UWise Flashcards
(283 cards)
1
Q
What is the sequential screen?
A
ComBines first trimester screen with quad screen - detects aneuploidies.
2
Q
Asherman’s syndrome results from trauma to what?
A
Basal layer of endometrium
3
Q
What blood pressures are needed for the diagnosis of preeclampsia with severe features?
A
SBP >160 or DBP >110
4
Q
Early decelerations are thought to represent fetal response to what?
A
Head compression
5
Q
What typically causes variable decelerations?
A
Cord compression
6
Q
What is hyperthecosis?
A
More severe form of PCOS; associated with virilization due to the high androstenedione production and testosterone levels
7
Q
Does a h/o SAB increase the risk of pre-E?
A
No
8
Q
A baby born to a mother that is HIV + and has a positive PPD with a negative CXR is managed how?
A
Start zidovudine immediately and test for HIV at 24 hours; no need to isolate infant as CXR is negative
9
Q
What is the risk of fetal loss associated with chorionic villus sampling?
A
1%
10
Q
A patient presents with Mullerian agenesis, what other test should be completed?
A
Renal ultrasound - 25-35% of patients with Mullerian agenesis have renal anomalies
11
Q
What are the risk factors for uterine atony?
A
Precipitous or prolonged labor, use of oxytocin, multiparity, general anesthesia, macrosomia, hydramnios, twins, chorioamnionitis
12
Q
How does a neonate appear when septic from chorioamnionitis?
A
Tachycardic, minimal variability suggest sepsis; septic infant will appear pale, lethargic and have a high temp
13
Q
What is the most effective screening test for Down syndrome?
A
Cell free DNA
14
Q
What is the most common cause of elevated maternal serum alpha fetal protein?
A
Under estimation of gestational age
15
Q
If a patient has an exposure to Hep B and has not get been vaccinated, what is the next steps for treatment of the patient?
A
Post-exposure prophylaxis should be initiated but no later than 7 days after blood contact and within 14 days after sexual exposure; should receive 1 dose of HBIG and the HBV series
16
Q
What studies can be conducted using chorionic villus sampling?
A
Chromosomal abnormalities, biochemical or DNA-based
17
Q
Patient presents in active labor with breech presentation, what should be done next?
A
C-section
18
Q
Prolonged fetal tachycardia is seen when?
A
Maternal fever or chorioamnionitis
19
Q
What is Chadwick’s sign?
A
Bluish color of cervix - seen in pregnancy
20
Q
What is the definition of postpartum hemorrhage?
A
Vaginal - 500 cc; C-section - 1000 cc
21
Q
G3P3 41 yo F presents with abnormal uterine bleeding, what test should be done first?
A
Ultra sound - less invasive than hysteroscopy
22
Q
In what type of DM is associated with IUGR?
A
Pre-existing DM
23
Q
What is Rokitansky-Kuster-Hauser syndrome?
A
Causes vaginal and uterine agenesis
24
Q
What are the signs of magnesium toxicity?
A
Resp depression, nausea, muscle weakness and loss of DTRs; Mag in high doses can lead to cardiac arrest
25
What effect does estrogen have on the endometrium?
Stimulation of rapid endometrial growth, conversion of proliferative to secretory endometrium and regeneration of the functional layer
26
What is twin-twin transfusion syndrome?
Complication of monochorionic pregnancies - characterized by an imbalance in the blood flow through communicating vessels across a shared placenta leading to under perfusion of the donor twin
27
At what magnesium levels are there loss of DTRs?
7-10 mEq/L
28
Head compression typically causes what type of decelerations?
Early
29
What are potential neonatal complications of vacuum assisted delivery?
Lacerations to scalp, separation of fetal scalp from underlying structures, cephalohematoma, jaundice, transient lateral rectus paralysis (not of clinical importance apparently)
30
If CVS is performed before 10 weeks gestation there is an increased risk of what?
Limb abnormalities
31
What is the most common risk factor for uterine inversion?
Iatrogenic- excessive traction on the umbilical cord
32
What is the treatment for cervical insufficiency?
Prophylactic cerclage (transvaginal cerclage)
33
What defect can be seen in pregnancy with prenatal exposure to valproic acid?
Lots but most common is NEURAL TUBE DEFECT
34
What are the complications to each twin in twin-twin transfusion syndrome?
