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U World Concepts Flashcards

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1
Q

rare polymorphonuclear leukocytes = microscopy
discharge post menses = copious white, mucoid, odorless

A

Physiologic Leukorrhea

Candidiasis = would be pruitic + erythemic

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2
Q

New onset of HTN (140/90+)
Protein in urine =

A

Pre-eclampsia

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3
Q

Pre-eclampsia risk factors

A

Nulliparity
Obesity
Preexisting medical condition (SLE, chronic HTN)
Multiple gestation
Advanced maternal age

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4
Q

Pre-eclampsia management

A

Labetalol = IV + Hydralazine = IV - 160/110+
Nifedipine = PO
Mg Sulfate = Prophlyxis Seziures (block Ca++ channel → higher seizure threshold)

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5
Q

Pre-eclampsia severe sx

A

160/110
Platelet <100,000
Creatinine 1.1+ or 2x normal
↑ transaminases
Pulmonary edema
Visionor cerebral sx (headache)

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6
Q

Fever 24 hr+ postpartum
Uterine fundal tenderness
Purulent lochia = malodorous discharge

A

Postpartum endometritis

Clindamycin + gentamicin

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7
Q

Amniotic fluid embolism vs Anaphylaxis

A

Amniotic fluid embolism = bleeding (DIC) + crackles due to pulmonary edema

Anaphylaxis = acute onset (dyspnea + HoTN + tachy) + wheezing - Hypersensitivity rxn 1

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8
Q

Fever postpartum
HoTN
Diffuse macular rash
Altered mentation

A

Staphylococcal toxic shock syndrome

Vancomycin + Cefepime + clindamycin

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9
Q

+/- Vaginal bleeding
Ab pain
High-frequency contraction
Tender uterus

PMHx = tobacco + drug use (cocaine)

A

Abruptio placentae = remature placental separation from uterus

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10
Q

Nausea + flushing + headache + ↓reflexes

Pre-eclampsia

A

Magnesium toxicity

Tx: Calcium gluconate (stablizes cardiac membranes)

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11
Q

Uterine atony managment

A
  1. Uterine massage
  2. high-dose oxytocin
  3. Tranexamic acid
  4. Carboprost tromethamine (prostaglandins) - C/I in pts w/ asthma (causes bronchospasm)
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12
Q

Progesterone effects on the kidney

A

Kidney Stones
↑ Ca++ excretion
↑ ureteral dilation
↓ peristalsis

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13
Q

Abruptio placentae vs Uterine rupture

A

Ab pain + vag bleeding + abnormal fetal heart rate tracing

Abruptio placentae = Similar to uterine rupture

Uterine rupture = irregulat ab protuberance (palpable fetal parts)

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14
Q

Fibrocystic changes vs Fibroadenoma

A

Fibrocystic changes = multiple small TENDER masses

Fibroadenoma = small, firm, wel-circumscrribed mobule mass

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15
Q

Painless cervical dilation
2+ painless 2nd trimester losses

A

Cervical insufficiency

Cerclage = suture to reinforce + add tensile strength to cervix

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16
Q

Lichen sclerosus dx & management

A

dx: Thin, white, wrinkled skin over the labia majora/minora; atrophic
∆ that may extend over the perineum & around the anus
Excoriations, erosions, fissures from severe pruritus
Dysuria, dyspareunia, painful defecation

Management: topical steroids

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17
Q

Parvo B19 infection

A

Hydrops Fetalis
- ascites
- pleural effusion

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18
Q

Rubella

A

hepatomegaly
growth restriction

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19
Q

Cytomegalovirus infection

A

Periventricular calcifications
Ventriculomegaly
Microcephaly
Intrahepatic calcifications
Fetal growth restriction
Hydrops fetalis = edema in 2+ regions

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20
Q

U/L Bloody nipple discharge

A

Intraductal papilloma

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21
Q

ulceration + crusting + sclaing nipple-areolar complexes

A

Invasive ductal carcinoma

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22
Q

Nausea + vomiting
RUQ pain/epigastric pain
hypoglycemia + hyperbilirubinema + thrombocytopenia = fulminant liver failure

