Rotations - Ob Gyn

Front 1

Urinary Incontinence
1) What are the 3 Types of Urinary Incontinence?

2) GSUI
a) Definition of GSUI?
b) Pathophys of GSUI?
c) Tx GSUI?

3) UUI
a) Def / Pathophys of UUI?
b) Tx UUI?

4) Overflow Incontinence
a) Def / Pathophys overflow incontinence?
b) Tx for overflow incontinence?

5) Misc Urinary Incontinence Questions
a) What is urethropexy?
b) Is surgery a helpful optionfor urge incontinence?
c) What helps differentiate b/t GSUI and UUI?
d) If a post-void catherization shows a large residual volume, it suggests what type of incontinence?
e) Describe the basic physiology of all incontinences?

Back 1

1)
GSUI (Genuine Stress Urinary Incontinence)
UUI (Urinary Urge Incontinence)
Overfow Incontinence

2)
a) Incontinence resulting froma sudden increase in intra-ABD pressure after coughing, sneezing, etc..

b) Bladder neck falls below ABD cavity -->
IntraABD pressure distributed to bladder and NOT the urethra -->
Bladder pressure > Urethral pressure

c) 1st Line: Kegel exercises + Timed voiding
2nd Line: Urethropexy (Burch procedure or Urethral sling)

3)
a) Detrussor muscle contraction -->
Bladder pressure > Urethral pressure

b) 1st Line: Kegel exercises + Timed voiding
2nd Line: Anticholinergic Rx to relax detrussor (Oxybutinin)

4)
a) DM, SC Injury, LM Neuropathies, Urethral Edema, MS, Anesthesia -->
Neurogenic Bladder -->
Overdistended, Hypotonic bladder that has no detrussor contractions
b) 1st Line: Kegel exercises + Timed voiding
2nd line: Self-catherization
3rd Line: Bethanechol (Muscarinic Antag)

5)
a) Surgical fixation of proximal urethra in its normal location above pelvic diaphragm for GSUI
b) No!
c) Cystometric Eval
d) Overflow incontinence
e) Intravesicular pressure > Urethral sphincter pressure

Front 2

Pregnancy Luteoma:
1) What is a PL?
2) What pt pops most commonly get PL?
3) 2 s/s of PL?
4) Tx for PL?

Back 2

1) Solid, BL, Multi-nodular tumors of the ovaries
2) African American women in their 30s and 40s
3) Hirsutism and Virilization
4) Self-Limited and reqs no treatment

Front 3

Breast Engorgement

1) What is BE?

2) Tx for BE?

Back 3

1) When milk accumulation -->
Breast swelling / Inc breast size, Br tender in the first 24-72 hrs after childbirth

2) Curative: Self-limiting
Sx-ic: Cool compresses, acetominophen, NSAIDs

Front 4

Hyperemesis in Pregnancy

1) Give 2 causes of Hyperemesis in pregnancy?

2) GT Dz (moles, etc...)
a) What are the 3 classic s/s for GT Dz (moles, etc...)?

3) Preggos w/ Hyperemesis Gravidarum (Severe, persistent vomiting) will have what lab value?

4) Misc Ques:
What is the 1st step in the management of severe vomiting during pregnancy?

Back 4

1) Gestational Trophoblastic Dz;
Hyperemesis Gravidarum

2) Enlarged Uterus,
Hyperemesis,
Markedly elevated hCG (--> Snowstorm appearance on US)

3) Ketonuria

4) hCG level to r/o gestational trophoblastic dz

Front 5

Hypogonadotropic Hypogonadism

1) What is HH?

2) 3 things that can --> Dec GnRH and TF HH?

3) In any type of hypogonadism (Hypogonadtropic or otherwise) you will have decreased estrogen production -->
Inc risk for what?

Back 5

1) Dec GnRH -->
Dec production of hormones from Ant Pit and Ovaries

2) Excessive Exercise,
Anorexia,
Depression

3) Osteoporosis

Front 6

Epidural Anesthesia-->
What potential CV SE?

Back 6

HYPO-TN from blood redistribution to LE and venous pooling

Front 7

PP Blood Loss

1) What is the MCC of excess PP blood loss?

2) Give 4 lines of tx w/ potential AEs / CIs?

Back 7

1) Uterine atony after birth

2) 1st Line:
Uterine Massage and Dilute Oxytocin
2nd Line:
Rectal Misoprostol;
PGF-2 (CI'd in asthma bc --> Inc risk bronchoconstriction);
Methergine (CI'ed in HTN bc Inc risk stroke)
3rd Line:
Exploratory Laparotomy
4th Line:
Hysterectomy

Front 8

Plan B

1) Which drug is commonly referred to as "Plan B" for pregnancy?
A) What is Levonorgestrel?
B) MOA of Levonorgestrel?
C) Levonorgestrel is effective how many hrs after intercourse?

Back 8

1) Levonorgestrel
A) A progestin only Rx
B) Inhibits midcycle LH & FSH -->
Suboptimal uterine environment for embryo to develop
C) 120 hrs

Front 9

Back 9

Front 10

FHR Decels

1) Late decels indicate fetal distress resulting from what?

2) What is the prevailing tx for fetal distress from PI --> Late decels?

Back 10

1) Placental Insufficiency

2) Emergent C-Sx

Front 11

Erythroblastosis Fetalis

1) What is RhoGAM?

2) Who is RhoGAM given to?

3) When is Rhogam administered?

Back 11

1) An Ab against the maternal anti-Rh Ab

2) RH - moms who have previously given birth to Rh + children

3) @ 28 wks gestation of 2nd child (if that child is Rh +)
AND/OR
w/in 72 hrs of possible mixing of maternal-fetal blood of 1st child (if that child is Rh +)

Front 12

Breech Presentations

1) You can be sure that the baby is in a breech position if you can palpate what?

2) When will most breech presentations self-correct?

3) TF when is the earliest you should try to correct a breech presentation?

4) What are the indications for using External Cephalic Version (ECV) to convert a breech presentation?

Back 12

1) The vertex of the head of the baby @ the fundus

2) By 37 wks gestation

3) @ 37 wks gestation

4) Breech pregnancy;
> 37 wks GA;
w/out CI to vaginal delivery;
if Fetal Well-being is established

Front 13

Adenomyosis

1) What is adenomyosis?

2) What are the 5 aspects of a typical profile for adenomyosis?

Back 13

1) When endometrial tissue digs down into the myometrium of the uterus

2) Symetrically enlarged uterus;
Multiparous women;
> 40 y/o;
Dysmennorrhea;
Menorrhagia

Front 14

Different Types Placentation

1) Circumvallate Placenta
a) What?
b) Complications?

2) Placenta Previa
a) What?

3) Placenta accreta
a) What?
b) Incidence of PA increases in what other type of placentation?

4) Placenta Increta
a) What?

5) Placenta Percreta
a) What?

6) Vasa previa
a) What?
b) Babies w/ Vasa previa will have what characteristic FHR pattern?

7) Velamentous Placenta
a) What?
b) Complications?

8) Succenturiate placenta
a) What?
b) Complications?

9) Placental abruption
a) What?
b) Tx for PA?
c) 1 major RF for placental abruption?

Back 14

1)
a) When membranes double back over edge of the placenta -->
Dense ring around edge of placenta
b) 2nd Trimester hemorrhage

2)
a) When placenta develops over internal cervical os

3)
a) When the placenta is tightly adhered to the uterine wall
b) Inc risk of PA in placeta previa

4)
a) When placenta invades myometrium

5)
a) When placenta invades THROUGH myometrium and into uterine serosa and SOMETIMES even adjacent organs (bladder, rectum, etc..)

