ob Flashcards
(220 cards)
1
Q
There is increased risk of MS when ??
A
Although pregnancy is protective for MS, there is an increased risk in the early postpartum period
2
Q
PROM typically causes a large gush of fluid but may also cause vaginal wetness or intermittent leakage of small volumes. Confirmation is usually with visualization of amniotic fluid emerging from the cervix with ???, nitrazine-positive testing (ie, turns blue), and/or ferning on microscopy.
A
Valsalva (eg, cough)
3
Q
Patients with breech presentation and no contraindications to vaginal delivery (eg, placenta previa, prior classical cesarean delivery) are offered ?? , a procedure in which the fetus is manually rotated to cephalic presentation
A
external cephalic version (ECV)
4
Q
monochorionic diamniotic twins (1 placenta, 2 amniotic sacs) are at risk for ??? , a complication that can result in heart failure and fetal/neonatal mortality in both twins. unbalanced arteriovenous anastomoses are present between the shared placental vessels that supply the twins
A
twin-twin transfusion syndrome (TTTS)
5
Q
Normal internal genitalia, external virilization (eg, clitoromegaly), and undetectable serum estrogen levels in a female patient are consistent with a diagnosis of ??
A
aromatase deficiency
6
Q
Müllerian agenesis causes primary amenorrhea due to the failed development of the uterus, cervix, and upper 1/3 of the vagina. (Normal external vagina + ovaries) development from a common embryologic source causes abnormalities in which system?
A
renal malformations are common and patients require evaluation with a renal ultrasound
7
Q
complete torsion, typically triggered by physical activity (eg, walking), presents with severe, constant, unilateral pelvic pain due to ongoing ovarian ischemia.
Management is ???
A
diagnostic laparoscopy for manual detorsion of the adnexa and removal of any contributory cysts or masses; oophorectomy may be required if the ovary is necrotic.
8
Q
patient’s anterior vaginal wall mass is most likely a ????, an abnormal localized outpouching of the urethral mucosa into surrounding tissues
A
urethral diverticulum
9
Q
Bartholin glands are located at the ??? vulvar vestibule (4 and 8 o’clock positions)
A
posterior
10
Q
vaginal bleeding and a tender, firm uterus after rupture of membranes most likely has >>
A
abruptio placentae. Placental abruption is the premature placental separation from the uterine wall prior to fetal delivery.
11
Q
Secondary amenorrhea is amenorrhea for ≥ ???? months in women with previously regular menses (or ≥6 months in women with previously irregular menses). Initial evaluation includes a pregnancy test, followed by serum prolactin, TSH, and FSH level testing.
A
3
12
Q
multiple gestation pregnancy (eg, triplet), pregnancy reduction to a lesser order gestation (eg, singleton) decreases ??
A
maternal morbidity (eg, preeclampsia, postpartum hemorrhage).
13
Q
causes a diffuse maculopapular rash due to the widespread circulation of the pathogen. The rash usually begins along the skin-cleavage lines of the trunk and extends to the extremities, including the palms and soles.
A
secondary syphilis
14
Q
Postpartum thyroiditis is an autoimmune disorder characterized by lymphocytic inflammation of the thyroid and disruption of thyroid follicles occurring <12 months after parturition. It can cause a self-limited hyperthyroid phase due to release of preformed thyroid hormone. Management includes ??
A
a beta blocker to attenuate adrenergic symptoms, but specific antithyroid therapy is not usually needed
15
Q
composition of ovarin mass seen on ultrasound as a partially calcified mass with multiple thin, echogenic bands
A
cystic teratoma
calcified mass (eg, teeth) with multiple thin, echogenic bands (eg, hair).
16
Q
Intra-amniotic infections (IAIs) are usually polymicrobial and ascend from the vagina, spreading through the amniotic fluid, membranes, placenta, uterine decidua, and umbilical cord. Treatment is with broad-spectrum intravenous antibiotics (eg, ampicillin, gentamicin, clindamycin) and ??
A
immediate delivery via augmentation of labor (to remove the source of infection).
17
Q
hypertension, hyperreflexia (eg, clonus), and positive pregnancy test are concerning for preeclampsia with severe features. In addition to new-onset hypertension, pre-eclamptic patients often have signs of end-organ damage such as right upper quadrant pain (due to hepatic swelling and stretching of the Glisson capsule) and headache. Although preeclampsia typically presents in the late third trimester, preeclampsia at <20 weeks gestation can be a complication of ???
A
hydatidiform mole (HM)
18
Q
risk factors for breech position include:
Advanced maternal age (≥35), Multiparity, Uterine didelphys, septate uterus, Uterine leiomyomas, Fetal anomalies (eg, anencephaly), Preterm (<37 weeks gestation), Oligohydramnios/polyhydramnios. and ????
A
Placenta previa
19
Q
cardiovascular contraindications to pregnancy include Pulmonary arterial hypertension, Bicuspid AV with ascending aorta enlargement >50 mmC, and Symptomatic (3)????
A
Symptomatic mitral stenosis
Symptomatic aortic stenosis
Symptomatic heart failure with LVEF ˂30%
20
Q
development of significant proteinuria (>300 mg/24 hr, ≥1-2+ protein) prior to 20 weeks gestation suggests what etiology?
A
underlying kidney disease that was likely present before conception
likely DM or other nephropathy
21
Q
work up of bilateral vs. unilateral nipple discharge
A
see image
22
Q
Patients in preterm labor at <32 weeks gestation require corticosteroids, penicillin, tocolysis, and ???? to decrease neonatal morbidity and mortality associated with preterm delivery.
A
magnesium sulfate
23
Q
(1) ??? is the first-line treatment at <32 weeks gestation because of its high efficacy and few maternal adverse effects; as gestational age increases, however, indomethacin poses greater fetal risks (eg, premature closure of the ductus arteriosus). Therefore, (2)???? is preferred between 32 and 34 weeks gestation
A
Indomethacin
nifedipine
24
Q
Indications for intrapartum prophylaxis:
GBS bacteriuria or GBS urinary tract infection in current pregnancy (regardless of treatment)
GBS-positive rectovaginal culture in current pregnancy
Unknown GBS status PLUS any of the following: <37 weeks gestation, Intrapartum fever, Rupture of membranes for ≥18 hours
?????? (one more)
A
Prior infant with early-onset neonatal GBS infection
25
Advanced ovarian cancer may present in postmenopausal women with an immobile pelvic mass. Suspected ovarian cancer with no distant metastases is managed with ??
exploratory laparotomy, staging, and tumor debulking
26
The initial menstrual cycles in adolescents are irregular and anovulatory due to ???
hypothalamic-pituitary-gonadal axis immaturity and insufficient secretion of gonadotropin-releasing hormone.
