Uworld Review 2 Flashcards
(318 cards)
1
Q
What is the next step after US in the workup of an ovarian mass in a postmenopausal woman?
A
CA-125 levels
2
Q
When is needle aspiration indicated for a suspected ovarian CA?
A
Never-might sead cancer
3
Q
What is the treatment for comedonal acne?
A
Topical retinoids and lotions
4
Q
What is the treatment for inflammatory acne?
A
Mild =topical retinoids and benzoyl peroxide
Moderate = Topical ABx
Severe = Oral abx
5
Q
What is the treatment for nodular (cystic) acne?
A
topical retinoids and other topical stuff
If severe, oral abx. If that doesn’t work, oral isotretinoin
6
Q
When is oral isotretinoin indicated the treatment of acne?
A
In severe cases of nodular (cystic) acne that is first unresponsive to oral abx
7
Q
During a vaginal delivery, retraction of the head back into the perineum is called what sign? What does this suggest? What should be done?
A
- Turtle sign
- It is indicative of shoulder dystocia
- Flexion of the mother’s thighs against her abdomen (McRoberts maneuver)
8
Q
What is McRobert’s maneuver?
A
Flexion of the mother’s thighs during vaginal delivery to facilitate delivery of an infant at risk of shoulder dystocia
9
Q
Why should excessive pressure be avoided in infants presenting at risk of shoulder dystocia?
A
May cause hyperextension of the neck, and lead to a brachial plexus injury
10
Q
What is the Zavanelli maneuver? When is it used?
A
Pushing infant back into mother and preparing for cesarean delivery. Last step in cases of infants at risk of shoulder dystocia
11
Q
What is the drug of choice for vaginal candidiasis?
A
Fluconazole
12
Q
When is Rhogam first administered to a pregnant women?
A
28 weeks unless there is a risk of bleeding earlier
13
Q
What neoplastic process is most associated with postcoital bleeding?
A
Cervical cancer
14
Q
When is transmission of toxoplasma most likely in pregnancy? When is it most likely to be symptomatic?
A
Transmit = increase as pregnancy progresses Symptomatic = first trimester
15
Q
True or false: immunocompetent women who have been infected with toxo prior to the pregnancy virtually never pass on the infection
A
True
16
Q
What two organisms typically cause chorioamnionitis?
A
GBS
E.coli
17
Q
How long after sex do diaphragms need to be left in?
A
6-8 hours
18
Q
What is the next step after the McRobert’s maneuver, if that fails to deliver an infant?
A
Suprapubic pressure
19
Q
When are forceps indicated in the delivery of an infant with possible shoulder dystocia?
A
never
20
Q
When is fundal pressure indicated for the delivery of an infant at risk of shoulder dystocia?
A
never–may lead to uterine rupture
21
Q
What is the role of inhaled anesthetics in labor?
A
Used to relax the uterus in an attempt to remove retained placenta
22
Q
True or false: vaginal hygiene has not been associated with BV
A
True
23
Q
What is danazol used for?
A
Synthetic androgen used to treat endometriosis
24
Q
What are the components of the VACTERL syndrome? Is it associated with polyhydramnios , or oligohydramnios?
A
Vertebral Anal atresia Cardiac Tracheal Esophageal Renal Limb
Poly
25
Why should TVUS be avoided in pts with suspected placenta previa?
May cause bleeding
26
When does GBS cause sepsis/pneumonia in a neonate? Chlamydia?
```
GBS = with 48 hours
Chlamydia = 4-12 weeks
```
27
A difference of how many cm on fundal height is concerning for IUGR?
4 cm
28
What is the maximal interval post intercourse for which effective emergency contraception is available? What are the contraceptives that can be used at this point?
120 hours (Cu IUD or ulipristal)
29
What is the average return to menses with post-pill amenorrhea? Women who do not menstruate beyond what timeframe require further workup?
32 days
| 3 months + requires more workup
30
Primary amenorrhea is diagnosed as the absence of menses by what age?
16
31
If a mother has recurrent outbreaks of HSV infections, when should she begin prophylaxis to reduce the chances of transmission to the baby, and/or reduce chances of a cesarean section?
At 36 weeks onward.
32
True or false: if a woman becomes infected with HSV during the pregnancy, she should be managed expectantly, with a possible cesarean section
false-treat now to alcyclovir
33
What is the treatment for subacute thyroiditis in recently postpartum patients?
Same as not postpartum--NSAIDs and supportive therapy.
34
What is the likely etiology of urge incontinence in a young woman who has an over exaggerated response to bethancochol administration?
MS
35
What does a bethancol administration test assess for in the work up of urinary incontinence?
