CREOG Review Flashcards
(286 cards)
1
Q
What positioning causes the majority of femoral nerve compression? P/w? MCC? RF’s? Trmt?
A
Extreme flexion, abduction and external rotation of the hip can cause femoral nerve to be compressed under inguinal ligament. Cutaneous dysthesia in anterior/medial thigh, anteromedial leg/foot, decreased leg extension and thigh flexion, most objective = decreased/absent knee reflex. MCC’s = poor positioning, compression from retractors & hematoma, suture transfixation, surgical transection. RF’s = BMI
2
Q
Causes of postpartum incontinence? Work-up? Trmt?
A
MCC = anal sphincter injuries, pudendal nerve injury, neuro (MS), GI (IBS) and Rx’s. PE for sphincter tone assessment and endoanal U/S. Only 35% of those with e/o sphincter probs on U/S were incontinent. Fecal incontinence = 60 sensitive and 80% specific for sphincter injury. Trmt = EMG biofeedback for weakness but no anatomic deficit. Anal sphincteroplasty if + anatomic deficit AND symptomatic. Neurophysiologic testing for those suspected with pudendal injury.
3
Q
MC’ly occurs in 2nd-4th decade of life - inflammation of apocrine glands in axillary, periareolar, perianal regions = ?. RF’s? Trmt? Complications
A
Hidradenitis Suppurativa (Ddx = chron’s folliculitis, and granulomatous STI). RF’s = obesity, DM, perianal antiperspirant use, androgen excess, poor hygiene, smoking. Patho = follicular hyperkeratosis w/ plugging of pore. Vulvular SCC = 5% w/ dx. Medical therapies = long-term antibiotics, antiandrogens, retinoic acid, cyclosporin. Surgery if refractory and extensive. Complications = scarring, draining sinuses, cutaneous fistulae
4
Q
Common locations, presentations, and trmt of: bartholin cyst, skene duct cyst, inclusion cyst, urethral diverticulum, fibroma.
A
Bartholin cyst - posterior lateral vulva, MC’ly present after sexually active; MC 2/2 infections. Acutely can drain and place word catheter; recurrent cases can get marsupialization
Skene duct cyst - marsupialize in children, total excision in adults b/c accompanied by chronic inflam(remnant of urogenital sinus derivatives)
Inclusion cyst - MC cystic mass of the vagina, found in lower third of vagina; occur from birth trauma or prev pelvic surg and contain yellow/oily substance - only need to excise if painful
Urethral diverticulum - distinguished from skene duct cyst via locale - suburethral midline; occur 30-50 yo’s from congenital probs, trauma, but MC’ly infection. Diverticulectomy in proximal/middle third, marsupialization if distal
Fibroma - MC benign solid tumors of the vulva, found midline to anterior, freely mobile. If suspicious or painful, wide local excision
5
Q
Complications of FC/FGM?
A
Recurrent vaginitis, painful menses, chronic pelvic infections, infertility, chronic UTI’s, urinary stones urinary incontinence, and dyspareunia. Problems arise from disruption of outflow tract
6
Q
Risks of CEE and MPA?
A
Increased Risk: PE, DVT, Stroke, CAD, BC. Decreased Risk: Hip fracture, CRC
7
Q
Risk of malignant cyst with no septations or solid components?
A
8
Q
Indications for surgery for adnexal masses?
A
Cyst >5cm being followed more than 6-8wks / any solid ovarian lesions / papillary formations / adnexal mass >10cm / ascites / palpable mass in premenarchal or post-menopausal patients
9
Q
Anatomic landmarks to avoid inferior epigastrics?
A
5cm superior to symphysis and 8 cm lateral to midline (vessels within 7cm of midline), past rectus. Medial to medial umbilical ligament (vessels are lateral but run risk of being too medial).
10
Q
Inferior epigastric branches off ______ and anastomoses with _________ after inserting through rectus.
A
External iliac artery; Superior epigastric (branch of internal thoracic artery)
11
Q
Ways to stop bleeding from injured inferior epigastrics?
A
Foley through the port site and inflated to tamponade. Passing suture around vessel.
12
Q
Prophylactic meds against developing ovarian cancer? BRCA 1 vs 2 risks for ovarian cancer?
A
OCP’s decrease 40-50% risk vs. general population. Protection lasts 10-15yrs after stopping OCP’s (some say lifetime)
BRCA 1 = 45%, BRCA 2 = 25%
13
Q
MC site of vascular injury with trochar placement? Pt’s at risk for larger vessel damage? Vasculature to wary of?
A
Inferior epigastrics. Thin pts and obese pts (BMI >30) at risk. Want to use sacral promontory and sacral curve as entry site/angle. Aorta, iliac artery and veins = risk! Bifurcation of aorta occurs at umbilicus or right below. Left common iliac vein at risk because lowest at midline and thin walled.
14
Q
Appearance of vulvar Pagets? MC symptom?
A
Raised edges, appears exzematoid, red background, pale islands. Itching is MC symptom
15
Q
Quintero Staging for Mo/Di Twins? Monitoring frequency?
A
Stage 1 - Poly/Oli (MVP >8, MVP <2) Stage 2 - Bladder of donor twin not visualized Stage 3 - Doppler abnormalities Stage 4 - Hydrops fetalis Stage 5 - Death of one fetus
Start screening every two weeks for TTTS at 16wks. TTTS occurs in 15% of MoDi Twins
16
Q
Persistent fever s/p abx in post-op/partum patient w/o PE findings? Treatment?
A
Ovarian Vein Thrombosis / Septic Pelvis Thrombophlebitis. Therapeutic IV Heparin = trmt
17
Q
Possible scenarios to consider conservative management of placenta accreta? Associated treatment course for each?
A
(1) Partial Accreta - wedge resection of invaded portion
(2) Extensive Accreta Involving Intraabdominal Organs - MTX to help preserve involved organs
18
Q
FDA approved medication for dyspareunia?
A
Ospemafine = estrogen-agonist/antagonist
19
Q
Positive CST Definition?
A
Late OR variable decels w/ 50% or more decels. Need at least 3 ctx’s in 10min period. If tachysystole occurs, requires repeat testing
20
Q
Progressive treatment of uterine inversion?
A
- Immediate attempt at replacement
- If uterus is contracted, may need anesthesia’s help with tocolytic to then attempt replacement
- Huntington Procedure: laparotomy, clamping inside of “ring” (created by inversion) below level of cervix with subsequent traction, re-clamping, and more traction to “fish it out”
- Haultaim Procedure: laparotomy with incision in the posterior “ring” in attempt to create more space to replace uterus
21
Q
Contraindications to cell saver technology use?
A
- Contaminants (ex: fat) - can hook up two suction machines to use separately for blood and other for contaminants
- Carbon Monoxide - a biproduct of electrocautery, can cause cell lysis and subsequent end organ damage, try to minimize use until after blood is collected
- Clotting agents - (ex: Surgicel, Avitene)
- Irrigating Solutions - can cause red cell lysis too secondary to osmotic forces
22
Q
Monsel’s ingredients?
A
Ferrous Sulfate, Sulfuric Acid, Nitric Acid
23
Q
NYHA Classes I-IV?
