OBGYN Flashcards
(241 cards)
1
Q
when would you NOT treat fibroma w uterine artery embolization
A
pt wanting to get pregnant in future
2
Q
key difference between uterine fibroid vs endometrial polyp
A
fibroid= MC in AA, “lumpy”/irregular/enlarged uterus on palpation
endometrial polyp= not palpable
3
Q
postmenopausal uterine bleeding
A
endometrial cancer until proven otherwise
4
Q
post-coital bleeding
A
MC presentation of cervical cancer
5
Q
management of post-op fever
A
expectant - cytokine-mediated, 48 hours post-op
*after 48 hours: CBC, inspection of wound, full rectovaginal exam
6
Q
first step in management of suspected domestic abuse
A
ask open-ended and nonjudgmental questions
once abuse is confirmed, then you can provide them with resources for victims
7
Q
primary ovarian insufficiency
dx/tx
A
dx:
menopause (1 year w/o menses) in < 40yo + postmenopause range FSH (>40)
tx:
HRT (estrogen)
*risk of osteopenia/porosis without HRT*
8
Q
increased risk of (three) with E/P combined hormone therapy
A
breast cancer
ischemic stroke
myocardial infarction
9
Q
MCC pituitary adenoma
A
lactotroph adenoma - hyperprolactinemia
10
Q
absolute contraindication to vaginal delivery with complete breech
A
absence of easily accessible OR
11
Q
permanent treatment for severe uterine prolapse
A
colpocleisis – vaginal walls sewn together
12
Q
treatment for cystocele vs rectocele
A
ant vag wall defect - anterior colporrhaphy
post vag wall defect - posterior colporrhaphy
reinforce/strengthen wall
13
Q
uterine blood supply
A
aorta -> ovarian a (w/in suspensory ligament of ovary)
internal iliac a -> uterine a + vaginal a
14
Q
screening indicated for BRCA-1/-2 positive
A
@ 25yo
1-2 clinical breast exams q1 year
1 mammogram q1 year
@ 30yo
1 MRI q1 year
2 CA-125 q1 year
**everyone should do self breast exam @ 18yo+
15
Q
safe anti-HTN in pregnancy (4)
A
methyldopa
CCB- nifedipine
hydralazine
labetalol
16
Q
what happens to kidneys during preg
A
inc GFR (renal protection)
17
Q
when is ASA indicated in preg
A
when pt has inc risk of preeclampsia
18
Q
4 steps of puberty in females in order
A
thelarche
pubarche
growth spurt
menarche
19
Q
McCune-albright triad
A
precocious puberty (before 8yo)
fibrous bone dysplasia
cafe-au-lait spots
20
Q
acceleration definition
A
< 32 WGA: 10x10
> 32 WGA: 15x15
21
Q
what to do next when no accelerations?
A
fetal scalp stimulation
if acceleration occurs, fetal hypoxia/acidosis are ruled out
22
Q
first step in managing postmenopausal bleeding ALWAYS
A
endometrial bx
23
Q
combination vs estrogen-only hormone replacement
A
combination= women w/ uterus estro-only= women w/o uterus
24
Q
scarred skin
chorioretinitis
limb hypoplasia
A
congenital varicella
< 20 WGA
Horner’s syndrome
cataracts
low birth weight
cortical atrophy
microcephaly
25
when is Tdap given
27-36 weeks
26
pre-term
\< 37 weeks
27
post-term
\> 42 weeks
28
early-term
37.0 - 38.6
29
full-term
39.0 - 40.6
30
late-term
41.0 - 41.6
31
low birth weight
ventriculomegaly
hearing impairment
periventricular calcification
CMV
32
PDA
hearing impairment
purpuric/petechial rash
rubella
33
