uWISE Flashcards
(334 cards)
1
Q
CO increase in pregnancy
A
30-50%, w/50% of that occurring by week 8
2
Q
mechanism of increased CO in pregnancy
A
increased stroke volume (first half), increased maternal heart rate (second)
3
Q
what shunts blood in late pregancy when IVC may be occluded
A
paravertebral collaterals
4
Q
CO and MAP in labor
A
40% increased CO, MAP increased by 10mmHg
5
Q
normal hyperdynamic PE findings in late pregnancy
A
increased 2nd heart sound split w/inspiration, distended neck veins, low-grade systolic ejection murmur
6
Q
total body oxygen consumption increase in preg
A
20%: 50% to uterus, 30% heart and kidneys, 18% respiratory muscles, rest to mammary tissue
7
Q
ABG in pregancy
A
normally show respiratory alkalosis
8
Q
plasma increase in single gestation
A
50% (blood volume increases 35% by term
9
Q
iron needed in preg
A
60mg qD. (recommended supplement is 27mg) actively transported to fetus, so fetal hemoglobin is normal even if mother is Fe deficienct
10
Q
clotting factor increase in preg
A
I, VII, VIII, IX, and X by 50%, rest normal
11
Q
VTE risk increase in preg
A
5.5x
12
Q
WBC in labor
A
may increase up to 30
13
Q
trace glucose on dipstick in preg
A
normal! but proteinuria is concerning
14
Q
renin and angiotensin increase in preg
A
renin activity increases 10x, angiotensin by 5x
15
Q
creatinine and BUN in preg
A
decrease!
16
Q
GI changes in preg
A
lower esophageal sphincter tone (GERD), decreased GI motility, impaired gallbladder contractility: gallstones, cholestatis of bile salts
17
Q
estrogen on the liver in preg
A
increases synthesis of fibrinogen, ceruloplasmin, and binding proteins for corticosteroids, sex steroids, thyroid hormone and vit. D
18
Q
ptyalism
A
sensation of excess saliva caused by decreased swallowing 2/2 nausea
19
Q
LFTs in preg
A
alk phos doubles, cholesterol increases, albumin increases but appears dilutionally lowered
20
Q
thyroid in early pregnancy
A
hCG stimulates transient rise in free T4, estrogen increases TBG, leading to lasting elevation of total T3 and T4
21
Q
carb metabolism in preg
A
human placental lactogen (hPL) leads to decreased tissue response to insulin, hyperglycemia after meals, and hypoglycemia while fasting
22
Q
hyperpigmentation of pregancy cause
A
elevated estrogen and melanocyte-stimulating hormone, cross-react with similarly structured hCG
23
Q
skin changes in preg
A
vascular spiders, striae gravidarum, hyperpigmentation, linea nigra, chloasma (mask of pregnancy), eccrine sweating and sebum increase leading to acne
24
Q
colostrum
A
thick yellow fluid expressed from breasts in late preg
25
placenta produces
estrogen, progesterone, hCG, hPL
26
why HgbF has higer oxygen affinity and saturation than HgbA
more avid 2,30DPG binding
27
primary source of amniotic fluid by mid second trimester
fetal urine
28
why neonatal vitamin K is given
fetal livers don't do much; K prevents hemmorhagic disorders
29
when does fetus make own T3/T4
24-28 weeks
30
sex differentiation happens when
testes in week 6 (testosterone and mullerian inhibitory factor), ovaries in week 7 (no hormones, wolffian ducts regress)
31
passive immunity comes from
maternal IgG
32
Iron deficiency v. dilutional anemia
Fe deficiency comes w/microcytic anemia
33
contributes to pulmonary edema in pregnancy
decreased plasma osmolality
34
other causes of pulmonary edema in preg
tocolytic use, fluid overload, preeclampsia
35
if PVR exceeds SVR in the setting of VSD
left to right shunting, cyanosis
36
can cause hydronephrosis in late preg, usually R
right ovarian vein complex dilation
37
implanted egg w/o DNA, chorionic villi dilate with fluid (grape like), hyperplasia of tropoblastic tissue
molar pregancy, results in spontaneous abortion. check lungs for metastatic disease
38
wt gain in preg, BMI under 18.5
28-40lb
39
wt gain in preg, BMI normal
25-35lb
40
wt gain in preg, BMI over 25, under 30
15-25lb
41
wt gain in preg, BMI over 30
11-20lb
42
most common cause of PPH
uterine atony (more than 500cc if vag, 1000 if C)