A
Class I: Heart disease without limitations on physical exercise
Class II: Can walk >2blocks, climb stairs quickly, with minimal limitation with exercise activity
Class III: Limitation with <2 blocks, often will occur with ADL
Class IV: Limitation at rest
24
Q
Pathologic description of Call-Exner Body? Associated with? Most useful marker for this?
A
Microfollicular pattern with small cavities with eosinophillic fluid. Associated with Granulosa Cell Tumor, a germ cell tumor. Inhibin is elevated secondary to increase in estrogen. Occur at extremes of ages and MC’ly present with AUB and pelvic mass.
25
Pathologic description of Shiller-Duval body and associated tumor?
Central capillary with surrounding connective tissue and peripheral layer of columnar cells. Yolk sac tumor (germ cell tumor variant)
26
Associated tumor w/ + PAS?
Cytoplasmic glycogen is demonstrated with periodic acid-schiff stain. Associated with dysgerminomas (germ cell tumor)
27
Pathologic description of immature teratoma?
Immature neural tissue with rosettes and tubules (germ cell variant)
28
Pathologic description of choriocarcinoma?
Plexiform pattern of syncytiotrophoblasts and cytotrophoblasts
29
Most common female genital tract cancer? Two different subcategories?
Endometrial:
- Type I: adenocarcinoma, secondary to increased estrogen exposure (MC)
- Type II: clear cell and papillary types
30
Fertilization normally occurs in what portion of the fallopian tube?
Ampulla
31
What is the name of the fertilized ovum when it enters the uterine cavity? What day typically does this occur?
Morula (12-16cells) - Post Fertilization Day 3
32
What day does implantation typically occur? this occurs with what specifically named fertilized ovum?
Post Fertilization Day 6-7; blastocyst (50-60 cells with central body and surrounding trophoblasts). IL's and B-hCG is secreted to help with implantation
33
Three stages of blastocyst implantation into uterus?
Apposition, Adhesion, Invasion
34
Don't use GnRH antagonist for more than how many months?
12 months secondary to concern for bone mineral density loss. Patients treated with these for endometriosis purposes typically experience relief within 3months of therapy. Can consider "add-back" estrogen to help decrease risk of medically-induced menopause
35
What time interval is a post-op fever likely benign in etiology?
1-2days post-operatively (secondary to possible blood products if received, stress and trauma of long surgeries, medications, etc). Become more concerned for abscess formation, infectious process, or vascular injury for persistent fevers lasting >2days or if it starts after post-op day 2
36
Side effect profile or anticholinergic therapies?
Used for urinary incontinence, anticholinergics (via anti-muscarinic control) can cause:
- anhidrosis
- dysregulation of thermal temp (over heated)
- delerium
- blurry vision
- urinary retention
37
Fascia has what % of original strength at post-op week 1 through 4?
Week 1: 10%
Week2: 25%
Week3: 40%
Week4: 50%
38
Strongest to weakest knot-pull tensile strength for sutures (nonabsorbable vs. absorbable; synthetic vs. natural)?
1. Absorbable Synthetic (Polyglactin 910, Polydioxanone = PDS)
2. Absorbable Natural (chromic gut)
3. Nonabsorbable Synthetic (Nylon, Prolene), Natural (silk)
4. Nonabsorbable Natural (cotton or linen)
39
MC time to experience fascial dehiscence?
POD 2-12
40
Difference between chromic vs. plain catgut?
Addition of chromic salts help decrease inflammatory response and thus last longer. Maintains almost half of tensile strength at day 7-10 vs. plain gut losing 70% by day 7
41
PDS maintains what % of tensile strength weeks 1/2/4/6 following surgery? Vs. Polyglactin 910 (Vicryl)?
PDS V.S. Vicryl
- Week1: Almost all / Almost All
- Week2: 80% / 50-60%
- Week4: 50% / None
- Week6: 25%
42
Maternal/Fetal indications for forceps? Need to know what things?
Maternal: exhaustion, medical contraindication to valsalva, prolonged 2nd stage
Fetal: NRFHRT
Know: fetal station, head position, membranes ruptured,, empty maternal bladder
43
Normal cord gasses?
```
pH = 7.2 +/- 0.05
pCO2 = 50 +/- 8.4
pO2 = 18 +/- 6
HCO3 = 22 +/- 2
```
44
Lichen planus - look and distribution?
Involving both oropharynx and vagina with white, reticulate lacy striae. Histology shows band-like infiltrate of lymphocytes and colloid bodies in the basal layer of the epidermis
45
What's the MCC of PUD in reproductive aged female? Trmt?
H. Pylori - Need to get two different tests done when they are not taking bismuth (bisphosphonates), PPI's, upper GI bleeding or abxs 2/2 false negatives.
Trmt = Clarithromycin/Amoxacillen x14days
46
When looking at the numerical "Type" categorization of fibroids, which can be removed hysteroscopically?
Type 0 (intracavitary/pedunculated) and Type 1 (<50% of fibroid in myometrium)
47
What's the size cut off for macroadenomas?
> 10mm, if less, they are microadenomas
48
What two places does the umbilical vein shunt oxygenated blood to fetus?
50% to ductus venosus
| 50% hepatic-portal system
49
When to screen for DM?
At age 45 OR if the patient is at risk for developing DM with BMI > 25:
- inactive lifestyle
- first degree relative w/ DM
- Black/Hispanic/Asian/Native American
- Women who delivered baby >9lbs
- Women with h/o GDM, HTN
- PCOS
- Prior Hgb A1C > 5.7%
- h/o CV disease
50
Screening tests and cut-offs for DM:
1) Fasting Glucose (>125 mg/dL)
2) 2hr GTT (>200 mg/dL)
3) Random Glucose (>200 mg/dL w/ symptx)
4) HgbA1c > 6.5%
51
When to recommend colonoscopy for black women?
Age 45yo (vs. 50 for Caucasians)
52
Fasting Lipid panel recommended at what age?
Age 45 or earlier at 35yo w/ risk factors
53
When to recommend C/S for HSV? When to start suppression therapy?
C/S when active outbreak OR prodromal symptoms.
Start Acyclovir at 36wks GA
54
For Toxo: MCC? What GA is it worse to be infected? Why to be cautious with testing?
MCC = eating undercooked meat. Can also get it from consuming insect-contaminated foods, handling cat litter that contains oocysts from infected cats.
Worse to be infected earlier in pregnanct. Risk of becoming infected increases w/ GA.
Risk of neonatal transmission if placenta has parasitemia = 20-50%
Most infants with congenital Toxo are asymptomatic at birth but 90% will have hearing/visual damage in childhood.
55
Risk of 2nd twin death after one loss in monochorionic pregnancy? Dichorionic? When to deliver 2nd twin?
1) Monochorionic
- Risk of 2nd fetus dying = 15%
- Risk of neurologic injury = 18%
2) Dichorionic
- Risk of 2nd fetus dying = 1%
- Risk of neurologic injury = 3%
Delivery has not decreased risk to 2nd twin UNLESS GA is >34wks or the surviving twin shows distress
56
Most likely finding of a focal thickening on TVUS = ?
Endometrial Polyp
- 86% benign, 13% hyperplastic, 3% malignant
- well defined uniformly hyperechoic mass that's <2cm = MC US findings of polyp
57
Factors decreasing chance of successful TOLAC?
