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122 Cards in this Set
- Front
- Back
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Components of BPP (BioPhysical Profile); Mnemonic; and scoring results |
Test the Baby, MAN! |
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1st step in diagnosis of Hyperemesis Gravidum:
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RULE OUT MOLAR PREGNANCY with β-hCG & ultrasound
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4 major components to mgmt of Gestational Diabetes
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1- ADA diet
2- insulin if needed 3-US for fetal growth 4- NST beginning at 30-32 weeks if requires insulin or an oral hypoglycemic |
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Classic triad of ECTOPIC PREGNANCY and its Mnemonic
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"The classic triad of ectopic pregnancy PAVEs the way for diagnosis."
Pain (abdominal) Amenorrhea Vaginal bleeding Ectopic pregnancy |
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Clinical diagnosis of Endometritis (3)
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1) Fever > 38 (> 100.3 F) |
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The 7 W'S OF Postpartum Fever (10 days postdelvery)
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1) WOMB (Endomyometritis)
2) WIND (Pnemonia, Atelectasis) 3) WATER (Urinary tract infection) 4) WALKING (DVT, pulm embolism) 5) WOUND (Incision, Episiotomy) 6) WEANING (Breast engorgement, abcess, mastitis) 7) WONDER DRUGS (Drug fever) |
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Name 3 conditions in which breastfeeding is contraindicated
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HIV infection |
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⨁ Chandelier sign
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When you touch the cervix, there is so much pain that the patient jumps to the chandelier.
Likely Pelvic Inflammatory Disease. |
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Acute causes of Pelvic Pain: (mnemonic)
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A ROPE |
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If a uterine mass continues to grow after menopause:
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Suspect malignancy.
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Any palpable ovarian or adnexal mass in a premenarchal or postmenopausal patient is suggestive of:
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An ovarian neoplasm
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Causes of Urinary Incontinence w/o specific urogenital pathology (Mnemonic)
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DIAPPERS
Delirium/confusional state Infection Atophic vaginitis/urethritis Pharmaceutical Psych causes (depression) Excessive urinary output (hyperglycemia, hypercalcemia, CHF) Restricted mobility Stool impaction |
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DDX for a breast mass (5)
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Fibrocystic disease Fat necrosis |
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__________ and _________ are common causes of bloody nipple discharge.
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Intraductal papilloma and Mammary duct ectasia
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1st step in workup of a suspicious mass. ➤.in a postmenopausal woman or woman > 30?
➤ in a woman < 30 |
Mammogram |
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Naegele's rule
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EDD = LMP + 7 days - 3 months
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Hegar's sign
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= softening of the cervix
(Nonpregnant cervix feels like cartilage of nose. Pregnant cervix feels like the lips of the mouth) |
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Chadwick's sign
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= bluish discoloration of the vaginal & cervical mucosa due to vascular congestion in pregnancy
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What does Quickening mean?
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First fetal movements felt by mother
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Plasma β-hCG levels should double every 2 days prior to what gestational age?
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Prior to 10 weeks
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If fetal heart tones aren't heard by ____ weeks, a US should be done to document a viable pregnancy.
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by 10 weeks
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Up to _____ weeks, the ___________ is predictive of best. age by +/- 4 days
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up to 12 weeks, Crown-Rump length
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When is β-hCG detectable in maternal serum?
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After implantation has taken place (~8-10 days after conception)
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If mom has β-thalassemia trait/disease or Sickle cell trait/disease, what's your next step in management?
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Test the after to determine the risk of inheritance for the fetus.
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Normal acid-base status in pregnancy:
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Compensated Respiratory Alkalosis
(more CO2 blown off, pH 7.45) |
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Thyroid hormone levels in pregnancy and why the change?
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total T4 & T3 |
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Definition of Reactive NST
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2 or more accelerations within 20 minutes = fetal well-being
(2 accelerations where it goes 15 beats above the baseline for 15 seconds.....within a 20-minute time period) |
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Components of modified BioPhysical Profile (mBPP)?