43
Sheehan syndrome
AP necrosis from PPH, causing lost of gonadotropin, ACTH and TSH. Tx estrogen, progesterone, thyroid and adrenal hormones
44
greatest risk for puerperal infection
protracted labor, prolonged rupture of membranes, multiple vaginal examinations, internal fetal monitoring, removal of the placenta manually and low socioeconomic statu
45
risk of endometritis in vag v C
3% of vaginal, 5-10x higher in C
46
most common cause of post-partum fever
endometritis (uterine fundal tenderness on PE)
47
bacteria in PP endometritis
polymicrobial resulting in a mix of aerobes and anaerobes in the genital tract. The most causative agents are Staphylococcus aureus and Streptococcus
48
PP blues, duration and prevalence
less than two weeks, 40-85%
49
most telling sign of PP depression
no love for family, indifferent toward infant
50
breastfeeding duration rec
six months
51
breast feeding benefits
decreased ovarian cancer, maybe breast cancer, and provides IgA to baby
52
vaccinations in pre-preg
rubella, varicella, pertussis and hep B. (don't give attentuated vaccines, like rubella, to pregnant pt)
53
always test pregnant woman for
HIV
54
screening by background: african
sickle hemoglobinopathies
55
screening by background: Mediterranean, SE asian, african
alpha, beta thalassemia
56
screening by background: ashkenazi, french canadian, cajun
tay-sachs
57
screening by background: ashkenazi
tay-sachs, faconi anemia, neimann-pick, bloom, gauchier, canavan disease, familial dysautonomia, CF
58
recommended folic acid
0.4 mg, unless prior NTD pregancy or meds affecting folate, then 4mg)\
59
bluish vagina
chadwick sign
60
softening cervix
hegar sign
61
quickening happens when
16-18 weeks, sometimes as late as 20
62
standard urine hCG labs detect pregnancy
4 weeks after LMP
63
serum pregancy tests detect
unique b-subunit of hCG, so don't count LH, and detect pregnancy sooner
64
mean doubling time for hCG in normal pregancy
1.5-2 days
65
doppler detects fetal HR at
12 weeks. fetoscopes at 18-20 weeks
66
fundal height in cm represents gestational age
when exits pelvis until 36 weeks
67
Naegele rule
add 7 days to LMP, then subtract three months
68
normal pregnancy
40 plus or minus two weeks
69
ultrasound can detect pregnancy
3-4 weeks (transvag) or 5-6weeks from lmp
70
b-hCG 1,500
should see gestational sac, if not consider ectopic
71
b-hCG over 4000
should see embryo and fetal heartbeat
72
antenatal appointment schedule
every 4 weeks for 28 weeks, every two until 36, and weekly after
73
gestational hypertension
140/90 (either) after 20 weeks w/o proteinuria
74
normal monthly weight gain
3-4 pounds
75
normal fetal HR
110-160 bpm
76
percent of fetuses in cephalic (head-down) position at term
95%
77
contraindications to external cephalic version
multifetal gestation, fetal compromise, uterine abnormalities, problems of placentation
78
optimal first ultrasound
18-20w
79
placenta accreta
chorionic villi attach to myometrium
80
placenta increta
chorionic villi invade into myometrium
81
placenta percreta
chorionic villi invade through myometrium and serosa, and sometimes into adjacent organs
82
first trimester screening (10-13w)
PAPP-A, b-hCG, u/s assessment of nuchal transparency
83
second trimester screening (15-20w)
triple (MSAFP, estriol, and inhibin), or quadruple (hCG) screening
84
third trimester screening (24-28w)
glucose challenge (then GTT if abnormal), group b strep at 35w, H/H, antibodie screening repeat in Rh- or HIV pt
85
big fetus ddx
incorrect age, multiples, macrosomia, hydatidiform mole, polyhydramnios
86
small fetus ddx
incorrect age, hydatidiform mole, FGR, oligohydramnios, or fetal demise
87
indications for fetal testing; prexisting
anti-phospholipid, cyanotic heart dz, SLE, renal dz, DM on insulin, HTN
88
indications for fetal testing: fetal
HTN of preg, decreased movement, oligo/polyhydramnios, growth restriction, postterm, isoimmunization, previous unexplained fetal demise, multiples, monochorionic diaminotic multiple gestation