Recurrent indication for C/S (CPD), increased maternal age, Hispanic/AA women, GA >40wks, maternal obesity, pre-E, short-interval pregnancy, increasing neonatal weight
58
Symptoms of femoral nerve injury?
Inability to flex at hip, weak quadriceps, unable to flex knee
59
Symptoms of iliohypogastric nerve injury?
Paresthesia of labia, suprapubic region, or around pfannensteil incision. Nerve is 2cm medial and 1cm inferior to ASIS
60
Symptoms of obturator nerve injury?
Weakness in adduction of leg, paresthesia of inner thigh
61
MCC mastitis?
Staph Aureus and Viridens. Abx of choice = Dicloxicillin
62
How do ACEi and Dopamine blockers increase risk of urinary incontinence?
ACEi's have increased risk for coughing. Dopamine blockade can cause relaxation of internal sphincter w/ unopposed detrusor muscle contraction = risk of incontinence
63
ACEi are particularly helpful for anti-HTN in non-pregnant patient with h/o?
H/o MI, HF, diabetes (because renal protective). African American ethnicity
64
Symptoms of and pt population at risk for pelvic congestion syndrome?
Diagnosis of exclusion and pt must have pelvic pain for 6mo's w/o otherwise identified etiology. Pt's can have chronic pelvic pain, post-coital ache, and abdominal pain. Sometimes imaging will show congested pelvic vasculature but is not diagnostic.
65
What imaging study gives the highest radiation exposure to a fetus?
CT - threshold for ealry danger is 50mGy and CT is 20 - 40 mGy
66
Which aneuploidy is associated with these findings: (separate, not all in one syndrome) club foot, diaphragmatic hernia, omphalocele, and non-immune hydrops?
All associated with aneuploidy involving chromosomes 13, 18, 21 EXCEPT club foot (not associated w/ chromosome 21).
Gastroschesis is NOT associated with aneuploidy. Thought to be secondary to problem with involution of right hepatic vein.
67
U/S findings diagnostic of early preg loss?
- CRL > 7mm without heartbeat
- MSD > 25mm and no embryo
- If previous yolk sac present, 11 days without embryo and FCA
- If NO previous yolk sac present, 14 days without embryo and FCA
68
Contraindications to UAE? Who is good candidate for this?
Patient's who desire definitive treatment (ie: fibroids) and are poor surgical candidates. Hypogastric artery is identified and alcohol beads released
Contraindications = allergy to contrast medium, pregnancy, active pelvic infection, AVM's
69
MC stage endometrial cancer found? Staging?
Stage IB
```
Staging:
IA - involves < 50% myometrium
IB - involves > 50% myometrium
II - involves cervical stroma
IIIA - Involves serosa of uterus, tubes or ovaries
IIIB - involves vagina
IIIC - LN's other than periaortics
IV - involves bladder, rectum, or more distant mets
```
70
Need to do what prior to performing cruciate incision with imperforate hymen?
Ultrasound - a transverse vaginal septum could present in similar way and thats best treated with resection vs. incision
71
Symptx of PCOS? Pathophys? Trmt?
Hyperandrogenism = hirsutism, acne, oligo/ammenorhea, elevated glucose. Ovaries with >12 cysts measuring 2-9mm in diameter
Increased LH leads to hyperandrogenism and increased insulin resistance
SERM needed to increase FSH production by pituitary gland. Clomiphene citrate inhibits feedback inhibition at both pituitary (increasing FSH) and hypothalamus (increasing GnRH), thus promoting ovulation
72
Tool used to dx PMS? Criteria? Trmt?
COPE Tool:
- 1 or > affective symptx (depression, anger, irritability, confusion, social withdrawal, or fatigue)
- 1 or > somatic symptx ( breast tenderness, abd bloating, HA or swollen limbs)
- occurs 5days prior to menses and should cease 4days after menses and NOT occur before cycle D12
73
What does each of these cardinal movement allow: engagement, flexion, extension, internal rotation, external rotation
1) Engagement - allows BPD to pass into pelvic inlet
2) Flexion - allows fetal chin to be brought into intime contact with fetal thorax
3) Extension -allows fetal occiput to come into direct contact with inferior margin of PS
4) Internal rotation - allows rotation that allows the fetal occiput to move towards the PS
5) External Rotation - allows bisacromial diameter (outermost border of shoulders) into relation with AP diameter of the pelvic outlet
74
Treatment for Lichen Planus?
Local corticosteroids (ex: Clobetasol) -> systemic corticosteroids -> MTX vs. Cyclosporin
Surgery is only used for correction of post-inflammatory sequeala of Lichen Planus; never primary treatment
75
What are cell-saver mixed solutions that would be a contra-indication for its use?
Sterile water, hypotonic solutions, toxic substances if delivered intravascularly (antibiotic irrigation, hydrogen peroxide, alcohol, or iodine solns, hemostatic or coagulating substances)
76
Single, enlarging breast mass in 40yo, palpated as firm, circumscribed, and mobile and often visibly stretching overlying skin = dx? Trmt?
Phyllodes Tumor - local excision with greater than 1cm surrounding to prevent recurrence. FNC and core needle bx not useful.
5% risk of aggressive behavior
77
How long to keep monitoring CIN 2 or > after first negative screening?
Screening with cytology q3yrs for 20yrs after first negative cytology or 20yrs after sx
78
Gestational thrombocytopenia presents when and should resolve when?
Presents 2nd to 3rd trimester
Resolves 1-2mo's following delivery
79
MCC of severe thrombocytopenia among newborns?
Alloimmune Thrombocytopenia - it's 2/2 maternal alloimmunization of father's platelet antigens - maternal PLT count is normal; UNLIKE Rh-D alloimmunization, the first pregnancy is at risk
80
Bleeding issues in first years of life, macrothrombocytopenia, eczema, recurrent bacterial/viral infxns = dx?
Wiskott-Aldrich Syndrome
81
Benefits of DCC?
Decreased incidence of Fe-def anemia and ICH, more immunoglobulins - benefits only proven in preterm GA
82
Beta Thal electrophoresis shows increased levels of ?? and decreased levels of ??
Increased Hgb F (two alpha chains and two gamma chains). B-thal gene mutation causes deficient B-chain production leading to absence of Hgb A (2alpha, 2 beta) ...and decreased levels of Hgb A2 (2alpha, 2 delta chains) but to a lesser extent.
Hgb F increases the most to compensate!
83
Origin of the following arteries: ovarian, renal, uterine
- Ovarian from abdominal aorta
- Renal from aorta below level of SMA
- Uterine from anterior branch of internal iliac
Extra:
- external iliac becomes femoral a. once it passes Poupart's ligament
84
MC day of post-op infxn presentation for SSI?
5-7days
85
At-risk time for BSO for ureteral injury? What type of repair?
When taking the IP ligament.
Tension free repair ovar a stent. Mobilize distal ureter for more length. Spatulate both prox/distal end of bisection - interrupted sutures to finish repair over stent.
86
Type of ureteral repair for different places of damage?