27
Endometriosis can present with dysmenorrhea and deep dyspareunia. Symptomatic patients are offered empiric medical therapy with ?? (2)
nonsteroidal anti-inflammatory drugs and/or combination oral contraceptives, which treat inflammation and suppress ovarian stimulation of endometriosis.
28
Stress urinary incontinence typically presents with leakage of urine with increased intraabdominal pressure (eg, intercourse). Treatment includes pelvic floor muscle exercises or ???
surgical midurethral sling placement
29
most common cause of unilateral, bloody nipple discharge is a ??
benign intraductal papilloma
30
Management of preterm premature rupture of membranes diagnosed at \<34 weeks gestation is typically expectant. However, in patients with maternal fever + (3 things ????) delivery is indicated to decrease maternal and neonatal morbidity.
Fetal tachycardia (\>160/min)
Maternal leukocytosis
Purulent amniotic fluid
31
The active phase of labor (6-10 cm cervical dilation) has an expected, predictable rate of cervical dilation of ≥??? cm every ?? hours.
≥1 cm every 2 hours
32
Preeclampsia with severe features increases the risk of which neurological condition?
acute stroke due to endothelial cell damage, dysregulation of cerebral blood flow, cerebral vasospasm, and vascular microthrombi formation, particularly in patients with severe hypertension (ie, systolic ≥160 or diastolic ≥110 mm Hg)
33
? is often diagnosed incidentally on second-trimester ultrasound revealing a low-lying placenta, myometrial thinning, and numerous placental lacunae.
Placenta accreta is the abnormal attachment of placental villi directly onto the myometrium rather than the decidua basalis
34
patient has uterine leiomyomata (ie, fibroids), benign tumors of the uterine myometrium. Women with symptomatic fibroids have prolonged, heavy menstrual bleeding (eg, 7-8 days every month, anemia).
Treatment of heavy menstrual bleeding is ???
Tranexamic acid (TXA) is used in heavy menstrual bleeding because it can reduce blood loss during menses by up to 50%.
35
inevitable abortion presents with heavy vaginal bleeding, cramping, and a dilated cervix without passage of gestational tissue. what is the management??
Surgical management (eg, suction curettage) is indicated for patients whose condition is hemodynamically unstable.
36
?? is an aggressive breast cancer that can present with unilateral breast rash, erythema, and edema. Metastatic disease (eg, axillary lymphadenopathy) is common on initial presentation
Inflammatory breast carcinoma (IBC)
37
Postpartum hemorrhage is defined as an estimated blood loss ≥1,000 mL or bleeding with signs/symptoms of hypovolemia. The management of postpartum hemorrhage due to uterine atony occurs in a stepwise approach. Initial treatment includes administration of ???
high-dose oxytocin, the first-line uterotonic agent.
38
is a potentially life-threatening postpartum complication that presents with a **vaginal mass** and possible hypovolemic shock due to massive occult bleeding.
Vaginal hematoma
39
Prior cone biopsy (eg, cervical conization) is a risk factor for ???? because it shortens the cervix and may alter its structural integrity.
Cervical insufficiency
40
how does hypothyroidism effect prolactin, FSH, and LH
Hypothyroidism causes decreased responsiveness of the pituitary to GnRH, leading to decreased gonadotropin (ie, FSH, LH) secretion.
Thyrotropin-releasing hormone, which is upregulated in hypothyroidism, stimulates the pituitary secretion of prolactin.
Hyperprolactinemia, whether due to hypothyroidism or as an isolated disorder, further suppresses gonadotropin secretion.
41
Condylomata acuminata vs Condylomata lata
Condylomata acuminata (anogenital warts) caused by human papillomavirus (HPV); lesions are exophytic, dry-appearing, and verrucous (ie, cauliflower-like), pruritic, friable lesions (eg, those that bleed with manipulation) may occur.
Condylomata lata, caused by secondary syphilis, are raised, gray-white lesions that develop on mucosal surfaces (eg, mouth, perineum).
42
primary amenorrhea (absent menarche by age ≥15 with secondary sexual characteristics), female external genitalia (eg, shortened lower two-thirds of the vagina), and male-range testosterone levels most likely has ???
androgen insensitivity syndrome (AIS)
43
life-threatening complication of epidural anesthesia is ??? that causes ascending motor, sensory, and sympathetic blockade. Patients are at risk for respiratory paralysis (eg, dyspnea, hypoxemia).
high spinal anesthesia, or accidental injection of local anesthetic into the subarachnoid space
44
Indomethacin (used for tocolysis during early contractions), a nonspecific cyclooxygenase inhibitor, decreases prostaglandin production and leads to fetal vasoconstriction (eg, premature closure of the ductus arteriosus).
this increases risk of what?
The subsequent decreased renal perfusion and fetal oliguria can result in **oligohydramnios** (ie, amniotic fluid index ≤5 cm)
45
Nonreactive NSTs are concerning for fetal hypoxemia and acidemia; however, the most common cause of a nonreactive NST is a ??
quiet fetal sleep cycle (which lasts ≤40 min).
46
management of adolescent girls with a new breast mass with clinical features consistent with a fibroadenoma
unilateral, firm, well-circumscribed, mobile masses in the upper outer quadrant
observation and reexamination after completion of a full menstrual cycle (or 4-6 weeks)
47
Leiomyomata uteri (particularly submucosal fibroids) can cause heavy, prolonged menses. Patients with symptomatic submucosal fibroids who desire future fertility are treated with ???
hysteroscopic myomectomy, which improves heavy menstrual bleeding and restores normal uterine anatomy, thereby decreasing infertility and future pregnancy complications (eg, recurrent pregnancy loss)
48
High-grade squamous intraepithelial lesions (HSILs) on Pap testing are concerning for underlying severe neoplasia (eg, CIN2, CIN3) or invasive cervical cancer, and all patients require evaluation with ???
immediate colposcopy
49
??? is a major risk factor for placenta previa
Prior cesarean delivery
50
If fetal presentation (eg, cephalic, breech) is uncertain on digital cervical examination, a ??? should be performed to confirm fetal presentation and determine the safest route of delivery.
transabdominal ultrasound
51
HELLP (Hemolysis, Elevated Liver enzymes, Low Platelets) syndrome can present with right upper quadrant pain, microangiopathic hemolytic anemia, elevated transaminases, and thrombocytopenia. The pathogenesis involves ???
widespread endothelial dysfunction leading to microangiopathy, overactivation of the coagulation cascade, and excessive platelet consumption.
52
First-line management of recurrent variable decelerations is intrauterine resuscitation with ???
umbilical cord compression with ≥50% of contractions = recurrent variable decelerations)
maternal repositioning (eg, left lateral, all-fours), which may reduce cord compression and improve fetal-placental blood flow. If the variable decelerations do not improve, an amnioinfusion (instillation of saline into the intrauterine cavity) can be administered.
