UWorld All Qs Flashcards
(132 cards)
1
Q
Postpartum (months later), enlarged uterus, irregular vaginal bleeding, pulmonary symptoms, multiple infiltrates on cxr, dx?
A
Choriocarcinoma (metastatic GTD can occur after molar preg, normal preg, or SAB), dx w/ quantitative beta-hCG
2
Q
Acute onset abdl pain ddx??
A
GI (PUD, appe, bowel obstruction/perforation), GU (kidney stone, ectopic preg, ovarian torsion, PID), vascular (bowel ischemia), MSK
3
Q
Palpable breast mass on exam (irregardless of size), first step?
A
> 30yo = mammography (+/- US, then core prn). <30yo = US (+/- mammography, then needle aspiration for simple cyst, vs image guided bx for complex cyst aka solid mass)
4
Q
Acute breast erythema, warmth, pain, and edema w/ peau d’orange (diffuse many dimpling), dx, next step
A
Inflammatory breast carcinoma, mammogram US and bx
5
Q
Benign breast diseases (5)
A
Breast cyst, fibrocystic changes, fibroadenoma, fat necrosis (post-trauma/sex, firm irregular mass, ecchymosis, and skin/nipple retraction *hyperechoic mass, foamy macrophages, fat globules, excise and return to nrml routine screen)
6
Q
Eclampsia, seizure, violent muscle contractions leading to what? Shoulder held in adduction and internal rotation?
A
Posterior shoulder dislocation, tx is closed reduction
7
Q
Indications for endometrial bx (broken down into three age groups)
A
> 45: AUB or post-menopausal bleeding to r/o endometrial hyperplasia/cancer
<45: AUB and unopposed estrogen, obesity, anovulation (despite stripe of less than 4mm which is the cut off for postmenopausal women, a small stripe means nothing in premenopausal), failed medical mgmt, or lynch syndrome (HNPCC)
8
Q
HTN in pregnancy
A
The first-line agents for management of essential hypertension during pregnancy are labetalol and methyldopa. Calcium channel blockers and hydralazine are acceptable alternate therapies. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers arecontraindicated in pregnancy
9
Q
Immediate postpartum or during delivery, cardiogenic shock, hypoxemic respiratory failure, DIC w/ generalized purpuric rash and bleeding from line site (coagulopathy), coma/seizures, dx and tx and risk factors?
A
Amniotic fluid embolism, tx w/ intubation/vent support +/- transfusion, risk factors = advanced maternal age, G5 or >, placenta previa/abruption, pre-E
10
Q
Loss of fetal station, diminishing contractions, and palpable fetal parts
A
Uterine rupture
11
Q
Adverse effect of tamoxifen (SERM)
A
Endometrial hyperplasia and carcinoma (good for breast bad for uterus)
12
Q
Causes of hyperandrogenism in pregnancy (3 masses)
A
Luteoma (benign), thecal luteum cyst (benign), krukenberg tumor (met from GI cancer). All have some risk of fetal infertility virilization
13
Q
Neonatal thyrotoxicosis (levothyroxine or antibody)?
A
Antibodies cross placenta -> s/s warm, tachy, irritable, low birth weight. Dx maternal anti-TSH receptor antibodies (can cross placenta). Self-resolving w/ disappearance of maternal antibody, symptomatically tx w/ methimazole and beta blocker
14
Q
Hyperandrogenism (elevated DHEA, testosterone), oligomenorrhea (irregular >32 day cycle menses), hirsutism, elevated 17-OHP, normal electrolytes, dx?
A
Non-classic CAH (note normal lytes d/t spectrum of 21-hydroxylase def resulting in some aldo/cortisol and elevated 17-OHP), if elevated 17-OHP = not PCOS
15
Q
S/s of placental abruption?
