True Learn Wrongs Flashcards
1
Q
increased risk for PPH
A
PreE w sF (cause for atony)
2
Q
most common complex adnexal mass found during prgnancy
A
mature teratoma/dermoids
3
Q
soft markers downs
A
NT (first tri only) cystic hygroma (first tri only)
Nuchal fold (second tri only) echogenic bowel echogenic focus mild ventriculomeglay chorioid plexus shortened femur
4
Q
amount folic acid needed
A
4 mg if prior problem (4000ug)
4mcg if no prior prob (400ug)
5
Q
APLS dx and treatment
A
one:
- vascular thrombosis
- preg morbility (death fetus >10w, premature delivery due to pre e shit, three unexplained losses
one:
- lupus anticoag 12w apart x2
- anticardiolipin antibody IgG or IgM 12w aparment x2
- anti-b2-glycoprotein IgG or IgM 12w apartmet x2
unfractionated heparin
6
Q
tiem to wait for intercourse
A
unknown
7
Q
most liekly outcome acute parvo virus infection
A
normal pregnancy
(most commonly pregoblematic if infected >20w
8
Q
MLO of physical abuse in pregn
A
preterm labor
9
Q
adequate contraction stress test
A
3 contractions, 40 seconds each, in a 10m period
10
Q
echogenic bowel on US
A
- subchroinic collection can cause echogenic bowel because fetal injection of blood
- can’t be eval in first tri and is normal in third tri 9only matters in second tri)
- 80-90% have normal outcomes
11
Q
US and LMP rules
A
<9w: >5 d off 9-15.6: >7d off 16-21.6: >10d 22-27.6: >14d 28w: >21d
12
Q
perimortum
A
do it after 4 failed miutes of resusictation with hopes of delivery at 5 minutes
13
Q
HIE dx:
A
- apgar <5 at 5 and 10
- fetul umbilical acidemia
- multisystem organ failure
- spastic quadripleegia and dyskinectic cerebral palsy
(seizures are not par tof this most commonly)
14
Q
glyburide
A
reasonspible for more hypoglycemia in infants compared to insulin
15
Q
leukorrhea in pregnancy due to which hormones
A
estrogen
16
Q
FHT which mostly predictis acid/base status
A
- accelerations
17
Q
scheudle CS for HIV+ high viral load
A
38w
18
Q
MLO of fiboirds in pregnancy
A
pain due ot degradation
NOT assocaited with PPROM
19
Q
reason to die from UAE
A
sepicemia
20
Q
BPP negative and postitive predeictve values
A
high negative predictibe
low positive predictibe
this is true of all antepartum tests
21
Q
NST false positive rate
A
55-90%
22
Q
screen is anti-kell antibody positive
yo ushoudl do what
A
- check paternal antigen status
- causes severe hemolytic disease of fetus and newborn
- if dad antigen negative then no work up is necessary
23
Q
rate of shoudler dystocias in vaginal deliveries
A
3%
24
Q
ACE I side effects pregnancy
A
oligo and calvarium maldevleopement
25
danzol preg effects
virilization
26
US finding congenital rubella syndrome
- cafdiac anomlaies
- CNS defects
- heptosplenomegaly
- microcephaly
27
twinning is high and low in hwat countires
high : nigeria, united states > englahd, india, japan
28
obese weight gqin recs in preg
11-20 lbs
29
acute fatty liver in pregnancy - dx criteria that i cannot care aout rih now .
.
30
pp thyroiditis
- transient distruction of thyroid tissue
- autoimmune
- treatment includes beta blocker becuase it's transient (and other meds wont help because its autoimmune and breaking down shit)
31
PTU SE
heptotoxicity
32
methimazone SE
aplasia cutis
33
cryopercipitate includes what factos
- factor 8, 13
- vWF
- fibrinogen
34
fetal heart arryhtmia with worst outcome
- atrial flutter
- difficult to treat
- often requries lots of meds to prevent fetal hydrops
35
which screen is not reliable in pregnancy
proetin S
| shitty screen
36
ITP, you give IVIG, when shoudl the patlets start to go up?