If overreactive, the suggests UMN lesion (MS)
If not reactive, then suggests Detrusor muscle problem
36
What is velamtous umbilical cord insertion? How is this managed?
Insertion of the umbilical cord between the chorion and the amnion, as opposed to the chorionic plates.
Expectantly with close monitoring for fetal anemia, which would suggest cord rupture. If this occurs, then immediate c-section is indicated, regardless of fetal maturity
37
What is a major hepatic complication in the postpartum mother with HELLP syndrome?
Hepatic hematoma rupture, resulting in severe internal bleeding
38
What are the components of the BECALM mnemonic for recalling the steps to take in cases of potential infant should dystocia?
```
Breathe, do not push--lower head of bed
Elevate legs into McRobert's position
Call for help
Apply suprapubic pressure
enLarge opening with episiotomy
Maneuvers
```
39
What is the Gaskin maneuver for delivering an infant?
Mother on all fours
40
What is the classic triad of McCune albright syndrome?
Cafe au lait spots
Polyostotic fibrous dysplasia
autonomous endocrine hyperfunction
41
What is ovarian hyperthecosis?
Hyperplasia of the theca interna of the ovary causing virilization
42
What is the normal change in pulmonary status in pregnant women?
Chronic, mild respiratory alkalosis with metabolic compensation
43
What are the renal/urinary changes that occur in pregnancy?
Increased GFR
Decreased BUN
Mild hyponatremia
44
What causes the increased respiratory rate in pregnant women?
Increased progesterone stimulates the medullary respiratory center of the brain
45
Does acute cervicitis present with uterine tenderness?
No
46
Under what gestational age are corticosteroid indicated to hasten pulmonary maturity?
34 weeks
47
Is chorioamnionitis an indication for a c-section?
No
48
What is the pathophysiology of mittelschmerz?
Rupture of the follicle on day 14 causes concomitant release of a small amount of blood into the peritoneum, causing mild peritonitis
49
What are the point values of a BPP that are normal, equivocal, and abnormal respectively?
```
Normal = 8+
Equivocal = 6
Abnormal = 4 or below
```
50
What are luteomas? Treatment?
Solid, Androgen producing ovarian masses found in pregnancy
Most will regress after pregnancy
51
When are luteomas operated on?
If torsion of ovary occurs
52
With what type of pregnancy are luteomas concerning?
If fetus is female--excess androgen exposure
53
Why are pregnant women more likely to get pyelonephritis?
Progesterone causes dilation of urethra
54
Untreated asymptomatic bacteriuria in pregnant women predisposes them to what conditions?
Pyelonephritis
Preterm labor
Low birth weight
55
What does osteogenesis imperfecta cause to a fetus?
broken bones
| Hypoplastic thoracic cavity
56
What is amniotic band sequence?
Sequence associated with limb defects, Craniofacial defects, and/or abdominal wall defects
57
What is a major neonatal morbidity associated with preeclampsia?
Chronic placental insufficiency and low birth weight
58
What are cystic hygroma?
Congenital loculations of lymphatic tissue filled with lymph. They are benign, but can be disfiguring.
59
Women over what age with a breast mass should receive a mammography?
over 30
60
What is the treatment for syphilis in pregnant pts who are allergic to PCN?
Skin testing a PCH desensitization
61
True or false: OCP cause weight gain
False
62
After how many weeks gestation are tocolytics contraindicated?
34 weeks or above
63
If a fetus is in breech presentation and the mother goes into preterm labor, how should the infant be delivered?
C-section
64
What is the causative agent of lymphogranuloma venereum? S/sx?
Chlamydia trachomatis
| Large and painful LAD
65
What is the most effective form of emergency contraception?
Cu IUD
66
How long after intercourse can the Cu IUD be used as emergency contraception?
0-120 hours
67
How long after intercourse can the Ulipristal pill be used as emergency contraception?
0-120 hours
68
How long after intercourse can the Levonorgestrel pill be used as emergency contraception?
0-72 hours
69
How long after intercourse can the OCPs be used as emergency contraception?
0-72 hours
70
How is hypothyroidism managed in pregnancy?
Increase dose of levothyroxine when becomes pregnant, and follow TSH according to pregnancy norms
71
What are the indications for inpatient admission for treatment of PID? (4)
- Pregnant
- cannot tolerate oral meds
- Severe presentation (fever, vomiting)
- Complications
72
What are the medications used to treat PID as an inpatient?
IV cefoxitin + PO doxycycline
73
What are the meds used to treat PID as an outpatient? What is added to this in cases of tubo ovarian abscess?
IM ceftriaxone + PO doxycycline
Metronidazole
74
When diagnosing preeclampsia, a BP should be taken twice, how far apart?
