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39 Cards in this Set

  • Front
  • Back
Presentation of a chancroid
Chancroid does not cause systemic symptoms of fever and leads to a soft, non indurated, painful ulcer.

Haemophilus ducreyi

Management : erythromycin PO
Adverse events in pre-eclampsia
1) headache, visual changes or grand mal seizure
2) blood pressure greater than 180/100
3) pulmonary edema
4) right upper quadrant pain or elevated liver function tests
5) Oliguria (<500 ml/24 hours)
6) Microangiopathic hemolytic anemia or thrombocytopenia
7) Oligohydramnios or IUGR
Which women should receive antibiotics for GBS?
GBS are a part of the normal flora of many women. During pregnancy, as many as 20 to 40% of women will be colonized with GBS. Most neonates born to colonized mothers will not develop infection with GBS; however, approximately 1 to 4% will.

Two primary methods are used to determine which women should receive antibiotics :

1) Base on the mother's risk factors
- Positive urine culture
- Previous delivery of baby with GBS infection
- Membrane rupture duration greater than 18 hours
- Preterm labour (< 37 weeks)
- Intrapartum fever of 38.5 or greater

2) Positive GBS screening at 35 weeks (vaginal and rectal sampling)
Management of a rubella non immune woman planning on becoming pregnant
Administer MMR vaccine preferably 3 months before conception.
Managing a non immune pregnant woman who has been exposed to VZV
Measure serum IgG for VZV. If negative, administer VZIG, which is 75% effective if given within 96 hours of exposure.
Trichomonas vaginalis shape
Pear shape, flagellated organism on the normal saline, wet mount smear preparation.
RIsk factors for uterine rupture
The most commonly cited risk factor is prior surgery to myometrium (C/S, myomectomy)

It can also be associated with:
- blunt abdominal trauma
- oxytocin use
- perforation with an intrauterine pressure catheter
- grand multiparity
- fetal malpresentation
- difficult delivery with forceps or breech extractions
Management of an acute hypertensive episode in pregnancy
The goal of antihypertensive therapy during an acute episode of severe hypertension is not to lower blood pressure to normotensive levels but rather to a mild-moderate hypertensive level, with a diastolic blood pressure of 90-100 mm Hg.
When should an external fetal version be performed?
It should be performed after 37 weeks, because it could increase the risks of labour induction.

If a mother is Rh negative, WinRho should also be administered because there i as risk of isoimmunisation.
Presentation of post partum psychosis
Postpartum psychosis usually occurs hours to days postpartum and is characterized by anxiety, agitation, insomnia, confusion and ideation of hurting oneself, the baby or others.

Referral to a psychiatrist STAT.
Treatment of pyelonephritis in pregnancy
If the patient is stable, outpatient treatment with TMP-SMX or Augmentin may be tried, although many suggest that a pregnant woman with pyelonephritis should be hospitalized.

Inpatient management includes IV Ancef +/- Gentamycin. 48 hours post no fever, patient can be switched to TMP-SMX or Nitrofurantoin.
Main treatment is type I diabetic pregnant woman during pregnancy.
Insulin (continuous infusion pump).

Avoid hyperglycemias as much as possible.
Presentation of placenta abruptio
The classic triad of presentation is T3 bleeding, painful uterus contractions and fetal distress. Definitive diagnosis can be made when there is a retroplacental clot.

The most common causes of abruption are maternal hypertension and trauma.
Cocaine use is also associated with abruption.
Clear cell adenocarcinoma of the vaginal tract
Rare cancer associated with in utero exposure to DES.
Treatment of vaginal trichomoniasis
Metronidazole for patient and partner
Protection factor against ovarian cancer
OCP
Molluscum contagiosum
Poxvirus

Infection can occur with or without sexual contact. It is a rare infection that tends to occur in immunocompromised patients.

The lesions have a typical appearance in that they are small, dome-shaped, flesh coloured papules with a smooth surface. Many of the lesions will be umbilicated.

Diagnosis is made by biopsy.
Treatment is made by destruction with laser, liquid nitrogen or trichloroacetic acid.
Management of cervical cancer during pregnancy
If cervical cancer develops during the first trimester, the pregnancy should be terminated and treatment of cancer should start.

If the cancer is diagnosed late in pregnancy, one can wait for fetal maturity prior to delivery and treatment.
Prognosis of migraine headaches during pregnancy
They usually improve in 2/3 of pregnant women with pre-existing migraine.
Diaphragm use
It should be placed prior to coitus. Spermicide should be added.

If a second coitus takes place, additional spermicide should be added.

After coitus, the diaphragm should be left in place for 6 hours to allow for complete immobilization of sperm.

It should be taken out in 6 hours or at most the next morning in order to prevent TSS.
When to start evaluation of recurrent abortions? What to screen for?
After 2 spontaneous abortions, screening for causes should be started.

Screen for :
- uterine anomalies
- diabetes
- lupus
- T4 disease
- coagulopathy
- Karyotype
- infection
- auto immune antibodies
DMPA side effects
Weight gain (2.5 kgs)
Spotting
Irregular bleeding patterns
Amenorrhea for 6 months after stopping the injections
Headache
Decreased libido
Tiredness
Hair loss
Spontaneous abortions risks
Approximately, 20% to 25% of pregnant women will have T1 bleeding and the chief concern is with ectopic pregnancy and spontaneous abortion.

Of those women, about 50% will go on to have a spontaneous abortion.

However, once fetal cardiac activity is seen, the risk of abortion is around 10%.
Management of hydatiform mole
Evacuation and curetage + serial follow ups until b-hcg negative
Most common congenital malformation associated with type I diabetes
Sacral agenesis
Timing for placement of cerclage
Late first or early second trimester, because the patient is at risk of spontaneous abortion during T1,
Risk factors for post C/S wound infection
Poor surgical technique
Low SES
Extended duration of labour and ruptured membranes
Chorioamnionitis
Obesity
Type I diabetes
Immunodeficiency
Corticosteroid therapy
Which patients can have a vaginal delivery after C/S
Those with a prior low transverse uterine incision or low vertical uterine incision.
Methotrexate use in ectopic pregnancy
< 3.5 cm
no fetal heart
Reliable patient
b-hcg < 15 000
No medical contra-indication to MTX use
PAP smear frequency in HIV positive women
Q 6 months
Characteristic of ovaries on physical exam in post menopausal women
They are not palpable.
If they are, they should raise the possibility of malignancy.
Does Depo Provera increase the risk of thrombo-embolic events?
no
Approved regimen for interruption of pregnancy after implantation
Mifepristone (RU-486)
What is Plan B composed of?
2 doses of 750 ug of levonorgesterl taken 12 h apart

May alternatively take levonorgestrel 1.5 mg once
What is the yuzpe method composed of?
PO administration of 2 doses of EE 100 ug + levonorgestrel 500 ug 12 h apart.

"Ovral" tablets are most commonly used to provide these doses.
SI of triptans during pregnancy
labour induction
promoting Uterine contractions
constricting fetal and placental vessels
Branches of the internal iliac artery
Posterior division
- superior gluteal
- iliolumbar
- lateral sacral

Anterior
- obturator
- internal pudendal
+ middle rectal
+ inferior rectal
- uterine
- superior and inferior vesical
- vaginal branches
- umbilicated artery
Average time for resumption of menses after pregnancy (if not breastfeeding)
8 weeks.

70-90% of women have their menses back at 3 months.

They could have them back as soon as 6 weeks PP.
Chandelier Sign
Pain on cervix mobilisation