A
Vaginal bleeding, distended and TENDER uterus, and fetal tracing abnormalities
16
Q
Placenta previa s/s, risk factors, mgmt
A
Risk = multiparity, SMOKING, previous uterine sx. Look for PAINLESS antepartum vaginal bleeding, nrml tracing, avoid digital vaginal exam or intercourse
17
Q
Sudden painful onset vaginal bleeding, abdl/back pain, high freq contractions, hypertonic/tender uterus, dx and risk factors
A
Placental abruption! Risks = maternal HTN/pre-E, abdl trauma, prior abruption, COCAINE (back pain comes from blood pooling aka retroplacental bleeding btw placenta and uterine decidua
18
Q
Vaginal and/or intra-abdominal bleeding, pain, fetal distress/demise, look for no presenting fetal parts vaginally and abdominally palpable detal parts at the rupture site, dx?
A
Uterine rupture
19
Q
Blunt abdl trauma to pregnant mother, dx? Mgmt?
A
Placenta abruptio (this is the 3rd card), aggressive IV fluids and left lateral decub to displace uterus off vessels (tranfuse if persistent bleeding and hypotension unresponsive to fluids)
20
Q
Mgmt of intrauterine fetal demise (death >20 wks gestation before labor)
A
20-23 weeks = D&E or vaginal delivery
24 weeks = vaginal delivery (C-section by maternal choice if hx of prior classical C-section - thereby preventing TOLAC essentially)
21
Q
Magnesium in pregnancy indications/
A
Prevention of eclamptic seizures and decreases risk for cerebral palsy (neuroprotection). Signs of Mg toxicity - loss of DTRs, respiratory depression (labored effort dec resp rate), cardiac dysarythmia. Monitor urine output - since MG is cleared renally
22
Q
HTN during pregnancy w/ edema, joint pain, malar rash, UA w/ proteinuria and RBC casts, dx?
A
SLE complicated by nephritis, ddx compared to pre-E look for decreased complement levels and inc ANA titers and usual SLE symptoms eg joint pain, malar rash
23
Q
Elevated AFP vs dec AFP indications
A
Elevated = neural tube defects, ventral wall defects (omphalocele, gastroschisis), and multiple gestation (check fundal height correlation). Decreased = aneuploidies (trisomy 18/21)
24
Q
Prenatal screening: non-diag vs diag
A
Non-diag (screening) = cell-free, tri-screen, quad-screen
CVS (before 15wks), amniocentesis (after 15wks); note give Rho-gam for RH-
25
Second tri quad screening: msAFP, inhibin A, estriol, beta hCG, levels and dx?
Trisomy 21: low AFP. elevated b-hCG, low estriol, high inhibin
Neural tube: just high AFP
Trisomy 18: just low inhibin
26
Small body size, microcephaly, digital hypoplasia, midfacial hypoplasia, hirsutism, clef palate, what fetal tetratogen?
Hydantoin syndrome w/ PHENYTOIN
27
Risk factor for clear cell adenocarcinoma of the vagina and cervix (look for hooded cervix, T-shaped uterus, small uterine cavity, vaginal septae, vaginal adenosis - structural anomalies)? Cryptochidism, microphallus, hypospadias, testicular hypoplasia in men
Dx = DES exposure (carcinogenic and teratogenic effects)
28
Tamoxifen (SERM) has activity where?
Blocks estrogen in breast thereby dec breast CA, also dec estrogen at hypothalamus causing hot flashes (note also inc risk of endometrial hyperplasia/CA)
29
Persistent eczematous ulcerating rash localized to NIPPLE w/ spread to possible vesicles, scales, bloody discharge, nipple retraction. Dz? Associated w/?
Paget's disease, 85% a/w adenocarcinoma
30
Pregnancy and respiratory status/changes?
Elevated progesterone during pregnancy stimulates respiratory centers in brain to cause inc tidal vol, inc minute vent, increased PaO2 and physiological chronic compensated resp alkalosis (compare to hyperemesis card)
31
Hyperemesis gravidarum vs normal respiratory physiologic pregnancy changes
In hyperemesis look for alkalosis, elevated bicarb and elevated CO2. Vs normal physiologic changes: during preg expect inc tidal vol, minute ventilation -> expect to see dec in CO2 w/ alkalosis and normal bicarb
32
2nd/3rd trimester, elevated bile acids, elevated liver aminotransferases, elevated bili, intense puritus, dx?
Intrahepatic cholestasis of pregnancy (you missed this since you saw elevated aminotransferases - but this is possible, just r/o acute hepatitis). Tx w/ ursodeoxycholic acid
33
Pregnant, malaise, RUQ pain, N/V, sequelae of liver failure, look for hypoglycemia, transamnitis, elevated bili, possible DIC, NO puritus, dx?
