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Obstatrics and Gynacology > OBGYN 4 > Flashcards

OBGYN 4 Flashcards

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1
Q

Postpartum thyroiditis?

A

the spectrum of Hashimoto thyroiditis
occur in 7-8 % of pregnancy
resolve within 12 months of postpartum

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2
Q

another Hashimoto thyroiditis occurs in post partum

A

painless tyroditis

diagnosed one year after postpartum

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3
Q

why these two called the spectrum of Hashimoto thyroiditis?

A

Painless defuze thyroid enlargement
Positive TPO
will have transient hyperthyroidism then will have hypotyroidism symptom

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4
Q

why they differ from Hashimoto?

A

they are reversible

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5
Q

radioisotope studies?

A

Low uptake in both

variable uptake in Hashimoto

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6
Q

Effect of pregnancy on GI?

A

Biliary stasis
GERD
Constipation
Hemorrhoid

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7
Q

Cause for this?

A

Enlarged uterus

Progesterone

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8
Q

Physiologic Anemia of pregnancy?

A

> =10.5
In second trimenister
Normocytic anemia

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9
Q

Hematologic change of pregnancy?

A

Pasma volume Inc.
RBC mass inc.
HB concentration low
Platelet count dec.

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10
Q

IBD and pregnancy?

A

Px flare-up IBD

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11
Q

Brest feeding contraindication?

A

Maternal

Fetal

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12
Q

Maternal?

A 
Active untreated TB
HIV infection(except in developing)
Herpetic breast lesion
Active varicella infection
Chemotherapy or radiotherapy
Active substance use disorder
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13
Q

Fetal?

A

Galactosemia

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14
Q

What about active HCV and HBV?

A

Not C/I
HCV–Not detected in breast
HBV-Safe after giving infant vaccine and immunoglobulin

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15
Q

taking Cocain in breastfeeding?

A

Since secreted in milk can cause
Intoxication symptom
Withdrawal symptom(irritability and tremor)
long-term NB comp.(Hyperactivity and cognitive
dysfn)

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16
Q

effect of shoulder dystocia?

A 
Clavicular #
Humeral #
Erbs Duchene
Clumpy
Birth asphyxia
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17
Q

What we suspect in absent moro (due to pain) in the affected side with intact grasp and biceps reflex?

A

Clavicular #

Humeral #

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18
Q

How to differentiate?

A

crepitation and irregularity area

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19
Q

Erbs Duchene?

A

Dec MORO and biceps reflex
Waiters tip(Extended elbow, pronated arm, and flexed hand and finger)
C5-C6–injury

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20
Q

Clumpy?

A

Intact moro and biceps reflex
Claw hand(Extended wrist, hyperextended MCP joint, and flexed interphalangeal joint)
horner syndrome
C8-T1 injury

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21
Q

management?

A

physiotherapy to prevent contracture

not resolve 3-9 month –surgery

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22
Q

Infertility diagnosis?

A

> 12 months despite adequate sex in age <35

>6 months despite adequate sex in age >35

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23
Q

Appendicitis and PX?

A

Px–make appendix cephalic position–RUQ,RMQ and flank pain.

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24
Q

management?

