• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/1426

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

1426 Cards in this Set

  • Front
  • Back
Q001. what is the genital system developed from?
A001. mesoderm
Q002. what portion of the embryo gives rise to the reproductive system?
A002. Urogenital ridges
Q003. what portion of the ovary contains the developing follicles?
A003. cortex
Q004. what is the first indication of the sex in the embryo?
A004. formation of the tunica albuginea
Q005. the primordial germ cells can be identified during the 4th week of development where?
A005. Yolk sac
Q006. Embryo:; what results following the absence of the uterus?
A006. Paramesonepheric (Mullerian)ducts degenerate
Q007. Embryo:; what results in the formation of a double uterus?; technical name of this?
A007. Inferior part of the Mullerian ducts do not fuse; "Uterus didelphys"
Q008. Embryo:; what results in the absence of the vagina?
A008. Vaginal plate does not develop
Q009. Embryo:; what results in vaginal atresia?
A009. Vaginal plate does not canalize
Q010. Embryo:; what does the labia minora develop from?
A010. Urogenital folds
Q011. Embryo:; what does the labia majora develop from?
A011. Labioscrotal swelling
Q012. Embryo:; what does the clitoris develop from?
A012. Genital tubercle
Q013. Embryo:; what does the fallopian tube develop from?
A013. Mullerian ducts
Q014. Embryo:; what (2) structures does the vagina originate from?
A014. Urogenital sinus; Mullerian ducts
Q015. what are the innominate bones composed of?; (3)
A015. Ileum,; Ischium,; Pubis
Q016. what separates the false pelvis from the true pelvis?
A016. Linea terminalis
Q017. which pelvis does the fetus pass during labor?
A017. True pelvis
Q018. what plane separates the false pelvis from the true pelvis?
A018. Pelvic Inlet
Q019. at what plane does the arrest of fetal descent occur?
A019. Plane of Least diameter
Q020. what is the value of the obstetric conjugate?
A020. 10.0 - 11.0
Q021. what is the value of the transverse diameter of the pelvic inlet?
A021. 13.5
Q022. what is the value of the Bispinous diameter of the pelvic midplane?
A022. 10
Q023. what is the transverse diameter of the Greatest Diameter?
A023. 12.5
Q024. what is the most common pelvic type?
A024. Gynecoid
Q025. what is found in the labia majora but not the labia minora?
A025. Hair follicles
Q026. Name type of epithelium:; Bartholin ducts
A026. Transitional
Q027. Name type of epithelium:; Skene duct
A027. Transitional
Q028. Name type of epithelium:; Urethra
A028. Transitional
Q029. Name type of epithelium:; Endocervical canal
A029. Columnar
Q030. what is the name of the part of the uterus where the fallopian tubes enter?
A030. Cornu
Q031. what are the (2) main anatomic divisions of the uterus?
A031. Corpus,; Cervix
Q032. what (2) arteries supply the uterus?
A032. Uterine artery,; Ovarian artery
Q033. where do the uterine veins enter the venous system?
A033. Internal iliac veins
Q034. what portion of the fallopian tube boarders the ovary?
A034. Infundibulum
Q035. what ligament supports the ovary?
A035. Broad ligament
Q036. before puberty, what is the ratio of the body of the uterus and the cervix length?
A036. 0.0423611111111111
Q037. what is the portion of the broad ligament b/t the ovaries and fallopian tube?
A037. Mesosalpinx
Q038. what ligaments prevent uterine prolaspe?
A038. Uterosacral ligaments
Q039. when do Oogonia stop developing?
A039. just before birth
Q040. how are trisomy pregnancies detected?
A040. Chorionic villus sampling
Q041. Genetics Dx:; microcephaly, distinctive facial features
A041. Cri-du-chat
Q042. what occurs with failure of testicular development in a XY zygote?
A042. patient develops as a female with uterus, tubes, vagina, and vulva (no ovaries)
Q043. what is the most common cause of mental retardation?
A043. Fragile X syndrome
Q044. what amount of folic acid should be taken by a pregnant woman who already has a child with a neural tube defect?
A044. 4 mg
Q045. when is the developing brain most susceptable to teratogens?
A045. 3 - 16 weeks
Q046. when is the developing neural tube most susceptable to teratogens?
A046. 2 - 4 weeks
Q047. when is the developing heart most susceptible to teratogens?
A047. 3 - 6 weeks
Q048. Cause of Teratogenic effect:; intrauterine growth retardation, fetal hypotension, pulmonary hypoplasia
A048. ACEi
Q049. Cause of Teratogenic effect:; skeletal defects, cleft palate
A049. Antiepileptics
Q050. Cause of Teratogenic effect:; CNS and ear defects, cleft lip/palate, cardiac and great velles defects; (2)
A050. Cyclophosphamide; Accutane
Q051. Cause of Teratogenic effect:; nasal hypoplasia, vertebral abnormalities, CNS malformations
A051. Warfarin
Q052. Cause of Teratogenic effect:; limb reduction, VSD, GI atresia
A052. Thalidomide
Q053. Cause of Teratogenic effect:; vaginal and cervical cancer, genital tract abnormalities
A053. DES; (Diethylstilbestrol)
Q054. Cause of Teratogenic effect:; staining of primary teeth
A054. Tetracycline
Q055. what mouth problem increases with pregnancy?
A055. Gingival Disease
Q056. how does glucose cross the placenta?
A056. faciliated diffusion
Q057. how do amino acids cross the placenta?
A057. active transport
Q058. how does pregnancy effect appetite?; gastric motility?
A058. apetite Increases; motility Decreases
Q059. how does pregnancy affect GB emptying?
A059. emptying is delayed
Q060. how does pregnancy affect liver enzymes?
A060. Increase
Q061. when does "morning sickness" begin?
A061. 4 - 8 weeks
Q062. what causes Ptyalism?
A062. inability for patient to swallow normal amounts of saliva
Q063. what causes the decreased GI motility during pregnancy?
A063. increased Progesterone
Q064. how many additional calories is allowed daily with pregnancy?
A064. 300
Q065. transit time in the stomach and small intestines increases by what percent in the second and third trimesters?
A065. 15 - 30%
Q066. during pregnancy how does the tone of the gastroesophageal sphinctor change?
A066. it Decreases; (GERD increases)
Q067. Definition:; pregnancy-related vascular swelling of the gums
A067. Epulis
Q068. what pulmonary measurement is decreased throughout pregnancy?
A068. Carbon dioxide pressure
Q069. what pulmonary measurement is decreased in late pregnancy?
A069. Functional Reserve Capacity; (FRC)
Q070. what is the maternal acid-base balance in pregnancy?
A070. mild Respiratory Alkalosis
Q071. the Tidal volume in pregnancy increases by what percent?
A071. 30 - 40%
Q072. in a normal singleton pregnancy what is the percent increase of maternal blood volume?
A072. 0.45
Q073. in what position is maternal BP the highest?
A073. Seated
Q074. what is the BP change in the lateral recumbent position of the inferior arm of a pregnant mother?
A074. BP in inferior arm is higher then superior arm
Q075. pregnancy-assoc systolic ejection murmurs are heard best where?
A075. over left upper sternal boarder
Q076. compensation for the occlusion of the inferior vena cava by the pregnant uterus is accomplished by shunting blood through what?
A076. Paravertebral collateral circulation
Q077. what causes inferior vena cava syndrome?
A077. compression by the gravid uterine corpus
Q078. what causes the decrease in peripheral vascular resistance during pregnancy?
A078. increased Progesterone
Q079. plasma volume begins to increase at the sixth week of pregnancy and reaches its maximum at what time?
A079. 30 - 34 weeks
Q080. what hematologic parameter is decreased in pregnancy?
A080. Hematocrit
Q081. what lab value related to iron is increased in pregnancy?
A081. Total Iron-binding capacity
Q082. what CV risk increases with pregnancy?
A082. thromboembolism
Q083. what does lack of maternal iron ingestion during pregnancy result in?
A083. Maternal Anemia
Q084. what renal functions increase during pregnancy?; (3)
A084. GFR,; Renal Plasma Flow,; Renin
Q085. during pregnancy, what is the effect of progesterone on the ureters?
A085. there is more dilation of the right versus the left
Q086. what (3) urinary labs decrease in pregnancy?
A086. Creatinine,; Uric Acid,; Blood Urea Nitrogen
Q087. Definition:; change in facial pigmentation during preganacy
A087. Chloasma
Q088. what causes blurred vision during pregnancy?
A088. swelling of the lens
Q089. what percent of total CO is channeled to the uterus during pregnancy?
A089. 0.2
Q090. what is the main metabolic change that occurs with pregnancy?
A090. Hyperglycemia
Q091. what causes the "hemorrhoids" that develop late in pregnancy?
A091. elevated pelvic venous pressure
Q092. what is the thyroid change in pregnancy?
A092. none...Euthyroid
Q093. what is Diastasis recti?
A093. Midline separation of the rectus muscles
Q094. how does the CO2 gradient b/t fetus and mother change in the later half of pregnancy?
A094. Increases
Q095. how much does the BUN fall in the first trimester?
A095. 0.25
Q096. what is the urinary protein loss in pregnancy?
A096. 100 - 300 mg/24 hrs
Q097. how long after the delivery will the hair loss assoc with pregnancy return?
A097. 6 - 12 months
Q098. when does breast enlargement occur with pregnancy?
A098. first trimester
Q099. the vision changes in pregnancy assoc. with increased thickness of the cornea regresses within what time?
A099. 6 - 8 weeks postpartum
Q100. why is supplemental vitamin K given to newborns?
A100. b/c of their fetal liver immaturity in the immediate newborn
Q101. what is the change in serum bicarb levels during pregnancy?
A101. significantly lower
Q102. the umbilical blood flow represents about what percent of the combined output of both fetal ventricles?
A102. 0.4
Q103. the fetal kidney forms urine at what rate?
A103. 400 - 1200 mL/day
Q104. in the later half of pregnancy, umbilical blood flow is what?
A104. 300 mL/mg/minute
Q105. what is the normal constant fetal heart rate?
A105. 120 - 180 bmp
Q106. maternal diastolic BP and Mean Arterial volume nadir when?
A106. 16 - 20 weeks
Q107. an increase in breast volume of what percent is common in pregnancy?
A107. 25 - 50%
Q108. Definition:; the patient's initial perception of fetal movement; at how many weeks gestation is it normally felt?
A108. Quickening; felt at 20 weeks
Q109. Definition:; congestion and a bluish color of the vagina
A109. Chadwick sign
Q110. Definition:; a softening of the cervix on physical exam
A110. Hegar sign
Q111. when are fetal heart tones in a normal pregnancy hear by simple auscultation?
A111. 18 - 20 weeks
Q112. commonly used electronic Doppler devices will detect fetal heart tones at how many weeks?
A112. 12 weeks gestation
Q113. home urine preg tests become positive approx how many weeks following the first day of the last menstrural period?
A113. 4 weeks
Q114. how high should progesterone be for a viable uterine pregnancy?
A114. > 25 ng/mL
Q115. intrauterine pregnancy is detectable by transvaginal US when the beta-HCG is greater then what?
A115. 1000 - 2000 mIU/mL
Q116. in what percent of pregnant women is rubella titer positive?
A116. 0.85
Q117. specific screening for treponema is required following what positive test?
A117. Rapid Plasma reagin
Q118. when can maternal alpha-fetoprotein testing be done?
A118. 15 - 18 weeks
Q119. in a normal singleton pregnancy, from approx 16 - 18 weeks gestation until 36 weeks, the fundal height in cm is equal to what?
A119. the number of weeks gestational age
Q120. what is the prescribed recommendation for weight gain during pregnancy?
A120. 25 - 35 pounds
Q121. Definition:; when the patient reports a change in the shape of her abdomen and that the baby has gotten less heavy
A121. Lightening
Q122. what is the direct result of "lightening"?
A122. decreased fundal height
Q123. a breech presentation occurs in what percent of deliveries?
A123. 0.035
Q124. estimation of gestional age by US is least accurate at what time during pregnancy?
A124. 36 - 38 weeks
Q125. what is the normal fetal heart rate at term?
A125. 120 - 160 bpm
Q126. a reactive nonstress test is characterized by a fetal heart rate increase of how many beats per minute?
A126. 15
Q127. what is an abnormal contraction stress test?
A127. fetal heart rate decreases in response to uterine contraction
Q128. what is the number of contractions in a ten minute window that must occur for a contraction stress test to be measurable?
A128. 3
Q129. a biophysical profile in which there is one or more episodes of fetal breathing in 30 min, 3 or more descrete movements in 30 min, opening/closing of the fetal hand, a nonreactive nonstress test and no pockets of amnioticfluid greater then 1 cm would have a total score of what?
A129. 6
Q130. exclusive of the fetal HR reactivity, what is the biophysical profile considered most important?
A130. qualitative amniotic fluid volume
Q131. repetative decelerations following each contraction when three contractions occur in a 10-min window is an indication of what?
A131. nonreassuring fetal status
Q132. tests of fetal lung maturity are generally used when delivery of a fetus is contemplated at a gestational age of less then how many weeks?
A132. 36
Q133. at how many weeks does phospholipid production increase resulting in a positive phosphatidyl-glycerol test?
A133. 32 - 33 weeks
Q134. during a normal pregnancy, the patient should be encouraged to engage in non-weight-bearing activity at what interval?
A134. three times a week
Q135. in pregnancy, psyllium hydrophilic mucilloid is used to manage what?
A135. constipation
Q136. because of the position of the fetus, round ligament pain is more pronounced where?
A136. on the right side
Q137. which Pregnancy Risk Factor indicates that human controlled studies do not exist?
A137. PRF B
Q138. which Pregnancy Risk Factor means that the drug should only be given if the benefits outweigh the risks?
A138. PRF C
Q139. which Pregnancy Risk Factor means that there is evidence that the fetus is at risk?
A139. PRF D
Q140. which Pregnancy Risk Factor indicates that animal and human studies demonstrate fetal abnormalities, such that the risk outweighs any possible benefit?
A140. PRF X
Q141. Definition:; progressive effacement and dilation of the cervix, resulting from rhythmic contractions of the uterine musculature
A141. Labor
Q142. Definition:; Uterine contractions without cervical dilation
A142. False Labor; (Braxton-Hicks contractions)
Q143. what is "bloody show" associated with at term?
A143. extrusion of endocervical gland mucous
Q144. lower abdominal and groin pain are usually assoc with what type of labor?
A144. False labor
Q145. Definition:; the descent of the fetal head into the pelvis and the changing contour of the abdomen late in pregnancy
A145. Lightening
Q146. what is the definition od "fetal lie"?
A146. relationship of the long axis of the fetus with the maternal long axis
Q147. what is the "Presentation" determined by?
A147. portion of the fetus lowest in the birth canal
Q148. what is "Position" defined as?
A148. relationship of the fetal presenting part of the right and left side of the pelvis
Q149. the descent of the presenting part is identified by which Leopold maneuver?
A149. Third maneuver
Q150. the location of the small parts is determined by which Leopold maneuver?
A150. Second maneuver
Q151. determining what occupies the fundus is accomplished by what Leopold maneuver?
A151. First maneuver
Q152. identifying the cephalic prominence is accomplished by what Leopold maneuver?
A152. Fourth maneuver
Q153. what is the most common "fetal lie" found during early labor?
A153. Longitudinal
Q154. what is the most common "fetal presentation" found in early labor?
A154. Vertex
Q155. Definition:; the turning of the fetal head toward the sacrum
A155. Anterior Asynclitism
Q156. what is the station of a patient in labor with the vertex at the level of the ischial spines?
A156. Zero
Q157. At Zero station, where is the biparietal diameter of the fetal head in relation to the pelvic inlet?
A157. Passed below the pelvic inlet
Q158. the clinical significance of the fetal head presenting at zero station is that the biparietal diameter of the fetal head has negotiated what?
A158. Pelvic inlet
Q159. what is cervical effacement?
A159. the degree of cervical thinning
Q160. how is the First Stage of Labor described?
A160. Onset of labor to full cervical dilation
Q161. how is the Second Stage of Labor described?
A161. Complete dilation of the cervix to delivery of the infant
Q162. how is the Third Stage of Labor described?
A162. Delivery of the infant to delivery of the placenta
Q163. how is the Fourth Stage of Labor described?
A163. period extending up to two hours after delivery of the placenta
Q164. the Active Phase of the first stage of labor is defined to begin when the cervix is how dilated?
A164. 4 cm
Q165. what describes the cardinal movement of labor that allows the smaller diameter of the fetal head to present to the maternal pelvis?
A165. Flexion
Q166. what describes the movement of the fetal head as it reaches the introitus?
A166. Extension of the fetal head
Q167. what describes the movement of the fetal head to "face forward" relative to the shoulders?
A167. External rotation
Q168. Definition:; movement of the presenting part through the birth canal
A168. Descent
Q169. Times in Nulliparas:; 1) Latent phase of stage 1; 2) Active phase of stage 1; 3) Second stage of labor
A169. Nulliparas:; Latent phase of stage 1: 6.5 hours; Active phase of stage 1: 4.5 hours; Second stage of labor: 1 hour
Q170. Times in Multiparas:; 1) Latent phase of stage 1; 2) Active phase of stage 1; 3) Second stage of labor
A170. Multiparas:; Latent phase of stage 1: 5 hours; Active phase of stage 1: 2.5 hours; Second stage of labor: 0.5 hours
Q171. during the active phase of labor, if electronic monitoring is not used, the fetal heart rate should be auscultated how often?
A171. every 15 min
Q172. during the second stage of labor, if electronic monitoring is not used, the fetal heart rate should be auscultated how often?
A172. each uterine contraction
Q173. an external tocodynamometer provides information about what?
A173. Contraction frequency
Q174. the sensory nerves form the lower birth canal and the perineum enter the spinal cord where?
A174. S2 - S4
Q175. What is an epidural best used for specifically compared to a spinal and pudendal?
A175. Epidural:; Active phase of labor and delivery; Spinal:; short-term for vaginal and abdominal delivery; perineal anesthesia for vaginal delivery
Q176. what is the major cause of maternal mortality from OB anesthesia?
A176. Aspiration of vomitus
Q177. what is the MC result of compression of the fetal head during delivery?
A177. Molding
Q178. what is the usual postpartum blood loss in a vaginal delivery?
A178. 500 mL
Q179. what is the First-degree vaginal laceration at birth?
A179. involves the vaginal mucosa and perineal skin
Q180. what is the Second-degree vaginal laceration at birth?
A180. involves the underlying fascia or muscle but not rectal sphinctor or rectal mucosa
Q181. what is the Third-degree vaginal laceration at birth?
A181. extends through rectal sphinctor but not into the rectum
Q182. what is the Fourth-degree vaginal laceration at birth?
A182. extends into the rectal mucosa
Q183. during the delivery of the fetal head the likelihood of laceration or extension of episiotomy is decreased by what maneuver?
A183. Ritgen maneuver
Q184. how many minutes should one wait for the spontaneous extrusion of the placenta?
A184. 30 minutes
Q185. IUGR - What is it
A185. Wt. < 10th percentile; suspect if > 4 between fundal ht. (cm) and GA (weeks); asymmetric - 80%, placenta mediated: HTN, poor nutrition, maternal smoking; symmetric - fetal problem: cytogenetic, infection, anomalies
Q186. IUGR - Dx
A186. Serial exams,; US every 3-4 weeks; NST, CST, BPP; Doppler
Q187. IUGR - Tx
A187. Steroids; consider early delivery - esp. asymmetric; continuous FHR monitoring during labor; C-section if decelerations persist
Q188. Oligohydramnios - What is it
A188. Excess loss of fluid - ROM (amniotic leak); decreased in fetal urine produced; fetal urinary tract abnorm; obstructive uropathy; chronic uteroplacental insufficiency; maternal HTN; severe toxemia; AFI < 5 on US
Q189. Oligohydramnios - Complications
A189. Pulmonary hypoplasia; club foot; flattened facies; IUGR; fetal distress; fetal hypoxia - (umbilical cord compression)
Q190. Oligohydramnios - Tx
A190. Rule out inaccurate gestational dates; Tx underlying cause,; if possible, amnioinfusion - NaCl
Q191. Polyhydramnios - What is it
A191. Excess of fluid; AFI > 20 on US; Maternal DM; "baby can't swallow": esoph atresia, TEF, duodenal atresia; anencephaly; multiple gestations; twin-twin transfusion syn
Q192. Polyhydramnios - Dx/Tx
A192. US for fetal anomalies; glucose test; Rh screening; Tx depends on cause
Q193. Polyhydramnios - Complications
A193. Preterm labor; cord prolapse; fetal malpresentation
Q194. Rh Isoimmunization - What is it
A194. Ag protein on RBC; AD; maternal anti-Rh IgG ab => erythroblastosis fetalis; 2nd pregnancy - fast production by memory plasma cells
Q195. Rh Isoimmunization - History/PE; What do you ask on History
A195. Ask about - prior delivery of Rh+ child, ectopic pregnancy, abortion, blood transfusions, amniocentesis, abdom trauma
Q196. Rh Isoimmunization - Evaluation
A196. Maternal - on 1st visit, check ABO & Rh; if Rh- then check dad's Rh,; if dad Rh+ then, check mom's titer at 26-28 weeks; if pos., test serially for high titers (> 1:16), fetal - amniocentesis or US-guided umbilical bld sample, blood type, Coombs' titer, bilirubin level, HCT, reticulocytes; postnatally - fetal cord blood, Rh,HCT
Q197. Rh Isoimmunization - Tx
A197. Prevention - . at 28 weeks, if mom Rh- and dad Rh+ or status unknown, give RhoGAM (IgG anti-D); if baby Rh+, give RhoGAM postpartum, too; give RhoGAM to Rh- moms if have had abortion, ectopic pregnancy, amniocentesis, vaginal bleeding, placenta previa, placental abruption, sensitized Rh- moms with titers > 1:16; monitor closely, serial US, amniocentesis in severe cases - enhance lung maturity, intrauterine blood transfusion, init preterm delivery
Q198. Rh Isoimmunization - Complications
A198. Fetal hypoxia => lactic acidosis => heart failure => hydrops fetalis, death; kernicterus; prematurity
Q199. Gestational Trophoblastic Dis - What is it
A199. Prolif of trophoblastic tissue, range of diseases, benign or malignant; risk factors: age < 20 or > 40, def. in folate or B-carotene; hydatidiform mole - 80%, benign, may progress to malignant; complete, sperm fertilize empty ovum, 46XX; paternal derived incomplete/partial fertilized by 2 sperm, 69XXY; has fetal tissue; choriocarcinoma; placental site trophoblastic tumor
Q200. Gestational Trophoblastic Dis- History/PE
A200. History - 1st trimester uterine bleeding; hyperemesis gravidarum; preeclampsia-eclampsia <24 weeks; excessive uterine enlargement; hyperthyroidism; PE - no fetal heartbeat, enlarged ovaries with b/l theca-lutein cysts, expulsion of grapelike cluster, blood in cervical os
Q201. Gestational Trophoblastic Dis- Dx
A201. High B-hCG (> 100,000 mlU/mL); "snowstorm" on pelvic US; no fetus; CXR - may have lung mets
Q202. Gestational Trophoblastic Dis- Tx
A202. D&C; monitor B-hCG; no pregnancy for 1 yr; if malignant – methotrexate, dactinomycin; residual uterine disease - hysterectomy
Q203. Gestational Trophoblastic Dis- Complications
A203. Malignant GTD; pulmonary or CNS mets; trophoblastic PE, acute respiratory insufficiency
Q204. Placenta Abruptio - What is it
A204. Premature separation of normally implanted placenta; any degree of separation; MCC of late-trimester bleeding; MCC of painful late-trimester bleeding
Q205. Placenta Abruptio - Risk factors
A205. HTN; abdominal/pelvic trauma; tobacco; coke; previous abruption; premature membrane rupture; rapid decompression of; overdistended uterus
Q206. Placenta Abruptio - Sx
A206. Painful, dark vaginal bleeding that doesn't spontan stop; abdom pain; fetal distress
Q207. Placenta Abruptio - Dx
A207. Mainly clinical (US sensitivity 50%); check for retroplacental clot
Q208. Placenta Abruptio - Tx
A208. Mild – admit, stabilize, IV, fetal monitoring, type and cross blood, bed rest; moderate to severe - immediate delivery; if both stable: amniotomy, vaginal delivery; if distress: C-section
Q209. Placenta Abruptio - Complications
A209. Hemorrhagic shock; DIC => ATN; fetal hypoxia; couvelaire uterus
Q210. Placenta Previa - What is it
A210. Abnorm implant of placenta:; total - covers internal os; partial - partially covers; marginal - at edge of os; low-lying - near os without reaching it
Q211. Placenta Previa - Risk factors
A211. Prior C-sections; multiparity; advanced maternal age; multiple gestation; prior placenta previa
Q212. Placenta Previa - Sxs
A212. Usually first occurs in late preg; painless, bright red bleeding; may be heavy; usually no fetal distress
Q213. Placenta Previa - Dx
A213. US
Q214. Placenta Previa - Management
A214. No vaginal exam; premature fetus - stabilize; tocolytics (MgSO4); serial US; detect fetal lung maturity - by amnio and augment; Delivery indicated if - persistent labor, life-threatening bleeding, fetal distress, fetal lung maturity, 36 weeks GA; deliver by C-section; vaginal - lower edge of placenta > 2cm from internal os
Q215. Placenta Previa - Complications
A215. Increased risk of pl. accreta; vasa previa; preterm delivery; PROM; IUGR; congenital anomalies
Q216. PROM - What is it
A216. ROM before onset of labor; > 37 weeks gestation; may be due to - vaginal or cervical infections; abnorm membrane physiology; cervical incompetence
Q217. PPROM (preterm PROM) - What is it; Risk factors
A217. ROM < 37 weeks gestation risk factors:; low socioeconomic status; young maternal age; smoking; STDs
Q218. Prolonged ROM - What is it
A218. ROM > 24 hours prior to labor
Q219. PROM - History/PE
A219. Gush of clear or blood-tinged vaginal fluid; may have uterine contractions
Q220. PROM - Evaluation
A220. Sterile speculum exam - amniotic fluid (in vaginal vault); meconium; vernix caseosa; positive nitrazine paper test; positive fern test; US - assess fluid volume; cultures; smears; no digital vaginal exam; check for chorioamnionitis - fetal heart tracing; maternal temp; WBC count; uterine tenderness
Q221. PROM - Tx
A221. Balance risk of infection when delivery is delayed with risks due to fetal immaturity; if no sign of infection - tocolytics: B agonists, MgSO4, NSAIDs, Ca2+ ch blocker, prophylactic Antibiotics, corticosteroids; if signs of infection or fetal distress – Antibiotics, induce labor
Q222. PROM - Complications
A222. Increased risk of; preterm L&D; chorioamnionitis; placental abruptio; cord prolapse
Q223. Preterm Labor - What is it; Risk factors
A223. Onset of labor bet. 20-37 weeks; primary cause of neonatal M&M; risk factors - multiple gestation, infection, PROM, uterine anomalies, previous preterm L or D, polyhydramnios, placental abruptio, poor maternal nutrition, low socioeconomic status; Most patients have no identifiable risk factors
Q224. Preterm Labor - History/PE
A224. May have menstrual-like cramps; onset of low back pain; pelvic pressure; new vaginal discharge or bleeding
Q225. Preterm Labor - Dx
A225. Regular contractions >3, 30 sec. each, over 30 min. concurrent cervical change; sterile speculum exam; US; UA/UC; cultures for – chlamydia, gonorrhea, GBS
Q226. Preterm Labor - Tx
A226. Hydration; bed rest; tocolytics; steroids; GBS prophylaxis - PCN or ampicillin
Q227. Preterm Labor - Complications
A227. RDS; IVH; PDA; NEC; ROP; BPD; death
Q228. Fetal Malpresentation - What is it; Risk factors
A228. Any presentation not vertex (Normal is vertex); MC malpresentation - breech Risk factors; prematurity; prior breech delivery; uterine anomalies; poly- or oligohydramnios; multiple gestations; PPROM; hydrocephalus; anencephaly; placenta previa
Q229. Fetal Malpresentation - What are the subtypes
A229. Frank - thighs flexed and knees extend; footling - 1 or both legs extended below the butt; complete - thighs and knees flexed
Q230. Fetal Malpresentation - Dx
A230. Leopold maneuver
Q231. Fetal Malpresentation - Tx
A231. Follow external version - risks of placental abruptio, cord compression; prepare for emergency C-sect; elective C-section; breech vaginal delivery only if delivery imminent
Q232. Postpartum Hemorrhage - What is it; MCC; MC Risk Factor
A232. > 500 mL for vaginal delivery, > 1000 mL for C-section; MCC - bleeding at placental implantation site; MC risk factor - uterine atony due to overdistention
Q233. Postpartum Hemorrhage - Dx
A233. Palpation of soft, enlarged, "boggy" uterus; explore for lacerations and retained placental tissues
Q234. Postpartum Hemorrhage - Tx
A234. Bimanual uterine massage; oxytocin infusion; methergine - if not HTN; prostin (PGF2a) - if no asthma
Q235. Mastitis - What is it
A235. Cellulitis of perigland tissue; caused by - nipple trauma from breastfeeding & staph from baby's nostrils => nipple ducts
Q236. Mastitis - History/PE
A236. Sxs start 2-4 weeks postpartum; usually unilateral; breast tender erythema, edema, warmth; maybe purulent nipple drainage
Q237. Mastitis - Dx
A237. Sxs; possible breastmilk culture; increased WBC; fever
Q238. Mastitis - Tx
A238. Continue breastfeeding!; po Antibiotics - PCN, diclox, erythro; incise and drain abscess (if present)
Q239. Sheehan's Syndrome - What is it
A239. Postpartum pituitary necrosis; pituitary ischemia & necrosis => ant. pituitary insuff. due to massive obstetric blood loss & hypovol shock; decreased prolactin
Q240. Sheehan's Syndrome - History
A240. No lactation; menstrual disorder; fatigue; loss of pubic & axillary hair
Q241. Postpartum Fever- What is it
A241. Genital tract infection; temp >= 38 C at least 2 of 1st 10 postpartum days; not including 1st 24 hrs.
