UWorld 2 Flashcards
(33 cards)
Levonorgestrel intrauterine device (IUD) vs copper IUD
- highly efficacious, long-acting, reversible contraception that works by thickening cervical mucus and impairing implantation
- progestin-containing IUDs have added benefit of amenorrhea and minimal systemic side effects
—vs—
copper:
- long -lasting reversible use for up to ten years
- can cause heavy menstrual bleeding and shouldn’t be placed in women with hypermenorrhea or anemia
PID
- lower abdo pain, abnml bleeding
- cervical motion tenderness, fever, mucopurulent cervical d/c
- third gen ceph and azithro or doxy
- complications: tubo-ovarian abscess, infertility, ectopic pregnancy, perihepatitis
Leiomyomata
- can cause irregularly enlarged uterus and size-date discrepancy d/r pregnancy
- subserosal and pedunculated uterine leiomyomata can cause bulk-related s/s (pelvic pressure, sensation of incomplete voiding)
eclampsia=severe pre eclampsia plus seizures
- most common cause on new-onset seizures in pregnant patients with HTN
- associated with proteinuria and signs of CNS dysfunction (HA, vision changes), RUQ or epigastric pain, tonic-clonic sz (self-limited)
hyperemesis gravidum
- significant volume depletion
- loss of gastric acid
- leading to primary metabolic alkalosis (vs diarrhea metabolic acidosis)
most common causes of hyperandrogenism in pregnancy
- luteomas and theca luteum cysts
- luteomas: appear as solid masses on US, can induce virilization in female fetuses, no maternal tx warranted
- theca guys: unlikely to cause virilization in female offspring, suction curettage indicated if underlying cause is molar pregnancy
three liver disorder unique to pregnancy
- intrahepatic cholestasis of pregnancy (ICP)
- HELLP
- AFLP: acute fatty liver of pregnancy
ICP intrahepatic cholestasis of pregnancy
cp: intense pruritus
labsL elevated bile acids, elevated AFT, diagnosis of exclusion
HELLP
cp: pre eclampsia, RUQ pain, n/v
labsL hemolysis, moderately elevated liver aminotransferases, thrombocytopenia
AFLP-acute fatty liver of pregnancy
cp: malaise, RUQ pain, n/v, sequelae of liver failure
labs: hypoglycemia, mildly elevated liver aminotransferases, elevated bilirubin, possible DIC
submucous fibroids
- arise from myometrium immediately under endometrial lining and protrude into the uterine cavity
- commonly cause heavy and prolonged menstrual bleeding and can prolaps through the cervical os presenting with a typical labor-like pain d/t cervical distension by the solid mass
gonococcal pharyngitis with PID
-pharyngitis with fever and lower abdo pain in young sexually active pt
HPV
dz associations: cervical ca, vulvar and vaginal cancers, anal cancer, penile ca, oropharyngeal ca, genital warts
vaccine indications: all girls and women* age 11-26, boys and men 9-21 (to 26 for MSM, indivs with HIV)
*includes those with h/o genital warts, abnml cytology, or positive HPV DNA test
2T quad screening
trisomy 21: beta hcg and inhibin A are increased
trisomy 18: everything down except for nml inhibin A
NT or abdo wall defect: all nml except for inc MSAFP
HIV management during pregnancy
maternal combo antiretroviral therapy during pregnancy and neonatal zidovudine (>6weeks) can dec perinatal HIV transmission to <1%
- three drug regimen: 2 NRTIs and one nonNRTI or a protease inhibitor
- NRTI with good placental transfer: Zidovudine, Tenofovir
Ectopic pregnancy
- rf: previous ep, prev pelvic/tubal sx, PID
- cp: abdo pain, amenorrhea, vag bleeding, hypovol shock 2/2 ruptured; cervical motion, adnexal or abdo tenderness
- diagnosis: positive beta-hcg, TVUS adnexal mass, empty uterus
- management: stable with MTX, unstable with sx
neonatal complications of fetal growth restriction
-polycythemia, hypoglycemia, hypocalcemia, poor thermoregulation
SERMS
-Tamoxifen and Raloxifene
moa for both: competitive inhibitor of estrogen binding, mixed agonist and antag action
indication both: prevention of breast ca in high risk pts
T: adjuvant tx of breast ca
R: postmenopausal osteoporosis
adverse effects: hot flashes, VTE, endometrial hyperplasia and carcinoma (T only)
ovarian torsion
rf: ovarian mass, repro age women, infertility tx with ovulation induction
cp: sudden onset unilat pelvic pain, n/v, palpable adnexal mass
us: adnexal mass with absent doppler flow to ovary
tx: laproscopy with detorsion, ovarian cystectomy, oophorectomy for necrosis or malignancy
when to stop pap testing
-age 65 or hysterectomy PLUS -no h/o CIN2 or higher AND -3 consec negative pap tests OR 2 consec negative co-testing results
epithelial ovarian carcinoma
cp:
- acute: sob, obstipation/costipation with v, abdo distention
- subacute: pelvic/abdo pain, bloating early satiety
- asymptomatic advexal mass
lab finding: inc ca-125
US: solid mass, thick septations, ascites
management: ex lap
Antihypertensive during pregnancy-first line
- beta blockers (Labetalol)
- CCB (nifedipine)
- hydralazine
- methydopa
contraindicated: ace-i, ARB, direct renin inhibitors, nitroprusside, mineralcort receptor antagonists (spironolactone)
recommended vaccines during pregnancy
-Tdap, inactivated influenza, Rho(D) Ig
contraindicated vaccines during pregnancy
-HPV, MMR, live attenuated influenza, varicella
