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my world > obstetrics and gyncology 1 > Flashcards

obstetrics and gyncology 1 Flashcards

1
Q

Raloxifene also whats its effect on ldl and lipoproteins ratio ***although it neither increases nor decreases the risk of coronary heart diseas

A

decreases total and low-density lipoprotein cholesterol levels,

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2
Q

considered as contraindication for raloxifen

A

Contraindications include a history of venous thromboembolism.

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3
Q

early 1-hour glucose challenge test may be indicated ———
and not in pts with normal Hx

A

in patients with diabetes risk factors (eg, obesity, prior gestational diabetes mellitus)

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4
Q

rapid plasma reagin. its the test for ——-
and its usually done at — prenatal visit

A

syphillis
1st

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5
Q

multiple limb fractures, and a hypoplastic thoracic cavity ur Dx
and its considered a major risk factor for both

A

type II osteogenesis imperfecta (OI)
1-intrauterine fetal demise

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6
Q

neuroleptic malignant syndrome has a similar presentation to MH (eg, fever, muscle rigidity), it is triggered by name drugs ——
and if its caused by anesthetics its called

A

neuroleptic agents (eg, haloperidol, promethazine) rather than anesthetic

malignant hyperthermia

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7
Q

Thin, white, wrinkled skin over the labia majora/minora; atrophic
changes
ur Dx??
ur next step of managment
ur Tx

A

Punch biopsy of adult-onset lesions to exclude malignancy
Superpotent corticosteroid ointment

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8
Q

contraindication to an intrauterine device (IUD)

A

divergent endometrial cavity and indented fundus)
in this case we use
depot medroxyprogesterone acetate

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9
Q

progestin-only contraceptive pills are commonly used which type of pts

A

in women who are breastfeeding

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10
Q

Primary ovarian insufficiency (POI), a form of hypergonadotropic hypogonadism, is the cessation of ovarian function at age <40
labs???
its the same for premature ovarian failure

A

characterized by elevated gonadotropin-releasing hormone and FSH levels and a low estrogen level.

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11
Q

Because a third of patients do not completely eradicate the bacteriuria with initial treatment in asymptomatic bactirurea in pregnant women

A

repeat urine culture (ie, test of cure) is required.

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12
Q

what also u suspect

A

Ventricular septal defect

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13
Q

Management of migraines in pregnancy is complicated due to limited therapeutic options.

In patients who do not improve with acetaminophen alone, a low-potency opioid (eg, acetaminophen-codeine), antiemetics (eg, promethazine), or

A

Acetaminophen is the preferred first-line option;
\
if 2nd line of Tx fails More potent opioids (eg, oxycodone) are typically not used due to their tendency to worsen gastrointestinal symptomsMore potent opioids (eg, oxycodone) are typically not used due to their tendency to worsen gastrointestinal symptoms

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14
Q

Tamoxifen effect on blood lipid level
most common adverse effect is

A

Hot flashes

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15
Q

estrogen-containing contraception is contraindicated in what type of pts?? so we use ———-

A

in patients with migraine with aura due to the increased risk of stroke

progestin-releasing subdermal implant
in controling heavy bleeding

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16
Q

Active phase arrest is managed by

and its criteria is?

A

cesarean delivery.
defined as no cervical change for ≥4 hours with adequate contractions or ≥6 hours with inadequate contractions.

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17
Q

Patients with lactational mastitis who do not improve with antibiotic therapy next step??

A

require breast ultrasound to evaluate for breast abscess

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18
Q

Asymmetric fetal growth restriction causes ———–

A

second- and third-trimester placental insufficiency (eg, hypertension) that results in restricted abdominal growth that is more pronounced than the restricted head growth.

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19
Q

Symmetric FGR is due to

A

congenital disorders or first-trimester infections.