Upper third ureter = ureteroureterostomy
Distal third ureter = ureteroneocystostomy w/ psoas hitch
If ureter is suture ligated, you'd de-ligate it over a stent
Nephrostomy tube if urteral repair can't be achieved
Boari flap is only employed if extensive urteral injury occurs (NOT first line)
87
Name clinical, genetic, and histologic differences among molar pregnancies
Partial - triploid karyotype 69 (XXX, XXY), focal trophoblastic proliferation and villous edema comparatively, contain some fetal parts, amnion and placental tissue. Beta's are typically not exceeding 100,000. Stain positive for p57Kip2 immunostaining.
Complete - diffuse villous edema, diffue trophoblastic hyperplasia, no fetal tissue, 46 XX or 46 XY karyotype, 5-10% malignancy
88
First line tocolytics include?
Beta-adrenergic receptor agonists, CCB's and or NSAIDS
89
Peripheral arthropathy, reticular rash on the trunk, aplastic anemia of mother = dx?
Parvovirus B19 = erythema infectiosum
Women are only infectious 5-10 days after exposure, which is also before the rash presents, therefore NOT infectious once rash is seen
90
HPV vaccination doses < 15yo needed doses?
Only need 2doses if vaccinated before age 15.
If after 15yo, need to give at 0 months, 1-2 months, 6 months
91
Paget's of breast associated with? Proceed with?
Paget's of the breast a/w DCIS in 85% of cases. Need to get full-thickness biopsy of the affected lesion with additional imaging to r/o other invasive carcinomas
92
Natural VTE RF's in pregnancy caused by? MCC mutation causing VTE in pregnancy
Normal Physiology = decreased anticoagulant activity, decreased fibrinolysis, and increased venous stasis in lower extremities from uterine compression of great vessels
Heterozygous Factor V Leiden
93
When to use ductus venosus evaluation of fetus?
Concerns for fetal cardiac compromise
94
MCA doppler peak systolic velocity abnormalities helps assess for fetuses with suspected?
Fetal Anemia. PSV > 1.5 MoM has 75% sensitivity in predicting severe anemia in 2nd 3rd trimester until 34-35wks given higher false positives
95
Congenital absence of vagina with variable uterine development = dx?
Mayer-Rokitansky-Kuster-Hauser Syndrome
96
Difference b/w septate uterus and bicornuate uterus?
Septated uterus has normal external surface and 2 endometrial cavities. Bicornuate uterus has fundal depression >1cm with 2 endometrial cavities
97
DIC criteria = ?
Elevated PT/PTT/INR , decreased fibrinogen, elevated D-dimer (unreliable in preg), thrombocytopenia
98
Name 4 patient related and 3 operative related RF's for post-op surgical complications
Patient related = age greater than 60, obesity w/ BMI >30, 20yr smoking hx (can prevent by quitting 6-8wks prior to sx), COPD
Sx Related = large abdominal incision approaching diaphragm, operating > 3hrs, emergency sx
99
Max GA for which Miso can be used with h/o C/S and new fetal demise?
GA = 28wks
100
Common Autosomal Dominant genetics syndromes = ?
Marfan's, NF Type 1, Noonan, Tuberous Sclerosis
101
PKU inheritance = ?
Autosomal Recessive
102
Lymphatic spread of:
1) Vaginal Ca.
2) Cervical Ca.
3) Endometrial Ca.
1) Upper third goes to ovarian LN's and Para-Aortics; lower third goes to Inguinal and Femoral LN's; middle third goes to both
2) Parametrial to pevic LN's
3) Paracervical, paramedian and pelvic LN's, ovarian LN's to para-aortics
103
Primary Dysmenorrhea Treatment considerations?
First-line = NSAIDs (Ibuprofen or Naproxen) on first day of menses - can switch to mefenamic acid
2nd Line = COC (or first line if need BCM too) ; Progestin-only (injectable, implanon, or IUD)
Heat = Ibuprofen >> Tylenol
Laparoscopy only for severe cases that're refractory
104
First Year failure rates for:
1) Nexplanon
2) Mirena IUD
3) Paragard IUD
1) 0.05%
2) 0.2%
3) 0.8%
105
Theca lutein cysts are responsive to prolonged elevations in what two hormones? Can be a/w what other dx's?
LH and BhCG
Hydatiform mole (25% develop them), multifetal gestation, placentomegaly, ovarian hyperstimulation
106
Fetal growth restriction, hydrops fetalis, and myocarditis = concern for?
CMV - sequelae are worse when transmission is first tri. Avidity testing for IgG is low with infection 2-4 month's old vs. high with older infection
107
Frankenhauser plexus refers to?
Plexus lateral to uterosacrals with rich supply of nerves - paracervical block at 4 and 8 o'clock, site of uterosacral insertion on uterus help achieve blockade. If used with epinephrine, causes vasoconstriction and causes local vasoconstriction
108
MC aneuploidy a/w AMA?
Autosomal Trisomy - a/w age > 35yo at time of delivery
109
vWD inheritance?
Can be dominant or recessive, fetus can have up to 50% risk of affected. Estrogen levels increase in preg and thus, once postpartum, have higher risk of delayed PPH
110
Multidose regimen of MTX? Gets Betas on what days? Leucovorin dose and timing?
MTX 1mg/kg on D1, 3, 5, and 7 - these are same days for Betas. Leucovorin 0.1mg/kg of body weight = dosing. Given on D2,4,6,8
111
MTX MoA?
Competitively inhibits the binding of dihydrofolic acid to the enzyme dihydrofolate reductase resulting in lower levels of purines and thymidylate and an arrest of DNA, RNA and protein synthesis
112
Gonorrhea Trmt?
Ceftriaxone and Azithromycin (Chlamydia presumptive trmt)
113
Pelvic Congestion Syndrome - most sensitive imaging modality?
TVUS
114
MCC of UTI in preg...followed by?
E. Coli, Klebsiella PNA, Proteus -> GBS, Enterococci, Staph
115
Antihypertensive medication that has off-label use for vasomotor symptx?
Clonidine
116
MoA for following:
- Clonidine
- Melthyldopa
- HCTZ
- Labetalol
- Clonidine: centrally acting alpha-2 agonist
- Melthyldopa: centrally acting alpha-2 agonist
- HCTZ: reduces reabsorption of Na in distal tubule therefore causing increased loss of Na with H2O, K, H++
- Labetalol: beta blocker with some alpha blockade
117
First line therapy for asthma? Treatment considerations
Low dose inhaled corticosteroids. Can go up to medium dose on this and then consider adding short acting B2 agonist for exacerbations and low dose inhaled long acting B2 agonist (can also go up on this dose). Budesonide is the initial therapy of choice
118
When does neural tube finish closing? What accompanying cranial feature do fetuses have with spina bifida??
Fourth week of conception - two types of NTDs, cranial and spinal defects. Most have associated ventriculomegaly. Spina bifida defects can include: meninges, spinal cord, vertebra
119
What size bladder injuries can be treated expectantly? When do you need to close surgically?
< 2mm can be managed expectantly
< 1cm can be managed with foley for 5-7days
>1cm need 1 to 2 layer closure with delayed absorbable suture
120
Difference between salpingostomy vs. salpingectomy in relation to fertility or future risks?
Equivocal fertility rates (60% salpingostomy / 58% for salpingectomy) - former is technically more difficult and has higher rate of ectopic
121
How many women quit smoking during pregnancy?
55% quit during pregnancy and 40% return to smoking within first 6months post-partum
122
Contraindications to regional anesthesia?
