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320 Cards in this Set
- Front
- Back
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how is the bladder pushed near term?
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anterior and superior
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alk phos in pregnancy?
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elevated due to placental AP isozymes
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plasma volume increase in preg?
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50%
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RBC volume increase in preg?
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20-30%
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why decrease in hct?
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plasma volume increases more than RBC volume
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female pseudohermaphrodites
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females with masculinized external genitalia
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clitoral enlargement
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associated with androgen stimulation in-utero
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labial fusion
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MCC'd by congenital adrenal hyperplasia
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MC Congenital Adrenal Hyperplasia
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21-hydroxylase (CYP21) deficiency
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What to give mother with history of CAH in previous child?
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dexamethasone - transplacental suppression pituitary suppression
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hymen
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remnant of the junction between the embryonic sinovaginal bulb and the urogenital sinus
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Mayer-Rokitansky-Kuster-Hauser syndrome
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vaginal agenesis with absence of the uterus in 46, XX women (not inherited)
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transverse vaginal septum
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occurs where the embryonic sinovaginal bulb and Mullerian ducts meet (Mullerian Tubereclee)
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VACTERL
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vertebral anomalies
anal atresia CV anomalies TE fistula esophageal atresia renal anomalies preaxial limb abnormalities |
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MCC of generalized pruritus in the absencee of skin lesions
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cholestasis of pregnancy
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intrahepatic cholestasis
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process in which bile salts are incompletely cleared by the liver, accumulate in the body, deposited in the dermis
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PUPPP
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Pruritic urticarial papules and plaques of pregnancy: intense pruritus and erythematous papules on the abdomen and extremities
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Herpes gestationalis
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intense itching and vesicles on abdomen and extremities
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When does intrahepatic cholestasis usually occur?
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third trimester
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What confirms intrahepatic cholestasis?
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Increased levels of circulating bile acids; elevated LFTs are uncommon
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Cholestasis of pregnancy, especially when accompanied by jaundice, is associated with an increased incidence of what? (3)
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prematurity, fetal distress, fetal loss
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First line treatment of intrahepatic cholestasis?
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antihistamines and cornstarch baths
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Second line treatment of intrahepatic cholestasis?
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ursodeoxycholic acid
cholestyramine (assoc. with vit K deficiency) |
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Labor
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Cervical change accompanied by regular uterine contractions
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Latent phase of Labor
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initial part of labor - cervix mainly effaces rather than dilates (<4cm)
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Active phase - nullips and multips
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cervical dilation occurs more rapidly (>4cm)
nullips: >1.2 cm/hr multips: >1.5 cm/hr |
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Protraction of active phase
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cervical dilation in active phase that is less than expected
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Arrest of active phase
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No progress of labor for 2 hours
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How many Stages of Labor?
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3
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1st stage of Labor
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1st stage: onset of labor to complete dilation of cervix
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2nd stage of Labor
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2nd stage: complete cervical dilation to delivery of infant
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3rd stage of Labor
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3rd stage: delivery of infant to delivery of placenta
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How long is the normal latent phase of labor for a nullip?
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<18-20 hours
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How long is the normal latent phase of labor for a multip?
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<14 hours
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How long is the normal second stage of labor? (nullip v. multip)
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nullip: <2hr/3hr if epidural
multip: <1hr/2hr if epidural |
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How long is the normal third stage of labor?
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<30 mins.
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Clinically adequate uterine contractions
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contractions every 2-3 mins, firm on palpation, lasting at least 40-60 secs or >200 Montevideo units
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bloody show
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loss of the cervical mucus plug - sign of impending labor
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bloody show v. antepartum bleeding
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bloody show has sticky mucus admixed with blood
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What dictates normalcy in labor?
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change in cervix per time; NOT the uterine contraction pattern
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When to c-section in the absence of clear CPD?
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arrest of active phase with adequate contractions
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Magic number distinguishing latent labor and active labor?
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4 cm
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The 3 P's
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Pelvis, Passenger, Powers
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Causes of galactorrhea (5)
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pituitary adenoma
pregnancy breast stimulation chest wall trauma hypothyroidism |
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How are hypothyroidism and prolactin related?