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Nonstress test(NST)
and AFI (Amniotic Fluid Index) |
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Most common cause of Oligohydramnios:
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Rupture of Membranes
note: assoc'd w/ IUGR 60% of the time |
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Fetal Tachycardia and Fetal Bradycardia
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<110 and >160 for 10 minutes or more
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First-Trimester Screen (FTS)
⦿ What is it & when performed? ⦿ What are the results if Downs syndrome |
b/w 11-13 weeks |
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High MSAFP is seen with:
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Underestimation of gestational age |
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How do you monitor IUGR?
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Serial ultrasounds
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3 P's that affect the duration of Active phase of Labor:
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POWER: strength & freq. of CTX
PASSENGER: size of baby PELVIS: size & shape of mom's pelvis |
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Abnormal Labor table
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Indication Nullipara Multipara
Prolonged latent phase >20 h >14 h Average second stage 50 min 20 min Prolonged second stage without (with) epidural >2 h (>3 h) >1 h (>2 h) Protracted dilation < 1.2 cm/h < 1.5 cm/h Protracted descent < 1 cm/h < 2 cm/h Arrest of dilation* >2 h >2 h Arrest of descent* >2 h >1 h Prolonged third stage >30 min >30 min *Adequate contractions >200 Montevideo units [MVU] per 10 minutes for 2 hours. (Please refer to the Pathophysiology for information regarding adequate contractions.) |
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What can cause a false positive nitrazine test? (3)
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Vaginal infection with Trich
Blood Semen |
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Which fontanelle is smaller?
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Posterior fontanelle (smaller triangle shape)
vs ant fontanelle is larger and diamond shape |
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Most common cause for postpartum hemorrhage:
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Uterine atony
Treat with uterotonic agents (piton, methergine, hem abate, misoprostal) |
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Causes of PosTparTum Hemorrhage & Mnemonic
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THE 4 T's
TISSUE: Retained placental tissue TRAUMA: Instrumentation,lacerations, episiotomy TONE: Uterine atony THROMBIN: Coag defects, DIC |
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DefineArrest of Labor
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Lack of cervical change in active first stage for >2 hour with >200 Montevideo units of uterine activity
(Montevideo units are calculated by subtracting the baseline uterine pressure from the peak contraction pressure for each contraction in a 10-minute window and by adding the pressures generated by each contraction. Or easier way is to take the avg peak pressure minus the baseline resting tone and multiply that value times the number of contractions in 10 minutes) |
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Management of worrisome decal's: and Mnemonic
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"STOP when you see decelerations"
Sterile vaginal exam Turn the pt to her left side Oxygen Pitocin off |
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Most common indication for C-section:
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Dystocia (difficult labor--characterized by abnormally slow or no progress of labor)
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The most common reason for C-section:
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Previous C-section
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Most common cause of persistent pyelonephritis (in pregnancy) despite adequate therapy:
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Nephrolithiasis (Kidney stones)
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Most common indications for surgery in pregnancy: (3)
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Appendicitis
Cholecystitis Adnexal masses |
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In pregnant patients with SLE, presence of anti-Ro (SS-A) and anti-La (SS-B) are associated with:
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Congenital Heart Block
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Shoulder Dystocia management (& Mnemonic)
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HELPERRR
call for Help Episiotomy Legs up (McRobert’s position) Pressure suprapubically Enter vagina for shoulder rotation (Woods corkscrew) Reach for posterior arm Rupture clavicle or pubic symphysis Return head into vaginafor C-section (Zananelli). |
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Standard dose of RhoGAM is 300 µg, which is sufficient for:
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30 mL of whole fetal blood (15 mL of D-positive fetal RBCs)
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Fetal Hydrops = collection of fluid in 2 or more body cavities: (name the 4)
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Scalp edema |
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Contraindications to Tocolysis (& Mnemonic)
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BAD CHU |
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2 most common causes of 3rd-trimester bleeding:
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Placenta Previa (usu painless)
& Placental Abruption (painful) |
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US reveals that baby is lying transversely. What are you suspicious of?
