OBGYN17 Flashcards
(98 cards)
1
Q
Urethral laceration symptom?
A
Present within 2 weeks of pelvic surgery Bloating nausea and vomiting Sign of peritonitis If unilateral normal Cr If after hysterectomy may have vaginal discharge
2
Q
elder abuse risk factor?
A
age >60
women
physical impairment
mental impairment
3
Q
CM?
A
unexplained body inlury Non-osteoporotic # sign of neglect(malnutrition) Perinial injury(laceration(friable,vulvar edema) Behavioral change(indirect agresion)
4
Q
Management?
A
report to adult protective service immediately
5
Q
Amnioinfusion?
A
indicated for oligo + variable deceleration
if the only oligo–not indicated B/C not affect the fetal outcome(pulmonary hypoplasia)
6
Q
Tocolysis in prom?
A
C/I
B/C contraction may be related to infection or abruption
7
Q
Risk of the prom?
A
Genital tract infection
polyhydramnios
Antepartum hemorrhage
Previous history
8
Q
C/I for ECV?
A
Raptured membrane
Decrease amniotic fluid
Prematurity
the patient has C/I for vaginal delivery
9
Q
Lambda sign?
A
Dichorionic with diamniotic with fused placenta
10
Q
Inverted T?
A
Monocorionic diaminiotic
11
Q
Monochorionic and monoamniotic twin management?
A
elective C/S at 32-33 week
high risk of cord entanglement and fetal death
12
Q
short Px interval?
A
Px in <6-18 month after delivery
13
Q
complication?
A
Maternal anemia
Low birth weight
PPROM
Preterm delivery
14
Q
pathophysiology?
A
mother does not replace folate/iron/another nutrient
persistent GT infection
15
Q
neonatal tyrotoxicosis cause?
A
a Transplacental move of anti-TSH antibody in GD mother(>5 % normal Ab)
16
Q
CM?
A
warm moist skin
Tachycardia
poor feeding, irritability, and poor wt gain
LBW and preterm delivery
17
Q
management?
A
resolve within 3 month
methimazole + b-blocker
18
Q
physiologic neonatal thyrotoxicosis?
A
A transient rise in TSH
That is the reason for newborn hypothyroidism screening
19
Q
Thyroid hormones /medication pass placenta?
A
No
20
Q
why septic TP have no localized sign?
A
Infection is in the retroperitoneum?
21
Q
an obstetric complication of Sickel cell disease?
A
spontaneous abortion abruption APH preeclampsia/eclampsia Growth retardation Oligohydramnios Preterm birth
22
Q
prenatal care?
A
baseline 24 hr protein PCV vaccination baseline chemistry serial urine culture aspirin folic acid follow growth
23
Q
pathophysiology?
A
uteroplacental insuficiency
24
Q
vulvar ca CM?
A
friable vulvar plaque
bleeding
irritation
25
Tool for post partum depresion?
Edinburg post natal depresion scale
26
Intraductal papilama?
bloody unilateral niple disharge
no mass/Lymphadinophaty
u/s==ductal dilation--but no mass
27
why is OCP C/I in migrain?
Increase risk of strock
28
white coat HTN eclude if?
Diastolic B/P >105
29
pregnancy related effect of Chronic HTN?
```
Superimposed preeclapsia
GDM
PPH
AP
C/S
IUGR
Oligohydraminos
preterm birth
perinatal mortality
```
30
risk factors for HG?
MG
HFM
previous Hx
31
clinical future?
Vomiting
>5% wt loss
DHN
Ortostatic HYN
32
Laboratory?
```
Ketonuria
Hypochlorimic MA
Hypokalemia
Hemoconsentrasion
Hypoglaycemia
```
33
tx?
admition
34
Pathophysiology?
Increase HCG and progestrone
35
Tenar stages?
I/II/III/IV/V
36
what we see?
sexual hair
breast(first apear in femals)
scrotum/penis(first apear in mals)
37
I?
pre pubertal
no hair
flay chest with raised nipple in F
38
II?
