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472 Cards in this Set
- Front
- Back
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Rx for advanced (Stages II+) ovarian cancer
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Surgical removal, followed by adjuvant chemo (taxane + carboplatin)
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When is magnesium sulfate given for preeclampsia?
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During delivery and 24 hours postpartum
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Therapeutic level of mag sulfate
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4-7
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Mag sulfate levels associated with respiratory depression and cardiac arrest
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>12 and >15
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Contraindications to expectant management of severe preeclampsia (e.g. indications for delivery)
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Thrombocytopenia < 100,000,
Inability to control BP w/ max doses of 2 antihypertensives, Non-reassuring fetal surveillance, LFTs < 2x nml, Eclampsia Persistent CNS Sx Oliguria |
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How fast should hCG rise in a normal pregnancy?
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Should double (or increase by 66%) every 48 hours
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Inappropriately rising (e.g. too low) beta-hCG levels indicate
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Abnormal pregnancy (e.g. ectopic, incomplete abortion, or resolving complete abortion)
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Distinction btwn a normal gestational sac and a pseudogestational sac
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Pseudo is located in the midline
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Serum progesterone <5 indicates
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Specific for nonviable pregnancy
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What is the Arias-Stella reaction?
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Hypersecretory endometrium of prengnacy on histology that occurs w/ BOTH ectopic and intrauterine pregnancies
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Culdocentesis is looking for
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Blood in peritoneal cavity, e.g. from ruptured ectopic (or purulent fluid from infection)
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Medical Rx for ectopic
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Methotrexate
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Relative contraindications to MTX for ectopic
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Cardiac activity
Mass >3.5cm (often correlates with b-hCG > 15,000) |
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Absolute contraindications to MTX
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Breastfeeding, immunodeficient, alcoholic, blood dyscrasia, pulmonary disease, PUD, hepatic/renal/hematology dysfxn
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When is more than one dose of MTX needed?
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If beta-hCG levels plateau or increase after 7 days
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Asherman's Syndrome includes the presence of what?
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Uterine synechiae (intrauterine adhesions)
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What is threatened abortion, what is the risk of subsequent spontaneous abortion, and what are the risks if carry to viability?
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Bleeding in the first trimester without tissue or fluid loss
50% Greater risk of preterm and low birth weight |
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What is inevitable abortion?
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Gross rupture of membranes w/ cervical dilation (contractions typically begin soon afterward)
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After what time are the fetus and placenta typically expelled separately?
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10wks
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After how many days should surgical abortion be performed instead of medical?
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49 days since LMP
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3 drugs for early medical abortion
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Mifepristone (antiprogestin), MTX (antimetabolite), misoprostol (prostaglandin)
All induce uterine contractility, either directly (misoprostol) or by decreasing progesterone inhibition |
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Rx for a septic abortion
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Broad spectrum IV Abx, IVF, prompt evacuation of uterus
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What is postabortal syndrome and how is it treated?
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Uterus fails to remain contracted after spontaneous abortion or elective abortion (pain, bleeding, open cervix, hematometra)
Suction curettage |
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At what beta-hCG level can an intrauterine pregnancy be appreciated?
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>2000
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Most common abnormal karyotope in aborted fetuses
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Autosomal trisomy
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Systemic maternal diseases associated w/ early pregnancy loss
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DM, SLE, CKD
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Rx for significant anemia during spontaneous abortion
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D&C
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Effect of single, prior first trimester surgical abortion on fertility/ likelihood of future early pregnancy losses
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No effect/ no increased risk
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Once pt at high risk for cervical cancer and has lesion, management option
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Cervical biopsy (can skip Pap smear, a screening test, as well as colposcopy since lesion can already be visualized)
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Screening tests for a normal African American couple wanting to conceive
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CBC and Hb electrophoresis
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Valproic acid is associated with an increased risk of these three abnormalities
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Neural tube defects, hydrocephalus and craniofacial malformations
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Women with poorly controlled DM during organogenesis are at risk for structural anomalies in these two systems
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CNS and CV
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Chorionic villus sampling is used to detect
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Chromosomal abnormalities
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Three components of triple screen + extra of quad screen
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AFP, hCG, unconjugated estriol
Inhibin A |
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Test for Down's in first trimester
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PAPP A (pregnancy associated plasma protein A)
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Risk of fetal loss with CVS
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1%
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Most sensitive screen for Down's in second trimester (and its sensitivity)
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Quad screen, 80-85%
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Risks of gestational diabetes
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Shoulder dystocia, metabolic disturbances, preeclampsia, polyhydramnios and fetal macrosomia
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Risk of pre-existing, but not gestational, diabetes
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IUGR
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Most common anomaly associated with valproic acid
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NTDs
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Definition of postpartum hemorrhage
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>500cc in a vaginal delivery or >1000cc in a C section
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Most common cause of postpartum hemorrhage
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Uterine atony
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Significant blood loss during delivery --> inability to breast feed, amenorrhea, constipation, slurred speech
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Sheehan Syndrome
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Cause of Sheehan Syndrome
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Anterior pituitary necrosis after significant blood loss
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Hormones affected by Sheehan Syndrome
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Gonadotropin, TSH, ACTH
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Increased risk of endometritis
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C section
With vaginal delivery: prolonged labor, prolonged ROM, multiple vaginal exams, internal fetal monitoring, manual removal of placenta, low SES |
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Most common cause of postpartum fever
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Endometritis
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Most common bacteria in postpartum endometritis
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Polymicrobial, aerobes + anaerobes (often staph and strep)
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Sign that can distinguish postpartum depression from postpartum blues
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Ambivalence toward newborn/ family
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Safest method of suppressing lactation
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Breast binding, ice packs and analgesics
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Cause of a normocytic anemia in pregnancy
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Hemodilution: maternal blood volume increases more than RBC volume
(iron deficiency would cause microcytic) |
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Physiologic respiratory/ acid base changes during pregnancy
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Increased minute ventilation --> compensated respiratory alkalosis
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Why does minute ventilation change in pregnancy?
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Because tidal volume increases (RR stays constant)
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Why are pregnant women susceptible to pulmonary edema?
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Decreased plasma osmolality
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Tocolysis with alpha agonists (e.g. terbutaline) increases the risk of this respiratory finding
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Pulmonary edema
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Hydronephrosis is more common on which side during pregnancy?
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Right
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Snowstorm pattern on ultrasound
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Gestational trophoblastic disease
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First step in the work-up of GTD
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CXR (will need weekly quants and a CBC as well)
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Substance that produces insulin resistance?
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Chorionic somatomammotropin (previously called human placental lactogen)
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Does insulin cross the placenta?