6)
a) When velamentous cord insertion -->
fetal vessels pass over internal cervical os
b) Tachy --> Brady --> Sinusoidal Pattern

7)
a) When blood vessels insert b/t amnion and chorion, away from placental margin
b) Vessels are unprotected --> Compression or injury

8)
a) When there is an extra lobe of the placenta that is implanted a distance away from rest of placenta
b) Vessels may course b/t 2 lobes -->
unprotected vessels which may rupture

9)
a) When placental dissociates from endometrial wall
b) Vaginal delivery
c) Pre-ecclampsia

Front 15

GYN Infxns

1) Bacterial Vaginosis
a) 1st Line treatment for bacterial vaginosis (Gardnerella Vaginalis)?
b) ) 2 second line txs for bacterial vaginosis (Gardnerella Vaginalis)?

2) Gonorrhea:
a) Rx of choice?

3) Chlamydia
a) 2 Rx options for Chlamydia?

4) Testing for G&C:
a) Which screening test is HIGHLY accurate for G&C?
b) Which test is NOT accurate for Gonorrhea AND CAN NEVER detect Chlamydia?

5) Trichimonas vaginalis
a) Tx of choice and 1 major CI?

Back 15

1)
a) Oral metronidazole
b) Vaginal Metronidazole;
Clindamycin

2)
a) Ceftriaxone

3)
a) Single dose azithromycin; 10 day course Doxy

4)
a) Nucleic Acid Amplitude Test
b) Gram Stain

5
a) Metronidazole, ETHOL bc of disulfuram rxn

Front 16

OB-GYN Rx

1) In which tissue is raloxifene an Estrogen Receptor AGONIST?

2) In which tissues is raloxifene an estrogen receptor ANTAGONIST?

Back 16

1) Bone

2) Breast;
Vaginal Tissue

Front 17

OB-GYN Imaging

1) A hysterosalpingogram ks a radiographic test that looks for what?

Back 17

1) Abnormalities in the anatomy of the uterus and fallopian tubes

Front 18

GYN Infxns

1) What is another name for GBS?

2) Who does GBS usually effect?

3) GBS can be passed from mom to baby, TF how should you test for it?

4) What is the appropriate medical response?

Back 18

1) Strep agalactiae

2) Women, Neonates, Young Infants

3) Rectal and Vaginal swabs @ 35-37 wks

4) Pen G or Ampicillin prophylactically @ time of delivery

Front 19

OB-GYN Misc

In the 1st 24 hrs post partum, what are 3 common occurrences for mom?

Back 19

Low grade fever;
Leukocytosis;
Vaginal Discharge

Front 20

Bacteriuria (+/- UTI)

1) When is a person considered to have bacteriuria?

2) 4 ABX to use for bacteriuria in a preggo?

3) 3 ABX that are CI'ed in preggos and why?

Back 20

1) > 100,000 CFU of a single organism / mL of urine

2) Nitrofurantoin;
Amoxicillin;
Amoxicillin-Clavulanate;
Cephalexin

3) Tetracyclines (-cycline):
Gray teeth;
Improper bone dev

Fluoroquinolones (-floxacin);
Damage to tendons

TMP-SMX (Bactrim);
CI'ed in 1st TM bc inhibs folate synth;
CI'ed 3rd TM bc inc risk kernicterus

Front 21

HELLP Syndrome

1) What does HELLP Syndrome stand for?

2) Apart from the above, pts w/ HELLP syndrome may also have what 2 other cond'ns?

3) What is the tx of HELLP syndrome in a pt w/ EGA > 34 wks?

Back 21

1) Hemolysis,
Elevated Liver Enz,
Low PLT

2) Pre-ecclampsia;
RUQ pain from distension of hepatic capsule

3) Delivery of the baby

Front 22

Contraception

1) What is the best form of contraception in a breast feeding woman?

2) Why NOT combined estrogen-progestin contraceptive pills?

Back 22

1) Progestin-only oral CP

2) They dec milk production;
They pass into breast milk

Front 23

Galactorrhea

1) What is the ddx of a woman w/ Galactorrhea that is:
Guaic Negative,
BIL

2) What's the w/u of the above?

Back 23

1) Pregnancy;
Prolactinoma;
Hypothyroid;
Overstim of nipple;
OCPs;
Meds which lower dopamine levels

2) hCG (r/o pregnancy);
PRL levels (r/o Prolactinoma);
MRI (r/o prolactinoma)
TSH (r/o Hypothyroid);

Front 24

IUFD

1) What is IUFD?

2) How to make Dx of IUFD?

3) Next step after dx?

4) IUFD pts are @ increased risk DIC, TF what labs should you get?
a) What is the MOA of DIC in an IUFD pt?

Back 24

1) Intrauterine Fetal Demise is:
Death of a fetus in utero that occurs AFTER 20 wks gestation and BEFORE the onset of labor

2) US

3) Labor should be induced

4) Coag profile to detect incipient DIC
a) POC --> Low fibrinogen and PLTs --> DIC

Front 25

Infertility

1) Infertility in a woman w/ irregular cycles is most often due to what?

2) Then how do you test to see if ovulation is occuring?

Back 25

1) Anovulation

2) Mid-luteal progesterone levels

Front 26

FHR

VEAL CHOP
a) What?
b) Indicates?

Variable FHR Decels:
a) Unpredictable FHR decels that do not have any relation to maternal contractions -
Look like a "V"
b) Indicates Cord Compression

Early FHR Decels:
a) Dec FHR decels that coincide w/ a maternal contraction
b) Indicates Head Compression

Accelerations:
a) FHR accelerations that do not necesarilly have any relation to maternal CTX
b) Indicate nothing - ok

Late FHR Decels
a) FHR that begin after the onset of a maternal contraction and end after the end of a maternal CTX
b) Indicates placental insufficiency

Back 26

FHR

VEAL CHOP
a) What?
b) Indicates?

Variable FHR Decels:
a) Unpredictable FHR decels that do not have any relation to maternal contractions -
Look like a "V"
b) Indicates Cord Compression

Early FHR Decels:
a) Dec FHR decels that coincide w/ a maternal contraction
b) Indicates Head Compression

Accelerations:
a) FHR accelerations that do not necesarilly have any relation to maternal CTX
b) Indicate nothing - ok

Late FHR Decels
a) FHR that begin after the onset of a maternal contraction and end after the end of a maternal CTX
b) Indicates placental insufficiency

Front 27

Ectopic Pregnancy

1) 3 Major sx of ectopic pregnancy?
a) If pt presents w/ above sx, what is the next best step?
b) @ what level does hCG have to be in order for an intrauterine gestational sac to be seen on US?
c) TF give a combo of 3 things that will indicate ectopic pregnancy?

2) Txs of ectopic pregnancy and its indication

Back 27

1) AAV
ABD pain;
Amenorrhea;
Vaginal bleeding
a) hCG
b) > or = 1500
c) AAV sx;
hCG > or = 1500;
No intrauterine gestational sac seen on US

2) Surgical:
-Salpingectomy
(If tube ruptures and you don't want kids)
-Salpingostomy
(If tube is unruptured and do want kids)

MTX (Folate antag)
(Ectopic pregnancy < 4 cms and DO want kids)

Front 28

OB-GYN Rx: OCPs

1) What are 8 SE of OCPs?

2) Is wt gain a SE of OCPs?

Back 28

1) BAT H L
Breakthrough Bleeding
Amenorrhea
Thromboembolic dz
HTN

Inc risk:
-Cervical and Breast CA
-DM
-Cholestasis
-Cholecystitis

Dec Risk of:
-Ovarian CA
-Endometrial CA
-Ovarian CA

Liver Disorders (Hepatic Adenoma)

2) NO!

Front 29

GDM

1) When is screening performed?
a) Iniital screening test for GDM?
b) Give results guidelines?

Back 29

1) b/t 24-28 wks gesation
a) 1 hr, 50 gram OGTT
b) Blood glucose > or = 140 means you should have a 3 hr 100 gram OGTT

Front 30

Reproductive Disorders

1) 3 Characteristics of a woman w/ mullerian agenesis?

Back 30

1) Blind-ended vaginal pouch;
Dec or no uterine tissue;
XX genotype

Front 31

HTN In Preggos

What is the mech of HTN in pregnancy?

