OBGYN UW1 Flashcards
(195 cards)
1
Q
HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome presentation during pregnancy
A
-worsening RUQ pain due to gradual distension of hepatic (Glisson) capsule
-HTN
-proteinuria
2
Q
life threatening complication of preeclampsia with severe features
A
-pulmonary edema
-caused by increase SVR, capillary permeability, and pulmonary capillary hydrostatic pressure and decreased serum albumin levels
3
Q
preeclampsia with severe features presentation
A
greater or equal 20weeks + HTN (140/90) + HA with vision changes (blurry vision)
increases risk of acute stroke due to endothelial cell damage, dysregulation of cerebral blood flow, cerebral vasospasm, vascular micro thrombi formation
4
Q
Complete abortion
A
passage of products through cervix at <20weeks
-cervix then closes
-pain and bleeding subside
-Ultrasound: empty uterus
5
Q
Transverse lie: presentation and management
A
-fetal spine perpendiculat to long axis of uterus
-common at early gestational ages
-most spontaneously convert to longitudinal lie and cephalic by term (equal or greater 37w)
-preterm transverse lie manangement: expectantly
6
Q
acute postpartum urinary retention: presentation and RF
A
-inability to void and overflow incontinenece due to pudenal nerve injury and bladder atony
-RF: prolonged labor, perineal trauma, regional neuraxial anesthesia
7
Q
Granulosa cell tumor results in?
A
Granulosa cells: primary component of ovarian stroma. converts testosterone to estradial via aromatase
-high levels estrogen and inhibin
-malignant proliferation results in high estradial levels that affect breast tissue (tenderness, fibrocystic changes) and uterine lining (postmenopausal thickened endometrium)
-juvenile subtype granulosa cell tumors present with precocious puberty and adnexal mass
8
Q
What is ulipristal? MOA
A
-highly effective emergency contraception
-delays ovulaton and impair implantation
-can take up to 120 hours after unprotected sex
9
Q
What is the most accurate way to deteremine estimated gestation age?
A
Ultrasound dating with fetal crown-rump measurement in 1T
10
Q
Signs concerning for breast malignancy (unilateral, blood tinged breast milk or bloody nipple discharge, new breast mass) NBS?
A
breast imaging
11
Q
What is cervical insufficiency?
A
structural weakness of cervix that causes painless cervical dilation and potential 2T pregnancy loss.
managed with prophylactic cerclage performed in 1T to decrease risk of recurrence
12
Q
RF for cervical insuffiency
A
prior cone biopsy (cervical conization)- shortens cervix and alters structural integrity
13
Q
Nonclassic congenital adrenal hyperplasia cause and presentation
A
-partial 21 hydroxylase deficiency
-reproductive age with hyperandrogenism (hirsutism, acne) and AUB
14
Q
Cervical cancer cause and presentation
A
-cause: high risk 16/18 HPV
-an AIDS defining illness
-px: postcoital bleeding, painless ulcerative lesion, painless inguinal lymphadenopathy, irregular bleeding, vaginal discharge, visible raised cervical lesion
confirm: biopsy
15
Q
Why are estrogen containing contraceptives contraindicated in pts with migraine with aura?
A
-increase for ischemic stroke
-migraine: episodic, severe, unilateral throbbing HA; photophibia, phonophobia, N/V, aura (focal, reversible, neurologic symptoms that precede or accompany HA)
16
Q
What is physiologic leukorrhea?
A
-white, odorless mucoid cervical discharge occurs midcycle due to increasing estrogen prior to ovulation
-microscope: no evidence of inflammation or infection (rare polymorphonuclear leukocytes)
17
Q
Uterine rupture: px, RF, mx
A
-Px: ab pain, fetal heart tracing abnormalities, progressively decreasing contraction amplitude, loss of fetal station
-RF: prior uterine surgery (C section)
-Mx: emergency laparotomy and C section
18
Q
What is androgen insensitivity syndrome?
A
-nonfunction androgen receptor
-genotypically male (46XY) to appear phenotypically female
-primary amenorrhea (due to lack of female internal genitalia), normal breast and female external genitalia, minimal or no axillary/pubic hair
19
Q
Benign breast pain signs
A
-cyclic (a.w menses), bilateral, and diffuse, no mass
-reassure and symptom management (supportive bra, NSAIDs)
20
Q
Management of uncomplicated (no fever or purulence) perineal lacerations
A
-common after vaginal delivery
-causes perineal edema and pain with urination
-Mx: conservative (NSAIDs, sitz bath)
21
Q
Gestational diabetes mellitus screening when?
A
-at 24-28 weeks
-earlier screening (at initial prenatal visit): for pts with obesity and additional RF for undiagnosed pregestational DM (prior macrosomic infant, PCOS)
22
Q
What is postpartym thyroiditis?
A
-form of painless AI thyroiditis within 12 months of delivery
-px: signs of hyperthyroidism (weight loss, tremor, elevated T4 and T3) and low uptake on RAI uptake scan
23
Q
Stress urinary incontinence occurs due to? txt?
