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68 Cards in this Set
- Front
- Back
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Patient presents with molar pregnancy. Next appropriate step?
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CXR, as lungs are the most common site of metastatic dz in pts with gestational trophoblastic dz
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Identify cardiovascular adaptation in pregnant women
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CO increases 33% due to increases in HR and SV
SVR falls during pregnancy 95% have systolic murmur due to increased volume (diastolic always abnl) |
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What is a potential complication of terb?
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pulmonary edema
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Explain the hemodynamic changes in pregnancy
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increase in 1/3 total blood volume -> dilutional effect lowers hemoglobin (no change in MCV
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Respiratory changes in pregnancy
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Respiratory rate does not change during pregnancy, but TV is increased which increases minute ventilation, which is responsible for RESPIRATORY ALKALOSIS
TLC decreases, while TV increases |
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Most common form of inherited mental retardation
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Fragile X
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What is the fourth marker in the quad screen?
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inhibin A -> makes test more sensitive for Down syndrome -> 15-18 wks gestation -> performed up to 22 wks (80% effective)
PAPP A is effective for screening for Down in the first trimester |
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Gestational diabetes vs Pregestational diabetes
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gestational: shoulder dystocia, metabolic disturbances, preeclampsia, polyhydramnios, fetal macrosomia
IUGR only seen with preexisting diabetes |
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Cutoffs for 3 hour glucose tolerance test
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fasting: 95, 1 hr 180, 2hr 155, 3hr 140
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Return precautions for woman in possible labor
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ctx every five minutes for one hour, rupture of membranes, fetal movement less than 10 per two hours or vaginal bleeding
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Braxton-Hicks contractions`
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short in duration, less intense than true labor
discomfort in lower abdomen and groin areas (not to back) |
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4th stage of labor:
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immediate postpartum period of approx two hours after delivery of placenta
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most common cause of postpartum fever?
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endometritis -> look for uterine fundal tenderness
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safest method of lactation suppression?
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breast binding, ice packs and analgesics
- don't use hormones as it will predispose to thromboembolic events |
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Postpartum depression -> most useful s/s to distinguish from postpartum blues and normal changes occurring after delivery?
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ambivalence towards newborn/family
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postpartum blues
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last for less than two weeks (40-85% women)
self limited |
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after breastfeeding -> sore nipples, burning pain, worse when feeding, tips of nipples pink and shiny with peeling at periphery
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classic for candidiasis
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Prolactin and oxytocin role in milk
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prolactin: synthesis of milk (inhibited by estrogen and progesterone)
oxytocin: milk letdown |
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beta-hCG discriminatory zone
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level at which an intrauterine pregnancy should be seen on U/S, usually 2000 mIU/ml
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Pregnant woman with bad breast cancer. What to avoid?
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radiotherapy
can still do mastectomy and chemotherapy |
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How to control lupus flares in pregnancy?
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steroids
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renal calculi treatment in pregnancy
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double-J urethral stent, followed by percutaneous nephrostomy
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diagnosing appendicitis in pregnancy
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graded compression U/S
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antidepressant contraindicated in pregnancy
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Paxil (paroxetine) -> fetal cardiac malformations and persistent HTN
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mitral valve prolapse in pregnancy: sx + tx
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if symptomatic (palpitations and intermittent chest pain) -> use beta blockers
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how to detect amount of fetal transplacental hemorrhage
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K-B test
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current recommendation of Rh-negative women to prevent isoimmunization
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administration for Rh- pts with no Rh antibodies at 28 weeks
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ways to detect fetal anemia
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amniocentesis, cordocentesis, doppler U/S of MCA peak systolic velocity
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associations with breech presentations
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prematurity, multiple pregnancy, genetic disorders, polyhydramnios, hydrocephaly, anencephaly, placenta previa, uterine anomalies and uterine fibroids
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smoking complications of pregnancy
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placental abruption, placental previa, fetal growth restriction, preeclampsia and infection
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What does FFP contain? cryo?
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FFP: fibrinogen, clotting factors V and VIII
cryo: fibrinogen, factor VIII and VW factor |
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Tocolytics -> contraindications to terb, ritodrine, mag sulfate, and indomethacin?
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terb/ritodrine - contraindicated in diabetes
mag sulfate: contraindicated in myasthenia gravis indomethacin: contraindicated at 33weeks due to risk of premature ductus arteriosus closure |
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before administering steroids for preterm labor, what should you administer?
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amniocentesis if person has unexplained fever and elevated WBC -> look for intra-amniotic infection
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betamethasone benefits in preterm labor
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decrease incidence and severity of RDS, decrease intracerebral hemorrhage and necrotizing enterocolitis
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PPROM - when to induce labor?
