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296 Cards in this Set
- Front
- Back
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Name 4 major risk factors for BRCA carrier status |
- breast AND ovarian cancer - Ashkenazi Jewish and ovarian cancer - Ashkenazi Jewish and breast cancer < 40 - close relative with known BRCA mutation |
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What is the risk reduction of ovarian cancer and breast cancer by performing risk-reducing BSO? |
Ovarian cancer risk reduced by 85-90% Breast cancer risk reduced by up to 50% |
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Describe the injury in Erb palsy, the muscles affected and the clinical description. |
ERB (and ERB PLUS) C5-C6 Paralysis of deltoid, infraspinatous, biceps Appears as adduction, internal rotation, and forearm extension With C7 involvement (Erb plus), there is pronation of forearm and flexion of wrist and fingers (waiter's tip posture) |
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Explain the steps of breaking bad news. |
SPIKES S: Setting up the interview—arrange for privacy, sit down, manage interruptions. P: Assessing the patient's Perception—ask open-ended questions about how the patient perceives the medical situation. I: Obtaining the patient's Invitation—how would the patient like the information disclosed. K: Giving Knowledge and information to the patient—use nontechnical words and give information in small chunks. E: Addressing the patient's Emotions with empathic responses—observe for emotion, identify it and its reason, let the patient know you've made this connection. S: Strategy and Summary—discuss the plan going forward and summarize the discussion. |
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What are three aspects of acute fatty liver of pregnancy that can help differentiate it from HELLP? |
1. Severe transaminitis 2. Hypoglycemia 3. DIC |
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What are the physiologic steps of arousal in women? |
Pelvic congestion, myotonia, and subjective feelings of arousal, which accumulate to sustained, relatively high levels |
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What is the approach to labial agglutination in prepubertal girls? |
Symptomatic vs. asymptomatic Main questions - affecting urine stream - associated with recurrent infections - pain Asymptomatic - leave alone until puberty Symptomatic - estrogen cream twice weekly |
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Which pregnancy dermatoses have fetal implications and what are they? |
Intrahepatic cholestasis of pregnancy (1%) - IUFD (when bile acids ≥ 40); IOL -- fetal distress, resp distress, meconium
Pemphigoid gestationis (rare) - PTL, IUGR, transient neonatal lesions |
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What is seen in this slide When is it seen What should be considered in the management of this issue? |
Goblet cells Mucinous ovarian cysts/cancer Consider an appendectomy in addition to management of ovarian cyst/cancer |
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What are the recommendations for a young women who is a BRCA carrier? |
● Breast awareness starting at age 18 ● Clinical breast exams every 6 to 12 months beginning at age 25 ● Annual breast magnetic resonance imaging (MRI) from ages 25 to 29 years ● Annual mammogram and breast MRI from ages 30 to 75 ● Consideration of chemoprevention (tamoxifen) and risk-reducing mastectomy ● RRSO typically between age 35 to 40 and when childbearing is completed |
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Risk factors for OHSS (6) |
- Young age - PCOS - High AMH - High AFC - Previous OHSS - Pregnancy - High doses of gonadotropins - Lots of follicles during ovarian stimulation - Lots of follicles retrieved - Use of hCG instead of progesterone for luteal phase support |
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Differentiate between severe and critical OHSS |
SEVERE - clinically presented ascites - occasionally pleural effusion - HCT > 45% - ovarian size > 12 cm - oliguria CRITICAL - tense ascites - large pleural effusion - HCT > 55% - WBC > 25 000 - oliguria/anuria - VTE - acute respiratory distress syndrome |
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List three methods to confirm ovulation |
1. Menstrual cycles - regular with molimina 2. Basal body temperature - increase of 0.5º in the presence of progesterone from the CL 3. Progesterone levels in mid-luteal phase |
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What is the lifetime risk of breast and ovarian cancer with BRCA 1 and 2? |
BRCA 1 breast: 65% BRCA 2 breast: 45% BRCA 1 ovarian: 30-50% BRCA 2 ovarian: 10-20% |
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List 4 indications for PGS/PGD |
- single gene disorder - chromosomal abnormalities - x-linked disorders - general aneuploid screening |
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What is loss rate when a live embryo is seen on ultrasound? |
3-5% |
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Name 4 minor risk factors for BRCA carrier status |
- ethnicity - Ashkenazi, Icelandic, French Canadian - breast cancer < 40 - high grade serous ovarian cancer - breast cancer and ≥ 2 close relatives with breast cancer, at any age |
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What is the differential diagnosis for recurrent pregnancy loss? |
AGE2I2T Anatomic Genetic (**parental chromosome abn) Endocrine Environmental Immune/infectious Idiopathic (**MC - 50%) Thrombotic (**APLA) |
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What questions are important to ask on history if concerned about a urinary tract injury in gynecologic surgery? |
- leaking of urine from vaginal or abdominal incisions - unilateral or bilateral flank pain - abdominal pain - distension - hematuria - oliguria/anuria - nausea and/or vomiting - ileus - fever |
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What are the ultrasound criteria needed to calculate RMI II score? |
Solid lesions Ascites Bilaterality Loculations Extraovarian disease |
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What is the likelihood of pelvic lymph node involvement in Stage I endometrial cancer, endometrioid type? |
I A Grade 1 - 3% Grade 2 - 9% Grade 3 - 18% I B - 40% |
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What coagulation factors increase in pregnancy? |
1, 7, 8, 9, 10 Factor I (Fibrinogen) Factor VII Factor VIII Factor IX Factor X Plasminogen and plasminogen activator inhibitor |
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List two reasons for the development of placenta accrete syndromes |
1. Absence of decidua basalis 2. Imperfect development of the Nitabuch layer |
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What is seen here? In what setting is this seen? |
Walthard cell nests Can be seen in normal fallopian tubes or in Brenner tumours of the ovary |
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What is seen here? What does this histology likely represent? |
Signet ring cells Krukenberg tumour of the ovary (most likely metastasis from gastric cancer) |
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What is the incidence of Rh alloimmunization, without and with Rh Ig? |
Without - 2% With - 0.2% |
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Discuss the steps to a risk-reducing BSO |
- pelvic washings - inspect all peritoneal surfaces - inspect all pelvic structures - biopsy of any suspicious surfaces - removal of entire ovary and fallopian tube (secure IP ligament at least 1-2cm distal from the ovary) |
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Describe the injury in Klumpke palsy, the muscles affected and the clinical description |
KLUMPKE PALSY C8, T1 Paralysis of hand muscles Claw hand Involvement of T1 may also result in Horner syndrome |
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Define placenta accreta, increta, percreta What are the proportions of these in clinical practice? |
Accreta = chorionic villi are attached to the myometrium Increta = villi are invading into the myometrium Percreta = villi are through the myometrium and to or through the serosa 80:15:5 |
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If a woman has a current placenta previa, what is her risk of an ACCRETE SYNDROME if she has had 1, 2, 3, 4, or 5 cesarean sections? |
1 = 3% 2 = 11% 3 = 40% 4 = 61% 5 = 67% |
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Describe the four types of female genital mutilaton |
Type I - prepuce excision with or without clitoral excision Type II - Clitoral excision with or without labia minora excision Type III* - Labia minora and/or majora excision with or without clitoral excision and then fusion of the wound - termed infundibulation Type IV - unclassified - includes piercing, incision, stretching, corrosive substances |
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List 3 indications for a cold-knife cone biopsy |
1) Endocervical glandular lesions (i.e. AIS) 2) Suspected microinvasive disease 3) Persistent or recurrent CIN |
