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138 Cards in this Set
- Front
- Back
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what is associated with pelvic pain worsened by bladder filling or intercourse accompanied by urinary frequency, urgency, and nocturia
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interstitial cystitis
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what is the most likely cause of sudden onset hirsutism or viriluzation during pregnancy in a multiparous AA woman
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pregnancy luteoma bilaterally
*masses are solid **reassurance and follow-up |
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three hallmark features of endometriosis
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dyspareunia
dysmenorrhea dyschezia |
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treatment option for endometriosis
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OCP
Leuprolide Danazol |
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what cancer are patients with PCOS at risk of developing
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endometrial carcinoma
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what is the next step in management of an obese, hypertensive, diabetic woman who is >35 presenting with dysfunctional uterine bleeding
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endometrial biopsy
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when should testes be removed in a testicular feminization
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after puberty
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next step in management of a septic abortion
*results from retained products of missed, incomplete, inevitable, elective abortion |
cervical/blood cultures
IV antibiotics gentle suction curettage |
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most serious consequence of prolonged fetal demise
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DIC
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what should be done after the first episode of an intrauterine fetal demise
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autopsy of the fetus and placenta
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what is associated with fever, uterine tenderness, and foul-smelling lochia in the postpartum period
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postpartum endometritis
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what are risk factors for postpartum endometritis
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prolonged rupture of membranes
prolonged labor c-section |
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treatment of choice for postpartum endometritis
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IV clindamycin and gentamicin
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what is the next step in managment in a patient with a biophysical profile score of 2 or less
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deliver the baby immediately
*consistent with severe fetal asphyxia |
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treatment of choice for seizures in eclampsia
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magnesium sulfate
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what is the earliest sign of magnesium sulfate toxicity
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depression of the deep tendon reflexes
*CNS depressant and neuromuscular blocker **second sign of toxicity is respiratory depression |
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treatment of magnesium sulfate toxicity
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administration of calcium gluconate
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hypothyroidism can also elevate the prolactin level
TRH --> prolactin |
measure the TSH in a women with secondary amenorrhea with fatigue and milky secretion of nipples
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what should be suspected in a patient when fetal heart monitoring shows tachycardia --> bradycardia --> sinusoidal pattern after artificial rupture of membranes
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vasa previa
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what are patients with hypogonadotropic hypogonadism secondary to low FSH and LH at risk of developing
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osteoporosis
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next step in management of a 15 year old girl with amenorrhea and no secondary sexual characteristics
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FSH level
*increased - karyotyping *decreased - MRI |
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most common cause of an abnormal maternal serum AFP level
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gestational age error
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an increase in blood pressure that appears before 20-weeks gestation
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chronic hypertension
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most common risk factor for placental abruption
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hypertension
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best screening test for PCOS in a pt with oligomenorrhea, obesity, male pattern baldness
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2-hour oral glucose tolerance test
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pseudocyesis
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psychiatric condition which women present with all signs and symptoms of pregnancy, but have normal endometrial stripe and negative pregnancy test
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next step in management of a women in preterm labor at 30 weeks with cervical dilation and effacement changes
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tocolysis and steroids
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gold standard for diagnosis of endometriosis
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laparoscopy
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next step in management of a pt with HSIL on pap smear who is 15 weeks pregnant, successful colposcopy is done
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repeat colposcopy and biopsy after delivery
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copious vaginal discharge that is white or yellow in appearance, nonmalodorous,and occurs in the absence of symptoms or findings on vaginal exam
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physiologic leukorrhea
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painless vulvar ulcer with non-exudative base and bilateral inguinal lymphadenopathy
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chancre - syphillis
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what two hormones should be check in a 45 year old patient presenting with night sweats, insomnia, and irregular menses for 6 months
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TSH - r/o hyperthyroid
FSH - look for elevated levels |
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next step in management of a 35 week gestation patient with fever, leukocytosis, and PPROM
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antibiotics and immediate delivery
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what can induce ovulation in patients with PCOS
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clomiphene citrate
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role of B-HCG during pregnancy
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preservation of the corpus luteum in early pregnancy
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next step in management of a woman presenting with vaginal bleeding and RLQ pain with B-HCG of 1000 and no evidence of an intrauterine pregnancy on U/S