4 hours
75
How do OCPs cause HTN?
Estrogen is converted to ANG II via hepatic first pass metabolism
76
In a pt with a h/o a conization for cervical CA, what should be done to assess the risk of preterm labor?
TVUS to determine remainder of cervical length
Done in second trimester
77
What medication is given to women with a short cervix to prevent preterm delivery?
Progesterone
78
What amount of urine is diagnostic or urinary retention?
Over 150 mL
79
What are the risk factors for urinary retention s/p vaginal delivery?
Perineal edema
| Epidural anesthesia
80
What is the biggest risk factor for a preterm delivery?
h/o
81
Does a LEEP procedure increase the risk for preterm delivery? How about laser ablation?
LEEP maybe
| Laser = no
82
True or false: gastric bypass increases the risk for preterm pregnancy?
False
83
Which ethnicity has the highest rates of breast CA?
Whites
84
What is the definition of tachysystole?
More than 5 contractions in 10 minutes, averaged over a 30 minute period
85
What hemodynamic changes occur with rapid oxytocin administration?
Hypotension
86
What electrolyte changes are associated with oxytocin administration? Why?
Normovolemic hyponatremia
Oxytocin is similar structurally to ADH
87
What is the pathophysiology behind HELLP syndrome?
Abnormal placentation triggers the immune system and complement cascade, causing platelet consumption, microangiopathic hemolytic anemia, and hepatocellular necrosis
88
What preterm gestational age is the turning point for deciding between delivery and delayed delivery?
34 weeks
89
Under what level of platelets should transfusion be administered prior to c-section and vaginal delivery respectively?
C section = under 40^3
| Vaginal = under 20^3
90
What is the management for preterm labor under 32 weeks gestation?
Betamethasone
Tocolytics
MgSO4
PCN if GBS +
91
What is the management for preterm labor between 32-34 weeks gestation?
- Betamethasone
- Tocolytics
- PCN
92
What is the management for preterm labor [34,37) weeks?
Betamethasone
| PCN
93
What are the tocolytics of choice for preterm labor?
Nifedipine
| Indomethacin
94
Why should MgSO4 be administered in preterm deliveries prior to 32 weeks gestation?
Protection against cerebral palsy
95
True or false: progesterone has tocolytic properties
False--Helps prevent preterm deliveries, but is not a tocolytic
96
What are the causes of a non-reactive stress test? What is the most common cause?
1. Fetal sleep
- placental insufficiency
- fetal hypoxia
97
How long can fetal sleep last for?
40 minutes
98
When does fetal CNS develop? What does this mean for NST results?
26-28 weeks
| If before this, then NST will not be reactive
99
What is the treatment for infertility associated with PCOS? MOA?
Clomiphene
| Estrogen receptor modulator that blocks estrogen receptors at the pituitary
100
What electrolyte disturbances are common with hyperemesis gravidarum? (4)
- Hypochloremic metabolic alkalosis
- Hypokalemia
- Hypoglycemia
- Elevated LFTs
101
What vitamin deficiency, usually seen in alcoholics, can be seen with hyperemesis gravidarum?
Wernicke's encephalopathy 2/2 thiamine deficiency
102
What are the classic s/sx of Wernicke's encephalopathy? (3)
- Encephalopathy
- Oculomotor dysfunction
- Gait ataxia
103
What are the s/sx of acute fatty liver of pregnancy? When in gestation does it usually occur?
N/v
Elevated LFTs
Hypoglycemia
Occurs in the third trimester
104
What is the usual presentation and treatment for ABO incompatibility between mother and fetus?
Mild anemia, maybe jaundice.
Phototherapy, or exchange transfusion if severe
105
In whom is CA-125 serum testing useful for evaluation of an ovarian mass?
Postmenopausal women
106
What is the treatment for a hemodynamically unstable pt with an incomplete/inevitable abortion?
Suction and curettage to evacuate fetus and stop bleeding
107
What are the treatment options for a hemodynamically stable pt with an incomplete/inevitable abortion?
- Expectant
- Misoprostol
- Suction and curettage
108
When can oxytocin be used to evacuate a fetus from an inevitable abortion? Why?
In the third trimester, since earlier than this the uterus does not have enough oxytocin receptors for the medication to work
109
What are the effects of DES on male fetuses? (4)
Microphallus
cryptorchidism
Hypospadias
Testicular hypoplasia
110
What labs can distinguish between preeclampsia and SLE flare in pregnancy?
Decreased complement and increasing ANA with SLE flare
111
What are the three classic s/sx of HUS?
- Thrombocytopenia
- Renal dysfunction
- Microangiopathic hemolytic anemia
112
What are the 6 P's of lichen planus?
