uWise Facts

Question 1

Contraindications to expectant management of Pre-E w/SF

Answer 1

• All deliver @ 34 weeks at latest
• contraindications to expectant management prior to 34 weeks
  
  • thrombocytopenia
  • pulmonary edema
  • renal failure
  • abruption- placentae
  • disseminated intravascular coagulation
  • persistent cerebral symptoms
  • non-reassuring fetal testing
  • fetal demise.

Question 2

• Dx?
• hirsutism, irregular menses and obesity
• patient’s hirsutism has worsened
• depressed
• She has also gained 20 pounds in the past two months and has noticed purple stretch marks
• terminal hair growth on her chin and hair growth on the back of her hands.
• Her cheeks appear flushed

Answer 2

Cushing’s syndrome likely

Question 3

Contraindications to using a patch

Answer 3

weight > 198 lbs

Question 4

Weight necc. for menses to begin

Answer 4

85 to 106 poinds

Question 5

Inpatient tx of PID

Answer 5

• options parenteral antibiotics covering both gonorrhea and chlamydia
  
  • Cefotetan or cefoxitin PLUS doxycycline
  • clindamycin PLUS gentamicin

Question 6

Outpatient tx of GC/CT

Answer 6

• For outpatient treatment, the 2010 CDC guidelines recommend:
  
  • ceftriaxone, cefoxitin, or other third-generation cephalosporin (such as ceftizoxime or cefotaxime)
  • PLUS doxycycline
  • WITH or WITHOUT metronidazole.

Question 7

Criteria for PMDD

Answer 7

• PMDD is a psychiatric diagnosis, describing a severe form of premenstrual syndrome
• diagnostic criteria include five out of 11 clearly defined symptoms, functional impairment
• prospective charting of symptoms present during the last week of the luteal phase that begin to resolve with the beginning of the follicular phase
• All three areas of symptoms need to be represented for the diagnosis of PMDD.

Question 8

Menstrual cycle overview

Answer 8

• Days 0-14 = follicular phase
• Days 14-28 = luteal phase

Question 9

Tx of mastitis

Answer 9

• anti-staphylcoccal agent
• Dicloxacillin is used due to the large prevalence of penicillin resistant staphylococci
• Erythromycin may be used in penicillin allergic patients.
• Doxycycline, gentamicin, and cefotetan are not appropriate antibiotics for treatment of mastitis.

Question 10

Source of estrogen in postmenopausal women

Answer 10

• Estrogen production by the ovaries does not continue beyond menopause.
• estrogen levels in postmenopausal women can be significant due to the extraglandular conversion of androstenedione and testosterone to estrogen
• This conversion occurs in peripheral fat cells and, thus, body weight has been directly correlated with circulating levels of estrone and estradiol.
• Since menopausal ovaries are known to continue production of androgens, surgical removal of postmenopausal ovaries may result in the resurgence of menopausal symptoms from the abrupt drop in circulating androgens.

Question 11

Characteristifs of Postpartum telogen effluvium (hair loss)

Answer 11

• affects 40-50% of women postpartum
• High estrogen levels in pregnancy increase the synchrony of hair growth (hair growth normally asynchronous)
• ==> hair grows in the same phase and is shed at the same time.
• ==> significant postpartum hair loss at 1 to 5 months postpartum

Question 12

Tx of urge incontinence

Answer 12

• urge incontinence = detrusor instability
• acetylcholine is the transmitter that stimulates the bladder to contract through muscarinic receptors
• Thus, anticholinergics are the mainstay of pharmacologic treatment
• Oxybutynin is one example

Question 13

Control of prolactin production

Answer 13

• inhibited by dopamine
  
  • dopamine antagonists ==> elevated prolactin
    
    • antipsychotics, TCAs, MAOIs
• stimulated by TRH and serotonin
• hypothalamic and pituitary tumors ==> increased prolactin

Question 14

Cervical mucuous at various phases of menstrual cycle

Answer 14

• early follicular phase (just after menstruation) = thick, scant, acidic
• ovulatory phase = clear and thin
  
  • stetches (to 6cm)
  • more basic than other phases; pH>6.5
• mid-late luteal phase =
  
  • ovulation already occured
  • thicker, less stretching ability
  • inhospitable to sperm

Question 15

Paget’s disease of breast associated with…

Answer 15

adenocarcinoma of the breast

Question 16

Management of preterm labor

Answer 16

1. tocolytics x 48 hours
   
   1. to allow effects of steroids ==> increased fetal lung maturity and decreased interventricular hemorrhage
2. steroids (betamethasone) < 34 weeks
3. Mg-sulfate < 32 weeks
   
   1. for fetal neuroprotection
4. Indomethicin < 32 weeks
5. ABX - penicillin
   
   1. GBS prophylaxis

Question 17

Management of PROM (premature ROM)