A

Immediate laparoscopic surgery

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25
Psudothrombocytopnia?
Thrombocytopnia due to labratory eror
26
cause?
incompletely mixed-blood--due invitro coagulation | Ab to EDTA--blood coagulate in vitro(Tube)
27
Diagnosis?
Thrombocytopenia in CBC and clumped platelet in pheripherial morphology
28
management?
used non-EDTA tube heparin and sodium citrate)
29
GDM screening?
At 24-28 wk
30
first to do
1 hr 50 mg glucose
31
what to do next?
If >140 do 3 hr 100 mg glucose test | If < 140 normal and no need for further testing
32
interpretation in 100 mg of glucose?
1hr--->=180mg 2hr--->= 155mg 3hr--->=140 mg
33
diagnosis?
If two positive finding from above 3 and FBG >95(total of 4 criteria)
34
surgical site cellulitis CM?
Fever >38 degrees after 24 hr of delivery | incision site induration and erythema extend to the mons pubis.
35
Risk factor?
obesity | emergency surgery
36
Idiopatic intracranial HTN risk?
Obese women in the reproductive age. | Drug(Vit A, Tetracycline, GH, and danazol)
37
CM
``` Headache (positional, worse lying flat) Pulsatile tinnitus Visual loss enlarged BS Diplopia (CN Vl pulsy) papilledema ```
38
Papilloedema Fundoscopy findings?
venous engorgement (usually the first signs) loss of venous pulsation. hemorrhages over and/or adjacent to the optic disc. the blurring of optic margins. elevation of the optic disc. Paton's lines (radial retinal lines cascading from the optic disc)
39
Related to Px?
Px is not directly associated | But excessive wt gaining may exacerbate it.
40
Diagnosis?
LP after brain MRI
41
why after MRI?
Exclude ICSOL--risk of herniation while doing LP
42
why MRI?
To not expose the fetus to radiation
43
management.
weight loss | Acetazolamide
44
LP diagnosis?
pressure >250 mmHg
45
Is trace protine normal in Px.
yes
46
stress incontinence cause?
``` urethral hypermobility(Ass with bladder decent) Intersec urethral sphincter defect ```
47
Management?
kegel exercise weight loss continence pessary mid-urethral sling
48
what mimic it?
UTI
49
how to differentiate?
UTI has a more acute onset and lab findings like leukocyte esterase.
50
association with Px?
Px increase stress urinary incontinence
51
pathophysiology?
pelvic muscle relaxation(loss of sphincter loss) | pudendal nerve injury during vaginal delivery--spnicter strength loss
52
symptom?
urine leak in Valsalva(coughing, laughing..) Loss of bladder fullness sensation--due to loss of pudendal nerve function(help for bladder sensation) Normal up to 6 weeks post-delivery
53
management?
if <6 weeks--reassurance and kegle ex | >6 weeks--continence pessary, mid-urethral sling
54
preeclampsia severity future?
``` b/p s .160 and d.>110 platlet<100,000 creatinin >1.1 or 2x elevation LTAE..>2x Pulmonary edema cerebral symptom(headache and blurring of vision) ```
55
How preeclampsia cause strock?
Activation of CS, Platelet aggregation and microthrombi formation----ischemic stroke Dysregulation of CBF--spasm of the cerebral artery--high perfusion pressure--Hemorrhagic stroke
56
pancreatitis and pregnancy?
Px especially in the third trimester--Increase TG containing LP and decrease the clearance of LDL---Hypertriglyceridemia---Pancreatitis increase--biliary sludge--stone--pancreatitis
57
management?
hydration, pain control if glucose >500 insulin if less than 500 and severity future like LA and hypocalcemia --consider plasmapheresis fibrates if TG>1000
58
PCOS CM?
``` androgen exes(acnne,baldnes......) oligo or anoovulation(minstual iregularity) obesity PCO in U/S Insulin res(skin pigmentation>>>) ```
59
pathophysiology?
High LH/FSH---High testostron---converted to estrogen in adipose--negative feedback on GNRH by constant supresion
60
comorbidity?
metabolic syndrome non alcoholic steatohepatitis OSA Endometrial hyperplasia
61
managment?
wt loss(decrease estrogen production in periphery) OCP(for menestrual iregularity) letrozole for ovulation induction(decrease pheripherial conversion)
62
utrine sarcoma presentation?
bulcky mass--pelvic presure,pain and constipation abdormal bleeding--mainley in post-menoupose utrine mass
63
risk factors?
Tamoxifine Radiation post menoupose
64
diagnosis?
U/S endometrial biopsy surgical biopsy histopathology
65
treatment?
hysterectomy | chemo and radiation
66
next step after pap test done and found posetive AGC?
colposcopy--visualise ectocervix endocervical curitage--endocervix endometrial biopsy--endometrium
67
endometrial biopsy indication/
age>=45 age 35-45 age >35
68
age>=45
AUB | Post menouposal bleeding
69
age 35-45
AUB plus one of following unoposed estrogen(obese,unovulation) failed medical management lynch syndrome
70
Age > 35
posetive pap smear
71
false labour ?
Iregular contraction | No cervical change
72
what do we do for patients with FL?
Non stress test--if normal reasurance and discharge
73
choice of intrapartum GBS prophylaxis?
Iv penicillin
74
If allergic to penicillin?
allergy is low risk(develop the only nonpruritic rash) and high risk(develop shock, bronchospasm, urticaria, and anaphylaxis)
75
High risk--
Clindamycin---cross-resistance is high with erythromycin If resistance pattern unknown/resistant--b/C GBS is highly resistant to erythromycin--vancomycin--the poor entrance to AF--observe the neonate
76
low risk--
repeat penicillin/cephalosporine
77
why not co-trimoxazole?
GBS is highly resistant | risk of kernicterus in 3rd TM
78
primary ovarian failure?
hypogonadotropic hypogonadism?
79
cause of POF in cancer patients?
chemotherapy and radiotherapy
80
Ass. symptoms?
estrogen deficiency symptom
81
physiologic leukorrhea?
white cervical discharge common in mid ovulation(10-14 day)--due to estrogen excess no infection symptom(pain, pruritis and erythema other infection cause must be excluded
82
when to stop pap smear?
``` Age>65/hysterectomy and no risk factor plus no history of CIN stage 2 or higher and three consecutive negative tests or two negative tests with cotests(HPV) ```
83
what are the risks?
multiple sexual partners smoking immunosuppression DeS exposure
84
at what age should a pap smear start?
21
85
frequency?
every 3 year
86
at what age should a pap smear with HPV co-test start?
30
87
frequency?
every 5 year
88
Duodenal atresia is associated with?
Down syndrome | VACTERL
89
pregnancy and fibroid relation?
increase size b/c of estrogen and progesterone | risk of degeneration(necrosis) b/c of blood shift to placenta and fetus in proportion to the growth
90
symptom of degeneration?
``` abdominal pain and vomiting tender uterus induce contraction(prostaglandin release) leukocytosis tender mass on the uterus ```
91
diagnosis and management?
u/s | pain management with NSAID if <3 week

Obstatrics and Gynacology (18 decks)

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