Incorrect Questions Flashcards
(824 cards)
1
Q
what is increased in a granulosa-theca cell tumor
A
inhibin
2
Q
what is inhibin
A
a peptide that is produced by the ovaries in response to follicle-stimulating hormone and luteinizing hormone
- most sensitive tumor marker for granulosa cell tumor
3
Q
granulosa-theca cell tumors produce what
A
estrogen
4
Q
sertoli-leydig cell tumors produce what
A
androgens (androstenedione and testosterone)
5
Q
symptoms of hyperestrogenism
A
postmenopausal bleeding, menstrual abnormalities, and sexual precocity in children
6
Q
how do granulosa cell tumors present
A
hyperestrogenism and abdominal or pelvic pain
7
Q
granulosa-theca cell tumor in a postmenopausal patient
A
unopposed estrogen can lead to endometrial hyperplasia or carcinoma
8
Q
postmenopausal woman with vaginal bleeding and a large ovarian mass
A
hyperplasia or carcinoma of endometrium, but think granulosa cell tumor
9
Q
when is CA-125 elevated
A
epithelial ovarian tumors
10
Q
when is lactate dehydrogenase elevated
A
dysgerminomas
11
Q
patient with mosaic Turner’s syndrome cc of infertility, menses started at 15, ended at 19. what is the diagnosis?
A
ovarian failure
12
Q
definition of preterm labor
A
uterine contractions that affect cervical change experienced prior to 37wks of gestation
13
Q
how do you confirm diagnosis of preterm labor
A
rupture of membranes or vaginal bleeding
14
Q
what is the initial management of preterm delivery prior to 34wks?
A
corticosteroid therapy to hasten lung maturity and reduce perinatal morbidity and mortality
- betamethasone or dexamethasone
15
Q
when should corticosteroids be given for fetal lung maturity
A
any pregnant woman likely to deliver her baby within the next 2wks so long as she is between 24 and 34wks gestational age
16
Q
signs of ovarian carcinoma
A
frequently asymptomatic
late stage with vague GI symptoms including dyspepsia, anorexia, and abdominal fullness and/or bloating
17
Q
risk factors of ovarian carcinoma
A
family history of ovarian cancer, BRCA1 and 2 gene mutations and hereditary non-polyposis colorectal cancer (HNPCC) mutations
nulliparity, early menarche, late menopause (d/t increased risk of mutations with ovulation)
18
Q
why do patients with ovarian carcinoma present in late stages?
A
lack of reliable routine screening test
19
Q
what will rectovaginal exam show in ovarian carcinoma?
A
solid, irregular adnexal mass or fullness and/or nodularity in the posterior cul-de-sac
20
Q
what is an ominous sign for ovarian carcinoma?
A
ascites
- sign of intra-abdominal spread of disease
21
Q
what is a uterine leiomyoma
A
benign smooth muscle tumor of the uterus
22
Q
how does a patient with uterine leiomyoma present
A
hemorrhagia, pelvic pain and pelvic pressure, and/or infertility
23
Q
how is uterine leiomyoma diagnosed
A
transvaginal ultrasound
24
Q
presentation of placental abruption
A
sudden onset vaginal bleeding associated with severe abdominal or back pain
25
how is placental abruption diagnosed
ultrasound reveals separation of the placenta from the uterine wall
26
what is a serious maternal complication of placental abruption?
DIC
27
what are the fetal complications of DIC
hypoxemia, asphyxia, preterm labor, and low birth weight
28
how is a severe placental abruption managed
prompt cesarean delivery
29
what is a severe placental abruption
maternal hypotension
severe coagulopathy
ongoing maternal blood loss
non-reassuring fetal status
30
what is DIC
disruption of the hemostatic process, during which a massive activation of the clotting cascade leads to widespread thrombosis causing depletion of platelets and fibrinogen
31
what are risk factors for DIC
severe preeclampsia, amniotic fluid embolism, sepsis, placental abruption, and prolonged retention of fetal tissue after fetal demise
32
what is the most common long term complications of hysterectomy
incontinence, pelvic organ prolapse, and pelvic organ fistula
33
treatment of iron deficiency anemia in 2nd and 3rd trimester
IV iron supplementation
34
treatment of iron deficiency anemia in 1st trimester
oral iron replacement
35
clinical signs and symptoms of anemia
fatigue, pallor, palpitations or throbbing pulse, headache, dizziness or lightheadedness, and pica
36
what maternal complication is a patient with multiple gestations at an increased risk?
anemia
- in twin pregnancies, cardiac output increases up to 20% higher than singleton pregnancies -> increased plasma volume -> physiologic anemia
37
what are risks of multiple gestations
gestational hypertension and preeclampsia, gestational diabetes and physiologic anemia
38
next step in management of LSIL on pap smear
perform a colposcopy
39
what is a colposcopy
applying acetic acid to the cervix, which will turn dysplastic areas 'acetowhite'
- these lesions should be biopsied and sent for histologic diagnosis
40
what receives a prompt colposcopy as the next step in management?
pregnant women with an LSIL pap smear
any woman regardless of age or pregnancy with high-grade intraepithelial lesion (HSIL)
women who have an atypical squamous cells of undetermined significance (ASCUS) + positive HPV
any woman with ASCUS cannot exclude high grade lesion
41
appropriate management of an LSIL on pap smear (or ASCUS) in a woman under 21
repeat pap in 1 year
42
patient requests the most accurate test to diagnose fetal anomaly at 10wks. what do you perform?
chorionic villus sampling
43
what is CVS
placing a needle transcervically to obtain a sample of the placenta for fetal karyotyping
44
what is asherman syndrome
condition of intrauterine adhesions (synechiae)
45
etiology of asherman syndrome
direct endometrial trauma, which causes endometrial inflammation, scarring, and the formation of adhesions
46
who presents with asherman syndrome
woman who have had several D&Cs, but may occur as a result of chronic uterine inflammation due to infection
47
asherman syndeom presentation
irregular menstrual bleeding (either hypomenorrhea or secondary amenorrhea) and infertility
48
risk factors for endometrial cancer
late menopause, obesity, irregular ovulation, olgomenorrhea, and nulliparity
49
most common pathologic type of endometrial cancer
adenocarcinoma
50
signs of endometrial cancer/hyperplasia
any postmenopausal bleeding until proven otherwise
51
congenital varicella
limb hypoplasia, IUGR, cicatricial skin lesions, chorioretinitis
52
what to do if a patient has no immunity to varicella zoster and is exposed between 8 and 20wks?
varicella zoster immune globulin to prevent transmission of disease and/or to minimize the severity of the infection
53
elective termination of pregnancy before 7wks?
medically induced
| methotrexate, mifepristone, +misoprostol
54
elective pregnancy termination after 7wks, but before 14wks
suction dilation and curettage
55
what is a contraindication to trial of breech vaginal delivery?
absence of immediately accessible to operating rooms and staff for cesarean delivery if necessary
56
what is the first line therapy for a woman with acute episode of prolonged or heavy menstrual bleeding who has normal vital signs?
high dose oral estrogen-progesterone
57
what is a nucleic acid amplification test?
a way gonorrhea and chlamydia are tested
58
what is annual protocol for women under 24 who are sexually active
tested annually for chlamydia, gonorrhea, and HIV
59
what is the only benefit of laser vaporization for cervical intraepithelial neoplasia?
preservation of the squamocolumnar junction
60
what are the benefits of cryoablation for CIN
less perioperative bleeding
less perioperative pain
less risk of disease recurrence
lower cost of procedure
61
how is grade 1 CIN handled
generally left untreated until it has persisted for greater than 2 years or progressed to a higher grade lesion
62
what is the management of CIN 1 if persisted for 2 years?
ablation
63
what is the best treatment of the management of hot flashes and emotional lability due to menopausal symptoms with a history of thromboembolism?
paroxetine
64
what is the first line treatment for hot flashes
hormone replacement therapy
- estrogen and progesterone
- progesterone is added in women who still have a uterus to protect the endometrium from constant stimulation that results in an increase in endometrial cancer
65
what is a contraindication for HRT
risk of coronary artery disease and thromboembolic events
66
what is the second line treatment for hot flashes
venlafaxine or an SSRI
67
what does HRT relieve
hot flashes and vaginal atrophic
| helps prevent osteoporosis
68
what is the next appropriate step in management of a 28wk-er 3/90% with a bulging bag after betamethasone and indomethacin are administered?
administer magnesium sulfate
| - provide fetal neuroprotection
69
management of preterm labor: 34w0d - 36w6d
+- betamethasone
| PCN if GBS positive/unknown
70
management of preterm labor: 32w0d - 33w6d
betamethasone
tocolytics
PCN if GBS positive/unknown
71
management of preterm labor: <32wks
betamethasone
tocolytics
magnesium sulfate
PCN if GBS positive/unknown
72
risk factors for preterm labor
multiple gestation, history of preterm delivery, history of cervical surgery (conization)
73
what is a first-line tocolytic?
nifedipine
74
what is a positive fetal fibronectin test
a positive fetal fibronectin test and a shortened cervix are associated with increased risk of preterm delivery
75
potential complications of Hepatitis C in pregnancy
gestational diabetes
cholestasis of pregnancy
preterm delivery
76
maternal management of Hepatitis C in pregnancy
Ribavirin is teratogenic & should be avoided
no indication for barrier protection in serodiscordant, monogamous couples
Hep A & B vax
77
prevention of vertical transmision of hepatitis C in pregnancy
vertical transmission strongly associated with maternal viral load
cesarean delivery not protective
scalp electrodes should be avoided
breastfeeding should be encouraged unless maternal blood present (nipple injury)
78
risk factors for vaginal cancer
age >60
HPV
tobacco use
in utero DES exposure (clear cell adenocarcinoma only)
79
clinical features of vaginal cancer
vaginal bleeding
malodorous vaginal discharge
irregular vaginal lesion
80
diagnosis of vaginal cancer
vaginal biopsy
81
management of vaginal cancer
surgery +/- chemoradiation
82
what is the initial evaluation of mixed incontinence?
voiding diary
- tracks fluid intake, urine output, and leaking episodes
- classify predominant type of urinary incontinence and determine optimal treatment
83
treatment of mixed incontinence
all require bladder training with lifestyle changes (weight loss, smoking cessation, decreased alcohol and caffeine intake) and pelvic floor muscle exercises
84
clinical presentation of mittelschmerz
recurrent mild and unilateral mid-cycle pain prior to ovulation
pain lasts hours to days
85
ultrasound findings of mittelschmerz
not indicated
86
clinical presentation of ectopic pregnancy
amenorrhea, abdominal/pelvic pain & vaginal bleeding
| positive ß-hCG
87
ultrasound findings of ectopic pregnancy
no intrauterine pregnancy
88
clinical presentation of ovarian torsion
sudden-onset, severe, unilateral lower abdominal pain; nausea and vomiting
unilateral, tender adnexal mass on examination
89
ultrasound findings of ovarian torsion
enlarged ovary with decreased or absent blood flow
90
clinical presentation of ruptured ovarian cyst
sudden-onset, severe, unilateral lower abdominal pain immediately following strenuous or sexual activity
91
ultrasound findings of ruptured ovarian cyst
pelvic free fluid
92
clinical presentation of pelvic inflammatory disease
fever/chills, vaginal discharge, lower abdominal pain & cervical motion tenderness
93
ultrasound findings of PID
+/- tubo-ovarian abscess
94
epidemiology of vulvar lichen sclerosus
prepubertal girls & perimenopausal or postmenopausal women
95
clinical features of vulvar lichen sclerosus
thin, white, wrinkled skin over the labia majora/minora; atrophic changes that may extend over the perineum & around the anus
excoriations, erosions, fissures from severe pruritus
dysuria, dyspareunia, painful defecation
96
workup of vulvar lichen sclerosus
punch biopsy of adult-onset lesions to exclude malignancy
97
treatment of vulvar lichen sclerosus
superpotent corticosteroid ointment
98
definition of preterm prelabor rupture of membranes (PPROM)
membrane rupture at <37wks prior to labor onset
99
risk factors for PPROM
prior PPROM
GU infection (ASB, BV)
antepartum bleeding
100
diagnosis of PPROM
vaginal pooling or fluid from cervix
nitrazine-positive fluid
ferning on microscopy
101
management of PPROM in <34wks, reassuring
latency abx, corticosteroids
102
management of PPROM in <34wks, non-reassuring
delivery
103
management of PPROM in >34wks
delivery
104
complications of PPROM
preterm labor
intraamniotic infection
placental abruption
umbilical cord prolapse
105
risk factors of postpartum urinary retention
primiparity
regional neuraxial anesthesia (suppress micturition reflex and decrease detrusor tone -> bladder atony)
operative vaginal delivery
perineal injury (damage to pudendal nerve -> decreased voiding sensation and EUS dysfunction)
cesarean delivery
106
clinical features of postpartum urinary retention
small-volume voids or inability to void
incomplete bladder emptying
dribbling of urine
107
management of postpartum urinary retention
self-limited condition
| intermittent catheterization
108
etiology of condylomata acuminata
HPV 6 & 11
109
clinical features of condylomata acuminata
multiple pink or skin-colored lesions
| lesions ranging from smooth, flattened papules to exophytic/cauliflower-like growths
110
treatment of condylomata acuminata
chemical: podophyllin resin, trichloracetic acid
immunologic: imiquimod
surgical: cryotherapy, laser therapy, excision
111
prevention of condylomata acuminata
vaccination
| barrier protection
112
pathology of a mature cystic teratoma
benign ovarian germ cell tumor
| endoderm, mesoderm, ectoderm tissue
113
clinical features of mature cystic teratoma
most asymptomatic
ovarian torsion
struma ovarii subtype: hyperthyroidism
unilateral adnexal mass
ultrasound: complex, cystic, calcifications
gross appearance: sebaceous fluid, hair, teeth
114
management of mature cystic teratoma
ovarian cystectomy or oopherectomy
115
risk factors of ABO hemolytic disease
infants with blood types A or B born to a mother with blood type O
116
clinical features of ABO hemolytic disease
```
jaundice within 24hrs of birth
anemia
increase reticulocyte count
hyperbilirubinemia
positive Coombs test
```
117
management of ABO hemolytic disease
serial bilirubin levels, oral hydration, & phytotherapy for most neonates
exchange transfusion for severe anemia/hyperbilirubinemia
118
contraindications to copper IUD & progestin IUD placement (shared c/i)
```
pregnancy
endometrial or cervical cancer
unexplained vaginal bleeding
gestational trophoblastic disease
distorted endometrial cavity
acute pelvic infection
```
119
contraindications to progestin IUD
active liver disease
| active breast cancer
120
contraindications to copper IUD
Wilson disease
121
risk factors for intraamniotic infection (chorioamnionitis)
```
prolonged rupture of membranes (>18hrs)
PPROM
prolonged labor
internal fetal/uterine monitoring devices
repetitive vaginal examinations
presence of genital tract pathogens
```
122
diagnosis of chorioamnionitis
maternal fever PLUS >/= 1 of the following:
- fetal tachycardia (>160/min)
- maternal leukocytosis
- purulent amniotic fluid
123
management of chorioamnionitis
broad-spectrum abx
| delivery
124
maternal complications of chorioamnionitis
postpartum hemorrhage, endometritis
125
neonatal complications of chorioamnionitis
preterm birth, pneumonia, encephalopathy
126
what is the postexposure prophylaxis for sexual assault?