AFLP - no pruritus and this occurs in 3rd trimester
34
Arrest of labor versus protraction and mgmt?
```
Protraction = cervical change slower than expected and inadequate contractions -> start with Oxytocin.
Arrest = no change for > 4 hrs w/ adequate contractions OR > 6 hrs w/ inadequate contractions. GO to section with arrest
```
35
Postpartum hemorrhage requiring oxytocin infusion, hyponatremia, hypotension, tachysystole, p/w tonoic-clonic seizure, dx/mgmt?
Oxytocin toxicity (essentially similar to ADH, thereby causing hyponatremia -> progressing to sz), give hypertonic saline
36
False labor vs true?
```
False = mild, irregular contractions that ultimately resolve w/ no cervical change.
True = regular contractions w/ inc freq and intensity (no need for GBS proph if not in true labor)
```
37
PPROM mgmt in <34 vs 34-37 wks
34: infection or fetal compromise? No = abx, corticosteroids, surveillance. Yes = abx, steroids, Mg for neuroprotection against CP, and DELIVER
34-37: abx, steroids, deliver!
38
Another card on fetal growth restriction (pathway for FGR)
```
Determine symmetric (mainly 1st tri) vs assymetric (2nd/3rd tri).
Symmetric = think baby's problem (chr abnormalities and congenital infection).
Asymmetric = think 1) placental (HTN and pre-gestational diabetes, NOT GDM) and 2) maternal malnutrition *shunt blood to vital organs like brain.
1st tri symmetric baby's fault; 2nd/3rd tri asymmetric baby was good, until mother/placental problem shunted blood to vital brain
```
39
IUGR ddx?
Maternal diseases (HTN, malnutrition), fetal diseases (chr abnormalities, congenital infection), utero-placental insufficiency. Remember symmetric (1st tri) vs asymmetric (2nd/3rd). Mgmt w/ weekly BPP, serial umbilical artery Doppler, serial growth US
40
Complications of late-term (41wks) or post-term (>42wks) pregnancies
Fetal: (bad placenta w/ large and dry baby) oligohydramnios, meconium aspiration, stillbirth, macrosomia, convulsions. Oligo = single deepest vertical pocket <2cm, OR AFI <5cm -> path, aging placenta has dec fetal perfusion -> dec renal perfusion
-> dec urinary output from fetus
Maternal complications of late/posterm: C-section, infection, PP hemorrhage, perineal trauma
41
Lochia types RSA - rubra red/brown, serosa thin/pink, alba white/yellow. Normal decidua shedding
Other post-partum stuff to look out for: fever >38 or 100.4 after 24hrs delivery - could be endometritis if fever or infection - abx. Also bladder fxn: nrml to have difficult initiating, as long as voiding occurs then no need for urethral catherterization, should self-resolve. D/t regional anesthesia, nerve palsy, PERI-URETHRAL SWELLING, epidural
42
How to suppress lactation in pt who does not want BF or shouldn't
Breast engorgement occurs when not BF - advise to wear supportive bra, AVOID nipple stimulation/manipulation aka no dumping, use ice packs/analgesics
43
Random note about prolactin and GnRH
High prolactin inhibits release of GnRH from hypothalamus (that's why BF women can be amenorrheic and menopausal like states - low estrogen)
44
Inability to lactate, amenorrhea, and hypotension post-partum, dx?
Sheehan syndrome - absent LH/FSH/prolactin d/t pituitary infarction
45
Post-partum exclusive BF, w/ 12 wks amenorrhea, dx?
Elevated prolactin inhibits GnRH thereby inhibiting LH/FSH causing anovulation and menopausal like states (low estrogen)
46
Post-partum fever unresponsive to abx, dx and mgmt?