89
reactive Nonstress test
2+ accelerations (15 beats above baseline for 15seconds) in 20 minutes. bad is no accelerations in 40minutes
90
decelerations in contraction stress test
postitive, equivocal, or unsatifcatory, depending on pattern, frequency and strength (high rate of false positives)
91
biophysical profile components
NST, fetal breathing movements, fetal movement, fetal tone, amniotic fluid at least 2cm
92
important phospholipids in the surfactant complex
lecithin/sphingomylen (L/S ration), phosphatidylglycerol (marks complete lung maturation at 35w)
93
RDS signs
grunting, chest retractions, nasal flaring, hypoxia leading to acidosis or death
94
recovery after delivery
4-6 weeks
95
exercise while preg
30minutes moderate daily
96
hot tubs, saunas, supine exercise
no
97
mineral supplementation while preg
just iron, 27 mg
98
avoid sex in preg if
placenta previa, premature rupture of membranes, hx or current preterm labor
99
air travel restrictions in preg
up to 36 weeks, unless poor DM, HTN, or sickle cell (should stay near providers or travel with records), and move every 1-2 hours
100
birth defect prevalence
2-3%, 5% results of enviromental chemicals or drugs, 15 pharmaceuticals
101
recommended limit on radiation exposure in preg
5 rad (CT ab/spine has max dx rad at 3.5)
102
fish restriction
methyl mercury. under 12oz (two servings0 per week, only 6oz albacore tuna
103
FAS triad
growth restriction, facial abnormalities (short palpebral fissures, low ears, mid-face hypoplasia, smooth philtrum, thin upper lip), CNS dysfunction (microcephaly, intellectual disability, behavior disorders)
104
tx for constipation of pregancy
docusate, psyllium hydrophlic mucilloid, lubricants
105
Women with poorly controlled diabetes immediately prior to conception and during organogenesis have a four- to eight-fold risk of having a fetus with a
structural anomaly, most likely CNS or cardiac
106
highest detection rate for trisomy 21
Sequential screen: (first trimester NT and PAPP-A + second trimester quad screen, 93% Detection Rate)
107
HPV strains in vaccine
(6,11) 16, 18
108
nonspecfic tests for syphilis
VDRL, RPR (nontreponemal)
109
strawberry cervix
trichomoniasis. frothy yellow-green discharge as well. tx:metronidazole, tinidazole
110
herpes culture sens/spec
highly specific, not sensitive (10-20% false negative rate)
111
How/where HPV causes cancer
carcinogenesis in the transformation zone of the cervix, where the process of squamous metaplasia replaces columnar with squamous epithelium
112
ACOG breast cancer screening
annually after 40
113
screening: first degree relative with colon cancer before 60
begin screening with colonoscopy at age 40, or 10 years before the youngest relative diagnosis, and repeat every five years
114
DEXA screening
age 65, or sooner with risk: early menopause, glucocorticoid therapy, sedentary lifestyle, alcohol consumption, hyperthyroidism, hyperparathyroidism, anticonvulsant therapy, vitamin D deficiency, family history of early or severe osteoporosis, or chronic liver or renal disease
115
cause of compensated respiratory alkalosis in pregnancy
increased minute ventilation
116
causes of acute pilmonary edema in pregnancy
tocolytic use, cardiac disease, fluid overload and preeclampsia
117
ureter prone to compression by uterus and ovarian veins
right. left is cushioned by sigmoid colon
118
why total T3 and T4 increase in pregnancy
Thyroid binding globulin (TBG) is increased due to increased circulating estrogens with a concomitant increase in the total thyroxine.
119
Poorly controlled DM prior to pregnancy most often leads to
cardiac anomolies
120
Can CVS dx neural tube defects?
No. just dna abnormalities
121
fragile X prevalence
1 in 3,600 males and 1 in 4,000 to 6,000 female
122
first trimester ultrasound gives dating within
3-5 days. second: within 1 week third: within 3 weeks
123
quad screening false positive rate
5%
124
GTT cutoffs
fasting under 95, one hour under 180, two hour under 155, three hour under 140.