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TRH acts as a prolactin releasing hormone
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How does increased prolactin levels lead to oligomenorrhea?
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hyperprolactinemia inhibits hypothalamic GnRH pulsations, decreasing levels of LH and FSH, leading to oligomenorrhea
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Primary action of prolactin?
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stimulate breast epithelial cell proliferation and induce milk production
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What is PPH?
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loss of 500mL or more after a vaginal delivery; loss of 1000mL or more during cesarean
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MCC of PPH
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uterine atony - myometrium has not contracted to cut of the uterine apiral arteries supplying the placental bed
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First line treatment for uterine atony?
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uterine massage and dilute oxytocin
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Methylergonovine maleate (Methergine)
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ergot alkaloid agent that induces myometrial contraction to tx. uterine atony
*contraindicated in HTN |
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Prostaglandin F 2-alpha
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causes smooth muscle contraction
*contraindicated in asthmatic patients |
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MCC of PPH in a well-contracted uterus
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genital tract laceration
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Three parts to health maintenance
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1. cancer screening
2. immunizations 3. addressing common diseases for particular pt. group |
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Recommendations for Pap smears
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Annually, 3 yrs. after onset of sexual activity or after age 21
until age 30, 2-3 years if 3 consecutive neg. Pap smears until age 65-70 |
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At what age should one start to get the influenza vaccine annually?
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50
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When does cholesterol screening begin?
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every 5 years @ age 45
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When does fasting blood sugar level screening begin?
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every 3 years @ age 45
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When does TSH screening begin?
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every 5 yrs @ age 50
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What screening begins at age 45? 50?
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45: cholesterol every 5 years; fasting blood sugar every 3 years
50: TSH every 5 years |
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MCC of mortality in a woman <20 years
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MVA
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MCC of mortality in a woman >39 years
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CV disease
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Major conditions in women >65 years
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osteoporosis
heart disease breast cancer depression |
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What cancer screening is done >50 years?
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stool for occult blood
barium enema with flexsig q 5 OR colonoscopy q 10 annual mammogram |
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When do bone mineral density studies begin?
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65 years old
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Four signs of placental separation:
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1. gush of blood
2. lengthening of the cord 3. globular and firm shape of the uterus 4. uterus rising up to the anterior abdominal wall |
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Uterine relaxation agents
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terbutaline
mag |
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Uterotonic agents
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oxytocin
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Climacteric
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perimenopausal state
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What are hot flashes?
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typical vasomotor change due to decreased estrogen levels: skin temp. elevation and sweating lasting for 2-4 mins.
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What is the effect of low estrogen concentration on the vagina?
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decreases the epithelial thickness, leading to atrophy and dryness
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When a woman still has her uterus, the addition of _____ to ______ ______ is important for preventing endometrial cancer.
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progestin to estrogen replacement
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FSH and LH levels are increased/decreased during perimenopause
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increased
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Treatment for hot flashes?
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estrogen replacement therapy with progestin
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menopause v. premature ovarian failure
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menopause >40 y/o
premature ovarian failure <40 y/o |
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Avg. age of menopause
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50-51
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Hormone levels at the beginning of menopause?
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LH and FSH rise because oocytes are not responding and not producing estrogen
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What is responsible for hot flashes, sweats, mood changes and depression in menopause?
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Fall in estradiol
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What test is diagnostic of menopause?
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elevated FSH
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During menopause, why do FSH levels rise even before estradiol levels fall?
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ovarian inhibin levels are decreased
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Why can FSH levels not be used to titrate the estrogen replacement dose?
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FSH level responds to inhibin and not to estrogen -- FSH concentrations remains elevated with estrogen replacement
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Advantages of HRT?
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fewer fractures
lower incidence of colon cancer |
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Disadvantages of HRT?
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breast ca
heart disease pulmonary embolism stroke |
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Both hypothyroidism and hyperprolactinemia may cause ____.
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hypothalamic dysfunction which inhibits GnRH pulsations which inhibits pituitary FSH and LH release which leads to hypoestrogenic amenorrhea
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MC location of an osteoporosis-associated fracture is ____.
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thoracic spine manifested as a compression fracture
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When/Why should progestin be added to estrogen replacement therapy?
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When a woman has her uterus to prevent endometrial cancer.