Because the most common etiology for puerperal fever is endometritis, patients are initially treated empirically with antibiotics. Persistent fever unresponsive to broad-spectrum antibiotic therapy and a negative infectious evaluation (eg, blood and urine cultures, urinalysis) suggest septic pelvic thromboplebitis, which is a diagnosis of exclusion. Risk factors include cesarean delivery and chorioamnionitis/endometritis. Treatment is with anticoagulation and broad-spectrum antibiotics
47
Note on physiologic vaginal discharge
Cervical mucus just prior to ovulation is profuse, clear, thin, and corresponds w/ LH surge, not a finding of infection
VS cervical mucus plug = barrier to ascending infection during preg
*brown, red, or yellowish thick mucus that is shed before or during labor
48
Whats in primary ovarian insufficiency?
Oligomenorrhea/amenorrhea, infertility and menopausal symptoms (hot flashes), ELEVATED FSH, and dec estradiol level. VS ugh you missed hypogonadotropic hypogonadism (low FSH and low estradiol, d/t low weight -> low GnRH -> LOW FSH/LH/estradiol). So elevated FSH = primary ovarian insufficiency; low FSH = hypogonadotropic hypogonadism
49
Unilateral abdl pain in young women with menses just 14 days ago (not long enough for preg...), pain occurring middle of menstrual cycle, dx?
Mittelschmerz = physiologic cause of unilateral pain corresponding with ovulation, reassurance
50
STI treating partners?
Just trichomoniasis (BV think bacterial flora found normally)
51
70yo vaginal lesion, bloody discharge, smoking, dx?
Squamous cell carcinoma, dx w/bx (APGO vaginal lesions two processes - cancer vs inflammatory)
52
Not vulvodynia (external pain) but what: pain w/ vaginal penetration, distress/anxiety over symptoms, no other medical cause =
Genito-pelvic pain/penetration disorder (vaginismus), risk factors include sexual trauma, lack of sexual knowledge, abuse, tx - desensitization therapy/kegels
53
HTN and OCPs mgmt?
Switch! Although most women have no blood pressure changes, a risk of OCP use is HTN d/t increased angiotensinogen synthesis by estrogen during hepatic first-pass metabolism
54
Low back pain in pregnancy, mechanism, r/o, tx?
Postural changes/weakened abdominal muscles/joint&ligament laxity, mgmt w/ conservative and reassurance behavioral modifications
55
Major risk factor for fragility fracture
Prior fragility fracture. Nonmodifiable osteoporosis risk factors = adv age, postmenopausal, low body weight. Modifiable = smoking, alcohol, sedentary lifestyle
56
Thyroid levels during pregnancy?
Thyroid hormone production increases during pregnancy to cope with metabolic demands. Estrogen causes an increase in thyroxine-binding globulin, leading to increased total (but not free) thyroid hormone levels. hCG directly stimulates TSH receptors, causing increased production of thyroid hormones. So if hypothyroid, increase Levo during preg
57
Normal adaptions to pregnancy = renal, coagulable state, HgB state
Inc in GFR/RBF = decreased Cr and BUN, hypercoagulability minimizes bleeding during delivery, dilutional anemia
58
Mother w/ blood group O and dad with AB, baby will have? Condition associated for fetus? Mgmt?
Baby will be either A or B, ABO incompatability mostly results in mild hemolytic anemia, tx jaundice w/ phototherapy and serial bili, transfuse if severe
59
Complications of shoulder dystocia? (5 syndromes)
1) Fractured clavicle, 2) fractured humerus, 3) Erb-Duchenne palsy (waiter's tip), 4) Klumpke palsy (claw hand, remember Horner syndrome ptosis, miosis involvement), and 5) perinatal asphyxia (AMS, resp/feed difficulties, poor tone sz)
60
Hormones reduced in Sheehan syndrome?
TSH (fatigue, bradycardia), FSH/LH (amenorrhea, hot flashes, vaginal atrophy), prolactin (lactation failure), ACTH (anorexia, weight loss, hypotension)
61
Asymptomatic bacteria path, bugs, complications, 1st line tx
Progesterone causes smooth muscle relaxation and dilation-ascending infection, E. coli/Kleb/Enterobacter/GBS, tx w/ cephalexin/augmentin, nitrofurantoin/fosfomycin AVOID doxy and fluoroquinolones (d/t bone issues)
62
Female athlete triad syndrome
Low caloric deficiency -> dec levels of GnRH -> dec LH -> estrogen deficiency = inc risk for estrogen deficiency, infertility, vaginal atrophy, breast atrophy, dec BMD
63
Normal internal genitalia, external virilization, and undetectable serum estrogen levels in a female pt, dx?