125
seen with preexisting DM but not gDM
IUGR
126
When is ibuprofen dangerous in pregnancy?
can close ductus arteriosis after week 32
127
tx umbilical cord prolapse
attempt to push head back and immeadiate c/s
128
wide spaced nipples and lymphadema in neonate
turner's syndrome
129
Mother w/DM1, moderate glucose control, neonate with
small, hypoglycemic
130
TTTS effects on donor and recipient
recepient: volume overload, polyhydramnios, polycythemia, hydrops. Donor: IUGR, oligo
131
neonate, mother with gDM
hypoglycemia, polycythemia, hyperbilirubinemia, hypocalcemia and respiratory distress
132
in HIV+ mom, start neonate AZT
immeadiately at birth
133
neonate CPR position
sniffing position (tilting the neonate’s head back and lifting the chin (not flex, as in adult)
134
APGAR components
HR, RR, reflex, activity, color (2 each)
135
breastfeeding is associated with decreased
ovarian cancer
136
burning pain in breasts, shiny nipples with peeling periphery
candidiasis
137
signs that baby is getting sufficient milk
3-4 stools in 24 hours, six wet diapers in 24 hours, weight gain and sounds of swallowing
138
percent of spontaneous abortions w/chromosomal anomalies
50-60% (most often autosomal trisomy)
139
when to place cerclage
hx of cervical incompenence, second trimester (14weeks)
140
testing for multiple early pregnancy losses
Testing for lupus anticoagulant, diabetes mellitus and thyroid disease are commonly performed. Maternal and paternal karyotypes should also be obtained
141
ACE inhibitors in pregnancy
beyond the first trimester of pregnancy has been associated with oligohydramnios, fetal growth retardation and neonatal renal failure, hypotension, pulmonary hypoplasia, joint contractures and death
142
treat thyroid storm in pregnancy
thioamides (i.e. PTU), propranolol, sodium iodide and dexamethasone (NOT radioactive iodine)
143
tx kidney stones in preg
aggressive hydration, double-J stent if needed
144
tx lupus in preg
corticosteroids, hydroxychloroquine for skin symptoms
145
tx breast cancer in preg
no radiotherapy (chemo okay?)
146
antidepressant bad in preg
paxil (paroxetine). increased risk of fetal cardiac malformations and persistent pulmonary hypertension
147
test for appendicitis in preg
graded compression ultrasound (remember, appendix could be anywhere!)
148
pre-eclampsia!
systolic blood pressure of 160 mm Hg or higher, or diastolic blood pressure of 110 (2x, 4h apart) thrombocytopenia, LFTs x2, severe persistent right upper quadrant or epigastric pain unresponsive to medication, renal insufficiency, pulmonary edema or new-onset of cerebral or visual disturbances.
149
Mg in preeclampsia
if BP over 160/110
150
mg toxicity causes
respiratory depression
151
thromobcytopenia over 100,000
contraindication to expectant management of severe preeclampsia remote from term.
152
indicate immeadiate delivery in preeclampsia
high BP on max 2 meds, non-reassuring fetal surveillance, LFTs x2, eclampsia, persistent CNS symptoms and oliguria
153
risk of isoimmunization w/o rhogam
2% antepartum, 7% after full term delivery, and 7% with subsequent pregnancy
154
best test for the noninvasive diagnosis of fetal anemia
MCA peak systolic velocity
155
how much rhogam at 28weeks
300mcg, which neutralizes 30cc of fetal blood
156
determine dose of rhogam to give to mother after exposure
kleinhauer-betke test
157
indicates the severity of materal Rh hemolytic disease
bilirubin
158
tx severe fetal Rh disease
fetal transfusion, maternal plasmaphoresis is second line
159
days and twins
di/di split within three days, mono/di 4-8, mono/mono 8-12, conjoined after 13
160
risk of multiples with ArT
5-6%
161
twinning is not related to
paternal family hx
162
intellectual disabilities from x-rays
8-15 weeks
163
ultrasound criteria for missed abortion
CRL over 7 with no fetal heart beat
164
induce labor with closed cervix
cytotec (miso) prior to pitocin (no foley if cervix isn't open)
165
associated with breech
Prematurity, multiple gestation, genetic disorders, polyhydramnios, hydrocephaly, anencephaly, placenta previa, uterine anomalies and uterine fibroids
166
AROM when?
arrest in active phase (more than 4cm)
167
success rates in VBAC
70-80% after one c/s, 70% after two
168
before digital exam in third trimester bleeding
pelvic ultrasound. determine placenta placement before further exam!