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No
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Normal PVR
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50-60cc
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PVR > 300cc indicates
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Overflow incontinence (due to underactive detrusor muscle or obstruction)
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Name for detrusor overactivity incontinence (e.g. when bladder is contracting too frequently)
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Urge incontinence
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Incontinence due to increased abdominal pressure in the absence of a detrusor contraction
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Genuine stress incontinence
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What is used for measurement of hypermobility in genuine stress incontinence?
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Straining Q-tip angle (if >30 degrees from horizon)
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Best surgical options (2) for pts with genuine stress incontinence w/ hypermobility
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Retropubic urethropexies or slings
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When are urethral bulking procedures effective for incontinence?
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When there is little to no mobility of the urethra
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Urethral bulking procedures are best for this type of incontinence
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Intrinsic sphincteric deficiency
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Best medical Rx for urge incontinence (detrusor overactivity)
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Anticholinergics, e.g. oxybutynin
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Kegel exercises are useful for this type of incontinence
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Stress urinary incontinence
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What does vaginal estrogen help with in terms of incontinence?
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Urgency, but NOT urge incontinence
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What is repaired in rectoceles?
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Defects in the rectovaginal fascia
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What is repaired in central and lateral cystoceles?
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Defects in pubocervical fascia
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Rx for uterine prolapse
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Vaginal hysterectomy
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Cause of stress incontinence
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Increase in intra-abdominal pressure (coughing, sneezing) when the patient is in the upright position
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What structural defects are associated w/ stress incontinence?
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Cystocele or urethrocele
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Continuous loss of urine
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Vesicovaginal fistula
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Cause of mixed incontinence
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Increased intra-abdominal pressure causes the urethral-vesical junction to descend causing the detrusor muscle to contract
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Small amt of continuous leaking
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Overflow incontinence
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What is colpocleisis and what is it used to treat?
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Surgical obliteration/ closure of the vaginal canal; vaginal prolapse
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Best least invasive option for prolapse
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Pessary
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Management of pt with FHR in the 60s and head at the introitus?
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IF patient cannot deliver vaginally with 1-2 pushes, go to assisted operative vaginal delivery
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Significant amt of vaginal bleeding after placement of an IUPC
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Presume uterine perforation–remove, monitor fetus; if reassuring, can reattempt
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Advantages of the midline episiotomy over the mediolateral episiotomy
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Less pain, less blood loss, ease of repair
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How long does the fourth stage of labor last?
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From delivery of the placenta until two hours afterward
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Abnormalities that may indicate Down's
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Flattened nasal bridge, small size, small rotated/ cup-shaped ears, andal gap toes, hypotonia, a protruding tongue, short broad hands, Simian creases, epicanthic folds, and oblique palpebral fissures
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Most likely fetal complication after maternal treatment with mag
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Respiratory distress
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Mom with T1DM will most likely have a baby that is small/large and hypo/hyperglycemic?
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Small
Hypoglycemic |
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Appearance of a septic infant
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Pale, lethargic, high temp
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Infants born to diabetic mothers are at increased risk of these 5 complications:
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Hypoglycemia, polycythemia, hyperbilirubinemia, hypocalcemia, respiratory distress
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When to start treatment and testing in an infant born to an HIV+ mother
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Treatment immediately
Testing starts at 24hrs |
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2 growth issues in diabetic mothers
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Growth restriction
Macrosomia |
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Other risks in diabetics
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Polyhydramnios
Caudal regression syndrome CV defects NTDs Preterm birth Hypertensive complications |
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When should zidovudine be initiated in pregnancy?
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14wks (oral, switch to IV at delivery)
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Most common cause of sepsis in pregnancy
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Pyelo
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Drug for thyroid storm contraindicated in pregnancy
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Radioactive iodine (concentrates in fetus --> hypothyroidism)
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Rx for thyroid storm in pregnancy
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Thioamitdes, propanolol, sodium iodide, dexamethasone
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White classification for diabetes in pregnancy
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Class A1: gestational, diet controlled
Class A2: gestational, insulin controlled Class B: onset >20yo w/ duration <10yrs Class C: onset <20yo or duration >10yrs Class D: onset <10yo or duration >20yrs Class E: calcified pelvic vessels Class F: nephropathy Class R: retinopathy Class H: ischemic heart disease Class T: prior kidney transplant |
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Rx for bacterial vaginosis during pregnancy
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Immediate oral metronidazole to reduce risk of preterm delivery (no partner treatment needed)
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Highest mortality rates in pregnancy (>25-50%)
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Pulmonary hypertension, Marfan's syndrome, aortic coarctation w/ valve involvement
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Which uterotonic med is contraindicated in pts with HTN or preeclampsia?
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Methylergonovine (is a vasoconstrictor)
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Which uterotonic is contraindicated in pts with asthma?
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Prostaglandin F2 (Hemabate) (is a smooth muscle constrictor and therefore a bronchoconstrictor)
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Most common risk factor for uterine inversion?
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Excessive traction on umbilical cord during 3rd stage
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How might uterine inversion present?
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Globular pale mass presenting at introitus while attempting to deliver placenta + signs of hypovolemia
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How are prostaglandin F2 and methylergonovine delivered?
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IM (never IV, b/c can cause bronchoconstriction and stroke, respectively)
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Which vessel should be ligated in the case of an XL for refractory PPH?
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Internal iliac (hypogastric) to decrease vascular pressure in the pelvis
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4 signs of dizygotic twins
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Dividing membrane thickness >2mm
Twin peak (lambda) sign Different genders 2 separate placentas (anterior and posterior) |
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Time period of various types of monozygotic twins
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Di-di: 3-4 days
Dichorionic-monoamniotic: 4-8 days Mono-mono: 8-12 days Conjoined: >13 days |
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Rx for mastitis
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Antibiotics
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Breastfeeding with pink shiny nipples and peeling at the periphery + burning while feeding
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Candidiasis (examine baby's mouth)
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Signs that baby is getting sufficient milk
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3-4 stools in 24 hours, 6 wet diapers in 24 hours, weight gain and sounds of swallowing
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Rx for engorgement
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Frequent feedings, warm compresses, analgesic 20min before feeding, expressing some milk, good support bra
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Most Rh incompatible pregnancies have what amount of feto-maternal blood transfer
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<0.1 cc of fetal blood in the maternal circulation; however, that is all that is required for sensitization
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Noninvasive test for fetal anemia
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Doppler ultrasound of middle cerebral artery peak systolic velocity
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US findings of Rh disease
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Excess fluid (from decreased hepatic protein production) --> ascites, pericardial and/or pleural fluid, scalp edema, hepatosplenomegaly, placentomegaly, polyhydramnios
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What is the standard dose of RhoGAM and how much fetal blood does it neutralize?
