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370 Cards in this Set
- Front
- Back
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Breast screen:
-ACOG -USPSTF |
ACOG: q1-2 yrs 40 --> q1 yr 50
USPSTF: q2yrs 50 |
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OCP:
pregnancy rate (typical use) |
3%
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Increased osteoporosis:
-hyper- or hyperthyroid? -parathyroid? |
Hyper (both)
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Hypothyroid: increase osteoporosis?
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No
(unless o/d Synthroid) |
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Folate: increase or decrease homocysteine?
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Decrease (good)
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If pregnant woman has hyperhomocysteinemia --> admin what vitamin?
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Folate
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Folate supplement:
-normal preg -h/o NTD |
Normal: 400 MICROgrams
NTD: 4 MILLIgrams |
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Hemodilution of preg: peaks which week?
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w36
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MCV: increase or decrease?:
-iron def -folate def |
Iron: decrease MVC
Folate: increase |
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Physiologic dyspnea of preg: worse which TM?
|
TM3
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Preg: increase or decrease:
-diaphragm excursion -subcostal angle of diaph |
Increase diaphragm excursion (elevates 4cm)
Increase angl: 68-103 |
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Which tocolytic:
S/E PULMONARY EDEMA |
TERBUTALINE
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Terbutaline: beware which specific S/E?
|
Pulmonary edema
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Normal preg: increase or decrease:
-HR -SV |
Both INCREASE
(increase 33% CO) |
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What % pregs have syst murmur?
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95%
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Progesterone: relax or contract SM?
|
Relax
(e.g. see ureter dil) |
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Normal preg: increase or decrease:
-TBG -total T4 |
Increase (both)
(no change free T4) |
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What dz:
SNOWSTORM UTERUS |
gest trophoblastic dz
|
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If see snowstorm uterus --> order what other image?
|
CXR
(GTD --> #1 mets to lungs) |
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Another name for:
human placental lactogen |
chorionic somatomammotropin
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HPL: increase or decrease glucose uptake?
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Decrease (i.e. anti-insulin)
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Can glycosuria in preg be normal?
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YES - increase GFR AND impaired tubular reabs
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Cross placenta?:
-insulin -glucose |
insulin: NO (peptide)
glucose: yes via carrier-mediated |
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What tests to screen for Hgb abns?
|
CBC & electrophoresis
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What genetic disease:
-most common in Mediterraneans |
Beta-thal
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Safe in preg?:
Valproic acid |
No - NTDs, hydroceph, craniofacial malforms
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Poorly-controlled IDDM --> what fetal malforms (2)
|
Cardio
NTDs |
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When perform:
CVS |
10-12w
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CVS: able to detect?:
-chromo abns -NTDs |
Chromo yes
NTDs no |
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CVS: % fetal loss?
|
1%
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#1 inherited MR
|
Fragile X
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COMBINED TEST (NT + PAPP-A + HCG):
-detect what % Downs? -% FP? |
85% Downs, 5% FP
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Abn GTT (#s)
|
95 --> 180 --> 155 --> 140
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BMI >30: limit how much wt gain in preg?
|
limit 10-20 lbs
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Organogenesis: ends what week?
|
w8
(no risk teratogens if >8w) |
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Pt should RTC for r/o labor if:
-what freq cxns? -what freq kicks? |
1 cxn per 5 mins x 1hr
<10 kicks per 2h |
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Place IUPC --> significant vaginal bleed
-suspect what etio? -next step? |
Uterine perf
W/D --> monitor fetus --> reattempt IUPC |
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Midline or mediolateral episio:
More pain |
Mediolat
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Midline or mediolateral episio:
Less blood loss |
MIDLINE
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Midline or mediolateral episio:
Increased risk 3-4' tears |
Midline
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4th stage labor: how define?
|
0-2h postpartum
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Which tocolytic:
S/E resp depress infant |
Mg sulfate
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Chorio: infant appears RED or PALE?
|
Pale
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GDM: infant risks:
-hypo or hypergly? -polycythemia or anemia? -hypo or hyperbiliruin? |
Hypogly
Polycyth Hyperbilirubinemia |
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Infant w/out resp effort:
-what intervention? what position? |
PPV (10L/min) in SNIFFING position (NOT flex)
(NOT suction - doesn't stim resp) |
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#1 etio PPH
|
Uterine atony (1:20 preg)
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Sheehan: lose which hormones?
|
FSH
LH TSH ACTH |
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#1 etio post-partum fever
|
Endometritis
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Endometritis:
-what % C/S? -SVD? |
10% C/S
1% SVD |
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Endometritis:
-which pathogens? (3 groups) |
Staph
Strep Anaerobes |
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Post-partum blues: what %?
|
40-80%
|
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Should you prevent lactation with bromocriptine?
|
NO --> risk thromboembo --> CVA, HTN, szs
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Breast-feed: supplement what vitamin?
|
IRON
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Does breast milk contain adeq iron?
|
NO
|
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Inhibit or promote milk production?:
-E -P |
Both inhibit alpha-lactalbumin -> inh PRL --> inh milk production
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Why can woman not produce adeq milk d0-2?
