Dunn OB/GYN VI

Question 1

heavy bleeding and terrible nausea/vomiting

previous vaginal births
miscarriage

tissue at cervical os
enlarged ovary

ultrasound - snowstorm
very high HCG**

Answer 1

gestational trophoblastic neoplasm

Question 2

first trimester US

Answer 2

best for determining length of pregnancy

Question 3

tx of gestational trophoblastic neoplasm

Answer 3

D and C

Question 4

gestational trophoblastic disease

Answer 4

abnormal proliferation of trophoblast of placenta

Question 5

benign non-neoplastic trophoblastic lesions

Answer 5

exaggerated placental site

placental site nodule

Question 6

most common cause gestational trophoblastic disease

Answer 6

hydatidiform mole
-80%

complete, partial, and invasive

Question 7

gestational trophoblastic neoplasia

Answer 7

GTN

• true neoplasia
• potential for invasion / mets

choriocarcinoma
placental site trophoblastic tumor
epithelioid trophoblastic tumor

curable 85-100% cases**

Question 8

chorioadenoma sestruens

Answer 8

invasive hydatidiform mole

Question 9

complete mole

Answer 9

46, XX

XY - if fertilized two sperm

all paternal chromosomes

haploid sperm fertilize empty ovum

no fetal tissue**

Question 10

incomplete mole

Answer 10

69 XXY

fertilization of ovum with haploid maternal chromosome by two sperm

fetal tissue present**

Question 11

maternal genes

Answer 11

fetal growth

Question 12

paternal genes

Answer 12

placental growth

excess - trophoblastic grwoth

Question 13

incidental finding on endometrial curettage or hysterectomy

Answer 13

benign nonneoplastic trophoblastic lesion

Question 14

genomic imprinting

Answer 14

certain genes expressed in parent of origin specific manner

DNA methylation, histone mods

occurs in moles

• heterozygote - two sperm
• homozygote - duplicated DNA sperm

Question 15

complete molar pregnancy

Answer 15

fertilization of empty ovum by two sperm or one duplicated sperm

can become choriocarcinoma

Question 16

partial molar pregnancy

Answer 16

fertiliation of haploid ovum by two sperm or one duplicatd sperm

presence of fetal tissue

less likely malignant

Question 17

molar pregnancy complications

Answer 17

most due to very high HCG levels

large overies
hyperemesis gravidarum
preeclampsia
hyperthyroid
hemorrhage

Question 18

asian women and latin american countries

Answer 18

gestational trophoblastic disease

Question 19

partial mole

Answer 19

less dangerous

small uterus for dates

Question 20

complete mole

Answer 20

46 XX

no fetal tissue

large uterus for dates

Question 21

risk fx for GTD

Answer 21

40yo

diet deficient in folate or beta carotene

Question 22

1st trimester painless bleeding, uterine large, hyperT, hyperemesis gravidarum, preeclampsia

Answer 22

gestational trophoblstic disease

Question 23

hyperemesis gravidarum

Answer 23

severe nausea and vomiting

-during pregnancy

Question 24

very high beta-HCG, enlare ovaries, grapelike clusters in vagina, US snowstorm

Answer 24

GTD

Question 25

Tx for GTD

Answer 25

D and C - scrape tissue out - follow beta-hcg levels - plateau and go up - repeat D and C or chemotherapy

Question 26

persistent disease

Answer 26

15-20% after complete 3-5% after partial theca lutein cyst, large uterus age >40, initial hCG >100,000 follow hCG levels

Question 27

hcg<5 for 3 weeks

Answer 27

ok to resume pregnancy attempts

Question 28

23yo F taking OCP - daily spotting since period - LMP 1 month ago cervix - blood from os tender right ovary beta-hCG positive

Answer 28

ectopic pregnancy

Question 29

break through bleeding

Answer 29

diagnosis of exclusion don't know cause

Question 30

normal pregnancy

Answer 30

hCG doubles every 48 hours first trimester bleed

Question 31

abnormal pregnancy

Answer 31

hCG stay same, decrease, or increase minimally

Question 32

threatened abortion

Answer 32

1st trimester bleeding in normal pregnancy

Question 33

risk with 1st trimester bleeding

Answer 33

miscarriage abnormal placental implantation IUGR - intrauterine growth restriction

Question 34

abnormal pregnancy - in uterus

Answer 34

missed, complete, incomplete abortion molar pregnancy

Question 35

incomplete abortion

Answer 35

patient to ER - bleeding heavily

Question 36

missed abortion

Answer 36

got pregnant | didn't grow - and haven't passed tissue yet

Question 37

complete abortion

Answer 37

get pregnant - but hCG goes down

Question 38

risk factors for spontaneous abortion

Answer 38

``` age 45yr 80% risk previous abortion prolonged time to implantation interval prolonged time to conception smoking alcohol cocaine NSAIDs caffeine low folate fever celiac disease ```

Question 39

chromosomal abnormalities

Answer 39

50% of spontaneous abortions most commonly - aneuploidies - trisomy, monosomy, etc. congenital abnormalities and trauma also causes

Question 40

maternal cause of spontaneous abortion

Answer 40

uterine structural issue acute maternal infection maternal endocrinopathies hypercoagulable state

Question 41

vaginal bleeding, pelvic pain, absence of fetal movement, incidental US findings

Answer 41

symptoms for spontaneous abortion

Question 42

work up for spontaneous abortion

Answer 42

``` 1 - doppler - fetal heart sounds 2 - pelvic exam 3 - pelvic US 4 - hCG level - more than one 5 - blood type antibody - Rh 6 - serum progesterone ```

Question 43

CRL >7 no cardiac activity

Answer 43

spontaneous abortion

Question 44

absence of embryo heartbeat >2weeks after without yolk sac

Answer 44

spontaneous abortion

Question 45

threatened abortion

Answer 45

diagnostic criteria for spontaneous not met vaginal bleeding occured and closed os up to 50% will miscarry tx - bed rest and expectant management

Question 46

inevitable abortion

Answer 46

vaginal bleeding, cramphy pelvic pain, dilated cervix products of conception felt or visualized tx - medical abortion - misoprostol D and C surgical abortion

Question 47

misoprostol

Answer 47

medical abortion tx

Question 48

complete abortion

Answer 48

hCG has gone down cervix closed and uterus small >12 weeks gestation - common

Question 49

missed abortion

Answer 49

got pregnant - os closed then did not feel pregnant anymore misoprostol or D and C tx

Question 50

ectopic pregnancy

Answer 50

outside the uterus -cervix, fallopian tube, ampulla, ovary, abdomen ampulla - most common

Question 51

methotrexate

Answer 51

folic acid inhibitor tx for ectopic pregnancy

Question 52

risk fx for ectopic pregnancy

Answer 52

``` previous PID ** chlamydia assisted reproductive technology history of peritonitis smoking previous tubal ligation ```

Question 53

tx of ectopic pregnancy

Answer 53

methotrexate - folic acid inhibitor surgical - removal same fertility with either tx**