Q242. Postpartum Fever- Risk Factors
A242. MC - endometrial infection; C-section; emergent C-section; PROM; prolonged labor; multiple intrapartum vag exams; intrauterine manipulations
Q243. Postpartum Fever- Causes (7 W's)
A243. Wind - atelectasis, pneumonia; water - UTI; wound - incision, episiotomy; walk - DVT, PE; wonder drug; womb - endomyometritis; weaning - breast engorgement, abscess, mastitis
Q244. Postpartum Fever- Dx
A244. UA/UC; BC; pelvic exam - rule out hematoma; rule out lochial block
Q245. Postpartum Fever- Tx
A245. Admit; broad-spectrum IV Antibiotics - clindamycin, gentamicin until afebrile for 48 hrs. if complicated - add ampicillin; if 3 drugs not effective after 48 hrs. - consider other Dxs
Q246. Breastfeeding - What inhibits prolactin rel.
A246. Hi levels of progesterone & estrogen during pregnancy; high levels also cause breast hypertrophy
Q247. Breastfeeding - Why can physiologically; breastfeed after birth
A247. Levels of progesterone and estrogen drop after delivery of placenta; infant sucking stimulates rel. of prolactin & oxytocin
Q248. Breastfeeding - What gives passive immunity; what gives active immunity
A248. Colostrum has hi IgA; IgA - passive immunity; hi leukocyte levels - active
Q249. Breastfeeding - Contraindications
A249. HIV infection; active hepatitis; meds – tetracycline, chloramphenicol, warfarin
Q250. Hyperemesis Gravidarum - What is it; Risk factors
A250. Persistent vomiting => wt. loss > 5% (or poor wt. gain); dev. of dehydration and ketoacidosis; persists past 16-18 weeks – rare, can damage liver risk factors; nulliparity; molar pregnancy (increased B-hCG); multiple gestations
Q251. Hyperemesis Gravidarum - Dx
A251. Serum electrolytes; hypoK-hypoCl metab alkalosis; urine ketones; BUN/Cr
Q252. Hyperemesis Gravidarum - Tx
A252. IV hydration; correct electrolyte def, Mg, P; antiemetics; fluids => freq. small meals as tolerated
Q253. Gestational DM - What is it; Risk factors
A253. 3-5% of all pregnancies; usu due to of late pregnancy - usu Dx 24-28 weeks; hypergly in 1st trimester - usu means preexisting, may be due to insulin-antag hormones from placenta risk factors; > 25 y/o; obesity; personal or family History; prior macrosomia; congen deformed infants
Q254. Gestational DM - History/PE
A254. Typically asymp; edema; polyhydramnios; LGA - warning sign
Q255. Gestational DM - Dx
A255. UA tests done 24-28 weeks; 2 abnorm glu tests to include - fasting >= 126 mg/dL, random >= 200 or abnorm GTT; 1 hr (50g) GTT >140 suggestive, confirm with 3 hr (100g) GTT - any 2 of following:; fasting >= 95; 1 hr >= 180; 2 hr >= 155; 3 hr >= 140
Q256. Gestational DM - Tx
A256. Tight maternal glu control - 90; ADA diet; regular exercise; add insulin if diet insuff. no oral hypogly; periodic US and NST; intrapartum insulin and dextrose during delivery; may need to induce labor at 38-40 weeks
Q257. Gestational DM - Complications
A257. > 50% develop glu intolerance and/or DM Type 2
Q258. Pregestational DM & Pregnancy- What is it
A258. HbA1C > 10% has ↑ risk of - congen malformations; ↑ mat./fetal morbidity during L&D
Q259. Pregestational DM & Pregnancy- Management of Mom
A259. Prenatal care; nutrition counseling; Renal eval; ophthalmologic eval; CV eval; Strict glucose control - Type 1 get insulin to maintain; Fasting morning: ≤ 60-90 mg/dL; Prelunch: 60-105; Two-hour postprandial: < 120
Q260. Pregestational DM & Pregnancy- Management of Fetus
A260. 16-20 weeks - US; AFP; 20-22 weeks - echo; 3rd trimester - close surveillance, NST, CST, BPP; admit at 32-36 weeks if DM poorly controlled, fetus is of concern
Q261. Pregestational DM & Pregnancy- Management of Delivery and; Postpartum
A261. Maintain 80–100 during labor consider early delivery if:; poor maternal glu control; preeclampsia; macrosomia; fetal lung maturity; C-section if macrosomia; monitor glucose postpartum
Q262. Pregestational DM & Pregnancy- Maternal Complications
A262. DKA; HHNK; preeclampsia/eclampsia; cephalopelvic disproportion (macrosomia) and need for C- section; preterm labor; infection; polyhydramnios; postpartum hemorrhage; maternal mortality
Q263. Pregestational DM & Pregnancy- Fetal Complications
A263. Macrosomia; cardiac defects; renal defects; neural tube defects; hypocalcemia; polycythemia; hyperbilirubinemia; IUGR; hypoglycemia from hyperinsulinemia; RDS; birth injury; perinatal mortality
Q264. Gestational & Chronic HTN - What is it
A264. Both increased risk of preeclampsia & eclampsia, M&M; Chronic - high before pregnant or before 20 weeks gestation; gestational - after 20 weeks, usually after 37 weeks remits by 6 weeks postpartum; MC in multifetal
Q265. Gestational & Chronic HTN - Dx
A265. Monitor BP routinely; if severe for 1st time - check for other causes
Q266. Gestational & Chronic HTN - Tx
A266. Methyldopa; B-blocker; hydralazine; no ACEI or diuretics
Q267. Preeclampsia - What is it; Risk factors
A267. New-onset HTN; proteinuria; nondependent (hands & face) edema; > 20 weeks gestation Risk factors:; nulliparity; Black; extremes of age; multiple gestations; molar pregnancy; renal dis. (from SLE or DM1); family History; chronic HTN
Q268. Mild Preeclampsia - History/PE
A268. Often asymp; BP > 140/90 on 2 occasions, > 6 hrs. apart; proteinuria; nondependent edema
Q269. Mild Preeclampsia - Dx
A269. UA; 24-hour urine protein; CBC; electrolytes; BUN/Cr; uric acid; measure fetal age; amniocentesis - lung maturity; LFTs; PT/PTT; fibrinogen and FSP; urine tox screen; US; NST/CST/BPP - as needed
Q270. Mild Preeclampsia - Tx
A270. Only cure - delivery; induce - IV oxytocin, prostaglandins or amniotomy based on mom and fetus; if far from term - bed rest, expectant management
Q271. Severe Preeclampsia - History/PE
A271. Based on Sxs, organ damage, fetal growth restriction; BP > 160/110 on 2 occasions, > 6 hrs. apart; proteinuria; HELLP syndrome; RUQ/epigastric pain; oliguria; pulmonary edema/cyanosis; cerebral changes; visual changes; hyperactive reflexes; oligohydramnios or IUGR
Q272. Severe Preeclampsia - Dx
A272. UA; 24-hour urine protein; CBC; electrolytes; BUN/Cr; uric acid; measure fetal age; amniocentesis - lung maturity; LFTs; PT/PTT; fibrinogen and FSP; urine tox screen; US; NST/CST/BPP - as needed
Q273. Severe Preeclampsia - Tx
A273. Only cure - delivery; control BP – Hydralazine, labetalol, MgSO4 - prevent Seizures, postpartum - MGSO4 - 1st 24 hrs. monitor for Mg2+ toxicity: loss of DTRs, respiratory paralysis, coma, Tx with IV Ca2+ gluconate
Q274. Preeclampsia - Complications
A274. Prematurity; fetal distress; stillbirth; placental abruption; seizure; DIC; cerebral hemorrhage; serous retinal detachment; fetal/maternal death
Q275. Eclampsia - What is it
A275. Seizures in patients with preeclampsia; antepartum, intra or post; if post - MC within 48 hrs.
Q276. Eclampsia - History/PE
A276. MC Sxs before attack - headache; visual changes; RUQ/epigastric pain; Seizures severe if not controlled; with anticonvulsant therapy
Q277. Eclampsia - Dx
A277. UA; 24-hour urine protein; CBC; electrolytes; BUN/Cr; uric acid; measure fetal age; amniocentesis - lung maturity; LFTs; PT/PTT; fibrinogen and FSP; urine tox screen; US; NST/CST/BPP - as needed
Q278. Eclampsia - Tx
A278. Monitor ABCs, O2; control seizures - MgSO4, consider IV diazepam; control BP – Hydralazine, labetalol; limit fluids: foley catheter- monitor I/Os; monitor Mg2+ level, Mg2+ toxicity; monitor fetal status; postpartum - MgSO4 - 1st 24 hrs; monitor for Mg2+ toxicity: loss of DTRs, respiratory paralysis, coma, Tx with IV Ca2+ gluconate
Q279. Eclampsia - Complications
A279. Cerebral hemorrhage; aspiration pneumonia; hypoxic encephalopathy; thromboembolic events; fetal/maternal death
Q280. Alcohol - Teratogenic Effect
A280. Fetal alcohol syndrome; microcephaly; midfacial hypoplasia; MR; IUGR; cardiac defects
Q281. Cocaine - Teratogenic Effect
A281. Bowel atresia; IUGR; microcephaly
Q282. Streptomycin - Teratogenic Effect
A282. CN8 damage; ototoxicity
Q283. Tetracycline - Teratogenic Effect
A283. Tooth discoloration; bone growth inhib; small limbs; syndactyly
Q284. Sulfonamides - Teratogenic Effect
A284. Kernicterus
Q285. Quinolones - Teratogenic Effect
A285. Cartilage damage
Q286. Isotretinoin - Teratogenic Effect
A286. Heart and great vessel defects; craniofacial dysmorphism; deafness
Q287. Iodide - Teratogenic Effect
A287. Congenital goiter; hypothyroidism; MR
Q288. Methotrexate - Teratogenic Effect
A288. CNS malformations; craniofacial dysmorphism; IUGR
Q289. DES (Diethylstilbestrol) - Teratogenic Effect
A289. Clear cell adenocarcinoma of vagina/cervix; genital tract abnorm; cervical incompetence
Q290. Thalidomide - Teratogenic Effect
A290. Limb reduction (phocomelia); ear and nasal anomalies; cardiac and lung defects; pyloric stenosis; duodenal stenosis; GI atresia
Q291. Coumadin - Teratogenic Effect
A291. Stippling of bone epiphyses; IUGR; nasal hypoplasia; MR
Q292. ACEIs - Teratogenic Effect
A292. Oligohydramnios; fetal renal damage
Q293. Lithium - Teratogenic Effect
A293. Ebstein's anomaly; other cardiac diseases
Q294. Carbamazepine - Teratogenic Effect
A294. Fingernail hypoplasia; IUGR; microcephaly; neural tube defects
Q295. Phenytoin - Teratogenic Effect
A295. Nail hypoplasia; IUGR; MR; craniofacial dysmorphism; microcephaly
Q296. Valproic Acid - Teratogenic Effect
A296. Neural tube defects; craniofacial defects; skeletal defects
Q297. HELLP Syndrome - What is it
A297. Variant of pre-eclampsia; Hemolytic anemia; Elevated Liver enzymes; Low Platelet count
Q298. Physio Changes in Pregnancy - CV
A298. Increased HR x increased SV = increased CO; CO lowest - supine; CO highest - lt. lateral position; sys vascular resistance - decreased; normal - systolic murmur, S3; abnorm - new diastolic murmur; CVP unchanged; FVP increases; BP - decreased in 1st trimester, diastolic more than systolic, nadir at 24 weeks, increased thereafter, but never to baseline; uterus displaces heart up & Left => looks like cardiomeg on CXR
Q299. Physio Changes in Pregnancy - Cervix
A299. Softens and cyanosis ~ 4 weeks; "bloody show" - at or near labor; cervical mucus looks granular on slide
Q300. Physio Changes in Pregnancy - Endocrine
A300. Increased thyroid blood flow => thyroid increased in size; increased - TBG; increased bound T3 & T4, and total; unchanged - free T4; increased - total & free cortisol; adrenal gland unchanged in size; HPL - maintains fetal glucose levels => prolonged postprandial hyperglycemia, fasting hyperinsulinemia,; fasting Hypertriglyceridemia, exaggerated starvation ketosis
Q301. Physio Changes in Pregnancy - GI
A301. N/V resolves by 14-16 weeks; increased acid reflux; aspiration; constipation; predisposed to gallstones
Q302. Physio Changes in Pregnancy - Hematology
A302. "physiologic anemia" - increased plasma vol (50%) & RBC mass (30%) => decreased H&H => normal pregnancy Hb is 10-12; WBC increased; ESR increased; platelets unchanged; hypercoagulable state; increased factors 7, 9, 10 & C; MC nonobstetric cause of postpartum death - thromboembolic disease
Q303. Physio Changes in Pregnancy - Musculoskeletal
A303. Increased motility – sacroiliac, sacrococcygeal, pubic joints
Q304. Physio Changes in Pregnancy - Pulmonary
A304. TV - increased; RR unchanged; TV x RR = VE (min. ventilation) so, VE increased; decreased - RV (IRV, ERV, TLC); increased - alveolar & arterial PO2; decreased - alveolar & arterial PCO2; so, resp. alkalosis => increased renal loss of bicarb => alkaline urine; "dyspnea of pregnancy" - from increased VE and decreased PCO2
Q305. Physio Changes in Pregnancy - Renal
A305. Increased renal blood flow => kidneys increased in size (until 3 mos. postpartum); ureters - diameter increased, right > left (due to progesterone); dilation of collecting system, can be mistaken for hydronephrosis; increased - GFR (by 50%), renal plasma flow, Cr clearance, aldosterone, all leads to - decreased BUN, Cr, uric acid; urine glucose increased because reabsorb threshhold decreased
Q306. Physio Changes in Pregnancy - Skin
A306. striae – abdomen, breast, thighs; spider angiomas; palmar erythema; hyperpigmentation - linea nigra – midline, chloasma – face, perineum; diastasis recti
Q307. Physio Changes in Pregnancy - Uterus
A307. 12 weeks, uterus - contracts anterior abdo wall, displaces intestines, felt above symphysis pubis; Braxton Hicks - irreg painless contractions throughout pregnancy => freq., rhythmic in 3rd trimester (false labor)
Q308. Physio Changes in Pregnancy - Vagina
A308. Thick, acidic secretions; Chadwick's sign
Q309. Prenatal Care and Nutrition - Estimated Delivery Date; Gestational Age
A309. Nagele's rule - EDD; 1st day of LMP + 9 mos.+7 days; GA determined by - uterine size; heart tones (10 weeks); quickening (17-18 weeks); US - crown rump (5-12 weeks); biparietal diameter (20-30weeks)
Q310. Prenatal Care and Nutrition - Weight Gain
A310. gain 25-35 lbs. obese to gain less; thin women to gain more; need 2,000-2,500 kcal/day; need additional - 300 kcal/day during pregnancy; 500 kcal/day in breastfeeding
Q311. Prenatal Care and Nutrition - Nutrition
A311. Prenatal vitamins; 1 mg/day of folate; 30-60 mg/day of elemental iron
Q312. Prenatal Labs - Initial Visit
A312. CBC; UA/UC; pap smear; blood type, Rh; Ab screen; rubella Ab titer; HBV surface Ag test; syphilis screen - RPR, VDRL; cervical gonorrhea and; chlamydia cultures; PPD; glucose testing; sickle prep; HIV
Q313. Prenatal Labs - 15-19 weeks
A313. Maternal serum AFP (MSAFP) or triple screen - MSAFP, estriol, B-hCG; offer amniocentesis if >35 y/o
Q314. Prenatal Labs - 18-20 weeks
A314. US - GA (if needed); fetal anatomy; amniotic fluid volume; placental location
Q315. Prenatal Labs - 26-28 weeks
A315. Glucose loading test (GLT); HCT
Q316. Prenatal Labs - 28 weeks
A316. Rhogam (if needed)
Q317. Prenatal Labs - 32-36 weeks
A317. HCT; screen for GBS - if positive - PCN during labor; cervical chlamydia and gonorrhea cultures if need
Q318. AFP - How to measure
A318. MSAFP at 15-20 weeks; results reported as - MoMs (multiples of the median)
Q319. AFP - What does elevated MSAFP mean
A319. > 2.5 MoMs: gastroschisis, omphalocele, multiple gestation, incorrect gestational dating, fetal death, placental abnorm – abruptio, open neural tube defects – anencephaly, spina bifida; MCC of high - date is wrong, if high - get US (check date); if true age more than thought - why "high" value, if still 15- 20 weeks, repeat MS-AFP; if date is right and no explanation on US - amnio for AF-AFP & acetylcholinesterase; high levels - open NTD; normal levels - still at risk for: IUGR, stillbirth, preeclampsia
Q320. AFP - Abnormally low MSAFP means
A320. < 0.85 MoM; MCC of low - date is wrong, check date - get triple marker screen; if not available - then get US; if true age less than thought - why "low" value, if still 15-20 weeks, repeat MS-AFP; if date is right and no explanation on US - amnio for karyotype; sensitivity to detect chromosome abnorm increased by triple screen; trisomy 18 - all 3 are low; trisomy 21 - AFP and estriol low, B-hCG high
Q321. Amniocentesis - When done; Risks; Why done
A321. 15-17 weeks; US-guided needle; risks - fetal-maternal hemorrhage; fetal loss; why done - > 35 y/o at time of delivery; Rh-sensitized pregnancy; evaluate fetal lung maturity in conjunction with abnorm triple screen
Q322. Chorionic Villus Sampling - What is it; Advantages; Risks
A322. Transvaginal or transabdom aspiration; advantages - as accurate as amniocentesis; available 10-12 weeks (amniocentesis - 15-17 weeks) Risks; fetal loss 1%; can't Dx neural tube defects; if do < 9 weeks - association with limb defects
Q323. Percutaneous Umbilical; Blood Sampling (PUBS) - What is it
A323. Done in 2nd & 3rd trimesters; fetal karyotyping; fetal infection; evaluate genetic diseases; evaluate fetal acid-base status; assess & Tx Rh isoimmunization; erythroblastosis fetalis
Q324. Labor - First Stage
A324. Latent - from onset of labor to 3-4 cm dilation; active - from 4 cm to complete cervical dilation (10 cm); prolonged with cephalopelvic disproportion
Q325. Labor - Second Stage
A325. From complete cervical dilation to delivery
Q326. Labor - Third Stage
A326. From delivery of infant to delivery of placenta; uterus contracts to establish hemostasis
Q327. Nonstress Test (NST) - What is it
A327. Left lateral supine, FHR - monitored by Doppler, correlate with spontaneous fetal movement as reported by mom, unrelated to contractions; normal - accelerate 15 bpm above baseline for 15 seconds; reactive test - 2 accelerations in 20 mins. repeat weekly; nonreactive - 80% false positive, do vibroacoustic stimulation. if persistently nonreactive, do BPP; no accelerations can be due to: GA < 30 weeks, fetal sleeping, fetal CNS anomalies, moms' sedative admin, fetal hypoxia
Q328. Contraction Stress Test (CST)- What is it
A328. Used in high-risk pregnancies; assess uteroplacental dysfunction; monitor FHR during contraction; positive - repetitive late decelerations during at least 3 contractions in 10 mins. > 36 weeks - deliver; < 36 weeks - do BPP, negative - no late decelerations, fetus well, repeat weekly
Q329. Vasa Previa - What is it; Risk Factors
A329. Fetal vessels cross internal os; if they rupture - exsanguinate very fast => fetal death Risk factors:; accessory placental lobes; multiple gestation; velamentous insertion of umbilical cord
Q330. Vasa Previa - History/PE
A330. Classic triad - ROM; painless vaginal bleeding, then fetal bradycardia
Q331. Vasa Previa - Dx
A331. Antenatal US with color Doppler; confirm - after delivery; exam of placenta & fetal vessels; rarely confirm before delivery
Q332. Vasa Previa - Tx
A332. Immediate C-section
Q333. Uterine Rupture - What is it; Risk Factors
A333. Complete separation of wall of uterus with or without expulsion of fetus; complete or incomplete rupture before or during labor Risk factors:; previous classic uterine incision; myomectomy; excessive oxytocin stimulation; grand multiparity; marked uterine distention
Q334. Uterine Rupture - History/PE
A334. Nonreassuring fetal monitoring; vaginal bleeding; abdom pain; change in uterine contractility
Q335. Uterine Rupture - Dx
A335. Surgical exploration of uterus
Q336. Uterine Rupture - Tx
A336. Immediate C-section; uterine repair - stable, young; hysterectomy - unstable or no desire for more kids
Q337. Multiple Gestation - Complications
A337. Nutritional anemia; preeclampsia; preterm labor; malpresentation; C-section; postpartum hemorrhage
Q338. Multiple Gestation - History/PE
A338. Hyperemesis gravidarum - more common; from high levels of B-hCG; uterus larger than dates; MS-AFP very high
Q339. Multiple Gestation - Tx:; Antepartum; Intrapartum; Postpartum
A339. Antepartum - iron and folate, monitor BP, serial US; intrapartum - vaginal - if both cephalic, C-section - if 1st noncephalic, controversial - if 1st cephalic and 2nd not; postpartum - watch for postpartum hemorrhage from uterine atony (due to overextended uterus)
Q340. A pt on birth control has amenorrhea, what is the most common cause?
A340. Pregnancy, no contraception is 100%
Q341. Si/sx of pregnancy
A341. amenorrhea,; morning sickness,; weight gain,; linea nigra,; melasma,; fetal heart tones,
Q342. Hegar's sign
A342. softening and compressibility of the lower uterine segment
Q343. Chadwick's sign
A343. dark discoloration of the vulva and vaginal walls
Q344. Define macrosomia
A344. a newborn that weighs more than 4 kg (9 lbs), usually because of maternal diabetes
Q345. It's the first prenatal visit. What do you order?
A345. Pap smear,; UA,; CBC,; type and screen,; syphilis,; rubella,; glucose if risk factors present,; GC and chlamydia for every teenager and patient with risk factors
Q346. When do you screen for maternal diabetes?
A346. At the first visit if risk factors present. If not, screen at 24-28 weeks.
Q347. How do you screen for maternal diabetes?
A347. Get a fasting serum glucose and glucose levels 1-2 hours after an oral glucose load.
Q348. When do you do a triple screen?
A348. 16-20 weeks
Q349. How does Down Syndrome present on triple screen?
A349. low AFP,; low estriol,; high hCG
Q350. When can fetal heart tones be picked up by doppler?
A350. 10-12 weeks
Q351. When can fetal heart tones be picked up by stethescope?
A351. 16-20 weeks
Q352. When does the uterus reach the umbilicus?
A352. 20 weeks
Q353. When is ultrasound the most accurate in estimating the fetal age?
A353. At 16-20 weeks
Q354. What is a hydatiform mole?
A354. It's when the products of conception basically become a tumor.
Q355. Sx of a hydatiform mole?
A355. Preeclampsia before third trimester,; hCG that does not return to zero after delivery (or abortion or miscarriage) or one that rises rapidly during pregnancy,; 1st or 2nd trimester bleeding with possible expulsion of "grapes,"; excessive nausea/vomiting,; uterine size/date discrepancy,; "snow storm" appearance on ultrasound
Q356. Define complete mole
A356. comes "completely" from the father,; karyotype is 46XX, no fetal tissue
Q357. Define incomplete mole
A357. karyotype 69XXY,; fetal tissue present
Q358. Tx of hydatiform moles
A358. dilation and curettage,; hollow with serial measurements of hCG until they go to zero,
Q359. What if a pt is treated for hydatiform mole, and their hCG doesn't go to zero?
A359. They have an invasive mole or choriocarcinoma. They need chemotherapy.
Q360. What is a choriocarcinoma?
A360. An aggressive form of mole
Q361. What chemo agents are used for moles?
A361. Methotrexate and actinomycin D
Q362. Define IUGR
A362. fetal size below the tenth percentile for age.
Q363. Three type of causes of IUGR
A363. Maternal (smoking, alcohol, drugs, lupus),; Fetal (TORCH infections, congenital anomalies),; and Placental (HTN, preeclampsia)
Q364. When do you order a fetal ultrasound?
A364. size/date discrepancy,; risk factors for IUGR,; problems with previous pregnancies,; fetal death,; distress,; suspected abortion
Q365. What is a non-stress test?
A365. Done while mother is at rest, tracing of fetal heart tones is obtained for 20 minutes
Q366. What is a normal non-stress test?
A366. A normal strip has at least 2 accelerations of fetal heart rate,; each at 15 beats above baseline,; lasting at least 15 seconds.
Q367. How do you do a biophysical profile?
A367. it includes a non-stress test, and ultrasound measurement of amniotic fluid, fetal breathing movements, and general fetal movements
Q368. What do you do if a fetus scores poorly on BPP?
A368. The next test is the contraction stress test
Q369. What is a contraction stress test?