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repeat B-HCG in 48 hours
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cut off for screening one hour glucose tolerance test during pregnancy
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140
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differentiate vaginal discharge: candida, bacterial vaginosis, trichomonas
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Candida - thick and white, erythema, pruritis
BV - malodorous, thin, no inflammation trichomonas - thin, malordorous, pruritis with inflammation |
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next step in management of a pregnant woman with a fetus with a congenital anomaly incompatible with life (renal agenesis) who is currently in labor at 28 weeks
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allow spontaneous vaginal delivery
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differentiate next step in management of a high vs. low risk patient with LSIL
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low risk - HPV testing or repeat in 6-12 months
high risk - colposcopy |
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treatment of choice in a premenopausal woman with intermentrual bleeding, biopsy shows endometrial hyperplasia without atypia
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cyclic progestins
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best test for detection of fetal chromosome abnormalities in the 1st trimester
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chorionic villus sampling
*performed between 10-12 weeks after an abnormal ultrasound |
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what is most associated with distal limb defect during CVS
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gestational age, <10 weeks is higher risk
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Anti-Rh antibody titer levels
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1:16 is critical level
>1:6 means the mother is already sensitized |
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most accurate way to measure fetal weight during U/S
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abdominal circumference
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next step in management if a woman presents with decreased AFP
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U/S to look for abnormalities, confirm gestational age, confirm viable pregnancy
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vaginal bleeding occurring before 20 weeks pregnant with live fetus and a closed cervix
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threatened abortion
*reassurance and outpatient follow up |
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etiology of primary dysmenorrhea
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increased levels of prostaglandins
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at what week should external cephalic version indicated
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37th week
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test of choice in a patient with LMP 6 weeks ago presenting with abdominal pain and vaginal spotting. B-HCG is 1500, transabdominal U/S does not reveal intrauterine pregnancy
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transvaginal U/S
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preferred form of oral contraceptive for lactating mothers
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progestin-only
*estrogen antagonizes milk production |
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thyroid function during pregnancy
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increased in TBG leading to increased total T4, unchanged free T4 and normal TSH
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woman at 34 weeks gestation presents after MVA with abdominal pain and vaginal bleeding
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uterine rupture
*more likely to lead to hypovolemia and shock than abruptio placenta |
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single most important intervention to reduce maternal-fetal transmission of HIV
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zidovudine treatment of mother and neonate
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what is associated with dysmenorrhea and menorrhagia in woman >40 years and on physical exam they have a symmetrically enlarged uterus; denies dyspareunia or other symptoms
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adenomyosis
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painless third trimester bleeding with normal fetal heart monitoring
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placenta previa
*vasa previa would have rapid deterioration of the fetal heart tracing |
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what should post term pregnancies be monitored for
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oligohydramnios
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tamoxifen is associated with increased risk of what
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endometrial cancer
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raloxifene is associated with increased risk of what
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blood clots
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what should be ruled on in pregnant patients with severe vomiting
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gestational trophoblastic disease, get quantitative B-HCG
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treatment of choice for uncontrolled bleeding in women with dysfunctional uterine bleeding
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high dose estrogen therapy
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differentiate treatment of CIN I, II, and III lesions
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I - repeating pap smear in 6 and 12 months is appropriate
II and III - LEEP or cold knife conization |
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B-HCG, AFP, Estriol, and Inhibin A in Down syndrome quad screen
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Increased - B-HCG and Inhibin A
Decreased - AFP and Estriol |
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treatment of choice for trichomonas
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metronidazole for both patient and partner
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what causes excessive levels of B-HCG
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twins
molar pregnancy choriocarcinoma |
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what hormone antagonizes insulin during pregnancy
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HPL
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which hormone is produced by the corpus luteum after ovulation
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progesterone
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purpose of progesterone during pregnancy
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prevent contractions
makes endometrium favorable for implantation |
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main estrogen during pregnancy
how is it made |
estriol
converted from fetal adrenal DHEAS |
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normal blood gas during pregnancy
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respiratory alkalosis
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significant events for weeks 1-3 postconception
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week 1 - implantation
week 2 - epibalst and hypoblast, B-HCG is now positive week 3 - ectoderm, mesoderm, endoderm |
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no hormone stimulation is needed for this formation
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mullerian duct and normal female genitalia