```
Purple
Planar
Polygonal
Pruritic
Plaques
Papules
```
113
When should a pt with a likely simple breast cyst be seen again (assuming no malignant US features, clear fluid drained etc)?
2 months.
114
Over what age do breast masses require mammography, generally?
30
115
What is the role of lithotripsy in pregnancy?
Not used
116
True or false: HTN is a risk factor for PPROM
False
117
True or false: HTN is a risk factor for preterm labor
True
118
Premature ovarian failure is defined below what age?
40 years
119
What are the normal findings in the recently postpartum time that are easily mistaken for infection?
- Chills/rigors
- Enlarged fundus
- Red/brown vaginal d/c from lining being shed (2-3 weeks)
120
What causes the urinary retention in the normal postpartum period?
Suppression of micturition reflex and/or a decrease in bladder tone after regional anesthesia
121
Breast abscesses that are larger than how many cm require I+D as opposed to needle drainage?
5 cm
122
What is the uterine cornua?
The interstitium around the uterus
123
Bicornuate uterus is a risk factor for what type of pregnancy pathology?
Ectopic
124
What is the treatment for stable vs unstable ectopic pregnancies?
```
Stable = methotrexate
Unstable = surgery
```
125
What are the s/sx of breast engorgement? When does it commonly occur?
- Breast fullness, TTP, and warmth
| - 3-5 days after delivery when colostrum is replaced by milk
126
What is the treatment for breast engorgement?
Cool compresses
| Acetaminophen /NSAIDs
127
What are the s/sx of mastitis?
Unilateral breast pain with isolated, firm, tender, erythematous area accompanied by a fever
128
How long does the brown/red lochia from pregnancy last for?
6-8 weeks
129
What are the abx to treat postpartum endometritis?
Clindamycin and gentamicin
130
What are the s/sx of postpartum endometritis? What bacteria cause(s) it?
Purulent lochia and uterine tenderness
| Polymicrobial
131
What is the abx of choice for pyelo in pregnancy?
Ceftriaxone
132
What is the abx of choice for the treatment of lactational mastitis?
Dicloxacillin
133
What is the treatment for a septic abortion?
D+S and broad spectrum Abx
134
What are the s/sx of a septic abortion?
Malodorous d/c
| Enlarged, boggy, Tender uterus
135
When is a hysterectomy indicated for the treatment of a septic abortion?
If pelvic abscess develops or does not improve after D+S and 48 hours of abx
136
Why isn't misoprostol indicated for septic abortions?
Too slow
137
When can cephalic version by attempted?
from 37 weeks until onset of labor
138
What are the contraindications for external cephalic version? (4)
Ruptured membranes
Hyperextended fetal head
fetal/uterine abnormalities
Non-reassuring fetal monitoring
139
What should always be available when external cephalic version is attempted? Why?
C-section (can cause fetal distress)
140
What are the four major options to treat endometriosis?
- NSAIDs
- OCPs
- IUD (not Cu)
- Leuprolide
141
What is an aborting myoma?
Fibroid that is large and near the cervix, such that it causes dilation and occasionally prolapses through
142
If PPROM happens what are the deciding factors to induce delivery?
If there are s/sx of infection or fetal compromise
143
PPROM under how many weeks gestation is an indication for Mg? Why?
Under 32 weeks, since this will reduce incidence of cerebral palsy
144
What is the first time a mother should receive Rhogam? Why this time?
At 28-32 weeks gestation
| Abs last for 6 weeks, which would cover any exposure
145
Within how many hours of delivery is rhogam given?
72 hours
146
What organism is most commonly associated with mastitis?
Staph Aureus
147
What are the three major causes of increased afp in pregnancy?
NTDs
Ventral wall defects
Multiple gestation
148
What disease results from a delta-508 mutation?
CF
149
What liver pathology can cause elevated afp?
hepatocellular carcinoma
150
During what gestational weeks is the first trimester combined test ordered?
9-13
151
During what gestational weeks is the cell free DNA test ordered?
Over 10 weeks
152
During what gestational weeks is the quadruple screen ordered?
15-22 weeks
153
During what gestational weeks is amniocentesis ordered?
15-20 weeks
154
During what gestational weeks is anatomic US done?
18-20 weeks
155
What are the usual US findings of ovarian epithelial cancers?
Solid mass with septations and ascites / free peritoneal fluid
156
What are the US findings of cystic teratomas?
Hyperechoic nodules with calcifications
157
What is the presentation of uterine Atony?
Uterus that is soft, boggy, above the umbilicus, and vaginal bleeding
158
What are the risk factors for uterine atony?
prolonged labor
Induction of labor
Operative delivery
159
What is the first line treatment for uterine atony?