Back 31

Inc Na and H2O Reabsorption

Front 32

Dysmenorrhea

1) Define dysmenorrhea
2) What is the underlying cause of the pain experienced bc of primary dysmenorrhea?

Back 32

1) Cramping lower ABD pain occuring just before or during menstruation
2) Inc PGs

Front 33

Cervical Incompetence / Insufficiency

1) What is cervical incompetence / insufficiency?

2) What are the RF for CI / CI?

3) CI / CI --> Inc risk for what?

4) If CI / CI is suspected, what is the next step to eval the cervix?

Back 33

1) Cervical dilation and effacement

2) Prior GYN surg (LEEP or cone biopsy);
Multiple gestations;
SAB

3) Miscarriage or pre-term birth in 2nd & 3rd TM

4) TVUS (Trans-vaginal US)

Front 34

AFP

1) Inc AFP = what 4 things?

2) Dec AFP = what 4 things?

3) What is the 1st step in the management of BOTH an increased or decreased AFP?

Back 34

1) Neural Tube defects
ABD wall defects (gastroschisis or omphalocele)
Multiple gestations
Inaccurate EGA

2) Chromosomal abnormalities
Down's syndrome
Trisomy 18
Inaccurate EGA

3) US to r/o innacurate EGA

Front 35

Syphilis

1) What are 2 screening tests for syphilis?

2) What is 1 confirmatory test for Syphilis?

3) What is the gold standard test for syphilis (Esp primary syphilis)?

Back 35

1) VDRL, RPR

2) FTA-ABS

3) Darkfield microscopy

Front 36

Menstrual cycle

1) What is "Mittelschmerz"?

2) The pain is actually a result of what?

Back 36

1) Pain that occurs mid-cycle in women who are NOT taking birth CTL.

2) Ovulation itself and TF can be unilateral

Front 37

Labor

1) Define labor?

2) Define arrest of dilation?

3) Define arrest of descent?

Back 37

1) Uterine CTX that result in cervical dilation &/or effacement

2) No change in dilation for 2 hrs

3) No descent in 2 hrs in a primigravid woman;
No descent in 1 hr in a multi-gravid woman;
No descent in 2 hrs in a multi-gravid woman who has an epidural in place

Front 38

b-hCG

1) How much does b-hCG increase in a viable pregnancy?

2) @ what point can an IUP be seen on US?

Back 38

1) b-hCG doubles every 48 hrs until it peaks @ 6-8 wks

2) When b-hCG is > or = 1500

Front 39

Endometriosis

1) What are the 3 major sx of endometriosis?

2) How to definitively dx endometriosis?

3) 3 tx options for endometriosis?

Back 39

1) 3 D's:
Dyspareunia,
Dysmenorrhea,
Dyschezia (Painful defecation)

2) Laparoscopy

3) Combined OCPs
GnRH analogs: Leuprolide
Danazol

Front 40

Pregnancy and the Thyroid

1) Describe the levels of T3 / T4, TSH you expect to see in a pregnant pt?

2) Name one hormone of pregnancy that can stimulate TSH receptors?

Back 40

1) Pregnancy --> inc TBG -->
Inc T3 / T4
BUT
Amt of free T3 / T4 i same -->
Normal amt TSH

2) beta-hCG

Front 41

NST (Non-stress test)

1) What?





2) When do you perform a NST?

3) What is a normal NST?

4) MCC of abnormal NST?

Back 41

1) FIND A GOOD DEFINITION!








2) High risk preggos @ 32-34 wks
OR
When Mom has loss of perception of fetal MVT

3) If in 20 mins:
2 FHR accels above the baseline,
of @ least 15 BPM,
lasting @ least 15 Seconds each

4) Sleeping baby, TF use vibroacoustic stim to wake baby up

Front 42

HTN in Pregnancy -
What is:

1) Pre-ecclampsia?

2) Chronic HTN?

3) Molar pregnancy?

4) Transient HTN of pregnancy?

5) HTN of any kind -->
Inc risk of what in preggos?

Back 42

1) HTN + PRO-uria

2) Inc BP before 20 wks gestation

3) HTN + Snowstorm appearance on US

4) HTN in 2nd 1/2 of pregnnacy or during L&D

5) Placental abruption

Front 43

RX in Preggos

1) Risperidone is an anti-psychotic RX that can lead to an increase in what hormone?

2) Inc PRL -->
What sx in women?

Back 43

1) PRL

2) Amenorrhea;
Oligomenorrhea;
Galactorrhea;
Breast tenderness

Front 44

Primary Amenorrhea

Write down flow chart on 13 question quiz from U-World

Back 44

Write down flow chart

Front 45

Vaginismus

1) What is vaginismus?

2) What are 2 tx for vaginismus?

Back 45

1) Painful musculature CTX -->
Painful intercourse

2)
Kegel exercises (to relax vaginal muscles);
Insertion of objects of increasing size to encourage desensitization

Front 46

GDM

1) What is the ideal range for maternal fasting glucose?

2) What isthe Tx for GDM?

3) Does insulin cross placenta?

4) Give 4 FX of GDM on baby?

5) Give the pathogenesis of Hyperviscosity in GDM?

Back 46

1) 75 - 90 mg / dL

2) 1ST LINE: Dietary restrictions
2ND LINE: Sub-Q insulin

3) NO!

4) Macrosomia;
Hypocalcemia;
Hypoglycemia;
Hyperviscosity

5) Inc blood glucose -->
Inc BMR -->
Fetal hypoxia -->
Inc EPO -->
Inc RBCs (Polycythemia) -->
Hyperviscosity

Front 47

Lupusin pregnancy

Describe why pts w/ lupus have an increased risk of miscarriage after 10 wks gestation?

Back 47

Lupus =
Anti-phospholiipid Ab (Lupus anti-coag & anti-cardiolipin Ab) -->
Thrombus Development in Placenta

Front 48

Secondary Amenorrhea

U-World Quiz - Ques 1 w/ u of secondary Amenorrhea

Back 48

U-World Quiz - Ques 1 w/ u of secondary Amenorrhea

Front 49

HIV in preggos

1) What is the best way to dec risk of transmission of HIV from mom to baby?

2) Which of the above is more effective as a stand-alone Tx?

Back 49

1) Zidovudine to Mom & Baby during pregnancy and labor and to neonate during first 6 wks

+

C-sx

2) Zidovudine

Front 50

Teratogens

1) If mom is exposed to DES while female baby is in utero, her baby will have an inc risk of what as she gets older?

Back 50

1) Clear cell vaginal and cervical adenocarcinoma

Front 51

IUGR (Intrauterine Growth Restriction)

1) What is IUGR?

2) Write are 2 types of IUGR?

3) Symmetric IUGR
a) Definition of Symmetric IUGR?
b) Describe head and body growth in Sym IUGR?
c) Et of Sym IUGR?
d) Prognosis of Sym IUGR?

4) Assymetric IUGR
a) Describe head and body growth in Assym IUGR?
b) Et of Assymetric IUGR?
c) Prognosis of Assym IUGR?

Back 51

1) Fetal wt < or = 10th %-ile

2) Symmetric & Assymetric

3)
a) Insult to fetus before 28 wks
b) Delayed growth of head & body
c) Fetal Factors -
Chromosomal abnorms;
Congenital Infxns;
Congenial Anomolies
d) Bad prognosis

4)
a) Normal head size, Dec ABD circumference
b) Maternal factors-
Mat HTN (ie: Pre-ecclampsia)
-->
> blood to vital organs (brain)
&
< blood to non-vital organs (viscera)
c) Better prognosis

Front 52

Pregnancy Dates

1) What is considered a pre-term pregnancy?

2) What is considered a post-term pregnancy?

3) Post-term pregnancy -->
Inc risk of what?