53
During pregnancy, patients with sickle cell disease have an increased incidence of ??? due to increased metabolic demands and a hypercoagulable state.
acute vasoocclusive pain episodes (eg, abdominal pain)
54
Ectopic pregnancy (ie, pregnancy implanted in an extrauterine location) can be diagnosed by a persistent rise in β-hCG level following diagnostic ??
vs nonviable intrauterine pregnancy
dilation and curettage.
55
anti-D immune globulin is routinely administered at ??? weeks gestation and again within 72 hours of delivery if the baby is found to be Rh (D) positive.
28-32
The initial timing of 28-32 weeks is selected because the half-life of anti-D immune globulin is about 6 weeks, which would cover any potential future exposure to fetal red blood cells through most of the third trimester.
56
Uncomplicated preterm prelabor rupture of membranes at \<34 weeks gestation is managed how?
expectantly with prophylactic latency antibiotics, corticosteroids, and inpatient monitoring. Delivery is at 34 weeks gestation or earlier in the event of complications (eg, intraamniotic infection, placental abruption).
57
Because oxytocin has a similar structure to antidiuretic hormone, prolonged or excessive oxytocin administration can cause severe ??
hyponatremia leading to cerebral edema and generalized tonic-clonic seizures.
58
initial prenatal labs include:
Rh(D) type & antibody screen
Hemoglobin/hematocrit, MCV, ferritin
HIV, VDRL/RPR, HBsAg, anti-HCV Ab
Rubella & varicella immunity
????
Urine dipstick for protein
Chlamydia PCR (if risk factors are present)
Pap test (if screening indicated)
Urine culture
59
labs at 24-28 weeks???
Hemoglobin/hematocrit
Antibody screen if Rh(D)-negative
1-hr 50-g GCT
60
labs at 36-38??
Group B Streptococcus rectovaginal culture
61
epidural analgesia blocks sympathetic nerve fibers responsible for vascular tone in the lower extremities, resulting in ??
vasodilation (venous pooling), decreased venous return to the heart, and decreased cardiac output.
Therefore, many patients develop hypotension and compensatory tachycardia (because sympathetic innervation to the heart via T1-T4 is unaffected by the block).
62
First-line medications for acute antihypertensive therapy include (for preeclampsia): (3)
**Intravenous labetalol:** a beta blocker with alpha-blocking activity. Labetalol is fast-acting, effective, and safe for use during pregnancy; however, **contraindicated in patients with bradycardia** (ie, \<60/min), beta blockade with labetalol can further decrease the heart rate, resulting in dizziness or lightheadedness
**Intravenous hydralazine**: a direct arterial vasodilator. Hydralazine can cause tachycardia due to sympathetic nervous system stimulation.
**Oral nifedipine**: a calcium channel blocker. Although oral nifedipine can rapidly lower blood pressure, this patient may not be able to tolerate oral medications due to nausea/vomiting.
63
?? presents in the third trimester with pruritus that is worse on the hands and feet with no associated rash.
Intrahepatic cholestasis of pregnancy
Diagnosis is confirmed by elevated total bile acids (≥10 µmol/L). Management includes ursodeoxycholic acid and delivery at 37 weeks gestation.
64
???, commonly used in obstetrics for seizure prophylaxis (eg, in preeclampsia with severe features), is contraindicated in patients with myasthenia gravis because it may trigger a myasthenic crisis due to the inhibition of acetylcholine release.
Magnesium sulfate
65
Postpartum fecal or flatal incontinence can occur due to external anal sphincter injury associated with a third- or fourth-degree obstetric perineal laceration. Patients typically have weakened anal sphincter tone, asymmetric sphincter contraction, or a palpable defect on examination. Evaluation is with ???
endoanal ultrasonography.
66
Neonatal lupus can occur due to passive placental transfer of maternal anti-SSA (Ro) and anti-SSB (La) antibodies. fetus may develop which cardiac condition?
fetal atrioventricular block, which appears on fetal heart rate tracing as persistent bradycardia.
67
Pregnant patients positive for group B Streptococcus (GBS) receive intrapartum antibiotic prophylaxis to prevent early-onset neonatal GBS disease. Patients with a penicillin allergy that is low risk for anaphylaxis receive .
cefazolin
first-generation cephalosporin
68
fetus has ascites (eg, echolucent abdominal fluid), skin edema, polyhydramnios (single deepest pocket ≥8 cm), and placental thickening (reflecting intravillous edema) consistent with ??
hydrops fetalis (fetal hydrops);
69
The principle behind labor management of patients with lethal fetal anomalies (eg, anencephaly, bilateral renal agenesis) is to minimize maternal morbidity and mortality. Therefore, obstetric care for these patients is typically?
Vaginal delivery bc has a lower risk for maternal complications compared to cesarean delivery (eg, hemorrhage, infection, pulmonary embolism)
70
Sinusoidal fetal heart rate tracings are typically associated with severe fetal ???? They are a category III tracing that reflects an increased risk of fetal compromise (eg, hypoxemia, acidemia) and requires urgent cesarean delivery.
anemia
71
A complete hydatidiform mole can present with pelvic pressure, uterine size larger than expected for gestational age, and an ultrasound showing bilateral theca lutein ovarian cysts and an enlarged uterus with a heterogeneous mass composed of cystic spaces. Management is???
uterine evacuation with suction curettage.
72
Progestin-containing IUDs have the added benefit of ?? and minimal systemic side effects.
amenorrhea
73
???? (low FSH and estradiol) causes irregular menses and infertility via loss of pulsatile GnRH secretion precipitated by weight loss, stress, or chronic illness.
Hypogonadotropic hypogonadism
74
Patients with PCOS are at increased risk for ??? due to unregulated endometrial proliferation from unopposed estrogen stimulation.
endometrial hyperplasia and cancer
75
???? typically presents with a uterine mass (as in this patient's enlarged, irregularly shaped uterus) that causes bulk symptoms (eg, pelvic pressure, constipation) and abnormal or postmenopausal bleeding.
Uterine sarcoma
76
Tamoxifen use is a significant risk factor for ??? due to its estrogen agonist effects on the uterus.
uterine sarcoma
77
Postmenopausal symptoms treatment for patients with a uterus require estrogen-plus-progesterone therapy. In contrast, patients without a uterus require ??
estrogen-only therapy (eg, transdermal estrogen patch)
78
Ultrasound features suggesting ??? are a solid mass with thick septations and the presence of ascites
Epithelial ovarian carcinoma w/malignancy
79
??? may occur secondary to chemotherapy and presents with amenorrhea and signs of estrogen deficiency (eg, vaginal dryness). Ovarian failure is characterized by increased FSH and LH due to lack of feedback inhibition from estrogen.