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What type of pelvis predisposes to persistent fetal occiput posterior position?
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anthropoid pelvis
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lower ab pain + vaginal spotting in a woman of childbearing potential
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considered ectopic until otherwise proven
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If normal intrauterine gestation, how much should the hCG level rise?
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hCG levels should rise at least 66% every 48 hours
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best tools for evaluating possible ectopic pregnancy
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hCG levels and transvaginal US
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What is hCG?
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glycoprotein that is secreted by the chorionic villi of a pregnancy
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Single progesterone level less than 5 ng/mL
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nonviable gestation
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Single progesterone level greater than 25 ng/mL
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normal intrauterine gestation
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hCG threshold
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level of serum hCG such that an intrauterine pregnancy should be seen on US; for endovaginal sonography, this is 1500 - 2000 mIU/mL
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patient with an early pregnancy who is hypotensive, tachycardic and has severe adnexal pain
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surgery
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placenta accreta
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abnormal adherence of the placenta to the uterine wall due to an abnormality of the decidua basalis layer of the uterus
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placenta increta
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abnormally implanted placenta penetrates into the myometrium
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placenta percreta
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abnormally implanted placenta penetrates entirely through the myometrium to the serosa
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placenta previa
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implantation of the placenta over or near the internal os of the cervix
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5 risk factors for placenta accreta
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placenta previa
implantation of the lower uterine segment prior c-s scar or other uterine scar uterine curretage down syndrome |
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Best choice treatment for placenta accreta
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hysterectomy
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blue tissue densely adherent between the uterus and bladder
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placenta percreta
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What is "transmigration of the placenta"?
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low-lying placenta or placenta previa diagnosed in the 2nd trimester may resolve in the third trimester as the lower uterine segment grows more rapidly
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gram-negative intracellular diplococci
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highly suggestive of N. gonorrhea
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Tx. of gonococcal cervicitis
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125-250 mg ceftriaxone IM
(+ chlamydia Tx: azithromycin 1 g PO or doxycycline 100 mg 2X daily for 7-10 days) |
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Tx. of chlamydia
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azithromycin 1 g PO or doxycycline 100 mg 2X daily for 7-10 days
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mucopurulent cervicitis
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yellow exudative discharge arising from thee endocervix with 10+ PMNs per hpf
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gonococcal and chlamydial organisms have a propensity for?
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the columnar cells of the endocervix
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MC organism implicated in mucopurulent cervical discharge
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Chlamydia trachomatis
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Gram stain of cervical discharge is negative
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Chlamydia
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MCC of septic arthritis in young women
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gonorrhea
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fishy odor
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BV
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sexually transmitted pharyngitis
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gonococcal pharyngitis
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Which is more likely to disseminate? Gonorrhea or chlamydia?
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Gonorrhea
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Which is more likely to cause conjunctivitis and blindness? Gonorrhea or chlamydia?
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BOTH
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hCG levels in completed abortions
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halve every 48 to 72 hours
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threatened abortion
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<20 wga with vaginal bleeding and no cervical dilation
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inevitable abortion
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<20 wga with cramping, bleeding and cervical dilation; no passage of tissue
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incomplete abortion
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<20 wga with cramping, bleeding, open cervical os, some passage of tissue per vag but also some retained
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completed abortion
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<20 wga with all POCs having passed; closed cervix, no cramping
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missed abortion
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<20 wga with embryonic or fetal demise but no symptoms such as bleeding or cramping
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inevitable abortion v. incompetent cervix
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cramping leading to cervical dilation v. painless cervical dilation
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uterine US with "snowstorm"
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molar pregnancy
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MCC of first trimester miscarriage
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fetal karyotypic abnormality
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What is usually the problem in shoulder dystocia?
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impaction of the anterior shoulder behind the maternal symphysis pubis
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Erb's Palsy
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brachial plexus injury involving C5-6 nerve roots; weakness of the deltoid and infraspinatus muscles as well as flexor muscles of the forearm; arms hangs limply by the side and is internally rotated
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Shoulder dystocia should be suspected with what 4 things?
