 weeks
- GBS 35-37 weeks
14
Q
Which of the initial prenatal labs are repeated in third trimester?
A
- HIV in populations with prevalence above 1/1000
- CBC for anemia
- other STDs if indicated based on risk factors
15
Q
Labs for: threatened abortion
A
-HCG and progesterone
16
Q
Labs for: menorrhagia
A
- CBC
- endometrial biopsy
- pap smear
17
Q
Ovarian tumor markers (2)
A
- CEA
- CA125
18
Q
Thickened endometrial stripe significance:
A
- premenopause: pregnancy
- postmenopause: endometrial cancer
19
Q
Test that determines patency of fallopian tubes:
A
-HSG
20
Q
Test that determines patency of ureters
A
-IVP
21
Q
Test that best evaluates uterine anomalies
A
-MRI
22
Q
Top two causes of post partum hemorrhage
A
- uterine atony
- genital tract laceration
**distinguish by looking for presence of “boggy” vs firm uterus
23
Q
Multiparous woman with loss of urine when coughing:
- diagnosis
- PE finding
- initial treatment, second treatment option
A
- stress incontinence
- hypermobile urethra +/- cystocele
- kegel exercises, fix urethra above pelvic diaphragm (urethropexy)
24
Q
What maintains continence in a healthy individual?
A
-urethral pressure exceeds bladder pressure (requires that both be located in the intraabdominal cavity)
25
MC cause overflow incontinence
diabetes/ neuropathy
26
MC cause stress incontinence
cystocele
| hypermobile urethra
27
Describe mixed incontinence
-urge to void AND loss of urine with Valsalva
28
Treatments for stress incontinence
-kegels --> urehtropexy --> transvaginal fixation
29
Treatment of urge incontinence
anticholinergic medication to relax detrusor
30
Treatment of overflow incontinence
intermittent self cathetherization
31
What differentiates genuine and urge incontinence
-cystometric/ urodynamic evaluation
32
Three components of health maintenance
1) cancer screening
2) immunizations
3) addressing common disease in patient group
33
When are pap smears performed?
every three years 21-65
**may do every 5 years with co-testing ages 30-65
34
Requirement for stopping pap screening at age 65:
paps negative for CIN2 during last 20 years
35
What age groups receive HPV vaccine?
9-26
36
When should tetanus boosters be administered?
q10 years
37
What age groups receive varicella zoster + pneumonia vaccine?
60+
38
What two health maintenance screenings begin at age 45?
cholesterol q5 years
fasting blood sugar q3 years
(may start sooner if warranted)
39
When should TSH screening begin?
q5 years at age 50
40
When should DEXA scanning begin?
65+
41
For what age groups is cancer #1 COD? Heart DiseasE?
19-64: cancer
65+ heart disease
(younger = MVA... now probably Overdose is more accurate)
42
Mammography guidelines
q1 year starting age 40
43
Four major conditions in women 65+
- depression
- CVD
- osteoporosis
- breast cancer
44
Signs of placental separation
gush of blood + lengthening of the cord
45
What defines an abnormally retained placenta
third stage of labor longer than 30 minutes
46
Cause of uterine inversion
excessive force on the umbilical cord
47
Risk factors for uterine inversion
1) grand multiparous patient w/ placenta implanted at fundus
2) placenta accreta
48
1st step in management of uterine inversion
clinicians fist placed inside uterus to maintain structure until surgery can take place
49
If placenta is not delivered after 30 minutes, what is the next step in management?
manual extraction attempt
50
What is climacteric?
perimenopausal state
51
What confirms the diagnosis of perimenopausal state?
FSH + LH levels (expected to be high)
52
Mean age of menopause
51
53
Age at which premature ovarian failure is diagnosed?
less than 40
| At 30 or younger: consider AI disease or karotypal abnormality
54
Four risks associated with Estrogen+ Progestin therapy in menopause
- breast cancer
- stroke
- PE
- heart disease
55
Two diseases with decreased incidence when using E/P therapy in menopause
1) colon cancer
| 2) osteoporosis
56
In addition to estrogen, what drug may be used to treat hot flashses?
clonidine
57
How are estrogen levels changed in PCOS?
INCREASED
| HIGH estrogen + testosterone and poor ovulation
58
How does hyperprolactinemia effect estrogen levels?
PRL ---I GNRG -----I LH/FSH = low estrogen
59
MC location osteoporosis fracture
thoracic spine
60
Nectroizing fasciitis buzzword
crepitus
61
Bacteria responsible for nec fas
anaerobes
62
First sign of septic shock
decreased urine output --> tachy
63
Cause of hypotension in shock
vasodilation
64
Sepsis + sunburn like rash suggests what bacteria?
