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265 Cards in this Set

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T/F There is an increased incidence of dental caries in pregnancy.
False: the incidence of dental caries does not increase, but gingival disease does. Look for edematous gums that bleed easily.
Epulis gravidarum, violaceous pedunculated lesions that appear on the gum line, tend to regress within what time frame post partum?
2 months
When does morning sickness typically appear and resolve?
Appear: 4-8 weeks
Resolve: 14-16 weeks
What are the criteria for a diagnosis of hyeremesis gravidarum?
morning sickness that extends beyond the middle of the second trimester or any associated weight loss, ketonemia, or electrolyte imbalance
What is ptyalism?
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
What are the changes in tidal volume, residual volume and total lung capacity that occur during pregnancy?
Tidal volume: 30-40% increase
RV: 20% decrease
TLC: 5% decrease
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)?
Decreased PCO2 is compensated by an increased renal excretion of bicarbonate. Pregnancy bicarb levels are significantly lower than nonpregnant levels (18-31)
At what point in pregnancy do diastolic and MAP reach their highest level?
16-20 weeks; they return to prepregnancy levels by term
What causes inferior vena cava syndrome?
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
What causes the decreased peripheral vascular resistance associated with pregnancy?
increased levels of progesterone
What are some of the normal CV findings on exam in a pregnant woman?
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
Cardiac output increases ____% in the course of labor above that in late pregnancy?
40%
The mean increase in plasma volume in pregnancy is approximately ____%.
50%
How much more iron does a pregnant woman need?
1000 mg of additional iron
T/F: iron supplements are used to prevent iron deficiency in the fetus.
False: the are used to prevent iron deficiency anemia in the mother
By how much do bleeding time and clotting time change during pregnancy?
Bleeding and clotting times do not change during pregnancy
What causes the renal pelves and ureters to dilate during pregnancy?
Progesterone
What is the normal range for creatinine clearance in pregnancy?
150-200 mL/min (increased GFR and RPF)
What causes hyperpigmentation during pregnancy?
elevated levels of estrogen and melanocyte-stimulating hormone and a cross-reaction with the structurally similar b-HCG
In pregnancy, more hair follicles are in what stage?
Anagen (growth)
By how much do bleeding time and clotting time change during pregnancy?
Bleeding and clotting times do not change during pregnancy
What causes the renal pelves and ureters to dilate during pregnancy?
Progesterone
What is the normal range for creatinine clearance in pregnancy?
150-200 mL/min (increased GFR and RPF)
What causes hyperpigmentation during pregnancy?
elevated levels of estrogen and melanocyte-stimulating hormone and a cross-reaction with the structurally similar b-HCG
In pregnancy, more hair follicles are in what stage?
Anagen (growth)
At what point in pregnancy does the pubic symphysis separate?
28-30 weeks
What is the function of increased parathyroid hormone in pregnancy?
maintain serum Ca levels by increasing absorption fromt he intestine and decreasing the loss of Ca through the kidney
What causes the blurred vision of pregnancy?
increased thickness of the cornea associated with fluid retention and decreased intraoccular pressure
What is the average size of the uterus at term?
1,100 g (from 70 g prepregnancy)
What are the three endocrine "hypers" of pregnancy?
Hyperglycemia
Hyperlipidemia
Hyperinsulinemia
What hormones are responsible for the diabetogenic effects of pregnancy?
HPL (increases resistance of peripheral tissues and liver to the effects of insulin)
Progesterone
Estrogen
Glucose is passed from mother to fetus through what mechanism?
facilitated diffusion
T/F: fetus is dependent on the mother for glucose but not insulin.
True: fetal insulin is apparent at 9-11 weeks of gestation
What two factors cause the lower fasting glucose levels in a pregnant woman?
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
What causes the increased levels of total T3 and T4 in pregnancy?
Estrogen causes the increased levels of thyroxine-binding globulin. Free T3 and T4 remain unchanged from prepregnant
What causes the increase in plasma cortisol levels?
Estrogen-induced increase in corticosteroid-binding globulin
What vessel carries oxygenated blood from the lacenta to the fetus?
Umbilical vein
What is the normal range of fetal heart rate?
120-160 bpm
What is the primary substrate for lacental metabolism?
glucose
The fetal kidney forms how much urine per day?
400-1200mL/day
What is the primary source of amniotic fluid?
Fetal urine
Why is Vitamin K given to newborns?
Because the neonatal liver is still not fully functional, Vitamin K is given to prevent bleeding problems
At what point in gestation do primordial germ cells migrate from the endoderm of the yolk sac to the genital ridge?