Space occupying lesions in the brain or thrombocytopenia (< 80k)
123
What GA to consider following: MgSO4, Steroids
23 weeks both can be considered but no data on under 24wks GA
124
High risk GTN with WHO score >7 needs this med regimen b/c of higher risk of resistance to single agent therapy
EMACO: etoposide, methotrexate, dactinomycin, cyclophosphamide, vinccristine
125
Cell-free DNA is a screening test, not a diagnostic test. Routine cell-free DNA screens only for ??
the common trisomies, with especially high sensitivity and specificity for trisomies 18 and 21.
126
Dorsal lithotomy positioning can cause damage to what three nerves?
Common peroneal, femoral nerve, sciatic nerve
127
How does injury to the common peroneal, femoral and sciatic nerve present?
Common peroneal nerve - can't dorsiflex, numbness over shin and top of foot, slapping gait
Femoral nerve - "can't kick a ball", adduct or abduct hip; numbness over quads
Sciatic nerve - back of the leg pain
128
When to redate EDD for sono vs. LMP when < 9wks GA?
> 5days discrepancy
129
When to redate EDD for sono vs. LMP when < 14wks GA?
> 7 days discrepancy
130
What happens to BNP/ANP levels in pregnancy?
Despite the large plasma volume expansion of normal pregnancy, ANP and BNP remain in the same range as outside of pregnancy.
131
What's the baseline risk of SD? Recurrent risk after an episode?
Baseline risk = 3%
| Recurrence Risk = 10% (some quote up to 16%)
132
What is the most thrombogenic mutation for pregnant women? How does this mutation with and without a h/o VTE affect their risk in pregnancy?
Antithrombin Mutation. W/o prior history, 3-7% risk of VTE in preg, WITH prior VTE, have 40% risk in pregnancy
133
Abx to give someone for hysterectomy with severe PCN allergy?
Clindamycin and Gentamicin
134
What type of pain does Presacral Neurectomy treat with endometriosis?
Midline pain; does poor with any other type of pain. Complications = constipation and urinary urgency
135
Stillbirth rate with normal BPP within the week? General score interpretations?
0. 8 in 1000 = stillbirth rate with normal BPP.
- BPP 6/10 = equivocal, repeat in 24hrs (if >37wks, consider delivery)
- BPP 4/10 = grossly abnormal (deliver unless < 32wks)
136
% of women with preterm delivery symptoms actually deliver at term?
50%
137
Side effects of TB in pregnancy for Ethambutol, Pyrazinamide, Rifampin, Isoniazid = ?
Ethambutol - optic neuritis
Pyrazinamide - hepatotoxicity
Rifampin - orange urine
Isoniazid - peripheral neuropathy (give VB6)
138
When to start treatment for latent TB in preg?
After first trimester with 6-9mo's of therapy
139
Risk of PTD following excisional procedure (LEEP or CKC)?
6.6% (double that of background risk of 3.5%)
140
Embryologic origin of following:
- ovaries, tubes, uterus, upper third of vagina
- bladder (except trigone), bulbourethral glands, urehtra, bottom 2/3 of vagina
- ovaries, tubes, uterus, upper third of vagina = paramesonephric ducts
- bladder (except trigone), bulbourethral glands, urehtra, bottom 2/3 of vagina = urogenital sinus
141
Most predictive U/S finding of placenta accretta?
Placenta Lacunae
142
PCOS dx'd via Rotterdam criteria = ?
At least two of the following:
- oligo-anovulation
- chemical or physical hyperandrogenism
- > 12 follicles on ovary or ovary > 10mL
143
Routine labs to order for fetal demise include:
CBC, Kleihauer Betke test, APS labs, Thyroid level, Human Parvovirus B-19.
ONLY screen for thrombophilias when really abnormal placenta, growth restriction, or personal/family hx. TORCH only needs w/u if exposure concern of presenting with concerning symptoms for infxn.
144
MC sex chromosome vs. autosomal aneuploidy?
Klinefelter Syndrome XXY; Trisomy 21 (Down Syndrome)
145
Only viable monosomy?
Turner Syndrome (X)
146
BRCA 1/2 Risks for OC and BC = ?
```
BRCA1 = 55-70% BC risk / 40% OC risk
BRCA2 = 45-70% BC risk / 20% OC risk
```
BRCA accounts for 3-5% of BC's and 10% of OC's
147
Fragile X is associated with what RF for women?
Premature Ovarian Failure - Fragile X is X-linked d/o and is the MCC of mental retardation and autism and spectrum d/o's
148
Two medications (not OCP's) good for decreasing fibroid size?
GnRH agonists can decrease size in 3 months (if more than 6, need add back therapy)
Mifepristone decrease fibroid size by 25-75%
149
Risk of ovarian cancer at baseline for women?
1 in 75 (1.3%)
150
FFP vs. Cryo components?
FFP contains all factors of the soluble coagulation system, including the labile factors V and VIII.
Cryoprecipitate (cryo) contains a concentrated subset of FFP components including fibrinogen, factor VIII coagulant, vonWillebrand factor, and factor XIII.
151
FFP vs. Cryo Indications?
FFP is indicated when a patient has MULTIPLE factor deficiencies and is BLEEDING.
Cryoprecipitate is used for hypofibrinogenemia, vonWillebrand disease, and in situations calling for a "fibrin glue." Cryo IS NOT just a concentrate of FFP. In fact, a unit of cryo contains only 40-50% of the coag factors found in a unit of FFP, but those factors are more concentrated in the cryo (less volume).
152
DCC decreases risk of fetal ___ and ____?
NEC and IVH
153
Alternative trmt for Chlamydia infxn if allergic to Azithromycin?
Doxycycline 100mg BID x7days
154
Routine treatment following sexual assault to cover what STI's and possible other unintended consequences?
STI prevention = Chlamydia, Trich, Gonorrhea
| Pregnancy Prevention = 1.5 LNG within 120 (ideally < 72hrs)
155
Trmt for those with GTN disease resistant to EMACO?
BEP = bleomycin, etoposide, cisplatin
156
Clomiphene Citrate MoA?
SERM = selective estrogen receptor modulator = increases GnRH in hypothalamus, and causes increases in FSH
157
What most effectively can detect a concealed placental abruption?
Contractions. Placental abruption is the leading cause of fetal demise in the setting of trauma
158
GA for amniocentesis is recommended at? Pregnancy loss rate =?
14wks GA. Preg loss rate = 0.1 - 0.3% (provider dependent)
159
If microcytic anemia is diagnosed and normal hgb electrophoresis, next appropriate w/u?
Alpha-thal testing
160
Two general known complications of dermoid cyst rupture at the time of surgery?
Chemical Peritonitis and Dense Adhesions
161
MC antigen responsible for NAIT? What determines if each subsequent pregnancy is affected? Treatment options in future pregnancies?
HPA-1a (Human Platelet Antigen-1a). Pregnancy becomes affected by fetal platelet antigens being present with absent antigen in maternal circulation. However, the incidence is lower because you need maternal-fetal hemorrhage to occur and it has to be enough to cause immunogenic response. Each subsequent pregnanc is affected if paternity is the same (because mom's antigen is going to become present). Trmt includes trying to increase fetal PLT's with maternal IVIG and steroids starting at GA 12 or 20wks GA
162
When to recommend risk-reducing BSO for BRCA patients? What percentage reduction do patients experience?
