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Flashcards in UWorld 2 Deck (112)
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1

28 yo G2P1 at 37 wks p/w hypotension and tachycardia
-h/o C-sxn
-PE: palpable, irregular protuberance in lower abdomen and moderate vaginal bleeding
-FHT: late decels

Rupture uterus
-increased risk given h/o C-sxn
-palpable fetal part
-late decels indicating uteroplacental insufficiency (b/c uterus is ruptured...)

2

Mechanism of acute postpartum urinary retention

Bladder atony 2/2 a decrease in detrusor tone

3

Screening test for ovarian cancer

There is none...
-so if person wants to be screened (concerned b/c friend has it etc) there is no good option

4

Best diagnostic test for primary syphilis

Dark field microscopy showing spirochetes

At the time of primary syphilis- often too early, antibodies aren't made yet => RPR would give false negative

5

Differentiate the etiologies of symmetric vs. asymmetric fetal growth restriction

Symmetric (both head and body affected): 2/2 fetal factors
-chromosomal abnormalities
-early maternal infection (causing congenital infxns)

Asymmetric (only body affected, head intact), 2/2 fetal adaptation to suboptimal maternal factors
-'head sparing' fetal growth restriction
-maternal HTN, DM, preeclampsia, smoking

6

78 yo w/ h/o Alzheimer's p/w urinary incontinence x1 week
-less active
-afebrile

Next best step

UA and Cx-

UTI is a very common cause of acute urinary incontinence in the elderly

7

Clinical features of newborn clavicular fracture

Crepitus over the clavicle/palpable bony irregularity
-complication of macroscomia

8

36 yo F p/w lump in right breast found on self exam
-no other symptoms
-1 cm firm, round mass in UOQ of right breast w/ no palpable LN

Next step?

Palpable breast mass, next step depends on age
Over 30: mammogram is first step
Under 30: Ultrasound in first step

So first use mammorgam (pt is 36) to further locate/characterize lump

9

45 yo G5P5 p/w involuntary loss of urine x5mo while jogging
-loses small amoung after coughing
-normal UA and low post-risidual volume

(a) Dx
(b) Mechanism

(a) Stress incontinence
(b) Urethral hypermobility

10

Define tachysystole

Tachysystole = abnormally frequent contractions defined as more than 5 contractions in 10 minutes averaged over 30 minutes

11

Main clinical feature of Sheehan syndrome

Sheehan syndrome = postpartum hypopituitarism 2/2 pituitary necrosis from hypovolemic shock/bloodloss after childbirth

Presents w/ lactation failure w/ hypotension and anorexia (2/2 adrenal insufficiency)

12

Clinical presentation of placental abruption

Biggest one = sudden-onset vaginal bleeding
-abdominal or back pain
-high-frequency (really close together), low-intensity contractions
ex: contractions q2 minutes
-hypertonic, tender uterus

Diagnosed primarily by clinical presentation, then can use US to r/o placenta previa

13

Mechanism by which urinary incontinence risk increases in post-menopausal women

Estrogen deficiency

Hypoestrogenemia => atrophy of urethral mucosal epithelium and diminished urethral closure pressure => urinary frequency, urgency, UTI, incontinence

Tx = low-dose vaginal estrogen

14

23 yo F presents for infertility, irregular periods for past 2 yrs
-intense exerciser, lots of stress at work, BMI 18, negative pregnancy test
-labs: low FSH/LH, normal prolactin/TSH

(a) Dx
(b) Tx

(a) Hypogonadotropic hypogonadism
-problem is at the level of the hypothalamus not secreting proper GnRH

(b) Tx = pulsatile GnRH

15

Purpose if fetal fibronectin screening

Screening test for preterm labor-
-Best for negative predictive value (sensitive not specific): good predictor of spontaneous preterm labor before cervical dilation

-done as vaginal swab (preferably before manipulation by vaginal exam)

16

43 yo G6P5 at 39 wks w/ brief TC seizure
-BP 80/40, HR 110/min, RR 30, O2 75% on facemask
-PE: purpuric rash and bleeding from IV site

Dx
Mgmt

Respiratory failure 2/2 amniotic fluid embolism
-hypoxemia => seizures

Mgmt = intubation and mechanical ventilation

17

Common causes of fetal tachycardia

Maternal fever (ex: chorio)
Maternal hyperthyroid
Medication use (ex: terbutaline- tocolytic)
Placental aburption