Donor twin becomes anemia, has IUGR, oligohydramnios; recipient has over perfusion and becomes polycythemic, experiences volume overload and polyhydramnios which may lead to heart failure and hydrops
35
What is the most common cause of inherited mental retardation?
Fragile X syndrome
36
What are the treatment options for vestibulodynia?
TCAs, pelvic floor rehabilitation, biofeedback, topical anesthetics. Surgery for patients who do not respond to standard therapies
37
Valproic acid exposure in utero is associated with an increased risk for what anatomical defects?
NTDs, hydrocephalus and craniofacial malformations
38
What is the treatment for Kallmann syndrome?
Pulsatile GnRH therapy
39
What are risk factors for uterine inversion?
Grand multiparity, multiple gestation, polyhydramnios, macrosomia
40
If a patient is exposed to Hep B but is a nonresponder to the vaccine, what is the course of treatment?
HBIG plus HBV or HBIG time two doses
41
What type of contraception should be used with caution in women with a history of depressoin?
Progestins
42
When is methergine contraindicated?
Hypertension
43
What weight is needed for menarche to occur?
85-106 lbs
44
What type of cancer has an increased incidence in patients with PCOS?
Endometrial and considered to increase the risk of ovarian
45
Prostaglandins are contraindicated in patients with what obstetrical history? Why?
C section - due to potential uterine rupture
46
What are the management options for endometrial polyps?
Observation, medical management with progestin, curettage, surgical removal and hysterectomy
47
Patient presents with anorexia nervosa and amenorrhea. You suspect hypothalamic-pituitary dysfunction. What hormone should be evaluated to confirm the diagnosis?
FSH level - would expect to be very low
48
What is the diagnostic criteria for PCOS?
Two of the following three criteria: chronic anovulation, hyperandrogenism (clinical or biological), polycystic ovaries on US
49
What does partial deletions of the long arm of the X chromosome cause?
Premature ovarian failure
50
What is the therapeutic range of magnesium?
4-7 mEq/L
51
A mother with a h/o substance abuse delivers a limp unresponsive infant with HR >90 bmp and no respiratory effort. What is the most appropriate next step?
Give positive pressure ventilation and prepare to intubate the infant
52
Newborns of mothers with T1DM are usually what size? Blood sugar levels?
Smaller in size and worry about hypoglycemia
53
What are initial measures to treat fetal hypoperfusion?
Maternal position to left lateral position - increases perfusion to uterus; maternal supplemental oxygen, treatment of maternal hypotension, d/c oxytocin
54
When is amnioinfusion used?
Repetitive variable decelerations
55
Late decelerations are associated with what?
Uteroplacental insuff.
56
What age are DEXA scans recommended?
65 for women, sooner if have risk factors
57
Why can anorexia nervosa result in amenorrhea?
Hypothalamic-pituitary dysfunction - lack of normal pulsatile secretion of GnRH
58
What is the normal and predictable sequence of sexual maturation?
Breast budding (thelarche) then adrenarche (hair growth), a growth spurt and then menarche
59
What is the recommended rate of oxygen flow for an infant needing positive pressure ventilation?
10 L/minute
60
What is the treatment for bacterial vaginosis?
Metronidazole 500 mg orally BID x7 days or vaginal metronidazole 0.75% gel QHS x 5 days
61
What is the recommended daily dose of folate for pregnancy with a h/o neural tube defect?
4 mg
62
When is an amniocentesis performed?
After 15 weeks
63
What is the treatment for uncomplicated vulvovaginal candidiasis?
Topical azoles (1-3 days)
64
During what weeks of gestation is chorionic villus sampling done?
Weeks 10-12
65
What organism is the likely cause of mucopurulent cervicitis with exacerbation in the symptoms during and after menstruation?
Gonorrhea
66
Infants born to diabetic mothers have an increased risk of developing what?
Hypoglycemia, polycythemia, hyperbilirubinemia, hypocalcemia, and respiratory distress
67
Acanthosis nigricans is associated with increased blood levels of what?
Elevated androgen levels and hyperinsulinemia
68
At what magnesium level does cardiac arrest occur?
15 mEq/L
69
When is hemabate contraindicated?
Asthmatics
70
Patient presents with thin, gray discharge with a fishy odor that is often worse after menses or intercourse. What is the likely cause? What is seen on wet prep? Vaginal pH?
Bacterial vaginosis; clue cells; pH >4.5
71
What is the most likely complication a patient will experience after postpartum tubal ligation?