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High E & P --> inh PRL --> no milk prod
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Sucking --> stim WHICH HORMONE?
|
Sucking --> stim OXY!!
(NOT PRL) |
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What dz:
Breast-feed --> burning nipples with PINK-SHINY PEEL |
Breast candidiasis
|
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Baby getting enough milk if:
-# stools/d -# wet diapers/d |
3-4 stools/d
6 diapers/d wt gain, sucking sounds |
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Tx engorgement:
Loose or tight bra? |
Tight
|
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Tx engorgement:
Safe to admin analgesic before feed? |
YES -- give 20 min before
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Ectopic tx: able to use MTX if:
-what size (#) w/heart beat? -w/out beat? |
<3.5cm w/beat
<4cm w/out |
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Tx recurrent SAB: when place cerclage?
|
14w (TM2)
|
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Does h/o surg abortion --> predispose to future SAB?
|
NO
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What maternal dz:
Caudal regression syndrome |
DM
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DM:
see oligo or poly? |
Poly
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Safe in preg?:
Amitriptylline |
Safe
(use to tx HAs) |
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Safe in preg?:
Lisinopril |
No
S/E oligo, IUGR, neonate RF, pulm hypoplasia, joint contractures |
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Which anti-HTN in preg:
S/E joint contractures, pulm hypoplasia, IUGR/oligo |
Lisinopril
|
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HIV:
-when start po ZDV? -when start IV? |
po at 14w --> IV at L&D (regardless viral load)
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#1 etio sepsis in preg
|
Pyelo
|
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Safe in preg?:
Cromolyn |
Yes
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Acute asthma attack in preg --> admin leukotriene inh?
|
NO
-not useful acute -unclear safety |
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Which White Class?:
Onset >20yo |
B
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Which White Class?:
Duration <10 yrs |
B
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Which White Class?:
Onset 10-19yo |
C
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Which White Class?:
Duration 10-19 yrs |
C
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Which White Class?:
Onset <10yo |
D
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Which White Class?:
Duration >20 yrs |
D
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Which White Class?:
Nephropathy |
F
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Which White Class?:
Retinopathy |
R
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What % mothers die in preg if:
Pulm HTN |
25%
|
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What % mothers die in preg if:
Ao coarct |
25%
|
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What % mothers die in preg if:
Marfan |
25%
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How tx: preg & obstructed ureter:
-initial -after 72h |
IVF + abx
if no improve: U/S w/double J stent |
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Breast cancer in preg: safe to admin:
-chemo? -XRT? |
Chemo yes
XRT no |
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Safe in preg?:
Paroxetine |
No; cardiac malforms, pulm HTN
|
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Which anti-dep:
S/E cardiac malforms, pulm HTN |
Paroxetine
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If suspect appendicitis in preg --> order what image?
|
Graded compression U/S
|
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How protein in urine:
-mild preeclamp -severe |
Mild: >300 mg
Severe: >5g |
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Mg:
-therapeutic range -lose DTRs -Resp depress -Cardiac arrest |
Therapeutic: 4-7
Hyporeflex: 7-10 Resp depress: 12 Cardiac: 15 |
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Severe preeclamp REMOTE FROM TERM: deliver if:
-plts < ___ (#) -uncontrolled BP on ___ (#) meds -LFTs increased by __x |
Plts <100k
No control 2 meds LFTs 2x |
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Severe preeclampsia: is delivery based on DEGREE of oliguira?
|
No
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AFLP:
-develop ACUTE or INSIDIOUS? |
INSID: days-weeks
|
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What preg dz:
n/v; epigastric pain; progressive jaundice; VOMIT IN TM3; hypoglycemia |
AFLP
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AFLP: see increased or decreased:
-glucose -BP -fibrinogen -albumin -cholesterol -clot time |
Hypogly
HYPERTENSION Hypofibrinogen Hypoalbumin HYPOCHOLESTEROL Prolonged clot time |
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Severe preeclamp: goal DBP
|
90-100
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What dz:
child given abx --> itchy vagina |
Candida
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Possible to perform SVE on child?