During the 8th week
Development of the fetal ovary occurs at what point in gestation?
Week 7
What is the only immunoglobulin to cross the placenta?
IgG: maternal IgG comprises the majority of the fetal immunoglobulin in utero and in early neonatal period
What is the Chadwick sign? Hegar sign?
Chadwick: bluish discoloration of the vagina--a asign of pregnancy
Hegar: softening of the cervix--sign of pregnancy
When do fetal movements become apparent to the mother?
Between 16-20 weeks depending on the parity of the mother.
At what point may a Doppler detect fetal heart signs?
12 weeks
What hormone do urine pregnancy tests measure?
b-hCG
Where is hCG produced?
in the syncytiotrophoblast of the growing placenta
hCG shares an alpha subunit with what other hormone?
LH
Why are serum pregnancy tests more effective than urine pregnancy tests?
because it tests for the beta subunit
3/4's of maternal mortality are caused by what 3 things?
Suicide
Homicide
Trauma associated with vehicular accidents where seatbelts were not used
The initial assessment of gestational age is done through what practice?
Menstrual history - date of onset of LMP
At 20 weeks gestation, the uterine fundus is located where on exam?
Umbilicus
What is the most accurate measure of gestational age?
ultrasound
How often should a mother receive monthly antenatal care?
Until 32 weeks
How often should a mother receive antenatal care in two-week intervals?
between 32-36 weeks; weekly after that
What is the only laboratory test performed at EVERY prenatal visit?
determination of glucosuria and proteinuria; anything more than a trace of either warrants evaluation
What is the recommended weight gain in pregnancy for a normal-weight woman?
25-35 pounds
What pathology should be considered in a woman whose fundal height is significantly greater than expected?
1. inaccurate calculation of gestational age
2. multiple pregnancy
3. hydatidiform mole
4. hydramnios
5. macrosomia (large fetus)
What is the accepted variability in fundal height measurement?
2 cm +/-
At what gestational age is ultrasound used to measure nuchal thickness?
10-13 weeks
If mom is lying comfortably, how many fetal movements in one-hour is considered healthy?
4+
What constitutes a normal/reactive nonstress test (NST)?
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)
Why must women get bi-weekly NSTs?
The validity of a NST is only valid for 4-5 days.
What does it mean to say that fetal well-being tests have a high false-positive value?
They suggest the baby is in jeopardy when the fetus is actually healthy
What five assessments of fetal well-being are evaluated in the biophysical profile (BPP)?
1. Fetal breathing movements
2. Gross body movement
3. Fetal tone
4. Reactive fetal heart rate (NST)
5. Qualitative amniotic (Ultrasound)
A BPP score below what number requires immediate intervention?
< 4
What organ system is evaluated for fetal maturity?
Respiratory
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?
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
A class B medication means what to a pregnant woman?
that animal studies have not demonstrated fetal risk but there are no controlled human studies
What is meant by indirect maternal death?
Death of the mother during pregnancy from a disease made worse by pregnancy
What is the mechanism and treatment for urge incontinence?
Mechanism: overactive detrussor muscle that contracts unpredictably

Treatment: anticholinergic medication to relax the muscle
What is the primary treatment for stress incontinence?
Surgical: urethropexy replaces the proximal urethra back to its intra-abdominal position
A post void catherization showing a large residual volume suggests what type of incontinence?
overflow
What is the MC complication of uterine inversion?
postpartum hemorrhage
What are the signs of placental separation?
1. gush of blood
2. lengthening of the cord
3. globular shaped uterus
4. uterus rising to the anterior abdominal wall
What is the upper limit of mormal for the third stage of labor?
30 minutes
What is another word for perimenopause?
climacteric
What is the mean age of menopause?
51
Wat should be added to HRT to prevent endometrial cancer in a woman who still has her uterus?
Progesterone
What is the cause of high FSH levels in perimenopausal women?
decreased levels of ovarian inhibin
What diagnostic test is used to determine whether a not a woman is climacteric?
serum FSH and LH levels
What is the first step in the treatment of toxic shock syndrome?
IV fluids
What is the MCC of TSS?
Exotoxin from S. aureus
What is a characteristic skin change of TSS?
Sunburn-like rash that converts to maculopapular and eventually desquamative over time
What is the treatment of choice for S. aureus TSS?
IV nafcillin or methicillin
T/F: the normalcy of labor is determined by measuring the timing and strength of contractions.