A
-Weakened pelvic floor muscles that cause urethral hypermobility and reduced bladder support
-intermittent loss of urine from increased intraabdominal pressure (lifting, coughing, laughing, jogging, sex)
-first line txt: pelvic floor muscle (Kegel) exercises or surgical midurethral sling placement
-common in postmenopausal women due to weakened pelvic floor muscles and urogenital mucosa atrophy
24
Q
Ovarian torsion: px and mx
A
-rotation of ovary around infundibulopelvic ligament, causing ovarian vessel occlusion and ischemia
-px: n/v, new onset severe unilateral pelvic pain, adnexal tenderness, palpable adnexal mass
-mx: emergency requiring diagnostic laparoscopy
25
What is cornual ectopic pregnancy?
-pregnancy implantation in upper outer corner of uterine fundus
-highly vascular and rupture can cause life threatening intrabdominal hemorrhage
-hemodynamically unstable + hemoperitoneum = emergency surgical exploration
26
When do you give intrapartum antibiotic (penicllin) prophylaxis for GBS?
-unknown GBS status
-RF for vertical transmission: ROM for more than 18 hours, intrapartum fever, fetal prematurity (<37 weeks)
27
What are early decelerations?
uniform, shallow decels with gradual onset that occur symmetrically with contractions
-nadir at peak of contraction and return to baseline at end of contraction
-benign finding caused by fetal head compression
-expectant management
28
IUD have higher risk for what? Dx?
-lower absolute risk for ectopic pregnancy but higher risk for ectopic implantation
-dx: transvaginal US, better visual of pelvic structures compared to transab US
29
PCOS causes infertility due to? Px?
-anovulation
-Px: irregular menses, enlarged ovaries, signs of insulin resistance
30
Ovulation can be induced in PCOS with?
letrozole (aromatase inhibitor)
31
What is pelvic organ prolapse?
-herniation of pelvic organs (rectum) into vagina
-due to damage levator ani muscle complex
-prolapse vaginal wall (rectocele): chronic constipation and vaginal bulge
32
What is postpartum endometritis?
-fever >24h postpartum, uterine tenderness, purulent or malodorous lochia
-polymicrobial infection of uterine decidua
-if symptoms do not improve with antibiotics, do blood cultures and pelvic US to exclude retained products and pelvic abscess
33
What is rectus abdominis diastasis?
weakening of linea alba between rectus abdominis muscles
-px: nontender ab bulge in pregnant or postpartum
-mx: conservation with observation and reassure
34
life threatening complication of epidural anesthesia
high spinal anesthesia or accidental injection of local anesthetic into subarachnoid space that causes ascending motor, sensory, and sympathetic blockage.
-at risk for respiratory paralysis (dyspnea, hypoxemia)
35
what is genitourinary syndrome of menopause (atrophic vaginitis)
-low estrogens causes decrease vulvovaginal tissue elasticity and blood flow
-dyspareunia due to narrowing of vaginal introitus and dryness from loss of natural lubrication
-vaginal pruritis, thin vulvar skin with decreased elasticity, pale/dry vagina
-Tx: lubricants or moisturizers; vaginal estrogen for persistent or severe symptoms
36
When is a biophysical profile performed? What is an abnormal test?
-in patients at risk for uteroplacental insufficiency (equal or greater than 41 weeks)
-chronic hypoxemia causes abnormal BPP score and suggests imminent risk of fetal demise; delivery is indicated
37
what is sertoli-leydig tumors
testosterone secreting sex cord stromal ovarian tumors that present with rapid onset virilization (bitemporal hair thinning, clitoromegaly), amenorrhea, large pelvic mass, signs of estrogen def (breast atrophy, vulvovaginal atrophy)
38
endometrial polyps presentation and treatment
regular monthly menses + intermenstrual bleeding
-symptomatic polyops are treated with hysteroscoopic polpectomy
39
When does endomentrial cells on Pap require additional evaluation (biopsy)?
-when they are symptomatic (AUB) or high risk for endometrial hyperplasia and cancer (obesity)
40
pregnancy presentation in perimenopausal women
insomnia, fatigue, weight gain, amenorrhea, enlarged uterus
-evaluate with hCG levels
41
Low back pain is common in 3T due to?
postural changes, weakended abdominal muscles, joint/ligament laxity
-reassure and conservative mx (exercise, heating pads, massage)
42
Turner syndrome patients are at risk for?
-AI disorders, including celiac disease which can present with signs of micronutrient malabsorption (IDA, vit D def) without overt GI symptoms.
-first step evaluation: tissue transglutaminase antibody level measurement
43
What is gestational thrombocytopenia?
-usually asymptomatic (no bruising, bleeding, anemia)
-mildly reduced platelet counts of 100-150k
-benign, self limited, reassure and observe
44
what is pemphigoid gestationis?
-AI disease in 2T or 3T
-pruritis, erythematous plaques that involve umbilicus that develop into vesicles and bullae
-Tx: high potency topical corticosteroids
45
Neuraxial anesthesia (epidural) can cause sympathetic block resulting in?