```
chlamydia - azithromycin
gonorrhea - ceftriaxone
trich - metronidazole
HIV - multidrug regimen (tenofovir-emtricitabine with raltegravir)
hep B - hep B vax +/- hep B IG
```
127
indications for prophylactic administration of anti-D IG for Rh (D) - negative patients
- at 28-32wks gestation
- <72hrs after delivery of Rh(D)-positive infant
- <72hrs after spontaneous abortion
- ectopic pregnancy
- threatened abortion
- hydatidiform mole
- chorionic villus sampling, amniocentesis
- abdominal trauma
- 2nd- & 3rd- trimester bleeding
- external cephalic version
128
clinical features of PCOS
androgen excess : acne, male pattern baldness, hirsutism
oligoovulation or anovulation : menstrual irregularities
obesity
polycystic ovaries on ultrasound
129
pathophysiology of PCOS
increase testosterone
increase estrogen
LH/FSH imbalance
130
comorbidities of PCOS
metabolic syndrome
obstructive sleep apnea
nonalcoholic steatohepatitis
endometrial hyperplasia/cancer
131
treatment options of PCOS
weight loss (first line)
OCPs for menstrual regulation
letrozole for ovulation induction
132
evaluation of unilateral nipple discharge
pathologic discharge
- breast ultrasound
- mammography if >30yo
133
evaluation of bilateral nipple discharge that is bloody or serous
pathologic discharge
- breast ultrasound
- mammography if >30yrs old
134
evaluation of bilateral nipple discharge if milky, nonbloody with palpable lump or skin change
pathologic discharge
- breast ultrasound
- mammography if >30
135
evaluation of bilateral nipple discharge if milky, nonbloody and without palpable lump or skin change
likely physiologic
- pregnancy test
- guaiac test
- serum prolactin, TSH
- consider MRI of pituitary
136
risk factors for uterine sarcoma
pelvic radiation
tamoxifen use
potsmenopausal patients
137
presentation of uterine sarcoma
abnormal/postmenopausal bleeding
pelvic pain or pressure
uterine mass
138
diagnosis of uterine sarcoma
ultrasound +/- additional imaging
endometrial biopsy
histopathology of surgical specimen
139
treatment of uterine sarcoma
hysterectomy
| +/- adjuvant chemotherapy, radiation therapy
140
risk factors of chlamydia & gonorrhea in women
age <25
| high-risk sexual behavior
141
manifestations of chlamydia & gonorrhea in women
asymptomatic
cervicitis
urethritis
perihepatitis (Fitz-Hugh-Curtis syndrome)
142
diagnosis of gonorrhea and chlamydia in women
nucleic acid amplification testing
143
treatment of chlamydia and gonorrhea in women
empiric: azithromycin + ceftriaxone
confirmed chlamydia: azithromycin
confirmed gonorrhea: azithromycin + ceftriaxone
144
complications of gonorrhea and chlamydia in women
pelvic inflammatory disease
ectopic pregnancy
infertility
145
genotype of α-thalassemia minima
1 gene loss
| aa/a-
146
genotype of α-thalassemia minor
2 gene loss
| aa/-- or a-/a-
147
genotype. of hemoglobin H disease
3 gene loss
| a-/--
148
genotype of hydrops fetalis, hemoglobin Barts
4 gene loss
| --/--
149
clinical features of α-thalassemia minima
asymptomatic, silent carrier
150
clinical features of α-thalassemia minor
mild microcytic anemia
151
clinical features of hemoglobin H disease
chronic hemolytic anemia
152
clinical features of hydrops fetalis, hemoglobin Barts
high-output cardiac failure, anasarca, death inutero
153
definition of nonalcoholic fatty liver disease
hepatic steatosis on imaging or biopsy
exclusion of significant alcohol use
exclusion of other causes of fatty liver
154
clinical features of non-alcoholic fatty liver disease
mostly asymptomatic
metabolic syndrome
+/- steatohepatitis (AST/ALT ratio <1)
hyperechoic texture on ultrasound
155
treatment of non-alcoholic fatty liver disease
diet & exercise
| consider bariatric surgery if BMI >/= 35
156
Rome IV diagnostic criteria of irritable bowel syndrome
recurrent abdominal pain/discomfort >/= 1 day/week for past 3 months & >/= 2 of:
- related to defecation (improves or worsens)
- change in stool frequency
- change in stool form
157
alarm features of irritable bowel syndrome
```
older age of onset (>50)
GI bleeding
nocturnal diarrhea
worsening pain
unintended weight loss
iron deficiency anemia
elevated CRP
positive fecal lactoferrin or calprotectin
family history of early colon cancer or IBD
```
158
modifiable breast cancer risk factors
hormone replacement therapy
nulliparity
increased age at first live birth
alcohol consumption
159
non-modifiable breast cancer risk factors
genetic mutation or breast cancer in first-degree relatives
white race
increasing age
early menarche or later menopause
160
reactive nonstress test
baseline of 110-160/min
moderate variability (6-25/min)
>2 accelerations in 20mins, each peaking >15/min above baseline & lasting >15sec
161
nonreactive nonstress test
does not meet criteria for reactivity
162
recommended vaccines during pregnancy
Tdap
inactivated influenza
Rho(D) IG
163
vaccines indicated for high risk pregnant patients
```
Hep B
Hep A
pneumococcus
Haemophilus influenzae
Meningococcus
Varicella-zoster IG
```
164
vaccines contraindicated in pregnancy
HPV
MMR
live attenuated influenza
varicella
165
risk factors for ectopic pregnancy
previous ectopic pregnancy
previous pelvic/tubal surgery
PID
166
clinical features of ectopic pregnancy
abdominal pain, amenorrhea, vaginal bleeding
hypovolemic shock in ruptured ectopic pregnancy
cervical motion, adnexal &/or abdominal tenderness
+/- palpable adnexal mass
167
diagnosis of ectopic pregnancy
positive hCG
| TVUS revealing adnexal mass, empty uterus
168
management of ectopic pregnancy
stable: methotrexate
unstable: surgery
169
pregnancy management of patient with no prior HSV infection
routine prenatal care
170
pregnancy management of patient with prior HSV infection
antiviral suppression beginning at 36 wks
171
pregnancy management of patient with lesion/prodromal symptoms of HSV during labor
Cesarean delivery
172
pregnancy management of patient with history of HSV without lesion/prodromal symptoms of HSV during labor
vaginal delivery
173
risk factors of intrauterine adhesions
infection - septic abortion, endometritis
| intrauterine surgery - curettage, myomectomy
174
clinical features of intrauterine adhesions
```
abnormal uterine bleeding
amenorrhea
infertility
cyclic pelvic pain
recurrent pregnancy loss
```
175
evaluation of intrauterine adhesions
hysteroscopy
176
etiology of condyloma acuminata in children
HPV
177
clinical features of condyloma acuminata in children
pink/flesh-colored, verrucous papules & plaques
asymptomatic (most common)
pruritic, friable lesions
178
management of condyloma acuminata in children
sexual abuse assessment, especially age >4
179
clinical features of intrahepatic cholestasis of pregnancy
```
develops in 3rd trimester
generalized pruritus
pruritus worse on hands and feet
no associated rash
RUQ pain
```
180
laboratory abnormalities of intrahepatic cholestasis of pregnancy
increase total bile acids (>10micromol/L)
increase transaminases (<2x normal)
+/- increase total & direct bilirubin
181
obstetric risks of intrahepatic cholestasis of pregnancy
intrauterine fetal demise
preterm delivery
meconium-stained amniotic fluid
neonatal respiratory distress syndrome
182
management of intrahepatic cholestasis of pregnancy
delivery at 37wks gestation
ursodeoxycholic acid
antihistamines
183
clinical features of chronic autoimmune thyroiditis (Hashimoto thyroiditis)
predominant hypothyroid features
| diffuse goiter
184
diagnostic testing of chronic autoimmune thyroiditis (hashimoto thyroiditis)
positive TPO antibody
| variable radioiodine uptake
185
clinical features of painless thyroiditis (silent thyroiditis)
variant of chronic autoimmune thyroiditis
mild, brief hyperthyroid phase
small, nontender goiter
spontaneous recovery
186
diagnostic testing of painless thyroiditis (silent thyroiditis)
positive TPO antibody
| low radioiodine uptake
187
clinical features of subacute thyroiditis (deQuervain thyroiditis)
likely postviral inflammatory process
prominent fever & hyperthyroid symptoms
painful/tender goiter
188
diagnostic testing of subacute thyroiditis
elevated ESR & CRP
| low radioiodine uptake
189
GU syndrome of menopause symptoms
```
vulvovaginal dryness, irritatoin, pruritus
dyspareunia
vaginal bleeding
urinary incontinence, recurrent UTIs
pelvic pressure
```
190
GU syndrome of menopause physical examination
narrowed introitus
pale mucosa, decreased elasticity, decreased rugae
petechiae, fissures
loss of labial volume
191
GU syndrome of menopause treatment
vaginal moisturizer & lubricant
| topical vaginal estrogen
192
risk factors for cervical cancer
```
immunocompromise
early onset of sexual activity
multiple or high-risk sexual partners
previous STI
tobacco use
```
193
pathogenesis of cervical cancer
HPV infection (16 & 18)
194
clinical manifestations of cervical cancer
```
asymptomatic
postcoital or intermenstrual bleeding
increased vaginal discharge
inguinal lymphadenopathy
pelvic or low back pain
```
195
diagnosis of cervical cancer
cervical biopsy on colposcopy
196
clinical presentation of epithelial ovarian carcinoma
asymptomatic; incidental adnexal mass
subacute: pelvic/abdominal pain, bloating, early satiety
acute: dyspnea, obstipation/constipation, abdominal distension
197
risk factors of epithelial ovarian carcinoma
```
family history
genetic mutations (BRCA1, BRCA2)
age >50
HRT
endometriosis
infertility
early menarche/late menopause
```
198
protective factors of epithelial ovarian carcinoma
OCPs
multiparity
breastfeeding
199
laboratory findings of epithelial ovarian carcinoma
increase CA-125
200
ultrasound findings of epithelial ovarian carcinoma
solid, complex mass
thick septations
ascites
201
management of epithelial ovarian carcinoma
surgical exploration
| +/- chemotherapy
202
pathogenesis of sertoli-leydig cell tumor
sex cord-stromal tumor
| increase testosterone
203
clinical features of sertoli-leydig cell tumor
```
rapid onset virilzation
- voice deepening
- male-pattern balding
- increased muscle mass
- clitoromegaly
oligomenorrhea
unilateral, solid adnexal mass
```
204
management of sertoli-leydig cell tumors
surgery (tumor staging)
205
clinical features of uterine leiomyomas (fibroids)
```
heavy, prolonged menses
pressure symptoms
- pelvic pain
- constipation
- urinary frequency
obstetric complications
- impaired fertility
- pregnancy loss
- preterm labor
enlarged, irregular uterus
```
206
workup of uterine leiomyomas
ultrasound
207
treatment of uterine leiomyomas
asymptomatic: observation
symptomatic: CHC, surgery
208
clinical features of PMS/PMDD
physical: bloating, fatigue, headaches, hot flashes, breast tenderness
behavioral: anxiety, irritability, mood swings, decreased interest
209
evaluation of PMS/PMDD
symptom/menstrual diary
210
treatment of PMS/PMDD
SSRI
211
ultrasound findings of congenital CMV
```
periventricular calcifications
ventriculomegaly
microcephaly
intrahepatic calcifications
fetal growth restriction
hydrops fetalis
```
212
neonatal features of congenital CMV
petechiae
hepatosplenomegaly
chorioretinitis
microcephaly
213
long-term sequelae of congenital CMV
sensorineural hearing loss
seizures
developmental delay
214
description of lochia rubra
dark or bright red (blood)
odor similar to that of menstrual blood
occasional small clots
quantity decreasing each day
215
expected duration of lochia rubra
birth to 3-4 days postpartum
216
description of lochia serosa
serosanguineous (pink)
brownish (old blood)
quantity gradually decreasing in amount
217
expected duration of lochia serosa
4th postpartum day to 10th or 14th postpartum day
218
description of lochia alba
white/yellow
creamy
light quantity
219
expected duration of lochia alba
11th postpartum day to 6wks postpartum
220
risk factors of pyelonephritis in pregnancy