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1. fetal macrosomia
2. maternal obesity 3. prolonged 2nd stage of labor 4. gestational diabetes |
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McRoberts maneuver
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Shoulder dystocia: sharp flexion of the maternal hips decreases the inclination of the pelvis and frees the anterior shoulder
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rationale of suprapubic pressure in shoulder dystocia
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move the fetal shoulders from the AP to an oblique plane allowing the shoulders to slip out from under the pubic symphysis
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Should fundal pressure be used with shoulder dystocia?
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NO - increased associated neonatal injury
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Si/Sx of pyelonephritis + recent hysterectomy - next step?
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IVP (CT could also be diagnostic)
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Cardinal ligament
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attachments of the uterine cervix to the pelvic side walls through which the uterine arteries traverse
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hydronephrosis
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dilation of the renal collecting system - evidence of urinary obstruction
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MC location for ureteral injury
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cardinal ligament where the ureter is only 2-3 cm lateral to the internal cervical os; injured upon clamping of the uterine arteries
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Where is the ureter in relation to the uterine artery?
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"water under the bridge" ureter is just under the uterine artery
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constant urinary leakage after pelvic surgery
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vesicovaginal fistula
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antepartum vaginal bleeding
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vag bleeding occurring after 20 wga
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placental abruption
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premature separation of the placenta
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What is usually associated with painful uterine conctractions or excess uterine tone?
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placenta abruption
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Hx. of postcoital spotting
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previa
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Vasa previa
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umbilical cord vessels that insert into the membranes with the vessels overlying the internal cervical os and thus are vulnerable to fetal exsanguination upon ROM
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Patient presents with antepartum hemorrhage - first thing Dr. should do?
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R/O placenta previa by US (speculum or dig exam may induce bleeding)
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Best plan for placenta previa at term (>35 wga)?
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C-S
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Why is multiple gestation a risk factor for placenta previa?
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increased surface of area of placentation
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Painful antepartum bleeding
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placental abruption
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Concealed abruption
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bleeding occurs completely behind the placenta and no external bleeding is noted
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Fetomaternal hemorrhage
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fetal blood that enters into thee maternal circulation
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couvelaire uterus
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bleeding into the myometrium of the uterus giving a discolored appearance to the uterine surface
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Risk Factors for Abruptio Placentae: drugs
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cocaine
cigarettes |
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Risk Factors for Abruptio Placentae: Diseases
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HTN
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Risk Factors for Abruptio Placentae: umbilical cord
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short umbilical cord
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Risk Factors for Abruptio Placentae: uterus
|
uteroplacental insufficiency
sudden uterine decompression submucosal leimyomata |
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Risk Factors for Abruptio Placentae: membranes
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PPROM
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Risk Factors for Abruptio Placentae: other
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trauma
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Kleihauer-Betke test
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tests for fetal erythrocytes in thee maternal blood using the different solubilities of maternal v. fetal Hgb
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Usual management of placental abruption?
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delivery - usually c-s; unless no active bleeding or fetal compromise, then just expectant management
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MC presenting symptom of invasive cervical cancer
|
abnormal vaginal bleeding - may be postcoital
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mean age of presentation of cervical cancer
|
51
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best diagnostic test to evaluate a cervical mass
|
cervical biopsy (not Pap)
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cervical intraepithelial neoplasia
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preinvasive lesions of the cervix with abnormal cellular maturation, nuclear enlargement and atypia
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Where do the majority of cervical dysplasia and cancers arise?
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near the squamocolumnar junction of the cervix
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punctations seen on colposcopy
|
mild vascular patter: vessels seen end-on
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atypical vessels seen on colpo
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corkscrew and hairpin vessels
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early cervical cancer tx.?
|
surgery or radiation
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advanced cervical cancer tx.?
|
chemo to sensitize tissue then radiotherapy consisting of brachytherapy (implants) with teletherapy (whole pelvis radiation)
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Cervical cancer often spreads how?
|
Through the cardinal ligaments toward the pelvic sidewalls - can obstruct one or both ureters
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MCC of death due to cervical cancer?