Ovarian failure
80
Patients with cervical intraepithelial neoplasia 3 on biopsy (eg, endocervical curettage) require ???
cervical conization, a type of excisional biopsy, due to the high risk of concurrent invasive cervical cancer and/or progression to cancer
81
Vulvovaginal candidiasis is characterized by white vaginal discharge, pruritus, erythema, and excoriations. Risk factors include ??? , immunosuppression, and antibiotic use. Recurrent candidiasis warrants evaluation for diabetes mellitus.
diabetes mellitus
82
Elevated prolactin levels associated with breastfeeding suppress ???? release and induce a hypoestrogenic postpartum state. Patients may experience dyspareunia due to atrophic vaginal changes (eg, dryness, loss of rugation). Treatment is supportive with nonhormonal lubricants and moisturizers.
GnRH release
83
the most common risk factor for endometrial adenocarcinoma
obesity
84
Herpes simplex virus (HSV) infection typically resolves how??
spontaneously within a week of lesion development
Antivirals (eg, acyclovir, valacyclovir) are used to decrease symptom duration and the number of recurrences.
85
In women with ovulatory menstrual cycles, a dominant follicle (ie, a large cyst with multiple smaller cysts) is formed during the follicular phase (resulting in an enlarged adnexa); when the oocyte is released during ovulation, pain can develop due to rupture of the follicle and subsequent release of a small amount of blood and fluid that irritates the peritoneum
what is this called??
Mittelschmerz
86
is a metastatic form of gestational trophoblastic neoplasia that may occur after a hydatidiform mole, normal pregnancy, or spontaneous abortion. The lungs are the most frequent site of metastasis.
Choriocarcinoma
87
should be suspected in postpartum women with an enlarged uterus, irregular vaginal bleeding, pulmonary symptoms, and multiple infiltrates on chest x-ray. Diagnosis is confirmed by an elevated β-hCG level.
Choriocarcinoma
88
As the ???? infection spreads farther into the intraperitoneal cavity, it can cause inflammation of the liver capsule (ie, perihepatitis or Fitz-Hugh–Curtis syndrome in 6%-10% of patients), resulting in vomiting and right upper quadrant tenderness. The pain is often pleuritic (ie, worsened with inspiration) due to fibrinous adhesion formation on the anterior liver surface
pelvic inflammatory disease
89
Recurrent urinary tract infections (≥3 episodes in a year or ≥2 episodes in 6 months) commonly occur in postmenopausal patients due to vulvovaginal atrophy, decreased bulk and elasticity of the bladder trigone and urethra, and increased vaginal pH. Treatment is with ???
vaginal estrogen.
90
The most common risk factor for pelvic organ prolapse is ??
**multiparity** because pregnancy causes pelvic floor muscle weakening from chronic, increased intraabdominal pressure and pelvic floor injury.
91
??? typically presents with vulvovaginal erythema, vaginal pruritus, and discharge with a normal vaginal pH (3.8-4.5).
Candida vulvovaginitis
92
Vulvar lichen sclerosus is a chronic inflammatory condition that can present with vulvar pruritus, white vulvar plaques, and loss of normal architecture (eg, loss of labia minora). A ??? is recommended to confirm the diagnosis and rule out vulvar cancer.
vulvar punch biopsy
First-line treatment of vulvar lichen sclerosus is with superpotent topical corticosteroids (eg, clobetasol)
93
Patients with vaginal bleeding and positive β-hCG require transvaginal ultrasonography to determine pregnancy location. Patients with a nondiagnostic ultrasound result (eg, no intrauterine pregnancy, free fluid, or adnexal masses) require a ??
repeat quantitative β-hCG level in 48 hours to evaluate for potential ectopic pregnancy
94
A ?? abortion refers to the passage of the products of conception through the cervix at \<20 weeks gestation. The cervix then closes, and the associated pain and bleeding subside. Ultrasonography reveals an empty uterus.
complete
95
In pregnancy, the cardiovascular system adapts to growing metabolic demands and prepares for expected blood loss from delivery by increasing cardiac output and blood volume. As a result, normal renal adaptations in pregnancy include increased renal blood flow, glomerular filtration rate, and urine protein excretion. These changes result in a physiologic ??? in serum blood urea nitrogen and creatinine.
decrease
96
Patients with acute pyelonephritis who do not improve within 48-72 hours of broad-spectrum intravenous antibiotic therapy require evaluation with renal ultrasound to assess for a ???
renal abscess.
97
Neuraxial anesthesia (eg, epidural) can cause sympathetic block, resulting in maternal hypotension and decreased placental perfusion, as evidenced by recurrent late fetal heart rate decelerations. Management is with left lateral patient positioning, intravenous fluid bolus, and ???``
vasopressors (eg, phenylephrine).
98
This patient's dyspnea, hypoxia, and bibasilar crackles on examination are most likely due to ???, a life-threatening complication of preeclampsia with severe features.
acute pulmonary edema
Patients with preeclampsia typically have generalized arterial vasospasm, leading to increased systemic vascular resistance and high cardiac afterload.
99
Preeclampsia with severe features has what effect on fetal growth???
increases the risk of fetal growth restriction (ie, **small-for-gestational-age infant**) due to uteroplacental insufficiency.
100
Treatment of a hydatidiform mole involves uterine evacuation via suction curettage and surveillance for the development of gestational trophoblastic neoplasia (GTN), such as choriocarcinoma. After suction curettage, β-hCG levels are followed weekly until undetectable; a plateau or increase in the β-hCG level is diagnostic of GTN. Once the β-hCG becomes undetectable, monthly monitoring of β-hCG levels continues for ??? months.
6
101
??? develops in the third trimester as a pruritic, erythematous papular rash that is limited to the abdominal striae and spares the umbilicus. It is not associated with adverse maternal-fetal outcomes and resolves spontaneously postpartum. Treatment is with topical corticosteroids.
Polymorphic eruption of pregnancy (PEP)
102
A complete hydatidiform mole results from abnormal fertilization of an empty ovum by either 2 sperm or by 1 that subsequently duplicates its genome. The resultant gestation is composed of proliferative trophoblastic tissue that secretes high levels of β-hCG. The markedly elevated β-hCG level causes hyperstimulation of the ovaries and formation of ???, which are large, bilateral, multilocular ovarian cysts.
theca lutein cysts
103
Patients typically have pain that is exacerbated by bladder filling and relieved by voiding. Symptom onset is typically gradual and worsens over a period of months. Other clinical features include urinary frequency and urgency, chronic pelvic pain, and dyspareunia
Interstitial cystitis (IC) (also known as painful bladder syndrome)
104
Postmenopausal women with endometrial cells on Pap testing require an ??? to evaluate for endometrial hyperplasia/cancer.
endometrial biopsy
105
In ???, patients have increased endometrial prostaglandin production, which causes uterine hypercontractility and hypertonicity and resultant ischemia. The cumulative effect of primary dysmenorrhea results in cramping, midline lower abdominal pain that begins 1-2 days prior to menses and radiates to the lower back and thighs (uterine hypertonicity and ischemia).
primary dysmenorrhea
106
???? typically presents in women age \>40 and is characterized by dysmenorrhea; heavy menstrual bleeding; progressive chronic pelvic pain; and a boggy, tender, symmetrically enlarged uterus. within the myometrium.