169
steroids cutoff
under 34 weeks
170
low anterior placenta and prior c/s means risk for
placenta accreta
171
most preterm labor is
idiopathic
172
most cervical incompetence is dx'd
early second trimester
173
tocolytics contraindicated in DM
terbutaline (never use for more than 48h), ritodrine
174
tocolytics contraindicated in myasthenia gravis
magnesium sulfate
175
indomathcin contraindicated as tocolytic when
after 33 weeks (d. arteriosis closure) also associated with oligohydramnios
176
magnesium toco mec
competing with calcium entry into cells.
177
ritodrine, terbutaline, and salbutamol toco mec
Beta-adrenergic agents work by increasing cAMP in the cell, thereby decreasing free calcium.
178
nifedipine toco mec
Calcium channel blockers prevent calcium entry into muscle cells by inhibiting calcium transport
179
indomethacin toco mec
Prostaglandin synthetase inhibitors, such as Indomethacin, work by decreasing prostaglandin (PG) production by blocking conversion of free arachidonic acid to PG.
180
associated w/nifedipine use
Fetal hypoxia and decreased uteroplacental blood
181
betamathasone effects on neonate
increased lung maturity, decreased RDS, decreased ICH, decreased necrotizing enterocolitis(no increase in infections)
182
fetal fibronectin NPV in symptomatic women
99% 99 out of every 100 patients with a single negative test result will not deliver in the next 14 days
183
first test for PROM
vaginal fluid nitralazine or ferning
184
risks for PPROM
mostly infection, also 2x inrease from smoking, prior pprom. Shortened cervix
185
time from ROM to delivery
At term, 90% will spontaneously go into labor within 24 hours of PROM. At 28 weeks to 34 weeks, 50% will go into labor within 24 hours and 80% within 48 hours
186
prolongs latency in PROM by 5-7 days
antibiotics (steroids prolong less)
187
Neonatal survival when rupture occurs between 20 and 23 weeks
25%
188
amniocentesis signs of infection
glucose under 20, increased interleukin 6 (leukocytes aren't very helpful)
189
tx fetal hypoperfusion
change in maternal position to left lateral position, supplemental O2, treatment of maternal hypotension, discontinue oxytocin, consider intrauterine resuscitation with tocolytics and intravenous fluids, fetal acid-base assessment with fetal scalp capillary blood gas or pH measurement
190
smooth muscle constrictor, contraindicated in PPH in pt w/HTN
methylergovine
191
smooth muscle constrictor, contraindicated in PPH in pt w/asthma
prostaglandin F-2 alpha (hemabate, always delivered IM)
192
associated with retained placentas
prior Cesarean delivery, uterine leiomyomas, prior uterine curettage and succenturiate lobe of placenta (NOT Placental abruptions, labor augmentation, degree of parity and circumvallate placenta)
193
tx endomyometritis
ampicillin (or other gram + coverage), gentatmicin (or other gram negatives)
194
most common agents acute cystitis
. coli (75%), P. mirabilis (8%), K. pneumoniae (20%), S. faecalis (
195
first tx of infected wound
open drainage, then abx if indicated
196
tx septic thrombophlebitis
add anticoagulant to antibiotics
197
most common source of fever first day postpartum
lungs! get cxr before starting abx
198
FDA catergory C
Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well controlled studies in humans
199
most common SSRI side effect
insomnia
200
fluoxetine in preg
abnormal muscle movements (EPS) and withdrawal symptoms: agitation, abnormally increased or decreased muscle tone, tremor, sleepiness, severe difficulty breathing, and difficulty feeding
201
peaks higher at ovulation
LH
202
follicular phase
pre-ovulatio, selected tertiary follicle
203
luteal phase
post ovulation, corpus luteum becomes albicans and degrades
204
associated with post-term pregnancies
placental sulfatase deficiency, fetal adrenal hypoplasia, anencephaly, inaccurate or unknown dates and extrauterine pregnancy
205
risks of postterm pregnancy
macrosomia, oligohydramnios, meconium aspiration, uteroplacental insufficiency and dysmaturity
206
favorable cervix after 42 wks
induce!