|
NO - always examine under anesth
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Molar preg: more common WHITE or ASIAN?
|
ASIAN
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Molar preg:
Assoc w/defs in which 2 vitamins? |
Folate
B-carotene |
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Molar preg: ALL pts present w/what sign?
|
Painless vaginal bleed
|
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Molar preg:
Assoc w/HTN? Obese? Parity? |
No
|
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Molar preg: see:
-maternal tachy or brady? -mat hypo or HTN? |
Tachy, HTN
(increase bHCG --> stim thyroid) |
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Molar preg:
D/C --> tx w/OCPs for how long? |
OCPs x6mos
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What mole type?:
Egg fertilized by disperm |
Partial
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What mole type?:
XXY |
Partial
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What mole type?:
XXX |
Partial
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What mole type?:
XYY |
Partial
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What mole type?:
XX |
Complete
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Invasive GTD: tx w/what modality?
|
CHEMO (easily cured)
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Mole: low or high risk of recurrence?
|
Low (1-2%)
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Choriocarcinoma: dx via bx?
|
NO - lesions are vasc --> met
|
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#1 vulvar malig
|
SCC of vulva
|
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Vulvar SCC: tx w/wide excision if:
<___ (diam) & <___ invasion |
<2cm diam + <1mm invasion
|
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What VULVAR dz:
Elevated, firm, erythematous, ulcerated & itchy lesion |
SCC
|
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Vulvar SCC: assoc w/smoking?
|
YES
(esp HPV) |
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What VULVAR dz:
Assoc w/BREAST cancer |
Paget's dz of vulva
|
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What VULVAR dz:
fiery-red plaques w/lacy white mottling (NOT discrete mass) |
Paget's dz of vulva
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What VULVAR dz:
Cauliflower |
Verrucous carcinoma
|
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What VULVAR dz:
SHINY, non-pigmented papules w/central umbilication |
Molluscum (poxvirus)
|
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Trichloroacetic acid: txs what vulvar dz?
|
WARTS
(NOT VIN) |
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How tx:
- single VIN III -multifocal |
Single: Local supericial exicision
(NOT cryo, TCA) Mult: CO2 laser ablation |
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Next step:
-ASCUS in <21yo -ASCUS in >21yo |
<21: Pap in 12mos
(NOT colpo) >21: colpo OR Pap in 6mos |
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What Pap schedule in HIV+ pt?
|
initial Pap --> repeat 6mo --> annual
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Next step:
HGSIL & visible lesion --> negative ECC --> ? |
CONE BX
|
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Next step:
CIN I w/positive ECC |
Cone bx
|
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Next step:
Pap w/adenocarcinoma in situ |
Cone bx
|
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Next step:
HGSIL --> "negative colpo bxs" |
Cone bx
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Relation to BM:
-CIN III -CIS -microinvasive cancer |
CIN III & CIS: extend to BM but not beyond
Micro: 2-3mm beyond BM |
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#1 sxs fibroids
|
Menorrhagia (heavy scheduled bleed)
|
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What dz:
14-16w sized uterus; heavy bleed; perimeno |
Fibroids
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Fibroids in preg: how tx?:
-small fibroid -fibroids in LUS/cervix? |
Small: no tx
LUS: may req C/S |
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Myomectomy:
-safe in preg? -safe at C/S? |
preg: no
C/S: NO - may increase blood loss |
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What fibroid type:
Most likely to cause infertility |
Submucosal
|
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What fibroid type:
Tx: hysteroscopic resect |
Submucosal
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Fibroids: max duration GnRH
|
3-6mos
|
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Top 5 female cancers
|
1. Breast
2. Lung 3. Colorectal 4. Endometrial 5. Ovarian |
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#1 sx endometrial cancer
|
post-meno bled
|
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What dz:
thin yellow discharge; abn post-meno bleed; lower abd discomfort |
endomet cancer
|
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If bx reveals endometrial cancer --> order what other image?