A

Acute Fatty Liver

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23
Q

Magnesium Sulfate C/I

A

myasthenia gravis

severe renal failure = soley excreted in the kidney

cardiac ischemia

heart block

pulmonary edema = ADR made worse

Blocks Ca++

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24
Q

Infertility Workup

A
  1. Semen analysis
  2. Hysterosalpingogram
  3. Midluteal phase progesterone level = confirms ovulation
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25
Increase progesterone level after ovulation causes molimina sx
fatigue bloating premenstrual breast tenderness
26
When is Terbutaline used
tocolytic = inhibit contractions of myometrial smooth muscle cells recurrent late decelerations when 5+ contractions/ 10 min
27
When is amnioinfusion used
during variable decelerations = cord compression
28
when is Phenylephrine
Vasopressor = late decelerations + maternal HoTN
29
Breast abscess vs Lactational mastitis
Breast absecess = axillary lymphadenopathy Lactational mastitis = U/L breast pain + flulike sx
30
Galactocele vs Plugged duct
palpable mass
31
bladder filling pain + relief w/ voiding ↑ frequency + urgency - urinary Dyspareunia = pain w/ sex + exercise
Interstitial cystitis = bladder pain syndrome
32
Parvovirus B19 vs Toxoplasma gondii
Ascites Toxoplasma = intracranial calcification w/n basal ganglia (gray-white matter junction)
33
1st line tx for migraine headaches in pregos
BB
34
Post epidural positional headache
Postdural puncture headache ## Footnote Managment = self-limiting = laying down Epidural blood patch
35
Normal urterine contractions
5 or less in 10 mins 200 Montevideo units (MVU)
36
Tachysystole uterine contractions
5+ contractions Montevideo units
37
SERM role in infertility in PCOS
SERM inhibits estradiol negative feedback at the pituitary → ↑ GnRH pulse frequency → ↑ secretion of FSH & LH = ovulation
38
Oxytocin toxicity
Postpartum hemorrhage
39
Wt loss = (↓ATCH & GH) Amenorrhea = ↓FH/LH Lactation failure = (↓ prolactin) ↓HR + fatigue = (↓ TSH) blood loss
Sheehans Syndrome = Pituitary Ischemic Necrosis
40
SLE flare vs Pre-eclampsia
Look for sx of SLE flare = macular rash + joint pain + swelling Pre-eclampsia
41
Vaginal discharge vaginal pooling or granulation tissue
Vesicovaginal fistula ## Footnote Dx: bladder dye Tx: surgical repair
42
Primary Ovarian Insuffiency
depletion or dysfunction of ovarian follicles with cessation of menses before age 40 years - hot flushes - vaginal sx = dryness + dyspareunia + AUB | FMR1 gene for fragile X + Turner syndrome
43
Mass on the anterior vaginal wall tender to palpation expresses a purulent discharge from the urethra
urethral diverticulum | Dx: MRI ## Footnote Tx: Surgical excision
44
gestational trophoblastic neoplasia (GTN) management
1. Suction 2. Surveillance w/ OCP for 6 months
45
Category 3
- Absent variability + recurrent late decelerations - Absent variability + recurrent variable decelerations - Absent variability + bradycardia - Sinusoidal pattern ## Footnote GET c-section
46
No uterus or ovaries Blind vagina pouch breast
androgen insensitivity syndrome (AIS) | 46, XY (no ovaries)
47
No uterus + cervix + upper 1/3 vagina Has ovaries + pubic hair + breast
Müllerian agenesis (Mayer-Rokitansky-Küster-Hauser syndrome) | 46,XX (ovaries)
48
Vesicovaginal fistula vs urethral diverticulum
Vesicovaginal fistula = constant leakage + clear fluid collection urethral diverticulum = dripple + associated anterior vaginal wall mass or purulent urethral discharge
49
STI tx
Empiric: ceftriaxone + doxycycline* Confirmed chlamydia: doxycycline* Confirmed gonorrhea: ceftriaxone
50
biophysical profile
Points given if: Fetal movement = 3+ movements w/n 30 min Fetal breathing = 1+ episodes of rhythmic breathing for 30+ secs Fetal tone = 1+ episodes of extension w/ return to flexion or opening + closing hand Volume = deepest vertical pocket 2+ cm & horizontal dimension 1+ cm NST = 2+ acceleration
51
Ectopic Management
Stable: Methotrexate Unstable: Surgery
52
Bishop Score
0: 0cm + < 30% effaced + -3 station + Firm consistency + OP 1: <2cm + < 50% effaced + -2 station + Medium consistency + Mid position 2: <4cm + < 70% effaced + -1/0 station + Soft consistency + OA 3: <6cm + 80% effaced + 2+ station ## Footnote 8+ = vaginal birth
52
GBS prophylaxic if allergic to penicillin?
clindamycin or vancomycin
53
carboprost tromethamine C/I
asthma
54
methylergonovine maleate C/I
HTN
55
stress incontinence (cough + sneeze) + urge incontinence (leaked on the way to the bathroom)
Mixed incontinence ## Footnote Voiding dairy = to determine the predominant type of incontinence
56
Emergency contraception up to 5 days
IUDs Ulipristal acetate
57
Indications for CVS include
- maternal age > 35 years - abnormal 1st-trimester screen - abnormal US findings - FH of a chromosomal or genetic disorder - parents who are known carriers for a genetic disease