asymptomatic bacteriuria
diabetes mellitus
age <20
221
common pathogens of pyelonephritis in pregnancy
Escherichia coli
Klebsiella
Enterobacter
Group B strep
222
complications of pyelonephritis in pregnancy
preterm labor
low birth weight
acute respiratory distress syndrome
223
treatment of pyelonephritis in pregnancy
IV abx
| supportive therapy
224
contraindication to labetalol
asthma
225
treatment of pre-eclampsia acutely
IV hydralazine, IV labetalol, or nifedipine PO
| - lower BP acutely to decrease stroke risk
226
prevention/treatment of eclamptic seizures
magnesium sulfate IV or IM
227
management of CIN 3 if not currently pregnant
LEEP
cold knife conization
cryoablation
228
follow-up testing for CIN 3
pap testing with HPV co-testing 1 and 2 years postprocedure
229
definition of postpartum hemorrhage
>500mL after vaginal delivery
| >1000mL after cesarean delivery
230
risk factors for postpartum hemorrhage
```
prolonged or induced labor
chorioamnionitis
multiple gestation
polyhydraminos
grand multiparity
operative delivery
```
231
causes of postpartum hemorrhage
```
uterine atony (most common)
retained placenta
genital tract laceration
uterine rupture
coagulopathy
```
232
treatment of postpartum hemorrhage
```
bimanual uterine massage, oxytocin
IV fluids, oxygen
uterotonics - methylergonovine, carboprost, misoprostol
intrauterine balloon tamponade
uterine artery embolization
hysterectomy
```
233
how does neonatal lupus occur
passive placental transfer of maternal anti-SSA (Ro) and anti-SSB (La) antibodies
234
fetal findings of neonatal lupus
cardiac and cutaneous
235
most serious fetal finding of neonatal lupus
fetal atrioventricular block -> fetal bradycardia
236
what can prolonged fetal heart block cause?
cardiomyopathy and hydrops fetalis
237
what is the treatment of retroperitoneal hematoma
emergency laparotomy
238
what is the cause of post-cesarean delivery patients with hemorrhagic shock?
if no signs of uterine atony, most likely have intraabdominal bleeding from uterine artery injury
- most likely retroperitoneum bleeding
- no incisional bleeding
- minimal abdominal or back pain
239
what are the signs of hypovolemic shock due to postpartum hemorrhage
hypotension, tachycardia, and signs of decreased end-organ perfusion (e.g. fatigue, lightheadedness, cold skin)
240
most common cause of postpartum hemorrhage
uterine atony
241
what can be diagnosed in the second-trimester quadruple screen?
trisomy 18
trisomy 21
neural tube or abdominal wall defect
242
what markers are tested in the second-trimester quadruple screen?
maternal serum α-fetoprotein
ß-hCG
estriol
inhibin A
243
what are the markers for trisomy 18?
decreased maternal serum α-fetoprotein, ß-hCG, and estriol
| normal inhibin A
244
what are the markers for trisomy 21?
decreased maternal serum α-fetoprotein, estriol
| increased ß-hCG, inhibin A
245
what are the markers for neural tube or abdominal wall defects?
increased maternal serum α-fetoprotein
| normal ß-hCG, estriol, inhibin A
246
how do you evaluate suspected polyuria?
complete 24hr urine collection
247
what to do if complete 24hr urine output is <3L?
not true polyuria
| work up causes of urinary frequency
248
what is the diagnosis of complete 24hr urine output >3L?
polyuria present
249
if urine output in 24hrs >3L AND dilute:
water diuresis
| primary polydipsia, diabetes insipidus
250
if urine output in 24hrs >3L AND concentrated
osmotic diuresis
| increased solute excretion (glucose, urea, saline)
251
benefits of estrogen-progestin contraceptives
```
pregnancy prevention
endometrial & ovarian cancer risk reduction
menstrual regulation (e.g. anovulation, dysmenorrhea, anemia)
hyperandrogenism treatment (e.g. hirsutism, acne)
```
252
risks of estrogen-progestin contraceptives
```
venous thromboembolism
hypertension
hepatic adenoma
stroke, myocardial infarction (both very rare)
cervical cancer
```
253
who are high-risk patients for STI screening in pregnancy
age <25
prior STI
high-risk sexual activity (e.g. multiple partners, commercial sex work)
254
what is the required screening of high-risk STIs in pregnancy
performed at initial PNV & 3rd trimester
- HIV
- syphilis
- hepatitis B
- gonorrhea
- chlamydia
255
what is the pathogenesis of endometriosis
ectopic implantation of endometrial glands
256
clinical features of endometriosis
```
dyspareunia
dysmenorrhea
chronic pelvic pain
infertility
dyschezia
```
257
physical examination of endometriosis
immobile uterus
cervical motion tenderness
adnexal mass
rectovaginal septum, posterior cul-de-sac, uterosacral ligament nodules
258
diagnosis of endometriosis
direct visualization and surgical biopsy
259
treatment of endometriosis
medical (OCPs, NSAIDs)
| surgical resection
260
etiology of vulvar cancer
persistent HPV infection
| chronic inflammation
261
risk factors of vulvar cancer
```
tobacco use
vulvar lichen sclerosus
immunodeficiency
prior cervical cancer
vulvar/cervical intraepithelial neoplasia
```
262
clinical features of vulvar cancer
vulvar pruritus
vulvar plaque/ulcer
abnormal bleeding
263
diagnosis of vulvar cancer
biopsy
264
management of preterm prelabor ROM - first question
<34 wks or 34 to <37wks?
265
management of preterm prelabor ROM if 34 to <37wks
```
delivery
GBS prophylaxis (e.g. PenG)
+/- corticosteroids
```
266
management of preterm prelabor ROM if <34wks and uncomplicated
expectant management
latency antibiotics (e.g. ampicillin & azithromycin)
corticosteroids
fetal surveillance
267
management of preterm prelabor ROM if <34 wks and complicated by infection, fetal/maternal compromise
delivery
intra-amniotic infection treatment (e.g. ampicillin & gentamicin)
corticosteroids
magnesium if <32wks
268
what is eclampsia
severe preeclampsia + seizures
269
clinical features of eclampsia
```
hypertension
proteinuria
severe headaches
visual disturbances
right upper quadrant or epigastric pain
3-4mins of tonic-clonic seizure, usually self-limited
```
270
management of eclampsia
administer magnesium sulfate
administer antihypertensive agent
deliver the fetus
271
etiology of esophageal perforation
```
instrumentation (e.g. endoscopy), trauma
effort rupture (Boerhaave syndrome)
esophagitis (infectious/pills/caustic)
```
272
clinical presentation of esophageal perforation
chest/back &/or epigastric pain, systemic signs (e.g. fever)
crepitus, Hamman sign (crunching sound on auscultation)
pleural effusion with atypical (e.g. green) fluid
273
diagnosis of esophageal perforation on chest x-ray or CT scan
widened mediastinum pneumomediastinum, pneumothorax, pleural effusion
274
diagnosis of esophageal perforation on CT scan
esophageal wall thickening, mediastinal fluid collection
275
diagnosis of esophageal perforation on esophagography with water-soluble contrast
leak from perforation
276
management. of esophageal perforation
NPO, IV antibiotics & proton pump inhibitors
| emergency surgical consultation
277
what is the inheritance of hemophilia A
x-linked recessive
278
maternal contraindications to breastfeeding
```
active untreated tuberculosis
HIV infection
herpetic breast lesions
active varicella infection
chemotherapy or radiation therapy
active substance abuse
```
279
infant contraindications to breastfeeding
galactosemia
280
clinical features of engorgement
bilateral, symmetric fullness, tenderness & warmth
281
clinical features of nipple injury
abrasion, bruising, cracking &/or blistering from poor latch
282
clinical features of plugged duct
focal tenderness & firmness &/or erythema
| no fever
283
clinical features of galactocele
subareolar, mobile, well-circumscribed, nontender mass
| no fever
284
clinical features of mastitis
tenderness/erythema + fever
285
clinical features of abscess
symptoms of mastitis + fluctuant mass
286
risk factors of hyperemesis gravidarum
hydatidiform mole
multifetal gestation
history of hyperemesis gravidarum
287
clinical features of hyperemesis gravidarum
severe, persistent vomiting
>5% loss of prepregnancy weight
dehydration
orthostatic hypotension
288
laboratory abnormalities of hyperemesis gravidarum
ketonuria
hypochloremic metabolic alkalosis
hypokalemia
hemoconcentration
289
treatment of hyperemesis gravidarum
admission to hospital
| antiemetics & IV fluids
290
pathogenesis of granulosa cell tumor
sex cord- stromal tumor
increase estradiol
increase inhibin
291
clinical features of granulosa cell tumor
```
complex ovarian mass
juvenile subtype
- precocious puberty
adult subtype
- breast tenderness
- abnormal uterine bleeding
- postmenopausal bleeding
```
292
histopathology of granulosa cell tumor
Call-Exner bodies (cells in rosette pattern)
293
management of granulosa cell tumor
```
endometrial biopsy (endometrial cancer)
surgery (tumor staging)
```
294
definition of fetal growth restriction
ultrasound estimated fetal weight <10th percentile for gestational age
295
onset of symmetric fetal growth restriction
1st trimester
296
onset of asymmetric fetal growth restriction
2nd/3rd trimester
297
etiology of symmetric fetal growth restriction
chromosomal abnormalities
| congenital infection
298
etiology of asymmetric fetal growth restriction
utero-placental insufficiency
| maternal malnutrition
299
clinical features of symmetric fetal growth restriction
global growth lag
300
clinical features of asymmetric fetal growth restriction
'head-sparing' growth lag
301
management of fetal growth restriction
weekly biophysical profiles
serial umbilical artery Doppler sonography
serial growth ultrasounds
302
primary syphilis manifestations
painless genital ulcer (chancre)
303
secondary syphilis manifestations
```
diffuse rash (palms & soles)
lymphadenopathy (epitrochlear)
condyloma latum
oral lesions
hepatitis
```
304
latent syphilis manifestations
asymptomatic
305
tertiary syphilis manifestations
CNS (tabes dorsalis, dementia)
cardiovascular (aortic aneurysm/insufficiency)
cutaneous (gummas)
306
first test in evaluation of secondary amenorrhea
ß-hCG
307
if ß-hCG negative in secondary amenorrhea, what is checked next?
prolactin
FSH
testosterone
TSH
308
in evaluation of secondary amenorrhea: ß-hCG negative, increase prolactin, normal TSH
pituitary adenoma
309
in evaluation of secondary amenorrhea: ß-hCG negative, increase FSH
primary ovarian insufficiency
310
in evaluation of secondary amenorrhea: ß-hCG negative, hormones normal
prior uterine procedure
| Asherman syndrome
311
in evaluation of secondary amenorrhea, ß-hCG negative, increase testosterone
PCOS
312
in evaluation of secondary amenorrhea: ß-hCG negative, increase TSH
hypothyroidism
313
definition of intrauterine fetal demise
fetal death at >20wks
314
diagnosis of intrauterine fetal demise
absence of fetal cardiac activity on ultrasound
315
management of intrauterine fetal demise at 20-23wks
dilation & evacuation
OR
vaginal delivery
316
management of intrauterine fetal demise at >24wks
vaginal delivery
317
complication of intrauterine fetal demise
coagulopathy after several weeks of fetal retention
318
clinical features of primary ovarian insufficiency
amenorrhea at age <40
hypoestrogenic symptoms (e.g. hot flashes)
increase FSH
decrease estrogen
319
major causes of primary ovarian insufficiency
```
Turner syndrome (45, XO)
fragile X syndrome (FMR1 premutation)
autoimmune oophoritis
anticancer drugs
pelvic radiation
galactosemia
```
320
management of primary ovarian insufficiency
estrogen therapy (with progestin if intact uterus)
321
management of endometriosis
suspected endometriosis
- chronic pelvic pain
- dysmenorrhea
- deep dyspareunia
- dyschezia
322
questions to ask in management of endometriosis
contraindications to medical therapy?
need for definitive diagnosis?
history of infertility?
concern for malignancy or adnexal mass?