Recommend RR-BSO when completed childbearing or age 40yo. Reduces risk of BC by 40-70% and OC by 80-95%
163
What % of infertility patients have fibroids as only identified cause? Following myomectomy, what're pregnancy % rates in following 1-2yrs?
1-2.4% of patients have fibroids as sole source of infertility. 40-60% rate of pregnancy in next 1-2yrs
164
What intraoperative additive for bleeding doesn't rely on normal clotting factors?
Fibrin glue - thus, good to use when DIC is suspected.
165
Borders of Hesselbach's triangle?
Inguinal ligament, lateral border of rectus sheath, inferior epigastric artery
166
When to test luteal phase progesterone for w/u of infertility?
7days prior to onset of menses.
167
Screen for fetal malpresention at what GA and when should you perform ECV?
Scan and document fetal presentation starting at 36wks and candidacy following 37wks
168
months following Essure to test for tubal patency and for recommended time of backup BCM?
3months
169
Obesity predisposes patient to what peripartum complications?
Longer 1st stage of labor (esp. multips), lower successful VBAC rates, PPH, endometritis
170
Infants with NTD's have what associated allergy?
Latex
171
MC bugs causing chorio? two abx options if needed C/S too?
Prevotella, Bacteroides, GBS, E Coli, Mycoplasma, Anaerobic Gram + Cocci. IF C/S needed, anaerboic coverage provided via Clindamycin or Metronidazole
172
When is Advanced Paternal Age considered? Risks?
Age 40 - 50, no real cut-off. Child with single gene disorder (achondroplasia, Crouzon, Apert) - thought to occur during spermatogenesis as the male ages
173
What labor risks are associated with epidural use?
Shorter first stage of labor, longer second stage, increased risk of operative vaginal delivery
174
If following an ASCUS patient who is 21-24yo, what time frame do you use until next screening?
1yr OR request HPV testing
175
When to screen for CRC in black patients?
Age 45yo
176
Factors that predict successful ECV's?
Multiparity, adequate AFI, transverse/oblique lie, regional anesthesia, tocolysis
177
RF's for persistent OP?
Black race, Nulliparity, Obesity, Anterior Placenta, fetal macrosomia, anthropoid pelvis
178
Normal cord gasses values?
pH: 7.23 - 7.32
pCO2: 40 - 60
pO2: 12 - 24
HCO3: 20 - 24
179
Brief description of fibroid classification system Type 0/1/2
Type 0: completely in endometrial cavity
Type 1: some involvement in myometrium, less than 50%
Type 2: >50% myometrial involvement
180
Most common sexual dysfxn d/o for women?
Hypoactive Sexual Desire (5-15% women), affects women who are 40-60 most commonly, testosterone therapy <6months shown to be best
181
What abx rec'd for breast mastitis who is allergic to PCN?
Erythromyin
182
What type of vaccine is HPV? What are the two vaccines?
Gardasil (quadrivalent) HPV types 6/11/16/18
Cervarix (bivalent) HPV types 16/18
Uses the L1 viral capsid protein, very immungenic
183
Need how much time for alcohol-based prep agents prior to draping for surgery?
> 3 min - therefore they require more time but do increase the effectiveness of the cleaning agent. Biggest risk of not complying with this is increased risk of electrothermal arcing
184
Reasons for increased VTE in pregnancy? What GA is this greatest?
RFs = decreased anticoagulant activity, decreased fibrinolysis, increased stasis from uterine compression. Risk is greatest prior to 20wk GA; post-partum period is even higher
185
SCD is associated with what complications?
PTD, increased antepartum admissions, PPROM, post-partum infections
186
What vitamins and how often do they need to be screened for in women with Roux-en-y gastric bypass surgery?
Deficiencies = protein , Vit B12, Iron, Folic Acid, Ca, Vit D
Test for vitamins every trimester
This procedure is restrictive (smaller gastric pouch) and malabsorptive (stomach outlet connected to jejunum, bypassing duodenum)
187
Different types of GTN? MC place to metastasize?
Molar and Non-Molar Pregnancies. Histologies include: invasive mole, choriocarcinoma, placental site trophoblastic tumor, epithelioid trophoblastic tumor
Mets to lung (80%) and can present with Right Heart Strain; embolic trophoblastic cells can cause small pulm emboli with subsequent right heart strain
188
Risk of developing invasive/metastatic disease with molar pregnancy? Partial mole?
15% risk for locally invasive disease; 5% risk of metastases. Partial molar pregnancy risk = 1-5%
189
Most predictive U/S finding for respective GA's: < 14wks /
| 14 - 22wks / > 28wks
< 14wks = CRL
14 - 22wks = HC
> 28wks = FL
Obvi, multiple fetal biometry measurements are better than single correlates
190
Effects of NSAIDS on COX1/COX2?
COX1 - inhibited, leading to inhibition of COX1 and Thromboxane A2 on PLTs, causing decreased PLT fxn
COX2 - anti-inflammatory result
191
MC pathogen associated with endocarditis?
Staph Aureus
192
How to decide laparoscopic vs. hysteroscopic approach to myomectomy for those desiring fertility sparing therapy?
Laparoscopic approach better for those with symptoms of pelvic pressure and bulk sensation (pressure symptx, early satiety, change in bowel habits)
Hysteroscopic better for those fibroids with < 50% intramural involvement
193
Minimum criteria for singleton breech vaginal delivery?
37wks, EFW 2500 - 4000g, Complete or Frank Breech, Adequate pelvis
194
Biochemically what happens to cause the deformed RBC in those with SCD? What vitamin does the patient need more of?
Single nucleotide (thymine instead of adenosine) on the B-globin chain causes Glutamic Acid to substitute Valine on B-globin polypeptide.
4mg FA given the increased RBC turnover (can affect brain, lung, kidney, heart and spleen)
195
Besides being general soft markers, what work-up should be considered with those having echogenic bowel?
Cystic Fibrosis and CMV
196
U/S findings concerning for CMV? Neonatal complications of CMV?
Perventricular calcifications, ventriculomegaly, hydrops, growth restriction.
Neonatal hearing loss, vision loss, intellectual disability, and seizures
197
Corpus luteum is stimulated by what hormone to produce several factors, what are they
BhCG and costimulate estradiol and 17-a-hydroxyprogesterone, relaxin, inhibin
198
What vaccine should all family members of the house get to help protect newborn?
Tdap
199
Benefits of 2 doses of LNG vs. Yuzpe method for EBC?
More effective unintended pregnancy prevention and decreased N/V, emesis, HA and breast tenderness
200
IUD perf rate and expulsion rate (normal rate and post-placental rate)?
Perf Rate = 1/1000
Expulsion Rate = 2-10%
Post-Placental = 25%
201
Earliest GA to consider PPROM latency abx?
GA of 20wks
202
Total blood volume expansion % compared to non-pregnant women?
30-50% increase
203
Most rapid expansion of maternal blood volume = what trimester?
2nd Trimester - at 12wks GA, 15% of blood volume increased. Most rapid gain in 2nd tri. Third trimester the increase slows. Physiologic increase of blood plasma > blood erythrocytes causes physiologic anemia.
204
Fetal exposure to carbamazepine causes?