|
CXR
|
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How tx:
-EARLY endometrial cancer -High-grade/metastatic |
Early: TAH-BSO + pelvic-paraaortic lymphadenectomy (BILAT) + washings
High-grade: omentectomy |
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Tamoxifen:
-increase what type cancer? automatic bx? |
Endometrial
Only bx if BLEED/sx |
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Ovarian cancer:
-Whites or Blacks? -Smoking? |
W > B
NOT assoc smoking |
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Ovarian cancer:
OCPs in/decrease risk? |
DECREASE (inhibit ovulation)
|
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Ovarian cancer:
How dx mets/spread? (what image) |
Abd/pelv CT
(only PET if KNOW mets or detect recurrence) |
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Ovarian cancer:
What 2 chemo agents |
Cis-plat
Taxane |
|
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Ovarian cancer:
Is px correl w/tumor stage? |
YES
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Feto-maternal hemorrhage: usually how many cc's? enough to sensitize mother?
|
<0.1cc
Enough to sens |
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Best test to detect fetal ANEMIA
|
MCA peak syst velocity
|
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Fetal hydrops: see poly/oligo
|
Poly
|
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Admin how much Rhogam to neutralize 30 cc fetal blood?
|
300 ug
|
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TTTS: what type of twins
|
Monochorion, monoamnion
|
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DeltaOD: suspect erythroblast fetalis if what spectrum?
|
420-460nm
|
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Liley curve:
-detect what comp? |
Erythroblastosis fetalis
(via deltaOD) |
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Zone 3 of Liley curve:
-IUFD w/in how many days? -how tx? |
7-10d
IU transfusion OR delivery |
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What % deliver PRETERM:
-twins -tirplets -quads |
50% twins
90% trips 100% quads |
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SAb: most common ANEUPLOIDY
|
Trisomy 16 (!!!)
|
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What gest age:
Greatest risk M.R. & microceph |
8-15w
|
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Factor V Leiden: affect risk of:
-preeclam? -stillbirth? -abrupt? |
Yes -- increase all
|
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If 1 twin dies (not delivered) --> order what bi/weekly tesT?
|
FIBRINOGEN
(risk coagulopathy) |
|
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Name for:
Overlapping fetal skulls --> suggests IUFD |
Spaulding sign
|
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Spaulding sign: what is it?
|
Overlapping fetal skulls (suggest IUFD)
|
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How tx:
-Arrest in LATENT phase -Arrest of dilation in ACTIVE phase (3 steps) |
Latent: rest or pit
Active: AROM --> pitocin --> place IUPC |
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Affect position?:
-Previa -Fibroids? |
Both lead to BREECH
|
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How define: prolonged latent phase in:
-nullip -multip |
Null: >20h
Multip: >14h |
|
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Arrest in latent phase: can you AROM?
|
NO -- increase infxn
|
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How define: secondary arrest of dilation
|
no change cervix 2h
|
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How tx:
Previa near-term & 2nd bleed |
C/S
|
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What blood replacement product:
Fibrinogen + V + VII |
FFP
|
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What blood replacement product:
Fibrinogen + VIII + vWF |
Cryo
|
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Contains which factors:
-FFP -Cryo |
FFP: fibrinogen + V + VII
Cryo: fibrino + VIII + vWF (NEITHER CONTAIN RBCs, plts) |
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vWD: admin which replacement product?
|
CRYO
(fibrino + VIII + vWF) |
|
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Smoking: increase risk macrosom?
|
NO --- incresae IUGR
|
|
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Threatened Ab: more common TM1 or 2?
|
1
|
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How tx:
Cxns + no cervical change |
OBS
(50% preterm cxns spont resolve) (do NOT admin steroids; not labor) |
|
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Which tocolytic contraindicated?:
DM (2) |
Terb
Ritodine |
|
|
Which tocolytic contraindicated?:
Myasthenia Gravis |
Mg
|
|
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Which tocolytic contraindicated?:
>33w |
Indomethaicn
|
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Indomethacin: do not administer (tocolytic) after what age?
|
>33w
|
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Terbutaline: contraI in what dz?
|
DM
|
|
|
Ritrodine: contraI in what dz?
|
DM
|
|
|
Mg sulfate: contraI in what dz?
|
Myasth gravis
|
|
|
Which tocolytic:
Competes w/Ca for entry |
Mg
|
|
|
Which tocolytic:
Increases cAMP |
Terb/ritro
|
|
|
Terbutaline: mxn of action?
|
Increase cAMP --> decrease Ca+
|
|
|
Which tocolytic:
Inhibits Ca2+ transport |
Nifedipine
|
|
|
Which tocolytic:
Blocks prostaglandin prod |
Indomethacin
|
|
|
Which tocolytic:
S/E fetal hypoxia, decrease uteroplacental BF |
Nifedipine
|
|
|
Do steroids affect risk of intracerebrla hemorr?
