Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
83 Cards in this Set
- Front
- Back
|
Workup for sudden onset of hirsutism or virilization during pregnancy when exam or US shows:
no ovarian mass |
Abdominal CT looking for adrenal mass
|
|
|
Workup for sudden onset of hirsutism or virilization during pregnancy when exam or US shows:
bilateral cystic masses |
rule out high beta-HCG states-
most likely Theca Leutein cysts |
|
|
Workup for sudden onset of hirsutism or virilization during pregnancy when exam or US shows:
bilateral solid masses |
reassurance- most likely pregnancy leutomas
|
|
|
Workup for sudden onset of hirsutism or virilization during pregnancy when exam or US shows:
unilateral solid mass |
laparotomy or laparoscopic biopsy to r/o malignancy
|
|
|
Clusters of pink lesions on the genitalia and treatment
|
HPV/Genital warts and tricholoracetic acid or podophyllin in office for small lesions
|
|
|
Algorithm for cervical dysplasia in:
adolescents post-adolescents/pre-menopausal post-menopausal women |
Adolescents- repeat pap in 12 mo
Post-adolescent/pre-menopausal- colposcopy Post-menopausal women- reflex HPV testing and colpo if positive, or just colpo |
|
|
Times to give anti-D Ig during pregnancy
|
standard dose at 28 wks in a (-) mom and (+) dad and increase the dose after events a/w excessive feto-maternal hemorrhage
|
|
|
Mechanism of amenorrhea in lactating women
|
Elevated prolactin levels suppress GnRH production which in turn suppresses LH and FSH production
|
|
|
Management of HELLP
|
# if less than 34 weeks and either is unstable -> stabilization and delivery
# If less than 34 weeks and both stable -> dexamethasone and deliver at 34 weeks or when fetal lungs mature # If 34 weeks or greater -> immediate deliver |
|
|
Child with purulent, foul-smelling discharge and bleeding and management
|
Foreign body; attempt removal with warm irrigation
|
|
|
TORCH infxs and complications
|
Toxoplasmosis, Rubella, CMV, HSV, Syphillis
Complications: Mirocephaly, HSM, deafness, chorioretinitis and thrombocytopenia |
|
|
Stage of menstrual cycle: profuse, clear and thin (can stretch when lifted vertically)
|
Ovulatory
|
|
|
Dyspareunia, dysmenorrhea, dyschezia And Treatment
|
Endometriosis combo OCPs, GnRH analogs (leuprolide) or danazol
|
|
|
Fever, uterine tenderness, foul-smelling lochia in the postpartum period and Risk Factors
|
Endometritis
Broad spectrum Abx PROM, prolonged labor, operative vaginal delivery and C-section |
|
|
MCC of puerperal fever
Causative agent Treatment |
Endometritis
Polymicrobial (gram pos/neg, aerobes/anaerobes) IV Clinda and Gent |
|
|
Initial evaluation for amenorrhea
|
1. Beta-hcg
2. TSH 3. PRL 4. FSH (for ovarian failure) |
|
|
Management of PPROM
|
1. if the lungs are immature (L/S < 2) -> systemic glucocorticoids
|
|
|
Abnormal vaginal bleeding > 3 wks post-partum and pulmonary sx
|
Choriocarcinoma
|
|
|
Pelvic pain worsened by bladder filling or intercourse accompanied by urinary urgency and frequency
|
Interstitial cystitis
|
|
|
Number one preventable cause of fetal growth restriction
|
Smoking
|
|
|
MCC of excess postpartum hemorrhage and Management
|
Bimanual uterine massage, fluid resuscitation, uterotonic agents (oxytocin, methylergonovine, corboprost), and transfusion as needed
|
|
|
Risk factors for uterine atony
|
1. factors that cause uterine distention (multiple gestation, polyhydramnios, macrosomia)
2. prolonged labor |
|
|
Management of breech presentation
|
# If < 37 weeks -> routine f/u
# If > 37 wks -> external cephalic version (unless placental abnormailities, fetopelvic disproportion or hyperextended fetal neck) # c-section if doesn't correct prior to laber |
|
|
Management of breech presentation
|
# If < 37 weeks -> routine f/u
# If > 37 wks -> external cephalic version (unless placental abnormailities, fetopelvic disproportion or hyperextended fetal neck) # c-section if doesn't correct prior to laber |
|
|
Effects of pregnancy on renal dynamics
|
Renal plasma flow and GFR increase and peak at mid-pregnancy at 40-50% above pre-pregnancy levels.
Manifested as decrease in BUN and Cr |
|
|
Maternal quadruple screen that carries an increased risk of Down Syndrome
|
increased: beta-hCG and inhibin A
decreased: maternal serum alpha-fetoprotein and estriol |
|
|
Way to investigate suspected renal calculi in a pregnant patient
|
abdominal or pelvic us
|
|
|
Marked pruritus, esp on palms and soles and esp at night, and elevated total bile acids during pregnancy and management
|
Intrahepatic Cholestasis of pregnancy.