Adenomyosis
107
??? is a defect in the female genital outflow tract resulting in hematocolpos. The accumulated material causes pain and sometimes difficulty with defecation.
\*\*\* blue-tinged bulge between the labia
Imperforate hymen
108
Imperforate hymen
Treatment is with ???
hymenal incision and drainage
109
Imperforate hymen is a defect in the female genital outflow tract resulting in hematocolpos. The accumulated material causes pain and sometimes difficulty with defecation. Treatment is with ??
hymenal incision and drainage.
110
All hormone-containing contraception is absolutely contraindicated in patients with breast cancer. A ?? is a safe, effective, hormone-free, long-term method of contraception.
copper intrauterine device
111
Vaginal squamous cell carcinoma is due to persistent infection with human papillomavirus (HPV) infection high-risk types 16 and 18. ??? decreases the normal immune response, which allows for persistent HPV infection and squamous cell metaplastic changes
Chronic tobacco use
112
Mature cystic teratomas are benign germ cell tumors common in premenopausal women. These heterogeneous tumors (eg, hair, teeth) appear on sonogram as complex ovarian cysts with calcified, hyperechoic areas. Treatment is with ???
surgical removal to reduce the risk of ovarian torsion.
113
abnormal vaginal bleeding is a contraindication to intrauterine device insertion
t/f?
true
114
Polycystic ovary syndrome (PCOS) causes infertility due to anovulation and may present with irregular menses, enlarged ovaries, and signs of insulin resistance. Ovulation can be induced with ?? in patients with PCOS
letrozole (an aromatase inhibitor)
115
The ?? are a readily available and effective emergency contraception option that prevent pregnancy by delaying ovulation.
levonorgestrel pill (ie, Plan B)
116
??? tumors are malignant sex cord–stromal tumors of the ovary that secrete estradiol. Patients typically present with a large ovarian mass and postmenopausal bleeding (due to associated endometrial hyperplasia from chronic unopposed estrogen exposure).
Granulosa cell
117
cervical lesion suspicious for malignancy (eg, ulcerative, friable, raised), particularly in patients with risk factors (eg, long-term tobacco use), require a ???
cervical biopsy
118
Patients with PCOS may have infertility due to anovulation from failed
follicular maturation.
119
Primary ovarian insufficiency (POI) occurs due to accelerated ovarian follicle depletion in women age \<40, resulting in secondary amenorrhea, elevated ????, and low estrogen levels
FSH
120
dental caries + dyspareunia
Sjögren syndrome
121
Primary ovarian insufficiency, cessation of ovarian function at age \<40, may present with infertility, irregular menses, and menopausal symptoms. It is characterized by elevated gonadotropin-releasing hormone and FSH levels and a ?? estrogen level.
low
122
??? are soft, mobile, nontender masses at the base of the labia majora at the 4 and 8 o'clock positions.
Bartholin duct cysts
123
Due to the increased risk of maternal morbidity and mortality, patients with intraamniotic infection require therapeutic antibiotics and ??? regardless of gestational age.
immediate delivery
124
As hCG (both α and β subunits) and TSH have a similar structure, elevations in hCG can mimic TSH and cause an increase in triiodothyronine (T3) and thyroxine (T4) concentrations. The markedly elevated hCG levels associated with ???? can therefore cause overt hyperthyroidism (eg, hot flashes, tachycardia, smooth warm skin, low TSH)
hydatidiform mole
125
Pregnant patients with chronic hypertension are at increased risk for obstetric complications, including superimposed preeclampsia, fetal growth restriction, and ???
preterm delivery
126
Patients with hemoperitoneum from ruptured ectopic pregnancy and hemodynamic instability (eg, hypotension, tachycardia) require ???
emergency surgical exploration to remove the ectopic pregnancy and achieve hemostasis.
127
Uterine atony is the most common cause of postpartum hemorrhage, and first-line treatment includes bimanual uterine massage and high-dose oxytocin. In patients with persistent bleeding, the best next step in management is administration of ???
tranexamic acid, an antifibrinolytic agent that prevents the breakdown of blood clots to achieve hemostasis.
128
This patient with intrauterine fetal demise in the setting of a recent episode of watery diarrhea likely had a foodborne infection due to ???
Listeria monocytogenes
129
Placenta accreta occurs due to direct placental villi attachment to the uterine myometrium. Patients typically have difficulty with placental detachment following fetal delivery and continued placental bleeding due to dense adhesions to the uterine wall. Treatment is with ???
hysterectomy (with the placenta left in situ) to prevent life-threatening maternal hemorrhage.
130
Risk factors for Hyperemesis gravidarum include: Hydatidiform mole, history of hyperemesis grav, and ???
Multifetal gestation
elevated hCG and progesterone concentrations from a larger placental volume. hCG levels (which peak at the same time as hyperemesis gravidarum symptoms) may be a cause for increased nausea. Elevated progesterone levels, which relax smooth muscle tone at the lower esophageal sphincter (ie, gastroesophageal reflux) and in the stomach (ie, delayed gastric emptying), can cause increased or persistent vomiting.
131
Ultrasound dating with fetal crown-rump measurement when??? is the most accurate way to determine estimated gestational age (EGA)
first trimester
132
Patients with a rapid onset (\<1 year) of virilization should be evaluated for an ??
androgen-secreting tumor of ovarian or adrenal origin
133
A significant risk factor for recurrent cystitis (ie, ≥2 episodes in 6 months or ≥3 episodes in a year) in women is sexual intercourse. Postcoital ??? can reduce the rate of recurrence.
antibiotic prophylaxis (eg, nitrofurantoin, trimethoprim-sulfamethoxazole)
134
During most of pregnancy, patients with a history of HSV infection typically require no additional management compared with uninfected patients. However, beginning at ?? weeks gestation until delivery, pregnant women with a history of genital HSV receive antiviral prophylaxis (eg, acyclovir, valacyclovir) regardless of symptoms
36
135
Toxic shock syndrome, caused by Staphylococcus aureus bacteremia and associated exotoxin release, typically presents with fever, hypotension, tachycardia, and a diffuse, red, macular rash. Treatment includes fluid replacement and antibiotic therapy with ???
clindamycin plus vancomycin
Vancomycin has bactericidal activity against gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), and clindamycin is highly effective at inhibiting TSS exotoxin production.