Future pregnancy - failure rate of 1%
72
Patient presents with hirsutism, why can testing 17-hydroxyprogesterone be useful?
Evaluation for late onset 21-hydroxylase
73
When trying to place an IUPC, frank vaginal blood and amniotic fluid are noted. What is the next step to management?
Monitor fetus - worried about placenta separation or uterine perforation
74
What is Kallmann syndrome?
Arcuate nucleus does not secrete GnRH and there is olfactory tract hypoplasia; no sense of smell and do not develop secondary sexual characteristics
75
When is a B-lynch suture used for postpartum hemorrhage?
Recalcitrant cases of PPH - needs to be laparoscopic.
76
What is the recommended daily dose of folate in a non-high risk pregnancy?
0.6 mg
77
What uterotonic agent is contraindicated in asthmatics?
Prostaglandin F2 alpha (Hemabate) - smooth muscle constrictor and brochio-constrictive effect
78
Placental insuff is associated with what type of decelerations?
Late
79
At what size is observation of a polyp not recommended?
If the polyp is >1.5 cm observation is not recommended
80
What screening test can be done in the first trimester for downs syndrome?
Combined test - beta hcg, PAPP-A and nuchal translucency.
81
What is the pathophysiology behind postpartum telogen effluvium?
High levels of estrogen during pregnancy increase synchrony of hair growth. Therefore, hair grows in the same phase and is shed at the same time
82
What uterotonic agent is contraindicated in patients with hypertension?
Methergine - ergot alkaloid
83
Patient presents with features of PCOS, what is a the next lab tests for evaluation?
Fasting insulin
84
What phase of the menstrual cycle is inhibin increased?
Luteal phase
85
At what age does breast development begin?
Age 10
86
Uterine hyperstimulation may produce what on FHT?
Prolonged fetal bradycardia
87
Why is testosterone elevated in patients with PCOS?
It is elevagted because sex hormone binding globulin is decreased by elevated androgens
88
What needs to be given in magnesium toxicity?
Calcium gluconate
89
What is the most appropriate treatment for PCOS?
OCPs
90
What position should the head be in for an infant needing positive pressure ventilation?
Sniffing position - tilting he neonate's head back and lifting the chin
91
What are the early skin changes seen with lichen sclerosis?
Polygonal ivory papules involving the vulva and perianal areas, waxy sheen on labia minora and clitoris
92
What is the loss rate of amniocentesis vs CVS?
Amniocentesis 0.5% vs CVS 1-3%
93
What is the MOA of medroxyprogesterone acetate for anovulatory bleeding?
Converts endometrium from proliferative to secretory endometrium
94
What are the risk factors for retained placenta?
Cesarean delivery, uterine leiomyomas, prior uterine curettage and succenturiate lobe of placenta
95
What age doe leiomyomas typically present?
30s and 40s
96
What urine protein levels are requires for the diagnosis of preeclampsia? Severe pre-elcampsia?
Preeclampsia = 300 mg; severe preeclampsia = 5000
97
Patient had an abortion and is now complaining of cyclic midline abdominal cramping pain. What is the likely diagnosis?
Hematometra
98
What complications might occur after suction and dilatation?
Anesthesia risk, bowel and bladder injury, cervical lacerations, and uterine perforations
99
What is the most common abnormal karyotype encountered in spontaneous abortions?
Autosomal trisomy
100
What systemic disease are associated with early pregnancy loss?
Diabetes mellitus, chronic renal disease and lupus
101
What is fetal fibronectin? How is it used?
Fetal fibronectin leaks into the vagin if a preterm delivery is likely to occur; +fFN is inconclusive but used as a negative predictor of preterm delivery
102
When should a cervical cerclage be done when a patient has an incompetent cervix?
14 weeks
103
Patient presents with recurrent (successive) first trimester losses. What tests should be performed?
Testing for lupus anticoagulant, diabetes mellitus and thyroid disease; can also obtain maternal and paternal karyotypes
104
What position is best for breast feeding?
Baby and mom belly to belly
105
What hospital policies promote breastfeeding?
Getting baby on breast within half hour of delivery and rooming-in for the baby to ensure frequent breastfeeding on demand
106
What hormone has an inhibitory influence on alpha-lactalbumin?
Progesterone; prolactin has a positive influence
107
How does candida of the nipple present?
Intense nipple pain
108
If mother has candida of the nipple, what else should you check for?
Check babies mouth
109
What are the signs that baby is getting enough milk?