18

Pt w/ hyperemesis gravidarum has pelvic US: enlarged ovaries w/ multilocular cystic appearance

Dx

Molar pregnancy
-b/l ovarian enlargement 2/2 hyperstimulation and ovarian cyst formation (theca lutein cysts)
-even more elevated beta-hCG puts these pts at higher risk for hyperemesis

19

When is external cephalic version performed

External cephalic version = convert breech into vertex for delivery
-performed btwn 37 weeks and onset of labor
-not before 37 wks: breech before can just move/convert to vertex

20

Thyroid hormone production during pregnancy

T4/T3/TSH

During pregnancy- total T4 is 1.5x greater than pre-pregnancy state, free T4 and T3 moderately increased
-slightly decreased TSH production b/c higher T3/T4 suppresses the TSH

beta-hCG stimulates thyroid hormone production, estrogen does increase TBG production but net effect is increase in T4

21

39 yo G4P0030 at 35 wks p/w intense constant lower abdominal pain
-h/o fibroids, s/p abdominal myomectomy where uterine cavity entered
-cervical dilation of 4cm, contractions q2-3 min
-FHR: persistent variable decels to the 90s

Next best step

Laparotomy and delivery
-aka C-section

Abdominal myomectomy- if uteirne cavity is entered then trial of labor is contraindicated 2/2 risk of uterine rupture
(if uterine cavity not entered you can do trial)

22

Cause of infertility:

37 yo w/ regular 28 day cycles, no other GU complaints
-no h/o STIs
-previous child w/ husband at age 31
-aeorbics instructor, normal vital

Decreased ovarian reserve

-significant drop in oocytes in 4th decade, one in 5 women are infertile btwn 35-39

23

What is hyperemesis gravidarum?

Such excessive/severe nausea/vomiting in pregnancy that it results in wt loss and dehydration

24

Causes of hypogonadotropic hypogonadism

Hypogonadotropic hypogonadism causes infertility 2/2 hypothalamic dysfunction: insufficient GnRH pulses from hypothalamus causes insufficient LH/FSH production

Causes: severe life stressors, eating d/o, excessive exercise
-anorexia
-marathon runners

25

2 maternal complications of abruptio placentae

2 maternal complications of placental abruption
-DIC
-hypovolemic shock

Increased risk w/ larger detachment

26

Which is a worse risk factor for osteoporosis: obesity or excessive EtOH

Ok so adipose tissue actually is protective from osteoporosis- inherent increase in wt bearing and adipose tissue acts as endogenous source of excess estrogen

27

2 hr old boy w/ minimal right arm movement after vacuum-assisted vaginal delivery at 37 wks gestation c/b shoulder dystocia
-birth wt 9 lbs
-RUE: adduction and internal rotation w/ elbow extended
-absent moro and biceps reflexes

Next step

Reassurance about prognosis

2/2 Erb-Duchenne palsy (brachail plexus injury to C5-7) => 'waiter's tip posture'
-up to 80% have spontaneous recovery
-surgical intervention only if no improvement by 3-6 mo

28

Function of MgSO4 when not used for seizure ppx

Give MgSO4 in under 32 weeks gestation when anticipating preterm birth for fetal neuroprotection, specifically CP (cerebral palsy)

29

28 yo G1P0 at 35 wks p/w N/V/epigastric and RUQ pain
-gestation HTN, BP 160/94, 2+ edema, 3+ protein on UA
-elevated AST/ALT, PT/PTT

(a) Dx
(b) Pathophys

(a) HELLP = hemolysis and elevated liver enzymes w/ low platelets
-complication/subtype of severe preclampsia

(b) Systemic inflammation and platelet consumption
-platets rapidly consumed and microangiopathic hemolytic anemia causes hepatocellular necrosis

30

Tx for urinary incontinence

(a) stress
(b) Urge
(c) Overflow

Treatment for urinary incontinence

(a) stress: kegels and urethral sling surgery
(b) Urge (sudden overwhelming need to empty bladder) tx w/ antimuscarinic
(c) tx overflow w/ cholinergic agents
-last line catheterization