323
if the answer is yes to questions re endometriosis:
laparoscopy
324
if the answer is no to questions re endometriosis
NSAIDs +/- oral contraceptives
| -> laparoscopy
325
pathogenesis of endometriosis
ectopic implantation of endometrial glands
326
clinical features of endometriosis
```
dyspareunia
dysmenorrhea
chronic pelvic pain
infertility
dyschezia
```
327
physical examination of endometriosis
immobile uterus
cervical motion tenderness
adnexal mass
rectovaginal septum, posterior cul-de-sac, uterosacral ligament nodules
328
diagnosis of endometriosis
direct visualization & surgical biopsy
329
treatment of endometriosis
medical (OCPs, NSAIDs)
| surgical resection
330
what is the management of shoulder dystocia?
BE CALM
B - breathe; do not push
E - elevate legs & flex hips, thighs against abdomen (McROberts)
C - call for help
A - apply suprapubic pressure
L - enLarge vaginal opening with episiotomy
M - Maneuvers
- deliver posterior arm
- rotate posterior shoulder (Woods screw): apply pressure to anterior aspect of the posterior shoulder
- adduct posterior fetal shoulder (Rubin): apply pressure to the posterior aspect of the posterior shoulder
- mother on hands & knees : ' all fours' (Gaskin)
- replace fetal head into pelvis for cesarean delivery (Zavanelli)
331
severe side effect of oxytocin
severe hyponatremia
| -> seizure
332
treatment of oxytocin-induced hyponatremia
cessation of oxytocin infusion
gradual administration of hypertonic saline in symptomatic patients (e.g. seizures) to raise serum osmolality and reverse cerebral edema
333
what risk factors make methotrexate more likely to fail for ectopic pregnancy
ß-hCG >5000
gestational sac >3-4cm
positive fetal heart tones
334
treatment of symptomatic condyloma acuminata in pregnancy
trichloroacetic acid
335
treatment of endometriosis
laparoscopy
336
screening tests in the first trimester (before 14wks)
nuchal translucency ultrasound with PAPP-A
| hCG measurement
337
relative contraindication to IUD
history of STI within the past 3 months
338
what is the initial diagnostic testing for PCOS
serum testosterone
339
after stabilizing the patient's airway what is the most appropriate management for hypovolemic shock?
massive transfusion of packed red blood cells
340
what is the most appropriate course of action for a patient with suspected domestic violence?
ask open-ended questions to learn about possible abuse
341
what can poorly controlled blood sugars in the second and third trimester cause?
diabetic fetopathy
- fetal hyperinsulinemia
- hyperglycemia
- macrosomia
342
what is the screening test for HIV
HIV-1/2 antibodies and p24 antigen assay
343
presentation of tubo-ovarian abscess
fever, abdominal pain, and a complex multiloculated adnexal mass with thick walls and internal debris
344
laboratory findings in tubo-ovarian abscess
nonspecific increases
- leukocytosis, CRP, CA-125
- paired with fever -> infection rather than malignancy
345
how to diagnose tubo-ovarian abscess
imaging (pelvic ultrasound/CT scan)
346
treatment of TOA
broad-spectrum parenteral antibiotics
347
risk factor for magnesium toxicity
renal insufficiency
| - excreted by the kidneys
348
clinical features of magnesium toxicity
mild: nausea, flushing, HA, hyporeflexia
moderate: areflexia, hypocalcemia, somnolence
severe: respiratory paralysis, cardiac arrest
349
maternal cardiopulmonary adaptations in pregnancy
```
cardiac:
- increase cardiac output
- increase plasma volume
- decrease SVR
respiratory:
- increase tidal volume
- decrease functional residual capacity (elevation of diaphragm
```
350
clinical manifestations of maternal cardiopulmonary adaptations to pregnancy
```
peripheral edema
decrease BP
increase HR
systolic ejection murmur
dyspnea
```
351
pathogenesis of adenomyosis
abnormal endometrial tissue within the uterine myometrium
352
risk factors for adenomyosis
age >40
multiparity
prior uterine surgery (e.g. myomectomy)
353
clinical features of adenomyosis
```
dysmenorrhea
heavy menstrual bleeding
chronic pelvic pain
diffuse uterine enlargement (e.g. globular uterus)
+/- uterine tenderness
```
354
diagnosis of adenomyosis
clinical presentation
MRI & ultrasound: thickened myometrium
confirmation via pathology
355
treatment of adenomyosis
hysterectomy
356
adenomyosis vs. fibroids
adenomyosis
- chronic pelvic pain
- boggy and tender symmetrically enlarged uterus
fibroids
- pelvic pressure
- firm, irregularly enlarged uterus
357
what are endometrial polyps
common, well-vascularized, hyperplastic endometrial gland growths that extend into the uterine cavity
358
signs of endometrial polyps
abnormal uterine bleeding due to their friability and vascularity
- do not affect ovulation, so typically have regular monthly menses with painless, light intermenstrual bleeding
359
treatment of endometrial polyps
hysteroscopic polypectomy
360
definition of urethral diverticulum
urethral mucosa herniated into surrounding tissue
361
clinical features of urethral diverticulum
dysuria
postvoid dribbling
dyspareunia
anterior vaginal wall mass - associated expressed purulent or bloody urethral discharge
362
treatment of urethral diverticulum
surgical excision of the diverticulum
363
symptoms of PID
lower abdominal pain
| abnormal bleeding
364
physical exam of PID
cervical motion tenderness
fever >38.3 C (>100.9)
mucopurulent cervical discharge
365
treatment of PID
third-generation cephalosporin + azithormycin or doxycycline
366
complications of PID
tubo-ovarian abscess
infertility
ectopic pregnancy
perihepatitis
367
what is Fitz-Hugh-Curtis disease
infection extends from the upper genital tract to spread throughout the abdomen and cause liver capsule inflammation
- patients with hepatic involvement present with symptoms of acute PID (fever, lower abdominal pain) as well as pleuritic RUQ pain
368
clinical features of acute fatty liver of pregnancy
nausea, vomiting
RUQ pain/epigastric pain
fulminant liver failure
369
laboratory findings of acute fatty liver of pregnancy
```
profound hypoglycemia
increase aminiotransferases (2-3x normal)
increase bilirubin
thrombocytopenia
DIC
```
370
management of acute fatty liver of pregnancy
immediate delivery regardless of gestational age
371
clinical features of menopause
- vasomotor symptoms
- oligomenorrhea/amenorrhea
- sleep disturbances
- decreased libido
- depression
- cognitive decline
- vaginal atrophy
372
diagnosis of menopause
clinical manifestations
| increase FSH
373
treatment of menopause
topical vaginal estrogen
| systemic hormone replacement therapy
374
what is ovulation
transition from the follicular phase to the luteal phase
375
what occurs before ovulation
LH surge
376
what is cervical mucus
secreted close to ovulation (late follicular phase) increases in quantity and can be perceived by patients as vaginal discharge
- clear, elastic, thin in consistency, and described similar in appearance to an uncooked egg white
- thought to facilitate transport into the uterus for conception
377
clinical presentation of acute appendicitis
nausea, vomiting, anorexia
initially: diffuse abdominal pain (visceral pain)
later: localized RLQ pain (somatic pain)
mild leukocytosis
378
examination of acute appendicitis
McBurney point tenderness
psoas sign: pain with right hip extension
obturator sign: pain with right hip internal rotation
rovsing sign: RLQ pain with LLQ palpation
379
diagnosis of acute appendicits
clinical presentation
| CT scan or ultrasound
380
treatment of acute appendicitis
surgical appendectomy
381
acute appendicitis vs. ectopic pregnancy vs. ovarian torsion
acute appendicits: intrauterine pregnancy with normal adnexa and normal Doppler
ectopic pregnancy: non-intrauterine pregnancy
ovarian torsion: intrauterine pregnancy with abnormal Doppler
382
what is tranexamic acid
antifibrinolytic agent that prevents the breakdown of blood clots to achieve hemostasis
383
neonatal abstinence syndrome
high-pitched cry and irritability, sleep/wake disturbances, hyperactive primitive reflexes, hypertonicity, difficulty feeding, GI disturbances, autonomic dysfunction, and failure to thrive
384
what is the first step in managing postmenopausal bleeding
endometrial biopsy to exclude endometrial hyperplasia or endometrial carcinoma
385
causes of chronic neuropathic pelvic pain
entrapment of the ilioinguinal and/or iliohypogastric nerves during closure of a low-transverse fascial incision
386
where does ilioinguinal nerve entrapment occur
commonly at the lateral edge of the fascial incision where the nerves are coursing between the transversalis and internal oblique muscles
387
hallmark of neuropathic pain by nerve entrapment
burning or searing pain that is reproducible with palpation
388
trigger point nodule palpated at the lateral incision of c/section
inject with local anesthetics for diagnostic & therapeutic relief
389
what is the most common neonatal complication associated with vacuum-assisted delivery
cephalohematoma
- can result in hyperbilirubinemia as the extra blood products in the hematoma break down and enter the bloodstream
- causes jaundice
390
what is Kleihauer-Betke testing
serum evaluation that detects and quantifies fetal blood cells within maternal circulation
391
what is massive fetomaternal hemorrhage
blood loss of greater than 20mL/kg fetal weight
| can occur spontaneously and can lead to intrauterine fetal demise
392
how is a stillbirth defined
fetal demise after 20wks GA
393
maternal symtpoms of fetal demise
decreased fetal movement and decrease in pregnancy symtpoms (breast tenderness, nausea, fatigue)
394
how is an unexplained stillbirth evaluated
postmortem diagnostic testing
- complete blood count
- urine toxicology
- serology for syphilis (in absence of prior testing)
- blood antibody screen (r/o alloimmunization)
- fasting glucose or glycosylated glucose testing (in absence of prior gestational diabetes testing)
- Kleihauer-Betke testing or flow cytometry to detect presence of fetomaternal hemorrhage
395
how to evaluate fetal hypoxemia
fetal scalp stimulation to induce accelerations
396
what is acute salpingitis
synonymous with pelvic inflammatory disease
397
most common cause of acute salpingitis
chlamydia trachomatis
| neisseria gonorrhea
398
sexually active woman without a more likely cause for abdominal pain
PID - minimal diagnostic criteria:
| - adnexal, uterine, or cervical tenderness on exam
399
supportive findings for diagnosis of PID
```
vaginal discharge
fever >101
elevated CRP or ESR
positive chlamydia/gonorrhea testing
pelvic ultrasound = dilated tortuous fallopian tube (hydrosalpinx)
```
400
what's the first thing a patient should receive upon admission for delivery?