1-3 d
| peak response 2-7d
37
% of fetuses with increased NT will have aneupoloidly
50%
38
% twin gestations that go into PTB
60% before 37w
| 10% before 32w
39
MCC CS in US
failure to progress
40
steriliztion benefits
- reduce PID
| - reduce ovarian cancer rates
41
normal fetal acid-base status at delivery
- pH 7.28
- PCO2= 498 (+- 8)
- PO2 18 (+- 6)
- HCO2 22 (+- 3)
42
asympotmatic BV in pregnancy
- no treatment rec
- is associated with low birth weight, PPROM, PTB
- treating asymptomatic women doesn't help though
- treat asumptomatic if hx prior PTB
43
most sensitive test for chorio on amnio
- IL-6
| - gold standard is fluid culture
44
% of neonates born 23w who will be normal afterwards
- 13%
45
endometritis
- how long abx after afebrile
- what abx:
run abx for 24h post fever
| gent/clinda
46
methimzale
- SE
- MOA
SE: aplasia cutis (absence of skin, usually on top of head, possibly with no bone underneath)
47
risk of post term delivery
oligo, increase lacerations, operative deliveries, increased CS, increased PPH, inscreased infection
fetaL: convulsions, meconium aspiration, NICU admission, macrosomnia, low agars, post maturity syndrome (essentially malnourishment due to shitty placenta)
48
measurement used to diagnose FGR
- EFW
| - or AC alone
49
MC cancer in pregnancy
| second most common in preg
breast (common and diagnosed)
second: thyroid cancer
50
Vit D deficiency risks
- darker skin
- not outdoors
- malnutrition issues
- vegetarians
51
stress dose steroids during delivery indciations
- not indicated fr 7 day taper
- DONT need it if:
- - taken any dose fr less than 3w
- - <5mg morning dose for any amount of time
- - <10mg every other day for any amount of time
52
neonatal alloimmune thrombocytopenia
- due to differences between maternal and paternal antigens
- first pregnancy at risk (different then Rh)
- MCC neonatal thrombocytopenia
53
MC congenital infection worldwide
CMV
- women can be asymptomatic
- fetus usually severely affected with IQ, hearing loss, visual impairment, cerebral calcifications, intraparaenchymal cysts, cerebellar abnormalities, microcephaly, bentriculomegaly, hepatospemomegaly, dydrops, FGR
54
MC thrmobophilia
| Worse thrombophilis
Factor 5 Lieden
| Antithrombyn 3 deficiency
55
tranfuse in PPH for
- 1500 blood loss with continued bleeding
- hemodynamic instability
- DIC needs more than just blood transfusion
56
MCC non-immune fetal hydrops
- cardiac issues (it's CHF)
| - also this is the MCC overall (immune isn't that common)
57
BPP 6/10
- more monitoring and repeat testing tomorrow for <37w
58
BV diagnosis
- pH > gREATER than 4.5
- grey discharge
- >20% clue cells
59
later term
| post term
- 41
| - 42
60
2h pp glucose test amount
75
61
LMWH vs Unfractionated heparin during delivery (w/wo epidural)
LMWH
- better tolerated dosing, less likely HIT, less bleeding problems, preferred
Unfractionated hep:
- shorter half life, can reverse, can monitor with PTT
REcs same for LMWH and Unfractionated heparin
- ppx: hold 12h prior to anticipated del
- thera: hold 24h prior to anticipated del
- pp: 4-6h after sVD
- pp: 6-12h after CS
Only different with epidural sp del
- Unfractionated:
- ----ppx: restart 1h after placement or removal of catheter
- ----thera: 1h after placement or removal of catheter
- LMWH:
- ---ppx 12 after placement or 4 hours after removal
- ---thera: 24h after placement or 4 hours after removal
62
the earlier you get PreE, what is the risk of next preg
```
higher.
26w = 50%
27-30: 40%
31-36: 30%
term: 20%
```
63
risk accrete with previa
- primary CS: 3% > 11 > 40 > 61> 67 > 67
64
MCC genetic first trim abortion
- trisomy
- most specific kind is not tri, it's XO
- most common trisomy is 16 however (but not more than XO when taken alone)
65
accertino def
10 increase over 10 sec
| 15 increase over 15 sec
66
post menopausal asymptomatic increased lining
no biopsy ever
67
goals BG after meals
fasting: <95
1h pp: <140
2h pp: <120
68
early onset infant group B infection s/sx
| late onset infant group B infection s/sx
early:
<7d after birth
vertical transmission
sepsis, pneumonia, meningitis
late:
>7d - 3m after birth
horizontal transmission
bacteremia, meningitis, organ/soft tissue infection
(not caused by maternal status and ppx maternal does not prevent it)
69
erythema infectiosum is also called....
parvo virus
70
NTD prevalence
5 in 10,000 all deliveries
71
what % of women with preG diabetes also have cHTN
5-10%
72
estimated fetal weight for singleton breech del
2500
73
weed poor neonatal outcome
FGR mosty (less like is still birth, IQ deficients, behavioral changes)
74
uncontrolled hyperthyroidism increase your risk for ___
PreE
75
how long does it take for the uterus to get back to normal size after SVD
4w
76
twins with short cervix
no management required. no studies support giving anything
77
risk vertical transmission HIV >1000 not on treatment with SVD
25%
78
amount of Rh positive fetal blood needed to cause alloimmnization in Rh neg mother
0.1mL
79
negative CST means
no decels
80
treatment during pregnancy for latent TB (neg chest)
- begin after first trimester
- continue for 9 months
- treat with isoniazid for 9 months if reason to suspect will progress (immunosuppression, recent exposure <2 years ago, HIV infection)
81
cephalic presenting means
vertex
82
iron def anemia in pregnancy
- physiologic blood cell mass and volume expansion
83
macrosomnia is defined by
4000-4500
84
days opioid use after CS recommend
4d
85
hetero factor 5 lieden managment
survillence without intervention
86
after CNS infection with herpes, infants will have XX percent change long erm seuqele
- 20%
87
first tri screen
- NT
| - PaPPA, free/total bhcg
88
sequential forceps/vaccum are problematic. because
- neonatal outcomes are poor
89
modi screenign for TTTS by US should be how frequently?