|
DECREASE
|
|
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Terbutaline: contraI in what dz?
|
DM
|
|
|
Ritrodine: contraI in what dz?
|
DM
|
|
|
Mg sulfate: contraI in what dz?
|
Myasth gravis
|
|
|
Which tocolytic:
Competes w/Ca for entry |
Mg
|
|
|
Which tocolytic:
Increases cAMP |
Terb/ritro
|
|
|
Terbutaline: mxn of action?
|
Increase cAMP --> decrease Ca+
|
|
|
Which tocolytic:
Inhibits Ca2+ transport |
Nifedipine
|
|
|
Which tocolytic:
Blocks prostaglandin prod |
Indomethacin
|
|
|
Which tocolytic:
S/E fetal hypoxia, decrease uteroplacental BF |
Nifedipine
|
|
|
Do steroids affect risk of intracerebrla hemorr?
|
DECREASE
|
|
|
FFN:
-normal in first 1/2 preg? -indicates feto-mat injury at which week? |
NORMAL in first 1/2
22-34w: feto-mat injury |
|
|
FFN: low or high NPV?
|
HIGH NPV (99%)
-if neg --> baby will not deliver in 14d |
|
|
Role of steroids controversial at how many weeks?
|
>32
|
|
|
Goal of tocolysis in PROM?
|
Admin steroids
(NOT prolong preg) |
|
|
#1 risk PPROM
|
Infxn (esp BV)
|
|
|
PPROM at 28-34 weeks: what % will be in labor:
-w/in 24h -w/in 48h |
24h: 50%
48h: 80% |
|
|
PPROM: abx can prolong preg how many days?
|
5--8d
|
|
|
Amnio in chorioamnionitis: increase or decrease:
-AF glucose -IL-6 |
glucose: decrease
IL-6: increase (presences of WBCs has LOW PPV) |
|
|
h/o PPROM --> affect risk future PPROM?
|
YES - 30% recurrence
|
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|
Methylergonovine: use?
|
Uterotonic (induce labor)
|
|
|
Which uterotonic agent contraI:
HTN, preeclamp |
Methylergonovine:
|
|
|
Which uterotonic agent contraI:
Asthma |
PGF2
|
|
|
Affect risk of retained placenta?:
-prev curretage? -fibroids? -parity? -circumvallate placenta? -pitocin use? |
Increase risk: curretage, fibroids
No: parity, cicumvallate, pit |
|
|
How tx:
uterine atony s/p oxy |
IM PGF2
|
|
|
How tx:
Uncontrolled PPH |
Hypogastric ligation --> THEN hyst (last resort)
|
|
|
Hyperthyroid: how affect menses?
|
Freq & irreg
|
|
|
Next step:
known genital warts + ASCUS |
HPV-type
(determine if high-risk type) THEN proceed colp or repeat 6mo |
|
|
What dz:
Thayer Martin media |
Gonorrhea
|
|
|
What dz:
Darkfield |
Syph
|
|
|
What dz:
NT, non-itchy vulvar plaques; brown rash on palms & soles |
Condyloma lata (SYPHILIS)
|
|
|
What dz:
Condyloma lata |
Syph
|
|
|
Syphilis: are plaques tender/itchy? contain spirochetes?
|
NT, non-itchy
YES - contain spirochetes |
|
|
What dz:
yellow, FROTHY discharge |
Trich
|
|
|
What dz:
strawberry cervicitis |
Trich
|
|
|
What dz:
PMNs w/multicelll giants |
Herpes
|
|
|
HSV: what is GOLD standard dx?
|
culture
(10-20% FN) (better than Ab) |
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Endometritis: mono/poly? an/aer?
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Poly, mostly ANAEROBES
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Endometritis: admin abx for how long?
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Until 24h afebrile
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Endometritis: which abx?
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Gent + amp
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What POST-PARTUM complication?:
Spiking high fever + non-responsive to abx |
Septic thrombophlebitis
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Septic thrombophleb: responds to abx?
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No
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Septic thrombophlebitis: low or high fevers?
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Spiking high
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What POST-PARTUM complication?:
Wound w/GRAY EDGES |
Nec fasc
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How tx:
Septic thrombophlebitis |
abx + (ST) anticoag
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What rating (A-X):
Human studies --> ok in preg |
A
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What rating (A-X):
Animal studies --> ok in preg |
B
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What rating (A-X):
Animal studies --> bad |
C
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What rating (A-X):
Human studies --> bad |
D
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What rating (A-X):
NEVER IN PREG |
X
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Sertlaine: what CLASS of meds?
