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265 Cards in this Set
- Front
- Back
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T/F There is an increased incidence of dental caries in pregnancy.
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False: the incidence of dental caries does not increase, but gingival disease does. Look for edematous gums that bleed easily.
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Epulis gravidarum, violaceous pedunculated lesions that appear on the gum line, tend to regress within what time frame post partum?
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2 months
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When does morning sickness typically appear and resolve?
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Appear: 4-8 weeks
Resolve: 14-16 weeks |
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What are the criteria for a diagnosis of hyeremesis gravidarum?
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morning sickness that extends beyond the middle of the second trimester or any associated weight loss, ketonemia, or electrolyte imbalance
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What is ptyalism?
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A perception by the patient to be an excessive production of saliva, but probably an inability of the nauseated patient to swallow the normal amounts of saliva that are produced
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What are the changes in tidal volume, residual volume and total lung capacity that occur during pregnancy?
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Tidal volume: 30-40% increase
RV: 20% decrease TLC: 5% decrease |
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Given that the pregnant woman is in a chronic state of mild respiratory alkalosis, how odes maternal arterial pH remain normal (7.4-7.45)?
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Decreased PCO2 is compensated by an increased renal excretion of bicarbonate. Pregnancy bicarb levels are significantly lower than nonpregnant levels (18-31)
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At what point in pregnancy do diastolic and MAP reach their highest level?
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16-20 weeks; they return to prepregnancy levels by term
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What causes inferior vena cava syndrome?
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When lying supine, the IVC may be close to completly occluded, forcing venous return fromt he lower extremities to be shunted to dilated paravertebral collateral circulation
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What causes the decreased peripheral vascular resistance associated with pregnancy?
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increased levels of progesterone
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What are some of the normal CV findings on exam in a pregnant woman?
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increased second heart sound split with inspiration
distended neck veins low grade systolic ejection murmurs (icreased blood flow across aortic and pulmonic valves) S3 gallop after midpregnancy |
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Cardiac output increases ____% in the course of labor above that in late pregnancy?
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40%
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The mean increase in plasma volume in pregnancy is approximately ____%.
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50%
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How much more iron does a pregnant woman need?
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1000 mg of additional iron
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T/F: iron supplements are used to prevent iron deficiency in the fetus.
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False: the are used to prevent iron deficiency anemia in the mother
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By how much do bleeding time and clotting time change during pregnancy?
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Bleeding and clotting times do not change during pregnancy
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What causes the renal pelves and ureters to dilate during pregnancy?
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Progesterone
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What is the normal range for creatinine clearance in pregnancy?
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150-200 mL/min (increased GFR and RPF)
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What causes hyperpigmentation during pregnancy?
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elevated levels of estrogen and melanocyte-stimulating hormone and a cross-reaction with the structurally similar b-HCG
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In pregnancy, more hair follicles are in what stage?
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Anagen (growth)
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By how much do bleeding time and clotting time change during pregnancy?
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Bleeding and clotting times do not change during pregnancy
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What causes the renal pelves and ureters to dilate during pregnancy?
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Progesterone
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What is the normal range for creatinine clearance in pregnancy?
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150-200 mL/min (increased GFR and RPF)
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What causes hyperpigmentation during pregnancy?
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elevated levels of estrogen and melanocyte-stimulating hormone and a cross-reaction with the structurally similar b-HCG
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In pregnancy, more hair follicles are in what stage?
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Anagen (growth)
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At what point in pregnancy does the pubic symphysis separate?
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28-30 weeks
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What is the function of increased parathyroid hormone in pregnancy?
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maintain serum Ca levels by increasing absorption fromt he intestine and decreasing the loss of Ca through the kidney
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What causes the blurred vision of pregnancy?
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increased thickness of the cornea associated with fluid retention and decreased intraoccular pressure
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What is the average size of the uterus at term?
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1,100 g (from 70 g prepregnancy)
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What are the three endocrine "hypers" of pregnancy?
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Hyperglycemia
Hyperlipidemia Hyperinsulinemia |
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What hormones are responsible for the diabetogenic effects of pregnancy?
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HPL (increases resistance of peripheral tissues and liver to the effects of insulin)
Progesterone Estrogen |
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Glucose is passed from mother to fetus through what mechanism?