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current recommendations are that the benefits to the neonate outweigh the potential risks of intra-amniotic infection prior to 32 weeks, but only int eh absence of e/o intra-amniotic infxn
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primary risk factor for preterm rupture of membranes?
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genital tract infection, particularly BV
other risk factors: multiple gestations, smoking, prior PPROM, shortened cervical length |
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breast engorgement can cause ___
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low grade fever
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optimal mgmt for postdates
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NST and AFI twice a week with induction of labor for nonreactive stress test or oligohydramnios
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benefits of amnioinfusion
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decreases repetitive variable decels
(routine prophylactic amnioinfusion for meconium stained amniotic fluid is not recommended |
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Symmetric vs asymmetric fetal growth restriction
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asymmetric: uteroplacental insufficiency -> think vascular abnormalities!!
symmetric: early event -> secondary to one or more organ system anomalies, fetal aneuploidy or chronic intrauterine infection |
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IUGR babies risk for development of what?
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CV dz, chronic HTN, chronic obstructive lung dz and diabetes
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Identifying extent of ovarian metastatic cancer?
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CT scan of abdomen and pelvis
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factors a/w development of ovarian CA
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low parity and delayed childbearing
protective by OCPs |
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Advanced ovarian CA tx
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surgical cytoreduction followed by chemotherapy
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CIN classification
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CIN 1: 1/3 to BM
CIN 2: 2/3 to BM CIN 3/carcinoma in situ: up to BM carcinoma: past BM |
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indications for cervical conization
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cervical bx show severe dysplasia, carcinoma in situ, or if positive endocervical curettage
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tamoxifen risks
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benefit breast, risk to endometrial CA
annual exam for risk of endometrial CA once tamoxifen is initiated |
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nonpregnant female with menorrhagia and 14week size irregularly shaped uterus. next most appropriate step?
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if patients present with menstrual abnormalities, the endometrial cavity may be sampled to r/o endometrial hyperplasia or CA
otherwise use GnRH analogue to inhibit estrogen |
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manual vacuum aspiration effective in what timeframe?
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less than 8 weeks
age, parity, and medical illnesses are n ot contraindications |
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mgmt of septic abortion
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fever, lower abdominal pain, vaginal bleeding, dilated cervix, enlarged uterus disproportionate to anticipated size
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tx of recurrent pregnancy loss due to antiphospholipid antibody syndrome
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ASA and heparin
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diagnostic criteria of acute salpingitis
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lower abdominal tenderness, uterine/adnexal tenderness and mucopurulent cervicitis
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urge incontinence tx
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anticholinergics to maintain stability -> oxybutynin
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normal post-void residual. What does it mean if it's too large?
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50cc
if too big, then overflow incontinence |
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clinical features of ovarian torsion
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sudden onset of pain and nausea as well as presence of cyst on U/S
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how to dx endometriosis definitively
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exploratory laparoscopy
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tx for endometriosis in a patient who wants to become pregnant
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ovarian stimulation with clomiphene citrate
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what type of breast mass must be evaluated cytologically
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FNA for any solid dominant breast mass, or histologically with an excisional bx
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tx of mastitis
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PCN is first line
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proper sexual development
thelarche, menarche, adrenarche, growth spurt |
thelarche -> adrenarche -> growth spurt -> menarche
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three critical elements for secondary sexual characteristics
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adequate body weight, sleep and optic exposure to sunlight
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true precocious puberty
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dx of exclusion where the sex steroids are increased by the hypothalamic-pituitiary-gonadal axis, with increased pulsatile GnRH secretion
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person with mullerian agenesis. next study?
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renal u/s -> 25% have renal anomalies
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Progesterone pills work by what mechanism?
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converts endometrium from proliferative to secretory
withdrawal of progestin then mimics the effect of the involution of the corpus luteum, creating a normal sloughing of the endometrium |
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PCOS lab values
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free testosterone elevated because sex hormone binding globulin is decreased by elevated androgens
LH increased in response to increased circulating estrogens fed by an elevation of ovarian androgen production |
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how oral contraceptives relieve primary dysmenorrhea
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the progestin in oral contraceptives creates endometrial atrophy. Since prostaglandins are produced in the endometrium, there would be less produced. Dysmenorrhea should be improved!
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most common reason why women stop hormone therapy for menopausal sx
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irregular bleeding (usually in first 6mo)
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exercise-induced hypothalamic amenorrhea -> lab studies?
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normal FSH and low estrogen levels
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