GAS
65
What dictates normalcy in labor?
change in the cervix, not contractions
66
Define: latent phase of labor
stage 1,
time when cervix effaces as opposed to dilating.
less than 4 cm
67
Define: active phase of labor
dilation occurs more rapidly
| greater than 4 cm
68
Define adequate labor
primigravid: 1.2 cm/ hr
multip: 1.5 cm/hr
69
Contrast arrest and protaction of labor
arrest: no progress 2 hours
protraction: inadequate cervical dilation
70
Define the stages of labor:
first: onset to 10 cm dilation
second: complete dilation to delivery of infant
third: delivery of placenta
71
define adequate acceleration
15 bpm for at least 15 seconds
72
What should be first evaluated during labor abnormalities?
Three P's
powers
passenger
pelvis
73
How long should stage one of labor last?
primi: 18-20
multip: 14
74
How long should stage two of labor last?
primi: 2, 3 with epidural
multip: 1, 2 with epidural
75
How long should stage three of labor last?
30 mins
76
Define clinically adequate contractions
q2-3 minutes lasting at least 40- 60 seconds
| or 200 MVUs
77
How are Montevideo units calculated?
10 minute window, add each contractions rise above baseline
78
MC cause of early, late, and variable decelerations
early- head compression
variable- cord compression
late- hypoxia
79
How is normalcy of labor assessed?
cervical change IN ACTIVE STAGE
| time in latent phase
80
When is cesarean delivery considered for abnormal labor?
CP disproportion
| arrest of active phase w/ adequate contractions
81
When should a uterine pregnancy see visible on US
1500-2000 mIU/mL b HCG
| 25 ng/mL progesterone
82
What is a normal rise in b-HCG
66% over 48 hours
83
Who is a candidate for MTX?
women with small ectopics (less than 3.5 cm)
| *reliable patient, no heart beat etc
84
Treatment for patient with suspected ectopic who is acutely symptomatic?
laparoscopy
85
Common ADR of MTX therapy
mild abdominal pain, can observe these patients with stable vitals
86
Best treatment for placenta accreta
hysterectomy
87
Cause of placenta accreta
defect of the decidua basalis layer
88
Treatment of placenta accreta in young patient who strongly desires further fertility
pack the uterus
| excess mortality
89
Highest risk factors for placenta accreta
previous C-section/ D&C
placenta previa
fetal down syndrome
90
Placental position most commonly associated with placenta accreta
anterior placenta
91
Most common complication of placenta accreta treated with uterine artery ligation/ packing
hemorrhage
| 2nd most common infection
92
What procedures increase the risk of placenta accreta?
those that penetrate the uterine wall fully (ie cesarean not myomectomy)
93
Treatment for cervicitis (empiric)
gonococcal protection- ceftriaxone IM single dose
| chlamydial protection- azithromycin oral single dose
94
Alternative to azithromycin for treatment of chlamydia
doxycycline
95
Where does the "lower genital tract" begin?
cervix and below
96
Two MC symptoms of cervicitis
post coital bleeding
| mucopurulent discharge
97
What should be offered to patients with cervicitis?
counseling+ testing for other common STDs
98
MCC septic arthritis in young women?
gonorrhea
99
MC cause mucopurulent discharge in US women?
chlamydia
100
Presentation of disseminated gonococcal disease
multiple painful pustules on the skin
101
Treatment for complete spontaneous abortion
follow hcg levels to zero
102
How are inevitable abortion and cervical incompetence distinguished
presence or absence of contractions
103
MC risk factor for shoulder dystocia
maternal diabetes
| multiparity, obesity
104
Sign of shoulder dystocia
turtle sign
105
Erb's Palsy involves what nerve roots?
C5-6
106
What is the Zavanelli maneuver?
cephalic replacement --> cesarean delivery
107
How might bony diameter from shoulder to axilla be decreased in the case of shoulder dystocia?
delivery of posterior arm
108
How can anterior rotation of the pubic symphysis be achieved in the case of shoulder dystocia?
mcroberts maneuver
109
How might fetal shoulder axis switch from AP --> oblique?
suprapubic pressure
110
What should be avoided in the case of shoulder dystocia?
fundal pressure
111
Symptoms of pyelonephritis post op suggest _____
ureteral injury --> need IVP or CT
112
Through which ligament do the uterine arteries traverse?
cardinal
113
IVP images what structures?