Bimanual massage + oxytocin
160
What is the second line treatment for uterine atony? What is the contraindication for this, and why?
Methylergonovine--HTN since this med causes vasoconstriction and will worsen it
161
When is carboprost contraindicated for the treatment of uterine atony?
If h/o asthma
162
What are four major risk factors for placenta previa?
h/o it
Prior c-section / surgery
Multiparity
Advanced maternal age
163
How is placenta previa handled prior to delivery?
No sex
| No digital vaginal exams
164
A cervical length under what measurement is an indication for cerclage?
2.5 cm
165
What is the FSH:LH in premature ovarian failure? Why?
Over 1.0, with both components elevated
This is due to slower clearance of FSH from the circulation
166
What are the main factors that determine the length of the second phase of labor?
Parity and neuraxial anesthesia
167
What is the most common cause of failure of descent during the second stage of labor?
Fetal malposition
168
What is the definition (in hours) of arrested second stage of labor for nulliparous and multiparous pts respectively?
```
Nulliparous = More than 3 hours
Multi = more than 2 hours
```
169
What is the fetal position?
The fetal presenting part in relation to the mother's pelvis (OA, OP, OT, etc.)
170
What are the six factors that determine if preeclampsia has severe features?
- 160/110
- Thrombocytopenia
- Increased cr
- Increased LFTs
- Pulmonary edema
- Visual/neuro symptoms
171
When should pts with eclampsia deliver if they do and do not have severe features?
```
severe = at/over 34 weeks
Not = at or over 37 weeks
```
172
After how many gestational weeks can preeclampsia be diagnosed?
over 20 weeks
173
What are the anti hypertensive medications of choice for the acute treatment of preeclampsia? Which is first line and why?
1. Hydralazine since will not lower HR like:
- labetalol
- nifedipine
174
Why isn't methyldopa used to treat acute preeclampsia?
Slow onset and sedating effect at levels needed
175
What are common US findings in pregnancy, besides the presence of a fetus?
```
Ovarian cyst (corpus luteum cyst)
Fluids in the posterior cul-de-sac
```
176
What are the three treatment options for inevitable abortions?
- Expectant
- Prostaglandins
- Suction curettage
177
What characterizes a normal, reactive NST?
- two or more accelerations in 20 mins that are 15 beats above baseline and over 15 seconds long
- No late/variable decels
178
A BPP of what score indicates the need for repeat in 24 hours?
6/10
179
When is doppler sonography of the umbilical artery indicated?
If less than 10th % weight
180
What is the test that is used to determine the dose of Rhogam needed?
Kleihauer-Betke test
181
What is done with the Kleihauer-Betke test?
Maternal RBCs gathered on a slide, and added to acid. Maternal cells lyse easier and leaves only fetal ones. % calculation is then used to determine dose of Rhogam needed
182
What is the drug used to induce ovulation in a woman with PCOS?
Clomiphene
183
What are the relative testosterone levels in PCOS? What may lead to false results?
Usually elevated, but may be normal if binding globulin is low
184
True or false: severe nodulocystic acne is a sign of hyperandrogenism
True
185
Why are women with PCOS at elevated risk of endometrial cancer?
Decreased progesterone secretion due to chronic anovulatory cycles. This leads to unbalanced estrogen, and chronic proliferation
186
What hormone is responsible for maintaining the endometrium during pregnancy?
Progesterone
187
What is the role of hCG in pregnancy?
Maintain the corpus luteum
188
What cells produce hCG?
Syncytiotrophoblasts
189
What other hormones share the same alpha subunit as hCG?
TSH
LH
FSH
190
What subunit is specific to hCG and forms the basis of pregnancy tests?
beta
191
Why are fluoroquinolones contraindicated in pregnancy?
Bone defects
192
Why are tetracyclines contraindicated in pregnancy?
Bone and tooth defects
193
When is TMP-SMX safe in pregnancy?
During the second trimester; it is contraindicated in the first d/t interference with folic acid metabolism, and increases the chances of kernicterus
194
What four abx are first line to treat uncomplicated UTIs in pregnant women?
Macrobid
Augmentin
Cephalexin
Fosfomycin
195
What age is an indication for endometrial bx in the presence of abnormal uterine bleeding?
45
196
What are the three criteria the warrant an endometrial bx in a woman under 45 years in work up of aub?
- Unopposed estrogen (obesity, PCOS)
- Failed medical management
- Lynch syndrome
197
What are the genital findings of 5alpha-reductase deficiency pts?
since no 5alpha-reductase to convert testosterone to DHT, ambiguous genitalia
198
What hormone simulates the regression of the mullerian ducts? What is the significance of this?
