OB Shelf Flashcards
1
Q
What are the screening recommendations for chlamydia?
A
- All sexually active non-pregnant women aged 24 and younger, or >25 if high risk
- All pregnant women aged 24 and younger, and >25 if high risk
2
Q
What are the risk factors for chlamydial infection?
A
- Hx of chlamydial or other STIs
- New or multiple sex partners
- Inconsistent condom use
- Exchanging sex for money or drugs
3
Q
What is Goodells sign?
A
Softening of the cervix during pregnancy
4
Q
What is Hegars sign?
A
Softening of the uterus during pregnancy
5
Q
What is Chadwicks sign?
A
bluish purple hue in the cervix and vaginal walls during pregnancy
- caused by hyperemia
6
Q
How do you date pregnancies?
A
Naegle’s Rule:
minus 3 months, plus 7 days!
so if LMP was Sept 25th, 9-3 = 6, June 25th, Add 7 days = July 2nd
7
Q
Triad of interstitial cystitis??
A
- Urinary urgency
- Urinary frequency
- Chronic pelvic pain
8
Q
In interstitial cystitis, what exacerbates the pelvic pain?
relieves it?
A
- Sexual intercourse
- Filling of the bladder
- Exercise
- Spicy foods
- Certain beverages
Relieved via voiding of bladder
9
Q
What does cystoscopy classically demonstrate in interstitial cystitis?
A
submucosal petechiae or ulcerations
10
Q
What is the triad of pelvic inflammatory disease?
A
- Pelvic pain
- Cervical motion tenderness
- fever
11
Q
What is the single most useful parameter for predicting fetal weight by ultrasonogram in suspected FGR?
A
Abdominal circumference
12
Q
What is fetal growth restriction? Describe the 2 types
A
2 types: symmetrical and asymmetrical
- Symmetrical: insult to fetus <28wks gestation and growth of head and body is deficient
- usually the result of genetic anomalies or TORCH infections - Asymmetric: insult to fetus after 28wks, normal head size and reduced abdominal circumference
13
Q
When is FGR suspected?
A
when fundal height is at least 3cm less than the actual gestation age in weeks
14
Q
What measurement can be used to differentiate between symmetric and asymmetric FGR?
A
head to abdomen circumference
15
Q
When are serum progesterone measurement taken to detect ovulation?
A
Mid-luteal phease
16
Q
What are the symptoms of severe preeclampsia?
A
- HTN (160/110)
- Proteinuria (>5g on 24hr urine)
- Oliguria
- Pulmonary edema
- Thrombocytopenia
- Elevated liver enzymes
17
Q
What is HELLP syndrome?
A
Hemolysis
Elevated liver enzymes
low platelets
18
Q
What causes RUQ pain in preeclampsia?
A
hematoma formation and formation of thrombi in the portal capillary system can cause swelling of the liver with distention of he hepatic (Glissons) capsule
19
Q
Pt with eclampsia is given what to prevent further seizures?
A
magnesium sulfate
20
Q
what screening test is performed in all pregnant women, regardless of risk factors?
A
RPR!
21
Q
What is the difference between mild and severe eclampsia?
A
Mild: HTN >140/90, proteinuria >0.3g/24hr after the 20th week gestation
Severe: HTN >160/110, proteinuria >5g/24hrs, oliguria, elevated liver enzymes, thrombocytopenia, and possibly Pulmonary edema
22
Q
when is transient HTN seen in pregnancy?
A
second half of pregnancy or during labor and delivery
23
Q
What is the tx for the HTN seen in preeclampsia and eclampsia?
A
Methyldopa: centrally acting alpha agonist
24
Q
What is the ideal range of maternal fasting glucose?
A
75-90mg/dL
25
What is the tx for gestational diabetes?
subcutaneous insulin (doesnt cross the palcenta)
26
What are the risks to the fetus associated with gestational diabetes?
1. Macrosomia
2. Hypocalcemia (from PTH suppression)
3. Hypoglycemia
4. Hyperviscosity due to polycythemia
5. Respiratory difficulties
6. Cardiomyopathy
7. CHF
27
What is the mechanism behind the polycythemia in infants of a diabetic mother?
- fetal hypoxia due to increased BMR incuded by hyperglycemia
- this causes increased EPO production by the fetus -> increased red blood cell mass and O2 capacity of the blood
28
What causes early decelerations?
Fetal head compression leading to a vagal response
29
What causes variable decelerations?
Umbilical cord compression
30
What causes late decelerations?
Uteroplacental insufficiency -> fetal hypoxia -> fetal acidosis
31
What is ERT affect on metabolism of thyroid hormones?
- incraesed due to induction of P450
32
What are the symptoms of neonatal thyrotoxicosis?
1. Goiter
2. Tachypnea and tachycardia
3. Cardiomegaly
4. Restlessness
5. Diarrhea
6. Poor weight gain
- all within 1-2 days following delivery
33
What causes neonatal thyrotoxicosis?
- Moms with Graves disease- circulating levels of thyroid stimulating immunoglobulin (IgG autoantibodies) cross the placenta and cause thyrotoxicosis via stimulating the thyroid gland
- these levels can remain high even months after a thyroidectomy in a mother
34
What is the definition for arrest of descent during labor?
a lack of change (of descent in fetal presenting part) in 2 hours for primigravid patients or 1 hour for multigravid patients
- an extra hour for descent is allowed if an epidural is in place
35
What are the 5 categories of an Apgar score?
1. Color
2. Pulse
3. Respirations
4. Grimace
5. Tone
36
What are the different degrees of perineal lacerations?
- First: involve the fourchette, perineal skin and vaginal mucosa but not the underlying gascia and muscle (skid mark)
- Second: first degree + fascia and muscle but NOT the anal sphincter
- Third: second degree + anal sphincter
- Fourth: Extend through the rectal mucosa to expose the lumen of the rectum
37
What are the two types of episiotomy?
1. Midline: the incision is made in the midline from the posterior fourchette, most common
2. Mediolateral: the incision is oblique starting from 5/7oclock position of the vagina, causes more bleeding and pain
38
A midline episiotomy increases the risk for what?
fourth degree laceration
39
what is the most common cause of postpartum hemorrhage?
uterine atony
40
Postpartum Hemorrhage causes what?
the 4 t's:
1. Tissue: retained placenta
2. Trauma: instrumentation, lacerations, episiotomy
3. Tone: uterine atony
4. Thrombin: coagulation defects, DIC
41
How often should vaginal exams be performed during labor?