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Placenta Previa
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Biggest risk for uterine rupture:
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A Prior C-section
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Causes of postpartum hemorrhage: (& Mnemonic)
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CARPIT |
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What are the types of Placental Attachment disorders (& Mnemonic)
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Accreta = Attaches
(plac. villi attach directly to myometrium instead of decidua basalis) Increta = Invades (plac. villi invade the myometrium) Percreta = Penetrates (plac. villi penetrate thru the myometrium, and may even invade the bladder!) |
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Most common cause of perinatal infection:
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CMV
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Name 3 infections associated with preterm delivery:
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Bacterial Vaginosis, Trichomonas, & Gonorrhea
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DDX for size/date discrepancy in pregnancy: (8)
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Twins |
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Top 5 etiologies of spontaneous abortion
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1. Chromosomal abnormalities
2. Unknown 3. Infection 4. Anatomic defects 5. Endocrine factors |
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DDX for 1st trimester bleeding (4)
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1. Spontaneous abortion
2. Ectopic pregnancy 3. Molar pregnancy 4. Vaginal/cervical lesions/lacerations |
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DDX for 3rd trimester bleeding (4)
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Placental Abruption
Placenta Previa Uterine Rupture Rupture of Vasa Previa |
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Medical methods of abortion are best used within the 1st ___ days
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up to 49 days (i.e. 1st 7 weeks)
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Most common site of ectopic pregnancy:
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Ampulla of fallopian tube
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Biggest risk factor for ectopic pregnancy:
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Prior ectopic pregnancy
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Which method of contraception may be less effective in obese females? More effective in obese?
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Less effective: Implant (Nexplanon) and Transdermal patch (>200 lbs)
More effective: Nuvaring and DepoProvera |
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4 mechanisms of Combined OCPs
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1-prevent ovulation
2-alterine uterine and fallop tube mobility 3-thicken cervical mucus to prevent sperm penetration 4-cause endometrial atrophy |
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Definition of Oligomenorrhea
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Absence of menses for more than 35 days up to 6 months
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Definition of Secondary Amenorrhea
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6 months of amenorrhea after a history of normal menses
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Definition of Primary Amenorrhea |
Primary amenorrhea definition: age 14 without secondary sex characteristics, age 16 with secondary sex characteristics
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3 findings in Premature Ovarian Failure
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Age <40 |
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A baby with ambiguous genitalia is born to a mother who complains of increased facial hair growth over the last few months. Suspect:
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Luteoma of pregnancy
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How much blood loss is necessary to define monrrhagia?
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> 80 mL
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Most common cause for hospital admission for menorrhagia in adolescents:
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von Willebrand disease
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Vaginal bleeding + foul-smelling discharge in a postmenopausal woman =
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Cervical cancer
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➜ DDX for thickened endometrial stripe (endometrial lining seen on US) in a postmenopausal woman
➜ What thickness should the stripe be to prompt an evaluation? |
Endometrial cancer |
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Endometrial stripe > ______ in a patient with postmenopausal bleeding should prompt an evaluation.
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> 4-5 mm
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Name for pain associated with ovulation (in the middle of the cycle).
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Mittelschmerz
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DDX for Chronic Pelvic Pain (& Mnemonic)
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"LEAPING pain" |
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DDX for Acute Pelvic Pain (& Mnemonic)
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A ROPE PID (tubo-ovarian abcess) |
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A female with new-onset pelvic pain and a negative pregnancy test has an echogenic adnexal mass on ultrasound. What is the diagnosis?
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A ruptured corpus luteum cyst
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A 37 y.o. has hemptysis during their menstrual period. Suspect:
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Endometriosis of the lung or nasopharynx |
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Long-term complications of Endometriosis
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• Adhesions (prolonged bleeding causes scarring) |
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Classic findings of enDometriosis
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3 D's |
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Classic findings on physical exam of pt with Endometriosis
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Nodularities on the uterosacral ligament and a fixed retroverted uterus
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"Enlarged, globular, boggy uterus"
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Adenomyosis
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Bilateral ___________ are usually seen in molar pregnancies, due to elevated β-hCG levels.