8-11.5
bubic hair in F & M
brest bud in F
scrotal enlargment in M
39
III?
coarsning of pubic hair(M & F)
penis size enlargment in M
Breast enlargment in F
40
Iv?
PH graow throgh pelvis with sparing tigh in M & F
penis and glance enlargment in M?
breast enlargment with areolar enlargment in F
41
V?
Age > 15
CPH also cover inner tigh
Breast enlarge to adult size and areola flat
Penis and scrotum enlarge to adult size?
42
menarcha normaly starts?
at tenar stage 4
| average 12.5 year
43
primary amenorhea defn?
no meses at 13 in pt without secondary sexual Cxs development
no meses at 15 in pt with secondary sexual Cxs development
44
primary investigation?
Pelvic U/S
TSH
FSH/LH
45
Diferenciation of adrenal tumour and ovarian cell tumour(SCLCT)?
Testostrone and DHEA level?
| Onset and progresss of Virilization
46
ovarian cell tumour(SCLCT)?
Normal DHEA
Elevated Testostrone
Clasic and rapid (within 1 year) virilization
47
adrenal tumour?
Normal Testostrone
Elevated DHEA
Clasic and rapid (within 1 year) virilization
48
DHEA secreted from?
Adrenal and ovaries
49
Testostrone secreated from?
ovaries
50
Ovarian mass aproch in post menoposal?
Do U/S and CA-125 first
51
If aone of them show abnormality?
CT/MRI--to check metastasis(procedure like laparascopy increase risk of metastasis)
52
If immaging show no sighn of metastasis or no?
helps for surgical exlporation?
53
What about FNAC and Laparoscopic biopsy?
C/I-Increase risk of metastasis
54
ulipristal?
progestrone receptor blocker
| delay ovulation and impair implantation
55
preeclampsia proteinuria parameter?
2r hr protin/300
cr/protin ratio.0.3
deepstick >=+1
56
sever preeclampsia HTN managment?
```
Hydralazine
IV labetalol (if no C/I)
Nifidipine PO(if no vomiting)
```
57
cause of hyperandrogenism in Px?
aromatase deficiency
lutoma
tecca lutial cyst
sartoli/lyding cell tumour
58
Differentiation?
aromatase deficiency--No ovarian mass
lutoma:solid uni/bilateral mass
tecca lutial cyst: Bilateral cystic ovarian mass
Sertoli/lyding cell tumor: solid uni/bilateral mass
59
management?
S/L tumor: surgery at second trimester
| other 3:observation--resolve after delivery
60
which one has high maternal and fetal virilization risk?
aromatase deficiency and SLT
61
Do Prostaglandin synthetase inhibitors benefit in polyhydramnios?
They stimulate fetal secretion of arginine vasopressin and facilitate vasopressin-induced renal antidiuretic responses, and reduced renal blood flow, thereby reducing fetal urine flow.
These agents also may impair production or enhance reabsorption of lung liquid
C/I after 32 week
62
aminioreduction in polyhydramnios?
if symptomatic and preterm
63
vaginal ca risk factor?
Age > 60
tobacco
HPV
intrauterine DES exposure
64
cause of PPH after c/s?
uterine artery ligation
retroperitoneal hematoma
peritonitis sighn
65
management?
immediate laparotomy
66
cause of cervicitis?
Chlaymidia and nisseria
| Tricomonas
67
how to differentiate?
Chlamydia and Neisseria--yellow/prulent discharge with cervix blled after trauma
Trichomonas--green discharge, punctuate hemorrhage on the cervix
68
how to differentiate AIS from 5 alpha-reductase deficiency?
In 5aRD: No breast and virilization at puberty
| In AIS: breast development;; No rapid virilization
69
s/e of large oxytocin?
hyponatremia--seizure
70
pathophysiology?
oxytocin mimic vasopressin/ADH
71
HPV vaccination?