Every 4 hours in latent phase
| Every 2 hours in active phase
42
What is the definition of arrest of labor?
lack of cervical change in active first stage for >2 hr with >200 montevideo units of uterine activity
43
How do you calculate a montevideo unit?
calculated by an increase in uterine pressure above baseline multiplied by contraction frequency over 10 min
44
What is the definition of a reactive strip?
15beats/min above baseline lasting at least 15 seconds, 2 time twithin 20 minutes
45
What age gestation is a fetus expected to be non reactive?
<28 weeks
46
What is the cause of early decelerations?
normal!!! due to head compression, usually between 4-7cm dilation
- due to vagal nerve activation
- no intervention is necessary
47
What causes late decelerations?
- abnormal
- due to uteroplacental insufficiency (blood without enough oxygen) during contractions
- can follow epidural or uterine hyperstimulation
48
What position optimizes Cardiac output and uterine blood flow?
left lateral recumbent position
49
How do you manage a pt with decelerations?
```
STOP
Sterile vaginal exam
Turn the pt to her left
Oxygen
Pitocin OFF!!!
```
50
When should you consider immediate delivery in a patient with late decelerations?
if repetitive and there are no other reassuring findings present
51
What is the cause of variable decelerations?
- abnormal
| - due to cord compression (oligohydramnios or a nuchal cord)
52
what are the classifications of variable decelerations?
1. Mild = lasts 70-80beats/min
2. Moderate=lasts 30-60 sec and depth 60sec and depth = 70-80 bpm
3. Severe = lasts >60sec and depth <70bpm
53
How does one manage variable decels?
- Amnioinfusion: infuse normal saline, mostly severe variable decels
- change maternal position to side/ trendelenburg position
- plan delivery of fetus soon if worsening or non reassuring
54
What are 4 causes of prolonged decelerations?
1. Cervical examinations
2. Uterine hyperactivity
3. Maternal hypotension leading to transient fetal hypoxia
4. umbilical cord compression
55
How are prolonged decelerations treatment?
1. Stop oxytocin and prostaglandins
2. Change maternal position
3. Administer IV fluids and vasopressors if mom is hypotensive
4. Administer maternal O2
5. Sterile vaginal exam to exclude cord prolapse, sudden cervical dilation, or fetal descent
56
What are the causes of fetal tachycardia?
1. Fetal hypoxia
2. Intrauterine infection
3. Maternal fever
4. Drugs
57
What is the definition of fetal tachycardia?
Baseline HR >160bpm for >10minutes
58
What is used as the intital screening test for GDM?
1 hour 50g oral glucose tolerance test (OGTT)
| if >140mg/dL, perform a three hour 100g OGTT
59
How is gestational diabetes diagnosed?
- if two or more of the serum glucose values obtained during the 3hr OGTT are elevated above:
1. Fasting glucose >95mg/dL
2. One hour glucose >180
3. Two hour glucose >155
4. Three hour glucose >140
60
- intense abdominal pain assoc with vaginal bleeding
- hypovolemic vital signs
- retraction of presenting parts on pelvic exam
- palpability of fetal extremities
Uterine rupture (can be due to trauma like car accident)
61
In what instances do you see an increased AFP level?
1. Neural tube defect
2. Abdominal wall defect (gastroschisis, omphacele)
3. Multiple gestation
4. Inaccurate getsational age** most common
62
With neural tube defects, what two levels will be increased on amniocentesis?
1. AFP
| 2. Acetylcholinesterase`
63
Tx of bacterial vaginosis?
Metronidazole
64
Primigravid pt at 6wks gestation has syphillis, but penicillin allergy, how do you treat?
Penicillin desensitization!
65
When can steroids be used to accelerate fetal lung maturity?
between 24-34 weeks!
66
what is a normal amniotic fluid index?
>5 and <25
67
What are the management steps of septic abortion?
1. Cervical and blood cultures
2. Antibiotics
3. Gentle suction curettage
68
when can chorionic villus sampling be performed?
10-12weeks of gestation
69
when can amniocentesis be performed?
16-18 weeks gestation
70
What are some complications of pyelonephritis in pregnancy?
1. Septicemia
2. Preterm labor
3. low birth weight babies
71
Tx of pyelonephritis in pregnant women?
1. Amoxicillin
2. Ampicillin
3. Nitrofurantoin
4. Cephalexin
72
What causes chorioamnionitis?
1. PROM
2. Intrauterine instrumentation
3. Sexually transmitted diseases
4. Prolonged labor
73
How do you distinguish between central precocious puberty and peripheral?
Central have pubertal levels of basal LH that increase with GnRH stimulation
- Peripheral have low LH levels with no response to GnRH
74
What is central precocious puberty?
- idiopathic premature activation of the hypothalamic-pituitary gonadal axis
- have pubertal levels of basal LH that increase with GnRH stimulation
75
What is the workup that all pts with central precocious puberty should have??
should have brain imaging to rule out any underlying CNS lesion!!
76
Tx of central precocious puberty?
GnRH agonist therapy in order to prevent premature epiphyseal plate fusion
77
What organism most likely causes a yellow mucupurulent discharge seen at the cervical os?
Chlamydia trachomatis
| - mucupurulent cervicitis (50% are asymptomatic)
78
What are the serious side effects of OCPs?
- breast cancer
- cervical cancer
- MI, stroke, venous thromboembolism
- HTN
- Diabetes
- Elevation of triglyceride levels
- cholestasis
79
OCPs are protective against what?
- ovarian cysts and cancer
- endometrial cancer
- benign breast disease
- dysmenorrhea (anemia)
80
Which antipsychotic can cause amenorrhea, galactorrhea etc.?
Risperidone: DA antagonist, increases prolactin levels
81
Why do women with rheumatic heart disease become more symptomatic in pregnancy?
- they have mitral stenosis and because of the physiologically increased total blood volume
- causes pulmonary edema and atrial fibrillation due to left atrial overload and enlargement
82
What is a pregnancy luteoma?
bilateral multinodular solid masses on both ovaries
- onset during pregnancy
- most commonly seen in AA multiparous women in their 30s or 40s
- can cause hirsutism and virilization
83
tx of pregnancy luteoma?
reassurance and follow up with ultrasonogram
84
What are the causes of symmetric intrauterine growth restriction?
Fetal Factors:
1. Chromosomal abnormalities
2. Congenital anomalies
3. Congenital infections (TORCH)
85
What are the causes of asymmetric intrauterine growth restriction?
Maternal factors:
1. Maternal hypertension
2. Preeclampsia
3. Uterine anomalies
4. Maternal antiphospholipid syndrome
5. Collagen vascular disease
6. Maternal cigarette smoking
86
What are the risk factors for endometritis?
