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205 Cards in this Set
- Front
- Back
A young female with LLQ pain s/t simple cyst. What's the treatment?
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Repeat US in 6-8 weeks
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Enlarged, globular uterus w/ cystic areas in myometrium
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Adenomyosis
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RFs for pseudomonal UTI
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Metabolic & anatomic abnormalities
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MC manifestations of Trichomoniasis
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Vaginitis & urethritis
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MC etiologic agent of UTI in otherwise healthy 25 yof
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E. coli
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38 yof 8 days s/p C/s w/ red, painful, fluctuant mass at lateral margin of incision. Afebrile. What treatment?
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I & D
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Complication of untreated wound abscess
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Spread to fascia, bacteremia, sepsis
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27 yof w/ + RPR. What test is required as follow-up?
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MHA-TP or FTA-ABS
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Perinatal mortality rate of fetus infected by syphilis
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Up to 50%
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Sequelae of congenital syphilis
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Hydrops, macerated skin, hepatosplenomegaly
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Treatment of congenital syphilis
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Penicillin (+/- prior desensitization)
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MMR & pregnancy?
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Contraindicated
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For a rubella-nonimmune pregnant patient, when should MMR be administered?
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Postpartum
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Indications for RhoGAM in Rh- pregnant patient
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28 weeks' gestation or with bleeding during pregnancy
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23 yobf w/ normal Hb electrophoresis, no complaints, w/ Hb 11.2, WBC 11, Plt 154, nl MCV, nl ferritin. What type of anemia?
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Dilutional
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When is Hb diluting the most during pregnancy?
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2nd trimester
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Anemia assoc w/ b-thal?
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Hypochromic, microcytic
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2nd trimester pt w/ foul-smelling discharge & + chlamydia. What antibiotic?
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Azithromycin
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Complications of maternal chlamydia infection
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PPROM, premature labor
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Complication of congenital chlamydia infection
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Conjunctivitis
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Besides azithromycin, what else can be used to treat pregnant patient w/ chlamydia?
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Erythromycin or amoxicillin
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Why is doxycycline contraindicated in pregnancy?
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Effects on fetal teeth & bone
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Why are fluoroquinolones contraindicated in pregnancy?
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Arthropathies
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Why is streptomycin contraindicated in pregnancy?
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CN VIII damage
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30-wks gestation, no contractions, no bleeding, fundal height 27 cm x 4 weeks. Dx = ?
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IUGR
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IUGR is associated with what fetal weight in percentile?
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< 10
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When is US dating of a pregnancy most accurate?
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Early
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Complications of hypothyroidism in pregnant patient?
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Preeclampsia, placental abruption, cretinism
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Two major RFs for uncomplicated UTI
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Sex & hypoestrogenism
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67 yof not sexually active w/ genital atrophy & UTI
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Hypoestrogenism
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Sequelae of vertically-transmitted GBS
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Sepsis, meningitis, PNA
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Indications for treating GBS in pregnant patient
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h/o GBS-infected neonate, + urine/BCx,
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Why should asymptomatic bacteriuria in the pregnant woman be treated?
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Risk of PTD/low birth weight
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3 meds used for treatment of asymptomatic bacteriuria in pregnant woman?
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TMP-SMX, nitrofurantoinm, cephalexin
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Most common reason for condom failure?
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Improper or inconsistent use
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Established consequences of hypothyroidism in pregnancy?
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LBW or still-born infant
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Besides LBW & still-births, what other consequences are associated with hypothyroidism in pregnancy?
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Preeclampsia, placental abruption, heart failure
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Is there any known association between taking the OCP during the first trimester & birth defects?
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No.
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Consequences of taking tetracycline during pregnancy
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Fetal teeth & bone malformations.
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G2P2 presents w/ depression, but denies S/H ideations. What's the appropriate action?
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Psych referral
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What are the three types of psychological illness in the postpartum period?
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Blues, depression, & psychosis
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Which ovarian neoplasm is associated with the carcinoid tumor?
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Struma ovarii
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What are the four most common mets to the ovary?
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Colon, breast, stomach, & pancreas.
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What is the advantage of vacuum extraction over the forceps in expediting delivery?
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Vacuum does not occupy space next to fetal head.
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Which type of presentation is a classic indication for forceps delivery?
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Face w/ mentum anterior
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What is the advantage of the vacuum providing more safe area around the head?
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Less damage to maternal tissues.
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In which situation will attempted vacuum delivery fail due to loss of suction?