False: labor is measured by cervical dilation over time
What is the cervical dilation cut-off for latent versus active labor?
4 cm
In 48hrs, by what percentage should b-hCG levels rise in a normal pregnancy?
66% (we say 50% in clinic)
What is the b-hCG threshold whereby a transvaginal ultrasound should reveal an IUP?
1500-2000 mIU/mL
When do recommend surgery versus methotrexate in an ectopic pregnancy?
Severe adenxal pain and hypotension are usually good indications that surgery will be necessary
What is the treatment for placenta accreta?
Hysterectomy
What is the clinical versus histological definition of placenta accreta?
Clinical: a placenta very adherent to the uterus (myometrium)

Hist: a defect of the decidua basalis layer of the uterus
T/F: the greater number of cesareans, the greater the risk for placenta accreta?
True
What are the 5 main risk factors for placenta accreta?
1. Placenta previa
2. implantation over the lower uterine segment
3. prior cesarean scar or other uterine scar
4. uterine curettage
5. Down syndrome
Acute salpingitis is synonymous with what other illness?
PID
Purulent vaginal discharge with gram-negative diplococci suggests what illness?
Gonococcal cervicitis (N. gonorrhoeae)
What is the sign of disseminated gonococcal disease (N. gonorrhoeae, not Chlamydia)
multiple pustules on the skin
What is the treatment for gonococcal cervicitis? Chlamydia?
Ceftriaxone for gonococcal

doxycycline or azithromycin for Chlamydia
What is a distinguishing factor between an incomplete and complete abortion?
The cervix is usually open in an incomplete abortion and closed in a complete abortion
What is distinguishing feature of incompetent cervix?
PAINLESS dilation of the cervix where the cervix opens spontaneously without uterine contractions
What is shoulder dystocia?
inability of the fetal shoulders to deliver spontaneously, usually due to impaction of the anterior shoulder behind the maternal pubic symphysis
What is the function of the McRobert's maneuver in cases of shoulder dystocia?
It causes anterior rotation of the pubic symphysis and flattening of the lumbar spine.
What is the purpose of applying suprapubic pressure in a case of shoulder dystocia?
to move the fetal shoulders from the anteroposterior to the oblique plane
What are the risk factors for shoulder dystocia?
fetal macrosomia
GDM
maternal obesity
What is the MC injury that results from shoulder dystocia?
Erb's palsy: a brachial plexus injury affecting C5-6 nerve roots causing weakness in the deltoids, infraspinatus and forearm flexor muscles
Where is the MC location for ureteral injury in an abdominal hysterectomy?
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
What is the test of choice for a patient suspected of having a ureteral injury?
IV pyelogram
What are the signs of a ureteral injury in a patient?
extreme costovertebral angle tenderness, fever, and a normal incision following an abdominal hysterectomy
What are the risk factors for endometrial cancer?
Unapposed estrogen (nullparity, late menopause, irregular periods, obesity, DM)
HTN
What is the MC femal genital tract malignancy?
Endometrial cancer
What are the symptoms of endometrial cancer?
postmenopausal bleeding
What is the most common cause of postmenopausal bleeding?
Atrophic endometrium--friable tissue inthe endometrium or vagina from decreased estrogen levels
An endometrial thickness greater than ____ is considered abnl in a postmenopausal pt.
5mm
What are the three main categories of nonreassuring fetal status?
uteroplacental insufficiency
umbilical cord compression
fetal conditions/abnormalities
What is the purpose of the APGAR score? What isn't it's purpose?
The APGAR score is used to assess the need for resuscitation of the newborn, it is NOT an indicator of future fetal status
When are APGAR scores taken?
1 and 5 minutes
What is the only cerebral palsyassociated with acute intrapartum blood flow disruption?
spastic quadriplegia
What type of heart rate monitoring is acceptable for low-risk patients?
intermittent FHR auscultation
How do you determine the baseline FHR?
The mean FHR during a 10-minute segment
What defines fetal tachy?
> 160 bpm for 10+ minutes
What is the MCC of fetal tachy?
elevated maternal temperature (sometimes first sign of developing chorioamnionitis)
What defines fetal brady?
< 120 BPM for 10+ minutes
A sinusoidal fetal heart rate may be associated with what conditions?
fetal-maternal hemmorhage and severe fetal anemia
What is the most reliable EFM indicator of fetal status/well being?