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C (animal studies -> bad in preg)
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Safe in BREAST FEED?:
SSRIs |
Secreted but negligble effect --> SAFE
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Premens Dysphoric Disorder: which mens PHASE?
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LUETAL (NOT follicular)
imp to ascertain timing of sxs |
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Placenta sulfatase deficiency: leads to pre- or post-temr?
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POST
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Fetal adrenal HYPOplasia: leads to pre- or post-term?
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POST
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Post-term: how affect risk of preeclamp?
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No change risk
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How tx:
41-42w and NOT want induction |
2x NST & AFI per week --> INDUCE if not reactive or decreased AFI
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Amnioinfusion w/NS: how affect risk of:
-variable decels -NICU admit -meconium asp |
Decels: DECREASE
NICU & meconium asp: no change |
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How tx:
Post-term & repetitive variable decels |
AMNIOINFUSION
(regardless meconium status) |
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What dz:
Increase SYST:DIAST in umbilical artery |
IUGR
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IUGR: see increase or decrease SYST:DIAST in umbilical art?
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INCREASED ratio
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Which bacteria:
Leads to IUGR? |
TRICK - no bact
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IUGR: increased risk:
-anemia or polycythemia? -polyhydramnios? |
Polycythemia
IUGR does NOT increase risk of poly |
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C/S indications:
-BPD > ___ (#) -DM + wt >___ (#) -nonDM + wt > ___(#) |
BPD >12
DM >4,000g nonDM >4,500 |
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Forceps or vacuum:
More vaginal lacs |
Forceps
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Forceps or vacuum:
Transient lateral rectus paralysis |
Vacuum
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Vacuum: see transient paralysis of which muscle?
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Lateral rectus
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What dz:
SYMM FETAL GROWTH RESTRICTION + polyhydramnios |
Trisomy 18
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Trisomy 18: see A/SYMM growth restrict? oligo/poly?
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SYMM restrict
Poly |
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Abortion:
If 1st low-dose OCP leads to n/v --> how admin 2nd dose? |
Intravag
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OCPs: in/decrease risk of:
-endomet cancer -ovarian -breast |
Decrease endomet & ovarian
Increase breast |
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BTL: how affect risk of:
-ovarian cancer -endomet cancer -endometriosis -mens flow |
DECREASE OVARIAN CA
No change others |
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Mirena: how affect risk of endomet cancer?
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DECREASE
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Estrogen patch: contraI if >___(lbs)
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>200lbs
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Which contraceptive:
increased risk thromboembo |
PATCH
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How tx:
septic abortion (any age) |
abx + EVACUATE (never med abortion)
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W/U of what dz?:
Russel viper venom time |
Antiphospholipid synd
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Antiphospholipid synd: what 3 labs to w/u?
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Anticardiolipin Abs
PTT Russel viper |
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Antiphospholipid synd:
-how tx? -what success preg? |
Hep + ASA
75% success |
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Medical or surgical abortion: higher blood loss?
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MEDICAL!!
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Abortion: when perform:
-manual vacuum -D&C -D&E |
vacuum: <8
D&C: <16 D&E: 16-24 |
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Next step:
Medical abortion --> heavy bleeding (hct 29) |
D&C
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What dz:
Thin gray discharge |
BV
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What dz:
Modified Amsel Criteria |
BV
1. thin grey 2. whiff 3. clue 4. ph >4.5 |
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What dz:
Vulva pain/itch + BLEEDING GUMS + wrist rash + ALOPECIA |
Lichen Planus
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Tx inpt or outpt?:
PID w/high fever |
INPT
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PVR:
-normal -if >300 --> what dz? |
Normal 50
>300 --> overflow incont |
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What type incontinence:
Urethral hypermobile |
Stress
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What type incontinence:
Urethral angle >30 |
Stress
(hypermobile) |
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Stress incontinence: how tx:
- hypermobile urethra - intrinsic sphincter defect |
Hypermobile urethra: Urethroplexy OR sling
Spincter defect: Urethral BULKING |
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Tx what underlying etiology of incont:
Urethroplexy |
Stress 2/2 hypermobile urethra
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Tx what underlying etiology of incont:
Sling |
Stress 2/2 hypermobile
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Tx what underlying etiology of incont:
Bulking |
Stress 2/2 intrinsic sphincter defect
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What dz:
Drain-pipe urethra; contin leak urine |
Intrins sphincter defect --> stress incont
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Tx what dz:
OXYBUTYNIN (anticholin) |
Urge incont (detrussor instab)
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Urge incont (detrussor instab): tx w/what drug?