-maternal hypotension and decreased placental perfusion = recurrent late decelerations
-mx: left lateral positioning, IV fluidbolus, vasopressors (phenylephrine)
46
What is active phase arrest
-no cervical change in 4h with adequate contractions or 6h with inadequate contractions
-labor arrest managed with C section
47
what is vasa previa
-fetal vessels overlie cervix, making them prone to tear and bleed with ROM or contractions
-Mx of ruptured fetal vessel: emergency section because of high risk of fetal exsanguination and demise
48
short interpregancy intervals (<6-18 months between delivery and next pregnancy) are a/w?
preterm labor, preterm prelabor ROM, low birth weight
49
First stage of labor
latent phase (0-6 cm)
active phase (6-10 cm)
normal labor progession: equal or greater 1cm every 2h
50
What is preeclampsia? what is severe features
new onset HTN at >/20 weeks + proteinuria or signs of end organ damage (renal dysfunction)
-severe features: serum creatinine >1.1 or transaminases >2x normal. This increases morbidity (abruptio placentae, fetal demise)
51
Severe HTN increase maternal risk for? fetal risks?
Severe range HTN: systolic 160+ or diastolic 110+
Mom: stroke, pulmonary edema, MI
Baby: abruptio placentae and intrauterine demise
treat: hydralizine, labetalol, nifedipine
52
what is local anesthetic systemic toxicity?
a complication of epidural
-can cause CNS overactivity (perioral numbess, metallic taste, tinnitus) and generalized tonic clonic seizures
53
what is hidradenitis suppurativa?
-chronic inflammatory condition in intertriginous areas (inguinal region)
-lesions occur due to occluded follicles that cause painful nodules and abscesses that can develop into draining sinus tracts and signifanct scarring
54
what is antiphospholipid antibody syndrome?
-prothrombic AI disorder presents with recurrent pregnancy loss, arterial or venous thrombosis, mild thrombocytopenia, stillbirths
-stillbirths occurs due to uteroplacental artery thrombosis, leads to uteroplacental insufficeincy and asymmetric fetal growth restriction
-APS pts require anticoagulation (LMWH in pregnants) to decrease risk of complications
55
what is amniotic fluid embolism syndrome
rapid onset respiratory failure, obstructive shock with severe hypotension, DIC during labor or immediate postpartum period.
-Dx is clinical and managed supportively (intubate with mechanical ventilation)
56
Breech + contraindications to vaginal (prior c section, placenta previa)
external cephalic version not recommended, do a c section
57
Leiomyomata uteri (uterine fibroids) can cause what in pregnancy
uterine size greater than date discrepancy and irregular uterine contour
58
pregnancy can worsen diabetic kidney disease leading to?
HTN, elevated creatinine, frank proteinuria.
59
RF for superficial surgical site infection (cellulitis)
RF: obesity and emergency surgery (inadequate skin antisepsis or antibiotic prophylaxis)
-can occur after c section and presents with postpartum fever and incisional induration and erythema
60
what is placenta previa
-placenta covers cervix, creating potential massive antepartum painless hemorrhage from cervical dilation
-maternal blood loss, fetal monitor reassuring
-labor and vaginal delivery CI; c section at 36-37 weeks
-RF: prior c section
61
what is hyperemesis gravidarum
severe, persistent n/v leading to inadequate gestational weight gain and weight loss of >5% of prepregnancy weight, electrolyte abnormalitis, ketonuria
-increase risk for fetal growth restriction and preterm delivery
62
chlamydia trachomatis urethritis
-dysuria + sterile pyuria
-do nucleic acid amplification testing for C + G
63
what is endometrial ablation
minimimal invasive procedure that destroys and/or resects endometrial lining to decrease uterine bleeding
-candidates: ovulatory (cyclic) heavy menstrual bleeding, no plans for future fertility, low risk endometrial malignancy
-causes intrauterine scarring and adhesions that limit future endometrial evaluation (endometrial biopsy), ablation is CI in pts at high risk for endometrial cancer (postmenopausal, Lynch syndrome)
64
elevated maternal serum alpha-fetoprotein meaning
-congenital defects (ab wall defect, open neural tube defect)
-next: fetal anatomy US
65
what is choriocarcinoma
metastatic form of gestational trophoblastic neoplasia that may occur after a hydatidiform mole, normal pregnancy, or spontaneous abortion.
-lungs are frequent site of mets
-suspect in postpartum women with enlarged uterus, irregular vaginal bleeding, pulmonary symptoms, multiple infiltrates on CXR
-Dx: confirmed with elevated b-hCG
66
what is PCOS
-irregular menses and hyperandrogenism
-infertility due to anovulation from failed follicular maturation
67
prescribe ___ for pts at high risk for preeclampsia (multiple gestations)
low dose aspirin at 12-28 weeks (optimally before 16 weeks)
68
what is endometriosis
-ectopic implant of endometrial tissue in the abdomen and pelvis
-chronic inflammation, pain, fibrosis
-indications for txt: chronic pelvic pain, dysmenorrhea, dyspareunia, infertility. txt with NSAIDs and/or combined OCP, which treats inflammation and suppress stimulation of endometriosis
-failed medical management can go for laparoscopy
-asymptomatic: observe and reassure
-increased risk of infertility due to chronic pelvic inflammation, adhesions, distorted pelvic anatomy
69
uncomplicated preterm prelabor ROM at <34weeks management
expectantly with prophylactic latency antibiotics, corticosteroids, inpatient monitoring.
delivery is at 34 weeks or earlier if complicated (intraamniotic infection, placental abruption)
70
what is polymorphic eruption of pregnancy?
