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83 Cards in this Set
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Workup for sudden onset of hirsutism or virilization during pregnancy when exam or US shows:
no ovarian mass |
Abdominal CT looking for adrenal mass
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Workup for sudden onset of hirsutism or virilization during pregnancy when exam or US shows:
bilateral cystic masses |
rule out high beta-HCG states-
most likely Theca Leutein cysts |
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Workup for sudden onset of hirsutism or virilization during pregnancy when exam or US shows:
bilateral solid masses |
reassurance- most likely pregnancy leutomas
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Workup for sudden onset of hirsutism or virilization during pregnancy when exam or US shows:
unilateral solid mass |
laparotomy or laparoscopic biopsy to r/o malignancy
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Clusters of pink lesions on the genitalia and treatment
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HPV/Genital warts and tricholoracetic acid or podophyllin in office for small lesions
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Algorithm for cervical dysplasia in:
adolescents post-adolescents/pre-menopausal post-menopausal women |
Adolescents- repeat pap in 12 mo
Post-adolescent/pre-menopausal- colposcopy Post-menopausal women- reflex HPV testing and colpo if positive, or just colpo |
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Times to give anti-D Ig during pregnancy
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standard dose at 28 wks in a (-) mom and (+) dad and increase the dose after events a/w excessive feto-maternal hemorrhage
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Mechanism of amenorrhea in lactating women
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Elevated prolactin levels suppress GnRH production which in turn suppresses LH and FSH production
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Management of HELLP
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# if less than 34 weeks and either is unstable -> stabilization and delivery
# If less than 34 weeks and both stable -> dexamethasone and deliver at 34 weeks or when fetal lungs mature # If 34 weeks or greater -> immediate deliver |
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Child with purulent, foul-smelling discharge and bleeding and management
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Foreign body; attempt removal with warm irrigation
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TORCH infxs and complications
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Toxoplasmosis, Rubella, CMV, HSV, Syphillis
Complications: Mirocephaly, HSM, deafness, chorioretinitis and thrombocytopenia |
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Stage of menstrual cycle: profuse, clear and thin (can stretch when lifted vertically)
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Ovulatory
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Dyspareunia, dysmenorrhea, dyschezia And Treatment
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Endometriosis combo OCPs, GnRH analogs (leuprolide) or danazol
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Fever, uterine tenderness, foul-smelling lochia in the postpartum period and Risk Factors
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Endometritis
Broad spectrum Abx PROM, prolonged labor, operative vaginal delivery and C-section |
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MCC of puerperal fever
Causative agent Treatment |
Endometritis
Polymicrobial (gram pos/neg, aerobes/anaerobes) IV Clinda and Gent |
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Initial evaluation for amenorrhea
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1. Beta-hcg
2. TSH 3. PRL 4. FSH (for ovarian failure) |
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Management of PPROM
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1. if the lungs are immature (L/S < 2) -> systemic glucocorticoids
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Abnormal vaginal bleeding > 3 wks post-partum and pulmonary sx
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Choriocarcinoma
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Pelvic pain worsened by bladder filling or intercourse accompanied by urinary urgency and frequency
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Interstitial cystitis
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Number one preventable cause of fetal growth restriction
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Smoking
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MCC of excess postpartum hemorrhage and Management
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Bimanual uterine massage, fluid resuscitation, uterotonic agents (oxytocin, methylergonovine, corboprost), and transfusion as needed
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Risk factors for uterine atony
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1. factors that cause uterine distention (multiple gestation, polyhydramnios, macrosomia)
2. prolonged labor |
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Management of breech presentation
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# If < 37 weeks -> routine f/u
# If > 37 wks -> external cephalic version (unless placental abnormailities, fetopelvic disproportion or hyperextended fetal neck) # c-section if doesn't correct prior to laber |
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Management of breech presentation
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# If < 37 weeks -> routine f/u
# If > 37 wks -> external cephalic version (unless placental abnormailities, fetopelvic disproportion or hyperextended fetal neck) # c-section if doesn't correct prior to laber |
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Effects of pregnancy on renal dynamics
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Renal plasma flow and GFR increase and peak at mid-pregnancy at 40-50% above pre-pregnancy levels.
Manifested as decrease in BUN and Cr |
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Maternal quadruple screen that carries an increased risk of Down Syndrome
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increased: beta-hCG and inhibin A
decreased: maternal serum alpha-fetoprotein and estriol |
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Way to investigate suspected renal calculi in a pregnant patient
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abdominal or pelvic us
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Marked pruritus, esp on palms and soles and esp at night, and elevated total bile acids during pregnancy and management
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Intrahepatic Cholestasis of pregnancy.