136
Abruptio placentae is the premature separation of the placenta from the uterine decidua prior to fetal delivery. It typically presents with painful vaginal bleeding; a firm, tender uterus; and high-frequency contractions. Complications include maternal hemorrhage, hypovolemic shock, and ????
disseminated intravascular coagulation
137
Vasa previa is a rare condition in which the fetal vessels overlie the cervix, making them prone to tear and bleed with rupture of membranes or contractions. Management of a ruptured fetal vessel is with ???
emergency cesarean delivery because of the high risk of fetal exsanguination and demise.
138
Patients typically develop a fever \>24 hours following delivery and have purulent lochia and uterine tenderness. Risk factors include prolonged rupture of membranes, operative vaginal delivery, prolonged labor, and cesarean delivery. This patient has ???
postpartum endometritis, an infection of the uterine decidua and the most common etiology of puerperal fever.
139
postpartum endometritis, an infection of the uterine decidua and the most common etiology of puerperal fever
tx??
clindamycin plus gentamicin = broad spec
polymicrobial infection. Normal vaginal flora includes a mix of gram-positive cocci (eg, group B Streptococcus [GBS]), gram-negative bacilli (eg, Escherichia coli), and anaerobes (eg, Gardnerella vaginalis)
140
Postdural puncture headaches after neuraxial anesthesia (eg, epidural) occur due to unintentional dural puncture. Patients typically develop what kind of headache??? within 72 hours of the procedure and often have associated nausea, vomiting, and neck stiffness.
a positional headache (ie, worsens when upright, improves when supine)
141
Pulmonary arterial hypertension
Peripartum cardiomyopathy with residual LV dysfunction
Heart failure with LVEF \<30%
Severe coarctation
Severe mitral stenosis
Severe symptomatic aortic stenosis
Severe aortic dilation (eg, Marfan syndrome)
all are??
absolute contraindications to pregnancy
142
patients at high risk for preeclampsia (eg, preeclampsia in prior pregnancy) are initiated on ??? prophylaxis during pregnancy for preeclampsia prevention
low-dose aspirin
143
symmetric vs. asymmetric fetal growth restriction
symmetric = chromosomal anamoly most likely
aymmetric = maternal HTN/tobacco - spares the head
144
Intrahepatic cholestasis of pregnancy presents with pruritus that is worse on the hands and feet. Patients are at increased risk of fetal complications, including ????, particularly with markedly elevated total bile acids.
intrauterine fetal demise
145
Acute appendicitis in pregnancy may have an atypical presentation (eg, right mid-to-upper quadrant or flank pain) due to displacement of the appendix by the uterus. This can result in delayed diagnosis and increased risk for complications (eg, appendiceal rupture, fetal demise). Management is with ???
surgery
146
Amphetamine intoxication can present with hypertension, agitation, diaphoresis, dilated pupils, and a generalized tonic-clonic seizure (due to ????).
hyponatremia
147
Thyroid hormone production increases during pregnancy to cope with metabolic demands. Estrogen causes an increase in thyroxine-binding globulin, leading to increased total (but not free) thyroid hormone levels. hCG directly stimulates TSH receptors, causing increased production of thyroid hormones
what level of TSH?
lower due to feedback inhibition
148
first sign of magnesium sulfate toxicity is often ???
hyporeflexia
Treatment is immediate cessation of magnesium sulfate and administration of calcium gluconate.
149
Patients with ??? have cyclic, lower abdominal pain during menses and a normal pelvic examination (small uterus, no masses, no adnexal masses)
primary dysmenorrhea
150
Hyperandrogenism in pregnancy is commonly due to benign, bilateral ovarian masses such as luteomas and theca lutein cysts. Patients with virilization during pregnancy and bilateral ovarian masses are managed how???
observed and managed expectantly, as the symptoms and masses spontaneously regress after delivery
151
An intrauterine fetal demise associated with growth restriction, multiple limb fractures, and a hypoplastic thoracic cavity is consistent with type II ????
osteogenesis imperfecta (OI)
152
Patients with postpartum urinary retention, the inability to void ≥6 hours after vaginal delivery, may have dribbling of urine from overflow incontinence. ??? is indicated for diagnosis and treatment
Urethral catheterization
153
Patients with ??? may have painless, minimal vaginal bleeding and rapid fetal deterioration or demise.
vasa previa
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hyperemesis gravidarum causes metabolic ??? (pH change)
metabolic alkalosis
155
Twin pregnancies are at increased risk for ???? due to spontaneous causes and medically indicated deliveries secondary to maternal (eg, preeclampsia) and fetal (eg, fetal growth restriction) complications.
preterm delivery (ie, \<37 weeks gestation)
156
Persistently absent or minimal variability on fetal heart rate monitoring typically indicates fetal metabolic acidosis. However, what kind of medications can also cause decreased variability
CNS depressants - alcohol, opioid, recreational drugs
157
what do for syphilis tx with penicillin allergy?
Treatment with penicillin is required for all pregnant patients with syphilis to prevent fetal complications. Patients with penicillin allergy should receive skin testing to confirm an IgE-mediated reaction. If the test is positive, patients are desensitized to penicillin prior to receiving treatment with intramuscular penicillin G benzathine
158
??? is a chronic inflammatory condition typically found in intertriginous areas (eg, inguinal region). The lesions occur due to occluded follicles that cause painful nodules and abscesses that can develop into draining sinus tracts and result in significant scarring
Hidradenitis suppurativa
159
intrapartum penicillin for unknown GBS status PLUS any of the following:
\<37 weeks gestation
Intrapartum fever
????
Rupture of membranes for ≥18 hours
160
????, an abnormal stricture of the cervical canal, is a potential complication of cervical conization due to scar tissue.
Cervical stenosis
161
Short interpregnancy intervals (eg, \<6-18 months between delivery and next pregnancy) are associated with an increased risk of pregnancy complications including ??? (3 related)
preterm labor, preterm prelabor rupture of membranes, and low birth weight
162
Anti-D immune globulin should be administered to any Rh D-negative mother who delivers an Rh D-positive baby. The standard dose is usually adequate at 28 weeks gestation. After delivery or procedures, the ??? test is used to determine whether a higher dose is needed due to the increased risk of fetal blood cells entering the maternal circulation.
Kleihauer-Betke
163
All sexually active women age ?? are recommended annual screening for Chlamydia trachomatis and Neisseria gonorrhoeae due to high rates of asymptomatic infection and risk of long-term sequelae (eg, infertility).
25
164
??? is a white, odorless mucoid cervical discharge that typically occurs midcycle due to increasing estrogen levels prior to ovulation. Microscopic examination of the discharge reveals no evidence of inflammation or infection (eg, rare polymorphonuclear leukocytes).