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20
Q

spontanuous rupture of membranes could occur as fluid gush butttt on uworld it can presented as intermittent clear vaginal discharge over afew days

A

read again

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21
Q

oligohydramnios classification
1-early gestaional causes
2-2nd and 3rdtrimester causes

A

fetal etiologies (eg, aneuploidy, renal agenesis, posterior urethral valves)
2)spontaneous rupture of membranes.,,or Maternal vascular disease (eg, chronic hypertension, systemic lupus erythematosus) increases the risk for **uteroplacental insufficiency

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22
Q

Chlamydial infection diagnosed by nucleic acid amplification testing (NAAT) is treated with prevent long-term reproductive complications (eg, pelvic inflammatory disease, infertility). Concurrent treatment for gonorrhea with ceftriaxone is indicated if the gonorrhea NAAT result is positive with purlent cervitis .

A

doxycycline alone if negative naat

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23
Q

postpartum period CHANGES

A

1-Increased oxytocin levels (endogenous and administered) cause uterine contraction
2-Decreased estrogen and progesterone levels may cause postpartum chills and shivering
3-Decreased estrogen and progesterone levels may cause postpartum chills and shivering

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24
Q

URINE INCONTINANCE diffirintiate between detrusoser overactivity and urethral hypermobility

A

Detrusor overactivity causes inappropriate bladder spasms associated with urgency incontinence;

obesity, or chronic high-impact exercise such as jogging (as in this patient)—women can develop pelvic floor muscle weakness
Substantial weakness of the pelvic floor muscles can result in urethral hypermobility, in which the urethra abnormally moves with increased intraabdominal pressure

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25
Q

It causes virilization of female fetuses, resulting in normal internal genitalia with ambiguous external genitalia.
labs :high fsh lh and testorne,androstenodione

A

aromatase difficiency

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26
Q

scant blood and discharge; a bulging bag with fetal parts is protruding through the cervix which is dilated a 4cm , ur DX

A

Cervical insufficiency
examination, bulging amniotic membranes can be seen

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27
Q

hypotension, tachycardia, and a diffuse, red, macular rash involving the palms and soles.
ur Dx
if pts presented with heavy vaginal bleeding and has trip for asia for about 3 mths

A

toxic shock syndrome exotoxin relase

duo to prolonged tampon use

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28
Q

discontinuation of hydroxychloroquine in sle pt can lead to ———-
which will be presented as

A

Hypertension during pregnancy in a patient with edema, joint pain, a malar rash, and urinalysis with proteinuria and red blood cell casts is most likely due to a systemic lupus erythematosus flare

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29
Q

Uncomfortable urge to move legs with:

Unpleasant sensations in the legs
Onset with inactivity or at night
Relief with movement (eg, walking, stretching)
ur DX

risk factors??

A

Restless legs syndrome
Iron deficiency
Uremia
Pregnancy
Diabetes mellitus (especially with neuropathy)
Multiple sclerosis, Parkinson disease
Drugs: antidepressants, antipsychotics, antiemetics

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30
Q

systemic lupus erythematosus flare can be complicated by

A
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30
Q

restless leg syndrome Tx

A

Supplemental iron (if serum ferritin <75 ng/mL)
Mild intermittent symptoms: carbidopa-levodopa as needed
Frequent/daily symptoms: α2δ calcium channel ligand (eg, gabapentin, pregabalin)
Dopamine agonists (eg, pramipexole, ropinirole) not preferred

31
Q

Uterine atony Mx

A

1-bimanual massage and oxytocin indusion
2-if bleeding administration of tranxemic acid
3-if bleeding persist use 2nd line uterotonics such as carboprost tromethamine

32
Q

endometriosis, define :
give Sx

A

or ectopic endometrial implants within the abdominopelvic cavity

{
worsening pain with exercise or intercourse (ie, dyspareunia), as well as adhesion formation that can cause tubal infertility}

33
Q

Implants on the ovary can cause endometriomas, called chocolate cysts describe it
arise any where
\note:Pedunculated leiomyomas (ie, fibroids) can cause pelvic pressure due to mass effect; however, they arise from the uterus, not the ovaries.