3T, pruritic erythematous papular rash that is limited to abdominal striae and spares umbilicus
-resolves spontaneously, txt: topical corticosteroids
71
genital tract trauma (vaginal laceration) can cause?
postpartum hemorrhage.
72
systemic lupus erythematosus flare complicated by nephritis presentation
HTN during pregnancy with edema, joint pain, malar rash, UA with proteinuria and RBC casts
73
what is cell free fetal DNA testing
noninvasive and highly sensitive and specific screening test for fetal aneuploidy (trisomy 21,18,16)
-perform at more than 10 weeks
-abnormal results confirmed by chorionic villus sampling or amniocentesis
74
RF for breech presentation
uterine leiomyomas, which can distory uterine cavity, thereby limiting fetal mobility and preventing fetal cephalic engagement
75
if fetal presentation (cephalic, breech) is uncertain on digital cervical exam, NBS?
transabdominal US to confirm fetal presentation and determine safest route of delivery
76
When is exercise contraindicated in pregnancy?
high risk for preterm birth (cervical insufficiency), have antepartum bleeding, or underlying condition exacerbated by exercise
77
In teens, the immature HPO axis causes what?
-anovulation and heavy, irregular menstrual
-hemodynamically stable= heavy vaginal bleeding managed with high dose oral contraceptive to stablize endometrium and stop the acute bleeding
78
what is labor
painful, regular contractions that cause cervical change
79
what is false labor (braxton-hicks contractions)
mild, irregular contractions that cause no cervical change and resolve without intervention.
-patients can be d/c home with labor precautions
80
what is infertility
inability to conceive after 12 months of regular unprotected sex in women <35
-male factor infertility is a common cayse and intitial eval is semen analysis
81
what is genitourinary syndrome of menopause
causes estrogen deficiency that results in urogenital atrophy
-presents wtih dysuria, urgency incontinence, recurrent UTIs
-Txt: nonhormonal moisturizers, vaginal estrogen for severe symptoms
82
first line for primary dysmenorrhea in sexually active patients
Combined OCPs
-AE: irregular, unscheduled bleeding, HTN, venous thromboembolism
83
combined OCPs and cancer relation
-decrease risk of ovarian and endometrial (if ever used)
-increase risk of cervical (if currently or recently used)
84
Endometrial hyperplasia are at risk for
endometrial cancer.
-pt who desure future fertility: treat with progestin therapy (progestin releasing IUD)
85
Uncomplicated preterm prelabor ROM at <34 weeks management
expectantly with antibiotics and corticosteroids to promote in utero fetal development.
delivery is indicated: intraamniotic infection or deteriorating fetal/maternal status or pregnancy reached 34 weeks
86
ABO incompatibilty occurs when?
mother with O and infant with group A or B bood, which can cause mild hemolytic disease of newborn
-affected infants are usually asymptomatic at birth and have mild anemia and may develop neonatal jaundice that responds to phototherapy
87
Patients with PCOS are at incrased risk for?
endometrial hyperplasia and cancer due to unregulated endometrial proliferation from unopposed estrogen.
88
what is congenital aromatase def?
-rare enzyme def that prevents conversion of androgens to estrogens
-causes virilization of females resulting in normal internal genitalia with ambigous external genitalia
89
menopausal with moderate to severe vasomotor symptoms (hot flashe), first line txt?
patients with a uterus: estrogen + progesterone therapy
patients without uterus: estrogen only therapy (transdermal estrogen patch)
90
complete hydatidiform moles present
1T bleeding, uterine size greater than gestational age, elevated hCG, theca lutein cysts, bilateral multiloculated ovarian cysts, overt hyperthyroidism
US with snowstorm and no fetus.
management: suction D&C
can present with preeclampsia with severe featuers at <20weeks
91
secondary syphillis presentation
diffuse maculopapular rash along skin-cleavage lines of trunk (christmas tree pattern) that extends to extremities, palms and soles
92
Preventive migraine therapy may benefit patients with severe migraines (more than 4x/month, significant impairment). During pregnancy, first line prevention is with?
beta blockers (propanolol, metoprolol)
93
secondary amenorrhea
amenorrhea for more than 3 months who previously had regular menses (or more than 6 months in women with irregular periods)
initial eval: pregnancy test, serum prolactin, TSH, FSH levels
94
what is contraindicated in patients with active breast cancer due to risk for stimulating estrogen receptor+ and/or progestrone receptor+ tumor cells?
hormonal contraception (estrogen and/or progestin methods)
-these patients can use copper IUD
95
acute pyelonephritis in prgenancy presentation
fever, maternal and fetal tachycardia, flank pain or costovertebral angle tenderness.
due to high risk of severe complications (maternal sepsis, preterm delivery), managment= hospitalization and empiric IV ceftriazone
if no improvement 48-72h of IV antibiotics then do renal US to r.o renal abscess
96
what is active phase protraction adn the RF?