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facilitated diffusion
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T/F: fetus is dependent on the mother for glucose but not insulin.
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True: fetal insulin is apparent at 9-11 weeks of gestation
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What two factors cause the lower fasting glucose levels in a pregnant woman?
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1. constant diffusion to the fetus
2. hypertrophy of the maternal pancreas cells secreting two to three times the nonpregnant level of insulin late in pregnancy |
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What causes the increased levels of total T3 and T4 in pregnancy?
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Estrogen causes the increased levels of thyroxine-binding globulin. Free T3 and T4 remain unchanged from prepregnant
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What causes the increase in plasma cortisol levels?
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Estrogen-induced increase in corticosteroid-binding globulin
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What vessel carries oxygenated blood from the lacenta to the fetus?
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Umbilical vein
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What is the normal range of fetal heart rate?
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120-160 bpm
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What is the primary substrate for lacental metabolism?
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glucose
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The fetal kidney forms how much urine per day?
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400-1200mL/day
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What is the primary source of amniotic fluid?
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Fetal urine
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Why is Vitamin K given to newborns?
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Because the neonatal liver is still not fully functional, Vitamin K is given to prevent bleeding problems
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At what point in gestation do primordial germ cells migrate from the endoderm of the yolk sac to the genital ridge?
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During the 8th week
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Development of the fetal ovary occurs at what point in gestation?
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Week 7
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What is the only immunoglobulin to cross the placenta?
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IgG: maternal IgG comprises the majority of the fetal immunoglobulin in utero and in early neonatal period
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What is the Chadwick sign? Hegar sign?
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Chadwick: bluish discoloration of the vagina--a asign of pregnancy
Hegar: softening of the cervix--sign of pregnancy |
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When do fetal movements become apparent to the mother?
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Between 16-20 weeks depending on the parity of the mother.
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At what point may a Doppler detect fetal heart signs?
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12 weeks
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What hormone do urine pregnancy tests measure?
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b-hCG
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Where is hCG produced?
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in the syncytiotrophoblast of the growing placenta
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hCG shares an alpha subunit with what other hormone?
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LH
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Why are serum pregnancy tests more effective than urine pregnancy tests?
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because it tests for the beta subunit
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3/4's of maternal mortality are caused by what 3 things?
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Suicide
Homicide Trauma associated with vehicular accidents where seatbelts were not used |
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The initial assessment of gestational age is done through what practice?
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Menstrual history - date of onset of LMP
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At 20 weeks gestation, the uterine fundus is located where on exam?
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Umbilicus
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What is the most accurate measure of gestational age?
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ultrasound
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How often should a mother receive monthly antenatal care?
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Until 32 weeks
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How often should a mother receive antenatal care in two-week intervals?
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between 32-36 weeks; weekly after that
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What is the only laboratory test performed at EVERY prenatal visit?
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determination of glucosuria and proteinuria; anything more than a trace of either warrants evaluation
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What is the recommended weight gain in pregnancy for a normal-weight woman?
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25-35 pounds
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What pathology should be considered in a woman whose fundal height is significantly greater than expected?
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1. inaccurate calculation of gestational age
2. multiple pregnancy 3. hydatidiform mole 4. hydramnios 5. macrosomia (large fetus) |
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What is the accepted variability in fundal height measurement?
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2 cm +/-
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At what gestational age is ultrasound used to measure nuchal thickness?
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10-13 weeks
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If mom is lying comfortably, how many fetal movements in one-hour is considered healthy?
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4+
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What constitutes a normal/reactive nonstress test (NST)?
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when fetal HR increases by 15bpm over a period of 15 seconds following a fetal movement at 32+ weeks gestational age (at least 10bpm <32 weeks)
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Why must women get bi-weekly NSTs?
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The validity of a NST is only valid for 4-5 days.
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What does it mean to say that fetal well-being tests have a high false-positive value?
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They suggest the baby is in jeopardy when the fetus is actually healthy
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What five assessments of fetal well-being are evaluated in the biophysical profile (BPP)?
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1. Fetal breathing movements
2. Gross body movement 3. Fetal tone 4. Reactive fetal heart rate (NST) 5. Qualitative amniotic (Ultrasound) |
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A BPP score below what number requires immediate intervention?
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< 4
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What organ system is evaluated for fetal maturity?