A

brown fluid from accumulated old blood. Endometriomas typically appear as a unilocular adnexal mass with homogeneous, low level echoes (ie, blood)

34
Q
A
35
Q

Attorney is never above no harm
Menopausal women with Hx of dvt do u prescribe estrogen progesterone pills and she agreed for taking the risks

A

Hell no
You offer alternate therapies

36
Q

Luteomas of pregnancy, pts presentation
And ur Mx

A

often appear as solid, bilateral ovarian masses on ultrasound. Elevated β-hCG levels stimulate the luteoma (composed of large lutein cells) to release androgens, which may cause maternal virilization

Other benign pregnancy tumors :theca lutin cyst /serroli lyding tumor

Observation and expectant management

37
Q

If pregnant pts came with sign of verillization with high testosterone levels only in pregame period think of

A

Fetus aromatase deficiency

38
Q

Diminished tendon reflexes after preeclampsia episode reflect ——-
Ur Mx

A

Magnesium sulfate toxicity
Calcium glucunate

39
Q

Estrogen-containing contraceptives are avoided in patients at increased risk of thromboembolism due to——-
So u give ———

A

estrogen-induced hypercoagulability

progestin-releasing IUD is one of the most effective methods of pregnancy prevention, with an efficacy of >99% and duration of use up to 7 years
Coppper IUD MAY help r worsens the pts Sx

40
Q

Ovarian reserve define it
And based on pts hx of

A

characterized by regular menstrual cycles and decreased oocyte number and quality

Inability to conceive after 6 months of unprotected intercourse in women age ≥35 is considered infertility

41
Q

Sinusoidal fetal heart rhythm is characteristic of ———
Ur Mx

A

Fatal fetal blood loss and anemia duo to vasa previa r

Emergent Caesarian

42
Q

bites present as small, pruritic, erythematous papules, often arranged in a linear pattern on exposed areas and each with a central hemorrhagic punctum ——

A

Bed bugs
Supportive but definite treatment requires eradication of the bugs.

43
Q

In cystic fibrosis pts which type of bacteria depends on age

A

Child :staphylococcus aureus
Adult: pseudomonas aurgenosa

44
Q

Pneumatosis intestinalis refers to air in the bowel wall and is the hallmark x-ray finding in——

A

Necrotizing enterocolitis
Presented as : wall. Intestinal inflammation and necrosis cause feeding intolerance (eg, gastric residuals, bilious emesis), a tender and distended abdomen, and gastrointestinal (GI) bleeding (eg, hematochezia, hematemesis)

45
Q

asymptomatic abdominal mass with painless hematourea think of ——
Next thing u should do —-

A

Wilms tumor is the most common renal malignancy in children
Contrast Ct to determine the extent of the mass and subsequent chest Ct to determine if there’s any mets

46
Q

Elevated alpha feta protein indicates ——
And ur next step is /——-

A

Neural tube defect
Fetal ultrasound
Repeating the test will not help
Ca125 is indicative for ovarian cancer but it’s never informative in young pts unless had ovarian tumor removal for following

47
Q

Pregnant woman with Hx of hiv has her alt ast elevated but their initial prenatal test were negative for hep c ur next step ———

A

Viral hepatitis should be considered in pregnant patients with a hepatocellular pattern of liver injury (eg, elevated aminotransferases), even in those with negative screening tests at initial prenatal visits.
(Summary : just repeat the test because it will come at any time and usually the pts. Are a sympatomtic)

48
Q

Protraction means ——-and caused by ——

Usually seen in late term pregnancies

Additional risk factors include maternal obesity, excessive weight gain, nulliparity, advanced maternal age, and inadequate contractions.

A

is commonly caused by cephalopelvic disproportion, in which the fetal head is too large to fit through the maternal pelvis.