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OXYBUTYNIN
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Surg repair CENTRAL & LATERAL cystoceles: fix which FASCIA to sidewall?
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Pubocervical
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Should you offer induction to WELL-CONTROLLED GDM?
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yes -- 39-40w
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Endometrioma: how appear on U/S?
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COMPLEX cyst
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Endometriosis: what labs/imaging to confirm?
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Trick! none, req lap
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Hemorrhagic cyst: how appear U/S? how tx?
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COMPLEX or SIMPLE!
f/u U/S in 2 mos to r/o cancer |
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Next step:
Highly suspect ovarian torsion but normal Doppler --> |
IMMED SURG
-normal Doppler does not mean no torsion |
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How tx:
Endometriosis & infertile |
Clomiphene --> surg (if meds fail)
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Next step:
Adolescent p/w chronic pelvic pain |
DIAGNOSTIC LAP! --> r/o endometriosis & IUA
-do NOT use GnRH agonist in adol |
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How long use GnRH agonists in adolescents?
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Trick! No use GnRH in adols
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What dz:
Urinary urge, freq, dysuria, nocturia; chronic pelvic pain |
Interstitial cystitis (chronic inflamm bladdeR)
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What drug:
Suppresses mid-cycle FSH & LH |
DANAZOL
(NOT GnRH agonst: dysreg HPA production of FSH/LH) |
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Mxn of action:
-GnRH agonist -Danazol |
GnRH agon: suppress HPA production of FSH/LH
Danazol: suppress midcycle LH/FSH |
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What dz:
Pelvic varicositis; fullness in vulva & legs; vaginal discharge |
Pelvic congestion syndrome (2/2 high estrogen --> vasodil)
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Low transverse skin incision: risk entrapment of which nerves?
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Iliohypogastric (T12-L1)
Ilioinguinal (T12-L1) |
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Which nerve:
Sensation of GROIN & skin over PUBIS |
Iliohypogastric
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Which nerve:
Sensation of LABIUM & UPPER THIGH |
Ilioinguinal
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Next step: breast lump & FNA --> shows:
-clear fluid -blood |
Clear: f/u 2mos
Blood: mammo + excision bx |
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Breast cancer:
Is LAD tender or not? Mobile? |
NONTENDER
FIRM/FIXED |
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Mastitis: tx w/which abx?
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DICLOXACILLIN
(covers staph aureus) (ERYTHRO if pen-resistant) |
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Next step:
Positive ECC |
COLD KNIFE
(NOT LEEP) |
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Next step:
Cervical lesion extending into canal |
COLD KNIFE
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Next step:
Cannot remove IUD in office |
HysterOSCOPY
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Definitive tx of endometriosis
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Hyst PLUS BSO
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Radical hyst: txs what dz?
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Cervical cancer
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What genetic disorder:
Leads to premature ovarian failure |
Partial deletions of ovarian chromosome
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Partial deletions of X chromo:
Leads to what reprod dz? |
Premature ovarian failure
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What dz?:
Normal external genitals; no 2' sex; anosmia |
Kallman syndrome
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Kallman syndrome: how appear:
-ext genitals -2' sex |
Normal ext genitals
No 2' sex |
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Kallman syndrome: what defect?
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Olfactory tract hypoplasia --> arcuate no secrete GnRH
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Kallman syndrome: how tx?
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Pulsatile GnRH
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What dz?:
Olfactory tract hypoplasia --> arcuate no secrete GnRH |
Kallman syndrome
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What dz?:
Premature pulsatile GnRH |
True precocious pubery
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True precocious puberty:
-what underlying mxn? -how tx? |
mxn: premat pulsatile GnRH
tx: GnRH agonist |
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1' amenn: only w/u at what age?
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>17yo
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Premature ovarian failure: definition?
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<35yo
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What dz?:
Partial block conversion of 17-hydroxyprogest --> accum androgens --> early adrenarche |
CAH - 21 hydroxylase type
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21-hydroxylase deficiency: how present? how tx?
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block conversion 17-hydroxyP --> accum androgens --> EARLY ADRENARCHE
tx: replace steroids |
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Granulosa cell tumor: elevate what hormone?
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ESTROGEN
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deus, -i (m.)