Back 52

1) Pregnancy < 37 wks

2) Pregnancy > or = to 42 wks

3) Oligohydramnios

Front 53

Some ID

1) Anogenital warts in "teardrop shape" = what?
a) Application of acetic acid --> what?
b) Tx for small lesions?
c) Tx for large lesions?

Back 53

1) Condyloma acuminata from HPV
a) Lesions turn white
b) Trichloroacetic acid or Podaphylin
d) Excision or Fulguration (electric current)

Front 54

Lichen Sclerosis

1) What is lichen sclerosis?

2) LS --> Inc risk of what?

3) What dx-ic measures need to take in pt w/ lichen sclerosis?

4) Tx of lichen sclerosis?

Back 54

1) Inflamm of anogenital region -->
Vulvar pruritus, Discomfort & porelain-white vulvar atrophy

2) Vulvar squamous cell carcinoma

3) Biopsy to r/o vulvar SCC

4) Topical corticosteroid

Front 55

Ecclampsia

1) What is the underlying pathogenesis of seizures in ecclampsia?

Back 55

1) Cerebral vasospasm

Front 56

Menstrual cycle and menarche

1) In the first couple years after menarche, menstrual cycles are usually irregular and anovulatory. Why?

Back 56

1) BC the HP-Gonadal axis is still developing & does NOT produce adequate proporptions of LH and FSH in order to induce ovulation

Front 57

Kallman's Syndrome

1) What is KS?

2) Genotype of KS?

3) Lab findings in KS?

4) What is a major aspect of the pt's hx in Kallman's Syndrome?

5) What are the sexual characteristics in KS?

Back 57

1) A type of tertiary Hypogonadism (Dec GnRH)

2) 46 XX

3) Dec GnRH --> Dec LH & Dec FSH

4) Anosmia

5) Normal female internal reproductive organs
BUT
No external secondary sex characteristics

Front 58

Back Pain in Preggos

1) What is the mechanism that -->
Inc Back pain in preggos

Back 58

1) Inc Lumbar Lordosis

Front 59

DUB (Dysfnctnl Uterine Bleeding)

1) What is DUB?

2) DUB is usually the result of what?

3) Tx for DUB?

4) In what pts w/ DUB is endometrial biopsy indicated?

Back 59

1) Heavy vaginal bleeding that occurs in the absence of structural or organic dz

2) Anovulation

3) Depends on severity of bleeding and Age of Pt:
Adolescent + Mild Bleeding = Fe Supp
Adolescent + Mod Bleeding + No ACTIVE bleeding = Fe & Progestin
Adolescent + Mod Bleeding + ACTIVE bleeding = Estrogen
SEVERE DUB = Bleeding

4) Females > 35 y/o w/ DUB

Front 60

Precocious Puberty

1) Define PP?

2) What are 2 types PP?

3) How to dx central PP?

4) Tx of both types of PP?
a) Why this tx choice?

Back 60

1) Dev of secondary sex characteristics before 8 in girls and 9 in boys

2) Central:
Early activation of HPO Axis -->
Inc LH & FSH that increases in response to GnRH challenge

Peripheral:
Gonadal or Adrenal release of inc sex hormones
-->
Dec LH and FSH that will NOT increase w/ GnRH challenge

3) MRI or CT of brain

4) GnRH Analogues
a) Prevent premature epiphyseal plate fusion -->
Short Stature

Front 61

Variable FHR decels

1) Tx of variable FHR decels?

Back 61

1) O2 & change in Mom's Position

Front 62

Rho-GAM

1) So we already said that RhoGAM (anti-D Immunoglobulin) should be administered @ 28 wks gestation of 2nd Rh+ Child
&
w/in 72 hrs of possible mixing of maternal-fetal blood of 1st Rh+ child. What is something that can require you to adjust the PP dose?

Back 62

1) Excessive hemorrhage from something like placental abruption

Front 63

Preterm Labor

1) Define pre-term labor?

2) Mngmnt of Pre-term labor?

3) What is the goal GA if you have to deliver a pre-term infant?

Back 63

1) Labor occuring AFTER 20 wks & before 37 wks gestation

2) Corticosteroids for lung dev if baby is 24-34 wks
&
Tocolysis to extend pregnancy @ least 48 hrs to let steroids kick in

3) 34-36 wks

Front 64

Quad (Quadruple) Screen

1) Quad screen is a screen of what 4 things?

2) It asseses risk for what?

3) In cases of aneuploidy (ie: Down's Syndrome) describe the results of the maternal quadruple screen?

Back 64

1) MSAFP (Maternal Serum alpha-Fetoprotein)
Estradiol
hCG
Maternal Serum Inhibin A

2) Neural Tube Defects and Trisomy 18 & 21

3) Inc b-hCG;
Inc Inhibin A;
Dec MSAFP;
Dec Estradiol

Front 65

PPROM

1) What is PPROM?

2) Definition of PPROM?

3) What is the normal pH of amniotic fluid?

4) What is the normal pH of the vagina?

5) 1 major RF assoc w/ PPROM?

6) Give the "picture" of chorioamnionitis?

7) Tx of PPROM?

Back 65

1) Pre-term Premature ROM

2) Rupture of amniotic membranes BEFORE 37 wks accompanied by onset of labor -
Evidenced by regular uterine CTX

3) 7.0 - 7.5

4) 3.8 - 4.5

5) Intra-amniotic Infxn (Chorioamnionitis)

6) Prolonged or PROM
Maternal fever
Leukocytosis
Uterine Tenderness
Maternal Tachy
Fetal Tachy

7) Broad-spec ABX (If GBS pos or GBS status unknown)
+
Expedited delivery of fetus
(via Oxytoxin - if EGA > 34 wks)

Front 66

Secondary Amenorrhea

Secondary Amenorrhea from inc exercise is usually the result of dec GnRH --> Dec what?/

Back 66

1) Estrogen

Front 67

HELLP Syndrome

1) Remember, pts w/ HELLP syndrome may also have pre-ecclampsia and RUQ pain from distension of hepatic capsule. However, distension of hepatic capsule can also be assoc w/ pre-ecclampsia without HELLP Syndrome. Give the underlying mechanism of Hepatic Capsule Distension?

Back 67

-Centrilobular Necrosis
-Hematoma formation
-Formation of thrombi in portal capillary system

Front 68

Pre-ecclampsia and Ecclampsia Tx

1) Is MgSO4 given to pre-ecclampsia & Eclamptic women to CTL a current seizure or to p-lax further seizures?

2) what is the definitive tx of ecclampsia?

3) What is the sx-ic tx of ecclampsia?

Back 68

1) P-lax further seizures

2) Immediate TOP

3) Hydralazine + Labetolol to CTL HTN
&
MgSO4 to p-lax further seizures

Front 69

Breast Lump in a young woman

1) If no signs of malignnacy, what is the next best step?
a) What findings after menstrual period indicate benign dz?
b) If mass does not change in size after menstrual period, what are some dx-ic options?

2) Why no mammogram in a young woman?

Back 69

1) Return after menstrual period for re-examination
a) Mass decreases in size
b) US, FNA Biopsy, Excisional Biopsy

2) Young woman =
Inc breast density =
Mammogram NOT helpful

Front 70

Uterine Rupture

1) Give the clinical picture of uterine rupture

2) Tx of uterine rupture?

Back 70

1) Sudden onset ABD pain
FHR abnorms
Recession of presenting part during active labor
Hx of pre-existing uterine scar or ABD Trauma

2) Immediate C-sx -->
TAH to stop bleeding if pt does NOT want more kids
OR
Immediate C-sx -->
Debridement & closure of site of rupture in woman w/ dec parity who desires more children

Front 71

Thyroid and Pregnancy

1) Following Thyroidectomy, TSI (Thyroid Stimulating Ab) can remain as high as 500 Xs Normal for several months. TSI is a type of IgG, TF --> What in baby?

Back 71

1) Thyrotoxicosis (Goiter, Tachypnea, Tachycardia, Cardiomegaly, Restless, Diarrhea, Poor wt gain)
BC TSI will cross placenta

Front 72

Lactating Mom's have amenorrhea. Why?