<1cm cervical dilation in 2h during active phase (6-10cm dilation)
-RF: cephalopelvic disproprtion, inadequate contractions, maternal obesity, fetal malposition (occiput posterior)
97
Vulvar lichen sclerous presentation and txt
common in prepubertal girls with pruritus and thin, white lesions on vulva and perianal region.
txt: superpotent topical corticosteroids
RF for vulvar cancer
98
what is oligohydraminios?
AFI less than 5 cm or single deepest pocket amniotic fluids <2cm on US.
2T and 3T oligo: due to ROM or chronic uteroplacetal insufficiency
99
gestational DM with suboptimal glycemic control and/or need fr pharmacotherapy (insulin) are at increase risk for?
stillbirth.
these patients require 3T antenatal fetal surveillance (nonstress testing at regular intervals)
100
What are the most effetive emergency contraceptive methods?
IUD (cooper or progestin releasing)
101
what is ovarian hyperstimulation syndrome
complication of ovulation induction for infertility treatment.
-symptoms within 1-2 weeks: ab pain, ascites, bitlateral enlarged, cystic ovarias, third spacing leading to intravascular volume depletion (hemoconcentration)
-severe complications: thromboembolism, multiorgan failure and death
102
uterine sarcoma presentation and RF?
postmenopausal bleeding and uterine mass that causes bulk symptoms (pelvic pressure, constipation)
RF: tamoxifen (estrogen agonist on uterus and antagonist on breast)
103
what is vesicovaginal fistula
-may occur after pelvic surgery (hysterectomy)
-presents: continous, painless watery discharge from urine leaking into vagina (pooling of clear fluid), area of raised, red granulation tissue on anterior vaginal wall
-obstructed labor in resource limited areas is the most common cause worldwide
dx: pelvic exam and bladder dye test
104
what is eclampsia
Preeclampsia with severe features + seizures
-eclamptic seizures are typically generalized tonic clonic, last several minutes, a/w postitcal phase
txt: prompt delivery and magnesium sulfate infusion
105
what is osteogenesis imperfeta
AD, mutations in type 1 collagen
type II OI: most severe form, a/w multiple fetal fractures and IUFD; limb deformities, fetal growth restriction, hypoplastic thoracic cavity.
106
Renal colic in pregnancy
ab pain, flank tenderness, hematuria, often irregular uterine contractions.
diagnositc imaging: US
107
premenopausal women with adnexal mass on pelvic exam NBS
pregnancy test and pelvic US
108
what is von willebrand disease
common bleeding disorder causing impaired platelet adhesion and most common cause of heavy regular meneses in teens.
labs: aPTT normal or prolonged, platelet and PT both normal.
109
symptomatic cholelithiasis (bilary colic) is common in pregnancy due to?
increased gallstone formation.
recurrent RUQ and/or epigastric pain from intermittent obstruction of cystic duct
110
what is a vaginal hematoma
potentially life threatening postpartum complication that presents with a vaginal mass and possible hypovolemic shock due to massive occult bleeding
111
intraamniotic infection (chorioamnioitis) presents and txt
in patietns with premature or prolonged ROM, materal and fetal tachy, uterine fundal tenderness, maternal leukocytosis
-polymicrobial
-txt: broad spectrum IV antibiotics and expedited delivery to decrease neonatal and maternal morbidity
112
parvo b19 infection in pregnancy can cause severe fetal anemia due to?
viral cytotoxicity to fetal erythrocyte precursors.
fetal anemia increases cardiac output, which can lead to high output fetal heart failure, subsequent hydrops fetalis (skin edema, ascites) and fetal demise
113
during pregnancy, sickle cell disease pts are more likley to have acute vasooclusive pain episodes (ab pain) due to?
increased metabolic demands and hypercoagulable state
-txt: aggressive pain control and IV hydration
114
chronic HTN in pregnancy diagnosis and increased risks
dx: prepregnancy HTN and those with HTN at <20 weeks
increased risk for obstetic complications, superimposed preeclampsia, fetal growth restriction and preterm delivery
115
postpartum fecal or flatal incontinence can occur due to?
external anal sphincter injury a/w 3rd or 4th degree perineal laceration
-weakened anal sphincter tone, asymmetric sphincter contraction, palpaable defect on exam.
eval with endoanal US
116
significant obsteteric bleeding (postpartum hemorrhage) can cause?
DIC: bleeding, thrombosis (acute pumonary embolus), thrombocytopenia, prolonged PT and PTT
117
Toxoplasma gondii US findings
hydrocephalus and intracranial calcifications, particularly in basal ganglia
-hepatosplenomegaly and fetal growth restriction
118
what is restless legs syndrome
urge to move legs and dysesthesia that is worsened by inactivity and improve with movement
-symptoms worse in evening or night and may impair sleep
119
what is septic pelvic thrombophlebitis
postop or postpartum infected thrombosis of deep pelvic or ovarian veins, persistent fever unresponsive to antibiotics
txr: anticoagulation and broad spectrum antibiotics
120
blunt abdominal trauma (MVA) in pregnancy can cause?
severe maternal bleeding and hemorrhagic shock (abruptio placentae)
trauma pts with hemorrhagic shock require replacement of intravascular volume, transitioning from crystalloid to blood product resuscitation ASAP
121
what is paget disease of the breast
malignant; unilateral erythematous, intensely pruritic, ulcerative lesion of the nipple/areolar
-requires diagnostic mammography
122
spontanous abortion can cause Rh D alloimmunization in Rh D negative women due to?
fetomaternal blood mixing and maternal anti-D antibody production if fetal blood type is RhD+.
