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OB/GYN > UWorld 6+ > Flashcards

UWorld 6+ Flashcards

(42 cards)

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1
Q

treatment for different types of urinary incontinence

A

stress:
-lifestyle modifications, pelvic floor exercises, pessary, pelvic floor surgery

urgency:
-lifestyle modifications, bladder training, anti-MUSCARINIC drugs

mixed (stress and urgency)
-variable tx depending on predominant s/s

overflow:
-id and correct underlying causes, CHOLINERGIC agonists, intermittent self-catheterization

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2
Q

delivery planning for a nonviable fetus

A

fetal diagnosis

  • anencephaly
  • b/l renal agenesis
  • holoprosencephaly
  • acardia
  • thanatophoric dwarfism
  • intrauterine fetal demise

ob management (minimize mom m&m)

  • vaginal delivery
  • no fetal monitoring

neonatal management:
-palliative care if not stillborn

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3
Q

spontaneous abortion

A

pregnancy loss <20wks

CP: heavy vaginal bleeding, cramping, dilated cervix without passage of gestational tissue

RF

  • advanced maternal age
  • previous spontaneous abortion
  • substance abuse

tx options:

  • expectant
  • medical induction (misoprostol)
  • suction curettage if infection or hemodynamic instability

additional management:

  • Rho(D) ig
  • path exam
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4
Q

complications of a spontaneous abortion

A
  • hemorrhage
  • retained products of conception
  • septic abortion
  • uterine perforation
  • intrauterine adhesions
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5
Q

RF for fetal macrosomia (weight >4kg)

A

maternal

  • advanced age
  • diabetes
  • excessive weight gain d/r pregnancy or pre-existing obesity
  • multiparity

fetal:

  • AA or Hispanic
  • male sex
  • post-term pregnancy
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6
Q

Erg-Duchenne palsy

A
  • mc type of brachial plexus injury
  • 5th, 6th, and sometimes 7th CN
  • weakness of the deltoid and infraspinatus muscles (C5), biceps (C6), and wrist/finger extensors (C7) leads to predominance of the opposing muscles=waiters tip

tx: gentle massage and physical therapy to prevent contractors
- up to 80% of its have spontaneous recovery in 3 mo

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7
Q 
cervical ionization (excision of intact transformation zone)
-cold knife vs LEEP
A

indications: CIN2 and 3 (RF: HPV and tobacco)

complications:

  • cervical stenosis
  • preterm birth
  • preterm premature rupture of membranes
  • 2T pregnancy loss
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8
Q

cervical stenosis

A
  • abnml stricture of cervical canal
  • may impede menstrual flow=secondary dysmenorrhea or amenorrhea
  • block sperm=infertility
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9
Q

uterine rupture RF

A
  • prior uterine surgery (cesarean, myomectomy)
  • induction of labor/prolonged labor
  • congenital uterine anomalies
  • fetal macrosomia
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10
Q

Uterine rupture CP and management

A

CP:

  • excruciating abdo pain
  • vaginal bleeding
  • intraabdo bleeding (hypoTN, tachy)
  • fetal heart decals (d/t disruption of maternal-placental circulation)
  • l/o fetal station
  • palpable fetal parts on abdominal exam
  • l/o intrauterine pressure

management: laparotomy for delivery and uterine repair

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11
Q

shoulder dystocia

A

-failure of usual ob maneuvers to deliver fetal shoulders

RF:

  • fetal macrosomia** (>4.5kg/9.9lb)
  • maternal obesity
  • excessive pregnancy weight gain
  • gestational diabetes
  • post-term pregnancy (>42 wks)

warning signs:

  • protracted labor
  • retraction of fetal head into the perineum after delivery (turtle sign hehe. turtle turtle.)
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12
Q

what can shoulder dystocia cause

A

ob emergency d/t r/o:

  • neonatal brachial plexus injury
  • clavicular and humeral fracture
  • if prolonged: hypoxic brain injury and death
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13
Q

rectovaginal fistula

A

-may occur after ob trauma
CP: incontinence of flatus and feces through the vagina
-red velvety rectal mouse may be seen on posterior vaginal wall

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14
Q

ovarian ca

A
  • one of the leading causes of ca mortality
  • typically diagnosed in advanced stages with widespread mets
  • no screening tests exist to detect avg risk ppl in early, more treatable stages
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15
Q

granulosa cell tumor

A

path:

  • sex cord-stomal tumor
  • inc estradiol and inhibin
clinical features:
complex ovarian mass
juvenile subtype
-precocious puberty
adult subtype:
-breast tenderness
-abnml uterine bleeding
-postmenopausal bleeding

histo: call-exner bodies (cells in rosette pattern)
management: endometrial bx (endometrial ca) or sx (tumor staging)

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16
Q

granulosa cells

A

convert T to estradiol (via aromatase) and secrete inhibit (which inhibits FSH)

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17
Q

labs for hyperemsis gravidarum

Study These Flashcards
A

ketonuria
hypochloremic metabolic alkalosis
hypokalemia
hemoconcentration

18
Q

SLE nephritis in pregnancy CP and Labs

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A

CP: edema, malar rash, arthritis, hematuria
labs: nephritic range proteinuria, UA w/ RBC and WBC casts, dec complement, inc ANA titers

19
Q

SLE nephritis in pregnancy diagnosis and ob complications

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A

diagnosis: renal bx

ob complications:

  • preterm birth
  • cesarean
  • preeclampsia
  • fetal growth restriction
  • fetal demise
20
Q

engorgement

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A
  • may be caused by rapid cessation of breastfeeding
  • if pt desires lactation suppression:
  • wear a supportive bra
  • avoid nipple stimulation and manipulation
  • use ice packs and analgesics to relieve associated pain
21
Q

breast abscess from untreated mastitis

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A
  • S. aureus
  • localized erythema/pain, fever, malaise and fluctuant tender palpable mass
  • needle aspiration of abscess under US guidance and Abc (dicloxacillin, cephalexin) for surrounding mastitis
  • continue breastfeeding for continued milk drainage
22
Q

menopause (absent menses for 12 mo)

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A

CP:

  • vasomotor s/s (hot flashes)-manage with HRT or SSRI
  • oligomenorrhea/amenorrhea
  • sleep disturbances
  • dec libido
  • depression
  • cognitive decline
  • vaginal atrophy

diagnosis: clinical and inc FSH
tx: topical vaginal estrogen, systemic HRT

23
Q

gestational DM

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A

target bg levels:

  • fasting <95
  • 1 hr postprandial <140
  • 2hr pp <120

tx: 1. dietary modifications 2. insulin, metformin

24
Q

mammary paget disease

Study These Flashcards
A
  • painful, itchy, eczematous, and/or ulcerating rash on the nipple that spread to the areola
  • majority of its have underlying breast adenocarcinoma
25
epidural anesthesia
- se: hypoTN in 10% of patients | - hypotension is caused by blood redistribution to the LE and venous pooling from sympathetic blockade
26
routine prenatal labs at initial visit
``` Rh (D) type, Ab screen Hgb/HCt, MCV HIV, VDRL/RPR, HBsAg Rubella and varicella immunity pap test (if screening indicated) chlamydia PCR urine culture urine protein ```
27
24-28wks lab tests
- Hgb/HCt - Ab screen in Rh (D) negative - 50g 1hr GCT (for gestational DM)
28
RF for lactational mastitis
h/o mastitis engorgement and inadequate milk drainage d/t: -sudden increase in sleep duration -replacing nursing with formula or pumped breast milk -weaning -pressure on the duct (tight bra or clothing, prone sleeping) -cracked or clogged nipple pore -poor latch
29
placenta accreta
- occurs when uterine villi attach directly to the myometrium - CP: placental adherence and hemorrhage at the time of attempted placental delivery - RF: prior cesarean, h/o d&c, advanced maternal age
30
syphilis in pregnancy
screening: universal at 1st prenatal visit, 3T and delivery (if high risk) serologic tests: nontreponemal (RPR, VDRL), treponema (FTA-ABS) tx: intramuscular benzathine pen G pregnancy effects: intrauterine fetal semis and preterm labor
31
fetal effects of syphilis in pregnancy
- hepatic (hepatomegaly, jaundice) - heme (hemolytic anemia, dec platelets) - MSK (long bone abnormalities) - FTT
32
Hep C in pregnancy potential complications and maternal management
potential complications: - gestational diabetes - cholestasis of pregnancy - preterm delivery maternal management: - ribavirin is teratogenic, avoid it - no indication for barrier protection in serodiscordant, monogamous couples - Hep A and B vaccination
33
prevention of vertical transmission of Hep B
- vertical transmission strongly associated with maternal viral load - cesarean delivery not protective - scalp electrodes should be avoided - breastfeeding should be encourage unless maternal blood present (nipple injury)
34
postpartum period
nml: - transient rigors/chills - peripheral edema - lochia rubra (reddish brown vaginal dc-the nil shedding of the uterine decidua and blood) - uterine contraction and involution - breast engorgement routine care: - rooming-in/lactation support - serial examination for uterine atony/bleeding - perineal care - voiding trial - pain management
35
PMS/PMDD
Clinical features (occurring d/r luteal phase aka 1-2 wks prior to menses...resolve during follicular phase aka onset of menses): - Physical: bloating, fatigue, HA, hot flashes, breast tenderness - Behavioral: anxiety, irritability, mood swings, dec interest Evaluation: symptom/menstrual diary Treatment: SSRI
36
Rheumatic mitral stenosis
- insidious progressive disease - physiologic and hemodynamic changes during pregnancy can precipitate symptoms in previously asymptomatic its - development of new fib can further increase transmitral gradient and LA pressure with dramatic worsening of pulmonary congestion and pulmonary edema
37
ovarian ca risk after menopause
INCREASES - an ovarian mass in postmenopausal pt is highly concerning for malignancy - investigation by pelvic US and CA-125 measurement is necessary - even if the mass has no malignant features on US an elevated CA-125 is concerning, requires further imaging and possible surgical exploration
38
placenta previa
RF: prior pp, prior cs, multiple gestation CF: painless vaginal bleeding for >20wk gestation diagnosis: transabdo followed by transvaginal sonogram management: no intercourse, no digital cervical examination, input admission for bleeding episodes
39
neonatal thyrotoxicosis
pathophys: - transplacental passage of maternal anti-TSH R Ab - Ab bind to infants TSH R and cause excessive thyroid hormone release CF: - warm, moist skin; tachy - poor feeding, irritability, poor weight gain - low birth weight or preterm birth diagnosis: maternal anti-TSH R Ab >500% nml tx: self resolves within three months (disappearance of maternal Ab); methimazole PLUS beta blocker
40
endometriosis
- can have pelvic pain and/or infertility or be completely asymptomatic - tx: saids, ocp, progesterone IUD, leuprolide
41
lactational amenorrhea
- result of high levels of prolactin which has inhibitory effect on the production of the hypothalamic gonadotropin-releasing hormone (GnRH) - pulsatile GnRH release from hypothalamus is necessary for the production and release of LH and FSH by the ant pit - LH and FSH stimulate the ovary to induce ovulation - by inhibiting GnRH (and thus l and f) prolactin prevents ovulation and menstruation - because lactation suppresses ovulation it is a natural form of contraception for the first six months postpartum is om is exclusively breastfeeding
42
Bartholin cysts
- soft, mobile, contender masses - located at the base of the labia major - symptomatic cysts require incision and drainage, followed by Word catheter placement

OB/GYN (7 decks)

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