Aromatase deficiency (no conversion of testosterone to estradiol by aromatase in ovary)
64
Initial perinatal visit labs, 24-28 wks, 35-37 wks
Initial: Rh, ab screen, Hgb/Hct and MCV, HIV/VDRL/RPR, HBsAg, Rubella, pap, chlamydia, urine cx, dipstick proteinuria 24-28wks: Hgb/Hct, ab screen, 1hr GCT (unless risk factors do it earlier)
35-37: GBS
65
Evaluation of nipple DISCHARGE pathway?
1) Unilateral = pathologic go to US/mammography (remember can start first with mamo if >30)
2) Color -> bloody = go to step 1, palpable lump/skin change = go to step 1
3) Milky/nonbloody discharge and no lumps = likely physiologic (pregnancy test, guaiac test, serum prolactin/TSH, consider MRI pituitary)
Causes of hyperprolactinemia, ddx?
Pituitary prolactinoma, medications, HYPOTHYROIDISM, pregnancy, chest wall/nipple stimulation
66
Postpartum hemorrhage, lactation failure, hypotension, anorexia, dx?
Sheehan syndrome (postpartum ischemic necrosis of the anterior pituitary, dec prolactin, hypotension, anorexia (adrenal insufficiency)
67
Prior hx of multiple sore throats, current pregnancy at 29wks w/ cough, progressive dyspnea, orthopnea, ECG w/ A-fib and RVR, dx?
This is prior GAS infection -> rheumatic fever causing rheumatic mitral stenosis -> pulmonary edema w/ rapid decomp d/t new A-fib/ RVR
68
Chalmydia and gonorrhea in women tx?
Dx both with nucleic acid ammplification testing (NAAAT). Tx chlamydia by itself with just azithro, tx gonorrhea with azithro + ceftriaxone
69
Testing AUB
In patients w/ AUB, bleeding after exogenous progesterone administration confirms normal endogenous estrogen production and proliferative endometrium. It also eliminates causes of estrogen deficiency (eg primary ovarian insufficiency), endometrial abnormalities (eg intrauterine adhesions), and outlet tract abnormlaities (imperforate hymen). Tx of AUB in adolescents w/ either progestin-only
or combination estrogen/progestin OCP is indicated
70
Complications of endometriosis. Dx, mgmt?
Infertility. Laprascopy if NSAIDs/OCPs fail
71
Pregnancy related risks d/t HTN in mother and fetus
Mother: SI pre-E, gestational DB, PP hemorrhage, placenta abruptio
Fetus: oligo, IUGR, PTL
72
Painless chancre, dx and mgmt if negative non-treponemal test
Syphilis, high false negative rates w/ non-treponemal test. Just hit it with the empiric penicillin and f/u titers
73
Normal fasting glucose in preg, one hr postprandial, two hr postprandial?
<95, <140, <120. Complications of GDM = gHTN, pre-E, fetal macrosomia, C-section. Insulin doesn't cross placenta (1st line), can consider metformin, NO SULFONYLUREAS
74
Shoulder dystocia, mgmt mneumonic
BECALM = Breathe do not push, Elevate leg/flex hips thighs against abdomen (this is McRoberts), Call for help, Suprapubic pressure, enLarge vaginal opening with episiotomy, Maneuvers
75
Maternal fever, maternal/fetal tachycardia, uterine fundal tenderness, and maternal leukocytosis, dx?
Intra-amniotic infection (chorioamnionitis)
76
Clomitrazole vs corticosteroid lol
Anti-fungal vs steroidal
77
Contraindications to breastfeeding?
Active untreated TB, maternal HIV infection (unless in developing countries then as long as HAART), herpetic breast lesions, active varicella infxn, chemotherapy/radiation, active substance abuse (including THC)
78
Hypothyroid before pregnancy on levo, mgmt during pregnancy?