58
Amniocentesis purpose
performed between 15–17 weeks' gestation to detect fetal chromosomal abnormalities
59
Amniocentesis indications
- females aged > 35 years (at the time of delivery) - abnormal MSAFP, triple, or quad screen | Completed AFTER US
60
Uteroplacental blood flow and gas exchange are maintained by
Using inhalational agents
61
Using inhalational agents
- uterine relaxation - amnioinfusion to maintain uterine volume and avoid uterine collapse that could result in placental separation and/or cord compression
62
nonsinusoidal category III patterns interventions
1. Maternal repositioning 2. Administer an intravenous (IV) fluid bolus 3. Discontinue uterotonic drugs = Oxytocin + Misoprostol
63
Complete
No products of conception Closed cervix | before 20 weeks
64
Incomplete
Vaginal bleeidng Opened Cervix Some product of conception expelled & some remain | before 20 weeks
65
Inevitable
Vaginal bleeding Dilated cervix POC seen or felt at or above os | before 20 weeks
66
Missed Abortion
No vaginal bleeding Closed cervical os No fetal cardiac activity or empty sac | before 20 weeks
67
Threatened
Vaginal bleeding Closed cervix Fetal cardiac activity | before 20 weeks
68
2nd trimester painless bleeding
Placenta previa Vasa previa
69
Soft boggy uterus (atony) Postpartum bleeding
postpartum hemorrhage due to retained placenta or membranes
70
Nipple discharge is considered pathologic if
- spontaneous - U/L - persistent | Mammogram > US > MRI
71
Late and post-term pregnancy fetal complications
Macrosomia Dysmaturity syndrome Oligohydramnios Demise
72
Late and post-term pregnancy maternal complications
Severe obstetric laceration Cesarean delivery Postpartum hemorrhage
73
enlarged kidneys with thin renal cortices
hydronephrosis = posterior valve
74
Risk factors for breech position
Advanced maternal age (≥35) Uterine didelphys, septate uterus **Uterine leiomyomas** Fetal anomalies = anencephaly Preterm (<37 weeks gestation) Oligohydramnios/polyhydramnios Placenta previa
75
Polyhydramnios
Amniotic fluid index = ≥24 cm
76
indomethacin as a tocolytic ## Footnote not given after 32 weeks
MOA: cyclooxygenase inhibitor = ↓ prostaglandin production → fetal vasoconstriction ↓ renal perfusion + fetal oliguria can result in oligohydramnios = amniotic fluid index ≤5 cm ## Footnote AFI = asses the amount of amniotic fluid by dividing the uterus in 4 quadrants
77
# ``` Tocolytics =
Given up to 34 weeks = slow or stop the contractions of a woman's uterus during pregnancy **Indomethacin** = C/I after 32 due to potential closure of the ductus arteriosus **Nifedipine** = C/I after 34 weeks due to material hypotension + tachycardia **Magnesium sulfate** = weaker and good for neuroprotection up to 32 weeks
78
Routine Lab test
Prenatal visit = Rh(D) type & antibody screen Hbg/Hct, MCV, ferritin HIV, VDRL/RPR, HBsAg, anti-HCV Ab Rubella & varicella immunity Urine culture Urine dipstick for protein Chlamydia PCR (if risk factors are present) Pap test (if screening indicated) 24-28 weeks = Hbg/Hct Antibody screen if Rh(D)-negative 1-hr 50-g GCT 36-38 = GBS cultures
79
Cell-free fetal DNA testing indications
Maternal age ≥35   Abnormal maternal serum screening test Sonographic findings associated with fetal aneuploidy Prior pregnancy with fetal aneuploidy Parental-balanced robertsonian translocation
80
bupivacaine
local anesthetic = epidural toxicity = metallic taste + tinnitis + Seizure
81
brown rash palms + soles plaques w/ rolled edges on the vulva
Syphilis
82
Management in the presence of 1 STI
screening should be offered for other STIs
83
Dx Chorioamnionitis
Fever + maternal leukocytosis + Fetal tachycardia + purulent fluid
84
46 XX, 46XY paternal disomy
Complete Mole = sperm fertilizes empty ovum | No fetal tissue
85
69 XXY, 69 XXX, 69 XYY Triploidy
Partial Mole = normal ovum fertilized by 2 sperm | Fetal tissue present
86
a history of genital HSV receive antiviral prophylaxis w/ prego
beginning at 36 weeks gestation until delivery
87
anti-D antibody titer of 1:32
Pt is alloimmunized = sensitized
88
Risk factors for Vesicovaginal fistula
immediately following intraoperative bladder injury = cesarean delivery + hysterectomy weeks or months following surgery or childbirth (eg, obstructed labor) due to tissue necrosis and sloughing years after pelvic radiotherapy as a delayed presentation of radiation-induced microvascular injury (ie, endarteritis) and progressive tissue ischemia and breakdown (as seen in this patient)
89
no dividing intertwin membrane
single amniotic sac
90
Raloxifene C/I
deep venous thrombosis, renal vein thrombosis, pulmonary embolism, malignancy, active smoking, or any thrombophilia
91
Fetal Growth Restriction management
Regular nonstress testing Weekly biophysical profiles Serial umbilical artery Doppler sonography Serial growth ultrasounds

OBGYN (1 decks)

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