*Testosterone and DHT are needed to form wolffian ducts and external genitalia |
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period of greatest teratogenic risk
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weeks 3-8, during formation of the three germ layer to completion of oranogenesis
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most of first trimester loses result from what
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chromosomal abnormalities
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at what B-HCG value should an intrauterine pregnancy be visible on transvaginal U/S
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1500
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criteria for methotrexate usage in ectopic pregnancy
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mass <3.5 cm
absence of fetal heart rate B-hCG <6000 no history of folic supplementation |
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when is CVS done compared to amniocentesis
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CVS - between 10-12 weeks
Amnio - after 15 weeks |
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most common cause of an elevated or decreased AFP levels
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dating error
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most common cause of painful late-trimester bleeding
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abruptio placenta
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classically presents with painless late-pregnancy bleeding
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placenta previa
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drug of choice in pregnancy patient with syphillis with penicillin allergy
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penicillin after oral desensitization regimen
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most common cause of abnormal bleeding of ovulatory cycles are predictable vs. unpredictable
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predictable - structural: endometrial polyps, fibroids
unpredictable - hormonal: deficiencies/excess |
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causes of primary vs. secondary dysmenorrhea
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primary - prostaglandins (normal anatomy)
secondary - identifiable anatomic pathology: endometriosis, adhesions, adenomyosis, fibroids |
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classicaly, retroverted uterus with ureterosacral ligament nodularity and tenderness is associated with what
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endometriosis
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treatment of idiopathic hursitism in women
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spironolactone to suppress 5a-reductase
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next step in management of a 30 y/o F with unpredictable and irregular bleeding that is not overweight, B-hCG is negative
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progestin cycling
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next step in management of a 30 y/o F with bleeding between regular cycles
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hysteroscopy to look for anatomic lesion
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causes of virilization and their associated labs
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*rapid onset
adrenal tumor - elevated DHEAS ovarian tumor - elevated Testosterone (sertoli-leydig) *slow onset PCOS - LH/FSH > 3, elevated testosterone CAH - elevated 17-OHP |
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this disease is associated with premature puberty, skin pigmentation, and cafe au lait spots
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McCune-Albright syndrome
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next step in management of a 6 y/o F with signs of puberty: female body contours, breast development, and pubic hair
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pelvic u/s to rule out pelvic mass
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treatment of choice for McCune-Albright syndrome
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aromatase enzyme inhibitor, ovaries secrete estrogen independent of GnRH
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next step in management of a 6 y/o F with signs of puberty and normal pelvic u/s, FSH is elevated
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GnRH agonist to suppress premature activation of normal HPO axis
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3 different types of urinary incontinence and pathophys
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stress - urethral sphincter falls below UGD
urge - overactive bladder overflow - underactive bladder |
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3 different types of functional ovarian cysts
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1. follicular - unilateral
2. corpus luteum - unilateral, associated with pregnancy 3. theca lutein - bilateral, associated with elevated B-hCG |
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3 different types of nonfunctional, benign ovarian masses
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1. endometriomas - chocolate cysts
2. polycystic - PCOS 3. hyperthecosis - hirsutism |
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pregnant woman presents with bilateral adnexal masses which are partially solid and cystic
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theca lutein cyst
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in which situations should you suspect CA in a patient presenting with an ovarian mass
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1. mass is solid or complex
2. patient is postmenopausal |
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this CA is associated with post-coital bleeding
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cervical CA
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differentiate symmetric vs. asymmetric IUGR etiology
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symmetric - fetal in origin
asymmetric - placental in origin |
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etiology of 2nd trimester fetal loss
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maternal origin: uterine anomalies or incompetent cervix
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lab findings associated with antiphospholipid syndrome
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anticardiolipin antibodies
lupus anticoagulant prolonged PTT |
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differentiate complete vs. incomplete mole
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complete - 46 XX from paternal only, fetus absent, higher change of malignancy
incomplete - 69 XXY, fetus non-viable, lower malignancy |
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common places for choriocarcinoma to metastasize
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lung (#1), brain, or liver
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associated with excessively elevated B-hCG and snowstorm appearance on U/S
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hydatidiform mole
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treatment for antiphospholipid syndrome
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aspirin and heparin
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red flags associated molar pregnancy
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severely elevated B-hCG
large for gestational age hyperemesis absence of fetal heart tones *preeclampsia < 20 weeks |
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increasing order of antenatal fetal testing
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NST -> vibroacoustic stimulation -> contraction stress test or biophysical profile