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What is the normal fetal lactate level and what level has a 100% sensitivity for hypoxic ischemic encephalopathy? |
4.2 4.8 |
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In each of the following semen analysis scenarios, what tests should be ordered: 1) Low motility 2) Low sperm count 3) Poor morphology |
1) Low motility = antisperm antibodies, WBC assay 2) Low sperm count = endocrine, karyotype 3) Poor morphology = ultrasound (varicocele), exposure history |
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Which hemoglobin, HbA vs. HbF, has a greater affinity for O2 and how does this look on an oxygen dissociation curve? |
HbF HbF is left-shifted compared to HbA That is, HbF has a 50% hemoglobin saturation at a lower pO2 than HbA |
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Nugent score categories |
0-3 = normal flora 4-6 = intermediate flora 7-10 = bacterial vaginosis |
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Name two non-albicans candida species |
Candida glabrata Candida tropicalis |
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List 4 indications for intracytoplasmic sperm injection |
1. Severe oligospermia 2. Teratospermia 3. Retrograde ejaculation 4. Obstructive azoospermia 5. Failure during fertilization at IVF 6. Pre-implantation genetic screening/diagnosis |
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How long after the LH surge does ovulation occur |
36 hours after the start of the surge 12 hours after the peak of the surge |
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Types of cells that produce hormones in the anterior pituitary (4) |
1) Somatotropes - GH 2) Prolacins - Prolactin 3) Gonadotropes - LH, FSH 4) Corticotropes - ACTH 5) Thyrotropes - TSH * Also classified based on staining ability (acidophils, basophils, chromophobes) * Posterior pituitary - stores and releases oxytocin and vasopressin (does not make) |
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18 y.o. F with amenorrhea, no breasts, N vagina/uterus What test would you order for diagnosis? |
FSH With no breasts and normal uterus/vagina, this cannot be AIS or MRKH Diagnosis = CNS vs POI +ut, +b -- first order prolactin; other causes: PCOS, adrenal, obstruction, thyroid, chronic illness, hypo-hypo, constitutional +ut, -b -- FSH; CNS not producing gonadotropins or POI -ut, +b -- Testosterone; MRKH vs AIS -ut, -b -- Karyotype; no ut means MIS was produced in utero (therefore must be XY) except in MRKH (have ov/Estogren) |
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Hypertrophic villi No scalloping What is the diagnosis? Most common karyotype? |
Complete molar pregnancy 46XX Hydadtiform Mole •Partial (triploid) moles •MORE common Usually 2 paternal sperm +1 Normal Egg = Triploidy •Fertilization error triploid karyotype 69XXY •Complete (diploid) moles •Usually 1 sperm (haploid) + empty/inactivated ovum - paternal haploid sperm duplicates, creating diploidy •90%paternally derived chromosomes with a 46 XX karyotype Pathologic Features: •Grossly seen hydropicvilli, diffuse villous hydrops & diffuse trophoblastic hyperplasia •Complete: No identifiable embryonic or fetal tissue, generalized swelling of villi & diffuse trophoblastic hyperplasia. Have more villous vesicles than partials •Partial: Marked villus scalloping, prominent stromal trophoblastic inclusion, focal villous swelling & cavitation, focal trophoblastic proliferation, may see fetal tissues |
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16 y.o. F unreliable patient List 2 single dose ABx (drug, dose, route) to treat GC + Chlamydia |
Azithromycin 1g po once Ceftriaxone 250 mg IM once |
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Define Cerebral Palsy Most common type |
Symptom complex of non-progressive motor impairment syndromes secondary to brain injury or anomalies arising in early life Spasticity with athetoid movements |
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Features of CP (5) |
- spasticity - movement disorders - muscle weakness - ataxia - rigidity |
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Vicryl/Polysorb - generic name |
Polyglactin H2O + polyglactin --> glycolic acid + lactic acid (hydrolysis of ester linkages) |
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PDS - generic name/full name |
Polydioxanone (Delayed absorbable) |
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List four risk factors for hyperemesis gravidarum |
- family history - PMHx in previous pregnancy - low BMI - psychiatric and mood disorders |
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Triad of symptoms if spread of cancer to pelvic side wall |
- Sciatic pain - Unilateral leg edema - Ureteral obstruction |
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Incidental cervical cancer. What to do now? |
1. Imaging - chest/abdo/pelvis 2. Treat based on histo and radiologic findings; if margins +, deep stromal invasion, LVSI - consider radiation +/- chemo |
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Histologic findings in uterine sarcomas - 3 Name of criteria - 1 |
STANFORD CRITERIA 1. Mitotic index - > 10 mitoses/HPF 2. Cellular atypia 3. Coagulative necrosis |
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What criteria are used to diagnose Lynch syndrome? |
Amsterdam Criteria 1. At least three family members with pathology-proven Lynch cancer (colon, small bowel, endometrium, ureter, renal pelvis) 2. At least two successive generations 3. At least one diagnosed before age 50 |
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What is shown here? |
Psammoma bodies Papillary serous carcinoma of the ovary |
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What is this? |
Hobnail cells Seen in clear cell carcinoma of endometrium |
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Triad of symptoms in Fallopian tube cancer? |
1. Pelvic pain 2. Pelvic mass 3. Clear or blood-tinged vaginal discharge |
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Describe the "all-or-none period" |
Time from conception to somite formation (8 to 14 d from conception) If exposed to teratogen, either pregnancy will fail or will be unaffected from exposure |
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List FOUR reasons for early evaluation in a woman with recurrent pregnancy loss. |
1) Age > 35 years 2) Normal karyotype of products 3) FH(s) seen on ultrasound 4) Hx of infertility |
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Two standard tests for lupus anticoagulant |
1. Russel Viper Venon Test 2. Lupus activated partial thromboplastin time |
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What is the likelihood of pelvic lymph node involvement in Stage I endometrial cancer, endometrioid type? |
I A Grade 1 - 3% Grade 2 - 9% Grade 3 - 18% I B - 40% |
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Alternatives to autopsy in stillbirth (6) |
1. Head-sparing autopsy 2. Gross/microscopic placental exam + internal exam of fetus (organs left with body, brain untouched) 3. Placental exam + external exam with selected biospies 4. Placental exam + external exam 5. MRI 6. U/S |
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What is the overall risk of complication, major and minor, with laparoscopy? |
8.9% |
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Risk factors for post-term pregnancy (list 5)? |
- Past history of post-term pregnancy - Family history - Primiparity - Obesity - Advanced maternal age - Race - Male fetus - Placental sulfatase deficiency - Anencephaly - Adrenal hypoplasia |
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What is Post-Maturity Syndrome? |
- wrinkled, patchy, peeling skin - soles, palms - long, thin body (wasting) - long fingernails - meconium coating skin - advanced maturity - open-eyed, alert, worried |
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What happens to pituitary hormones in anorexia nervosa? |
DECREASE: TSH, T3, T4, LH, FSH UNCHANGED: PRL INCREASE: CORTISOL, GH |
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List 5 considerations for the care of an Aboriginal adolescent pregnant patient. |
- inclusion of Elders in prenatal care - use of herbal medicines - specific dietary recommendations - desire for delivery on traditional territory - use of traditional delivery practices |
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What is custom adoption? |
- in Aboriginal communities, custom adoption is the tradition of members of the community raising a child that is not their own - established in the Indian Act of 1985 - often between two families |
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What are 5 screening questions for Intimate Partner Violence? |
1. Do you feel safe in your relationship with your partner or family member? 2. Are there situations in the last 6 mo where you felt afraid of your partner or family member? 3. In the last 6 mo, have you been a victim of abuse from your partner or family member? 4. In the last 6 mo, have you been hit, kicked, punch, or physically hurt by your partner or family member? 5. In the last 6 mo, have you been forced to have sex or do sexual things that you did not want to do by your partner or family member? |