1. Prolonged ROM (>24hrs)
2. Prolonged labor (>12 hours)
3. Cesarean section
4. Use of intrauterine pressure catheters or fetal scalp elecrodes
87
What is the most likely organism responsible for postpartum endometritis?
Polymicrobial infection
88
What is the most common cause of puerperal fever o the 2nd and 3rd day postpartum?
endometritis!!
89
What is the treatment for endometritis?
Clindamycin and gentamycin
90
Why are initial menstrual cycles in pubertal females irregular and often anovulatory?
- insufficient gonadotropin secretion due to immaturity of the developing hypothalamic-pituitary-gonadal axis
91
What is the definitive treatment of HELLP syndrome?
delivery in women beyond 34 weeks gestation
92
What is Kallmann's syndrome?
- congenital absence of GnRH secretion
- associated with anosmia
- normal XX genotype and normal internal female organs
- absent secondary sex characteristics and amenorrhea
- low FSH and LH
93
What is the possible complication of intrahepatic cholestasis of pregnancy?
Stillbirth
94
what is the treatment of intrahepatic cholestasis of pregnancy?
- Antipruritics
| - Ursodeoxycholic acid
95
What is the optimal time to screen for glucose tolerance?
26(24)-28 weeks
96
What causes insulin resistance in pregnancy?
Human placental lactogen causes gestational diabetes because it causes insulin resistance as it increases in pregnancy
97
What is the normal pregnancy metabolic state?
1. Hyperlipemic
2. Glycosuric
3. Anabolic
98
What happens immunologically during T3? aka what increases and decreases
Increases:
1. Granulocytes
2. CD8 t lymphocytes
Decreases:
1. CD4 t lymphocytes
2. Monocytes
99
What increases/decreases to make pregnancy a hypercoagulable state?
Increases:
1. Concentrations of all clotting factors, except XI and XIII
2. Fibrinogen
3. Resistance to activated protein C
Decreases:
1. Protein S
100
What is the normal acid base status in pregnancy?
respiratory alkalosis (due to blowing off more CO2), compensated (decrease in Bicarb)
101
What happens to kidney futction during pregnancy?
Increase in GFR, Cr clearance, and renal plasma flow (leads to decreased effectiveness of meds)
- Decrease in serum creatinine and BUN
102
What happens to renal tubules in pregnancy?
- decreased resorptive capacity of Amino Acids, uric acid and glucose
- Na is retained at higher levels
103
What are the effects of progesterone on GI tract?
1. Decreased lower esophageal sphincter tone leading to heartburn
2. Decreased bowel peristalsis causing constipation
104
What happens to systemic vascular resistance during pregnancy?
decreases! but maternal systemic vascular resistance is greater than pulmonary
105
When a pt is found to have a molar pregnancy on ultrasound, what is the next step in management?
Chest x-ray: lungs are the most common site of metastatic disease
106
What is peripartum cardiomyopathy?
- an idiopathic cardiomyopathy that presents with heart failure secondary to left ventricular systolic functions towards the end of pregnancy or in the several months following delivery
- sx: fatigue, shortness of breath, palpitations and edema
107
What effect does minute ventilation have on the mother's metabolic state?
compensated resp alkalosis
108
what is one side effect of terbutaline or other beta agonists?
- increased susceptibility to pulmonary edema (esp with the use of isotonic fluids)
- plamsa osmolality is decreased during pregnancy during pregnancy, this increases the susceptability to pulmonary edema
109
which women are more likely to develop pulmonary edema?
those with chorioamnionitis! (but not main cause- unless pt is in septic shock)
110
What is the risk of fetal loss associated with CVS?
1%
111
What is the most common genetic disease among individuals of Eastern European Jewish descent?
Tay sachs! 1/30
112
Valproic acid causes what in the fetus?
1. Neural tube defects
2. Hydrocephalus
3. Craniofacial malformations
113
What are the three components of the triple screen? and what else is added in the Quad screen?
Tri:
1. AFP
2. Beta-hCG
3. Unconjugated estriol
Quad:
+ Inhibin A
114
What is the most common issue found in the fetus of women with poorly controlled diabetes immediately prior to conception?
Structural anomalies:
1. CNS: neural tube defects
2. Cardiovascular system
115
What blood tests should be performed on pregnant african american women?
Hemoglobin electrophoresis and CBC
116
What are the risks of gestational diabetes versus pre-existing diabetes?
Gestational:
1. Shoulder dystocia
2. Metabolic disturbances
3. Preeclampsia
4. Polyhydramnios
5. Fetal macrosomia
Pre-existing:
- intra-uterine growth restriction
117
What are the risk factors for gestational diabetes?
1. Previous large baby (greater than 9lb)
2. Hx of abnormal glucose tolerance
3. Pre-pregnancy weight of 110% or more of ideal body weight
4. Ethnicity (american indian or hispanic descent)
118
What test is most effective in screening for Down Syndrome in the second trimester?
quad screen:
1. Maternal serum AFP
2. Unconjugated estriol
3. HCG
4. Inhibin A
119
How much folic acid would you give a women with a previous pregnancy complicated by a fetal neural tube defect?
4mg daily before conception and through the first trimester
120
What is the folic acid dose recommended for non-high risk patients?
0.4mg/day
121
Pts should report to the hospital for suspected labor if any of the following occur:
1. Contractions every five minutes for one hour
2. Rupture of membranes
3. Fetal mvmnt less than 10 per 2 hours
4. Vaginal bleeding
122
what are the most common cause of variable decelerations?
cord compression
123
What are the criteria to consider for medical treatment (versus surgical) on ectopic pregnancy?
tx w methotrexate:
1. Hemodynamic stability
2. Non ruptured ectopic pregnancy
3. Size of ectopic mass <3.5cm in the presence of a fetal heart rate
4. Normal liver enzymes and renal function
5. Normal white cell count
6. Ability of pt to f/u rapidly if condition changes (reliable transportation)
124
What is the appropriate time interval for repeating the initial level of B-HcG?
48 hours
125
B- HCG Levels should be increasing by approx 50% every 48 hours for how many days?
first 42 days of gestation
126
What are the signs of a ruptured ectopic pregnancy?
1. Hypovolemia (tachycardia, hypotension)
2. Peritoneal sings (rebound, guarding and severe abdominal tenderness)
3. Positive pregnancy test
127
What is the management of ruptured ectopic pregnancy?
laparoscopy
128
What systemic diseases are associated with early pregnancy loss?