KUB
114
MC surgery injuring the ureter
abdominal hysterectomy
115
When the ureter is "dissected" during surgery, what risk is posed to the patient?
ureteral ischemia
116
In addition to surgery, what may cause a fistula leading to incontinence?
radiation therapy
117
Postmenopausal bleeding always warrants a __________
endometrial biopsy
118
risk factors for endometrial cancer
- late menopause, nulliparity, early menarche
| - obesity, diabetes, htn, pcos
119
In the case of negative biopsy in the face of PM bleeding and many risk factors, the next best step in management is?
direct visualization, hysteroscopy vs hysterectomy
120
MC cause post menopausal bleeding
friable tissue, only 20% will have endometrial cancer
121
Normal thickness of the endometrial stripe
5 mm
122
When do we worry about endometrial cancer in a 30 year old patient
history of anovulation (ie PCOS= unopposed estrogen)
123
MC female genital tract malignancy
endometrial cancer
124
Endometrial cancer in thin patients is _____
more aggressive
125
When is a patient with placenta previa delivered?
cesarean at 36-37 weeks with stable vitals
126
Three types of placenta previa
complete, partial, marginal
127
Placenta previa causes a risk of placenta _____
accreta
128
Risk factors for placenta previa
multips
surgeries
history
129
Order of appropriate examinations in case of placenta previa
U/S --> speculum --> digital
130
Treatment of stable placenta previa diagnosed early in pregnancy?
repeat US at second trimester
131
Three major risk factors for placental abruption
cocaine
trauma
HTN
132
Bleeding that occurs behind the placenta in an abruption
concealed abruption
133
What is couvelaire uterus?
bleeding into the myometrium that discolors the uterus
134
How is placental abruption diagnosed?
clinical picture, not US
135
What lab is critical in case of suspected coagulopathy secondary to abruption?
fibrinogen levels (less than 150)
136
What tests for fetal-maternal hemorrhage in case of abruption?
kleihauer betke test
137
Desried hematocrit and urine output in placental abruption?
hct 25-30%
| urine 30 ml/hour
138
post cotial bleeding
odorous discharge
suggestive of....
cervical cancer
139
Mean age of presentation for cervical cancer
51
140
Risk factors for cervical cancer
STDs
early sex/ many partners
cigarettes
multiparity
141
Ages during which HPV vaccine is given
9-26
142
Which strains of HPV cause cervical cancer? warts?
cancer: 16,18
warts: 6,11
143
#1 location cervical cancer
squamocolumnar junction
144
Appearance of CIN lesions on colposcopy
aceto-white changes
145
Best test for visible cervical lesion
biopsy, not pap smear
146
Treatment of early versus late cervical cancer
early: surgical vs chemo/radiation
late: radiation + chemo gold standard
147
Contrast brachytherapy and teletherapy
brachy: implants
tele: full pelvic radiation
148
MC chemo drug used in cervical cancer
cisplatin
149
Most common cause of death in cervical cancer
bilateral ureteral obstruction leading to uremia
150
Followup post hysterectomy for cervical cancer
hysterectomies of the vaginal cuff
151
What populations with ASCUS may be observed?
adolescents and pregnant women
152
Sheehan syndrome is _______ pituitary necrosis
anterior
153
Symptoms of Sheehan
amenorrhea
failure to breast feed
hypothyroid
adrenocortical insufficiency
154
Asherman syndrome is caused by damage to _____
the decidua basalis layer
155
How are Sheehan and Asherman distinguished?
determine whether the uterus is responsive to hormonal therapy
156
How is Ashermans definitively diagnosed?
hysterosalpingogram
157
Amenorrhea is formally defined as
lack of cycles for *6* months
158
Definition of PPH
500+ mL vaginal
| 1000+ mL cesarean
159
MCC amenorrhea in reproductive years
pregnancy
160
What hormones need to be replaced in Sheehan syndrome?
- thyroxine
- cortisol
- mineralocorticoids
- estrogen, progestin
161
Treatment asherman syndrome
hyperoscopic resection
162
Temperature chart associated with PCOS
monophasic
163
Treatment of cord prolapse
immediate cesarean delivery
164
Risk factors for cord prolapse
rupture of membranes with transverse fetal lie or unengaged presenting part
165
AROM should be avoided without ______
engagement of the presenting part ! `
166
Position that must be maintained while preparing patient for cesarean delivery in case of cord prolapse
trendelenburg + physicians hand maintains cord inside
167
Define engagement
largest diameter of the head has negotiated the fetal pelvic inlet
168
Initial triage steps in case of fetal bradycardia
1) patient on side
2) fluid bolus
3) 100% O2 by face mask
4) stopping oxytocin
169
How does hyperstimulated labor present?
| How is it managed?
fetal bradycardia
| B-agonists (terbutaline)
170
What most commonly causes fetal bradycardia during labor?
epidural, give fluids, it will resolve
171
Position that most strongly predisposes to cord prolapse
footling breech presentation
172
Ddx for bradycardia
1) epidural
2) hyperstimulation of labor
3) cord prolapse
4) uterine rupture
173
FIRST step in assessing fetal bradycardia
distinguish maternal and fetal pulse + look for cord prolapse
174
MC finding assc with uterine rupture
fetal HR abnormality
175
Treatment for uterine rupture
STAT cesarean
176
How do thyroid hormone levels alter prolactin levels?
TRH increases PRL levels
177
How does elevated PRL cause amenorrhea?