207
withered, meconium stained, long-nailed, fragile and have an associated small placenta
dysmaturity, 10% of babies born after 43 weeks
208
low birth weight, overlapping fingers, micronathia, and cardiac defects
trisomy 18
209
extremem DM causes IUGR by
uteroplacental insufficiency (vascular disease)
210
increased S/D ratio on umbical doppler
reflects increased vascular resistance. It is a common finding in IUGR fetuses.
211
head-sparing growth asymetry
uteroplacental insufficincy (as in HTN)
212
infective causes of IUGR
will be symmetric. rubella, CMV, syphilis, varicella, protozoan toxoplasmosis. No bacteria are known to cause IUGR.
213
morbities of IUGR
oligo, fetal demise, perinatal demise, meconium aspiration, polycythemia
214
adult complications of fetal IUGR
cardiovascular disease, chronic hypertension, chronic obstructive lung disease and diabetes
215
most reliable first trimester dating
ultrasound crown rump
216
when do fibriods indicate c/s
when in lower uterine sgement
217
requirements for forceps
complete cervical dilation, head engagement, vertex presentation, clinical assessment of fetal size and maternal pelvis, known position of the fetal head, adequate maternal pain control and rupture of membranes
218
vaccuums v. forceps
decreased lacs, increased cephalohematoma, jaudice, lateral rectus paralysis (resolves sponaneously)
219
BTL failure rate
1%
220
CVS v. amnio
CVS is earlier (12 v. 15), more rare limb abnormalities, more alloimmunization, more repeat attempts, higher procedure loss rate
221
Depot irregular bleeding should resolve by
2-3 months. (amenorrhea in 50%)
222
window for emergency contraception
72-130 hr
223
contraception that decreases ovarian and endometrial cancer
combined OCPs
224
slightly reduced the risk of ovarian cancer
BTL
225
strongest predictor of regret of BTL
age (40% under age 25)
226
patch fails more in pts
over 198 lbs
227
associated with early recurrent pregnancy loss
antiphosopholidid antibody. work-up: anticardiolipin, beta-2 glycoprotein antibody, PTT, russel viper venom test.
228
tx: antiphospholipid antibody in pregnancy
aspirin and heparin
229
medical abortion v. surgical
more blood loss
230
manual vacuum aspiration cut-off
less than eight weeks
231
asherman's syndrome
adhesions/fibrosis associated with d/c (up to 32% after 3 d/cs)
232
squamous cell carcinoma from lichen sclerosis?
less than 5%
233
inflammatory mucocutaneous lesions with relapsing obliterating rashes and lesions in skin, hair, nails, oral and vulvar mucosa
lichen planus, tx topical superpotent corticosteroids
234
severe vulvar pruritis, worse at night, thick rugose labia
lichen simplex chronicus. tx topical steroids and antihistamines
235
mucopurulent cervicitis tx
may be gonorrhea or chamydia--tx both
236
post-exposure prophylaxis for hep B
within 7 days of blood exposure, 14 days of sexual. give HBIG and start vaccination series (known exposure)
237
incubation period for hep B
6 weeks to 6 months
238
outpatient PID treatment
ceftriaxone, cefoxitin, or other third-generation cephalosporin (such as ceftizoxime or cefotaxime) PLUS doxycycline WITH or WITHOUT metronidazole
239
inpatient PID treatment
Cefotetan or cefoxitin PLUS doxycycline or clindamycin PLUS gentamicin
240
tubal infertility rates in PID
tubal infertility has been reported as 12% after one episode of PID, 25% after 2 episodes and 50% after three episodes
241
cause of overflow incontinence
underactive detrusor (neuro, MS, DM) or obstruction (postop, severe prolapse)
242
cause of urge incontinence
detrusor instability
243
best surgical option for genuine stress incontinence
retropubic urethoplexy (needle suspensions and anterior repairs have lower rates of success)
244
tx "drain pipe urethra", intrinsic sphincteric deficiency
urethral bulking is first line, then tight sling. artificial sphinter as last resort
245
anticholinergics for parasympathetic detrusor instability (urge incontinence)
oxybutynin.
246
complex mass in postmeno woman
exploratory surgery!