A369. It measures uteroplacental dysfunction. oxytocin is given and a fetal heart strip is monitored. If late decelerations are seen with each contraction, a c- section is usually performed
Q370. Would you do a BPP in a high risk pregnancy without obvious problems?
A370. yes, if worried, do a BPP once-twice a week at the start of the third trimester
Q371. Do you use aspirin in pregnancy?
A371. no, use tylenol, but there is an important exception-in patients with antiphospholipid syndrome, in whom aspirin may improve pregnancy outcome.
Q372. Define post-term pregnancy
A372. more than 42 weeks gestation
Q373. Why is morbidity and mortality increased in post-term pregnancies?
A373. Shoulder dystocia and difficult deliveries are increased
Q374. What do you do for post-term patients?
A374. Induce labor if cervix is favorable. If it's not favorable, do biweekly BPPs until 43 weeks, then induce.
Q375. What disorders are associated with prolonged gestation?
A375. anencephaly and placental sulfatase deficiency
Q376. Describe some normal changes in pregnant patients
A376. Nausea, vomiting,; heavy painful breasts,; increased pigment in nipples, backache, linea nigra, melasma,; striae gravidarum,; ankle edema,; heartburn,; increasing urination frequency
Q377. Causes of low AFP
A377. Down syndrome,; fetal demise,; inaccurate dates
Q378. Causes of high AFP
A378. neural tube defects,; ventral wall defects,; multiple gestation,; inaccurate dates
Q379. What do you do with an abnormal AFP or triple screen?
A379. First, do ultrasound, then amniocentesis is needed for definitive diagnosis.
Q380. When do you offer chorionic villous sampling?
A380. at 9-12 weeks
Q381. Why is chorionic villous sampling done?
A381. Because it offers the chance for first trimester abortion.
Q382. Can chorionic villous sampling detect neural tube defects?
A382. Nope, only genetic or chromosomal defects
Q383. What kind of birth defects are caused by thalidomide?
A383. Phocomelia--limbs are missing with hands and feet attached directly to torso
Q384. What kind of birth defects are caused by tetracycline?
A384. yellow or brown teeth
Q385. What kind of birth defects are caused by aminoglycosides?
A385. deafness
Q386. What kind of birth defects are caused by valproic acid?
A386. spina bifida,; hypospadias
Q387. What kind of birth defects are caused by progesterone?
A387. masculinization of female fetus
Q388. What kind of birth defects are caused by cigarettes?
A388. IUGR,; low birth weight,; prematurity
Q389. What kind of birth defects are caused by OCPs?
A389. VACTERL syndrome
Q390. What is VACTERL syndrome?
A390. Vertebral, Anal, Cardiac, TracheoEsophaeal, Renal, and Limb malformations
Q391. What kind of birth defects are caused by Lithium?
A391. Ebstein's cardiac anomaly
Q392. What kind of birth defects are caused by radiation?
A392. IUGR,; CNS defects,; eye defects,; leukemia
Q393. What kind of birth defects are caused by alcohol?
A393. Fetal alcohol syndrome
Q394. What kind of birth defects are caused by phenytoin?
A394. craniofacial, limb, and cerebrovascular defects,; mental retardation
Q395. What kind of birth defects are caused by warfarin?
A395. craniofacial defects,; IUGR,; CNS malformations,; stillbirth
Q396. What kind of birth defects are caused by carbamazepine?
A396. fingernail hypoplasia,; craniofacial defects
Q397. What kind of birth defects are caused by isotretinoin?
A397. CNS, craniofacial, ear, and cardiovascular defects
Q398. What kind of birth defects are caused by iodine?
A398. Goiter,; cretinism
Q399. What kind of birth defects are caused by cocaine?
A399. cerebral infarcts, mental retardation
Q400. What kind of birth defects are caused by diazepam?
A400. cleft lip and/or palate
Q401. What kind of birth defects are caused by diethylstilbestrol?
A401. clear cell vaginal cancer,; adenosis,; cervical incompetence
Q402. What kind of birth defects are caused by maternal diabetes?
A402. cardiovascular malformations,; cleft lip and/or palate,; caudal regression,; neural tube defects,; left colon hypoplasia/immaturity,; macrosomia,; microsomia (if mother has long-standing DM),
Q403. What kinds of problems do infants born to diabetic mothers have after birth?
A403. increased risk of respiratory distress syndrome,; postdelivery hypoglycemia,
Q404. How do you treat diabetes during pregnancy?
A404. insulin (after diet and exercise),; DON'T use oral hypoglycemics because they cross the placenta and cause fetal hypoglycemia
Q405. What drugs are safe during pregnancy?
A405. acetaminophen,; penicillin,; cephalosporins,; erythromycin,; nitrofurantoin,; H2 blockers,; antacids,; heparin,; hydralazine,; methyldopa,; labetolol,; insulin,; docusate
Q406. What does TORCH stand for?
A406. Toxoplasma,; Other,; Rubella,; Cytomegalovirus,; Herpes
Q407. risk factors for toxoplasma?
A407. exposure to cats
Q408. What kind of birth defects are caused by toxoplasma?
A408. intracranial calcifications,; chorioretinitis
Q409. What kind of birth defects are caused by varicella-zoster?
A409. limb hypoplasia,; scarring of the skin
Q410. What kind of birth defects are caused by syphilis?
A410. rhinitis,; saber shins,; Hutchinson's teeth,; interstitial keratitis,; skin lesions
Q411. What kind of birth defects are caused by rubella?
A411. effects are worse in the first trimester,; cardiovascular defects,; deafness,; cataracts,; microphthalmia
Q412. What kind of birth defects are caused by cytomegalovirus?
A412. deafness,; cerebral calcifications,; microphthalmia
Q413. What kind of birth defects are caused by herpes?
A413. vesicular lesions,; encephalitis,; early fusion of cranial bones,; seizures
Q414. What percent of fetuses are infected with HIV from their mothers if the mothers do not receive treatment?
A414. 0.25
Q415. How do you treat HIV in pregnant women?
A415. zidovudine (AZT) is given to the mother prenatally, and it's given to the infant for 6 weeks afer birth
Q416. What percent of fetuses are infected with HIV from their mothers if the mothers receive treatment?
A416. 0.08
Q417. When do you test an infant for HIV antibodies?
A417. between 6-18 months of age;; Abs tests will be positive at birth because maternal antibodies cross the placenta
Q418. How do you test newborns for HIV?
A418. HIV PCR, with follow up at 18 months with antibody test
Q419. can breastmilk transmit HIV?
A419. yes
Q420. What do you do if a woman has active visible genital herpes lesions during labor?
A420. do a c-section
Q421. What do you do if a woman has a history of genital herpes and goes into labor, and there's no visible lesions?
A421. proceed with vaginal birth
Q422. What do you do if a laboring mother has chronic hepatitis B?
A422. give infant the first hep B vaccine and hepB immunoglobulin at birth.
Q423. What do you do if a mother contracts chickenpox late in pregnancy?
A423. give the infant varicella-zoster immunoglobulin
Q424. How do you treat GC/chlamydia during pregnancy?
A424. ceftriaxone and erythromycin or azithromycin
Q425. How do you treat TB during pregnancy?
A425. same as in non-pregnant women. BUT don't use streptomycin (it's rarely use anyway). Make sure to give vitamin B6 with isoniazid.
Q426. How do you know if the placenta has separated during the third phase of delivery?
A426. there is a fresh gush of blood, lengthening of the umbilical cord, and a rising fundus that is firm and globular
Q427. If a pt has had a c-section, can they have a vaginal delivery during the next pregnancies?
A427. Maybe. If they have a vertical uterine incision, they have to have a repeat c-section. If they have a horizontal incision, they may deliver vaginally with only a slightly increased risk of uterine rupture.
Q428. 4 signs of placental separation
A428. 1. gush of blood - coincides with placenta separating from uterus; 2. cord lengthening - placenta has dropped to lower portion of the uterus; 3. globular uterus; 4. uterus ascends to anterior abdominal wall
Q429. what can cause uterine inversion; complication from inversion
A429. if cord doesn't separate from uterus and excessive force is used to cause the separation --> uterine inversion; massive hemorrhage
Q430. appearance of uterine inversion
A430. shaggy mass, red and bulging
Q431. definition of abnormally retained placenta; tx
A431. labor of placenta exceeds 30 mins; try manual extraction
Q432. risk factors for uterine inversion
A432. grand-multip; placental implantation in fundus
Q433. tx of uterine inversion
A433. halothane, terbutiline, and MgSO4 to cause uterine relaxation; emergent surgery
Q434. what is protective of uterine inversion
A434. attenuated umbilical cord: it will separate easily and cause cord severing
Q435. definition of premature ovarian failure
A435. cessation of ovulation younger than 40 yo
Q436. what causes ovarian failure in turner's syndrome
A436. ovarian failure
Q437. relationship between TSH and PRL and menstrual cycle
A437. low TSH and high PRL both inhibit GnRH pulsations --> FSH/LH inhibition
Q438. sx of TSS
A438. myalgias; n/v; hypotension; confusion; sunburn-like rash --> maculopapular rash --> desquamation with palm/sole involvement (by 10th day) --> increased serum bilirubin
Q439. what MAP is required to perfuse vital organs
A439. 65 mmhg
Q440. what is the organism in TSS; best way to culture it
A440. staph; exotoxin-1 enters body; vaginal culture
Q441. tx of TSS
A441. iv nafcillin or methicillin + amnioglycosides
Q442. definition of latent labor
A442. cervix mainly effaces and cervical dilation
Q443. time limit of latent labor
A443. <18-20 hrs in prime; <14 hrs in multip
Q444. arrest of active labor
A444. no cervical change during 2h of active labor
Q445. protracted active labor
A445. decreased cervical change over 2 hrs
Q446. causes of prolonged latent phase
A446. decreased power, pelvis, or passenger
Q447. definition of clinically adequate CTX
A447. q2-3 mins; firm abdomen 40-60 s; OR >200 montevideo units over 10 mins
Q448. bloody show
A448. loss of cervical mucous plug; sign of impending labor
Q449. 1st thing to consider in a woman with lower abdominal pain and vaginal spotting
A449. ectopic pregnancy, until proven otherwise
Q450. progesterone levels for nml uterine pregnancy; progesterone levels for nonviable pregnancy
A450. >25; <5
Q451. if non-viable pregnancy is dx, what is next step to determine etiology
A451. d&c to assess miscarriage (will see chorionic villi) or ectopic pregnancy (will see no villi)
Q452. when should MTX be given to tx miscarriage
A452. if patients are asymptomatic and fetus is <3.5 cm
Q453. what is cutoff in weeks for a pregnancy loss to be considered a spontaneous abortion
A453. 20w weeks
Q454. definition of PPROM
A454. rom prior to onset of labor <37 weeks; 50% will labor within 48 hrs and 90% w/i 1 week
Q455. sx of chorioamnionitis
A455. maternal fever, tachycardia, uterine tenderness, and malodorous d/c; fetal tachycardia >160 is also an early sign
Q456. tx of PPROM
A456. if <32 weeks, steroids and broad-spectrum antibiotics
Q457. dx of chorioamnionitis
A457. see gm stained bacteria on amniocentesis
Q458. time-frame of pre-term labor
A458. 20-37 weeks
Q459. complication of vbac
A459. uterine rupture
Q460. how to manage arrest of active phase of labor
A460. if CTX are not strong enough, give pit, then place IUCP if there is still no dilation
Q461. what things are included in the bishop score
A461. dilation; effacement; station; consistency; cervical position
Q462. what bishop score is favorable for induction
A462. >8
Q463. what are the cardinal movements of labor
A463. engagement (oociput transverse); internal rotation (to occiput anterior); complete rotation; extension of neck; external rotation; anterior shoulder; posterior shoulder
Q464. what is the most common type of breech presentation
A464. frank breech
Q465. what are the 3 types of breech and how do they differ
A465. frank: flexed hips with knees extended, feet are under fetal head; footling: one or both hips not flexed and foot or knee is in birth canal; complete: flexed hips and knees, with 1 foot near the breech
Q466. when can external version of breech be performed
A466. after 37 weeks b/c of risk of abruption or ROM secondary to external maneuvering
Q467. #1 cause of post-partum hemorrhage
A467. uterine atony
Q468. definition of post-partum hemorrhage
A468. >500 cc blood loss after vaginal birth; >1000 cc blood loss after c/s
Q469. orgs involved in endometritis
A469. anaerobes and aerobes
Q470. why is bromocriptine no longer given to prevent galactorrhea post-partum
A470. seizure and HTN can result (uncommonly)
Q471. what causes prolonged fetal tachycardia
A471. maternal fever; chorioamnionitis
Q472. cause of early decelerations; morphology
A472. head compression during CTX; mirror images of CTX tracing
Q473. cause of late decelerations
A473. placental insufficiency; chronic HTN; post-date pregnancy
Q474. causes of variable decelerations
A474. cord compression; cord around fetal parts; fetal anomalies; oligohydramnios
Q475. causes of sinusoidal FHT
A475. severe fetal anemia; maternal drugs
Q476. causes of prolonged bradycardia in FHT
A476. uterine hyperstimulation
Q477. when is an amnioinfusion performed
A477. to tx variable decelerations or meconium stained amniotic fluid
Q478. which PG is contraindicated in asthma
A478. PGF2
Q479. what is used to decrease uterine bleeding post-partum
A479. ergots; oxytocin; PGs
Q480. which 2 placental problems often go together
A480. accreta and previa
Q481. what effect does pregnancy have on peptid ulcer disease; on ms
A481. makes both of them better
Q482. dx of endometriosis
A482. laparoscopy
Q483. management of placental abruption in setting of painful bleeding in 3rd trimester
A483. can progress rapidly so pt should be carefully monitored; ensure rapid vaginal delivery; c/s only if there is rapid deterioration in early stages of labor
Q484. when is rhogam given
A484. at 28 weeks
Q485. after 1h gtt, what is the threshold for gdm
A485. >140
Q486. after the 3hr gtt what is the threshold for gdm
A486. at 1h >180; at 2h >155; at 3h >140
Q487. what can be done to decrease utis in sexually active women
A487. void after sex
Q488. what is the most common genetic mutation associated with ovarian ca
A488. p53 (much more common than brca)
Q489. consistency of granulosa theca cells
A489. solid
Q490. appearance of a serous cystadenoma
A490. larger than a functional cyst; pt has increased abdominal girth
Q491. what determines prognosis in ca
A491. tumor stage
Q492. standard of care for advanced ovarian ca in a pt s/p oopherectomy and surgical staging
A492. post-op chemo
Q493. definition of anemia in pregnancy; most common cause
A493. hb <10.5; Fe deficiency
Q494. tx of hellp
A494. delivery
Q495. what happens to haptoglobin lvls in hemolysis
A495. they decrease b/c they are bound by hb
Q496. side effects of MgSO4
A496. decreased DTR; pulmonary edema; respiratory depression
Q497. when should antenatal steroids be given in ptl
A497. between 24-34 weeks, after that not needed
Q498. should tocolysis be given to patients with suspected abruption
A498. no they should be delivered, b/c if tocolysis is used the abruption can continue
Q499. what effect do b-agonists have on K
A499. hypokalemia
Q500. complication of pyelonephritis in pregnancy
A500. 2-5% --> ARDs (usually endotoxin related)
Q501. what is the most common reason for septic shock in pregnancy
A501. pyelo
Q502. how is incidence of pyelo reduced
A502. at 1st pnv urine culture is done to id asx bacteriuria
Q503. tx of dvt in pregnancy
A503. heparin x 5-7 days then subq heparin to keep ptt 1.5-2.5 x nml limit x 3 mo
Q504. stages of pelvic relaxation
A504. first degree:structure has descended into the upper 2/3 of the vagina; 2nd degree: structure descends into the introitus; 3rd degree: structure protrudes outside the vagina
Q505. stress incontinence
A505. urine loss with exertion ro straining; caused by pelvic relzxation and displacement of urethrovesical junction
Q506. urge incontinence
A506. detrusor instability; urine leakage is 2ndary to involuntary and uninhibited bladder contractions
Q507. total incontinence
A507. continuous urine leakage secondary to urinary fistulas (usually 2ndary to pelvic surgery or pelvic radiation)
Q508. overflow incontinence
A508. incomplete voiding; urinary retention and overdistension of the bladder
Q509. treatment of bv
A509. metronidazole
Q510. primary causes of third-trimester bleeding
A510. placental abruption and placenta previa
Q511. classic ultrasound and gross appearance of complete hydatiform mole
A511. snowstorm appearance on ultrasound;; cluster of grapes on physical exam
Q512. chromosomal pattern of a complete mole
A512. 46, XX
Q513. molar pregnancy containing fetal tissue
A513. partial mole
Q514. symptoms of placental abruption
A514. continuous, painful vaginal bleeding
Q515. symptoms of placental previa
A515. self-limited, painless vaginal bleeding
Q516. when should a vaginal exam be performed with a suspected placenta previa?
A516. never
Q517. antibiotics with teratogenic effects
A517. tetracycline,; fluoroquinolones,; aminoglycosides,; sulfonamides
Q518. shortest AP diameter of the pelvis
A518. obstetric conjugate: between the sacral promonotory and the midpoint of the line of the symphysis pubis
Q519. medication given to accelerate fetal lung maturity
A519. betamethasone or dexamethasone x 48 hours
Q520. the most common cause of postpartum hemorrhage
A520. uterine atony
Q521. treatment for postpartum hemorrhage
A521. uterine massage;; if that fails, give oxytocin
Q522. typical antibiotics for group B strep (GBS) prophylaxis
A522. IV penicillin or ampicillin
Q523. a patient fails to lactate after an emergency C-section with marked blood loss
A523. Sheehans syndrome; (postpartum pituitary necrosis)
Q524. uterine bleeding at 18 weeks gestation; no products expelled; membranes ruptured; cervical os open
A524. inevitable abortion
Q525. uterine bleeding at 18 weeks gestation; no products expelled; cervical os closed
A525. threatened abortion
Q526. what is the definition of pre-term labor?
A526. regular uterine contractions + concurrent cervical changes at <37 weeks gestation
Q527. Group-B strep prophylaxix
A527. penicillin or ampicillin
Q528. what defines a post-partum hemorrhage?
A528. >500mL with vaginal delivery or >1000mL with c-section
Q529. most common cause of post-partum hemorrhage
A529. uterine atony
Q530. treatment for uterine atony protocol
A530. 1. uterine massage; 2. oxytocin; 3. methergine; 4. prostin PGF2-alpha
Q531. when should the uterus be palpable above the pubic symphysis?
A531. 12 weeks
Q532. what does human placental lactogen do?
A532. insulin-antagonist to maintain fetal glucose levels
Q533. what is the cut-off for anemia in pregnancy?
A533. Hgb below 11.0mg/dL
Q534. what is the average WBC count during pregnancy? what about during labor?
A534. 10.5 during pregnancy, 20+ during labor
Q535. Definition:; child at fertilization to 8 weeks
A535. Embryo
Q536. Definition:; child at 8 weeks to delivery
A536. Fetus
Q537. Definition:; Softening and cyanosis of the cervix at or after 4 weeks
A537. Goodell's sign
Q538. Definition:; softening of the uterus (after 6 weeks)
A538. Ladin's sign
Q539. Definition:; first trimester
A539. fertilization to 12 weeks
Q540. Definition:; second trimester
A540. 12 weeks to 24 weeks
Q541. Definition:; third trimester
A541. 24 weeks to delivery
Q542. Definition:; child delivery less then 24 weeks
A542. Priviable
Q543. Definition:; Quickening
A543. Patient's initial presentation of fetal movement
Q544. what are the changes in CO, HR, SV, TPR and BP during pregnancy?
A544. Increased CO, HR, SV; Decreased TPR,; Decreased BP (returns to nml >24 weeks)
Q545. (4) Respiratory changes during pregnancy
A545. Increased Tidal volume,; Increased PaO2 and PAO2,; Decreased lung capacity,; Mild Respiratory Alkalosis
Q546. (3) GI changes during pregnancy
A546. Increased vomiting,; Decreased motility (constipation),; Prolonged gastric emptying (GERD)
Q547. (4) Renal changes during pregnancy
A547. Increased kidney size,; Increased GFR (by 50%) leading to... Decreased BUN and Creatinine by 25%,; Increased Renin, Aldosterone and Na absorption (balanced by Inc GFR)
Q548. (4) Blood changes during pregnancy
A548. Increased plasma volume (50%),; Increased RBC (20%),; both percents lead to Decreased Hct,; possibly causing Iron deficiency anemia,; Increased Fibrinogen and factors VII - X leading to... Increased Thromboembolism
Q549. what hormones are maintained by the placenta in pregnancy?; (4)
A549. Estrogen,; hCG,; hPL,; Progesterone (after initial maintenance from corpus luteum)
Q550. what causes increased Thyroid Binding Globulin?; how does this affect T3 and T4?
A550. Inc estrogen; T3 and T4 inc binding to TBG leading to low serum levels of free T3 and T4
Q551. what is the cause of gestational diabetes?; how?
A551. hPL; it is an insulin antagoinist (inc diabetic effect and leading to inc insulin and protein synthesis)
Q552. what is the adequate amount of nutrition needed in pregnancy?; breast feeding?
A552. Pregnancy: 300 kcal/day; Breast feeding: 500 kcal/day
Q553. how often should prenatal visits be?
A553. every 4 weeks until week 28; week 28 - 36: every 2 weeks,; 36 to term: every week
Q554. when is genetic screening done?; what are the (3) main tests?
A554. during second trimester (usu 15 - 20 weeks); MSAFP,; b-hCG,; Estriol
Q555. which germ cell ovarian tumor has a different treatment method then the others?; what is the Tx?
A555. Dysgerminoma; Tx: Radiation
Q556. what is tested in pregnancy b/t 27 and 29 weeks?; (3)
A556. Glucose Loading Test (for gestational diabetes),; Hematocrit (for iron levels),; Glucose Tolerance Test if GLT is positive
Q557. how is the Glucose Loading Test performed?; (2)
A557. give 50g oral glucose and check in one hour if > 140 mg/dL, then do GTT
Q558. How is a Glucose Tolerance Test performed?; What are the blood glucose values for fasting, one, two and three hour intervals?
A558. Fasting glucose: give 100 g oral glucose and test at 1, 2 and 3 hours; Gestational Diabetes = Fasting glucose > 105 mg/dL; or any two values over 180, 155 or 140 respectively
Q559. what can dehydration lead to later in pregnancy?
A559. Braxton-Hicks contractions
Q560. what causes edema of lower extremities, feet and ankles, and hemorrhoids in pregnancy?; Tx?
A560. Compression of IVC and pelvic veins; Tx: elevating feet
Q561. what is the best test for fetal lung maturity?; normal levels?
A561. Lecithin/Sphingomyelin ratio; normal > 2
Q562. describe a positive Non-Stress Test
A562. 2 increases in FHR in 20 min that are >15 beats above nml and for >15 seconds
Q563. describe a positive Oxytocin Challenge Test
A563. 3 contractions in 10 minutes
Q564. (5)* categories of the Biophysical Profiles
A564. Test the Baby MAN!:; Fetal Tone,; Fetal Breathing,; Fetal Movement,; Amniotic Fluid volume,; NST (zero or 2 points each; nml is 8 - 10)
Q565. Definition:; multiple gestation with at least one IUP and at least one ectopic
A565. Heterotrophic Pregnancy
Q566. at what b-hCG levels should you detect an IUP on vaginal US?
A566. IUP should be seen on US with b-hCG of 1500 – 2000 mIU/mL
Q567. at what b-hCG levels should you detect a fetal heartbeat with trans-abdominal US?
A567. Fetal heartbeat should be seen with b-hCG > 5000 mIU/mL
Q568. Tx for Ruptured Ectopic
A568. Exploratory Lap (and maintain fluid levels)
Q569. what hormone best resembles b-hCG?; how?
A569. LH; they also have similar beta units (in addition to similar alpha)
Q570. what is the criteria to use Methotrexate for an ectopic?; (2)
A570. ectopic must be < 3.5 cm,; without heartbeat
Q571. what is the progesterone level in a nonviable intra- or extra- uterine pregnency?
A571. < 5 ng/mL
Q572. what is the progesterone level in 98% of intrauterine pregnancies?
A572. > 25 ng/mL
Q573. what does G5P2124 indicate?
A573. Twins
Q574. Definition:; Spontaneous abortion time
A574. pregnancy ending < 20 weeks
Q575. Type of Abortion:; any IU bleeding < 20 weeks without dilation or expulsion of POC
A575. Threatened abortion
Q576. Type of Abortion:; death of embryo of fetus < 20 weeks with complete retention of POC (usu leads to complete SAB)
A576. Missed abortion
Q577. Type of Abortion:; no expulsion of POC, but bleeding and dilation of cervix such that viability is unlikely
A577. Inevitable abortion
Q578. (2) ways an incomplete abortion can be taken to completion in first trimester
A578. D&C; Prostaglandins (Misoprotol)
Q579. causes of abortion in second trimester; (4)
A579. Congenital abnormalities; cervical / uterine abnormalities,; trauma,; systemic Disease or infection
Q580. (3) ways an incomplete abortion can be taken to completion in second trimester
A580. D&E,; Prostaglandins (Misoprostol),; Oxytocin at high doses
Q581. Definition:; Painless dilation leading to infection, Preterm Premature Rupture of Membranes (PPROM) or PTL
A581. Incomplete cervix
Q582. what should be done if patient is in first trimester and has a history of incomplete cervix?; when?
A582. Cerclage; 12 - 14 weeks
Q583. (3) tests to verify if patient has ruptured membranes
A583. Pool - collection of fluid in vagina; Nitrazine - turns blue (alkaline); Ferning
Q584. Definition:; Rupture of membranes > 1 hour before onset of labor
A584. Premature Rupture of Membranes; (PROM)
Q585. (5) parts of a Bishop score
A585. Dilation,; Effacement,; Station,; Cervical consistency,; Cervical position
Q586. Bishop score points zero - 3 for:; Dilation
A586. zero: Closed; 1 point: 1 - 2; 2 points: 3 - 4; 3 points: > 5
Q587. Bishop score points zero - 3 for:; Effacement
A587. zero: 0 - 30%; 1 point: 40 - 50%; 2 points: 60 - 70%; 3 points: > 80%
Q588. Bishop score points zero - 3 for:; Station
A588. zero: -3; 1 point: -2; 2 points: -1 to zero; 3 points: +1 - +3
Q589. Bishop score points zero - 3 for:; Cervical consistency
A589. zero: Firm; 1 point: Medium; 2 points: Soft; 3 points: (none)
Q590. Bishop score points zero - 3 for:; Cervical position
A590. zero: Posterior; 1 point: Mid; 2 points: Anterior; 3 points: (none)
Q591. Definition:; Lengthening (thinning) of the cervix
A591. Effacement
Q592. Definition:; relationship of fetal occiput to maternal pelvis
A592. Fetal Position
Q593. (4) ways to Induce labor
A593. Pitocin,; Prostaglandins (Cervadil or Misoprostol),; Mechanical dilation of cervix,; Rupture of membranes (Amniotomy)
Q594. MC 4 steps to Augment and monitor labor progress
A594. water broke? if not -> Amniotomy; change? if not -> IUPC; change? if not -> Pitocin; change? if not -> C-section
Q595. what does an IUPC measure with respect to contractions?; (2)
A595. 1. Time of contraction; 2. Strength of contractions
Q596. Name the (6)* movements of labor in order and what each means
A596. Engagement - biparietal diameter (largest) part of head enters pelvis,; Flexion - smallest diameter of head enters,; Descent - head completely into pelvis,; Internal rotation - from OT to OA or OP,; Extension - vertex passes beyond pubic synthesis; crowning occurs; External rotation - after delivery of the head as the head rotates to face forward
Q597. (3) P's of the Active Phase that may cause problems in delivery
A597. Power (strength of contractions),; Passenger (size and position of infant),; Pelvis (shape)
Q598. (5) steps of Tx in patient with Non-reassuring fetal status
A598. 1. Give mother oxygen mask; 2. turn her to Left side to decrease IVC compression; 3. D/C Pitocin; 4. if due to Hypertonus (long contraction) or Tachysystole (>5 contractions in 10 min), give Terbutaline to relax uterus; 5. If 1 – 4 does not work, C-section patient
Q599. Dx:; Painless vaginal bleeding in the third trimester; Tx for perterm patient (<36 weeks)?; (3); Tx for term patient?