IV catheter
401
what to give a patient who is stable, likely to deliver immediately, <34wks GA?
tocolytics to allow administration of a full course of antenatal corticosteroids, which takes 48hrs
402
most commonly given tocolytics
indomethacin
CCBs
terbutaline (beta2-agonist)
magnesium sulfate
403
what causes functional hypogonadotropic hypogonadism
excessive weight loss
strenuous exercise
chronic illness
eating disorder
404
what does hypogonadotropic hypogonadism cause?
decreased adipose tissue/fat reserves -> decrease leptin production
- > decrease GnRH from hypothalamus
- > decrease LH, FSH from pituitary
- > decrease estrogen from ovaries
- > amenorrhea, bone loss
405
risk factors for cervical insufficiency
collagen defects
uterine abnormalities
cervical conization
obstetric injury
406
clinical features of cervical insufficiency
>/= 2 prior painless, 2nd-trimester losses
| painless cervical dilation
407
management of cervical insufficiency
cerclage placement
408
how to diagnose cervical insufficiency
1 of:
- painless cervical dilation in the current pregnancy
OR
- second-trimester cervical length of = 2.5cm plus a prior preterm delivery (i.e. ultrasound-based)
OR
>/= prior consecutive, painless, second-trimester losses (i.e. history-based), which typically present with mild symptoms (e.g. vaginal discharge, light spotting) followed by precipitous delivery
409
risk factors for placenta previa
prior placenta previa
prior cesarean delivery
multiple gestation
410
clinical features of placenta previa
painless vaginal bleeding >20wks gestation
411
diagnosis of placenta previa
transabdominal followed by transvaginal sonogram
412
management of placenta previa
no intercourse
no digital cervical examination
inpatient admission for bleeding episodes
413
risk factors for septic abortion
retained POC from:
- elective abortion with nonsterile technique
- missed or incomplete abortion (rare)
414
clinical presentation for septic abortion
fever, chills, abdominal pain
sanguinopurulent vaginal discharge
boggy, tender uterus, dilated cervix
pelvic ultrasound: retained POC, thick endometrial stripe
415
management of septic abortion
IV fluids
broad-spectrum antibiotics
suction curettage
416
presentation of adenomyosis
heavy monthly menstrual bleeding with dysmenorrhea
417
what is the Jarisch-Herxheimer reaction
patients receiving antibiotics for syphilis
418
what is Jarisch-Herxheimer reaction characterized by
headache, fever, flushing, tachycardia, and hypotension
- begins within 1-2hrs after initiation
- self-limited to 24-48hrs
419
treatment of Jarisch-Herxheimer
supportie
| - acetaminophen and IV fluids
420
cause of Jarisch-Herxheimer
occurs after abx treatment of spirochete disease
| - caused by release of large amounts of treponemal lipopolysaccharides and cytokines
421
major risk factor for primary dysmenorrhea
nulliparity
422
what viral load is HIV at greatest risk of causing vertical transmission
> 1000 RNA copies/mL
423
how to handle HIV viral load >1000
final viral load evaluation at 34-36wks
| - Cesarean delivery at 38wks prior to the onset of labor or the rupture of membranes
424
treatment of HIV in pregnancy
IV zidovudine to decrease vertical transmission
| - all HIV-positive mothers should receive a minimum of 6wks of oral zidovudine therapy for prophylaxis
425
what is a rectocele
rectum bulges into the posterior vaginal wall
426
how is a rectocele identified
posterior vaginal wall prolapses while the vaginal apex and anterior vaginal wall are fixated with a bi-valved speculum
427
what is the next step in management of PROM after 34wks?
induction of labor
428
characteristics of klinefelter syndrome
tall slender male with lack of secondary sexual characteristics and infertility
history of learning disorder
shy and immature
429
cause of Klinefelter syndrome
non-disjunction of chromosomes during either meiosis I or meiosis II resulting in XXY karyotype
430
where does the corpus luteum come from
results from LH-induced ovulation
431
cause of postpartum hemorrhage in a patient with presence of firmly contracted uterus
cervical laceration
432
what are you thinking if child presents with age-innappropriate sexual behaviors that are disruptive or intrusive to others
child abuse
433
potential signs of child abuse
inappropriate genital touching and knowledge of sexually explicit anatomy or behavior
regression
434
red flags for child abuse
```
unexplained injuries
changes in behavior
regression to earlier behaviors
signs of neglect
inappropriate sexual behaviors
```
435
how to diagnose congenital CMV
PCR for CMV DNA in the amniotic fluid obtained via amniocentesis
436
what is hysteroscopy used for
evaluation of abnormal uterine bleeding when an endometrialc ause is suspected
437
classic bleeding pattern of an endometrial polyp
metrorrhagia or intermenstrual spotting
438
proper breast examination
sitting and supine
439
what is the first line treatment fo prevention of progression of stress/urge urinary incontinence and pelvic organ prolapse
pelvic floor muscle training
440
what is the most likely cause of irregular bleeding in an adolescent
anovulatory bleeding
| - failure of the ovary to develop a corpus luteum
441
where does the corpus luteum come from
results from LH-induced ovulation
442
why is the corpus luteum important
produces progesterone during a normal menstrual cycle and during pregnancy until about 8-10wks when placenta takes over
443
what is used to avoid cervical lacerations during dilatin
cervical preparation with prostaglandins or osmotic dilators
444
what are important allergies to remember for surgical patients
latex
| - may vary from mild to anaphylaxis
445
most common presentation of anaphylaxis
tachycardia
hypotension
bronchospasm
cutaneous signs - flushing, urticaria
446
what has a cross-allergy to shellfish?
iodine
447
fetal alcohol syndrome characterized by
facial dysmorphisms
- short palpebral fissure, thin upper lip, smooth philtrum
growth retardation
CNS abnormalities
448
what is the preferred med to assist with alcohol cessation during pregnancy
naltrexone
449
what is the most common cause of hypothyroidism
hashimoto thyroiditis
450
what are symptoms of hypothyroidism
```
weight gain
fatigue
dry skin
low pulse
menstrual dysfunction
- secondary amenorrhea -> decreased fertility
```
451
what is decreased in normal pregnancy
SVR
| - widespread vasodilation
452
what is the next step in managing a visible lesion on the cervix
biopsy
453
what does a person have with a visible lesion on cervical exam, postcoital bleeding, and dyspareunia
cervical cancer
454
risks of staphylococcal toxic shock syndrome
tampon use
nasal packing
surgical/postpartum wound infection
455
pathogenesis of staphylococcal toxic shock syndrome
staphylococcus aureus
| exotoxin release acting as superantigens
456
clinical features of staph toxic shock syndrome
fever >38.9 (102)
hypotension
diffuse macular rash involving palms & soles
desquamation 1-3wks after disease onset
vomiting, diarrhea
altered mentation without focal neurological signs
457
treatment of toxic shock syndrome
```
supportive therapy (fluid replacement)
removal of foreign body (tampon)
antibiotic therapy (clindamycin + vancomycin)
```
458
toxic shock rash vs. secondary syphilis
patients with syphilis have an indolent course rather than acute-onset hypotension and tachycardia (shock)
459
disease associations with HPV
```
cervical cancer
vulvar & vaginal cancers
anal cancer
oropharyngial cancer
penile cancer
anogenital warts
recurrent respiratory papillomatosis
```
460
vaccine indications for HPV
all female and male patients age 11-26
| NOT indicated in pregnant women
461
pathogenesis of fetal hydrops
increase cardiac output demand causing heart failure
| increase fluid movement into interstitial spaces (third spacing)
462
clinical features of fetal hydrops
```
pericardial effusion
pleural effusion
ascites
skin edema
placental edema
polyhdramnios
```
463
etiology of fetal hydrops
immune
- Rh(D) alloimmunization
Nonimmune
- parvovirus B19 infection
- fetal aneuploidy
- CV abnormalities
- thalassemia (hemoglobin Barts)
464
pathophysiology of androgen insensitivity syndrome
X-linked mutation in androgen receptor
465
clinical features of androgen insensitivity syndrome
genotypically male (46, XY)
phenotypically female
breast development
absent or minimal axillary & pubic hair
female external genitalia
absent uterus, cervix, & upper 1/3 of vagina
466
management of androgen insensitivity syndrome
gender identity/assignment counseling
| gonadectomy (malignancy prevention)
467
5-α reductase deficiency
cannot convert testosterone to dihydrotestosterone
- appear phenotypically female at birth
- develop virilization at puberty
- no breast development
468
Müllerian agenesis (Mayer-Rokitansky-Küster-Hauser syndrome)
primary amenorrhea due to lack of female internal genitalia
- otherwise normal female development
- female-range testosterone levels
469
cause of postoperative, unilateral back pain, nausea with vomiting and CVA tenderness
hydronephrosis from ureteral injury
470
risk of ureteral injury increases with
obesity
distorted pelvic architecture from malignancy
prior pelvic surgery
471
renal function in ureteral obstruction
normal because only 1 ureter is affected
| - normal creatinine and urinalysis
472
diagnosis of ureteral obstruction
renal ultrasound
473
treatment of ureteral obstruction
surgical correction
474
complications of shoulder dystocia
```
fractured clavicle
fractured humerus
Erb-Duchenne palsy
Klumpke palsy
Perinatal asphyxia
```
475
fractured clavicle
- clavicular crepitus/bony irregularity
- decrease Moro reflex due to pain on affected side
- intact biceps & grasp reflex
476
fractured humerus
- upper arm crepitus/bony irregularity
- decrease Moro reflex due to pain on affected side
- intact biceps & grasp reflex
477
Erb-Duchenne palsy
- decrease Moro & biceps reflexes on affected side
- "waiter's tip" = extended elbow, pronated forearm, flexed wrist & fingers
- intact grasp reflex
- damage to 5th and 6th cervical nerves
478
Klumpke palsy
- "claw hand" = extended wrist, hyperextended metacarpophalangeal joints, flexed interphalangeal joints, absent grasp reflex
- Horner syndrome (ptosis, miosis)
- intact Moro & biceps reflexes
- injury to 8th cervical nerve and 1st thoracic nerve & sympathetic fibers that run along
479
Perinatal asphyxia
- variable presentation depending on duration of hypoxia
| - altered mental status (irritability, lethargy), respiratory or feeding difficulties, poor tone, seizure
480
differential diagnosis for postpartum hemorrhage
uterine atony
retained products of conception
genital tract trauma
inherited coagulopathy
481
risk factors for uterine atony
```
prolonged labor
chorioamnionitis
uterine overdistension (multiples, fetal macrosomia, polyhydramnios)
```
482
examination of uterine atony
enlarged, boggy uterus
483
management of uterine atony
bimanual uterine massage
| uterotonic medications
484
risk factors for retained products of conception
succenturiate placenta
manual extraction of placenta
history of previous uterine surgery
485
examination of retained products of conception
enlarged, boggy uterus
placenta missing cotyledons
retained placental fragments on ultrasound
486
management of retained products of conception
manual extraction
487
risk factors for genital tract trauma
operative vaginal delivery
488
examination of genital tract trauma
laceration of cervix or vagina
| enlarging hematoma
489
management of genital tract trauma
laceration repair
490
risk factors for inherited coagulopathy
history of abnormal bleeding in patient or family members
491
examination of inherited coagulopathy
continued bleeding despite contracted uterus
492
management of inherited coagulopathy
correction of coagulopathy
493
first line treatment for severe hot flashes (vasomotor symptoms)
hormone replacement therapy
494
monochorionic diamniotic twins at risk for
twin-twin transfusion syndrome
495
monochorionic diamniotic twins on ultrasound
T-sign
| - 2 embryos, a single placenta, and a thin intertwin membrane that meets the placenta at a 90degree angle
496
dichorionic diamniotic twins on ultrasound
λ sign
497
complication of monochorionic monoamniotic
cord entanglement
| conjoined twins
498
complication of dichorionic diamniotic twins
vanishing twin syndrome
499
what causes a fever within first 48hrs after surgery?
cytokine-mediated reaction initiated by normal tissue trauma encountered during the procedure
500
management of fever prior to 48hrs postoperatively
expectant management
| - very unlikely to imply true infection
501
what is primary infertility
inability to conceive a child, despite efforts of regular unprotected intercourse, for a period of greater than 1yr
502
what is an important cause of infertility
pelvic inflammatory disease
- occurs in patients with an incompletely treated/untreated STI
- results in inflammation and scarring of reproductive organs
503
most common causes of PID
chlamydia trachomatis
| neisseria gonorrhoeae
504
classic symptoms of PID
abdominal pain, vaginal discharge, fever, cervical motion tenderness, dyspareunia, and irregularities in menstrual cycle
505
how to decrease risk of neonatal sepsis
intrapatum maternal antibiotic therapy
506
causes of early-onset neonatal sepsis
group B streptococcus or Escherichia coli
507
who should receive antibiotics during labor to decrease risk of neonatal sepsis?
all women who are GBS positive during the current pregnancy or had a previous child affected by GBS
women with unknown GBS status who are either preterm or who have ruptured membranes >18hrs or who have fever/chorioamnionitis
508
signs of sepsis in the infant
lethargy, hypoxia, temperature instability, respiratory distress, poor perfusion, and hypotension
509
risk factors for neonatal sepsis
preterm delivery, premature rupture of membranes, prolonged rupture of membranes during delivery, chorioamnionitis, known vaginal GBS colonization during pregnancy, and maternal fever during labor
510
routine postoperative care after cesarean delivery
pain management
maternal-infant bonding (breastfeeding)
prophylaxis for infection
thromboembolism and hemorrhage
511
what is the standard staging and treatment procedure for all endometrial carcinoma?