1. Diabetes
2. Chronic renal disease
3. Lupus
129
what is the most common abnormal karyotype encountered in spontaneous abortions?
Autosomal trisomy
130
What is the definition of a threatened abortion?
vaginal bleeding before 20weeks without the passage of any products
131
What is a missed abortion?
- experienced fetal demise without cervical dilatation or passage of products of conception
132
What is the definition of a recurrent abortion?
refers to three successive spontaneous abortions
133
What is the etiologic factor that accounts for the majority of first trimester spontaneous abortions?
Conceptus genetic anomalies
134
What are a patient's risks associated with a prior surgical abortion in the first trimester?
Does not predispose the patient subsequent spontaneous abortions
= no risk
135
What level is used as a negative predictor of preterm delivery?
Fetal fibronectin
136
In a pregnant patient, what is the next treatment of asthma after beta agonists and when do you decide to make the switch?
- switch to inhaled corticosteroids
| - switch when pt is using beta agonists more than twice a weeks
137
When should you screen a pregnant women with high risk for gestational diabetes?
- pt has severe obesity and strong family history
| - screening should be done as soon as feasible
138
What is the most common cause of sepsis in pregnancy?
acute pyelonephritis
139
what conditions put mom at highest risk for mortality during pregnancy??
- Pulmonary hypertension (25-50% death)
| - Cardiac disease
140
Why are ACE inhibitors contraindicated in pregnancy?
1. Oligohydramnios
2. Fetal growth retardation
3. Neonatal renal failure
4. Pulmonary hypoplasia
5. Joint contractures
6. Death
141
Mom is HIV positive and presents at 36wks, how do you proceed?
treatment with IV zidovudine at the time of delivery
142
How do you treat a severe SLE flair up in pregnancy?
Severe = corticosteroids
143
What SSRI cannot be used in pregnancy and why?
Paroxetine (Paxil)
| - increased risk of fetal cardiac malformations and persistent pulmonary hypertension
144
What are risk factors for preeclampsia?
1. Previous history of preeclampsia
2. Chronic HTN
3. Age
4. Multifetal pregnancy
145
What is the contraindication to expectant management of severe preeclampsia remote from term (<32 weeks)?
thrombocytopenia
146
What are the symptoms of abruptio placenta?
- third trimester bleeding
- tachysystole on tocometer
- fetal anemia (tachycardia and sinusoidal heart rate pattern)
147
300mcg of RhoGAM neutralizes what amount of fetal blood?
30mL of fetal whole blood or 15mL of Rh + RBCs
148
What noninvasive test is used to detect severe fetal anemia?
Middle cerebral artery peak systolic velocity
149
What test is used to assess fetal transplacental hemorrage?
The Kleihauer-Betke test
| -using acid elution, the mother's RBCs become very pale while the fetal cells (containing HbF) remain stained
150
What are the classifications of variable decelerations?
1. Mild: lasts 70-80 beats
2. Moderate: lasts 30-60sec and depth 60sec and depth = 70-80bpm
3. Severe: lats >60sec and depth <70 bpm
151
BTBVariability decreases with?
1. Fetal acidemia
2. Fetal asphyxia
3. Maternal acidemia
4. Drugs (narcotics, MgSO4, barbs)
5. Acquired or congenital neurologic abnormality
152
What causes increases in BTBV?
mild fetal hypoxemia
153
on a FHT, what is thought t be the most important predictor of fetal outcomes?
Short term variability
154
what happens when theres no BTBV?
fetal acidosis!!
| deliver immediately
155
What are maternal contraindications to IOL?
1. Placenta or vasa previa
2. Prior uterine surgery/malpresentation
3. Classical cesarean delivery
4. Active genital herpes infection
5. Previous myomectomy
156
What are the fetal contraindications to IOL?
1. Acute distress
2. Transverse fetal lie
3. Cord prolapse
157
What are the complications of oxytocin/pitocin?
1. Potent ADH effects -> hyponatremia (convulsions, coma, death)
2. Risk of hyperstimulation
158
What is misoprostol?
a synthetic PGE1 analong- used for cervical ripening and induction
159
when would one perform a classical cesarean incision?
1. lower uterine segment is not developed (prematurity)
2. fetus is transverse lie with back down
3. Placenta previa
160
what is a contraindication for vacuum delivery?
- prior scalp sampling
161
what position must a baby be in for a vacuum delivery?
vertex
162
what is cephalohemaoma?
collection of blood UNDER the periosteum of the skull of baby- it does NOT cross sutures
- due to rupture of vessels, resolves spontaneously over several weeks
163
what is caput succedaneum?
temporary swelling of fetal head from prolonged engagement of the head
- DOES cross the sutures
- resolves in 1-2 weeks
164
what are the nerve roots of the pudendal nerve?
S2-S4
165
What is a paracervical block and whats its use?
- anesthesia injected at 3 and 9 o'clock of cervix,
- provides good relief of pain of uterine contractions during first stage of labor, requires additional analgesia bc pudendal nerves are not blocked
166
Complication of paracervical block?
Fetal bradycardia (usually transient)
167
What are the complications of a spinal (subarachnoid) block?
- maternal hypotension (infusion w IL of solution to prevent)
- total spinal blockade
- spinal HA
- seizures
- bladder dysfunction
168
Contraindications of spinal block?
1. Severe preeclampsia (hypotension -> ischemic stroke)
2. Coagulation/hemostasis disorder
3. Neurologic disorders
4. Infection
5. Surgical emergency
169
When is a spinal block used?
uncomplicated cesarean and vaginal deliveries
170
in an epidural, qhere does the block begin and end in
a) abdominal delivery
b) vaginal delivery
Abdominal: begins at T8- S1 dermatome
Vaginal: T10 - S5 dermatome
171
what is an epidural's effects on labor?
- longer duration of labor
- increased incidence of:
1. chorioamnionitis
2. low forceps procedures
3. Cesarean delivery
4. maternal pyrexia
172
how do you treat a postpartum hemorrhage due to atony?
Oxytocin- occurs when uterine involution is defective
173
what are the risk factors for postpartum urinary retention?
1. Instrument assisted delivery
| 2. Regional and general anesthesia
174
for how long should iron supplementation be continued in the postpartum period?
3 months
175
when is mom given anti-D immune globulin and how much?
- within 72 hours of delivery, given 300ug (neutralizes 30mL of fetal whole blood or 15mL of Rh-positive RBCs)
176
What are the postdelivery causes of fever?
