women's health

Question 1

ectopic pregnancy RF

Answer 1

conception with IUD in place

Question 2

ectopic pregnancy presentation

Answer 2

missed/delayed menses
vaginal bleeding
abdominal pain/discomfort

risk for fallopian tube rupture - bleeding out

Question 3

ectopic pregnancy treatment

Answer 3

unstable - surgery - laparotomy
stable - med - MTX (CBC, creatinine, LFTs)

Question 4

methotrexate CI

Answer 4

hemodynamic instability/fallopian tube rupture, unable to follow up

hepatic/renal disease

thrombocytopenia, anemia

Question 5

ectopic pregnancy diagnosis

Answer 5

absence of intrauterine gestational sac with hcg levels of 1500 mlU/ml or greater via ultrasound

Question 6

gestational HTN

Answer 6

SBP >140 or DBP >90 on 2 separate readings at least 4 hours apart, with no proteinuria or severe preeclampsia

most cases resolve postpartum

first line: PO a-methyldopa and PO labatalol

Question 7

preeclampsia

Answer 7

BP 140/90 with proteinuria >300 for 24 hours (or other end organ damage) after 20th week of gestations in previously normotensive pt

may have HA, rapid weight gain, edema

mag sulfate for seizure prophylaxis

nicardipine/labetalol

Question 8

HELLP

Answer 8

hemolysis, elevated liver enzymes, low platelet count

RUQ pain

deliver the baby if >34 weeks, otherwise steroids, BP mgmt, seizure mgmt, transfusion

Question 9

HTN crisis

Answer 9

goal <160/110

labetalol, hydra, nifedipine

avoid nitroprusside - concern for cyanide and thiocyanate toxicity in mom/fetus

Question 10

eclampsia

Answer 10

emergency - DELIVER THE BABY
BP control
Seizure mgmt w mag sulfate

Question 11

amniotic fluid embolism

Answer 11

rapid decline in maternal or fetal status; hypotension w resp symptoms, coagulopathy, cardiac arrest

place in lateral decubitus position to minimize vena cava compression

Question 12

permpartum cardiomyopathy

Answer 12

dilated cardiomyopathy

onset last month of pregnancy/5 months postpartum

treatment like CHF exac

Question 13

VTE

Answer 13

treat w LMWH

Question 14

infectious diseases

Answer 14

rubella
HSV
CMV
listeriosis - wisespread absecesses/granulomas in internal organs

Question 15

pulmonary disease

Answer 15

SOB normal!!!
asthma
pneumothorax

Question 16

renal disease

Answer 16

nephrolithiasis common
treat pyelonephritis

Question 17

DM

Answer 17

normal DM - insulin req decrease 10–20% in first trimester

gest DM - lifestyle modifications, then metformin/glyburide

thyroid - hyperthyroid then hypothyroid. Synthroid. previous hypothyroid need Synthroid increase

Question 18

depression

Answer 18

blues, depression, psychosis

SSRI or SNRI

Question 19

neurocritical care

Answer 19

r/o venous sinus thrombosis -> stroke

consider for acute neuro changes

CT scan
EEG/TCD
seizure mgmt, BP mangt, reduction of ICP

Question 20

bleeding in second half of pregnancy

Answer 20

abrupt placentae
placenta previa
premature labor

Question 21

abrupt placentae

Answer 21

PAINFUL vaginal bleeding, abd pain, uterine tenderness

inquire about trauma, smoking hx, HTN, cocaine

MUST R/O in all patients w painful bleeding

Question 22

placenta previa

Answer 22

do not do a digital exam
ultrasound to confirm

Question 23

premature labor

Answer 23

bleeding
<37 weeks
steroid/abx

Question 24

fever most common cause

Answer 24

endometritis

assume pelvic infection until proven otherwise

Question 25

adnexal torsion

Answer 25

surgical emergency

potential ovarian ischemia
US w/wo doppler

Question 26

FDA drug categories

Answer 26

A - relatively safe for use in preg
B - no known risks, not well confirmed in human trials
C - studies not available, given only if benefit>risk
D - definitive fetal risk
X - contraindicated risk to fetus

Question 27

big physiologic change in preg

Answer 27

CO increases 50%