Physiologic leukorrhea
165
A ??? tumor, a sex cord–stromal tumor, is a testosterone-secreting ovarian tumor. Patients can have virilization (eg, clitoromegaly) and signs of estrogen deficiency (eg, breast atrophy, vulvovaginal atrophy)
Sertoli-Leydig cell
166
Toxic shock syndrome, due to Staphylococcus aureus bacteremia and associated exotoxin release, presents with fever, hypotension, tachycardia, and a diffuse, red, macular rash involving the ????
palms and soles
167
Initial evaluation of mixed incontinence includes a ????
voiding diary, which tracks fluid intake, urine output, and leaking episodes in order to classify the predominant type of urinary incontinence and determine optimal treatment
168
In adolescents, the immature hypothalamic-pituitary-ovarian axis causes anovulation and can result in heavy, irregular menstrual bleeding. In hemodynamically stable patients, heavy vaginal bleeding is managed with ???? therapy to stabilize the endometrium and stop the acute bleeding.
high-dose oral contraceptive
169
type 1 diabetes mellitus increases risk of what kind of pregnancy complication
preeclampsia
170
≥2 prior consecutive, painless, second-trimester losses (ie, history-based) is indication for?
cerclage
171
Pap testing may be discontinued in patients age ??? who have had adequate Pap testing without prior high-grade cervical lesions or cervical cancer risk factors (eg, tobacco use, immunocompromised status).
65
172
On examination, patients may have **lateral cervical displacement** or cervical motion tenderness
which condition?
Endometriosis
173
HPV
MMR
Live attenuated influenza
Varicella
what is common about these vaccines?
contraindicated in pregnancy
174
This massive intrahepatic injury results in acute-onset fulminant liver failure that manifests as profound hypoglycemia (from inability to convert glycogen to glucose), hyperbilirubinemia, thrombocytopenia (\<100,000/mm³), and possible disseminated intravascular coagulopathy
Acute fatty liver of pregnancy
175
Acute fatty liver of pregnancy typically occurs in the **third trimester** due to microvesicular fatty infiltration of hepatocytes, leading to liver inflammation (eg, right upper quadrant pain, elevated aminotransferases) and fulminant liver failure (eg, profound hypoglycemia, thrombocytopenia). Management is ???
immediate delivery
176
Endometriosis is initially treated with nonsteroidal anti-inflammatory drugs and combined oral contraceptives. Patients who fail medical therapy are recommended ???
laparoscopy, which can offer definitive diagnosis and treatment.
177
endometriosis increases the risk for??
infertility due to adhesions/inflammation/distored pelvic anatomy
178
what neuro condition can be caused by hyperemesis gravidarum?
Wernicke encephalopathy is a complication of hyperemesis gravidarum that results from thiamine deficiency. Classic presenting symptoms include encephalopathy, oculomotor dysfunction, and gait ataxia.
179
?? occurs due to partial 21-hydroxylase deficiency and typically presents in reproductive-aged women with signs of hyperandrogenism (eg, hirsutism, acne) and abnormal uterine bleeding
Diagnosis is with an elevated 17-hydroxyprogesterone level and an ACTH stimulation test
Nonclassic congenital adrenal hyperplasia
180
The combination of dysuria and sterile pyuria is a common presentation for ???? in sexually active women
Chlamydia trachomatis urethritis
181
Patients with ??? develop a large volume of intraabdominal fluid after gyn surgery but typically have normal voiding, serum creatinine levels, and urinalysis due to the functioning contralateral kidney and ureter.
unilateral ureteral laceration develop a large volume of intraabdominal fluid (uroperitoneum)
182
what can cause CNS overactivity (eg, perioral numbness, metallic taste, tinnitus) and generalized tonic-clonic seizures during a delivery??
Local anesthetic systemic toxicity bc the epidural catheter can sometimes be inadvertently inserted into the epidural vasculature, resulting in direct delivery of the anesthetic into the maternal circulation and rapid systemic drug absorption
\*\*\*bupivacaine
183
The maternal quadruple screen with ??? is suggestive of Down syndrome
which two increased?? which two decreased??
increased levels of β-hCG and inhibin A and decreased levels of maternal serum alpha-fetoprotein (MSAFP) and estriol
184
??? contraception is contraindicated in patients with migraine with aura due to the increased risk of stroke
estrogen-containing
185
??? is the best option for management of intrauterine fetal demise at ≥24 weeks gestation.
Induction of labor for vaginal delivery
186
??? is a common cause of vaginitis and typically presents with a malodorous, thin, frothy, **yellow-green** vaginal discharge with an elevated pH (\>4.5)
Trichomonas vaginalis
187
During early pregnancy, the corpus luteum produces progesterone, which prepares the endometrium for implantation, promotes implantation, and maintains the pregnancy through 10 weeks gestation. Patients who have the corpus luteum removed (eg, oophorectomy) prior to 10 weeks gestation require ???? to prevent pregnancy loss
progesterone supplementation
188
The risk of intimate partner violence (IPV) increases during the ??? period due to increased emotional, physical, and financial stressors. Therefore, routine postpartum screening for IPV is required to decrease the risk of maternal and infant morbidity.
postpartum
189
absolute contraindications to methotrexate include the following:
Hematologic abnormalities (eg, anemia, thrombocytopenia) and immunosuppression (eg, HIV) due to the increased risk for bone marrow suppression and pancytopenia
Hepatic or renal disease due to decreased drug metabolism and clearance, which increases the risk for methotrexate toxicity (eg, acute respiratory distress syndrome, bowel ischemia)
???2 more????
Breastfeeding due to the transfer to breast milk, which can cause toxic levels in the infant
and
Active pulmonary disease due to the risk for pulmonary toxicity
190
Hyperflexion of the hips during the second stage of labor can compress and entrap the ???? nerve under the inguinal ligament and cause a pressure-induced ischemia, leading to decreased anteromedial thigh sensation and weakness with hip flexion and leg extension.
femoral
191
Because of complete or partial obliteration of the endometrium, patients typically develop very light menses or secondary amenorrhea that does not respond to a progesterone challenge, as evidenced by no withdrawal bleeding during the placebo week of oral contraceptives.
which syndrome?
Asherman syndrome
192
Patients with late-term (≥41 weeks gestation) and post-term (≥42 weeks gestation) pregnancies are at increased risk for ????
oligohydramnios
Progressive placental dysfunction can lead to uteroplacental insufficiency and chronic fetal hypoxemia, which cause central nervous system suppression and intrauterine fetal demise. To prevent this suppression, blood is preferentially distributed to the brain rather than peripheral tissue. This redistribution can be evidenced on ultrasound as oligohydramnios (single deepest pocket \<2 cm or amniotic fluid index \<5 cm) as amniotic fluid is dependent on renal perfusion and urine production.
193
What is Ulipristal ??
Ulipristal is a highly effective emergency contraception option that prevents pregnancy by delaying ovulation and impairing implantation. It can be taken up to 120 hours after unprotected intercourse.