The 5 W's + B:
1. Wind: atelectasis, 1-2 days postop
2. Water: UTI, 2-3 days ppm
3. Wound: cesarean vs episiotomy (5-7days ppm)
4. Walking: DVT -> pulmonary embolus
5. Wonder drugs: drug fever, 7-10 days ppm
Breast: engorgement, mastitis, abscess, 3d-4wks ppm
177
what antibiotic is used as prophylaxis during cesarean deliveries?
- IV cefazolin
178
Lactational amenorrhea method of contraception can be used if:
1. The mother is not menstruating
2. Mom is nursing >2-3 times per night and more than every 4 hrs during the day without supplementation
3. The baby is <6 months old
179
what are COCPs effect on breastfeeding?
reduce the amount of breast milk, and very small quantities of the hormones are excreted in the milk
(progestin only OCPs are 95% effective without reducing breast milk)
180
when does ovulation typically occur in moms who are:
a) nursing
b) non nursing
a. Nursing = >10wks ppm
| b. Non nursing = 6-8 wks ppm
181
what vitamin is NOT found in human breast milk?
vitamin K
182
when is colostrum secreted? what's in it?
usually starts by the 2nd day ppm and is secreted for 5 days ppm
- cotains protein, fat, carbs, secretory IgA, and minerals
183
What is sheehan syndrome?
postpartum pituitary dysfunction possibly due to intrapartum ischemia
- pts cannot breast feed due to the absence of prolactin
184
What hormones are involved with breast feeting?
1. Prolactin = stimulates milk Production
2. Oxytocin = stimulates milk letdown/ejection, via suckling stimulus causes contraction of myoepithelial cells and small milk ducts
185
What organisms most commonly cause mastitis?
1. Staph aureus from the infant's nasopharynx
| 2. Staph coag negative and strep viridans
186
treatment of mastitis?
dicloxacillin for 7-10days, continue breast feeding, usually resolves w/in 48 hours
187
What viruses are excreted in breast milk?
1. CMV (not contraindicated, both virus and Ab present)
2. HBV (not contraindicated if baby receives hep B immune globulin
3. HIV (contraindicated)
188
What type of immunity is found in breast milk? (3)
1. Secretorry IgA antibodies against e coli and other infections
2. Memory T cells: gives baby maternal immunity
3. Colostrum contains IL-6 stimulating increase in breast milk monocytes
189
Can babies get Hepatitis C through breast milk?
4% risk of transmission (same as bottle fed babies)
190
What medications are contraindicated in breast feeding? (8)
1. Bromocriptine
2. Cyclophosphamide
3. Cyclosporine
4. Doxorubicin
5. Ergotamine
6. Lithium
7. Methotrexate
8. Estrogen containing OCPs
191
What is the time frame for classification of postpartum depression?
- if it begins within 3-6 months after childbirth
192
what are the two phases of postpartum thyroiditis? treatments?
1. Thyrotoxicosis: 1-4 mos ppm,tx = Beta-blockers
| 2. Hypothyroidism: 4-8 months ppm, tx = thyroxine for 6-12 months
193
What is the difference between A1 and A2 gestational diabetes?
A1: Fasting 105mg/dL, 2 hour >120mg/dL
194
Diabetic ketoacidosis may be induced in type 1 diabetics by what? (4)
1. Corticosteroids
2. B mimetics (for tocolysis)
3. Hyperemesis gravidarum
4. Infections
195
what are the complications of gestational diabetes versus pregestational diabetes?
Gestational -> macrosomia
| Pregestational -> growth restriction due to concurrent maternal vascular disease
196
What is the outcome of gestational diabetes versus pregestational dbm on the fetus?
Gestational = macrosomia, esp if fasting glucose is high
| Pregestational dbm: growth restriction due to concurrent maternal vascular disease
197
diabetic ketoacidosis may be induced in pregnant type 1 diabetics by what?
1. Corticosteroids (for lung maturity)
2. B mimetics (for tocolysis)
3. Hyperemesis gravidarum
4. Infections
198
why do the insulin requirements increase during the first trimester in diabetic moms?
due to antagonistic effects of pregnancy
199
why does uncontrolled diabetes cause neonatal hypoglycemia?
chronic maternal hyperglycemia -> hyperplasia of fetal B islet cells -> increased fetal insulin -> rapid decline in fetal plasma glucose after delivery
200
what congenital anomalies are associated with maternal diabetes? and what increases risk of them?
- caudal regression (rare but high assoc)
- cardiac anomalies
- Neural tube defects
* increased risk with HbA1C > 10%
201
what happens to thyroid hormones during normal pregnancy?
- Total T3, T4 and TBG are increased
| - free T4 and TSH do not change
202
What is the tx of hyperthyroidism during pregnancy?
PTU (drug of choice): inhibits conversion to T4 to T3, small amount crosses placenta
- can cause fetal hypothyroid/goiter bc crosses placenta
203
What is Methimazoles effect during pregnancy?
- readily crosses placenta
| - associated with aplasia cutis in fetus
204
What tx of hyperthyroidism is contraindicated in pregnancy?
radioactive iodine!
205
hyperthyroidism is noted in what two diseases?
1. Hyperemesis gravidarum
| 2. Gestational trophoblastic disease
206
how is overt hypothyroidism diagnosed in pregnancy? subclinical hypothyroidism?
Overt = increased TSH and decreased free T4
Subclinical = increased TSH and normal free T4
- ACOG recommends against routine screening for subclinical hypothyroidism
207
Tx of hypothyroidism in pregnancy?
levothyroxine
208
overt hypothyroidism is associated with what?
infertility and higher miscarriage rates
209
how does blood pressure usually change during pregnancy?
normally decreases in T2
210
What conditions are associated with a breech presentation? (6)
1. uterine fibroids
2. Prematurity
3. Polyhydramnios
4. Hydrocephaly
5. Anencephaly
6. Placenta previa
211
smoking during pregnancy increases the risk of what? (5)
1. Placental abruption
2. Placental previa
3. IUGR
4. Preeclampsia
5. Infection
212
What is the difference in contents between FFP and cryoprecipitate?
1. FFP = fibrinogen and factors V and VIII
| 2. Cryoprecipitate = fingrinogen, factor VIII, VWF
213
What are the presenting signs of placental abruption?
1. Abdominal pain
2. Bleeding
3. Uterine hypertonus
4. Fetal distress
214
What are the risk factors for placenta accreta?
1. Prior history of surgery- like c sections
| 2. Low anterior placenta
215
What are the contraindications for the following tocolytics?
1. Terbutaline
2. Ritodrine
3. Magnesium sulfate
4. Indomethacin
1. Terbutaline = diabetics
2. Ritodrine = diabetics
3. Magnesium sulfate = magnesium sulfate
4. Indomethacin = dont use prior to 34 weeks due to risk of premature closure of PDA
216
What is a side effect of terbutaline?