|
bilateral ureteral obstruction leading to uremia
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Cervical Cancer: intraepithelial carcinoma
|
Stage 0
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Cervical Cancer: strictly confined to the cervix
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Stage I
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Cervical Cancer: carcinoma extends beyond cervix but not into pelvic wall; involves upper 2/3s of vag
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Stage II
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Cervical Cancer: carcinoma has extended to pelvic wall; involves lower third of vag
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Stage III
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Cervical Cancer: spread to rectum/bladder
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Stage IVA
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Cervical Cancer: spread to distant organs
|
Stage IVB
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Cervical Cancer: hydronephrosis or non-functioning kidney
|
Stage IIIB
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What type of carcinoma accounts for 90% of all cervical cancers?
|
Squamous cell carcinoma (adenocarcinoma the rest)
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amenorrhea
|
no menses for 6 mos.
|
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Sheehan's syndrome
|
anterior pituitary hemorrhagic necrosis
|
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Cause of Sheehan's syndrome
|
hypertrophy of prolactin secreting cells in conjunction with a hypotensive episode, usually in the setting of postpartum hemorrhage
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Intrauterine adhesions (Asherman's syndrome)
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scar tissue that forms in the endometrium, leading to amenorrhea due to unresponsiveness of the endometrial tissue
|
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postpartum hemorrhage
|
vag delivery: >500 mL
c-s delivery: >1000 mL |
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MCC of amenorrhea in the reproductive years
|
pregnancy
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PCOS is characterized by:
|
estrogen excess without progesterone
obesity hirsutism glucose intolerance |
|
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elevated FSH level is indicative of?
|
ovarian failure
|
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amenorrhea after vag delivery: 2 most likely causes?
|
Sheehan's syndrome or intrauterine adhesions (Asherman's)
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MCC of ovulatory dysfunction in a reproductive-age woman
|
PCOS
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MoA of Sheehan's syndrome
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bleeding in the anterior pituitary induces pressure necrosis
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First step in evaluation of fetal bradycardia in the face of ROM
|
r/o umbilical cord prolapse
|
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Tx. of cord prolapse
|
emergent c-s
|
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umbilical cord accidents are more likely with what two things?
|
unengaged presenting part (usually the head)
transverse fetal lie |
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Fetal bradycardia
|
baseline <110 bpm for >10 mins.
|
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Initial steps after encountering fetal bradycardia:
|
Improve maternal oxygenation and delivery of cardiac output to the uterus:
|
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How does one improve maternal oxygenation and delivery of cardiac output to the uterus after encountering fetal bradycardia?
|
1. placement of pt. on side to move the uterus from the great vessels, improving blood return to heart
2. IV bolus pt. 3. administer 100% oxygen by face mask 4. stop oxytocin |
|
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MC finding in a uterine rupture
|
FHR abnormality such as fetal brady, deep variable decels or late decels
|
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What position is associated with the highest risk of cord prolapse?
|
transverse lie
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What is the first step in assessment of fetal brady?
|
differentiate FHR from maternal pulse
|
|
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Tubo-ovarian abscess
|
collection of purulent material within and around the distal tube and ovary
|
|
|
Classic clinical triad of PID
|
lower abdominal tenderness, cervical motion tenderness and adnexal tenderness
|
|
|
What is the "gold standard" in diagnosis of acute salpingitis?
|
laparoscopy with visualization of purulent drainage from the fallopian tube
|
|
|
Fitz-Hugh-Curtis syndrome
|
salpingitis with perihepatic adhesions manifesting as RUQ pain
|
|
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Tx. of acute salpingitis
|
IM ceftriaxone
oral doxycycline |
|
|
Tx of acute salpingits if non-adherent
|
IV cefotetan and doxycycline
|
|
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Organisms responsible for salpingitis
|
polymicrobial: gonorrhea, chlamydia, anaerobes and gram negative rods
|
|
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long term sequelae of acute salpingitis
|
chronic pelvic pain, ectopic pregnancy and involuntary infertility
|
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MC reason for hysterectomy in the US
|
symptomatic uterine fibroids
|
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MC symptom of uterine leiomyomata
|
menorrhagia
|
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|
leiomyomata
|
smooth muscle, benign tumors of the uterus
|
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leiomyosarcoma
|
malignant, smooth muscle tumor, with numerous mitoses
|
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carneous degeneration
|
changese of the leiomyomata due to rapid growth; center of the fibroid becomes red, causing pain
|
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irregular, midline, firm, nontender mass that moves contiguously with the cervix
|
uterine leiomyomata
|
|
|
PE of uterine leiomyomata is:
|
3 M's:
1. mobile 2. midline 3. moves contiguously with cervix |
|
|
Preeclampsia
|
HTN with proteinuria (>300mg in 24 hours) at >20 wga
|
|
|
What causes preeclampsia?