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300ug
30cc |
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Diagnostic tests for a fetus with poor growth
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Amniotic fluid volume, NST, doppler umbilical artery systolic/diastolic
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Most likely cause of asymmetric growth restriction
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Uteroplacental insufficiency (whereas symmetric restriction indicates an earlier insult, e.g. aneuploidy)
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Fetal growth restriction can have adult disease complications of (4)
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Cardiovascular disease, chronic HTN, COPD, and diabetes
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Pts with what type of diabetes are most likely to have macrosomic infants?
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Gestational
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Pts with what type of diabetes are more likely to have growth restricted infants?
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Long-standing diabetes with end-organ damage
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Most common abnormal karyotype found in spontaneously aborted fetuses
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Autosomal trisomy
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When is the risk of developing microcephaly and severe mental retardation the greatest?
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Weeks 8-15
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Thrombophilic abnormality associated with stillbirth, preeclampsia, placental abruption and IUGR
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Factor V Leiden
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Fat tissue during a D&C?
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Worry is omental tissue/bowel, proceed with laparoscopy to better visualize
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Lab test to measure after a fetal demise
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Fibrinogen: worry about coagulopathy developing (if was one fetus of a twin gestation, continue to monitor throughout the rest of the pregnancy)
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Most significant reason for increase in C-section rate?
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Declining rate of vaginal births after C/S
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What is cytotec?
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Misoprostol
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Meds used for IOL
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Cytotec to increase favorability of cerix
Pitocin |
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Risk factors associated with breech presentation?
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Prematurity, multiple pregnancy, genetic disorders, polyhydramnios, hydrocephaly, anencephaly, placenta previa, uterine anomalies and uterine fibroids
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When should you not AROM?
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Latent phase of labor
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Likelihood of success of vaginal trial after C-section
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70-80% (lower if have had multiple C-sections)
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2nd trimester vaginal bleeding with reassuring maternal and fetal status: first step in management
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US to r/o placenta previa (before vaginal exam b/c of risk of bleeding
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2nd trimester vaginal bleeding with reassuring maternal and fetal status: first step in management
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US to r/o placenta previa (before vaginal exam b/c of risk of bleeding
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Hypertensive smoker with tense/tender smoker, FHR with poor variability and late decels
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Placental abruption --> C section
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Hypertensive smoker with tense/tender smoker, FHR with poor variability and late decels
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Placental abruption --> C section
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Smoking increases the risk of these five things during pregnancy
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Placental abruption, placental previa, fetal growth restriction, preeclampsia and infection
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2nd trimester vaginal bleeding with reassuring maternal and fetal status: first step in management
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US to r/o placenta previa (before vaginal exam b/c of risk of bleeding
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Smoking increases the risk of these five things during pregnancy
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Placental abruption, placental previa, fetal growth restriction, preeclampsia and infection
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Bloody show as the cause for bleeding must be associated with
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Cervical dilation
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Bloody show as the cause for bleeding must be associated with
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Cervical dilation
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Hypertensive smoker with tense/tender smoker, FHR with poor variability and late decels
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Placental abruption --> C section
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Causes of friable cervix/ bleeding in 2nd trimester
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Trauma, cervicitis, cancer
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Smoking increases the risk of these five things during pregnancy
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Placental abruption, placental previa, fetal growth restriction, preeclampsia and infection
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Causes of friable cervix/ bleeding in 2nd trimester
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Trauma, cervicitis, cancer
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Bloody show as the cause for bleeding must be associated with
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Cervical dilation
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Causes of friable cervix/ bleeding in 2nd trimester
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Trauma, cervicitis, cancer
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Most common cause of preterm labor?
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Idiopathic
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Management of preterm contractions in a hydrated pt with a closed cervix
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Continue to monitor
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Management of preterm febrile pt with elevated WBC count presenting with ctx/cervical dilation
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Amniocentesis to rule out intra-amniotic infection
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Contraindications for tocolytics: terbutaline and ritodrine
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Diabetes
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Contraindications for tocolytics: magnesium sulfate
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Myasthenia gravis
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Contraindications for tocolytics: indomethacin
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33wks or later due to risk of premature ductus arteriosus closure
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How does mag sulfate work?
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Competes with calcium for entry into cells
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Side effects of terbutaline
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Beta-adrenergic: tachycardia, hypotension, anxiety and chest tightening or pain.
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Side effect of mag sulfate
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Respiratory depression (12-15mg), cardiac depression (.15mg), flushing, headache
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Betamethasone has shown decreased incidence of this non-pulm complication of prematurity
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Intracerebral hemorrhage
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When is fibronectin useful?
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For its negative predictive value to demonstrate women unlikely to deliver in next 2 weeks
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Sudden onset lower abdominal pain that radiates to the back + N/V
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Ovarian torsion (mass usually palpable)
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3 causes of late decels
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Uteroplacental insufficiency --> fetal acidosis --> fetal hypoxia
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When to think benign edema of pregnancy vs. DVT?
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Bilateral symptoms, esp. w/o fever, redness, or tenderness
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What % of cases of placenta accreta require a hysterectomy to stop the bleeding?
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66%
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Rx for placenta previa with continued bleeding
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Emergent C-section, even if premature
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Management of nipple discharge with blood
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Mammography
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Ulcerated papule w/ a punched out base and raised, indurated margins + painless inguinal LAD
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Syphilis
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Ulcer with red beefy base and no LAD
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Granuloma inguinale (Donovanosis)
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Best diagnosis of primary syphilis
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Dark field microscopy (may not have Abs yet)
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LH and FSH in PCOS
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High LH, low FSH
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4 indications for endometrial biopsy in pts with DUB
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Age >35, diabetes, obesity, chronic HTN
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Rx for DUB
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Cyclic progestins (if fail, endometrial ablation or hysterectomy)
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How does estrogen therapy affect thyroid hormones?
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Increases their metabolism/ increases TBG, so increases the need for L-thyroxine in pts w/ hypothyroidism
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Diabetes is often associated with this type of incontinence
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Overflow incontinence
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Rx for carpal tunnel syndrome (and back-up options)
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Wrist splint, then injection of corticosteroids, then surgical decompression; avoid NSAIDs in pregnancy
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Med to suppress endometriosis symptoms
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GnRH agonists
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Rx of DUB in adolescent with no abnormalities on US
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Iron therapy if mild
Add progestin if moderate Need high-dose estrogen if severe/ active bleeding |
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When is internal podalic version indicated?
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Twin gestation when 2nd twin is transverse or oblique and want to --> breech
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Where should the fluid be tested from for nitrazine/ ferning?
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Vagina, NOT cervical mucous
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Primary risk factor for PPROM?