^^ PRL --I GnRH
178
How is galactorrhea definitively diagnosed
fat droplets under the microscope
179
Differential diagnosis of pruritis in pregnancy
cholestasis
herpes gestationalis
PUPPP
180
what does PUPPP stand for?
pruritic urticarial papule and plaques of pregnancy
181
Cholestasis of pregnancy:
- most common location of pruritis
- most common time of onset
- extremities
| - third trimester, at night
182
What confirms the dx of cholestasis in pregnancy?
increased bile acids
183
Treatment of cholestasis of pregnancy?
antihistamines
184
Cause of herpes gestationis
IgG autoantibodies against basement membrane (not virus")
185
dx and Treatment of herpes gestationis
IgG levels, corticosteroids
186
Where does PUPPP typical start?
abdomen --> thighs and buttocks
187
Treatment of PUPPP
topical steroids and antihistamines
188
Effect of cholestatis, PUPPP, and HG on pregnancy
- cholestatis: increased neonatal mortality
- PUPPP: none
- HG: will see transients neonatal lesions
189
Pelvic inflammatory disease is AKA
acute salpingitis
190
2 longterm sequelae of PID
infertility
| ectopics
191
The best method for diagnosing PID is?
laparoscopy
192
Perihepatic lesions in the presence of PID is termed:
Fitz-Hugh Curtis syndrome
193
What is required to manage PID outpatient?
absence of peritoneal signs
low fever
tolerance of oral meds
not pregnant or at extremes of age
194
Most common cause and treatment of tuboovarian abscess
anaerobes
| metronidazole/clinda
195
Most common culture findings in PID
multiple organisms
| gonorrhea, chlamydia, anaerobes, gram -
196
Sulfur granules are classic for infection with what bacteria?
actinomyces
197
Is multiparity or nulliparity assc with higher PID risk?
nulliparity
198
vital sign changes assc with PE
tachycardia
| tachypnea
199
classic test for PE
Spiral CT or MRA
200
What predisposes pregnant women to DVT?
venous stasis (vena cava) + hypercoagulable state (estrogen) of pregnancy
201
How does estrogen cause hypercoagulable state?
increases fibrinogen levels
202
"Rales" on exam in a patient woman are suggestive of:
1) pneumonia
2) CHF
3) ARDS
4) atelectasis
203
Normal pH, pCO2, HCO3 in a pregnant woman?
```
7.45
28 CO2 (higher tidal volume)
19 bicarb (higher renal excretion to compensate for respiratory changes)
```
204
How is peripartum cardiomyopathy treated in pregnancy?
diuretics
| ionotropic therapy
205
How is PE treated?
IV heparin 5-7 days followed by subQ therapy to maintain PTT 1.5-2.5 for at least 3 months
206
What tests should be done to detect clotting disorders?
- Protein S/C levels
- Factor V levels
- AT levels
- homocysteinuria/ APL syndrome
207
MCC maternal mortality
PE
208
What PO2 is concerning in a pregnant woman?
less than 80 mmHg
209
Painful vaginal lesions + inguinal adenopathy =
chancroid (haemophilus ducreyi)
210
MC symptom of leiomyomata
heavy bleeding/ anemia
211
what medication is used to shrink the size of fibroids?
GnRH agonist
212
Change seen in leiomyoma during pregnancy?
red degeneration
213
What types of leiomyomata exist?
- subserosal
- submucosal
- intramural
- pedunculated
214
MC reason for hysterectomy
fibroids (30%)
215
Risk factor for leiomyosarcoma
pelvic radiation
216
When should an asymptomatic leiomyomata be removed?
rapid growth
| ureteral compression
217
How might pre-eclampsia lead to blood loss/ severe hypotension?
hepatic rupture
218
Proteinuria + BP diagnostic for PreE
300+ mg over 24 hour period
| 140/90+
219
Underlying pathogenesis of PreE
vasospasm and leaky vessels
220
What labs are included in the PIH panel?
ULAC PP
- uric acid
- ldh
- AST/ALT
- Creatinine
- Platelet
- Protein/creatinine ratio
221
How is magnesium sulfate excreted?
kidneys, monitor urine output +reflexes
222
Treatment for severe PreE
deliver, regardless of gestational age
223
When are platelets transfused?
50,000 or less
224
How do ecclamptic seizures lead to maternal mortality?
intracranial hemorrhage
225
Treatment for mild pre-eclampsia:
```
expectant management before term
at term (37 weeks) deliver
```
226
When are monochorionic twins delivered?
35 weeks
227
When are PPROM patients delivered?
34 weeks
228
HTN that persists beyond 12 weeks postpartum is deemed
chronic HTN
229
Difference between fine and core needle biopsies
core needle biopsies preserve cellular architecture
230
What is a "triple assessment" of a breast mass?
clinical exam
imaging
FNA/CNB
231
What are the five main causes of infertility?