total extrafasical hysterectomy with bilateral salpingo-oopherectomy with pelvic and paraaortic lymph node dissection
512
what is stage Ia endometrial carcinoma
tumor invades less than half the myometrium or endometrium
513
stage Ib endometrial carcinoma
tumor invades more than half of the myometrium
514
stage II endometrial cancer
tumor invades stromal connective tissue but confined to uterus
515
stage III endometrial cancer
tumors involves vagina, adnexa, with positive regional lymph nodes
516
stage IV endometrial cancer
tumor involves bladder mucosa with distant metastasis
517
treatment of low risk endometrial cancer
stage I
| surgical resection only
518
treatment of intermediate risk endometrial cancer
stage Ib or stromal invasion
| radiation therapy, but no clear data
519
treatment of high risk endometrial cancer
stage III or IV
| chemotherapy and radiation therapy
520
how to diagnose herpes simplex virus
Tzanck smear of vesicle fluid
521
what are typical findings on Tzanck smear
multinucleated giant cells and epithelial cells containing eosinophilic intranuclear inclusion bodies
522
bacterial vaginosis examination
thin, off-white discharge with fishy odor
| no inflammation
523
trichomoniasis examination
thin, yellow-green, malodorous, frothy discharge
| vaginal inflammation
524
candida vaginitis examination
thick 'cottage cheese' discharge
| vaginal inflammation
525
BV lab findings
pH >4.5
clue cells
positive whiff test (amine odor with KOH)
526
trich lab findings
pH >4.5
| motile trichomonads
527
candida lab findings
normal pH
| pseudohyphae
528
BV treatment
metronidazole or clindamycin
529
trich treatment
metronidazole
| treat sexual partner
530
candida treatment
fluconazole
531
how to diagnose vesicovaginal fistula
bladder dye test
532
cause of vesicovaginal fistula
excessive fetal head compression during obstructed labor causes injury & necrosis to the maternal vagina, rectum, and bladder -> erosion and fistula development
- occurs within the first weeks postpartum
533
signs of vesicovaginal fistula
continuous vaginal discharge with an abnormally elevated pH (due to urine) which may be malodorous (due to surrounding necrotic tissue)
534
pelvic exam of vesicovaginal fistula
vaginal pooling of urine, visible defect, or an area of raised, red granulation tissue on the anterior vaginal wall
535
what does total/free T4 do in pregnancy and why
increases
ß-hCG stimulates thyroid hormone production in first trimester
estrogen stimulates TBG; thyroid increases hormone production to maintain steady free T4 levels
536
how is TSH changed in pregnancy and why
decreased
| increased ß-hCG & thyroid hormone suppress TSH secretion
537
what to do with levothyroxine dose during pregnancy?
increase levothyroxine when patient becomes pregnant
538
definition of recurrent cystitis in women
```
>/= 2 infectons in 6 months
>/= 3 infections in a year
```
539
risk factors for recurrent cystitis in women
sexually active
postmenopausal
first UTI at age <15
spermicide use
540
prevention of recurrent cystitis in women
daily abx prophylaxis
| postcoital prophylaxis
541
presentation of a theca lutein cyst
multilocular
bilateral
10-15cm ovaries
542
pathogenesis of theca lutein cyst
ovarian hyperstimulation due to:
- gestational trophoblastic disease
- multifetal gestation
- infertility treatment
543
clinical course of theca lutein cyst
resolve with decreasing ß-hCG levels
544
pathogenesis of sheehan syndrome
obstetric hemorrhage complicated by hypotension
| postpartum pituitary infarction
545
clinical features of sheehan syndrome
lactation failure (decrease prolactin)
amenorrhea, hot flashes, vaginal atrohpy (decrease FSH, LH)
fatigue, bradycardia (decrease TSH)
anorexia, weight loss, hypotension (decrease ACTH)
decreased lean body mass (decrease growth hormone)
546
what is sheehan syndrome
postpartum hypopituitarism
547
manifestations of Sheehan syndrome
fatigue, weight loss, hypotension, inability to breastfeed
548
associated conditions of wernicke encephalopathy
chronic alcoholism (most common)
malnutrition (e.g. anorexia nervosa)
hyperemesis gravidarum
549
pathophysiology of wernicke encephalopathy
thiamine deficiency
550
clinical features of wernicke encephalopathy
encephalopathy
oculomotor dysfunction (e.g. horizontal nystagmus, bilateral abducens palsy)
postural & gait ataxia
551
treatment of wernicke encephalopathy
IV thiamine followed by glucose infusion
552
exocrine features of sjögren syndrome
keratoconjunctivitis sicca
dry mouth, salivary hypertrophy
xerosis
553
extraglandular features of sjögren syndrome
```
raynaud phenomenon
cutaneous vasculitis
arthralgia/arthritis
interstitial lung disease
non-hodgkin lymphoma
```
554
diagnostic findings of sjögren syndrome
objective signs of decreased lacrimation (Schirmer test)
positive anti-Ro (SSA) &/o anti-La (SSB)
salivary gland biopsy with focal lymphocytic sialoadenitis
classification: primary if no associated CTD, secondary if comorbid CTD (SLE, RA, scleroderma
555
what is late-term pregnancy
>/= 41wks gestation
556
what is post-term pregnancy
>/= 42wks gestation
557
risk factors for late & post term pregnancy
```
prior post term pregnancy
nulliparity
obesity
age >/= 35
fetal anomalies (e.g. anencephaly)
```
558
complications of late & post term pregnancy
```
fetal/neonatal
- macrosomia
- dysmaturity syndrome
- oligohydramnios
- demise
maternal
- severe obstetric laceration
- cesarean delivery
- postpartum hemorrhage
```
559
management of late & post term pregnancy
frequent fetal monitoring (nonstress test)
| delivery prior to 43wks gestation
560
onset of anaphylactic transfusion reaction
within seconds to minutes
561
cause of anaphylactic transfusion reaction
recipient anti-IgA antibodies directed against donor blood IgA
562
key features of anaphylactic transfusion reaction
angioedema, hypotension, respiratory distress/wheezing, shock
IgA deficient recipient
563
onset of acute hemolytic transfusion reaction
within 1hr
564
cause of acute hemolytic transfusion reaction
ABO incompatibility (often clerical error)
565
key features of acute hemolytic transfusion reaction
fever, flank pain, hemoglobinuria
disseminated intravascular coagulation
positive Coombs test
566
onset of febrile nonhemolytic transfusion reaction
within 1-6hrs
567
cause of febrile nonhemolytic transfusion reaction
cytokine accumulation during blood storage
568
key features of febrile nonhemolytic transfusion reaction
fever & chills
569
onset of urticarial transfusion reaction
within 2-3hrs
570
cause of urticarial transfusion reaction
recipient IgE against blood product component
571
key features of urticarial transfusion reaction
urticaria
572
onset of transfusion-related acute lung injury
within 6hrs
573
cause of transfusion-related acute lung injury
donor anti-leukocyte antibodies
574
key features of transfusion-related acute lung injury
respiratory distress
| noncardiogenic pulmonary edema with bilateral pulmonary infiltrates
575
onset of delayed hemolytic transfusion reaction
within days to weeks
576
cause of delayed hemolytic transfusion reaction
anamnestic antibody response
577
key features of delayed hemolytic transfusion reaction
often asymptomatic
laboratory evidence of hemolytic anemia
positive Coombs test, positive new antibody screen
578
onset of graft vs. host
within weeks
579
cause of graft vs. host
donor T-lymphocytes
580
key features of graft vs. host
rash, fever, GI symptoms, pancytopenia
581
gestational thrombocytopenia in pregnancy
isolated, mild (100-150k)
asymptomatic
diagnosis of exclusion
582
preeclampsia with severe features/HELLP syndrome causing thrombocytopenia in pregnancy
moderate to severe (<100k)
hypertension +/- headache/scotomata
+/- increase creatinine, increase AST & ALT
583
immune-mediated thrombocytopenia in pregnancy
isolated, moderate to severe (<100k)
asymptomatic or mucosal bleeding/bruising
normal PT, aPTT
584
thrombotic thrombocytopenic purpura (TTP)
severe (<30k)
neurologic symptoms (e.g. confusion, seizure), fever, abdominal pain, petechiae
normal PT, aPTT
585
disseminated intravascular coagulopathy (DIC)
moderate to severe (<100k)
bleeding (e,g. oozing IV sites) +/- thrombosis
increase PT, increase aPTT, decrease fibrinogen
586
how does levonorgestrel-containing IUD work
thickens cervical mucus
| impairs implantation through decidualization of the endometrium
587
common side effect of levonorgestrel IUD
amenorrhea - can be used to improve anemia and abnormal uterine bleeding
systemic - mood changes, breast tenderness, headaches
weight gain is not a side effect
588
definition of vasa previa
fetal vessels overlying the cervix
589
risk factors of vasa previa
placenta previa
multiple gestations
in vitro fertilization
succenturiate placental lobe
590
clinical presentation of vasa previa
painless vaginal bleeding with ROM or contractions
FHR abnormalities (bradycardia, sinusoidal pattern)
fetal exsanguination & demise
591
management of vasa previa
emergency cesarean delivery
592
vasa previa vs. placenta previa
painless vaginal bleeding
placenta previa is primarily maternal blood loss -> heavy, persistent, signs of maternal hemorrhagic shock (hypotension, tachycardia) are present prior to severe fetal compromise
593
what is a urethral diverticulum
abnormal localized outpouching of the urethral mucosa into surrounding tissues
594
cause of urethral diverticulum
recurrent periurethral gland infections, which can develop into an abscess
595
urethral diverticulum presentation
tender anterior vaginal wall mass
- dyspareunia or a palpable mass on pelvic examination
may collect urine and debris -> purulent discharge, dysuria, postvoid dribbling
596
how to confirm diagnosis of urethral diverticulum
MRI
597
how to treat urethral diverticulum
surgical excision
598
acute management of tachyarrhythmias in pregnant women
adenosine
599
second-line agents for symptomatic SVT in pregnancy
digoxin
calcium channel blockers (verapamil)
ß blockers (metoprolol)
600
what are common causes of hyperandrogenism in pregnancy?