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What is the likelihood of vertical transmission of HCV? Can this be modified? |
5% No - mode of delivery, breastfeeding do not change transmission risk |
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What is Neonatal Abstinence Syndrome (NAS)? What are the clinical features (four)? |
NAS = Neonatal withdrawal from daily antenatal opioid exposure. Presents based on half-life of opioid (later onset = longer half-life) Respiratory - resp distress Gastrointestinal - poor feeding, vomiting, regurg, diarrhea CNS - increased tone, tremor, seizures Autonomic - sweating |
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What is the most effective strategy for preventing CVD? |
Reduction of modifiable risk factors 94% of CVD risk is attributable to modifiable RFs |
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Definition of osteoporosis in postmenopausal and premenopausal woman? |
Postmenopausal: - Radiologically, BMD T-score of less than -2.5 at the lumbar spine, hip, or radius - Clinically, presence of a low-trauma # Premenoausal: - ONLY clinically, if presence of fragility # - BMD cannot be used |
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Etiologies of thrombocytopenia (6) |
- idiopathic thrombocytopenic purpura (Dx of exclusion outside of pregnancy) - drug-induced (quinine) - viral illness-related (HIV) - medical illness-related (SLE, APLA, HUS, TTP) |
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What is the Hawthorne effect? |
The change in behaviour in a person when part of a research study |
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What is the most important factor for survival of a premature fetus? |
Gestational age > Birth weight |
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What is the current recommendation for management of PPROM < 32 weeks, 32-34 weeks, and > 34 weeks and why? |
< 32 Weeks = admin ABx to prolong pregnancy by 48 hours, possibly 7 days and reduce risk of chorio and composite of neonatal morbidity outcomes 32-34 Weeks = check fetal lung maturity - if mature, IOL. If not mature, ABx as above and give corticosteroids > 34 Weeks = IOL |
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CMV "Most Commons" (2) |
Most common viral cause of cerebral palsy Most common infectious cause of IUFD |
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What factors impact AFP level? |
Gestational age (incorrect dating) Race (AFP in black > AFP in white) Weight (underweight - FP, obesity - FN) Multiple gestation Insulin-dependent DM Fetal death Open NTDs, abdominal wall defects, renal anomalies |
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List the live attentuated vaccines contraindicated in pregnancy (7) |
- MMR - Polio - Varicella - Influenza (nasal spray only - IM safe) - Yellow fever - Rotavirus - BCG |
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What are the four components of Steege's Integrated Model of Chronic Pain? |
1. Biological event sufficient to initiate nociception 2. Alteration of lifestyle and relationshio 3. Anxiety and affective disorders 4. Circular |
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Risk factors for ongoing or increased pain following hysterectomy for CPP (5) |
- young age (<30) - NO pelvic disease identified - history of PID - 2 or more pregnancies - low SES |
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1) Define myofascial trigger point 2) Describe 4 characteristics |
1) a focus of hyperirritability of muscle/fascia causing pain symptoms 2) ALWAYS tender, prevents muscle lengthening, refers pain on direct compression, local twitch response |
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Outline the elements of the WHO Semen Analysis |
Volume 1.5cc Concentration > 1.5 x 10^6 sperm/cc Motility Total > 40%; Prog > 32% Morphology 4% (Tygerberg method) WBC < 1 x 10^6 WBC/cc |
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List 5 criteria for suppressive therapy of HSV |
- more than 6 episodes per year - less than 6 eps but complications of episodes - need to lower transmission risk (partner/fetus) - health-related quality of life - social and/or sexual dysfunction |
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When to consider paracentesis in OHSS (4) |
- symptomatic relief - tense ascites - pleural effusion (resp compromise) - oliguria/anuria (high pressure yields poor renal perfusion) |
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What is Perrault Syndrome? |
Autosomal recessive syndrome resulting in spontaneous POI (pure gonadal dysgenesis) and deafness |
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What are the risks of adding estrogen too fast in delayed puberty (5)? |
- tubular breasts - brown nipples - bone closure/acceleration of bone maturation - inadequate uterine development - asynchronous with peers |
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Name 5 structures that arise from the ectoderm |
- CNS - Skin - Enamel - Nails - Hair - Glands |
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Name 5 structures that arise from the mesoderm |
- Muscle - Vascular tissue - Bone/Cartilage - Urogenital tissue (not bladder) - Subcutaneous tissue |
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Name 5 structures that arise from the endoderm |
- Epithelial lining of 1) GI tract, 2) Resp tract, 3) Urinary bladder - Thyroid, parathyroid - Liver, pancreas |
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List the component of a genital exam for ambiguous genitalia |
- Palpate gonads in inguinal region/scrotal folds - Prader scale (degree of labioscrotal fold fusion) - Phallus length/Clitoral index (clitoris <1cm) - Location of urethral opening - DRE for presence of uterus - Presence of vagina/blind pouch |
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How many carbons are in the following: 1. Estrogens 2. Progestagens 3. Androgens 4. Mineralocorticoids 5. Glucocorticoids |
1. 18 2. 21 3. 19 4. 21 5. 21 |
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What are the diagnostic criteria for metabolic syndrome? |
1. Abdominal obesity: waist circumference > 88cm (35 inches) 2. TG > 1.7 mmol/L 3. HDL < 1.3 mmol/L 4. Blood Pressure > 130 / >85 5. Fasting & 2h glucose from OGTT: a. Fasting: 6.1-7.0 mmol/L and/or b. 2h glucose: 7.8-11.1 mmol/L *Need 3 out of 5 above criteria |
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What is Yousef's Triad? |
Symptoms of vesicouterine fistula following C/S 1. Vaginal urinary leakage 2. Cyclic hematuria 3. Amenorrhea |
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Describe management of a pregnant women with uterine prolapse |
1. Bedrest 2. Trendelenberg 3. Pessary until labour - doughnut or lever (Smith, Hodge) |
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What pessary can be used with an incarcerated uterus in pregnancy? |
Hodge pessary - anterverted the uterus, which is generally stuck in a retroverted position at around 12 weeks GA |
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What are the categories of effects on fetuses when exposed to radiation (4) |
1. Miscarriage 2. Malformations 3. Abnormal growth/development 4. Mutagenic and carcinogenic effects |
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What is the effect of radiation to fetus if dose is 0.05 Gy (5 rad or 5000 mrad)? |
No effect no evidence of an increased risk of fetal anomalies, intellectual disability, growth restriction, or pregnancy loss from ionizing radiation at doses less than 0.05 Gy CT Abdo 250 mrad Conception to 14d - "all or none" period, where 100rad will likely kill 50% of embryos |
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At what dose of radiation is there concern for carcinogenic effect? |
1 to 2 rad Carcinogenic effects are more pronounced during late fetal development |
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What are three strategies to decrease side effects secondary to anticholinergic medications in OAB? |
1. Decrease dose 2. Extended release 3. Transdermal administration |
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What are the possible etiologies for recurrent SUI after surgery, early (5) vs. late (3)? |
Early - Wrong OR - Poor surgical technique - UTI - Voiding dysfunction - OAB - Fistula Late - poor pelvic floor strength - medical condition (COPD, BMI) - urogenital aging, E deficiency |
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List 2 common and 2 uncommon side effects of nitrofurantoin. What can happen if nitrofurantoin given in last 4 weeks of pregnancy? |
Common - headache, nausea Uncommon - aplastic anemia, pulmonary toxicity Pregnancy - if fetus has G6PD deficiency, nitrofurantoin can cause hemolysis |
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List three mechanisms of action for injury to iliohypogastric and ilioinguinal nerves |
Pfannenstiel Lateral laparoscopic ports Fascial closure |
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What are the three branches of the pudendal n? |
1. Inferior rectal nerves 2. Perineal nerve 3. Dorsal nerve of the clitoris |
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What is "meralgia paresthetica"? |