intracranial calcifications
disseminated purpuric rash
seizure
toxo
34
anemia
high output heart failure
cardiomyopathy
parvo
35
inc nuchal translucency
inc NT = inc risk aneuploidy
36
diagnostic test for chromosomal defect
chorionic villous sampling @ 10-14 weeks
or
amniocentesis @ 15 weeks
37
painless bleeding in 2nd/3rd trimester
placentra previa
transabdominal U/S, then transvaginal U/S
38
when is color doppler U/S indicated
placenta accreta (placental villi attached to myometrium instead of decidua)
39
continuous external fetal cardiotocography indications (3)
suspected growth restriction
maternal T1 DM
preeclampsia
40
normal fetal heart rate range
110-160 bpm
41
decelerations
\> 15 bpm decrease for \> 15 seconds
indicates fetal compromise
42
early vs late decelerations
```
early= begin when contraction begins, ends when contraction ends
late= begin when contraction peaks, ends after contraction ends
```
43
when is MTX indicated for management of ectopic pregnancy
hemodynamically stable
b-HCG \< 5,000
no fetal heart tones
44
when to give second dose of MTX in management of ectopic pregnancy
if beta-HCG difference between day 4 and day 7 is \< 15%
45
\> 20 weeks gestation w sudden-onset:
vaginal bleeding
abd pain
back pain
uterine contractions
placental abruption (incomplete or complete separation from decidua)
46
placenta previa vs. abruption:
diagnostic method
delivery options
digital cervical exam
diagnosis
previa= U/S
abruption= clinical diagnosis, (but would still do U/S during initial workup of \> 20 WGA bleeding to rule out PP)
delivery
previa= requires C/S
abruption= does not require C/S
digital exam
previa= abs contraindi
abruption= not contraindi
47
\< 20 WGA
vaginal bleeding
U/S shows viable fetus
threatened miscarriage
48
\< 20 WGA
vaginal bleeding
no abd pain
U/S shows hypo-/an-echoic crescent-shaped area behind fetal membranes
subchorionic hematoma
inc risk of:
abruption,
preterm labor
49
top three breast masses in women \< 30 yo
fibroadenoma= MCC= glandular + fibrous tissue (smooth, rubbery, mobile, solid)
breast cyst
fibrocystic change= luteal phase, caffeine
50
initial workup for breast mass in
\< 30 yo
\> 30 yo
\< 30= U/S
\> 30= U/S + mammo
51
when is IV iron supplement indicated (3) during preg
2nd or 3rd tri
oral not effective or not tolerated
severe anemia (hgb @ 8-10)
52
asymptomatic thrombocytopenia in preg
```
immune thrombocytopenia (ITP)= plt \< 100,000
tx= steroids
```
53
initial serum test for PCOS
androgens/testosterone
54
false vs latent labor
false (braxton hicks)= contractions diminish, \< q8 minutes, no cervical change
latent (first stage of active labor)= contractions intensify, \> q5 minutes, cervical change
55
von willebrand dz
prothrombin deficiency
bleeding tendency
56
factor V leiden mutation
antithrombin III deficiency
clotting tendency
57
triple test of breast mass
clinical exam
imaging
biopsy
58
biopsy of choice for breast mass
if solid -\> core needle biopsy
if bloody on FNA -\> excisional bx
59
first trimester weeks
weeks 1-13
60
second trimester weeks
weeks 14-26
61
third trimester weeks
weeks 27-40
62
```