q14d
90
vasectomy truths
- wrose than nexplanon
- better, less expensive, safer than abodminal sterilizatoin of women
- 98% azospermia at 6m
91
herpes infection suppression doses
- acyclovir
- valacyclovir
acyclovir: 400 TID @36w
valacylovir: 500 BID @36w
92
eclampsi aMRI findings
parietal and occipital lobe edema
93
waht kind of fish are you not supposed to eat
king mackeral, marlin, tuna, bigeye, tilefish, orange roughe, swordfish
94
tranfusion associated citrate toxicity
calcium CHLORIDE (not carbonate)
95
rate of uteirne rupture one prior CS, vs 2 prior CS, vs classical
- 0.5%
- 1-2%
- 10%
96
greatest risk postterm dates
nulliparity
97
bishop score makes IOL same as spontaneous labor
8
98
recommended iodine intake for
- reproductive aged women
- pregnant women
- breast feedig woman
- 150
- 220 mcg
- 290 mcg
99
amniotic fluid embolisms
- avoid large scale volume resussitaiton
100
gas emobolism
left decubitus position
101
most accurate test for venous thrombus in pregnancy
- promthrombin G20210A mutation
102
PTL caused by vaginal infections
1. BV before 16w
2. gonorrhea
3. asymptomatic bacteriuria
4. clamydia
5. trich
6. urea plams
103
listeria monocytogenes findings
| treatment
- foul smelling abscess placenta
- hispanic women at higher risk
- head ache, fatigue, myalgias, backache, gastrointestinal symptoms. (most common in third tri)
- spread hematogenously
- abcess of the fetus
treatment is nothing if asymptomatic
- expectedly manage if mildly sx but no fever
- febrile: blood cultures, high dose IV amp/gent (allergic penicillin: sulfamethoaxazole)
104
epidural placement location
L4-5
105
AFP sensitivty NTD
75%
106
nausea treatment in preg
B6 vitamen
107
partuition
Phase 1: quiescense of uterus
Phase 2: uterine preparedness of labor, cervical ripening
Phase 3: stimulation of uterus, cervical dilation, fetal and placental expulsion
Phase 4: uterine involution, cervical repair, breast feeding
108
prenatal testing and downs
109
hydral protocol
- 5/10, 10, 10 administration
110
varicella active in pregnancy, treatment
- oral acyclovir start 24h oral
- IV acyclovir if pneumonia
- VZIG given to neonates
111
Risk of still birth for FGR
- 1.5%
112
prolonged latent phase nullip vs multiparous
- 20 nullip, 14h multiparous
113
delivery rec for placenta previa
36-37.6w
114
toxo infection in first trimester work up
- check serologic toxoplasmosis IgG and IgM
115
vacuum cannot be placed belwo what GA
34 (but forceps can)
116
HIV course in pregnancy
- no change, no increase in viral load expected for associated diseases
117
heterozygous factor 5 lieden with personal hx of VTE (wht is chance of vTE in pregnancy)
10%
118
who needs to be screen for thyroid disease in preg
- people with personal hx of thyroid disease
- family hx of thryoid diesease
- type 1 diabetes pts
- clincal suspicion for thyroid dieaes (not include mild enlargement, but does include nodules etc)
119
things that are high while delivering (liek werid proteins called contraction - associated - proteins)
- oxytocin receptos
- calium receptos
- connexin 43
- PGF2 a receptors
120
possible effects of oxytocin bolus
- maternal hypotension (relaxation of smooth muscle)
- would then cause tachycardia
- hyponatremia can occur after long administrations of oxytocin
- can alos cause arrhythmias
- water intoxication
- analypyalsix
121
risk of verticel transmissino HSV primary outbreak at time of delivery
40-80%
122
personal hx of VTE raises risk for VTE in pregnancy by how much
3.5 times (3-4 fold)
123
CST satisfactory parameteres
| negative, positive, equioval, unsat
- 3 ctx in 10 minutes at least
- each contrctions is 40 second long at least
- neg: no late or sig variables
- positive (bad): late after 50% even if ctx less than 3/10 m
- equivocal: intermittent late or sig variable decels
- unsat: fewer than 3 ctx in 10 minutes or uniterpretable strip
124
treatment ITP in pregnancy first line
| definition
prednisone
- <150 x109
- treatment rec if <30, or if >30 and symptomatic
- if preg not helpful, then IVIG if plts <100,000
125
definition latent labor
maternal perception of regular contractions
126
NT that needs wu
- 3mm
127
TXA and PPH
helpful if within 3h of pph and if other meds fail
128
siezure meds are associated with what fetal anomaly
- NTD increased
- therefore need AFP measurements
- folic acid supplementation isn't actually hepful
129
diagnose PE in pregnancy
- CT (angio)
130
outlet forceps
- fetal skull that has reached the pelvic floor, fetal sclap that is visible at teh introitus without spreading the labia
131
low forcepts
- lead poitn of fetal skull +2 station or more and not on the pelvic floor (modify with vs without rotation, which is related to 45 degrees)
132
mid forceps
station above +2 but head is engaged
133
vacuum related del compliqcations
brain bleeding (intracranial hem, subgaleal hematoma, hyperbilirubinemiia, retinal hemorrhage
134
shakling a pt may cause
```
fall problems
delay in dx of abruption.