49
Q

Define Uterine procidentia
And ur Mx if the pt in Nyha 3

A

is a form of pelvic organ prolapse in which the entire uterus herniates through the vagina along with the anterior and posterior vaginal walls.

Pessary placement is appropriate in poor surgical

50
Q

Hydroid fetalis remember 2 causes
And how you differentiate between them

A

Parvovirus b19 causing viral cytotoxicity to fetal erythrocytes precursors .

Rh alloimmunization

51
Q

The clinical consequences include inability to lactate, amenorrhea, and hypotension. This patient’s normal blood pressure and ability to breastfeed suggest normal pituitary function.

A

In Sheehan syndrome amenorrhea -lactation issues

If the pts is lactating but have amenorrhea think that there is a lot of prolactin That causes an inhibition of the hypothalamic pituitary axis .

52
Q

Intramuscular betamethasone, a corticosteroid, is indicated for patients at risk for preterm delivery at <34 weeks gestation
Butttttt magnisuium sulfate ———-regarding pre term babies

A

Duo to magnesium toxicity, it is not typically administered for fetal neuroprotection after 32 weeks gestation.

53
Q

Pts with severe hypotension and lethargy post part hemorrhage having tonic clonic seizure

Magnesium sulfate toxicity dnt cause seaziure and acute blood loss anemia also dnt cause seaziure
Wild wild wild card

A

oxytocin has a similar structure to antidiuretic hormone, prolonged or excessive oxytocin administration can cause severe hyponatremia, cerebral edema, and generalized tonic-clonic seizures.

54
Q

Ultrasound dating with fetal crown-rump measurement should be noted at ——-trimester

A

in the first trimester is the most accurate way to determine estimated gestational age (EGA). EGA should not be changed based on measurement discrepancies on a second- or third-trimester ultrasound.

55
Q

Considered contraindication to a vaginal delivery due to the increased risk of uterine rupture

A

prior classical cesarean delivery (vertical uterine incision)/previous myomectomy
Why ever the pts says

56
Q

Pregnant women with headache blurry Vision headache and throbbing with normal Bp and normal tracing protein and urine analysis
Acetaminophen provide mild improvement

Although pregnancy is t risk factor for the Dx

A

Idiopathic intracranial hypertension is most common in obese women of childbearing age and can present with positional headaches, pulsatile tinnitus, and papilledema. Diagnosis is with MRI of the brain followed by lumbar puncture.

57
Q

Indication for prophylactic group b streptococci intrapartim prophalxis
Rupture of membrane s more than —-hr
Pre term ««—weeks

A

1-GBS bacteriuria or GBS urinary tract infection in current pregnancy (regardless of treatment)
2-GBS-positive rectovaginal culture in current pregnancy
Unknown GBS status PLUS any of the following:
<37 weeks gestation
Intrapartum fever
Rupture of membranes for ≥18 hours
**Prior infant with early-onset neonatal GBS infection***

58
Q

Does pt mother o negative with ab husband have a child with risk of hemolytic disease (abo type )

A

Yes cause she has anti A ANTI B IG G type which can cross placenta
Buttttt

ABO incompatibility typically occurs between a mother with blood group O and an infant with blood group A or B, which can cause mild hemolytic disease of the newborn. Affected infants are usually asymptomatic at birth or have mild anemia, and may develop neonatal jaundice that typically responds to phototherapy

59
Q

Look at the watch give this card 3 min of reading

postpartum urinary retention, defined as an inability to void ≥6 hours after vaginal delivery
2 Causes Ur Mx
If urethral injury drippling and dysurea with Hx if foreign body
If vesicovaginal fistula usually take multiple days to decouple with Hx of obstetrics complications and perineal injury

A

Self-limited condition
Intermittent catheterization
Caused mostly duo to
1) Perineal trauma from a prolonged second stage of labor and/or perineal laceration that results in a pudendal nerve injury. Damage to the pudendal nerve can result in a decreased voiding sensation, thereby promoting urinary retention, and cause external urethral sphincter dysfunction.
2) Reduced sensory and motor sacral spinal cord impulses from regional neuraxial anesthesia (eg, epidural anesthesia), which can suppress the micturition reflex and decrease detrusor tone, resulting in bladder atony.