AFP= dec
estriol= dec
hCG= dec
inhibin-a= same
```
trisomy 18
63
```
AFP= dec
estriol= dec
hCG= inc
inhibin-a= inc
```
trisomy 21
"HI"= high hCG & inhibin
64
```
AFP= inc
estriol= same
hCG= same
inhibin-a= same
```
open neural tube
65
thyroid in first trimester
estrogen -\> inc TBG
hCG mimics TSH -\> dec TSH + inc T3/T4
total thyroid hormone= inc
free/active thyroid hormone= unchanged
\*similar process w sex hormone binding globulin and androgens/testosterone during preg\*
66
female @ puberty
no ovaries, blind vaginal pouch
normal breasts, no pubic/axillary hair
high serum testosterone
androgen insensitivity syndrome
genotypic male
67
female
no uterus, shallow vaginal pouch
normal breasts, pubic hair
normal ovaries
normal serum testosterone
```
mullerian agenesis (mayer-rokitansky-kuster-hauser)
geno-/pheno-typic female
```
68
anosmia
```
kallman
zero GnRH (zero LH, FSH, testo/estro)
XX= primary amenorrhea, no breasts, no pubic hair, normal mullerian structures (vagina, cervix, uterus)
```
69
PAP/HPV screening frequency
21-30yo: PAP+HPV q3 years
30-65yo: PAP q3 years, or PAP+HPV q5 years
70
cold knife colonization of cervix indications (2)
1. CIN III
2. cervical lesion extending into endocervical canal
71
pre-eclampsia definition
proteinuria \> 0.3g/day
HTN \> 140/90
WGA \> 20
72
rib notching on CXR +
BP in UE \>\>\> BP in LE
coarctation of aorta
73
colposcopy indications (3)
HSIL
LSIL
ASCUS w/ HPV++++
74
adnexal mass
abnormal uterine bleeding
uterine hyperplasia
```
granulosa cell tumor
produces estrogen (-\> uterine hyperplasia -\> inc risk of endometrioid cancer type I)
```
75
cells w scant cytoplasm
coffee bean nuclei
arranged in rosettes w central clearing
call-exner bodies
granulosa cell tumor
76
clear cell carcinoma of ovary most characteristic risk factor
endometriosis
77
mittelschmerz
sudden-onset
mid-cycle pain
U/L to ovarian follicle that has ruptured during ovulation
no other acute abd findings (dx of exclusion)
78
postpartum hemorrhage definition + management
\> 500mL blood post-vaginal delivery
\> 1,000mL blood post-C/S
```
MCC= uterine atony (soft/boggy uterus)
management= bimanual uterine massage; if unsuccessful, admin oxytocin
```
79
PGE1 analog
misoprostol
80
goserelin, leuprolide MOA
GnRH agonist
indicated for central precocious puberty
81
umbilical cord prolapse management
immediate C/S
while awaiting delivery, elevate fetal presenting part to reduce pressure in prolapsed cord
82
MC sign of umbilical cord prolapse
bradycardia
83
diagnosis of inflammatory breast cancer
diagnostic mammogram and/or U/S
previously normal mammos (develops in 6 months)
84
large, obstructing genital warts inc risk of
dystocia (large enough to obstruct birth canal)
indication for C/S
85
parchment-like labia tx
clobetasol
lichen sclerosus
86
baby with maculopapular rash
"snuffles"
LAD
HSM
hemolysis
treponema pallidum
87
indication for D&C in pt with prolonged heavy menstrual bleeding
hemodynamic instability (hypotension, hgb \< 7) + IV estrogen
in stable pt: combined OCP
88
MCC irregular bleeding \< 21yo
anovulatory cycle= physiologic in adolescents!