** can manage sx with ursodeoxychilic acid, but b/c ICP is a/w poor fetal outcomes, delivery as soon as lungs are mature |
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Most effective parameter for estimation of fetal weight in cases of suspected fetal growth restriction
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Abdominal circumference
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Different types of FGR, distinguishing factors and contributing factos
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1. Symmetric: occurs before 28 wks; fetal factors: genetic defects or early congenital infxs (TORCH)
2. Asymmetric: after 28 wks, Maternal factors: HTN, hypoxia, smoking, vasculat disease and toxic exposures |
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Reason to suspect FGR
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Fundal height > 3 cm less than expected based on dates
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Repetitive late decelerations and management
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Fetal distress
# If far enough along-> emergent delivery by fastest means possible (C-sections) |
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Uterine bleeding with neg pregnancy test, normal physical and us exam
# cause # management |
1. Disordered uterine bleeding (DUB)
2. anovulation 3. high dose estrogen, if pt > 35 yo -> endometrial bx |
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Definition of mild preeclampsia
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After 20th week of gestation:
1. HTN > 140/90 proteinuria 2. 300 mg/24h |
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Definition of severe preeclampsia
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After 20th week of gestation:
1. HTN > 160/100 2. proteinuria > 5g/24h 3. oliguria 4. elevated LFTs 5. low platelets 6. +/- pulmonary edema |
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When fetal movement is imperceptible by the mother
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NST: reactive if 2 accels > 15 beats above baseline in 20 min; non-reactive if less than 2 accels-> BPP
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Inflammation, pruritis and thin, maloderous vaginal discharge
# what will you see in wet mount # pH of vaginal fluid |
Trichomonas vaginitis
Flagellated motile organisms pH = 5.0-6.0 |
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Relative contraindication to IUD use
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H/o ectopic pregnancy
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Common side effect of Depo medroxyprogesterone acetate DMPA)
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Weight gain (so shouldn't be used in obese women)
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Name and cause of the condition a/w lower abdominal pain that radiates to the thighs and back with menstruation
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Primary dysmenorrhea
Elevated levels of prostaglandins |
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Main difference b/w central and peripheral causes of precocious puberty
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In central, FSH and LH are high, whereas they are low in peripheral because of negative feedback
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Common cause of low back pain in the 3rd trimester
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increase in lumbar lordosis
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Disappearance of the n/v of early pregnancy and an arrest of uterine growth
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Missed Abortion
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Management of asymptomatic bacteriuria of pregnancy
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Must be treated because of increased risk of cystitis, pyelo, preterm birth and perinatal mortality.
Tx: 7d course of nitrofurantoin, amoxicillin and 1st generation ceph |
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Tx guidelines for a woman with clinical or microbiological evidence of gonorrhea infection
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Ceftriaxone (for gonorrhea) + either 1 dose of azithromycin or 10d of doxy (for chlamydial coinfection)
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Appropriate screening and treatment measures for GBS
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Rectal and vaginal swabs at 35-37 weeks
If colonized, PCN or ampicillin at delivery |
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Treatment for idopathic central precocious puberty
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GnRH agonist
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Steps to prevent vertical transmission of HIV
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Zidovudine to mother throughout pregnancy and to child for first 6 wks of life
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Erratic onset of abrupt slowing of the FHR in associating with uterine contractions and steps of management
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Variable decels.
1. administer O2 and change maternal position 2. place mom in t-berg position 3. Fetal scalp pH testing 4. c-section |
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Management of complex hyperplasia with and without atypia on endometrial bx
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# With: pre-menopausal women who desire preserved fertility-> cyclic progestins and repeat bx in 3-6 mo
# W/o: cyclic progestins and repeat bx in 3-6 mo |
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Beta-HCG levels at which an intrauterine pregnancy would be seen
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1500-2000
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Management of a pt with vaginal bleeding and RLQ pain, beta-HCG of 1000 and no ultrasonographic evidence of an intra or extrauterin pregnancy
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Repeat the beta-HCG and transvaginal us in 48 hrs
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MCC for elevated level of MSAFP and management
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# gestational age error
# perform another us to look for any anomolies, assess fetal size to see if it agrees with dates, identify any multiple gestation |
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Fertility options in a women with premature ovarian failure
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IVF
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Condition to frequently monitor for in prolonged pregnancy
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Oligohydramnios
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Way to suppress milk production and manage pain in women who don't wish to breast feed
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Wear tight-fitting bras, avoid nipple stimulation, and use ice packs and analgesics to relieve associated pain
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Cause of neonatal thyrotoxicosis in a baby born to a mother who is s/p thyroidectomy for Graves Dz before pregnancy and in whom hormone levels have be normal throughout the pregnancy
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Persistance of thyroid stimulating Ig, which is usually 500 times normal for several months after thyroidectomy, and cross the placenta
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Vulvar pruritus and discomfort with porcelain white atrophic polygonal lesions that have a cigarette paper quality and way to approach
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Most likely lichen sclerosus (et atrophicus), but need to do a punch bx to r/o SCC.