seizure not safely treated in cuffs
can't walk
cna't be moved for emergency CS
recommend baby remain wth mother after delivery for bonding
```
135
resusitat preg in cardiac arrest
left lateral decubiuts (same with gas embolis)
136
endometritis treatment
- gent/clinda
137
B lynch is doen with what sturue
1 chromic
138
TTTS US screenign starts when
16w + every 2w thereafter
139
4th degree repair meds
- abx x1 (ancef) or clinda
140
most commoon way to get toxo
pork and lamb undercooked
141
VTE is most likely when in preg
pp
142
when is uterus no longer palpible abdominally pp
2w sp del
143
TB test positive when how big for various diseases
HIV/organ transplant, recent contacts with active TB pt - 5mm
IV drug users, high risk setting resident, <4yo = 10 mm
everyone else without risk factors = 15
144
rates of NTD
- 1 parent ith NTD = 4.5 %
- 1 parents, 1 sibling NTD = 12%
- 2 parents with NTD = 30%
- 2 parents, 1 sibling NTD = 33%
145
endocarditis and pregnancy
- need ppx abx n preg and vaginal del with high risk features:
- prostetic cardiac valve
- previous episode of infective endocarditis
- unrepaired cyanoitc cardiac diease with palliative shunts
- cardiac tranplant with valve regurgitation due to structually abnoral valve
146
epidural and T6 spinal cord injury
- Up to T 10 level to prevent autonomic dysregulation.
| - CS would be at T4 so taht doesn't matter really
147
s/sx of amniotic fluid embolism
- DIC, hemodrynamic compromise, respiratory compromise
148
risk PPROM united states
3%
149
hemoglobinopathies wu
- black women should get CBC and electrophoresis
- South asian/medeterianian CBC and electrophoresis if needed
- all women CBC
150
HSV with recurrent herpes outbreaks, how likely get outbreak during pregnancy
75%
151
waht does mag prevent for fetus
CP
152
define IAI
- fetal tachy, maternal leukocytosis, maternal fever
153
what is most likely cause of fetal/maternal hemorrhage
delivery (SVD and CS)
154
dysmaturity syndrome
post dates risk
155
MCC of pyelso
anemia
156
Rec Vit D def during pregnancy
600 international units
157
clinical features of congenital varicella
LIMB ABNORMALITIES
- low birth weight
- IQ , hydrocephalus, microcephaly, seizures
- eye stuff
- GI: reflux, stenotic bowel, atretic bowel
- Skin: cutanoue scars
158
consequence of inadequatesly treated hypothyroidism in pregn
- PTB
| - fetal demise, spontaneous abortion, low birth weight, IQ delays
159
sickle cell hgb goals
10.0 nad HbS 40% is what you transfuse up to once you decide to you need to tranfuse them
160
negative predictive value of neg nitrazine
99%
161
nucle transulcency is most sensitive at what gestation
13 w
| available 11-14w
162
most likely verticle transmission hep C
prolonged rupture of membranes
163
TTP treatment pregnancy
plasma pheresis
164
stage 1-5 TTTS
1: oli/poly
3: ab dopplers
5 dead
165
Rh negative most likey race
white
166
endometritis treatment for extended fever
gent/clinda + amp for ENTEROCOCCUS
167
lwo risk maternal cardiac issue in pregnancy
mild pumonary stenosis
168
upper limit of safe to take Vit D in preg
4000 international units
169
increased calorie intake in pregnancy
1: none
2: 350
3: 450
170
syphilis screening
VDRL & RPR (and both have titers so you can tell if old infection and trated or new infection)
171
persistent locia 12w pp, first step wu is
TVUS (not a CBC, but should get a b-hcg)
- normal duration is 8w
- persistent locia could be PSTT
- you need to evlautat sp 8w
172
breast abscess for mastitis treatment
- I&D (some would suggest IV abx vanc 1g q12h
| - normal mastitis is dicloxacillin 500 mg QID 10-14d
173
varicella worst outcomes when contract when
48h from del
| - this is chicken pox
174
vaginal progesterone good for which pts to prevent PTD
- 16-24w
- current with singleton
- prior PTD spontaneous singleton
175
PPH can occur how far out from pregnancy
12w
176
severe range BP recheck for labetalol
10 minutes (not 20)
177
cerclage indications
178
acute appendicitis during prengnancy
give steriods and then do surgery without delay
179
tell between primary or recurrent HSV pock
