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115 Cards in this Set
- Front
- Back
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how to manage postpartum hemorrhage
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fundal or bimanual massage, IV access, infusion to keep SBP above 90, notify blood bank for pRBCs, give oxytocin
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when to do uterine artery embolization with hemorrhage
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stable vital signs and persistent bleeding if rate of loss is not excessive
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risks for uterine atony
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overdistention, uterine fatigue (prolonged labor)
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hyperemesis gravidarum
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usually 4-10wks, usually managed with supportive care, ketonuria
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gesterational trophoblastic disease
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enlarged uterus, hyperemesis, markedly elevated bHCG
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ddx of hyperemesis gravidarum
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pyleo, gestational trophoblastic disease, gastroenteritis, heptatobiliary disease
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presenation of trichomonas vaginalis
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pruritic, green frothy, foul smelling, pear shaped motile organisms, tx is oral metronidazole
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decels- early, late, variable
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early- fetal head compression, late uteroplacental insufficiency/ acidosis, variable- fetal cord compression
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inhibin b checks for?
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ovulatory reserve, older women have less
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when/what to test for ovulation
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mid luteal serum progesterone level (should be >10ng/mL)
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tx of DUB
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mild: iron, mod: progestin, mod w/ bleeding or severe: estrogen
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PCOS
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androgen and LH excess
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contra to breast feeding
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HIV, tb, HSV on breasts, malaria, sepsis, typhoid, eclampsia, nephritis, substance abuse, breast ca
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tx of preg pt with RMSF
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chloramphenicol, not preg- doxy
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aromatase def
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poor funct or absent conversion of androgens to estrogens, maculinization of mother during pregnancy, nomral internal b/ ambiguous external genetalia, clitoromegaly, delayed puberty, osteoporosis, undetectable estrogen, high LH FSH, PCOS,
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mccune albright
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cafe au lait, polyostotic fibrous dysplasia and autonomous endocrine hyperfunction, precocious puberty
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htn meds during pregnancy
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NO ACE, ARB, give labetalol and methyldopa, only start if BP> 150/95
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epidural effects on bp
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10% hypotension from sympathetic fiber block that results in vasodilation of lower extremities
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pathophys of preeclampsia
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vasospasm
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metformin and PCOS
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helps prevent type 2 DM, helps lose weight, helps with fertility, helps with hirsutism
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clomiphene citrate
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used to induce ovulation in PCOS
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NSAIDs and pregnancy
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can increase risk of miscarriage, promote premature closure of fetal ductus arteriosus
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tx of UTI during pregnancy
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ampicillin, amox, nitrofurantoin, cephalexin
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causes of chorioamnionitis
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PROM, intrauterine instrumentation, STD, prolonged labor
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pt with multiple sex partners, mucopurulent urethral d/x
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chlamydia (gonorrhea is more purulent and will see organisms on gram stain)
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amenorrhea... approach?
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preg test --> TSH--> prolactin
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tx of gonorrhea, chlamydia
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ceftriaxone, azithromycin OR doxycycline, if stain shows gonorhea- tx for both
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pt with placental abruption, but stable pt and baby
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vaginal delivery, only to C/S if condition calls for it
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coag neg staph
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skin
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endometriosis and adenomyosis
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endometrial tissue inside uterus (endometriosis) if OUTSIDE like uterine muslce (adenomyosis)
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ruptured fetal umbilical vessel
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antepartum hemorrhage, fetal heart changes from tacky to brady (late decal) vasa previa
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abruptio placenta
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premature placental separation, dark red antepartum hemorrhage, and pain, uterin tenderness, increased uterine tone
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placenta previa
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abd insertion of placenta on lower segment of uterus over os, painless antepartum hemorrhage
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ideal maternal fasting glucose?
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75-90
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is low grade fever worrisome postpartum?