247
first line endometriosis management
combined OCPs
248
pelvic “fullness” or “heaviness,” which may extend to the vulvar area and legs. Associated symptoms include vaginal discharge, backache and urinary frequency
pelvic congestion syndrome
249
provides cutaneous sensation to the groin and the skin overlying the pubis
iliohypogastric nerve (T12 L1)
250
provides cutaneous sensation to the groin, symphysis, labium and upper inner thigh
ilioinguinal nerve (T12 L1)
251
May increase pain of fibrocystic breast changes
caffeine
252
nipple itch is usually
chemical irritation! (rarely, paget's)
253
abx for breastfeeding mastitis
dicloxacillin (or penicillin type, for s. aureus. can give erythro if allergic)
254
sequence of sexual maturation
breast budding, then adrenarche (hair growth), a growth spurt and then menarche. In a minority of cases, pubarche (pubic hair growth) can occur before thelarche (breast/areolar development).
255
body weight for menses
at least 85 lbs
256
olfactory tract hypoplasia and the arcuate nucleus does not secrete GnRH
Kallman syndrome (no smell, no secondary sex characteristics) tx: pulsatile GnRH
257
premature menses before breast and pubic hair development
McCune Albirght syndrome
258
tx precocious puberty
GnRH agonist
259
normal age of menarche
9-17
260
check in patients with mullerian agenisis
renal utrasound! 25-35% have renal ageneisi
261
secondary amenorrhea resulting from intrauterine scarring/synechiae.
asherman's syndrome
262
causes of hypothalamic-pituitary amenorrhea
functional (weight loss, obesity, excessive exercise), drugs (marijuana and tranquilizers), neoplasia (pituitary adenomas), psychogenic (chronic anxiety and anorexia nervosa). Get LH/FSH
263
dyspareunia in premature ovarian failure
due to vaginal dryness from decreased estrogen
264
initial laboratory assessment for a patient with amenorrhea and no other symptoms or findings on physical exam
Prolactin! Prolactinoma is most common pituitary tumor causing amenorrhea
265
Asian e/short duration hirsutism and the significantly elevated DHEAS
adrenal tumor
266
looks lik PCOS w/normal serum testosterone
check 17-hydroxyprogesterone for 21-hydroxylase deficiency
267
terminal hair growth, depression, striae
cushings! check dexa suppression test
268
post pregnancy hair loss
high estrogen in preg causes synchrony, leading to increased shedding 1-5 months postpartum
269
unilateral tumor in pt 20-40; hirsutism and virilization.
sertoli-leydig cell tumors
270
estrogen secreting tumors
granulosa cell, thecomas
271
ancanthosis nigricans, temporal balding, clitoral enlargement and deepening of the voice
hyperthecosis (severe PCOS)
272
second line (after OCPs) for idiopathic hirsutism
spironalactone
273
leuprolide
GnRH agonist. Precocious puberty, fibroids, enodmetriosis, breast and prostate cancer, pedophilia
274
progestin mechanism for AUB
inhibit further endometrial growth, converting the proliferative to secretory endometrium.
275
polyp observation cutoff
bigger than 1.5cm
276
tx for submucosal fibroid
hysteroscopic myomectomy (can't access with laproscopy)
277
dysmenorrhea failing OCPs and depot
ex lap
278
Hyperplastic overgrowth of endometrial glands/stroma
polyps
279
Endometrial glands/stroma and hemosiderin-laden macrophages
endometriosis
280
adenomyosis and GnRH agonists
pain recurs after therapy
281
physical examination in patients with primary dysmenorrhea
normal!
282
should be performed on all women over age 40 with irregular bleeding to rule out endometrial carcinoma
endometrial biopsy
283
good endometrial strip postmeno
less than 4 cm
284
premature ovarian failure occurs
before age 35
285
postenopausal calcium requirement
1200 mg qd
286
repeat DEXA how often
q2y
287
HRT and cholesterol
HDL levels increase and LDL levels decrease (good!)
