Ob-Gyne Pathology Flashcards
(158 cards)
1
Q
Puerperium is defined as _________
A
4-6 weeks postpartum
2
Q
Episiotomies will heal when?
A
1-2 weeks
3
Q
In the puerperial period, blood volume returns to normal when?
A
1 week
4
Q
In the puerperial period, CO returns when?
A
2 weeks
5
Q
Obstetrical neuropathies?
A
Footdrop from lumbosacral root compression
6
Q
Common fibular (peroneal) nerve injury is caused by
A
Stirrups
7
Q
What is shedding of decidua superficialis?
A
Lochia
8
Q
Most common cause of mastitis
A
S. Aureus
9
Q
Puerperial infection manifested by persistence of fever more than 72 hours despite IV antimicrobials
A
Parametrial phlegmon
10
Q
Time period of postpartum blues
A
Occurs within 10 days
Resolves 3 days after
11
Q
Return of menses returns for non-lactating?
A
7-8weeks
12
Q
Postpartum checkup?
A
4-6 weeks
13
Q
Undergo papsmear postpartum what period?
A
6 months
14
Q
MINIMUM criteria of preeclampsia
A
> 140/90mmHg after 20 weeks
Proteinurua >300mg/24 hours or >+1 dipstick
15
Q
Severe preeclampsia is defined as ________
A
160/110mmHg
>2gm/24 hours
16
Q
Basic Pathology of preeclampsia
A
Vasospasm
17
Q
Passage of meconium is a sign of _______ due to stimulation of posterior pitiitary gland which produce ADH thereby increases GI motility
A
Fetal hypoxia
18
Q
Normal leve of MgSO4
A
4-7 meq/L
19
Q
Mg 10meq/L will manifest as
A
Disappearance of patellar reflex
20
Q
Mg 12meq/L will manifest as ________
A
Respiratory paralysis and depression
21
Q
Antidote for MgSO4 toxicity
A
Calcium gluconate
22
Q
When is the BP of postpartum mother returns back to normal?
A
< 12 weeks
23
Q
What is chronic hypertension with superimposed severe preeclampsia?
A
New onset proteinuria >= 300mg/24 hours in hypertensive women but no proteinuria before 20 weeks’ AOG
24
Q
What is chronic hypertension?
A
BP equals to or >140/90 mmHg before pregnancy or diagnosed before 20 weeks gestafion nir attributable to GTD
Hypertension first diagnosed after 20 weeks’ AOG and persistent after 12 weeks postpartum
25
MAP value in the 2nd trimester
>90 mmHg
26
MAP value in the 3rd trimester
>105 mmHg
27
What are the screening maneuvers of pre-eclampsia?
MAP
Supine pressure test or roll-over test
Conbination of MAP and roll-over test
28
What is the finding at 12-14 weeks AOG that is considered to be a useful tool in predicting the developement of hypertensive disorders in high risk prengnancy?
Bilateral notching
29
Effective test in predicting PIH at 24 weeks AOG
Doppler velocimetry of the uterine and uteroplacental arteries
30
Glycoprotein derived principally from the liver and endothelialbcells and its release into plasma is a marker of vascular disruption and endothelial cell activation
Fibronectin
31
Level of fibronectjn that is capable of predicting preeclampsja in the 3rd trimester
40mg/dL
32
Tests to predict preeclampsia for chronic HPN
Hypocalciuria and calcium/creatinine ratio
33
2nd most common cause of maternal death
Eclampsia
34
Stage of preeclampsia characterized by faulty vascular remodeling of uterine artery cauding placental hypoxia
Stage 1 - preclinical
35
Stage of preeclampsia characterized by release of placental factors into the ciculationb-> SIR and endothelial activation
Stage 2 - late stage
36
Hallmark of eclampsia
Hemoconcentration
37
Renal biopsy finding of eclamptic pregnant
Glomerular capillafy endotheliosis
38
Headache and scotoma (as a manifestation of eclampsia) are thought to arise from cerebrovascular hyperperfusion that has predilection at what part of the brain?