3-4 stools in 24 hrs, 6 wet diapers in 24 hrs, weight gain and sounds of swallowing
110
What factors does fresh frozen plasma contain?
Fibrinogen, clotting factors V and VIII
111
What are the common presenting signs of placental abruption?
Abdominal pain, bleeding, uterine hypertonus and fetal distress
112
A patient presents with placental abruption and deteriorating fetal condition, what is the next best step?
Emergent cesarean delivery
113
Smoking increases the risk of what complications during pregnancy?
Placental abruption, placenta previa, fetal growth restriction, preeclampsia and infection
114
How does a cervical polyp appear on examination?
Bleeding and are typically soft (not hard)
115
What is the treatment protocol for pregnant women with HIV?
HAART therapy, IV zidovudine at time of delivery, zidovudine treatment for neonate, cesarean section prior to labor
116
What is the most common cause of sepsis in pregnancy?
Acute pyelonephritis
117
Why is radioactive iodine (I-131) contraindicated in pregnancy?
Concentrates in fetal thyroid and can cause congenital hypothyroidism
118
18 week pregnant woman presents with symptomatic mitral valve prolapse. What treatment should be used at this time?
Beta blockers; because she is symptomatic this should be treated
119
What is seen on hemoglobin electrophoresis in Beta thalassemia?
Hemoglobin F and hemoglobin A2
120
Women with obesity that are pregnant are at increased risk for developing what complications?
Chronic HTN, gestational DM, pre-E, fetal macrosomia
121
What SSRI is contraindicated in pregnancy? Why?
Paroxetine (Paxil); increased risk of fetal cardiac malformations and persistent pulmonary hypertension
122
What is pruritus gravidarum?
Pregnancy-related skin condition that is a mild variant of intrahepatic cholestasis of pregnancy; there is retention of bile salt which is deposited in the dermis which leads to pruritus
123
What is the treatment for gravidarum pruritus?
Antihistamines and topical emollients should be used initially; refractory cases ursodeoxycholic acid is helpful; naltrexone can also be used
124
Where is the appendix in pregnancy?
Enlarged uterus shifts the appendix upward and outward toward the flank (pain and tenderness may not be in RLQ)
125
What is the chance an Rh negative mom who refuses Rhogam will have isoimmunization if she gives birth to an Rh positive fetus?
2% antepartum, 7% after full term delivery and 7% with subsequent pregnancy; less than 20%
126
What test can be used to assess fetuses at risk for anemia?
Middle cerebral artery peak systolic velocity
127
Anti-D antibodies increase the risk of what complication for the fetus?
Hydrops fetalis - defined as fluid in two more more cavities
128
What amount of fetal blood is neutralized by 300 micrograms of rhogam?
30 cc of fetal blood is neutralized; this is equivalent to 15 cc of fetal red blood cells
129
When is Rhogam administered?
28 weeks gestation after testing for sensitization and given following amniocentesis, CVS, delivery, and abortion
130
What are Lewis antibodies?
IgM antibodies that do not cross the placenta
131
Amniotic fluid ferritin is associated with what?
Spontaneous preterm delivery
132
Patient's amniotic fluid stains yellow, what does this indicate?
Yellow is bilirubin; this is due to erythroblastotic fetus - severe hemolysis
133
Fetus at 30 weeks EGA has severe hemolytic disease (zone 3 of the Liley curve); what can be done to help the fetus at this time?
Intrauterine Intravascular transfusion
134
What ultrasound markers are suggestive of dizygotic twins?
Dividing membrane thickness greater than 2 mm, twin peak (lambda) sign, different fetal genders and two separate placentas (posterior and anterior)
135
What is the twin infant death rate in comparison to singletons?
Five times higher
136
What is the risk for development of cerebral palsy in twin infants vs singletons?
5-6x higher
137
Twin-twin transfusion most comonly occurs in what type of twins?
Monochorionic, diamniotic twins
138
The surviving twin of a twin-twin transfusion syndrome has increased rates of what?
Neurological morbidity - including cerebral palsy
139
The recipient twin in twin-twin transfusion can have what complications?
Cardiomegaly, tricuspid regurgitation, ventricular hypertrophy, plethoric
140
What are the reasons for elevated alpha fetoprotein?
Twins, neural tube defects, pilonidal cysts, cystic hygroma, sacrococcygeal teratoma, fetal abdominal wall defects and fetal death
141
What is the most common chromosomal aneuploidy in abortuses?