194
The choice of medical therapy for uterine atony depends on patient contraindications: Methylergonovine is contraindicated in ??? patients, carboprost tromethamine is contraindicated in patients with asthma, and tranexamic acid is used with caution in patients with hypercoagulability
hypertensive
195
Symptomatic ??? typically presents with suprapubic pain that radiates to the back, hips, thighs, or legs and is exacerbated by walking, weight-bearing, or position changes. The diagnosis is made clinically; patients have point tenderness to palpation over the pubic symphysis and sometimes have a waddling gait after a traumatic delivery
pubic symphysis diastasis
196
Preterm prelabor rupture of membranes, rupture of membranes \<37 weeks gestation before the onset of labor, requires inpatient management due to the risk of ???, intraamniotic infection, umbilical cord prolapse, and preterm labor
placental abruption
197
patients with ??? insufficiency are at increased risk for magnesium toxicity.
renal ; because magnesium is excreted primarily by the kidneys
198
Patients with ??? typically develop localized low back or buttock pain immediately after delivery. The pain is typically worse with sitting and leaning back due to the increased weight on the coccyx. It is diagnosed clinically based on exquisite tenderness on palpation of the coccyx with no associated signs of infection (eg, erythema, swelling) or neurologic deficits (eg, reduced strength and reflexes).
coccydynia
199
which contraceptive has no contraindication with HTN, \>99% efficacy, and no effect on future fertility
copper IUD
200
Secondary amenorrhea is relatively common in female athletes and results from ???. The subsequent decreased LH secretion and estrogen deficiency result in decreased bone mineral density
hypothalamic amenorrhea (eg, GnRH deficiency)
They are thought to have a relative caloric deficiency secondary to inadequate nutritional intake compared to the amount of energy expended. Women with this condition have been shown to have decreased levels of gonadotropin-releasing hormone (GnRH), with a subsequent decrease in LH secretion, resulting in estrogen deficiency
201
Immediate routine neonatal resuscitation includes drying, stimulating, and warming. THen?
Healthy newborns should be placed on the mother's chest for skin-to-skin care, which provides warmth and allows early breastfeeding initiation.
202
???, an acquired hyperpigmentation disorder that commonly occurs during pregnancy, typically presents with bilateral, symmetric macules on sun-exposed areas of the face. It is clinically diagnosed and typically resolves postpartum. It is managed with avoidance of sun exposure and use of broad-spectrum sunscreen.
Melasma
203
??? (typically the first sign of puberty) is normal in girls age ≥8 and is characterized by firm, often tender, breast buds posterior to the nipple. Breast buds can be unilateral in the early stages of puberty.
Thelarche
204
??? are a common cause of cyclic, premenstrual breast tenderness in women of reproductive age. Patients typically have diffusely nodular breasts and bilateral, nonfocal breast or chest pain.
Fibrocystic breast changes
205
Adolescents often have anovulatory cycles with irregular, heavy menstrual bleeding due to an immature hypothalamic-pituitary axis. ?? treatment normalizes menstruation by stabilizing unregulated endometrial proliferation
Progesterone
206
Vaccines that are safe during pregnancy and recommended include ??? (3)
inactivated influenza, Tdap, and Rho(D) immunoglobulin.
207
The risk of breast cancer in women increases with age; therefore, routine screening mammography is age based and typically initiated at age ≥??.
50
age is a major risk factor
208
???commonly occurs in adolescents after the establishment of ovulatory menstrual cycles. Excessive endometrial prostaglandin production results in lower abdominal cramping and other associated symptoms (eg, fatigue) during menses. Symptoms typically decrease with age.
\*also normal pelvic exam
Primary dysmenorrhea
209
The ??? muscle is the landmark for distinguishing the surgical levels of axillary lymph nodes during axillary lymph node dissection.
pectoralis minor
210
Patients with ??? have primary amenorrhea and lack of breast development due to low estrogen levels associated with gonadal dysgenesis. Lack of feedback inhibition by estrogen on the hypothalamic-pituitary-ovarian axis results in increased FSH and LH. An absent X chromosome on karyotype analysis is diagnostic.
Turner syndrome
211
In utero exposure to maternal estrogen causes neonatal findings of labial swelling, physiologic leukorrhea, and breast hypertrophy; vaginal bleeding can also occur due to withdrawal of maternal hormones after delivery. These findings are physiologic, benign, and self-limited. Management is ???
observation and reassurance alone.
212
Neonatal ??? infection typically results from vertical transmission during delivery. The presentation in newborns with CNS disease (ie, encephalitis) typically occurs in weeks 2-3 of life with seizure and temporal lobe hemorrhage
herpes simplex virus
213
placenta previa vs. vasa previa
both present with painless 2nd/3rd trimester bleeding
vasa previa mainly involves fetal vessels, therefore on fetal heart tracing you will see abnormalities in fetal HR !
214
The pathophysiology of hypocalcemia in infants of diabetic mothers relates to maternal ??, which is caused by osmotic diuresis in the setting of poorly controlled gestational diabetes. Low fetal magnesium concentrations, which reflect maternal levels, lead to PTH suppression and low calcium levels in the neonate.
Serum calcium level should be obtained for symptomatic neonates (eg, jitteriness), particularly if serum glucose is normal.
hypomagnesemia
215
Erb-Duchenne palsy is the most common type of brachial plexus injury and involves the ??? cervical nerves, leading to the "waiter's tip" posture. The affected arm may have decreased or absent Moro reflexes, but grasp reflex remains intact
\*part of shoulder dystocia
5th and 6th
216
??? palsy is a rare complication of shoulder dystocia caused by injury to the 8th cervical and 1st thoracic nerves. Presentation can include hand paralysis (ie, "claw hand") and ipsilateral Horner syndrome.
Klumpke
217
Simple breast cysts are a common cause of palpable breast masses in women age 30-50; they are typically mobile and well-circumscribed. Fine-needle aspiration can be performed for symptomatic (ie, painful) breast cysts. Patients with nonbloody fluid on aspiration and complete resolution of both the mass and symptoms require ??
no additional management.
218
?? can mimic breast cancer in its clinical and radiographic presentation because it commonly presents as a fixed mass with skin or nipple retraction and gives the appearance of calcifications on mammography. Ultrasonography can demonstrate a hyperechoic mass, which often correlates with a benign etiology. Biopsy is diagnostic and typically shows **fat globules and foamy histiocytes.**
Fat necrosis
219
Patients with a complete small bowel obstruction (eg, obstipation, no air in the rectum on abdominal x-ray) require nasogastric tube insertion for gastric decompression plus ???? due to the high risk of life-threatening complications (eg, bowel ischemia, perforation).
\*\*can happen after ovarian/uterine surgery from incisional hernia
\*\*partial SBO can be treated conservatively
emergency laparotomy
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