# if lichen sclerosus, treat with high-potency topical steroid ointment |
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Treatment for vaginismus
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Kegel exercises and gradual dilation
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Use of magnesium sulfate in preeclampsia
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In mild preeclampsia, it is administered during labor and 24 hrs after.
In severe preeclampsia, it is administered from the time of admission until 24 hrs after delivery |
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MCC of antepartum hemorrhage and management
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Placenta previa and abruptio placenta
# hemodynamic resuscitation before investigating cause of bleeding (ABCs) # then TV ultrasound |
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Scattered round lesions in b/l peripheral lung fields on CXR and 2+ protein in a pt suspected of bacterial endocarditis
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Septic pulmonary emboli
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Weakness, dizziness, sweating, nausea, tachcardia, HA, visual disturbances, lethargy, agitation, confustion
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Hypoglycemia: either factitious or insulinoma
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Contraindications to ACEi tx in a patient with RAS
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If RAS is b/l
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How to screen for and diagnose gestational diabetes
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# screening (b/w 24-28 wks): 1 hr 50 G oral glucose tolerance test
# If less than 140, GDM is r/o # if greater, then 3 hr 100 G OGTT, GDM if: a. fasting > 95 b. 1 hr > 180 c. 2 hr > 155 d. 3 hr > 140 |
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Abdominal pain uterine tenderness and hemodynamic collapse
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Abruptio placentae
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Biophysical profile score of 8-10
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reassurance and repeated 1-2x/week until term for high risk pregnancies
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Parameters of a biophysical profile
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1. fetal tone
2. fetal movements (3/10) 3. fetal breathing (30/10 min) 4. amniontic fluid index (5-20) each category gets a score of 0 or 2 |
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Pregnant pt that appears with several BP readings >140/90 prior to the 20th week
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Chronic HTN if appears < 20 weeks. All other BP-related dxs in pregnancy can only be attributed to pregnancy if they are made after the first 20 weeks
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Tx for early localized Lyme dz in pregnant or lactating women
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Amoxicillin (not doxy b/c it can causes skeletal and dental problems)
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Rright-sided & retro-orbital HA, agitation, blurred vision, constipation and vomiting in a pt with Parkinsons, hypothyroidism and HTN
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Signs of anti-cholinergic excess likely from tirhexyphenidyl or benztropine, anticholinergics used in Parkinsons and drug-induced EPMs
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Best test to order in a young person with hypertension, muscle weakness and numbness
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Aldo/renin ratio
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Differences b/w true and false labor
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True labor: contractions occure at regular intervals with progessively shorter intervals and increasing intensity and the pain is felt in the upper abdomen and the back and is not relieved by sedation; cervical changes define labor
False labor: contractions are irregular, pain is the lower abdomen and is relieved by sedation: cervical changes are absent |
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Stages of labor
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First stage: Latent (from onset of labor to 2 cm) and Active (from 2 cm dilation to 10 cm)
Second stage: from 10 cm to delivery Third stage: from delivery to placenta |
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Side effects of OCPs
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1. VTE
2. CV events/Stroke 3. Elevation of TG 4. Cholestasis or cholecystitis 5. DM 6. HTN |
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Benefits of OCPs
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Protective against:
1. ovarian cysts 2. endometrial cancer 3. benign breast dz 4. Dysmenorrhea (anemia) |
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Diff b/w raloxifen and tamoxifen
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Raloxifen does not increase risk of endometrial cancer, whereas tamoxifen does.
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Dysmenorrhea and menorrhagia in a 40+ yo and a symmetrically enlarged uterus
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Adenomyosis
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Indications for i/p tx for PID
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1. high fever
2. failure of oral outpatient tx 3. inability to take oral meds 2/2 to n/v 4. those at risk for poor compliance (teenagers, low SES) 5. Pregnancy |
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Definition of PPROM and management
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preterm, premature rupture of the membranes: before 37 weeks but with the onset of labor
If prolonged, administer antibiotics |
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Signs of intraamniotic infx and management
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in a pt with PPROM and a fever plus, maternal tachy, fetal tachy (>160 bpm), maternal leukocytosis, uterine tenderness or foul-smelling amniotic fluid.
# administer broad spectrum abx and expedite delivery |
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Normal rate of progression of cervical changes
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1 cm/hr, less = protraction
Arrest = failure to dilate after 4cm |
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Causes of labor protraction
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Power, pelvis, passenger
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