Trisomy 16
142
At what gestational age is the greatest fetal risk for developing neurological deficits when exposed to radiation?
8-25 weeks (8-15 weeks)
143
Uncontrolled diabetes during organogenesis is associated with what?
High rate of birth defects - most common are spine and heart
144
Advanced maternal age is associated with what pregnancy complications?
Stillbirth, preeclampsia, gestation DM, IUGR
145
What is the ultrasound criteria for a missed abortion?
CRL >7mm with no cardiac activity
146
What conditions are associated with breech presentation of a fetus?
Prematurity, multiple gestation, genetic disorders, polyhydramnios, hydrocephaly, anencephaly, placenta previa, uterine anomalies, uterine fibroids
147
Whta is the definition of prolonged latent phase?
>20 hours for nulliparous and >14 hours for multiparous
148
What is the typical presentation of cervical incompetence?
Usually diagnosed in early 2nd trimester and is associated with painless cervical dilation
149
Patient presents in preterm labor, what mediations are important for this patient?
Nifedipine - tocolytic; betamethasome - baby lungs; ampicillin (azithromycin + amoxicillin also)
150
By what MOA does Magnesium work as a tocolytic?
Competes with calcium entry into the cells
151
Indomethacin cannot be used as a tocolytic past what EGA?
32 weeks - premature closure of ductus arteriosus
152
What side effects does nifedipine have when used in pregnancy?
Fetal hypoxia and decreased uteroplacental blood flow
153
What is the statistical significant bullshit behind fetal fibronectin in a preterm labor lady?
Has a negative predictive value of 99.2% -- MEANING.... 99/100 with a negative test result will not deliver in the next 14 days. HAS NOTHING TO DO WITH SENSITIVITY.... Also it has a low PPV.
154
What complications can occur with a bacterial vaginosis infection?
PPROM
155
What are the levels of glucose and IL-6 in chorioamnionitis?
Glucose levels are low and IL-6 would be increased
156
What medication can reduce the risk of premature labor?
17 alpha hydroxyprogesterone (administered between 16-20 weeks until 36 weeks)
157
What is the treatment for postpartum endometritis?
Clindamycin + gentamicin
158
How is septic pelvic thrombophlebitis diagnosed?
Diagnosis of exclusion - characterized by high fever not responsive to antibiotics
159
What is the treatment for septic thrombophlebitis in postpartum?
Anticoagulation and antibiotics;
160
What is the most common cause of fever on the first postpartum day?
Lungs - especially if patient had general anesthesia
161
Clindamycin covers what type of organisms?
Anaerobic organisms apparently...
162
Patient is 24 weeks pregnant and starts treatment with fluoxetine (Prozac), what is the most common side effects?
Insomnia and sexual dysfunction
163
Mother wishes to breastfeed her baby but is concerned about taking sertraline while breastfeeding. How do you counsel her?
Tell her its fine. She can take SSRIs if she wants. Its fine.
164
What side effects does a neonate experience when a mother uses fluoxetine during pregnancy?
It has been associated with abnormal muscle movements (EPS) and withdrawal sxs (decreased muscle tone, tremor, sleepiness, severe difficulty breathing)
165
At what time of the menstrual cycle do PMS and PMDD begin?
Luteal phase (second half) - resolves shortly after the onset of menses
166
A patient is postterm, what diseases are associated with postterm pregnancies?
Placental sulfatase def, fetal adrenal hypoplasia, anencephaly, inaccurate or unknown dates
167
Late term and postterm pregnancies are associated with what complications?
Macrosomia, oligohydramnios, meconium aspiration, uteroplacental insufficiency and dysmaturity; also increased risk preeclampsia
168
What is a reasonable approach to repetitive variable decelerations?
Amnioinfusion
169
How does an infant with dysmaturity appear?
Withered, meconium stained, long-nailed, fragile and have associated small placenta
170
What is most commonly used for cervical ripening?
Prostaglandins applied locally (tablet)
171
An increased systolic/diastolic ratio of the umbilical artery reflects what?
Increased vascular resistance
172
Fetal growth restriction is a significant risk factor for developing what diseases as an adult?
COPD, type II DM, CVD, CHTN, stroke, obesity
173
What are the characteristics of a threatened abortion?
Vaginal bleeding, positive pregnancy, positive pregnancy test and cervical os closed or uneffaced
174
What is the management of septic abortion?