placental aromatase deficiency
luteoma
theca lutein cyst
Sertoli-leydig tumor
601
clinical features of placenta aromatase deficiency in pregnancy
no ovarian mass
high maternal & fetal virilization risk
resolution of maternal symptoms after delivery
602
clinical features of luteoma in pregnancy
solid, unilateral/bilateral ovarian masses
moderate maternal virilization risk; high fetal virilization risk
spontaneous regression of masses after delivery
603
clinical features of theca lutein cyst in pregnancy
cystic, bilateral ovarian masses
moderate maternal virilization risk; low fetal virilization risk
spontaneous regression of masses after delivery
604
clinical features of sertoli-leydig tumor in pregnancy
```
solid unilateral ovarian mass
high maternal & fetal virilization risk
surgery required (2nd trimester or postpartum)
```
605
pathogenesis of müllerian agenesis
müllerian duct system defect
| abnormal development of uterus, cervix, & upper third of vagina
606
clinical features of müllerian agenesis
```
primary amenorrhea
normal female external genitalia
blind vaginal pouch
absent or rudimentary uterus
bilateral functioning ovaries (normal FSH)
```
607
management of müllerian agenesis
```
evaluate for renal tract abnormalities (renal ultrasound)
vaginal dilation (surgical or nonsurgical)
```
608
definition. ofvasa previa
fetal vessels overlying the cervix
609
risk factors for vasa previa
placenta previa
multiple gestations
in vitro fertilization
succenturiate placental lobe
610
clinical presentation of vasa previa
painless vaginal bleeding with ROM or contractions
FHR abnormalities (bradycardia, sinusoidal pattern)
fetal exsanguination & demise
611
management of vasa previa
emergency cesarean delivery
612
prenatal care for sickle cell disease in pregnancy
```
baseline 24hr urine for total protein
baseline chemistry panel
serial urine culture
pneumococcal vaccination
folic acid supplementation
aspirin
serial fetal growth ultrasound
```
613
obstetric complications of sickle cell disease
spontaneous abortion
preeclampsia, eclampsia
abruptio placentae
antepartum bleeding
614
fetal complications of sickle cell disease
fetal growth restriction
oligohydramnios
preterm birth
from uteroplacental insufficiency
615
causes of hirsutism in women
```
polycystic ovary syndrome
idiopathic hirsutism
nonclassic 21-hydroxylase deficiency
androgen-secreting ovarian tumors, ovarian hyperthecosis
cushing syndrome
```
616
clinical features of PCOS
oligomenorrhea, hyperandrogenism, obesity
| associated with type 2 diabetes, dyslipidemia, hypertension
617
clinical features of idiopathic hirsutism
normal menstruation
| normal serum androgens
618
clinical features of nonclassic 21-hydroxylase deficiency
similar to PCOS
| elevated serum 17-hydroxyprogesterone
619
clinical features of androgen-secreting ovarian tumors, ovarian hyperthecosis
more common in postmenopausal women
rapidly progressive hirsutism with virilization
very high serum androgens
620
clinical features of Cushing syndrome
obesity (usually of the face, neck, trunk, abdomen)
| increased libido, virilization, irregular menses
621
antepartum fetal surveillance
nonstress test
biophysical profile
contraction stress test
doppler sonography of umbilical artery
622
description of nonstress test
external fetal heart rate monitoring for 20-40mins
623
normal result of nonstress test
reactive: >/= 2 accelerations
624
abnormal resul of nonstress test
nonreactive: <2 accelerations
| recurrent variable or late decelerations
625
description of biophysical profile
nonstress test plus ultrasound assessment of:
- amniotic fluid volume
- fetal breathing movement
- fetal movement
- fetal tone
2 points per category if normal & 0 points if abnormal
max of 10
626
normal result of biophysical profile
8 or 10 points
627
abnormal result of biophysical profile
equivocal: 6 points
abnormal: 0, 2, or 4 points
oligohydramnios
628
description of contraction stress test
external fetal heart rate monitoring during spontaneous or induced (e.g. oxytocin, nipple stimulation) uterine contractions
629
normal result of contraction stress test
no late or recurrent variable decelerations
630
abnormal result of contraction stress test
late decelerations with >50% of contractions
631
description of doppler sonography of the umbilical artery
evaluation of umbilical artery flow in fetal intrauterine growth restriction only
632
normal result of doppler sonography of umbilical artery
high-velocity diastolic flow in umbilical artery
633
abnormal result of doppler sonography of umbilical artery
decreased, absent, or reversed end-diastolic flow
634
components of biophysical profile (BPP)
```
nonstress test
amniotic fluid volume
fetal movements
fetal tone
fetal breathing movements
```
635
normal finding of nonstress test for BPP
reactive fetal heart rate monitoring
636
normal finding of amniotic fluid volume for BPP
single fluid pocket >/= 2cm x 1cm or amniotic fluid index >5
637
normal finding of fetal movements for BPP
>/= 3 general body movements
638
normal finding of fetal tone for BPP
>/= 1 episodes of flexion/extension of fetal limbs or spine
639
normal finding of fetal breathing movements for BPP
>/= 1 breathing episode for >/= 30 seconds
640
BPP score of 0-4 /10 indicates
fetal hypoxia due to placental dysfunction
641
risk factors for placental insufficiency
advanced maternal age
tobacco use
hypertension
diabetes
642
risk factors for pubic symphysis diastasis
fetal macrosomia
multiparity
precipitous labor
operative vaginal delivery
643
presentation of pubic symphysis diastasis
difficulty ambulating
radiating suprapubic pain
pubic symphysis tenderness
intact neurologic examination
644
management of pubic symphysis diastasis
conservative
NSAIDs
physical therapy
pelvic support
645
clinical presentation of epithelial ovarian carcinoma
acute: shortness of breath, obstipation/constipation with vomiting, abdominal distention
subacute: pelvic/abdominal pain, bloating, early satiety
asymptomatic adnexal mass
646
laboratory findings of epithelial ovarian carcinoma
increase CA-125
647
ultrasound findings of epithelial ovarian carcinoma
solid mass
thick septations
ascites
648
management of epithelial ovarian carcinoma
exploratory laparotomy
649
assessing arterial blood gas
1 - look at pH
- <7.35 acidemia
- >7.45 alkalemia
2 - determine primary process
- in alkalemia, if elevated bicarb & PaCO2 = primary metabolic alkalosis
3 - determine degree of compensation
- Winter's formula: PaCO2 = (0.9 * bicarb) + 16 +/- 2
650
metabolic acidosis
low pH <7.35
low HCO3- < 22
compensation:
- respiratory alkalosis (decrease PaCO2)
651
respiratory acidosis
low pH < 7.35
high PaCO2 >45
delayed compensatory response:
- metabolic alkalosis (increase HCO3-)
652
respiratory alkalosis
high pH > 7.45
low PaCO2 < 35
delayed compensatory response:
- metabolic acidosis (decrease HCO3-)
653
metabolic alkalosis
high pH >7.45
high HCO3- >28
compensatory response:
- respiratory acidosis (increase PaCO2)
654
commonly causes metabolic alkalosis in pregnancy
hyperemesis gravidarum
655
pathogenesis of congenital zika syndrome
single-stranded RNA flavivirus
transplacental transmission ot fetus
targets neural progenitor cells
656
clinical features of congenital zika
microcephaly, craniofacial disproportion
neurologic abnormalities (spasticity, seizures)
ocular abnormalities
657
diagnosis of congenital zika
neuroimaging: calcifications, ventriculomegaly, cortical thinning
zika RNA detection
658
risk factor for listeria monocytogenes
consumption of unpasteurized dairy products
659
in utero L monocytogenes
fetal demise or neonatal disseminated granulomatous disease
660
modifiable breast cancer risk factors
hormone replacement therapy
nulliparity
increased age at first live birth
alcohol consumption
661
non-modifiable breast cancer risk factors
genetic mutation or breast cancer in first-degree relatives
white race
increasing age
early menarche or later menopause
662
common cause of acute cervicitis
Chlamydia trachomatis
| Niesseria gonorrhea
663
classic findings of acute cervicitis
mucopurlent cervical discharge and edematous, friable cervix that bleeds with manipulation
664
what would be visualized on light microscopy for acute cervicitis
no organisms
665
clinical features of bacterial vaginosis
thin, off-white discharge with fishy odor
| no vaginal inflammation
666
laboratory findings of BV
pH >4.5
clue cells
positive whiff test
667
treatment of BV
metronidazole or clindamycin
668
complications of BV
increase risk of preterm birth
| increase risk for acquisition of HIV, HSV type 2, gonorrhea, chlamydia, & trichomonas infections
669
risks of metronidazole in first trimester?
no! treat BV!
670
approach to postmenopausal bleeding
endometrial biopsy or TVUS endometrium
671
in evaluation of postmenopausal bleeding, if TVUS endometrium reveals >4mm
endometrial biopsy
672
in evaluation of postmenopausal bleeding, if TVUS endometrium reveals = 4mm
observation
673
in evaluation of postmenopausal bleeding, if endometrial biopsy benign
observation
674
in evaluation of postmenopausal bleeding, if endometrial biopsy atypic neoplasia
progestins
| surgery
675
clinical presentation of hydatidiform mole
```
abnormal vaginal bleeding +/- hydropic tissue
uterine enlargement > gestational age
abnormally elevated Bega-hCG levels
theca lutein ovarian cysts
hyperemesis gravidarum
preeclampsia with severe features
hyperthyroidism
```
676
risk factors for hydatidiform mole
extremes of maternal age
| history of hydatidiform mole
677
diagnosis of hydatidiform mole
'snowstorm' appearance on ultrasound
quantitative serum ß-hCG
histologic evaluation of uterine contents
678
management of hydatidiform mole
dilation & suction curettage
serial serum ß-hCG post evacuation
contraception for 6 months
679
clinical features vulvar lichen planus
```
women age 50-60
vulvar pain or pruritus
dyspareunia
erosive variant (most common)
- erosive, glazed lesions with white border
- vaginal involvement +/- stenosis
- associated oral ulcers
papulosquamous variant
- small pruritic papule with purple hue
```
680
diagnosis vulvar lichen planus
vulvar biopsy
681
treatment vulvar lichen planus
high-potency topical corticosteroids
682
lichen planus vs. lichen sclerosus
lichen sclerosis has no vaginal involvement
683
management of hydatidiform mole
suction curettage -> weekly ß-hCG levels until undetectable
684
for hydatidiform mole, if weekly ß-hCG are increasing/plateauing
diagnosis of gestational trophoblastic neoplasia
685
for hydatidiform mole, if weekly ß-hCG are decreasing
monthly ß-hCG levels x6 months
686
for hydatidiform mole, if monthly ß-hCG x 6 months undetectable
surveillance complete
| can attempt pregnancy
687
for hydatidiform mole, if monthly ß-hCG x 6 months becomes detectable
diagnosis of gestational trophoblastic neoplasia
688
example of gestational trophoblastic neoplasia
choriocarcinoma
689
clinical features of intraductal papilloma
unilateral bloody nipple discharge
| no associated mass or lymphadenopathy
690
management of intraductal papilloma
mammography & ultrasound
| biopsy, +/- excision
691
side effects & risks of combination oral contraceptives
```
breakthrough bleeding
breast tenderness, nausea, bloating
amenorrhea
hypertension
venous thromboembolic disease
decreased risk of ovarian & endometrial cancer
increased risk of cervical cancer
liver disorders (hepatic adenoma)
increased triglycerides (due to estrogen component
```
692
examples of selective estrogen receptor modulators (SERMs)
tamoxifen
| raloxifene
693
mechanism of SERMs
competitive inhibitor of estrogen binding
| mixed agonist/antagonist action
694
indications for SERMs
prevention of breast cancer in high-risk patients
Tamoxifen: adjuvant treatment of breast cancer
Raloxifene: postmenopausal osteoporosis
695
adverse effects of SERMs
hot flashes
venous thromboembolism
endometrial hyperplasia & carcinoma (tamoxifen only)
696
missed abortion
no vaginal bleeding
closed cervical os
no fetal cardiac activity or empty sac
697
threatened abortion
vaginal bleeding
closed cervical os
fetal cardiac activity
698
inevitable abortion
vaginal bleeding
dilated cervical os
products of conception may be seen or felt at or above cervical os
699
incomplete abortion
vaginal bleeding
dilated cervical os
some products of conception expelled & some remain
700
complete abortion
vaginal bleeding
closed cervical os
products of conception completely expelled
701
bartholin duct cyst
occurs due to blockage of the bartholin gland duct
702
location of bartholin glands
bilaterally at the posterior vaginal Introits and have ducts that drain into the vulvar vestibule at 4 and 8 o'clock positions
703
signs of bartholin duct cyst
often asymptomatic
| increased tissue tension & friction -> vaginal pressure & discomfort with sexual activity, walking, or sitting
704
pelvic exam of bartholin duct cyst
soft, mobile, nontender, cystic mass palpated behind the posterior labium magus with possible extension into the vagina
705
treatment of bartholin duct cyst
I&D with possible Word catheter placement
706
what is external cephalic version
manual rotation of fetus to cephalic presentation
| decreases cesarean delivery rate
707
indications for external cephalic version
breech/transverse presentation
| >/= 37wks gestation
708
absolute contraindications to external cephalic version
contraindication to vaginal delivery
- prior classical cesarean delivery
- prior extensive uterine myomectomy
- placenta previa
709
complications of external cephalic version
abruptio placentae
| intrauterine fetal demise
710
presentation of inflammatory breast cancer
rapid-onset edematous cutaneous thickening with a 'peau d'orange' appearance
edematous, erythematous, and painful
axillary lymphadenopathy suggestive of metastatic disease
711
next step in evaluation of inflammatory breast cancer
mammography and ultrasound
| tissue biopsy necessary to confirm diagnosis
712
what is duodenal atresia
complete bowel obstruction
| - fluid filled stomach and proximal duodenum with no distal intestinal air or fluid
713
duodenal atresia on ultrasound
double bubble sign
| - fluid-filled stomach ad duodenum
714
signs of duodenal atresia
impairs fetal swallowing of amniotic fluid -> polyhdramnios
715
definition of polyhydramnios
single deepest pocket of amniotic fluid >/= 8cm
716
what is VACTERL associated with
trisomy 21 (Down syndrome)
717
what is VACTERL
```
Vertebral =
Anal atresia
Cardiac = ventricular septal defct
Tracheoesophageal fistula
Esophageal atresia
Renal
Limb
```
718
what is the two step approach for screening and diagnosing gestational diabetes
at 24-28wks:
- step 1: administer 50g oral glucose load, check serum glucose 1hr later
- step 2: if blood glucose >/= 140, administer 100g oral glucose load, check fasting serum glucose each hour afterwards for 3hrs
719
how to diagnose gestational diabetes
>/= 2 abnormals:
- fasting >/= 105
- 1hr >/= 190
- 2hr >/= 165
- 3hr >/= 145
720
what are physiologic adaptations to pregnancy as it relates to diabetes
pancreatic ß cell hyperplasia
increased insulin secretion
increased peripheral insulin resistance
721
what is pseudothrombocytopenia
laboratory error caused by platelet aggregation in vitro
722
how is pseudothrombocytopenia identified?