A599. Placenta previa; Tx for Preterm:; 1. Monitor in hospital; 2. Transfusion PRN; 3. Tocolytic to prolong until 36 weeks; Tx for Term: C-section
Q600. Dx:; Vaginal bleeding, painful contractions, firm and tender uterus; Tx?
A600. Placental Abruption; Tx – Delivery (by C-section if mother or baby is unstable)
Q601. Dx:; sudden onset of intense abdominal pain assoc with pregnancy; Tx?
A601. Uterine rupture; Tx - immediate laparotomy
Q602. Dx:; Vaginal bleeding and sinusoidal FHR pattern; MCC?; Tx?
A602. Fetal Vessel Rupture; MCC - Velamentous cord insertion; Tx - emergency C-section
Q603. Dx:; contractions and changes in cervix at < 37 weeks gestation
A603. Preterm Labor
Q604. The only Tocolytic approved by the FDA; MOA?
A604. Ritrodrine; MOA: Beta-agonist
Q605. Tocolytic that acts as a calcium antagonist
A605. Magnesium sulfate
Q606. what is the test to determine if patient is near a Magnesium sulfate toxicity?
A606. check DTRs continuously. they are depressed less then the toxic level of 10 mg/dL
Q607. what Calcium channel blocker is used as a Tocolytic?
A607. Nifedipine
Q608. what NSAID is used as a Tocolytic?
A608. Indomethacin
Q609. MC concern with PROM?
A609. Chorioamnionitis
Q610. when is it common to see maternal hypotension?; what can it cause in child?; what is Tx for maternal hypotension?
A610. After epidural; causes - Fetal bradycardia; Tx - IV hydration and Ephedrine
Q611. Tx for fetal bradycardia lasting for longer then 4 - 5 minutes?
A611. C-section
Q612. Monozygotic Twins:; separation before the differentiation of trophoblasts
A612. Dichorionic-Diamnionic
Q613. Monozygotic Twins:; separation after trophoblast differentiation and before amnion formation
A613. Monochorionic-Diamnionic
Q614. what type of twins can develop Twin-to-Twin Transfusion Syndrome?
A614. Mono-Di (one big baby and one small)
Q615. Twin type:; division of fertilized ovum
A615. Monozygotic
Q616. Twin type:; fertilization of two ova by two sperm
A616. Dizygotic
Q617. Monozygotic Twins:; separation after amnion formation
A617. Monochorionic-Monoamnionic (highest mortality rate)
Q618. Dx:; pregnant woman with HTN, edema, proteinuria
A618. Preeclampsia
Q619. (3) risk factors for onset of Preeclampsia
A619. Nulliparity,; Multiple gestation,; Chronic HTN
Q620. Tx for Preeclampsia near term and preterm
A620. Near term: Delivery; Preterm (and Eclampsia Tx): Mag sulfate - against seizures, Hydralazine - HTN
Q621. with Eclampsia, what percentage of patients have seizures before labor, during labor and after labor?
A621. Before: 25%; During: 50%; After: 25%
Q622. what anti-hypertensives are given to mothers with chronic HTN during birth?; (2)
A622. Nifedipine; Labetolol
Q623. what tests should be performed if patient has chronic HTN with pregnancy?; (2); why?
A623. Baseline ECG,; 24-hr urine collection; helps differentiate superimposed preeclampsia
Q624. How common is gestational diabetes?
A624. approx 15% of pregnancies
Q625. (3) fetal complications of Gestational Diabetes
A625. Macrosomia,; Shoulder dystocia,; neonatal Hypoglycemia
Q626. when is a C-section indicated in gestational diabetes?
A626. if fetal weight > 4500g
Q627. How is the DM-1 patient managed during pregnancy?; Delivery?
A627. Pregnancy - insulin pump; Delivery - insulin drip
Q628. What gestational age of onset would you stop considering using a tocolytic agent?; A steroid agent?; What is done after that?
A628. Tocolytic: >34 weeks; Steroid: >36 weeks; then: Expectant management
Q629. how are lower UTIs treated versus pyelonephritis in pregnancy?
A629. Lower UTI - oral Antibiotics; Pyelonephritis - IV Antibiotics
Q630. (2) complications of pyelonephritis during pregnancy for mother
A630. Septic shock; ARDS
Q631. what can Bacterial Vaginosis cause during pregnancy?
A631. Preterm delivery
Q632. Leading cause of Neonatal sepsis; Tx?
A632. Group B strep; Tx: Ampicillin
Q633. Dx:; maternal fever, uterine tenderness, high WBC, fetal tachycardia; Tx? (2)
A633. Chorioamnionitis; Tx: Delivery, IV Antibiotics
Q634. Dx:; nausea and vomiting in pregnancy to the extent where the patient cannot maintain adequate hydration and nutrition; (3) Tx?
A634. Hyperemesis Gravidarum; Tx: IV hydration, Electrolyte repletion, Antiemetics
Q635. Management of women with Epilepsy during pregnancy; (3)
A635. check antiepileptic drug levels monthly,; Level 2 Ultrasound at 19 - 20 weeks,; supplement with Vitamin K from 37 weeks to delivery
Q636. what do women with mild renal disease have a risk of getting during pregnancy?; (2 pregnancy problems)
A636. Preeclampsia,; IUGR
Q637. Leading cause of maternal death
A637. Pulmonary emboli
Q638. Tx for pregnancy-related DVT and PE
A638. Heparin
Q639. Management for Hyperthyroidism in pregnant woman; (3)
A639. Thyroid-stimulating immunoglobulins (TSI) should be screened. if elevated, screen for fetal goiter and IUGR; continue with PTU medication
Q640. Management for Hypothyroidism in pregnant woman
A640. Synthroid (Increased Synthroid requirements during preg for somone already on meds)
Q641. (3) common problems that can occur in the pregnant SLE patient. what (3) meds can be used in these patients as prophylaxis?
A641. Risk for: Pregnancy loss, IUGR, Preeclampsia; Meds: Low-dose aspirin, Heparin, Corticosteroids
Q642. how are Lupus flares and Preeclampsia differentiated in pregnancy?
A642. Complement levels
Q643. SLE and Sjogren mothers with anti-Ro and Anti-La antibodies have risk of developing what fetal problem?
A643. Fetus with Congenital Heart Block
Q644. Dx:; infant is delivered and has growth restriction, CNS problems, cardiac defects and abnormal facies
A644. Alcohol abuse during pregnancy; (FAS)
Q645. Pregnancy Risk:; Caffeine > 150 mg/day
A645. Spontaneous abortions
Q646. Pregnancy Risk:; Cigarette smoking; (4)
A646. Growth restriction,; Abruptions,; Preterm delivery,; Fetal death
Q647. Pregnancy Risk:; Cocaine; (2)
A647. Placental Abruption,; CNS defects in children
Q648. what is best for the pregnant woman on Heroin during pregnancy?
A648. Quitting outright will endanger fetus--need to be enrolled in a methadone clinic, then quit after delivery
Q649. (2) central issues in the immediate postpartum period for the patient
A649. Pain management,; Wound care
Q650. when do diaphragms and cervical caps need to be refitted postpartum?
A650. 6 weeks
Q651. what are the (3) hormonal contraceptives of choice postaprtum?; Why?
A651. Depo-provera,; Norplant,; Progesterone-only minipill b/c they are less likely to decrease milk production in breast-feeding patients
Q652. What are the causes of postpartum hemorrhage?; (6)*
A652. Coagulation Defect;; Atony;; Rupture;; Placenta (POC) retained;; Implantation site bleed;; Trauma
Q653. what are the steps in managing a postpartum hemorrhage?; (4 steps)
A653. 1. RULE OUT cervical/vaginal lacerations; 2. if still bleeding: give Uterotonic agents (Oxytocin); 3. if still bleeding: D&C; 4. if still bleeding: Laparotomy with bilateral O'Leary sutures to tie off uterine arteries
Q654. Dx:; fever, high WBC, uterine tenderness 5 - 10 days post C- section; Tx?; (2)
A654. Endomyometritis; Tx: D&C, broad-spectrum Antibiotics until afibrile for 48 hrs
Q655. what is the underlying cause of labial fusion?
A655. excess Androgens
Q656. MC form of enzymatic deficiency assoc with ambiguous genitalia; what is deficient?
A656. Congenital Adrenal hyperplasia; (21-hydroxylase deficiency)
Q657. Dx:; hyperandrogenism, salt wasting, hypotension, hyperkalemia, hypoglycemia, ambiguous genitalia
A657. Congenital Adrenal Hyperplasia; (21-hydroxylase deficiency)
Q658. what main lab is elevated in Congenital Adrenal Hyperplasia?; what is Tx?
A658. 17-alpha-hydroxyprogesterone; Tx: Cortisol (and a mineralcorticoid if pt is salt-wasting)
Q659. what is the name of the fertilized oocyte 2 - 4 days after fertilization?; what is it called in the next stage?
A659. Blastomere / Morula; next: Blastocyst
Q660. Dx:; patient at puberty with primary amenorrhea and cyclic pelvic pain, lower abdominal girth
A660. Imperforate hymen
Q661. Definition:; build-up of blood behind the hymen in person with imperforate hymen; Tx?
A661. Hematocolpos; Tx: surgery
Q662. (2) causes of Vaginal Agenesis
A662. Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH); Androgen Insensitivity
Q663. Dx:; normal female karyotype with ovaries and secondary sexual characteristics, but congenital absence or hypoplasia of vagina, cervix, uterus and fallopian tubes
A663. Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH)
Q664. what is the Tx for Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH)?
A664. Create vagina: with dilators; or McIndoe procedure (surgically creating vagina with skin grafts)
Q665. Dx:; woman with scant pubic hair and small breasts with vaginal agenesis or absence and absence of uterus; cause?
A665. Androgen Insensitivity; cause: nonfunctioning androgen receptors (normal levels of Testosterone)
Q666. Dx:; symmetric white, thinned skin on labia, perineum and perianal region. Shrinkage and agglutination of labia with occasional pruritis or dysparunia; Tx?
A666. Lichen Sclerosis; Tx: Topical steroids (Clobetasol)
Q667. Dx:; localized thickening of the vuvlar skin from edema with chronic pruritis, possible raised white lesion on labia majora or clitoris
A667. Squamous cell hyperplasia
Q668. Dx:; multiple shiny, flat, purple papules usu on the inner aspects of the labia minora, vagina and vestibule. Often erosive and causing pruritis and mild inflammation
A668. Lichen Planus
Q669. Dx:; Thickened white epithelium, slight scaling, usually unilateral and circumscribed on vulva, with pruritis; (2) Tx?
A669. Lichen Simplex Chronicus; Tx: Ultraviolet light, Topical steroids
Q670. Dx:; Red, moist and sometimes scaly lesions on vulva, which may also be found on scalp, axilla, groin and trunk
A670. Vulvar Psoriasis
Q671. Dx:; palpable red granular spots and patches in the upper third of the vagina on the anterior wall
A671. Vaginal Adenosis
Q672. how are vulvar lesions Dx?
A672. Biopsied
Q673. MC benign tumor on the vulva
A673. Epidermal Inclusion cysts
Q674. Definition:; Disease that causes occlusion of the sweat glands on mons pubis and labia majora, causing cyst formations; Tx?
A674. Fox-Fordyce Disease; Tx: I&D
Q675. how do you differentiate an epidermal cyst from a sebaceous cyst?
A675. Epidermal - solitary cyst; Sebaceous - collection of cysts
Q676. where are the Skene glands located?
A676. Paraurethral
Q677. where are the Bartholian glands located?
A677. Bilaterally at 4 and 8 o'clock on labia majora
Q678. what is first step in Tx if a Bartholian cyst first appears in woman over 40yo?
A678. Biopsy to RULE OUT Bartholian gland carcinoma
Q679. Tx of a Bartholian Abscess; what is Tx for recurrent Bartholian Abscesses?
A679. Tx: I&D with placement of Word catheter; Recurrent: Marsupialization
Q680. Definition:; Cervical dilated retention cysts
A680. Nabothian cysts
Q681. Definition:; Cervical cysts that lie deep in the stroma and are from remnants of Wolffian ducts
A681. Mesonephric cysts
Q682. even though cervical polyps are not premalignant, why are they removed?
A682. to avoid masking bleeding from other sources and to avoid misidentification for an endometrial polyp
Q683. MC Uterine formation anomaly; cause?
A683. Septate uterus; cause: Problems with fusion of Paramesonepheric ducts
Q684. what are anomalies of the uterus assoc with (non-gyn medical)?; (2)
A684. Urinary tract anomalies; Inguinal hernias
Q685. Dx:; amenorrhea or dysmenorrhea, dyspareunia, cyclic pelvic pain, infertility or recurrent pregnancy loss or premature labor
A685. Uterine anatomic anomalies; (Septate uterus)
Q686. Dx:; small uterine cavity, second-trimester pregnancy loss, malpresentation and possible premature labor
A686. Bicornuate uterus
Q687. Tx of Septate and Bicornuate uteri
A687. Surgical removal of septum
Q688. Definition:; Benign, estrogen-sensitive smooth muscle tumors of the uterus; found in what percentage of reproductive-age women?
A688. Fibroids (Uterine Leiomyomas); in 20 - 30% of reproductive-age women
Q689. Incidence of Fibroids in Black women; (3) causes to increase risk of developing fibroids
A689. 3 - 9 x higher in Black Risks:; Non-smoking,; Obese,; PeriMenopausal
Q690. what distinguishes a Fibroid from adenomyosis?
A690. Fibroid has a Pseudocapsule
Q691. Top (2) MC Sx in patient with Fibroids
A691. Asymptomatic (50 - 65%) (MC otherwise is Prolonged bleeding)
Q692. Drug Tx for Fibroids; (3); MOA of these drugs collectively
A692. Provera,; Danzol,; GnRH agonists (Lupron) MOA - shrink fibroids by reducing circulating Estrogen
Q693. If drugs dont work, what is the name of the surgical Tx for Fibroids?; Only Difinitive Tx?
A693. Myomectomy (removal of one or more Fibroid surgically); Only Difinitive Tx: Hysterectomy
Q694. what causes Endometrial Hyperplasia?
A694. continuous endogenous or exogenous Estrogen in absence of Progesterone
Q695. In endometrial hyperplasia, what proliferates in endometrium?; (2)
A695. Glandular and Stromal elements of endometrium
Q696. Risk factors for getting Endometrial Hyperplasia; (9)
A696. CLONED PHD:; Chronic Anovulation,; Late Menopause (> age 55),; Obesity,; Nulliparity,; Estrogen-producing tumors (granulosa-theca cell tumor),; Diabetes,; PCOS,; Hypertension,; Drugs - Tamoxifen
Q697. Dx:; long periods of Oligomenorrhea or amenorrhea followed by irregular or excessive uterine bleeding
A697. Endometrial Hyperplasia
Q698. main Dx evaluation used to Dx Endometrial Hyperplasia; what is second choice?
A698. Endometrial biopsy (or D&C...second choice)
Q699. Risk of malignant transformation from Endometrial Hyperplasia in:; 1. Simple Hyperplasia; 2. Complex Hyperplasia; 3. Atypical Simple Hyperplasia; 4. Atypical Complex Hyperplasia
A699. Simple = 1%; Complex = 3%; Atypical Simple = 8%; Atypical Complex = 29%
Q700. what is the initial Tx for all types of endometrial hyperplasia in child-bearing patient?; Non-child bearing patient?
A700. Child bearing:; Progestin therapy for 3 months; (followed by resampling of Endometrium); Non-child bearing:; Hysterectomy
Q701. MC functional Ovarian cyst; usu unilateral; what can they lead to?; Tx?
A701. Follicular cyst; leads to: Ovarian torsion; Tx: resolve spontaneously
Q702. MCC of infertility in USA
A702. PID
Q703. Dx:; patient with abdominal pain, adnexal tenderness and cervical motion tenderness, possible ESR, Inc WBC, fever, or purulent cervical discharge
A703. PID
Q704. how is the tuboovarian abscess rupture treated in PID?
A704. Removal of infected tube
Q705. Antibiotic Tx for outpatient versus inpatient with PID
A705. Outpatient: Ceftriaxone + Doxycycline; Inpatient: Clindamycin + Gentamycin
Q706. Bug that causes PID in pt with intrauterine device
A706. Actinomyces Israelii
Q707. Dx:; nodularities on Broad ligament and a retroverted uterus with abdominal pain; Tx?
A707. Endometriosis; Tx: birth control pills
Q708. MCC of infertility in menstruating woman over age of 30 without PID?
A708. Endometriosis
Q709. How is chlamydia Tx in pregnant patient?
A709. Erythromycin
Q710. Dx:; ovarian cyst that can cause a missed period or dull lower; Quadrant pain; can rupture to cause acute abdominal pain and intraabdominal hemorrhage; Tx?
A710. Corpus Luteum cyst; Tx: resolve spontaneously (or oral contraceptives if recurrent)
Q711. Dx:; large, bilateral ovarian cysts filled with clear, straw-colored fluid;; high b-hCG
A711. Theca-Lutein cyst
Q712. First step in management for a cystic adnexal mass in premenarchal and postmenopausal patients
A712. Exploratory Lap (due to high risk on cancer in those age groups)
Q713. what percent of ovarian masses in women of reproductive age are functional cysts?; non-functional neoplasms?
A713. functional cysts = 75%; non-functional neoplasms = 25%
Q714. First Dx evaluation for Ovarian cysts
A714. Pelvic Ultrasound...wait 6 - 8 weeks then repeat
Q715. in reproductive-aged woman who has an ovarian cyst seen on ultrasound, what management steps are taken if the cyst size is:; 1. < 6 cm; 2. 6 - 8 cm; 3. > 8 cm
A715. 1. observe for 6 - 8 weeks -> start on oral contraceptives -> repeat US; 2. if Unilocular = repeat steps above; if multilocular or solid on US = Exploratory Laparoscopy; 3. Exploratory Laparoscopy for cystectomy
Q716. if ovarian cysts do not resolve with oral contraceptives in 60; 90 days, what is next step?
A716. Cystectomy via Laparoscopy
Q717. Definition:; Endometriosis in the ovary
A717. Endometrioma
Q718. Risk factors for endometriosis; (2)
A718. First-degree relatives (mothers AND Sisters); autoimmune disorders
Q719. how is endometriosis detected on rectovaginal exam?
A719. Uterosacral nodularity
Q720. Instead of using oral contraceptives for endometriosis, what else can be used?; (2); what do they do?
A720. GnRH agonists in steady state (Leuprolide); or Danazol (inhibits gonadal steroid synthesis); they supress FSH and LH
Q721. what are the drawbacks to Danazol therapy for Endometriosis?
A721. Androgen-related anabolic side effects:; Acne, Oily skin, weight gain, deep voice, Hirsutism
Q722. AE of GnRH agonists
A722. Estrogen deficiency; Menopausal symptoms: hot flashes, loss of bone density, HA, vaginal atrophy and dryness
Q723. what intraabdominal problem can endometriosis lead to?
A723. Adhesion formation -> bowel obstructions
Q724. what is the drug management of Endometriosis in the woman wanting to conceive?
A724. None; Only Tx in these patients is Conservative surgical therapy by removal of lesions laparoscopically
Q725. what percent of women with Adenomyosis also have Endometriosis?; Fibroids?
A725. Endometriosis - 15%; Fibroids - 50%
Q726. Incidence of Adenomyosis?
A726. 15% of women in late 30s - early 40s
Q727. Dx:; pelvic exam reveals a diffusely enlarged globular uterus and secondary dysmenorrhea
A727. Adenomyosis
Q728. What is the first Dx test for Adenomyosis?; What is the only definitive Dx test?; What is the Tx?
A728. Ultrasound (if suggestive, then MRI to distingiush b/t it and Fibroids); Definitive means of Dx and Tx: Hysterectomy
Q729. Tx for Adenomyosis; (3 meds or one procedure)
A729. NSAIDs and analgesics,; Oral Contraceptives,; Progestins; Definitive Tx: Hysterectomy
Q730. Dx:; fever, rash and desquamataion of palms and soles of feet, hypotension
A730. Toxic Shock Syndrome (s.aureus)
Q731. how is HIV screened and confirmed?
A731. screened with ELISA; confirmed with Western blot
Q732. Dx:; Cottage cheese-like discharge, pruritis, burning, dysuria, vulvar edema; what is Dx test and result?; Tx?
A732. Candida Albicans; Test: branching hyphae and spores on KOH prep; Tx: Topical OTC Azole cream
Q733. Dx:; diffuse, malodorous, gray-green, frothy discharge from vagina; what is Dx test and result?; Tx?
A733. Trichomonas Vaginalis; Test: Bugs swimming under microscope; Wet prep; Tx: Metronidazole (Flagyl) 2g orally in single dose
Q734. Dx:; vaginal discharge that is thin, yellow and has a "fishy" amine odor; what is Dx test and results?; Tx?
A734. Bacterial Vaginosis (Gardnerella); Test: Clue cells on Wet prep, Whiff test exaggerates the odor with KOH; Tx: Metronidazole (Flagl) 500mg orally BID for 7 days
Q735. Dx:; Painless cancre; what is the Hystological Dx test and results?; Tx?
A735. Syphilis (stage 1); Test: Spirochetes on Dark-field Microscopy; Tx: Penicillin
Q736. Dx:; maculopapular rash extending to the palms and soles and/or moist papules on the skin or mucous membranes
A736. Syphilis (stage 2)
Q737. Dx test for HSV; Tx?
A737. Tzanck smear; Tx: Acyclovir
Q738. Dx:; painful, demarcated, non-indurated ulcer located anywhere in the anogenital region; painful inguinal lymphadenopathy
A738. Chancroid (Haemophilus Ducreyi)
Q739. Dx:; STD that causes LGV; (2) possible Tx?
A739. Chlamydia (MC STD); Tx: Doxycycline 100mg orally BID for 7 days, 1-time dose of Azithromycin
Q740. Dx:; mucopurulent cervicitis; gram-negative bug; Tx?
A740. N. Gonorrhea; Tx: Ceftriaxone 250mg IM
Q741. Dx:; small, 1 - 5mm domed papule with umbilicated center, can occur all over body; what is Dx test and results?; Tx?
A741. Molluscum contaginosum; Tests: waxy material and intracytoplasmic inclusions on Wright stain or Giemsa stain; Tx: Cryotherapy
Q742. Dx:; Pruritis, iritated skin, vesicles and burrows confined to pubic area; Tx?
A742. P. Pubis (Pediculosis) ["Crabs"]; Tx: Lindane (Kwell) shampoo to pubic hair
Q743. what is the protrusion of the vaginal vault secondary to the loss of support structures post hysterectomy?
A743. Vaginal Vault Prolapse
Q744. Initial Tx for pelvic relaxation or Stress Incontinence?; If that doesn't work, what is the Tx?
A744. Kegel exercises; if not: Vaginal Pessaries (and/or Estrogen replacement)
Q745. Dx:; Urine loss with exertion or straining (coughing, exercise, etc); cause?
A745. Stress incontinence; cause: Pelvic relaxation and displacement of the Urethrovesical junction
Q746. Dx:; urine leakage due to involuntary and uninhibited bladder contractions; cause?
A746. Urge Incontinence; cause: Detrusor instability
Q747. Dx:; continuous urine leakage; cause?
A747. Total Incontinence; cause: Urinary fistulas from birth trauma or pelvic surgery / radiation
Q748. Dx:; incomplete voiding, urinary retention and overdistention of the bladder; cause?
A748. Overflow Incontinence; cause: poor or absent Bladder Contractions due to meds or neurological dysfunction
Q749. what are (2) easy office Dx evaluations for incontinence?
A749. Standing stress test; Cotton swab test
Q750. what class of meds are used to help Tx Stress Incontinence?
A750. Alpha Adrenergic agents
Q751. what class of meds are used to Tx Urge Incontinence?
A751. Anticholinergics (help with detrusor stability)
Q752. how is Total Incontinence treated?
A752. Surgical repair of the fistula
Q753. what drug class increases bladder contractility?
A753. cholinergics
Q754. what drug class lowers urethral resistance?
A754. alpha-adrenergic agents
Q755. what is the Tx for Overflow Incontinence?; (1 procedure or 2 possible meds)
A755. Self catheterization; or Meds: Cholinergics, Alpha-adrenergic agents
Q756. what is the order of the (5) stages of Puberty in females?
A756. All Girls Think Puberty's Messy:; Adrenarche (Androgen production),; Gonadarche (GnRH production),; Thelarche (Breast production),; Pubarche (pubic hair),; Menarche
Q757. what is stage 4 of Thelarche?
A757. Areolar mound (in stage 5, mound disappears again)
Q758. what is the first phenotypic sign of puberty?
A758. Thelarche (breast production)
Q759. when does menarche occur in relation to thelarche?
A759. about 2.5 years after the development of breast buds
Q760. what (2) phases of the menstrual cycle describe the ovary?; the endometrium?
A760. Ovary: Follicular phase, Luteal phase; Endometrium: Proliferative phase, Secretory phase
Q761. when does the placenta begin to develop its own estrogen and progesterone?
A761. at 8 - 10 weeks gestation
Q762. Definition:; the termination of the reproductive phase in a woman's life
A762. Climacteric (menopause, the final menstruation, marks the cornerstone event of the climacteric)
Q763. what during menopause leads to the hot flashes, mood changes, insomnia and depression?
A763. fall in Estrogen production
Q764. what is the average age of menopause?
A764. 48 - 52
Q765. what occurs with respect to the CV system during menopause?
A765. Affects lipid profiles, leading to atherosclerosis and increased risk of CAD
Q766. Dx:; severe pain with menses that cannot be attributed to an organic cause, is usually dx before 20 yo
A766. Primary Dysmenorrhea
Q767. what is believed to be the reason of Primary Dysmenorrhea?; Tx? (3)
A767. Increased levels of Prostaglandins Tx:; NSAIDs,; OCPs,; and/or TENS (Transcutaneous Electrical Nerve Stimulation)
Q768. Dx:; HA, weight gain, bloating, breast tenderness, mood fluctuation, anxiety, irritability in the second half of the menstrual cycle
A768. Premenstrual Syndrome (PMS)
Q769. what is the Dx criteria for PMS?; (2)
A769. symptoms of PMS in the second half of the menstrual cycle with at least 7-day symptom-free interval during the first half;; symptoms must occur in two consecutive cycles
Q770. Dx:; regularly timed menses, but an unusually heavy or prolonged flow
A770. Menorrhagia
Q771. How many days is the flow suppose to last in the normal menstrual cycle?; how much blood loss?