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Bilateral theca lutein cysts
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Leiomyomas are most commonly which type:
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Subserosal
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Submucosal and intramural leiomyomas usually present as ________________, whilecan present with ________________.
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Submucosal and intramural leiomyomas--> menorrhagia |
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What risks are increased in a pregnancy with fibroids (5)
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Abruption |
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Risk factors for Cervical dysplasia (& Mnemonic)
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OSHA Ends Dirt, Garbage, & Chemicals |
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Regarding cervical dysplasia, both _______ and ________ are needed for a histologic/pathologic diagnosis.
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Colposcopy and Biopsy (confirmatory tests) |
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What must be visualized for adequate colposcopic evaluation?
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1- TZ (Transition zone)
2- Extent of lesion in its entirety |
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Radical hysterectomy requires removal of:
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1-Uterus |
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Basic treatment for Invasive Cervical cancer:
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If confined to cervix: Radical hysterectomy, and Pelvic and Para-aortic Lymphadenectomy |
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Side effects of progestins (5)
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Weight gain |
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______ is the most prognostic indicator of Endometrial cancer
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Grade
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What type of ovarian cancer accounts for 85% of all ovarian cancers?
And what subtype of this type is the most common type of ovarian cancer? |
Epithelial cell ovarian cancer |
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_______________ is a fixed pelvic and upper abdominal mass when associated with ascites, and is pathognomic for ovarian cancer.
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Omental caking
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How does ovarian cancer usually spread:
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By exfoliation of cancerous cells into the peritoneal fluid/ thru the peritoneal fluid, which carries cancer cells to other abdominal structures
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Palpable nodule on the umbilicus of a patient with known ovarian cancer:
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Sister Mary Josephs nodule = ovarian cancer metastasis to umbilicus
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➤ Malignant conditions that cause ⬆ CA-125: (5) ➤ Benign conditions that cause ⬆ CA-125: (6)
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Ovarian cancer |
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Name for a tumor that has metastasized from another primary cancer to the ovaries
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Krukenberg tumor (usu from the GI tract)
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Most common complaint in vulvar cancer:
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Itching & burning of the vulva |
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3 possible precursors to Vulvar cancer
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a lump or wart-like lesion |
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If an itch-scratch-itch cycle is mentioned, think:
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LSC (lichen simplex chronicus)
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Preeclampsia prior to 20 weeks gestational age:
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Suspicious for Molar pregnancy
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What substances are secreted by Gestational Trophoblastic disease?
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• β-hCG
• Lactogen • Thyrotropin |
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3 things required for a clinical diagnosis of PID
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1) Abdominal tenderness |
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5 Criteria for hospitalization for PID (& Mnemonic)
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GU PAP |
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Screening tests for Syphilis:
Confirmatory tests for Syphilis: |
Screening: RPR & VDRL
Confirmatory: FTA-ABS & MHA-TP |
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Most common infection with an IUD
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Actinomyces
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Suspicious findings for breast cancer on a breast exam:
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Hard, fixed, irregular mass |
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Suspicious findings for breast cancer on a mammogram
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Cluster of calcifications |
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Risk factors for breast cancer (7)
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Personal hx of breast cancer |
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In which obstetrical conditions should pregnant patients avoid sex?
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Placenta previa |
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3 factors that can decrease the age of menopause (menopause at a younger age)
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1) Smoking (age down by 3 years!)
2) Chemo 3) Genetics |
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Menopause is considered "late" if it occurs after age:
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after age 55
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Estrogen creates a hypercoaguale state due to:
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production of hepatic coagulation factors |
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What muscles make up the pelvic diaphragm
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Levator ani and Coccygeal muscles |
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Risk factors for developing Prolapse (9)
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Advancing age |
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Name 5 complications of Pelvic organ prolapse
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Urinary retention UTI's |
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Name the 5 types of urinary incontinence (& MNEMONIC)
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"This Urine Flow is So Outrageous" |