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Respiratory
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A woman in her third trimester of pregnancy presents to you concerned about a shorp pain in her R groin. What is the MCC (most common cause) of this pain?
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stretching and spasm of the round ligaments. It is often more pronounced on the R side because of the ususal dextrorotation of the gravid uterus
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A class B medication means what to a pregnant woman?
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that animal studies have not demonstrated fetal risk but there are no controlled human studies
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What is meant by indirect maternal death?
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Death of the mother during pregnancy from a disease made worse by pregnancy
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What is the mechanism and treatment for urge incontinence?
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Mechanism: overactive detrussor muscle that contracts unpredictably
Treatment: anticholinergic medication to relax the muscle |
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What is the primary treatment for stress incontinence?
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Surgical: urethropexy replaces the proximal urethra back to its intra-abdominal position
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A post void catherization showing a large residual volume suggests what type of incontinence?
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overflow
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What is the MC complication of uterine inversion?
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postpartum hemorrhage
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What are the signs of placental separation?
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1. gush of blood
2. lengthening of the cord 3. globular shaped uterus 4. uterus rising to the anterior abdominal wall |
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What is the upper limit of mormal for the third stage of labor?
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30 minutes
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What is another word for perimenopause?
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climacteric
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What is the mean age of menopause?
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51
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Wat should be added to HRT to prevent endometrial cancer in a woman who still has her uterus?
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Progesterone
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What is the cause of high FSH levels in perimenopausal women?
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decreased levels of ovarian inhibin
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What diagnostic test is used to determine whether a not a woman is climacteric?
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serum FSH and LH levels
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What is the first step in the treatment of toxic shock syndrome?
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IV fluids
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What is the MCC of TSS?
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Exotoxin from S. aureus
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What is a characteristic skin change of TSS?
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Sunburn-like rash that converts to maculopapular and eventually desquamative over time
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What is the treatment of choice for S. aureus TSS?
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IV nafcillin or methicillin
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T/F: the normalcy of labor is determined by measuring the timing and strength of contractions.
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False: labor is measured by cervical dilation over time
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What is the cervical dilation cut-off for latent versus active labor?
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4 cm
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In 48hrs, by what percentage should b-hCG levels rise in a normal pregnancy?
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66% (we say 50% in clinic)
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What is the b-hCG threshold whereby a transvaginal ultrasound should reveal an IUP?
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1500-2000 mIU/mL
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When do recommend surgery versus methotrexate in an ectopic pregnancy?
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Severe adenxal pain and hypotension are usually good indications that surgery will be necessary
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What is the treatment for placenta accreta?
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Hysterectomy
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What is the clinical versus histological definition of placenta accreta?
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Clinical: a placenta very adherent to the uterus (myometrium)
Hist: a defect of the decidua basalis layer of the uterus |
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T/F: the greater number of cesareans, the greater the risk for placenta accreta?
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True
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What are the 5 main risk factors for placenta accreta?
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1. Placenta previa
2. implantation over the lower uterine segment 3. prior cesarean scar or other uterine scar 4. uterine curettage 5. Down syndrome |
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Acute salpingitis is synonymous with what other illness?
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PID
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Purulent vaginal discharge with gram-negative diplococci suggests what illness?
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Gonococcal cervicitis (N. gonorrhoeae)
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What is the sign of disseminated gonococcal disease (N. gonorrhoeae, not Chlamydia)
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multiple pustules on the skin
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What is the treatment for gonococcal cervicitis? Chlamydia?
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Ceftriaxone for gonococcal
doxycycline or azithromycin for Chlamydia |
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What is a distinguishing factor between an incomplete and complete abortion?
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The cervix is usually open in an incomplete abortion and closed in a complete abortion
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What is distinguishing feature of incompetent cervix?
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PAINLESS dilation of the cervix where the cervix opens spontaneously without uterine contractions
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What is shoulder dystocia?
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inability of the fetal shoulders to deliver spontaneously, usually due to impaction of the anterior shoulder behind the maternal pubic symphysis
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What is the function of the McRobert's maneuver in cases of shoulder dystocia?
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It causes anterior rotation of the pubic symphysis and flattening of the lumbar spine.
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What is the purpose of applying suprapubic pressure in a case of shoulder dystocia?
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to move the fetal shoulders from the anteroposterior to the oblique plane
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What are the risk factors for shoulder dystocia?