|
vasospasm and "leaky vessels"
|
|
|
severe pre-E
|
BP >160/110
24 urine protein >5g |
|
|
greatest risk for occurrence of eclampsia is when?
|
just prior to delivery, during labor and within 24 hr. postpartum
|
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|
MCC of maternal death due to eclampsia is?
|
intracerebral hemorrhage
|
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|
first sign of mag toxicity
|
loss of DTR's
|
|
|
core needle biopsy
|
use of a 14-16 gauge needle to extract tissue from a breast mass; preserves cellular architecture
|
|
|
fine need aspiration
|
use of a small gauge needle with associated vacuum via a syringe to aspirate fluid or some cells from a breast mass and/or cyst
|
|
|
fibroadenoma
|
benign, smooth muscle tumor of thee breast, usually occurring in young women
|
|
|
How do fibroadenomas feel on on palpation?
|
firm, rubbery, mobile and solid in consistency
|
|
|
MCC of bloody (serosanguinous) nipple discharge unilaterally in the absence of breast mass
|
intraductal papilloma
|
|
|
"lumpy-bumpy" breast exam
|
suggestive of fibrocystic changes
|
|
|
Nipple retraction or skin dimpling over a mass
|
breast cancer
|
|
|
young woman with a dominant nontender mass
|
fibroadenoma
|
|
|
Any 3-dimensional breast mass generally necessitates what to confirm the diagnosis?
|
tissue - FNA or core needle biopsy
|
|
|
Five basic etiologies of infertility
|
1. ovulatory
2. tubal 3. uterine 4. peritoneal factor (endometriosis) 5. male factor |
|
|
3 D's of enDometriosis
|
Dysmenorrhea
Dyspareunia Dyschezia |
|
|
Normal BBT
|
rise of 0.5 degrees F after ovulation due to release of progesterone (thermogenic) by the ovary
|
|
|
How long after the LH surge does ovulation usually occur?
|
approx 36 hours. (1.5 days)
|
|
|
Gold standard for diagnosis of endometriosis
|
laparoscopy
|
|
|
Clomiphene citrate
|
treatment for anovulation, particularly in PCOS
|
|
|
Gold standard for diagnosing tubal disease
|
laparoscopy
|
|
|
Common presenting symptoms of appendicitis
|
nausea
emesis fever anorexia |
|
|
Location of abdominal pain in a pregnant women with appendicitis
|
superior and lateral to McBurney's point -- mimicking pyelonephritis
|
|
|
Acute onset of colicky abdominal pain is typical of?
|
ovarian torsion
|
|
|
methotrexate
|
folic acid antagonist
|
|
|
How is methotrexate dosed?
|
one time, low dose IM injection
|
|
|
When is methotrexate used?
|
ectopic pregnancies <4cm in diameter
|
|
|
Side effects of methotrexate?
|
abdominal pain 3-7 days following therapy
|
|
|
plateau in hCG over 48 hr means?
|
nonviable pregnancy - no clue as to the location
|
|
|
What progesterone level reflects normal IUP?
|
>25 ng/mL
|
|
|
classic triad of ectopic pregnancy:
|
amenorrhea
vaginal spotting abdominal pain |
|
|
anemia in pregnant women
|
<10.5 g/dL
|
|
|
preterm labor
|
cervical change assoc. with uterine contractions prior to 37 competed weeks and after 20 weeks' gestation
|
|
|
preterm labor in a nullip
|
uterine contractions and a single cervical exam revealing 2cm dilation and >80% effacement
|
|
|
MC tocolytic agents (4)
|
magesium sulfate
terbutaline ritodrine indomethacin |
|
|
antenatal steroids
|
betamethasone
dexamethasone |
|
|
When does one administer steroids?