** can manage sx with ursodeoxychilic acid, but b/c ICP is a/w poor fetal outcomes, delivery as soon as lungs are mature |
|
|
Most effective parameter for estimation of fetal weight in cases of suspected fetal growth restriction
|
Abdominal circumference
|
|
|
Different types of FGR, distinguishing factors and contributing factos
|
1. Symmetric: occurs before 28 wks; fetal factors: genetic defects or early congenital infxs (TORCH)
2. Asymmetric: after 28 wks, Maternal factors: HTN, hypoxia, smoking, vasculat disease and toxic exposures |
|
|
Reason to suspect FGR
|
Fundal height > 3 cm less than expected based on dates
|
|
|
Repetitive late decelerations and management
|
Fetal distress
# If far enough along-> emergent delivery by fastest means possible (C-sections) |
|
|
Uterine bleeding with neg pregnancy test, normal physical and us exam
# cause # management |
1. Disordered uterine bleeding (DUB)
2. anovulation 3. high dose estrogen, if pt > 35 yo -> endometrial bx |
|
|
Definition of mild preeclampsia
|
After 20th week of gestation:
1. HTN > 140/90 proteinuria 2. 300 mg/24h |
|
|
Definition of severe preeclampsia
|
After 20th week of gestation:
1. HTN > 160/100 2. proteinuria > 5g/24h 3. oliguria 4. elevated LFTs 5. low platelets 6. +/- pulmonary edema |
|
|
When fetal movement is imperceptible by the mother
|
NST: reactive if 2 accels > 15 beats above baseline in 20 min; non-reactive if less than 2 accels-> BPP
|
|
|
Inflammation, pruritis and thin, maloderous vaginal discharge
# what will you see in wet mount # pH of vaginal fluid |
Trichomonas vaginitis
Flagellated motile organisms pH = 5.0-6.0 |
|
|
Relative contraindication to IUD use
|
H/o ectopic pregnancy
|
|
|
Common side effect of Depo medroxyprogesterone acetate DMPA)
|
Weight gain (so shouldn't be used in obese women)
|
|
|
Name and cause of the condition a/w lower abdominal pain that radiates to the thighs and back with menstruation
|
Primary dysmenorrhea
Elevated levels of prostaglandins |
|
|
Main difference b/w central and peripheral causes of precocious puberty
|
In central, FSH and LH are high, whereas they are low in peripheral because of negative feedback
|
|
|
Common cause of low back pain in the 3rd trimester
|
increase in lumbar lordosis
|
|
|
Disappearance of the n/v of early pregnancy and an arrest of uterine growth
|
Missed Abortion
|
|
|
Management of asymptomatic bacteriuria of pregnancy
|
Must be treated because of increased risk of cystitis, pyelo, preterm birth and perinatal mortality.
Tx: 7d course of nitrofurantoin, amoxicillin and 1st generation ceph |
|
|
Tx guidelines for a woman with clinical or microbiological evidence of gonorrhea infection
|
Ceftriaxone (for gonorrhea) + either 1 dose of azithromycin or 10d of doxy (for chlamydial coinfection)
|
|
|
Appropriate screening and treatment measures for GBS
|
Rectal and vaginal swabs at 35-37 weeks
If colonized, PCN or ampicillin at delivery |
|
|
Treatment for idopathic central precocious puberty
|
GnRH agonist
|
|
|
Steps to prevent vertical transmission of HIV
|
Zidovudine to mother throughout pregnancy and to child for first 6 wks of life
|
|
|
Erratic onset of abrupt slowing of the FHR in associating with uterine contractions and steps of management
|
Variable decels.
1. administer O2 and change maternal position 2. place mom in t-berg position 3. Fetal scalp pH testing 4. c-section |
|
|
Management of complex hyperplasia with and without atypia on endometrial bx
|
# With: pre-menopausal women who desire preserved fertility-> cyclic progestins and repeat bx in 3-6 mo
# W/o: cyclic progestins and repeat bx in 3-6 mo |
|
|
Beta-HCG levels at which an intrauterine pregnancy would be seen
|
1500-2000
|
|
|
Management of a pt with vaginal bleeding and RLQ pain, beta-HCG of 1000 and no ultrasonographic evidence of an intra or extrauterin pregnancy
|
Repeat the beta-HCG and transvaginal us in 48 hrs
|
|
|
MCC for elevated level of MSAFP and management
|
# gestational age error
# perform another us to look for any anomolies, assess fetal size to see if it agrees with dates, identify any multiple gestation |
|
|
Fertility options in a women with premature ovarian failure
|
IVF
|
|
|
Condition to frequently monitor for in prolonged pregnancy
|
Oligohydramnios
|
|
|
Way to suppress milk production and manage pain in women who don't wish to breast feed
|
Wear tight-fitting bras, avoid nipple stimulation, and use ice packs and analgesics to relieve associated pain
|
|
|
Cause of neonatal thyrotoxicosis in a baby born to a mother who is s/p thyroidectomy for Graves Dz before pregnancy and in whom hormone levels have be normal throughout the pregnancy
|
Persistance of thyroid stimulating Ig, which is usually 500 times normal for several months after thyroidectomy, and cross the placenta
|
|
|
Vulvar pruritus and discomfort with porcelain white atrophic polygonal lesions that have a cigarette paper quality and way to approach
|
Most likely lichen sclerosus (et atrophicus), but need to do a punch bx to r/o SCC.