| (failure to produce corpus luteum, which makes progesterone)
89
clomiphene citrate
indicated for infertility secondary to PCOS
SERM
90
endodermal sinus tumors secrete
AFP
91
dysgerminomas secrete
LDH
92
choriocarcinomas secrete
hCG
93
Mullerian malignancies of ovaries secrete
CA-125
94
histo: glomeruloid structures with nuclei palisading around capillaries
shiller-duval bodies
endodermal sinus tumor aka yolk sac tumor
95
histo: syncytiotrophoblasts and cytotrophoblasts
choriocarcinoma
ass. w molar preg
96
histo: central nucleus with cytoplasm around it, "fried egg" like
dysgerminoma in F
seminoma in M
97
histo: eosinophilic/red intracytoplasmic inclusion
"reinke crystals"
leydig or sertoli-leydig tumor
secrete testosterone
98
velvety red vulvar lesion w white plaques
paget's dz of bartholin glands
99
DES exposure causes which 3 cancers
vaginal adenocarcinoma
embryonal rhabdomyosarcoma
clear cell carcinoma
100
cysts seen in molar pregnancy
theca lutein
101
MCC elevated AFP
error in gestational age
102
levonorgestrel
plan B
103
AE: oral bisphosphonates
esophageal burning
104
AE: IV bisphosphonates and denosumab
osteonecrosis of jaw
105
vaccines for preg and HIV+
Tdap
inactivated influenza
Hep A
Hep B
106
weight gain based on pre-conception BMI
SINGLETON- underweight, normal, overweight, obese
TWINS- normal
**_SINGLETON_**
UNDERWEIGHT= 28-40lbs
NORMAL= 25-35 lbs
OVERWEIGHT= 15-25lbs
OBESE= 11-20 lbs
**_TWINS_**
NORMAL= 37-54 lbs
107
trichloroacetic acid
initial tx for condyloma acuminata in preg woman
108
@ 15 WGA, fetal growth: ___ grams/day
@ 20 WGA, fetal growth: ___ grams/day
@ 32-34 WGA, fetal growth: ___ grams/day
15 WGA= 5 grams/day
20 WGA= 10 grams/day
32-34 WGA= 15 grams/day (???? unsure)
109
therapeutic abortion \< 10 WGA
mifepristone + misoprostol
110
therapeutic abortion @ 10-14 WGA
D&C
111
therapeutic abortion \> 14 WGA
D&E
112
bx for solid vs cystic breast mass
```
solid= core needle bx
cystic= FNA
```
113
common complication of hysterectomy
urinary incontinence
114
mechanism underlying symptoms of menopause
hormonal effects of anovulation
115
3 elevated serum markers in acute phase HBV infection
HBsAg, HBeAg, anti-HBc IgM
window period= no anti-HBsAg or HBsAg, only anti-HBc
\*\*ON EXAM: cannot have elevated anti-HBsAg and HBsAg at same time
116
conjugated estrogens + progestins
turner syndrome
117
leuprolide pre-surgical indication
reduce fibroids prior to surgery
118
bromocriptine
cabergolin
DA agonists for hyperprolactinemia (d/t microprolactinoma, \< 10 mm diameter)
\*DA= prolactin-inhibiting factor\*
119
when to initiate antiviral therapy in HBV+ mom
only when viral load \> 1,000 and/or signs of acute liver impairment
telbivudine or tenofovir (tenofovir also tx maternal HIV)
120
most common complication FOR MOM forceps-assisted vaginal delivery
perineal laceration
121
holoprosencephaly
single eye (cyclopia) or nose
cystic hyogroma
trisomy 13
122
choroid plexus cyst
congenital diaphragmatic hernia
rocker bottom feet
clenched fists
overlapping digits
trisomy 18
123
when is gestational DM screened for and why
24-28 WGA
placenta produces enough human placental lactogen at this time to cause insulin resistance
124
congenital GnRH deficiency
Kallman
amenorrhea + anosmia
125
mullerian agenesis
Mayer-Rokitansky-Kuster-Hauser syndrome
126
androgen insensitivity
46, XY
x-linked recessive
female external genitalia
no axillary or pubic hair
127
MCC hypergonadotropic hypogonadism
turner
128
hypothalamic hypopituitarism
female athlete triad
129
pathogenesis of preeclampsia
cytotrophoblast cells fail to migrate to spiral arteries -\> insufficient spiral artery transformation/expansion @ 18-20 WGA -\> PLACENTAL hypoperfusion
130
cervical cytology vs biopsy
```
cytology= pap; ASCUS, LSIL, etc; examines CELLS
biopsy= CIN I-III, invasive cervical cancer; examines TISSUE
```
131
initial management of visible lesion on cervix
always biopsy (not cytology)
132
tx for syphilis in pregnant pt w PCN allergy
PCN desensitization -\> IM PCN G
non-preg tx= alt abx (erythromycin, tetracycline)
133
lower pelvic pain + mucopurulent discharge + cervical motion tenderness
PID
134
inc estrogen, inc LH, dec FSH
PCOS
135
inc LH, inc FSH, dec estrogen
turner
136
hyperprolactinoma -\> LH, FSH, estro levels?