Facial dysmorphism, fingernail hypoplasia
205
Fetal exposure to valproic acid?
NTD's and fetal valproate syndrome = facial dysmorphism, limb and heart defects, fetal growth restriction
206
Lithium and Paroxetine both put fetus at risk for developing what?
Congenital heart defects
207
Best bipolar disorder rx?
Lamotrigine
208
What happens to level of prostaglandins in pregnancy? What do they help with?
The levels increase (Prostaglandin E2 = made by maternal kidney; Prostaglandin GI2/prostacyclin = endometrium) - they help maintain vascular tone, BP, and sodium balance
209
What inherited thrombophilia testing can be affected by pregnancy?
Protein C/S Deficiency
210
Treatment dosing for HSV daily suppression?
Patient with recurrent outbreaks are good candidates for these regimens:
- Acyclovir 400mg BID
- Famciclovir 250 BID
- Valciclovir 0.5g or 1g QD
211
What tumor markers would you order in adolescent with ovarian mass?
AFP - endodermal sinus tumor, mixed germ cell tumor, immature teratomas
LDH - dysgerminomas
212
Absolute contraindications to aerobic exercise in pregnancy?
Hemodynamically significant heart disease, restrictive lung disease, incompetent cervix or cerclage, multiple gestation and risk for PTD, persistent 2nd and 3rd trimester bleeding, placenta previa after 26wks, premature labor, ROM, PreE and severe anemia
213
When is maternal Cardiac Output highest?
Post-Partum. It increases throughout pregnancy and labor but peaks in PP period.
Nonpregnant CO = 5L/min
28wks GA = 7L/min
2nd Stage of Labor = 9L/min
Postpartum = >9L/min
214
Needed % of body weight needed to lose for beneficial results?
5-10%
215
Low molecular weight heparin dosing appropriate for documented VTE?
1mg/kg
216
Femoral Nerve Nerve Roots?
L2-L4 - the nerve perforates the psoas muscle and then courses medially to the inguinal ligament prior to exiting the pelvis and then enters the femoral tringle lateral to artery and vein - points most susceptible to impingement is the psoas muscle and inguinal ligament
217
Lateral Femoral Cutaneous Nerve Root and manifestation if injured?
L2-L4; pain and paraesthesias to anterior and posterior-lateral thigh
218
Ilioinguinal Nerve Root and manifestation if injured?
T12 - L1: sensory nerve, causes burning and pain in groin area, inner thigh, labia majora - MCC = suture entrapment of nerve at lateral borders of transverse abdominal incision
219
Iliohypogastric Nerve Root and manifestation if injured?
T12 - L1: sensory nerve, causes burning and pain in gluteal and hypogastric area - MCC = suture entrapment of nerve at lateral borders of transverse abdominal incision
220
Source with highest yield for fetal karyotyping?
Amniotic fluid = 84%
Others = 30% including proximal cord, placenta, fetal cartilage costochondral junction or patella
8% fetal demise have found abnormal karyotype
221
Thyroid storm or thyrotoxic heart failure treatment = ?
PTU (propylthiouracil) with iodide in 2-3hrs following to prevent release of further T3/T4. Dexamethasone can also be given to prevent further conversion of peripheral T4 to T3. Subsequent B-blocker can be given if needed only following PTU administration
222
What % of babies enter pelvis in OP position when entering pelvis?
20% enter OP, 5% remain OP
50% enter OA
25% enter OT
223
First tri screening components? What happens to levels if Trisomy 21 or 18 detected?
NT and Pregnancy Associated Plasma Protein A (PAPP-A) and BhCG. NT and BhCG are increased in aneuploidy; decreased PAPP-A
224
Next step in working up intraductal papiloma?
Core Biopsy - with atypia, 15-20% are malignant
225
For patient who need 4mg FA for NTD risk prevention, can't just take more PNV's to make up for it because of risk of what toxicity?
Vitamin A
226
BIRADS categories?
```
BIRADS 0 = needs additional imaging
BIRADS 1 = no abnormality
BIRADS 2 = benign lesion
BIRADS 3 = probably benign
BIRADS 4 = A - low suspicion, B - intermediate, C - moderate
BIRADS 5 = likely malignant
BIRADS 6 = bx-proven malignancy
```
227
When to consider preop CXR to evaluate surgical candidacy?
Women > 50yo with chronic or RF's for cardiopulmonary compromise
228
Cluster HA symptx?
Unilateral HA with associated same-sided nasal congestion, runny nose, eyelid swelling, and tearing eyes
229
Symptx concerning for temporal arteritis?
Autoimmune d/o often affecting the aorta and causing scalp tenderness and jaw pain and sudden loss of vision
230
MCC of death following UAE?
Septicemia from necrotic fibroid. UAE is accomplished by depositing polyvinyl alcohol particles in the uterine artery, accessed from the femoral artery
231
What is postembolization syndrome following UAE?
50% pts have fever, pain, and nausea lasting from a few hours to a few days
232
Thrombophilia w/u if pt's test negative for MC inherited thrombophilia?
Protein C/S Deficiency, Antithrombin III, Prothrombin Gene Mutation G20210A.
MC thrombophilia = Factor V Leiden
233
MCC of chronic pelvic pain?
Endometriosis
234
Lynch Syndrome or Mismatch Repair DNA Mutations have associated risks of what types of cancers?
Colorectal, Endometrial, hepatobiliary, renal pelvis/ureters, brain gliomas, stomach and SB
235
Exogenous testosterone use side effects?
Hursitism = MC; decreased HDL; very low risk, but if deepening of voice occurs, it's thought to be irreversible
236
Overall, MOST accurate predictor of EDD?
1st Tri Sono (up to 13 6/7)
237
UAE ABSOLUTE contraindications; what's a relative one?
Absolute = current pregnancy, malignancy, infection, asymptomatic fibroids
Relative = desire for future pregnancy
238
Other method besides prophylactic abx which is proven to prevent recurrent STI's?
Cranberry juice or tablets
239
PCOS responsible for what percentage of infertility patients?
25-30%
240
Phyllodes tumor characteristic presentation? Trmt?
Tend to be single enlarging breast mass, present around age 40, can cause skin stretching given the rapid growth. Recommend excisional biopsy bc difficult to diagnose benign vs. sarcomatous vs. malignant type - want 1 cm margin
241
General benefits of BF'ing?
Decreased newborn: infxns / obesity
Decreased maternal: HTN, diarrhea, MDD, hyperlipidemia, CVD, unintended pregnancy risk, BC/OC
Increased maternal: weight loss, bonding
242
Obstetric Anal Sphincter Injury (OASIS) = 3rd/4th degree lacerations should be offered subsequent C/S depending on what few factors?
Patient request, anal incontinence, wound complications (infxn, needing additional repairing, etc)
243
When to administer Hep B vaccination AND immunoglobulin for baby?
Unknown status OR known history; even if mom received therapy during pregnancy (b/c household contacts) - administer these within 12hrs of delivery
244
Fibroid size amenable to endometrial ablation?
2cm (some say 3cm)
245
MC pathologic types of adnexal masses in pregnancy?
Mature teratoma, paraovarian or corpus luteum cysts
- if > 5cm or appears complex, higher rate of persistence
- CA125 is elevated in normal pregnancy
246
Absolute contraindications to BF'ing?