- viral culture and HSV IgG antibody testing
| - primary: +culture or PCR & NEGATIVE serologic tests
180
breakdown of 3rd or 4th degree repair NOT severely infected
- 1w outpt abx prior to surgery scheduled
181
expected weight gain for normal pregnancy
- 25-35lbs
- overweight BMI 25-30, (15-25)
- obese BMI 30 (11-20lbs)
182
alloimmunization and fetal hydrops is associated with which red blood cell antigens
- c, C, D, E, K, e
| - MCA indicated for 1:8
183
BPP in order of disappearance for distress
First to disappear > last to disappear
| - heart rate reactivity > breathing > gross movement > tone > amniotic fluid
184
active mangement of third stage of delv
- uterotonics
- uterine massage
- umbilical cord TRACTION
185
known complication of massive transfusion
HYPER kalemia
HYPO calcemia
metabolic aciodsis (from lactic acid and decreased removal of citrate)
186
CI of progesterone implants
- pregnancy
- pst hx of thrombosis
- liver tumors
- active liver lesions
- hx breast cancer
- allergic reaction to component of implant
187
meconium aspiration syndrome risk factor for it would be
- NRFHT
- the infant shits, aspirates it, causes respirtory distress
- occurs in 2-10% of infants with meconium
188
fetal growth slowing twins vs singelton
| timing of twin delivery
Slowing:
twins 28w
singletons 32w
delivery:
di/di 38w
mo/di: 34-37w
mo/mo: 32-34w
189
postmaturity syndrome is seen in what percentage of post term deliveries
15-20%
190
NT 3.5mm at 11w. what is diagnostic testing to follow
CVS
191
massive transfusion infcludes
FFP, plts, RBC
192
ITP approaching del, when start treating
- CS/other surgical procedure : 50K
- Treat 30K even if unsymptomatic
- treat with steiods taper (IVIG if steriods not okay)
- treat with plts in emergency situation
- splenectomy only for refractory cases
193
rate of SAB if IUD is left in place
- 50%
194
earlierst you can use a vaccum
34w
195
appropriate time to resume anticoagulation after CS
6-12h
| if epidural was used, then 24h afterwards
196
ITP if pregnisone is gong to work, plts shoudl start increasing when?
- 4-14d after administration
| - max effect 2-3 w after admin
197
CMV recent vs old infection
IgM positive, IgG positive with low avidity
(IgM is immediate in first month, IgG comes in the months to follow)
(avidity
198
incidence of shoulder dystocia
3%
199
early pp IUD defined as
<10m after del to >1w pp
200
ovulation after del starts how many week pp
4
201
estrogen contraception can start how many weeks pp
3
202
mirena vs copper immediate pp IUD expulsion rates
mirena 2x expulsed more
203
most serious long term fetal vacuum complication
- intracranial hemorrhag (fetal daeth and brain damange)
- subgaleal hematoma can cause hemorrahgic shock cuase 1/2 fetal blood can collect, but with intervention resolves and doesnt have long term consequecnes
204
hep C risk inreased most with
IV drug use
205
penicillin rash and spyhilis dx in pregnancy
| - treatment
- no desentiziatin needed for maculpapular rask, just give penicillin
- if uticaria, broncospams, angioedems then densit
- primary syph: 2.4 million uins IM x1
- latent syph 2.4 million units IM x3w
206
:which hemolobinpathies is assocated wtih fetal hydrops
- alpha thal deletion severe
207
varicilela findings
- fetal hydrops
- FGR
- microcephaly
- limb malformations
- hyperechogine foci bowel and liver
- cardiac malformations
208
featl hearting loss associatedw ith what infection
CMV
209
periventricular calcifications associatedw ith wht featl infection
toxo
210
wAth shoudl you use for anticognatulion if pt has HIT
fondaprinux (syntheitc pentasaccaride
211
waht hormone prevents lactations during pregnancy
progesterone
212
Rate PPH after
svd
cs
4%
| 6%
213
MCC secondary PPH
retained POC
214
iron requirement in pregnacy
1000 mg total
| daily you take 27 mg to supplment cause 1000 isn't found in food stores
215
2nd tri
| most sensitive and specific US finding for DS
- thickened nuchal fold
216
twin chorioniscity
if the placenta is seen as one with a large piece going upwards towards the bags, then this is a lambda sign and it's di/di
217
gold tandard for dx BV?