Fetal heart rate variability
Good variablilty on the EFM is indicative of what?
adequate fetal CNS oxygenation
What defines whetherr or not FHR accelerations are present at or after 32 weeks?
when FHR has acme of 15 bpm or more above baseline lasting between 15 sec and 2 minutes
What causes fetal HR accelerations?
release of NE; intact fetal mechanism unstressed by hypoxia and acidemia
What causes an early d-cell?
pressure on the fetal head during contractions - physiologic and not cause for concern
What causes late d-cells?
Uteroplacental insufficiency, fetal hypoxia and acidemia - nonreassuring
What causes variable d-cells?
umbilical cord compression mediated through the vagus nerve with sudden and ofter erratic release of ACh at the fetal SA node
What can you do to relieve variable d-cells?
changing the maternal position to relieve pressure on the umbilical cord
What are the steps for intrauterine resuscitation in cases of fetal hypoxia?
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
What is the transformation zone?
the area between the old and new SCJs where squamous metaplasia occurs
Where does 95% of squamous intraepithelia neoplasia occur?
Within the tansformation zone
What is the most important risk factor for the development of cervical neoplasia and cancer?
HPV
Of the approx 100 tyoes of HPV, how many affect the anogenital tract?
30
Which HPV types are high risk for neoplasia?
16, 18, 31, 33, 45
Which HPV types cause genital warts?
6 and 11
What classification of virus is HPV?
DS DNA
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?
Koilocytes
Why is HPV testing indicated for ASCUS but not LSIL and HSIL?
because of the high association between LSIL and HSIL and HPV (83% and 90%, respectively)
What are the 4 categories of atypical squamous cells (ASC)?
Undetermined significance (ASCUS), ASC that cannot exclude high-grade intraepithelial lesion (ASC-H), LSIL, HSIL
What is the next step in management for a pt with a ASC-US on pap?
repeat in 4 to 6 mos, or immediate colpo or HPV testing (prefered method)
ASC-H is followed up with colpo for what reason?
It's higher risk of CIN 2-3 lesions
What is the recommended treatment for AGC favor neoplasia or AIS?
excisional conization
What is required for a colposcopy to be considered satisfactory?
visualization of the entire SCJ
What iare the three reasons to perform a conization?
Unsatisfactory colpo, positive ECC (endocervical curettage), substantial discrepency between Pap and biopsy results
What is the most appropriate treatment for a cone biopsy of a pt with positive high-grade epithelial lesion or carcinoma in situ?
hysterectomy, depending on the pt's views about her fertility and maintaining her organs
What is the average age of diagnosis for invasive cervical cancer?
50 years
What is the main etiology of cervical cancer?
HPV in 90% of cases
What cervical cancer is associated with the pt's exposure to diethylstilbestrol (DES) in utero?
Clear cell carcinoma
What are the two main symptoms often associated with cervical carcinoma?
irregular uterine bleeding, postcoital bleeding
What is the path of invasion of cervical carcinoma?
direct invasion by lymphatic metastisis
What grade of cervical cancer is treated with radical hysterectomy?
Stage IA1 with lymph space invasion up to IB1
What grades of cancer are candidates for radiation therapy?
IB or IIA who are poor surgical candidates or all other advanced stages of disease
What are the chemotherapeutic drugs taken in conjunction with radiation therapy?
either cisplatin or cisplatin with 5-fluorouracil
The mesonephric ducts eventually form what structures?
epididymis, ductus defrens and ejaculatory ducts
The paramesonephric ducts develop into what structures?
fallopian tubes, uterus and upper 1/3 of vagina
The fusion of the paramesonephric ducts forms what structures?
Braod ligaments of the uterus
In the absence of androgens, the phallus develops into which structure?
clitoris
In the absence of androgens, the urogenital folds develop into which structure?
labia minora
In the absence of androgens, the labioscrotal swellings develop into which structure?
labia majora
What constitutes the vulva?
labia majora, labia minora, mons pubis, clitoris, vestibule and ducts that open to the vestibule
What is the frenulum?
the fused junction of the labia minora found on the ventral surface of the glans clitoris
What are the three muscles of the vulva?
superior transverse perineal, bulbocavernosus and ischiocavernosus)
What is the major blood supply to the vagina? Of what vessel is this a branch of?
Vaginal a.; a branch of the hypogastric a. and parallel veins
What structures are contained in the broad ligament?
uterine a. and veins, ureters
What is the cornu?
the part of the uterine body where the uterine tubes enter
Which ligaments support the uterus?
uterosacral, cardinal, round, and broad
What is the major blood supply to the uterus? Of what vessel is this a branch of?
uterine awith a little ovarian a.; They are branches of the hypogastric a. (a branch of the common illiac)
Working inside the uterine cavity outward, name the layers of the uterus?