Occipital lobe
39
Proposed MOA of MgSO4 in the prevention of eclampsia
1. Reduced presynaptic release of glutamate
2. Blockade of NMDA
3. Potentiation of adenosine action
4. Improved mitochondrial calcium buffering
5. Blockade of clacium entry
40
Maneuver stating that the fetal head should be maintained in a flexed position during delivery to allow passage of the smallesr diameter of the head
Mauriceau Smellie Veit maneuver
41
Maneuver employed when the arm of the baby cannot be deliver during breevih delivery. Fetal body is turned 90 degreesbinto then transverse, reached over the baby’s shoulder and slipsnthenfinger down into brachial plexus sweeping the arm down in front of the baby’s body
Loveset’s maneuver
42
Forceps that may br used if the mentum is anterior
Kielland forcep
43
Prophylactic CS is warranted if with the following EFW findings
EFW >4,500g (with maternal DM)
| EFW >5,000g (without DM)
44
What is the dystocia drill?
```
Call for help
Episiotomy
Suprapubic pressure
McRobert maneuver
Delivery of posterior arm
Woods screw maneuver
Rubin maneuver
Zavanelli maneuver
Cleidotomy
Symphysiotomy
```
45
Maneuver that involves progressively rotates the posterior shoulder 180 degrees, the impacted anterior shoulder could be released
Woods screw maneuver
46
Maneuver that involves the fetal shoulders rocked from side to side by applying force to the maternal abdomen
Rubin maneuver
47
Maneuver that most often abducts both shoulders which in turn produces a smaller shoulder to shoulder diameter which permits displacement of the anterior shoulder behind the symphysis
Rubin maneuver
48
Maneuver that replaces or flexes the fetal head back into the vagina and then CS is performed
Zavanelli maneuver
49
Deliberate fracture of the anterior clavicle to free the shoulder impaction
Cleidotomy
50
Intervening symphyseal cartilage and much of its ligamentous support is cut to widen the symphysis
Symphysiotomy
51
Maneuver needed with a frank breech to facilitate delivery of the legs but only after the fetal umbilicus has been reached. Pressure is exerted in the popliteal space of the knee. Flexion of the knee follows and the lower leg is swept medially and out of the vagina
Pinard maneuver
52
Elective CS for vasa previa is done at what AOG?
35-37 weeks AOG
53
Mode of delivery for pregnants who develop primary genital herpes within 6 weeks of delivery
CS
54
AOG wherein elective CS with HBV profile are as follows: HbeAg positive, HBV DNA copies >1,000,000 and does not received oral antiretroviral therapy
39 weeks
55
AOG of planned CS
39 weeks
56
The following anomalies may benefit from CS:
a. NTDs with fetus in breech
b. NTDs with sac > 6cm
c. Cystic hygromas
d. Sacricoccygeal teratomas > 5cm
e. Hydrocephalus with BPD > 10cm
57
Sexual intercourse may be resumed as early as how many week postpartum?
2 weeks
58
Most common chromosomal abnormality in abortion
Autosomal trisomy
59
Most common type of abortion
Incomplete
60
Type of abortion with dead fetus retained in utero for more than 4 weeks
Missed abortion
61
Management of missed abortion
< 12 weeks
> 12 weeks
< 12 weeks: vaginal evacuation
| > 12 weeks: induce
62
Most common heart disease in pregnancy
Rheumatic heart disease
63
2nd most common heart disease in pregnancy
Congenital heart disease
64
AOG most CHF occurs
30-32 weeks
65
Amount of polyhydramnios
2000mL
66
Amount of oligohydramnios
<1,000mL
67
Developmental problem in the child with GDM
Autism
68
Normal glycosuria level in pregnancy
300mg/day
69
Postpartum hemorrhage is defined as blood loss of how much after completion of 3rd stage of labor
>500mL
70
What theory is placenta previa based on and its principle?
Dropping down theory - poor decidual reaction in the upper segment
71
Elective CS for asymptomatic placenta previa is done at what AOG?
>37 weeks
72
Elective CS for suspected placenta accreta is done at what AOG?
> 36 weeks
73
Important cause of vaginal bleeding in the 2nd half of pregnancy complicating about 1% of births
Abruptio placenta
74
Most common cause of abruptio placenta
PIH
75
Illicit drug use that causes placental abruption
Cocaine
76
What diagnostic imaging is used if the clinical circumstance of UTZ findings are confusing?