- gram stain
(MC way to dx is actually differet: two criteria of the following: thing/white/grey discharge, pH >4.5, KOH fishy oder, clue cell on microscopiy
218
PPV of fetal fibronectin
30%
219
annual percentage of PTB
10%
220
3rd tri IUFD IOL/TOLAC
- no prostaglindins beacuse rupture risk increased
| IO- L vs spontaneous labor has increased rutpure risk but absolute risk is low
221
term PROM IOL method
pit
| cytotec increases rate of chorio
222
GDM puts a woman at what percentage risk T2DM
70%
223
rate of twinning
3/1000 (0.3%)
224
reason to screen fro inherited thrombophilia
first degree relaive with thrombophilias
225
KB is 1.8% adn pt has 5000mL blood, standard does is 300 mcg, how many vials shoudl be given
1.8% x 5000 = 0.018 X 5000 = 90
ALso 300 mcg covers 30 mL fetal whole blood (or 15 featl red cells)
therefore 90 / 30 = 3 vials
226
GDM & >4500, the rate of shoulder dystocia is
20-50%
227
rubella non-immune and is exposed to rubella in pregnancy. what do you do
- expected management
| - if symptoms then, IgG and IgM (IgM 7-10d, IgG for 1y)
228
- risk of brachial plexus injurty with current shoulder dystoochia
- % of brachial plexus injuries asociated with normal deliveries
- 10-20%
| - 50% are just normal SVD
229
MCC acute pancreatitis
gallsteones, just like outside of pregnancy
230
which genetic disease is most associated with ashkenzi ancestry
- CF (1:29)
| - tay-sachs (1:30)
231
CA-125 elevation
- protein found in many locations throughout the body including genitals, pancreas, gall bladder, stomach, kidney,lung, breast, heart.
- inflammation of these srufces causes elevations
- brain isnt' one of these, likely a blood/brain barrier issue therefore primary brain cnacer wont elevate this.
232
cervical cancer and OCP assocaition
- long term use increases risk for cervical cancer
- risk also decreases with cessataion of use of OCPs
- those wtih HPV who have never used OCPs are at lower risk than women who HPV+ and HAVE used OCPs
233
association tumor markers and choriocarcinoma
+hcg
neg everything else
contains syncytiotrophoblasts (who make hcg)
234
association tumor markers and dysgerminoma
+hcg, +LDH
neg: AFP, CA-125
MCC germ cell tumor
10% associated wth gonadoblastomas
MCC tumor in peope lwith gonadal dysgenesis
235
association tumor markers and enbryonal carcinoma
+hcg, AFP
Neg: LDH, CA 125
- extremely rare seen in ovary, 14 cases every reported in last 30 years
- syncytiotrophoblasts cells may be present (therefore +hcg)
236
association tumor markers and endodermal sinus tumor
+AFP
neg: everything else
- germ cell tumor
- AKA yolk sac tumor, which makes AFP
- also contain schiller duval bodies
237
association tumor markers and immature teratoma
+AFP, LDH, CA 125
| neg: hcg
238
chart of cancer tumors and assoicated markers
239
cervical cancer figo wu includes:
THIS CARD ISNT: ACTUALLY ACCURATE
SEeems that it can be clinically staged: exam, +biopsy + limited endoscopy and limited imaging but what this actually means is unclear to me. Catn' get actual figo paper cause you have to pay for it.
Below is uptodate but this will give you the wrong answers too
- PE: palpate bimunual
- Biopsy: colpo, ECC, conization (extension is by visual assessment, biospy not needed)
- Endoscopy: hysteroscopy, cystoscopy, proctoscopy (and biopsy as needed)
- Imgaing: CT, MRI, or IVP (IV pyelogram) & CXR
240
risk GTN following evacuation of complete mole
15%
241
risk breast/ovarian cancer with BRCA types
BRCA 1: Breast 55-65%, ovarian 39%
BRCA 2: Breast 45%, ovarian 15%
BRCA 1/2: ovarian 85%
242
FIGO cervical cancer staging per review course
243
indications for onc referral
- post meno
- pre meno
post meno
- CA 125 >35
- US suggestive of malignancy
- ascities
- evidence abnormal distant mets
premeno
- fixed pelvic mass
- a very eleated CA 125 (there is no cut off for this, so
- US suggestive of malignancy
- ascites
- evdience of malignancy other places
Simple cysts <10cm do not need referral to gyn onc and can be monitored.
US signs concerning fro malignancy:
- ascites
- cyst larger than 10 cm
- papillary projections or solid components
- high color flow doppler
244
HPV strain for
- squamous cell cervical cancer
- adenocarcinoma with cervical cancer
16
| 18
245
MC cell in epithelial ovarian cancer
serous cells -- serous cystadenocarcinoma
- epithelial cell cancer is the most common ovarian cancers
- serous tumors cause large ascites when progressed
- most epithelial cancers are diagnosed at stage III
246
vaginal cancer staging
- clinical staging (no hyst/LN etc for surgical staging)
- acceptible studies include: EUA, cysto, procto, CXR, IVP
- extremly rare cancer
- early stages are treated with surgery, however, most advnaced stages are treated with chemo/radiation
247
mature teratoma other name is
dermoid cyst
248
MC ovrian cancer diagnosed in pregnancy is
- dysgerminomas
- note: MC benign ovarian tumor is mature cystic teretoma (desmoid tumor)
- 5-10% are associated with gonadoblastoma
249
most importnat risk factor for epithelial ovarian cancers for the standard population
age
| - increases after menopause (68% diagnosed after 55 years)
250
Risk underlying carcinoma in the surrounding areas of atypical ductal hyperplasia?