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Genital tract infection, usually BV
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Nml cervical length
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34mm
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What can prolong the length of time before delivery by up to 7 days after PPROM?
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Antibiotics
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What does a tender uterine fundus indicate?
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Chorio
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Indicators of infection on amniocentesis
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Low glucose (<20), presence of leukocytes (poor predictive value), presence of IL-6
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Prevalence of PROM and PPROM
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10-15% and 1%, respectively
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Recurrence risk of PPROM
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30%
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Definition of postterm pregnancy
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42 completed weeks
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Post-date pregnancies are associated with these 4 factors:
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Placental sulfatase deficiency, fetal adrenal hypoplasia, anencephaly, extrauterine pregnancy
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Postterm pregnancies are associated with these 5complications
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Macrosomia
Oligohydramnios Meconium aspiration Uteroplacental insufficiency Dysmaturity |
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Management of pt at 41wks with unfavorable cervix who doesn't want to be induced
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Biweekly NST and AFI, induce for nonreactive or oligo
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Usage (and non-indication) of amnioinfusion
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Does not affect neonatal outcomes or decrease incidence of meconium aspiration
Used to treat repetitive variable decels |
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Findings of dysmaturity
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Withered, meconium stained, long-nailed, fragile, small placenta
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Dysmature infants are at great risk for?
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Stillbirth
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Common cause of fetal tachy
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Maternal fever/chorio
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Common cause of variable decels (specific, not just umbilical cord compression)
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Nuchal cord
Oligo |
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Late decels do not begin until
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At or after the peak of the uterine contraction
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Acute/ fast decels are
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Variable
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3 complications of epidurals
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Spinal headache, localized back pain, meningitis
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Endometritis is a complication of these 3 things
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Prolonged labor, prolonged ROM, multiple exams
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Rx for endometritis
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Amp and gent (G+ and G- coverage, respectively)
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Cause of low-grade 3 day postpartum fever without other signs/symptoms
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Breast engorgement
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Ddx for postpartum fever
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Endometritis, mastitis, cystitis
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Persistent postpartum fever despite Abx, without other signs/symptoms
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Septic thrombophlebitis
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Rx for septic thrombophlebitis
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Abx + anticoagulation
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Maternal fever after vaginal repair with gray edges
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Necrotizing fasciitis
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Swollen, tender, and painful area of vaginal laceration repair that is expanding
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Hematoma
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Rx for necrotizing fasciitis
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Extensive debridement
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What category drug is sertraline?
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Category C
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2 most common side effects of fluoxetine
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Sleep and sexual disturbances
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Are SSRIs safe while breastfeeding?
|
Yes!
|
|
|
Depression during luteal phase but not follicular phase
|
Premenstrual Dysphoric Disorder
|
|
|
Vacuums have a decreased rate of ___ compared to forceps
|
Maternal lacerations
|
|
|
When is external cephalic version contraindicated?
|
Active labor
|
|
|
Management of IUGR with polyhydramnios?
|
Amniocentesis to obtain fetal karyotype b/c of potential for Trisomy 18
|
|
|
Risk factors for cervical insufficiency
|
Prior gyne surgery (esp LEEP), prior obstetrical trauma, multiple gestation, Hx of preterm birth, 2nd trimester pregnancy loss
|
|
|
How long should the cervix be at 24 wks?
|
>25mm
|
|
|
Rx for trichomonas
|
Oral metronidazole for pt and her partner
|
|
|
Amenorrhea, normally developed breasts, absent pubic/axillary hair
|
Androgen insensitivity syndrome; will have internal testicles and be 46XY w/ high male-level testosterone
|
|
|
Nml internal genitalia, ambiguous external genitalia, clitoral hypertrophy, high FSH/LH, low estrogen
|
Aromatase deficiency
|
|
|
How to differentiate aromatase deficiency from CAH
|
In CAH estrogen is still synthesized (nml level) and internal genitalia are nml
|
|
|
Rx for asymptomatic bacteriuria of pregnancy
|
7 days of nitrofurantoin, amox, or cephalosporin (TMP contraindicated in pregnancy)
|
|
|
When should gonadectomy be performed in androgen insensitivity syndrome?
|
After puberty (completion of breast dev't and attainment of adult height)
|
|
|
Rx for androgen insensitivity syndrome after gonadectomy/ puberty?
|
Estrogen therapy (no need for progesterone as there is no uterus)
|
|
|
Rx for mild pre-eclampsia in a preterm pt with immature fetal lunds
|
Bed rest and frequent f/u
|
|
|
Low grade fever and leukocytosis 12 hrs postpartum
|
Normal!
|
|
|
Rx for endometritis
|
IV clinda (anaerobic coverage) and gent (G- coverage)
|
|
|
Karyotype and FSH and LH in Kallman's
|
46XX
Low and low |
|
|
Low-normal platelets and fibrinogen in pt with IUFD
|
Worry about early consumptive coagulopathy, esp b/c fibrinogen is normally elevated in pregnancy
|
|
|
Rx for consumptive coagulopathy, or concern for it, post-IUFD
|
IOL
|
|
|
Bleeding patterns typical on Depo
|
Irregularity for first 2-3 months; amenorrhea in 50% after 1 yr
|
|
|
How to avoid the nausea associated with OCPs used as emergency contraception
|
Inserting second dose vaginally or taking anti-emetic 1hr beforehand
|
|
|
Which type of emergency contraception requires two doses?
|
OCPs; levonorgestrel can be taken in 1 or 2
|
|
|
Reduced risk of what with tubal ligation?
|
Ovarian cancer
|
|
|
Pts with poorly controlled HTN are not a candidate for which type of contraception
|
OCPs
|
|
|
+ hcg, open cervix, fever
|
Septic abortion
|
|
|
Rx for septic abortion
|
Evacuation of uterus and broad spectrum Abx
|
|
|
Rx for pt wishing to get pregnant with antiphospholipid syndrome
|
Aspirin + heparin
|
|
|
Which has a higher blood loss, medical or surgical termination?
|
Medical
|
|
|
Concern with repeat D&C
|
Increased risk of Asherman's
|
|
|
After what gestational age is manual vacuum aspiration contraindicated?
|
8wks
|
|
|
D&E is performed in lieu of D&C in pts after how many weeks?
|
16
|
|
|
Drug used for induction for abortion if mom wants fetal autopsy
|
Intravaginal prostaglandins
|
|
|
Management of heavy bleeding post medical termination of pregnancy
|
D&C
|
|
|
Maternal fever two days after elective abortion
|
Postop endometritis
|
|
|
Management of postop endometritis
|
Abx + ultrasound to look for products of conception (if found, will need repeat D&C)
|
|
|
What reduces the risk of limb reduction defects with CVS?