```
Tachycardia
hypotension
anxiety
chest tightening or pain
- terbutaline is a beta adrenergic agent
```
217
What are the risk factors for placental abruption?
1. Smoking
2. Cocaine use
3. Abdominal trauma
4. Chronic hypertension
5. Multiparity
6. prolonged, premature rupture of membranes
218
Smoking during pregnancy increases the risk of what?
1. Placental abruption
2. Placenta previa
3. fetal growth restriction
4. Preeclampsia
5. Infection
219
What are the possible adverse fetal affects of indomethacin?
1. Premature constriction of the ductus arteriosus (esp before 34 weeks)
2. Oligohydramnios
220
What are the possible adverse fetal affects of calcium channel blockers?
1. Fetal hypoxia
| 2. Decreased uteroplacental blood flow
221
What are the most common causes of preterm labor?
1. Idiopathic most common!
2. Dehydration
3. Uterine distortion (from fibroids or structural malformations)
222
What is betamethasone's effect on the newborn?
Decreased risk of intracerebral hemorrhage, RDS, and necrotizing enterocolitis
223
What is magnesium sulfate's MOA?
competes with calcium for entry into cells
224
Unexplained fever + increased WBC count makes you worried of...? how do you rule it out?
intra-amniotic infection
| - amniocentesis`
225
What is the first line treatment for hyperemesis gravidarum?
Vitamin B6 with doxylamine
226
how long to anti-D immunoglobulin last for and when is the highest risk of sensitization?
lasts for 12 weeks and highest risk is during T3
227
What is the critical antibody titer?
1:16, follow titer every 4 weeks
228
if rh- mom is pregnant with a rh+ baby and has an antibody titer of 1:32, what are the next steps of management
1. Do an amniocentesis
2. Serial US monitoring for anatomy scan for hydrops, MCA doppler for presence of severe anemia
3. Delivery:
Mild anemia = Induce at 37-38weeks
Severe anemia= deliver at 32-34 weels
229
What are the symptoms of hemolytic disease of the newborn?
1. Fetal hyperbilirubinemia + kernicterus
2. Heart failure
3. Edema
4. Ascites
5. Pericardial effusion
- DEATH
230
What is fetal hydrops?
collection of fluid in two or more body cavities:
1. Scalp edema
2. Pleural effusion
3. Pericardial effuion
4. Ascites
231
what is a predictor of preterm labor?
transvaginal cervical length measurement:
>35mm: low risk of preterm delivery
<25mm: high risk of preterm delivery
OR
Fetal fibronectin assay: negative = 99%for no preterm
232
Magnesium sulfate as a tocolytic:
| MOA:
suppresses uterine contractions
- competes with calcium, inhibits myosin light chain
- shown to decrease chance of hypoxic brain injury in babies
233
Magnesium sulfate as a tocolytic:
| Maternal side effects
1. Flushing
2. Lethargy
3. MM weakness
4. Diplopia
5. Pulmonary edema
6. Cardiac arrest
234
how do you treat magnesium toxicity?
calcoium gluconate
235
Magnesium sulfate as a tocolytic:
| fetal side effects
1. Lethargy
2. Hypotension
3. Respiratory depression
236
Magnesium sulfate as a tocolytic:
| contraindications
Myasthenia gravis
237
Nifedipine as a tocolytic:
| Maternal side effects
1. Flushing
2. HA
3. Dizziness
4. Transient hypotension
238
Nifedipine as a tocolytic:
| contraindications
1. Maternal hypotension
2. Cardiac disease
3. Caution w renal disease
- DO NOT USE W MAGNESIUM
239
Ritodrine, terbutaline: MOA
Beta 2 receptor stimulation on myometrial cells -> increase in cAMP -> decrease in intracellular Ca -> decreased contractions
240
Ritodrine, terbutaline: maternal side effects
1. Pulmonary edema
2. Tachycardia
3. HAs
241
Ritodrine, terbutaline: fetal side effects
tachycardia
242
Ritodrine, terbutaline: contraindications
1. cardiovascular disease
2. Hyperthyroidism
3. Uncontrolled diabetes
243
Indomethacin: MOA
prostaglandin inhibitors for <32 weeks
244
Indomethacin: maternal side effects
Nausea & heartburn
245
Indomethacin: fetal side effects
1. Premature constriction of ductus arteriousus
2. Pulmonary HTN
3. Reversible decrease in amniotic fluid
246
Indomethacin: contraindications
1. Renal or hepatic impairment
| 2. PUD
247
Overall contraindications to tocolysis?
```
BAD CHU
Bleeding, severe
Abruptio placentae, severe
Death: fetal
Chorioamnionitis
Hypertension: severe pregnancy induced
Unstable maternal hemodynamics
```
248
What is 17alpha-hydroxyprogesterone used for and when?
- a weekly IM injection at 16-20 weeks to women with risk factors or history of preterm labor
- prevents preterm laborvia relaxing the myometrium
- prevents rejection of the fetus by suppressing lymphocyte production of cytokines
249
What is an apt test?
determines whether or not blood is maternal or fetal
- put blood from vagina into tube w KOH
Brown = maternal
Pink = fetus
250
two most common causes of T3 bleeding
1. PLacenta previa
| 2. Placenta abruptio
251
pregnant woman + vaginal bleeding + pain =
placental abruption until proven otherwise
252
what is the clinical presentation of placenta previa?
1. Painless profuse bleeding in 2nd or 3rd trimester
2. Postcoital bleeding
3. Spotting during first and second trimester that subsides then recurs later in pregnancy
253
what two conditions cause third trimester bleeding resulting from fetal vessel rupture?
1. Vasa previa
| 2. Velamentous cord insertion
254
what do you give for uterine atony and what are their contraindications?
1. Dilute oxytocin
2. Methergine: contraindicated in HTN
3. Prostaglandin F2a: contraindicated in asthma
4. Misoprostol
255
What are the 3 different types of placental attachment disorders?
1. Placenta accreta: attaches directly to the myometrium
2. Placenta increta: invades into the myometrium
3. Placenta percreta: penetrates through the myometrium, could invade the bladder
256
what is the tx of choice for placenta problems?
hysterectomy
257
what do you think when a mass is palpated in the vaginal canal immediately after the placental delivery?
uterine inversion
258
what does varicella infection cause in pregnant moms?
pneumonia
259
what are the fetal effects of early pregnancy varicella infection?