Compression of the lateral femoral cutaneous nerve, which innervates the ant and lat thigh to the knee, under the inguinal ligament Results in tingling, numbness, burning Dx - no motor deficit; sensory findings, positive Tinel's Sign |
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Differentiate between factors affecting wound healing - local vs. systemic (5 of each) |
Local - dessication, bacteria/infection, necrosis, pressure, edema Systemic - obesity, diabetes, smoking, age, hormonal status, nutrition |
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What are two risks in attempting natural conception for an HIV + seroconcordant couple? |
- super-infection - transmission of drug-resistant strain |
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List 6 factors to consider when selecting a drug regime for HIV + women in pregnancy. |
- gestation age - current co-morbidities - teratogenicity of medications - HIV resistance status - social status - IVDU - compliance |
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What does cervical cancer stage IAII mean? When is post-op radiation necessary (5)? |
Microinvasive disease 3-5mm depth, ≤ 7mm width; Give radiation if 1) + surgical margins, 2) LVSI, 3) pelvic LN, 4) parametrial involvement, 5) > 1/3 stromal depth, or 6) > 2cm size |
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What is the hypothetical concern in pregnant women with Graves' disease who have had a partial subthyroidectomy or ablation? |
Patient may have low thyroid levels AND high levels of circulating thyroid antibodies Resulting in maternal eu or hypothyroidism and neonatal Graves' - can give Synthroid + PTU |
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What are Hunner's lesions? |
They are distinctive areas of inflammation on the bladder wall that characterize the “classic” form of IC |
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List causes of low APGAR score (5)
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- asphyxia - meconium aspiration - infection - metabolic disorder - congenital anomaly - respiratory - prematurity - drugs (narcotics) |
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Diagnosis and order of actions in maternal hypotension and apnea following regional analgesia |
Dx: high block - HELP - ABCs - IV lines + IV fluid bolus - Position - LLD +trendelenberg - vasopressors - prepare for cardiac arrest |
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Three strategies to decrease risk of aspiration in GA C/S |
- NPO x 8 hours - cricoid pressure during intubation/extubation - antacids - e.g. sodium citrate |
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List the steps of shoulder dystocia emergency |
1. Call for HELP 2. Tell mom to STOP pushing 3. McRobert's 4. Suprapubic pressure 5. Corkscrew 6. Reverse corkscrew/Rubin's Maneuver 7. Deliver posterior shoulder 8. Episiotomy 9. All fours 10. Fracture clavicle 11. Zavanelli |
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Outline the steps involved in managing a patient declining C/S for fetal bradycardia |
1. Counsel risks/benefits/alternatives of C/S 2. Assess capacity if concerns of decision-making 3. Understand pt's reasoning/reasons for refusal 4. Document 5. Respect patient autonomy 6. Reassess situation regularly 7. Continue to provide best care possible |
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List contraindications to vaginal delivery |
- placenta previa - abn fetal lie or presentation (transverse lie, footling breech presentation) - prior classical or inverted T uterine incision - prior significant uterine surgery (e.g. myomectomy) - active genital HSV - invasive cervical carcinoma - previous uterine rupture |
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List two metabolic abnormalities associated with post-term pregnancy (42+0 weeks) |
- hypogylcemia - acidemia |
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Factors that effect resumption of intercourse postpartum (5)
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- vaginal atrophy (breastfeeding) - perineal trauma - postpartum depression - relationship strain - fatigue |
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What are the risks of early amniocentesis (4)?
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- risk of miscarriage - PPROM - culture failure - talipes |
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List 5 criteria for the diagnosis of systemic lupus erythematosus. |
Blood - pancytopenia, APLA Renal - lupus nephritis ANA Immune - anti-dsDNA, anti-Ro, anti-La Neurologic - seizures, psychiatric |
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DSM criteria for postpartum depression |
- must be within 4 weeks of delivery - not caused by meds, drugs, bereavement - 5 of the following, with at least one being 1 or 2: 1. depressed mood 2. loss of interest/pleasure 3. sleep disturbance 4. guilt/worthlessness 5. decreased energy 6. concentration (diminished ability) 7. appetite - decrease or increase 8. psychomotor agitation/retardation 9. suicidality |
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Cornerstone characteristics of PMDD (4) What other symptoms? |
1. Mood - depressed 2. Anxious, tense 3. Anger, irritability 4. Labile mood SIGECAPS |
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What is pediculosis ciliaris? |
Pubic lice in the eyelashes! |
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List 5 intra-op risk factors for infection |
1. Poor hemostasis 2. Excessive use of cautery 3. Contamination - e.g. bowel injury, breech sterile technique 4. Inadequate antibiotic prophylaxis 5. Foreign body |
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What is this pigmented lesion? Differential (4)? |
Seborrheic keratosis DDx: Melanoma Nevus Lentigo VIN |
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What is this pigmented lesion? |
Vulvar melanoma |
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What are Honan's Criteria? |
Diagnostic criteria for Bartholin's Carcinoma 1) correct anatomical location 2) deep in labia majora 3) overlying skin intact 4) some recognizable normal gland seen 5) on histology, transition from normal to malignant seen 6) absence of another primary cancer |
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List 5 non-infectious etiologies for genital ulcer |
- cancer - SCC, BCC - lichen planus - trauma - contact dermatitis - Behcet's - crohn's |
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List risk factors for osteoporosis; Which are major? Which are minor? |
Major: age > 65, previous fragility fracture, glucocorticoid use > 3 months Others: POI, FMHx of fragility fracture, malabsorption, excessive alcohol, smoking, low BMI |
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Criteria for asphyxia causing cerebral palsy (4)
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1. pH < 7 or base excess > 12 2. early onset moderate or severe neonatal encephalopathy > 34 weeks 3. CP of the spastic quadriplegia or dyskinetic type 4. Exclusion of other causes (e.g. trauma, infection, genetic) |
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What features suggest an intrapartum timing for asphyxia insult (5)? |
1. Sentinel hypoxic event in labour 2. Sudden and sustained fetal bradycardia or minimal variability, usually after sentinel event 3. Apgar scores < 5 beyond 5 minutes 4. pH < 7.0 and/or BD ≥12 mmol/L 4. Imaging suggesting nonacute cerebral abn 5. Onset of multisystem involvement w/in 72h |
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What are the serologic tests used to diagnose syphilis? |
- Non-treponemal tests - SCREENING; VDRL, RPR - Treponemal tests - DIAGNOSTIC; FTA-ABS, MHA-TP, TP-PA |
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What signs on u/s can be used to determine chorionicity and amnionicity before 10 wks? |
1. Number of gestational sacs (2 = dichorionic) 2. Number of yolk sacs (2 = diamniotic) 3. Number of amniotic sacs |
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What signs on u/s can be used to determine chorionicity and amnionicity after 10 wks? |
1. Number of placentas 2. Membrane characteristics - thick, thin, none 3. Chorionic sign - T vs lambda/twin peak sign 4. Fetal genitalia |
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What are 5 risk factors for multiple gestation? |
1. Assisted reproductive technology 2. Age 3. Parity 4. Maternal size 5. Genetics |
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What Korotkoff phase should be used to designate diastolic blood pressure? |
Five - when the sound completely disappears |
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What are the ways to define proteinuria (3)? |
1. Urine dipstick - 2+ proteinuria 2. 24 h urine protein ≥ 0.3 g/d 3. Protein : creatinine ratio ≥ 30 mg/mmol |
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What are the three structures of the decidua? |
1. Basalis 2. Capsularis 3. Parietalis |
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What is the Nitabuch layer? |
The Nitabuch layer is a zone of degeneration in which invading trophoblasts meet the decidua basalis |