dec LH, dec FSH, dec estrogen
137
dec LH, dec FSH, inc estrogen
granulosa-theca tumor, OR
exogenous estrogen
138
when is endometrial bx indicated in pre-menopausal (\< 45 yo) - three
persistent abnormal uterine bleeding in setting of:
- obesity or anovulation - unopposed estrogen
- failure to respond to previous medical tx
- high risk for endometrial CA
139
three hematologic considerations for heavy menses
VWD, plt dysfunction, immune thrombocytopenic purpura
140
next step in managing symptomatic pt with positive 1hr GTT
give diagnosis (GDM) + lifestyle modifications
3hr GTT in asymptomatic w pos 1hr GTT
141
first-line med for GDM
insulin
second-line is glyburide
142
fasting and 2hr PP glucose cutoff in preg pt
normal=
fasting \< 95
2hr PP \< 120
143
three factors influencing pap testing frequency and/or testing over 65yo
hx of HIV/HPV diagnosis
hx of cervical cancer
cervical dysplasia
144
smoking cessation tx
buproprion
145
placental abruption w \> 50% separation of placenta from uterine wall -\> MC complication?
DIC
146
MC neonatal complication of vacuum-assisted delivery
cephalohematoma -\> JAUNDICE
147
medication-induced hirsuitism
phenytoin, danazol
148
pregestational (first tri) diabetes causes
caudal regression syndrome
endocardial cushion defects and/or VSD
149
gestational (2nd and 3rd tri) diabetes causes
diabetic fetopathy (hyperglycemia-induced **hyperinsulinemia**)
in utero:
1. macrosomia: insulin acts like growth hormone, using mom's sugar to build
2. hypoxia: inc insulin -\> inc BMR-\> using up all oxygen
3. polyhydramnios (leading to PPH, cord prolapse, PROM)
neonatally:
1. hypoglycemia: insulin without mom's sugars
150
next step in managing PPROM w unknown WGA
fetal biometry - estimate WGA in second/third tri
biparietal diameter, femur length, humerus length, abd circumference
151
dating method in first tri
CRL
152
HCG produced by ___ cells and peaks at \_\_\_
trophoblasts; 8-11 WGA
153
four conditions where hx of condition is greatest RF for recurrence
ectopic preg
preterm labor
shoulder dystocia
preeclampsia
154
two findings on mammo suspicious for cancer
1. microcalcifications, especially linear (irregular more likely benign)
2. spiculated, irregular soft tissue mass
A spiculated mass is a **centrally dense lesion** seen on mammography with **sharp lines radiating from its margin**.
155
hx suspicious for PID + presenting w mucopurulent discharge and signs of sepsis
ruptured tuboovarian (fallopian tube or ovary) abscess - d/t untreated PID - emergent surgery
156
hysterosalpingogram showing uniform uterine filling and symmetric bilateral spillage
NORMAL
spillage of dye from fallopian tubes into peritoneum
157
uterine synechiae
intrauterine adhesions - when symptomatic= Ashermann syndrome
158
HNPCC (Lynch) inc risk of which cancer
endometrioid CA
159
endometriosis inc risk of which cancer
ovarian CA
160
bisphosphonate AE
esophageal ulcer
esophagitis
osteonecrosis of jaw
161
-dronic acid/-dronate
bisphosphonate
162
osteoporosis T-score
\< -2.5 = osteoporosis
163
prolonged retention of tissue after intrauterine fetal demise -\>
DIC
164
uterotonics- three
misoprostol - PGE1 analog
carbaprost - PGF2-alpha analog - CI in asthma
methylergonovine - ergot alkaloid - CI in HTN
165
lochia
superficial endometrial decidua tissue
begins as bloody -\> turns pinkish/watery
lasts = 6 weeks PP
166
when can twins undergo trial of vaginal delivery
only when DIAMNIOTIC with presenting fetus in VERTEX
167
prevention of transmission to fetus when mom is HBsAg+/IgG anti-HBcAg+ (chronic infection)
immediately after birth, baby gets HBV immune globulin & HBV vaccine
168
flunitrazepam
gamma-hydroxybutyrate
```
flunitrazepam= roofie
gamma-hydroxybutyrate= unspecific date rape drug
```
both cause amnesia
169
most important aspect of PE in sexual assault victim
photographs!!