Answer 17

• overall goal = prolong pregnancy

1. sterile speculum exam
   
   1. confirm ROM
   2. est. cervical dilation
2. r/o labor
3. r/o infection
4. Tx:
   
   1. Amoxicillin + Erythromycin
   2. minimize digital cervical exams
   3. admit and monitor for labor (?)

Question 18

Indications for C/S

Answer 18

1. Arrest of labor (maternal)
2. Non-reassuring FHTs
3. Malpresentation
4. Placenta previa ==> schedule C/S @ 37
5. Vasa previa ==> schedule C/S @ 37

Question 19

First & Second line antihypertensives in pregnancy

Answer 19

• first-line
  
  • methyldopa
  • beta-block (labetalol)
  • hydralazine
  • Ca-channel blockers
• second-line
  
  • thiazide diuretics
  • clonidine

Question 20

Anti-hypertensives contraindicated in preganacy

Answer 20

• ACE-i/ARBs
• aldosterone blockers
• direct renin inhibitors
• Furosemide

Question 21

Second trimester quad screen interpretations

Answer 21

• Trisomy 18
  
  • aFP = low
  • B-hCG = low
  • estriol = low
  • inhibin = normal
• Trisomy 21
  
  • aFP = low
  • B-hCG = high
  • estriol = low
  • inhibin = low
• NTD/abd wall defect
  
  • aFP = high
  • all others normal

Question 22

Causes of asymmetric fetal growth restriction

Answer 22

• generally, maternal factors ==> asymmetric
  
  • vascular dz (hypertension, pre-e)
  • antiphospholipid ab
  • autoimmune dz
  • cyanotic cardiac dz
  • substance abuse (tobacco, alcohol, cocaine)

Question 23

Causes of symmetric fetal growth restriction

Answer 23

• generally, fetal factors:
  
  • genetic disorder (aneuploidy)
  • congenital heart dz
  • intrauterine infection
    
    • malaria, CMV, toxo, varicella, rubella

Question 24

AUB approach in older women/approaching menopause

Answer 24

• ==> endometrial biopsy to rule out endometrial carcinoma
• hyperplasia w/out atypia ==> progestin therapy
• hyperplasia w/atypia
  
  • considering future pregnancy ==> progestin therapy
  • no plans for future preg/fail of medical ==> hysterectomy

Question 25

Benefits and risks of combined estrogen-progesterone birth control

Answer 25

* benefits * preg. prevent * decreased endometrial and ovarian cancer * menstrual regulation * less benign breast disease * risks * venous thromboembolism * HTN * hepatic adenoma * rarely ==\> stroke and MI

Question 26

Thyroid changes in pregnancy

Answer 26

* Total T4 ++ (1.5x pre-preg) * B-hCG stimulates thyroid * increased TBG binds extra T4 ==\> * significant increase in total T4 * slight increase in free T4 * Free T4 + * TSH - * increased B-hCG and T4 suppresses TSH

Question 27

DDx of hyperandrogenism in females

Answer 27

* PCOS * nonclassic CAH = oligo-ovulation, hyperandrogenemia, increased 17-OH-progesterone * ovarian/adrenal tumors * older, rapid sx, increased androgens * hyperprolactinemia * cushing's * cushing's features, nonsuppressible dexamethasone, increased 24 hour urine cortisol * acromegaly * excessive growth, elevated GH and IGF-1

Question 28

Contraindications to breastfeeding

Answer 28

* active untreated TB * maternal HIV infection * herpetic breast lesions * varicella infection \<5 days before or 2 days after delivery * chemotherapy or ongoing radiation therapy * active abuse of alcohol or drugs

Question 29

Vaginismus presentation and tx

Answer 29

* vaginismus = pain with sex, related to penetration; tensing upon entry * tx = kegel exercises and gradual dilation

Question 30

Congenital anomalies associated with valproic acid

Answer 30

* NTDs * ASD (cardiac) * cleft palate * hypospadias * polydactyly * craniosynostosis

Question 31

Signs of fetal Rh disease on US

Answer 31

* Fetal hydrops * develops in the presence of decreased hepatic protein production ==\> collection of fluid in two or more body cavities, such as ascites, pericardial and/or pleural fluid and scalp edema. * On occasion, when extramedullary hematopoiesis is extensive, there will be evidence of hepatosplenomegaly. * Placentomegaly (placental edema) and polyhydramnios are also seen on ultrasound

Question 32

Management of patients with IUFD and DIC risk

Answer 32

* induction of labor * cesearan section not indicated as can lead to complications

Question 33

Acid-base disorder causes in first trimester

Answer 33

* hyperemesis gravidum ==\> metabolic alkalosis * pH \> 7.45 * HCO3 high (\> 28) * physiologic changes (over course of pregnancy) ==\> respiratory alkalosis * pH \> 7.45 * pCO2 low (\< 35)