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fetal macrosomia
GDM maternal obesity |
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What is the MC injury that results from shoulder dystocia?
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Erb's palsy: a brachial plexus injury affecting C5-6 nerve roots causing weakness in the deltoids, infraspinatus and forearm flexor muscles
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Where is the MC location for ureteral injury in an abdominal hysterectomy?
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The cardinal ligament (attaches the cervix to the pelvic side walls and house the uterine arteries) since the ureter is only 2-3 cm lateral to the cervix
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What is the test of choice for a patient suspected of having a ureteral injury?
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IV pyelogram
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What are the signs of a ureteral injury in a patient?
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extreme costovertebral angle tenderness, fever, and a normal incision following an abdominal hysterectomy
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What are the risk factors for endometrial cancer?
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Unapposed estrogen (nullparity, late menopause, irregular periods, obesity, DM)
HTN |
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What is the MC femal genital tract malignancy?
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Endometrial cancer
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What are the symptoms of endometrial cancer?
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postmenopausal bleeding
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What is the most common cause of postmenopausal bleeding?
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Atrophic endometrium--friable tissue inthe endometrium or vagina from decreased estrogen levels
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An endometrial thickness greater than ____ is considered abnl in a postmenopausal pt.
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5mm
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What are the three main categories of nonreassuring fetal status?
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uteroplacental insufficiency
umbilical cord compression fetal conditions/abnormalities |
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What is the purpose of the APGAR score? What isn't it's purpose?
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The APGAR score is used to assess the need for resuscitation of the newborn, it is NOT an indicator of future fetal status
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When are APGAR scores taken?
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1 and 5 minutes
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What is the only cerebral palsyassociated with acute intrapartum blood flow disruption?
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spastic quadriplegia
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What type of heart rate monitoring is acceptable for low-risk patients?
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intermittent FHR auscultation
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How do you determine the baseline FHR?
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The mean FHR during a 10-minute segment
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What defines fetal tachy?
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> 160 bpm for 10+ minutes
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What is the MCC of fetal tachy?
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elevated maternal temperature (sometimes first sign of developing chorioamnionitis)
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What defines fetal brady?
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< 120 BPM for 10+ minutes
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A sinusoidal fetal heart rate may be associated with what conditions?
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fetal-maternal hemmorhage and severe fetal anemia
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What is the most reliable EFM indicator of fetal status/well being?
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Fetal heart rate variability
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Good variablilty on the EFM is indicative of what?
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adequate fetal CNS oxygenation
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What defines whetherr or not FHR accelerations are present at or after 32 weeks?
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when FHR has acme of 15 bpm or more above baseline lasting between 15 sec and 2 minutes
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What causes fetal HR accelerations?
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release of NE; intact fetal mechanism unstressed by hypoxia and acidemia
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What causes an early d-cell?
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pressure on the fetal head during contractions - physiologic and not cause for concern
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What causes late d-cells?
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Uteroplacental insufficiency, fetal hypoxia and acidemia - nonreassuring
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What causes variable d-cells?
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umbilical cord compression mediated through the vagus nerve with sudden and ofter erratic release of ACh at the fetal SA node
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What can you do to relieve variable d-cells?
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changing the maternal position to relieve pressure on the umbilical cord
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What are the steps for intrauterine resuscitation in cases of fetal hypoxia?
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1. discontinue oxytocin infusion, if one was needed for induction or augmentation
2. administer O2 by mask (5-6L) 3. check maternal BP and treat hypotension if needed 4. change maternal position to LLD 5. consider IV tocolytic (terbutaline) to relax uterine tone and slow contraction rate -> increasing blood flow to uterus |
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What is the transformation zone?
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the area between the old and new SCJs where squamous metaplasia occurs
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Where does 95% of squamous intraepithelia neoplasia occur?
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Within the tansformation zone
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What is the most important risk factor for the development of cervical neoplasia and cancer?
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HPV
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Of the approx 100 tyoes of HPV, how many affect the anogenital tract?
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30
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Which HPV types are high risk for neoplasia?
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16, 18, 31, 33, 45
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Which HPV types cause genital warts?
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6 and 11
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What classification of virus is HPV?
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DS DNA
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What is the term for HPV virus that infects the reproducing cells of the basal layer, but are not yet incorporated intot he host genome?