|
Gestational age (lower risk if before 9-10wks)
|
|
|
Profuse, clear, thin cervical mucous indicates what stage of the menstrual cycle?
|
Ovulation
|
|
|
Thick, less-stretchy mucous indicates what stage of the menstrual cycle?
|
Luteal
|
|
|
Inability to lactate after severe PPH?
|
Sheehan's Syndrome (anterior pituitary necrosis) has developed due to pituitary hypoperfusion --> decreased PRL (and TSH and FSH)
|
|
|
OCPs cause a decreased rate of these two kinds of cancer
|
Endometrial and ovarian
|
|
|
What is the general cause of asymmetric IUGR?
|
Non-ideal maternal factors (e.g. HTN) --> fetal redistribution of blood flow to vital organs (brain, heart) at the expense of other organs, e.g. abdominal viscera
|
|
|
Management of unknown MMR status?
|
Check to see if rubella immune; vaccinate post-partum (live vaccine, not safe in pregnancy)
|
|
|
Diagnostic management of Rh-negative woman
|
Test for Rh status and antibodies at 10 wks and again at 28 wks
|
|
|
When is GTT screening done and which test is it?
|
24-28wks
1 hr 50 gram glucose tolerance test |
|
|
What is an abnl 1hr GTT and how is it managed?
|
>140 after 1hr; do a 3hr 100gram GTT
|
|
|
Thin/dry/white vulva with anogenital discomfort/pruritus, dyspareuna, dysuria
|
Lichen sclerosis
|
|
|
Why biopsy potential lichen sclerosis?
|
To rule out vulvar squamous cell carcinoma
|
|
|
Rx for lichen sclerosis
|
High potency topical corticosteroids
|
|
|
What causes RUQ pain in pre-eclampsia?
|
Distention of liver capsule
|
|
|
6 aspects of severe pre-eclampsia
|
HTN >160/110, proteinuria >5g on 24hr, oliguria, pulmonary edema, thrombocytopenia, elevated liver enzymes
|
|
|
Cause of irregular menstrual cycles in teens (e.g. shortly after menarche?
|
Inadequate LH/FSH secretion, often leading to anovulation and then breakthrough bleeding (HPG axis immaturity)
|
|
|
What effect does TSH have on prolactin?
|
Increases it
|
|
|
Goal of colposcopy during pregnancy
|
Exclusion of invasive cancer
|
|
|
Management of HSIL during pegnancy
|
Colpo and biopsy; if normal, second biopsy 6-8wks after delivery
|
|
|
Who is raloxifene (a SERM) contraindicated in?
|
Pts with a history of thromboembolism
|
|
|
Risk for endometrial cancer: tamoxifen vs. raloxifene
|
Increased with tamoxifen, not with raloxifene
|
|
|
Raloxifene is a first-line agent for prevention of
|
Osteoporosis (possibly also breast cancer)
|
|
|
Rx for lactation suppression
|
No meds! Tight bras, no nipple manipulation, ice packs, analgesics
|
|
|
Urinary urgency, urinary frequency, chronic pelvic pain
|
Interstitial cystitis
|
|
|
Causes and relief of pain in interstitial cystitis
|
Sex, full bladder, exercise, spicy foods
Relieved by voiding |
|
|
Rx for young woman with a breast mass
|
Re-examine just after menstrual period; if no smaller, FNA or excisional biopsy (no role for mammography b/c of high density of breast tissue in young women)
|
|
|
3 potential causes of variable decels
|
Cord compression, low amniotic fluid, fetal hypoxia
|
|
|
Multi-step management of non-reassuring fetal heart tones
|
Maternal oxygenation and repositioning --> fetal scalp pH to assess for hypoxia --> amnioinfusion --> C-section
|
|
|
Affect of pregnancy on thyroid hormones
|
Increased TBG and stimulation of TSH receptor by hCG -->
Increased total T3/T4, normal free T3/T4, low-normal TSH |
|
|
Rx for yeast infection
|
Oral fluconazole
|
|
|
Chronic pelvic pain, worse premenstrually; dysmenorrhea; pain with defection' rectovaginal tenderness; tenderness with movement of the uterus
|
Endometriosis
|
|
|
Management of suspected endometriosis
|
Laparoscopy
|
|
|
Pts with endometriosis are at risk for developing
|
Infertility
|
|
|
Management of repetitive late decels
|
Emergent C-section
|
|
|
Most common risk factor for placental abruption
|
Maternal HTN
|
|
|
Respiratory failure and cardiac shock during amniocentesis or labor
|
Amniotic fluid embolism
|
|
|
What is Stein-Levanthal syndrome?
|
PCOS
|
|
|
Fertility option for patients with premature ovarian failure
|
IVF
|
|
|
Premature ovarian failure is associated with what class of diseases?
|
Autoimmune diseases
|
|
|
What is a luteal phase defect?
|
Failure of corpus luteum to produce sufficient progesterone to maintain endometrium and allow implantation
|
|
|
Rx for luteal phase defect
|
Progesterone supplement
|
|
|
How to distinguish btwn leiomyomas and adenomyosis?
|
Fibroid uterus is usually irregularly shaped, rather than symmetrically enlarged
|
|
|
Endometrial glands in the uterine muscle is called
|
Adenomyosis
|
|
|
Hyperventilation, agitation, and tachy in pt with prior C-section
|
Imminent uterine rupture
|
|
|
Maternal symptoms in vasa previa
|
None! Only fetal exsanguination
|
|
|
How to distinguish btwn uterine rupture and abruptio placenta?
|
Uterine rupture has abdominal exam with irregular contours (fetal limbs), more likely to cause hypovolemia/shock
|
|
|
Most common cause of increased MSAFP
|
Dating error
|
|
|
3 other causes of increased MSAFP
|
NTDs, abdominal wall defects, multiple gestation
|
|
|
Management of increased MSAFP
|
Ultrasound to look for multiple gestation/ fetal size for dating/ identifiable anomalies
|
|
|
Quad screen with low MSAFP, low estriol, high beta-hCG, high inhibin A
|
Down syndrome
|
|
|
Quad screen with low MSAFP, low estriol, low beta-hCG, normal inhibin A
|
Edward
|
|
|
Protein excretion in preeclampsia is >?
|
300mg/24hr
|
|
|
Rx for mild pre-eclampsia with pre-term fetus
|
Methyldopa and bed rest
|
|
|
Amsel criteria are used to diagnose
|
BV
|
|
|
Waht are the 4 Amsel criteria?
|
Thin, gray-white vaginal discharge
Vaginal pH > 4.5 Positive whiff test w/ KOH Clue cells |
|
|
When is IOL used for a missed abortion?