Back 72

BC they have in PRL which inhibits GnRH -->
Dec LH & Dec FSH -->
No ovulation & Menses

Front 73

Endometrial Hyperplasia

1) What are the 4 categories of hyperplasia of the endometrium and their risk of progression to uterine CA?

2) Tx for pre-menopausal women w/ simple or complex hyperplasia without atypia is what?

Back 73

1) Simple w/OUT Atypia
(Penny - 1%)
Complex w/OUT Atypia
(Nickel - 5%)
Simple WITH Atypia
(Dime - 10%)
Complex WITH Atypia
(Quarter - 25%)

2) Cyclic progestins

Front 74

PPROM

1) Do you remember the tx for PPROM?
a) What ABX?
b) Do GBS neg moms require ABX P-lax?

Back 74

1) Broad Spec ABX (If GBS status unknown or GBS Pos)
+
Expedited delivery of fetus via oxytocin if EGA > 34 wks

a) 1st Line: PCN
2nd Line: Ampicillin;
Cefazolin;
Clindamycin;
Vanc
b) No!

Front 75

Rx in Preggos

1) 2 HTN Rx that are CI'ed in Preggos?

2) 1st Line Agents for essential HTN in preggos?

Back 75

1) ACE I & ARBs

2) Labetolol & Methyldopa

Front 76

PMS

1) What is the clinical picture of GBS?

2) When do sx of PMS begin and end?

3) How to begin w/u of PMS?

Back 76

1) Bloating;
Fatigue;
HA;
Breast Tenderness
----------
Anxiety
Mood swings
Dec Concentration
Dec Libido
Irritability

2) Begin 1-2 wks before menses -->
End around time of menstrual flow

3) Menstrual diary to see if sx correlate w/ 1-2 wks before menses

Front 77

Ante-partum hemorrhage

1) What are the 2 MCC of ante-partum hemorrhage?

Back 77

1) Placental previa;
Placental abruption

Front 78

ID

Mom has an active HSV infxn (Vesicular Vulvar Lesions) How to manage pregnancy?

Back 78

C-sx to reduce risk of transmission to baby

Front 79

Uterine Fibroids

1) What is the classic clinical picture of uterine fibroids?

2) Fibroids are estrogen dependent, TF they will increase in size in what 2 situations?

3) When will uterine fibroids dec in size?

Back 79

1) Dysmenorrhea;
Heavy menses;
Enarged uterus

Also: Infertility

2) OCP use & Pregnancy

3) Menopause

Front 80

CVS and Pregnancy

1) What cardiac cond'n classically presents in pregnancy?

2) Mitral stenosis in pregnancy is often due to what Infxous dz?

Back 80

1) Mitral stenosis

2) Rheumatic fever (Hx of sore thraots from s. pyogenes)

Front 81

Pre-ecclampsia Tx

1) PE + Term pregnancy w/ mature fetal lungs?

2) PE + NO Term pregnancy OR Fetal lungs NOT mature?

3) During what wks can dex be given to increase fetal lung maturity?

Back 81

1) Delivery baby

2) Bed rest and close observation

3) 24-34th wks

Front 82

ID in preggos

1) Regardless of the pt dx, what IDz should be screened for @ 1st pre-natal visit?

2) How to screen for syphilis?

3) How to tx a syphillis infxn?

Back 82

1) Syphillis

2) RPR or VDRL = screening
If either are Positive -->
FTA-ABS to confirm

3) PCN

Front 83

Kidneys and Preggos

1) What happens to renal plasma flow and GFR in preggos?

2) What effect does this have on BUN & Cr?

Back 83

1) Increases

2) Decreases

Front 84

1) So, we know that pre-ecclampsia reqs tx w/ MgSO4. What are some signs of Mg Toxicity?

2) How to tx Mg toxicity?

Back 84

1) Dec DTRs (Earliest sign of Mg Tox);
Resp depression

2) d/c Mag and give IV Ca-Gluconate

Front 85

Ectopic Pregnancy

1 When w/u a possible ectopic pregnancy, what type of US should be used when looking for an IU gestational sac?

Back 85

1) TVUS if hCG b/t 1500 and 6500;
ABD US if hCG > or = 6500

Front 86

Premature Ovarian Failure

1) POF is characterized by what 3 things?

a) All of the above are the result of what?
b) How is the dx confirmed?

2) Do ptsw/ POF have viable oocytes?

3) How can these pts get pregnancy?

4) How is the dx of POF made?

5) Def of POF?

6) What is the major source of estrogen in a woman?

7) Why is FSH / LH radio > 1?

Back 86

1) Amenorrhea;
Hypoestrogenism (--> Amenorrhea, hot flashes, vaginal and Br atrophy);
Inc serum Gonadotropins
ALL in women < 40 y/o

a) Dec estrogen levels
b) Inc FSH & LH w/ FSH / LH ratio > 1;
Low Estrogen

2) NO!

3) in Vitro Fertilization

4) FSH elevation in setting of > or = 3 mos amenorrhea in women < 40 y/o

5) Hypogonadism in women < 40 y/o

6) Developing ovarian follicles

7) Slower clearance of FSH from circulation

Front 87

Placental PRevia

1) Clinical Picture of PP?

2) RF of PP?

3) Pathophys of bleeding in PP?

Back 87

1) Antepartum, 3rd TM Painless bleeding

2) Multiparous;
Inc Maternal Age;
Prior C-sx;
Smoking;
Multiple Gestations

3) As uterus stretches in pregnancy, it stretches the placenta

Front 88

Granulosa Cell Tumors

1) GCT produce excess amts of what hormone?

2) Presentation of GCT in young?

3) Presentation of GCT in old?

Back 88

1) Estrogen

2) Precocious Puberty

3) Postmenopausal bleeding

Front 89

Quad-Screen MSAFP

1) What is the MCC of an abnormal MSAFP?

2) Inc MSAFP is seen in what 4 major probs?

3) If pt has in MSAFP, what is the next step?

Back 89

1) Gestational age error

2) NT defects;
ABD wall defects;
Multiple Gestations;
Inaccurate Gestational Age

3) US -Anomalies
-Asses fetal size to see if agree w/ dates
-ID multiple gestations

Front 90

Misc

What is pseudocyesis?

Back 90

Psychiatric cond'n in which a woman presents w/ nearly all s/s of pregnnacy, w/ an US that shows:
1) Normal endometrial stripe
2) Neg pregnancy test

Front 91

Atrophic Vaginitis

1) Sx?

2) PE?

3) Tx?

Back 91

1) Vaginal dryness;
Dyspareunia;
Dysuria

2) Pale dry vaginal mucosa;
Dec labial fat pad;
Scarce pubic hair

3) Vaginal estrogen replacement

Front 92

Intrahepatic Cholestasis of Pregnancy

1) What are the Sx of ICP?

2) Lab findings in ICP?

3) ICP tx?

4) ICP is a dx of _____

Back 92

1) Pruritus

2) Inc Serum total bile acids;
+/- inc Aminotransferases

3) 1st: Ursodeoxycholic Acid
2nd: Hydroxyzine;
Cholestyramine

4) Exclusion

Front 93

Kidney stones and Preggos

1) Suspcion of Kidney stones in a pregnancy woman should be investigated using what imaging modality?

Back 93

1) US

Front 94

Aromatase Defic

1) If baby has AD what FX will ht at have on mom in utero?

2) FX on baby?

3) Pts w/ AD may alsohave cliteromegaly. Why?

4) FX on ovaries?

Back 94

1) Masculinization of Mom

2) Inc gestational androgens -->
XX baby that is highly virilized:
Normal internal genitalia BUT ambiguous External Genitalia

3) Cliteromegaly occurs when ther are excessive androgens

4) Polycystic ovaries

Front 95

ID

Why do women get more UTIs than men?

Back 95

1) Shorter urethra

Front 96

PRL

1) 2 things that stim PRL production?