1) ovarian
2) uterine
3) tubal factor
4) semen
5) peritoneal factor (endometriosis)
232
Define fecundability
probability of achieving viable pregnancy during one menstrual cycle (20-25% is normal)
233
Ovulation occurs _____ hours after the LH surge
36
234
Gold standard for diagnosis of endometriosis
laparoscopy
235
When is temperature highest during the menstrual cycles?
after LH surge (luteal phase)
236
HSG revealing blocked tubes should be followed up with ______
laparoscopy
237
Most common time of ovarian torsion during pregnancy?
14 weeks when uterus rises or immediately post partum
238
What distinguishes ovarian torsion from appendicitis and cholecystitis?
absence of fever/ anorexia/ leukocytosis
239
Timing of appendicitis vs cholecystitis in pregnancy ?
appy: any trimester
cholecystitis: after first trimester
240
What predisposes women to gall stones?
increases size of gallbladder
| increased biliary sludge
241
Ddx of abdominal pain in pregnancy
```
cholecystitis
appendicitis
placental abruption
ectopic
torsion
```
242
MCC pancreatitis in pregnancy
gallstones
243
Labs assc with pancreatitis:
amylase
| lipase
244
How is cholelithiasis/ cholecystitis treated in pregnancy?
lowfat diet
observe until post partum
**not to be confused with choleCYSTITIS (treat with cholecystectomy)
245
#1 cause maternal mortality in the first twenty weeks of pregnancy
ruptured ectopic
246
Gold standard for diagnosis of ectopic
laparoscopy
247
After giving MTX, what should raise suspicion of rupture?
hypotension and low Hct
*abdominal pain is normal
248
What progesterone level denotes a normal IUP
25 ng/mL
249
Most common cause of anemia in pregnancy women
iron deficiency, fetus has increased need for iron
250
Sickle Cell anemia mutation
glutamic acid --> valine on B globin chain
251
B-thal presentation at birth
normal, until Hb F falls
| life expectancy in third decade
252
Which is more common in pregnancy: folic acid or B12 deficiency?
folic acid, B12 stored for years
253
Three common causes of hemolysis in patients with G6Pd deficiency?
nitrofurantoin
antimalarials
sulfa drugs
254
Elevated A2 Hb suggests ______.
| Elevated Hb F suggests ______.
A2: B thal
F: A thal
255
What test of vaginal fluid determines risk of preterm delivery?
fetal fibronectin assay
256
What steps should be taken to manage preterm labor?
- abx for GBS px
- steroids
- tocolysis
- cause of labor?
257
What is needed to diagnose preterm labor in a nulligravida
2cm dilated, 80% effaced
258
At what week gestational age are steroids/tocolytics no longer necessary in face of preterm delivery
34
259
What are common tocolytic agents?
CCBs
terbutaline
indomethacin
260
How does MgSO4 work to maintain a pregnancy?
competitively inhibits calcium
261
How does 17 a hydroxyprogesterone caproate work to stop labor?
(progesterone) inhibits pituitary gonadotropin release; maintains pregnancy
262
Nifedipine should never be combined with _____
MgSO4
263
Terbutaline/ Ritodrine ADRs
pulmonary edema
hyperglycemia
hypokalemia
tachy
264
MgSO4 ADRs
pulmonary edema and respiratory distress
265
How often are steroids given when mother is at risk of preterm delivery?
17aOHprogesterone caproate?
steroids: once
17aOHPC: weekly to maintain pregnancy
266
What infection is strongly linked to preterm delivery?
gonorrhea
267
What is a contraindication to tocolytic therapy?
suspected abruption
268
Dyspnea in a woman given tocolysis is generally caused by ______
pulmonary edema, give furosemide
269
E .coli = MC etiology of simple UTI.
| What abx are known to treat e coli?
```
SCQN
super cocks never quit
sulfa
cephalosporins
quinolones
nitrofurantoin
```
270
#1 cause urethritis
chlamydia
271
Why does female sex predispose to UTIs?
| Why do pregnant women have high risk UTIs?
women- shorter urethra
| pregnancy- incomplete emptying of bladder
272
What abx is e coli commonly resistant to?
ampicillin
273
DOC for chlamydia? gonorrhea?
chlamydia- azithromycin, doxy
| gonorrhea- ceftriaxone
274
Which two drug classes cover e coli AND penetrate kidney for treatment of pyelo?
FQs
| TMP-SMX
275
Most simple difference in presentation of lower UTI vs pyelo?
fever
276
What are contraindications to IUD placement?
```
recent infection (STD)
scandalous sexual behavior. give them condoms.
abnormal size/shape uterus
```
277
Does hormonal IUD increase risk of DVT/PE?
no. its progesterone, not estrogen.