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god
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Hirsutism: tx w/what drug?
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SPIRONOLACTONE
(aldosterone antagonist) |
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Due to E or P:
Proliferative endometrium |
E
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Due to E or P:
Secretory endomet |
P
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Anovulatory bleed: underlying etio? how tx?
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Unopposed E --> proliferative endometrium
Tx: admin P --> secretory endomet |
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Leuprolide: why not use >6mo?
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S/E osteoporosis
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What dz?:
BOGGY UTERUS |
ADENOMYOSIS
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Which presents at later age?:
Endometriosis or adenomyosis? |
Adeno
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Fibroids: encapsulated?
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NO
(well-circumscribed myometrial tissue) |
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Leiomyosarcoma: req how many mitotic figures/hpf?
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>10
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Pt w/pathologic fx:
-req DEXA to tx w/bisphosphonate? -DEXA how often? |
Tx w/out DEXA
DEXA q2-3y |
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PCOS: how affect LH:FSH?
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INCREASE LH:FSH ratio
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What drug:
Increase PRL --> 2' amenn |
IMIPRAMINE
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Imipramine: how affect serum PRL?
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Increase PRL --> 2' amenn
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Hypo or Hyper thyroid:
Increase PRL --> 2' amenn |
HYPOthyroid
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Hypothyroid: how affect serum PRL?
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INCREASE PRL --> 2' amenn
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Exercise-induced amenn:
-how affect FSH? estrogen? -how measure estrogenization? |
NO CHANGE FSH
Decrease estrogen PROGEST CHALLENGE TEST (see if w/d bleed) |
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PMS: give what 3 vitamins?
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A
B6 E |
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Txs what dz?:
McCall culdoplasty |
uterine prolapse
(hyst followed by plication of US ligaments) |
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Txs what dz?:
Sacrospinous ligament suspension |
Vaginal vault prolapse s/p hysterectomy
(also tx via abd sacral colpoplexy) |
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Txs what dz?:
Abdominal sacral colpoplexy |
Vaginal vault prolapse s/p hyst
(also tx via Sacrospinous ligament suspension) |
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#1 risk vaginal vault prolpase
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s/p hysterectomy
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What nerves to bladder carry:
-Symp (hold pee) -Parasymp (urinate) -somatic |
Symp: hypogastric (T10-L2)
Parasymp: Pelvic (S2-4) somatic: pudendal |
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Imipramine txs what type of incontinence?
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MIXED (urge & stress) - has anti-cholinergic & alpha-adrenergic props
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Leads to what type of incontinence?:
Detrusor insuff |
Overflow
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Leads to what type of incontinence?:
Detrusor areflexia |
Overflow
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What type of incontinence?:
Constant urinary dribbling |
Overflow
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What type of incontinence?:
Tx with CHOLINERGICS (bethanecol) |
Overflow incontinence (increase bladder contractility)
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Screen recs:
Cholesterol |
q5 45-75
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Screen recs:
BG |
q3 45+
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Screen recs:
Thyroid |
q5 50+
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Screen recs:
Osteoporosis (no risks) |
65
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Retained placenta --> UTERINE INVERSION:
Admin WHAT DRUG? |
HALOTHANE (relaxes uterus)
(once uterus returns position: stop halothane --> start pit) |
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Increased risk uterine inversion if placenta implants where?
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FUNDUS
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Raloxifene:
-drug class -tx what problem? |
SERM; txs bone loss
(NOT hotflashes) |
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How tx?:
Pt w/hotflashes but no want E |
CLONIDINE
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Clonidine: tx what problem?
|
Hotflashes
(alt to E) |
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Should you base estrogen replacement dose on FSH level?
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NO
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Necrotizing fasc: usu due ENDO or EXTOTOXINS?
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ENDO
(unless S aureus: exo) |
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What pathogen:
FLESH EATING BACT |
group A strep
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Necrotizing Fasc: how monitor hemodyn? (2 invasive)
|
Central ven cath
Swan-Ganz |
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Nec Fasc: which abx?
|
Pen + gent + metro
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How tx Staph Aureus infxn?
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nafcillin
vanco |
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Normal lenghts of LATENT and ACTIVE PHASES:
-nullip -multip |
nullip: <20h, >1.2 cm/h
multip: <14h, >1.5 |
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Arrested active phase: define
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No dilation x2h
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Anthropoid pelvis: predisp what position?
|
AntrOPoid --> OP
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What pelvis type?:
AP diam > transverse |
anthropoid
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