Anti-Mullerian hormone (AMH)
-Pts with androgen insensitivity will still produce this, and thus not have a uterus. However, testosterone is needed to make boy bits, so rudimentary vag forms
199
What is a common side effect of tamoxifen usage? Why?
Hot flashes-exhibits antiestrogenic activity in the CNS
200
What is the most significant risk factor for the development of osteoporosis?
Fragility fracture
201
What is the role of EtOH in osteoporosis?
Excessive drinking increases the risk
202
True or false: being a vegetarian increases the risk for osteoporosis
False
203
What is the effect of a hematoma/blood in the uterus 2/2 placental abruption?
Uterotonic effect, causing a firm, distended uterus and unusually low amplitude, but frequent contractions
204
What is the usual presentation of placental abruption?
Sudden onset of LBP or abdominal pain, and vaginal bleeding
205
What are the signs of uterine rupture?
Diminishing contractions
Palpable fetal parts
Loss of fetal station
206
Sudden onset of abdominal pain, vaginal bleeding, and loss of fetal station = ?
Uterine rupture
207
Is hep C transmissible by breast milk?
No
208
What is the incidence of vertical transmission of Hep C? Does a c-section decrease this risk?
2-5%
| No
209
What is the risk of transmitting Hep C in serodiscordant, monogamous couples?
Less than 0.1%
210
What are the s/sx of intrahepatic cholestasis of pregnancy?
-Intolerable, generalized pruritus, especially on palms and soles, worse at night
211
What is the treatment for intrahepatic cholestasis of pregnancy?
Ursodeoxycholic acid
| Early delivery after fetal lung maturity
212
What is the typical distribution of PUPPP?
Red papules within striae sparing around the umbilicus palms, soles, and face. May extend to extremities
213
With what activities do bartholin gland cyst cause discomfort?
Sex
Walking
Sitting
Exercise
214
True or false: cervical bx is still done during pregnancy
True
215
True or false: Pts with HSIL on pap smear can be treated with immediate LOOP, even if pregnant
False--not if they're pregnant, but otherwise true
216
When is the HiB vaccine indicated for a pregnant woman?
Only if immunocompromised or asplenic
217
What is the test to assess for ovarian reserve?
FSH levels on day 3 of cycle
218
What are the s/sx of Mg toxicity?
Loss of DTRs
Respiratory depression
Somnolence
219
How is Mg excreted? What is the significance of this?
100% by kidneys
| Need to be careful when preeclamptic women have renal failure
220
What may happen to calcium levels with administration of MgSO4?
Decreased
221
What is the risk of transmission of HIV to the fetus if the mother is on triple antiretroviral therapy with good CD4 and low viral titers?
Less than 1%
222
If the mother has not been taking her triple antiretroviral therapy and the child is born, what should it be given?
Zidovudine
223
When should the mother start receiving antiretroviral therapy for HIV in pregnancy?
ASAP
224
What should be avoided in a HIV+ mother during pregnancy?
- Avoid amniocentesis until titers low
| - Avoid artificial ROM, instrumentation
225
When is a c-section indicated for HIV+ mothers?
If viral load over 1000 copies
226
What is genito-pelvic pain/penetration disorder? Who is it seen in? What are the features and treatment?
- Disorder characterized by pain on and an aversion to attempted vaginal penetration.
- Common in women with a h/o of sexual abuse.
- Pain w/ vaginal penetration + anxiety + no medical reason
- Desensitization and kegels
227
What is female sexual interest/arousal disorder?
Lack of interest
228
What age does clear cell vaginal cancer develop?
UNder 20 years
229
Where in the vagina is clear cell and squamous cell cancer found respectively?
Clear cell = Upper 1/3 of anterior wall
| SCC = Upper 1/3 of posterior wall
230
What are the two major risk factors for development of SCC of the vagina?
Smoking
| HPV infx
231
How does the arm appear with Klumpke's palsy?
- Extended wrist
- Hyperextended MCPs
- Flexed ICPs
- Absent grasp reflex
232
What nerve roots are affected with Klumpke's palsy?
C8-T1
233
What associated condition might be seen with Klumpke's palsy?
Horner's syndrome
234
What nerve roots are affected with Erb Duchenne's palsy?
C5-C6
235
How is the arm held with Erb Duchenne's palsy?
- Extended elbow
- Pronated forearm
- Flexed wrist and fingers
236
What is the treatment for brachial nerve plexus injury in babies?
PT and massages
237
Which has an intact grasp reflex: Erb-duchenne palsy or Klumpke's?
Erb-Duchenne (waiter's tip can grasp)
238
What are the clinical features of intraductal papilloma?