278
ADR assc with hormonal patch for contraception
nausea and vomiting
279
How does the levonorgestrel IUD work?
thickens cervical mucus, thins endometrium
**doesn't prevent ovulation
280
How does the copper IUD work?
inhibits sperm migration/viability
| damages ovum
281
What patients cant have copper IUD?
wilsons disease
282
How long should a diaphragm be left in?
put in 1-2 hours before sex and leave in for 8 hours after
must also use spermicide
283
MOA compination OCPs
progresterone inhibits ovulation and thickens cervical mucus
estrogen stabilizes endometrium to prevent breakthrough bleeding
284
Three risks OCPs
1) clotting (stroke, MI, PE)
2) benign hepatic tumors
3) cholelithiasis
285
What is the preferred method of oral emergency contraception and why?
progestin only, as opposed to combination.....
| less nausea
286
when must emergency contraception be initiated?
within 72 hours of intercourse
287
For what conditions is contraception with IMPA indicated?
SCA, epilepsy
288
What may occur after initiation of abx therapy for treatment of gram negative infection?
ARDS
| endotoxin release after bacteria are lysed
289
What is the pathogenesis of ARDS?
leaky capillaries
290
CT finding in case of ARDs
patchy infiltrates
291
MC cause septic shock in pregnancy
pyelo
292
Proper evaluation test for DVT
Doppler ultrasound
293
How common is PE in untreated DVT?
40%
294
Which anticoagulant leads to osteoporosis?
heparin
295
What chromosomes are assc with the BRCA genes?
What types of genes are they?
What is the inheritance pattern?
- BRCA1 17
- BRCA2 13
- tumor supressors
- AD
296
Any palpable dominant mass requires _____
histologic diagnosis regardless of imaging findings
FNA for young women
Excisional biopsy for women 50+
297
MC type of breast cancer
intraductal carcinoma
298
Tumor producing TH
struma ovarii
299
MC type ovarian neoplasm + type assc with CA 125
epithelial tumor in ages 30+
| younger than 30 dermoid more common
300
U/S features of mature/benign cystic teratoma
hypoechoic area, cystic structures, fat fluid level
301
What are the five types of epithelial ovarian neoplasms?
1) serous
2) mucinous
3) endometroid
4) brenner
5) clear cell
302
What epithelial tumor is most rapidly growing?
mucinous, assc with pseudomyxoma peritonei
303
What size ovarian cyst warrants operation in:
- prepubertal girls
- reproductive age girls
- menopausal girls
- prepuberty: 2+ cm
- reproductive 8+
- menopausal: 4+
304
Appearance of ovarian neoplasms on US:
- granulosa cell
- dermoid
- follicular
- granulosa cell: solid
- dermoid: complex
- follicular: simple cyst
305
Treatment of surgical site infection
immediate surgical closure and abx
306
Contrast wound dehiscence, fascial disruption, and evisceration
dehiscence: separation of surgical incision
fascial disruption: communication of the perionteal cavity with the skin
evisceration: disruption of all layers, bowel protruding through
307
MCC post op fascial breakdown
suture tearing through fascia
308
How can urine vs lymphatic drainage be distinguished?
creatinine
309
Copious amounts of serosanguinous fluid from abdominal incision suggest _____
fascial disruption
310
Risk factors for fascial disruption
- obesity
- malnutrition
- chronic cough
311
Endometrial tissue floating with a frond pattern is diagnostic of _____
IUP
312
Hemoperitoneum in the presence of a viable IUP is likely caused by
ruptured corpus luteum cyst, less commonly co-existing ruptured ectopic + IUP
313
Symptoms of hemoperitoneum:
```
hypovolemic symptoms
peritoneal signs (pain)
```
314
What part of pregnancy requires progesterone from the corpus luteum
first 10 weeks
315
Symptoms of degenerating leiomyomata in pregnancy:
localized tenderness over the site of the mass
316
What percentage of blood volume must be lost before hypotension is seen?
30-40%
317
How is ashermans syndrome diagnosed?
HSG, trial of progesterone withdrawl bleeding
318
Treatment for ashermans
operative hysteroscopy
319
Classic finding suggestive of breast cancer on mammography
Small cluster of calcifications around a mass.
Mass with spiculated borders
320
Annual mammograms age 40-90 exposes patients to how many rads?
10; safe.
321
Tx for palpable breast mass with normal imaging
Biopsy; false negative up to 10% of cases
322
Lesion caused by trauma to breast + it's mammogram appearance
Fat necrosis
Mimics breast cancer
** Still must excise lesion to confirm
323
At what age is primary amenorrhea diagnosed?
16
324
Ddx of painless primary amenorrhea with normal breast development
Androgen insensitivity vs mullerian agenesis
325
Treatment of androgen insensitivity
Removal of intra-abdominal gonads after puberty
326
Anomaly commonly assc with mullerian anomalies
Renal anomalies
327
What explains breast development in androgen insensitivity syndrome?