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True CPD
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Which types of situations are best suited for forceps or vacuum delivery?
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< +2
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Contraindication to vacuum delivery
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Facial presentation, intact membranes
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contraindication to forceps delivery
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Intact membranes
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G2P2 has received 7 days of MTX for ectopic. LLQ pain & BhCG persist. No decrease in size of ectopic, but w/ increased fluid in pelvis. Treatment?
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Laparoscopy.
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What is the definitive surgical treatment of a ruptured ectopic?
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Salpingostomy or salpingectomy.
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Grayish vaginal discharge in pregnant patient which produces a strong amine odor with addition of KOH. Diagnosis?
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Bacterial vaginosis.
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Treatment of bacterial vaginosis =
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Metronidazole po
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Microbiology of bacterial vaginosis
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Decrease in lactobacilli & increase in anaerobic organisms.
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Grayish malodorous vaginal discharge
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Bacterial vaginosis
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Clue cells go with which clinical test?
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Whiff test
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Sequela of bacterial vaginosis
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PTD
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Treatment of syphilis in pregnancy
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IM penicillin
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Treatment of GBS during labor
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IV penicillin
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First trimester bleeding
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Threatened ab
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Treatment of incomplete abortion
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D & C
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Definition of missed abortion
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Retention of a failed IUP for > 2 menstrual cycles
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Signs of PTL?
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20-37 wks, contractions, dilation
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What is the treatment of PTL?
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Tocolytics, corticosteroids (wks 24-34), & penicillin
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How to prophylax against vertically-transmitted GBS in pen-allergic patient?
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Clinda or erythromycin
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How is placenta previa diagnosed?
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Sono
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What's the pH of the discharge produced in PPROM?
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Strongly basic
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Signs of uterine rupture in pregnancy
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Abdominal pain, vaginal bleeding, & abnormal FHR
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Signs of PID
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Diffuse abdominal pain, no guarding, no rebound
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What's another name for Fitz-Hugh-Curtis syndrome?
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Perihepatitis
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What's the pathogenesis of Fitz-Hugh-Curtis syndrome?
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Inflammation & scarring of anterior surface of liver & surrounding peritoneum.
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First test of choice for PID
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Bimanual pelvic
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How much glucose is used in the GCT vs the GTT?
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50 vs 100
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What's the Kleihauer-Betke test used for?
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Determining correct amount of RhoGAM to administer.
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Four situations where an unimmunized Rh- patients should receive RhoGAM
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28 wks gestation, w/in 72 hrs after birth of Rh+ infant, after spontaneous Ab, or after amniocentesis
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What's the main difference between the OCP & HRT?
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Dosage
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An excellent test to rule out TOA or appy
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US
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"Cottage cheese" vaginal discharge
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Candidiasis
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Clue cells
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Bacterial vaginosis
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Treatment for newly resolved herpes in 36 wk patient
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Prophylactic acyclovir
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Initial drug of choice for PMDD?
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Fluoxetine
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Consequence of excessive Vitamin B6?
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Peripheral neuropathy
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"Bad flu" plus labial rash
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Genital herpes
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Prodrome of herpes genitalis
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Tingling, itching, burning.
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Sequelae of gonorrhea in the pregnant patient
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PTD & chorioamnionitis
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How is ceftriaxone given to the pregnant patient w/ GC?
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One-time IM injection
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When can Flagyl be used on the pregnant patient?
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2nd or 3rd trimester
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Maternal serum markers suggesting Down's Syndrome?
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Low AFP, low estriol, relatively high HCG
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Window for chorionic villus sampling
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9 to 12 wks
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Another name for cordocentesis
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PUBS
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In a patient with h/o incompetent cervix who declines cerclage placement, when should vaginal exams begin?
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16 wks
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When does cervical incompetence cause miscarriages?
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2nd trimester
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RFs for cervical incompetence
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Trauma, Mullerian anomalies, DES
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Where might a cerclage be placed?
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At internal os after bladder dissection or as high up on cervix as possible
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When's a cerclage place?
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Between wks 12 & 16
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When's a cerclage removed?
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37 wks
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Treatment of uterine hyperstimulation d/t oxytocin?
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Discontinue oxytocin
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How much dilation is required for forceps- or vacuum-assisted delivery?
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Full
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Role of antibiotics in pregnant pt w/ mitral valve prolapse desiring C-section?
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Not needed
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Woman w/ no risk factors for breast CA or family history who asks for BRCA screening?