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not first 24 hr, chills also normal, also d/c lochia rubra--> serosa--> alba
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adenomyosis
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>40yo, severe dysmenorrhea, menorrhagia, enlarged and generlaly symmetric uterus
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syphillis ulcer
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punched out base, raised, indurated margins
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chancroid
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deep purulent are, painful lymphadenopathy, gram +, h. ducreyi, tx ceftriaxone, erythromycin, azithromycin
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granuloma inguinale (donovanosis)
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painless genital ulcer red beefy base, NO adenopathy, donovan bodies, tx: doxy or TMP-SMX
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what test results predicts downs
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increase bHCG, inhibit A, decrease AFP and esriol
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chrorionic villus sampling
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fetal chr abnl first trimester (10-12 wk)
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amniocentesis
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16-18 wks, early amnio can be done before 15 wks, but only for pts
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when to do cordocentesis or percutaneous umbilical blood sampling
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rapid karyotype analysis or fetal blood dyscrasias (fetal anemia or Rh isoimmunization) or when mosaicism suspected by CVS or amniocentesis
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sinusoidal fetal heart rate pattern
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uniform oscillations of 3-5 cycles/ min, sign of fetal distress, inability of CNS to control HR
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pregnant woman with syphillis tx
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penicillin remains drug of choice, if allergic-- penicillin desensitzation
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thyroid tests during pregnancy
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increased total T3, T4, and nl free T3,T4, TSH
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what ovarian tumor secretes thyroid hormone?
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struma ovarii
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threatened abortion
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hemorrhage before 20 wk, cervix closed, no passage of tissue
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inevitable abortion
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vaginal bleeding, dilated cervix, ruptured or collapsed gestational sac w/o fetal cardiac motion
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mild preeclampsia
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140/90, proteinuria >300 mg/24hr, edema
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severe preeclampsia
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160/110, >5g proteinuria, oliguria, elevated liver enzymes, thrombocytopenia, pul edema
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false labor
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irregular, lower abdomen, last few weeks can mimic it more and may be regular
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tx of patient with simple or complex hyperplasia without atypic in endometrial biopsy
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cycli progestins
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preeclampsia and liver
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stretching of capsule causes pain. centrilobular necrosis, hematoma formation, thrombi in portal system
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fibrinogen levels above nl after intrauterine fetal demise…
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not need to do emergent c/s
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management of variable decels
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change position, give o2 --> trandelenburg --> aminoinfusion
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when can you see a pregnancy with transvaginal u/s
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1500-2000
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lichen sclerosus
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chronic inflamm condition, autoimmune possibily, porcelain white polygonal macules and patches with atrophic cigarette paper quality, obliteration of labia minor and clitoris, decrease diameter of introitus
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risks of chronic htn during pregnanc
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placental abruption
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post op hyponatremia? pregnant?
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pain and narcotics (rarely adrenal insuff- also hypotension); oxytocin
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potassium and ca can't be corrected without
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magnesium correted
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what condition commonly causes hypomag?
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alcoholism
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fluid for pt not eating
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1/2 nl saline 5% dextose in adult, children 1/4 to 1/3 nl saline and dextose
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human milk
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70% whey 30% casein, lactoferrin, lysozyme, immunoglobulin A
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PPROM what wk give corticosteroids?
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<32 wks
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hypogonadotropic hypogonadism can result from...
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strenuous exercise, anorexia nervosa, marijuana, starvation, stress, depression, chronic illness
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postpartum endometritis
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prolonged rupture of membranes, prolonged labor, c/s, intrauterine pressure cath or fetal scalp electrodes-- usually polymicrobial
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gonococcemia
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polyarthralgia, tenosynovitis, painless vesiculopustular skin lesions
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erbs duchenne paralysis
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wrist and fingers flexed, adduction and pronation, secondary to traction on infant head during delivery
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b/l solid nodules on ovaries during pregnancy
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pregnancy luteoma
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BPP
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nl 8-10, 6 w/o oligo (contracture stress tes), 4 delivery considered, <4 delivery
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drugs causing peripheral neuropathy
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cisplatin, vincristine, phenytoin, -taxel, isonizid, amiodarone, hydralazine
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carcinoid syndrome
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flushing ,diarrhea, valvular disease, can have def of niacin
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wernicke
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encephalopathy, oculomotor dysfunction, gait ataxia
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pneumonia
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louder bronchial sounds esp on expiration, dull to percussion
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incontinence in diabetes
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overflow
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pericardial effusion on xray
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waterbottle heart
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causes of biphasic pulse
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aortic regurg and HCM
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fried rice, vom hrs later
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bacillus cereus
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s. aureus food poisoning
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egg, salad, meat, dairy
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shock with normal MVo2?