|
After the 16th week of gestation
|
|
|
Management of inevitable abortion
|
Hospitalization, analgesics, observation (same as for incomplete abortion to monitor for sepsis, DIC, hemorrhage) + suction curettage
|
|
|
Dull, ill-defined pelvic ache worse prior to menstruation and relieved by menses; Hx of sexual problems
|
Pelvic congestion syndrome
|
|
|
5 aspects of a BPP
|
NST, tone, movements, breathing, amniotic fluid volume
|
|
|
BPP of 4 or less
|
Delivery if fetus is >26wks
|
|
|
pH of amniotic fluid
|
7-7.5
|
|
|
Definition of maternal leukocytosis
|
>15,000
|
|
|
Amenorrhea eval
|
Uterus on pelvic U/S: if FSH increased --> karyotype; if FSH decreased --> cranial MRI
Uterus absent on U/S: if 46,XX/ nml testosterone, indicates abnormal Mullerian dev't; if 46,XY/male testosterone levels, indicates androgen insensitivity |
|
|
How does FSH aid in the diagnosis of amenorrhea
|
If increased, is hypergonadotropic amenorrhea: peripheral problem
If decreased, is hypogonadotropic amenorrhea: central problem |
|
|
Cause of amenorrhea in female athlete's trial
|
Decreased GnRH/LH --> estrogen deficiency
|
|
|
Test to determine whether vaginal bleeding is from a fetal hemorrhage
|
Apt test
|
|
|
Rx for gonorrhea or chlamydia
|
Ceftriaxone and azithro (or doxy)
|
|
|
Most common cause of a nonreactive NST
|
Sleeping baby: wake up with vibroacoustic stimulation
|
|
|
Cause of vaginismus
|
Involuntary contraction of perineal musculature (psychological)
|
|
|
Rx for vaginismus
|
Relaxation, Kegels, gradual dilation w/ dilators, fingers, etc.
|
|
|
Rx for primary anorgasmia
|
Self-stimulation
|
|
|
After what point are breech presentations attempted to be converted?
|
37wks (b/c most self-resolve by then)
|
|
|
When are fetuses at highest risk from ionizing radiation exposure?
|
8-15wks
|
|
|
Effects of ionizing radiation
|
Mental retardation, microcephaly, abnormal genitalia, growth restriction, microphthalmia, cataracts
|
|
|
Test when suspect anovulation as cause of infertility
|
Mid-luteal phase serum progesterone (should be increased to >10)
|
|
|
Monomorphous pink papules, absence of comedones
|
Steroid-induced folliculitis (steroid acne)
|
|
|
Most preventable cause of fetal growth restriction in the US
|
Smoking (causes 1 in 3 cases)
|
|
|
Most common infection leading to IUGR
|
CMV
|
|
|
DES exposure in utero increases the risk for
|
Adenocarcinoma of the vagina
|
|
|
pH of vaginitis infections
|
Normal (4-4.5) in yeast infections; elevated (5-6) in BV and trich
|
|
|
How to distinguish BV and tric clinically?
|
Pruritis and inflammation seen only in trichomonas
|
|
|
Decreased long-term variability can be due to this benign condition
|
Fetal sleep
|
|
|
Yellow mucopurulent discharge from the cervix
|
Most commonly chlamydia
|
|
|
Dyspareunia, dysmenorrhea, dyschezia
|
Endometriosis
|
|
|
Rx for endometriosis
|
OCPs; GnRH analogs; danazol
|
|
|
Bilateral, multinodular, solid masses on both ovaries
|
Pregnancy luteoma: benign condition, no Rx
|
|
|
Things to rule out with hyperemesis in pregnancy
|
Hyaditiform mole
|
|
|
Enlarged uterus, hyperemesis, and greatly increased hCG
|
Hyaditiform mole
|
|
|
Vomiting, weight loss, ketonuria
|
Hyperemesis gravidum (can have mild increases in ALT/AST, amylase/lipase)
|
|
|
Definition of arrest of descent
|
No change in descent of fetal presenting part after 2hrs in nullips, 1 in multips (add an hr with epidural in place)
|
|
|
Definition of arrest of dilation
|
Dilation does not change (once >4cm) >1cm/hr in nullips or 1.2cm/hr
|
|
|
What is the Zavanelli maneuver?
|
Last resort for a shoulder dystocia: pushing baby back into uterine cavity followed by C-section
|
|
|
Mechanism of hypotension post-epidural
|
Sympathetic block --> vasodilation of lower extremity vessels --> blood redistribution and venous pooling in lower extremities
|
|
|
Relationship btwn hypothyroidism and hyperprolactinemia
|
TRH stimulates prolactin production
|
|
|
When is a contraction stress test indicated?
|
When the BPP score is 6
|
|
|
Best Abx for UTIs in pregnancy
|
Amox, nitrofurantoin, cephalexin
|
|
|
Why is the risk of UTI increased in pregnancy?
|
Progesterone causes smooth muscle relaxation --> ureteral dilation --> facilitates bacterial colonization and ascension
|
|
|
Post-delivery, woman with respiratory failure, cardiogenic shock, and DIC
|
Amniotic fluid embolism (can also occur post-amniocentesis)
|
|
|
Rx for AFE
|
Respiratory support first; then IVF
|
|
|
How to differentiate btwn central and peripheral precocious puberty?
|
Central: high basal LH that increases with GnRH stimulation
Peripheral: low LH with no response to GnRH |
|
|
Rx for central precocious puberty and reasoning
|
GnRH agonist; prevention of premature epiphyseal plate fusion
|
|
|
How to distinguish mastitis from breast engorgement
|
Mastitis is usually unilateral
|
|
|
What lecithin/sphingomyelin ratio indicates lung maturity?
|
> 2.0
|
|
|
Management of decreased fetal movements with no fetal heart tones heard on Doppler
|
Ultrasonography to confirm IUFD
|
|
|
When is serial fibrinogen monitoring necessary after IUFD?
|
Only if monitored expectantly to look for DIC (e.g. not if fetus is evacuated)
|
|
|
What is the cause of primary dysmenorrhea
|
Increased prostaglandins
|
|
|
Rx for women with refractory PMS
|
Low-dose SSRIs; if unsuccessful, alprazolam
|
|
|
Precocious puberty is defined as before what age
|
8yo in girls
|
|
|
Cause of central precocious puberty
|
Early activation of the HPO axis
|
|
|
Cause of peripheral precocious puberty
|
Gonadal or adrenal release of excess sex hormones
|
|
|
Rx for HELLP syndrome
|
Immediate delivery if >34wks; otherwise steroids, monitoring, etc.