A771. days: 3 - 5; blood loss: 30 - 50mL
Q772. Definition:; idiopathic heavy and/or irregular bleeding that cannot be attributed to another cause
A772. Dysfunctional Uterine Bleeding (DUB)
Q773. Dx:; regularly timed menses but unusually light amount of flow
A773. Hypomenorrhea
Q774. Dx:; bleeding that occurs b/t regular menstrual periods
A774. Metrorrhagia
Q775. Dx:; excessive (greater then 80mL) or prolonged bleeding at irregular intervals
A775. Menometrorrhagia
Q776. Dx:; irregular periods greater then 35 days
A776. Oligomenorrhea
Q777. Dx:; frequent periods that occur less then 21 days apart
A777. Polymenorrhea
Q778. (3) of the MCC of Oligomenorrhea
A778. PCOS,; Chronic Anovulation,; Pregnancy
Q779. when is DUB most common?; (in General and list 4 times)
A779. when she is "Anovulatory":; Adolescence,; Perimenopause,; Lactation,; Pregnancy
Q780. When does pathologic Anovulation related to hormones occur?; (3)
A780. Hypothyroidism,; Hyperprolactinemia,; Hyperandrogenism
Q781. if a woman > 35 yo has abnormal uterine bleeding, what is the next step?
A781. Endometrial biopsy to rule out cancer
Q782. Drug Tx for DUB (Anovulatory vs. Ovulatory)?; Tx for Acute Hemorrhage / Heavy bleed from uterus?
A782. Anovulatory DUB: Progestins to stimulate withdrawal bleeding; Ovulatory DUB: NSAIDs; Acute hemorrhage/heavy bleed: IV Estrogens to stop bleeding
Q783. what is the metabolic goal of pregnancy?
A783. Increase availability of Glucose for the fetus, while mother utilizes lipids
Q784. MCC of postmenopausal bleeding
A784. Endometrial and/or Vaginal Atrophy
Q785. what is responsible for the conversion of vellus hair to terminal hair at puberty?
A785. Androgens (DHT)
Q786. what converts testosterone to DHT?
A786. 5-alpha-reductase
Q787. what precursor to cancer does a woman with PCOS have an increased risk for?
A787. Endometrial Hyperplasia (moreso then ovarian cancar)
Q788. what are the (2) most common adrenal androgens?; what is the immediate precursor to them?
A788. DHEA and DHEAS; precursor: 17-alpha-hydroxypregnenolone
Q789. what stimulates the Theca cells?; what is produced?; (2)
A789. LH; makes: Androstenedione, Testosterone
Q790. what stimulates the Granulosa cells?; what is produced?; (2)
A790. FSH; makes: Estrone (from Androsterone), Estradiol (from Testosterone)
Q791. what lab elevation is the marker for adrenal androgen excess production?
A791. Increased DHEAS
Q792. Dx:; Inc cortisol, androgens, hirsutism, acne, menstrual irregularities
A792. Cushing's syndrome
Q793. how can you tell if Cushing's syndrome is from an adrenal tumor?
A793. ACTH is low; if from Pituitary or paraneoplastic, ACTH would be high
Q794. what is the diagnostic test for Cushing's syndrome?
A794. Dexametasone suppression test
Q795. MC Congenital Adrenal Hyperplasia disorder; what is in excess?
A795. 21-alpha-hydroxylase deficiency; in excess: 7-alpha-hydroxyprogesterone
Q796. Dx:; mild virilization, menstrual irregularities, low cortisol and salt wasting
A796. Congenital Adrenal Hyperplasia
Q797. what is the first step in Dx Congenital Adrenal Hyperplasia?; how do you confirm this?
A797. see if 17-OHP is > 200ng/dL; confirm: ACTH stimulation test
Q798. Dx:; enlarged ovaries, hirsutism and possible virilization; how is Dx made?
A798. Theca Lutein cysts; Dx by Ovarian biopsy
Q799. what drug inhibits 5-alpha-reductase?
A799. Finesteride
Q800. what can occur if a contraception diaphragm is left in for too long?
A800. Toxic Shock Syndrome (s.aureus)
Q801. what (2) things must be done if a woman wants to use the cervical cap contraception device?
A801. 1. Must be fitted by a doctor; 2. Must be used with spermicidal jelly
Q802. what are the (2) most widely used spermicides?
A802. Nonoxynol-9; Octoxynol-9
Q803. what is the efficacy rate of condoms, diaphragms and cervical caps?
A803. 75 - 85%
Q804. what is the efficacy rate of spermicides alone?
A804. 70 - 80%
Q805. what is the most widely used method of reversible contraception in the world?
A805. IUDs
Q806. how do IUDs work?
A806. elicit a sterile inflammatory response -> sperm destruction
Q807. what is the advantage to the Mirena (levonorgestrel) IUD?; (3)
A807. Progesterone addition acts to:; thicken the cervical mucous,; atrophy the endometrium (dec bleeding),; decreases dysmenorrhea
Q808. (4) serious side-effects of IUDs
A808. Insertion-related salpingitis,; Spontaneous abortion,; Uterine perforation,; Ectopic pregnancies
Q809. what is the single most important characteristic of the baseline FHR?
A809. Beat-to-beat variability
Q810. what are the (2) main IUDs and the amount of years each is good for?
A810. Copper (ParaGard) = 10 years; Mirena (with Progesterone) = 5 years
Q811. how do OCPs work?; (specifically)
A811. place body in "pseudo-pregnancy" state by supressing hormones at Anterior Pituitary (supressing ovulation); Estrogen supresses FSH - no follicles made; Progesterone supresses LH surge
Q812. (5) CV and (2) non-CV complications assoc with OCPs
A812. CV: DVT, PE, CVA, MI, HTN; other: cholelithiasis, cholecystitis
Q813. Benefits from combined OCPs:; what (2) cancers does it protect women from?; what can it help reduce the incidence of?; (3)
A813. protection from: Ovarian CA, Endometrial CA,; reduction in: Osteoporosis, Ectopic pregnancies, PID
Q814. (3) MOA of Progesterone-only contraception
A814. Supress ovulation,; thicken cervical mucous,; make endometrium unsuitable for implantation
Q815. (3) AE of Depo-provera
A815. Irregular bleeding,; Bone demineralization,; Long time to return to fertile after discontinuation
Q816. how does Emergency contraception work?; what is the only stipulation?
A816. Inhibits ovulation, fertilization or implantation; Must take w/i 72 hours of intercourse
Q817. what are (2) common misconceptions of Emergency contraception?
A817. They Do NOT: cause Abortions,; Protect against STDs
Q818. what is the hysteroscopic transcervical approach to tubal ligations called?; How is it confirmed?; what is patient required to do post-operation?
A818. "Essure"; Confirmed: Hysterosalpingogram; patient must: Use backup contraception for 3 months
Q819. what type of anesthesia is used in a D&C?
A819. Paracervical block
Q820. when is the most effective time to have a D&C in the first trimester?
A820. 6 - 12 weeks
Q821. what abortifacient blocks progesterone stimulation causing detatchment of the embryo?; when can it be used?
A821. Mifepristone; can be used: up to 7 weeks from the LMP
Q822. what is the test performed 2 weeks after medical abortion to confirm?; (2)
A822. Ultrasound; and serum b-hCG level
Q823. what abortifacient interrupts placental villi proliferation?
A823. Methotrexate
Q824. what can both Methotrexate and Mifepristone be used with to increase efficacy rates of medical abortion?
A824. Misoprostol; (prostaglandin analogue)
Q825. what is the primary reason for second trimester abortions?
A825. congenital abnormalities
Q826. how is induction of labor for second-trimester pregnancy termination accomplished?; (3 steps)
A826. Cervical ripening agents,; Amniotomy,; high-dose IV Oxytocin
Q827. Definition:; likelihood of achieving pregnancy in a given month; what is the percentage?
A827. Fecundity; 20 - 25%
Q828. what is tested in a male sperm count?; (6); [give norms]
A828. Volume (> 2 mL),; Sperm count (> 20k),; Motility (> 50%),; Morphology (> 30% nml),; pH,; WBC count
Q829. what is the first way to help patients increase the probability of conception?; (3 ways to Improve coital practices)
A829. 1. Timing: Intercourse every other day near ovulation; 2. Position: Woman on Bottom; 3. Post-coital: woman lies on back with knees to chest for 15 min
Q830. how is low semen volume most commonly treated?
A830. Wash sperm for Intrauterine insemination
Q831. what is the option for infertility if male problem is low sperm density or impaired motility?
A831. Intracytoplasmic Sperm Injection (ICSI)
Q832. (2) main causes of peritoneal/tubal factors of female infertility
A832. Endometriosis,; Pelvic adhesions
Q833. what is the drug treatment for infertility caused my endometriosis?; surgical?
A833. Drug: No Tx increased fertility rates; Surgical: laparoscopic excision or vaporization of implants
Q834. (2) risk factors for intrauterine adhesions
A834. multiple D&Cs,; PID
Q835. how can uterine synechiae and septae be treated for infertility?
A835. Ligation via Hysteroscopy
Q836. what is the MCC of ovulatory-related infertility?
A836. PCOS
Q837. what is the next step if a pruritic area of the vulva does not respond to antifungals?
A837. Vulvar biopsy
Q838. Dx:; velvety red lesions on the vulva that become eczematous and scar as white plaques, pruritis, patient is > 60yo, possible coexistent adenocarcinoma
A838. Padget's Disease of the Vulva
Q839. (2) possible Tx for Vulvar intraepithelial neoplasia?
A839. Wide Local Excision; or Laser vaporization (if not extensive and no tissue sample needed)
Q840. what is the follow-up for a VIN patient?
A840. colposcopies every 3 months until Disease-free for 2 years, then every 6 months
Q841. Dx:; vulvar pruritis, pain and bleeding
A841. Vulvar cancer
Q842. what in surgery must also be done when Dx a vulvar SCC?
A842. Inguinal LN dissection (for staging)
Q843. what is the Tx for stages I - IV in Vulvar SCC?
A843. I: Wide local excision (< 1cm) and LN removal; II: Radical Vulvectomy and LN removal; III and IV: Radical Vulvectomy, removal of affected organs and Radiation
Q844. what is the most important prognostic factor of vulvar SCC?; what is the 5-year survival rate?
A844. the number of positive inguinal LN; 5-year Survival rates; 1 positive LN: 90 - 95%; 2 positive LN: 50 - 80%; 3 or more: 15%
Q845. what vulvar cancer has a 100% mortality rate if it metastasizes?
A845. Melanoma
Q846. Dx:; asymptomatic, multifocal lesions in the vaginal apex, History of HPV
A846. Vaginal Intraepithelial Neoplasia (VAIN)
Q847. what is seen in 50% of patients with VAIN?
A847. coexistant Neoplasia (usu of lower genital tract)
Q848. Dx:; patient has regular abnormal pap smears but no cervical neoplasia on cervical biopsy
A848. Vaginal Intraepithelial Neoplasia (VAIN)
Q849. (3) possible Tx for Vaginal Intraepithelial Neoplasia; (VAIN); (2 possible procedures and 1 drug)
A849. Surgical excision; or Laser vaporization, topical 5-FU
Q850. MC cancer of the vagina
A850. SCC: 85% (Clear cell is with DES exposure: 5%)
Q851. How is Vaginal SCC Tx with each stage (I-IV)?
A851. Stage I and II: Surgical excision; Stage III and IV: Radiation therapy
Q852. where does CIN usually begin and where is it most likely to be growing?
A852. starts: Transformation zone of cervix; MC place: Anterior lip of cervix
Q853. what are the (4) HPV types that are high-risk types for CIN and CA?
A853. 16, 18, 31, 45
Q854. at what age is CIN most commonly Dx?; by what percent can Pap smears reduce the incidence?
A854. women in their 20's; Paps reduce incidence by 90%
Q855. if woman has a hysterectomy for a benign condition like fibroids, how often should they have a pap smear?
A855. they do not need to continue regular paps; (they do if their cervix is intact)
Q856. current recommendations of time to begin Pap smears
A856. within 3 years of becoming sexually active or by age 21
Q857. what percent of women have Atypical Squamous Cell Pap smears that harbor severe dysplasia histology?
A857. 10 - 15%
Q858. what is the next step in Tx for pap smears that come back as:; ASC-US (unknown significance); ASC-H (cannot rule-out High grade)
A858. ASC-US: HPV testing (HPV negative: regular Paps) (HPV positive: Colposcopy with biopsy); ASC-H: Colposcopy with biopsy
Q859. what is the management of Tx if patient has ASC-US, High risk HPV negative?
A859. repeat Pap smear and HPV testing in one year
Q860. what is the management of Tx if patient has CIN-I versus CIN-II and CIN-III?
A860. CIN-I: repeat Pap every 6 mo for 1 year; if still has CIN-I, do LEEP; CIN-II and CIN-III: LEEP
Q861. Complications of LEEP; (4)
A861. Cervical Stenosis,; Cervical Incompetence,; Infection,; Bleeding
Q862. what is management if patient has CIN that is a large lesion, in a teenage patient or involves the vagina?
A862. Laser Ablation
Q863. what is the Tx for Preinvasive (stage 0) or microinvasive; (stage Ia-1) cervical cancer?; (2 possible)
A863. Cone biopsy,; Simple Hysterectomy
Q864. what is the Tx for Stage IIb - IV cervical CA?; (2)
A864. Chemotherapy (Cisplatin); and Radiation (ONLY)
Q865. what is the Tx for Stage Ia-2 to IIa cervical CA?; (2 possibilities)
A865. Radical Hysterectomy; or External Radiation
Q866. what is the difference b/t the presentation of:; Mastitis,; Blocked duct,; Mammary Ectasia,; Engorgement
A866. Mastitis: Unilateral and fever; Blocked duct: Unilateral, no fever; Mammary Ectasia: Bilateral, green discharge; Engorgement: Bilateral during preg
Q867. what is the 5-year survival rate for cervical CA stage I?; stage IV?
A867. Stage I: 85 - 90%; Stage IV: 15 - 20%
Q868. MC GYN cancer in USA
A868. Endometrial CA
Q869. MC type of endometrial CA; what is the average age to Dx endometrial CA?
A869. Endometrioid AdenoCA; Ave age: 61
Q870. what is the Tx for endometrial CA for stages:; 1. I and II; 2. III and IV
A870. I and II: TAHBSO, then radiation; III and IV: TAHBSO and Para-aortic LN removal, then radiation
Q871. what is the Tx for recurrent endometrial CA?; when does recurrence usually occur?
A871. High-dose Progestins; recurrence: 85% occur w/i 3 years
Q872. how common is Ovarian CA compared to all GYN cancers?; what percent of deaths from cancer of the female gential tract?
A872. 25% of all GYN cancers; responsible for 50% of GYN deaths; (b/c of lack of screening tools)
Q873. MC place on ovary where cancers form
A873. Epithelium on ovary capsule; (Coelomic epithelium)
Q874. what is a common familial cancer syndrome that also is seen to include ovarian cancer?
A874. Lynch II syndrome; (Hereditary nonpolyposis Colorectal CA)
Q875. what is the chance a woman will get ovarian cancer?
A875. 1 in 60
Q876. Dx:; ovarian cancer that mets to umbilicus
A876. Sister Mary Joseph nodule
Q877. what is the tumor marker in 80% of epithelial ovarian tumors?; at what stage are most diagnosed?
A877. CA-125; most Dx at Stage III
Q878. Ovarian tumor type:; asymptomatic, with possible low abdominal discomfort and early satiety
A878. Ovarian Epithelial tumor
Q879. what is the 5-year survival rate for Epithelial Ovarian CA?
A879. 0.2
Q880. Tx for Epithelial Ovarian CA; (procedure and 2 drugs)
A880. TAHBSO,; followed by: Taxol and Carboplatin chemo
Q881. (2) of the MC types of Germ cell tumors
A881. Dysgerminomas; Immature Teratomas
Q882. Dx:; ovarian tumor with cancer markers of CA-125 and LDH
A882. Dysgerminoma
Q883. what is the only thyroid or parathyroid hormone that crosses the placenta?
A883. TSH
Q884. germ cell ovarian tumors are most commonly seen in what population?
A884. women < 20 yo
Q885. Tx for Germ cell tumors; (procedure and 3 drugs)
A885. Unilateral Saplingo-oophorectomy; drugs (BEP): Bleomycin, Etoposide, CisPlatin [med for GERM: BE Penicillin]
Q886. MC age for all Sex-cord tumors except Sertoli-Leygig. what is age for Sertoli-Leydig?
A886. 40 - 70 yo; S-L: < 40 yo
Q887. MC type of Sex-cord tumor
A887. Granulosa cell tumor (70%)
Q888. Dx:; ovarian tumor that secretes Inhibin and Estrogen; (causing feminization)
A888. Granulosa-Theca cell tumor
Q889. Dx:; ovarian tumor that secretes Androgens (causing virilization)
A889. Sertoli-Leydig cell tumors
Q890. what causes the nonfunctioning tumor: Ovarian Fibroma?
A890. mature fibroblasts
Q891. Dx:; Ovarian tumor, ascites, right hydrothorax
A891. Meig's syndrome
Q892. what sex cord-stromal ovarian tumor can recur 15 to 20 years later?
A892. Granulosa cell tumors
Q893. Tx for sex cord-stromal tumors in young patients?; old patients?
A893. young: Unilateral Salpingo-Oophorectomy; older: TAHBSO; (never chemo or radiation)
Q894. MC type of fallopian tube cancers
A894. Adenocarcinoma (from mucosa)
Q895. Dx:; abdominal pain, profuse watery discharge from vagina, pelvic mass
A895. Fallopian tube CA
Q896. Tx for fallopian tube CA; (procedure and 2 drugs)
A896. TAHBSO,; drugs: Taxol, Carboplatin
Q897. Definition:; intermittent hydrosalpinx; what is it seen in?
A897. Hydrops tubae profluens; (seen in fallopian tube CA)
Q898. Definition:; fertilization of an egg without a nucleus by one sperm
A898. Complete Mole
Q899. who do the chromosomes come from in a Complete mole?; what is most common karyotype?
A899. Paternal; 46,XX
Q900. Dx:; irregular or heavy bleeding during early pregnancy, hyperemesis gravidarum, preeclampsia, hyperthyroidism, large uterine size, b-hCG > 50,000
A900. Complete mole
Q901. what is the lab sign of a Complete mole?; Dx test sign on US?
A901. b-hCG > 50,000; US: "snowstorm" pattern
Q902. Tx for Complete and Incomplete moles; (2 steps)
A902. 1. Immediate D&E; 2. IV Pitocin (post D&E)
Q903. what is the average time to normalize the hCG levels for molar pregnancies?; what percent results in malignancy?
A903. 8 - 14 weeks; to CA: 15 - 25%
Q904. Definition:; pregnancy caused by simultaneous fertilization of a normal ovum by two sperm; Karyotype?
A904. Incomplete mole; (69,XXY)
Q905. GYN bug:; Giant multinucleated cells with intracellular inclusions on Wright stain
A905. HSV
Q906. GYN bug:; Granular-appearing epithelial cells that are coated with coccobacillary organisms on saline
A906. Baterial Vaginosis; (Gardinella)
Q907. GYN bug:; Motile, flagellated organisms on saline
A907. Trichomonas
Q908. GYN bug:; Squamous cells with perinuclear halos on Pap
A908. HPV
Q909. (3) types of Malignant Gestational Trophoblastic Disease
A909. Persistant/Invasive moles; Choriocarcinoma,; Placental Site trophoblastic Tumors
Q910. Tx for all types of Malignant Gestational Trophoblastic Disease if it is confined to the uterus; (2 possible)
A910. Single-agent therapy: Methotrexate or Actinomycin-D
Q911. Tx for the (3) types of Malignant Gestational Trophoblastic Disease if it has mets to outside the uterus; (5)
A911. Multi-agent therapy: [EMA/CO]; Etoposide,; Methotrexate,; Actinomycin-D,; Cytoxan,; Oncovin (Vincristine)
Q912. Dx:; plateauing or rising b-hCG after molar evacuation; Chemotherapy Tx?; (inside vs outside)
A912. Persistent/Invasive moles; Tx: Inside uterus only: M or A, Outside: EMA/CO
Q913. Definition:; malignant necrotizing tumor that can arise from trophoblastic tissue weeks to years after any type of gestation; (molar, live birth, etc)
A913. Choriocarcinoma
Q914. Histology:; sheets of anaplastic cytotrophoblasts and synctiotrophoblasts in the absence of chorionic villi
A914. Choriocarcinoma
Q915. Histology:; tumors with absence of villi and proliferation of intermediate cytotrophoblasts
A915. Placental Site Trophoblastic Tumors
Q916. what is the only Gestational Trophoblastic Disease that presents with low b-hCG?
A916. Placental Site Trophoblastic Tumors
Q917. what is the only Gestational Trophoblastic Disease that does not respond to chemotherapy?; what is the Tx of choice?
A917. Placental Site Trophoblastic Tumors; Tx: Hysterectomy (with multi-agent chemo [EMA/CO] one week after surgery to prevent recurrence)
Q918. chance of a woman having breast cancer in her lifetime?
A918. 1 in 8
Q919. what is the major blood supply to the breasts?; (2)
A919. Internal Mammary; and Lateral thoracic artery
Q920. what does estrogen do for breast development?; (2)
A920. Ductal development,; Fat deposition
Q921. what does Progesterone do for breast development?
A921. Lobular-alveolar development (makes lactation possible)
Q922. what is responsible for milk letdown?
A922. Oxytocin
Q923. when should self breast exams be performed?
A923. monthy about 5 days after menses
Q924. what are the mammography screening guidelines?
A924. start every other year at 40yo then every year at age 50yo;; women with history of breast CA in family should start 5 years before youngest Dx of breast CA
Q925. what percent of breast cancers are not detected by mammography?
A925. up to 20%
Q926. why is US useful in breast masses?
A926. detects if cystic or solid
Q927. what is the first step in Dx a breast mass?; what if this doesn't work?
A927. Needle aspiration (if not working -> excisional biopsy)
Q928. Dx Nipple discharge:; Bloody; (2)
A928. Invasive Papillary CA,; Intraductal CA
Q929. Dx Nipple discharge:; Serous; (4)
A929. normal Menses,; OCPs,; Fibrocystic Disease,; early pregnancy
Q930. Dx Nipple discharge:; Yellow-tinged; (2)
A930. Fibrocystic Disease,; Galactocele
Q931. Dx Nipple discharge:; Green, sticky
A931. Mammary Duct Ectasia
Q932. Dx Nipple discharge:; Purulent
A932. Breast abscess
Q933. Dx:; cyclic breast pain with multiple, bilateral masses
A933. Fibrocystic Disease
Q934. reducing what should help with ameliorating fibrocystic disease?
A934. Caffeine (coffee, tea, chocolate)
Q935. what drugs are used to help Sx of Fibrocystic Disease?; (4)*
A935. TPD Bro:; Tamoxifen,; Progestins,; Danazol,; BROmocriptine
Q936. Dx:; rubbery, non-tender breast mass in patient younger then 25yo
A936. Fibroadenoma
Q937. Dx:; large, bulky mobile breast mass with overlying skin being warm, erythematous, shiny and engorged; Tx?
A937. Cystosarcoma Phyllodes; Tx: wide local excision (b/c 10% go to CA)
Q938. what (4) breast problems require only "Local excision" as the Tx of choice?
A938. Phyllodes,; Papilloma,; Ectasia,; LCIS
Q939. Dx:; inflammation of the ductal system at or after menopause causing nipple retraction, discharge and pain, usu bilateral; Tx?
A939. Mammary Duct Ectasia (Plasma cell Mastitis); Tx: Local excision of inflammed area
Q940. what are the top three risk factors for Malignant Breast cancer?
A940. 1. First-degree relative with bilateral premenopausal onset; 2. Previous breast cancer; 3. first birth after age 34
Q941. Dx:; bilateral malignant breast cells, non-palpable, not seen on mammography; Tx?
A941. Lobular Carcinoma In Situ (LCIS); Tx: Local excision
Q942. Dx:; malignant epithelial cells in mid-50's woman, microcalcifications on mammography, unilateral; Tx?
A942. Ductal Carcinoma In Situ (DCIS); Tx: Simple Mastectomy (additional Radiation if margins < 10mm)
Q943. what is the most reliable predictor for survival in breast cancer?
A943. the stage of breast cancer at the time of diagnosis
Q944. what is the recommended follow-up for breast cancer patients?
A944. Exam every 3 months for first year,; every 4 months in second year,; every 6 months thereafter (mammogram, LFTs and Alk-phos is done 6 months after Tx)
Q945. what percent of breast cancer is related to genetic predisposition?
A945. 5 - 10%
Q946. what is the criteria in treating a Breast cancer patient if she has negative or positive lymph nodes versus her ER/PR (receptor) status?
A946. Neg LN + ER/PR Neg - Chemo ONLY (Cyclophosphamide, Methotrexate, 5-FU); Neg LN + ER/PR Pos - Tamoxifen or Anastrozole ONLY; Pos LN: Always Chemo (CMF),; Pos LN + ER/PR Pos - Chemo plus Tamoxifen or Anastrozole
Q947. "Double-bubble" on US indicates what problem?
A947. Down's syndrome
Q948. what should the mother avoid during first trimester b/c it could lead to increased risk of neural tube defects?
A948. Hyperthermia (fevers and hot tubs)
Q949. what are the (2) possible initial tests for syphillis that become negative over time?
A949. RPR,; VDRL
Q950. what are the (2) confirmatory tests for syphillis that are always reactive (positive) if you are exposed?
A950. FTA-ABS,; TP-PA
Q951. what is the next step in management if a FNA is performed on a woman with a breast mass and clear fluid is withdrawn?
A951. repeat the exam in 4 - 6 weeks (clear fluid indicates Fibrocystic Disease)
Q952. what course of action is always contraindicated in placenta previas?; (2)
A952. Vaginal exams; Labor Induction
Q953. if a placenta previa is diagnosed without bleeding, what is the course of management?
A953. deliver by C-section at 36 - 37 weeks
Q954. if placenta previa is diagnosed with bleeding, what is the course of management?
A954. Manage expectantly to increase gestational age, then C- section when necessary
Q955. if baby has decreased fetal movement, what is the first step?
A955. order Non-Stress Test (then BPP)
Q956. what are the (2) reasons for an Amnioinfusion?
A956. Relieve cord compression,; Dilute meconium
Q957. what is next step in management of 26 week gestation PPROM in breech with oligohydramnios?
A957. Admission and expectant management (and test for Chorioamnionitis)
Q958. Define:; Fetal Demise
A958. Intrauterine death > 20 weeks
Q959. what is the blood pressure difference b/t mild preeclampsia and severe preeclampsia?
A959. Mild: > 140/90; Severe: > 160/110
Q960. what do the following Biophysical Profile scores mean:; 1. 8 - 10; 2. 6 - 7; 3. less then 5
A960. 8 - 10: Normal; 6 - 7: Deliver at term; less then 5: Deliver immediately
Q961. what is the name of Postpartum vaginal discharge?; what color is normal at 3 - 4 days PP?; at 10 days PP?; how long can it continue?
A961. Lochia; 3 - 4 days: Red; 10 days: Yellow-white; can last 4 - 8 weeks
Q962. Definition:; infection of placental implant site or hysterectomy scar upward thru venous or lymphatic routes; what is the classic initial sign?
A962. Septic Pelvic Thrombophlebitis; sign:; continued temperature 5 days after Antibiotics given postpartum
Q963. Dx:; patient has delivery and begins to run fever, so antibiotics are given, but the fever does not go down. what is the first step in management?; what is the Tx?