2) Inc PRL will inhibit what axis?

3) 1 thing that will inhib PRL production?

4) Total DDx for inc PRL?

Back 96

1) Serotonin;
TRH (Note: HYPOthyroid pts will have Inc TRH)

2) Inc PRL inhibs GnRH --> Amenorrhea

3) Dopamine

4) Hypothyroid;
Dopamine Antags (Anti-psychotics, TCA, MAOIs);
Hypothal Tumors;
Pit Tumors

Front 97

Turner's Syndrome

1) Underlying pathophys?

2) CVS findings?

3) Ht?

4) Menstrual Hx?

5) Hormone levels in Turner's Syndrome?

Back 97

1) Ovarian dysgenesis

2) Coarctation of Aorta

3) Short Stature

4) Primary Amenorrhea

5) Inc FSH bc NO neg feedback from ovaries

Front 98

Vacs in preggos

1) CBC recs that all women WITHOUT CIs be vaccinated against what

Back 98

1) Influenza

Front 99

What is the gold standard for Dx of endometriosis?

Back 99

Laparoscopy

Front 100

Hypothyroid and estrogen

Hypothyroid pt receives estrogen. What changes will you have to make to her thyroid meds (Levothyroxine)? Why?

Back 100

Inc dose of levothyroxine bc estrogen -->
Inc TBG -->
Dec Free Thyroid Hormone

Front 101

SAB

In any of the 5 types of SAB, what must be administered to Rh-Neg women who do NOT have anti-Rh Ab?

Back 101

1) RhoGAM (anti-D gamma globulin)

Front 102

ID

Woman w/ dx of trichomonas vaginalis. What's the tx and who gets it?

Back 102

Metronidazole;
Her and her partner

Front 103

1) PAINFUL 3rd TM vaginal bleedng w/ normal US is most likely due to what?

2) What is the role of US in the eval of antepartum hemorrhage?

3) RF for placental abruption?

Back 103

1) Placental abruption

2) r/o placental previa;
It is NOT to dx placental abruption!!!!

3) Mat HTN;
Pre-ecclampsia;
Trauma;
Short umbilical cord;
Tobacco use;
Cocaine use;
Folate defic

Front 104

Sheehan's Syndrome

1) What is sheehan's syndrome?

2) Sx of sheehan's syndrome?

Back 104

1) Post-partum pituitary necrosis

2) Sx of dec pit hormones

Front 105

Teratogens

1) Lithium (BP) is assoc w/ inc incidence of what?
a) Mngmnt?

2) Isotretinoin --> What fetal probs?

3) Before taking isotretinoin, a woman must have a pregnancy test and must have what else as far as contraception?

Back 105

1) CV disorders:
Ebstein's Anomaly
a) Slowly taper lithium

2) Craniofacial Dysmorphism;
Heart defects;
Deafness

3) Using 2 forms of contraception for @ least 1 month before tx

Front 106

Secondary amenorrhea

In any woman of child-bearng age w/ secondary amenorrhea, what is the 1st step?

Back 106

hCG to r/o pregnancy

Front 107

ID

1) 2 Rx that predispose to Candida infxn?

2) Tx for Candida infxn?

Back 107

1) Corticosteroids;
ABX

2) -azole antifungal

Front 108

PPROM

1) What is PROM?

2) What is PPROM?

3) What is the biggest concern for baby w/ PPROM?

4) How to asses pulmonary hypoplasia?

5) When can steroids be given for pulmonary hypoplasia?

Back 108

1) Premature ROM -
Rupture of fetal membranes @ any time BEFORE onset of labor

2) Pre-term Premature ROM -
When PROM occurs pre-term

3) Pulmonary Hypoplasia

4) Pregnancy < 34 wks;
Lecithin / Sphingomyelin Ratio < 2.0

5) 24-34 wks

Front 109

RX: Tamoxifen

1) What drug class is tamoxifen?

2) Agonist in what tissue?

3) Antagonist in what tissue?

Back 109

1) SERM w/ mixed estrogen receptor AGONIST and ANTAGONIST activity

2) Endometrium --> Inc risk endometrial CA
Bone --> Dec risk osteoporosis

3) Breast --> Dec risk Br CA

Front 110

Androgen Insensitivity Syndrome

1) What is the clinical picture of androgen insensitivity syndrome?

2) Tx and why?

Back 110

1) Primary amenorrhea;
BL inguinal mass (testes);
Breast dev WITHOUT pubic or axillary hair;
Blind vaginal pouch;
46 XY genotype but phenotypically female

2) Gonadectomy AFTER completion of puberty to avoid testicular carcinoma

Front 111

Amniocentesis

1) 1 Major potential complication?

2) 3 Major s/s of AFE?

3) Most feared complication of AFE?

4) 1st step in management?

Back 111

1) Amniotic fluid embolism

2) Sudden resp failure;
Cardiogenic shock;
Seizures

3) DIC

4) Airway / Breathing (ABCs)

Front 112

Hypogonadotropic Hypogonadism (dec GnRH)

1) Acquired HH causes amenorrhea as a result of stress, excessive exercise, etc...How to tx?

2) Why NOT CONTINUOUS GnRH?

3) Who gets continuous GnRH?

Back 112

1) PULSATILE GnRH

2) Continuous GnRH desensities GnRH receptors -->
Anovulation and amenorrhea

3) GnRH dependent precocious puberty
AND
women w/ sex hormone dependent tumors (prostate and breast)

Front 113

In suspected cases of Fetal Growth Restriction, what is the best parameter to est fetal wt?

Back 113

ABD circumference

Front 114

Septic Abortion

1) Describe what septic abortion is?

2) Tx of Septic Abortion?

3) Why avoid vigorous suction curretage?

Back 114

1) When after an abortion their are still some POC that become infected

2) Cervical and Blood cultures -->
ABX -->
Gentle Suction

3) May --> Perforatin of uterus

Front 115

PID

1) Criteria for PID

2) PID usually caused by what 3 Infxous agents?

3) Tx PID?

Back 115

1) Fever;
Leukocytosis;
Inc ESR;
Purulent Cervical Discharge;
Adnexal Tenderness;
Cervical Motion Tender;
Lower ABD tender

2) N. gonorrhoeae;
C. trachomatis;
genital mycoplasmas

3) Ceftriaxone & Doxy

Front 116

Sq Cell CA of Vagina

1) If a pt is NOT a surgical candidate, What tx is an excellent 2nd line option?

Back 116

1) Radiation tx

Front 117

Interstitial Cystitis

although the et and pathophys is unknown, what is the classes triad for interstitial cystitis?

Back 117

Urinary urgency;
Urinary frequency;
Chronic pelvic pain

ALL in the absence of another dz or cause

Front 118

1) PAINLESS 3rd TM bleeding usually indicates what?

2) How to dx PP?

3) What exam is CI'ed in antepartum hemorrhage?

4) Tx of PP?

5) How / when to assess fetal lung maturity?

Back 118

1) Placenta Previa

2) US

3) Pelvic exam

4)
Mom stable and fetus is term:
Scheduled section

Mom stable and fetus NOT term:
Expectant mngmnt w/ close monitoring of mother and fetus

5) Amniocentesis @ 36 wks. If mature you can section.

Front 119

ID

1) Pt w/ Pos VDRL and Confirmatory FTA-ABS, but has allergy to PCN. How to tx?

Back 119

1) PCN desensitization tx w/ increasing oral dose of Pen V -->
PCN administration

Front 120

Learn BPP

Back 120

Learn BPP

Front 121

How to suppress breast milk production?

Back 121

CANT

Cold compress
Acetominophen
NSAID
Tight Bra

Front 122

Both menopause and HYPERthyroidism have similar presentations. TF anyone presenting w/:
1) Irreg / absent menses
2) Heat intol
3) Flushing
4) Insomnia
5) Night Sweats

Should have what labs?