Active metabolites from chemo, recent radioactivity exposure, TB, T-cell lymphotrophic virus, HSV on maternal breast, active use of illicit substances, newborns with galactosemia, HIV (unless third world)
NOT Hep B/C
247
First line antihypertensives in Caucasian vs. blacks?
Thiazide diuretic and CCB for blacks; Caucasians include the aforementioned, ACEi and ARB
248
Permanent types of suture?
Silk, Nylon, Prolene (monocryl and vicryl = absorbable)
249
Why is Parvovirus B19 so dangerous if transmitted vertically?
Can cause aplastic anemia and subsequent hydrops - thus need monitoring for 8-10wks if contracted during pregnancy
250
MCC of neonatal congenital infection?
CMV
251
Umbilical arteries originate from? Later after delivery they eventually become?
Internal Iliac Arteries; Medial Umbilical Ligament
252
What is associated with a false negative for PPROM? False Positive?
Delayed ROM
| Blood, semen, BV, soap (all basic)
253
MC infectious cause of non-immune hydrops fetalis (NIHS)?
Parvovirus
254
How soon before a C/S should a patient with active HIV (>1,000 copies/mL) be started on Zidovudine? What's it's % decrease in vertical transmission?
With active HIV, transmission rate = 25%. Giving Zidovudine 3hrs prior to C/S confers 5-8% risk of transmission. Antiretroviral therapy + C/S = 2-3% of vertical transmission.
255
When to screen women for osteoporosis via DEXA scan?
Screen at age 65yo, UNLESS they have RF's: h/o fragile fracture, parents with hip fracture, medications causing bone loss, smoking, alcohol, rheumatoid arthritis
256
Initial treatment options for women with PCOS pertaining to these specific concerns:
- AUB/hirsutism
- Fertility
- Glucose Intolerance
- AUB/hirsutism: OCP's
- Fertility: Clomiphene Citrate
- Glucose Intolerance: Metformin
All woman should be counseled on lifestyle behavioral modifications because decrease in weight 5-10% can result in normal return of menses
257
Risks more associated with VAVD vs. FAVD?
Intracranial hemorrhage, Subgaleal hematoma
258
RF's for developing fetal macrosomia?
Age <17, GA >40, failing 1hr GTT but passing 3hr GTT, male infant, excessive weight gain in pregnancy, gestational diabetes, multiparity
259
Which hepatitis associated with most severe hepatic injury?
Hepatitis D = 80% have cirrhosis and portal hypertension
260
When is STD screening considered routine or indicated?
Sexually active females < 25yo OR women > 25yo who are high risk (sex trafficking,
261
When to treat for suspected Listeriosis?
Possible exposure (hot dogs, unpasteurized cheeses, lunch meats) and fevers with symptoms (muscle aches, vomiting/diarrhea) - treat with Ampicillin
262
When is abx treatment indicated for women who undergo HSG?
If they had a h/o PID, give dose of Doxycycline 100mg PO BID x5days if dilated tubes are seen on imaging. If no abnormal tubes seen, preoperative doxy is sufficient
263
Physiologic changes of thyroid hormone levels in pregnancy?
BhCG has similar alpha-subunit to TSH, therefore jump in TSH causes increased thyroid hormone production, with subsequent decrease in TSH.
Increased estrogen causes increase in Thyroid Binding Globulin, causing increase in total T3/T4 but not in level of free T3/T4 and thus no subsequent change of TSH.
264
Risk of NTD for mother with elevated MSAFP?
2%
265
Risk of heteroectopic pregnancy?
1/30,000
266
What % of normal IUPs have increase of less than the standard 66% in BhCG over 48hrs?
15%
267
MC type of vaginal cancers?
Squamous cell > adenocarcinoma > melanoma > sarcoma
268
Contraindications to regional anesthesia?
Coagulopathy, space-occupying brain lesions that increase ICP*, thrombocytopenia (<80k) and recent use of anticoagulant (10-12hrs of prophylactic LMWH; 24hrs since therapeutic LMWH)
*If imaging is performed and there is no evidence of ICP or mass effect, can consider regional anesthesia
269
Risk of gestational choriocarcinoma in normal pregnancy?
1/30,000 (2/3 are after term delivery; 1/3 following SAB/TAB)
270
Mastalgia types (3)? Treatment options?
Cyclic (having to do w/ menses), noncyclic and focal (cyst, cancer, etc), extramammary (HSV, costochondritis).
NSAIDS/Tylenol, fitted bra, decrease caffeine/fat/salt, and can consider continuous OCPs
271
MCC of ambiguous genitalia?
Congenital Adrenal Hyperplasia - 90% have normal karyotype 46, XX; autosomal recessive and results in lack of cortisol production. 21-hydroxylase deficiency results in build up of 17a-hydroxyprogestrone - causes a "right" shift towards more testosterone
272
Mgmt of perineal laceration if it becomes infected AND opens up?
Abx and surgical repair in 2-3days as long as it looks better
273
When to consider the two vs. three dose vaccination series of 9vHPV?
If first dose is given age 9-14yo can give the now dose and only one more in 6months. If first dose given after age 14yo, give full three doses
274
Treatment options for hirsutism? Expected time frame?
OCPs or anti-androgen rx's (spironolactone, finasteride, flutamide) - see change in 6 months (half life of hair follicle)
275
Risk of placenta accreta with 1st, 2nd, 3rd, 4th, 5th and greater C/S?
```
1st = 3.3%
2nd = 11%
3rd = 40%
4th = 61%
5th and greater = 67%
```
276
Two indications for thrombophilia screening in obstetric patient?
1) Personal h/o unprovoked VTE
| 2) First degree relative with high-risk thrombophilia
277
Primary hormone responsible for dysmenorrhea?
Prostaglandin F2a and E2
278
How long is the ureter? where are the thirds divided?
20-25cm
- upper third: from renal pelvis to the top edge of the sacrum
- middle third: from the top edge to the pelvic brim
- distal third: pelvic brim to the urinary bladder.
279
Vaccines contraindicated in pregnancy?
MMR, zoster, varicella, live influenza
280
When can you perform CVS vs. amniocentesis?
CVS 10-12wks; Amniocentesis > 15wks
281
Recommended GA to deliver HIV + woman needing C/S?
38wks (in order to prevent onset of spontaneous labor)
282
Criteria needed to diagnose Hypoxic Ischemic Encephalopathy?
HIE needs:
- umbilical artery acidemia
- spastic quadriplegia or dyskinetic CP
- Apgar score <5 at 5 and 10min
- Multisystem organ failure
283
Management of pelvic abscess?
Rare complication of post-partum endometritis. Commonly see in anterior, posterior culdosac or within the broad ligaments. Abx's include= amp, gent/clinda. Common pathogens include: coliforms and gram negatives (bacteroides / prevotella). Need to drain!!!
284
Luteo-placental shift occurs at what GA?
7-9wks GA
285
COC's users have _____ relative risk of developing VTE vs. non-users?
2-4x RR
286
Most dangerous time for fetus to contract Parvovirus B19? How to monitor serially?
GA 13-16wks b/c hematopoeitic system is most active during this time. Monitor q2wks (for 10wks) for signs of HSM, placentomegaly, hydrops fetalis and MCA dopplers.