|
<34 weeks gestation with preterm labor
|
|
|
Speculated MoA of mag as a tocolytic agent
|
competitive inhibition of Ca to decrease its availability for actin-myosin interaction thus decreasing myometrial activity
|
|
|
weekly injections of what may help prevent preterm birth in women at high risk
|
17 alpha hydroxyprogesterone caproate
|
|
|
T/F: uterine fibroids can be assoc with preterm delivery
|
T
|
|
|
side effects of terbutaline?
|
beta agonist: increased pulse pressure; hyperglycemia; hypokalemia, tachy
|
|
|
dyspnea occurring in a woman with preterm labor and tocolysis usually is due to?
|
pulmonary edema (from tocolytics, usually beta agonists like terb)
|
|
|
MCC of neonatal morbidity in a preterm infant
|
respiratory distress syndrome
|
|
|
negative FFN
|
no delivery within 1 week
|
|
|
cystitis
|
bacterial infx. of the bladder
having >100,000 CFU of a singlee pathogenic organism on a mid-stream voided specimen |
|
|
Urethritis
|
infection of the urethra commonly caused by C. trachomatis
|
|
|
urethral syndrome
|
urgency and dysuria caused by urethral inflammation of unknown etiology
|
|
|
Sy's of UTI but negative urine cultures
|
urethritis caused by chlamydia or gonococcus
|
|
|
Emergency contraception is most effective if given within how many hours of coitus?
|
72 hrs
|
|
|
major SE of emergency contraception
|
nausea and/or emesis
|
|
|
Mechanisms whereby combination oral contraceptives may act
|
ovulation inhibition
decreased tubal motility interference with implantation |
|
|
ARDS
|
acute respiratory distress syndrome: alveolar and endothelial injury leading to leaky capillaries, clinically causing hypoxemia, large alveolar-arterial gradient and loss of lung volume
|
|
|
MCC of septic shock in pregnancy
|
pyelonephritis
|
|
|
ARDS assoc. with pyelonephritis is caused by what?
|
endotoxin release from gram-neg. bacteria
|
|
|
Why is heparin preferable to warfarin (Coumadin)?
|
Coumadin may cause congenital abnormalities and is more difficult to reverse.
*heparin does not x the placenta |
|
|
What is the reason for the hypercoagulable state in pregnancy?
|
venous stasis due to the uterus compressing the vena cava
|
|
|
accurate method for diagnosing DVTs
|
NOT PE - venous duplex doppler sonography
|
|
|
MC cancer in women
|
breast cancer
|
|
|
most important risk factor of breast cancer
|
age
|
|
|
MC ovarian tumors in women <30 years
|
benign cystic teratomas (dermoid cysts)
|
|
|
The presence of ascites is consistent with what?
|
ovarian cancer
|
|
|
ToC for ovarian neoplasms is:
|
exploratory laparotomy with ovarian cystectomy
|
|
|
Struma ovarii
|
Benign cystic teratoma containing thyroid tissue - may cause hyperthyroidism
|
|
|
epithelial ovarian tumor
|
neoplasm arising from outer layer of ovary: MC type of ovarian malignancy, usually in older women
|
|
|
Ovarian Tumors: Epithelial Ovarian Tumors
|
Serous
Mucinous Endometrioid Brenner Clear Cell |
|
|
Ovarian Tumors: Germ Cell Tumors
|
"DEEP CT"
Dysgerminoma Endodermal sinus Embryonal carcinoma Polyembryoma Choriocarcinoma Teratoma |
|
|
Ovarian Tumors: Sex Cord Tumors
|
Granulosa Cell Tumor
Sertoli-Leydig cell tumors |
|
|
How do the sex cord tumors usually appear on US?
|
solid
|
|
|
Granulosa-theca cell tumors produce what? Sertoli-Leydig cell tumors?
|
Granulosa-theca cell tumors produce estrogen while Sertoli-Leydig tumors produce androgens
|
|
|
What ovarian tumor is characterized by its large size?
|
mucinous
|
|
|
MC ovarian tumor in a woman >30 y/o
|
epithelial, most commonly cystadenoma
|
|
|
wound dehiscence
|
separation of part of the surgical incision but with an intact peritoneum
|
|
|
fascial disruption
|
separation of the fascial layer, usually leading to a communication of the peritoneal cavity with the skin
|
|
|
evisceration
|
disruption of all layers of the incision with omentum or bowel protruding through the incision
|
|
|
MC reason for fascial disruption
|
suture tearing through the fascia
|
|
|
What can be used to distinguish between urine and lymphatic fluid?