No mass
| Unilateral bloody nipple discharge
239
What are the clinical features of fibroadenomas of the breast?
Solitary, painless, firm, and mobile mass averaging 2 cm size
240
What is the classic presentation of fibrocystic changes of the breast?
Cyclical mastalgia and diffuse nodularity on breast examination
-Usually no d/c, but if present, serous
241
How does lobular breast cancer usually present?
(Bilateral) fixed irregular mass
242
What are the first three labs that should be obtained in the evaluation of secondary amenorrhea, after a pregnancy test? What test/diagnosis should follow if the respective lab is elevated?
- TSH-hypothyroidism
- Prolactin-brain MRI
- FSH-premature ovarian failure
243
What is the technical definition of secondary amenorrhea?
Absence of menses for more than / = to 6 months or 3 cycles
244
When is a hysteroscopy indicated in the workup of secondary amenorrhea?
If woman has a h/o uterine procedure or infx
245
What is the drug of choice to treat gonorrhea?
Ceftriaxone
246
What is the drug of choice to treat chlamydia?
Doxycycline
247
What topical therapy may be used on condyloma acuminata?
Trichloroacetic acid
248
What are the warning signs of shoulder dystocia?
Prolonged first/second stage of labor
| Turtle sign
249
True or false: adenomyosis usually presents with symptoms of mass effect
False--much more common with leiomyomas
250
What result from the Q-tip test indicates stress urinary incontinence 2/2 urethral hypermobility?
Deviation 30 degrees or more from the horizontal
251
What is oxybutynin used for? MOA?
Urge incontinence
| Anticholinergic
252
What is the classic presentation of inflammatory breast CA?
```
Edematous
Erythematous
Painful
Pruritic
Dimpling
```
253
What causes worsening of rheumatic heart disease in pregnant women?
Physiologic increases in HR and blood volume raise the transmitral pressure gradient an LA pressure
254
What is peripartum cardiomyopathy?
Rapid onset cardiomyopathy seen at over 36 weeks gestation
255
True or false: A-frib is common with peripartum cardiomyopathy
False--relatively rare
256
What type of chemo is indicated for the treatment of ovarian cancer?
Platinum compounds
257
What degree of vaginal lacerations are risk factors for rectovaginal fistula?
3rd or 4th degree
258
Over what weight is fetal macrosomia diagnosed?
4 kg
259
What is the main cervical nerve innervating: the biceps
C6
260
What is the main cervical nerve innervating: infraspinatus
C5
261
What is the main cervical nerve innervating: wrist/finger extenders
C7
262
What is the prognosis for brachial plexus injuries in infants?
Usually self limiting
263
What is the presentation and prognosis for cephalohematoma?
Hematoma that does not cross suture lines
| Self limiting
264
What is the test to assess for PMS? Treatment?
- Symptom diary for two menstrual cycles that results in socioeconomic impact
- SSRIs
265
What will the symptom diary of a pt with PMS demonstrate?
REcurrence of s/sx during the luteal phase (1-2 weeks prior to menses) and resolution during the follicular phase
266
What common neurological pathology is a contraindication to OCPs?
Migraines
267
What is the major absolute contraindication to raloxifene or tamoxifen treatment?
h/o venous thrombosis
268
What non-malignant disease is raloxifene used to treat?
Osteoporosis
269
True or false: a h/o CAD is a contraindication to raloxifene use
False
270
Does raloxifene increase or decrease the risk for endometrial cancer?
Decrease (antagonist here, unlike tamoxifen)
271
True or false: SERMs are associated with an increase in ovarian cancer
False
272
What lab abnormality is often seen with Turner's syndrome?
Increase FSH levels
273
What is the treatment for neonatal hyperthyroidism?
Beta blockers and methimazole
274
How much does T3/T4 cross the placenta?
Not much
275
What are the teratogenic effects of valproic acid and carbamazepine?
NTDs
| Craniofacial abnormalities
276
What are the US findings of endometriosis of the ovary?
Homogenous, Cystic like mass
277
True or false: surgical resection of endometriosis usually improves fertility
True
278
What are the typical US characteristics of tubo-ovarian abscesses?
Complex, thick walled mass with air-fluid levels
279
Atypical *glandular* cells on pap smear warrants colp + endometrial bx if what criteria are met?
- Age 35 or more
| - Less than 35 with risk factors (e.g. obesity, anovulation)
280
What is the treatment for breast engorgement in a woman that is not /does not plan breastfeeding?
NSAIDs + supportive bra + no nipple stimulation
281
Over what age is mammography preferred over US for evaluation of nipple discharge?