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Differential for fetal anemia (5) |
- alloimmunization - fetomaternal hemorrhage - infection - parvovirus B19 - alpha thalasemmia - G6PD deficiency - leukemia |
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What is the critical titre for anti-D antibodies? |
1:16 |
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What 5 antigens compose the rhesus system? |
C, c, D, E, e Bonus details: C, c, E, e have lower immunogenicity anti-E is most common but anti-c is most likely to require fetal/neonatal transfusion |
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What are the minor antigens in alloimmunization |
Kell - most common to cause alloimmunization bc anti-D Ig prevents alloimmunization ++ bad - requires MCA dopplers for anemia around 16 weeks onward Duffy group A Lewis - pose no fetal risk |
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List four ways to differentiate between ABO and CDE incompatibility |
1. Firstborn vs. not firstborn 2. Non-progressive with subsequent pregnancies vs. progressively more severe 3. Mostly IgM vs IgG 4. Pediatric disease vs fetal disease |
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Abnormal blood pressure definitions |
Hypertension Diastolic BP ≥ 90 mmHg Severe hypertension Systolic BP ≥ 160 mmHg or dBP ≥110 mmHg Pre-eclampsia - If pre-existing HTN, 1) resistant HTN, 2) new or worsening proteinuria, or 3) one or more adverse conditions - If gestational HTN, 1) new proteinuria or 2) one or more adverse conditions Severe pre-eclampsia - pre-eclampsia before 34 weeks GA with 1) heavy proteinuria or 2) one or more adverse conditions ~ Adverse conditions = maternal symptoms, signs of end organ damage, bloodwork abn, or fetal morbidity |
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Blood pressure targets |
With Comorbidities - sBP 130-139, dBP 80-89 Without comorbidities - sBP 130-155, dBP 80-105 |
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Explain the pathophysiology behind the classic symptoms of pre-eclampsia |
Visual scintillations and scotomas - occipital ischemia Headaches - cerebral edema and/or ischemia RUQ pain - capsular irritation secondary to hepatic necrosis and/or hematoma Chest pain - non-cardiogenic edema |
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Outline the risk of VTE in baseline population, OCP users, in pregnancy, and peripartum |
Baseline 5/10,000 OCP users 10/10,000 Pregnancy 30/10,000 Peripartum 300-400/10,000 |
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What are the 5 pathologic features assessed in gestational trophoblastic disease? |
1. Fetal/embryonic tissue 2. Scalloping of chorionic villi 3. Hydatidiform swelling of chorionic villi 4. Trophoblastic stromal inclusions 5. Trophoblastic hyperplasia |
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How do you follow a molar pregnancy after suction D&C? |
- weekly hCG until 3 negativelevels, then monthly hCG x 6 along with regular pelvic examination - regular pelvic exams - CXR if BhCG rises - contraception (no IUD) to avoid pregnancy untilhCG normal for 6 months - Early ultrasound in subsequent pregnancies - 1-2% risk of second mole |
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How do you diagnose a postmolar GTN using FIGO criteria? |
1. Weekly hCG plateau (± 10 % of previous) over 3 week period - 4 values 2. hCG levels > 10 % over three values taking in 2 week period 3. Persistence of hCG 6 months after evacuation |
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What does LASER stand for? |
laser amplification by stimulated emission of radiation |
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What is MURCS? |
Mullerian duct aplasia Renal aplasia Cervicothoracic somite dysplasia |
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What are the histologic features of a borderline tumour? |
1. Epithelial hyperplasia 2. Nuclear atypia and increased mitotic activity 3. Detached cell clusters 4. No stromal invasion |
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What are the tests for von Willebrand (vW) disease? |
First - CBC, ferritin, PT/aPTT Then - bleeding time, G+S, von Willebrand studies 1. Factor VIII 2. vW antigen 3. vW functional assay - aka Ristocetin co-factor |
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Which chromosomal number abnormalities are equal across all maternal ages (3)? |
- 45 X - Triploidy - XXX, XXY, XYY |
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Which soft markers, when seen in ISOLATION, are not concerning for aneuploidies (4)? |
- pyelectasis ≥5mm and ≤10mm - single umbilical artery - enlarged cisterna magna - CPC if age/bloodwork risk of aneuploidy < 35 yo |
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What is this? |
Schiller-Duval bodies |
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How is it that monosomy X makes it to being a livebirth? |
98% abort in T1 A second group have significant cystic hygromas, hydrops and die Last group that is liveborn is only true monosomy X 50% of the time; a portion have mosaicism or isochromosome X |
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Describe the features in Turner Syndrome (name 6) |
- Cardiac 30-50% - coarctation, bicuspid aortic valve - Renal - horseshoe kidney - Hypothyroid - Short stature - Broad chest, wide-spaced nipples - Webbed posterior neck - Bone/cartilage abnormalities - Nevi - Short 4th metacarpal - Low hair line - Low set ears - Chronic otitis media - High arched palate - |
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Describe the features in Down Syndrome (name 6) |
- Cardiac 40% - VSDs - GI - duodenal, esophageal atresia - Brachycephaly - Epicanthal folds, upslanting palpebral fissures - Flat nasal bridge - Single palmar crease - Sandal-toe gap - Loose skin at nape of neck - Optical refractory errors - Cataracts - Thyroid - Leukemia - Mild-moderate mental retardation |
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What is gonadal mosaicism? |
Mosaicism confined to the gonads. This concept can explain the recurrence risk of genetic diseases after the birth of a child with a "new/de novo" mutation in a previously unaffected family. |
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What are the four VERY bad outcomes of a dermoid cyst/mature teratoma? |
1. Malignant transformation 2. Strumii ovari 3. NMDA receptor encephalitis 4. Carcinoid |
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What is the most important prognostic factor for immature teratomas and what tissue type is being evaluated? |
Grade of the lesion (1-3) Neural |
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What is associated with single umbilical artery (3) |
- renal - cardiac - low birth weight |
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What is the characteristic histological feature of endodermal sinus tumours? |
Schiller-Duval bodies |
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What is this and in what condition is it seen? |
Call-Exner body Granulosa cell tumours |
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What is Meigs Syndrome? What is Pseudo-Meigs Syndrome? |
Triad of ovarian fibroma, ascites, and pleural effusion. Pseudo-Meigs - benign ovarian tumour other than fibroma + other above findings |
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What is the rate of recurrent miscarriage for 0 previous losses, 1 previous losses, 2 previous losses and 3 previous losses? |
0 previous losses - 7% 1 previous losses - 14% 2 previous losses - 26% 3 previous losses - 28% |
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What are the diagnostic criteria for Fetal Alcohol Syndrome? |
1. Facial Dysmorphic Features (must have all 3) a. Smooth philtrum b. Thin upper lip c. Short palpebral fissures 2. Prenatal and/or postnatal growth impairment 3. CNS impairment (at least 1) a. Structural - HC < 10%ile and brain abn on ultrasound b. Neurological dysfunction c. Functional - intellectual or cognitive deficit |
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What is the Kessner Index? |
Kessner Index incorporates three items from the birth certificate: length of gestation, timing of the first prenatal visit, and number of visits. Although it does not measure the quality of care, the index remains a useful measure of prenatal care adequacy |
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What are the causes of infertility in couples? |
Tubal and pelvic pathology 35% Male factor 35% Ovulatory dysfunction 15% Unexplained infertility 10% Unusual problems 5% |
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What is capacitive coupling and what are scenarios it can occur in (3)? |
Establishment of current between two conductors separated by an insulator, usually in higher voltage output settings Examples: 1. Use of coagulation mode 2. Long, uninterrupted periods of activation 3. Non-contact with tissue |
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What metabolic effects are seen in a neonate born of a woman with diabetes (4)? |
Hypoglycemia Hypocalcemia Polycythemia Hyperbilirubinemia |