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Koilocytes
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Why is HPV testing indicated for ASCUS but not LSIL and HSIL?
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because of the high association between LSIL and HSIL and HPV (83% and 90%, respectively)
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What are the 4 categories of atypical squamous cells (ASC)?
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Undetermined significance (ASCUS), ASC that cannot exclude high-grade intraepithelial lesion (ASC-H), LSIL, HSIL
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What is the next step in management for a pt with a ASC-US on pap?
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repeat in 4 to 6 mos, or immediate colpo or HPV testing (prefered method)
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ASC-H is followed up with colpo for what reason?
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It's higher risk of CIN 2-3 lesions
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What is the recommended treatment for AGC favor neoplasia or AIS?
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excisional conization
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What is required for a colposcopy to be considered satisfactory?
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visualization of the entire SCJ
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What iare the three reasons to perform a conization?
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Unsatisfactory colpo, positive ECC (endocervical curettage), substantial discrepency between Pap and biopsy results
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What is the most appropriate treatment for a cone biopsy of a pt with positive high-grade epithelial lesion or carcinoma in situ?
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hysterectomy, depending on the pt's views about her fertility and maintaining her organs
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What is the average age of diagnosis for invasive cervical cancer?
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50 years
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What is the main etiology of cervical cancer?
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HPV in 90% of cases
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What cervical cancer is associated with the pt's exposure to diethylstilbestrol (DES) in utero?
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Clear cell carcinoma
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What are the two main symptoms often associated with cervical carcinoma?
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irregular uterine bleeding, postcoital bleeding
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What is the path of invasion of cervical carcinoma?
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direct invasion by lymphatic metastisis
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What grade of cervical cancer is treated with radical hysterectomy?
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Stage IA1 with lymph space invasion up to IB1
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What grades of cancer are candidates for radiation therapy?
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IB or IIA who are poor surgical candidates or all other advanced stages of disease
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What are the chemotherapeutic drugs taken in conjunction with radiation therapy?
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either cisplatin or cisplatin with 5-fluorouracil
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The mesonephric ducts eventually form what structures?
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epididymis, ductus defrens and ejaculatory ducts
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The paramesonephric ducts develop into what structures?
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fallopian tubes, uterus and upper 1/3 of vagina
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The fusion of the paramesonephric ducts forms what structures?
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Braod ligaments of the uterus
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In the absence of androgens, the phallus develops into which structure?
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clitoris
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In the absence of androgens, the urogenital folds develop into which structure?
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labia minora
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In the absence of androgens, the labioscrotal swellings develop into which structure?
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labia majora
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What constitutes the vulva?
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labia majora, labia minora, mons pubis, clitoris, vestibule and ducts that open to the vestibule
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What is the frenulum?
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the fused junction of the labia minora found on the ventral surface of the glans clitoris
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What are the three muscles of the vulva?
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superior transverse perineal, bulbocavernosus and ischiocavernosus)
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What is the major blood supply to the vagina? Of what vessel is this a branch of?
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Vaginal a.; a branch of the hypogastric a. and parallel veins
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What structures are contained in the broad ligament?
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uterine a. and veins, ureters
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What is the cornu?
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the part of the uterine body where the uterine tubes enter
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Which ligaments support the uterus?
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uterosacral, cardinal, round, and broad
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What is the major blood supply to the uterus? Of what vessel is this a branch of?
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uterine awith a little ovarian a.; They are branches of the hypogastric a. (a branch of the common illiac)
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Working inside the uterine cavity outward, name the layers of the uterus?
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Endometrium (simple columnar), myometrium
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Working from the uterus to the ovaries, name the sections of the fallopian tubes?
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isthmus, ampulla and infundibulum
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What vessels supply blood to the fallopian tubes?
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ovarian and uterine a.
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What is the histology of the epithelial lining of the fallopian tubes?
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ciliated columnar
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What are the ligaments holding the ovaries to the uterus and pelvis, respectively?
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ovarian ligament and infundibulopelvic ligament
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Ovarian arteries are direct branches of what vessel?
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abdominal aorta
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What is the venous return for the ovaries?
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R ovarian vein to the IVC and L ovarian vein to L renal vein
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What is the primary cause of spontaneous abortions in the first trimester?