Endometrium (simple columnar), myometrium
Working from the uterus to the ovaries, name the sections of the fallopian tubes?
isthmus, ampulla and infundibulum
What vessels supply blood to the fallopian tubes?
ovarian and uterine a.
What is the histology of the epithelial lining of the fallopian tubes?
ciliated columnar
What are the ligaments holding the ovaries to the uterus and pelvis, respectively?
ovarian ligament and infundibulopelvic ligament
Ovarian arteries are direct branches of what vessel?
abdominal aorta
What is the venous return for the ovaries?
R ovarian vein to the IVC and L ovarian vein to L renal vein
What is the primary cause of spontaneous abortions in the first trimester?
chromosomal abnormalities
Chromosomal abnormality: Trisomy 21
Down Syndrome
Chromosomal abnormality: Trisomy 18
Edwards syndrome (you can vote in an E-lection at 18)
Chromosomal abnormality: Trisomy 13
Patau syndrome (you hit P-uberty at 13)
Chromosomal abnormality: del(5p)
Cri du Chat
Chromosomal abnormality: 47 XXY, XYY, XXX
Klinefelter's syndrome
Chromosomal abnormality: 45, X
Turner syndrome
What are the three main indications for Parental Cytogenetic Analysis?
Advanced maternal age, previous child with a chromosomal abnormality, parental chromosomal abnormality
A low MSAFP and a high hCG is associated with which chromosomal abnormality?
Trisomy 21
When is amniocentesis traditionally performed?
15-20 weeks
When is the critical period for brain development in the fetus?
3 to 16 weeks
When is the critical period for neural tube development in the fetus?
2-4 weeks
When is the critical period for heart development in the fetus?
3-6 weeks
What is the classic clinical triad of PID?
lower abdominal tenderness, cervical motion tenderness and adenexal tenderness
What is the gold standard for confirming PID?
laparoscopy
What is the treatment for acute salpingitis?
broad stpecturm antibiotics and doxycycline
What complication of PID is a surigical emergency, leading to mortality if left unattended?
Rupture of a TOA
What are the long term complications of salpingitis?
chronic pelvic pain, involuntary infertility and ectopic pregnancy
What is the mechanism by which pregnancy causes venous stasis?
mechanical effect of the uterus on the vena cava
What hormone is responsible for the hypercoaguable state of pregnancy?
estrogen
At what pulse ox reading should supplemental oxygen be given to a pregnant woman complaining of pleuritic chest pain and dyspnea?
< 90%, corresponds to a oxygen tension of less than 60mmHg
What is the diagnostictest for PE?
V/Q scan
What is the treatment for PE in pregnancy?
full IV anticoagulation therapy for 5 to 7 days, followed by subcutaneous therapy for three months after the event
What is the MC presenting symptom of PE?
dyspnea
What is the MCC of maternal mortality?
embolism, both thromboembolism and amniotic fluid embolism
What are the prodromal symptoms of HSV?
burning, itching or tingling of the perineal region
What is the treatment for a neonate inadvertently exposed to HSV?
acyclovir
What is the MCC of infectious vulvar ulcers in the US?
HSV
What are the most common tumors of the pelvis?
leiomyomata
What is the MC presenting symptom of symptomatic leimyomata?
mennorhagia
What are the signs, symptoms of a leiomyosarcoma?
rapid growth (increase on more than 6 weeks gestational size in 1 yr), hx of radiation
What are the MC physical exam signs of a leiomyomata?
irregular, midline, firm, nontender mass that moves contiguously with the cervix
What is the initial treatment for uterine fibroids?
NSAIDS, progestins, GnRH agonists to shrink size
Which type of fibroids are most likely to be associated with recurrent abortions?
submucous
What characterizes preeclampsia?
hypertension with proteinuria (nondependent edema may also be present)
What is the underlying pathophysiology of preeclampsia?
vasospasm and "leaky vessels" -> hypoxemia -> hemolysis, necrosis, and end organ damage
What are the risk factors for preeclampsia?
nullparity, extremes of age, African-American, hx of severe preeclampsia, chronic htn, chrinic renal dz, antiphospholipid syndrome, DM, multifetal gestation
When is eclampsia most likely to occur?
just prior to delivery, during labor, or within first 24 hrs postpartum
What is a side effect of magnesium sulfate?
pulmonary edema and hyporeflexia
What is the main difference between fibroadenomas and fibrocystic change?
fibroadenomas don't change with the menstrual cycle
What is the diagnositc test to confirm fibroadenoma in a patient with low risk for breast cancer?