(similar card) Levo requirements increase during pregnancy (beta-hCG inc thyroglobulin binding protein - causing dec in Free T4), need to inc levo dose when pregnant and adjust accordingly w/ serial TSH
79
Why do progesterone test for amenorrhea
In anovulation, the FSH and LH levels are normal. The ovaries are still producing estrogen, but progesterone is not being produced at the normal post ovulation levels. Therefore, progesterone withdrawal menses at the end of the cycle does not occur
80
Bloating, fatigue, headaches hot flashes, breast tenderness w/ possible anxiety, irritability, mood swings, dec interest two 1-2 weeks prior to menses and resolution following onset menses or days after, dx? Evaluation? Tx?
PMS/PMDD, symptom diary (at least two phases), 1st line tx w/ SSRI or causing anovulation w/ OCPs (care smoking)
81
Risk factors for ovarian cancer
Age, fertility drugs, nulligravidity (no ovulation interruption), BRCA mutation *side note: CA-125 elevated in leiomyomata, endometriosis especially pre-menopausal, but more specific in postmenopausal women. AKA post menopausal woman w/ adnexal mass and elevated CA-125 = c/f ovarian cancer
82
Concerning features of ovarian mass on U/S = ?
Large mass, solid components, septations -> if yes then CA-125 -> MRI/CT
83
HPV associated with what diseases?
Cervicla cancer, vulvar and vaginal cancers, anal/penile/oropharyngeal cancer/genital warts. Give to all girls/women age 11-26, boys/men age 9-21
84
Pain at midcycle ovulation?
Mittelschmerz is midcycle pain due to follicular rupture with ovulation. The pain is typically mild, unilateral, and lasts less than a day; it occurs 2 weeks into the menstrual cycle, corresponding with the time of
ovulation
85
Palpable adnexal mass, sudden N/V, severe pain
Ovarian torsion
86
Fever, discharge, lower abdl pain, CMT
PID, severe form of PID is tubo-ovarian abscess
87
Antenatal fetal testing in order of sequence?
NST -> BPP -> CST if NST not reactive. BPP measurements = out of 10 pts looking at amniotic fluid volume, fetal breathing mvmt, fetal mvmt, fetal tone. CST incorporates monitoring during induction test. Doppler
of umbilical artery *if dec, absent, or reversed end diastolic flow = bad
88
BPP is done to assess fetal oxygenation through US observation and NST
IF BPP <4/10 w/ oligo (single deepest pocket <2cm of AFI <5) = fetal hypoxia d/t placental dysfunction. DELIVER
89
Risk factors for placental insufficiency/dysfunction = ?
Advanced maternal age, tobacco use, HTN and diabetes
90
Order of pre-natal DNA testing?
Cell-free fetal offerred immediately to pts not high risk criteria -> can order at 10 wks, if abnormal can confirm with CVS at 10-12 or amniocentesis at 15-20. If not high risk can screen initially with triple screen then quad
91
Contraindications to trial of labor?
Classical C-section (vertical incision), abdl myomectomy w/ and w/o uterine cavity entry
92
Unilateral bloody nipple discharge (can be brown, red or pink) w/o mass or lymphadenopathy, dx? Mgmt?
Intraductal papilloma (bloody but nothing else), mammography/US, bx +/- excision
93
Palpable firm irregular shaped breast mass w/o discharge, ecchymosis
Fat necrosis (just irregular firm mass)
94
Nipple discharge, w/ breast mass and lymphyadenopathy, imaging with lesion and microcalcifications
Infiltrating ductal carcinoma
95
BRCA mutations and cancer risks?
Premenopausal epithelial ovarian cancer, fallopian tube cancer, primary peritoneal cancer, breast CA <50, breast cancer in male. Consider BSO, OCP, early pregnancy BF, tubal
96
Pregnant, vaginal bleeding, hyperemesis gravidarum, diffusely enlarged uterus w/ regular contour
Classic s/s of complete molar pregnancy
97
Best contraception for pts w/ breast cancer
NO HORMONE containing contraception including Mirena. Consider paraguard
98
Postpartum hemorrhage scenarios and findings:
Uterine rupture: disruption along uterine wall along rupture site
Uterine atony: enlarged body uterus vs firm well contracted at umbilicus
Retained placental tissue: enlarged atonic uterus (US findings of thick stripe)
Extra lacs: forceps assisted, inspect perineum, vagina, and cervix care for genital tract lacs
99
Signs of chorioamniotis?