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Which has a higher genetic predisposition for fetal anomalies - T1DM or T2DM? |
T2DM |
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What are the causes of infertility in women? |
Tubal and pelvic pathology 40% Ovulatory dysfunction 40% Unexplained 10% Unusual problems 10% |
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What are ideal characteristics of suture material? |
- knot security - inertness - adequate tensile strength - flexibility - ease of handling - smooth passage through tissue - nonallergenic - resistance to infection - predictable dissolvability |
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What constitutes an nonabsorbable suture? |
Maintains tensile strength for more than 60 days |
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What is the risk of recurrent preterm birth in 1. One preterm birth ≤ 34 weeks 2. Two preterm births ≤ 34 weeks |
1. 16% 2. 41% |
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What are strategies to reduce capacitive coupling (6)? |
- activate only with tissue contact - avoid prolonged, uninterrupted activation - avoid over dilation of cervix - use weighted speculum - use lower voltage "cut" current - check for insulation defects |
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What are the pathways of amniotic fluid regulation (4)? |
1. Fetal urination = + 1000 mL/day 2. Fetal lung fluid secretion = + 350 mL/day 3. Fetal swalling = - 750 mL/day 4. Intramembranous flow across fetal vessels on placenta surface = - 400 mL/day |
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What might be seen on ultrasound in fetuses affected by CMV (8)? |
IUGR Ventriculomegaly Microcephaly Hydrops Ascites Oligo/polyhydramnios Hyperechogenic bowel Intracranial calcifications |
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What might be seen on ultrasound in fetuses affected by VZV (10)? |
IUGR Ventriculomegaly Microcephaly Hyperechogenic bowel Hydrops Ascites Polyhydramnios Limb abnormalities Chest wall abnormalities |
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What are risk factors for developing varicella pneumonitis in pregnancy (2)? |
Cigarette smoking > 100 skin lesions |
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|
What are the four main theories of endometriosis origin? |
1. Retrograde menstruation + direct implantation 2. Coelemic metaplasia 3. Hematogenous spread 4. Lymphatic/autoimmune |
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What are the mechanisms of infertility in endometriosis (6)? |
1. Mechanical impairment 2. Peritoneal fluid composition 3. Hormonal/Ovulatory dysfunction 4. Abnormal immune response 5. Fertilization/implantation 6. Early spontaneous abortions |
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What constitutes MODERATE risk for NTD (5) and what do they require? |
1. Personal or family history of folate-sensitive congenital anomaly 2. Family history of NTD in 1st or 2nd degree relative 3. Maternal T1 or T2DM 4. Teratogenic medications 5. Maternal GI malabsorption 1mg Folic Acid 3 month pre-conception, first trimester, then step down to 0.4 mg FA until 4-6 weeks postpartum |
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Discuss HNPCC and endometrial cancer. |
Lifetime risk 40-60% Women should have endometrial biopsy screening starting at age 30 or 5-10 years younger then the youngest person diagnosed with cancer |
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What are the four steps to managing eclampsia, besides the basic initial steps? |
1. Magnesium sulfate to increase seizure threshold 2. Intermittent administration of anti-hypertensives 3. Avoidance of diuretics unless obvious pulmonary edema 4. Delivery |
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What is the first step of assessment and management of PPH? |
Call for help Resuscitation - ABCs - Oxygen by face mask - Two large bore IVs - Crystalloid, isotonic fluid resuscitation - Monitor BP, HR, RR - Empty bladder, monitor urine output Lab tests - CBC - Group and screen, crossmatch - Coagulation screen |
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What coagulation factors remained unchanged in pregnancy (3)? |
Antithrombin III Factor V Protein C |
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|
How does thyrotoxicosis present? |
Acutely Fever Tachycardia Arrhythmias CNS dysfunction (seizures) GI symptoms |
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|
Which physiologic lung aspects INCREASE and which DECREASE? |
INCREASE - vital capacity, tidal volume, inspiratory capacity, minute ventilation DECREASE - total lung capacity, functional residual capacity, residual volume, expiratory residual volume |
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What is the Apt test and what is it useful for? |
Samples blood from the vagina in the setting of an APH; done if ultrasound concerns for velamentous cord insertion or vasa previa. The test shows whether the blood is fetal or maternal. |
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What is this? |
Betke-kleinhauer test Bright pink cells - fetal RBCs; light pink cells - maternal RBCs |
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What physiologic changes occur in the kidney? |
INCREASED GFR Creatine clearance Renal plasma flow Protein excretion Glucosuria DECREASED BUN Uric acid Creatinine Bicarbonate |
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What is the differential diagnosis for hyperprolactinemia? |
- Idiopathic - lactotroph adenoma - drugs - dopamine antagonists - pregnancy - stress - chronic renal failure |
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What is this? What are other features of this disease? |
Trichomonas on wet prep Yellow, malodorous, excessive discharge pH > 4.5 Negative whiff test |
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List 5 viruses that can be transmitted via breastfeeding |
HIV HBV CMV HTLV West Nile |
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What is the management of hepatitis B in pregnancy with respect to the newborn (4)? |
Vaginal delivery is safe Breastfeeding is safe Neonate needs HB Ig and Hep B Vaccine @ 0, 1, 6 months Early bath before injections |
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|
Describe Quintero Staging. |
Stage I: Poly/Olihydramnios Stage II: Bladder absent in the donor twin. Stage III: Abnormal Doppler flow Stage IV: Fetal hydrops. Stage V: IUFD |
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What is this? What is the significance? |
Double bubble sign Represents duodenal atresia 20-30% association with T21 Seen with polyhydramnios 50% will delivery prematurely |
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What is this? What is the significance? |
Bladder exstrophy Distortion of penis/clitoris and urethra |
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What 3 enzymes can be impaired in Congenital Adrenal Hyperplasia and what molecule goes up in response? |
21 α hydroxylase - 17 α OHP 11 β hydroxylase - 11 deoxycortisol, deoxycortisone 3 β hydroxysteroid dehydrogenase - early in steroid pathway - lots of impairment |
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|
What is the PLISS IT model? |
Behavioural treatments of sexual problems P = Obtain Permission LI = Give Limited Information SS = Give Specific Suggestions IT = Consider Intensive Therapy |
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|
What muscles make up the urogenital diaphragm? |
- bulbocavernosus - ischocavernosus - superficial and deep transverse perineal - urethral sphincter |
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|
What muscles make up the levator ani? |
- puborectalis - pubococcygeus - iliococcygeus |
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What separates the deep and superificial urogenital triangles? |
Inferior fascia of the urogenital diaphragm AKA perineal membrane |
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|
What structures make up the pubococcygeus? |
- pubovaginalis - pubourethralis |
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|
Describe the principles of surgery in repairing a fistula. |
- operative field free of inflammation or infection - wide mobilization of tissues - excision of fistula tract - repair in layers without tension - good hemostasis - for VVF, bladder catheter post-op - for RVF, avoid strain on repair post-op |
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List 3 surgical options for each of RVF and VVF |
RVF - episioproctotomy - simple fistulectomy - transperineal approach VVF - Latzko - Interposition - O'Conor |
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|
What are the three obstetrical indications for antiphospholipid antibody testing? |
1. Three or more consecutive losses before 10 weeks, where maternal anatomical/hormonal abnormality and parental chromosomal abnormality has been ruled out 2. One or more fetal losses after 10 weeks, of a morphologically normal fetus 3. One or more deliveries before 34 weeks, of a morphologically normal neonate, due to either (i) pre-eclampsia or (ii) placental insufficiency |
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|