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5 parts of the BPP
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1. NST
2. AFI 3. extension-flexion 4. gross body movements 5. breathing |
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management of non-reassuring fetal tracings
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oxygen
stop oxytocin isotonic fluid bolus change maternal position |
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normal fetal scalp pH
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>7.2
* <7.2 indicates acidosis |
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medications given during postpartum hemorrhage
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oxytocin
methylergonovine carboprost |
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when can vaginal delivery of twins be performed
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both cephalic
baby A is cephalic, baby B is breech |
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differentiate why fetal tracings are different in placenta previa vs. vasa previa
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placenta previa - blood loss is maternal in origin, baby is fine
vasa previa - blood loss is fetal in origin, fetal bradycardia occurs |
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what is the next step in management of a patient presenting with 3rd trimester bleeding
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1. stabilize the patient
2. rule out placenta previa with U/S before speculum/digital examination |
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define mild vs. severe preeclampsia
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mild - elevated BP >140/90 with >300mg protein in urine; without HA, epigastric pain, or vision changes
severe - elevated BP >160/10 OR >5g proteinuria OR lab changes or symptoms along with mild HTN and proteinuria |
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which forms of antepartum HTN require emergent delivery of the fetus
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sever preeclampsia
eclampsia cHTN with superimposied preeclampsia HELLP syndrome |
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neonatal complications associated with gestational diabetes
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macrosomia
hypoglycemia polycythemia hyperbilirubinemia hypocalcemia |
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this rare condition during pregnancy can lead to pulmonary hypertension and right-sided heart failure, it is almost always fatal
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amniotic fluid embolism
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treatment of cholestasis of pregnancy
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ursodeoxycholic acid
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most common pruritic dermatosis of pregnancy
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pruritic urticarial papules and plaques of pregnancy (PUPPP syndrome)
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complication associated with sickle cell trait
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asymptomatic bacteriuria causing increased risk for cystitis
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4 stages of labor
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stage I (latent and active) - begins onset of regular UCs, ends when cervix is fully dilated
stage II - begins with fully dilated cervix, ends with delivery of fetus stage III - begins with delivery of baby, ends with delivery of the placenta stage IV - 2 hours post-partum |
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normal duration of latent, active, and stage II of labor
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latent - <20 hr prime, <14 hr multip
active - 1.2cm/hr prime, 1.5cm/hr multip stage 2 - <2hr prime, <1 hr multip |
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next step in management in a patient with active phase arrest
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assess quality of UCs, treatment is oxytocin augmentation if inadequate
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next step in management of a fetus that has just undergone vaginal delivery and has respiratory depression, mom has epidural in
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naloxone
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next step in management of woman with prolonged stage 2 of labor, it has been 3 hours, she is exhausted and cannot push anymore; baby's station is -2
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c/s, no trial of forceps this high
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what is the only breech presentation that is safe for delivery
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frank breech - feet are near baby's head
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risk factors associated with PROM
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ascending infection
smoking |
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when should prompt delivery of a fetus occur in a patient with PROM
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fetal lung maturity
maternal fever, unexplained by UTI or URI nonreassuring fetal monitoring |
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is tocolysis contraindicated in PROM with chorioamnionitis
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YES, do not stop labor
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management of patient at 42 weeks gestation
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sure of dates - induction with oxytocin and AROM if cervix is favorable, unfavorable cervix needs PGE2
unsure of dates - twice-weekly NST/AFI and wait |
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differentiate postpartum blues vs. depression
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blues - tearful, mood swings, but still care for their infant
depression - feelings of despair, hope, neglect care of infant |
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risk factors associated with uterine atony
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prolonged labor
overdistended uterus (macrosomia, twins, polyhydramnios) |
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list causes of post-partum fever
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wind - atelectasis
water - uti womb - endomyometritis (most common) wound infection walk - pelvic thrombophlebitis breast engorgement/mastitis |
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differentiate painful vs. painless genital ulcers
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painful - HSV, chancroid (haemophilus ducreyi)
painless - chancre (syphilis) |
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when should patient be hospitalized for treatment of PIC
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fever >102.2
evidence of abscess pregnant outpatient treatment failure |
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differentiate causes of primary amenorrhea: breasts absent and uterus present, breast present and uterus absent, both are present
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BA UP - turner's, Hypothalamic-pituitary insufficiency
BP UA - mullerian agenesis, androgen insensitivity BP UP - imperforate hymen |
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best way to work through causes of secondary amenorrhea
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1. B-hCG to r/o pregnancy
2. progesterone challenge a. positive (bleeding) - TSH and prolactin b. negative - need EP challenge 3. estrogen/progesterone challenge a. positive (bleeding) - FSH to differentiate HP failure vs. ovarian failure b. negative - outflow tract obstruction, need hysterosalpingogram |