Prolonged membrane rupture (>18hrs), maternal fever, fetal tachycardia, maternal leukocytosis, purulent amniotic fluid, maternal tachycardia, uterine fundal tenderness
100
Dysmenorrhea (secondary) w/ heavy menstrual bleeding in >40yo woman w/ progression to chronic pelvic pain
Adenomyosis! Look for classic boggy (SOFT/flaccid), tender, uniformly enlarged uterus. DDx from endometriosis w/ HMB, nodularity in posterior cul-de-sac
101
Tenderness over anterior vaginal wall w/ dysuria/urinary frequency
Interstitial cystitis
102
Heavy menstrual bleeding, non-tender firm and irregularly enlarged uterus
Fibroids
103
Postpartum urinary RETENTION *so not urge incontinence ie detrusor problem* (also overflow incontinence) risk factors, clinical features, mgmt?
Risk = primiparity, regional anesthesia, operative vag delivery, perineal injury, C section
Clinical features = inability to void/small volume voids, incomplete bladder emptying, dribbling
Mgmt = self-limited, analgesia/ambulation not work -> then intermittent cath
104
Pelvic pain, gassy bloating, early satiety. Acutely, SOB, abdl distention. US: solid mass, thick septations, ascites. Dx?
Ovarian CA
105
Postmenopausal bleeding, thickened endometrial stripe, left adenxal mass, tumor? Tx?
Granulosa tumor secreting estrogen causing breast tenderness, spotting in post menopausal, thick endometrium. EMB to r/o malignancy, sx resection of mass
106
Chronic, inflammatory, bright erythematous lesions w/ erosive ulcerated areas - like canker sore of the vagina
Lichen planus
107
Abdl pain, amenorrhea, vaginal bleeding, hypovolemic shock (if ruptured - will see in posterior cul de sac), positive beta-hCG, transvaginal US revealing adnexal mass, empty uterus, dx?
Ectopic pregnancy +/- rupture, if unstable surgery if stable methotrexate. Risk factors = previous ectopic, previous pelvic/tubal sx, PID
108
Hyperechoic ovarian nodule w/ calcifications = ?
Teratoma
109
U/S findings of cyst w/ calcifications and hyperechoic nodules?
Cystic teratoma (dermoid ovarian cyst) common benign germ cell tumor occuring in premenopausal women, tx w/ sx removal of cyst. Complications include ovarian torsion - necrosis
110
Mass in young women less than 30 best dx tool?
BIOPSY, like previous card, US best initial imaging study d/t dense breast tissue in young women
111
Painless, continuous urine leakage from vagina following pelvic surgery, dx? Use what studies, tx?
Vesicovaginal fistula, physical exam/dye test/cystourethroscopy, surgery!
112
You missed acute cervicitis (d/t chlamydia and N. gonorrhoeae only dx w/ NAAAT) vs trichomonitis
Trichomoniasis = erythematous cervix w/ punctate lesions (strawberry lesion) and GREEN frothy discharge. Not yellow discharge and friable edematous cervix that bleeds w/ manipulation/sex (acute cervicitis)
113
HPV and tobacco are important risk for what cervical process?
CIN (I-III, II/III need LEEP d/t premalignant at high risk of progressing to SCC), and squamous cell carcinoma
114
Pathophys/mech of gestational diabetes?
Inc levels of placental somatomammotropin (eg human placental lactogen production; insulin resistance exceeds production)
115
More risk factors for shoulder dystocia?
Macrosomia, post term pregnancy, maternal obesity, gestational DM (not DB before - remember small baby), excessive maternal weight gain during pregnancy. You put fibroids dumb ass not correct
116
Fetal malposition vs fetal malpresentation
Malposition = nonocciput anterior (ie vertex but transverse aka looking left). Malpresentation = breech (not vertex)
117
Lab abnormalities in hyperemesis gravidarum. Tx? Risk factors
Hypochloric metabolic alkalosis, ketonuria, hypoK, hemeconcentration. Admission, IV fluids. Multiple gestation, hydatidiform mole, prior hyperemesis
118
Complications of hyperemesis gravidarum (electrolyte abnormality w/ what clinical syndrome)
Thiamine deficiency - Wernicke encephalopathy look for AMS, gait ataxia, nystagmus
119
Infant, thin, loose skin, thin umbilical cord, wide anterior fontanel, dx?