FNA or core-needle biopsy
How are fibroadenomas characterized?
firm, rubbery, mobile and solid in consistency
What criterria are necessary for a diagnosis of arrest of active phase of labor?
1. competion of latent phase (cervical dilation 4+cm), 2. no cervical dilation for 2+hrs
What sign on the fetus is indicative of adequate uterine contractions?
Caput on the fetal head
What are the five factors to consider when approaching infertility?
ovulatory, uterine, tubal, male factor, peritoneal factor
What are the "3 D's" on endometriosis?
dysmennorhea, dyspareunia, dyschezia
What is the fecundability for a normal couple?
20% to 25% of nl couples will achieve pregnancy within one menstrual cycle
What is the initial test to determin uterine and tubal factors influencing infertility?
HSG
What is a normal spern volume and concentration?
Volume >/= 2.0mL Concentration >/=20 million/mL
What is the gold standard for the diagnosis of endometriosis?
laparoscopy to show classic "powder burn" color
What is the main therapy for endometrial or tubal abnormalities associated with infertility?
surgery
When is ovarian torsion most likely to present?
either at 14 weeks (when uterus rises above the pelvic brim) or immediately postpartum with the uterus rapidly involutes
Where does acute appendicitis in pregnancy commonly present?
superior and lateral to McBurney's point
What is the treatment for biliary colic in pregnancy?
low-fat diet and observed until postpartum
What is a typical presentation of ovarian torsion?
acute onset of colicky pain
What is the first line of treatment for ovarian torsion?
surgery to try to untwist the pedicle and observe the ovary for viability
What is the MC route of HIV transmission?
heterosexual intercourse (now > IVDU)
What is the most common cause of preventable blindness worldwide?
Chlamydia
Why is Chlamydia typically not seen on a gram stain?
because it is an obligate intracellular organism
What are the best treatments for Chlamydia in pregnancy?
erythromycin, azithromycin and amoxicillin
What is the HIV viral load goal during pregnancy?
less than 1000 RNA copies per milliliter
What distinguishes the symptoms of hyperthyroidism (nervousness and palpitations) from Thyroid Storm?
autonomic instability (disoriented, markedly confused)
What is the therapy for thyroid storm?
beta-blocker, corticosteroids, PTU
What is the effect of pregnancy on thyroid hormones as compared to the nonpregnant state?
Total T4 is increased in pregnancy, but free T4 and TSH are unchanged
What is the diagnosis when no chorionic villi are found on uterine curretage of a pregnant woman?
ectopic pregnancy
How does Methotrextate work?
inhibits DNA synthesis by interfering with folate metabolism
When is methotrexate contraindiciated in ectopic pregnancies?
when the ectopic is larger than 3.5 cm or there is the presence of fetal cardiac activity in the tube
What is the MC pathogen associated with mastitis?
S. aureus
The presence of fluctuance in an indurated, erythematous, lactating breast suggests what pathology?
an abscess assocaited with mastitis
How do you treat an abscess associated with mastitis?
incision and drainage
When does mastitis typically present?
3-4th postpartum week
What is the MCC of primary amennorhea?
gonadal dysgenesis (Turner's)
What test can be performed to distinguish ovarian failure from CNS dysfunction in delayed puberty?
FSH levels
which hormone levels determine the gonadotropic and gondal states, respectively?
FSH = gonadotropic
estradiol = gondala
hypergondaotropic hypogondism is MCC by what pathology?
gondal deficiency (Turner's)
hypogondaotropic hypogondism is MCC by what pathology?
CNS dysfunction
The lack of breast development means a lack of what hormone?
Estrogen
What is the MCC of PPH?
uterine atony
What is the definition of PPH?
> 500mL in vaginal delivery or > 100mL following cesarian
What should be the initial management of PPH?
uterine massage
In whom is prostaglandin F2 contraindicated for PPH?
asthmatics (potential for bronchoconstriction)
In whom is methergine contraindicated for PPH?
ppl wit hHTN (risk of stroke)
What is the MCC of infection in a septic abortion?
polymicrobial infection from the vagina (ascending)
What are the steps in management for septic abortions?
1. maintain BP
2. monitor BP, oxygenation, and urine output
3. antibiotic therapy
4. uterine curretage
A patient with normal breast development, scant pubic hair and c/o primary amennorhea, typically has what diagnosis?
androgen insensitivity