Back 122

TSH to r/o HYPER-thyroid (TSH will be low)

&

FSH to r/o menopause
(FSH will be high)

Front 123

CASE FILES

Back 123

CASE FILES

Front 124

Case 3: Uterine Inversion

1) What is uterine inversion?

2) MCC of uterine inversion?

3) What are the 4 signs of placental separation?

4) The 3rd stage of labor is from delivery of infant to delivery of placenta. What is the upper limit of normal for the amt of time the 3rd stage of labor should take?

5) Uterine inversion USUALLY occurs when traction is placed on cord before placental separation. But, where will the placenta usually be located in the uterus?

6) What are 3 RF for uterine inversion?

7) Tx
a) What 3 uterine relaxation agents may be used to allow for uterine replacement?
b) If placenta has already separated, how can you replace the uterus?
c) Once the uterus is moved back into place, the uterine relaxation agents are stopped and what is administered next?
d) What is oftentimes done to maintain the shape of the uterus?

8) Miscellaneous
a) What should you do if the placenta does not deliver after 30 minutes? why?
b) Explain why uterine inversion can lead to significant maternal post-partum hemorrhage?

Back 124

1) When the uterus turns "inside out" and the fundus move through the cervix into the vagina

2) Traction on cord before placental separation

3) -Gush of blood
-Lengthening of cord
-Uterus moves up into ant abd wall
-Uterus becomes firm and globular

4) 30 minutes

5) Fundus

6) Multi-parous woman;
Placenta implanted in fundus;
Placenta Accreta

7)
a) Halothane, terbutaline, Mg
b) Manually w/ gloved palm and cupped fingers
c) Uterotonic agents: Oxytocin
d) The clinician will place his fist inside the uterus in order to maintain normal structure of the uterus

8)
a) Manual extraction of the placenta;
BC waiting more time may lead to excessive maternal hemorrhage --> need for hysterectomy
b) BC it prevents the uterus from being able to contract down (AKA: it causes uterine atony!) and cut off spiral arteries

Front 125

Case 4: Perimenopause (Climacteric) & Menopause

1) What is perimenopause (climacteric)?

2) Define menopause?
a) Avg age of menopause?

3) What is premature ovarian failure?

4) In a woman experiencing sx of menopause, what should be ordered and why?
a) What are some of the sx of perimenopause (Climacteric)?
b) What is the underlying cause of these sx?

5) Turner's syndrome pts have a 45 XO genotype --> ovarian failure. What are 2 diagnostic signs of turner's?

6) Define Sheehan's Syndrome?

7) Remember, PRL inhibits what hypothalamic hormone, TF --> Dec estrogen and amenorrhea?

8) What is the MC location of an osteoporosis-associated fracture?

???) Tx
a) What is the tx for hot flashes?
b) Does the SERM raloxifene tx hot flashes?
c) Although estrogen replacement tx is indicated for hot flashes, it presents an increased risk for what? Dec risk for what?
d) Although estrogen replacement tx is indicated for hot flashes, bc of the above risks, how should it be administered?
e) Woman has hot flashes but does NOT want to take estrogen replacement. What is another Rx that can be used for vasomotor sx?

Back 125

1) The 2-4 yrs that span immediately BEFORE menopause to immediate AFTER menopause

2) Cessation of menses due to follicular atresia, occuring after the age of 40
a) 51 y/o

3) Look up definition in flashcards done already

4) FSH & LSH: to r/o menopause
TSH: to r/o Hyperthyroid
a) Irregular menses;
Feelings of inadequacy;
Sleeplessness;
Hot flashes
b) Dec estrogen

5) Elevated gonadotropins (LH, FSH); Streaked Ovaries

6) Post partum pituitary necrosis associated w/ post-partum hemorrhage

7) GnRH

8) Thoracic spine

???) Tx
a) Estrogen w/ a progestin = If pt still has uterus (to prevent endometrial CA)
Estrogen alone = Possible tx if pt does NOT have uterus
b) NO!, but it does prevent bone loss
c) Breast CA, Heart dz, PE, Stroke;
Osteoporosis; Colon CA
d) In the smallest dose for the shortest duration
e) Clonidine

Front 126

Case 5: Necrotizing Fasciitis-->
Septic Shock

1) Necrotizing Fasciitis
a) Define NF?
b) Necrotizing fasciitis is a possible complication of what common delivery procedures?
c) The NF is usually from what type of bacteria?

2) Septic Shock resulting from NF
a) What is SS?
b) What MAP is required to maintain perfusion of vital organs?
c) The low BP in SS is usually the result of vasodilation resulting from what?
d) Equation for MAP?

??) Tx
a) 3 Steps of tx for Necrotizing Fasciitis --> Septic Shock?

Back 126

1)
a) Infxn of muscle and fascia, oftentimes after a surgical procedure
b) C-Sx or episiotomy
c) Anaerobic Bacteria, but sometimes s. aureus, GAS (Strep pyogenes), clostridium

2)
a) HYPO-TN resulting from bacterial infxn
b) 65 mm Hg
c) Release of endotoxins
d) MAP = [(2 X DBP) + (1 X SBP)] / 3

??) Tx
a) Step 1: IV Fluids (Septic Shock) +/- Pressors like Dopamine

Step 2: Broad Spec ABX (Necrotizing Fasciitis)
-PCN, Gentamicin, Metronidazole
UNLESS from s. aureus, then use:
Nafcillin, Methicillin, OR Vanc if MRSA is suspected

Step 3: Surgical Debridement (Necrotizing Fasciitis)

Front 127

Case 6: Normal Labor

1) Define labor.

2) Give the stages & Phases of labor and their variants.

3) What is considered a term infant?

4) What determines the normalcy of labor, uterine contraction time or dilation/ effacement of cervix?

5) When the above stages and phases of labor (as discussed above) do not progress normally, what 3 things need to be assesed?
a) If "Powers" (CTX) are thought the be the problem, what is the next tx step? What is considered adequate CTX?
b) What is the MC "Pelvis" problem? Tx?

??) Misc
a) The rubella vaccine is what type of vaccine?
b) BC the rubella vaccine is a live-attenuated vaccine, and TF should not be administered during pregnancy, when should it be administered?
c) What is a normal fetal HR?
d) What is "bloody show"?
e) Give 2 indications for C-Sx?

Back 127

1) See Earlier Flashcard

2) Stage 1: Onset of labor --> Complete dilation of cervix
Latent Phase of Labor:
When cervix effaces more than dilates (Dilation is < 4 cm);
Nullipara: < or = 18-20 hrs Multipara: < or = 14 hrs

Active Phase of Labor:
When cervix dilates more than effaces (Dilation > 4 cm);
Nullipara: @ least 1.2 cm / hr Multipara: @ least 1.5 cm/hr

Protraction of Active Phase of Labor:
When cervix dilates @ a rate less than above markers

Arrest of Active Phase:
No cervical dilation for @ least 2 hrs

Stage 2: Complete Dilation to expulsion of infant
Nullipara: < or = 2 hrs if no epidural; < or = 3 hrs if epidural
Multipara: < or = 1 hr if no epidural; < or = 2 hrs if epidural

Stage 3: Expulsion of infant to delivery of placenta
< or = 30 mins for all

3) b/t 37 - 42 wks from LMP

4) Dilation / Effacement of cervix

5) 3 P's: Powers (Contractions); Passenger (Fetus); Pelvis
a) Oxytocin.
CTX q 2-3 minutes, firm on palpation, lasting 40-60 secs
OR
> or = 200 Montevideo units in a 10 minute window
b) Cephalopelvic disproprotion (baby's head is bigger than mom's pelvis). Tx w/ C-sx.

??) Misc
a) Live-attenuated vaccine
b) Post-partum
c) 110-160 BPM
d) Loss of cervical mucus plug (Cervical mucus mixed w/ blood)
e) Cephalopelvic disproportion;
Arrest of active phase w/ adequate uterine CTX

Front 128

Case 7: Threatened Abortion

***MAKE COPY AND REVIEW ALGORITHM FOR POSSIBLE ECTOPIC IN CASE FILES P. 74***

1) ***Rev 5 diff types SAB from Step-up chart***

2) A female of childbearing age presents w/:
-Amenorrhea (or pregnant)
-ABD Pain
-Vaginal Bleeding
Should be considered to have what until proven otherwise?

