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205 Cards in this Set

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