170
when to diagnose anemia in preg
first/third tri= hgb \< 11
second tri= hgb \< 10.5
171
RBC & WBC levels in preg
RBC increase - MCV increases (young RBCs are largest)
WBC increase - esp neutrophils
172
pregnancy is \_\_\_-coagulable state
HYPERCOAGULABLE - inc fibrinogen
173
infant with lethargy, temp instability, hypoxia, poor perfusion, hypotension, resp distress
neonatal sepsis
174
indications for intrapartum antibiotics in GBS-unknown
PROM
prolonged rupture of membranes (\>18 hours)
fever
+/- ssx of chorioamnionitis
175
"failure of germ cell meiosis" describes pathogenesis of
teratoma
176
risk factor for endometriosis based on the most likely pathogenesis
anterograde outflow obstruction= inc risk of developing endometriosis
177
rotterdam criteria for diagnosis of PCOS
\*requires 2/3\*
1. oligo-/an-ovulation
2. hyperandrogenism (measure serum testosterone)
3. polycystic ovaries
178
HPV 6/11 cause
benign warts/condyloma accuminata
respiratory papillomatosis
179
APGAR components
@ 1 and 5 minutes
appearance, pulse, grimace, activity, respiration
```
heart rate (\>100, \<100, 0)
respiratory effort (reg, irreg, none)
muscle tone (active, moderate, limp)
reflex irritability (crying, whimpering, silent)
color (pink, extremities blue, totally blue)
```
\> 7= normal
\< 6= further evaluation
180
twins separating @ 0-72 hours
dichorionic/diamniotic
181
twins separating @ 4-8 days
monochorionic/diamniotic
MOST COMMON
182
twins separating @ 8-12 days
monochorionic/monoamniotic
183
twins separating @ \> 13 days
conjoined
184
why are NSAIDs CI in preg
risk of premature closure of ductus arteriosus in third tri
185
one indication for all three drugs
indomethacin, nifedipine, mag sulfate
tocolysis??
186
where is puberty initiated
hypothalamus - GnRH
187
first step in managing 38 WGA with clear fluid leaking from vag, without cervical change
confirm that the fluid is amniotic fluid!!
188
biophysical profile
fetal tone, fetal movement, fetal breathing, amniotic fluid
189
biophysical profile 4/10 at \>/= 32 WGA
DELIVERY
190
GBS prophylaxis in - three settings
1. preterm w unknown GBS status
2. previous infant affected by GBS
3. GBS bacteriuria anytime during pregnancy
191
percentile at which infants are "large for gestational age"
\>/= 90th percentile
192
absent grasp reflex
normal biceps and radial reflex
klumpke palsy/claw hand deformity (C7-T1)
193
erb duchenne palsy
C5-C6
194
brachial plexus injury RF - 8
1. multiparity
2. LGA infants (\>/= 90%ile)
3. maternal DM
4. breech presentation
5. previous child w birth-related brachial plexus injuries
6. shoulder dystocia
7. prolonged **2nd stage** labor (NOT 1st stage)
8. vacuum or forceps assisted delivery
195
amsel criteria for diagnosing BV
1. positive whiff test (using KOH)
2. vaginal pH \> 4.5 (lactobacilli normally produce lactic acid, creating acidic enviro around pH 3.8-4.2)
3. clue cells on saline microscopy
4. thin, homogenous discharge coating vaginal walls
196
according to comquest, when should mammo screening begin
age 50, then q2 years
197
four questions to ask for any OB w contractions
contractions
vaginal bleeding
vaginal clear fluid
fetal movement
198
first step in managing previously healthy pt w irreg menses and infertility
evaluate for ovulation:
cycle day 21 progesterone
FOLLICULAR --\> LH surge --\> ovulation (day 14) --\> LUTEAL --\> inc progesterone (day 21) --\> inc basal body temp
199
preg pt w vaginal bleeding + abd/low back pain + firm/tender uterus
DX
RF- 7
COMPLICATIONS- 3
placental abruption (separation of placenta from uterus prior to delivery)
RF: abd trauma, cocaine, HTN, polyhydramnios, multiparity, AMA, smoking
inc risk for: maternal hemorrhage, DIC, fetal death
200
placental villi invasion --\>
to superficial endometrial decidua basalis
to deeper endometrial decidua basalis
to myometrium
thru uterine serosa +/- bladder
NORMAL: to superficial endometrial decidua basalis
PLACENTA ACCRETA: to deeper endometrial decidua basalis
PLACENTA INCRETA: to myometrium
PLACENTA PERCRETA: thru uterine serosa +/- bladder
201
next step in managing a pt measuring at WGA \> LMP
and severe N/V
TVUS
\*\*b-hCG only to confirm preg\*\*
consider multiple gestation preg!!