|
creatinine - significantly more elevated in urine
|
|
|
MC time period in which fascial disruption or evisceration occurs
|
5-14 days post-op
|
|
|
In 9/10 cases, a pregnant woman with hemoperitoneum has ____?
|
an ectopic pregnancy
|
|
|
hemoperitoneum
|
collection of blood in the peritoneal cavity
|
|
|
Pts. with hemorrhagic corpus lutea usually present with?
|
sudden onset of severe lower abdominal pain
|
|
|
A ruptured corpus luteum can mimic?
|
an ectopic pregnancy
|
|
|
NONclotted blood obtained from culdocentesis is consistent with?
|
intra-abdominal hemorrhage
|
|
|
Clotted blood from culdocentesis is consistent with
|
a leak from a blood vessel, NOT intraperitoneal blood (this would be nonclotting due to consumption of clotting factors within the peritoneal cavity
|
|
|
When the corpus luteum is excised in a pregnancy of <8 wga, ______.
|
exogenous progesterone should be supplemented.
|
|
|
MC method for diagnosing IUA
|
hysterosalpingogram
|
|
|
hysterosalpingogram
|
radiologic study in which radiopaque dye is injected into the endometrial cavity via a transcervical catheter; used to evaluate the endometrial cavity and/or patency of the fallopian tubes
|
|
|
"Gold standard" for diagnosing IUA
|
hysteroscopy
|
|
|
Ideal treatment for IUA
|
operative hysteroscopy/hysteroscopic resection
|
|
|
Mammographic findings suggestive of cancer
|
small cluster or calcifications around a mass or a mass with irregular borders
|
|
|
2 accepted methods for assessing suspicious, mammographic, nonpalpable masses
|
stereotactic core biopsy and needle-localization excisional biopsy
|
|
|
androgen insensitivity
|
androgen receptor defect in which 46,XY individuals are phenotypically female with normal breast development
|
|
|
Mullerian agenesis
|
congenital absence of development of the uterus, cervix and fallopian tubes in a 46,XX female; primary amenorrhea
|
|
|
primary amenorrhea + congenital renal abnormality + developed breasts
|
mullerian agenesis
|
|
|
primary amenorrhea + scant/absent pubic hair + developed breasts
|
androgen receptor defect
|
|
|
Why do individuals with androgen insensitivity have breast development?
|
peripheral conversion of androgens to estrogen and they lack the receptors to inhibit breast development
|
|
|
MCC of delayed puberty and absent breast tissue after 14 y/o
|
gonadal dysgenesis
|
|
|
Treatment of septic abortion:
|
1. maintain BP
2. monitor BP, oxygenation and UO 3. broad-spectrum Abx 4. uterine evacuation |
|
|
PPH + HTN: do NOT give
|
methergine, ergot alkaloids
|
|
|
PPH + asthma: do NOT give
|
prostaglandin F2-alpha
|
|
|
Ligation of what artery is a method for helping PPH?
|
ascending branch of the uterine arteries to decrease the pulse pressure to the uterus
|
|
|
MCC of late postpartum hemorrhage
|
subinvolution of the uterus
|
|
|
lack of breast development means what?
|
lack of estrogen
|
|
|
delayed puberty
|
lack of secondary sexual characteristics by age 14
|
|
|
delayed puberty can be subdivided based on two factors:
|
gonadotropic state: FSH
gonadal statee: ovarian production of estrogen |
|
|
hypergonadotropic hypogonadism means what?
|
high FSH
low estrogen due to gonadal deficiency (Turners) |
|
|
hypogonadotropic hypogonadism means what?
|
low FSH
low estrogen central defect |
|
|
MC time for occurrence of postpartum mastitis
|
3-4 weeks after delivery
|
|
|
hallmark of thyroid storm
|
autonomic instability
|
|
|
Tx. of thyroid storm
|
beta blocking agent
corticosteroids (prevents peripheral conversion) additional PTU |