1. Chorioretinitis
2. Cerebral cortical atrophy
3. Hydronephrosis
4. Cutaneous and bony leg defects
260
what are the fetal effects of parvovirus (b19) during pregnancy?
1. Fetal death
| 2. Nonimmune hydrops: due to fetal aplastic anemia
261
what are the fetal effects of rubella (german measles)?
1. Cataracts, congenital glaucome (blindness)
2. Deafness: most common single defect
3. CNS defects: MR, microcephaly
262
what is the congenital infection found with CMV?
1. Intracranial calcifications
2. Chorioretinitis
3. Microcephaly
4. Mental and motor retardation
263
what is the triad of toxo infection in newborns?
1. Chorioretinitis
2. Intracranial calcifications
3. Hydrocephalus
- similar to CMV, look at hx
264
tx of toxo in pregnancy?
sulfonamides + pyrimethamine, sulfonamides
| - spiramycin
265
BV increases the risk of what antepartum complications?
1. Preterm birth
2. PROM
3. Preterm labor
4. Chorioamnionitis
266
what is jarisch-herxheimer reaction?
- occurs with penicillin treatment
- involves uterine contractions and late decels in the fetal heart rate as the dead spirochetes (and their endotoxins) affect the placental circulation
267
what infections are associated with preterm delivery?
1. Gonorrhea
2. Trichomoniasis
3. Bacterial vaginosis
268
how do you treat a gonorrhea infection in pregnancy?
ceftriaxone
269
what is the most common cause of ophthalmia neonatorum?
chlamydia trachomatis
270
how do you treat a chlamydia infection in pregnacy?
erythromycin, amoxicillin, azithromycin
271
pt has a hx of herpes, suppression with what and when is recommended?
acyclovir at 36 wks
272
is it possible for infant to breast feed when mom has hep B?
yes- but only when infant givent prophylaxis (HBIG at birth and first of three hepatitis B vaccines upon delivery)
273
what is given during antepartum/intrapartum/neonate to reduce risk of vertical transmission of HIV?
zidovudine or HAART
| - cesarean delivery
274
what can HPV cause in the fetus?
laryngeal papillomatosis: rare benign neoplasm of the larynx
| - HPV 6 and 11
275
what is the recommended weight gain for multiple gestation pregnancy?
24lbs in 24 weeks, 35-45 total lbs
276
twins: division of ovum between 0-3 days:
dichorionic, diamniotic, monozygotic
277
twins: division of ovum 4-8days:
monochorionic, diamniotic, monozygotic
278
twins: division between 9-12 days:
monochorionic, monoamniotic, monozygotic
279
twins: division >13 days:
conjoined twins
280
which type of twins are at risk for twin-twin transfusion syndrome?
monochorionic
281
IOL should be considered when in multiple gestations?
38wks
282
what is the tx of twin-twin transfusion syndrome?
laser coagulation of the anastomoses
283
top 5 etiologies of spontaneous abortion
1. Chromosomal abnormalities (trisomy 16)
2. Unknown
3. Infection (toxo, herpes)
4. Anatomic defects (bicornate, cervical incomp)
5. Endocrine (PCOS, DBM)
284
what is the management of an inevitable abortion?
1. surgical evacuation of the uterus if fetal cardiac activity is absent
2. expectant management if fetal cardiac activity it present
285
what kind of abortions have a dilated cervical os?
Inevitable and Incomplete
286
what is a missed abortion?
fetal demise before 20wks of gestation without expulsion of any POC
287
what is an uncommon but serious complication of septic abortion?
DIC
288
what is the most common parental chromosomal abnormality that causes recurrent abortions?
balanced translocation
289
What is the differential diagnosis for T1 bleeding?
1. Spontaneous abortion
2. Ectopic pregnancy
3. Molar pregnancy
4. Vaginal/cervical lesions/lacerations
290
Differential diagnosis for T3 bleeding?
1. Abruptio placenta
2. Placenta previa
3. Rupture of vasa previa
4. Uterine rupture
291
Contraindications to PGF2a?
asthamatics! bc it induces smooth muscle contraction
292
most common reason for T2 abortions?
congenital anomalies
293
Biggest risk factor for ectopic pregnancy?
prior ectopic pregnancy
294
what are the signs of ruptured ectopic pregnancy?
1, Hypotension
2. Tachycardia
3. Abdominal exam with rebound and guarding
295
what is the threshold of B-hCG that you should expect an ectopic pregnancy?
>1200mIU/mL and theres no evidence of an IUP
296
Significance of these B-hCG values:
1. >25
2. 1200-2000
3. >5000
1. >25 = positive urine pregnancy test
2. 1200-2000 = IUP detectable with TVUS
3. >5000 = IUP detectable with abdominal US
297
when can you give methotrexate for an ectopic pregnancy?
if:
1. It's early in the pregnancy
2. Unruptured
3. Mom is hemodynamically stable
4. Pregnancy is <3.5cm
298
what are the relative contraindications for using methotrexate in an ectopic pregnancy?
1. Fetal cardiac activity present
2. Quantitative B-hCG >15,000mIU/mL
3. Ectopic pregnancy >3.5cm
299
what are the absolute contraindications for using methotrexate in an ectopic pregnancy? (6)
1. Hemodynamically unstable pt
2. Leukopenia
3. Renal/hepatic disease
4. Thrombocytopenia
5. Active PUD
6. Breastfeeding
300
what type of birth control is best for patients with sickle cell disease?
injectables
301
what type of birth control is best for patients with epilepsy?
injectables
302
what are some side effects of injectables?
1. Depression
2. Weight gain
3. Osteoporosis/osteopenia
303
what are the p450 induces that will decrease the effectiveness of OCPs?
1. Phenytoin
2. Rifampin
3. Griseofulvin
4. Carbamazepine
5. Alcohol
6. Barbs
304
what are the types of estrogens and when do you see them?
1. Estradiol: reproductive life
2. Estriol: Pregnancy
3. Estrone: Menopause
305
mechanism of action of estrogen in combined OCPs?
suppresses FSH preventing follicular emergence
| - maintains stability of endometrium
306
MOA of progesterone in combined OCPs?
1. Prevents LH surge, inhibiting ovulation
2. Thickens crevical mucus to pase as a barrier for sperm
3. Alters motility of fallopian tube and uterus
4. Caues endometrial atrophy
307
why is estrogen a procoagulant?
it increases factors VII and X and decreases antithrombin III
308
what is a contraindication for IUD placement?
1. Multiple sexual partners
2. Recent hx of PID
3. Immunocompromised
309
What are the two options for emergency contraceptions?