202
hCG \> 1500 w/out evidence of intrauterine pregnancy
ectopic
203
MC delayed complication of D&E
delayed= \> 72 hours
most common= post-abortal endometritis
\*pts given doxycycline before surgery\*
204
management of severe preeclampsia
immediate induction of labor to reduce risk of maternal death
205
eclampsia inc risk of fetal
intrauterine demise -- d/t hypoxia
206
important allergies in surgical patients
latex (gloves, indwelling catheters)
iodine/betadine (pre-op antimicrobial)
207
STD screening recommendation
women \< 24 yo who have been sexually active before:
NG/CT and HIV testing annually
208
when should you expect and how should you diagnose Rh alloimmunization in Rh (-) primip with potential Rh (+) baby
6 examples
whenever fetal blood may have come into contact with mom's blood!!
TRAUMA, placenta previa, placental abruption, spontaneous AB, threatened AB, intrauterine procedures
209
non-immune causes of hydrops fetalis - 4
lymphatic obstruction
obstructed venous return
hepatocellular dz
fetal infection -- parvo B19
210
methods for decreasing vertical HIV transmission
C/S when viral load \> 1,000
baby: oral zidovudine for 6 weeks (regardless of mom's viral load)
mom: IV zidovudine (only if vaginal delivery)
211
severe maternal anemia (hbg \< 6) is RF for
preterm delivery
212
intrauterine adhesions secondary to D&C inc risk of - 3
dec flow/amenorrhea
cyclic pelvic pain
infertility (MOST COMMON), recurrent preg loss
213
amenorrhea due to uterine synechiae
uterine synechiae= IU adhesions
## Footnote
**Asherman's Syndrome**
214
17-hydroxyprogesterone caproate
indication: pt w hx of preterm delivery --\> reduce risk of preterm delivery in subsequent preg
215
enterocele vs rectocele
enterocele= (small bowel) prolapse thru vaginal apex \*\*\*common in s/p total hysterectomy
rectocele= prolapse thru posterior vaginal wall
216
darifenacin
tolterodine
oxybutynin
anticholinergics, muscarinic antagonists @ bladder
treat urge incontinence
217
CFU when bacteriuria is diagnosed
\> 100,000
218
why is TMP/SMX contraindicated in preg
folic acid antagonist -- developmental defects in first tri
219
treatment of choice for fibroids in pt who desires future preg
myomectomy
leuprolide may be used to shrink fibroids, but contraindicated in women trying to conceive
continuous GnRH analog --\> artificially induced menopause, aka infertility
220
PALM-COEIN for abnormal uterine bleeding
polyps
adenomyosis
leiomyoma
malignancy
coagulopathy
ovulatory dysfunction -- menarche, perimenopause, endocrinopathies
endometrial
iatrogenic
not yet specified
221
BMI range for:
underweight
normal
overweight
obese
BMI
\< 18.5 = underweight
18.5-24.9 = normal
25-29.9 = overweight
\> 30 = obese
222
pt with ssx mastitis/inflamm cancer
---she is breast feeding
---first step in management??