RhD negative women require anti-D immunoglobulin after spontaneous abortion
123
Txt of acute cervicitits
can presesnt as 1T bleeding and mucopurulent endocervical discharge
-empiric txt with ceftriazone and azithromycin followed by a test of cure
124
what is a urethral diverticulum
abnormal localized outpouching of the urethral mucosa into surrounding tissues
-can cause dyspareunia
-palpable, tender mass on anterior vaginal wall a.w purulent discharge
125
congenital uterine anomalies, which typically lead to separate, smaller uterine cavities, can increase risk for?
preterm labor because uterus cannot accommodate the size of a full term pregnancy
126
how does duodenal atresia prsent on fetal US
-congenital anomaly causing complete bowel obstruction
-px: fluid filled stomach and duodenum (double bubble sign) with polyhydraminos
-common in Down syndrome and VACTERL association (vertebral, anal atresia, cardiac, tracheoesphageal atresia, renal, limb)
-presence of duodenal atresia requires eval for other fetal malformations (ventricular septal defects)
127
what are mature cystic teratomas (dermoid cyst)
benign germ cell tumors common in premenopausal women.
-heterogenous tumors (hair, teeth): complex ovarian cysts with calcified hyperechoic areas on US
-txt: surgical removal to reduce risk of ovarian torsion
128
in multifetal pregnancies (triplets), pregnancy reduction to lesser order gesteration (twin, singleton) decreases the risk for?
fetal growth restriction, intrauterine fetal deminse, and preterm delivery
129
pelvic inflammatory disease presentation
fever, diffuse lower ab pain, mucopurulent cervical discharge, cervical motion/uterine/adnexal tenderness, inflamed friable cervix (cervicitis)
indications for inpatient txt with IV antibiotics: high fever, inability to tolerate oral antibiotics, risk of nonadherence to outpatient treatment
130
intrahepatic cholestasis of pregnancy increase risk of?
-pruritis worse on hands and feet
-increased risk of fetal complications: intrauterine fetal demise, especially with markedly elevated total bile acids
131
ovarian failure levels of FSH and LH
ovarian failure may occur secondary to chemotherapy and present with amenorrhea and signs of estrogen def (vaginal dryness)
-increased FSH and LH due to lack of feedback inhibition from estrogen
132
uterine rupture presentation
severe ab pain, intraabdominal and/or vaginal bleeding, and abnormal fetal HR tracing (late decels)
ab exam may show palpable fetal parts (irregular protuberance)
133
acute appendicitis presenation
fever,n/v, RLQ pain.
dx is clx. atypical presenation can occur postpartum due to displacement of appendix by enlarged uterus
134
RF for shoulder dystocia
-inability to deliver fetal shoudlers with usual obstetric maneuvers
-warning signs: prolonged first or second stage of labor and retraciton of fetal head into perineum after it delivers (turtle sign)
-maternal obesity which predisposes to fetal macrosomia is a RF
135
amphetamine intoxication presentation
HTN, agitation, diaphoresis, dilated pupils, generalized tonic clonic seizure due to hyponatremia
-use in pregnancy increases risk for spontaenous abortion, preeclampsia, abruptio placentae, fetal growth restriction, preterm delivery, intrauterine fetal demise
136
fetal tachycardia is a/w?
maternal fever due to intraamniotic infection (chorioamnionitis)
137
hyperandrogenism in pregnancy is commonly due to?
benign bilateral ovarian masses such as luteomas and theca lutein cysts
pts with virilization during pregnancy and bilateral ovarian masses are observed and managed expectantly, as the symptoms and masses spontaneously regress after delivery
138
what is placenta accreta
abnormal attachment of placental villi to uterine myometrium
-px: difficulty detaching placenta after fetal delivery. attempts at manual placental extraction are unsuccessful and can cause profuse vaginal bleeding.
txt: emergency hysterectomy
139
a positive tuberculin skin or interferon gamma release assay should be followed with?