MRI
77
Classification of abruptio placenta:
Class I
Class II
Class III
*only indicated what’s confusing among the three
```
Class I (mildest - 48%)
No coagulopahty
No fetal distress
Class II (moderate - 27%)
Low fibrinogen present
Fetal distress
Class III (severe - 24%)
Coagulopathy
Fetal death
```
78
Mild abruptio management
Vaginal delivery
79
Moderate abruptio management
CS
80
Severe abruptio management
Vaginal delivery
81
It is known as uteroplacental apoplexy as a compication of abruptio wherein there is extensive extravasation of blood into the uterine musculature
Couvelaire’s uterus
82
Most common cause of early postpartum hemorrhage
Uterine atony
83
Most common cause of maternal mortality
Uterine atony
84
What are the arteries ligated in devascularization as a management of uterine atony?
Uterine artery
| Internal iliac artery
85
In women para ____or greater, the 2.7% incidence of postpartum hemorrhage was increased fourfold compared with that of the general obstetrical population
7
86
Location where uterine artery ligation is done in women suffering from uterine atony
Superiorly at the approximate junction between the utero-ovarian ligament and the uterus and inferiorly just below the uterine incision
87
Classification of uterine inversion wherein the inverted fundus extends beyond the introitus
Prolapsed
88
Classification of uterine inversion wherein the uterus and vaginal wall inverts
Total
89
Classification of uterine inversion wherein the fundus extends beyond the external os
Complete
90
What are the classifications of uterine inversion?
Invomplete, complete, prolapsed, total
91
When does acute uterine inversion occurs?
Before cervical ring contraction
92
When does subacute uterine inversion occurs?
Contracted cervical rings
93
When does chronic uterine inversion occurs?
4 weeks after the event
94
Physical examination finding of uterine inversion
Abnormal palpation of the crater-like depression and vaginal palpaion of the fundal wall in the LUs and cervix
95
Maneuver done for uterine inversion by immediately pushin up on the fundus with the palm of the hand and fingers in the direction of te long axis of the vagina
Johnson maneuver
96
Procedure in uterine inversion described as laparotomy, clamps placed in cup of inversion below cervical rung, gentle upward traction, repeated clamping and traction
Huntington procedure
97
Procedure in uterine inversion described as incision inposterior portion of inversion ring, through the abdoment to increase the size of the rong and allow repositionong of the uterus
Haultaim procedure
98
What is commonly referred as iterine dehiscence?
Incomplete uterine rupture
99
Classification of uterine rupture and describe
Complete: all layers of the uterine wall are separated
Incomplete: when the uterine muscle is separated but the visceral peritoneum is intact
100
Most common sign of uterine rupture
Non-reassuring fetal heart rate pattern
101
Primary surrogate for cervical neoplasia
HPV
102
High risk HPV types
16, 18, 31 and 45
103
Intermediate risk HPV
33, 35, 39, 51, 53, 56, 58, 59, 73
104
Low risk HPV
6, 11, 53
105
How many individual HPV types?
70
106
HPV 16 and 18 causes
Cervical, vaginal and anal cancers
107
HPV 6, 11 causes
Condyloma acuminata
108
HPV lesions appearance
4-6 weeks
109
Molecular police
p53 and Rb
110
HPV early proteins that immortalizes human keratinocytes
E6 and E7
111
Screening methods of HPV
1. Cervical cytology
2. Visual inspection using Acetic acid or Lugol’s iodine
3. HPV test
112
Premalignant HPV lesions fall into 3 categories:
ASCUS
LSIL
HSIL
113
Pre-malignant lesion characterized as mild cervical intraepithelial neoplasia and other HPv associated lesions (condylomatous atypia or koilocytic atypia)
LSIL
114
Pre-malignant lesion characterized as moderatento severe cervical intraepithelial neoplasia and carcinoma - in situ
HSIL
115
When and how often is papsmear done?
Starts as 18 y/o or at initiation of sexual activity and to continue annually
After 2 negative consecutive results, 1 year apart and to proceed every 3 years to age 69
116
If CIN I or LSIL is found, when is papsmear done?
Repeated every 6 months for 2 years
117
Immeidate colposcopy is done in what type of cervical dysplasia?