A963. Septic Pelvic Thrombophlebitis; Test: MRI to see thrombosis or vascular edema; Tx: IV Heparin + IV broad Antibiotics
Q964. what level is hCG, AFP and Estriol for:; Trisomy 21
A964. hCG: Increased; AFP: Decreased; Estriol: Decreased
Q965. what level is hCG, AFP and Estriol for:; Trisomy 18
A965. hCG: Decreased; AFP: Decreased; Estriol: Decreased
Q966. maternal infection that causes the following fetal problem:; skin scarring, abnormalities of the lens of the eye, abnormal motor movements and extremitiy hypoplasia
A966. Varicella
Q967. maternal infection that causes the following fetal problem:; deafness, cerebral calcifications, microopthalmia
A967. CMV
Q968. maternal infection that causes the following fetal problem:; pneumonia, meningoencephalopathy, petichae, mental retardation
A968. HSV
Q969. maternal infection that causes the following fetal problem:; cataracts, congenital heart defects, deafness, possible "blueberry muffin" rash
A969. Rubella
Q970. maternal infection that causes the following fetal problem:; IUGR, microencephalopathy, possible fetal hydrops, chorioretinitis
A970. Toxoplasma gondii
Q971. pregnancy risk for mother with DM-1
A971. Preeclampsia
Q972. what is the first line of Tx for DUB and dysmenorrhea?
A972. NSAIDs
Q973. what is the first line of Tx for DUB and menorrhagia?
A973. OCPs
Q974. Dx:; hirsutism, amenorrhea, overweight, infertile
A974. PCOS
Q975. Tx of choice for PCOS?; what if the patient desires to be pregnant?
A975. Tx: OCPs; if desires pregnancy: Clomiphene
Q976. what is the first step in evaluating a couple for infertility?
A976. Semen analysis
Q977. what medications can be used in female for infertility if she does not have adequate estrogen?; (2)
A977. 1. Human Menopausal Gonadotropins (hMG); 2. Clomiphene
Q978. what does Clomiphene citrate need to work?
A978. adequate levels of Estrogen
Q979. (4)* causes of Secondary Amenorrhea
A979. PACE:; PCOS,; Anorexia,; Chemotherapy History,; Endocrine disorders
Q980. a 21 yo girl comes to office for routine check. What test is most important?
A980. Chlamydia culture
Q981. what is the first step in care for a suspicious breast lesion in woman under 35 yo?
A981. FNA or Breast biopsy (mammography is not as efficient in this age group)
Q982. what is the first step of Tx in a woman over 50 yo who has a breast mass?
A982. FNA or Breast biopsy
Q983. Dx:; woman with mulitple deliveries has back pain,a heaviness in the pelvis, with sx that worsen with standing and get better lying down
A983. Pelvic Relaxation (Vaginal Prolapse)
Q984. what is the most non-obstetric cause for hospitalization during pregnancy?
A984. Pyelonephritis
Q985. Definition:; puberty in girls less then 8 yo or boys less then 9 yo; Cause?; Tx? (2)
A985. Precocious Puberty; cause: Idiopathic (but RULE OUT hormone-secreting tumor or CNS disorder); Tx: Underlying cause, GnRH analog to prevent premature closure of epiphyseal plates
Q986. Dx:; prepubescent girl with diabetes has vaginal itching
A986. Candidiasis
Q987. what is the usual cause of vaginal bleeding in neonates?; Tx?
A987. maternal estrogen withdrawl; Tx: resolves on its own
Q988. (4) absolute contraindications to Estrogen therapy
A988. Unexplained vaginal bleeding,; Liver Disease,; History of throbophlebitis or TE,; History of endometrial or breast CA
Q989. why is progesterone given with estrogen replacement therapy?; when dont they need it?
A989. to counteract the unapposed estrogen that can lead to cancer in women with a uterus; women with hysterectomy don't need Progesterone therapy
Q990. MCC of secondary HTN in women
A990. Oral Contraceptive Pills
Q991. why should OCPs be stopped 1 month before a major surgery and then restarted 1 month after?
A991. risk of Thromboembolism
Q992. a woman is on OCP and has amenorrhea. What is the most likely cause?
A992. Pregnancy (no pill is 100% effective)
Q993. (2) main vitamins women should take during pregnancy
A993. Folate; Iron
Q994. when are fetal heart tones heard with doppler and with normal stethoscope?
A994. Doppler: 10 - 12 weeks; Stethoscope: 16 - 20 weeks
Q995. where is the fundus of the uterus at 12 weeks?; 20 weeks?
A995. 12 weeks: Pubic bone; 20 weeks: Umbilicus
Q996. when is US most accurate for fetal age?
A996. 16 - 20 weeks
Q997. when is the only time aspirin should be used during pregnancy?
A997. antiphospholipid syndrome
Q998. what (2) rare disorders are assoc with prolonged gestation?
A998. Anencephaly,; Placental Sulfatase deficiency
Q999. what are the steps if a person has an abnormal AFP?; (2)
A999. 1. Ultrasound; 2. Amniocentesis
Q1000. when is Chorionic Villus Sampling done instead of an Amniocentesis?; when is it done?; risk?
A1000. For women with previously affected offspring or known genetic Disease; Performed: at 9 - 12 weeks to offer the option of abortion in first trimester; Risk: higher risk of miscarriage then amniocentesis
Q1001. what does CVS detect?; what can't it detect?
A1001. Detects: genetic or chromosomal disorders; Not Detect: Neural Tube Defects
Q1002. Teratogen/drug that causes:; spina bifida; hydrospadius
A1002. Valproic Acid
Q1003. Teratogen/drug that causes:; cleft lip/palate, limb, CV defects, mental retardation
A1003. Phenytoin
Q1004. Teratogen/drug that causes:; cleft lip and/or palate
A1004. Diazepam; (Benzodiazepines)
Q1005. Teratogen/drug that causes:; Cardiac (Ebstein's) anomalies
A1005. Lithium
Q1006. Teratogen/drug that causes:; fingernail hypoplasia, craniofacial defects
A1006. Carbamazepine
Q1007. Teratogen/drug that causes:; deafness
A1007. Aminoglycosides
Q1008. Teratogen/drug that causes:; vertebral, anal, cardiac, tracheo-esophageal,renal and limb malformations
A1008. Oral Contraceptive Pills; (VACTERL syndrome)
Q1009. Dx:; baby is born with cleft lip or palate; lower half of body incompletely formed; left colon hypoplasia, CV defects, microsomia or macrosomia
A1009. Mother with untreated DM
Q1010. what was mother exposed to if baby has:; saber shins, interstitial keratitis, skin lesions, rhinitis, unusual teeth
A1010. Syphillis
Q1011. in untreated HIV patients, what is the transmission rate to the fetus?
A1011. 0.25
Q1012. when should Zidovudine be given to the HIV mother and baby?; what does this reduce the risk to?
A1012. mother: Prenatally (at 14 weeks); baby: for 6 weeks after birth; reduces risk to 10% transmission
Q1013. why might a non-infected baby of an HIV mother test positive at birth?; when does it revert to a negative test?
A1013. mother's antibodies can cross the placenta; reverts to negative:; 6 months
Q1014. what should you do for a newborn if the mother has chronic; Hep B?
A1014. give newborn first Hep-B vaccination and Hep-B immunoglobulin at birth
Q1015. what should be done for baby if the mother contracts chicken pox w/i the last 5 days of pregnancy or the first 2 days post-delivery?
A1015. give the child a VZV immunoglobulin shot
Q1016. what is suspected if the lochia is foul-smelling?
A1016. Endometriitis
Q1017. (4) common Infection-based contraindications to breast feeding
A1017. 1. HIV; 2. Hepatitis B; 3. CMV; 4. Active Herpes lesions on breast
Q1018. what (2) ilicit drugs are not teratogens?
A1018. Weed,; LSD
Q1019. what should you consider if preeclampsia develops before the third trimester?; (2)
A1019. Hydatiform mole,; Choriocarcinoma
Q1020. what are the signs of Magnesium sulfate toxicity?; (3)
A1020. Hyporeflexia,; Respiratory depression,; CNS depression; (leading to coma and death)
Q1021. when eclampsia occurs (seizure), when do you deliver the infant?
A1021. Only when the mother is stable...never do C-section during seizure
Q1022. Dx:; recent postpartum mother with tachypnea, SOB, chest pain, hypotension, DIC
A1022. Amniotic fluid pulmonary embolism
Q1023. Definition:; true labor has begun, but is progressing slower then normal time values
A1023. Protraction Disorder
Q1024. Definition:; true labor has begun, but there has been no change in dilation in over 2 hours or no change in desent in 1 hour
A1024. Arrest Disorder
Q1025. what is the first step in managing Protraction or Arrest disorder?
A1025. Rule-out: Abnormal Lie and Cephalopelvic disproportion
Q1026. MCC of Protraction or Arrest disorder?; Tx?
A1026. Cephalopelvic disproportion (head wont fit); Tx: C-section
Q1027. what possible problems can be encountered when Oxytocin is used to induce labor; (4: 2 uterine, one fetal one electrolyte); Tx?
A1027. Uterine hyperstimulation (painful, irregular contractions),; Uterine rupture,; FHR decelerations,; Water intoxication/HypoN; Tx: stop the Pit (short T-1/2)
Q1028. what are the contraindications to Labor induction and/or Vaginal delivery?; (7)*
A1028. Placenta or Vasa Previa,; Umbilical cord prolapse,; Prior classic C-section,; Cervical CA,; Cephalopelvic disproportion; Active genital Herpes,; Transverse Fetal Lie,
Q1029. when is it detected on US:; 1. Gestational sac; 2. Fetal image; 3. Beating heart
A1029. Gestational sac = 5 weeks; Fetal image = 6 - 7 weeks; Beating heart = 8 weeks
Q1030. What is normal steps of management for mother when Variables are seen?; (3); if bradycardia continues, what is next step?
A1030. 1. place in Lateral decubitus position; 2. give her oxygen; 3. stop Pitocin if continues: insert pH scalp monitor
Q1031. if the mother had Variables or Lates and you went thru the steps to the insertion of the fetal scalp pH monitor. what is the next step if the pH is below 7.2?; Above 7.2?
A1031. pH < 7.2 = Immediate C-section; pH > 7.2 = continued monitoring
Q1032. if the child has a shoulder distocia during delivery, what is the first step?; what is done if this fails?
A1032. McRobert's maneuver; if it fails: C-section
Q1033. what is always the initial step in management for Third Trimester bleeding?; Why?
A1033. Ultrasound; b/c it may be due to a placenta previa (CI to pelvic exam)
Q1034. what can a placental abruption lead to if fetal products enter maternal circulation?
A1034. DIC
Q1035. Biggest risk factor for fetal bleeding; (vasa previa or velamentous cord) in third trimester?
A1035. Multiple gestations
Q1036. Definition:; blood-tinged mucous plug that is a normal cause of third trimester spotting
A1036. Bloody show
Q1037. once a woman in preterm labor is stable, what is the next step in management?
A1037. manage as outpatient with oral tocolytics
Q1038. assuming there are no prenatal procedures done, when is the normal time RhoGAM is given?; (2)
A1038. 1. 28 weeks; 2. w/i 72 hours after delivery
Q1039. what are the (3) possible ways to treat Hemolytic Disease of the Newborn?
A1039. Delivery (if at term),; Intrauterine transfusion (risky),; Phenobarbitol (helps liver breakdown bilirubin)
Q1040. what is the blood type for the mother and infant that can also cause hemolytic disease?
A1040. Mother: Type O; Baby: Type A, B or AB
Q1041. (3) possible reasons a postpartum patient will go into shock without evidence of bleeding
A1041. Amniotic fluid embolism,; Uterine Inversion,; Concealed hemorrhage
Q1042. what strange lab tests are NORMAL in pregnancy?; (5)
A1042. ESR is high,; Total T4 and TBG inc, but free T4 is nml,; Dec Hct and Hb,; Alk Phos inc,; mild proteinuria and glycosuria,
Q1043. Dx:; itching and abnormal LFT in any trimester, poss jaundice; Tx?
A1043. Cholestasis; Tx: Delivery (but cholestyramine helps with Sx)
Q1044. Dx:; girl never had period with breast development, patent vagina, no uterus and 46, XY
A1044. Androgen Insensitivity; (Testicular Feminization)
Q1045. Dx:; girl never had period, without breast development, normal uterus and vagina, 46,XX, FSH is low
A1045. Hypothalamic-Pituitary dysfunction
Q1046. Dx:; girl never had period without breast development, normal uterus and vagina, 46,XX, FSH is high
A1046. Gonadal Dysgenesis; (Primary Ovarian failure)
Q1047. Syndrome:; Hypothalamic-Pituitary dysfunction that results in a defect in GnRH production; what is unusual about patient presentation?; what are FSH and LH levels?
A1047. Kallman syndrome (patient lost sense of smell); LH and FSH are low
Q1048. Definition:; defect in ovarian receptors for LH and FSH
A1048. Savage syndrome (a Hypogonadotropic Hypogonaism defect)
Q1049. what are (3) pathologic causes of Primary ovarian failure; (primary amenorrhea)?
A1049. Turner's syndrome,; Defects in Steroid synthesis,; Savage's syndrome (no ovarian LH and FSH receptors)
Q1050. what is the maternal MCC of IUGR?
A1050. Chronic maternal Hypertension
Q1051. what is considered normal in the Hunter-Sims postcoital test for sperm?; (2)
A1051. 1. 8 - 10 motile sperm in highpowered field; 2. thin cervical mucous
Q1052. Abortion type:; bleeding, cervical dilation, retained POC
A1052. Inevitable abortion
Q1053. Dx:; woman at 18 week with decrease in uterine size, loss of pregnancy symptoms (no Fetal Heart Beat) and brownish vaginal discharge. The cervix is closed and no intrauterine contents have passed
A1053. Missed abortion
Q1054. what is the cause of Testicular femninization?; How do they present?; (5)
A1054. cause: absence or dysfunction of testosterone receptors; Breasts, no pubic hair, amenorrhea, vagina that ends in blind pouch and without Hirsutism
Q1055. what is the staging for ovarian cancer (Ia,b,c - IV)?
A1055. Ia: confined to one ovary; Ib: involves both ovaries; Ic: either a or b with rupture of ovary, disease outside capsule or positive washings; II: Extends into pelvis; III: Mets into abdomen; IV: Distant Mets
Q1056. what gestational time does the formation for the (3) types of twins occur:; 1. Di-Di; 2. Mono-Di; 3. Mono-Mono
A1056. Di-Di: zero - 3 days; Mono-Di: 3 - 8 days; Mono-Mono: 8 - 13 days
Q1057. what ovarian tumor is most commonly assoc with increased AFP?
A1057. Endodermal Sinus Tumor; (Most Aggressive Germ Cell Tumor; Schiller-Duval Bodies; from extraembrionic tissue)
Q1058. what ovarian tumor is most commonly assoc with increased hCG?
A1058. Choriocarcinoma
Q1059. what are the steps and Dx in diagnosing a Secondary Amenorrhea?; (5)
A1059. 1. RULE OUT Pregnancy; 2. If Galactorrhea present: High TSH = Hypothyroidism, Nml TSH and High Prolactin = Pituitary tumor or drug; 3. Galactorrhea not present: Progesterone challenge, (+) Bleeding = good estrogen -> Anovulation; 4. (-) Bleeding -> Hysteroscopy for Ashermans; 5. Neg Ashermans -> test LH/FSH: Low LH/FHS = Hypothalamic-Pituitary, High LH/FSH = Ovary problem
Q1060. what is the safe treatment for a pregnant woman who may get alcohol poisoning from bindge drinking?
A1060. Benzodiazepines
Q1061. Of all the woman trying to get pregnant, how many will conceive in one year?
A1061. 80 - 85%
Q1062. Dx:; anterior abdominal wall defect in the infant where the skin, muscles and fascia are missing and the cord inserts into a created amniotic membrane that covers the abdominal organs
A1062. Omphalocele
Q1063. Dx:; anterior abdominal wall defect in the infant where the abdominal contents are herniated lateral to the normal insertion of the umbilical cord
A1063. Gastroschsis
Q1064. MC female sexual disorder
A1064. Hypoactive sexual desire
Q1065. what are the precursor cells to the placental membranes?
A1065. Trophoblasts
Q1066. during a Threatened abortion, what lab is low?
A1066. Estradiol levels
Q1067. what is the most common reason for an abnormal triple screen?; what is the first step for an abnormal triple screen?
A1067. incorrect gestational age; first step: Ultrasound for accurate dating
Q1068. what test determines the amount of fetal RBC in the maternal circulation?
A1068. Kleihaur-Bettke test
Q1069. (5)* safe Vaccines during pregnancy
A1069. HOTY-D:; Hep B,; Oral Polio,; Tetanus,; Yellow fever,; Diphtheria
Q1070. what (5)* exposures in pregnancy require Immune Globulin?
A1070. The Mom Can Really Hurt:; Tetanus,; Measles,; Chickenpox,; Rabies; Hep A and B,
Q1071. Dx:; post-delivery in third stage there is a sudden gush of blood, umbilical cord lengthening and the uterus rises and firms
A1071. Placental separation
Q1072. Definition:; the fatty substance consisting of desquamated epithelial cells and sebaceous matter that covers the skin of the fetus
A1072. Vernix
Q1073. what is the main use of prostaglandins in delivery?
A1073. ripening of the cervix
Q1074. which Leopold Maneuver:; What fetal part occupies the fundus?; What apect of fetal to mother relationship does it determine?; (2)
A1074. First maneuver determines:; 1. Fetal Lie; 2. Fetal Presentation
Q1075. which Leopold Maneuver:; On what side is the fetal back?
A1075. Second amneuver
Q1076. which Leopold Maneuver:; What fetal part lies over the pelvic inlet?; What apect of fetal to mother relationship does it determine?
A1076. Third maneuver; determines: Fetal Position
Q1077. which Leopold Maneuver:; On which side is the cephalic prominence?
A1077. Fourth maneuver
Q1078. Type of Breech:; thighs are flexed, legs extended over anterior surface of body, feet are in front of face
A1078. Frank breech
Q1079. Type of Breech:; thighs are flexed on the abdomen and legs are flexed (folded)
A1079. Complete breech
Q1080. Describe the 4 types of vaginal tears
A1080. First degree: skin and vaginal mucosa; Second degree: including underlying muscle; Third degree: including anal sphinctor; Fourth degree: including rectal mucosa
Q1081. what causes fluid retention postpartum?; (2)
A1081. High Estrogen levels during Pregnancy; Increased Venous Pressure in lower body during pregnancy
Q1082. what external stimulus provokes milk letdown?
A1082. cry of the infant
Q1083. what are the diabetic classifications?; (8)
A1083. Gestational:; A1: < 120 two-hr PP glucose; A2: > 120 Non-Gestational (normal DM):; B: onset > 20 yo; C: onset 10 - 19 yo; D: onset < 10 yo; F: any onset age including neFropathy; H: any onset age including Heart prob; R: any onset age including Retinopathy
Q1084. what is the CNS anomaly most specific to mother with DM?
A1084. Caudal regression
Q1085. if a woman is taking anticonvulsants during pregnancy, what vitamin should be supplemented?
A1085. Folic Acid (if not, risk of defects or Anemia related to folic acid deficiency)
Q1086. since asthma can be exacerbated by respiratory tract infections in pregnant women, what specific vaccine should be given to all asthma patients for prophylaxis?
A1086. Killed Influenzae Vaccine
Q1087. which anti-HTN medication in pregnancy can cause the AE of SLE-like syndrome?
A1087. Hydralazine
Q1088. (5)* contraindications to giving Tocolytics
A1088. BAD CHad:; Bleeding (severe),; Abrupto placentae,; Death of fetus,; Chorioamnionitis,; HTN (severe)
Q1089. first step in management for PROM
A1089. evaluate for Chorioamnionitis; (if so, deliver baby and Antibiotics)
Q1090. what is the Apt test and its results?
A1090. place vaginal blood in tube with KOH; turns Brown = Maternal; turns Pink = Fetal
Q1091. Dx:; pregnant woman is rushed into ER from car accident and has back pain
A1091. Placental abruption
Q1092. why is Estrogen a Pro-coagulant?; (2)
A1092. Increases Factors VII and X; Decreases Anti-Thrombin III
Q1093. best method of hormonal birth control for woman with SLE?
A1093. Injectable Progesterone
Q1094. what secretes Progesterone in the Luteal phase?; what does the secretion cause with respect to hormones?
A1094. Corpus luteum; causes: decrease in LH and FSH
Q1095. what hormone not related to menstrural cycle, inhibits GnRH pulsations and ovulation?
A1095. Prolactin
Q1096. MC postoperative complication?
A1096. Pulmonary Atelectasis
Q1097. MC cause of primary amenorrhea?
A1097. Gonadal dysgenesis
Q1098. MC reason for neonatal sepsis?
A1098. Chorioamnionitis (GBS or e.coli)
Q1099. Dx:; a baby with ambiguous genitalia is born to a mother who complains of increased facial hair growth over the last few months
A1099. Luteoma of pregnancy (Dx after birth...virilization in mother and fetus)
Q1100. Diff Dx for Menorrhagia; (6)*
A1100. LACE-UP:; Leiomyoma,; Adenomyosis,; Coagulopathy,; Endometrial Hyperplasia,; Uterine (Endometrial) or Cervical CA,; Polyps of endometrium
Q1101. Diff Dx for postcoital bleeding; (3)
A1101. Trauma,; Infection,; Cervical cancer
Q1102. Definition:; pelvic pain assoc with ovulation
A1102. Mittelschmerz
Q1103. MCC of acute pelvic pain
A1103. Ruptured ovarian cyst
Q1104. Dx:; premenopausal patient complains of hemoptysis with each period
A1104. Endometriosis of nasopharynx or lung
Q1105. what must be completely visualized for adequate colposcopic evaluation?
A1105. Transformation zone
Q1106. what (4)* cancers metastasize to cervix by direct extension?
A1106. RIB-Eye steak:; Rectal,; Intra-abdominal,; Bladder,; Endometrial
Q1107. which cervical cancer is susceptable to radiation therapy?; which is not?
A1107. Radiation: SCC of cervix; not: Adenocarcinoma of cervix
Q1108. what are the 4 basic stages of endometrial CA?
A1108. I: only uterine involvement; II: includes cervical involvement; III: includes local spread; IV: includes distant spread
Q1109. what is the most important prognostic indicator of endometrial CA?
A1109. Grade; G1 = Well differentiated; < 5% solid; G2 = Moderate differentiation; 5 - 50% solid; G3 = Poor differentiation; > 50% solid
Q1110. Dx:; postmenopausal woman with a widening girth notices she can no longer button her pants
A1110. Ovarian cancer
Q1111. Definition:; a fixed pelvic and upper abdominal mass with ascites; what is it a sign of?
A1111. Omental caking; sign: Ovarian cancer
Q1112. what GYN cancers are staged Surgically?; Clinically?
A1112. Surgically:; Ovarian,; Endometrial; Clinically:; Cervical
Q1113. In addition to a TAH/BSO for epithelial cell ovarian cancer, what is the Tx in stages I-IV?
A1113. Stage I and II: Only chemotherapy (Taxol and Cisplatin); Stage III and IV: Chemotherapy plus... 1. Radiation if tumor < 2 cm; 2. Interval Debulking (more surgery) if > 2 cm
Q1114. what is the tumor marker for a Granulosa-Theca cell tumor?
A1114. Inhibin (and high estrogen)
Q1115. what is the tumor marker for a Sertoli-Leydig ovarian tumor?
A1115. Testosterone
Q1116. what class of female cancers secrete hCG, Lactogen and Thyrotropin?
A1116. Gestational Trophoblastic Neoplasias (GTN)
Q1117. what is the criteria for hospitalization for PID?; (5)*
A1117. GU PAP:; GI symptoms,; Unknown Dx,; Peritonitis,; Abscess,; Pregnancy
Q1118. what is the diagnostic test for Gonorrhea?
A1118. culture on Thayer-Martin agar
Q1119. what is the diagnostic test for chlamydia?
A1119. Microimmunofluorescence test (MIF)
Q1120. Dx:; painless papule on genitals, lymphadenitis, rectovaginal fistula
A1120. Lymphogranuloma Venereum (LGV); [serotype L1-L3 of chlamydia]
Q1121. what is the level of Vaginal Prolapse with each Grade I-IV?
A1121. I: to level of Ischial spines; II: b/t Ischial spines and Introitus; III: within Introitus; IV: past Introitus
Q1122. what type of incontinence does the Q-tip test measure?
A1122. Stress incontinence
Q1123. Common COD for Ovarian CA patient?
A1123. Mets to bowel causing obstruction
Q1124. if a female patient has HIV, what cancer will progress the Dx to AIDS?
A1124. Cervical CA; (HPV)
Q1125. what is the next step if you cannot see the transformation zone on colposcopy?
A1125. LEEP procedure
Q1126. what is the only cancer you can slice through without taking all of it out?
A1126. Ovarian CA
Q1127. Definition:; Absence of spermatozoa
A1127. Azoospermia
Q1128. Definition:; Low concentration of spermatozoa
A1128. Oligozoospermia
Q1129. Definition:; Poor motility of sperm
A1129. Asthenozoospermia
Q1130. Definition:; Poor morphology of sperm
A1130. Teratozoospermia
Q1131. what is the difference in FSH levels of the Dx of Poor Oocyte Reserve versus Premature Ovarian Failure?; what are estrogen levels with each?
A1131. Poor Oocyte Reserve:; FSH > 10; Estrogen = normal; Premature Ovarian Failure:; FSH > 25; Estrogen is Low (same as menopause)
Q1132. Dx:; 35yo female with secondary amenorrhea, low estrogen and very high FSH and LH
A1132. Premature Ovarian Failure; (menopause in female < 36 yo)
Q1133. MCC of maternal death in the first trimester
A1133. Ectopic pregnancy
Q1134. what is the cause of vaginal lubrication during sex?
A1134. Vaginal Transudation; (edema from engorged vaginal vessels)
Q1135. Dx:; patient ovulates day 14 and starts bleeding day 22; low progesterone; Dx exam?
A1135. Luteal Phase Defect (shortened luteal phase); Dx exam: Late Luteal Phase endometrial biopsy
Q1136. (3) reasons to use a Sterile vaginal Speculum on assessing the Laboring patient
A1136. 1. Suspect Rupture of Membranes; 2. Preterm Labor; 3. signs of Placenta Previa
Q1137. Dx:; PID with Perihepatic inflammation and adhesions from liver to diaphragm
A1137. Fitz-Hugh-Curtis syndrome
Q1138. What is the next step in Tx for a patient with ASCUS?
A1138. Repeat Pap smear in 3 months
Q1139. Patient comes in with a suspected Fibroadenoma. Next step?
A1139. Ultrasound (cannot send home without checking; this is sufficient to confirm Dx0
Q1140. How long should HRT be used?
A1140. 6 - 12 months; (then if Sx persist, switch to another method)
Q1141. Most deaths from Cervical CA are due to what?
A1141. Uremia; (and pyelonephritis)
Q1142. Most common form of contraception in USA?
A1142. Sterilization
Q1143. Pregnant woman comes in with a gush of clear fluid from the vagina. First step?
A1143. Sterile Vaginal Exam
Q1144. Dx test for HSV
A1144. Viral Culture (not Tzank smear)
Q1145. Medicine to rapidly relax the Uterus if it is inverted?; (2)
A1145. 1. Nitroglycerine; 2. Terbutaline
Q1146. Most sensitive test to distinguish types of Incontinence
A1146. Urethrocystometry
Q1147. 50-yo patient with Breast CA presents with Lytic lesions of the spine. First step?
