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Flashcards in UWorld 1 Deck (99)
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1

35 yo F evaluated for fixed palpated breast mass s/p b/l reduction mammoplasty for mammary hyperplasia 2 yrs ago
-mammo shows spiculated 3x3 mass w/ calcifications
-US: hyperechoic mass
-Core biopsy: foamy macrophages and fat globules

(a) Dx
(b) Tx

(a) Fat necrosis = benign
-associated w/ prior breast surgery: reduction/reconstruction
-give away is the biopsy

(b) Tx = reassurance and f/u

2

Tx of uterine atony

First: bimanual massage and oxytocin

Then uterotonic meds
-methylergonovine (if no h/o HTN) b/c vasoconstricts
-carbopost (if no h/o asthma)
-misoprostol

3

Normal pH of vaginal secretions

3.8-4.5

4

Congenital rubella syndrome triad

Deafness, cataracts, cardiac defect = congenital rubella

5

When to give bethamethasone

Immature fetus can benefit from bethamethasone if given btwn 24-34 weeks
-also takes 24-48 hrs to take full effect => wouldn't give to fetus that is urgently getting delivered

6

How finding of malignant features changes workup of an ovarian cyst

Changes workup if CA-125 is not elevated, if CA-125 is elevated you automatically do CT scan or met disease exploratory surgery anyway

CA-125 not elevated, if don't have any malignant features, can observe w/ serial CA-125 and US

7

Mammary Paget disease

Mammary Paget disease = painful, ithcy, eczematous +/- ulcerating rash on nipple that spreads to areola

-85% have underlying malignancy (adenocarcinoma)

8

How to differenate fat necrosis vs. breast cancer

Need biopsy

Fat necrosis- will see fat globules and foamy histiocytes (macrophages).

9

25 yo nulligravid p/w pelvic and lower sacral back pain x1 yr, intensifies before menstruation
-unimproved w/ ibuprophen/OCPs
-PE: fornix tenderness, decreased uterine motility, thickening of uterosacral lig

Dx and Mgmt

Dx = endometriosis- chronic pelvic pain

Next step = laproscopy = direct visualization, biopsy, and removal of endometrial lesions
-indicated when conservative tx (NSAIDs/OCPs) fail

10

Contraindications to breast feeding

Active Tb, maternal HIV, herpetic lesions, varicella less than 5 days before or 2 days after delivery
-chemo/radiation
-active substance use (EtOH, drugs)**

-NOT HEP C

11

Describe the 5 parts of the BPP

1. NST
2. Amniotic fluid volume
3. Fetal breathing movement
4. fetal movement
5. fetal tone

BPP: get 2 pts for each, 2 accels
(2) Amniotic fluid volume- single fluid pocket > 2x1cm or amniotic fluid index over 5
(3) 1+ breathing episode for 30+ seconds
(4) 3+ general body movements
(5) 1+ episodes of flexion/extension of fetal limbs or spine

12

Fetal US shows anterior placenta covering the cervical os and amniotic fluid index under 1.5 with single fluid pocket of 1.5x1cm
-4 episodes of fetal mov't
-2 extension/flexion events
-nonreactive NST
-no fetal breathing

Calculate the BPP

BPP:
(1) 0 pts for nonreactive NST
(2) Oligohydramnios- want amniotic fluid index over 5 => 0 for amniotic fluid volume
(3) no breathing episodes => 0 for breathing episode (want 1+ for 30+ seconds)
(4) 2 pts for 3+ general body movements
(5) 2 pts for 1+ flexion/extension

= 4/10 = indicates fetal hypoxia 2/2 placental dysfunction/insufficiency

13

34 yo F at 32 weeks gestation p/w intense itching especially on soles of feet
-negative hepatitis panel
-elevated total bile acids, AST/ALT, D. bili

Dx

Intrahepatic cholestasis of pregnancy = functional d/o of bile formation
-presents w/ intense pruritis, 10% present w/ jaundice
-dx of exclusion

14

Clomiphene citrate

(a) Mechanism
(b) Indication

SERM = selective estrogen receptor modulator prescribed to induce ovulation
-pro-fertility agent to reverse anovaulation (ex: PCOS) or oligoovulation

Acts as estrogen analog to increase GnRH (and therefore FSH) release to stimulate ovulation

15

Presentation of HELLP syndrome

HELLP = Hemolytic anemia w/ Elevated Liver enzymes and Low Plts

-preeclampsia, nausea/vom, RUQ pain

16

Describe 3 changes in the BMP seen in pregnancy

1. Decreased BUN
2. Decrease creatinine
^both 2/2 increased GRD

3. Mild hyponatremia 2/2 increase in ADH release

17

Triad of congenital toxo

Chorioretinitis, hydrocephalus, intracranial calcifications

-big give away is intracranial calcifications = toxo

18

When is GBS testing performed

Test results are valid for about 5 weeks => perform at 35-37 weeks

-purpose is to identify mothers who need ppx abx to prevent transmission

19

Signs of IUFD

Signs of intrauterine fetal demise (death of fetus after 20 weeks)
-disappearance of fetal movement
-decrease or stagnation in uterine size
-fetal heart sounds no longer present

Not beta-hCG decline- b/c remains elevated as placenta is still in tact

20

Timeline for giving RhoGAM

Up to 72 hrs after delivery
-so if it's an emergency and mother starts bleeding you can wait and deal w/ other stuff first

21

RF for vasa previa

Placenta previa in 2nd T that resolves in the 3rd- b/c possibly leaves vessels over the internal cervical os

Recall: vasa previa = fetal vessels transverse the membranes over the internal cervical os

22

Presenation of vasa previa

Painless vaginal bleeding w/ ROM
+
Fetal deterioration: sinusoidal waveform or bradycardia

23

Differentiate fibrocystic changes and fibroadenoma

Both are cyclic changes in breast tissue causing premenstrual tenderness

Fibrocystic changes = multiple diffuse nodulocystic masses
Firboadenoma = solitary nodule

24

Why do we screen for bacturia in pregnant ladies?

(a) When is the screening?

B/c pregnant F are more likely to have asymptomatic bacturia which can => cystitis, low fetal birth weight, pyelo, preterm birth, increased perinatal mortality

(a) Screen w/ clean-catch UA at 12-16 wks

25

How to prevent vertical transmission of HIV

Maternal combination (triple drug) tx + neonatal Zidovudine reduces perineal HIV transmission to under 1%

26

First step to work up a nonreactive fetal stress test

First thing is to let the test go on longer, test is only 20 minutes but fetal sleep cycle can be up to 40 mins => extend test to 40-120 minutes to ensure fetus is not sleepping

27

Most common symptom of neisseria gonorrhoeae

Usually asymptomatic (over 50%), if symptoms = cervicitis
-mucopurulent discharge w/ friable and easily bleeding cervix

28

What a BPP of 2/10 tells you

BPP tells you about the FUNCTION of the placenta (not location)

BPP under 4/10 indicates fetal hypoxia 2/2 placental insufficiency/dysfunction

29

Explain why pregnancy is a prothrombic state

-decrease protein S activity
-increase in fibrinogen and cogulation factors

30

Describe management if pt presents at 37 and 5/7 w/ vaginal spotting
-on exam visualize placental tissue over the internal cervical os

Dx = placenta previa

Mgmt = C-section, vaginal delivery would require placenta to be delivered before the fetus => deprive fetus of O2

-first step would NOT be rhogam, you can give that later!