Flashcards in UWise Deck (55)
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31
35 yo G4P1021 at 7 wks p/w vaginal bleeding and cramping
-2 early first T losses
-s/p stroke
-US: empty uterus w/ slightly enlarged irregularly shaped uterus, beta-hCG 23
Most likely cause of this miscarriage?
Hypercoagulability- antiphospholipid syndrome
32
33 yo at 29 wks presents w/ PPROM, next step?
Latency abx- ampicillin and erythromycin
-shown to prolong latency period for 5-7 days, and to reduce maternal amnioitis and neonatal sepsis
33
2 signs of magnesium toxicity and levels at which they occur
High levels of magnesium sulfate can cause diminished or absent DTRS (around 10mg/dl) then respiratory depression (12-15) or cardiac depression (over 15)
34
35 yo G0 p/w 6 mo spotting btwn periods and desire for pregnancy
-menorrhagia w/ increased blood loss w/ past 3 menses
-TVUS: 2 cm endometrial polp
Tx
Hysteroscopic polypectomy
-Could do medical management w/ progestin but not if she wants to get pregnant
35
Describe the discharge seen in
(a) Trichomonas
(b) Candida
Vaginal discharge
(a) Trichomonas- yellow-green 'frothy" discharge
(b) Candida- thick white 'cottage-cheese' like discharge
-neither would cause fever/abdominal pain => think PID if present
36
20 yo at 28 wks presents w/ contractions q4min
-101F, HR 120, BP 110/65, white count 18k
-tender uterine fundus w/ otherwise normal exam
-1/50/-3, fetus in vertex
-FHT: category I tracing
Next step
Fever, tender fundus, white count- c/f intra-amniotic infection (chorio)- only thing is to get the baby out...
Next step = labor induction
-category I tracing => can induce labor instead of C-sxn
37
60 yo p/w urinary frequency and urge incontinence
-cystometrogram: uninhibited detrusor contractions upon filling
-normal post void ridicual
Best tx
Best tx = oxybutynin (anticholinergic/antimuscarinic)
Mechanism of urge incontinence = detrusor instability, overactive bladder (doesn't relax = uninhibited contractions)
38
At what age does a F w/ a hysterectomy no longer need pap smear?
Pap test screening is not indicated in pts who have had a hysterectomy, unless it was done for cervical cancer or a high-grade cervical dysplasia
women w/ a uterus can d/c pap smears after 65 if have had 3 consecutive negative smears w/ no hx cervical neoplasia/cancer
39
Tx of baby born to HIV+ mother
Baby gets zidovudine (AZT) immediately after delivery
-don't need to wait until 24 hrs of life, at 24 hrs of live HIV testing begins (not at time of delivery)
40
Contraindication to vacuum aspiration instead of D and C
Vacuum aspiration only for under 8 wks of gestation
41
Which type of leiomyomas have the highest risk of infertility
Submucosal and intracavitary
-very unlikely for fibroids to cause infertility, but if they do it'll probably be a submucsal or intracavitary: tx w/ hysteroscopic resection then should be able to conceive
42
Postterm pregnancies association w/
(a) placental sulfatase
(b) fetal adrenal gland function
Postterm pregnancies
(a) placental sulfatase deficiency
-placenta is the organ w/ an expiration date! not meant to last that long
(b) postterm associated w/ fetal adrenal hypoplasia
43
Risk factors that would indicate DEXA before age 65
-early menopause
-glucocorticoid therapy
-sedentary lifestyle
-EtOH
-hyperthryoid, hypereparathryoid
-anticonvulsant therapy
-vit D deficiency
-FHx for early or severe osteoporosis
-chronic liver or renal disease
44
Type 1 diabetic w/ A1C of 9.2% is at highest risk for what fetal complication?
Fetal growth restriction
-higher risk than macrosomia when this poorly controlled for this long
-thought to be 2/2 placental microvasculature disease
45
25 yo G1P1 p/w left breast pain and fever, currently breastfeeding her 2 1/2 week old infant
-erythema of the upper outer quadrant of left breast, TTP
(a) Dx
(b) Tx
(a) Puerperal (aka lactational- in a breastfeeding F) mastitis
(b) Tx = abx (oral vs. IV depending on severity) and ibuprophen/acetaminophen for pain relief
-don't have to stop breast feeding!!! encourage to keep breast feeding!!!
46
Describe classic presentation of gonorrhea induced PID
Lower abdominal pain, adnexal tenderness, fever, cervical motion tenderness
-mucopurulent vaginal discharge
-classically w/ exacerbation of symptoms during and after menstruation
47
Risks of phenytoin and carbamazepine in pregnancy
Clinical syndrome called fetal hydantoin syndrome with group of findings:
-microcephaly
-hypoplasia of phalanges
-excess hair, cleft palate
48
What hormone is responsible for breastmilk production?
Prolactin
Prolactin is made throughout the pregnancy but its fxn is inhibited by estrogen and progesterone. Post-partum, inhibition of estrogen/progesterone is lifted, prolactin continues to be secreted- and milk is produced
49
28 yo G0 p/w severe endometriosis, failed conservative medical management
Best tx option?
Tx = laser ablation of adhesions- wouldn't do hysterectomy/salpingo-oophorectomy in young nulliparous F
Sidebar: conservative management is OCPs and analgesia
50
36 yo G0 p/w severe abdominal pain x2-3 days w/ N/D
-febrile to 102
-abdomen TTP w/ mild guarding and rebound, elevated white ct
-pelvic US: b/l 3-4cm complex masses
Dx
Dx = ascending infection causing salpingitis, ultrasound findings consistent w/ tubo-ovarian abscess
-most often sexually transmitted: gonorrhea, chlamydia, or any other thing ascending from the GU or GI tract
51
Uterotonic agents: contraindications for methylergonovine vs. prostaglandin F2-alpha
Methylergonovine = methergine, can't use in h/o HTN
Prostaglandin F2-alpha = hemabate, can't use in h/o asthma
52
Microscopic evaluation of discharge findings indicative of
(a) bacterial vaginosis
(b) trichomoniasis
(a) BV: clue cells on saline wet mount
-drop of KOH releases amines from the cells => fishy odor
(b) trichomoniasis = motile ovoid protozoa w/ flagella
trichomonads = unicellular protozoans
53
Use of amitriptyline in pregnancy
Used in pregnancy to treat migraine headaches
54
Associations with breech position
-premature
-multiple gestations
-polyhydramnios
-hydrocephaly
-placenta previa
-uterine anomalies and fibroids
55