30
282
What type of nipple discharge is concerning for CA, and warrants US/Mammogram as the first step? (3)
Unilateral
Bloody
Serous
283
True or false: any breast mass that is palpable with abnormal discharge needs US/Mammogram
True
284
What type of nipple discharge does NOT require mammography/US in diagnosis? (3)
- Bilateral
- Non-bloody, milky
- No lump associated
285
How can chronic use of antihistamines lead to galactorrhea?
inhibits estradiol metabolism and increase prolactin levels
286
What causes the RUQ pain with HELLP syndrome?
Distention of the liver capsule
287
What are the s/sx of acute fatty liver of pregnancy?
- n/v
- Abdominal pain
- Elevated LFTs
- Leukocytosis
- hypoglycemia
- AKI
288
How can you differentiate acute fatty liver of pregnancy and HELLP syndrome?
AFLP is characterized by AKI, leukocytosis, hypoglycemia
289
What is the pathophysiology of pulmonary edema in preeclampsia?
- Generalized arterial vasospasm leads to increased systemic vascular resistance and high cardiac afterload. The heart becomes hyperdynamic to overcome systemic resistance
- Decreased renal function
- Decreased serum albumin
290
What are the five major *fetal* problems that can occur with late term pregnancies?
- Macrosomia
- Oligohydramnios
- Meconium aspiration
- Stillbirth
- Convulsion
291
What are the five major *maternal* problems that can occur with late term pregnancies?
- Cesarian section
- Infx
- Postpartum hemorrhage
- Perineal trauma
292
Prolonged pregnancies are at risk for polyhydramnios or oligohydramnios? Why?
Oligo
| Aging placenta may have decreased fetal perfusion, resulting in decreased renal perfusion and decrease urinary output
293
What is the definition of oligohydramnios?
Single deepest pocket 2 cm or less or fluid index 5 cm or less
294
What is the precursor to estrone?
Androstenedione
295
What is the role of progesterone in the treatment of endometrial hyperplasia?
Causes differentiation of endometrium
296
When (in gestational weeks) is external cephalic version offered?
37 weeks and over
297
What are the complications of marijuana use while breastfeeding for the infant?
- Decreased muscle tone
- Sedation
- Delayed motor development
298
What are the six major contraindications to breast feedings? (4 infectious, 2 environmental)
- Untreated, active TB
- HIV
- Herpetic lesions
- Active varicella infx
- Chemo
- Substance abuse
299
Why is the fetus largely unaffected by bleeding from placenta previa?
Maternal blood loss, not fetal
300
What is the treatment for confirmed chlamydia infx? Confirmed Gonorrhea infx?
```
Chlamydia = z-pack
Gonorrhea = z pack + ceftraiaxone
```
301
When does co testing for HPV start with pap smears?
30+
302
All sexually active women under what age should be tested for gonorrhea and chlamydia?
25
303
Gestational age over how many weeks is a contraindication to cerclage?
24 weeks
304
What is the relationship between EtOH consumption and breast cancer?
Dose dependent increase in risk
305
When is PID pain the worst, usually?
Menstruation
306
True or false: Gonorrhea and chlamydia are not screened for in initial pregnancies if pts are over 25 and are not high risk
True
307
True or false: hep C is screened for at every initial prenatal visit for all pts
False-only for at risk pts
308
What are the absolute contraindications to exercise in pregnancy? (7)
- Amniotic fluid leak
- Cervical incompetence
- Multiple gestation
- Placental abruption or previa
- Premature labor
- Preeclampsia
- Severe heart or lung disease
309
What exercise activities are not safe for pregnant women? (4)
- Contact sports
- High fall risk
- Scuba diving
- Hot yoga
310
What is the recommended amount of exercise for pregnant women?
20-30 minutes most or all days
311
Why should pregnant pts avoid dehydration?
Chance for preterm labor
312
Why should pregnant pts avoid lying supine for long periods?
Decreases venous return and thus placental perfusion
313
What are the characteristics of false labor in terms of:
- Timing
- Strength
- Pain
- Cervical change
- irregular, infrequent contractions
- Weak strength
- None to mild pain
- No cervical changes
314
What are the characteristics of latent labor in terms of:
- Timing
- Strength
- Pain
- Cervical change
- Regular, increasing in frequency
- Increasing intensity
- Painful
- Cervical changes
315
What are the indications for the HPV vaccine?
All women ages 11-26
| Males 9-21 (until 26 if MSM or HIV+)
316
When does pap testing begin?
Age 21
317
What are the US findings of placenta accreta?
Intraplacental villous lakes
318
How do you differentiate uterine atony and placenta accreta on exam?
Placenta accreta will have a firm uterus, as opposed to a soft one