FGR d/t HTN - more FGR note, get histopath exam of placenta since FGR likely utero-placental insufficiency
120
Notes on molar pregnancy
This patient presents with hyperemesis gravidarum, an enlarged uterus (12-week size at 8 weeks gestation), and bilaterally enlarged ovaries, a presentation concerning for a complete hydatidiform mole (HM), a type of gestational trophoblastic disease. A complete HM results from abnormal fertilization of an empty ovum by either 2 sperm or by 1 that subsequently duplicates its genome. The resultant gestation is composed of proliferative trophoblastic tissue that secretes high levels of ß-hCG. The markedly elevated ß-hCG level causes hyperstimulation of the ovaries and formation of theca lutein cysts, which are large, bilateral, multilocular ovarian cysts. Theca lutein cysts are expectantly managed as they resolve after treatment of the HM by suction curettage
or hysterectomy when the ß-hCG level decreases
121
Postpartum endometritis - purulent lochia, fever, and uterine tenderness, tx?
Clindamycin plus gentamicin for broad spec coverage (vaginal flora ascends up uterus after delivery)
122
Another note on hydatidiform mole: pre-E (d/t abnormal placental spiral artery dvlpt) BEFORE 20 wks w/ enlarged uterus (> gestational age), dx?
Hydatidiform mole w/ pre-E, D&C that out
123
Beta-hCG in pregnancy?
Double every 28hrs until a certain date, will continue to increase till the end of 1st tri (13wks); so if value drop = consider missed abortion
124
Amphetamine risk in pregnancy, complications?
Fetal growth restriction, pre-E, placenta abruptio, preterm delivery, IUFD
125
Thyroid levels postpartum
Brief hyperthyroid, self-limited hypothyroid, and ultimately euthyroid. A/w with anti-thyroid peroxidase autoantibodies
126
You missed tubo-ovarian abscess vs ovarian serous cystadenocarcinoma
TOA: fever, abdl pain, complex multiloculated adnexal mass w/ thick walls and debris *look for fever, white count, non-specific elevated CRP/CA-125 Ovarian serous cystadenocarcinoma: despite elevated CRP/CA-125 tho non-specific, there was fever and white count which suggests infection
127
CMV s/s =
EBV s/s =
Gonococcal pharyngitis =
CMV = prolonged fever and malaise, no pharyngitis
EBV = exudative pharyngitis and TENDER cervical lymphadenopathy
Neisseria gonorrhoeae = potential pharyngeal edema, nontender cervical lymphadenopathy, and usual cervicitis (mucopurulent
discharge, irregular bleeding)
128
Pelvic pressure, urinary retention, incontinence, obstructed voiding, risk factors = multiparity, postmenopausal age, hysterectomy, obesity, dx?
Pelvic organ prolapse! Mgmt = weight loss, pelvic floor muscle exercises, vaginal pessery, or surgery
129
Note on vulvar puritus from APGO
Vulvar puritus think two processes: HPV vs chronic inflammatory *r/o squamous cell carcinoma
130
Radiating suprapubic pain down back or hips, suprapubic tenderness, postpartum difficult delivery, dx and mgmt?
Pubic symphisis diastasis (separation of pubic bones that won't re-fuse after delivery), can last 4 wks, tx is conservative w/ supportive care
131
Painless bleeding, stable mother, fetal tachycardia then bradycardia, positive Apt test
Fetal bleeding d/t vasa previa *aka velamentous insertion of the cord, tx w/ c-section
132
Note on hemolytic disease of the newborn
In its most severe form causes fetal hydrops (fluid in 2 compartments ie edema, ascites, and or pericardial effusions) and death. Monitor w/ amniotic fluid spectrophotometry and US. Tx w/ 1) delivery if mature - check lung maturity with lecithin-to-sphingomyelin ratio, 2) intrauterine transfusion, and 3) phenobarbital which helps fetal liver break down bili by inducing enzymes