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septic shock
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new case of AIDS
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PPD, HIV RNAx2, CD4, VDRL, anti toxo antibody, MMS, pneumococcal vaccine, hep A&B screen and vaccines
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how to confirm intrauterine fetal demise?
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real time u/s
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what does sheehan's syndrome present like?
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lymphocytic hypophysitis- headaches, visual disturbances, pit failure (neoplasm)
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primary dysmenorrhea- lower abd pain hrs before menses
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from prostaglandins
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plan b
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good for 120hrs, levonorgestrel
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inhibin
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by granulosa cells, exert feedback on FSH
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trichomonal
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metronidazole (avoid ETOH), ph 5-6, erythematous vaginal mucosa, motile pear shaped organisms
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when to screen for gestational diabetes?
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24-28 wks with 1 hr 50g oral glucose tolerance test (>140--> 3 hr 100g OGTT>140)
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OGTT by hr that are considered positive
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fasting >95, 1hr>180, 2hr>155, 3hr >140
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when is physiologic jaundice
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after 24 hrs, usually peak in first few days
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menopause hormones
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decreased estrogen, increased FSH and LH
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what is he most prevalent preventable cause of fetal growth restriction in the US
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smoking
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hormone tests for infertility
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early follicular phase FSH, clomiphene challenge test, inhibit b level
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why do PCOS patients have anovulation
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abnl GnRH secretion, excess LH and insuff FSH
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what measure to use for FGR?
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>3 less than gestational age --> abdominal circumference (decreased in symmetric and asymmetric growth restriction)
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de quervain tenosynovitis
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in new mothers, pain with flexion of thumb, fibrosis as pass through sheath at radial styloid process,
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ovulatory phase cervical mucus
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thin, clear, profuse
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pre and post ovulatory cervical mucus
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scant, thick, opaque
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pseudocyesis
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signs/ sympt of pregnancy, nl endometrial stripe, neg office preg test, strong desire to be pregnant, type of conversion d/o
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HPV warts
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pink/ skin colored, teardrop shaped, smooth, tx with trichloroacetic acid or podophyllin,
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symmetric vs asymmetric FGR
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symmetric: earlier than 28wks, chr abnl, congenital infections,congenital anomalies vs asymmetric: from maternal causes like HTN
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acid base changes of pregnancy
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resp alk with renal compensation
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meig's synd
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ovarian fibroma, R hydrothorax, ascites
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primary amenorrhea
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16yo, 14yo NO sex characteristics
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contra to estrogen
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relative: seizure, HTN, leiomyoma, familial hyperlipidemia, migraines, thrombophebitis, endometriosis, gallbladder disease definite: unexplained vag bleeding, thromboembolism, active liver disease, breast or endometrial ca
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most common cause of female infertility
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endometriosis
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ratio of LH:FSH in PCOS
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>3
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lactobacilli on wet mount
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nl
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which diseases do you tx the partners for as well
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trichomonas, chlamydia, gonorrhea
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lymphogranuloma venereum
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Chlamydia, papule painless --> heals, inguinal buboes--> elephantiasis, fistula, abscess, tx: tetracycline, doxy, erythromycin
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what do you look at when there is bloody d/c
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excisional biopsy, ductal lavage
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what is the false neg for FNA
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20%
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fatty liver of pregnancy
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third trimester or postpartum, increased LFTs, prolonged PT and PTT
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tx of HELLP after 34 wks
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delivery
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