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No benefit
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31 yo woman at 9 wks gestation w/ resolved profuse bleeding, closed os, & no products of conception seen on US. What treatment?
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Counseling
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DDx of first-trimester bleeding
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Ectopic, incomplete abortion, missed abortion, inevitable abortion, threatened abortion, and complete abortion.
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Treatment of incomplete abortion
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D & C
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Most common significant sequela of complete previa
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Placenta accreta
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Major RFs for previa
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Maternal age, minority, previous C-section
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What's the placenta attached to in placenta accreta?
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Myometrium
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Radical treatment of previa + accreta?
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Post-delivery hysterectomy
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Relationship between previa & IUFD
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None demonstrated
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4 days s/p C-section w/ fever & incision that is discolored, cyanotic, & numb
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Necrotizing fasciitis
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Common cause of necrotizing fasciitis in ob setting?
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C-section
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What's lochia?
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Period-like vaginal discharge following delivery
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Signs of endometritis
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Abd pain, foul-smelling lochia, fever, malaise, uterine tenderness
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An absolute contraindication to IUD?
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Multiple partners and h/o recent STD
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Symptoms of adenomyosis?
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Heavy or abnormal uterine bleeding & dysmenorrhea
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How does one diagnose adenomyosis?
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Histologically
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Hallmark finding of leiomyosarcoma?
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Rapidly expanding solitary uterine mass
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Which drugs can be used in the treatment of typical UTI in the pregnant patient?
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TMP-SMX, nitrofurantoin, cephalexin
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Most significant cause of morbidity w/ a dermoid cyst?
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Torsion
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Hematologic sequela of mature cystic teratoma
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Hemolytic anemia
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Urinary frequency + incontinence associated with coughing, laughing, or weight lifting = ?
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Stress incontinence
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Pelvic floor exercises used to treat stress incontinence
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Kegel maneuvers
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What are three causes of functional incontinence?
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Psycologic unwillingness or pathology, immobility, & physical barriers.
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Causes of overflow incontinence
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Detrusor sphincter dyssynergy or anatomic abnormalities
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Treatment of overflow incontinence
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Surgery and/or cath
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What's the cause of urge incontinence?
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Neurologic
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Treatment of sexual preference issues
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Refer to psychological counseling
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Complications of tamoxifen therapy
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DVT, menopausal sx, endometrial CA
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When should evaluation of late menarche be done?
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15
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The best candidates for a LEEP procedure
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HGSIL
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Does a LEEP require hospitalization?
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No
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Infectious complications of LEEP
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Cervicitis, parametritis, salpingitis, pelvic abscess
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Long-term complications of a LEEP?
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Cervical incompetence or stenosis
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Why is uterine perforation more common in postmenopausal women?
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Uterus is more anteflexed or atrophied
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Definition of inevitable abortion?
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Rupture of membranes or cervical dilation in first half of pregnancy
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Retention of failed IUP for more than 2 cycles
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Missed ab
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When should a pregnant woman get a HepB test?
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First visit
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When should a pregnant woman get a Pap smear?
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First visit
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Medical treatment of postpartum endometritis?
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Clinda-gent
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Mechanism of infection in postpartum endometritis?
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Ascending
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First step in suspected rupture of ectopic?
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Laparoscopy
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What's the advantage of progestasert?
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Decreased menorrhagia
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What's the advantage of Mirena?
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Decreased bleeding & cramping
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Initial treatment of TOA
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IV abx
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PID affects which cells primarily?
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Epithelial cells of fallopian tube
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Causes of ovarian hyperstimulation syndrome
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Gonadotropins of clomiphene citrate
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Si/Sx of severe OHSS?
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Ascites, hydrothorax, oliguria, hemoconcentration.
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Treatment options for severe OHSS?
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Paracentesis, thoracentesis, or surgery.
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What is the correct action if an HIV-positive woman w/ no h/o mental illness decides to deliver vaginally?
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Respect decision
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What is the most common physical symptom associated w/ PMDD?
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Abdominal bloating
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49 yo previously healthy f w/ irritability, fatigue, and new variability in menstrual cycles. What's the diagnosis?
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Perimenopause
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What is the location of Bartholin's glands in relation to the vagina?
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Near posterior fourchette
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Where on a clock would Bartholin's glands be located?
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5 and 7
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What type of catheter is used in the treatment of a Bartholin's abscess?
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Word
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When is marsupialization of a Bartholin's abscess appropriate?
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When Word catheter fails
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What's another name for granuloma inguinale?