|
|
|
What is pseudocyesis
|
Woman who desperately wants to be pregnant presents with all the signs and symptoms, but has a normal endometrial stripe and negative hCG
|
|
|
Best measurement on U/S for estimation of fetal size
|
Abdominal circumference (b/c affected in both symmetric and asymmetric fetal growth restriction)
|
|
|
At what antibody titer level is the mother already sensitized (i.e. RhoGAM not helpful), and at what level is the fetus at risk for hemolytic disease
|
1:6
1:16 |
|
|
Role of beta-hCG and what secretes it
|
Syncytiotrophoblast: to maintain corpus luteum (for its progesterone production until placenta takes over)
|
|
|
Definition of missed abortion
|
IUFD <20wks w/ complete retained products of conception and a closed cervix
|
|
|
Sx of missed abortion
|
Brown vaginal discharge and loss of pregnancy symptoms
|
|
|
Medical Rx for spontaneous vs. elective abortion
|
Misoprostol/mifepristone can eliminate products of conception from uterus
Methotrexate is an abortifacient (useful for ectopic as well) |
|
|
FSH and LH levels in Turner's
|
High (due to poor estrogen function: lack of negative feedback)
|
|
|
Inhibin levels in Turner's
|
Low (b/c is a marker of ovarian function)
|
|
|
When do you not need to treat for both chlamydia and gonorrhea?
|
When the other infection has been ruled out with a highly sensitive test, e.g. NAAT
|
|
|
Management of pt with antepartum hemorrhage
|
Resuscitation first! IVF, etc.; then ultrasound, then emergency C-section if needed
|
|
|
Cause of neonatal thyroidtoxicosis if mother has just had thyroidectomy due to Graves?
|
Thyroid stimulating Ig levels remain high for several months after thyroidectomy and can cross placenta
|
|
|
Increased osteoporosis/fracture risk in pts who drink more than ___ drinks/day
|
2
|
|
|
Why is asymptomatic bacteriuria treated in pregnant women?
|
Progresses to pyelo in 30-40%, which may cause septicemia, preterm labor, and low birth weight
|
|
|
Management of placental abruption if pt and fetus are stable
|
IOL
|
|
|
What two lab values raise concern for DIC after IUFD?
|
Low fibrinogen and low platelets
|
|
|
How do granulosa cell tumors present in postmenopausal women?
|
Breast enlargement, lack of menopausal symptoms
|
|
|
4 methods of treating vaginal warts
|
Trichloroacetic acid, podophyllin, excision, fulguration (electric current)
|
|
|
Condyloma acuminata vs. condyloma lata?
|
Former is HPV (pink, clustered, teardrop lesions); latter is secondary syphilis (flat, velvety lesions)
|
|
|
Which common STD is always tested for, even if asymptomatic, in pregnancy?
|
Chlamydia (not gonorrhea)
|
|
|
Indications for inpatient Rx for PID
|
High fever, unresponsive to orals, inability to take orals b/c of N/V, pregnancy, non-compliance
|
|
|
Unexpected potential Abx regimen for PID
|
Clinda + gent
|
|
|
FSH and LH in premature ovarian failure
|
Both increased due to lack of negative feedback from estrogen; FSH/LH >1 b/c FSH is cleared slower
|
|
|
Flank pain and hematuria in pregnancy
|
Nephrolithiasis (which may lead to hydronephrosis beyond the physiologic amt in pregnancy)
|
|
|
BUN and Cr levels in pregnancy
|
Both decrease due to increased GFR and renal plasma flow
|
|
|
Uterine tenderness, hyperactivity, and increased uterine tone
|
May be placental abruption, even without bleeding: can have concealed hemorrhage
|
|
|
Besides HTN and cocaine use, risk factors for abruption include
|
Short umbilical cord
Tobacco use Folate deficiency |
|
|
Cause of stress incontinence
|
Weak pelvic floor muscles --> urethral hypermobility with increased intraabdominal pressure --> ineffective sphincter closure
|
|
|
Rx for stress incontinence
|
Kegels and urethropexy
|
|
|
Cause of urge incontinence
|
Detrusor hyperactivity
|
|
|
Rx for urge incontinence
|
Oxybutynin
|
|
|
Rx for overflow incontinence
|
Bethanechol and alpha blockers
|
|
|
Dysmenorrhea and dyspareunia
|
Endometriosis
|
|
|
Management of ovarian cyst seen on US in a postmenopausal pt
|
Exploratory surgery
|
|
|
2 first line options for endometriosis
|
NSAIDs and OCPs
|
|
|
Management of suspected hemorrhagic cyst
|
Repeat US in 2mo
|
|
|
Pathophys of interstitial cystitis
|
Disruption of glycosaminoglycan layer in bladder mucosa
|
|
|
Rx for interstitial cystitis
|
Dimethyl sulfoxide (DMSO), pentosan polysulfate, or anti-inflammatory and analgesics
|
|
|
How to aid fertility in women with endometriosis
|
Clomiphene citrate (+ IUI if needed)
|
|
|
Management of chronic pelvic pain if NSAIDs and OCPs have failed?
|
Diagnostic laparoscopy to look for endometriosis (can't use GnRH agonist until diagnosis confirmed)
|
|
|
2 non-gyne conditions associated with chronic pelvic pain
|
Interstitial cystitis
IBS |
|
|
How do GnRH agonists work vs. danazol
|
GnRH agonists down-regulate HPA axis, decrease FSH/LH/estrogen
Danozol suppresses the mid-cycle surge in FSH/LH |
|
|
50% of women with chronic pelvic pain have a history of
|
Physical or sexual abuse
|
|
|
Imaging study of choice for potential ovarian cancer
|
Transvaginal US
|
|
|
Surgical management of chronic pelvic pain due to past unilateral PID in pt hoping for future fertility
|
Laparoscopic unilateral salpingectomy (leave both ovaries if can)
|
|
|
Which 2 nerves are at risk of entrapment after LTCS
|
Iliohypogastric
Ilioinguinal |
|
|
Loss of sensation in which distributions for iliohypogastric vs. ilioinguinal nerve entrapment
|
Iliohypogastric nerve: groin, skin overlying the pubis
Ilioinguinal nerve: groin, symphysis, labium and upper inner thigh |
|
|
Breast nodule with normal mammogram
|
Still need cytology, e.g. FNA
|
|
|
This substance can increase the pain from fibrocystic breast changes
|
Caffeine
|
|
|
Management of bloody vs. clear fluid on breast lump FNA
|
Clear: f/u in 2mo if mass decreases in size after aspiration (if not, need excisional biopsy)
Bloody: excisional biopsy |
|
|
Rx for mastitis
|
Abx and ibuprofen/tylenol
|
|
|
Bug and abx choice for mastitis
|
Dicloxacillin (erythro if pen-allergic)
|
|
|
Management of vulvar lesion unresponsive to trichloroacetic acid and imiquimod cream
|
Vulvar biopsy (if negative, then laser excision)
|
|
|
How does medroxyprogesterone acetate work to promote regular menses and how is it given
|
Switches endometrium from proliferative --> secretory
10mg for 10 days each month |
|
|
LH:FSH ratio in PCOS
|
Increased
|
|
|
Androgen levels are ___ and estrogen levels are ___ in PCOS
|
Both increased
|
|
|
What is hyperthecosis?