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chromosomal abnormalities
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Chromosomal abnormality: Trisomy 21
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Down Syndrome
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Chromosomal abnormality: Trisomy 18
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Edwards syndrome (you can vote in an E-lection at 18)
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Chromosomal abnormality: Trisomy 13
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Patau syndrome (you hit P-uberty at 13)
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Chromosomal abnormality: del(5p)
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Cri du Chat
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Chromosomal abnormality: 47 XXY, XYY, XXX
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Klinefelter's syndrome
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Chromosomal abnormality: 45, X
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Turner syndrome
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What are the three main indications for Parental Cytogenetic Analysis?
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Advanced maternal age, previous child with a chromosomal abnormality, parental chromosomal abnormality
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A low MSAFP and a high hCG is associated with which chromosomal abnormality?
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Trisomy 21
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When is amniocentesis traditionally performed?
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15-20 weeks
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When is the critical period for brain development in the fetus?
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3 to 16 weeks
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When is the critical period for neural tube development in the fetus?
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2-4 weeks
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When is the critical period for heart development in the fetus?
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3-6 weeks
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What is the classic clinical triad of PID?
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lower abdominal tenderness, cervical motion tenderness and adenexal tenderness
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What is the gold standard for confirming PID?
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laparoscopy
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What is the treatment for acute salpingitis?
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broad stpecturm antibiotics and doxycycline
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What complication of PID is a surigical emergency, leading to mortality if left unattended?
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Rupture of a TOA
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What are the long term complications of salpingitis?
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chronic pelvic pain, involuntary infertility and ectopic pregnancy
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What is the mechanism by which pregnancy causes venous stasis?
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mechanical effect of the uterus on the vena cava
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What hormone is responsible for the hypercoaguable state of pregnancy?
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estrogen
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At what pulse ox reading should supplemental oxygen be given to a pregnant woman complaining of pleuritic chest pain and dyspnea?
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< 90%, corresponds to a oxygen tension of less than 60mmHg
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What is the diagnostictest for PE?
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V/Q scan
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What is the treatment for PE in pregnancy?
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full IV anticoagulation therapy for 5 to 7 days, followed by subcutaneous therapy for three months after the event
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What is the MC presenting symptom of PE?
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dyspnea
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What is the MCC of maternal mortality?
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embolism, both thromboembolism and amniotic fluid embolism
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What are the prodromal symptoms of HSV?
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burning, itching or tingling of the perineal region
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What is the treatment for a neonate inadvertently exposed to HSV?
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acyclovir
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What is the MCC of infectious vulvar ulcers in the US?
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HSV
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What are the most common tumors of the pelvis?
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leiomyomata
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What is the MC presenting symptom of symptomatic leimyomata?
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mennorhagia
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What are the signs, symptoms of a leiomyosarcoma?
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rapid growth (increase on more than 6 weeks gestational size in 1 yr), hx of radiation
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What are the MC physical exam signs of a leiomyomata?
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irregular, midline, firm, nontender mass that moves contiguously with the cervix
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What is the initial treatment for uterine fibroids?
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NSAIDS, progestins, GnRH agonists to shrink size
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Which type of fibroids are most likely to be associated with recurrent abortions?
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submucous
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What characterizes preeclampsia?
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hypertension with proteinuria (nondependent edema may also be present)
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What is the underlying pathophysiology of preeclampsia?
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vasospasm and "leaky vessels" -> hypoxemia -> hemolysis, necrosis, and end organ damage
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What are the risk factors for preeclampsia?
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nullparity, extremes of age, African-American, hx of severe preeclampsia, chronic htn, chrinic renal dz, antiphospholipid syndrome, DM, multifetal gestation
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When is eclampsia most likely to occur?
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just prior to delivery, during labor, or within first 24 hrs postpartum
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What is a side effect of magnesium sulfate?
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pulmonary edema and hyporeflexia
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What is the main difference between fibroadenomas and fibrocystic change?
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fibroadenomas don't change with the menstrual cycle
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What is the diagnositc test to confirm fibroadenoma in a patient with low risk for breast cancer?
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FNA or core-needle biopsy
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How are fibroadenomas characterized?
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firm, rubbery, mobile and solid in consistency
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What criterria are necessary for a diagnosis of arrest of active phase of labor?
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1. competion of latent phase (cervical dilation 4+cm), 2. no cervical dilation for 2+hrs
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What sign on the fetus is indicative of adequate uterine contractions?