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Donovanosis
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Cause of Donovanosis?
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Calymmatobacterium granulomatis
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What are the signs of granuloma inguinale?
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Papules progressing to ulcers
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Common cause of hematocolpos?
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Imperforate hymen
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Treatment of arrest of dilation?
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IV oxytocin
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Treatment of torsed benign cystic teratoma
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Laparoscopy
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When is an oophorectomy warranted in the treatment of a torsed benign cystic teratoma?
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When the detorsed ovary looks non-viable & necrotic
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Young pt with menorrhagia and elevated aPTT?
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vW dz
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An example of an absolute contraindication to CS?
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A classic uterine scar
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Compared to amniocentesis, CVS places the fetus at greater risk for what?
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Limb defects
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When can CVS be performed?
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10 to 12 wks
|
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When is amniocentesis done?
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2nd trimester
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34 yo F with dyschezia, dyspareunia, and dysmenorrhea. She is guiac negative. Diagnosis established via what?
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Laparoscopy
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What's another word for endometrioma?
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Chocolate cyst
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What is visualized when a sonographer detects an endometrioma?
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Adnexal enlargement
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Some RFs for an infection characterized by thick white vaginal discharge w/ pruritus?
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Systemic steroids, abx, DM, OCP
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Precipitants of genital herpes recurrences
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Sex, stress, intercurrent disease
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What is mupirocin used for?
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2nd line for S. aureus skin infections
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How can terbinafine be anti-Candidal?
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Systemic administration
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What's the window period for meperidine administration leading to respiratory depression in the newborn?
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2 to 3 hours
|
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Indications for administering penicillin in labor
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Either h/o GBS-infected neonate or h/o GBS in urine
|
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What is the most common side effect of giving corticosteroids to a 30 wk pregnant patient?
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Increased maternal insulin requirement
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Greenish-gray vaginal discharge plus petechial cervical lesions
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Trichomoniasis
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Strawberry cervix
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Trichomoniasis
|
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How is vaginal fluid treated in order to diagnose candidiasis?
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KOH, saline, or Gram Stain
|
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Sequelae of trichomoniasis in pregnancy
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PTD, low BW, PPROM
|
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A pregnant patient's BP hovers around 140/90 - 144/92 since before her pregnancy. What do you do?
|
Follow BPs.
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Sequelae of chronic hypertension in a pregnant patient?
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Preeclampsia, abruption, fetal growth restriction, PTD
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When should antihypertensive therapy begin for a pregnant patient?
|
Persistent diastolic > 100
|
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Sequelae of beta blockers during pregnancy?
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IUGR, PTD
|
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Sequelae of ACE inhibitors during pregnancy?
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Fetal anomalies & death
|
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Common side effect of raloxifene?
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Hot flashes
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Raloxifene & osteoporosis?
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Preventive
|
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Bilateral malar rashes on face in pregnant woman?
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Normal/chloasma/melasma
|
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Treatment for pregnant pt w/ mitral valve prolapse & regurge going into labor?
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No abx
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Definition of compound presentation?
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Prolapse of an extremity w/ presenting part
|
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Treatment for compound presentation?
|
Expectant management
|
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Complications of vitamin A excess during pregnancy?
|
Cranial neural crest malformations
|
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Fluctuant mass at margin of incision in postop patient?
|
Wound abscess
|
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Proper treatment of abdominal wound abscess?
|
IND
|
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Consequences of inadequate treatment of chancroid?
|
Draining sinuses
|
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Something used to soften an unfavorable cervix
|
PGE2 gel
|
|
Major side effect of PGE2 gel?
|
Uterine hyperstimulation
|
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19 yo F w/ normal appearing breasts but blind-ended vaginal pouch & scant pubic hair
|
Androgen insensitivity syndrome
|
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Treatment of androgen insensitivity syndrome?
|
b/l orchiectomies
|
|
Four cardinal features of Kallman's syndrome?
|
Amenorrhea, color-blindedness, anosmia, facial deformities
|
|
Treatment for condyloma accuminata?
|
Cryotherapy, laser therapy, tricholoracetic acid, or imiquimod
|
|
Predisposing factors for transmission of GBS from infected patient to fetus?
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PTD, PPROM, & T > 38 C
|
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Drugs that can be used for GBS Px in pen-allergic pt?
|
Clinda, Erythro, (cefazolin), vanco
|
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Treatment of pyelo w/ possible sepsis?
|
IV TMP/SMX
|