Broad spectrum antibiotics and uterine evacuation
175
17-hydroxyprogesterone is indicated when?
History of prior preterm birth
176
What is the treatment for antiphospholipid antibody syndrome in a patient that wants to become pregnant?
Heparin and aspirin
177
Prolonged diluted Russell viper venom time and 3 early pregnancy losses is suggestive of what?
Antiphospholipid antibody syndrome
178
What is mifepristone? Misoprostol?
Mifepristone - antiprogestin; misoprostol - prostaglandin
179
When can manual vacuum aspiration of a pregnancy be performed?
Less than eight weeks
180
What is the management for ovarian torsion?
Surgery
181
What is the first line treatment option for a woman with endometriosis trying to conceive?
Ovarian stimulation with clomiphene citrate
182
What can be used for pain relief in mastitis?
Acetaminophen and ibu
183
What is interstitial cystitis? What is the presenting complaint usually?
Chronic inflammatory condition of the bladder characterized by recurrent voiding symptoms of urgency and frequency; can also complain of pelvic pain and dyspareunia
184
What is the MOA of GnRH agonists in treatment of endometriosis?
Down-regulates hypothalamic-pituitary gland production and the release of LH and FSH leading to dramatic reduction in estradiol level
185
What is pelvic congestion syndrome?
Pelvic pain in the setting of pelvic varicosities
186
The iliohypogastric nerve provides cutaneous sensation to what?
The groin and skin overlying the pubis
187
The ilioinguinal nerve supplies sensation to what region?
Groin, symphysis, labium and upper inner thigh
188
What are the common complications of a LEEP procedure?
Infection, bleeding, cervical stenosis, persistent disease, possibility risk for preterm delivery
189
Hyperplastic overgrowth of endometrial glands/stroma is consistent with what disease?
Polyps
190
What effect can quetiapine have on fertility?
Can cause hyperprolactinemia, resulting in subfertility
191
What are the characteristic lab findings in exercise-induced hypothalamic amenorrhea?
Normal FSH with low estrogen levels
192
What lab test can be used to asses ovarian reserve?
Anti-mullerian hormone levels
193
What is a last resort treatment option for women with PMDD?
Bilateral oophorectomy
194
Prior to bilateral oophorectomy for patients with refractory PMDD, what treatment option can be done short-term to evaluate the success of the surgery?
Administer a course of GnRH agonist to initiate a menopause-like state
195
Who is at increased risk for molar pregnancies?
Asian women have a higher incidence, higher incidence in areas where people consume less beta-carotene and folic acid, increased risk in women with 2 or more miscarriages
196
What is the risk of recurrence for molar pregnancies?
1-2% which is a 20-fold increase from background risk; the risk of recurrence after two molar pregnancies is 10%
197
What is seen on ultrasound in a complete mole?
Snowstorm appearance; due to presence of multiple hydropic villi
198
What is the standard management for molar pregnancies?
Suction and curettage
199
What is the karyotype of a partial mole?
69XXY, 69XXX or 69XYY
200
What type of molar pregnancy shows marked villi swelling?
Partial moles
201
What needs to be done to evaluate a mass in the region of the Bartholin gland in a woman over the age of 40?
Should be biopsied; any finding of a new Bartholin gland cyst in a post-menopausal woman should be further investigated; worried about adenocarcinoma
202
What are the risk factors for vulvar cancer?
HPV expsoure, smoking, vulvar dystrophy (lichen sclerosis), immunocompromised
203
What are the follow-up guidelines for ASCUS?
Perform HPV DNA testing or repeat cytology in 12 months; if HPV testing was negative then routine screening can be resumed at 3 years; for women ages 21-24 with HPV positive - cytology should be repeated in 12 months
204
What is the major symptom associated with leiomyomas?
Heavy menstrual bleeding
205
What type of leiomyomas can cause infertility or miscarriages?
Submucosal (or intracavitary)
206
What are the risk factors for endometrial carcinoma? Which is the strongest risk factor?
Nulliparity, obesity, late menopause, HTN, exposure to unopposed estrogens, tamoxifen therapy, diabetes; obesity is the greatest risk factor
207
What is the recommended treatment to endometrial cancer?
TAH, BSO with pelvic and paraaortic lymphadenectomy
208
When is a theca lutein cyst usually seen?
Pregnancy (molar usually) and is often bilateral
209
What is a granulosa cell tumor?
An estrogen secreting tumor
210
What is the most common cause of postmenopausal bleeding?