A1147. Radiation
Q1148. Greatest risk factor for Endometrial Hyperplasia
A1148. Obesity; (50lbs overweight increases risks 10 times)
Q1149. 3-yo develops breasts without vaginal bleeding or pubic hair; First step?; Dx?
A1149. First: obtain Serum Estradiol level; Dx: Premature Thelarche; (MC before age 4 due to increase circulating E2; No Tx)
Q1150. Ligament that contains the Ovarian artery and vein
A1150. Infundibulopelvic ligament
Q1151. Ovarian tumor with Call-Exner bodies
A1151. Granulosa cell tumor; (increased serum E2)
Q1152. Where is Hematopoiesis the most in development at age:; 1. <12 weeks; 2. 12 - 24 weeks; 3. >24 weeks until birth
A1152. 1. <12 weeks = Yolk Sac; 2. 12 - 24 weeks = fetal Liver; 3. >24 weeks until birth = fetal Bone Marrow
Q1153. 27-yo with secondary amenorrhea and 4 months of hirsutism; normal pelvic exam and US; First step?
A1153. Serum DHEAs; (to see if it is from ovary or adrenal gland)
Q1154. At what age does a female have the most Oocytes?
A1154. 20 weeks gestation; (at birth 1/2 are lost)
Q1155. Dx:; Condyloma ACUMINATUM
A1155. HPV
Q1156. woman being evaluated for infertility is found to have a double uterus; Next test?
A1156. IVP; (30% of women with uterine anomaly have urinary tract anomaly)
Q1157. Patient has confirmed Chlamydia; Tx?
A1157. Tx Patient and Partner with Doxycycline ONLY
Q1158. Patient has confirmed Gonorrhea; Tx?
A1158. Tx Patient and Partner with both Ceftriaxone and Doxycycline; (if it was Chlamydia, it would be Doxy only)
Q1159. Dx test for Septic Pelvic thrombophlebitis; Tx?
A1159. Dx test: MRI of pelvis; Tx: Heparin and IV Antibiotics
Q1160. a 44-yo with normal pap smear 3 years ago has intermenstrual and post-coital spotting intermittently for 6 months. First test?
A1160. Pap Smear; (cervical polyp is strong possibility of Dx0
Q1161. Name of the surgery for Stress Incontinence
A1161. Retropubic Urethropexy
Q1162. Best predictor of Breast CA that has spread outside of the breast?
A1162. Initial SIZE of the Tumor; (which is Stage in this case)
Q1163. Dx:; Purulent vaginal discharge and pH of 4.2 - 5.0
A1163. Monilial Vaginitis
Q1164. Dx:; Decreased ejaculate volume and azoospermia without fructose
A1164. Absent Seminal vesicles; (SV adds the fructose to ejaculate)
Q1165. Total time for sperm to ejaculate
A1165. 90 days
Q1166. what type of immunity is a RhoGAM shot?
A1166. Passive Immunity; (b/c you give the Antibody)
Q1167. after delivery, what should be suspected if placenta does not separate spontaneously after 30 minutes?
A1167. Placenta Accreta
Q1168. What VD can affect the throat and present with exudative pharyngitis?
A1168. Herpes
Q1169. (5) reasons to hospitalize for PID
A1169. 1. Bad infection (>39C; N/V);; 2. Adolescent; 3. NULLIPAROUS; 4. Low SES; 5. Failure to respond to IV meds
Q1170. In a woman with IDM, what should be done for fetal surveillance?
A1170. NST; (starting at 28 weeks; 2 times weekly to decrease risk of Sudden Intrauterine Death)
Q1171. Which form of incontinence is associated with DM?; Tx?
A1171. Overflow Incontinence (Detrusor instability from neuropathy; will present with increased post-void volume); Tx: Self-catheterization
Q1172. which type of incontinence may be treated by alpha- adrenergic meds?
A1172. Stress Incontinence; (after Kegel exercises are attempted; also E2 therapy works; if all else fails, then this is the only one that can be cured by surgery)
Q1173. How long must a diaphragm stay in after intercourse?
A1173. at least 6 hours
Q1174. pregnant woman presents with tachycardia, increased breathing, and chest pain. CXR is negative; Next step?
A1174. V/Q exam
Q1175. what is the follow-up post delivery if the patient has gestational diabetes?
A1175. 2-hour GTT in 6 weeks post partum
Q1176. 14-yo presents with vaginal bleeding causing a Hct of 30%; no History of blood disorder; Beta-HCG and US are negative; normal vitals; First step?
A1176. give OCPs; (will stabilize bleed in initial menstrual cycles; no transfusion needed)
Q1177. Uterine Leiomyoma (Fibroids) - What is it
A1177. MC benign gyn lesion; MC in Blacks and patients > 35; smooth muscle cell tumors; responds to hormones; increased during pregnancy; usu regresses after menopause; transform to leiomyosarcoma is rare
Q1178. Uterine Leiomyoma (Fibroids) - History/PE
A1178. Usu asymp; may have - abnorm uterine bleeding; pelvic pressure; dysmenorrhea; urinary freq. pain; NT; irreg enlarged uterus; "lumpy bumpy"
Q1179. Uterine Leiomyoma (Fibroids) - Dx
A1179. US
Q1180. Uterine Leiomyoma (Fibroids) - Tx
A1180. If asymp - manage expectantly; monitor growth; serial exams; US; if severe Sxs or postmenopausal growth - myomectomy or hysterectomy; med therapies - shrink tumors; tumors grow when meds stopped; use in perimenopausal
Q1181. Infertility - What is it
A1181. Inability after 1 year; female dysfunction (no. 1); male dysfunction; female - no. 1 = endometriosis, PID, cervix, uterine-tubal, ovulation prob, peritoneum, multiple factors, UNK
Q1182. Infertility - Dx
A1182. FSH; LH; TSH; prolactin; hysterosalpingography; semen analysis
Q1183. Infertility - Tx
A1183. Tx underlying cause; endometriosis - lap removal of implants; clomiphene citrate; Pergonal - purified human FSH & LH; GIFT, IVF
Q1184. Menopause - What is it
A1184. Due to end-organ ovarian resistance to gonadotropins; median age 50-52; premature - < 40: idiopathic premature ovarian failure, assoc. with cigarettes, artificial - after removal of ovaries, after irradiation of ovaries; postmenopausal - lose protection from estrogen, increased risk for osteoporosis and heart dis.
Q1185. Menopause - History/PE
A1185. Menstrual irreg; sweating; sleep disturb; mood changes; decreased libido; dyspareunia; dysuria; vaginal dryness; decreased breast size; genital tract atrophy
Q1186. Menopause - Dx
A1186. Increased serum FSH - suggestive; 1 yr without menses
Q1187. Menopause - Tx
A1187. HRT - can relieve Sxs, help prevent osteoporosis; contraindications - unDx vag bleeding, liver disease, acute vas thrombosis, history of endometrial cancer, history of breast cancer; progesterone/estrogen - if still have uterus; estrogen alone - if had TAHBSO; clonidine; topical estrogens; calcium, vit D; calcitonin; bisphosphonates
Q1188. Contraception - Rhythm Method; What is it
A1188. Use body temp and cervical mucus consistency to predict time of fertility
Q1189. Contraception - Rhythm Method; Side Effect
A1189. Unreliable
Q1190. Contraception - Coitus Interruptus; What is it
A1190. Withdraw before ejaculation
Q1191. Contraception - Coitus Interruptus; Side Effect
A1191. High failure rate
Q1192. Contraception - Diaphragm and Cervical Caps; What is it
A1192. Domed sheet of rubber or latex placed over cervix; must be fitted by physician; must remain in vagina 6-8 hrs after intercourse
Q1193. Contraception - Diaphragm and Cervical Caps; Side Effects
A1193. Possible allergy to latex or spermicides; risk of UTI, TSS
Q1194. Contraception - Condoms; What is it
A1194. Latex sheath
Q1195. Contraception - Condoms; Side Effects
A1195. Possible allergy to latex or spermicides
Q1196. Contraception - IUD; What is it
A1196. Plastic and/or metal device placed in uterus; causes local sterile inflammatory reaction in uterine wall so that sperm engulfed and destroyed
Q1197. Contraception - IUD; Side Effects
A1197. Increased vag bleeding - copper IUD; uterine perforation; IUD migration; infection; increased risk of PID; increased risk of ectopic preg
Q1198. Contraception - OCPs; What is it
A1198. Suppress ovulation by inhibiting FSH/LH; change consistency of cervical mucus; make endometrium unsuitable for implantation
Q1199. Contraception - OCPs; Side Effects
A1199. HTN; hepatic adenoma; weight gain; increased risk of thromboembolism; nausea; acne; breast tenderness; mood changes
Q1200. Contraception - Levonorgestrel (Norplant) - What is it
A1200. Taken off market 2002; progestin subdermal implant; suppresses ovulation; thickens cervical mucus; makes endometrium unsuitable for implantation; effect lasts 5 yrs.
Q1201. Contraception - Levonorgestrel (Norplant) - Side Effects
A1201. Irreg vag bleeding; weight gain; galactorrhea; acne; breast tenderness; headache; hard to remove
Q1202. Contraception - Postcoital morning-after pill; What is it
A1202. Progesterone +/- estrogen; take within 72 hrs of unprotected sex; suppresses ovulation; discourages implantation
Q1203. Contraception - Postcoital morning-after pill; Side Effects
A1203. N/V; fatigue; breast tenderness; headache; dizziness
Q1204. Contraception - Medroxyprogesterone; (Depo-Provera); What is it
A1204. IM injection given every 3 mos; suppresses ovulation; thickens cervical mucus; makes endometrium unsuitable for implantation
Q1205. Contraception - Medroxyprogesterone; (Depo-Provera); Side Effects
A1205. Irreg vag bleeding; depression; weight gain; breast tenderness; delayed restoration of ovulation after discontinue
Q1206. Contraception - Surgical Sterilization; (Tubal Ligation, Vasectomy); What is it
A1206. Tubes ligated, cauterized or mechanically occluded
Q1207. Contraception - Surgical Sterilization; (Tubal Ligation, Vasectomy); Side Effects
A1207. Essentially irreversible; bleeding; infection; failure; ectopic pregnancy
Q1208. Intraductal Papilloma - What is it
A1208. Common cause of bloody nipple discharge
Q1209. Fibrocystic Change - What is it
A1209. Catchall term; spectrum of clinical findings; mastalgia; breast cysts; fibroadenoma; mastitis; hyperplasia; nodularity; commonly seen in premenopause; from exaggerated response of stroma to hormones & growth factors; increased cancer risk only if cellular atypia
Q1210. Fibrocystic Change - History/PE
A1210. Cyclic,; premenstrual,; b/l breast pain,; tenderness, swelling; excessive tissue nodularity
Q1211. Fibrocystic Change - Dx
A1211. Fine-needle aspiration; cytologic exam
Q1212. Fibrocystic Change - Tx
A1212. Decreased caffeine and nicotine; vit E; progestins; danazol; tamoxifen; diuretics
Q1213. Fibroadenoma - What is it
A1213. MC breast lesion < 30; benign, slow-growing tumor; epithelial & stroma components; recurrence common; phyllodes tumor - (cystosarcoma phylloides); grows fast; large type of fibroadenoma; rarely malignant
Q1214. Fibroadenoma - History/PE
A1214. Round; firm, NT; mobile; solitary mass, discrete
Q1215. Fibroadenoma - Dx
A1215. Surgical excision - tissue for Dx
Q1216. Fibroadenoma - Tx
A1216. Surgical excision
Q1217. Breast Cancer - What is it
A1217. MC cancer (incidence); no. 2 in cancer death; risk factors – gender, age, breast Ca 1st degree relatives, history of breast cancer, 1st fullterm preg after 35 y/o, history of fibrocystic change with cellular atypia, increased exposure to estrogen – nullparity, early menarche, late menopause, late menarche - decreased risk, BRCA-1 & BRCA-2 mutations - early-onset familial breast, and ovarian cancers
Q1218. Breast Cancer - History/PE
A1218. Lump – hard, irreg, not mobile, painless; possible nipple discharge; can be asymp and nonpalpable; MC location - upper outer quad; mets to - lymph nodes, bones, brain, lung, liver; advanced disease - skin changes: dimpling, redness, ulceration, edema, axillary adenopathy
Q1219. Breast Cancer - Dx
A1219. Mammography - ↑ density, microcalcifications, irregular borders; US - solid mass vs. benign cyst; tumor markers for recurrent- CEA, CA 15-3, CA 27-29, estrogen receptor (ER), progesterone receptor (PR), HER2/neu status; metastatic disease - ↑ ESR, ↑ alk phos, ↑ calcium; CXR - pulmonary metas; CT - chest, abdomen, pelvis, brain; bone scan
Q1220. Breast Cancer - Tx
A1220. All hormone receptor pos. - tamoxifen; estrogen rec. neg - chemo; trastuzumab - HER2/neu-expressive cancers; partial mastectomy and axillary dissection followed by radiation; modified radical mastectomy (total mastectomy plus axillary dissection); contraindications to breast-conserving therapy - large tumor, multifocal tumors, subareolar location, fixation to chest wall, nipple involved, overlying skin involved; Invasive cancer requires axillary dissection; stage IV - radiation and hormones, mastectomy may required; ER- and PR+ - favorable
Q1221. Ectopic Pregnancy - What is it
A1221. Implants outside uterus cavity; MC site - ampulla; risk - history of PID (most common), prior ectopic pregnancy, tubal/pelvic surgery, DES exposure in utero, IUD
Q1222. Ectopic Pregnancy - History/PE
A1222. Classic triad – amenorrhea, light vag bleeding, lower abdom or pelvic pain/tender pelvic or adnexal mass; ruptured ectopic - surgical emergency; sudden, sharp abdom pain, shock, orthostatic hypotension, tachycardia; shoulder pain; generalized abdominal and adnexal tenderness with rebound tenderness
Q1223. Ectopic Pregnancy - Dx
A1223. B-hCG - levels lower than normal preg, level takes > 2D to double; serum progesterone < normal; transabdom or transvag US; Dx - empty uterine cavity and B-hCG of 6,500; culdocentesis - > 5cc of nonclotting blood, identifies hemoperitoneum, not sensitive nor specific
Q1224. Ectopic Pregnancy - Tx
A1224. Serial B-hCG and US; expectant management if - asymp; decreased B-hCG; small mass; no US evidence of bleeding; methotrexate - stable, unruptured; all others, surgery – salpingostomy, salpingectomy, salpingo-oophorectomy; RhoGAM if appropriate
Q1225. Ectopic Pregnancy - Complications
A1225. Inevitable loss of fetus; hemorrhagic shock; future ectopic pregnancy; infertility; maternal death; Rh sensitization
Q1226. Vaginitis - What Causes it
A1226. Vagina normally - mixed bacterial flora; acidic envi (pH 3.5-4.5); maintained by lactic acid- producing lactobacilli; change in environment => overgrowth of other bacteria, can be bact., fungi, protozoa
Q1227. Bacterial Vaginosis - History/PE
A1227. Gray, fishy-smelling discharge; often pruritus and irritation
Q1228. Bacterial Vaginosis - Dx
A1228. pH > 4.5; saline smear - clue cells; KOH prep - positive whiff test
Q1229. Bacterial Vaginosis - Tx
A1229. PO metronidazole
Q1230. Trichomonas - History/PE
A1230. Profuse, malodorous, yellow-green discharge; dysuria; dyspareunia; erythema; strawberry petechiae in upper vagina/cervix
Q1231. Trichomonas - Dx
A1231. pH > 4.5; saline smear - motile trichomonads; KOH prep - nothing
Q1232. Trichomonas - Tx
A1232. PO metronidazole; Tx partner; test for other STDs
Q1233. Candidal Vaginitis - History/PE
A1233. Thick, white discharge - cottage-cheese texture; pruritus with or without burning; erythematous, excoriated vulva/vagina
Q1234. Candidal Vaginitis - Dx
A1234. pH - normal; saline smear - nothing; KOH prep - pseudohyphae
Q1235. Candidal Vaginitis - Tx
A1235. Topical antifungals (miconazole); po fluconazole
Q1236. Vaginitis - Dx
A1236. Detect vag pH with nitrazine paper; micro exam of discharge - saline (wet prep), KOH; rule out STDs - gram stain of discharge; Chlamydia Ag test; rule out UTI - clean-catch UC and UA
Q1237. Vaginitis - Complications
A1237. Increased risk of PID - with bacterial vaginosis; preterm labor; ROM
Q1238. Cervicitis - What is it
A1238. N. gonorrhea; Chlamydia; co-infection common; infect cervical glandular epithelium; cervix - red & bleeds easily; yellowish-green mucopurulent discharge; discharge can be seen exuding from endocervical canal
Q1239. Cervicitis - Dx
A1239. Cervical motion tenderness (CMT); no other signs of PID
Q1240. Pelvic Inflammatory Disease - What is it; Risk Factors
A1240. Microorg. ascend into:; endometrium - endometritis; uterine wall - myometritis; fallopian tubes - salpingitis; ovaries - oophoritis; parietal perit. - peritonitis; most causes - gonorrhea & chlamydia; risk factors - multiple sexual partners, unprotected or freq. sex, young age at 1st intercourse, mucopurulent cervicitis, prior PID, IUD; incidence decreases with – OCPs, barrier contraception
Q1241. Pelvic Inflammatory Disease - History/PE
A1241. Lower abdominal pain; fever, chills; menstrual disturbances; purulent cervical discharge; cervical motion tenderness; adnexal tenderness; RUQ pain may indicate perihepatitis (Fitz-Hugh–Curtis syndrome)
Q1242. Pelvic Inflammatory Disease - Dx
A1242. Lower abdom, adnexal and cervical motion tenderness; fever; increased ESR; increased CRP; WBC > 10,000; cervical swab pos. for chlamydia or gonorrhea; US - pelvic abscess; Def. Dx - laparoscopy; consider - B-hCG, RPR/VDRL, HIV, LFTs
Q1243. Pelvic Inflammatory Disease - Tx
A1243. Don't wait on culture results; treat partner; outpatient (3 options) - cefoxitin + probenecid × 1dose; ceftriaxone IM × 1 dose and doxycycline × 14 days; ofloxacin × 14 days and metronidazole × 14 days; admit - if surgical emergency can't be ruled out, tubo- ovarian abscess - admit for at least 24 hours, pregnant, don't improve after 48-72 hrs. of outpatient Tx, severe illness, n/v, high fever, immunodeficient, noncompliant; cefoxitin or cefotetan and doxycycline × 14 days.
Q1244. Pelvic Inflammatory Disease - Complications
A1244. Ectopic pregnancy; chronic pelvic pain; infertility; repeated infections; Fitz-Hugh-Curtis syndrome; pelvic/tubo-ovarian abscess - severe pain, high fever, n/v, signs of sepsis, peritoneal signs, adnexal mass; admit - IV Antibiotics, hydration, drainage or TAHBSO
Q1245. Toxic Shock Syndrome - What is it
A1245. Acute illness; caused by preformed S. aureus toxin (TSST-1); 90% women of childbearing age in 5 days of onset of menses, tampon use; nonmenstrual almost as common- organisms from: nasopharynx, bones, vagina, rectum, wounds
Q1246. Toxic Shock Syndrome - History/PE
A1246. Abrupt onset - fever, vomiting, diarrhea; can => hypotensive shock, diffuse macular erythematous rash (sunburn-like); nonpurulent conjunctivitis; desquamation of palms and soles within 1–2 weeks
Q1247. Toxic Shock Syndrome - Dx
A1247. BC - neg
Q1248. Toxic Shock Syndrome - Tx
A1248. Admit; rehydration; remove source of toxin; antistaph Antibiotics - nafcillin, oxacillin; manage renal or cardiac failure
Q1249. Menorrhagia - What is it; Cause
A1249. ↑ amount of flow > 80 mL per cycle or prolonged bleeding, flow lasts > 8 days causes; leiomyoma; endometrial hyperplasia; endometrial polyps; endometrial cancer; cervical cancer; pregnancy complications
Q1250. Oligomenorrhea - What is it; MCC
A1250. ↑ length of time between menses; 35–90 days between cycles; MCC - pregnancy
Q1251. Polymenorrhea - What is it; Cause
A1251. Frequent menstruation; < 21-day cycle; cause - anovulation
Q1252. Metrorrhagia - What is it; Causes
A1252. Bleeding between periods Causes:; endometrial polyps; endometrial cancer; cervical cancer; pregnancy complications; exogenous estrogen
Q1253. Menometrorrhagia - What is it; Causes
A1253. Excessive and irregular bleeding causes:; endometrial polyps; endometrial cancer; cervical cancer; pregnancy complications; exogenous estrogen
Q1254. Postmenopausal Bleeding - What is it; Causes
A1254. Uterine bleeding > 1 year after menopause Causes:; vaginal atrophy; exogenous hormones; cancer
Q1255. Abnormal Uterine Bleeding - Dx
A1255. Distinguish ovulatory from anovulatory disorders; thorough menstrual History - bleeding freq., vol, duration, bimanual exam, pap smear; ovulatory - transvag US, sonohysterogram, D&C with hysteroscopy; anovulatory - B-hCG, CBC, coag profile, FSH, LH, TSH, prolactin, endometrial biopsy; any postmenopausal woman with uterine bleeding - endometrial biopsy to rule out endometrial cancer
Q1256. Abnormal Uterine Bleeding - Tx
A1256. Treat underlying disorder; ovulatory - NSAIDs +/- OCPs; anovulatory – OCPs, cyclic progestin (medroxyprogesterone); high-dose IV estrogen; D&C; endometrial ablation; hysterectomy - last resort
Q1257. Amenorrhea - What is Primary Amenorrhea
A1257. No menses by 16 y/o; no secondary sexual characteristics by 14 y/o
Q1258. Primary Amenorrhea - Causes
A1258. Mullerian anomalies; vaginal agenesis; imperforate hymen; testicular feminization; ovarian failure; Turner's; Kallmann's; anorexia; excess exercise; weight loss; stress; tumor; infection
Q1259. Amenorrhea - What is Secondary Amenorrhea
A1259. No menses for 3 cycles if history of irreg cycles - no menses for 6 mos.