# if lichen sclerosus, treat with high-potency topical steroid ointment |
|
|
Treatment for vaginismus
|
Kegel exercises and gradual dilation
|
|
|
Use of magnesium sulfate in preeclampsia
|
In mild preeclampsia, it is administered during labor and 24 hrs after.
In severe preeclampsia, it is administered from the time of admission until 24 hrs after delivery |
|
|
MCC of antepartum hemorrhage and management
|
Placenta previa and abruptio placenta
# hemodynamic resuscitation before investigating cause of bleeding (ABCs) # then TV ultrasound |
|
|
Scattered round lesions in b/l peripheral lung fields on CXR and 2+ protein in a pt suspected of bacterial endocarditis
|
Septic pulmonary emboli
|
|
|
Weakness, dizziness, sweating, nausea, tachcardia, HA, visual disturbances, lethargy, agitation, confustion
|
Hypoglycemia: either factitious or insulinoma
|
|
|
Contraindications to ACEi tx in a patient with RAS
|
If RAS is b/l
|
|
|
How to screen for and diagnose gestational diabetes
|
# screening (b/w 24-28 wks): 1 hr 50 G oral glucose tolerance test
# If less than 140, GDM is r/o # if greater, then 3 hr 100 G OGTT, GDM if: a. fasting > 95 b. 1 hr > 180 c. 2 hr > 155 d. 3 hr > 140 |
|
|
Abdominal pain uterine tenderness and hemodynamic collapse
|
Abruptio placentae
|
|
|
Biophysical profile score of 8-10
|
reassurance and repeated 1-2x/week until term for high risk pregnancies
|
|
|
Parameters of a biophysical profile
|
1. fetal tone
2. fetal movements (3/10) 3. fetal breathing (30/10 min) 4. amniontic fluid index (5-20) each category gets a score of 0 or 2 |
|
|
Pregnant pt that appears with several BP readings >140/90 prior to the 20th week
|
Chronic HTN if appears < 20 weeks. All other BP-related dxs in pregnancy can only be attributed to pregnancy if they are made after the first 20 weeks
|
|
|
Tx for early localized Lyme dz in pregnant or lactating women
|
Amoxicillin (not doxy b/c it can causes skeletal and dental problems)
|
|
|
Rright-sided & retro-orbital HA, agitation, blurred vision, constipation and vomiting in a pt with Parkinsons, hypothyroidism and HTN
|
Signs of anti-cholinergic excess likely from tirhexyphenidyl or benztropine, anticholinergics used in Parkinsons and drug-induced EPMs
|
|
|
Best test to order in a young person with hypertension, muscle weakness and numbness
|
Aldo/renin ratio
|
|
|
Differences b/w true and false labor
|
True labor: contractions occure at regular intervals with progessively shorter intervals and increasing intensity and the pain is felt in the upper abdomen and the back and is not relieved by sedation; cervical changes define labor
False labor: contractions are irregular, pain is the lower abdomen and is relieved by sedation: cervical changes are absent |
|
|
Stages of labor
|
First stage: Latent (from onset of labor to 2 cm) and Active (from 2 cm dilation to 10 cm)
Second stage: from 10 cm to delivery Third stage: from delivery to placenta |
|
|
Side effects of OCPs
|
1. VTE
2. CV events/Stroke 3. Elevation of TG 4. Cholestasis or cholecystitis 5. DM 6. HTN |
|
|
Benefits of OCPs
|
Protective against:
1. ovarian cysts 2. endometrial cancer 3. benign breast dz 4. Dysmenorrhea (anemia) |
|
|
Diff b/w raloxifen and tamoxifen
|
Raloxifen does not increase risk of endometrial cancer, whereas tamoxifen does.
|
|
|
Dysmenorrhea and menorrhagia in a 40+ yo and a symmetrically enlarged uterus
|
Adenomyosis
|
|
|
Indications for i/p tx for PID
|
1. high fever
2. failure of oral outpatient tx 3. inability to take oral meds 2/2 to n/v 4. those at risk for poor compliance (teenagers, low SES) 5. Pregnancy |
|
|
Definition of PPROM and management
|
preterm, premature rupture of the membranes: before 37 weeks but with the onset of labor
If prolonged, administer antibiotics |
|
|
Signs of intraamniotic infx and management
|
in a pt with PPROM and a fever plus, maternal tachy, fetal tachy (>160 bpm), maternal leukocytosis, uterine tenderness or foul-smelling amniotic fluid.
# administer broad spectrum abx and expedite delivery |
|
|
Normal rate of progression of cervical changes
|
1 cm/hr, less = protraction
Arrest = failure to dilate after 4cm |
|
|
Causes of labor protraction
|
Power, pelvis, passenger
|