Peripheral conversion of androgens
328
Treatment for septic abortion:
IV broad spectrum abx
D&C
Also monitor BP/O2/urine output
329
MC etiology of septic abortion
Usually polymicrobial
330
Pockets of gas on pelvic CT suggest what diagnosis?
What was the treatment?
Metritis
| Treatment = urgent hysterectomy
331
Ergot alkyloid used to treat atony
Methergine
332
What vessels are ligated to treat uterine atony?
Uterine artery
| Internal iliac artery
333
Late post partum hemorrhage cause
Subinvolution of the placenta
334
MCC sexually infantile delayed puberty
gonadal dysgenesis, chromosomal abnormality
| kallman v turners
335
Contrast Kallman and Turners
FSH, LH increased in Turners
336
Four stages puberty
thelarche --> adrenarche --> growth spurt --> menarche
337
MC health concern in Turners Syndrome
osteoporosis
338
No menses at age 15 is diagnosed as?
delayed puberty (no sex characteristics at 14-15) --> primary amenorrhea not diagnosed until 16 years
339
______ determines gonadotropic state, _____ determines gonadal state.
FSH-gonadotropic
| estrogen- gonadal
340
breast fluctuating lesion:
dx:
tx:
etiology:
abscess
drain
staph aureus, from infants nose and throat
****continue breast feeding
341
What vitamin is absent in breast milk?
Vitamin D, supplement by 2 months
342
What proteins are in breast milk?>
whey + casein
343
What immunogenic compounds are found in breast milk?
lactoferin
secretory IgA
lysozyme
344
Treatment of thyroid storm in pregnancy
- Bber
- corticosteroids
- PTU
345
Rare but serious ADR of PTU
bone marrow aplasia
| check white cell count before giving
346
Changes to thyroid panel in pregnancy
- normal free T4/TSH
| - increased TBG, total T4
347
MC cause hyperthyroidism in the postpartum patient
destructive lymphocytic thyroiditis
| antimicrosomal antibodies
348
Manifestations of chlamydial infection in pregnancy
- neonatal conjunctivitis and pneumonia
- late postpartum endometritis
- mucopurulent urethritis/cervicitis
349
MCC neonatal conjuncitivits
chlamydial
| erythromycin given at birth prevents gonococcal conjunctivitis
350
Manifestations of gonococcal infection in pregnancy
- PPROM/premature labor/SAB/chorio
- disseminated gonococcal disease
- postpartum endometritis
- neonatal sepsis, conjuncitivits
351
MC mode of transmission of HIV
heterosexual intercourse
352
How long after infection are HIV ab's detectable
by three months
353
How should delivery be handled in HIV+ patient?
scheduled cesarean prior to rupture of membranes
**If PPROM just go ahead and deliver vaginally, baby already exposed
354
Chlamydia prefers what tissue type?
transitional and columnar epithelium
355
Treatment of chlamydia in pregnancy
ORAL azithro/amox
356
How does parvovirus B19 lead to hydrops?
inhibits bone marrow erythrocyte production --> anemia --> hydrops
(aplastic anemia)
357
Describe adult rash associated with parvo
"lacy"/reticular
358
What ab is assc with past parvo infection? current?
| How long after infection might it take for ab's to become evident?
IgG-past
IgM- current
20+ days after infection
359
Describe fetal hydrops
fluid in multiple body cavities
360
What fetal heart tracing is assc with fetal hydrops?
sine wave with cycles of 3-5/minute
361
Describe the viral structure of parvo
small single stranded DNA
362
What are some causes of fetal hydraminos?
- CNS, GI, chromosomal anomalies
- maternal DM, multiple gestation
- syphilis, parvo
- Rh isoimmunization
363
Fetal findings assc with ITP
thrombocytopenia
| IUGR
364
Abx for postpartum endometritis should cover what bugs?
- anaerobic, gram -
cesarean: clinda +gent
vaginal: amp + gent
365
Ddx of postpartum fever, most common causes (4)
- mastitis
- wound infection
- endometritis
- pyelo
366
Postpartum fever persisting beyond 72 hours after abx treatment warrants _____
CT of abdomen
367
Best treatment of wound infection
open the wound.
368
Greatest risk factor for endometritis?
cesarean
369
MC bacteria assc with endometritis
bacteroides (anaerobes)
370
Treatment for septic thrombophlebitis
heparin + abx
371
Exam finding assc with syphilis
nontender lesion + lymphadenopathy
372
What test is more specific that RPR/ VDRL for syphilis?
FTA-ABS
373
2 MC infectious causes of ulcers in the US
syphilis + herpes
374
What are the stages of syphilis infection?
primary (painless ulcer)
secondary (rash on hands and feet)
latent (1+ year)
tertiary (ocular, CNS,CV findings)
375
How is neurosyphillis diagnosed?
| What are the manifestations of neurosyphilis?