Atrophy of the endometrium
211
A spiral fracture is indicative of what?
Abuse/violence associated with the Fx
212
What are the risk factors for ovarian cancer?
Nulliparity, family history, early menarche, late menopause, white race, increasing age, residence in north America or northern europe
213
How does a functional ovarian cyst appear on ultra sound?
As a simple cyst - unilocular simple cyst without evidence of blood, soft tissue elements or excrescences
214
How does a dermoid tumor appear on ultrasound?
Echogenic, may contain teeth, cartilage, bone, fat and hair
215
What type of ovarian tumor can produce estrogen and therefore cause endometrial hyperplasia/cancer?
Granulosa cell tumor
216
What is the most common subtype of ovarian tumors?
Epithelial tumors
217
Prognosis of ovarian cancer is based on what?
Tumor stage
218
What is the standard of care for advanced ovarian cancer?
Tumor debulk followed by post-operative chemotherapy with combination of taxane and platinum adjunct
219
What chemotherapeutic agents are used for ovarian cancers?
Taxane and platinum
220
What is the most common ovarian tumor found in women of all ages?
Dermoid
221
75 yo F presents with dyspareunia. Atrophic vaginal mucosa is noted on exam. What is a good treatment option for her?
Topical estrogen cream
222
How can a female help prevent vaginal atrophy?
By staying sexually active
223
What is the most important source of lubrication during intercourse for a female?
Transudate of the fluid across the vaginal mucosa
224
What prescriptions should be offered to a rape victim?
Ceftriaxone, doxycycline, and anti-retrovirals; emergency contraception if desired
225
What is peripartum cardiomyopathy? What are the presenting s/sx?
Heart failure secondary to left ventricular systolic function; fatigue, SOB, palpitations and edema
226
What does peripartum cardiomyopathy usually present?
Towards the end of pregnancy or in the several months following delivery
227
Why is there a compensated respiratory alkalosis during pregnancy?
Pregnancy increases minute ventilation - blow off more CO2, excrete by HCO3
228
What happens to the inspiratory capacity during pregnancy?
It increases by 15% due to increases in TV and IRV
229
How is the minute ventilation increased in pregnancy?
Increase in tidal volume, no change in RR
230
What happens to the functional residual capacity in pregnancy?
Reduced to 80% of non-pregnant volume
231
What ureter and renal pelvis becomes more dilated in pregnancy? Why?
R>L; the left is cushioned by the sigmoid colon
232
What is the recommended weight gain in pregnancy for a woman with a pre-pregnancy BMI of <18.5?
28-40 lbs
233
What is the recommended weight gain in pregnancy for a woman with a pre-pregnancy BMI of 18.5-24.9?
25-35 lbs
234
What is the recommended weight gain in pregnancy for a woman with a pre-pregnancy BMI of 25-29.9?
15-25 lbs
235
What is the recommended weight gain in pregnancy for a woman with a pre-pregnancy BMI of >30?
11-20 lbs
236
Beta thalassemia anemia is seen in populations from what region?
Mediterranean
237
In chorionic villus sampling, what region of the chorion is the sampling done from?
Chorionic frondosum
238
What is the most common cause of inherited mental retardation?
Fragile X syndrome
239
Women with poorly controlled diabetes prior to conception have an increased risk for having a fetus with what structural anomalies?
Lesions of the CNS (neural tube defects) and the cardiovascular system
240
What is the risk of fetal loss with CVS?
1%
241
Prior history of ectopic pregnancy increases the risk of ectopic pregnancy by how much?
10 fold
242
Age between 35-44 increases the risk of ectopic pregnancy by how much?
3 fold
243
What progesterone level suggests a healthy pregnancy?
Progesterone >25 ng/ml
244
What criteria must be met for use of methotrexate?
Hemodynamically stable, non-ruptured ectopic pregnancy, size of ectopic mass <4 cm without a fetal heart rate or <3.5 cm in the presence of fetal hear rate, normal liver enzymes and renal function, normal white cell count, reliable to follow up
245
What should be rule out and documented prior to starting HRT for menopause?
R/o endometrial hyperplasia/cancer; normal endometrial bx or US with endometrial stripe < or equal to 4 mm
246
How often should bone mineral density testing be done in a patient with an osteoporotic fracture?
Repeated every two years
247
HRT increases the risk for what cancer? And decreases the risk of what other cancer?