Q1260. Secondary Amenorrhea - Causes
A1260. Asherman's syndrome; cervical stenosis; pregnancy; polycystic ovarian syndrome; anorexia; excess exercise; weight loss; stress
Q1261. Amenorrhea - Tx
A1261. Tx underlying cause; if low estrogen – HRT, Ca2+ supplements
Q1262. Dysmenorrhea - What is it
A1262. Pain during menses that - requires meds; prevents normal activity; primary - no structural gyn disorder, start < 20 y/o, tends to decreased with age, due to uterine contractions, probably mediated by PGE, Tx - NSAIDs and OCPs; secondary - pelvic pathology, MC – endometriosis, adenomyosis, myomas, pelvic congestion, PID, ovarian cysts, cervical stenosis, pelvic adhesions
Q1263. Endometriosis- What is it
A1263. Functional endometrial tissue (glands and stroma) implanted outside uterus; women of reproductive age; common sites – ovaries, cul-de-sac, uterosacral ligament; due to - implant via retrograde menses; vascular and lymph dissem, metaplasia; risk factors - family History, nulliparity, infertility
Q1264. Endometriosis- History/PE
A1264. History - premenstrual pain; dyschezia; chronic pelvic pain; dyspareunia; abnorm bleeding; infertility; PE - tender, nodularity along uterosacral ligament, fixed, retroverted uterus, tender, fixed adnexal masses
Q1265. Endometriosis- Dx
A1265. Definitive Dx - direct visualization via laparoscopy or laparotomy; implants - rust-colored, dark brown "powder burns", raised blue raspberry lesions"; severe - adhesions surround implants; ovary may have - endometrioma (chocolate cysts); pain severity - doesn't always correlate with extent of disease
Q1266. Endometriosis- Tx
A1266. OCPs or progestin; danazol or GnRH agonists; lap ablation; TAH-BSO; lysis of adhesions
Q1267. Vulvar Cancer - What is it; Risk Factors
A1267. 4th MC gyn malignancy; usu occurs after menopause - (peaks in 60s); squamous cell ca (90%); risk factors – diabetes, obesity, HTN, vulvar dystrophy, HPV- 16, HPV-18
Q1268. Vulvar Cancer - History/PE
A1268. Asymp in early stages; vulvar pruritis (MC); erythematous or ulcerated vulvar lesion; palpable vulvar mass
Q1269. Vulvar Cancer - Dx
A1269. Definitive Dx - Biopsy
Q1270. Vulvar Cancer - Tx
A1270. Wide local excision; regional lymph node dissection; radiation - decreased tumor metas, recurrence
Q1271. Cervical Cancer - What is it; Risk Factors
A1271. 3rd MC gyn malignancy; squamous cell ca (most); adenoca (most of remaining); results from cervical intraepithlial neoplasia (CIN), if untreated => invasive ca; spreads – directly, blood, lymphatics to - pelvic lymph nodes, para-aortic lymph nodes; Risk factors - HPV 16, 18 and 31, early onset of sex, multiple sex partners, immune compromised, tobacco, STDs
Q1272. Cervical Cancer - History/PE
A1272. History - usu asymp; if asymp, usu Dx by - Pap smear, colposcopy and biopsy; if symp - postcoital bleeding is usu 1st Sx, menorrhagia, metrorrhagia, pelvic pain, vag discharge; PE - cervical discharge, cervical ulceration, pelvic mass, fistulas
Q1273. Cervical Cancer - Dx
A1273. Bx all lesions; colposcopy and endocervical curettage if - dysplasia (on Pap smear),; squamous intraepithelial neoplasia (on Pap smear); or 2 consec findings of atyp squamous cells of undet signif (ASCUS); pelvic exam under anesthesia; CXR; IVP; staging – clinical based on invasion into adjacent structures and metastases; CT/MRI can't be used to stage
Q1274. Cervical Cancer - Tx
A1274. Carcinoma in situ - finished childbearing – TAH; wish to keep uterus - cervical conization; ablation of lesion: cryotherapy / laser; invasive: all stages - radiation & chemo; less radical surgeries: early stages - radical hysterectomy, lymph node dissection; advanced disease or bulky tumors - radiation +/- chemo
Q1275. Cervical Cancer- Staging of CIN
A1275. CIN I - mild dysplasia, low-grade squamous intraepithelial lesion (LSIL); CIN II - moderate dysplasia, high-grade squamous intraepithelial lesion (HSIL); CIN III - severe dysplasia or carcinoma in situ, high-grade squamous intraepithelial lesion (HSIL)
Q1276. Endometrial Cancer - What is it; Risk Factors
A1276. MC gyn malignancy; strong association with high levels of unopposed estrogen; ages 50-70; usu adenoca; mets to: direct – cervix; intraperitoneal seeding; blood - lungs, vagina; lymphatics - aortic node, pelvic node; risk factors - unopposed estrogen, diabetes, HTN, nulliparity, family History
Q1277. Endometrial Cancer - Examples of Unopposed Estrogen
A1277. Estrogen replacement therapy; chronic anovulation; early menarche; late menopause; ovarian granulosa cell tumors; polycystic ovarian syndrome; obesity; tamoxifen
Q1278. Endometrial Cancer - History/PE
A1278. postmenopausal bleeding; menorrhagia; metrorrhagia; lower abdom pain; cramping; uterus - fixed, immobile if spread to adnexa & peritoneum; signs of mets – hepatosplenomegaly, lymphadenopathy, abdom masses
Q1279. Endometrial Cancer - Dx
A1279. Pap smear - not very sensitive; ECC; EMB; D&C - if sample inadeq; US to rule out - fibroids; polyps; endometrial hyperplasia; grade - key prognostic factor; staging - surgical; peritoneal fluid cytology; abdom exploration; TAH-BSO; pelvic & para-aortic nodes
Q1280. Endometrial Cancer - Tx
A1280. High dose progestins - stage I; chemo – doxorubicin, cisplatin; advanced & recurrent dis. adjuvant radiation - cervical & extrauterine spread
Q1281. Ovarian Cancer - What is it; Risk Factors
A1281. 2nd MC gyn malignancy; leading cause of U.S. gyn ca deaths; MC - postmenopausal; OCPs - protective effect; risk factors - fam history of breast or ovarian ca, chronic uninterrupted ovulate- nulliparity, delayed childbearing, infertility, late menopause; categorize by site of origin - epithelial cell – MC; serous cystadenoca; germ cell – dysgerminoma; sex cord-stromal tumors
Q1282. Ovarian Cancer - History/PE
A1282. History - Usu asymp until advanced - abdom pain; bloating; pelvic pressure; urinary freq. early satiety; constipation; vag bleeding; systemic Sxs; PE - solid, fixed nodular pelvic mass, ascites, pleural effusion
Q1283. Ovarian Cancer - Dx
A1283. Pelvic US; CT or MRI; surgical staging - TAH-BSO; omentectomy; tumor debulking; monitor - CA-125, aFP, LDH, hCG
Q1284. Ovarian Cancer - Tx
A1284. Radiation - dysgerminomas; postsurgical chemo – carboplatin, paclitaxel; epithelial cell tumors
Q1285. Ovarian Cancer - Prevention
A1285. 2 first degree relatives - annual screening CA-125; transvag US after childbearng - prophylactic oophorectomy; OCPs may help decreased risk
Q1286. Polycystic Ovarian Syndrome - What is it
A1286. Oligomenorrhea; cause unknown; Sxs of - androgen overproduction; increased circulating androgens, excess LH; b/l polycystic ovaries; chronic anovulation; infertility; obese; hirsute; ages 15-30; association - insulin resistance, DM; increased risk of endometrial ca
Q1287. Polycystic Ovarian Syndrome - History/PE
A1287. History - hirsutism; obesity; amenorrhea; infertility; May have – virilization, acne, DM, HTN, acanthosis nigricans; PE - enlarged cystic ovaries
Q1288. Polycystic Ovarian Syndrome - Dx
A1288. Serum LH/FSH ratio > 3; increased serum androstenedione; increased DHEA; US
Q1289. Polycystic Ovarian Syndrome - Tx
A1289. weight reduction; clomiphene citrate; metformin; OCPs
Q1290. Spontaneous Abortion (SAB) - What is it; Risk Factors
A1290. Nonelective termination at < 20 weeks GA; most 1st tri - fetal factors; most 2nd tri - mat. factors; risk factors - advanced mat. Age, advanced pat. Age, increased gravidity, prior SAB, minority status
Q1291. Spontaneous Abortion (SAB) - History/PE
A1291. History - ask history of: abortions, infections, familial genetic abnorm; PE - vaginal bleeding, passage of tissue, open or closed cervical os
Q1292. Spontaneous Abortion (SAB) - Dx
A1292. B-hCG; establish GA; transvag US - assess viability; CBC; blood type
Q1293. Spontaneous Abortion (SAB) - Tx
A1293. Ensure hemodynamically stable; give Rhogam (if appropriate); uterine evacuation
Q1294. Threatened Abortion - Sxs
A1294. Minimal bleeding; possible abdom pain; no POC expelled; (POC= products of contraception)
Q1295. Threatened Abortion - PE/US
A1295. Closed internal cervical os; normal US
Q1296. Threatened Abortion - Tx
A1296. Avoid heavy activity; pelvic and bed rest
Q1297. Inevitable Abortion - Sxs
A1297. Profuse bleeding; severe cramping
Q1298. Inevitable Abortion - PE/US
A1298. Open internal cervical os
Q1299. Inevitable Abortion - Tx
A1299. Emergent D&C
Q1300. Incomplete Abortion - Sxs
A1300. Some POC expelled
Q1301. Incomplete Abortion - PE/US
A1301. Open internal cervical os; retained fetal tissue on US
Q1302. Incomplete Abortion - Tx
A1302. Emergent D&C
Q1303. Complete Abortion - Sxs
A1303. Minimal bleeding; minimal cramping; all POC expelled
Q1304. Complete Abortion - PE/US
A1304. Closed internal cervical os; empty uterus on US
Q1305. Missed Abortion - Sxs
A1305. No uterine bleeding; no POC expelled
Q1306. Missed Abortion - PE/US
A1306. Closed internal cervical os; no fetal cardiac activity; retained fetal tissue on US
Q1307. Missed Abortion - Tx
A1307. Evacuate uterus; D&C
Q1308. Septic abortion - Sxs
A1308. Fever; chills; peritoneal signs; often recent history of therapeutic abortion
Q1309. Septic abortion - PE/US
A1309. Hypotension; hypothermia; oliguria; resp distress if in shock; increased WBC
Q1310. Septic abortion - Tx
A1310. Evacuate uterus; D&C; IV Antibiotics
Q1311. Intrauterine fetal demise - Sxs
A1311. Mom may report absence of fetal movements
Q1312. Intrauterine fetal demise - PE/US
A1312. Uterus small for GA; no fetal heart tones or movement on US
Q1313. Intrauterine fetal demise - Tx
A1313. Induce labor; evacuate uterus to avoid DIC
Q1314. Urinary Incontinence - Risk Factors
A1314. Older age; pelvic relaxation; obstructed labor; traumatic delivery; menopause; chronic cough; straining; ascites; large pelvic tumors
Q1315. Urinary Incontinence - Causes
A1315. DIAPPERS; Delirium; Infection (UTI); Atrophic urethritis/vaginitis; Pharmaceutical; Psych causes (esp. depression); Excess urine output (hyperglycemia, hypercalcemia, CHF); Restricted mobility; Stool impaction
Q1316. Urinary Incontinence - Dx
A1316. UA and UC - to exclude UTI; Serum Cr - to exclude renal dysfunction; Cystogram - fistulas; bladder neck abnorm
Q1317. Stress Incontinence - What is it
A1317. Sphincter insufficiency; laxity of pelvic floor muscles; common in multiparous women or after pelvic surgery
Q1318. Stress Incontinence - History
A1318. Activities that ↑ intra-abdominal pressure; coughing,; sneezing,; lifting; not common in supine position
Q1319. Stress Incontinence - Tx
A1319. Kegel exercises; surgery - place bladder neck in correct anatomical position
Q1320. Urge Incontinence - What is it
A1320. Detrusor hyperreflexia or sphincter dysfunction; due to bladder - inflammatory conditions, neurogenic disorders
Q1321. Urge Incontinence - History
A1321. Preceded by strong, unexpected urge to void; unrelated to position or activity
Q1322. Urge Incontinence - Tx
A1322. Anticholinergics; TCAs
Q1323. Overflow Incontinence - What is it
A1323. Dribbling of urine from overly full bladder; Volume is usually small
Q1324. Overflow Incontinence - History
A1324. Chronic urinary retention
Q1325. Overflow Incontinence - Tx
A1325. Catheter - if acute; Tx underlying disease; timed voiding
Q1326. pt presentation of genuine stress incontinence
A1326. losing urine with coughing, sneezing, laughing, etc
Q1327. pt presentation of overflow incontinence
A1327. constant urinary dribbling + sx of stress or urge incontinence
Q1328. pt presentation of urge incontinence
A1328. urge to go, but can't make it to the bathroom in time; strong urge to void
Q1329. pt presentation of total incontinence
A1329. painless, continuous loss of urine
Q1330. dx of stress incontinence
A1330. q tip test: if it moves more than 30 degrees, then urethra is hypermobile
Q1331. dx of overflow incontinence
A1331. residual volumes >300 cc
Q1332. dx of total incontinence
A1332. inject dye to see if there is a fistula, if there is then do a cystourethroscopy to determine # and location
Q1333. tx of stress incontinence
A1333. non surgical: reduce fluid intake, alpha-adrenergics and estrogens; surgical: if there is intrinsic sphincter deficiency, then urethral bulking; otherwise, retropubic urethropexy
Q1334. tx of urge incontinence
A1334. bladder retraining; anticholinergics
Q1335. tx of overflow incontinence
A1335. alpha-1 inhibitors (to reduce urterhal closing pressure); cholinergics; intermittent self-cath
Q1336. tx of total incontinence
A1336. if ob fistula, repair immediately; if 2/2 surgery, wait 3-6 months, then repair
Q1337. MCC preventable infertility in the US?
A1337. PID
Q1338. Most likely cause of infertility in a normally menstruating woman below the age of 30? Above the age of 30, if it is not the answer to the previous question?
A1338. 1. PID; 2. Endometriosis
Q1339. What symptoms are necessary to diagnose PID?
A1339. 1. Abdominal Pain; 2. Adnexal Tenderness; 3. Cervical motion tenderness; 4. One of the following: Elevated ESR/CRP, Leukocytosis, fever, purulent cervical discharge
Q1340. How do you treat PID?
A1340. 1. Outpatient: Cefoxitin/Ceftriaxone + Doxycycline; 2. Inpatient: Clindamycin + Gentamycin
Q1341. What are the most common organisms you have to cover for when treating PID?
A1341. Gonorrhea, Chlamydia
Q1342. What causal organism do you have to consider in PID when a patient has a history of an IUD?
A1342. Actinomyces israelii
Q1343. What are the signs and symptoms of endometriosis?
A1343. 1. Dysmenorrhea (painful menstruation); 2. Dyspareunia (painful intercourse); 3. Dyschezia (painful defecation); 4. Perimenstrual spotting
Q1344. How do you treat endometriosis?
A1344. 1. Birth control pills; 2. Danazol and GnRH agonists; 3. Surgery & Cautery; 4. In older patients: Hysterectomy & Bilateral salpingoopherectomy
Q1345. Candida: Findings and treatment
A1345. 1. Findings: ""cottage cheese," pseudohyphae on KOH prep, History diabetes, antibiotic treatment, pregnancy. 2. Treatment: Topical or oral antifungal
Q1346. Trichomonas vaginalis: Findings and treatment
A1346. 1. Findings: Bugs swimming under microscope, pale green, frothy, watery, discharge, "Strawberry cervix"; 2. Treatment: Metronidazole
Q1347. Gardnerella vaginalis: Findings and treatment
A1347. 1. Findings: Malodorous discharge, fishy smell on KOH prep, clue cells; 2. Treatment: Metronidazole
Q1348. HPV: Findings and treatment
A1348. 1. Findings: Venereal warts, koilocytosis in PAP smear; 2. Treatment: Acid therapy, cryotherapy, laser therapy, podophyllin
Q1349. Herpes virus: Findings and treatment
A1349. 1. Findings: Multiple shallowl, painful ulcers, recurrence and resolution; 2. Treatment: Acyclovir
Q1350. Syphilis (stage 1): Findings and treatment
A1350. 1. Findings: Painless chancre, spirochete on dark-field microscopy; 2. Treatment: Penicillin
Q1351. Syphilis (stage 2): Findings and treatment
A1351. 1. Findings: Condyloma lata, maculopapular rash on palms, serology is positive at this point. 2. Treatment: Penicillin
Q1352. Chlamydia trachomatis: Findings and treatment
A1352. 1. Findings: Most common STD, dysuria, positive culture and antibody tests; 2. Treatment: Doxycycline or azithromycin
Q1353. Neiserria gonorrhea: Findings and treatment
A1353. 1. Findings: Muculopurulent cervicitis; gram negative bug on Gram-stain; 2. Treatment: Ceftriaxone or fluoroquinolone
Q1354. Molluscum contagiosum: Findings and treatment
A1354. 1. Findings: Characteristic appearance of lesions, intracellular inclusions; 2. Treatment: Curette, cryotherapy, electrocauterization/coagulation
Q1355. Pediculosis: Findings and treatment
A1355. 1. Findings: "Crabs," look for itching, lice can be seen on pubic hairs; 2. Treatment: Permethrin cream (or lindane)
Q1356. What do you need to treat for if you suspect a patient has gonorrhea?
A1356. You need to treat for gonorrhea, with Ceftriaxone or fluoroquinolone. You also need to treat for presumed chlamydial infection, with doxycycline or azithromycin.
Q1357. What do you need to treat for if you suspect a patient has chlamydia?
A1357. You need to treat for chlamydia, with doxycycline or azithromycin.
Q1358. How do you treat chlamydia in pregnancy?
A1358. Instead of doxycycline or azithromycin, use erythromycin.
Q1359. In a patient over 40, with dysmehorrhea, metrorrhagia, and a large, boggy uterus on physical exam: 1. What do you suspect? 2. How do you diagnose? 3. How do you treat?
A1359. 1. You suspect Adenomyosis; 2. Diagnose with dilation and curettage to rule out endometrial cancer; 3. Treat with hysterectomy, or GnRH agonists to relieve symptoms
Q1360. What is the relationship between leiomyomas and hormones?
A1360. Leiomyomas are estrogen-dependent. Rapid growth occurs during pregnancy or use of oral contraceptive pills, while regression occurs after menopause.
Q1361. What is the management of dysfunctional uterine bleeding after the age of 35?
A1361. 1. D&C to rule out endometrial cancer; 2. Hemoglobin & Hematocrit (or CBC) to make sure that the patient is not anemic from excessive blood loss.
Q1362. What is the most common nonphysiologic cause of dysfunctional uterine bleeding?
A1362. Polycystic ovarian syndrome
Q1363. How do you treat polycystic ovarian syndrome?
A1363. Oral contraceptive pills or cyclic progesterone
Q1364. What is the sequence of steps in evaluating infertility?
A1364. 1. History and physical exam; 2. Semen analysis: (>1ml, >20million/ml, >50% moving forwards, >60% normal morphology); 3. Documentation of ovulation (check basal body temperature, luteal phase progesterone levels, endometrial biopsy); 4. Hysterosalpingogram; 5. Laparoscopy (last resort)
Q1365. What medications are used to restore female fertility?
A1365. 1. Clomiphene citrate (ovulation induction in a woman with adequate estrogen); 2. Human menopausal gonadotropin (combination of FSH and LH to induce ovulation in a woman who is hypoestrogenic); 3. If medications fail: use IVF
Q1366. What are the causes of secondary amenorrhea?
A1366. PCOS, anorexia, endocrine disorder (think of a pituitary tumor in a woman with headaches, galactorrhea, and visual field defects),; antipsychotics (due to increased prolactin),; previous chemotherapy (which causes premature ovarian failure and menopause),; and menopause.
Q1367. What is the pathophysiology of exercise-induced amenorrhea?
A1367. Exercise-induced depression of GnRH.
Q1368. What is required to make a diagnosis of anorexia?
A1368. Amenorrhea
Q1369. How do you evaluate the cause of secondary amenorrhea? (If SUFFicient estrogen)
A1369. 1. Rule out pregnancy (check hCG); 2. Do H & P to look for obvious causes; 3. Administer progesterone to assess the patient's estrogen status. If vaginal bleeding develops within 2 weeks, the patient has sufficient estrogen. Check LH. If high, consider PCOS. If low or normal, check prolactin and TSH levels. High TSH levels in hypothyroidism cause high prolactin levels. If the prolactin is high with a normal TSH level, order an MR scan of the brain to rule out pituitary prolactinoma. If prolactin is normal, then look for low levels of GnRH, which may be induced by drugs, stress, or exercise. In these patients, clomiphene may be used to facilitate pregnancy.
Q1370. How do you evaluate the cause of secondary amenorrhea? (If INSUFFicient estrogen)
A1370. 1. Rule out pregnancy (check hCG); 2. Do H & P; 3. Administer progesterone. If no bleeding: estrogen levels are inadequate. 4. Check FSH. If elevated, premature ovarian failure is the problem, check for autoimmune disorders, karyotype abnormalities, history of chemotherapy. If FSH is low or normal, problem may be a brain tumor (craniopharyngioma). Order an MR of the brain.
Q1371. When do you suspect primary amenorrhea?
A1371. If no menstruation by the age of 16, no secondary sexual characteristics by age 14, or no menstruation within 2 years of secondary sex characteristics.
Q1372. What is the algorhythm for diagnosing the cause of amenorrhea?
A1372. 1. Pregnancy test; 2. If negative, administer progesterone; 3. Evaluate if bleeding or no bleeding; 4. With symptoms of hypothyroidism or pituitary tumor, order TSH and/or prolactin
Q1373. What medications can cause nipple discharge?
A1373. OCPs,; hormone therapies,; antipsychotics,; hypothyroidism symptoms.
Q1374. How do you evaluate bilateral, non-bloody nipple discharge?
A1374. 1. Check prolactin level to evaluate prolactinoma; 2. Check TSH to evaluate for endocrine disorder
Q1375. How do you evaluate unilateral, bloody nipple discharge?
A1375. 1. Biopsy if any mass is present.
Q1376. What are the characteristics of fibrocystic disease? What is the management?
A1376. 1. Bilateral, multiple, cystic lesions tender to the touch. 2. OCPs, progesterone or danazol to relieve symptoms.
Q1377. What are the characteristics of a fibroadenoma? What is the management?
A1377. 1. Painless, discrete, sharply circumscribed, unilateral, rubbery, mobile mass. 2. Observe, pregnancy and OCPs may stimulate growth, since these are hormone-dependent. Excision for cosmetic reasons.
Q1378. What are the characteristics of mastitis/abscess? What is the management?
A1378. 1. Swollen, erythematous breasts postpartum. 2. Treat with analgesics, continue to breastfeed, if severe symptoms, give antistaphylococcal antibiotics (Cephalexin, dicloxacillin). If fluctuant mass develops, or no response to antibiotics, mass is likely present and must be drained.
Q1379. What is the main sign of fat necrosis in the breast?
A1379. History of trauma in the area of the mass.
Q1380. How do you diagnose a breast lesion in women <30?
A1380. Ultrasound or biopsy. Do not to mammography, because breast tissue is too dense to discern a mass.
Q1381. Causes and symptoms of a cystocele
A1381. Bladder bulges into upper anterior vaginal wall. Symptoms include urinary urgency, frequency, and/or incontinence.
Q1382. Causes and symptoms of a rectocele
A1382. Rectum bulges into the lower posterior vaginal wall. Watch for difficulty with defecation.
Q1383. Causes of an enterocele
A1383. Loops of bowel bulge into the upper posterior vaginal wall.
Q1384. Causes and symptoms of a urethrocele.
A1384. Urethra bulges into the lower anterior vaginal wall. Common symptoms include urinary urgency, frequency and/or incontinence.
Q1385. What are the risks of an IUD?
A1385. Increased risk of ectopic pregnancy and PID (Actinomyces!)
Q1386. What is the classic cause of ambiguous genitalia on step 2?
A1386. Adrenogenital syndrome (congenital adrenal hyperplasia). 90% caused by 21-hydroxylase deficiency.
Q1387. What are the symptoms of 21-hydroxylase deficiency? Treatment?
A1387. Females: ambiguous genitalia; Males: Precocious sexual development, salt-wasting, hyperkalemia, hypotension, elevated 17- hydroxyprogesterone. Treatment: Treat with steroids, IV fluids to prevent death.
Q1388. MCC ""bunch of grapes" protruding from a pediatric vagina?
A1388. Sarcoma botryoides, a malignant tumor
Q1389. How do you diagnose precocious puberty in males and females, and how do you treat and why?
A1389. 1. Girls <8 years old, Boys <9 years old. 2. If idiopathic, treat with GnRH analog until age is appropriate. 3. Prevent premature epiphysial closure.
Q1390. What causes vaginitis or discharge in prepubescent girls?
A1390. Vaginal foreign body,; sexual abuse,; candida; (RULE OUT diabetes!)
Q1391. What is the cause of vaginal bleeding in neonates?
A1391. Physiologic, due to maternal estrogen withdrawal. No treatment required.
Q1392. What are the benefits of estrogen therapy?
A1392. 1. Decreased osteoporosis and fractures (hip!); 2. Decreased coronary heard disease, because estrogen increases HDL; 3. Reduced hot flashes, genitourinary symptoms of menopause (dryness, urgency, atrophy-induced incontinence, frequency)
Q1393. What are the risks of estrogen therapy?
A1393. 1. Increased risk of endometrial cancer; 2. Increased risk of venous thromboembolism; 3. Possible increased risk of breast cancer; 4. Increased risk of gallbladder disease
Q1394. What are the side effects of estrogen therapy?
A1394. 1. Endometrial bleeding; 2. Breast tenderness; 3. Nausea; 4. Bloating; 5. Headaches
Q1395. What are the absolute contraindications to estrogen therapy?
A1395. 1. Unexplained vaginal bleeding; 2. Active liver disease; 3. History of thrombophlebitis or thromboembolism; 4. History of endometrial or breast cancer
Q1396. What are the relative contraindications to estrogen therapy?
A1396. 1. Known seizure disorder; 2. HTN; 3. Uterine leiomyomas; 4. Familial hyperlipidemia; 5. Migraines; 6. Thrombophlebitis; 7. Endometriosis; 8. Gallbladder disease
Q1397. What are the absolute contraindications to OCP use?
A1397. 1. Smoking after age 35; 2. Pregnancy; 3. Breast feeding; 4. Active liver disease; 5. Hyperlipidemia; 6. Uncontrolled HTN; 7. DM with vascular changes; 8. Prolonged immobilization of an extremity; 9. History of thromboembolism or thrombophlebitis; 10. CAD; 11. History of stroke, sickle cell, estrogen dependent neoplasm (breast, endometrial,), liver adenoma, cholestatic jaundice of pregnancy
Q1398. OCPs and surgery
A1398. Need to stop OCPs one month before elective surgery, restart 1 month after.
Q1399. Side effects of OCPs
A1399. Glucose intolerance,; depression,; edema,; weight gain,; cholelithiasis,; benign liver adenomas,; melasma,; nausea, vomiting,; headache,; hypertension,; drug interactions.
Q1400. Relationship between OCPs and ovarian and endometrial cancer?
A1400. OCPs reduce the incidence of ovarian cancer by 50%, also decrease incidence of endometrial cancer.
Q1401. 32 y/o w/R complex adnexal mass; What is the next best step?
A1401. 1. Exploratory laparotomy; 2. R salpingo-oophorectomy; 3. Send for frozen section; (if borderline ovarian CA, then resection is curative)
Q1402. 42 y/o w/history menometrorrhagia; 1. Next step?; 2. Possible diagnoses and management
A1402. 1. Endometrial sampling; 2. If hyperplasia (cystic, adenomatous, adenocarcinoma), treat with oral progesterone (Provera). If atypical hyperplasia, do hysterectomy.
Q1403. 62 y/o w/vulvar pruritus, white lesion in L labia minora. 1. Next step and likely result?; 2. Treatment?
A1403. 1. biopsy, vulvar carcinoma in situ; 2. Treat with wide excision, laser therapy, cryotherapy.
Q1404. 62 y/o w/2cm white lesion in L vaginal wall. 1. Next step?; 2. Treatment based on likely cause?
A1404. 1. Biopsy. Result is severe dysplasia of vaginal. 2. This is a precancerous lesion, perform laser removal or cryotherapy.
Q1405. What do you do for the following PAP smear results:; 1. ASCUS; 2. HPV; 3. Precancerous lesion
A1405. 1. Repeat PAP in 3-6 months; 2. Repeat PAP in 3-6 months; 3. Colposcopy w/bx.
Q1406. What is Meigs syndrome?
A1406. 1. Benign ovarian tumor (adnexal mass/benign fibroma); 2. Ascites; 3. R pleural effusion
Q1407. What is the most common cancer in women?
A1407. Breast cancer
Q1408. What is the cancer in women with the highest mortality?
A1408. Lung Ca
Q1409. What is the gynecologic cancer with the highest mortality? Why?
A1409. Ovarian cancer. It is silent.
Q1410. What is the most common gynecologic cancer in women?
A1410. Endometrial carcinoma.
Q1411. What is the most common cause of mortality in patients with ovarian carcinoma?
A1411. Bowel obstruction.
Q1412. What is the most common cause of mortality in women?
A1412. Heart disease
Q1413. What are the three most common cancers in females, and what cancers have the highest mortality in women?
A1413. Most common cancers:; 1. Breast; 2. Lung; 3. Colon. Highest mortality:; 1. Lung; 2. Breast; 3. Colon.
Q1414. Cervical cancer:; 1. Etiology; 2. MC symptom; 3. Histology; 4. Mortality
A1414. 1. HPV; 2. Post-coital bleeding; 3. Squamous cell carcinoma (ectocervix), 15% adenocarcinoma (endocervix); 4. Renal failure
Q1415. Endometrial cancer:; 1. Etiology; 2. MC symptom; 3. Histology
A1415. 1. Estrogen; 2. Post-menstrual bleeding; 3. Adenocarcinoma
Q1416. Ovarian cancer:; 1. Etiology; 2. MC symptom; 3. Histology; 4. Treatment; 5. Mortality
A1416. 1. Ovulation; 2. Ascites (be suspicious in a postmenopausal patient w/ascites); 3. #1 Epithelial #2 Germ cell #3 Stromal; 4. Debulking surgery (TAH-BSO, Omentectomy), cytoreductive surgery, Carboplatin and Taxol. 5. Bowel obstruction, secondary to seeding.
Q1417. What are the types of epithelial ovarian cancer, the symptoms, and the tumor marker?
A1417. #1: Serous; Then: Mucinous, Endometrioid, Brenner. Symptom: No pain, picked up in stage 3 due to slow growth. Tumor marker: CA-125.
Q1418. Ovarian germ cell cancer:; 1. Types; 2. Symptoms; 3. Tumor markers
A1418. 1. Dysgerminoma, endodermal sinus tumor, teratoma, choriocarcinoma; 2. Pain due to rapid growth. Picked up in stage 1. Teenagers. 3. Dysgerminoma: LDH, Endodermal sinus tumor: alpha fetoprotein, Teratoma, Choriocarcinoma: hCG.
Q1419. Ovarian stromal cancer; 1. Types; 2. Tumor markers
A1419. 1. Sertoli-Leydig cell tumors, or granulosa thecal cell tumor; 2. Hormones. Sertoli-Leydig: Testosterone. Granulosa- theca: Estrogen.
Q1420. Vulvar cancer:; 1. Etiology; 2. MC symptom; 3. Histology
A1420. 1. HPV; 2. Pruritus; 3. #1: Squamous cell carcinoma #2: Melanoma (black lesion) #3: Paget's disease (Red lesion)
Q1421. Vaginal cancer:; 1. Etiology; 2. MC symptom; 3. Causes
A1421. 1. HPV; 2. Bloody vaginal discharge; 3. #1: Squamous cell carcinoma #2: Adenocarcinoma (DES exposure causing clear cell carcinoma, or metastasis from cervical carcinoma.
Q1422. Fallopian tube cancer:; 1. Etiology; 2. MC symptom
A1422. 1. Unknown; 2. Clear, serous vaginal discharge.
Q1423. When does PAP screening begin?
A1423. at 21 years old.
Q1424. At which point can PAP smears be done every 2 years?
A1424. If PAP smears are negative for 3 years in a row.
Q1425. What are the effects of DES?
A1425. 1. Clear cell carcinoma; 2. Structural abnormalities (hypoplastic cervix, t-shaped uterus (increased incidence of miscarriage/ectopics); 3. Adenosis of vagina (columnar cells)
Q1426. What do the L and R ovarian veins drain into?
A1426. L ovarian vein: L renal vein; R ovarian vein: IVC