|
Extreme PCOS; women experience virilization, usually refractory to OCPs
|
|
|
Elevated DHEAS, but normal testosterone
|
Adrenal tumor
|
|
|
2 tests for Cushing's
|
24hr urinary cortisol
Dexamethasone suppression test |
|
|
Hyperinsulinemia may present as
|
Acanthosis nigricans; can actually do a fasting insulin level if think pre-diabetic
|
|
|
Cause of postpartum hair loss
|
High estrogen in pregnancy --> synchrony of hair growth
|
|
|
Signs of hyperthecosis
|
Temporal balding, deepening of the voice, clitoral enlargement
|
|
|
Rx for hirsutism (first and second line)
|
OCPs, then add spironolactone
(can also use Lupron or danazol in lieu of OCPs) |
|
|
How do the bisphosphonates work
|
Inhibit osteoclast bone resorption
|
|
|
Oligospermia with low LH and normal testosterone
|
Exogenous steroid use
|
|
|
Recommended calcium supplementation for postmenopausal women
|
1200-1500mg
|
|
|
When to start treatment with bisphosphonates
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Low BMD on DEXA scan, or with history of osteoporotic fracture
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Most common reason women stop hormone replacement therapy
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Vaginal bleeding from cycles after previous amenorrhea
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Most effective treatment for hot flashes
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Estrogen
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Side effect of TCAs
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Hyperprolactinemia, which can lead to infertility
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Rx for infertility from functional hypothalamic amenorrhea
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Weight gain; otherwise, LH and FSH (clomiphene citrate doesn't work as well for ovulation induction)
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How to determine ovarian reserve in pt who may be perimenopausal and wants to conceive
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Clomiphene challenge test
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Basis for PMS/PMDD
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Serotoninergic dysregulation (decreased serotonin in progesterone-dominant luteal phase)
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What is entrainment?
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Luteal phase worsening of underlying medical/psychiatric disorder (e.g. IBS, MDD)
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How do OCPs help with dysmenorrhea?
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Induce endometrial atrophy; with less endometrium, less prostaglandins released
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When is chlamydia and gonorrhea testing indicated?
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In ALL sexually active women under 25
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Menorrhagia with severe dysmenorrhea
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Adenomyosis
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Definitive Rx for adenomyosis
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Hysterectomy (can also use Mirena)
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When do you need an EMB with diagnosis of fibroids?
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Woman >40 with AUB
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Which vitamins can reduce PMS symptoms?
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Vitamin A, E, and B6
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When do pts need a symptom diary for PMS/PMDD diagnosis?
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ALWAYS!
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Strongest risk factor for PMS
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Family history (other than vitamin deficiencies)
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Karyotype of complete vs. partial moles
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Complete: 46XX (entirely paternal)
Partial: 69XXY (one materanl and two paternal) |
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Which has a higher likelihood of malignant transformation, and which is more common
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Complete mole for both
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Second trimester bleeding, no fetal heart tones, exaggerated pregnancy symptoms
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Molar pregnancy (exaggerated symptoms due to high beta-hcg)
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Ovarian appearance with hyaditiform moles and why
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Multicystic from theca lutein cysts due to follicular stimulation from high levels of circulating hCG
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Choriocarcinomas can follow which types of pregnancies?
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Molar, normal, abortion, ectopic
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Form of metastases in choriocarcinoma
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Hematogenous embolization
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Why should metastatic sites in GTD not be biopsied?
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Bleeding complications
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Risk factors for molar pregnancy
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Asian, extremes of age, Hx of 2+ miscarriages, low beta carotene or folic acid
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Uterine size greater than dates can indicate
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Molar pregnancy, esp complete mole
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Rx for molar pregnancy
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Suction curettage
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Contraception length recommendation after molar pregnancy
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For 6mo after negative hCG values
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Risk factor of prolonged lichen sclerosis
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Extensive irritation can --> vulvar SCC
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Significant lifestyle risk factor for vulvar cancer
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Smoking
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Multiple white plaquelike lesions
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Paget disease of the vulva
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Thin, inelastic, white vulvar skin with "tissue paper" appearance
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Lichen sclerosis
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Multicentric brown-pigmented papules on the perineum, perianal area, and labia minora
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HPV-associated VIN (vulvar intraepithelial neoplasia)
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Rx for VIN III
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Wide local excision
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Rx for diffuse lesions from VIN II
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Laser therapy
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Vulva w/ fiery red background mottled with whitish hyperkeratotic areas without a distinct lesion
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Paget disease of the vulva
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Areas involved in lichen planus
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Hair-bearing skin and scalp, nails, oral mucous membranes and vulva
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Severe pain on attempted vaginal entry
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Vulvar vestibulitis
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Rx for vulvar vestibulitis
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TCAs, topical anesthetics, pelvic floor exercises; radical vestibulectomy if refractory
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Persistent itching and scratching --> thick, lichenified, enlarged labia
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Lichen simplex chronicus
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Cause of mucopurulent cervicitis
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Chlamydia or gonorrhea
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Name and management of white lesion on cervix
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Leukoplakia; always must biopsy
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Management of insufficient colpo
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CKC biopsy
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Management of HSIL but negative colpo/biopsy
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Cervical conization, given discrepancy in results
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Definition of microinvasive cancer
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Cells that extend <3mm beyond the basement membrane
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Why should myomectomy at the time of C-section be avoided?
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Increased blood loss
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Which fibroid pts are good candidates for GnRH agonist Rx?
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Pts close to menopause, or pts receiving hysterectomy in 6mo (to reduce size prior to surgery)
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Pregnant pts with myomas >3cm are at increase risk for?
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Preterm labor, placental abruption, pelvic pain, C-section
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Management of EMB with scant tissue and rare atypical cells
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D&C
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Best scan to look for mets in pt with stage 1 endometrial cancer
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CXR (more invasive scans not needed)
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How often do pts on tamoxifen need EMB?
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Never, unless symptomatic; still just regular annual exams
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Yellow-brown discharge and foul odor on a young girl
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Foreign body
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Management of vaginal foreign body in a young girl
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Removal under anesthesia
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