- 30%
- 5x higher risk of sugsequent breast cancer
- 30% of pts have either carinoma insitu or invasive carvinoma on excision of the mass of atypical ductal hyperplasia
251
Endometrial staging
-
252
DCIS is what
- precancerous or non-invasive cancerous lesions of the breast
- asymptomatic usually
- srugical removal w/wo radioation or tamoxifen is recommended
- lumpectomy or mastectomy are appropriate (neither is better)
253
GTN staging
- treat with methotrexate if lower rsk
- treat with EMA/CO if higher risk
- honeslty would need to memorize WHO grading criteria in addition to staging if you want ot ocrrectnly predict treatment needs
254
US findings adnexal mass concerning for malignancy
- 4 or more papillary strucutres
- irregular multilocular solid tumor with greast diamtere >10 CM
- very high color content on color doppler
255
BRCA carrier and risk reducing BSO and bilateral masterctomy, by how much is their risk reduced?
- bilateral mastectomy: 85-100% reduction in breast cancer
- BSO:
- --40-100% reduction breast cancer (50% if done before 50 yo)
- --80% for ovarian cancer
- --100% in HNPCC pt's for ovrian cancer
- --r68% all cuase mortality reduction
256
mucinous adenocarcinoma
- rare cancer
- most important to removal appendix because it's the most likley source of extra-mullerian origin. THis helpful to figure out how to treat them to make sure it's gyn in origin.
- less common to have contralateral ovary (5%)
257
PSTT path finding
| Treatment
- intermediate trophoblasts with syncytial elements, no villi (therefore low levels of hcg are expressed compared to chorio)
- treatment: hysterectomy
- slight elevation of hcg and placental lactogen
258
choriocarcinoma features on path
- abnormal tropholastic hyperplasia and anaplaisa
- no villi
- hemorrhage/necrosis
259
EIN treatment recs
- total hysterectomy if completed child bearing
- 40% EIN pts have concurrently early stage endometrial cancer, so hysterectomy is preferable when possible
- removal of ovaries is individualized and not required
- if not completed child bearing then can do progesterone oral, IM, or IU (nexplanon isnt' approved yet)
260
common presneting symtpoms of fallopian tube cancer
- hydrops tubae profluens (copiuos serosangiunous vaginal discharge)
261
BRAC 1/2 recs on BSO
BRAC 1: 35-40 yo
| BRCA 2: 40-45 yo
262
most comon type of uterine sarcoma
- leiomyosarcoma
263
simple or complex hyperplasia without atypica who want FUTURE (not now) feritlity should be treated with
progestine therapy
264
staging uterine SARCOMAs
265
chance of devleloping GTN after a
- complete mole
- partial mole
15-20%
| 1-5%
266
DCIS main treatment
- aka intraductal carcinoma
- most common non-invassive breast caancer currnetly
- 30% DCIS develops into breast cancer in 10 years if not treated
- treat with wide local excision
267
MC sym[tom of rhabdomyosarcoma
- embryonal rhabdomyosarcoma
- rare
- young girls
- presnting s/sx is VB
- treated with VAC chemo acronym
- usually no surgery and they can be fertile after treatment
268
inflammatory breast cancer details
- red, peau d'orange appearance
| - biopsy will show thrombi in dermal lyphatic channels but often shows nothing therefore DIAGNOSIS IS CLINICAL
269
cervical cancer has three main types
1. squamous (70%)
2. adenocarcomina (25%)
3. other (5%)
270
actual deinition of radical hysterectomy
- mainstay of cervical cancer treatment 1A2
- includes:
- --cardinal ligmenta to the pelvic side wall
- --complete resection of the USL to the insertin
- --resection of upper 1/3 of vagina
- --uterine artery at it's origin afrom anterior dvision of th ehypogastric artery
(modified radical hysterectomy -- parametrial tissue medial to the ureter)
271
waht % of mature teratomas will devlope in to squamous cell cancers?