(Intermittent catherization usually self resolving )

60
Q

persistent urine dribbling, incomplete bladder emptying).with anteverted, and anteflexed uterus with multiple irregular protrusions. T

A

Causes of of overflow incontinence are detrusor underactivity (often secondary to peripheral neuropathy [eg, diabetes mellitus]) and bladder outlet obstruction (caused by fibroids ) which compress the uterus and cause these Sx

61
Q

Complete jogging spare the fkin gymnastics

A

All healthy women with uncomplicated pregnancies are encouraged to perform moderate-intensity exercise for 20-30 minutes on most or all days of the week. Contact sports and activities with high fall risk should be avoided

62
Q

Ovarian cancer when u do it

A

1)check family Hx
(Male / Jewish/mutiple /+brca/bilateral r breast cancer <age of 50/>3 family member with lynch )

the high risk of ovarian cancer in women who test positive for BRCA1 or BRCA2, a pelvic ultrasound and a CA-125 level are recommended every 6 months

63
Q

nausea/vomiting; new-onset, severe unilateral pelvic pain; and adnexal with Hx OF adenomyosis tenderness+ur Dx and ur Mx

A

since its acute in nature and unliateral think of ovarian tortion in cases of adenomyois its acentral tenderness

Mx would be adiagnostic laprascopy

64
Q

Unexplained, abnormal vaginal bleeding is a contraindication to intrauterine device insertion

A

so its need further evaluation

65
Q

Hx of sexual relationship with ruq pain and liver tenderness u suspect with

A

Pelvic inflammatory disease (PID) can spread to the intraperitoneal cavity and cause perihepatitis (ie, Fitz-Hugh–Curtis syndrome).

66
Q

second-stage arrest criteria (ie, no further fetal descent), which are:

name it in both primi and multi
ur Mx is

A

≥3 hours of pushing in a primigravida without an epidural; some providers allow additional time with an epidural (ie, ≥4 hours pushing with an epidural, as in this patient)
≥2 hours of pushing in a multigravida without an epidural (≥3 hours pushing with an epidural

vacuum-assisted). delivry

67
Q

tubo ovarian abcess can be presented as ovarian mass and signs of tenderness but is usually take acourse over days as a complication of appendeciits

A

dnt confuse with ovarian torsion
acute unilaterla ovarian mass

68
Q

initial evaluation of mixed incontinence ————

urodynamic study when to use it with pts ——————

A

includes a voiding diary, which tracks fluid intake, urine output, and leaking episodes in order to classify the predominant type of urinary incontinence and determine optimal treatment.

pts with complicated urinary incontinence (ie, those who do not respond to treatment) or who are considering surgical intervention.

69
Q

urodynamic study include

A

measurement of bladder filling and emptying (ie, cystometry), urine flow, and pressure (eg, urethral, leak point)

70
Q

Uteroplacental insufficiency may present with decreased fetal movement and oligohydramnios (ie, amniotic fluid index ≤5 cm) due to decreased fetal perfusion.
uworld risk factor

A

maternal scd with occlusive crisis

71
Q

variable fetal decelerations Mx

A

Amnioinfusion caused by cord compression (eg, oligohydramnios) in labor.

72
Q
A
73
Q

late decelerations (ie, late decelerations in ≥50% of contractions).
causes
Mx

A

Late fetal decelerations are a sign of uteroplacental insufficiency and impending fetal hypoxemia and acidemia
most commonly cause due to uterine tachysystole, defined as >5 contractions/10 min. Uterine contractions temporarily interrupt intervillous blood flow;

tocolyisis see drugs

74
Q
A

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