CXR to differientiate latent infection vs active disease
140
hyperprolactinemia in women of reproductive age
-irregular menses, infertility, galactorrhea
-MCC= prolactinma
-can be treated with dopamine agonists (cabergoline, bromocriptine) to decrease prolactin secretion and tumor size
141
Turner syndrome LH and FSH levels
-short stature and primary amenorrhea
-ovarian dysgenesis results in low E and T levels, high FSH and LH
142
absolute contraindications to pregnancy
pulmonary arterial HTN
peripartum cardiomyopathy with residual LV dysfunction
HF with LVEF <30%
severe coarctation, severe mitral stenosis, severe symptomatic aortic stenosis, severe aortic dilation (Marfan)
143
incisional hernias develop due to?
fascial closure breakdown and may have a delayed presentation (months-years)
-slowly enlarging ab mass (protruding ab contents) that is palpable while supine and enlarges with valsalva
144
what is face presentation?
type of fetal malpresenation resulting from inadequate neck flexion during labor.
face presentation with a persistent mentum posterior position cannot deliver vaginally and requires c section
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elevated prolactin levels leads to
inhibits release of GnRH, suppressing LH and FSH
-women who breastfeed experience anovulation and lactational amenorrhea
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adnexal mass in premenopausal woman
benign, related to ovulation, resolves spontaneously.
mange with observation and repeat exam
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stillbirth with umblical cord inflammation and necrosis surrounding umbiical vessels NBS
prompt testing for infectious casues of stillbirth such as syphilis serologies
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primary dysmenorrhea occurs due to
increased endometrial prostaglandin production during menses that causes uterine hypercontractility and ischemia.
-midline lower ab pain with nausea, diarrhea
first line: NSAIDs
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evaluation of atypical glandular cells on Pap
colpo, endocervical curettage, and endometrial biospy in women age >35
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congential CMV findings
bilateral periventricular intracranial calcifications, intrahepatic calcifications, fetal growth restriction
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Neonatal lupus can occur due to
passive placental transfer of maternal anti-SSA(Ro) and anti-SSB(La) antibodies
patient may develop fetal AV block, appears on tracing as persistent bradycardia
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Excessive oxytocin can cause?
severe hyponatremia, cerebral edema, generalized tonic clonic seizures because oxytocin has a similar structure to antidiuretic hormone
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when does ectopic require surgical management
medical contraindications to methotrexate (breastfeeding) or hemodynamically unstable
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ectopic pregnancy will have no what?
chorionic villi
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what is imperforate hymen and the txt
-defect in female genital outflow tract, resulting in hematocolpos
-can cause pain and difficulty defecating
-txt: hymenal incision and drainage
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first line txt optionfor migraines
acetaminophen
2nd and 3rd line: opioids (acetaminophen-codeine), antiemetics, NSAIDs (in 2T only)
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second stage arrest of labor
-insufficient fetal descent after pushing more than 3 hours in nulliparous patients without epidural (more than 2h in multiparous)
-manage: operative vaginal delivery (vacuum-assisted)
MCC of second stage arrest: fetal malposition (nonocciput anterior) contributes to cephalopelvic disproportion
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pregnant with prior cervical surgery (cold knife conization) are at increased risk for?
preterm delivery
-these patients require transvaginal US cervical length measurement at 16-24 weeks to guide potential preventative measures (vaginal progestrone)
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RF for pelvic organ prolapse
-descent of pelvic organs through vagina
-px: pelvic pressure, urinary retention, incontinenece, obstructed voiding
RF: muliparity, postmenopausal age, hysterectomy, obesity
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primary ovarian insufficiency
<40 with secondary amenorrhea and signs of ovarian failure (elevated FSH)
-occurs due to accelerated ovarian primordial follicle depletion resulting in estrogen def (vaginal atrophy, thin endometrium)
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why does hypotension occur in epidural anesthesia?
caused by blood redistribution to lower extremities from venous pooling from sympathetic blockade
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what is acute fatty liver of pregnancy
3T; microvesicular fatty infiltration of hepatocytes leading to liver inflammation (RUQ pain, eleveated aminotransferases) and fulminant liver faulure (profound hypoglycemia, thrombocytopenia
management: immediate delivery
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Quadruple marker test for Down syndrome
low maternal serum alpha fetoprotein
low unconjugated estroil
high b-hCG
high inhibin
confirmation is with amniocentesis
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medical therapy for ectopic
methotrexate, a folate antagonist that inhibits DNA synthesis in rapidly dividing cells (trophoblasts)
-ectopic can be diagnosed by persistent rise in b-hCG level following diagnosistic dilation and curettage
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advanced ovarian cancer may present in postmenopausal women with?
an immobile pelvic mass.
suspected ovarian ancer with no distant mets is managed with exploratory laporatomy, staging, and tumor debulking
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ovrian masses in postmenopausal are initially evaluated with?
pelvic US and then CA-125
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what is indicated if diet and exercise fails to control gestational diabetes?
insulin or oral antoglycemic meds
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what is shoulder dystocia?
-impaction of fetal anterior should behind materal pubic symphysis that results in inability to deliver shoulders with routine gentle traction
-initial mx: McRoberts manuever (flexion of pt's hips back against abdomen) and application of suprapubic pressure
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laboring patients at high risk of uterine rupture require what?
-laparotomy and c cestion
-labor and vaginal delivery are contraindicated after classical c section or extensive myomectomy due to significant risk of uterine rupture.
