UWorld 5 Flashcards
(32 cards)
intraductal papilloma
CF: u/l bloody nipple d/c and no associated mass or LAD
management: mammo and US, bx +/- excision
genital warts (condylomata acuminata)
etio: hpv 6 and 11
CF: multiple pink or skin colored lesions, lesions ranging from smooth, flattened papules to exophytics/cauliflower-like growths
tx: chemical podophyllin resin, trichloroacetic acid; immuno imiquimod; sx: cryotherapy, laser therapy, excision
prevention: vaccination, barrier contraception
Rf for (squamous cell) cervical ca
- infection with high risk HPV (16,18)
- h/o STD
- early onset sexual activity
- multiple or high-risk sexual partners
- immunosuppresion
- oral contraceptive use
- low SES
- tobacco use
Indications for prophylactic administration of anti-D Ig for Rh(D)-negative pts
- at 28-32 weeks gestation
- <72hr after delivery of Rh(D)-positive infant
- <72 hr after spontaneous abortion
- ectopic pregnancy
- threatened abortion
- hydatidiform mole
- chorionic villus sampling, amniocentesis
- abdominal trauma
- 2T and 3T bleeding
- external cephalic version
syphilis in pregnancy
- treatment with penicillin is required for all pregnant pts with syphilis to prevent fetal complications (IUGR, fetal death, congenital infection)
- pts with pen allergy receive skin testing, if positive desensitize them and give IM pen G benzathine
Lichen sclerosis
- pale thin tissue and perianal thickening with fissures
- causes intense pruritus and white atrophic plaques involving vulva and sometimes perianal skin but not the vagina; loss of minora
- punch biopsy confirms the diagnosis and rules put vulvar SCC
- tx: high potency topical steroids
atrophic vaginitis
- vulvovaginal dryness
- loss of vaginal elasticity/rugae
- thinning vulvar skin/loss of minora
- dec vaginal diameter
- tx: low dose topical estrogen
nonreactive NST
- should last 40-120 minutes to ensure that fetal activity outside of sleep is captured
- should be followed with either a BPP or contraction stress test before concluding fetus may be hypoxic and needs intervention
lithium exposure in 1T
- increases r/o cardiac malformations including septal defects and possibly Ebstein’s anomaly
- 2T and 3T goiter and transient neonatal neuromuscular dysfunction are of concern
endometriosis
-ectopic implantation of endometrial glands
CF: dyspareunia, dysmenorrhea, chronic pelvic pain, infertility, dyschezia
PE: immobile uterus, cervical motion tenderness, adnexal mass, recto-vaginal septum, posterior cul-de-sac, uterosacral ligament nodules
diagnosis: direct visualization and surgical biopsy
tx: medical (oral contraceptives, NSAIDs), surgical resection
management of preeclampsia
- w/ severe deliver at >34 wks
- sans severe deliver at >37wks
severe features
- SBP >160 or dbp >110 (2 times >4 hours apart)
- thrombocytopenia
- inc cr
- inc transaminases
- pulm edema
- visual or cerebral s/s
cone biopsy-CIN3
all nonpreggo pts >25 with CIN3 require excision of the transformation zone (cone biopsy) d/t high risk of progression to invasive SCCC
GnRH, FSH, Estrogen in the following
- hypothalamic hypogonadism: all down
- primary ovarian insufficiency (forms of hypergonadotrophic hypogonadism): e down, rest up
- ->cp: irregular menses or infertility and h/o ai d/o or turner
- PCOS: f nml others up
- nml ovulation: all nml
- exogenous estrogen use: e up rest down
BPP
performed in pts at risk for uteroplacental insufficiency (>41 wks gestation)
-chronic hypoxemia causes an abnml BPP and suggests imminent risk of fetal demise–delivery usually indicated in such cases
epithelial ovarian carcinoma
- malignancy involving ovary, fallop tube, and peritoneum
- cp: hallmark large ovarian mass and widespread pelvic and abdo mets regardless of primary origin
- US: investigate pelvic pain and/or adnexal mass
- ->will see large ovarian mass with thick septations, solid components, and peritoneal free fluid (ascites)
- s/s: bloating, pain, early satiety/anorexia, abdo distension
exercise-induced hypothalamic amenorrhea
CP: strenuous exercise, relative caloric deficiency, stress fractures, amenorrhea, infertility
hormone levels: GnRH, LH/FSH and estrogen all DEC
long-term consequences: dec bone mineral density, inc total cholesterol and tg
tx: inc caloric intake, estrogen, calcium and vit D
secondary amenorrhea
- absence of menses for >3 cycles or >6 months in women who menstruated previously
- initial eval is beta hcg to exclude preggo then serum prolactin, TSH, and FSH
placenta previa
RF: multiparity, advanced maternal age >35
- at r/o antepartum bleeding (painless) with or sans contractions on toco
- placenta implants over internal cervical os
- contraindication to labor and vaginal delivery
- cesarean at 36-37 weeks
ABO hemolytic dz
RF: infants with bloodtypes A or B born to a mother with blood type O
clinical features: jaundice within 24hr of birth, anemia, inc retic ct, hyperbilirubinemia, positive coombs
management: serial bili levels, oral hydration and phototherapy for most neonates, exchange transfusion for severe anemia/hyperbili
primary vaginal ca
- bloody, malodorous d/c and irregular vaginal lesion
- RF for SCC of va are similar to cervical ca (smoking, HPV)
- diagnosis: by bx and treatment is determined after staging
Infertility
- failure to achieve pregnancy after 12 mo of unprotected sex with woman <35
- for women >35 infertility eval can begin after 6 mo without conception
- 25% of cases due to male factor-test with semen analysis (sperm concentration motility, morphology)
PPROM
pts at >34 wks gestation should be delivered
-intrapartum iv penicillin should be given for unknown or positive GBS status
risks and benefits of estrogen-progestin contraceptives
benefits:
- pregnancy prevention
- endometrial and ovarian ca reduction
- menstrual regulation (anovulation, dysmenorrhea, anemia)
- hyperandrogenism tx (hirsuitism, acne)
risks:
- VTE
- HTN
- hepatic adenoma
- stroke, MI (both very rare)
- cervical ca