To all wommen age 11-26/but may be given 9-45
72
non classic adrenal hyperplasia?
Late presentation
partial 21 hydroxylase deficiency
adult onset irregular menses,sever acne,hirtuism and virilization
clasic symptom like wasting,hypotension and electrolyte imbalance is absent.
high DHEAS
73
when we need to de endometrial biopsy when we found normal endometrial cell in pap test?
postmenoupose(age>45)
| premenoupose(if had AUB nad risk of endometrial hyperplasia/
74
copper and projestine containing IUCD?
```
Px
Acute pelvic infection
unexplained Vx bleeding
GTD
Distorted endometrizal cavity
Endometrial or cervical ca
```
75
How we follow high risk px?
BBP weekley after 32
76
future of tuboovarian absess in U/S and lab?
```
complex adenexal mass
lukocytosis,Elevated Crp and Ca 125
common in age <25
sighn of genital tract infection
polymicrobial ethiology
```
77
timeline of post-operative fever?
```
fever >38
0-6 hr--immediate
24 hr-1 week--Acute
1 week -1 month--Subacute
>1 month--Delayed
```
78
0-6 hr--immediate--cause?
```
Tissue trauma(resolve within 3 day)
Malignant HTN
Blood product(usually have hypotension)
```
79
24 hr-1 week--Acute?
Nosocomial infection
SSI
Non-infectious (MI.PE and DVT)
80
1 week -1 month--Subacute?
```
SSI
Catheter site infection
Closteridium difficele
Drug fever
DVT/PE
```
81
>1 month--Delayed?
VIral infection
| SSI
82
wound classification for surgery?
```
Clean(Cardiac,nurologic,orthopedic,vascular)
Clean contaminated(GI,GU, Gynecologic and obs, H & N and thoracic)
```
83
typical contamination?
Clean--Skin flora(Streeptoccocus and staph both CN &Cp)
| Clean cont.--Skin flora, G- bacilli,enterococci and viscus flora)
84
antibiotic prophylaxis?
clean:1st line cefazoline alt: vancomycin/clindamycin
| clean contaminated: based on surgical wound site: broad coverage mainly indicated
85
contaminated wound?
Inflamed/acute traumatic/with viscus spillage
86
Dirty?
Infected/necrotic or fecally contaminated
87
surgical indication for repair in chronic MVR?
Should be primary
EF 30-60 regardless of symptoms (repair/replacement)
Successful valve repair(not replacement) is likely inpatient symptomatic and LVEF <30 and asymptomatic LVEF >60.
88
secondary MR?
Medical management
| Valve surgery is rarely indicated
89
MC cause of GOO?
Pancreatic adenocarcinoma with gastric/duodenal invasion(may have unexplained hyperglycemia)
90
GOO secondary bezoars presentation?
Mainly patients with motility disorders like gastroparesis and surgery.
91
GOO secondary to gastric volvulus presentation?
Acute severe Abd.Pain, and hematemesis
92
patient with diverticular perforation presentation?
prolonged diverticulitis sx (vagu LAbd.Pain, Constipation and anorexia)
Acute fever and peritonitis
93
pain character?
at perforation: sudden Abd, pain(+/- vomiting and lightheadedness)
Within 2 Hr of perforation: relief of the abd. pain
> 2hr of perforation; Diffuse and constant pain due to peritonitis
94
Management?
laparotomy, Surgical washout, and resection of a ruptured bowel segment.
95
Parkinson's disease and aspiration pnumonia?
loss of dopaminergic neuron--dysfunction of striated muscles of oral area, pharynx, and esophagus--frequent aspiration.
96
Cathecolimine producing tumor?
Pheochromocytoma and ganglioma
97
CM?
Paroxysmal headache
Hytn
tachycardia
pallor
98
Paroxysm pricipitating factor?
a maneuver that increases intraabdominal pressure
Drug(anesthetics and beta-blocker)
surgical procedure