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Caput on the fetal head
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What are the five factors to consider when approaching infertility?
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ovulatory, uterine, tubal, male factor, peritoneal factor
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What are the "3 D's" on endometriosis?
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dysmennorhea, dyspareunia, dyschezia
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What is the fecundability for a normal couple?
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20% to 25% of nl couples will achieve pregnancy within one menstrual cycle
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What is the initial test to determin uterine and tubal factors influencing infertility?
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HSG
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What is a normal spern volume and concentration?
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Volume >/= 2.0mL Concentration >/=20 million/mL
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What is the gold standard for the diagnosis of endometriosis?
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laparoscopy to show classic "powder burn" color
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What is the main therapy for endometrial or tubal abnormalities associated with infertility?
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surgery
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When is ovarian torsion most likely to present?
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either at 14 weeks (when uterus rises above the pelvic brim) or immediately postpartum with the uterus rapidly involutes
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Where does acute appendicitis in pregnancy commonly present?
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superior and lateral to McBurney's point
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What is the treatment for biliary colic in pregnancy?
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low-fat diet and observed until postpartum
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What is a typical presentation of ovarian torsion?
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acute onset of colicky pain
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What is the first line of treatment for ovarian torsion?
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surgery to try to untwist the pedicle and observe the ovary for viability
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What is the MC route of HIV transmission?
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heterosexual intercourse (now > IVDU)
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What is the most common cause of preventable blindness worldwide?
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Chlamydia
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Why is Chlamydia typically not seen on a gram stain?
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because it is an obligate intracellular organism
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What are the best treatments for Chlamydia in pregnancy?
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erythromycin, azithromycin and amoxicillin
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What is the HIV viral load goal during pregnancy?
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less than 1000 RNA copies per milliliter
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What distinguishes the symptoms of hyperthyroidism (nervousness and palpitations) from Thyroid Storm?
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autonomic instability (disoriented, markedly confused)
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What is the therapy for thyroid storm?
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beta-blocker, corticosteroids, PTU
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What is the effect of pregnancy on thyroid hormones as compared to the nonpregnant state?
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Total T4 is increased in pregnancy, but free T4 and TSH are unchanged
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What is the diagnosis when no chorionic villi are found on uterine curretage of a pregnant woman?
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ectopic pregnancy
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How does Methotrextate work?
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inhibits DNA synthesis by interfering with folate metabolism
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When is methotrexate contraindiciated in ectopic pregnancies?
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when the ectopic is larger than 3.5 cm or there is the presence of fetal cardiac activity in the tube
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What is the MC pathogen associated with mastitis?
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S. aureus
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The presence of fluctuance in an indurated, erythematous, lactating breast suggests what pathology?
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an abscess assocaited with mastitis
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How do you treat an abscess associated with mastitis?
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incision and drainage
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When does mastitis typically present?
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3-4th postpartum week
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What is the MCC of primary amennorhea?
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gonadal dysgenesis (Turner's)
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What test can be performed to distinguish ovarian failure from CNS dysfunction in delayed puberty?
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FSH levels
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which hormone levels determine the gonadotropic and gondal states, respectively?
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FSH = gonadotropic
estradiol = gondala |
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hypergondaotropic hypogondism is MCC by what pathology?
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gondal deficiency (Turner's)
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hypogondaotropic hypogondism is MCC by what pathology?
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CNS dysfunction
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The lack of breast development means a lack of what hormone?
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Estrogen
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What is the MCC of PPH?
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uterine atony
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What is the definition of PPH?
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> 500mL in vaginal delivery or > 100mL following cesarian
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What should be the initial management of PPH?
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uterine massage
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In whom is prostaglandin F2 contraindicated for PPH?
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asthmatics (potential for bronchoconstriction)
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In whom is methergine contraindicated for PPH?
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ppl wit hHTN (risk of stroke)
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What is the MCC of infection in a septic abortion?
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polymicrobial infection from the vagina (ascending)
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What are the steps in management for septic abortions?
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1. maintain BP
2. monitor BP, oxygenation, and urine output 3. antibiotic therapy 4. uterine curretage |
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A patient with normal breast development, scant pubic hair and c/o primary amennorhea, typically has what diagnosis?
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androgen insensitivity
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