3) What is the threshold level by which TVUS could reveal an IUP?

4) What is the major way to determine whether or not a pregnancy is a normal intrauterine gestation or an abnormal pregnancy?
a) Describe what happens to the b-hCG in a normal IUP?
b) If the b-hCG does NOT increase by 66% in 48 hrs, than the pt most likely has what?
c) What is a less commonly used, but still acceptable way to assess a normal IU gestation or an abnormal pregnancy?
d) If serial b-hCG's or Single progesterone level indicates an abnormal pregnancy, what is often the next step?

??) Rh-negative women w/ a Threatened Abortion, Spontaneous Abortion, Ectopic Pregnancy should receive what?

Back 128

1) ***Rev 5 diff types SAB from Step-up chart***

2) Ectopic Pregnancy

3) 1500 mIU/mL

4) Serial b-hCGs
a) It increases 66% q 4 hrs
b) Abnormal pregnancy (SAB or Ectopic)
c) Single progesterone level:
If progesterone > 25 ng / mL = Normal IUP
If progesterone < 5 ng / mL = Abnormal Pregnancy (SAB or ectopic pregnancy)
d) Uterine curretage:
Histology shows chorionic villi = SAB;
Histology shows NO chorionic villi = Ectopic Pregnancy

??) Rho-GAM to prevent isoimmunization

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Case 8: Placenta Accreta

1) Give 5 RF for placenta accreta?

??) Tx
a) If after a vaginal delivery, a placenta is so firmly adhered to the utereus that it cannot be removed by manual extraction, what is the next best step in tx?
b) Why is it not a good idea to try to keep the uterus by removing the placenta "piecemeal"?
c) If pt refuses hysterectomy, what is the next best step? 2 possible negative sequelae of this tx?

??) Misc
a) What is a myomectomy?
b) What is the underlying reason that the placenta is so firmly attached to the uterus in a placenta accreta?
c) What is transmigration of the placenta?
d) Placenta percreta will often lead to the placenta perforating through the entire thickness of the uterus, past the serosa, and into nearby adjacent organs. (Bladder, etc...) What color will the placental tissue often be in an percreta?
e) Does myomectomy predispose a woman to placental accreta?

Back 129

1) Low lying placenta / placenta previa
Prior C-sx or other uterine scar
Prior myomectomy
Prior Uterine curretage
Fetal Down Syndrome

??) Tx
a) Hysterectomy
b) BC this may lead to hemorrhage and exsanguination
c) Ligation of the umbilical cord as high up as possible + IV MTX. Coagulopathy (hemorrhage) and Infxn

??) Misc
a) Surgical removal of leiomyomas
b) There is absence of the decidua basalis
c) When a low-lying placenta or placenta previa diagnosed in 2nd TM, spontaneously resolves in the 3rd TM as the lower part of the uterus grows
d) Blue
e) Not usually, bc the fibroids are accessed via the outer serosa, and TF the inner endometrium is NOT disturbed

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Case 9: Gonococcal Cervicitis

1) Give the dx-ic w/u of cervicitis?

??) Tx
a) Since gonococcal and chlamydial cervicitis often occur together, it is prudent to manage tx how?
b) Tx for gonococcal cervicitis?
c) Tx for chlamydial cervicitis?

??) Misc
a) 2 Major complications of cervicitis?
b) In ANY pt that presents w/ abnormal vaginal bleeding, what types of disorders should be r/o first?
c) Remember, that cervicitis puts a pt @ increased risk for PID. How do you assess for the possible presence of PID?
d) What are some s/s of disseminated gonorrhea?
e) What is a lower genital tract infection?
f) What is an upper genital tract infxn?
g) What is the pathophys of post-coital spotting in cervicitis?
h) What is a more common cause of cervicitis, chlamydia or gonorrhea?
i) What is the MCC of sexually transmitted pharyngitis from oral sex?
j) What 2 infxns in mom -->
Blindness in baby
k) Is Gonorrhea usually accompanied by Chlamydia
Or
Is chlamydia usually accompanied by Gonorrhea?

Back 130

1)
-Gram Stain
-Intracellular gram-negative diplococci = N. gonnorhoeae = Tx for both gonorrhea and chlamydia bc chlamydia often co-infects w/ gonorrhea
-No = Tx for chlamydia (but DON'T NEED TO tx for gonorrhea)

??) Tx
a) By tx-ing for both of pt has gonorrhea. Just tx Chlamydia if pt has chlamydia
b) -Ceftriaxone
-Fluoroquinolones
(CI'ed in preggos)
c) -Azithromycin
-Doxycycline
(CI'ed in preggos)

??) Misc
a) Salpingitis --> Infertility and ectopic pregnancy
Disseminated Gonococcal Infxn
b) Pregnancy-Related disorders (Ectopic pregnancy, SABs, etc...)
c) Salpingitis = Adnexal tenderness
ABD tenderness = Uterine involvement
Heavy Menses = Uterine involvement
d) Joint pain, Painful pustules on an erythemetous base
e) Infxn of vulva, vagina, cervix
f) Infxn of uterus, fallopian tubes, ovaries
g) Infxn of endocervix -->
Friability of endocervical tissue -->
Post-coital spotting
h) C. trachomatis
i) N. gonorrhoeae
j) Gonorrhea (presents b/t 2nd-5th days of life) and Chlamydia (presents b/t 5t5th - 14th day of life)
k) Gonorrhea is usually accompanied by Chlamydia

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Case 10: Complete SAB

***Their are 5 diff types of SAB. What is the cut-off on a gestational timeline that differentiates SAB and IU Fetal Demise?

1) After dx of complete SAB is made, what is the f/u mngmnt?
a) Why?
b) How quickly should the hCG decrease?

2) What is one of the biggest "clues" that a SAB is a complete SAB?

3) What are the major risks of retained POC in an incomplete ab?

??) Tx
a) How do you tx an incompetent cervix?

??) Misc
a) It is important to differentiate b/t an Inevitable Abortion & and Incompetent Cervix. How can you do this?
b) Give the clinical picture of a molar pregnancy
c) Tx for Molar Pregnancy?
d) Vaginal bleeding / spotting BEFORE 20 wks gestation ML'ly means what?
e) Vaginal bleeding / spotting ON or AFTER 20 wks gestation ML'ly means what?
f) Give the w/u for antepartum hemorrhage ON or AFTER 20 wks that is ML'ly from P. previa or P. abruption?

Back 131

***< 20 wks : SAB
20 + wks = IU Fetal Demise

1) b-hCGs until levels return to zero
a) To ensure that all of the POC have passed. If pt has residual POC, the hCG will begin to decline and then plateau.
b) hCG will halve q 48-72 hrs

2) Pts pain and bleeding have subsided after passage of the POC

3) Bleeding & Infxn

??) Tx
a) Surgical ligature @ the level of the internal cervical os (cerclage)

??) Misc
a) Inevitable Abortion: Uterine CTX (cramping) --> Cervical dilation.
BL: PAINFUL cervical dilation
Incompetent Cervix: NO Uterine CTX (NO cramping --> Cervical dilation
BL: PAINLESS cervical dilation
b) Hyperemesis;
Vaginal spotting;
Absence of fetal heart tones;
Uterine size greater than dates;
Markedly elevated hCG;
Snowstorm appearance on US
c) Uterine suction & curretage w/ follow up hCGs (to make sure that all of the trophoblastic tissue has been removed)
d) 1/5 types SAB
e) Antepartum hemorrhage (Usually from P. Previa or P. abruption)
f) US to r/i or r/o P. previa
If not P. previa, speculum exam to r/i or r/o placental abruption