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Flashcards in UWorld 3 Deck (26)
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Complications of post-term pregnancies

-meconium aspiration
-oligohydramnios: aging placenta => decreased fetal perfusion => decreased urine output


Clinical presentation of Kallmann's syndrome

Amenorrhea or delayed puberty w/ low or absent LH and FSH (2/2 no GnRH)

Kallmann's = hypogonadotropic hypogonadism + anosmia


Signs of congenital adrenal hyperplasia

Verilization (b/c of high androgens) and salt wasting (b/c high aldo)


Differentiate cervical secretions during

(a) Pre-ovaulatory / early follciular
(b) Ovulatory
(c) Post-ovulatory . late follicular

Vaginal mucus secretions

Pre and post-ovulatory: mucus is scant, opaque, thick, acidic
-incompatible w/ penetration by spermatozoa

During ovulatory phase: clear cervical secretion that extends in a long thread (6 cm) when lifted vertically, pH of 6.5 (more basic)


SSRI safety during pregnancy

SSRIs except Paxil (paroxetine) are ok during pregnancy


Define menorrhagia

Technically: period lasting longer than 7 days or greater than 80 mls


How does hypothyroidism affect prolactin secretion

Hypothyroidism => hyperprolactinemia

b/c TRH (high when no negative feedback from low thyroid hormone) stimulates prolactin production
-explains how hypothyroidism can => amenorrhea and galactorrhea


When to suspect McCune Albright syndrome

Early puberty w/ some bony abnormalities and cafe au lait spots


17 yo G1P0 at 37 wks p/w HA

Preeclampsia (after 20 wks) w/ severe features


14 yo p/w excessive menstrual bleeding
-menarche at 13

Cause of the excessive bleeding?


-W/ recent menarche, menorrhagia (longer than 7 days or greater than 80 ml) is 2/2 anovulatory cycles due to an immature/irregular HPA axis


First step if F of reproductive age presents w/ amenorrhea and negative beta-hCG

Depends on if she's had a prior uterine procedure or infection

No prior procedure/infection => check prolactin, TSH, FSH
Prior uterine procedure or infection => hysteroscopy (camera up vagina to look inside uterus)


Genitalia of fetus w/ congenital aromase deficiency

Normal internal w/ ambiguous external genitalia


G2P1 at 29 wks w/ fetus in transverse lie and low lying placenta at 3cm away from the cervical os

Next step?

Reassure and wait

-don't have to do C-sex: transverse lie is typically transient and will spontaneously convert to cephalic


How to differentiate intraductal papilloma and infiltrating ductal carcinoma on physical exam

Both can present w/ pathologic nipple discharge (unilateral bloody discharge)

Intraductal papilloma = benign

Infiltrating ductal carcinoma as accompanying breast mass and lymphadenopathy


What is Kallmann's syndrome?

Hypogonadotropic hypogonadism (failure of hypothalamus to release GnRH) + anosmia (no sense of smell)
=> delayed puberty w/ low or absent LH/FSH

Mechanism = failure of GnRH secreting hypothalamic neurons to migrate to the correct place during embryonic development


Most common side effect of Tamoxifen

Hot flashes
-Tamoxifen blocks estrogen from its receptor => similar to estrogen withdrawal in menopause


Tamoxifen increases risk of which 2 dangerous conditions

-endometrial hyperplasia


Traid of McCune-Albright syndrome

1. hyperfunctioning endocrine disease => gonadotropin-independent precocious puberty

2. progressive fibrous dysplasia => polyostic (bony abnormalities)

3. cafe au lait macules (coast of Maine appearance)


Imaging finding on intraductal papilloma

Normal on imaging, potentially a single dilated breast duct


Unilteral bloody nipple discharge

Hallmark finding of intraductal papilloma (tis benign)


Lab findings: pseudohyphae


Dx = candida

-normal pH of secretions (3.8-4.5), not over 4.5 like BV and trich


Is oligo or poly hydramnios more assocaited w/ post-term pregnancies?

Oligo b/c aging/calcified placenta => decreased perfusion => decreased fetal urine output


Post-term induced neonates are at higher risk for which two fetal complications?

SGA and oligohydramnios
Placenta ages/calcifies => chronic uteroplacental insufficiency
-SGA b/c lack of nutrients in last bit
-oligo b/c decreased fetal perfusion => decreased fetal urine output


24 yo obese F w/ hirsuitism, acne, and menstrual irregularity

-greatest risk of which gynecologic malignancy?

Endometrial carcinoma 2/2 unbalanced estrogen secretion

-insufficiency estrogen + peripheral conversion of estrogen

Unopposed estrogen secretion => endometrial hyperplasia


Mode of inheritance of hemophilia

(a) A
(b) B

Both hemophilia A and B are X-linked recessive


Name features that count to make preeclampsia classified as severe

->160 or >110
-thrombocytopenia (plt under 100)
-Cr over 1.1
-AST/ALT over 2x ULN
-pulmonary edema
-new onset visual or cerebral symptoms