HRT increases the risk for breast cancer but decreases the risk for colon cancer
248
HRT has what effect on lipid levels?
Increases HDL and decreases LDL
249
What race increases the risk for osteoporotic fracture?
White/Asian
250
What is the size and blood sugar levels of neonates of a type 1 diabetic with moderately controlled sugars during pregnancy?
Small and watch for hypoglycemia
251
Infants born to diabetic mothers are at increased risk for what?
Hypoglycemia, polycythemia, hyperbilirubinemia, hypocalcemia, and respiratory distress
252
What is overflow incontinence?
Failure to empty the bladder adequately - due to underactive detrusor muscle
253
What is a normal post-void residual? What is considered elevated?
Normal is 50-60 cc; elevated is >300 cc
254
Family history of pelvic organ prolapse increases the risk of POP by how much?
2.5 fold increase
255
How is urethral hypermobility genuine stress incontinence diagnosed?
Straining Q-tip angle >30 degrees for horizontal
256
What is the best surgical treatment option for genuine stress incontinence?
Retropubic urethropexy
257
What is the best surgical treatment option for intrinsic sphincter deficiency?
Urethral bulking procedures
258
What neurotransmitter stimulates the bladder to contract?
Ach through muscarinic receptors
259
How is vaginal vault prolapse treated?
Supporting the vaginal cuff to the uterosacral or sacrospinous ligaments or by sacrocolpopexy
260
How are central and lateral cystoceles repaired?
Repaired by fixing defects in the pubocervical fascia or reattaching it to the sidewall if separated from the white line (arcus tendineus fascia)
261
How are rectoceles repaired?
Repairing defects in the rectovaginal fascia
262
What is the cause of urge incontinence?
Overactivity of the detrusor muscle
263
What is Sheehan syndrome?
Patient experiences significant blood loss (eg PPH) resulting in anterior pituitary necrosis
264
What factors are related to increased rates of infection with a vaginal birth?
Prolonged labor, prolonged ROM, multiple vaginal examinations, internal fetal monitoring, removal of the placenta manually and low SES
265
What is the most common cause of postpartum fever?
Endometritis; DDx includes UTI, lower genital tract infection, wound infections, pulmonary infection, thrombophlebitis, and mastitis
266
What bacteria are responsible for endometritis?
Bacterial isolates related to postpartum endometritis are usually polymicrobial resulting in a mix of aerobes and anaerobes in the genital tract. The most causative agents are Staphylococcus aureus and Streptococcus.
267
What is the safest method to suppress lactation?
Breast binding, ice packs and analgesics
268
Why are prostaglandins inhibited for cervical ripening in a patient with a prior cesarean section?
Risk of uterine rupture
269
What is the first initial step for fetal stimulation?
Digital scalp stimulation with the goal to elicit acceleration of 15x15
270
Fetal head with measurements great than what diameter would benefit from a cesarean?
Diameter >12cm
271
When is a patient a candidate for prophylactic cerclage?
Cervical insuff. - painless cervical dilation before 24 weeks with expulsion of pregnancy in second trimester, in absence of labor or other clear pathology such as infection or ROM
272
What is the MOA of medroxyprogesterone acetate?
Inhibits endometrial growth converting the proliferative to secretory endometrium
273
A polyp of what size or greater is an indication for polypectomy in a woman trying to conceive.
Polyp >1.5 cm in a woman with infertility a polypectomy is a treatment of choice
274
Which non-invasive test can detect severe fetal anemia?
Doppler study of middle cerebral artery peak systolic velocity
275
What about of fetal blood is neutralized by a dose of 300 micrograms of rhogam?
30 cc of fetal blood = 15 cc of fetal RBCs
276
What is the definition of prolonged latent phase labor?
>20 hours for nullips; >14 hours for multips
277
What is the most common type of breech presentation?
Frank breech - buttocks is presenting part
278
What is the most common cause of preterm labor?
Idiopathic
279
What tocolytics are contraindicated in diabetic patients?
Terbutaline and ritodrine
280
What tocolytic is contraindicated in myasthenia gravis?
Mag
281
What treatment option is first line for a woman presenting with infertility secondary to endometriosis?
Ovarian stimulation with clomiphene citrate
282
Preterm rupture of membranes is especially associated with what genital tract infection?
Bacterial vaginosis
283
What findings are seen on amniocentesis in triple I?
Chorioamnionitis - increased IL-6, low glucose, leukocytes