Moderate dysplasia
118
Component of molecular hybridization in cervical CA
Southern DNa blotting
Dot blotting
In siti DNA hybridization
119
Test sensitive for HPV DNA
PCR
120
Cervical CA clinical staging
Stage 1: confined to the cervix
Stage 2: beyond the cervix, not to the pelvic sidewall, not to the lower third of the vagina
Stabe 3: extension to the pelvic sidewall, involves the lower third of the vagina, with hydronephrosis or non-functioning kidney
Stage 4: extension to beyodn the true pelvis, clinically involved (biopsy proven) the mucosa of the bladder or rectum
121
Mechanism of HPV vaccination
DNa-free viruanlike particles synthesized by sef assembly of fusion proteins of the major capsid antigen L1 found to induce humoral response with neutralizing antibodies (type specific)
122
Most common cause of maternal death
Puerperal sepsis
123
Endotoxin cause by
Gram negative
124
Exotoxin A caused by
P. Aeruginosa
125
Toxic shock syndrome toxin caused by
S. Aureus
126
Circulation volume initially restored leads to high CO + low systemic vascular resistance
Warm phase of septic shock
127
Uncorrected with vigorous fluid infusion leads to peripheral vasoconstrixtion+ oliguria
Cold phase of septic shock
128
Diagnostic criteria of chorioamnionitis
Maternal fever + 2 of the following:
Maternal tachycardia
Purulent and foul-smelling amniotic fluid
Maternal leukocytosis
129
Single most significant risk factor for postpartum uterine infection
Abdominal delivery
130
Gold standard antibiotic for chorioamnionitis
Clindamycin + Gentamycin
131
Intrapartum infection causing chorioamnionitis
Group B strep
132
Curdy vaginal discharge with beefy red itchy vulva
Fungal vaginitis caused by C.albicans
133
Criteria to diagnose bacterial vaginosis
Vaginal pH >4.7
Clue cells
Thin homogenous discharge
Fishy odor (adding potassium hydroxide)
134
Green, frothy vaginal discharge
Trichomonas vaginalis
135
Diagnosis of trichomonas vaginalis
Normal saline wet mount demonstrates flagellates
136
Diagnosis media of Gonorrhea
Thayer Martin Broth
137
Diagnosis media of Chlamydia
Giemsa or Wright’s strain
138
Diagnostic tool for syphilis
Darkfield microscopy
139
Screening test for syphilis
VDRL or RPR
140
Specific test for syphilis
FTA-ABS
141
Most common cause of serious liver disease or jaundice in pregnancy
Viral hepatitis
142
AOG highest incidence of UTI
9th-17th
143
Screening of asymptomatic bacteriuria
16 weeks AOG
144
Organism causing Sterile pyuria
C. Trochomatis
145
Most common non-obstetric indiction for hospitalization of the pregnant patient
Acute pyelonephritis
146
50% unilateral on the _______because of the dextrorotation of the uterus causing pyelonephritis
Right
147
How many days after exposure to rubella for antibody?
10 days
148
If given with rubella virus vaccine, avoid pregnancy within how many months?
2-3 months
149
Susceptibel pregnant women with varicella exposure should be given VZIG within how many hours of exposure
Within 96 Hours
150
Lichen sclerosus is also called as
Chronic atrophic vulvitis
151
4 cardinal histologic features of lichen sclerosus
1. Thinning of the epidermis with disappearance of rete pegs
2. Hydropic degeneration of basal cells
3. Replacement of dermis by dense collagenous fibrous tissue
4. Monoclonal bandlike lymphocytic infiltrate
152
Complication of lichen sclerosus
Carcinoma
153
Lichen simplex chronicus is also known as:
Squamous hyperplasia, hyoerolastic dystrophy
154
Nonspecific condition of the female genital tract that arises from rubbing and scratching of skin
Lichen simplex chronicus
155
What layer of the epidermis is expanded in lichen simplex chronicus?
Stratum granulosum
156
Papillary hidradenoma is identical to what condition?
Intraductal papilloma of the breast
157
Types of vulvar carcinoma
Vulvar intraepithelial neoplasia
Basaloid carcinoma
Warty carcinoma
158
Most common location of papillary hidradenoma
Labia majora or interlabial folds