LP
| -argyl Robertson pupil, unsteady balance
376
Gram stain finding of chancroid
"school of fish"
377
What causes false + RPR
SLE
378
T pallidum:
| -organism type
Thin spirochete
379
Alternatives to penicillin in the treatment of syphilis
erythromycin, doxycycline
380
How long after PPROM does labor occur?
50% within 48 hours
| 90% within a week
381
Risk factors for PPROM
- cigarettes, STDs, low SES
- multiple gestation
- cone
- cerclage
382
MC acute complication of PROM
labor
383
How to definitively diagnose infection during PPROM
gram stain of amniotic fluid (amniocentesis)
384
Cause of intra-amniotic infection WITHOUT PROM
listeria via transplacental spread
385
Treatment for trich resistant to metronidazole
tinidazole
386
What vaginal bug may be isolated from a wet surface up to 6 hours after inoculation?
trich
387
Both BV and trich are assc with ____ and ____
alkaline pH and + whiff test
388
What are the three phases of hair growth and which determines length/ stability of hair?
anagen- length
catagen
telogen- strength
389
Diagnostic test for cushings
dexamethasone suppression test
390
Molecule elevated in adrenal tumor? sertoli leydig?
adrenal: DHEA
sertoli: testosterone
391
Molecule elevated in CAH
17 OH progesterone
392
Treatment of CAH
replace cortisol/ mineralocorticoid
393
Changes in LH/FSH assc with PCOS
^^ LH:FSH ratio (ie 2:1)
394
Cause of high AFP? low?
high- multifetal gestation, open defect
low- downs
*or incorrect dating
395
PAPPA/hcg/NT assc with downs in early pregnancy?
low hcg/papp-a thick NT
396
Trisomy 18 vs Downs findings 2nd trimester
all markers low in trisomy 18
| hcg,inhibin high/afp, estriol low in downs
397
First step in management of abnormal triple screen
ultrasound
398
Risks assc with amnio
death, chorio, prom
399
When does window for serum screening end?
21 weeks
400
Cystic masses in left + right abdominal region suggests
duodenal atresia- assc with downs
401
Unexplained elevated AFP puts babies at risk of what conditions?
- stillbirth
- IUGR
- preE
- abruption
402
Definition of PCOS
hyperandrogenic chronic anovulation + excess estrogen
403
Define BMI
kg/height in m2
404
Treatment of young patients with endometrial cancer (stage 1)
hysterectomy and surgical staging ...or high dose progesterone + repeat sampling if child bearing is desired. Hysterectomy indicated after childbirth
405
Patient with PCOS should be screened for ____ and ____.
glucose intolerance
| lipid abnormalities
406
What organs prolapse anteriorly through vagina? posteriorly? centrally?
anterior: cystocele
posterior: rectocele
central: enterocele
407
The vagina may be fixed to ______ to prevent prolapse
sacrospinous ligament
408
What muscles make up the pelvic diaphragm?
- pubococcygeus
- puborectalis
- levator ani
409
What organ sits on the pelvic diaphragm?
bladder
410
Define procidentia
uterus prolapses beyond the introitus
411
To what structure should the vaginal cuff be fixed after a hysterectomy?
cardinal or uterosacral ligament
412
How might prolapse be prevented in patient with deep culdesac?
culdoplasty
413
Bleeding with ROM suggests what diagnosis? treatment?
vasa previa
| stat cesarean
414
What is vasa previa?
fetal vessel overlies the os
415
Risks assc with twin pregnancies
1) congenital anomalies
2) preterm labor
3) preE
4) PPH
5) maternal death
416
How are OCPs related to twinning?
slow tubal motility
417
Best treatment of twin twin transfusion syndrome
laser ablation of shared vessels
418
Why are tocolytics relatively contraindicated in multifetal gestations?
^^ pulmonary edema risk
419
What screenings should be offered early for women over age 30?
cell free DNA
| glucose tolerance
420
PCO2 and bicarb are both _____ in pregnancy
decreased, increased tidal volume + urinary output
421
In patient with a history of unexplained abruption, how might future pregnancies be managed?
induce slightly before GA of previous abruption
422
What are the consequences of anti-Lewis and anti-Kell ab's in pregnancy?
Lewis Lives
Kell Kills
Duffy Dies
(Lewis is IgM and doesn't cross placenta)
423
Treatment of neonate after birth from HbS+ mom
HBIG
| HB vaccine
424
Three infectious diseases in which fetal well being can be dramatically improved
HIV
syphilis
HepB
425
Biopsy findings assc with lichen sclerosis (3)
thinned epidermis
hyperkeratosis
elongation of the rete pegs
426
Second most common type of vulvar cancer
melanoma
427
Treatment of Bartholin gland abscess
marsupialization
428
Lichen sclerosis shows predilection for _____
anus and vulva
429
Uncontrolled vaginal candidiasis may lead to
fissures in the labial folds = pain on urination