- risk factors
0.2-2%
- risk factors for malignant transformation
- --older than 45yo
- --tumor size greater than 10cm
- --rapid growth
272
WHO scoring system GTN
0-6 low risk (methotrexate)
| 7-32 high risk (EAC/MO)
273
Pt wtih ER/PR+ breast cancer then goes into menopause and wants help. waht do you give her
Venlafaxine (SNRI). Dont give SSRI with tamoxifen for theroretchial concern that it wont work as well
- -note ER/PR+ means estrogen negative, progesterone positive
- - these pts are usually on tamoxifen 5 years (for both pre/post menopausal)
274
MC partial mole karyotype
| complete mole karyltyoe
partial: 69, XXX (XXY is second most common, note 47 XXY is kleinfelters and unrelated.... due to 47 not 69)
cmplete: 46 XX (90%)
275
ovarian recurrenace adn chemo
palliative only, no improvement in outcomes.
276
most common dx stage of endometrial cancer
1B
277
ancef flip dosage preop
120 kg
278
slapingostomy vs saplpingecotmy fertililty rates
same
279
*ruptured* ectopic is or is nto allowed to be treated with salpingostomy
contraindicated (
280
COPD LSC is acidotic because
- they have airflow limitation from scaring, inflammation, secretion in the lungs that isnt' completely reversible wtih intubation.
- risk for HYPER CARBIA and respiratory acidsosi from OC2 gas absortion. beacuse they have fewer underlying abilities to compensate to eliminate CO2 dru to underlying diseased tiddue that reduces tissue for gas exchange. Hyperventilation to remove CO2 gas maybe not be possible due to need for prolonged expiraroty time patients with COPD
- also at risk for bradyarrhythmias and tacyarrhythmias
- *alternative reason for resp acidosis in heavy pt is **obesity hypovbentilation syndrome OSH* defined as daytime hypoventiliation (PaCO2 45) in pt without central, pulmonary, neuromuscular, or chest wall dieasese that expalins hypercarbia (BMI 30, OSA)
281
jehovah's witness refusal of autologous blood. they will refuse and accept what
- their own blood (can be included in refusal of all blood)
- they will also refuse: RBC, plts, plasma, WBC, whole blood
they will accept:
- immunoglobulins, albumin, and coagulation factors concentrates and recombinant coagulation factors.
282
ectopic pregnancy due when
- hcg >3500, adnexal mass, empty uterus, (free fluid suggests rupture)
- lsc salpingectomy: prefered with severe rubal damange and sig bleeding
- lsc salpingostomy: preferred with desried future futurility and contralateral tube damage, coudl consider single ppx dose of methotrexate
- lapartomy: unstable pt, large amounts of intraperitoneal bleeding, compromised visualization
283
hysteroscopy removal polyp, with continued bleeding, how do you stop the bleeding intraop
- resection loop on coag (already usign resection loop)
- you can't do rollerball coagulation (monopolar) with electrolyte rich medium like normal saline (which is true, i've never seen roller ball used on something other than cervix)
284
MC complication with LSC surgery
bleedign problems/anemia
285
lsc BTL approach that casues teh most tissue damage
- monopolar coagulation because doesn't use a closed circuit like bipolar coagulation
286
risk PTB after CKC
- 2x as high PTB rates
287
suture types and tensile stregnth
- non-absorbable natural/synthetic
- absorbale natural/synthetic
- most tensile strenght initially is absorbable synthetic
| - absorbable is the most, synthetic is the most. See chart
288
why do you close fat people fascia wtih PDS
absorbable synthetic -- most initial tensile stregnth to prevent wound dehiscence
289
what suture is used for longest lasting tensile strength
PDS (polydioxanone) lasts forever. at 6m there is 25% tensile strength
290
submucosal fibroids and infertility
removal doubles fertility rates
291
abdominal prep in surgery
chlorhexidine
| - requires 3 minutes to dry to have best decomtanination effects
292
chemical peritonitis
- chronic and acute abdominal pain
- sebaceous spill from mature teratomas
- those have hyperechoic lines, rokitansky protuberance (solid component that forms an acute angle with the cyst wall), tips of the iceberg (when solid compoennts in forground shadow on the background), point (colid complents lie hair, seen at orthoganal angle from hyperechoic points.
293
salpingectomy vs ostomy
- same fertility rates afterwards
| - but higher ectopic rates afterwards with ostomy
294
suture used for cerclage placement
- need permanet suture
- uncoated polymer/polyester (ethibond)
- mersaline suture also permanent
295
gold standard for tubal patency test
chromo actually
296
ectopic hemodynamic INstability
- LSC + salpingectomy (ostomy not recommended)
297
CKC and LEEP risks
CKC
- PPROM 16%
- PTB 11%
- FG <2500g 10%
LEEP
- PPROM 8%
- PTB 5%
- FG <2500 6% at time of delivery
298
way to avoid inferior epigastric vessel injury with trochar placement
- driect visualizaiton tranperitoneally of inferior epiastric vessel (aka you look at the abodminal wall and figure out where teh inferior epigasric artery is
299
TLH with risk factors
needs SCDs and heparin started 2h before surgery and contineud until ambulating...
300
abx septic abortion
amp/gent/clinda
301
ectopic rate highest for process of sterilization
- bipolar coagulation
302
POP-Q where anterior prolpase extends 1cm below the hymen
stage II