mild thrombocytopenia has peripheral blood smear evidence of large clumps of platelets
723
idiopathic thrombocytopenic purpura
presents with mild thrombocytopenia
often asymptomatic and no history of bleeding disorder
peripheral blood smear shows a paucity of platelets without platelet clumping
724
definition of preeclampsia
new-onset hypertension at >/= 20 weeks
plus
proteinuria &/or end-organ damage
725
severe features of preeclampsia
```
SBP >/= 160/110 ( 2x >/= 4hrs apart)
thrombocytopenia
increase creatinine
increase transaminases
pulmonary edema
visual or cerebral symptoms
```
726
management of preeclampsia
```
without severe features: delivery at >/= 37wks
with severe features: delivery at >/= 34wks
magnesium sulfate (seizure prophylaxis)
antihypertensives
```
727
breech types
frank
complete
incomplete
728
frank breech
hips flexed & knees extended (buttock presenting)
729
complete breech
hips & knees flexed
730
incomplete breech
1 or both hips not flexed (feet presenting)
731
risk factors for breech presentation
```
advanced maternal age >/= 35
multiparty
uterine didelphys, septet uterus
uterine leiomyomas
fetal anomalies (e.g. anencephaly)
preterm (<37wks)
oligohydramnios/polyhydramnios
placenta previa
```
732
management of breech presentation
external cephalic version
| cesarean delivery
733
risk factors for vulvovaginal candidiasis
```
diabetes mellitus
immunosuppression
pregnancy
OCPs
antibiotic use
```
734
when to stop Pap testing
```
age 65 or hysterectomy
PLUS
- no history of CIN 2 or higher
AND
- 3 consecutive negative Pap tests
OR
- 2 consecutive negative co-testing results
```
735
Graves disease
thyroid stimulated by autoantibodies to increase tissue metabolic activity causing increased thyroid hormone synthesis
736
Graves disease radioactive iodine uptake
increased reuptake
| increased release of thyroid hormone
737
painless autoimmune thyroiditis
the thyroid tissue is destroyed, leading to increased release of preformed thyroid hormone and resulting hyperthyroidism
738
painless autoimmune thyroiditis radioactive iodine uptake
low radioactive iodine uptake due to destroyed thyroid cells being unable to synthesize thyroid hormone
739
when to order CA-125
in a postmenopausal patient, measured in conjunction with pelvic ultrasonography to categorize an ovarian mass as likely malignant or benign
740
risk factors for endometrial hyperplasia/cancer
excess estrogen
- obesity
- chronic anovulation/PCOS
- nulliparity
- early menarche or late menopause
- tamoxifen use
741
clinical features of endometrial hyperplasia/cancer
heavy, prolonged, intermenstrual &/or postmenopausal bleeding
742
evaluation of endometrial hyperplasia/cancer
```
endometrial biopsy (gold standard)
pelvic ultrasound (postmenopausal women)
```
743
treatment endometrial hyperplasia/cancer
hyeprplasia: progestin therapy or hysterectomy
cancer: hysterectomy
744
definition of shoulder dystocia
failure of usual obstetric maneuvers to deliver fetal shoulders
745
risk factors for shoulder dystocia
```
fetal macrosomia
maternal obesity
excessive pregnancy weight gain
gestational diabetes
post-term pregnancy
```
746
warning signs for shoulder dystocia
protracted labor
| retraction of fetal head into the perineum after delivery (turtle sign)
747
methods of emergency contraception
copper-containing IUD
ulipristal
levonorgestrel
oral contraceptives
748
timing after intercourse for copper IUD emergency contraception
0-120hrs
749
timing after intercourse for ulipristal emergency contraception
0-120hrs
750
timing after intercourse for levonorgestrel emergency contraception
0-72hrs
751
timing after intercourse for OCPs emergency contraception
0-72hrs
752
efficacy of copper IUD for emergency contraception
>/= 99%
753
efficacy of ulipristal for emergency contraception
98-99%
754
efficacy of levonorgestrel for emergency contraception
59-94%
755
efficacy of OCPs for emergency contraception
47-89%
756
contraindications for copper IUD for emergency contraception
acute pelvic infection
severe uterine cavity distortion
Wilson disease
complicated organ transplant failure
757
diagnostic findings of amenorrhea in ovarian failure
increase FSH, LH
| normal prolactin, TSH
758
diagnostic findings of amenorrhea in functional hypothalamic amenorrhea
decrease FSH, LH
| normal prolactin, TSH
759
diagnostic findings of amenorrhea in Asherman syndrome
normal FSH, LH, prolactin, TSH
760
diagnostic findings of amenorrhea in prolactinoma
decrease FSH, LH
increase prolactin
normal TSH
761
diagnostic findings of amenorrhea in hypothyroidism
decrease FSH, LH
| increase prolactin, TSH
762
normal findings in the postpartum period
```
transient rigors/chills
peripheral edema
lochia rubra
uterine contraction & involution
breast engorgement
```
763
routine care in postpartum period
```
rooming-in/lactation support
serial examination for uterine atony/bleeding
perineal care
voiding trial
pain management
```
764
clinical features of obsessive compulsive disorder
obsessions
- recurrent, intrusive, anxiety-provoking thoughts, urges, or images
compulsions
- response to obsessions with repeated behaviors or mental acts
- behaviors not connected realistically with preventing feared event
time consuming (>1hr/day) or causing significant stress or impairment
765
treatment of OCD
SSRI
| cognitive behavioral therapy (exposure & response prevention)
766
physiologic corpus luteum cyst
confirmed by ultrasound revealing a simple-appearing ovarian cyst with normal Doppler flow
767
clinical features concerning for malignancy of adnexal mass
postmenopausal age
chronic or worsening pelvic pain
mass symptoms (bloating, constipation)
768
ovarian cancer screening
no screening tests exist
769
routine prenatal laboratory tests at initial prenatal visit
```
Rh (D) type, antibody screen
Hgb/Hct, MCV
HIV, VDRL/RPR, HBsAg
Rubella & varicella immunity
Pap test
Chlamydia PCR
urine culture
urine protein
```
770
routine prenatal laboratory tests at 24-28wks
Hgb/Hct
antibody screen if Rh (D) negative
50-g 1-hr GCT
771
routine prenatal laboratory tests at 35-37wks
Group B streptococcus culture
772
who requires endometrial sampling with benign-appearing endometrial cells on Pap?
pemenopausal women with:
- abnormal uterine bleeding OR
- risk for endometrial hyperplasia
postmenopausal women
773
who requires endometrial sampling with atypical glandular cells on Pap?
women >/= 35 OR at risk for endometrial hyperplasia
774
who requires endometrial sampling with atypical glandular cells, favor neoplastic on Pap?
all women
775
mature cystic teratoma on ultrasound
hyperechoic nodules and calcifications
776
evaluation of intimate partner violence
routine annual exam
suspicious signs/symptoms
prenatal visits
777
consequences of intimate partner violence
```
homicide
mental health disorders
unintended pregnancy
pregnancy complications (abrupt placentae)
sexually transmitted infections
```
778
management of intimate partner violence
```
safety planning (e.g. local shelter referral)
psychosocial counseling
```
779
high risk preeclampsia
```
prior preeclampsia
chronic kidney disease
chronic hypertension
diabetes mellitus
multiple gestation
autoimmune disease
```
780
moderate risk preeclampsia
obesity
advanced maternal age
nulliparity
781
prevention of preeclampsia
low-dose aspirin at 12wks gestation
782
pathophysiology of neonatal thyrotoxicosis
transplacental passage of maternal anti-TSH receptor antibodies
antibodies bind to infant's TSH receptors and cause excessive thyroid hormone release
783
clinical features of neonatal thyrotoxicosis
warm, moist skin
tachycardia
poor feeding, irritability, poor weight gain
low birth weight or preterm birth
784
diagnosis of neonatal thyrotoxicosis
maternal anti-TSH receptor antibodies >/= 500% normal
785
treatment of neonatal thyrotoxicosis
self-resolves within 3 months (disappearance of maternal antibody)
methmiazole plus ß blocker
786
fetal diagnosis of nonviable fetus
```
acardia
anencephaly
bilateral renal genesis
holoprosencephaly
intrauterine fetal demise
pulmonary hypoplasia
thanatophoric dwarfism
```
787
obstetric management of nonviable fetus
vaginal delivery
| no fetal monitoring
788
neonatal management of nonviable fetus
palliative care if not stillborn
789
management of Erb-Duchenne palsy
observation and physical therapy
| up to 80% have spontaneous recovery within 3 months
790
risk factors of ovarian torsion
ovarian mass
women of reproductive age
infertility treatment with ovulation induction
791
treatment of ovarian torsion
laparoscopy with detorsion
ovarian cystectomy
oopherectomy if necrosis or malignancy
792
major causes DIC
sepsis
severe traumatic injury
malignancy
obstetric complications
793
pathophysiology of DIC
procoagulant excessively triggers coagulation cascade ->
formation of fibrin-/platelet-rich thrombi & fibrinolysis ->
bleeding & organ damage (e.g. kidneys, lungs)
794
laboratory findings of DIC
```
thrombocytopenia
prolonged PT & PTT
decrease fibrinogen
increase D-dimer
microangiopathic hemolytic anemia (schistocytes)
```
795
congenital parvovirus 19
anemia (aplastic)
high-output congestive heart failure
cardiomyopathy
796
mom presentation of parvovirus 19
febrile illness with myalgia, arthralgias, lymphadenopathy, and lacy, erythematous rash
797
mom presentation of varicella-zoster
febrile illness
| pruritic vesicular lesions in all stages of healing
798
congenital toxoplasmosis
intracranial calcifications
disseminated purpuric rash
seizures
chorioretinitis, hydrocephaly
799
classic triad of congenital toxoplasmosis
chorioretinitis
intracranial calcifications
hydrocephaly
800
congenital cmv vs. toxoplasmosis
toxoplasmosis has more diffuse calcifications and hydrocephaly
CMV has periventricular calcifications and microcephaly
801
congenital CMV
low birth weight, ventriculomegaly, hearing impairment
| periventricular calcifications
802
congenital rubella syndrome
patent ductus arteriosus
hearing impairment
petechial, puerperal rash ('blueberry muffin' rash)
803
supplement for history of PPROM
spontaneous preterm birth prior to 37 weeks gestational age is an indication for 17-hydroxyprogesterone in subsequent pregnancies
804
when is progesterone given in history of PPROM
16 and 36 weeks
805
false labor
uterine contractions that do not result in cervical change
806
most likely cause of irregular bleeding in an adolescent
anovulatory bleeding
| - failure of the ovary to develop a corpus luteum
807
most sensitive indicator of IUGR
abdominal circumference
808
independent risk factor for preterm labor
African American race
809
contraindications to MTX in ectopic pregnancy
```
ß-hCG >5000
fetal cardiac activity on TVUS
heterotopic pregnancy
hypersensitivity
breastfeeding
immunodeficiency
active pulmonary disease
peptic ulcer disease
inability/unwillingness to comply with close follow-up
<4cm
```
810
treatment of ectopic pregnancy >5.5cm
laparoscopic surgery
| - salpingectomy or salpingostomy
811
pathophysiology of tuberous sclerosis complex
mutation in TSC1 or TSC2 gene
| Autosomal Dominant
812
clinical features of tuberous sclerosis complex - dermatologic
ash-leaf spots
angiofibromas of the malar region
shagreen patches
813
clinical features of tuberous sclerosis complex - neurologic
CNS lesions - subependymal tumors
epilepsy - infantile spasms
intellectual disability
autism & behavioral disorders - hyperactivity
814
clinical features of tuberous sclerosis complex - cardiovascular
rhabdomyomas
815
clinical features of tuberous sclerosis complex - renal
angiomyolipomas
816
surveillance for tuberous sclerosis complex
```
tumor screening
- regular skin & eye examinations
- serial MRI of the brain & kidney
- baseline echocardiography & serial ECG
baseline EEG
neuropsychiatric screening
```
817
medications to avoid in myasthenia gravis
```
magnesium sulfate
fluoroquinolones, aminoglycosides
NMS blocking agents
CNS depressants
muscle relaxants
CCBs
ß blockers
opioids
statins
```
818
risk of triglyceride-induced pancreatitis
triglyceride levels
- <500 = minimal risk
- 500-99 = mild risk
- 1000-1999 = moderate risk
- >= 2000 = high risk
other: pregnancy, alcoholism, obesity, uncontrolled diabetes
819
clinical features of triglyceride-induced pancreatitis
acute epigastric pain radiating to the back
+/- fever, nausea, vomiting
elevated serum lipase (>3x ULN)
820
management of triglyceride-induced pancreatitis
IV fluid hydration, pain control
glucose >/= 500 mg/dL: consider insulin infusion
glucose <500 mg/dL or severe pancreatitis (e.g. lactic acidosis, hypocalcemia): consider aphaeresis (therapeutic plasma exchange
821
risk factors of rectovaginal fistula
```
pelvic radiation
obstetric trauma
pelvic surgery
colon cancer
diverticulitis
Crohn disease
```
822
clinical features of rectovaginal fistula
uncontrollable passage of gas &/or feces from the vagina
823
diagnostic studies for rectovaginal fistula
physical examination
fistulography
MRI
endosonography
824
rectovaginal fistula
posterior vaginal wall
dark red, velvety lesion
malodorous, tan-brown discharge