288
osteopenia DEXA T-score
-1 to -2.5. review risk factors, encourage increased vit. D and Ca intake
289
menopausal symptoms in postmeno hysterectomy
decreased circulating androgens
290
conception over time in healthy couples
After one month, 20% of couples will conceive; after three months, 50%; after six months, 75%; and after 12 months, 90% will conceive
291
infertility after salpingitis
15%
292
characterized by normal FSH and low estrogen levels
exercise-induced hypothalamic amenorrhea. tx is less exercise, then exogenous gonadotropins (LH, FSH)
293
test for decreased ovarian reserve
clomiphene challended. give days 5-9, the check FSH on day 3 & 10. Elevated FSH means diminished reserve
294
male role in infertility
35%
295
PMDD timing
last week of luteal phase, resolve with follicular phase
296
vitamin deficiency associated with PMS
A, E, B6 (also Ca, Mg, and positive family hx)
297
SSRIs for PMS
daily, or for ten days of luteal phase
298
molar pregnancy risk factors
Asian, under 20 or over 40, 2 or more miscarriages, low beta-carotene and folic acid consumption.
299
recurrent risk in molar pregnancy
1-2% (20 fold!), 10% after two
300
enlarged uterus and vaginal bleeding, a Beta-hCG value >1,000,000 mIU/mL
mole!
301
partial mole
Karyotype 69XXY (or other triploid), fetus present, lower risk of developing post-molar GTD
302
complete mole
diploid resulting from fertilization of “empty egg” by single sperm (46XX, 90%) or by two sperm (X & Y = 46XY 6-10%
303
partial v complete mole presentation
partials have marked villi swelling, lower bHCG, older pts, longer gestations. completes are larger uteri, PEC, more GTD
304
new pregnancy after mole
6 mos after negative HCG
305
GTD risk in complete moles
20% (5 in partials)
306
tissue diagnosis needed for choriocarcinoma?
No! bHCG is sufficient
307
only vulvar carcinomas treated with excisional biopsy (all others radical vulvectomy and groin node dissection)
microinvasive squamous cell carcinoma of the vulva only made after pathology evaluation of a small (
308
90% of vulvar cancers
squamous cell carcinoma. (over 65, smoking, not pigmented)
309
pigmented vulvar lesion
melanoma or high-grade vulvar intraepithelial neoplasia
310
erythematous with lacy white mottleing of the surface
Paget's
311
VIN 3 tx
local superficial excision (precancerous!)
312
condyloma tx
TCA (thrichloroacetic acid), Aldara,
313
cervical dysplasia tx
cryotherapy
314
VIN 2 tx
lasers if multifocal, or vulvevtomy
315
in situ carcinoma associated with breast cancer
paget's disease of the vulva
316
ASGUS under 30
repeat pap in one year if HPV positive, three years if negative
317
white plaque on cervix
leukoplacia! biopsy asap
318
most concerning on colposcopy
disorderly vessels most of all, then punctations and mosiacism.
319
dx lesion in endocervical canal
conization of lesion can't be visualized (ECC has high flase negatives)
320
HSIL with normal biopsy
LEEP or conization, then cotesting at 12 and 24 months
321
CIN grading
extent of involvement of the epithelial layer. CIN does not extend below the basement membrane. Carcinoma in situ (CIS) involves the basement membrane. In cancer, the cells invade beyond the basement membrane. In microinvasive cancer, they invade less than 3 mm
322
indicated in positive ECC
cervical conizations
323
most common symptom of fibroids
menorrhagia
324
fibroid size reduction in GnRH treatment
estradiol level and with body weight, resumes growth potential if treatment is stopped
325
untreated CAH on endometrial biopsy
30% will have endometrial cancer
326
weight and endometrial cancer
10x increase if more than 50 lbs overweight
327
abnormal bleeding in postmenopausal woman, enlared endometrial stripe, rare atypia on biopsy
d/c for further eval
328
screening in patients on tamoxifen
none, just annual exams
329
risk factors for ovarian cancer
nulliparity, family history, early menarche and late menopause, white race, increasing age and residence in North America and Northern Europe. Not smoking
330
BRCA contribution to cancer
5 to 10 percent of breast cancers and 10 to 15 percent of ovarian cancers in white American women
331
The most useful radiologic tool for evaluating the entire peritoneal cavity and the retroperitoneum
CT (PET scan is not useful in diagnozing ovarian malignancy
332
The five-year survival of patients with epithelial ovarian cancer is directly correlated with
tumor stage
333
tx advanced ovarian cancer
debulking, post-op chemo with taxane and platinum adjunct
| response rate is 60-80%, five-year surivival in stage III ans IV is 30%
334
most common tumor in women of all ages
dermoid tumor (median 30y, 80% in reproductive age)