What is the ideal diet composition in pregnancies complicated with diabetes? |
55% carbohydrates 25% fat, < 10% saturated fat 20% protein |
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|
What are the caloric intake recommendations for women with BMI 18-25? |
T1 - no increase T2 - 340 kcal/day T3 - 450 kcal/day |
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|
What is the recommended weight gain for BMI... < 18 (Underweight) 18-25 (Normal) 25-30 (Overweight) 30-35 (Obese class I) 35-40 (Obese class II) > 40 (Obese class III) |
< 18 = 12-18 kg 18-25 = 11-16 kg 25-30 = 7-11 kg > 30 = 7 kg |
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|
List four conditions in which the "lemon sign" might be seen on ultrasound? |
Dandy Walker malformation Spinda bifida Chiari II malformation Corpus callosum agenesis |
|
What is this? What disease? Etiology? |
Donovan bodies Granuloma inguinale - red beefy, sharply demarcated Calymmatobacterium granulomatis |
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|
Name 5 rashes seen in pregnancy |
1) PUPPS (Pruritic urticarial papules and plaques of pregnancy) 2) Pemphigoid gestationis 3) Impetigo herpetiformis 4) Prurigo of pregnancy 5) Pruritic folliculitis of pregnancy 4+5 = Atopic eruption of pregnancy |
|
What are these lesions? What classic histologic finding do they have? |
Syringoma - benign sweat duct tumours; can be found on vulva Histologic finding - tadpole sign |
|
What is this? |
H bodies = RBC inclusions Seen on brilliant cresyl blue stain |
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|
What are the definitions of (i) microcytosis and (ii) hypochromia? What tests are necessary if these are abnormal in the context of a normal hemoglobin electrophoresis? |
Microcytosis - mean cellular volume < 80 fL Hypochromia - mean cellular hemoglobin < 27 pg Ferritin + brilliant cresyl blue stain |
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|
Which populations are NOT at increased risk for thalassemias and hemoglobinopathies? |
Japanese Koreans Northern European Indigenous Canadians - First Nations and Inuit |
|
|
What is Ballantyne Syndrome? |
Also known as mirror syndrome Exists in cases of fetal hydrops, where maternal condition mirrors fetal - presents with edema, hypertension, proteinuria |
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|
What is the surgical treatment for granulosa cell tumours, prepubertal vs postmenopausal? |
1. Prepubertal - USO ± contralateral ovary biopsy if enlarged 2. Peri- or postmenopausal - Hyst + BSO + endometrial biopsy5% association with cancer, 25-50% association with hyperplasia |
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|
What are the nutritional requirements of a pregnant women with Crohn's who has undergone a ileum resection? |
B12 Fat-soluble vitamins - ADEK + Folic acid 4mg |
|
|
What are the maternal GI malabsorption conditions that classify a pregnant as moderate risk for NTDs? |
Crohn’s or active Celiac disease Gastric bypass surgery Advanced liver disease Kidney dialysis Alcohol overuse |
|
|
Which congenital anomalies may be folate sensitive (4)? |
- oral facial clefts - cardiac defects - urinary tract abnormalities - limb reduction defects |
|
|
Discuss intrapartum management of asthma |
1) Continue regular medications 2) Administer stress dose of steroids if systemic steroids used in previous 4 weeks (until 24 hours after delivery) 3) PEFR or FEV1 on admission and repeat if symptoms 4) For IOL - oxytocin, PGE2s okay; PGF2α contraindicated |
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|
List 4 contraindications to breastfeeding |
HIV Breast cancer Chemo/rads Galactosemia in infant Others: TB HSV Alcohol/Drug abuse |
|
|
List 4 indications for cerclage |
1. History of 3 or more mid-trimester losses and cervical insufficiency, done at 12-14 weeks GA 2. Sonographic evidence of short cervix < 25 mm and prior preterm birth, < 24 weeks GA 3. Cervical incompetence in context of threatened preterm labour (no perceived contractions, dilated < 4 cm and < 24 weeks GA) = rescue cerclage 4. Trachelectomy - abdominal cerclage |
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|
What are the minimum, additional, and definitive diagnostic criteria for PID |
Minimum 1. Abdominal pain 2. Adnexal tenderness 3. Cervical motion tenderness Additional 1. Temp > 38.3º 2. WBC on wet mount 3. Elevated ESR 4. Elevated CRP 5. Lab evidence of Chlamydia or N. gonorrhea Definitive 1. Endometrial biopsy = endometritis 2. U/S showing thickened, fluid-filled tube(s) 3. Gold standard: laparoscopy |
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|
List 6 contraindications to uterine artery embolization |
1. Pregnancy 2. Malignancy/Undiagnosed pelvic mass 3. Active pelvic infection 4. Asymptomatic 5. Desire for fertility 6. Allergy to contrast dye 7. Subserosal/submucosal with narrow stalk |
|
|
What is postabortal syndrome and how is it managed? |
Acquired acute hematometria following termination of pregnancy Re-evacuation of the cavity |
|
|
What is postablation tubal sterilization syndrome and how is it managed? |
Cyclical or intermittent pain in women who have undergone a tubal sterilization procedure and then have a endometrial ablation Proposed mechanism - bleeding in the cornua that becomes trapped Managed by laparoscopic excision of the tubal stumps or hysterectomy |
|
|
What is Juvenile-onset Respiratory Papillomatosis |
Most severe outcome of HPV infection in children likely secondary to transmission during delivery |
|
|
What percentage of ASCUS, LSIL, ASC-H will go on to have HSIL on colpo-directed biopsy? |
ASCUS - 10-20% LSIL - 20-30% ASC-H - 60-70% |
|
|
What are the classic ABG findings in pulmonary embolism? |
Respiratory alkalosis Hypoxia Hypocapnea Increased A-a gradient |
|
|
What two conditions must be considered with very low unconjugated estriol < 0.25 MoM on second trimester screening? |
1) Smith-Lemli-Opitz 2) X-linked ichtyosis (steroid sulfastase deficiency) |
|
|
List 4 treatment options for VAIN and when they might be selected |
1. Laser ablation 2. Imiquimod 5% cream - young, HPV + women 3. 5-fluorouracil - multifocal; no anaesthesia required; good alternative to extensive excision 4. Excisional - VAULT |
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|
Which molecules cross the placenta via facilitated diffusion? |
Lactate Glucose |
|
|
List 4 possible mechanisms for pre-eclampsia |
1. Placental implantation with abnormal trophoblastic invasion of uterine vessels 2. Immunological maladaptive tolerance between maternal, paternal (placental), and fetal tissues 3. Maternal maladaptation to cardiovascular or inflammatory changes of normal pregnancy 4. Genetic factors including inherited predisposing genes and epigenetic influences |
|
|
Describe the pentad of features seen in TTP |
Fever Hemolytic anemia Decreased platelets Neurological symptoms Renal failure |
|
|
Ultrasound dating numbers |
Earliest U/S that dates the pregnancy at 7 weeks should be used MSD can be used until embryo seen or 14mm CRL needs to be between 10mm and 84mm CRL is accurate to between 3-8 days BPD to be used when CRL > 84mm BPD accurate to between 3-8 days in T1, and 7-12 days in T2 |
|
|
Definitions of ultrasound diagnosis of early pregnancy losses |
- Embryonic demise = intrauterine gestation, embryo with CRL ≥ 7 mm, no cardiac activity - Anembryonic demise = no embryo and mean sac diameter ≥ 25 mm |
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|
Traditional early pregnancy ultrasound findings - date and finding |
5+0 = empty gestational sac 5+4 = gestational sac and yolk sac 6+0 = gestation sac with yolk sac and adjacent FH |
|
|
What stain is necessary to differentiate between adenocarcinoma of the endometrium and adenocarcinoma of the cervix. |
Vimentin + in endometrial adenocarcinoma |
|
|
Describe the typical findings in adult respiratory distress syndrome (4) |
1. Intrapulmonary shunting 2. Widening of alveolar-arterial O2 gradient 3. Reduced pulmonary compliance 4. Reduced functional residual capacity 5. PaO2 difficult to maintain above 65 mm Hg |
|
|
What is the classic order of organ dysfunction in multi-organ failure? |
Lungs, liver, GI, kidney |
|
|
List 5 reasons for a EUA in a young girl |
- foreign body - recurrent infections - trauma - cancer - heavy bleeding |
|
What is this? How is it treated? |
Paget's Disease Wide local excision with 2cm margins |
|
|
List 4 indications for surgery in vaginal cancer and the specific type of surgery needed |
- Stage I cancer in posterior upper vagina - rad hyst, upper vaginectomy, pelvic LND - Cancer in lower 1/3 of vagina - bilateral inguinofemoral LND - Stage IV disease with VVF or RVF - pelvic exenteration, pelvic and para-aortic LND - Central pelvic recurrence - pelvic exenteration |
|
|
Define the paravesical space boundaries |
Medial - obliterated umbilical artery running along the bladder Lateral - obturator internus muscle along the pelvic sidewall Posterior - cardinal ligament Anterior - pubic symphysis |
|
|
Define the pararectal space boundaries |
Medial - rectum Lateral - internal iliac artery Posterior - sacrum Anterior - cardinal ligament |
|
|
Which molecules cross the placenta via simple diffusion? |