ABX
no need to image
223
screening in pt with fhx ovarian CA
---denies fhx breast CA
normal screens!!
CA-125 is not used for screening, only response to therapy
224
torches infections
TOXO
OTHER
---varicella
---syphyllis
---parvo
---listeria
RUBELLA
CMV
HSV-2
225
postpartum depression meds- whats the diff
amitryptiline
paroxetine
burpoprion
sertraline
amitryptiline= TCA, second-line (refractory depression), CI in suicidal thoughts
paroxetine= SSRI, CI in preg (cardiac malformation)
burpoprion= CI in seizure (dec seizure threshold)
sertraline= SSRI, first line PPD
226
post-meno
hx tamoxifen or pelvic irradiation
rapid uterine growth
uterine mass
---dx?
uterine sarcoma
requires surgery + post-op path for definitive dx
227
severe pre-eclampsia management
@ 34-40 WGA
@ \>40 WGA
@ any WGA, signs of end-organ damage -\> DELIVER
@ \<40 WGA:
---hydralazine, mag sulfate
---no improvement: VD
@ \>40 WGA: vaginal delivery
228
two causes of asymmetric IUGR
maternal vascular abnormalities - HTN, DM, smoking, illicit drug use
placental abnormalities
usually abd circumference (low) \<\<\<\< head circ (normal)
229
caudal regression syndrome is pathognomonic for
\*\*maternal PRE-gestational DM only\*\*
poorly controlled glucose in 2nd/3rd tri= only hyperinsulinemia
230
definitive diagnosis of multiple gestation preg in first tri
TVUS - multiple fetal poles (only way to diagnose twins or more)
231
MC nerves trapped in LTCS or other gyn surgery
ilioinguinal/iliohypogastric @ lateral edge
232
rx for pt with hot flashes and emotional lability (d/t menopause), w hx of VTE
paroxetine (SSRI)
second line ---- clonidine (alpha 2 agonist); gabapentin; pregabalin ---- venlafaxine (SNRI)
233
contraindications to hormone replacement therapy
PMHx of breast cancer, CAD, VTE, endometrial cancer, liver dz
234
38 WGA
no cervical change
fluid leaking from vag
unknown GBS
hx of previous preg complicated by GBS
FIRST STEP?
**amniotic fluid diagnostic test!!!**
**premature rupture of membranes** diagnosis requires
1. subjective -- hx of fluid leakage
2. objective/PE -- fluid from cervical os/pooling in vag canal
3. confirmed amniotic fluid - pH (alkaline) or microscopy
235
most significant complication of multiple gestation pregnany
preterm delivery
236
35 WGA
N/V, fever, anorexia, abd pain (periumbilical --\> RUQ)
U/S shows blind-ended tubular structure extending from R bowel that is no compressible
APPENDICITIS
237
when is fetal organogenesis complete
around 8 WGA
238
pt presentation sus of endometriosis
sus endometrioma in adnexa
NEXT STEP??
LAPAROSCOPY W/ BIOPSY - PATH DIAGNOSIS
239
KLEIHAUER BETKE --- WHEN? circumstances?
after ABD trauma -- tests for placental disruption
240
when is DIRECT COOMBS test relevabt
testing for autoimmune hemolytic anemia
--- etios ---
idiopathic
lymphoproliferative do - CLL, NHL
meds - cephalosporins, levodopa, methyldopa, procainamide
infection - mono, mycoplasma pneumo, HIV
241
ABD trauma to preg pt ---- next step in managing??
MOM: O neg, previously anti-Rh-D neg
BABY: unknown blood type
INDIRECT COOMBS
testing for maternal anti-Rh-D IgG
U/S can be used later to look for hydrops fetalis when Rh alloimmunization is already known to have occured