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why does preeclampsia with severe features increase the risk of fetal growth restriction (small for gestational age infant)
uteroplacental insufficiency
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what is vulvar lichen sclerosus? txt?
chronic inflammatory condition that can present with vulvar pruritis, white vulvar plaques, and loss of normal architecture (loss of labia minora)
confirm dx with vulvar punch biopsy and r.o vulvar cancer
txt: superpotent topical corticosteroids (clobetasol): decreases chronic inflammation, thereby improving symptoms and preventing disease progression
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leiomyomata uteri (particularly submucosal fibroids) can cause?
heavy prolonged menses.
symptomatic submucosal fibroids + desire fertility can be treated with hysteroscopic myomectomy: improves heavy bleeding and restores normal uterine anatomy, decreasing infertility and future pregnancy complications (recurrent pregnancy loss)
dx: pelvic US
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pubic symphysis diastasis px and txt
can occur after traumatic delivery
px: radiating suprapubic pain that is exacerbated by ambulation or weight bearing.
txt: conservative with supportive care
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heparin induced thrombocytopenia px
mild-moderate thrombocytopenia and paradoxical thrombosis (pulmonary embolus) withtin 5-10 days starting heparin
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what is uterine inversion
uterine fundus inverts and prolapses through cervix or vagina after delivery
-appears as firm, rounded mass protruding through
-severe ab pain, heavy vaginal bleeding, nonpalpable uterine fundus
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treatment of uterine inversion
discontinue uterotonics (oxytocin) and immediate manual replacement of uterus to prevent exsanguination.
-uterine relaxants and laparotomy may be required if initial attempts at manual reduction are unsuccessful
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magnesium sulfate toxicity signs and txt
signs of progressive neuromuscular inhibition (areflexia, respiratory depression)
txt: stop mag and start calcium gluconate to reverse neuromuscular paralysis and prevent cardiac arrest
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vaginal squamous cell carcinoma results from
persistent infection with HPV 16 and 18.
chronic tobacco use decrease the normal immune response which allows persistent HPV infection and squamous cell metaplastic changes
-vulvar irritation, intermittent bleeding, unifocal friable mass commonly located on labia majora
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menopausal symptoms in women less than 45 require what?
>45 with AUB and classic menopause symptoms (night sweats, insomnia, difficult concentrating) require no additional testing.
<45 with these symptoms, require FSH, TSH, and prolactin to exclude underlying endocrine disorder (hyperthyroidism)
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prepubertal girls with vaginal foreign bodies px
malodorous discharge and spotting.
mx: topical anestheic application and removal with swab or by vaginal irrigation with warmed fluid. exam under anesthesia may be required.
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hypothyroidism and menstrual and labs
menstual irregularities (irregular menses, infertility) are common in hypothyroidism.
Labs: elevated prolactin and low FSH and LH with low serum estradiol (low testoserone in men)
Reproductive function usually normalized with levothyroxine
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Risk of pregnancy in ulcerative colitis
Pregnanacy is a high risk period for ulcerative colitis; often worsening disease activity can lead to fetal complications- preterm delivery and small for GA.
Remission should ideally be achieved before conception. Most meds used to control UC are safe for continuation in preg
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bartholin duct cysts
soft mobile nontender masses at base of labia major at 4 and 8 oclock
-asymptomatic: observe and expectant management
-symptomatic: incision and drainage, followed by Word catheter placement
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patients with gestational diabetes mellitus are screened with?
-at increased risk for develping T2DM, screeded with 2 hour (75g) oral glucose tolerance test at 6-12 weeks postpartum
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hydronephrosis in pregnancy occurs due to?
ureteral compression from uterine enlargement and decreased ureteral peristalsis due to increased progesterone
US: bilateral renal enlargement (R > L) with dilated renal pelvises and proximal ureteres
physiologic hydronephrosis of pregnancy requires no additional mx
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asymmetric and symmetric fetal growth restriction is due to
2T and 3T placetal insufficeincy (HTN) that results in restricted abdominal growth that is more pronouced than restricted head growth.
symmetric FGR: due to congental disorders or 1T infections
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monochorionic monoamniotic twin pregnancy
single placenta and no intertwin membrane on US.
-risk of cord entanglement and fetal demise; pt require inpt monitoring
-delivery: 32-34 weeks via c section
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what is mullerian agenesis
causes primary amenorrhea due to failed development of uterus, cervix, upper third vagina.
urogenital structures develop from a common embryologic source, therefore renal malformations are common so patients require renal US
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later term (>41 weeks) and post term (>42 weeks) are increased risk for?
oligohydraminoas, a marker for placental insufficiency (as well as late decels) and indication for delivery
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postdural puncture headaches after neuaxial anesthesia (epidural) occur due to?
unintentional dural puncture.
-develop a positional headache (worsens when upright, improves when supine) within 72h of procesure and have n/v and neck stiffness
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postmenopausal bleeding require eval for endometrual cancer with either?
transvaginal US or endometrial biopsy.
TVUS: endometrium <4mm = no additional
endometrium >4mm= require biopsy
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genitourinary tract infection, particularly asymptomatic bacteria, is a RF for?
preterm prelabor ROM.
Universal urine culture screening, timely treatment, and reculturing for test of cure are recommended in pregnancy
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functional hypothalamic amenorrhea results from
suppression of HPO axis by strenuous exercise, calorie restriction, increased stress, chronic illness.
patients at risk for decreased bone mineral density due to estrogen def
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