Simple "things" in life Fat - fat-soluble vitamins, fatty acids Fluids - water Flatus - gases (O2, CO2) Fun - anaesthetics, barbituates, narcotics |
|
|
Discuss mucinous borderline ovarian cysts |
- second most common borderline tumour after serous - bilateral in about 10% - associated with pseudomyxoma peritonei - can have appendiceal origin |
|
|
List 5 indications for a classical C/S |
- transverse lie, back down in prematurity - cervical cancer - fibroid (lower segment inaccessible) - fetal anomalies - anterior previa |
|
What is seen here? What is treatment? |
Paget's disease of the vulva Paget cells - pale-stainingadenocarcinoma cells that are almost always confined to the epithelium Wide local excision 2cm margins |
|
|
List 2 non-cancer causes of ulceration along the inguinal ligament |
- lymphogranuloma venereum - granuloma inguinale |
|
|
List 3 features of congenital lupus |
- Heart block - Rash (at birth) - Other cardiac abnormalities - Hematologic - anemia, thrombocytopenia - Hepatic - inc. LFTs |
|
|
List the ultrasound findings of a fetus with toxoplasmosis? |
Most likely normal IUGR Ventriculomegaly Microcephaly Intracranial calcifications |
|
|
List 5 causes of non-cardiogenic pulmonary edema |
- sepsis - acute hemorrhage - tocolysis - pre-eclampsia - vigorous fluid resuscitation |
|
|
List 2 changes to lipid metabolism in pregnancy |
- increased maternal LDL - increased leptin |
|
|
Which molecules cross the placenta via active transport? |
Ions with a charge! Fe2+, Ca2+, I-, K+ Amino acids Water-soluble vitamins |
|
|
When does AFP peak in fetal, amniotic fluid, and maternal serum? |
Fetal: 10-13 weeks Amniotic fluid: 12-14 weeks Maternal serum: 28-32 weeks |
|
|
List 2 changes to water metabolism in pregnancy |
- increased water retention - decreased plasma osmolality |
|
|
When does the neural tube normally close? |
5-6 weeks |
|
|
What are the contraindications to vaginal breech delivery? |
- contraindications to labour - cord presentation - IUGR/macrosomia (less than 2500g and greater than 4000g) - any presentation other than frank/complete breech with flexed/neutral head attitude - clinically inadequate maternal pelvis - fetal anomaly incompatible w/ vaginal delivery |
|
|
What is the average gestation age for delivery for 1) DC/DA + MC/DA twins, 2) MC/MA twins, and 3) triplets? |
1. 35 weeks 2. 32-34 weeks 3. 32 weeks |
|
|
What is the Chamberlain classification and is it recommended in clinical use? |
Assessment of amniotic fluid Definition of 1) Oligohydramnios = single deepest pocket < 2cm depth x 1cm wide 2) Polyhydramnios = single deepest pocket > 8cm depth x 1cm wide |
|
|
Outline the ventilation goals for ARDS |
FiO2 < 50% PEEP < 15 mmHg PaO2 > 60 mmHg SPO2 % > 90% |
|
|
List 3 strategies to prevent excessive fluid absorption in operative hysteroscopy |
1. Pre-treatment of endometrium (e.g. lupron) 2. Injection of vasopressors 3. Distension pressure < patient MAP |
|
|
What are the diagnostic criteria for ARDS |
Berlin Definition (all required): 1. Acute onset 2. Bilateral opacities on chest x-ray 3. Cannot be explained by cardiac failure or fluid overload 4. A moderate to severe impairment of oxygenation must be present, represented by PaO2/FiO2 ratio |
|
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List contraindication to tocolysis (7) |
- IUFD - Fetal anomaly - Abnormal NST - Antepartum hemorrhage with maternal instability - Chorioamnionitis - Severe pre-eclampsia - Contraindication to tocolytic dryg |
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What is the risk of isolated cleft anomaly at baseline, with one sibling affected with 1) unilateral vs. 2) bilateral clefts? |
Isolated = 2% Sibling, unilateral = 4% Sibling, bilateral = 8% |
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List 5 criteria for the diagnosis of systemic lupus erythematosus. |
Blood - pancytopenia, APLA Renal - lupus nephritis ANA Immune - anti-dsDNA, anti-Ro, anti-La Neurologic - seizures, psychiatric |
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List 3 high risk, intermediate risk, and low risk HPV subtypes for squamous cell carcinoma of the cervix. |
HIGH RISK 16, 18, 45 INTERMEDIATE RISK 31, 33, 52 LOW RISK 6, 11, 44 |
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What strains of HPV does the nonavalent vaccine cover? |
6, 11, 16, 18, 31, 33, 45, 52, 58 |
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Differentiate severe sepsis from septic shock |
Both are a more significant form of sepsis (systemic response to infection) with hypotension, hypoperfusion, and organ dysfunction; the difference is septic shock persists despite adequate fluid resuscitation |
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List 4 causes for a sinusoidal fetal heart pattern |
Asphyxia Anemia Anomaly - cardiac Asleep |
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What are the requirements for a nuchal translucency scan (4) |
Gestation age 11-13+6 weeks CRL 45-84 mm Head in neutral position NT off amnion |
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What are the components of Chronic Pain Syndrome? |
1) Chronic pelvic pain > 6 months 2) Incomplete relief with most treatments 3) Signs of depression 4) Impairment at home or work 5) Altered family roles |
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What are 3 ways to differentiate premature thelarche from precocious puberty? |
1) Other secondary sexual characteristics, menarche 2) Bone age - normal in premature thelarche; advanced in PP (unless 2º to hypothyroid) 3) Response to GnRH stimulation test - prepubertal in thelarche vs pubertal in PP |
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What is the chance of congenital abnormality in maternal rubella infection? <11 weeks 11-12 weeks 13-14 weeks 15-16 weeks >16 weeks |
<11 weeks = 90% 11-12 weeks = 33% 13-14 weeks = 11% 15-16 weeks = 24% >16 weeks = 0% |
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What are the names of Melanoma staging? |
Clark Breslow Chung |
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What is the definition of ACUTE CHEST SYNDROME in Sickle Cell Disease? |
“Radiological appearance of a new pulmonary infiltrate accompanied by fever and respiratory symptoms” |
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What precipitates acute chest syndrome? |
Thromboembolism ' Atelectasis Infection Marrow Emboli |
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If both people in a couple are of Ashkenazi heritage, what should be screened for? |
1) Tay Sachs 2) Canavan 3) Familial dysautonomia |
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List FOUR reasons for early evaluation in a woman with recurrent pregnancy loss. |
1) Age > 35 years 2) Normal karyotype of products 3) FH(s) seen on ultrasound 4) Hx of infertility |
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What are the benefits of a planned C/S? |
- Known date for delivery - Avoidance of postterm pregnancy - Reduction in risks associated with unplanned surgery - Prevention of late stillbirth - Reduction in nonrespiratory neonatal disorders - Reduction in risk of pelvic floor injury - Reduction in early postpartum hemorrhage |
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What are the disadvantages of a planned C/S? |
● Increased risk of abnormal placentation in future pregnancies ● Increased risk of anesthetic complications ● Longer recovery period (hospitalization and post-hospitalization), which may interfere with mother-infant interactions ● Increased maternal morbidity related to surgery (eg, organ injury, wound infection, thromboembolism, intraabdominal adhesions) ● Increased risk of neonatal respiratory problems ● Increased risk of uterine rupture in future pregnancies ● Cost |
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Advanced paternal age has been associated with these FOUR outcomes: |
1. New gene mutations 2. Schizophrenia 3. Autism 4. Some cancers |
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List 5 reasons elective single embryo transfer is done |
- < 35 y.o. and good prognosis patient - 36-37 and good prognosis and has blastocysts - oocyte donor-recipient cycle - medical/ob contraindications to twins - cost-effectiveness |
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List FOUR risk factors for recurrent urinary tract infections |
- new sexual partners, intercourse, spermicides - voiding dysfunction - prolapse, incontinence, catheterization - hypoestrogenic state - DM - young age (< 15y.o.) |
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List FIVE predictors of unsuccessful fitting of a pessary |
1. Short vagina (<6cm) 2. Wide introitus (>4 fingers’ breadth) 3. Rectocele 4. Previous vaginal surgery 5. Coexisting SUI |
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What are the FOUR elements of the harm reduction philosophy? |
1) encourage abstinence or reduction of use 2) encourage safe use 3) treatment of withdrawal 4) counselling and/or psychotherapy |
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Name FIVE types of cervical cancer |
Squamous cell carcinoma Adenocarcinoma Adenosquamous carcinoma Neuroendocrine Metastases Melanoma Sarcoma |