1. Levonorgestrel up to 72 hours after intercourse
| 2. Copper IUD up to 5 days after intercourse
310
what is the motto about pregnancies after tubal ligation reversals?
theyre ectopic until proven otherwise
311
what are the pubertal landmarks?
1. Thelarche: breast budding, around age 10, due to estradiol
2. Pubarche: axillary and pubic hair growth, age 11, due to adrenal hormones
3. Menarche: first menses, age 12. increase in estradiol
312
which follicle is the one chosen to be released during ovulation?
the follicle that secretes more estrogen than androgen
313
what causes dysmenorrhea during menstruation?
prostaglandins released from endometrium
314
what is the average blood loss during menstruation?
30-50mL
315
what two medications can impair sperm number and function?
1. Calcium channel blockers
| 2. Furantoins
316
what two medications can impair sperm number and function?
1. Calcium channel blockers
| 2. Furantoins
317
normal values for semen analysis:
1. Volume:
2. Semen count:
3. Motility:
4. Morphology:
1. Volume: >2mL
2. Semen count: >20 million/mL
3. Motility: >50% with forward movement
4. Morphology: >40%
318
Primary amenorrhea + elevated plasma FSH?
gonadal dysgenesis (hypergonadotropic hypogonadism), most common cause of primary amenorrhea
319
what is the pathophys behind gonadal dysgenesis?
absence of ovarian follicles, no synthesis of ovarian steroids
320
17alpha hydroxylase deficiency:
46 XX =
46 XY=
46 XX= breast absent, uterus present
| 46 XY = breast absent, uterus absent
321
normal breast and pubic hair + no menses + cyclic pelvic pain + bulging blue mass at the introitus
hematocolpos from imperforate hymen
322
what are the most common non-prolactin secreting pituitary tumor?
chromophobe adenomas
323
what is sheehan syndrome?
pituitary cell destruction occurs due to hypotensive episode during pregnancy
- replace pituitary hormones
324
Simmonds disease?
pituitary disease unrelated tp pregnancy?
325
what is the drug of choice for women with PRL-secreting microadenomas who want to conceive?
Bromocriptine
326
what is the drug of choice for reducing prolactin levels and shrinking tumors?
Cabergoline (more effective and better tolerated than bromocriptine)
327
what is the management of a molar pregnancy?
suction curretage (even if person doesnt want any more children)
328
how do partial moles differ from complete moles?
1. Partial are triploidy, complete are diploid
2. Partial tend to have lower B-hCG levels
3. Partials affect older patients
4. Partials have longer gestations
5. Partials are often diagnosed as missed or incomplete abortions
6. Partials are less likely to develop into post molar GTD
329
how long after a partial molar pregnancy should one wait before getting pregnant again?
6 months
330
what is a downside to the patch for contraception?
it has a higher failure rate when used in women who weigh more than 198 pounds
331
what is increased in a woman undergoing a medical abortion compared to a surgical abortion?
blood loss!!
332
at what gestational age can you perform manual vacuum aspiration?
<8weeks
333
treatment of antiphospholipid antibody syndrome?
heparin plus aspirin
334
What is the treatment for vulvar vestibulitis syndrome?
1. TCAs to block sympathetic afferents
2. Pelvic flood rehab
3. Biofeedback
4. topical anesthetics
- surgery w vestibulectomy in refractory
335
erythematous vagina + frothy yellow discharge and multiple petechiae on cervix, vaginal pH is 7
trichomonas (tx w metronidazole)
336
polygonal ivory papules involving the vulva and perianal areas + waxy sheen on the labia minora and clitoris, and hypopigmentation
lichen sclerosus
| tx: high potency topical steroids
337
lacy reticulated pattern of labia and perineum, oral lesions, alopecia, extragenital rahes
lichen planus
| - supportive therapy + topical superpotent corticosteroids
338
gray homogenous vaginal discharge + positive whiff test + vaginal pH >4.5
BV!
| tx w metronidazole
339
most common organism causing acute cystitis in a healthy non-pregnant woman?
e coli
340
What is colpocleisis?
a procedure where the vagina is surgically obliterated and can be performed under local anesthesia
- used to tx vaginal prolapse
341
tx of stress incontinence??
retropubic urethropexies
342
what medication is used for detrusor instability?
oxybutynin- anticholinergics (bc ach is used in bladder emptying (contraction)
343
what is used for definitive diagnosis of endometriosis?
exploratory laparoscopy
344
nodularity at the back of the uterus is suggestive of what?
endometriosis
345
What nerves are at risk during low transverse surgical procedures?
1. Iliohypogastric (T12-L1): cutaneous sensation to the groin and skin overlying pubis
2. Ilioinguinal (T12-L1): cutaneous sensation to to the groin, labium, and upper inner thigh
346
WHat is pelvic congestion syndrome?
- pelvic pain occurring in the setting of pelvic varicosities
- pain exacerbated by standing, fatigue, and coitus
- hormonal factors contribute to vasodilation when pelvic veins exposed to high estradiol
347
what are the three critical elements for secondary sexual characteristics?
1. Body weight
2. Sleep
3. Optic exposure to sunlight
348
What is Noonan's syndrome?
- short stature, webbed neck, heart defects, abnormal faces, and delayed puberty
- normal genital tract
- partial deletions of the long arm of the X chromosome
349
tx for precocious puberty?
GnRH agonist to suppress potuitary production of FSH and LH unless theyre within months of the expected
350
in a pt with mullerian agenesis, what is the most appropriate next study after physical exam and pelvis us?
renal ultrasound!
351
when is observation okay management for an endometrial polyp?
when it's less than 1.5 cm
352
when do you do a polypectomy for an endometrial polyp?
when its causing infertility
353
what is mid cycle bleeding at the time of ovulation due to?
the drop in esrogen
354
what is the tx of choice for a pt with a leiomyoma who desires pegnancy?
hysteroscopic myomectomy (preserves the uterus)
355
premature ovarian failure occurs before what age?
35
356
what is the optimal daily calcium intake for a postmenopausal woman?
1000-1200 mg
357
HRT has what affect on lipid/cholesterol profile?
HDL levels increase and LDL levels decrease
358
what is the first line tx for ovulatory dysfunction in PCOS patients?
metformin and ovulation induction agnets
359
what is a side effect of imipramine that concerns us?
hyperprolactinemia
360
what is the clomiphene citrate challenge?
- giving clomiphene citrate days 5-9 of the menstrual cycle and checking FSH levels on day 3 and 10
361
what vitamins help with PMS?
Vitamins A, E, and B6
